Elbow
Lateral Epicondylitis (Tennis Elbow)
외측 상과염
Extensor tendinopathy at the lateral epicondyle — Tennis Elbow
- How common
- Very common
- Typical age
- Ages 30–60
What is it?
Microtears and degenerative changes (angiofibroblastic tendinosis) at ECRB attachment to lateral epicondyle
Commonly affected: Extensor carpi radialis brevis (ECRB), lateral epicondyle, lateral collateral ligament complex
How it develops
- Overuse InjuryRepetitive wrist extension and forearm supination cause excessive load on ECRB tendon
- MicrotearsMicrotears at ECRB attachment, repeated incomplete healing
- TendinosisAngiofibroblastic degeneration without angiogenesis — degeneration rather than inflammation is primary mechanism
- Chronic PainNeural sensitization and tendon structural changes perpetuate chronic pain
Symptoms
- Lateral Epicondyle PainLocalized pain at lateral epicondyle, may radiate down lateral forearm
- Specific Activity PainPain with wringing towel, handshaking, bread cutting, mouse clicking
- Grip WeaknessGrip strength reduction due to pain with grasping and lifting
- Morning StiffnessStiffness around elbow on waking
How it is examined
- Cozen TestResisted wrist extension with fist clenched reproduces lateral epicondyle pain → Positive
- Mill's TestSimultaneous elbow extension, forearm pronation, wrist flexion reproduces pain → Positive
- Lateral Epicondyle TendernessTenderness at 1cm distal to lateral epicondyle (ECRB attachment)
- Grip Strength TestReduced grip in elbow extension, improved in flexion
Imaging
Usually normal. Chronic cases may show calcification or osteophytes
- Usually normal
- Chronic: lateral epicondyle calcification
- Lateral epicondyle osteophyte (rare)
Assess tendon damage extent and tear — for surgical planning or treatment-resistant cases
- ECRB tendon thickening and T2 hyperintensity (tendinosis)
- ECRB partial or complete tear
- Lateral epicondyle bone marrow edema
Non-surgical care
- RICE and Activity ModificationRest during acute phase, avoid provoking activities, ergonomic workplace modification
- Physical TherapyEccentric exercise is most effective. Ultrasound therapy, TENS
- Elbow BraceCounterforce brace — worn proximal to lateral epicondyle
- Steroid InjectionShort-term (4-6 weeks) pain relief. Long-term outcomes inferior to physical therapy
- ESWTEffective when conservative treatment fails. Stimulates tendon regeneration
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative treatment 6-12 months
Procedures that may be discussed
- Open ECRB tendon release
- Arthroscopic release
- PRP injection (biologics)
Outlook
80-90% natural resolution within 1-2 years. Earlier appropriate treatment leads to faster recovery