Dr. Gregory Cunningham

What Are The Causes, Symptoms, and Treatment of epicondylitis?

Epicondylitis is a common condition affecting the elbow joints. It can limit the movements of the elbow by causing pain and inflammation.

Though epicondylitis is also called Tennis elbow or Golfer’s elbow, depending on the specific location of the elbow joint affected, the incidence of this condition is not limited to sportspersons.

Here is a detailed discussion about what epicondylitis means and the types of epicondylitis. We will also discuss the causes, risk factors, and symptoms of this condition and learn the most effective ways to treat it.

What is Epicondylitis?

Epicondylitis refers to a condition caused due to the damage and inflammation of the part of the bone called an epicondyle.
An epicondyle is the projection of a bone above a rounded prominence called the condyle. Condyles and epicondyles are situated at the ends of the long bones where one bone connects to another. It also marks the part of the bone where tendons and ligaments are attached.
Lateral epicondylitis and medial epicondylitis are the two common forms of epicondylitis.
Lateral epicondylitis, also called Tennis elbow, affects the lateral or outer part of the epicondyle present at the end of the bone of the upper arm called the humerus.
Medial epicondylitis, also called Golfer’s elbow, occurs due to a similar injury to the medial or the inner side of the same epicondyle.
Bilateral epicondylitis is a comparatively rare condition that may occur due to damage to both medial and lateral epicondyles.
Let us learn more about lateral epicondylitis and medial epicondylitis and why these conditions occur. It is important to differentiate between lateral epicondylitis and medial epicondylitis to be able to adopt appropriate strategies to minimize further damage to the bones and support faster recovery.

What is Lateral Epicondylitis?

Lateral epicondylitis or Tennis elbow is a painful condition, which occurs due to the overuse or overexertion of the muscles and tendons in the elbow, usually as a result of the repetitive movements of the wrists and arms.
Lateral epicondylitis affects the muscles and tendons of the forearm, which are responsible for causing the extension of the wrist and fingers.
The muscles in the forearm help us to extend our wrists and fingers. The forearm tendons also attach the muscles to the bone. Inflammation of these tissues can affect the movements of the wrist, elbow, and fingers.
The muscle commonly involved in the development of the tennis elbow is the Extensor Carpi Radialis Brevis (ECRB). The excessive use of this muscle can cause micro-tearing and inflammation of the tissues resulting in pain and restriction of movements.
Not surprisingly, people who play tennis or other racquet sports are more likely to develop this condition.

What is Medial Epicondylitis?

Medial epicondylitis or golfer’s elbow refers to a tendinous injury caused due to the overuse of the wrist and elbow joints.
It occurs due to the inflammation and degeneration of the flexor-pronator tendon as a result of the repetitive extension of the wrist (backward bending) and supination (outward rotation) of the forearm.
These activities are also more likely to occur during flexion (forward bending) of the wrist.
When these movements occur repeatedly, it leads to the inflammation of the tendons. Over a period of time, repeated inflammation and damage can prevent efficient healing resulting in the degeneration of the tissues thus triggering the development of medial epicondylitis.

Epidemiology of Epicondylitis

The incidence of medial epicondylitis is comparatively lower than that of lateral epicondylitis. It is estimated that about 9 to 20% of all cases of epicondylitis are diagnosed as medial epicondylitis.
In spite of the names of these conditions, tennis players, golf players, and athletes are not the only people who are at risk of developing epicondylitis. All men and women whose jobs or physical activities involve repetitive movements that create a strain on the ECRB or other muscles in the elbow joint can develop epicondylitis.
Epicondylitis occupational disease is also common in plumbers, painters, butchers, and carpenters as the work performed by these people involves repetitive movements of the wrist and elbow joints.

What are the Causes of Epicondylitis?

Lateral epicondylitis occurs due to the damage to the forearm muscles and tendons that help to stabilize the wrist joint when the elbow is straight.
Hence, people involved in jobs or participating in recreational activities that require vigorous and repetitive use of the muscles of the forearms and the repetitive extension of the elbow and wrist are more likely to develop this condition.
It is more commonly reported in sportspersons playing tennis, archery, racquetball, weightlifting, bowling, javelin throwing, and American football.
However, nearly 90 to 95% of all cases of epicondylitis do not involve sportsmen.
Autoworkers, cooks, and butchers can also develop tennis elbow due to the lifting of heavy weights and the repetition of activities of the elbow and wrists required in these occupations.
Some other causes of risk factors of lateral epicondylitis include:

Causes of Medial Epicondylitis

Medial epicondylitis occurs due to the excessive force used while bending the wrist towards the palm. This may happen while swinging a golf club and pitching a baseball.
Some other causes and risk factors of medial epicondylitis include:

What are the signs of Symptoms of Epicondylitis?

Most patients with lateral epicondylitis do not develop any obvious symptoms in the initial stages.
Patients generally present with persistent pain on the lateral side of the elbow joint that is often exacerbated following daily activities.
Athletes may be particularly symptomatic during the early acceleration and the late cocking phases of the throwing motions. In baseball pitchers, the pain may occur as a result of high-energy forces created during the overhead throw.
The pain is often felt from the elbow to the wrist on the palmer side of the forearms. In advanced cases, the pain may radiate until the fingers. The pain may become severe while bending the wrist forward against resistance, or while squeezing a rubber ball.
The pain caused due to lateral epicondylitis often radiates from the outer side of the elbow toward the forearm and wrist. It may also lead to a weak grip. These symptoms are accompanied by difficulty in shaking hands, holding an object, or turning a doorknob.

Symptoms of Medial Epicondylitis :

The symptoms of medial epicondylitis often develop gradually. The pain is usually mild in the initial stage and becomes worse slowly over a few weeks. There may not be a history of any specific injury associated with the beginning of the symptoms.
The other common signs and symptoms of medial epicondylitis include:
These symptoms often become worse during and after performing activities of the wrists and forearms like holding a racquet, shaking hands, or turning a wrench.

Diagnosis of Epicondylitis

The diagnosis of epicondylitis is based on the typical symptoms and the history of overuse of the elbow and wrist joints.
The diagnosis is also based on the assessment of how the symptoms developed, the presence of occupational risk factors, and participation in recreational sports.
Your doctor will also ask you about the activities that cause or worsen the symptoms and the exact location on the arm whether the pain is felt.
Here are the tests that can help in the diagnosis of medial and lateral epicondylitis.

Physical Examination

During the physical examination, your doctor will apply mild pressure to the lateral and medial epicondyles to check for pain, tenderness, stiffness, and discomfort.

Your doctor will also ask questions about the history of recent injuries, your occupation, and the kinds of physical activities you perform to ascertain the cause of the tennis elbow or golfer’s elbow.

Your doctor will ask you to straighten your fingers and wrist against resistance while keeping your arm straight. If you experience severe pain during this movement, it could be a sign of epicondylitis.

Imaging tests

Imaging tests like X-rays can help to assess the damage to the bones. X-rays of the elbow joint may be performed to rule out other common causes of elbow pain such as arthritis.

Magnetic resonance imaging (MRI) scan is another imaging test that provides images of the soft tissues like muscles and tendons. An MRI scan will help to assess the extent of damage in the tendons to confirm the diagnosis of epicondylitis or rule out other causes like injuries.

An MRI scan of the neck may also be performed to rule out a herniated disk and arthritic changes in the neck both of which are known to cause pain in the arms.

The diagnosis of medial or lateral epicondylitis can be made based on the physical examination, medical and occupational history, and the results of these tests.

Treatment of Epicondylitis

Most patients with epicondylitis can be treated with non-surgical methods like the use of braces and making appropriate changes in physical activities.
Surgical intervention is recommended only if the symptoms persist for longer than 6 months in spite of conservative treatment.
Approximately 80 to 95% of patients with medial and lateral epicondylitis have successful outcomes with non-surgical treatments.

Nonsurgical Treatment of epicondylitis

Rest

Ensuring your arm gets adequate rest is critical to faster recovery in patients with epicondylitis. It is advisable to limit your participation in sports or activities that involve excessive use of the elbow and wrists.

Medications

The use of acetaminophen or non-steroidal anti-inflammatory medications like ibuprofen may be recommended to reduce pain and swelling in the affected tissues.

Brace

The use of a brace that is centered over the back of the forearm may relieve the symptoms of tennis elbow by stabilizing the muscles and tendons.

Steroid injections

Injections containing steroidal medications like cortisone can be effective in reducing inflammation in the affected region. The medications can be injected into the painful area around the lateral or medial epicondyle to relieve the symptoms.

Platelet-rich plasma

Platelet-rich plasma (PRP) offers a biological treatment aimed at improving the internal biologic environment of the affected tissue.

It involves obtaining a sample of blood from your arm and centrifuging it to obtain platelets. These platelets contain a high concentration of growth factors that can stimulate healing when reinjected back into the affected tissues.

Extracorporeal shock wave therapy

This therapy involves the exposure of the tissues of the elbow to sound waves. The sound waves have the ability to create "microtrauma" that can stimulate the body's natural repair processes. This can accelerate healing and enable patients to recover faster.

Physical therapy

Specific exercises can be helpful for strengthening the forearm muscles. Ultrasound, muscle-stimulating techniques, and ice massage can be included in the treatment plan to accelerate muscle healing.

Surgical Treatment

If the symptoms do not respond to non-surgical treatments for more than 6 months, surgery may be needed to correct the damage.

Most surgical procedures for epicondylitis involve the removal of the damaged muscles and tendons and reattaching the healthy muscle tissues back to the bone.

Prognosis of Epicondylitis

Proper rehabilitation following recovery by non-surgical or surgical treatments is necessary to prevent the symptoms from recurring or flaring up. Most patients are able to resume their physical activities after the treatment.

However, it is important to adopt appropriate measures to prevent further damage to the elbow by changing the ways the wrists and forearms are used.

Limiting the activities that create more strain on the muscles of the elbow is highly recommended.

Also, patients should examine the tools or sports equipment they use and switch them with ergonomically suitable ones to ease the strain on the elbow. This would reduce damage to the muscles and improve the prognosis of epicondylitis.

If you are suffering from these symptoms, you can reach out to us to know more about lateral and medial epicondylitis. We can also discuss the possible diagnosis and the best treatment methods to help you overcome the symptoms and resume your activities in the shortest period.