Exploring the Anatomy of the Elbow for Better Understanding

Lateral epicondylitis, commonly known as tennis elbow, is a musculoskeletal condition characterized by pain and tenderness at the lateral epicondyle of the humerus. This condition typically results from overuse and repetitive stress on the forearm extensor muscles and their attachment to the lateral epicondyle.

The condition primarily affects adults aged 30-50 years and is commonly associated with occupational activities requiring repetitive wrist extension and forearm rotation. While traditionally linked to tennis players, it more frequently occurs in non-athletes, particularly workers involved in manual labor, such as those in manufacturing or construction industries.

The pathophysiology involves microtearing and subsequent degeneration of the common extensor tendon, particularly the extensor carpi radialis brevis. This leads to a failed healing response characterized by angiofibroblastic hyperplasia, rather than traditional inflammation, making the term “tendinosis” more accurate than “tendinitis.”

Clinical presentation typically includes pain that radiates from the lateral epicondyle down the forearm, weakness in grip strength, and pain exacerbated by activities involving wrist extension and forearm supination. Diagnosis is primarily clinical, based on history and physical examination findings, including point tenderness over the lateral epicondyle and pain with resisted wrist extension.

Initial management focuses on conservative treatment, including activity modification, relative rest, and ergonomic adjustments. Physical therapy emphasizing eccentric strengthening exercises is a cornerstone of treatment. Other conservative measures include:

• NSAIDs for pain management

• Counterforce bracing

• Wrist extensor stretching exercises

• Ice therapy for acute pain relief

For cases resistant to conservative treatment, additional interventions may be considered:

• Corticosteroid injections (though long-term benefits are debated)

• Platelet-rich plasma injections

• Extracorporeal shock wave therapy

• Ultrasound-guided tenotomy

Surgical intervention is reserved for cases that fail to respond to 6-12 months of conservative treatment. Surgical options include open, arthroscopic, or percutaneous release of the common extensor origin. The success rate for surgical intervention ranges from 80-90%.

Prognosis is generally favorable with appropriate management, though recovery can take several months. Prevention strategies include proper ergonomic setup at work, appropriate equipment sizing, and technique modification in sports activities. Work restrictions often include limiting repetitive wrist extension and heavy lifting until symptoms improve.

The condition can significantly impact occupational function, particularly in jobs requiring manual labor or repetitive arm movements. Therefore, early recognition, appropriate activity modification, and comprehensive rehabilitation are essential for optimal outcomes and prevention of chronic disability.