Lateral Epicondylitis and Medial Epicondylitis: (Tennis Elbow, Golfer’s Elbow)

Presentation

In lateral epicondylitis, the patient complains of pain in the lateral elbow that frequently radiates down the lateral aspect of the forearm. Because the lateral epicondyle is the bony origin of wrist extensors, patients are usually involved in an activity that requires repetitive wrist extension, such as tennis or mechanical work. Occasionally, the patient can recall a specific injury to the area, but more often the pain is of gradual, insidious onset. Most patients relate symptoms to activities that stress the wrist extensor and supinator muscles, and especially to activities that involve forceful gripping or lifting of heavy objects. Even holding lightweight objects such as a cup may be difficult. There is tenderness to palpation over the origin of the extensor carpi radialis brevis tendon immediately anterior, medial, and distal to the lateral epicondyle. This tenderness is more pronounced with resisted wrist extension while the elbow is in extension or when the forearm is pronated.

Patients with medial epicondylitis complain of pain over the medial epicondyle and the proximal forearm. The pain may radiate down the medial aspect of the forearm. Medial epicondylitis has been associated with activities involving repetitive forearm pronation and wrist flexion, as this is the insertion point for wrist flexors. It occurs frequently in baseball pitchers and is also related to golf, tennis, bowling, racquetball, archery, weightlifting, and javelin throwing. It is also associated with occupations such as carpentry, plumbing, and meat cutting. Onset is usually insidious, but there may be an inciting event. The patient may also complain of a weak grasp and pain with repetitive wrist flexion and pronation. There will be tenderness to palpation just anterior to the medial epicondyle at the origin of the pronator teres and flexor carpi radialis muscles. Resisted wrist flexion and forearm pronation while the patient’s elbow is in extension will reproduce symptoms.