Tennis elbow

Tennis elbow (also known as lateral epicondylitis, lateral elbow pain, rowing elbow, tendonitis of the common extensor origin, and peritendinitis of the elbow.) is characterised by chronic degeneration at the origin of the extensor carpi radialis brevis muscle on the lateral epicondyle of the humerus (1).

• the suffix “itis” is a misnomer since the pathology is no longer thought to be associated with inflammation
• it can be described more accurately as a partially reversible but degenerative overuse-underuse tendinopathy (2)

Tennis elbow is one of the most common overuse syndromes seen by primary care physicians (3).

• the annual incidence of lateral elbow pain in general practice is 4-7/1000 people with the peak age being between 35-54 years (4)
• in the general population the prevalence is 1-3% and affects men and women equally (3)
• more common in the fourth and fifth decades of life

The condition is usually caused by injury or overuse of the extensor muscles of the forearm (1).

• usually seen after minor and often unrecognised trauma of the extensor muscles of the forearm (5)
• overuse causes microtears near the origin of the extensor carpi radialis brevis at the lateral epicondyle of the humerus which leads to fibrosis and the formation of granulation tissue (6)

A review states (7):

• symptoms of lateral epicondylitis usually resolve within one year with activity modification and watchful waiting
• current evidence suggests that steroid injections do not offer long term benefit
• secondary care management may include percutaneous needle fenestration or injections of autologous blood or platelet rich plasma; however, evidence of moderate certainty shows no benefit from these treatments
• surgical management in refractory cases usually involves open or arthroscopic release of the affected muscle tendon

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2009. Extracorporeal shockwave therapy for refractory tennis elbow.
• (2) Orchard J, Kountouris A. The management of tennis elbow. BMJ. 2011;342:d2687.
• (3) Johnson GW et al. Treatment of lateral epicondylitis. Am Fam Physician.;76(6):843-8.
• (4) Smidt N, van der Windt DA. Tennis elbow in primary care. BMJ. 2006;333(7575):927-8.
• (5) Buchbinder R, Green SE, Struijs P. Tennis elbow. Clin Evid (Online). 2008;2008. pii: 1117
• (6) Finestone HM, Rabinovitch DL. Tennis elbow no more: practical eccentric and concentric exercises to heal the pain. Can Fam Physician. 2008;54(8):1115-6.
• (7) Karbowiak M, Holme T, Thambyrajah J, Di Mascio L. Management of lateral epicondylitis (tennis elbow) BMJ 2023; 381 :e072574 doi:10.1136/bmj-2022-072574