Epicondylitis

What is Epicondylitis?

Epicondylitis is an inflammation of the tendons surrounding the epicondyle, which is the bony protuberance in the elbow. The condition causes severe pain in the region surrounding the joint. It is commonly seen in adults due to occupational activities and sports activities that result in exertional pressure on the flexor or extensor carpi radialis brevis muscles in the forearm.

What Causes Epicondylitis?

The causes of epicondylitis include:

Repetitive and forceful movements of the hand and wrist
Lifting heavy weights
Small tendon tears
Trauma
Weak shoulder or wrist muscles

Types of Epicondylitis

The two types of epicondylitis are:

Medial Epicondylitis: This is the inflammation of the tendon that attaches the forearm muscle to the medial (inner)aspect of the elbow. This condition is also known as golfer’s or baseball elbow. It affects the tendon connecting the flexor carpi radialis brevis muscle, impairing flexion activities of the wrist and hand. It is caused by applying great force while serving in tennis, pitching a baseball, chopping wood with an axe etc.

Lateral Epicondylitis: This is the inflammation of the tendon that attaches the forearm muscle to the lateral (outer)aspect of the elbow. This condition is also known as tennis elbow. It affects the tendon connecting the extensor carpi radialis brevis muscle, impairing extension activities of the wrist and hand. It is caused by an improper backhand stroke while playing tennis and repeated hand motions in activities such as painting, carpentry, or playing musical instruments.

What are the Symptoms of Epicondylitis?

The following are the most common symptoms of epicondylitis:

Focal tenderness in the epicondyle region (around elbow)
Swelling
Severe pain even at rest
Instability with hand movements
Weakness in the hand
Difficulty with hand flexion (moving hand and fingers inwards) and extension (opening hand and fingers outwards)
Difficulty with palm and finger movements
Numbness or tingling sensation at the elbow

Diagnosis of Epicondylitis

The diagnosis of epicondylitis can be made by a physical examination and medical history taken by your doctor. Your doctor assesses the area affected and asks you to move your hand against resistance to elicit symptoms.

Your doctor may also order the following tests to rule out associated complications such as fractures, ligament tears, and nerve damage such as:

X-ray
MRI (Magnetic resonance imaging)
EMG(Electromyography)

Treatment of Epicondylitis

Conservative management is the first line of treatment for epicondylitis which typically takes 6-12 months for complete healing and recovery. The treatment plan includes the following:

Resting of the affected hand and stopping any action that causes pain for at least 3 months
Use of anti-inflammatory and muscle relaxant medications
Corticosteroids to reduce swelling and pain
Application of ice packs three times a day for at least 10-15minutes
Use of a brace to keep the arm still for at least 2 weeks
Strengthening exercizes or physical therapy
Surgery is only indicated if epicondylitis is associated with complex fractures and complications