Epicondylitis (tennis elbow)

Synonyms

• Lateral epicondylitis
• Epicondylopathy

What is the difference between epicondylitis and epicondylopathy?

The two are almost identical. Science has recently discovered that there is not always inflammation present in tendon pain.

When there is tendon pain without inflammation, it is called tendinopathy (epicondylopathy in this case). When there is tendon pain with inflammation, it is called tendinitis (epicondylitis in this case).

In both cases, whether it is tendinitis or tendinopathy, the management is similar. Therefore, we will include tendinopathies and tendinitis as being the same injury.

What is epicondylitis of the elbow?

It is an irritation or inflammation of the tendons on the outside of the elbow.

What is a tendon?

A tendon is what connects muscle to bone. When a muscle contracts, the force is transmitted to the tendon, which then stiffens to move the bones. The 'epicondylar' tendons are the tendons of the muscles that allow you to lift your wrist and fingers upwards.

Why is it called 'tennis elbow'?

Because it is a common injury among tennis players due to repetitive movements and the significant load on the elbow tendons.

What are the causes of epicondylitis of the elbow?

This can be caused by:

• Repetitive movements of the wrist or elbow
• Overload of the elbow muscles (after a new sport or activity, for example)
• Inflammatory arthritis (see inflammatory arthritis section)

Often, epicondylitis is caused by overuse of certain arm muscles compared to others. Poor muscle recruitment can contribute to this injury.

Here are some classic examples of the development of this pathology:

• Spending much more time at the computer than usual, using the mouse or keyboard a lot
• Doing renovations all day without being used to it, doing a lot of painting, hammering, or using a screwdriver
• Starting our tennis or badminton season without gradually increasing intensity

Did you know that a problem with the radial nerve can cause the same symptoms as epicondylitis?See the arm neuralgia section to learn more.

What are the symptoms of epicondylitis of the elbow?

The most common symptoms are:

• Specific pain on the outside of the elbow that has appeared gradually
• The pain may radiate into the forearm and even to the wrist and fingers
• Weakness and pain when picking up objects (picking up a pot, a coffee cup, a grocery bag)

If you also have pain that radiates towards the shoulder or numbness in your hand or fingers, it is likely that you also have arm neuralgia. (see arm neuralgia section).

How is epicondylitis of the elbow diagnosed?

Diagnosis is possible with a review of your symptoms and a clinical examination. Imaging tests are not necessary for diagnosis.

When should I see a physiotherapist for epicondylitis of the elbow?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

What are the physiotherapy treatments for epicondylitis of the elbow?

Your physiotherapist will perform an assessment to determine the cause of your epicondylitis by evaluating the following elements:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

Based on the assessment results, your physiotherapist will:

• Will mobilize your elbow to reduce pain and improve your movement.
• Will provide you with specific exercises to retrain the movement control of your elbow and wrist.
• Give you exercises to regain mobility, reduce pain and regain your muscle strength.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

What to do at home for elbow epicondylitis?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.

If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck. Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.

Here are some other tips that may help relieve the pain:

• Wear a compression band/bracelet for epicondylitis a few centimeters below the elbow (available at pharmacies).
• Slightly raise your shoulder upwards before straining or lifting a load (this helps reduce pain).

If you don't see any improvement after 10 days, you should consult a physiotherapist.

Sources

• Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT open reviews. 2016 Nov;1(11):391-7.