Lateral epicondylitis, commonly called tennis elbow, is degeneration of the tendon attachment of the wrist extensor muscles to the lateral epicondyle on the outside of the elbow. The condition develops from repetitive use and produces pain on the outside of the elbow with gripping, lifting, and wrist extension. It is one of the most common elbow conditions in adults and most cases resolve without surgery.
What Is Lateral Epicondylitis?
The lateral epicondyle is the bony prominence on the outside of the elbow where the wrist extensor muscles attach via a common tendon. The extensor carpi radialis brevis is the most commonly affected tendon. Repetitive gripping and wrist extension load this tendon, and chronic overload produces tendinosis (degenerative changes) rather than acute inflammation. The term tendinitis is often used clinically, but the underlying tissue change is degeneration without active inflammation in most cases.
Despite the common name, tennis is not the most common cause; the condition is more prevalent in non-athletic patients with repetitive gripping work or daily activities.
Causes and Risk Factors
- Repetitive gripping and wrist extension in sports (tennis, racquet sports, throwing)
- Manual labor and computer use with repetitive forearm activity
- Sudden increase in repetitive activity
- Poor sport technique (in tennis, hitting backhand with a bent elbow)
- Age 35 to 55 is the most common demographic
- Smoking and diabetes, both of which are associated with tendon degeneration
Symptoms
- Pain on the outside of the elbow, often gradual in onset
- Tenderness at the lateral epicondyle
- Pain reproduced with resisted wrist extension or middle finger extension
- Weakness with gripping
- Pain with lifting (especially with the palm down), shaking hands, or turning a doorknob
- Symptoms typically chronic rather than acute
Diagnosis
Dr. Chudik’s evaluation includes the activity pattern and occupational history. Examination findings include tenderness at the lateral epicondyle, pain with resisted wrist or middle finger extension, and a normal-appearing elbow without swelling or deformity. X-rays evaluate for calcifications or arthritic changes. MRI is ordered when the diagnosis is unclear or when other elbow pathology is suspected. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment resolves the majority of cases. Components include:
- Activity modification to reduce provocative loading
- A counterforce brace (forearm strap) to redistribute tendon load
- Anti-inflammatory medication for pain control
- A targeted physical therapy program emphasizing eccentric strengthening of the wrist extensors and forearm conditioning
- Corticosteroid injection in select cases for short-term relief, though injection is avoided in chronic tendinosis as it can weaken the tendon
- Platelet-rich plasma (PRP) injection in refractory cases
For cases that fail six to 12 months of non-surgical treatment, Dr. Chudik performs surgical debridement, removing the degenerative tendon tissue from the lateral epicondyle and stimulating healing. The procedure can be performed open through a small lateral incision or arthroscopically.
Recovery and Outcomes
Non-surgical recovery typically requires three to six months of dedicated treatment. Outcomes are good when activity modification and eccentric strengthening are completed.
Recovery after surgical debridement typically includes two to three weeks of brace protection, progressive motion and strengthening over three months, and return to full activity at four to six months.
When to See Dr. Chudik
Schedule an evaluation if lateral elbow pain has persisted beyond six weeks of activity modification, if it interferes with sport or work, or if prior treatment has not resolved symptoms. Call 630-324-0402 or request an appointment online.