Epicondylitis

Basics

Description

  • Tendinopathy of the elbow characterized by pain and tenderness at the myotendinous junctions or tendinous insertions of the wrist flexor/extensor tendons at the humeral epicondyles
  • Although commonly known as medial and lateral epicondylitis, without microscopic histologic examination, the more appropriate term is medial epicondyle tendinopathy (MET) and lateral epicondyle tendinopathy (LET).
  • Most commonly secondary to chronic (overuse) pathology, although acute (traumatic) etiology can occur.
  • Two types
    • MET/common flexor tendinopathy (CFT) (“golfer’s elbow”)
      • Involves the wrist flexor and pronator teres tendons, which have proximal attachment at the medial epicondyle
    • LET/common extensor tendinopathy (CET) (“tennis elbow”)
      • Involves the wrist extensor and supinator tendons, which have proximal attachment at the lateral epicondyle
      • Most commonly involves the extensor carpi radialis brevis (ECRB) tendon
  • May be caused by various different athletic or occupational activities
  • Common in carpenters, plumbers, gardeners, and overhead athletes
  • 75% of cases involve the dominant arm.

Epidemiology

  • Predominant age: >40 years
  • Predominant sex: male = female

Incidence

  • Common overuse injury
  • Lateral (80–90%) > medial (10–20%)
  • Estimated between 1% and 3%
  • Dominant extremity > nondominant

Prevalence

  • MET: 0.4%
  • LET: 1.3%

Etiology and Pathophysiology

  • Acute (tendonitis, tear)
    • Rare, uncommon pathology
    • Inflammatory response to injury or sudden, violent contraction
  • Chronic (tendinosis or tendinopathy)
    • Overuse injury
    • Repetitive wrist flexion (MET) or extension (LET) places strain across enthesis of flexor or extensor group, respectively.
    • Degeneration, calcium deposition, fibroblast proliferation, microvascular proliferation, hyaline cartilage destruction, diminished restorative inflammatory response
  • Aggravating activities
    • Tool/racquet griping
    • Shaking hands, picking up a beverage
    • Occupational (painters, mechanics, cooks)
    • Sports (golf, tennis, archery, throwing)

Genetics

There are no known genetic components to LET or MET.

Risk Factors

  • Repetitive wrist motions
    • Flexion/pronation: MET
    • Extension/supination: LET
  • Smoking
  • Obesity
  • Forceful activities of the upper extremity

General Prevention

  • Limit overuse of the wrist flexors, extensors, pronators, and supinators.
  • Proper technique when working with hand tools or playing racquet sports
  • Lighter tools and smaller grips

Commonly Associated Conditions

  • Ipsilateral metacarpal osteoarthritis (common)
  • Rotator cuff tendinopathy (common)
  • Carpal tunnel syndrome (rare)
  • Contralateral and MET (rare)

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