Epicondylitis refers to the inflammation of the epicondyles, the bony prominences located on the distal part of the humerus at the elbow joint. This condition manifests primarily in two forms:
- Lateral Epicondylitis (Tennis Elbow): Affects the outer part of the elbow.
- Medial Epicondylitis (Golfer’s Elbow): Affects the inner part of the elbow.
Both conditions result from overuse or repetitive strain on the tendons and muscles surrounding the elbow, leading to pain and tenderness.
Anatomy of the Elbow
The elbow joint comprises three bones:
- Humerus: Upper arm bone.
- Radius and Ulna: Forearm bones.
Muscles, ligaments, and tendons stabilize the joint. The epicondyles serve as attachment points for the forearm muscles responsible for wrist and finger movements.
Causes
Lateral epicondylitis arises from repetitive motions that overstrain the forearm muscles and tendons, particularly the extensor carpi radialis brevis (ECRB). Activities contributing to this condition include:
- Racquet sports (e.g., tennis, squash).
- Repetitive use of hand tools.
- Activities requiring repetitive wrist extension or forearm supination.
Symptoms
Common symptoms encompass:
- Pain or burning sensation on the outer elbow.
- Weak grip strength.
- Discomfort exacerbated by wrist and forearm activities.
Diagnosis
Diagnosis involves:
- Medical history evaluation.
- Physical examination focusing on tenderness over the lateral epicondyle.
- Tests such as resisted wrist extension to reproduce pain.
Imaging studies like X-rays or MRIs may be employed to exclude other conditions.
Treatment
Non-surgical treatments are effective in most cases and include:
- Rest: Avoiding activities that exacerbate symptoms.
- Medications: NSAIDs to reduce pain and inflammation.
- Physical Therapy: Exercises to strengthen and stretch forearm muscles.
- Bracing: Using a forearm strap to alleviate tendon strain.
- Injections: Corticosteroids or platelet-rich plasma (PRP) to promote healing.
Surgical intervention is considered when conservative treatments fail after 6 to 12 months.
Medial Epicondylitis (Golfer’s Elbow)
Causes
Medial epicondylitis results from repetitive stress on the forearm muscles that facilitate wrist flexion and forearm pronation. Contributing activities include:
- Golf swings.
- Throwing sports (e.g., baseball).
- Occupational tasks involving repetitive wrist flexion.
Symptoms
Symptoms typically involve:
- Pain on the inner side of the elbow extending to the forearm.
- Weakness in hand and wrist.
- Numbness or tingling in the ring and little fingers.
Diagnosis
Diagnosis is based on:
- Patient history and symptom description.
- Physical examination assessing tenderness over the medial epicondyle.
- Pain elicited by resisted wrist flexion and forearm pronation.
Imaging may be utilized to rule out other pathologies.
Treatment
Treatment strategies encompass:
- Rest and Activity Modification: Limiting activities that trigger symptoms.
- Medications: NSAIDs for pain relief.
- Physical Therapy: Focused on stretching and strengthening exercises.
- Bracing: Wrist or elbow braces to reduce tendon load.
- Injections: Corticosteroid injections for inflammation reduction.
Surgery is a last resort when conservative measures are ineffective over an extended period.
Preventive Measures
To prevent epicondylitis:
- Proper Technique: Ensure correct form in sports and occupational activities.
- Equipment Check: Use appropriate equipment, such as racquets with suitable grip sizes.
- Strength and Flexibility: Regular exercises to maintain muscle balance.
- Ergonomic Adjustments: Modify workspaces to reduce repetitive strain.
