Snapshot
- A 25-year-old man presents to his primary care physician due to elbow pain. He reports that the pain affects his right arm and is located in the right aspect of the elbow. He says that the pain is typically a 3/10 at baseline but increases to an 8/10 when playing badminton or squash. On physical exam, there is tenderness upon palpation of the lateral epicondyle, as well as pain with resisted wrist extension while the elbow is fully extended.
Introduction
- Pathoanatomy
- distal humerus
- contains both the medial and lateral epicondyle, which serves as the origin site for wrist flexors and extensors
- medial epicondyle
- origin site for wrist flexors
- lateral epicondyle
- origin site for wrist extensors
- medial epicondyle
- contains both the medial and lateral epicondyle, which serves as the origin site for wrist flexors and extensors
- microscopic analysis of the affected tendon demonstrates an angiofibroblastic degeneration and collagen disarray
- there are no signs of inflammation as this is an overuse syndrome
- distal humerus
- Clinical definition
- medial epicondylitis
- overuse injury affecting the wrist flexor tendons that originate in the medial epicondyle
- pronator teres and flexor carpi radialis muscle are injured
- also known as “golfer’s elbow”
- overuse injury affecting the wrist flexor tendons that originate in the medial epicondyle
- lateral epicondylitis
- overuse injury affecting the wrist extensor tendons that originate in the lateral epicondyle
- extensor carpi radialis brevis muscle (more common) and the extensor digitorum communis muscle (occasionally) are injured
- also known as “tennis elbow”
- lateral epicondylitis is much more common than medial epicondylitis
- overuse injury affecting the wrist extensor tendons that originate in the lateral epicondyle
- medial epicondylitis
| Repetitive Elbow Trauma | |||
| Category | Mechanism | Presentation | Management |
| Medial epicondylitis | Excessive wrist flexion activities | Symptomsmedial elbow painPhysical examtenderness palpation of the medial epicondylepain withresisted wrist flexion while the elbow is extendedpassive wrist extension while the elbow is extended | Activity modificationavoiding exacerbating activitiesPhysical therapyNon-steroidal anti-inflammatory drugs (NSAIDs) |
| Lateral epicondylitis | Excessive wrist extension activities | Symptomslateral elbow painPhysical examtenderness upon palpation of the lateral epicondylepain withresisted wrist extension while the elbow is extendedpassive wrist flexion while the elbow is extended | Activity modificationavoiding exacerbating activitiesCounterforce bracePhysical therapyNon-steroidal anti-inflammatory drugs (NSAIDs) |