Lateral Epicondylitis Management

Etiology and Diagnosis

Lateral epicondylitis results from repetitive wrist extension, radial deviation, and forearm supination that causes degenerative tendinopathy of the common extensor origin, particularly affecting the extensor carpi radialis brevis tendon, affecting men and women equally, most commonly after age 40, and involves the dominant arm in 75% of cases, occurring in racquet sports players and occupations requiring repetitive wrist flexion/extension 1
Diagnosis is primarily clinical based on pain at the lateral epicondyle and pain with resisted wrist extension 2
Plain radiographs are the most appropriate initial imaging to rule out other causes of elbow pain, and MRI or ultrasound may be considered if radiographs are normal but tendon degeneration or tear is suspected 2, 3

The American Academy of Family Physicians recommends beginning with relative rest, activity modification, and eccentric strengthening exercises as these form the foundation of treatment, with 80% of patients recovering within 3-6 months 2, 3
Relative rest and activity modification to reduce repetitive loading of the damaged tendon, and eccentric strengthening exercises to promote tendon healing and increase strength, are recommended 2, 3
Cryotherapy (ice application) for 10-minute periods for acute pain relief, and NSAIDs provide short-term pain relief but do not affect long-term outcomes 1, 2, 3
Counterforce bracing (tennis elbow brace) may improve function during daily activities, though evidence is limited, and deep transverse friction massage to reduce pain, and progressive stretching exercises for wrist extensors are also recommended 2, 3
Corticosteroid injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes, so use them judiciously for short-term relief only, according to the American Family Physician 1, 3
Manual joint mobilization combined with exercise therapy is more effective than exercise alone, as suggested by Praxis Medical Insights 2

The American College of Radiology suggests that lateral epicondylitis is the primary diagnosis for lateral elbow pain, but other anatomically distinct pathologies should be excluded, including osteochondral lesions, intra-articular bodies, and radiocapitellar arthritis 4, 5
Osteochondral lesions, such as those of the capitellum or radial head, can cause lateral elbow pain and should be considered in the differential diagnosis 4, 5
Intra-articular bodies can cause mechanical symptoms and should be ruled out with imaging studies 5
Radiocapitellar arthritis is a degenerative condition that can cause lateral elbow pain and should be considered in the differential diagnosis 4

Night pain or pain at rest suggests an inflammatory or neoplastic process and warrants further evaluation 4
Mechanical symptoms, such as locking or catching, suggest intra-articular pathology and should be investigated with imaging studies 5
Medial-sided pain points to medial epicondylitis or cubital tunnel syndrome and should be considered in the differential diagnosis 4

Plain radiographs of the elbow are the most appropriate initial imaging study and should be obtained in all patients to rule out osseous pathology 4, 5
Standard elbow radiographs can identify intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, occult fractures, and osteoarthritis 4, 5
Comparison views of the contralateral elbow are often useful in evaluating lateral elbow pain 5
MRI or ultrasound should be considered only if radiographs are normal or nonspecific and there is clinical suspicion for tendon tear, nerve entrapment, or other soft tissue pathology 4, 5
Electromyography (EMG) and nerve conduction studies should be obtained when neurologic symptoms suggest posterior interosseous nerve syndrome or radial tunnel syndrome 4