Lateral Epicondylitis Diagnosis and Treatment

Clinical Presentation and Pathophysiology

Lateral epicondylitis results from repetitive wrist extension, radial deviation, and forearm supination causing degenerative changes at the common extensor origin, particularly affecting the extensor carpi radialis brevis tendon, according to the American College of Radiology 1.
The condition affects men and women equally, most commonly after age 40, and involves the dominant arm in 75% of cases, as reported by the American Academy of Family Physicians 2, 1.
Pain radiating toward the thumb follows the anatomic distribution of the extensor carpi radialis brevis and longus tendons, which is a key characteristic of lateral epicondylitis 1.

The American College of Radiology recommends beginning with plain radiographs of the elbow as the most appropriate initial imaging study to rule out other causes of elbow pain, with a sensitivity of 76% and specificity of 50% for tendon pathology 3, 1.
Standard elbow radiographs can identify intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, occult fractures, and osteoarthritis, which are all potential causes of elbow pain 1.
MRI without IV contrast or ultrasound are equivalent alternatives for suspected tendon degeneration or tear when radiographs are normal or indeterminate, with MRI demonstrating 76% sensitivity and 50% specificity for tendon pathology, and ultrasound showing 64.52% sensitivity and 85.19% specificity for common extensor tendon tears 3, 4, 1, 5.

The American Academy of Family Physicians recommends beginning with relative rest, activity modification, and eccentric strengthening exercises as the foundation of treatment, which can lead to recovery in 80% of cases within 3-6 months 1.
Eccentric strengthening exercises can promote tendon healing and increase strength, and should be combined with manual joint mobilization and exercise therapy for optimal results 1, 6.
NSAIDs can provide short-term pain relief but do not affect long-term outcomes, and corticosteroid injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes, according to the American Academy of Family Physicians 2, 1, 6.
Surgical referral is recommended if pain persists despite 3-6 months of well-managed conservative treatment, and surgical techniques include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2.