Lateral Epicondylosis (Tennis Elbow) in Hairdressers

Cause and Risk Factors

The American College of Radiology notes that lateral epicondylosis is a degenerative tendinopathy of the common extensor tendon origin at the lateral epicondyle, caused by repetitive wrist extension and forearm movements inherent to hairdressing work 1, 2
Lateral epicondylosis is 7 to 10 times more common than medial epicondylosis and affects the dominant arm 75% of the time, making the right elbow the typical site in right-handed hairdressers 3
Occupations requiring repetitive wrist flexion and extension are primary risk factors, and hairdressing involves constant scissor work, blow-drying with sustained wrist positioning, and repetitive gripping motions 3

Tenderness on palpation directly over the lateral epicondyle with pain reproduced by resisted wrist extension is a characteristic sign of lateral epicondylosis 3
Initial imaging should be plain radiographs of the elbow, which may show soft tissue calcification or exclude other pathology, though they are often normal in epicondylosis 1
MRI or ultrasound are reserved for cases where diagnosis is unclear, surgery is contemplated, or symptoms fail conservative treatment, as they can demonstrate the extent of tendon degeneration and exclude other causes 1, 4

The American Academy of Family Physicians recommends that most patients (approximately 80%) fully recover within 3 to 6 months with conservative treatment, including relative rest from aggravating activities, ice application, and eccentric strengthening exercises 5
NSAIDs provide acute pain relief but cannot be recommended over other analgesics for long-term management, and corticosteroid injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes 3
Activity modification is critical—hairdressers should modify gripping technique, avoid sustained wrist extension positions, and incorporate rest breaks between repetitive movements 2

The American College of Radiology recommends plain radiographs of the elbow as the initial imaging study to exclude other pathology, such as intra-articular pathology or occult stress fractures, in patients with suspected tennis elbow 6
Radial nerve entrapment (posterior interosseous nerve syndrome) is a critical differential diagnosis to exclude in patients with lateral elbow pain, and can be evaluated with MRI or ultrasound 7
The American College of Radiology suggests that MRI elbow without IV contrast or CT elbow without IV contrast is usually appropriate as the next imaging study when radiographs are normal or nonspecific and occult pathology is suspected 6, 7

MRI can evaluate radial nerve, median nerve, and other entrapment syndromes in patients with atypical presentations of lateral epicondylitis 7