Patients with epicondylitis often present a history of repetitive strain or acute injury. The age group of patients who are affected by this condition is between 40 and 50 years. Symptoms of the onset occur 24 to 72 hours after repeated activity (wrist extension). Sometimes the symptoms are delayed due to microscopic tears in the tendon.

Patients often complain about the pain which worsens with activity and improves if rest is provided. The pain associated with epicondylitis may radiate to the posterior part of the forearm. This pain can range from mild to severe. The differential diagnosis of epicondylitis is olecranon bursitis, arthritis of elbow, carpal tunnel syndrome and cervical nerve root entrapment.

• Pain

  Maximal tenderness usually 2-5mm distal and anterior to the midpoint of the lateral epicondyle Resisted wrist and finger extension with the elbow in full extension exacerbates pain Normal wrist/elbow ROM If pt has pain on resisted suppination consider [eorif.com]

  RESULTS: The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. [ncbi.nlm.nih.gov]

• Inflammation

  In tennis elbow and golfer’s elbow, there is inflammation of the extensor forearm muscle, and the flexor forearm muscle respectively. Definition Inflammation of the muscles of tennis elbow or the golfer’s elbow is referred to as epicondylitis. [symptoma.com]

  Infection or inflammation of an epicondyle, or of associated tendons and other soft tissues. epicondylitis (ep´ikon´dəlī´tis), n a painful repetitive strain injury of the elbow characterized by inflammation or lesions in the muscles or tendons where [medical-dictionary.thefreedictionary.com]

  See my video InflammaSCAM Exposed for more on the inflammation myth: Tennis Elbow Tendonitis And The Inflammation SCAM The more likely possibilities with Tennis Elbow are: Good news: You can have a lot of pain in the early stages – before there’s any [tenniselbowclassroom.com]

  Definitions of epicondylitis 1 n painful inflammation of the muscles and soft tissues around an epicondyle Types: lateral epicondylitis, lateral humeral epicondylitis, tennis elbow painful inflammation of the tendon at the outer border of the elbow resulting [vocabulary.com]

  This is commonly referred to as a repetitive strain injury, and also leads to inflammation. Regardless of the cause, however, we can decrease inflammation, restore proper muscle balance if necessary and help improve your pain-free range of motion. [pelhamrehab.com]

• Weakness

  Pain, stiffness, and weakness associated with medial epicondylitis can improve with home remedies. Rest your arm. Repeatedly using the affected arm can prolong healing and worsen your symptoms. [healthline.com]

  Contributing factors include weak shoulder and wrist muscles, a racket strung too tightly, an undersized grip, hitting heavy wet balls, and hitting off-center on the racket. [merckmanuals.com]

  Symptoms of tennis elbow can include pain or weakness when grasping and aches or pain in the elbow area. Treatment of tennis elbow includes: activity modification, ice, medicine, stretching, braces and injections. [hopkinsmedicine.org]

  Common signs and symptoms of tennis elbow include: Pain or burning on the outer part of your elbow Weak grip strength (such as holding a racquet, turning a wrench, or shaking hands) The pain may be mild at first and gradually worsen over time. [summitortho.com]

• Swelling

  Painkillers such as ibuprofen can help relieve pain and reduce swelling in the elbow and forearm. In some cases, doctors may give people steroid injections to ease pain and help reduce swelling. Do stretching and strengthening exercises. [kidshealth.org]

  Follow your healthcare provider’s recommendations to get rest and manage pain and swelling. Let your healthcare provider know if these strategies don’t help reduce pain, swelling, and loss of function. [hopkinsmedicine.org]

  Tennis elbow is a type of tendinitis -- swelling of the tendons -- that causes pain in the elbow and arm. These tendons are bands of tough tissue that connect the muscles of your lower arm to the bone. [webmd.com]

• Surgical Procedure

  Between 1994 and 2006, the population-adjusted rate of ambulatory surgical procedures increased from 7.29 to 10.44 per 100,000 capita. [ncbi.nlm.nih.gov]

  procedure to treat Tennis Elbow called lateral epicondyle release surgery. [uppervalleyortho.com]

  It focused on tennis elbow and the recovery processes for 2 different surgical procedures. The fact that it read like some medieval torture tome was vindication of the fast advances being made in regenerative medicine. [regenexx.com]

  Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone. The right surgical approach for you will depend on a range of factors. [orthoinfo.aaos.org]

• Ulcer

  However, these drugs can cause side effects, such as bleeding and ulcers. You should only use them occasionally, unless your doctor says otherwise, since they may delay healing. [webmd.com]

• Elbow Pain

  Heaviness of labour was not associated with the elbow pain scores. The prevalence was highest in subjects aged 50 to 59 years (9% [95% CI, 3.8%-17.1%]) and those with no job (14% [95% CI, 1.1%-44.1%]). [ncbi.nlm.nih.gov]

  Patients often present with lateral elbow pain, which is frequently exacerbated when they grasp objects during wrist extension with resistance. [radiopaedia.org]

• Fracture

  BACKGROUND: Heterotopic ossification (HO) is a well-known complication following the surgical treatment of fractures and dislocations about the elbow but it is not commonly discussed as a complication following arthroscopy. [ncbi.nlm.nih.gov]

  […] and forearm form a functional unit whose primary role is to accurately position the hand in space. view Elbow Contusion An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains. view Ligament Tears and Elbow Fractures [rocmd.com]

  Elbow injuries include fracture of a bone near the joint, dislocation, and tearing of tendons and ligaments. Dislocation and fracture may occur together. arthritis may affect the elbow and make it stiff or impossible to move. [medical-dictionary.thefreedictionary.com]

  For a clinical differential diagnosis of lateral elbow pain, consider: occult fracture osteochondritis dissecans of the capitellum lateral osteoarthrosis lateral ulnar collateral ligament (LUCL) instability radial tunnel syndrome [radiopaedia.org]

• Wrist Pain

  Other common signs that arm pain might be caused by medial epicondylitis include: pain on the inside of the elbow pain that spreads from the elbow toward the wrist swelling and tenderness in the inner part of the elbow tightness or weakness in the forearm [kidshealth.org]

  Pain and tenderness over the lateral epicondyle of the humerus, radiating into the forearm, and pain on resisted dorsiflexion of the wrist, middle finger or both. [patient.info]

  (The finger flexor muscles cross the wrist, of course, and will flex the wrist too, unless opposed.) Figure : A wrist splint that may ameliorate elbow pain. [orthopaedicsone.com]

• Muscle Strain

  Anatomy The elbow and forearm form a functional unit whose primary role is to accurately position the hand in space. view Elbow Contusion An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains. view Ligament [rocmd.com]

  This can reduce tendinitis and muscle strain. Another option is wrapping an elastic bandage around your elbow. Most cases will improve with OTC medication and home remedies. [healthline.com]

• Myofascial Trigger Point

  Trigger Point Dry Needling Dry Needling is a physical therapy modality used in conjunction with other interventions to treat myofascial pain and dysfunction caused by trigger points. [mikereinold.com]

• Stroke

  Tendons that connect these forearm muscles to the lateral bones of the elbow can roll over the end of the elbow and become damaged when making a backhand stroke in tennis. [theorthoinstitute.com]

  When making a backhand stroke in tennis, the tendons that roll over the end of our elbow can become damaged. [hopkinsmedicine.org]

  With regards to tennis players, a number of factors including poor mechanics (particularly during the backhand stroke) and innappropriate racket type can predispose them to developing lateral epicondylitis. [dinesorthopedics.com]

  Tennis elbow is commonly seen in tennis players, hence the name, especially when poor technique is used when hitting the ball with a backhand stroke. [uppervalleyortho.com]

  Anyone who performs repetitive movements of the elbow, like a carpenter or painter, or who repeatedly moves the wrist forward and backward, such as tennis players on their backhand stroke, is susceptible. Such motions can strain tendons in the arm. [pelhamrehab.com]

• Laboratory studies are not useful in the diagnosis of the epicondylitis.
• For the workup of the lateral elbow pain, imaging studies are rarely used. Pain film radiologic evaluation is suggested in case the symptoms of epicondylitis are present, or to evaluate the degenerative joint disease. The plain films can reveal osteophytes or calcification, if present. For stress fractures, the magnetic resonance imaging, CT-scan and bone scan may be used. If the involvement of the ulnar nerve is suspected, nerve conduction study or electromyography is advised [5].

Though several treatment modalities are advised, it is still not clear if the treatment works or the condition is self-limiting. Some of the treatment methods are detailed as follows:

1. Restriction of activity, providing rest of the affected region, ice-treatment after exercise, ergonomic workplace, modification in the sports are some of the methods that play significant role in the management of epicondylitis. Rehabilitation exercise that focus on increasing the strength of tendons is often advised. Physiotherapy is found to be effective in managing epicondylitis [1].
2. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can provide short term relief. Local steroid injection can be injected at the point of maximum tenderness. Superficial injections are often avoided as they may cause skin atrophy. Long term use of steroids is not recommended as they are considered harmful in the long run, though use of glycerin trinitrate patches over the painful areas can improve the condition in the long run [4] [6] [7] [9].
3. Surgery: Though there is a shortage of the evidence to determine the effectiveness of surgery, it is occasionally indicated in patients whose problems are not resolved by conservative treatments [8].

Both the lateral and medial epicondylitis are self-limiting conditions. It generally takes around six to twenty-four months for the patients to recover from this injury, though around 90% of the patients recover within a year [4].

Complications

The complications of epicondylitis are as follows:

• Persistent pain the elbow, which worsens if the stress or trauma continues. 
• Chances of infection in the region increase significantly.
• There is a risk of deficit of residual strength and joint instability.
• Epicondylitis also poses several functional limitations.

The continued and repetitive stress at the muscle-tendon junction at the lateral and medial epicondyle of the humerus causes inflammation of the region, leading to epicondylitis.

Annually around 7 cases in every 1000 patients have reported the incidence of tennis elbow. Most of the patients belong to the age group of 40 and 50 years of age. Golfer’s elbow is less common than tennis elbow. Epicondylitis is more common in patients and age groups who overuse these joints owing to their jobs, or sports [2].

Due to the poor conditioning of the muscle, fatigue is caused to the core and the shoulder muscles. This leads to the overemphasis on the use of the extensor muscle of the forearm. Some of the causes of such trauma are improper training, improper technique, poor sport-equipment, or scapular dyskinesis [3].

Patients must identify the techniques and postures that can lead to the injury of the muscles due to their overuse. Day-to-day activities such as throwing sports and use of computers can contribute to this condition. Many patients have experienced acute trauma after the road traffic accident.

Epicondylitis is a musculoskeletal disorder. When there is a minor or unrecognized trauma caused in the proximal insertion of the extensor (tennis elbow) or flexor (golfer’s elbow) muscle leading to inflammation, it is referred to as lateral and medial epicondylitis respectively. These are often caused due to the overload injuries. In tennis elbow and golfer’s elbow, there is inflammation of the extensor forearm muscle, and the flexor forearm muscle respectively [1].

Definition

Inflammation of the muscles of tennis elbow or the golfer’s elbow is referred to as epicondylitis. This condition restricts the activity of the patient and can cause immense pain.

Causes

When there is continued and repetitive stress or trauma to the muscle-tendon junction in the epicondyle, it causes inflammation in the region, a condition which is called epicondylitis.

Symptoms

Patients complain about extreme pain which worsens with activity. Rest helps alleviate the pain. In most of the cases, the pain (mild or severe) caused by epicondylitis radiates to the posterior part of the forearm.

Diagnosis

Pain associated with epicondylitis must be differentiated with that of other similar conditions so that adequate management strategies are adopted. Imaging studies of the elbow can reveal the presence of osteophytes. Sometimes MRI and CT-scan and Bone-scan are also requested.

Treatment

Providing rest to the region by immobilization is the first step of treating epicondylitis. Since this condition is associated with extreme pain, the most important strategy is pain management. Short term management of pain includes the use of NSAIDs, steroids, and glycerin trinitrate. Physiotherapy also plays role in the treatment of epicondylitis.

1. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. Nov 4 2006;333(7575):939.
2. Johnson GW, Cadwallader K, Scheffel SB, et al; Treatment of lateral epicondylitis. Am Fam Physician. 2007 Sep 15;76(6):843-8
3. Autologous blood injection for tendinopathy, NICE Interventional Procedure Guideline (January 2009)
4. Smidt N, van der Windt DA, Assendelft WJ, et al; Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002 Feb 23;359(9307):657-62.
5. Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM. Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis. Am J Sports Med. Aug 11 2011
6. Tennis elbow, Prodigy (December 2008)
7. Orchard J, Kountouris A; The management of tennis elbow. BMJ. 2011 May 10;342:d2687. 
8. Buchbinder R, Green S, Bell S, et al; Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2002;(1):CD003525.
9. Nichols AW, Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005 Sep;15(5):370-5.