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.

• 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]

  Cervical radiculopathy can also present as elbow pain: C5 or C6 nerve roots for lateral elbow pain; C8 or T1 nerve roots for medial elbow pain. [orthopaedicsone.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.