Lateral epicondylitis, also known as tennis elbow, is a common cause of pain on the outside of the elbow. It is usually related to overuse of the extensor tendons of the forearm and can occur in racquet sports, manual labor, or repetitive daily activities.
Although the term “epicondylitis” may suggest inflammation, when the problem persists it is usually more accurate to speak of Lateral tendinopathy of the elbow. In these cases, there may be changes in the tendon and a lower tolerance to the load, so the treatment does not consist solely of reducing a supposed inflammation.
Lateral elbow pain alone is not sufficient to establish a diagnosis. The location of the discomfort, the movements that trigger it, the physical examination, and, when necessary, certain complementary tests help to differentiate epicondylitis from other conditions.
What is epicondylitis and why is it known as tennis elbow?
Lateral epicondylitis, or lateral tendinopathy of the elbow, affects the origin of the forearm extensor tendons at the lateral epicondyle of the humerus. The pain typically worsens with movements that combine gripping, wrist extension, or weight-bearing on the forearm.
The name “tennis elbow” comes from its association with racket sports, but It is not an injury exclusive to athletes. It can also occur in people who use tools, handle loads, or repeatedly perform certain hand and wrist movements.
Which tendon is usually involved in epicondylitis?
The structure most frequently involved is the extensor carpi radialis brevis, near its origin at the lateral epicondyle. Fibers from other nearby extensor tendons may also be involved, but not all extensor muscles are necessarily affected in every patient.
In persistent cases, changes characteristic of tendinopathy predominate over isolated acute inflammation. For this reason, recovery is usually focused on gradually restoring the tendon's load-bearing capacity.
What are the causes of epicondylitis in work and sports?
Lateral tendinopathy can occur when the demands placed on the tendon exceed its capacity to adapt and recover. There is not always a single cause, and in many patients, several factors are involved.
Repetitive movements, grip, and load changes
Repetitive gripping, wrist extension, pronation or supination of the forearm can increase discomfort, especially when combined with force, many repetitions, or sudden changes in the usual load.
It can also appear after changing a training routine, rapidly increasing the volume of activity, or performing a task for extended periods that the arm was not used to.
What activities can help or worsen pain?
- Tennis, padel, squash and other racket sports.
- Activities that require repeated or strong grips.
- Frequent use of hand tools.
- Jobs that involve repetitive handling of loads.
- Certain strength exercises performed with a load higher than tolerated.
- Prolonged use of the mouse or other sustained tasks that, in some people, can aggravate existing pain.
In athletes, in addition to treating the tendon, it can be helpful to review training load, technique, and the gradual return to activity. sports medicine unit This type of injury is addressed within a comprehensive assessment of the athlete.
What are the symptoms of epicondylitis?
The most characteristic symptom is pain on the outer side of the elbow, which can extend into the forearm and usually increases when using the wrist extensor muscles.
- Localized pain around the lateral epicondyle.
- Discomfort when gripping objects or closing the hand tightly.
- Pain when lifting a bag, a pan, or other objects.
- Discomfort when extending the wrist against resistance.
- Pain when using tools or practicing certain sports.
- Sensation of reduced grip strength due to pain.
The feeling of weakness may be due to pain inhibiting exertion. real and progressive loss of strength, tingling, or altered sensation They should not be automatically attributed to epicondylitis and justify evaluating other possible causes.
What is the difference between epicondylitis and other causes of elbow pain?
Not all pain on the outside of the elbow is epicondylitis. A medical history and physical examination help determine whether the symptoms actually originate from the tendon or another structure.
Epicondylitis and epitrochleitis
Epicondylitis predominantly affects the outer part of the elbow and is related to the extensor tendons. medial epitrochleitis or medial tendinopathy It produces pain in the internal area and mainly affects the origin of the flexor and pronator muscles.
Nerve entrapments
Some radial nerve disorders can cause pain in the lateral region of the elbow or forearm and may be mistaken for epicondylitis. The appearance of neurological symptoms, sensory disturbances, or weakness not solely attributable to pain requires further investigation.
Bursitis and joint problems
Olecranon bursitis typically causes swelling or pain at the back of the elbow. Osteoarthritis, loose bodies in the joint, and other joint disorders may be associated with stiffness, loss of mobility, clicking, or locking.
The conditions that appear after trauma and the pain that may originate from other areas, such as the neck or shoulder, must also be assessed differently.
How is epicondylitis of the elbow diagnosed?
The diagnosis is fundamentally clinical. The specialist reviews when the pain started, what activities trigger it, the exact location of the discomfort, and whether there are symptoms that suggest another pathology.
During the examination, the following may be assessed: sensitivity over the lateral epicondyle, pain with resisted extension of the wrist or fingers, grip strength, elbow mobility, and neurological status of the upper limb. No single maneuver alone confirms the diagnosis.
The BESS/BOA clinical pathway for lateral elbow tendinopathy It points out that the medical history and examination are the basis of the diagnosis and that imaging is mainly reserved for situations of diagnostic uncertainty.
When might an X-ray, ultrasound, or MRI be necessary?
In a typical presentation, imaging tests are not always necessary. They may be requested when symptoms are atypical, there is a history of trauma, there is significant limitation of mobility, neurological symptoms appear, or doubts about the diagnosis persist.
An X-ray can help investigate certain bone or joint conditions. Ultrasound and MRI can be used to assess tendons and other soft tissue structures in selected cases. Imaging findings should always be interpreted in conjunction with symptoms and the clinical examination.
How is epicondylitis treated?
Treatment depends on the intensity of the pain, its functional impact, the patient's activities, and their previous history. Generally, the initial approach is conservative and aims to... to control the symptoms and gradually restore the tendon's ability to bear load.
Temporarily modify the activity without completely immobilizing the arm
It may be necessary to temporarily reduce or modify movements that cause intense pain, but prolonged complete rest is not usually the goal. The aim is to maintain activity within tolerable limits and gradually resume normal tasks.
Therapeutic exercise and physiotherapy
Exercise is an important part of treatment. Depending on the clinical situation, isometric, concentric, or eccentric wrist extensor exercises may be used, progressively increasing the resistance as tolerance improves.
The Clinical guide on lateral elbow pain and alterations in muscle function It recommends resisted wrist extensor exercise in patients with subacute or persistent lateral tendinopathy.
Physiotherapy may also incorporate, depending on the case, mobility exercises, load management, correction of sports or work-related movements, and treatment of associated upper limb disorders. Passive techniques can be used as a complement, but do not necessarily replace the progressive recovery of function.
Orthotics and symptomatic treatment
In certain patients, elbow braces or orthoses may be tried, although their benefit is not uniform. Pharmacological treatment to control pain should be assessed individually by a healthcare professional, taking into account the patient's medical history, contraindications, and other treatments.
What evidence exists regarding infiltrations, PRP, and shock waves?
These options should not be presented as equivalent treatments or universal solutions. Their use depends on the patient's characteristics and the balance between expected benefits, scientific uncertainty, and potential adverse effects.
Corticosteroid injections
Some studies have observed short-term pain relief following corticosteroid injections. However, this benefit is not necessarily sustained, and certain studies have shown worse outcomes subsequently. The BESS/BOA guidelines advise against their routine use for lateral tendinopathy of the elbow.
Platelet-rich plasma or PRP
PRP is a product obtained from the patient's own blood with a higher than baseline platelet concentration. It should not be confused with stem cell therapy.
Its effectiveness in treating epicondylitis continues to be investigated. Recent meta-analysis of placebo-controlled clinical trials No significant improvement in pain or function was found with PRP during the evaluated periods. Therefore, it cannot be presented as a treatment that regenerates the tendon or guarantees recovery.
Shock waves
Extracorporeal shock wave therapy has been studied in persistent tendinopathies, but published results are inconsistent. It should not be presented as a proven way to "regenerate" the tendon or as a superior option for all patients. Some guidelines, including BESS/BOA, advise against its routine use in lateral elbow tendinopathy.
When can surgery for epicondylitis be considered?
Surgery may be considered in a selected group of patients with persistent and limiting symptoms after confirming the diagnosis and properly reviewing non-surgical options.
There is no single number of weeks or months that, by itself, determines the need for surgery. Before making a decision, it is advisable to rule out other causes of lateral pain and analyze the functional impact, previous treatments, and the patient's expectations.
Open or arthroscopic approaches may be used depending on the injury and the surgical judgment. The available evidence does not allow us to conclude that one intervention is necessary or superior for all patients with epicondylitis, and any surgery carries risks that must be explained on a case-by-case basis.
The Elgeadi Traumatology Elbow Unit It gathers information on the assessment and treatment of the various pathologies of this joint.
What is the recovery from epicondylitis like?
The outcome varies. It depends on the condition of the tendon, the duration of the injury, work or sports demands, load tolerance, and response to treatment.
Recovery can be organized in a phased manner:
- Control of movements that trigger intense pain.
- Recovery or maintenance of mobility.
- Progressive introduction of load on the forearm extensors.
- Improved strength and endurance.
- Reintroduction of the most demanding work, sports or daily tasks.
The return to activity should not depend solely on the time elapsed. It is more useful to assess the evolution of pain, strength, function, and the ability to progressively perform the necessary movement.
How to prevent relapses when returning to work or sports?
It is not always possible to prevent symptoms from recurring, but controlling factors that increase the load on the tendon can help.
- Gradually increase the intensity and volume of activity.
- Maintain forearm strength training when indicated.
- Review the technique in racket sports and strength exercises.
- Avoid sudden increases in workload after periods of lower activity.
- Introduce breaks or task changes when there are highly repetitive work movements.
- Adapt tools, sports equipment or ergonomics when necessary.
- Review the diagnosis if the pain changes in characteristics or stops responding as expected.
When is it advisable to consult a doctor for elbow pain?
It is advisable to request an evaluation when pain persists, limits usual activities, recurs frequently, or does not improve despite adjusting the workload and following appropriate treatment.
It is also advisable to assess the elbow beforehand if there are joint blockages, significant loss of mobility, noticeable swelling, tingling, altered sensation, or a weakness that progresses and is not explained solely by pain.
Following a major trauma, in the case of an obvious deformity, marked inability to use the arm, a progressive neurological deficit, or a very swollen joint accompanied by fever or general deterioration, an urgent medical evaluation may be necessary.
Frequently asked questions about epicondylitis of the elbow
Is epicondylitis an inflammation of the tendon?
Not necessarily. In acute phases, there may be an inflammatory response, but in many persistent cases, changes characteristic of tendinopathy predominate. Therefore, it should not be interpreted simply as "tendinitis" that needs to be relieved.
How can you tell if pain on the outside of your elbow is epicondylitis?
The location of the pain and its onset with gripping or wrist extension are consistent with epicondylitis, but do not confirm it on their own. Physical examination helps differentiate it from nerve and joint involvement, as well as other causes of lateral pain.
Is an MRI or ultrasound necessary for diagnosis?
Not always. In a typical presentation, the diagnosis is usually clinical. Imaging tests can be useful when there is diagnostic uncertainty, atypical symptoms, a history of trauma, or suspicion of other injuries.
Is it possible to continue working or playing sports with epicondylitis?
It depends on the severity of the symptoms and the activity level. Often, the workload is temporarily adjusted rather than completely stopping all movement. The return to more demanding tasks should be gradual and based on the elbow's tolerance.
Do injections, PRP, or shockwave therapy cure epicondylitis?
It cannot be guaranteed. Evidence and recommendations vary depending on the technique. Corticosteroids are not routinely recommended in some guidelines, the benefit of PRP versus placebo remains uncertain, and shockwave therapy has yielded mixed results. The indication should be individualized.
When should epicondylitis be operated on?
There is no universal timeframe that indicates surgery. It may be considered in selected patients with persistent and limiting symptoms after confirming the diagnosis and adequately reviewing conservative options. The decision should be individualized.
A correct diagnosis is especially important when lateral elbow pain persists, changes in characteristics, or limits work, sports, or usual activities. Epicondylitis is usually initially treated conservatively, but treatment should be tailored to each patient's situation. If you need to have your case reviewed, you can Request an evaluation with the Elgeadi Traumatology team and consult the available centers.
