Tennis and Golfer's Elbow Epicondylitis

1. Ade Wijaya, MD – November 2018

2. Introduction
• Epicondylitis lateral vs medial
• Lateral epicondylitis  Tennis elbow
• Medial epicondylitis  Golfer’s elbow
Boyer MI. Comprehensive orthopedic review. American Academy of Orthopedic Surgeons. 2014;2:988–90, 1027–8. ISBN: 978–0–89203-845-9.
Whaley AL, Baker CL. Lateral epicondylitis. Clin Sports Med. 2004;23(4):677–91. x

3. Pathophysiology
• Micro-trauma at the origin of the tendons secondary to repetitive
wrist flexion/extension which predisposes to tears.
• This micro-trauma results in prostaglandin release resulting in local
tenderness/swelling and may result in ulnar nerve irritation.
• Hypo-vascular
• Pathology: angio-fibroblastic hyperplasia, vascular proliferation and
focal hyaline degeneration of the tendon without inflammatory cells
Whaley AL, Baker CL. Lateral epicondylitis. Clin Sports Med. 2004;23(4):677–91. x
Morrey BF. The elbow and it’s disorders. 3rd ed. Philadelphia: W.B. Saunders Company. 2000; p. 543–48.103, 105.
Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2(1):1–8.
Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. J Bone Joint Surg Am. 2007;89(9):1955–63.

4. Clinical Presentation
• Subjective weakness in wrist flexion/extension
• In lateral epicondylitis, pain worsens with gripping activities or wrist
extension
• In medial epicondylitis, elbow/wrist flexion results in worsening of
symptoms. Patients may also complain of ulnar nerve symptoms
Boyer MI. Comprehensive orthopedic review. American Academy of Orthopedic Surgeons. 2014;2:988–90, 1027–8. ISBN: 978–0–89203-845-9.
Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2(1):1–8.
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015;23(6):348–55. Review. PubMed PMID: 26001427

5. Diagnosis
• History
• Physical examination
• Plain radiographs (AP/lateral of the elbow) to rule out osseus defects
• MRI & EMG/NCS (optional)
Matthews J, Boyle K. Tennis and Golfer’s Elbow: Epicondylitis. InOrthopedic Surgery Clerkship 2017 (pp. 87-90). Springer, Cham.

6. Treatment
• Rest / ice
• Activity modification
• Bracing
• NSAIDs
• Corticosteroid injections
• Physical therapy
• Botox / PRP
• Surgical
Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2(1):1–8.
Calfee RP, et al. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. 2008; 16(1):19–29.
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015;23(6):348–55. Review. PubMed PMID: 26001427

7. Injection Technique
Halperin, JS. Elbow Joint Injection. In: Malanga G, Mautner K. Atlas of Ultrasound-Guided Musculosceletal Injections. McGraw-Hill Education 2014. p.53-56

8. Summary
• Epicondylitis; medial vs lateral
• Repetitive injuries – microtrauma
• Non-pharmacology, NSAIDS, steroid injections, surgery