Lateral epicondylitis

1. Lateral epicondylitis
Dr. Ponnilavan
Ortho Resident
Pondicherry

2. Intro:
• Not an inflammatory condition
• Tendinosis that affects the common attachment of
tendons of extensor muscles of forearm( esp. ECRB)
• 1ST described by F.Runga in 1873
• Nirschl described angiofibroblastic tendinosis

3. Etiology
• Any activity that involves overuse of wrist extensors or
supinator muscles
• Popularly associated while playing tennis
• Goldie attributed the onset of symptoms to overexertion of
the extremity with repetitive wrist extension & alternating
forearm pronation or supination.
• Smidt & van der Windt identified factors that can be avoided
to relieve symptoms.

4. Associations
• Nirschl described mesenchymal syndrome suggesting a genetic
linkage to the development of the disease.
• Tennis elbow pts tend to have higher incidence of RF & HLA-27 +ve
• Not proved etiopath – Synovial fringe inflammation ( Trethwan)
- ECRB tear ( Cyriax)
- Radial nerve nephritis ( Kaplan)
- Radial nerve entrapment ( Roles & Maudsley)
- Radial head fibrillation ( Newman & Goodfellow)
- Anconeus inflammation ( Coe et al)

5. Pathogenesis
• Micro tears- Angiofibroblastic hyperplasia & disorganised collagen
• Under- use or stress shielding
• Compromised blood supply
• Thermal injury
• Apoptosis
• Genetic

6. Clinical features
• Gripping movements at wrist – painful
• Point tenderness just anterior & distal to lateral epicondyle &
proximal region of ECRB
• Cohen‘s or Thompson’s test – Resisted wrist extension +
radial deviation + full pronation- pain at anterolateral elbow
• Mill ‘s test – wrist flexion + forearm pronation + elbow
extension- pain
• Maudsley test – Resisted 3rd digit extension
• Chair lift test – lift chair with thumb, index & middle finger +
elbow extension

7. D/D
• Cervical nerve root compression
• Radiocapitellar overload syndrome
• Osteoarthritis of radial head or capitalism
• OCD of capitalism
• PIN Syndrome

8. Investigation
• Xrays
• Doppler usg
• Thermography
• MRI
• Nerve conduction study & EMG

9. Rx
• Non operative-
- Rest
- NSAIDS
- Physical therapy
- Counterforce brace
- Steroid injection
- Extracorporeal shock wave therapy
- Autologous blood injection
- PRP
- Acupuncture

10. Surgical
• Partial resection of annular ligament of Bosworth
• Distal lengthening of ECRB of Garden
Arthroscopic Mx – 1st described by Grifka, Boenke & Kramer in 1995
Percutaneous release – extensor slide or Hohmann’s epicondylar
stripping procedure
Rx failures was divided into 2 types by Morrey.

11. • Thank U...........