Alternate Names: Epitrochlear bursitis; Epicondylitis; Tennis elbow

Causes and Risks:

This injury is caused by repetitive twisting the wrist or forearm. There may be a partial tear of the tendon fibers at or near their point of insertion on the humerus. Risk factors are forceful repetitive wrist or forearm movement. The injury is classically associated with tennis playing, hence the name "tennis elbow", but any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to lateral epicondylitis.

Prevention:

Maintain good strength and flexibility in the arm muscles or avoid a repetitive motions. Rest the elbow when flexion and extension is painful.

Symptoms:

• Elbow pain that gradually worsens
• Pain radiating from the elbow to the forearm and back of the hand when grasping or twisting
• Weak grasp
• Often there will be pain when the tendon is gently pressed (palpation) near where it attaches to the upper arm bone (humerus)

Signs and Tests:

The diagnosis is made by clinical signs and symptoms, since X-rays are usually normal.

There is tenderness over the outside of the elbow. There is also pain near the elbow when the wrist is extended (lifted up when the palm is facing down) against resistance.

Treatment:

Treatment is aimed at pain relief and reducing inflammation.

Nonsteroidal anti-inflammatory medications, local injection of cortisone and a local anesthetic into the affected area, immobilization of the forearm and elbow with a splint for 2 to 3 weeks, heat therapy, and physical therapy are all treatments that may improve symptoms. To prevent the recurrence of the injury, a splint may be worn during aggravating activities, or the activities may need to be modified. Surgical release of the tendon at the elbow is rarely indicated to relieve the pain.

Prognosis: Over 90% of people improve with non-surgical treatment and 90% of people who have surgery also improve.

Complications:

• Recurrence of the injury with overuse
• Rupture of the tendon with repeated steroid injections

Apply home treatment (over-the-counter anti-inflammatory analgesics and immobilization) if symptoms are mild or if you have had this disorder before and you know this is what you have.

Call for an appointment with your health care provider if this is the first time you have had these symptoms, or if home treatment does not relieve the symptoms.