Epicondylitis is a common upper-extremity musculoskeletal disorder. It is most common at the age of 40–60 years. Epicondylitis seems to affect women more frequently than men. Diagnosis of epicondylitis is clinical and based on symptoms and findings of physical examination. The prevalence of lateral epicondylitis in the general populations is approximately 1.0–1.3% in men and 1.1–4.0% in women and that of medial epicondylitis is nearly 0.3–0.6% in men and 0.3–1.1% in women. The incidence rate of medical consultations has been estimated at 0.3–1.1 for lateral and 0.1 for medial epicondylitis per year per 100 subjects of general practice populations. Of occupational risk factors, forceful activities, high force combined with high repetition or awkward posture and awkward postures are associated with epicondylitis. The number of studies is limited to work-related psychosocial factors and the effects are not as consistent as those of physical load factors. Topical non-steroidal anti-inflammatory drugs, corticosteroid injections and acupuncture provide short-term beneficial effects. Workload modification should be considered, especially in manually strenuous jobs. According to clinical case series, surgical treatment has shown fair to good results; however, the efficacy of surgical treatment has not been evaluated in randomised controlled trials. Poorer prognosis of epicondylitis has been reported for individuals with high level of physical strain at work, non-neutral wrist postures during work activity and for those with the condition on the dominant elbow. Modification of physical factors could reduce the risk or improve the prognosis of epicondylitis.
Epicondylitis is one of commonly diagnosed upper-extremity musculoskeletal disorders. It is also called epicondylalgia, elbow tendinosis and elbow tendinopathy . Lateral epicondylitis or tennis elbow is a painful disorder of the tendinous origin of the wrist extensor muscles and medial epicondylitis or golfer’s elbow is a painful condition of the tendinous origin of the wrist flexor muscles . Lateral epicondylitis is more common than medial epicondylitis . In epicondylitis, pain is localised to the lateral or medial epicondyle of the humerus. It may spread up and down the upper extremity , and is aggravated with wrist and hand movements. Moreover, hand grip is impaired because of the pain .
Individuals with epicondylitis are typically 40 years or older , and epicondylitis is most common in individuals aged 40–60 years . The condition seems to affect women more often than men . The duration of epicondylitis symptoms usually ranges from few weeks to few months. It may sometimes be a rather long-lasting condition .
Diagnosis
Diagnosis of epicondylitis is clinical and based on symptoms and findings of physical examination . Pain in the lateral or medial aspect of the elbow is the main symptom. Pain is typically related to activity. There is tenderness at the lateral or medial humeral epicondyle on clinical examination. Clinical tests, consisting of active and resisted movements of the extensor or flexor muscles of the forearm, provoke epicondylar pain .
In most cases, imaging is not necessary for diagnosis of epicondylitis . Imaging can be used to evaluate the extent of tissue damage and to exclude other causes of elbow pain . Plain X-ray is useful in making differential diagnosis, such as osteoarthritis of elbow, osteochondrosis dissecans or other pathological processes of the bone. Ultrasonography and magnetic resonance imaging (MRI) may help to detect epicondylitis . On sonography, epicondylitis appears as thickening or thinning of the tendon, poor definition of the tendon and decreased echogenicity of the tendon . On MRI, epicondylitis appears as areas of thickening and high signal intensity of the tendon . Ultrasonography is more cost-effective, but is not as sensitive as MRI . MRI is the gold-standard imaging procedure for the diagnosis of epicondylitis . Both ultrasound and MRI have low specificity .
Few diagnostic criteria have been proposed for case definitions of lateral and medial epicondylitis . In 1997, a workshop of experts was organised by the UK Health and Safety Executive (HSE) and the University of Birmingham to develop consensus criteria for common work-related upper-extremity musculoskeletal disorders . The Birmingham workshop proposed diagnostic criteria for use in epidemiological research. The Birmingham workshop criteria for lateral and medial epicondylitis were local pain and two clinical signs ( Table 1 ).
| Reference | Lateral epicondylitis | Medial epicondylitis |
|---|---|---|
| Harrington et al., 1998 |
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| Sluiter et al., 2001 |
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