Clinical features

The typical patient is in the fourth decade (or older) with a history of minor trauma to the elbow or repetitive activity during work or recreation (1).

The classical history used to be of a tennis-related injury but since the advent of light rackets tennis is no longer the usual cause, with jobs involving repetitive heavy lifting or the use of heavy tools being major factors now, typically in the dominant arm (2).

Occasionally symptoms are seen after a specific injury to the area but often the symptoms are of gradual, insidious onset (2).

An abrupt onset of symptoms is uncommon (2).

• pain
  • localized to the front of the lateral epicondyle and often radiates down the forearm (2)
  • in severe cases the pain may become more generalized
  • the pain is made worse by movements such as pouring out tea, shaking hands or lifting the wrist whilst the forearm is pronated.
• weakness in grip strength or difficulty in carrying objects in hands (3)

On examination

• there is no swelling
• the elbow can be flexed and extended without pain
• tenderness is generally localized to the lateral epicondyle over the extensor mass (2)
• symptoms are usually reproduced with resisted supination or wrist dorsiflexion, particularly with the arm in full extension (2)
• grip strength may be decreased (compared to the unaffected side) or may cause significant discomfort

References:

1. Cutts S et al. Tennis elbow: A clinical review article. J Orthop. 2019 Aug 10;17:203-20

2. Cohen M et al. Lateral Epicondylitis of the Elbow. Rev Bras Ortop. 2015 Dec 8;47(4):414-20

3. De Smedt T et al. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med. 2007 Nov;41(11):816-9.