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 is of a tennis-related injury. The condition is seen often in the dominant extremity (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 (3).

• 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 (2)

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 (1)
• grip strength may be decreased (compared to the unaffected side) or may cause significant discomfort

Reference:

• (1) Johnson GW et al. Treatment of lateral epicondylitis. Am Fam Physician. 2007;76(6):843-8.
• (2) Whaley AL, Baker CL.Lateral epicondylitis. Clin Sports Med. 2004;23(4):677-91
• (3) Flatt AE. Tennis elbow. Proc (Bayl Univ Med Cent). 2008;21(4):400-2.