About Physiatry

Epicondylosis (Lateral) With and Without
Nerve Entrapment

Condition: Lateral epicondylosis (LE) is a common painful condition that affects the tendons that join the forearm muscles on the outside of the elbow. This condition is often referred to as “tennis elbow”.

Background: LE is a degenerative process that results from repetitive stress, causing injury and inflammation in the tendons that join the forearm muscles. Although this condition is often referred to as “tennis elbow”, only 5% of cases actually result from racquet sports.

Risk Factors: LE is the most common cause of elbow pain and typically occurs in patients of both genders in their 30s and 40s. Risk factors include faulty action mechanics, overexertion, or repetition with poor wrist and forearm positioning.

History and Symptoms: Pain is often sharp and localizes to the outside of the elbow, although it may radiate from the elbow. Pain may increase due to activities that involve gripping, straightening, or flexing the wrist. Swelling may be observed. If entrapment of the nerve that passes through the elbow (radial nerve) occurs, the patient may have numbness and weakness in the elbow, wrist, hand, and lower arm. Past history, including pain or swelling in other joints and aggravating and relieving factors, is important.

Physical Exam: The physical exam will involve inspection of the wrist, elbow, shoulder, and neck. Tenderness to the touch and range of motion will be assessed. Stretching ability and grip strength may be tested.

Diagnostic Process: To diagnose nerve entrapment, sensation and motor responses, including reflexes, should be evaluated. Evaluation of technique is helpful for athletes. X-rays, MRI, and ultrasound can help to diagnose LE and rule out any other problems.

Rehab Management: About 80% of patients report improvement within one year, and less than 11% of patients require surgery. Rest of the involved arm and splinting or bracing may be used for severe cases. Medications, such as topical or oral non-steroidal anti-inflammatory drugs, and cryotherapy (cold compression) are useful to alleviate pain. Injections of cortisone can help in the short term. Other treatment options (platelet-enriched plasma injections, topical glycerol trinitrate patches, transcutaneous nerve stimulation [TENS], ultrasound, or acupuncture) are also sometimes beneficial. Exercise therapy should include wrist extension exercises, passive stretching, and progressive strength training.

Other Resources for Patients and Families: Patients should be educated about modifications to sports- or work-related activities. Family and societal roles may be affected, suggesting that support for patients and families is beneficial.


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