External Elbow Pain – Lateral Epicondylitis

Outer elbow pain is most commonly caused by what is known as lateral epicondylitis or tennis elbow. Lateral epicondylitis is an overuse injury . It can be seen in people who are involved in various sports, especially tennis players. Occupational working conditions can also cause pain on the outer side of the elbow.

Lateral epicondylitis is associated with the overuse and strain of the muscles located between the wrist and elbow (forearm) that pull the wrist back. These muscles attach to the lateral epicondyle of the humerus on the outer edge of the elbow. Repeating the same movements too many times can damage these muscles and the tendons they attach to the bone. As a result, pain and tenderness occur in the outer part of the elbow.

The elbow is a joint where 3 bones are connected to each other. The humerus and radius and ulna bones in the forearm articulate with each other at the elbow. At the lower end of the humerus, there are two projections called the epicondyle. The outer protrusion is called the lateral epicondyle, and the inner protuberance is called the medial epicondyle. The elbow joint maintains its shape and strength with the help of ligaments, muscles and tendons. Lateral epicondylitis is a problem involving the muscles and tendons of the forearm that allow the hand to be pulled back from the wrist. Mainly the tendon of the muscle called extensor carpi radialis brevis is affected.

What Causes Tennis Elbow?

The extensor carpi radialis brevis muscle is the main muscle that supports the wrist when the elbow is straight. For example, it keeps the wrist straight during long strokes in tennis. If the muscle weakens due to overuse or as a result of friction as the elbow is bent and opened, microscopic tears may occur where it attaches to the lateral epicondyle. Immune system response (inflammatory response) and pain occur.

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Lateral epicondylitis is also common in painters, painters, plumbers, auto mechanics, cooks, and carpenters. In these occupations, the same movements and weight lifting can lead to injury. Sometimes this issue can occur without any initiating cause being found. Although tennis elbow can occur at any age, it is more common between the ages of 30 and 50.

Tennis Elbow Symptoms

In general, symptoms appear gradually. At first, the pain on the outer edge of the elbow is mild. It increases gradually over weeks and months. Often it cannot be associated with a specific traumatic injury. As the problem progresses, hand grip strength decreases. Complaints worsen with activities such as holding a racket, turning a wrench, or shaking hands. Mostly, the dominant hand side is affected. However, it can occur in the other arm or bilaterally.

How Is It Diagnosed?

If your elbow pain has started without any sudden injury, you may be examined by a physical therapy and rehabilitation doctor. The doctor first listens to your complaints. He/she may ask about the onset of pain, its location, its course over time, factors that increase and decrease it. He/she questions additional symptoms such as numbness, tingling sensation and loss of strength accompanying the pain. Your hobbies, sports and professional activities can be helpful in making a diagnosis. Presence of a previously known rheumatic disease may explain the complaints. On examination, he can evaluate the appearance of the elbow, its sensitivity to touch, the degree of movement, muscle strength and sensation. Pain on the outside of the elbow when pulling the hand strongly against resistance from the wrist is a special examination method that indicates lateral epicondylitis.

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X-rays may be taken to see if there is a problem with the bones. Emar (MR) film shows soft tissue problems and edema.

Elbow pain and loss of strength in the arm can also occur in neck hernia. If in doubt, a neck imaging film (cervical vertebra MRI) can be taken. Numbness from the elbow to the little finger and ring finger of the hand may be due to damage to the arm nerve called the ulnar nerve. Whether this happens or not can be determined by EMG (nerve conduction study).

Lateral Epicondylitis Treatment

Most patients can recover with self-help methods at home. Rest may be helpful in the first place, as this problem is often caused by overuse from hobby, sport or professional activities. Avoiding heavy activities for a few weeks may be sufficient. Hot or cold applications, pain relievers, and exercises that stretch and strengthen the forearm muscles are other useful methods of treatment. It may be beneficial to use an elbow brace or epicondylitis tape during activity. If these methods are insufficient, physical therapy can be applied. TENS, ultrasound therapy, ESWT in physical therapyMethods such as low-energy laser can be preferred. Another method is to apply a cortisone injection (local injection) to the painful point on the elbow. PRP and prolotherapy injections are regenerative medicine methods whose use has increased recently . There is scientific evidence that PRP injections are effective in the treatment of lateral epicondylitis.

If all these methods do not improve in 6 to 12 months (less than 5% of the patients), surgery may be considered. The surgery is performed by an orthopedic and traumatology specialist. The problem muscle is removed and the healthy muscle is attached to the bone again. Physical therapy is recommended to return to normal life after surgery.

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