Lateral epicondylopathy

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Also known as tennis elbow, lateral epicondylalgia, lateral epicondylitis
Commonly associated with microtrauma injury of the tendons attaching to the lateral epicondyle (although the exact etiology is not been well defined yet)
The extensor carpi radialis brevis is the most commonly affected muscle, although the pronator and other extensor carpial muscles are also commonly affected¹
The condition was originally thought to be an inflammatory process, hence the name lateral epicondylitis, especially in its initial phase. Repetetive microtrauma resulting from over-exertion can cause collagen fibril rupture and activation of the immune system. Studies have shown, in the later years, that there is absence of inflammatory cells in biopsies of chronic lateral epicondylopathy²,³
Findings show that there are angiofibroblastic hyperplasia changes as a result of the injury, meaning a degenerative process characterized by an abundance of fibroblasts, vascular hyperplasia, and unstructured collagen
Scar tissue is formed as a result of repetitive stretching which causes multiple microtears of the tendon and potentially causes an denaturing of matrix protein and proliferation of fibrous tissue – this leads to a vicious cycle where the limited tissue is further vulnerable to new repetitive forces with leads to subsequent additional tearing⁴

Affects 1-3% of the population⁵
7 patients per 1000 per year⁶
About 15% of workers in highly repetitive hand task industries⁷
Mainly affects those in middle age, generally speaking about 45-54 years of age⁸

Usually results from overuse after repetitive eccentric loading of the muscles responsible for wrist extension and gripping items which leads to microtrauma and subsequent degeneration of these tendons.
Sports with special focus on grip such as tennis, rowing or strength training, including tennis
- It is seen in tennis players that those playing two-handed backhand suffer more rarely than those playing with the one-handed techniques⁹
- Manual labors
- Heavy lifting
- Playing musical instruments for prolonged periods of time

Tendon of extensor carpi radialis longus, anterior aspect of the supracondylar ridge
Tenoperiost of extensor carpi radialis brevis, anterior aspect of lateral epicondyle
Tendon body of the extensor carpi radialis brevis, just over the head of the radius
Muscle bellies of both extensor carpi radialis longus and brevis

There are 4 stages of lateral epicondylopathy
- Peritendious inflammation
- A hardening, thickening and scarring of the tendon forms (tendinosis) and angiofibroblastic degeneration
- Pathological changes and complete structural failure occurs
- Calcification, further hardening, thickening and scarring of the tendon occurs
During the course of suffering from the condition the patient will often be increasingly wary in use of the arm which leads to a form of underuse and stress shielding of the affected tendons, which again leads to further structural weakening of the tendon, making it prone to even further injury¹⁰
This underuse of the tendon leads to necrosis of the tendon fibres¹¹

Pain around the lateral epicondyle of the elbow which radiates down the forearm sometimes as far as to the dorsal aspect of the hand, and also ring or long fingers
- Pain may also go towards the upper arm
Activities such as wrist extension, grasping objects or forceful grip may aggravate the pain¹²
Weakness of grip, dropping items due to painful twinges

Resisted wrist extension with elbow in extension– painful
Resisted radial deviation – painful
Resisted supination – may be painful
Palpation – tenderness of the lateral epicondyle of one of the 4 localizations mentioned under localization segment

Several authors have pointed towards a broader functional understanding is needed to understand lateral epicondylopathy. Meaning to incorporate and check the functional chain ranging from the cervical spine, shoulder and elbow
- In this consideration understanding how the c7 nerve innervation may functionally affect local reflex inhibition is also important as well as functional limitations of the neck which may be compensated through the myofascial lines