Medial and Lateral Epicondylitis
Medial Lateral Epicondylitits
Lateral
* Definition: Inflammation of the lateral side of the elbow * Why: Degeneration of tendon of the extensor carpi radialis brevis, that occurs where tendon attaches to lateral epicondyle * How: usually seen in patients who perform manual labor or sports which require twisting and extension of the wrist against resistance * Predisposing factors- forceful work, extreme posture, and repetitive movements, also they found that being a woman with low social support added to the likelihood of tennis elbow * Common signs and symptoms: pain on the outside of the elbow that sometimes radiates down into the wrist, swelling, and limitation of motion * How to test: start with gentle stretching (stretch out arm put wrist down, pull on wrist) put thumb on extensor tendons (just distal to the lateral epicondyle, put your other hand around wrist and have the patient extend the wrist and you resist the movement while pressing in with your thumb directly on the extensor tendons and see if it causes pain * Treatment: rest, modify physical activities, avoid heavy lifting, a brace, physical therapy these all fail surgical treatment (arthroscopic removal of damaged extensor carpi radialis brevis).
Medial (much less common) (sometimes called medial epicondylalgia because there is not always evidence of inflammation) * Definition: inflammation, soreness or pain of the medial side of the elbow * Why: degeneration of flexor- pronator tendons * How: repetitive stress(that causes interstitial tearing, and inflammation), overuse of flexors or overload activities * Predisposing factors: most common among people who are involved in repetitive wrist movements (such a typing) in their occupations * Common signs and symptoms: pain at medial epicondyle, pain with forced flexion of wrist and with any torqueing mechanisms with a high load of weight * How to test: resisted wrist flexion, patient elbow flexed
Lateral
* Definition: Inflammation of the lateral side of the elbow * Why: Degeneration of tendon of the extensor carpi radialis brevis, that occurs where tendon attaches to lateral epicondyle * How: usually seen in patients who perform manual labor or sports which require twisting and extension of the wrist against resistance * Predisposing factors- forceful work, extreme posture, and repetitive movements, also they found that being a woman with low social support added to the likelihood of tennis elbow * Common signs and symptoms: pain on the outside of the elbow that sometimes radiates down into the wrist, swelling, and limitation of motion * How to test: start with gentle stretching (stretch out arm put wrist down, pull on wrist) put thumb on extensor tendons (just distal to the lateral epicondyle, put your other hand around wrist and have the patient extend the wrist and you resist the movement while pressing in with your thumb directly on the extensor tendons and see if it causes pain * Treatment: rest, modify physical activities, avoid heavy lifting, a brace, physical therapy these all fail surgical treatment (arthroscopic removal of damaged extensor carpi radialis brevis).
Medial (much less common) (sometimes called medial epicondylalgia because there is not always evidence of inflammation) * Definition: inflammation, soreness or pain of the medial side of the elbow * Why: degeneration of flexor- pronator tendons * How: repetitive stress(that causes interstitial tearing, and inflammation), overuse of flexors or overload activities * Predisposing factors: most common among people who are involved in repetitive wrist movements (such a typing) in their occupations * Common signs and symptoms: pain at medial epicondyle, pain with forced flexion of wrist and with any torqueing mechanisms with a high load of weight * How to test: resisted wrist flexion, patient elbow flexed
References: Rogers R. Golfer 's elbow. Pulse [serial online]. October 27, 2010;70(32):22. Available from: Academic Search Complete, Ipswich, MA. Accessed April 20, 2013.