Lateral Epicondylitis

(AKA Tennis Elbow)

Jade Clawson
 Define Lateral Epicondylitis
Learning Review anatomy of involved structures
Objectives
Statistics about Lateral Epicondylitis
Causes & Symptoms
Special Tests
Surgery
Post-Op Phases of Recovery
Non-Surgical Phases of Recovery & Exercises
  Lateral Epicondylitis is a type of
tendinopathy that is usually defined as
inflammation and pain at and around
the lateral epicondyle.
 Not an instant inflammatory
response.
Lateral  Usually a degenerative process
caused by overuse of the wrist
Epicondylitis extensors.

Definition  First described in 1873 as ‘lawn tennis

arm.’

 Most common overuse syndrome in

the elbow.
Anatomy
• The area of maximal pain is usually just
distal to the origin of the extensor muscles
of the forearm. This is just below the lateral
epicondyle.

Extensor carpi radialis brevis (ECRB)

-greatest contributor
Extensor digitorum
Extensor carpi radialis longus (ECRL)
Extensor carpi ulnaris
  Occurs in 1% of men and 4% in women.
 Four times more common in women
 Approximately 10% of women will experience tennis
Lateral elbow between the ages of 35 and 50.
Epicondylitis
Statistics
 Causes & Symptoms
 Intrinsic causes: muscle contraction – excessive force placed on one
of the wrist extensor muscles.
 Extrinsic causes: traumatic overstretching or direct trauma.
 Other contributing factors include:
 -Weak wrist extensor muscles
 -Overuse – playing or working with excessive/repetitive forceful
gripping that usually results in microscopic tears and pain
 -Using tools that are too heavy or unbalanced
 -Improper form - excessive wrist action

 People with Tennis Elbow usually have pain with ADLs that involve
gripping, lifting, & carrying
 Symptoms may also include achiness & stiffness
Causes & Symptoms Continued

 Tennis elbow is not just common in tennis players, but also

in sports like:
 Squash
 Badminton
 Baseball / Softball
 Swimming
 Field throwing events

 Jobs:
 Electricians Painters
 Carpenters Plumbers
 Gardeners Computer use
Lateral Epicondylitis Special Tests
Mill’s Test
- Palpate the lateral epicondyle
- Passively pronate the patient’s
forearm
- Fully flex the patient’s wrist
- Fully extend the patient’s elbow
- (+) Reproduction of pain
Maudsley’s Test
- Palpate the lateral epicondyle
- Passively pronate the patient’s
forearm
- Resist extension of the 3rd digit
- (+) Reproduction of pain
Cozen’s Test
- Palpate the lateral epicondyle
- Instruct the patient to make a
fist
- Instruct the patient to actively
pronate the forearm
- Instruct the patient to actively
radially deviate the wrist
- Resist wrist extension
- (+) Reproduction of pain
Surgery
 90-95% of patients with lateral epicondylitis
not require surgery.
 Surgery is a last resort if other nonoperative
treatment fails to produce adequate pain
relief after 6-12 months.
 Goal: remove damaged muscle and tendon
tissue from the lateral epicondyle, then
reattach it to healthy surrounding tissue.
 Success rate for full symptom relief is 80-
90%.
 Two types

Open surgery: Incision about 3-4

cm long is made over the elbow.
The damaged portion of the
tendon is removed and the
remaining healthy tendon is
Surgery sutured back together.

Arthroscopic surgery: Small

instruments are inserted through
small incisions. Using video
guidance, the damaged portion of
the tendon is removed and the
remaining healthy tendon is
sutured back together.
 Post-Op Phases of Healing & Recovery
Phase 1
Days 1-7
-Sling
-PRICE
-Gentle hand, wrist, & elbow
ROM
-Shoulder AROM
-Minimize lifting, & combined
movements (elbow extension
& wrist flexion)
-Consider pre-fab custom
splint to minimize wrist
extension
-Patient education for
work/activity modification
Phase 2
Weeks 2-4
-Discontinue sling
-Begin PROM
-Gentle strengthening & sub
maximal isometrics
-Continue ice 3x/day
-Scar management as
needed
-Continue patient education
for work/activity modification
Phase 3 Phase 4
Weeks 5-7 Weeks 8-12
-Advanced strengthening as -Continue counterforce
tolerated with focus on bracing if needed for patient
endurance training of wrist to complete ADLs
extensors -Begin task-specific
-Include weights or functional training
TheraBand -Return to higher-level &
-Restoring full AROM/PROM recreational activities
-Ice after activity
-Modified activities in
preparation for beginning
functional training
-Gentle massage /scraping
along and against fiber
orientation
-Counterforce bracing to
common extensor tendon
 Phase 1 Phase 2 Phase 3
-Increase flexibility -Improve flexibility -Improve muscular
-Decrease inflammation -Increase muscular strength and endurance
with ice and NSAIDs strength and endurance of wrist extensors
-Promote tissue healing of wrist extensors -Improve muscular
by avoiding painful -Increase muscular strength and endurance
movements strength and endurance of shoulder musculature
Non-surgical -All interventions should of shoulder musculature -Gradually return to
be pain free -Increase functional high-level sport and
Phases of Recovery activities and return to work activities
function by using braces -Diminish use of brace
or tape -Ice as needed
-Continuing exercises
that aid in pain relief
-Mild injury may need 6-8 weeks to heal.
-Severe injury may need 6-12 months to heal & in some cases, pain may last for 2
years or longer.
  ELBOW
 Resisted wrist extension
 Resisted wrist flexion
Beginning  Resisted forearm supination and pronation
Exercises  Wrist flexor stretch
 Wrist extensor stretch

 SHOULDER
 Prone Ys and Ts
This Photo by Unknown Author is licensed under CC BY-SA-NC
 1. https://www.physio-pedia.com/Lateral_Epicondylitis

2. https://emedicine.medscape.com/article/1231903-treatment

3. https://www.sports-health.com/sports-injuries/elbow-injuries/surgery-tennis-elbow

4. https://www.physio-pedia.com/Lateral_Epicondylitis#cite_note-:11-5

5. https://www.physio-pedia.com/Mill%E2%80%99s_Test

6. https://www.uofmhealth.org/health-library/hw225372

7. https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/

8. https://www.physio-pedia.com/Mill%E2%80%99s_Test

References 9.

10.
https://www.physio-pedia.com/Cozen%E2%80%99s_Test

https://www.physio-pedia.com/Maudsley%27s_test

11. Bagade, Vijaya K., and Chhaya Verma. “Effect of Mulligan Mobilization with Movement (MWM) in the Treatment of
Chronic Lateral Epicondylitis: 24 Weeks Follow-up Study.” Indian Journal of Physiotherapy & Occupational
Therapy , vol. 9, no. 4, 2015, doi:10.5958/0973-5674.2015.00172.0.

12. Dasm, Pooja Ghosh. “Comparative Analysis of Cyriax Approach Versus Mobilization with Movement Approach in
the Treatment of Patients with Lateral Epicondylitis.”Indian Journal of Physiotherapy and Occupational Therapy,
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13. Dutton, Mark. Orthopaedics for the Physical Therapist Assistant. Jones & Bartlett Learning, 2019 pages 529-531

14. “Post-Op Protocol for Lateral Epicondyle Debridement.” Brigham and Women's Hospital , 2010, pp. 1–3.

15. “Tennis Elbow (Lateral Epicondylitis).” Sports Medicine Massachusetts General Hospital Orthopaedics.