ABSTRACT
Lateral epicondylitis, also called ‘tennis elbow’, is one of the most common causes of elbow pain in the general population and the athlete.1 The incidence of lateral epicondylitis has been reported to be four to seven times greater than medial epicondylitis.2 Many theories have been proposed as to the aetiology of lateral epicondylitis. These include inflammatory processes involving the radiohumeral bursa, annular ligament and periosteum.3 Other proposed theories have included decreased vascularity of the lateral epicondylar region and fluoroquinolone antibiotics.2 The most accepted theory focuses on the idea that repetitive wrist extension leads to cumulative microtears in the tendinous origin of the ECRB with the proliferation of fibrotic hypervascular healing (angiofibroblastic hyperplasia).3,4
Patients present with a complaint of pain in the lateral elbow that radiates down the forearm. In many cases that pain has a gradual and insidious onset, and may be associated with decreased grip strength.2 On examination, patients have point tenderness 1-2 cm distal to the lateral epicondyle. Pain is made worse with passive wrist flexion
and active wrist extension.1 Additional provocative manoeuvres include resisted long finger extension and resisted forearm supination. The ‘chair test’ is performed by asking the patient to lift a chair with the shoulder adducted, the wrist pronated and the elbow extended. The reproduction of symptoms in considered a positive test. Grip strength can be assessed with a dynamometer, and is often weaker on the affected side.4 Plain films are usually negative, although in some cases calcifications may be present at the lateral epicondyle.1 CT may be useful for better delineating the presence of calcifications or lateral epicondylar spurs, and MRI has limited indications for lateral epicondylitis.2
