Lateral Epicondylalgia

Lateral epicondylalgia (tennis elbow, or lateral elbow tendinopathy) is a tendinopathy of the common extensor origin at the lateral epicondyle, most often involving extensor carpi radialis brevis (ECRB).

It affects about 1 to 3% of the population, mostly aged 35 to 54, and men and women equally. Despite the name, only a minority of cases relate to racquet sports; most follow repetitive gripping, wrist extension and forearm rotation at work.

It is usually self-limiting. In a meta-analysis of untreated trial arms, 89% of patients reported global improvement within the first year.

The common extensor origin carries ECRB, extensor digitorum, extensor carpi ulnaris and extensor digiti minimi. ECRB is most often affected because it lies deepest, against the capitellum, and takes compressive and shear load during gripping and wrist extension.

The pathology is tendinopathy rather than tendinitis: disorganised collagen, neovascularisation and increased ground substance, with a failed healing response and a neurogenic pain component. Anti-inflammatory treatment does not address it.

The Cook and Purdam continuum guides loading:

• •Reactive: acute overload; responds to load reduction
• •Dysrepair: failed healing; responds to progressive loading
• •Degenerative: established structural change; may not fully reverse

Risk factors include repetitive gripping and wrist extension, smoking, obesity, diabetes and tendinopathy elsewhere.