Lateral Epicondylitis (Tennis Elbow)

Overview

Overuse injury caused by repetitive stress to the common extensor tendon at its origin - the lateral epicondyle of the humerus
Most often occurs in individuals who engage in repeated wrist extension or gripping tasks
Primary complaint is lateral elbow pain
Involves tendinosis (degeneration) of the tendon

Anatomy

Condition occurs at the common extensor tendon at the lateral epicondyle of the humerus
Specifically at the origin of the extensor carpi radialis brevis
The tendon becomes irritated from overuse and degenerates
- Microscopic tears, fibroblasts, and disorganized collagen are present, making the tendon weak, thickened, and painful

Image adapted from Lateral epicondylitis (tennis elbow) Orthobullets. Retrieved from https://www.orthobullets.com/shoulder-and-elbow/3082/lateral-epicondylitis-tennis-elbow

Causes

Eccentric overload of the extensor carpi radialis brevis tendon
Repetitive strain from activities involving wrist extension and/or gripping
- Such as using tools, playing racquet sports, or heavy lifting
Can be from poor technique or a sudden increase in activity that the body is not used to

Symptoms

Pain over the lateral elbow, especially 1–2 cm distal to the lateral epicondyle
Pain is worse with gripping, lifting, wrist extension
Tenderness to palpation
Pain reproduced with:
- Resisted wrist extension
- Resisted middle finger extension
- Forearm supination

Prognosis/Timeline

Most cases improve with conservative treatment in 3-18 months
80–90% of cases resolve with conservative treatment within 1–2 years
Surgery is very rare but has good outcomes when needed
Patients should stick to therapy regimens to prevent recurrence

Treatment Ideas

Always ask your fieldwork educator or supervising therapist and review any followed protocols before implementing any of the following

Gentle strengthening with emphasis on eccentric contraction and radial nerve glides

Wrist flexion and extension stretches

Theraputty donuts

Quiz Questions

1. What is the most common cause of lateral epicondylitis?

A. Overuse of the common extensor tendon at the lateral epicondyle

B. Compression of the radial nerve at the lateral elbow

C. Tearing of the triceps tendon

D. Overuse of the common flexor tendon at the lateral epicondyle

2. Which tendon is primarily affected in lateral epicondylitis?

A. Flexor carpi radialis

B. Extensor carpi radialis brevis

C. Extensor carpi ulnaris

D. Supinator

3. Lateral epicondylitis involves which of the following processes?

A. Acute inflammation of the tendon

B. Tendon avulsion

C. Tendinosis with degeneration of the tendon

D. Bone spur formation

4. Where is pain typically located in lateral epicondylitis?

A. Medial elbow and wrist

B. Lateral elbow, 1–2 cm distal to the lateral epicondyle

C. Posterior forearm

D. Lateral elbow, 2-5 cm proximal to the lateral epicondyle

5. What tissue changes are commonly present in lateral epicondylitis?

A. Microscopic tendon tears and disorganized collagen

B. Ligament rupture and synovial swelling

C. Cartilage erosion and nerve compression

D. Joint dislocation and muscle wasting

6. What are common contributing activities to the development of lateral epicondylitis?

A. Writing and typing

B. Rock climbing and cycling

C. Racquet sports and tool use involving wrist extension

D. Push-ups and tool use involving wrist flexion

Quiz Answers

References

Buchanan, B. K., & Varacallo, M. A. (2025). Lateral epicondylitis (Tennis elbow). In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK431092/

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