What is lateral epicondylitis of the elbow?

What is lateral epicondylitis of the elbow?

Your elbow joint consists of three bones: the humerus and two forearm bones (the radius and the ulna). At the lower part of the humerus, there are bony protrusions called epicondyles, where several forearm muscles begin their movement. The protrusion on the outer side of the elbow is called the lateral epicondyle.

A tendon attaches to this epicondyle of the humerus bone, which continues as a muscle on the outer surface of the elbow, and its main task is to lift the hand.

Lateral epicondylitis of the elbow, commonly known as tennis elbow, is an inflammation or, in some cases, microtears in the tendons connecting to the muscles of the forearm on the outer side of the elbow. Inflammation can be acute or chronic, lateral or medial.


Forearm muscles and tendons are damaged from excessive use – repeating the same movements over and over for 2 hours or lifting loads of more than 20 kg at least 10 times a day. Direct impacts to the elbow or sudden jerks can also be contributory. All of this can lead to inflammation and microtears in the tendons and, consequently, to epicondylitis.


“Tennis elbow” is one of the most common hand conditions. The frequency ranges from 3 to 11 patients per 1000 per year. The prevalence varies from 1% to 3% among the general population and can reach 23% among workers and athletes. People in certain professions are particularly prone to developing epicondylitis: painters, plumbers, carpenters, butchers, and cooks. The peak prevalence of “tennis elbow” is estimated at 1.3% in individuals aged 45 to 54 years.


Symptoms of lateral epicondylitis of the elbow develop gradually. In most cases, pain starts mildly and slowly intensifies over weeks and months. The dominant hand is most commonly affected, but both hands can be involved. Usually, there is no specific trauma associated with the onset of symptoms.

Patients often complain of lateral pain in the elbow, which often radiates into the muscles of the proximal forearm extensor:

  • Pain or burning on the outer part of the elbow;
  • Weak grip strength;
  • Night pain;
  • Sharp pain during forearm activities: holding a racket, turning a wrench, or shaking hands.

With severe inflammation, the pain can be so intense that even holding a coffee cup can be challenging.

Treatment of Epicondylitis

When diagnosing your condition, your doctor will consider many factors: how your symptoms developed, your level of activity, the sports you engage in, your age, and whether you’ve had any elbow injuries.

For accuracy in diagnosis, your doctor may prescribe additional tests: ultrasound of the elbow joint, X-ray for clear imaging of dense structures, magnetic resonance imaging (MRI) to visualize soft tissues of the body, including muscles and tendons. If your doctor suspects that your symptoms may be related to a neck problem, an MRI of the neck may be ordered to determine if you have a herniated disc or arthritic changes. Both of these conditions can cause arm pain.

The most common methods used to treat tennis elbow are:

  1. Restriction of movement, rest, and immobilization. These are the first steps in reducing inflammation. You may need to stop/reduce sports activities, heavy work, and other activities that cause painful symptoms for several weeks.
  2. Cold compresses.
  3. Medications. You can take anti-inflammatory drugs: acetaminophen or ibuprofen to reduce pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) containing diclofenac, ketoprofen, or others may also be prescribed, which act symptomatically and do not promote tissue regeneration.
  4. Physical therapy. Special exercises help strengthen the forearm muscles. Massage, iontophoresis, and laser therapy are effective in improving muscle healing.
  5. Wearing braces and orthotics. Using a brace placed on the central back of the forearm promotes rapid recovery. Orthotics massage tissues during exercises, stimulate metabolism and blood circulation, and help reduce swelling.
  6. Steroid injections. Steroids (cortisone) are highly effective anti-inflammatory drugs. They are injected into the area around the lateral epicondyle to relieve symptoms.
  7. PRP Therapy. Blood is taken from the patient, then the material obtained is centrifuged to obtain plasma. Platelet-rich plasma (PRP) injections, enriched with platelets, are intended to improve the biological environment of the tissue. Platelets are known for their high concentration of growth factors, which can be injected into the affected area.
  8. ESWT (Extracorporeal Shock Wave Therapy). Sound waves of various frequencies create “microtraumas” that contribute to the body’s natural healing processes. Many doctors consider shock wave therapy experimental, but numerous studies confirm its effectiveness.

Approximately 80% to 95% of patients achieve success with conservative treatment. If symptoms do not disappear after 6-12 months of conservative treatment, surgical intervention may be required.