Medial & Lateral Epicondylitis

Causes / Diagnosis / Symptoms / Treatment

Our muscles are attached to the bones with strong fibrous structures called tendons. Stressful muscular activities can result in inflammation of those tendons leading to a condition called tendinitis.

If the tendons attaching the muscles of the forearm to the elbow’s outer side are inflamed, this is called Lateral Epicondylitis or Lateral Epicondylar Tendinitis. This is also commonly known as Tennis Elbow, as it commonly affects tennis and racquetball players.

A similar condition called Golfer’s Elbow can affect the elbow as well. This is when the tendons attaching the forearm muscles to the elbow’s inner side are inflamed. This is known as Medial Epicondylitis or Medial Epicondylar Tendinitis.

Causes and Risk Factors of Tennis and Golfers Elbow

We use the muscles of the forearm in almost all the hand and wrist movements. Repetitive stressful movements of the hand can put pressure on the tendons of those muscles. As a result, tiny tears can happen in the tendon attaching the muscles to the bony prominence at the outer side of the elbow which leads to Tennis Elbow.

When it comes to Golfer’s Elbow, some tiny tears happen in the tendons attaching the forearm muscles to the bony prominence on the inner side of the elbow. Those tears are due to the overuse of the forearm muscles without giving them the adequate time to rest.

Tennis and Golfer’s Elbow can affect males and females of any age group; however, they are more commonly seen among people older than 30 years.

Athletes are among the most affected people. Sports like tennis, racquetball, weightlifting, and squash involve stressful repetitive hand movements that can lead to Tennis or Golfer’s Elbow. Moreover, some occupations are considered to be among the risk factors for medial and lateral epicondylitis. Those occupations include painters, plumbers, carpenters, butchers, and cooks.

Symptoms of Tennis or Golfer’s Elbow

The symptoms of epicondylitis depend on which group of muscles is being overused. If you overuse the forearm muscles attached to the outer side of the elbow, you will consequently develop lateral epicondylitis.

Tennis Elbow will have the following symptoms:

- Pain on the elbow that increases with grasping objects and flexing your wrist joint to the outer side.
- The bone on the outer side of the elbow will be tender to the touch.
- As a result of the inflammation, you might experience swelling on the outer side of the elbow.
- Elbow stiffness can occur in the case of advanced untreated Tennis Elbow.

If you stress the forearm muscles attached to the inner side of the elbow, you will be susceptible to developing Golfer’s Elbow or Medial Epicondylitis which presents with the following symptoms:

- Pain on the inner side of the elbow that is tender to the touch. This pain can increase when you flex your wrist joint or shake hands.
- Inflammation or swelling on the elbow’s inner side.
- Numbness or tingling sensation in one or more of your fingers.

Diagnosis of Tennis & Golfer’s Elbow

If you have one or more of the symptoms of Medial or Lateral Epicondylitis, your doctor will do a physical examination to confirm the presence of tendonitis in your elbow. They might order an X-ray of your elbow to exclude fractures. Other imaging techniques might be considered if your doctor suspects that you might have something else apart from epicondylitis.

Treatment of Epicondylitis

The treatment of medial and lateral epicondylitis is usually conservative. Most of the cases improve without surgical intervention. The treatment can involve the following:

- Applying ice packs to your elbow can be useful as ice will reduce the pain and inflammation in your tendons.
- Physical therapy exercises for your elbow can help ease your pain and treat stiffness or mobility issues.
- The use of over-the-counter non-steroidal anti-inflammatory medications can be used in the treatment of inflammation. However, you should not use them for long periods without consulting your doctor.
- An arm band can be used to protect the tendons from continuous overuse and pulling from the muscles.

If the above methods of treatment have not shown enough improvement, your doctor might consider more advanced treatments. This includes:

- Injection of steroids into the inflamed tendons to reduce inflammation and swelling. This can be only used for short-term as it is proven that it does not help in long-term conditions.
- Piercing the damaged tendon in many places in a procedure called dry needling.
- Tenex procedure in which a small needle can be inserted into the damaged tissue under ultrasound guidance. Then, ultrasound waves vibrate the needle to liquefy the damaged tissue.
- If none of the mentioned techniques are successful in treating epicondylitis in six to twelve months, surgery can be considered. In surgery, the damaged tissue will be removed. Rehabilitation and physiotherapy will be needed following the surgery.