Lateral (Tennis) + Medial (Golfers) Epicondylitis

The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.

Anatomy of the elbow

The elbow acts as a hinge joint allowing movements of flexion and extension. The joint is surrounded by soft tissues including the capsule, ligaments, tendons and muscles. The origin of extensors tendons of the wrist arises from the lateral epicondyle and the flexor tendons arise from the medial epicondyle. Both extensors and flexors expand to become muscle before forming tendons and acting on the wrist causing flexion and extension.

What is Tennis Elbow and Golfer’s Elbow?

  1. Tennis Elbow – This is also referred to as lateral epicondylitis. It leads to irritation/inflammation (and in some cases tearing) of the common extensor tendon insertion on the lateral epicondyle. It most commonly effects the extensor carpi radialis brevis tendon.

  2. Golfer’s Elbow – This is also referred to as medial epicondylitis. It leads to irritation/inflammation (and in some cases tearing) of the common flexor tendon insertion on the medial epicondyle.

What is the common cause?

Repetitive overuse of the forearm muscles can cause microtrauma to the insertion of the extensors and flexor tendons at the level of the elbow.

Activities that require repetitive extension of the wrist such as tennis players, cricketers (batsmen), laborers using heavy tools and work requiring prolonged grip strength can all lead to lateral epicondylitis. While, activities that utilise repetitive wrist flexion and pronation such as golf, throwing, cricket (bowlers) and weight lifters can lead to medial epicondylitis.

What are the preferred Investigations/Imaging?

  1. X-ray Elbow – This should be the first imaging modality used as it helps determine if there are any other conditions such as a subtle fracture, bony spur or arthritis that may be a cause of the pain.

  2. Ultrasound – This is not as sensitive as an MRI of the elbow, but in patients where an MRI may be contraindicated it serves as a reasonable imaging choice to help in the diagnosis of tendon tears.

  3. MRI Elbow– This is the best form of imaging to identify an injury to the common origin of the extensor or flexor tendons.  

What are the treatment options?

  1. Non-operative – This primarily involves a physiotherapy programme centred around offloading the diseased tendon and building tissue strength. Other non-operative measures such as the use of corticosteroid injections, appropriate analgesia and modification of the patient’s activities will also need to be considered.

  2. Open Surgical Debridement of Tendon – If non-operative measures have failed then surgery in the form of an open debridement of the diseased tendon with reattachment to its anatomical footprint would be recommended.

What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after elbow surgery please see our Rehabilitation Protocols here.