Epicondylitis is a common pathology characterized by pain on the outside of the elbow. Due to damage to the tendons attached to the epycondyle, just above the joint, this condition is also known as “tennis elbow”.

In reality, professional activity is much more often involved than sports! Resting, associated with pain relief, is the only treatment … Epicondylitis heals on its own, but you have to be patient, because the course can be long …

Definition

Epicondylitis is a tendon pathology (tendinopathy) of the outside of the elbow, also known as “tennis elbow”. It is characterized by pain localized at the level of the insertion of the tendons on the epicondyle, a bony relief of the bone of the arm (humerus) located just above the elbow joint.

This condition is classified as a musculoskeletal disorder (MSD) of the upper limb. Although it is often considered as tendonitis, that is to say as an inflammation of the tendons, current knowledge rather speaks in favor of tendon wear (degenerative pathology).

Affected tendons attach muscles in the forearm to the epicondyle that are used to extend the fingers, stretch the wrist, and rotate the forearm, called the epicondylar muscles.

Causes

The suffering of epicondylars can have different causes such as micro-tears of the tendons or a partial rupture at the level of their insertion on the bone. It generally occurs following repetitive movements or over-straining the muscles (carrying heavy objects, etc.), but the excess tension exerted on their attachment to the bone is not the only cause. The specialists evoke other entangled processes, in particular a defect of vascularization of the tendons and a phenomenon of physiological degeneration.

Diagnostic

The history of manual and sports activities as well as the context of the onset of symptoms generally make it possible to orient the diagnosis.

On clinical examination, the doctor checks whether the epicondyle region is inflammatory or not (no redness or swelling) and whether it is tender on palpation. The diagnosis is made if certain gestures performed against resistance (flexion-extension of the wrist and fingers or rotation of the arm) trigger the pain.

Rarely, imaging tests may be helpful, especially if sudden onset of symptoms suggests a tendon rupture or if chronic pain persists despite medical attention.

• Ultrasound of the elbow shows thickening of the tendons in the early stages, and may show micro-cracks or calcifications inside the tendons, indicating chronic suffering;
• Magnetic resonance imaging (MRI) offers the same type of information;
• Rarely, the differential diagnosis may involve other examinations: electromyogram (EMG), cervical spine radiography, etc.

The people concerned

Epicondylitis accounts for 80% of musculoskeletal disorders of the elbow. It is a common pathology, which mainly affects subjects aged 35-40 to 60 years.

It is above all an occupational disease, which affects every year in France from 1 to 3% of employees, mainly manual workers, but also cashiers or people working on computers. Leisure is only involved in about 1 in 10 cases.

The cases recorded by doctors have been steadily increasing over the past twenty years in industrialized countries, particularly in France.

Tennis elbow is mainly the tendonitis of bad technical gesture and especially the reverse. At first, it hurts when you play; especially when practicing a backhand, then little by little holding your racket becomes a nightmare, then in everyday life, shaking a hand, uncorking a bottle, opening a door, becomes intolerable.

Risk factors

At work, manual tasks (tightening, screwing, striking with the hand) and more generally any type of task which requires frequent rotations of the forearm with repeated flexions of the wrist, or even striking movements of the hand, promote the occurrence of epicondylitis.

Certain sports practices are more at risk than others: tennis and racket sports of course, but also golf, rowing, baseball … Very often, bad technical gestures – for example a badly executed backhand in tennis – can be incriminated. Thus, amateur tennis players are much more affected than professional players.

The risk is increased by the repetition of harmful gestures, especially if they are performed in a fixed position or in a bad position, by the absence of rest or recovery, by hard work and cold or by vibrations. Psychosocial risks linked to poor working conditions would also be aggravating factors.

Excessive tobacco consumption, certain diseases such as diabetes or even poor irrigation can contribute to the weakening of the tendons. 

Epicondylitis manifests itself by sometimes severe pain in the elbow, the onset of which can be sudden or on the contrary very progressive: the epicondyle becomes more and more sensitive to the touch, then the pain spreads to the external face of the elbow and radiates to the forearm.

Joint mobility is not limited, but the pain is reactivated by the repetition of the gesture that caused it, or by other daily activities that involve the injured tendon: carrying a load, shaking a hand, opening a door, pour water …

While some epicondylitis heal in a few weeks, for others the healing time is months or even years – this is called chronic epicondylitis.

The treatments available can relieve pain but not speed up healing of tendon injuries. We must therefore be patient …

Put to rest

Stopping the activities that cause pain is the most effective treatment for epicondylitis. This putting to rest may involve stopping work or sports practice, or even adapting the workstation. On a daily basis, it is also a question of avoiding any harmful movement.

If the elbow is put to rest as soon as symptoms appear, epicondylitis can heal spontaneously within a few weeks.

Physiotherapy

Different methods can help relieve pain: application of ice packs, physiotherapy sessions, wearing a suitable splint, etc.

Medical treatments

Analgesics such as paracetamol, but also non-steroidal anti-inflammatory drugs or NSAIDs (ibuprofen, etc.) can be used to calm the pain, provided the dosage is respected.

Corticosteroid injections seem to have some effectiveness. However, repeated infiltrations should be avoided because they are likely to weaken the tendon.

The infiltration of platelet-rich plasma, or PRP, is another type of treatment that has recently appeared and is still poorly evaluated. The principle is to inject blood plasma into the elbow from a blood sample taken from the patient himself, enriched in blood platelets after centrifugation. The growth factors provided by the platelets promote healing of tendon lesions.

surgery

The use of surgery is very rare, and mainly concerns people suffering from chronic epicondylitis resistant to medical treatment. Different procedures can be performed to lengthen the tendon or modify its insertion in the epicondyle.

Alternative therapies

Different natural therapies are offered in the treatment of tendinopathies, for example herbal medicine or homeopathy. They can be tried, but have not been shown to be effective. 

The prevention of epicondylitis is based on the adoption of protective gestures at work as well as on a daily basis: warm up before any hard work, drink water, avoid straining elbow, prefer fluid movements to jerky movements, place palm up to carry objects, plan recovery time …

When repetitive tasks are unavoidable, we can try to alternate with other types of work.

To avoid recurrence, steps can be taken by the occupational physician with the employer to adapt the organization and layout of the workstation.