Lateral Epicondylitis (tennis Elbow)

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Lateral epicondylitis ("tennis elbow") is a painful overuse tendinopathy of the extensor carpi radialis brevis (ECRB) at its origin on the lateral epicondyle. Despite the name, only 5% of cases occur in tennis players — it is most common in people aged 35–55 who perform repetitive gripping and forearm rotation activities: carpenters, painters, plumbers, and computer workers. The underlying pathology is tendinosis — degenerated, disorganized collagen — not acute inflammation.

Lateral elbow pain at the lateral epicondyle, worsened by resisted wrist extension and gripping (especially with the elbow extended). The Cozen test (resisted wrist extension) and Mill's test reproduce the pain. X-rays are usually normal. Ultrasound and MRI show intratendinous hypoechoic areas and thickening confirming tendinosis.

1. NSAIDs / topical diclofenac

   Short-term anti-inflammatory management.

2. Corticosteroid injection

   Provides rapid short-term pain relief but does not change long-term outcomes and may actually inhibit tendon healing — used sparingly.

3. PRP injection

   Platelet-rich plasma injection into the degenerated tendon — strong evidence supporting PRP over cortisone for long-term outcomes in lateral epicondylitis.

4. Extracorporeal shock wave therapy (ESWT)

   Non-invasive acoustic wave treatment for chronic cases.

Surgery is considered for the small minority (< 5%) with persistent, disabling symptoms after 6–12 months of comprehensive non-operative care including PRP and ESWT.

External patient-education references and related OSI pages for additional background:

• Britannica — Tendinitis
• Britannica — Joint (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language