Epicondylitis

Tennis Elbow (Lateral Epicondylitis)

Pathophysiology

• An enthesopathy caused by inflammation of the tendons of the extensor muscles of the forearm (esp. extensor carpi radialis brevis) at their point of attachment to the lateral epicondyle of the humerus
• Caused by activities which involve repetitive use of the extensor muscles of the forearm, and grip-intensive activities - such as playing tennis or painting. 

Clinical features

• Localised pain and tenderness over the lateral epicondyle of the humerus, and pain radiating into the forearm
• Pain is worse on wrist extension or supination of the forearm
• Examination:
  • Localised tenderness on palpation of the LE
  • Pain is increased with attempted wrist extension against resistance 

Management

• Analgesia - 1st line: paracetamol or topical NSAID. 2nd line: PO NSAID. 
• Refer to physiotherapy 

Golfer’s Elbow (Medial Epicondylitis)

Pathophysiology

• An enthesopathy caused by inflammation of the tendons of the flexor muscles of the anterior forearm at their point of attachment to the medial epicondyle 
• Caused by activities which involve repetitive use of the flexor muscles of the forearm, such as golf or baseball. 

Clinical features

• Localised pain and tenderness over the medial epicondyle of the humerus. Pain may radiate down into the forearm to the wrist. 
• Gripping can cause pain
• Examination:
  • Localised tenderness on palpation of the ME
  • Pain is increased with attempted wrist flexion against resistance 

  

Olecranon Bursitis

Pathophysiology

• The olecranon bursa overlies the olecranon process to reduce friction and facilitate movement at the elbow joint. 
• Irritation of the bursa results in bursitis, where increased fluid production and capillary permeability result in swelling of the bursa. 
• Causes:
  • Non-infective - trauma, or repetitive use - for example student’s elbow - leaning on desk
  • Infective - staphylococcus aureus (90%)

Clinical features

• Fluctuant swelling overlying the olecranon which accumulates usually over days
• The bursa may be redness, warm or painful to touch (can be painless)
• The elbow joint itself is unaffected, and ROM is usually non-painful 
• Features such as fever, spreading cellulitis or increasing pain may suggest an infective bursitis

Management

• Non-infective  - RICE, analgesia, consider symptomatic aspiration or steroid injection
• Infective 
  • Aspirate bursal fluid and send for MCS
  • Antibiotics (flucloxacillin 1st line) whilst a/w MCS