Elbow

The elbow is prone to painful maladaptive degeneration of the tendon attachments. These are typically of insidious onset but precipitating factors may be identified from a careful history. Lateral epicondylitis Medial epicondylitis Distal biceps tendinopathy Baseball pitcher’s elbow Lateral Epicondylitis Also known as tennis elbow This is the most common tendinopathy Pain originates from the origin of ECRB (extensor carpi radialis brevis) at the lateral epicondyle Most cases occur in those with a history of racquet use Sudden traumatic onset of pain -> tendon rupture -> often requires repair Usually occurs in active person aged 40-55 years Clinical features Lateral elbow pain Often after a period of unaccustomed activity Radiation down the forearm Elbow stiffness in the morning Pain is aggravated by lifting objects ROM - full Tenderness Palpation over the front of the lateral epicondyle Maudsley’s test -> resisted middle finger extension Mill’s sign -> elbow extension in pronation with a flexed wrist Diagnosis Imaging is not required except At the extremes of age History of trauma History of mechanical symptoms e.g. locking USG / MRI In patients with long-standing symptoms, not responding to treatment To exclude radial tunnel syndrome, radiocapitellar plica or PLRI (postero-lateral rotator instability) Treatment It spontaneously resolves within 12 months in 90% cases. ...