Lateral Epicondylitis


What is lateral epicondylitis?

Lateral epicondylitis occurs at the lateral part elbow joint where a tendon is attached with bone and causes pain. The reason of development of lateral epicondylitis is overuse of the forearm. The affected tendon, which is named as Extensor Carpi Radialis Brevis, is providing attachment of muscles and bones of the forearm. In lateral epicondylitis, the bony bump (epicondyle) becomes tender and pain arises.

lateral epicondylitis image

The condition is also termed as tennis elbow, but it is not only restricted in the tennis players, others who are doing any repeated gripping activity or excessive use of thumb and first two fingers can cause lateral epicondylitis. Both the genders (male and female) have an equal tendency to developing lateral epicondylitis. Usually after 40 years of age, the lateral epicondylitis develop.

Symptoms of lateral epicondylitis

The symptoms of the lateral epicondylitis are usually localized in elbow and extended up to forearm. The onset of symptoms is not sudden or immediately after an injury occurs. The usual symptoms associated with lateral epicondylitis are as follows:

Pain

The onset of pain is gradual. The initial pain intensity is mild, but over a week or a month the pain intensity becomes severe. Usually at the beginning, burning sensation is felt in the exterior part of the elbow and slowly it turns into pain sensation. The activities where the elbow and forearm are primarily used, such as shaking hand or any jerks at the elbow like lifting something worsen the pain.


Weak griping power

The strength of grip becomes weak and holding a bat or racquet or opening of the door is causing difficulty. Sometimes forceful griping causes uncontrollable shaking of the hand.

Causes

The following causes are considered for involving in lateral epicondylitis:

Over activity

The current study revealed that injury in specific forearm tendon causes lateral epicondylitis. The attached muscle with the ECRB tendon assisting the wrist joint to become stabilized during elbow is erect in posture.  But over activity of the forearm muscle causes slight tearing at the junction of the lateral epicondyle and ERCB tendon. This causes tenderness and pain.

During the bending and stretching of the forearm, friction of the attached muscles of the elbow with lateral epicondyle may also cause gradual injury of the ERCB tendon due daily wear and tear activities.

Occupational hazards

Not only sports persons are frequently affected with lateral epicondylitis, but painters, carpenters and plumbers are also using the forearm vigorously and continuously.  This often leads to lateral epicondylitis. Other professionals like chef, butchers and auto drivers are also have a higher risk than the rest of the population. Any activities where strain is generated in forearm like frequent weight lifting like coolies are also affected by tennis elbow.

Not only due to occupational hazards, recreational activities like sports activities (cricket, tennis, throwing practice) without proper training and kit repeatedly trying is also cause tennis elbow.

Age

Age is another one of the factors which contributes the additional risk for development of the lateral epicondylitis. Most of the cases the affected persons are in between the age of 30 or higher.

Accidental injury

Unknowing or sometimes not gives much attention for minor accidental injury in the forearm, which may affect ERCB or associated muscle can become gradually turned to lateral epicondylitis over time.

Diagnosis & Test

Initially doctors ask about signs and symptoms and accordingly occupation or recreational activities, discussion is part of the diagnosis. It is important to discuss any minor injury to the forearm happened in the past which was neglected that time or any incidence about neurological or joint related problems.

Physical examination and different postural change and movement which hurt the elbow also evaluated. Doctors usually recommended following diagnostic tests for evaluate the condition.

X-Ray

X-ray is conducted for checking the bone health and also confirming the possibility of the presence of arthritis in the elbow joint.

MRI

If any soft tissue injury or neck related problem causes the discomfort, then MRI helps to diagnose the problem. Arthritis or herniated disk in neck can cause similar pain like lateral epicondylitis which affect the arm.

Electromyography (EMG)

This test is conducted for checking the nerve compression, as in the elbow region, several nerves are passed and if any one nerve becomes compressed provides similar symptoms like lateral epicondylitis.

Treatment

The following available treatments are recommended for lateral epicondylitis

Oral medications

Non-steroidal-anti- Inflammatory drugs usually prescribed for short term relieve. But in case of chronic condition, steroid medications also prescribed for lessening the swelling.

Steroidal injection

Steroidal injection at the epicondyle gives better pain relieves than the oral medication, but due to its side effects, doctors prescribed when patient complains severe pain.

Extracorporeal shock wave therapy

Some review provides extracorporeal shock wave therapy is beneficial for treating lateral epicondylitis, but no scientific evidence yet found.

Wearing of forearm strap or Bracing

Some doctors also recommended for wearing a non-articular, proximal, inelastic forearm strap or bracing for improving the daily work activities.

Physical therapy

Different types of physical therapies, including iontophoresis, stretching and strengthening exercises or ultrasonography are also combined with steroidal or non-steroidal-anti- Inflammatory drugs for providing better outcome.

Physical therapies are combinations of mechanical and thermal therapies which increased stretching, metabolism and circulation on the targeted part.

If non-surgical procedures are not effective within 1 year time period, then doctor may recommend you surgical procedures.

Surgical intervention

The aim of the surgery is removal of the affected muscle and affixing the new muscular tissue with the bony structure of the elbow.

Open surgery

This is a traditional surgical method where an incision is conducted over the elbow.

Arthroscopic surgery

This is conducted by small incisions through which a tiny instrument is inserted for repairing purpose. This is conducted as outpatient department.

A splint is usually attached for one week to maintain immobilization for a temporary period and then removed it. It’s also advisable after removing splint to regain the strength and flexibility stretching exercises should continue for next 2 months. Sports person usually returns to field after 4 to 6 months of the surgery.

Exercises

The following exercises are helpful for lateral epicondylitis:

Elbow stretching

Straight your hand in forward direction and then stretched the affected hand by holding the wrist by another hand. Stretching is needed for holding the position for 15 -30 seconds and continue for 5 to 10 times. Possible movements of wrist joint including flexion, extension and rotation should continue.

Soft ball pressing

Take a tennis or rubber ball in hand palms and then tightly hold the ball. Press the ball and then release. Repeat this for 5 -10 times.

ICD9 Code

ICD-9- Code is effective before 30th September 2015, used for indicating a diagnosis on a reimbursement claim. Extensively, this billable medical code is denoted as ICD-9-CM 726.32. From October onwards the equivalent code newly formed which is established as ICD-10-CM code/or codes.

Reference

  1. http://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis?page=2
  2. http://handsurgery.org/multimedia/files/public/latpicondylitis.pdf
  3. https://www.orthocenterillinois.com/pdfs/Tennis-Elbow.pdf
  4. http://www.aafp.org/afp/2007/0915/p843.html
  5. http://orthoinfo.aaos.org/topic.cfm?topic=a00068
  6. http://www.icd9data.com/2013/Volume1/710-739/725-729/726/726.32.htm

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