Key points
- Epicondylitis is inflammation of the tendons at the bony prominences of the elbow due to repetitive, same-type movements of the arm.
- The pain intensifies when clenching a fist, rotating the forearm and lifting objects.
- The condition is managed by a trauma and orthopaedic surgeon; if an inflammatory cause is suspected, a rheumatologist is involved.
- Examination begins with inspection, palpation and resistance tests against movement.
- The basis of care is unloading the arm, physiotherapy and therapeutic exercise for the forearm muscles.
What is epicondylitis
Epicondylitis is inflammation and microtears of the tendons around the elbow that attach to the bony prominences. Most often it occurs due to repetitive, same-type movements and strain on the arm.
What happens in the body
The tendons around the elbow attach to the bony prominences and transmit force from the muscles of the forearm to the hand. With frequent, same-type movements of the arm, these tendons experience constant strain at the same point. Because of this, microtears appear in the tendon fibres, and inflammation develops around them. The tissue loses some of its strength, and any movement with effort responds with pain in the elbow. Over time, an area forms at the tendon attachment site that heals more slowly than usual. The person begins to spare the arm and change habitual movements so as not to disturb the painful area. If the strain is not reduced, the microtears recur, and recovery drags on for weeks.
What causes it to develop
- Frequent, same-type movements of the arm: repeatedly repeated flexion and extension of the hand creates constant strain on the same tendons.
- Working with a tool or a computer mouse: holding the arm tense for a long time and small movements of the hand load the tendon attachment site.
- Sports involving gripping and throwing: sharp movements with effort on the hand produce peak strain on the tendons around the elbow.
- A sharp increase in physical load: an unaccustomed volume of work with the arm does not give the tissues time to adapt and increases the risk of microtears.
- An elbow injury: a blow or a fall onto the arm weakens the tendon and makes it vulnerable to subsequent loads.
Who encounters this more often
This condition is encountered more often by people whose work or activities involve repetitive movements of the arm. These are builders, fitters, painters, cooks, hairdressers and those who work at a computer for long periods. In athletes, strain on the tendons arises when playing tennis, golf, when throwing and in strength exercises with gripping. Age also plays a role: with the years, tendons lose elasticity and tolerate constant strain less well. General condition also matters: lack of movement, weakness of the forearm muscles and excess weight increase the load on the elbow. In people who abruptly return to work or training after a long break, the risk is also higher. It is worth remembering that changing the habitual movement and giving the arm feasible relief help the tendon to recover.
What symptoms occur?
Epicondylitis manifests as pain in the elbow area, which intensifies with exertion and gripping the hand. It is important to distinguish ordinary fatigue in time from signs that require a visit to a doctor.
How it is noticed at the very beginning
At the beginning of its development, epicondylitis is noticed by discomfort in the elbow area, which appears after unusual physical work. The pain may radiate to the forearm and intensify when lifting objects or gripping the hand. Often a person attributes the unpleasant sensations to ordinary fatigue after exertion and does not pay attention to them. Gradually the discomfort begins to occur even with simple everyday movements, for example when turning a key or shaking hands. Tenderness when pressing on the bony prominence becomes increasingly noticeable and interferes with performing habitual actions. If these early signals are ignored, the pain will return after every rest and become constant. Therefore, if the discomfort persists after rest, it is worth seeing an orthopaedic traumatologist without waiting for the symptoms to worsen.
Signs that occur most often
- Pain on the outer or inner side of the elbow: indicates the site of inflammation and helps the doctor determine which muscle group is involved in the process.
- Increased pain when rotating the forearm or clenching the fist: these movements create load on the tendons, so they become especially sensitive.
- Weakness in the arm when lifting heavy objects: the muscles lack the strength for habitual work, and objects may slip from the fingers.
- Tenderness when pressing on the bony prominence: palpation of the elbow area gives a clear pain response, which helps distinguish this condition from others.
- Discomfort persists after rest: if the pain does not go away overnight, this is a reason not to postpone a visit to a specialist.
When to seek help urgently
Examinations and tests
Examination for epicondylitis begins with a conversation and a physical examination, and instrumental methods are used only to clarify the picture. Below is a breakdown of what exactly the doctor does at the appointment and which investigations help rule out other causes of pain.
How the examination begins
The examination of the elbow begins with questions about loads and the nature of the pain, and then the doctor moves on to the physical examination. The specialist asks you to show exactly where it hurts and gently palpates the area around the joint. Palpation helps to find tender points at the sites where tendons attach to bony prominences. This is followed by special tests: you need to resist a movement that the doctor sets with their hand. Such a check shows whether the tendon is involved and how it responds to effort. If the picture remains unclear, additional investigations are prescribed to rule out other causes of pain. It is worth recalling in advance after which movements the pain intensifies and telling the doctor about this at the appointment.
What is prescribed and what it shows
What to prepare for the appointment
- Discharge summaries: bring previous doctors' reports if the elbow has bothered you before, this will help to see the dynamics.
- Images and results: bring any available X-ray images, ultrasound or tomography reports so that they do not have to be repeated.
- Pain diary: write down after which movements or loads the pain intensifies and in which situations it subsides.
- List of loads: list the work and household activities where you often have to bend your arm or hold a tool.
- Questions for the doctor: formulate in advance what you want to clarify about your condition and further steps so that you do not forget anything.
Which doctor should I see?
For epicondylitis, doctors of two specialities provide care, and the choice depends on the cause of the pain. Below — who manages the condition, what treatment consists of, and what remains with the patient.
Which specialist manages this condition
Epicondylitis is managed by an orthopaedic trauma surgeon, and if an inflammatory nature of the process is suspected, a rheumatologist is involved. The orthopaedic trauma surgeon examines the elbow, checks the painful points at the site of tendon attachment, and assesses the strength of the hand. A rheumatologist is needed when the pain persists for a long time, affects other joints, or is combined with morning stiffness. If there is no specialist nearby, start with a general practitioner: they will examine you and refer you to the right specialist. At the first appointment, the doctor clarifies how long ago the pain appeared and after what load it intensified. Then they check the movements in the elbow and prescribe treatment, starting with unloading the arm and reducing the pain. Next, the doctor may refer you for physiotherapy or therapeutic exercise. It is not worth delaying the visit: without unloading the arm, the pain often returns with the very first load.
What treatment consists of
- Limiting loads on the elbow: the arm is temporarily freed from movements that cause pain, so that the tendon has time to recover.
- Selection of pain-relieving therapy by the doctor: the doctor selects agents that relieve pain and inflammation and monitors how you tolerate them.
- Physiotherapy procedures: they are prescribed to reduce pain and improve the nutrition of tissues in the area of the damaged tendon.
- Therapeutic exercise and stretching exercises: gradual work with the muscles of the forearm restores strength to the arm and reduces the risk of repeated injury.
- Surgery for persistent pain: it is resorted to when conservative treatment has not helped and the pain interferes with ordinary activities.
What depends on the patient themselves
The result in epicondylitis largely depends on how regularly a person follows the doctor's recommendations. Stretching and muscle-strengthening exercises pay off only with repetition, not from a single session. If you return to your usual load immediately after the pain has subsided, it often returns. Some people stop the exercises as soon as they feel better, and then are surprised by a new flare-up. A simple rule helps: keep a diary noting which movements cause pain, and show it to the doctor at the appointment. This way the specialist sees what exactly triggers the flare-up and adjusts the load. It is worth honestly telling the doctor if the exercises cause pain or are performed irregularly. Then treatment is changed in time, rather than after the pain becomes persistent.
What helps prevent an exacerbation?
Prevention of epicondylitis flare-ups largely depends on a person's own everyday decisions. Below is a breakdown of which habits are worth changing, what to keep under control, and how often to see a doctor.
What to change in habits
Alternating load and rest is the main thing that reduces the risk of epicondylitis recurring with repetitive hand work. During prolonged work at a keyboard or with a tool, it is useful to take breaks so that the forearm muscles have time to recover. A properly selected mouse and tool reduce tension at the point where the tendons attach to the bone. A sharp increase in loads, for example after a break in training, often becomes the trigger for a new flare-up. Strengthening the forearm muscles makes the arm more resistant to everyday and sports loads. In sports, it is important to monitor the technique of movements, especially when working with weights and a racket. If these changes are abandoned, discomfort in the elbow will return after every unusual load, and the periods of calm will become shorter.
What to keep under control
- Breaks during repetitive work: short pauses during the day reduce the accumulation of fatigue in the forearm muscles and lower the risk of repeated overuse.
- Workplace ergonomics: the height of the desk, the position of the mouse and keyboard affect how the load on the elbow is distributed throughout the day.
- Tools and sports equipment: a suitable handle size and weight reduce the tension that is transmitted to the forearm tendons during work.
- Volume and abruptness of loads: gradually increasing the pace helps avoid a situation where unusual work immediately makes itself felt.
- Your own sensations in the elbow: early signs of discomfort after a load are worth noticing in order to reduce the pace in time and not let it come to a flare-up.
How often to see a doctor
A regular check-up with a doctor is needed even when the elbow does not bother you and it seems that everything has passed. The specialist assesses how the arm copes with everyday and work loads and notices changes earlier than they become noticeable. During a period of calm, a person often returns to the previous volume of work and training too quickly, and this imperceptibly increases the risk of recurrence. At an appointment, you can discuss workplace ergonomics and movement technique in order to adjust them to a specific situation. If discomfort appears after a load, a visit helps to understand what exactly causes it and to change the usual routine in time. Scheduled visits make it possible to track the condition over time, and not only at the moment of a flare-up. It is reasonable to agree with the doctor on a convenient rhythm for such check-ups and to stick to it, even when you feel well.
What is worth remembering
Epicondylitis is a condition in which elbow pain returns if the load is not restructured. Below are the conclusions that help make a balanced decision.
Key conclusions
Epicondylitis is most often associated with repetitive arm movements, so the main step is to honestly review your daily habits. Pain in epicondylitis rarely goes away from a pause alone if, after rest, a person returns to the same pace of work. With epicondylitis, it is important not to endure discomfort for months, hoping that the elbow will "outache" on its own. If movements cause pain, it is reasonable to see a doctor earlier rather than wait until the arm stops coping with ordinary tasks. With epicondylitis, the doctor assesses which particular movements trigger the pain and helps to rebuild the load anew. Many people with epicondylitis make a mistake: they abruptly give up any activity and then immediately return to their previous volumes. With epicondylitis, it is more useful to change the load gradually and monitor the elbow's reaction throughout the day.
