Introduction
Lateral and medial epicondylitis are painful overuse conditions of the tendon origins at the elbow. They are among the most common causes of elbow pain in working-age adults and are recognised as occupational diseases when linked to repetitive, forceful hand and wrist work. This note covers definition, causes, pathogenesis, clinical picture, diagnosis, treatment and the principles of occupational medical expertise.
Definition and classification
Lateral epicondylitis (tennis elbow) is a degenerative tendinopathy at the common extensor origin on the lateral humeral epicondyle. Medial epicondylitis (golfer's elbow) affects the common flexor-pronator origin on the medial epicondyle. Although the name ends in 'itis', histology shows little true inflammatory infiltrate; the process is mainly degeneration with angiofibroblastic hyperplasia, so 'epicondylosis' is the more accurate term used in many texts.
Etiology and risk factors
The condition results from repetitive loading of the tendon origin, usually with a poor or sudden increase in load. Key risk factors include:
- Forced, resisted wrist movements: for lateral disease, forced wrist extension with the forearm pronated; for medial disease, forced wrist flexion and pronation.
- Occupational groups: diggers and excavator operators, press operators, miners, bricklayers and masons, keyboard and computer workers, assembly-line workers.
- Sports: tennis, badminton, squash, archery, shooting, golf, throwing.
- Other factors: age 40 to 50, poor tool ergonomics (grip size, vibration), faulty technique, and some systemic factors such as diabetes and obesity that are associated with poorer tendon healing.