The bony prominences on the inner and outer side of the elbow are known as the epicondyles. They are the lower part of the humerus (upper arm bone) and form the attachment of muscles that move the wrist. Muscles that move the hand away from the palm (as in a backhand stroke in tennis) attach to the outer or lateral epicondyle. Those that move the hand in the palmar direction (as in a forehand stroke) attach to the inner or medial epicondyle. When these attachments become inflamed, the condition is called epi-condylitis. In common usage they are often called tennis (outer epicondyle) or golfer's (inner epi-condyle) elbow, although less than 5 percent of lateral epicondylitis is found in tennis players and an even smaller percentage of medial epicondyli-tis in golfers.
Lateral epicondylitis is quite common, with between 1 and 3 percent of the population having it at some stage. Although most patients are not tennis players, nearly 50 percent of tennis players will suffer from it at some time. It is most frequent between the ages of 40 and 60 years. Many patients are manual workers, while in others there is no obvious cause. Medial epicondylitis or golfer's elbow is a very similar condition on the opposite epicondyle but is not common.
Small tears develop where the muscle joins the tendon close to the epicondyle. With repeated tears and scarring, chronic or ongoing inflammation develops, and the individual feels a persistent ache with more severe pain on use of the involved muscles. The grip will often weaken. In lateral epi-condylitis, there will be marked tenderness over the bony prominence on the outside of the elbow or close to it and the pain will be most severe on flexing the wrist up (as in a backhand stroke). Stretching these muscles (tuck the thumb into the palm of the hand, flex the wrist down, and then slowly straighten the elbow) may also produce some pain but is important in rehabilitation after treatment. The opposite movement of the wrist will bring out the pain of medial epicondylitis that is usually less severe and spread over a wider area.
The chief symptom is pain felt in the upper forearm. The pain is made much worse by use of the hand and forearm, particularly with gripping or repetitive movements. Most patients will complain of some weakness of the grip as well. The pain is not confined to the same, usually quite small, area that the tenderness is but will be around the affected epicondyle.
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