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Epicondylitis UpToDate performs a continuous review of over 330 journals and other resources. Updates are added as important new information is published. The literature review for version 13.1 is current through December 2004; this topic was last changed on November 29, 2004. The next version of UpToDate (13.2) will be released in June 2005. INTRODUCTION — Epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the lateral (extensor carpi radialis brevis and longus tendons) or medial (flexor carpi radialis tendon) epicondyle [1,2]. It is commonly referred to as "tennis elbow" when it occurs laterally and "golfer's elbow" when it occurs medially, but epicondylitis may be caused by a variety of sports and occupational activities. The injury results in elbow pain that usually spontaneously heals, although it can become a source of chronic pain and morbidity if left untreated, or if aggravating activities are not eliminated or curtailed. ETIOLOGY — Epicondylitis (medial or lateral) has numerous etiologies including repetitive wrist turning or hand gripping, tool use, shaking hands, or twisting movements that may exceed tissue capacity. It is an occupational hazard in carpenters, gardeners, dentists, and politicians. Repetitive eccentric muscle overload (implicated in these movements) occurs when an applied force causes the muscle to lengthen as it is activated. The resulting higher muscle tension is more likely to produce injury than concentric contractions [3]. Epicondylitis is usually unilateral and more commonly affects the lateral epicondyle [4]. Tennis players, particularly novices, often suffer lateral epicondylitis as a result of pressure grip strain, or due to backhand shots performed with a "leading elbow" in which the elbow is pointed to the net during racquet impact with the ball. Epicondylitis is more common in loose jointed tennis players [5]. Racket factors also may be important, with light, head heavy, and stiff racquets hypothesized to cause the greatest stress on the extensor carpi radialis brevis and longus tendons, although this is difficult to prove with certainty [6]. Squash players with a "wristy backhand," or who play a lob from the front of the court are also at risk for lateral epicondylitis, as are badminton players. Another possible cause is unconscious hand clenching, which may occur during sleep, while driving, or when reading. Several case reports have noted an association between the ingestion of specific drugs and the development of lateral epicondylitis. As an example, two patients developed this disorder after the first dose of a fluoroquinolone antibiotic [7]. These cases may be mechanistically related to the development of Achilles' tendinitis that is more often seen with the use of the fluoroquinolones. (See "Tendon injuries and inflammation around the ankle"). c
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