epicondylopathy

Epicondylopathy is a term used to describe disorders of the tendinous tissue at the elbow epicondyles, characterized by elbow pain and functional limitation. The spectrum includes lateral epicondylopathy (lateral epicondylitis, commonly known as tennis elbow) and medial epicondylopathy (medial epicondylitis, or golfer's elbow).

Pathophysiology involves repetitive microtrauma and failed healing leading to angiofibroblastic degeneration of the tendon origin at the lateral or medial epicondyle. Risk factors include repetitive wrist extension (lateral) or flexion (medial), participation in racquet or throwing sports, occupational elbow strain, and age in the 30s to 50s.

Clinical features: lateral epicondylopathy presents with lateral elbow pain worsened by wrist extension, gripping, or forearm rotation; exam may reveal tenderness over the lateral epicondyle and pain with resisted wrist extension. Medial epicondylopathy causes medial elbow pain with wrist flexion or forearm pronation; tenderness at the medial epicondyle. Diagnosis is primarily clinical; imaging is reserved for uncertain cases or to exclude alternative pathology. Ultrasound or MRI can demonstrate tendon degeneration or partial tears.

Management: first-line is conservative, including activity modification, nonsteroidal anti-inflammatory drugs, and physical therapy emphasizing eccentric loading and gradual strengthening of forearm muscles. Bracing or counterforce straps may help. Corticosteroid injections offer short-term relief but may have higher recurrence; evidence for platelet-rich plasma is mixed. Surgical intervention is considered for persistent symptoms after several months of unsuccessful conservative treatment.

Prognosis and epidemiology: most patients improve with conservative treatment within months; recurrence can occur. Lateral epicondylopathy is more common than medial, and is seen most often in adults aged 35–55 who perform repetitive elbow or wrist movements, especially in racquet sports or occupations involving repetitive arm use.