Lateral elbow pain is one of the most common sources of medical consultation for non-traumatic elbow disorders. The most frequent diagnosis is the tendinous disorder known as lateral epicondylitis (LE) or ‘tennis elbow’. However there are many pathological conditions that may mimic LE such as intra-articular plica, osteochondritis dissecans (OCD), radiocapitellar arthritis or posterolateral rotatory instability.1
Lateral epicondylitis was first described by Runge in 1873.2 It was described as a chronic symptomatic degeneration of the wrist extensor tendons involving their attachment to the lateral epicondyle of the humerus. It is a common condition, affecting between 1% and 3% of the population,3 generally affecting the middle-aged without gender predisposition.
Despite its relatively high prevalence, there is no single effective and consistent algorithm of management. Fortunately, most cases are self-limiting and well-managed with simple pain medication, with 90% of patients recovering within one year. Patients with severe or persistent symptoms are suitable for treatment with further conservative or operative options.4
The majority of the patients complain of pain located just anterior to, or in, the bony surface of the upper half of the lateral epicondyle, usually radiating in line with the common extensor mass. The pain can vary from intermittent and low-grade pain to continuous and severe pain which may cause sleep disturbance. It is typically produced by wrist and finger extensor and supinator muscle contraction against resistance. The pain lessens slightly if the extensors are stressed with the elbow held in flexion.
On inspection, there is no remarkable alteration in the early stages. As the disease evolves, a bony prominence over the lateral epicondyle can be detected. Muscle and skin atrophy as well as detachment of common extensor origin can be seen as a result of corticosteroid injections or long-standing disease.4
Range of motion is not usually affected. Motion may be painful in more advanced stages where it can be elicited in full elbow extension with the forearm pronated. If limited motion exists, other concomitant pathology needs to be excluded.12
There are many tests employed in LE physical examination. Maudley’s test,13 Thomson’s manoeuvre, diminished grip strength14 and the ‘chair’ test (Fig 1a, ,b)b) are some of the tests employed to reproduce the pain of LE.
