Lateral epicondyltis (tennis elbow) and medial epicondylitis (golfers elbow) are conditions affecting the forearm muscles on the humeral bone at the elbow called the lateral and medial epicondylitis respectively. This condition, as well as bicep tendon ruptures, occurs in patients between 30-50 years old. Lateral and medial epicondylitis are often associated with a minor traumatic event and rupture of the distal biceps tendon with a major traumatic event.
However, all three conditions are considered the result of a degenerative process in the muscle tendon structure and not the result of an inflammatory process.
1-2% of the population will experience lateral epicondylitis and biceps tendon ruptures. Medial epicondyltitis occurs 1/10th as often.
Most hand activity occurs in the palm down position which may indicate why tennis elbow is ten times more common than golfers elbow.
A biceps tendon rupture occurs when a heavy eccentric load is placed over the elbow, like lifting a heavy object.
In contrast, tennis and golfers elbow occurs with repetitive use of the hands and forearms; for example, repetitive and forceful forearm rotation and wrist extension and flexion movements.
Tendons Involved in Tennis Elbow
- In all cases the Extensor carpi radialis brevis
- In some of cases the Extensor digitorum communis
Tendons Involved in Golfers Elbow
- Pronator teres
- Flexor carpi radialis
In 30% of golfers elbow cases cubital tunnel syndrome, or compression of the ulnar nerve at the elbow, occurs as well.
Partial or complete rupture of the biceps tendon at its insertion occurs secondary to an eccentric load on the biceps tendon. This is a result of forceful contraction of the biceps while the elbow is simultaneously extending. The use of oral steroids has been associated with an increase incidence of distal biceps tendon ruptures.
- Associated weakness of grip
- Radiation of the pain down the dorsal forearm or towards the shoulder
Lateral epicondylitis and medial epicondylitis both present with pain as the initial complaint. The severity of the pain typically correlates with the severity of the condition and will dictate which treatment options are initially taken.