Painful Elbow
  • Tennis elbow - painful
  • Golfers elbow - painful
  • Ulnar neuritis - painful
  • Arthritis - painful and stiff
  • Bursitis - painful
Tennis Elbow
  • Lateral epicondylitis is misnomer as the bony epicondyle itself is normal. The tendon most commonly undergoes hypoxic, degeneration especially the ECRB origin.
  • Pain/tenderness is felt over lateral epicondyle (i.e. The outer bony prominence of the elbow) exacerbated by gripping and forearm release.
  • Pain - on resisted wrist dorsiflexion (Mills' Test)
  • Middle finger test = Pain on resisted extension of MCPJ of middle finger (because ECRB inserts into the base of the 3rd MC)
Different Diagnosis
  • Radial tunnel syndrome - 5%. Compressive neuropathy of the radial nerve tender distally in the extensor muscle mass.
  • Raio - Capitellar arthritis (Elbow Joint)
Treatment - 95% Nonoperative
  • Relative rest! Wait and see.
  • Activity Modification
  • Exercises, stretching
  • Splintage
  • Ultrasound
  • Steroid injection
  • Extra Corporeal Shock Wave Therapy
  • Surgery: Surgery is reserved for those that fail to respond to the above. Excision of diseased tissue is most commonly performed. It elicits inflammation leading to scar formation. This help resole the pain. This surgery can be done arthoscopically with the added advantage of addressing any intra articular problems at the same time.
  • Other surgical procedures that are sometime done include Extensor Origin Release, Release of portion of the annular ligament, ECRB lengthening in the distal forearm, Localised denervation of the lateral epicondyle.
Olecranon Bursitis

    Bursa of the olecranon (back of the elbow prominence) – This superficial bursa (fluid filled sac) helps as a lubrication between the prominent bone and the skin. It can be swollen and inflamed in the following situations and can cause pain:

  • Traumatic – overuse (Miner’s, student’s)
  • Inflammatory
  • Infective

Usually painless, but if painful it indicates a septic, or inflammatory process. Radiograph usually show an olecranon spur (overuse).

Bursa communicates with joint in Rheumatoid Arthritis and is treated with resting splint, elbow pads and Anti-inflammatory medications.

  • Acute inflammation or infection sometimes warrants an aspirate – and an analysis of the aspirated fluid is done including for bacterial infection. Depending on same antibiotics are started.
  • Chronic bursitis – repeat aspirate – suction drain.
  • Excision of the bursa-may rarely be indicated.
Tennis Elbow

Download Information Leaflet On Tennis Elbow

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Louise Mcguire
Spire Elland Hospital
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