Lateral elbow pain

When most people think of lateral elbow pain they think of tennis elbow. However this term gives very little indication of any pathologies at play and sports clinicians are in fact more likely to see this condition in non tennis players.

Pain in the elbow can potentially be from a number of sources: 

  • Referred pain from the neck or back or soft tissues in the arm and shoulder
  • Possible entrapment of a nerve
  • Joint irritation
  • Other joint pathologies
  • A condition called bursitis
 
 Figure 1: The muscles of the forearm with extensor carpi radialis brevis (ECRB) highlighted.

Figure 1: The muscles of the forearm with extensor carpi radialis brevis (ECRB) highlighted.

However, the majority of cases of lateral elbow pain will be due to a tendinopathy (a tendon overuse injury) of the wrist extensor muscles, with the tendon of the extensor carpi radialis brevis being the most common to be problematic (fig. 1).

The neighbouring muscles of the extensor digitorum, extensor carpi ulnaris and extensor carpi radialis longus can also be culprits in some cases of lateral elbow pain.

The peak incidence of lateral elbow tendinopathy is between 40 and 60 years old, but it can develop at any age.

 

What causes it?

Repeated gripping and/or wrist extension actions have a huge role to play in the onset of symptoms. As a result, participants in racquet sports, manual tradespeople like carpenters,  or musicians can all particularly be affected. So too can those who use computer keyboards regularly.

 Fig.2: Wrist flexion

Fig.2: Wrist flexion

 Fig.3: Wrist extension

Fig.3: Wrist extension

 

Normally there will be two ways people describe symptoms starting:

  • An insidious onset 1-3 days after doing a new activity involving repeated wrist extension
  • A sudden traumatic onset after something like a heavy lifting manoeuvre or striking a tennis backhand with large force and sub-optimal technique.

 

What to do:

If you have had prolonged symptoms or get pain each time you perform an activity then having an assessment is a good idea. The causal factors of lateral elbow tendinopathy will unlikely resolve by themselves unless the status quo is changed significantly.

 

How is it treated?

The first aim of any treatment will be to reduce any existing pain. This can be facilitated with pain-relieving medication, ice, acupuncture, relative rest and electrotherapy. If there is associated neck or back pain then targeting this can speed up the process significantly. 

The key to managing the condition in the longer term is exercise. Exercise therapy will encourage the arm and shoulder to work more efficiently and correct any mechanical problems that may have been contributing. These exercises do take quite a while to bear fruit but Physiotherapists have plenty of tricks up their sleeves to keep the progress coming!

The other thing that is often seen is a counterforce brace (fig.4). The primary aim of this piece of equipment is to reduce pain during activity. It is worn approximately 10cm below the elbow joint and increases the stretching pain tolerance of the forearm muscles affected.

 

 Fig. 4: Elbow counterforce brace

Fig. 4: Elbow counterforce brace

Normally the timeframe for managing lateral elbow pain would be about 8 weeks, but this can vary significantly from person to person.