Lateral Epicondylitis

1. What are some factors that cause lateral epicondylitis (LE)?
2. What is the pathology behind LE?
3. What are the clinical history of LE?
4. What is Cozen's test?
5. Why might X-rays be obtained?
6. What is the treatment for LE?

Answers:
1. Any repetitive sport (e.g. tennis) especially when poor techniques are used with a racket sport (inproper backhand, weak string tension, inappropriate grip size), overuse and poor mechanics.
2. Microtearing of the extensor carpi radialis brevis.
3. Patients c/o tenderness just distal to the LE at the ECR origin, pain and weakness of grip.
4. Cozen's test is when the examiner stabilizes the elbow with a thumb over the LE and there is pain with a fist, forearm pronation, radial deviation, and wrist extension against resistance. There may also be pain with passive extension of elbow with forced wrist flexion.
5. Obtain X-rays if there is suspicion of arthritis or loose body fragments.
6. Conservative treatment includes rest, ice, NSAIDs for 10-14 days. If no improvement, may do PT, splinting, steroid injection, and correction of improper techniques. Surgical treatment of ECRB debridement can be considered.