Clinical management and

rehabilitation of Epicondylitis
Gunawan K PM&R
epicodylitis
 Epicondylitis-describe inflammation ,pain or
tenderness in the region of medial or lateral
epicondyle.
 Medial epicondylitis-flexor muscle

group.golfer’s elbow
Tennis elbow
The lesion is found primarily in the extensor
carpi radialis brevis (ECRB) origin, with less
frequent involvement of the extensor carpi
radialis longus (ECRL) and the anterior
portion of the extensor digitorum communis .
 Nirschl maintains that angiofibroblastic

hyperplasia, resulting from avascular

compromise and subsequent micro tears in
the origin of the ECRB, is the basic cause of
chronic lateral epicondylosis
 Recent studies of chronic tennis elbow have
not found any significant evidence of
inflammatory processes and the term
epicondylosis has been suggested as a more
appropriate term than epicondylitis .
symptoms
 Pain in distal to lat epicondyle(lat
epicondylitis),med epicondyle(med
epicondylitis)
 Pain may radiate prox or distal.
 Pain with movement of the

wrist/hand;gripping a door knob or carrying

handcase
 Report swelling.
Physical examination
 Tenderness over ext muscle origin or flexor.
 In lat epicondylitis;
 pain is increased with resisted wrist ext ,with

elbow extended and forearm pronated,wrist

radially deviated,a hand in a fist.
 Middle finger test in ext can be used.
 Medial epicondylitis,pain is increased with

resisted wrist flexion

Functional limitation
 Complain of inability to lift or carry object.
 Typing ,use computer mouse.
 Handshaking.
 Athletic activity(tennis ,golf)
treatment
 Initial treatment consists of relative rest,
 avoidance of repetitive movement involving

wrist.
 Nsaid heat modalities or ice for acute.
Peri-articular HA treatment for tennis elbow
was significantly better than control in
improving pain at rest and after maximal grip
testing.
 HA treatment was highly satisfactory by

patients and physicians and resulted in better

return to pain free sport compared to control.

 Management of Tennis Elbow with sodium hyaluronate periarticular injection.

 Petrella et al. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010,
2:4
 Tennis elbow,
 modify their backhand stroke ;the forearm is

in midpronation and the trunk is leaning

forward,
 modify their equipment;reducing string

tension and enlarging the handle size.

 A two handedbackhand will relieve the stress
Execise for tennis elbow
 Golfers’elbow
 Modify their swing to avoid excessive force

on wrist flexor muscle. Forearm band

(counterforce brace) worn distal to flexor and
ext muscle group origin.
 Wrist immobilisation splint either med or lat

epicondylitis set in neutral or 30 ⁰wrist ext

will relieve ext carpi rad brev muscle
rehabilitation
 The first phase
 Decreasing pain :ultrasound,electrical

stimulation,phonophoresis,heat ,ice,massage)
 Decreasing disability:education,decreasing repetitive

stress and preservation of motion

 When pain free, do a gradual program to improve

strength and endurance of wrist exr or flexor ,this

program should be monitor closely
 Start with static exe,advance to progressive resistive

exe .
 Theraband ,light weights or self manual resistance

exe can be used

injection
 Steroid
 Post inj treatment should include icing the

area5-10 mts,wearing wrist splint 2-3 days

avoid axacerbating activities.
 Botox into ext dig com lll and iv in treating lat

epicondylitis
 Peri articular hyaluronic acid inj ,promising

for epicondylitis
 not recommended for med epicondylitis,risk

of ulnar nerve injury.

surgery
 Indicated for symptom not respond to
conservative treatment
Thank You