Overuse injury of the hand, especially finger extensor tendons which originate in the lateral humeral epicondyle

Aetiology

• Most commonly due to repeated or excessive pronation/supination and extension of the wrist (e.g. tennis players)

Pathophysiology

• Micro-tears in the common extensor origin

Clinical features

Symptoms

• Characterised by pain and tenderness over the lateral epicondyle to the attachment of the forearm
• Pain is worse when stretching the muscles e.g. opening a jar
• 10-20% bilateral

Signs

• Flex elbow to 90° in pronation, pain on resisted middle finger and wrist extension

Investigations

• Mainly clinical
• USS and MRI may be required where diagnosis uncertain
• Nerve conduction study: should be carried out if there are any nerve symptoms

Management

• Usually self-limiting
• Conservative - rest, physio, injection of LA and steroids, brace (elbow clasp)
• Surgical release for refractory cases - involves division and/or excision of some of the fibres of common extensor mechanism
  • Variable results