Conditions & Treatments - Lateral Epicondylitis (Tennis Elbow)


Lateral epicondylitis (tennis elbow) is a condition that is often associated with overuse and repetitive trauma. Injury to the wrist extensor muscles at their origin on the lateral humeral epicondyle results in fibrosis and microtears to this tissue (1). The extensor carpi radialis brevis (ECRB) tendon, which is part of the wrist extensor muscle group, is found to have the most pathological changes with lateral epicondylitis (1).

Causes and Symptoms
Lateral epicondylitis is associated with pain on the lateral side of the elbow which is aggravated with movements of the wrist, by palpation of the lateral aspect of the elbow or by contraction of the extensor muscles of the wrist (2). Individuals who experience lateral epicondylitis are usually between the ages of 30-55 years old and are found to have a deconditioned wrist extensor muscle group (1). Despite the term lateral epicondylitis being synonymous with “tennis elbow”, only 5% of individuals who have this condition are tennis players (1). Onset of lateral epicondylitis for tennis players is usually associated with poor back hand mechanics, incorrect grip size, string tension, poor racquet dampening and underlying weakness at the shoulder, elbow and arm (1). Other activities which are associated with lateral epicondylitis includes repetitive use of tools (ie. screw driver), lifting with palm down, raking, gardening, bowling, throwing and golfing (1).

Examination / Findings for Lateral Epicondylitis (1)
• Point tenderness at the lateral epicondyle region, particularly at the ECRB origin
• Pain is exacerbated with resisted wrist extension and forearm pronation
• Elbow extension may be mildly limited
• Chair-lift test exacerbates pain (patient is asked to lift a chair with the shoulder adducted, the elbow extended, and the wrist pronated)
•Maudsley’s exacerbates pain (patient resists extension of the middle finger at the MCP I joint with elbow fully extended)


Lateral Epicondylitis Treatment Options for a PT

Ice / NSAIDs

Rest / Activity Modification

Postural / Mechanics Correction

Manual Therapy / Manipulation (2)

ROM/Stretching (see videos 54 and 55 for elbow)

Strengthening (see video 57 for elbow) – Eccentric Strengthening (3)

Counterforce Bracing / Wrist Splint



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Last revised: October 30, 2015
by Jennifer, MPT, CSCS


1) Brotzman S.B., Wilk K. Clinical Orthopaedic Rehabilitation. Philadelphia, PA: Mosby. 2003; 104-111.
2) Struijs P, Pieter-Jan D, et al. Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study. Physical Therapy Journal. 2003; 83:608-616.
3) Stasinopoulos D, Stasinopoulos K, Johnson M. An Exercise Programme for the Management of Lateral Elbow Tendinopathy. Br J Sports Med. 2005;39:944-947.


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