Lateral Elbow Pain

Lateral Epicondylitis

Posterior Interosseous Nerve

    • Deep branch of the radial nerve exits the radial tunnel and pierces supinator as PIN (motor)
    • Dives deep to arcade of Frohse

Lateral Epicondylitis

  • Chronic symptomatic degeneration of the wrist extensor tendons involving their attachment to the lateral epicondyle of the humerus.
  •  Common condition, affecting between 1% and 3% of the population,
  • Generally affecting the middle-aged without gender predisposition.

Lateral Epicondylitis

Lateral Epicondylitis

  • Extensor carpi radialis brevis (ECRB) is the most commonly affected muscle, but supinator and other wrist extensors such as extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris can be involved.
  • Any activity involving excessive and repetitive use of these muscles (for example tennis, playing an instrument, typing, manual work) 
  • Smoking and obesity have been identified as significant risk factors.


  • Rest, modification or avoidance of painful activities usually leads to symptomatic relief.
  • Physiotherapy   
  • Non-steroidal anti-inflammatory drugs (NSAIDs) can be useful for the short-term relief of symptoms. Corticosteroid injections are commonly used to treat LE.
  • Platelet-rich plasma injections (PRP).
  • Percutaneous radiofrequency thermal treatment.  
  • Extracorporeal shock-wave therapy (ECSW) has been proposed as an alternative to non-operative management. The mechanism of action is not fully known. A generator of specific frequency sound waves is applied directly onto the overlying skin of the ECRB tendon. It has not been demonstrated to be more beneficial than other treatment modalities.38
  • The use of low-level laser therapy has been proposed due to the stimulating effect of laser on collagen production in tendons.
  •  Acupuncture has demonstrated good outcomes on short-term follow-up.  However, long-term results remain unclear.

Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials

Results: A total of seven randomized controlled trials (RCTs) involving 515 patients were finally included in our study. The present meta-analysis indicated that PRP injection yielded statistically significant superior in pain scores and elbow joint function at a 6-month follow up compared with local corticosteroid injection. No significant difference was identified between two groups regarding the post-injection adverse events.

Conclusion: Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months.

Xu Q, Chen J, Cheng L. Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials. Int J Surg. 2019 Jul;67:37-46. doi: 10.1016/j.ijsu.2019.05.003. Epub 2019 May 22. PMID: 31128316.

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and Interesting Articles

  • Buchanan BK, Varacallo M. Tennis Elbow. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  • Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2017 Mar 13;1(11):391-397. doi: 10.1302/2058-5241.1.000049. PMID: 28461918; PMCID: PMC5367546.
  • Priest JD, Braden V, Gerberich SG. The elbow and tennis, part 1: An analysis of players with and without pain. Phys Sportsmed 1980;8(4):80–91. doi: 10.1080/00913847.1980.11710917. Search PubMed


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