Diagnosis of epicondylar tendinopathy

Note: The diagnosis of epicondylar tendinopathy is usually made on history and physical examination, without the need for investigations.

The diagnosis of epicondylar tendinopathy is usually made on history and physical examination, without the need for investigations. Both lateral and medial epicondylar tendinopathies are characterised by pain and tenderness over the epicondyle and pain on resisted movements. Pain may occur at night, and stiffness usually occurs in the morning and after periods of inactivity.

Useful tests on clinical examination may include:

for lateral epicondylar tendinopathy—pain occurs on resisted extension of the wrist or middle finger extension
for medial epicondylar tendinopathy—pain occurs on resisted volar flexion of the wrist.

There may be associated tenderness but swelling is uncommon. In more chronic cases, weakness of wrist extension (in cases of lateral epicondylar tendinopathyMa, 2020) and reduced grip strength (in cases of medial epicondylar tendinopathy) may be foundReece, 2022.

Both conditions are generally self-limiting and many people recover within 1 year, but sometimes symptoms can persist beyond 2 years and may be recurrent.

If investigations are indicated, ultrasound, X-ray or magnetic resonance imaging (MRI) may be supportive to rule in or out other diagnoses; however, tendinopathic findings on imaging will not necessarily be the source of the person’s pain.