Epidemiology Epicondylitis lateralis

Epidemiology Epicondylitis lateralis

Epicondylitis lateralis humeri Humerus lateral epicondylitis is also known as the tennis elbow.

Lateral versus medial epicondylitis: Lateral is to six times more common (6:1) than medial epicondylitis.20
Epicondylitis lateralis humeri is caused by an overload of the extensor carpi radialis longus and / or brevis 1,3,4,14. This overload can be short term or long term in nature.

Incidence: According to CMR the incidence and prevalence are both 7.6.12
Prevalence Rompe indicates that the prevalence of tennis elbow among adults is between 1 and 3% .11
Sex: According to the NHG standard Epicondylitis1 there is no difference in sex.12,15
Age: Incidence is highest in the age group of 35 to 53 year6. According to the NHG standard incidence is the highest at 40 to 50 years and then gradually decreases.13, 15 under the age of 20, this condition is rarely found in general practice, then, after this age the incidence increases to 12.6 per age group .13,15
Pain location: The elbow and wrist joint
Pain sensation/ Symptoms: Symptoms:1,14
– Lateral epicondyle may become red, warm and swollen;
– In chronic symptoms, no pain at rest, pain provocation in certain actions, lift in above grip, power up and wringing
– In chronic complaints pain may sometimes radiate distally; because of more receptive fields an referred pain patterns.
– Movement Restriction and / or pain in full extension of the elbow;
– Sometimes weakness of the extensors of the forearm
– Stabbing pain in the area of ​​the lateral epicondyle
*Symptoms above are possibilities which occur in lateral epicondylitis. Patient does not have to meet all above criteria
Provocation: – Tenderness at the lateral epicondyle of the humerus;
– Pain Provocation when moving the wrist and elbow;
– Stretching of the mm. Extensores carpi radialis longus and brevis are provoking pain.
History of injury: In 89% of the cases it takes an average of 9 to 12 months for the symptoms disappeared.6 Smidt and Struijs et al. indicate that it may take between 6 and 24 months if no intervention are done.5, 16,17,18,19
A prolonged overload creates change in the muscle and tendon tissue, which affect the function of the tissue. The tissue is under continuous stress and do not get time to relax after strain. The body tries to adjust to this ‘new function’ by making fibrotic tissue ” and circulation of the muscle and tendon tissue becomes less. The supply of nutrients and the removal of waste materials is greatly reduced because of the reduction of the muscle pump. Van den Bosch2 describes in his article that fuel shortages in cells leads to apoptosis and cell death. This also leads to a decline in the quality of the muscle and tendon tissue. De Vos8 goes, as Wilson, into the aspect of a vascular tendinopathy. The insertion of the extensor at the height of the lateral epicondyle is designated as a hypo vascular zone. In response to an overload, neovascularization takes place in this zone. Another pathophysiologic process that is mentioned, is the mechanical accumulation of calcium in the overloaded tissue. Verhaar7 notes that lime precipitation can be seen around the lateral epicondyle. When there is lime precipitation, this often gives pain during movement and decrease of pain at rest.
  1. Assendelft, W.J.J. e.a.(2001) NHG-Standaard Epicondylitis
  2. Bosch, F. van den (2006) En tot stof zult gij wederkeren. AMC Magazine. September. Nr 7: pp. 24-25
  3. Morree, J.J. (2001) Dynamiek van het menselijk bindweefsel: Functie, beschadiging en herstel. 4e druk. Houten/Diegem: Bohn Stafleu van Loghum.
  4. Peers, K.H.E. (2005) Chronische tendinopathie: van tendinitis tot tendinose en tendinopathie. Geneeskunde en Sport. Oktober 2005: 38(5): pp. 149-153
  5. Smidt, N. vander e.a. (2002) Behandeling van laterale epidcondylitis. Minerva. Maart 2003. Vol 2, nr2: pp. 23-25
  6. Smidt, N & van der Windt, D.A.W.M. (2006) Tennis elbow in primary care. British Medical Journal. November 2006
  7. Vicenzino, B. (2003) Lateral epicondylalgia: A musculoskelatal physiotherapy perspective. Manual Therapy. 2003: 8(2): pp. 66-79
  8. Vos, R.J. e.a. (2006) Recente ontwikkelingen in de behandeling van chronische tendinopathieen. Geneeskunde en Sport. Juni 2006: 39 (3): pp. 97-105
  9. Rompe J.D., Theis C., Maffulli N.: Stosswellentherapie bei tennisellenbogen; Literaturüberblick. In: Orthopäde, volume 34, blz. 567-570, 2005
  10. Van de Lisdonk EH, Van den Bosch WJHM, Lagro-Janssen ALM. Ziekten in de huisartspraktijk. 5e. ed. Maarssen: Elsevier Gezondheidszorg, 2008.
  11. Bot SD, Van der Waal JM, Terwee CB, Van der Windt DA, Schellevis FG, Bouter LM et al. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis 2005a;64:118-23.
  12. Brosseau, L.E.a. (2002) Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev;(4):CD003528. Review.
  13. Johnson G.W., Cadwallader K., Scheffel S.B. Epperly T.D.: Treatment of Lateral Epicondylitis. In: Am Fam Physician. 2007 Sep 15; 76(6): 843-8.
  14. Smidt N., van der Windt D.A.W.M., Assendelft W.J.J., Devillé W.L.J.M., Korthalsde Bos I.B.C., Bouter L.M.: Corticosteroid injections, physiotherapy, or a wait and see policy for lateral epicondylitis: a randomised controlled trial. In: Lancet 2002: 359: 657-62.
  15. Struijs P.A.A., Kerkhoffs G.M.M.J., Assendelft W.J.J. and van Dijk C.N.:Conservative Treatment of Lateral Epicondylitis: Brace Versus Physical Therapy or a Combination of Both – A Randomized Clinical Trial. In: Am. J. Sports Med. 2004; 32;462.
  16. Struijs P.A.A., Assendelf W.J.J., Kerkhoffs G.M.M.J., Souer S., van Dijk C.N.: The Predictive Value of the Extensor Grip Test for the Effectiveness of Bracing for Tennis Elbow. In: Am J Sports Med. 2005 Dec; 33(12): 1905-9. Epub 2005 Sep 12.
  17. Struijs P.A.A., Korthals-de Bos I.B.C., van Tulder M.W., van Dijk C.N., Bouter L.M. and Assendelft W.J.J.: Cost effectiveness of brace, physiotherapy, or both for treatment of tennis elbow. In: Br J Sports Med 2006; 40: 637-643.
  18. Viola L.: A critical review of the current conservative therapies for the tennis elbow (lateral epicondylitis) In: Australas Chiropr Osteopathy. 1998 Jul; 7(2): 53-67


 Physical Examination / Evidence Based Practice

Cozen’s test Utility ?
Study Sensitivity (show) Specificity (exclude)
Cozen1 NT NT


Maudsley’s test Utility ?
Study Sensitivity (show) Specificity (exclude)


  1. Cozen L. The painful elbow. Ind Med Surg. 1962;31:369-371

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