🔑 Key Learning

  • Tennis Elbow (lateral epicondylitis): Repetitive extension → pain over lateral epicondyle, worse with resisted wrist extension.
  • Golfer’s Elbow (medial epicondylitis): Repetitive flexion → pain over medial epicondyle, worse with resisted wrist flexion.
  • Olecranon Bursitis: Fluctuant swelling over olecranon; may be infective (e.g. Staph aureus) or non-infective (e.g. trauma/pressure).
    • Infective bursitis → aspirate and treat with antibiotics - 1st line: Flucloxacillin

🎾 Tennis Elbow (Lateral Epicondylitis)

🧬 Pathophysiology

  • Enthesopathy due to overuse of wrist extensors, especially extensor carpi radialis brevis, at their point of attachment to the lateral epicondyle of the humerus
  • Caused by activities which involve repetitive use of the extensor muscles of the forearm, and grip-intensive activities - such as playing tennis or painting. 
Figure 233: Lateral Epicondylitis. www.scientificanimations.com, CC BY-SA 4.0.

👀 Clinical Features

  • Pain and tenderness over the lateral epicondyle of the humerus
  • Pain worsens with:
    • Wrist extension against resistance
    • Supination of the forearm
  • Pain may radiate down forearm
  • Examination findings:
    • Tenderness over lateral epicondyle
    • Pain provoked by resisted wrist extension

💊 Management

  • 1st Line: Paracetamol or topical NSAID
  • 2nd Line: Oral NSAID
  • Refer to physiotherapy for strengthening and stretching
  • NICE: 'Do not routinely offer corticosteroid injection' — short-term relief but unlikely to affect long-term outcomes, relapses common.
  • If no response at 6-12 months, consider referral to T&O for evaluation 

🏌️‍♂️ Golfer’s Elbow (Medial Epicondylitis)

🧬 Pathophysiology

  • Enthesopathy due to inflammation of flexor-pronator muscle origin at the medial epicondyle.
  • Caused by repetitive flexion (e.g. golf, throwing sports).
Figure 233: Medial Epicondylitis - Golfer's elbow. InjuryMap, CC BY-SA 4.0

👀 Clinical Features

  • Pain over the medial epicondyle of the humerus
  • Pain worsens with:
    • Wrist flexion against resistance
    • Gripping objects
  • May radiate to wrist

🧪 Examination Findings

  • Tenderness over medial epicondyle
  • Pain reproduced by resisted wrist flexion

💊 Management

  • Same as for tennis elbow:
    • Analgesia (paracetamol, NSAIDs)
    • Physio referral

🦴 Olecranon Bursitis

🧬 Pathophysiology

  • Inflammation of the olecranon bursa → increased fluid → swelling over the posterior elbow.
  • Causes:
    • Non-infective: repetitive trauma (e.g. "student’s elbow")
    • Infective: commonly Staph aureus (90%)

👀 Clinical Features

  • Fluctuant swelling over olecranon
  • May be red, warm, tender (especially if infected)
  • Full range of motion (ROM) usually preserved
  • Red flags: fever, spreading cellulitis, increasing pain
Figure 234: Olecranon bursitis.

🧪 Investigations

  • Clinical diagnosis
  • If infective suspected → aspirate and send fluid for MCS

💊 Management

  • Non-infective:
    • RICE, analgesia
    • Consider aspiration/steroid injection
  • Infective:
    • Aspirate + send for MCS
    • Start antibiotics: flucloxacillin 1st line

📝 Exam Clues & Clinchers

  • Lateral epicondylitis = pain with resisted wrist extension
  • Medial epicondylitis = pain with resisted wrist flexion
  • Olecranon bursitis = posterior swelling sparing joint ROM
  • Fever + swelling = infective bursitis → aspirate + treat