Understanding Lateral Epicondylitis

As an occupational therapist, at least half of my caseload typically consists of clients with elbow, wrist, hand, and/or thumb pain.  Recently, I have noticed an increase in clients with lateral epicondylitis specifically, so I thought I’d write a post on how I help clients with that diagnosis from an ergonomics perspective.

Lateral epicondylitis, also known as “tennis elbow”, is caused by inflammation of the tendons that attach to the outside aspect of the elbow (the lateral epicondyle).  The symptoms can range from occasional pain near the elbow to pain and weakness so disabling that use of the entire upper extremity is difficult.

When I work with clients who have lateral epicondylitis, most report a gradual onset of symptoms.  There isn’t always a specific incident that they associate with causing this pain, but they usually first notice intermittent soreness in the forearm that becomes more painful and consistent over time.  If left untreated, it often progresses to feelings of weakness with everyday tasks such as picking up a coffee cup or using a computer mouse.  And symptoms that were intermittent can become nearly constant, even at rest.

In addressing these symptoms from an ergonomics perspective, I think it’s important to first provide education on what the diagnosis means and which postures and movements will continue to aggravate the affected structures.  By the time most clients ask for my help, they are feeling a lot of stress and helplessness as they see their functional abilities decrease due to pain (especially when the symptoms are on their dominant side).  And if the onset of symptoms is fairly recent many of them have not sought any medical attention.  Educating them about their diagnosis and how to decrease stress to the elbow to manage their symptoms can be very empowering for them.

What I explain to my clients is that lateral epicondylitis, while technically a result of inflammation of the structures around the elbow, is usually primarily caused by overuse of the hand, not the elbow.  The tendons that attach to the lateral epicondyle of the elbow are part of the muscles that travel to the forearm, wrist, and hand.

Therefore, when the muscles of the hand and wrist are overused, the inflammation is felt at the attachment point of those tendons (at the elbow).  So how you’re using your hand and wrist is usually more to blame for the pain than what position your elbow is in.

The two postures that are most aggravating to the tendons when someone is experiencing lateral epicondylitis are:

  • gripping with the hand (especially if forceful and/or with high repetition)
  • extreme range of motion of the wrist

So, in addition to addressing any ergonomic risk factors that I see in their workstation setup, I ask clients to pay attention to the way they are using the hand on their affected side, especially when they are experiencing an increase in symptoms.  Are they gripping a pen or a kitchen knife tighter than necessary?  Are they doing activities that put their wrist in a very flexed or extended position?  Are they performing any activities with their hand that combine these two stressful postures?

Often, once clients better understand these risk factors, they can start to modify their behavior at work and at home and feel some relief.

However, it’s close to impossible to rest the arm completely in real life, especially if it’s the dominant side.  And if the inflammation is severe and the client has not sought any medical treatment, I often recommend that they at least see their doctor for a proper diagnosis and treatment plan.

Lateral epicondylitis, when not properly treated, can become a chronic condition and can significantly limit a person’s ability to participate in daily activities.  A short course of supervised anti-inflammatory treatment (whether with oral or injected medication, use of ice, use of a forearm band, and/or a few hand therapy or physical therapy visits) is often necessary to adequately reduce acute inflammation.

But even with medical care, the client is still at risk of a flare-up of symptoms if they do not make changes to how they use their hand and arm.  And there are definitely lifestyle habits that encourage and/or discourage inflammation in the body.  So ergonomic changes at work and at home and better awareness of posture and lifestyle are still important in order to treat the cause of the inflammation in the first place.

You can find out more about lateral epicondylitis here.

If you’re experiencing pain with activities at work or home, I’m here to help!  I can evaluate your home or work environment and recommend ergonomic and lifestyle changes to reduce risk factors for injury, lessen your pain, and improve your functional abilities for the activities that are important to you.  Contact me and let me know how I can help!