Lateral Epicondylitis (Tennis Elbow)

         Lateral epicondylitis is one of the most commonly diagnosed musculoskeletal disorders of the upper extremity. Also known as “tennis elbow”, this pathology is a painful condition of tendinous origin of the wrist extensor muscles.

       injury; It is due to stress around the attachment of the common extensor tendon to the lateral humeral epicondyle in response to high repetition or hand-held sports with compelling activities with high power (tennis, water polo, baseball, fencing).

      Lateral epicondylitis is more common than medial epicondylitis and usually affects individuals aged 40-60 years and is equally prevalent among men and women.

      The main symptom is pain localized in the lateral elbow region, which corresponds to the lateral epicondyle of the humerus. Typically associated with activity and exacerbated by wrist and hand movements. Pain may radiate to the forearm and impair grip. During the clinical examination, a typical tenderness on the lateral side of the elbow will often become evident. The duration of symptoms usually ranges from a few weeks to several months.

     First-line treatment usually consists of ice application, upper extremity immobility, and NSAIDs. Shock wave therapy can reduce symptoms in the medium term.

       As an interventional treatment, an injection with USG is planned. After the patient is seated in front of the doctor, the elbow is flexed to 90° and the thumb is facing up. With USG, the common extensor tendon is visualized using a longitudinal scan: the proximal part of the probe is placed on the hyperechoic bony line of the lateral epicondyle, while the distal part of the probe is aligned with the common extensor tendon.

       A 20G needle is then inserted in the proximal-distal direction and, after some anaesthetic is injected into the peritendinous soft tissues and degenerated parts along the path of the needle, 1 ml of long-acting steroid (40mg/ml) is injected superficially into the tendon attachment site, and then the needle is removed.

        After the procedure, the patient is kept under observation for at least 10 minutes. Pain may occur after treatment and is managed with oral NSAIDs. Although a systematic rest period is not recommended, patients are advised to use orthotic support and to reduce their manual activities.