Question
A 45 year old carpenter has 8 months of lateral elbow pain that is worse with gripping. A physiotherapy program and one corticosteroid injection have not helped.
- What is the pathology?
- What is the differential diagnosis?
- What are the treatment options?
Answer
Pathology
- Lateral elbow tendinopathy (tennis elbow), angiofibroblastic degeneration of the extensor carpi radialis brevis origin
- Degenerative tendinosis with disorganised collagen and neovascularisation, without inflammation
- Peak age 35 to 55, related to repetitive gripping and wrist extension
Differential diagnosis
- Radial tunnel syndrome, with tenderness over the supinator and pain on resisted middle finger extension
- Posterolateral rotatory instability
- Radiocapitellar arthritis or plica
- Cervical radiculopathy
Treatment options
- Most settle within 12 to 18 months
- Activity modification, counterforce brace and eccentric loading exercises
- Corticosteroid injection gives short term relief but worse outcomes at 1 year than physiotherapy or waiting (Bisset, BMJ 2006)
- Platelet rich plasma has mixed evidence
- Surgery for symptoms beyond 6 to 12 months, with open or arthroscopic debridement of the ECRB origin
- Avoid over release of the lateral ulnar collateral ligament, which causes instability
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.