This patient has signs and symptoms of lateral epicondylitis. The most common overuse syndrome is related to excessive wrist extension and commonly referred to as “tennis elbow,” but it is actually more common in non-tennis players. This is an overuse tendinopathy of the common extensor tendon origin of the lateral elbow. The typical age of those affected is 40 to 50 years and these patients most typically report an insidious onset, but they will often relate a history of overuse without specific trauma. The patient complains of pain over the lateral elbow that worsens with activity and improves with rest. Symptom onset generally occurs 24-72 hours after repeated wrist extension activity. Plain films are rarely needed in the initial workup of lateral epicondylitis however plain films may reveal osteophytes or calcifications along the lateral epicondyle. Conservative care that includes offloading the involved tendon is the key to improving outcomes at one year, which would mean modifying this patient’s work routines.
Surgery (C) is only recommended in cases unresponsive to conservative treatment. The evidence is weak for splinting (D), with one study showing it results in more limited activity and longer duration of treatment. Recent randomized controlled trials have made it clear that while corticosteroid injections (B) reduce acute pain for up to six weeks, their use increases rates of poor long-term outcomes.