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Epicondylitis N040

Document
Last amended 
10 May 2016
Current RMA Instruments:
Reasonable Hypothesis SOP
7 of 2015
Balance of Probabilities SOP
8 of 2015
Changes from previous Instruments:

SOP Bulletin 179

ICD Coding:
  • ICD-9-CM Codes: 726.31,726.32
  • ICD-10-AM Codes: M77.0, M77.1
Brief description:

The epicondyles of the elbow are bony bumps at the bottom end of the humerus (upper arm) bone.  Tendons of the muscles that flex and extend the wrist attach to the medial (inner) and lateral (outer) epicondyles respectively.  Epicondylitis is a painful condition involving those tendons. The condition is actually a chronic tendinosis (with degeneration of tissue and new blood vessel formation), rather than a tendinitis (inflammation).  Lateral epicondylitis is more common than medial epicondylitis.  In rare cases both can occur together in the same arm.  The elbow joint itself is unaffected by epicondylitis.

Confirming the diagnosis

This diagnosis is made based on the clinical symptoms and signs.  Imaging (ultrasound or MRI) is generally unnecessary for diagnosis but may be undertaken in the assessment of the condition.

The relevant medical specialist is an orthopaedic surgeon, sports physician or a rheumatologist.

Additional diagnoses covered by these SOPs
  • Medial epicondylitis  (golfer’s elbow)
  • Lateral epicondylitis  (tennis elbow)
Conditions excluded from these SOPs
  • Asymptomatic inflammation or degeneration of the conjoined tendons.
  • Intra-articular elbow joint pathology.
  • Referred pain at the elbow
  • Traumatic bruise of the region → external bruise SOP.
  • Traumatic tear of the conjoined flexor or extensor tendon → Sprain and strain SOP.
Clinical onset

Clinical onset can be established based on the time of commencement of characteristic symptoms of inner or outer elbow pain, worse with repetitive activity of the wrist and elbow.

Clinical worsening

Symptoms will generally persist for betwen 6 months and 2 years, but may last longer and be unresponsive to treatment.  A range of treatment options are available, for which there is limited evidence of effectiveness.  Assessment of worsening would be based on the severity of symptoms and the degree of functional impariment.