5299-5024 Epicondylitis (lateral or medial)

DBQ: Link to Index of DBQ/Exams by Disability for DC 5024 

Definition

Epicondylitis is defined as an inflammation of the lateral and medial epicondyles of the humerus and surrounding tissue.

Etiology

Etiologic factors related to lateral epicondylitis and medial epicondylitis are as follows:

  • Lateral epicondylitis is caused by overuse, e.g., supination of the wrist against resistance or pronation of the hand. Contributing factors are: poor technique in usage of the arm in tennis; weak wrist and arm muscles; improper racket handle; too-tightly strung racket; or hitting wet, heavy balls. This is referred to as backhand tennis elbow.

  • Medial epicondylitis is caused by using forceful wrist flexion and pronation of tendons that attach to the medial condyle. The condition is made worse by a tennis racket that is too heavy, or too much tension on the strings of the racket. Other factors include: weak shoulder and hand muscles, and carrying heavy items. Stress can cause the tendons to be pulled from the bone. This is referred to as forehand tennis elbow, golfers's elbow, or baseball elbow.

Signs & Symptoms

Manifestations of lateral epicondylitis and medial epicondylitis are as follows:

  • Lateral epicondylitis: When a person hits backhand in tennis, pain shoots along the lateral epicondyle. The pain becomes constant and extends to the wrist.

  • Medial epicondylitis: The patient complains of pain in the wrist when it is flexed.

Tests

Diagnostic measures for lateral and medial epicondylitis are as follows:

  • Lateral epicondylitis: The pain can be produced by having the patient try to raise the hand by bending the wrist against resistance.

  • Medial epicondylitis: The patient complains of pain when squeezing a hard rubber ball.

Treatment

Measures used to treat lateral and medial epicondylitis are as follows:

  • Lateral epicondylitis: Treatment involves ice; muscle strengthening; avoidance of activities that cause pain; and exercises for wrist pronator strength.

  • Medial epicondylitis: Treatment involves avoidance of activities that cause pain; and practice of exercises that strengthen wrist flexor pronators.

Residuals

When pain has been prolonged, surgical intervention has been successful.

Special Considerations

  • The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a).

  • Pain alone or any condition resulting in functional impairment of earning capacity, even in the absence of a specific diagnosis or otherwise identified disease or injury, may constitute a disability under 38 U.S.C. 1110 or 38 U.S.C. 1131 for which service connection may be granted. The Veteran’s pain or condition must result in functional impairment of earning capacity to constitute a disability.

  • When rating severity the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints.

  • When rating severity multiple involvement of the interphalangeal, metacarpal, and carpal joints; interphalangeal, metatarsal, and tarsal joints; and cervical vertebrae, thoracic/dorsal vertebrae, and lumbar vertebrae are considered minor joints, ratable as major joints.

  • The minimum compensable evaluation may be assigned under 38 CFR 4.59 based on subjective painful motion, and does not require objective evidence of painful motion.

  • To properly rate disability, accurate measurement of joint movement limitations is required and must be reported in degrees. The use of a goniometer in the measurement of range of motion in a joint is indispensable. 38 CFR 4.46 [Accurate measurement])

  • The provisions for 10 and 20 percent evaluations for arthritis with multiple joint involvement without limitation of motion do not apply to these conditions as is reflected in Note (2) under DC 5003.

  • Since this condition is not always chronic, chronic residuals are required to establish service connection.

  • May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

Notes

  • Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.