What is the treatment for lateral or medial epicondylitis (tennis elbow or golfer's elbow)?

From the Guidelines

Treatment for epicondylitis should begin with conservative measures, including rest, ice application, and over-the-counter pain medications, as well as physical therapy focusing on eccentric strengthening exercises and stretching, as recommended by the most recent guidelines 1. The goal of treatment is to reduce inflammation, promote healing, and prevent recurrence. Conservative measures are effective in most cases, and surgery is rarely needed.

• Rest from aggravating activities is essential to prevent further damage and promote healing.
• Ice application for 15-20 minutes several times daily can help reduce inflammation and relieve pain.
• Over-the-counter pain medications like ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) can be used for 1-2 weeks to reduce inflammation.
• A counterforce brace worn just below the elbow can help redistribute forces away from the injured tendon.
• Physical therapy focusing on eccentric strengthening exercises and stretching is crucial for recovery, typically 2-3 sessions weekly for 6-8 weeks. For persistent pain, corticosteroid injections may provide temporary relief, though they're generally limited to 2-3 injections spaced at least 3-4 months apart due to potential tendon weakening, as noted in earlier studies 1. Most cases resolve within 6-12 months with these approaches.
• Surgery is rarely needed (less than 10% of cases) and only considered after 6-12 months of failed conservative treatment. Proper ergonomics and technique modification in sports or work activities are essential to prevent the condition from returning once healed. The most recent guidelines 1 emphasize the importance of conservative measures and provide recommendations for treatment, including the use of imaging studies like radiographs to aid in diagnosis.

From the Research

Treatment Options for Epicondylitis

• Non-surgical approaches are the mainstay of management, including:
  • Rest
  • Nonsteroidal anti-inflammatory drugs
  • Physical therapy
  • Corticosteroid injections, which may provide short-term pain relief but may be detrimental to recovery in the long term 2, 3, 4
  • Bracing
  • Local modalities
• Other non-operative treatments include:
  • Platelet-rich plasma injections, although their effectiveness is not proven by well-controlled clinical trials 2, 3, 5
  • Botulinum toxin A injections, which may produce concomitant extensor weakness 3
  • Prolotherapy, which has been found to be superior to placebo but not to corticosteroids 3
  • Low-level laser therapy, which has shown superiority to placebo in some studies but not others 3
  • Autologous blood injections, which have been found to be both more and less effective than corticosteroid injections 3
  • Biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates, which are under clinical use and investigations 5

Surgical Intervention

• For patients with symptoms refractory to conservative management, surgical intervention has shown to be a successful treatment modality 2, 4, 5
• Surgical approaches include:
  • Open débridement technique
  • Arthroscopic procedures
  • Percutaneous procedures
• Surgical treatment is usually considered for patients with persistent debilitating pain for more than 6 months 5