From the Guidelines
Lateral epicondylitis should be treated with relative rest, icing, and eccentric strengthening exercises as the primary approach, given that most patients (about 80 percent) fully recover within three to six months with this regimen 1.
Diagnosis and Treatment Approach
Lateral epicondylitis, commonly referred to as tennis elbow, is a degenerative condition rather than an inflammatory one, and thus should be labeled as "tendinosus" or "tendinopathy" 1. The diagnosis is based on historical features, anatomy, and specific physical examination maneuvers, including inspection for swelling, asymmetry, and erythema, range-of-motion testing, palpation for tenderness, and maneuvers that simulate tendon loading to reproduce pain 1.
Management Strategies
Key management strategies include:
- Relative rest of the affected area to reduce further strain on the tendons
- Icing to help manage pain and inflammation
- Eccentric strengthening exercises, which are crucial for recovery and should be tailored to the individual's specific condition and capabilities
- Consideration of topical or systemic nonsteroidal anti-inflammatory drugs (NSAIDs) for acute pain relief, although their long-term use is not recommended due to potential side effects 1
- Injected corticosteroids may provide temporary relief but should be used cautiously due to potential long-term tendon weakening 1
Additional Considerations
Other treatment options such as ultrasonography, shock wave therapy, orthotics, massage, and technique modification may be considered, but the evidence supporting their use is limited 1. Surgery is an effective treatment option but should be reserved for patients who have failed conservative therapy 1. Proper ergonomics and technique modification in work and sports activities are essential for both prevention and recovery from lateral epicondylitis.
From the Research
Definition and Causes of Lateral Epicondylitis
- Lateral epicondylitis, also known as tennis elbow, is an overuse tendinopathy of the common extensor origin of the elbow in patients involved in repetitive movement of the wrist and forearm 2.
- It is generally regarded as an overuse injury involving repeated wrist extension against resistance, although it can occur as an acute injury (trauma to the lateral elbow) 3.
- The exact pathogenesis remains largely elusive with putative tendinosis, a symptomatic degenerative process of the local tendon 4.
Diagnosis and Prevalence
- Lateral epicondylitis is usually diagnosed by clinical examinations, and sometimes additional imaging is required for a specific differential diagnosis 4.
- It is estimated to affect 1-3% of the adult population each year and is more common in the dominant arm 3.
- Up to 50% of all tennis players develop symptoms due to various factors including poor swing technique and the use of heavy racquet 3.
Treatment Options
- Lateral epicondylitis is a self-limiting condition, with operative management only recommended in severe, recalcitrant cases 2.
- Non-operative treatment options are available, including corticosteroid injection (CSI), autologous blood (AB), and platelet-rich plasma (PRP) injections 5.
- The current best available evidence suggests that CSI improves functional outcomes and pain relief in the short term, while AB and PRP are the most effective treatments in the intermediate term 5.
- Surgical treatment options are also available, and the choice of treatment depends on the severity of the condition and the patient's response to non-operative treatment 6.