From the Guidelines
Tennis elbow, or lateral epicondylitis, is a painful condition that should be treated with rest, ice, and over-the-counter pain relievers like ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) for 1-2 weeks, as this approach has been shown to be effective in reducing pain and promoting healing 1.
Treatment Approach
The treatment of tennis elbow typically involves a combination of conservative measures, including:
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
- Cryotherapy, such as applying ice for 15-20 minutes every 2-3 hours, to provide acute relief of tendinopathy pain 1
- Eccentric strengthening exercises, which have been shown to be an effective treatment of tendinopathy and may reverse degenerative changes 1
- The use of orthotics and braces, such as a counterforce brace worn just below the elbow, to reduce strain and provide support 1
Medications and Injections
In addition to conservative measures, medications and injections may be used to manage pain and promote healing, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), which are recommended for short-term pain relief but have no effect on long-term outcomes 1
- Topical NSAIDs, which may be effective and have fewer systemic side effects 1
- Locally injected corticosteroids, which may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes 1
Surgery and Other Options
In cases where conservative treatment is not effective, surgery may be considered, as it has been shown to be an effective option in carefully selected patients who have failed three to six months of conservative therapy 1. Other options, such as extracorporeal shock wave therapy, may also be considered, although the evidence for their effectiveness is limited 1.
Prevention
Prevention of tennis elbow involves proper technique during activities, using appropriate equipment, taking breaks during repetitive tasks, and performing regular forearm strengthening exercises, which can help to reduce the risk of developing the condition 1.
From the Research
Definition and Causes of Tennis Elbow
- Tennis elbow, also known as lateral epicondylitis, is a common condition that presents with pain and tenderness around the common extensor origin of the elbow 2.
- It is estimated to affect 1-3% of the adult population each year and is more common in the dominant arm 2.
- Tennis elbow 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) 2.
- It is also seen in laborers who utilize heavy tools or engage in repetitive gripping or lifting tasks 2.
Symptoms and Diagnosis
- Tennis elbow is accompanied by degenerative changes in the enthesis of the extensor carpi radialis brevis muscle 3.
- It may be best diagnosed clinically by eliminating other possible causes of lateral elbow pain 3.
- The condition presents with pain and tenderness around the common extensor origin of the elbow 2.
Treatment Options
- Conservative treatment programs have resulted in a high success rate, and include relieving inflammation and pain, promoting the healing process, exercises for strength and flexibility, and reducing overload forces 4.
- Physical methods should always be selected as initial treatment, including immobilization, ultrasound, and low energy laser 3.
- Injection therapies, such as autologous blood and platelet-rich plasma, have been shown to be effective in treating tennis elbow 5.
- Surgery may be required as a last resort in patients with chronic symptoms 4, 3.
- Other forms of physical treatment, such as electrotherapy, thermotherapy, and massages, can be tried, although proof of their efficacy needs to be established more firmly 3.
- Acupuncture and shock wave therapy have been shown to be ineffective in treating tennis elbow 5.