From the Guidelines
The recommended treatment for lateral epicondyle tendonosis (tennis elbow) begins with conservative measures, prioritizing eccentric strengthening exercises and avoiding corticosteroid injections due to potential long-term detrimental effects.
Treatment Approach
The treatment approach should focus on:
- Conservative measures including rest, activity modification, and avoiding movements that aggravate symptoms
- Physical therapy focusing on eccentric strengthening exercises of the wrist extensors, typically performed for 6-12 weeks
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for short-term pain management, as noted in 1
- Counterforce bracing with a tennis elbow strap worn just below the elbow to reduce tension on the affected tendon during activities
- Ice application for 15-20 minutes several times daily for temporary pain relief
Additional Considerations
For persistent cases, physical therapy modalities such as ultrasound or iontophoresis might be beneficial. Corticosteroid injections, as discussed in 1, can provide short-term relief but may be detrimental long-term, and their use should be cautioned against due to the potential for inhibiting healing and reducing tensile strength of the tissue. Platelet-rich plasma injections are sometimes used for refractory cases, and surgery is reserved for cases that fail to improve after 6-12 months of conservative treatment, as suggested by 1. This stepped approach addresses the underlying pathology of tendon degeneration while managing symptoms and promoting healing.
From the FDA Drug Label
For the treatment of ... epicondylitis The recommended treatment for lateral epicondyle tendonosis (tennis elbow) is intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension as adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation, specifically for epicondylitis 2.
- Key points:
- Intra-articular or soft tissue administration
- Adjunctive therapy
- Short-term administration
- For acute episode or exacerbation
- Specifically for epicondylitis
From the Research
Treatment Options for Lateral Epicondyle Tendonosis
- Nonoperative management is often the first line of treatment, including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy 3
- For recalcitrant symptoms, additional nonoperative therapies such as injections may be implemented 3
- Platelet-rich plasma (PRP) injections and corticosteroid injections are two common injection therapies used to treat lateral epicondyle tendonosis 4, 5, 6
- Corticosteroid injections provide rapid symptomatic improvement in the short-term, but symptoms may recur afterwards 4, 5, 6
- PRP injections provide a slower but longer-term therapeutic effect with less rate of complications compared to corticosteroid injections 4, 5
Comparison of PRP and Corticosteroid Injections
- A systematic review of systematic reviews found that PRP injections were more efficacious for long-term pain relief and improved function, while corticosteroid injections were more efficacious for short-term pain relief 4
- Another systematic review found that PRP injections provided longer-term therapeutic effects and less rate of complications compared to corticosteroid injections 5
- A randomized controlled trial found that neither PRP nor corticosteroid injections were superior to saline in reducing pain at 3 months, but corticosteroid injections had a short-term pain-reducing effect at 1 month 6
Other Treatment Options
- Surgical intervention may be considered for refractory cases, but controversy remains regarding its role in treatment 7
- Other treatment options, such as bracing and physical therapy, may also be used to manage lateral epicondyle tendonosis, but more research is needed to determine their effectiveness 3, 7