From the Guidelines
Lateral epicondylitis, commonly known as tennis elbow, should be treated with a multimodal approach including activity modification, rest, ice, NSAIDs, and physical therapy, with corticosteroid injections considered for persistent cases. This condition is an overuse injury affecting the tendons that attach to the lateral epicondyle of the humerus, resulting from repetitive microtrauma to the extensor carpi radialis brevis tendon, causing inflammation and degeneration at its attachment to the lateral epicondyle 1.
Diagnosis
The diagnosis of lateral epicondylitis is primarily clinical, based on symptoms of pain and tenderness over the lateral epicondyle, with imaging such as radiographs and MRI used to rule out other causes of elbow pain 1. Key points to consider in diagnosis include:
- Clinical presentation of pain and tenderness over the lateral epicondyle
- Imaging to rule out other causes of elbow pain
- Differential diagnosis including osseous, soft tissue, cartilaginous, and nerve-related abnormalities
Treatment
Treatment begins with activity modification to avoid painful movements and rest from aggravating activities for 2-3 weeks. Apply ice for 15-20 minutes several times daily during acute pain phases. Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) can help manage pain and inflammation for 1-2 weeks 1. A counterforce brace worn just below the elbow may provide symptom relief during activities. Physical therapy focusing on eccentric strengthening exercises is crucial for recovery, typically 2-3 sessions weekly for 6-8 weeks. Gentle stretching of the wrist extensors (holding the arm straight, palm down, and gently pulling the hand downward for 30 seconds, repeating 3-5 times) should be performed several times daily. For persistent cases lasting over 6-12 months, corticosteroid injections may provide temporary relief, though they don't improve long-term outcomes 1.
Management
Key points in management include:
- Activity modification and rest
- Pain management with NSAIDs
- Use of a counterforce brace
- Physical therapy with eccentric strengthening exercises
- Gentle stretching of the wrist extensors
- Consideration of corticosteroid injections for persistent cases Most cases resolve with conservative treatment within 6-12 months, emphasizing the importance of a comprehensive and patient-centered approach to management 1.
From the FDA Drug Label
In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon The tendon may be readily palpated when placed on a stretch. When treating conditions such as epicondylitis, the area of greatest tenderness should be outlined carefully and the suspension infiltrated into the area. The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 to 30 mg In recurrent or chronic conditions, repeated injections may be necessary.
The diagnosis of lateral epicondylitis (Tennis Elbow) is not explicitly stated in the provided drug labels, but it can be inferred that it is a condition characterized by tenderness in the area. The treatment for lateral epicondylitis (Tennis Elbow) involves infiltrating the suspension into the area of greatest tenderness, with a dose ranging from 4 to 30 mg. Repeated injections may be necessary in recurrent or chronic conditions 2 2.
From the Research
Diagnosis of Lateral Epicondylitis
- Lateral epicondylitis is a common disease of the common extensor origin at the lateral humerus, leading to chronic therapy-resistant pain and functional disability of the affected arm 3.
- Radiological evaluation should be performed in therapy-resistant cases to determine the extent of the condition 3.
- Diagnosis is often based on clinical presentation and patient history, with imaging studies used to rule out other potential causes of elbow pain.
Treatment Options for Lateral Epicondylitis
- Conservative treatment is the primary choice for the treatment of lateral epicondylitis, including strengthening against resistance with eccentric stretching of the extensor group 3.
- First-line treatment consists of topical and oral anti-inflammatory drugs, ice application, and brace use 4.
- Dry needling has been shown to be an effective treatment option for lateral epicondylitis, with significant improvements in pain and function at 6 months 4.
- Other non-operative treatments include interventional therapies such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin injections 5.
- Operative treatment, including open, percutaneous, and arthroscopic approaches, is indicated for persistent debilitating pain in patients with lateral epicondylitis for more than 6 months 5.
- Arthroscopic extensor carpi radialis brevis debridement has been reported to be a safe and efficacious method for treating chronic lateral epicondylitis 6.
- Autologous blood injections and platelet-rich plasma injections are also used in the treatment of lateral epicondylitis, although more research is needed to determine their effectiveness 7.
Comparison of Treatment Options
- A study comparing dry needling to first-line treatment found that dry needling was significantly more effective at 6 months 4.
- A case study comparing platelet-rich plasma injection to arthroscopic extensor carpi radialis brevis tendon release and debridement found that the operative treatment was more effective in improving pain and function 6.
- A review of current trends in treating lateral epicondylitis found that non-operative injection therapies and arthroscopic intervention are emerging as effective treatment options 5.