From the Guidelines
Initial treatment for both tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) should focus on conservative measures including rest, activity modification, and pain management, as most patients improve within 6-12 weeks with consistent adherence to these measures.
Key Recommendations
- Rest the affected arm and avoid activities that cause pain
- Apply ice for 15-20 minutes every 2-3 hours for the first few days
- Use NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (250-500mg twice daily) for 1-2 weeks to reduce pain and inflammation
- Consider using a counterforce brace worn just below the elbow to redistribute forces away from the injured tendon
- Gentle stretching and strengthening exercises should begin after acute pain subsides, typically after 1-2 weeks, including wrist extensions for tennis elbow and wrist flexion exercises for golfer's elbow, starting with 3 sets of 10 repetitions daily
Rationale
These recommendations are based on the evidence from studies such as 1, which suggests that relative rest, cryotherapy, and eccentric strengthening are effective treatments for tendinopathy. Additionally, NSAIDs are recommended for short-term pain relief, but have no effect on long-term outcomes 1.
Additional Considerations
- Orthotics and braces may be useful adjuncts to therapy, but few data support definitive conclusions regarding their effectiveness 1
- Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1
- Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months with outpatient treatment consisting of relative rest, icing, and eccentric strengthening exercises 1
From the Research
Initial Treatment Recommendations
The initial treatment recommendations for tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) vary, but some common approaches include:
- Rest, ice, and anti-inflammatory medications to relieve inflammation and pain 2
- Corticosteroid injections, although their use is debated due to potential harmful effects in the long term 3, 4
- Platelet-rich plasma (PRP) injections, which have shown promise in treating chronic tennis elbow 5, 6
- Exercises for strength, endurance, and flexibility in the arm and forearm 2
- Use of a counterforce brace and modification of the player's technique and equipment to reduce overload forces 2
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for tennis elbow, including:
- PRP injections versus autologous whole blood injections, with some studies showing no significant difference between the two 5 and others suggesting PRP may be slightly superior in the long term 6
- Corticosteroid injections versus other treatments, with some studies highlighting the risks of adverse events and long-term reoccurrence associated with corticosteroid use 3, 4
Golfer's Elbow Treatment
There is limited information available on the treatment of golfer's elbow (medial epicondylitis) in the provided studies, which primarily focus on tennis elbow (lateral epicondylitis). However, it is likely that similar treatment approaches, such as rest, ice, and anti-inflammatory medications, may be recommended for golfer's elbow as well. Further research is needed to determine the most effective treatment options for golfer's elbow.