From the Guidelines
The management of bilateral elbow pain should prioritize a multidisciplinary approach, including identifying and addressing the underlying cause, providing symptomatic relief, and implementing preventive measures to reduce recurrence, as recommended by the most recent guidelines 1. The initial step in managing bilateral elbow pain involves identifying the underlying cause, which could range from tendinosis, osteochondral injuries, to nerve-related abnormalities.
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily
- Over-the-counter pain medications such as ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) for 1-2 weeks to reduce inflammation and pain, are typically the first line of treatment. Physical therapy focusing on stretching and strengthening exercises for the forearm muscles is often beneficial, particularly for conditions like lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer's elbow) 1. Ergonomic modifications to work and daily activities are essential to prevent recurrence, including proper positioning during computer use and using tools with larger grips. For persistent pain, a healthcare provider may recommend corticosteroid injections, although these provide temporary relief and are limited to 2-3 injections per year. Bracing or splinting the elbows, particularly during activities, can help reduce strain on affected tendons. More severe or persistent cases may require advanced treatments such as platelet-rich plasma injections or, rarely, surgical intervention. Imaging studies, such as radiographs, are beneficial for the initial assessment of chronic elbow pain, and may be followed by MRI or CT scans for further evaluation if necessary, as outlined in the appropriateness criteria for chronic elbow pain 1. Bilateral elbow pain often indicates systemic conditions like rheumatoid arthritis or nerve compression syndromes, which require specific medical management addressing the underlying disease process.
From the Research
Management Approach for Bilateral Elbow Pain
The management of bilateral elbow pain involves a combination of non-surgical and surgical modalities.
- Non-surgical management includes activity modification, anti-inflammatories, hand therapy, and corticosteroids 2.
- Operative intervention may be considered once non-surgical management has failed, with the choice of surgical treatment depending on the underlying etiology, chief complaint, patient age, and functional demand 2.
- Topical non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in relieving lateral elbow pain in the short term, with minimal adverse effects 3.
- Oral NSAIDs may also provide short-term benefit, but the evidence is limited and there is a higher risk of gastrointestinal adverse effects 3.
- Conservative management, including splinting and proprioceptive retraining, may be effective in managing elbow joint symptoms, including pain and instability 4.
- Surgical options, such as elbow replacement, may be indicated in cases where conservative measures are not successful 4.
Treatment Strategies for Specific Conditions
- For tennis elbow, conservative treatment starting with cessation of the offending activity and prescription of an NSAID, followed by isometric and isotonic exercises, may be effective 5.
- For simple elbow dislocation, conservative treatment with early functional training of the elbow remains the first-line therapy, while surgical approaches may be considered for patients with persistent instability 6.
- Early mobilization after conservative or surgical treatment has been shown to improve range of motion and clinical outcome scores 6.