What is the initial treatment for elbow tendinitis?

Initial Treatment for Elbow Tendinitis

The initial treatment for elbow tendinitis should include conservative measures such as rest, activity modification, analgesia with NSAIDs, physical therapy with eccentric strengthening exercises, and potentially corticosteroid injections. 1, 2

First-Line Management Algorithm

1. Rest and Activity Modification

   • Reduce or avoid activities that exacerbate symptoms
   • Modify technique in sports or occupational activities that trigger pain
   • Relative rest rather than complete immobilization 2

2. Pain Management

   • NSAIDs as first-line medication:
     • Naproxen 500mg twice daily initially, then adjust to lowest effective dose 3
     • Use for shortest duration necessary to control symptoms
     • Consider patient's renal function, age, and comorbidities when dosing
   • Acetaminophen (up to 4g/day) if NSAIDs are contraindicated 2

3. Physical Therapy (0-4 weeks)

   • Eccentric strengthening exercises of the affected tendon 2
   • Gentle stretching of the involved muscle groups
   • Deep transverse friction massage 2
   • Sport-specific or activity-specific exercises 2

4. Supportive Measures

   • Ice application for 15-20 minutes several times daily
   • Counterforce bracing/splinting to reduce stress on the tendon insertion 2, 4

If No Improvement After 4-6 Weeks

1. Corticosteroid Injections
   • Consider for persistent pain despite conservative measures 1, 2
   • Caution: Avoid peri-tendon injections due to risk of tendon rupture 2
   • Limited to 2-3 injections with at least 4-6 weeks between injections

Imaging Considerations

• Plain radiographs are beneficial as initial imaging to rule out other causes 1
• MRI or ultrasound only if symptoms persist despite 3-6 months of conservative treatment 2

Treatment Duration and Expectations

• Patient education about the typically prolonged recovery (3-6 months) is essential 5
• Reassess pain and function every 4-6 weeks 2
• Adjust treatment plan if no improvement after 8-12 weeks of consistent therapy 2

When to Consider Surgery

• Surgery should only be considered if symptoms don't improve after 3-6 months of well-managed conservative treatment 2, 5
• Required in less than 10% of cases 5, 4
• Surgical recovery also requires 3-6 months 5

Common Pitfalls to Avoid

1. Premature return to aggravating activities before adequate healing
2. Overreliance on passive modalities without proper eccentric strengthening
3. Excessive corticosteroid injections which can lead to tendon weakening
4. Failure to address biomechanical factors contributing to the condition
5. Delaying appropriate treatment which can lead to chronic tendinopathy

Remember that tendinitis (particularly lateral epicondylitis or "tennis elbow") has a good prognosis with appropriate conservative management, with over 90% of cases resolving without surgery 4.