What is the treatment for lateral epicondylitis?

Treatment for Lateral Epicondylitis

The most effective treatment approach for lateral epicondylitis is a comprehensive rehabilitation program including NSAIDs for pain relief, eccentric strengthening exercises, and functional support with a brace, while avoiding immobilization and limiting corticosteroid injections. 1

Initial Management

1. Pain Management:

   • NSAIDs are recommended for short-term pain relief
     • Ibuprofen 1.2g daily initially, can be increased to 2.4g daily if needed
     • Naproxen 500mg twice daily is an alternative option 1, 2
   • Apply ice for 15-20 minutes several times daily during acute phase

2. Bracing:

   • Use of an inelastic, nonarticular, proximal forearm strap (tennis elbow brace) improves function during daily activities 1, 2
   • The brace should be worn during activities that provoke symptoms

3. Activity Modification:

   • Temporarily avoid activities that exacerbate symptoms
   • Do not completely immobilize the elbow 1

Rehabilitation Program (Phased Approach)

Phase 1 (0-4 weeks): Pain Control and Protected Range of Motion

• Gentle stretching of wrist extensors
• Isometric exercises for wrist extensors
• Pain-free range of motion exercises

Phase 2 (4-8 weeks): Progressive Strengthening

• Eccentric strengthening exercises for wrist extensors
• Gradually increase resistance
• Continue stretching program

Phase 3 (8-12 weeks): Occupation-specific Training

• Functional exercises specific to patient's activities
• Sport or work-specific movement patterns
• Gradual return to normal activities 1

Advanced Interventions (for persistent symptoms)

1. Injection Therapy:

   • Corticosteroid injections provide short-term relief but do not improve long-term outcomes
   • Limit to 2-3 injections with 4-6 weeks between injections 1, 2
   • Biologics such as platelet-rich plasma (PRP) or autologous whole-blood injections may be superior to steroid injections for long-term management 3

2. Physical Therapy Modalities:

   • Ultrasound therapy
   • Soft tissue mobilization
   • Friction massage
   • Shockwave therapy (limited benefit) 3, 2

When to Consider Surgical Intervention

Surgery should only be considered when:

• Conservative measures have failed after 3-6 months of well-managed treatment
• Significant functional limitation persists 1, 4

Surgical options include:

• Open, arthroscopic, or percutaneous techniques (all highly effective)
• Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work 3, 4

Follow-up and Monitoring

Regular assessment at 2,6, and 12 weeks to evaluate:

• Pain levels
• Range of motion
• Functional improvement 1

Common Pitfalls and Caveats

• Avoid overreliance on corticosteroid injections as they may lead to tendon weakening with repeated use
• Do not completely immobilize the elbow as this can lead to stiffness
• Recognize that most cases are self-limiting over time, but may take several months to resolve completely 3
• Consider specialist referral if no improvement occurs after 6-8 weeks of conservative treatment 1
• Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective for lateral epicondylitis 2