What are the treatment options for lateral epicondylitis (tennis elbow)?

From the Guidelines

Tennis elbow can be effectively treated with a combination of rest, physical therapy, and medication, with the most recent evidence suggesting that rest, physical therapy, and medication are the most effective treatment options. When treating lateral epicondylitis, it is essential to prioritize rest and reduced activity to decrease repetitive loading of the damaged tendon, as recommended by 1. The treatment plan should include:

• Reducing activities that cause pain
• Applying ice to the affected area for 15-20 minutes several times daily
• Over-the-counter pain relievers like ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) to manage pain and inflammation for 1-2 weeks
• Physical therapy exercises focusing on stretching and strengthening the forearm muscles, including wrist extensions, flexions, and pronation/supination movements performed 2-3 times daily with 10-15 repetitions each
• A counterforce brace worn just below the elbow to provide support during daily activities For persistent cases, the doctor might recommend corticosteroid injections, platelet-rich plasma therapy, or in rare cases, surgery, as suggested by 1. It is crucial to note that most cases improve within 6-12 weeks with consistent treatment, and tennis elbow occurs when the tendons connecting the forearm muscles to the elbow become inflamed from repetitive strain, highlighting the importance of proper technique during activities and ergonomic adjustments to the workspace as preventive measures, as mentioned in 1. The use of imaging studies, such as radiographs and MRI, can aid in the diagnosis and management of chronic elbow pain, as discussed in 1. Overall, a comprehensive treatment plan that incorporates rest, physical therapy, and medication, along with lifestyle modifications and potentially imaging studies, can effectively manage lateral epicondylitis and improve patient outcomes.

From the FDA Drug Label

Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. Epicondylitis may be treated by infiltrating the preparation into the area of greatest tenderness.

The treatment option for lateral epicondylitis (tennis elbow) is infiltrating triamcinolone acetonide into the area of greatest tenderness 2.

• Intra-articular administration is an option for short-term administration to tide the patient over an acute episode or exacerbation of epicondylitis.
• The initial dose for intra-articular administration can range from 2.5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entity being treated 2.
• For adults, doses up to 10 mg for smaller areas and up to 40 mg for larger areas have usually been sufficient 2.

From the Research

Treatment Options for Lateral Epicondylitis (Tennis Elbow)

The treatment options for lateral epicondylitis (tennis elbow) can be categorized into conservative and surgical methods.

• Conservative treatment options include:
  • Physiotherapy, which focuses on pain management, functional recovery, and recurrence prevention 3
  • Dry needling, which has been shown to be effective in reducing pain and improving function 4
  • Radial shock wave therapy, which has been found to decrease pain and functional impairment, and increase pain-free grip strength 5
  • Low-level laser therapy, which may be effective in the medium term 6
  • Corticosteroid injections, which can provide short-term pain relief but are associated with risks of adverse events and long-term reoccurrence 6
• Surgical treatment options include:
  • Minimal incision technique, which has been shown to provide good to excellent outcomes in most patients with a low complication rate and high patient satisfaction 7
  • Other surgical techniques, which may be prescribed when non-operative treatment fails 7

Non-Surgical Approaches

Non-surgical approaches are often recommended as the first line of treatment for tennis elbow.

• A "wait and see" approach is recommended in primary care for most cases 6
• Physiotherapy and other conservative treatments can be effective in managing symptoms and improving function 3, 4, 5, 6

Surgical Intervention

Surgical intervention may be considered when conservative treatment fails.

• The minimal incision technique is a surgical option that has been shown to be effective in improving symptoms and patient satisfaction 7