What is the treatment for lateral epicondylitis?

Treatment of Lateral Epicondylitis

Conservative treatment is the first-line approach for lateral epicondylitis, with approximately 80% of patients recovering completely within three to six months. 1

Diagnosis

• Lateral epicondylitis (tennis elbow) is primarily diagnosed clinically based on pain in the lateral epicondyle and pain with resisted wrist extension 1
• Radiography is the most appropriate initial imaging study to rule out other causes of elbow pain 2, 1
• If radiographs are normal but tendon injury is suspected, ultrasound or MRI without IV contrast is appropriate for assessment 2

First-Line Treatment

• Activity modification and relative rest to reduce repetitive strain on the damaged tendon 1, 3
• Application of ice (cryotherapy) for 10-minute periods to provide acute pain relief 1
• NSAIDs for short-term pain relief, though they don't affect long-term outcomes 1, 4
• Counterforce braces/orthoses to reduce tension on the tendon origin 1, 3
• Eccentric strengthening exercises to promote tendon healing and increase strength 1, 5
• Stretching exercises for the wrist extensors 1

Physical Therapy Interventions

• Manual joint mobilization combined with exercise therapy is more effective than exercise therapy alone 2
• Deep transverse friction massage can help reduce pain 1, 6
• Progressive strengthening program focused on the extensor muscle groups 1, 4
• Ultrasound therapy may be beneficial as a complementary treatment 1, 6
• Local heat application (paraffin, warm compresses) before exercise 1

Advanced Interventions

• Injections may be considered for persistent cases:
  • Options include corticosteroid, autologous blood, platelet-rich plasma, and botulinum toxin 5
  • These can provide both short-term and long-term outcomes in pain resolution and functional improvement 5

Surgical Management

• Reserved for patients with persistent symptoms despite 6+ months of conservative treatment 5, 7
• Surgical approaches include open, percutaneous, and arthroscopic techniques 5, 4
• Surgery has good clinical outcomes but should not be first-line due to potential complications and because many patients respond well to conservative treatment 2

Prevention and Risk Reduction

• Modify gripping techniques to reduce stress on the lateral epicondyle during daily activities 8
• Incorporate appropriate warm-up before activities involving repetitive wrist extension 8
• Avoid activities that don't allow proper rest between repetitive wrist extension movements 8

Common Pitfalls

• Failing to recognize that lateral epicondylitis is primarily a degenerative tendinopathy rather than an inflammatory condition 5
• Overreliance on corticosteroid injections, which may provide short-term relief but can potentially lead to tendon weakening with repeated use 5
• Not addressing the underlying biomechanical factors that contribute to the condition, such as repetitive wrist extension against resistance 8
• Returning to aggravating activities too quickly before adequate healing has occurred 1, 3