What is the treatment for tennis elbow?

Treatment of Tennis Elbow (Lateral Epicondylitis)

Conservative management with relative rest, activity modification, eccentric strengthening exercises, and NSAIDs is the first-line treatment for tennis elbow. 1

First-Line Treatment (0-8 weeks)

• Relative rest and activity modification to prevent ongoing damage while avoiding complete immobilization that could lead to muscle atrophy 1
• Continue activities that don't worsen pain, but modify or temporarily stop those that aggravate symptoms 1
• Apply ice (cryotherapy) for 10-minute periods through a wet towel for effective short-term pain relief 1
• Use NSAIDs (oral or topical) for pain relief, with topical options preferred to avoid gastrointestinal side effects 1
• Apply counterforce bracing/tennis elbow bands to reinforce, unload, and protect tendons during activity 1, 2
• Begin eccentric strengthening exercises to promote tendon healing and increase strength 1
• Incorporate stretching exercises for the wrist extensors 1

Second-Line Treatments (if symptoms persist beyond 4-8 weeks)

• Consider corticosteroid injections for short-term relief in the acute phase, though they don't alter long-term outcomes 1
• Use corticosteroid injections with caution as they may inhibit healing and reduce tendon tensile strength, potentially predisposing to spontaneous rupture 2, 1
• Therapeutic ultrasound may decrease pain and increase collagen synthesis, though evidence for consistent benefit is weak 2, 1
• Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research 2, 1
• Deep transverse friction massage can reduce pain 1

Surgical Management (for refractory cases)

• If pain persists despite 6-12 months of well-managed conservative treatment, surgical evaluation is warranted 1
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2, 1

Common Pitfalls and Caveats

• Overreliance on corticosteroid injections may lead to tendon weakening and potential rupture 1
• Complete immobilization should be avoided as it leads to muscle atrophy and deconditioning 1
• Despite their widespread use, there's limited evidence supporting the effectiveness of orthotics and braces, though they are generally safe 2
• Many clinicians still use corticosteroid injections as second-line treatment despite evidence suggesting potential harmful effects on tendon healing 3

Tennis elbow is primarily a tendinopathy characterized by failed tendon healing rather than an inflammatory condition 4. This understanding has shifted treatment approaches away from purely anti-inflammatory strategies toward those that promote tendon healing and remodeling. The most recent evidence strongly supports a progressive, exercise-based approach as the cornerstone of treatment 1, 3.