What is the treatment for a right elbow extensor tendon condition?

Treatment for Right Elbow Extensor Tendon Condition

The treatment for right elbow extensor tendon condition (lateral epicondylosis or "tennis elbow") should begin with conservative measures including relative rest, ice therapy, NSAIDs, and eccentric strengthening exercises for 3-6 months before considering more invasive interventions. 1

Initial Conservative Management

• Relative Rest: Prevent ongoing damage by avoiding activities that worsen pain while maintaining some activity to prevent muscle atrophy and deconditioning. Complete immobilization should be avoided. 1

• Ice Therapy: Apply ice through a wet towel for 10-minute periods to provide short-term pain relief, reduce swelling, and blunt inflammatory response. 1

• Analgesics:

  • Both oral and topical NSAIDs effectively relieve pain in the acute phase 1
  • Topical NSAIDs may be preferable as they eliminate the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1

• Eccentric Strengthening Exercises: These stimulate collagen production and guide normal alignment of newly formed collagen fibers. 1

• Stretching Exercises: Generally thought to be helpful and widely accepted for tendon rehabilitation. 1

Second-Line Treatments

• Orthotics and Braces: Tennis elbow bands can help reinforce, unload, and protect tendons during activity. While limited data supports their effectiveness, they are safe and often helpful in correcting biomechanical problems. 1

• Corticosteroid Injections:

  • May be more effective than NSAIDs for relief in the acute phase but do not alter long-term outcomes 1
  • Use with caution as they may inhibit healing and reduce tensile strength of the tissue, potentially predisposing to rupture 1
  • Direct injection into the tendon substance should be avoided 1

• Other Modalities:

  • Therapeutic ultrasonography may decrease pain and increase collagen synthesis, though evidence for consistent benefit is weak 1
  • Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research 1
  • Iontophoresis and phonophoresis are widely used but lack well-designed RCTs to permit reliable recommendations 1

Surgical Management

• If pain persists despite 3-6 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 1
• Surgery is quite successful for patients who have failed conservative therapy 2

Important Considerations

• Most patients with overuse tendinopathies (about 80%) fully recover within 3-6 months with appropriate conservative treatment 1
• The pathoanatomy of tennis elbow is noninflammatory "angiofibroblastic tendinosis" rather than inflammation, which explains why anti-inflammatory treatments may have limited long-term effectiveness 2
• The specific area of abnormality in lateral epicondylosis is typically the extensor carpi radialis brevis-extensor digitorum communis complex 2
• Technique modification for athletes and manual laborers aims to minimize repetitive stresses placed on tendons 1

Diagnostic Pearls

• Lateral epicondylosis is 7-10 times more common than medial epicondylosis and involves the dominant arm 75% of the time 1
• Activities requiring repetitive wrist extension contribute to the development of lateral epicondylosis 1
• Physical examination typically reveals well-localized tenderness that reproduces the pain experienced during activity 1
• Plain radiography may show osteophyte formation at the epicondyles, degenerative joint disease, loose bodies, or fractures 1