What is the treatment for lateral epicondylitis (Tennis Elbow)?

From the Guidelines

The treatment of lateral epicondylitis (tennis elbow) should begin with conservative measures, including rest, ice application, and eccentric strengthening exercises, as these approaches have been shown to be effective in promoting recovery and reducing pain 1. The goal of treatment is to relieve pain, reduce inflammation, and promote healing of the affected tendons. Conservative measures are preferred, as they can help to avoid the potential risks and complications associated with more invasive treatments.

Conservative Measures

• Rest from aggravating activities is essential to prevent further injury and promote healing
• Ice application for 15-20 minutes several times daily can help to reduce inflammation and relieve pain
• Eccentric strengthening exercises, such as those that focus on stretching and strengthening the wrist extensors, can help to promote recovery and reduce pain 1
• A counterforce brace worn just below the elbow can help to reduce strain on the affected tendons during daily activities

Pharmacological Interventions

• Over-the-counter NSAIDs, such as ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily), can help to manage pain and inflammation for short periods, usually 1-2 weeks 1
• Topical NSAIDs can also be effective in reducing tendon pain and eliminating the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1

Alternative Therapies

• Corticosteroid injections may provide temporary relief for persistent cases, though they are generally limited to 2-3 injections due to potential tendon weakening 1
• Platelet-rich plasma injections, which utilize the body's own healing factors, may be a promising treatment option for lateral epicondylitis, though more research is needed to fully understand their effectiveness

Surgical Intervention

• Surgery is reserved for cases that do not respond to 6-12 months of conservative treatment, and should be considered only after all other treatment options have been exhausted 1

From the Research

Treatment Options for Lateral Epicondylitis

• Initial treatment for lateral epicondylitis can include rest, ice, tennis brace, and/or injections, with injections being a popular method due to their high success rate 2
• When the condition is chronic or not responding to initial treatment, physical therapy is often initiated, utilizing modalities such as ultrasound, phonophoresis, electrical stimulation, manipulation, soft tissue mobilisation, and stretching and strengthening exercises 2
• Other treatment options include laser therapy, acupuncture, and augmented soft tissue mobilisation (ASTM), which is becoming increasingly popular due to its ability to detect changes in soft tissue texture during rehabilitation 2
• In some cases, surgery may be considered as a last resort for chronic or resistant cases of lateral epicondylitis 2

Non-Surgical Treatment Methods

• A systematic review of randomized controlled trials found that non-surgical approaches to treating lateral epicondylitis are numerous, but the existing literature does not provide conclusive evidence for a preferred method of non-surgical treatment 3
• Corticosteroid injections may provide short-term pain relief, but there is no demonstrable long-term pain relief, and other treatments such as botulinum toxin A injection and prolotherapy have shown mixed results 3
• Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief, although some studies have shown low-level laser therapy to be superior to placebo 3

Efficacy of Physical Therapy

• A meta-analysis found that physical therapy for the treatment of lateral epicondylitis often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), and other modalities, with ECSWT and LLLT showing promise in reducing pain and improving function 4
• Another study found that shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions for lateral epicondylitis, although more research is needed to determine the most beneficial treatment options 5

Comparison of Treatment Methods

• A prospective, randomized, controlled study found that dry needling (DN) was more effective than corticosteroid (CS) injection in treating lateral epicondylitis, with DN-treated patients showing better improvement in PRTEE scores than CS-treated patients 6
• Both DN and CS injection afforded significant improvements during the 6 months of follow-up, although DN was found to be more effective and had fewer side effects than CS injection 6