Treatment of Tennis Elbow with Hifenac MR and Chymoral Forte
NSAIDs like Hifenac MR (aceclofenac and paracetamol) can be used for tennis elbow pain relief, but should be combined with other conservative treatments rather than with Chymoral Forte, as there is insufficient evidence supporting the combination with proteolytic enzymes for tennis elbow management.
First-Line Conservative Management
- Tennis elbow (lateral epicondylitis) is primarily treated with conservative measures as it is largely a self-limiting condition 1
- NSAIDs (oral or topical) effectively relieve pain in tennis elbow, though they may not affect long-term outcomes 2
- Hifenac MR (combination of aceclofenac and paracetamol) can be used at standard adult dosing (typically one tablet twice daily) for short-term pain relief 3
- Relative rest is essential to prevent ongoing damage while promoting tendon healing 2
- Cryotherapy (ice application) for 10-minute periods through a wet towel provides effective short-term pain relief 2
- Counterforce bracing/orthotics (tennis elbow bands) help reinforce and protect tendons during activity 2
Exercise and Rehabilitation
- Eccentric strengthening exercises are beneficial for promoting tendon healing and increasing strength 2
- Stretching exercises for the wrist extensors should be incorporated into the treatment plan 2
- Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 2
Regarding Chymoral Forte
- There is insufficient evidence in the guidelines to support the use of proteolytic enzymes like Chymoral Forte specifically for tennis elbow 2, 1
- The primary treatment guidelines do not mention proteolytic enzymes as a recommended treatment for tennis elbow 2
Second-Line Treatments (if NSAIDs are ineffective)
- Locally injected corticosteroids may be more effective than NSAIDs for short-term relief in the acute phase 2, 3
- A study showed that at 6 weeks, 73.33% of patients receiving steroid injection plus NSAIDs were pain-free compared to only 23.33% with NSAIDs alone 3
- However, corticosteroids should be used with caution as they may inhibit healing and reduce tendon tensile strength 2
- No more than 2 corticosteroid injections should be administered due to potential adverse effects 1
Treatment Algorithm
- Initial phase (0-4 weeks): Rest, activity modification, ice application, NSAIDs (Hifenac MR one tablet twice daily), and bracing 2
- Rehabilitation phase (2-8 weeks): Progressive eccentric strengthening exercises, stretching, and continued bracing as needed 2
- For persistent symptoms beyond 4-6 weeks: Consider corticosteroid injection or other second-line modalities 2, 3
- For refractory cases (>6-12 months): Surgical consultation may be warranted 2
Common Pitfalls and Caveats
- Overreliance on NSAIDs without addressing biomechanical factors may lead to poor outcomes 2
- Complete immobilization should be avoided as it leads to muscle atrophy and deconditioning 2
- Long-term NSAID use carries risks of gastrointestinal, renal, and cardiovascular adverse effects 2
- There is no strong evidence supporting the combination of Hifenac MR with Chymoral Forte specifically for tennis elbow management 2, 1