From the Guidelines
Lateral epicondylitis, commonly known as tennis elbow, is best treated with a combination of rest, physical therapy, and pain management. Initially, reduce activities that aggravate the condition and apply ice to the affected area for 15-20 minutes several times daily. Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) can help manage pain and inflammation for short periods, typically 1-2 weeks, as they are effective for acute pain relief 1. Physical therapy focusing on eccentric strengthening exercises and stretching is crucial for recovery, with a recommended frequency of 3-5 times weekly for 6-8 weeks. A counterforce brace worn just below the elbow can provide symptom relief during activities. For persistent cases, a corticosteroid injection (typically methylprednisolone 40mg or equivalent) may provide temporary relief, though benefits often diminish after a few months, as corticosteroid injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes of pain 1. These treatments work by reducing inflammation, promoting tissue healing, and gradually strengthening the affected tendons and muscles. Most cases resolve within 6-12 months with conservative management, though severe or persistent cases may require consultation with an orthopedic specialist to consider additional interventions like platelet-rich plasma injections or, rarely, surgery.
Some key points to consider in the treatment of lateral epicondylitis include:
- Rest and ice to reduce pain and inflammation
- NSAIDs for short-term pain management
- Physical therapy with eccentric strengthening exercises and stretching
- Counterforce brace for symptom relief
- Corticosteroid injections for temporary relief in persistent cases
- Consideration of additional interventions for severe or persistent cases, as most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months with outpatient treatment consisting of relative rest, icing, and eccentric strengthening exercises 1.
It's also important to note that the natural history of lateral epicondylitis is gradually increasing load-related localized pain coinciding with increased activity, and accurate diagnosis requires recognition of historical features, anatomy, and useful physical examination maneuvers for these common tendon problems 1.