What is the treatment for elbow tendon pain after a car accident?

Treatment of Elbow Tendon Pain After Car Accident

Begin with relative rest, ice therapy, NSAIDs, and eccentric strengthening exercises for 3-6 months before considering more invasive interventions, as this conservative approach resolves symptoms in approximately 80% of patients. 1, 2

Initial Conservative Management (First-Line Treatment)

Immediate Interventions

• Relative rest is essential—reduce activities that provoke pain while maintaining some movement to prevent muscle atrophy and deconditioning 1, 2
• Ice therapy provides short-term pain relief, reduces swelling, and blunts inflammatory response 2
• NSAIDs for pain control:
  • Topical NSAIDs are preferable to oral formulations due to elimination of gastrointestinal hemorrhage risk 2
  • NSAIDs provide short-term pain relief but do not alter long-term outcomes 1
  • Recommended for acute-phase symptom management only 1

Rehabilitation Program

• Eccentric strengthening exercises are the cornerstone of treatment—they stimulate collagen production and guide normal alignment of newly formed collagen fibers 1, 2
• Stretching exercises are widely accepted for tendon rehabilitation 2
• Physical therapy should be initiated early and continued throughout the 3-6 month conservative treatment period 2, 3

Diagnostic Evaluation

Physical Examination Findings

• Look for well-localized tenderness that reproduces the pain experienced during activity 1
• Assess for muscle atrophy (indicates chronicity), swelling, erythema, and asymmetry 1
• Range-of-motion testing is often limited on the symptomatic side 1
• Pain is typically described as "sharp" or "stabbing" 1

Imaging Recommendations

• Plain radiographs are the initial imaging study and may reveal osteophyte formation at the epicondyles, degenerative joint disease, loose bodies, or fractures 1, 2
• MRI or ultrasound should be reserved for cases where diagnosis remains unclear after thorough history and physical examination, or for recalcitrant pain despite adequate conservative management 1
• Ultrasound can demonstrate tendon thickening and heterogeneous echogenicity 1
• MRI is useful for showing degenerative thickening, fibrovascular proliferation, and mucoid degeneration 1

Second-Line Treatments (If Conservative Measures Insufficient)

Corticosteroid Injections

• May be more effective than oral NSAIDs for acute-phase pain relief but do not alter long-term outcomes 1, 2
• Use with caution—corticosteroids may inhibit healing, reduce tensile strength of tissue, and potentially predispose to rupture 2
• Consider only after initial conservative measures have been attempted 1, 2

Adjunctive Therapies

• Tennis elbow bands can help reinforce, unload, and protect tendons during activity, though limited data supports their effectiveness 2
• Extracorporeal shock wave therapy (ESWT) appears safe and effective but is expensive 1, 2
• Therapeutic ultrasonography has uncertain benefit with weak evidence for consistent results 1, 2

Surgical Management

Indications for Surgery

• Surgical evaluation is warranted if pain persists despite 3-6 months of well-managed conservative treatment 1, 2, 3
• Surgery is required in less than 10% of cases 3
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2

Surgical Outcomes

• Recovery period following surgery is similarly long (3-6 months) 3
• With appropriate treatment, prognosis is very good 3

Critical Pitfalls to Avoid

• Do not rely on corticosteroid injections as primary treatment—they provide only short-term relief without improving long-term outcomes and may weaken the tendon 1, 2
• Do not rush to surgery—approximately 80% of patients fully recover within 3-6 months with appropriate conservative treatment 2
• Do not overlook activity modification—technique modification for repetitive activities is essential to minimize ongoing tendon stress 2
• Do not delay diagnosis of acute tendon ruptures—if complete rupture is suspected (rare in car accidents but possible), early surgical repair within 4 weeks is critical 3

Expected Timeline

• Most patients with overuse tendinopathies fully recover within 3-6 months with appropriate conservative treatment 2, 3
• Pain may initially be present during activity but can subside after a warm-up period in early stages 1
• Pain gradually increases in intensity and duration if untreated, potentially becoming present at rest in later stages 1