From the Guidelines
Management of elbow pain should begin with conservative measures, including rest, ice, compression, and elevation (RICE protocol), as well as physical therapy focusing on stretching and strengthening exercises, as recommended by the most recent guidelines 1. The initial approach to managing elbow pain involves a combination of non-pharmacological and pharmacological interventions. For mild to moderate pain, over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) can provide relief by reducing inflammation 1.
- Key components of conservative management include:
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
- Cryotherapy for acute relief of tendinopathy pain 1
- Eccentric strengthening as an effective treatment of tendinopathy that may reverse degenerative changes 1
- Topical NSAIDs for effective pain relief with potentially fewer systemic side effects 1
- For cases where pain persists, corticosteroid injections (typically methylprednisolone 40mg with lidocaine) might be considered for short-term relief, but they do not alter long-term outcomes 1.
- Imaging plays a crucial role in the assessment of chronic elbow pain, with radiographs being beneficial as the initial imaging, and MRI or CT scans being considered for further evaluation based on clinical presentation and initial imaging findings 1.
- Surgery is typically reserved for cases that do not respond to 6-12 months of conservative treatment, and is considered an effective option in carefully selected patients who have failed conservative therapy 1.
From the Research
Management of Elbow Pain
- Elbow pain can be caused by various conditions, including lateral and medial epicondylitis, ulnar neuropathy, radial tunnel syndrome, and olecranon bursitis 2
- The location and quality of elbow pain can help localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior 2
- Conservative management of elbow pain includes exercise and splinting, which can help prevent and manage stiffness 3
Diagnosis of Elbow Pain
- Plain radiography is the initial choice for evaluating acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions 2
- Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain 2
- Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures 2
Treatment of Elbow Pain
- Topical non-steroidal anti-inflammatory drugs (NSAIDs) may be effective in relieving lateral elbow pain in the short term 4, 5
- Oral NSAIDs may also be effective, but the evidence is conflicting and they may be associated with gastrointestinal side effects 4, 5
- Glucocorticoid injection may be more effective than NSAIDs in the short term, but the evidence is limited 5
- Other treatments, such as manipulative therapy, leech therapy, and vasodilator therapy, may also be effective, but the evidence is limited 5
Common Elbow Injuries
- Lateral epicondylitis (tennis elbow) is a common condition that causes pain in the elbow and forearm 2, 6, 4, 5
- Medial epicondylitis (golfer's elbow) is another common condition that causes pain in the elbow and forearm 2, 6
- Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing 2, 6
- Olecranon bursitis is a common cause of posterior elbow pain and swelling 2