What is the treatment for lateral left elbow joint pain?

Treatment of Lateral Left Elbow Joint Pain

Begin with relative rest, activity modification, and eccentric strengthening exercises, as this conservative approach resolves symptoms in 80% of patients within 3-6 months and forms the foundation of evidence-based treatment for lateral epicondylitis. 1

Initial Diagnostic Considerations

Before initiating treatment, confirm the diagnosis is lateral epicondylitis and exclude other pathologies:

• Obtain plain radiographs of the elbow as the initial imaging study to rule out osteochondral lesions, intra-articular bodies, radiocapitellar arthritis, occult fractures, and osteoarthritis 1
• Look for night pain or pain at rest, which suggests inflammatory or neoplastic processes requiring further workup 1
• Assess for mechanical symptoms like locking or catching, which indicate intra-articular pathology 1
• Consider MRI or ultrasound only if radiographs are normal but clinical suspicion remains for tendon tear or nerve entrapment 1

First-Line Conservative Treatment (Weeks 0-12)

Implement this multicomponent approach simultaneously:

Activity Modification and Relative Rest

• Reduce repetitive wrist extension, radial deviation, and forearm supination activities that load the damaged extensor carpi radialis brevis tendon 1
• Continue activities that do not reproduce pain, as tensile loading stimulates collagen production and guides normal collagen fiber alignment 1
• Avoid complete immobilization to prevent muscle atrophy 1

Eccentric Strengthening Exercises

• Start eccentric exercises as soon as possible—this is the cornerstone of rehabilitation and may reverse degenerative tendinopathy changes 1
• These exercises promote tendon healing and increase strength 1
• Progressive stretching exercises for wrist extensors should accompany eccentric training 1

Pain Management

• Apply cryotherapy (ice through a wet towel) for 10-minute periods for acute pain relief 1
• NSAIDs provide short-term pain relief but do not affect long-term outcomes 1
• Per FDA labeling, ibuprofen 400 mg every 4-6 hours as needed is appropriate for mild to moderate pain, not exceeding 3200 mg daily 2

Adjunctive Modalities

• Counterforce bracing (tennis elbow brace) may improve function during daily activities, though evidence is limited 1
• Deep transverse friction massage may reduce pain 1
• Manual joint mobilization combined with exercise therapy is more effective than exercise alone 1, 3

Second-Line Interventions (If No Improvement by 6-12 Weeks)

Corticosteroid Injections

• Use corticosteroid injections judiciously for short-term relief only 1
• Injections are more effective than NSAIDs in the acute phase but do not change long-term outcomes 1
• This represents a common pitfall: while injections provide rapid symptom relief, they should not replace the fundamental rehabilitation program 1

Evidence Quality Note

Low-certainty evidence from a single trial suggests manual therapy may provide clinically worthwhile benefit in pain (MD -2.1 points on 0-10 scale) and disability (MD -25 points on 0-100 scale) at end of treatment compared to placebo 3. However, when combined with exercise and compared to minimal intervention, the benefit is smaller (pain MD -0.53 points, disability MD -5.00 points) and may not be clinically worthwhile 3.

Surgical Consideration (After 6-12 Months of Failed Conservative Treatment)

• Surgery should only be considered after failure of 6-12 months of appropriate conservative treatment 1
• This is reserved for refractory cases where conservative management has been exhausted 1

Common Pitfalls to Avoid

• Do not rely solely on corticosteroid injections—they provide temporary relief but do not address the underlying tendinopathy or improve long-term outcomes 1
• Do not skip plain radiographs—other pathologies like osteochondral lesions or intra-articular bodies can mimic lateral epicondylitis and require different management 1
• Do not prescribe complete rest or immobilization—this leads to muscle atrophy and does not promote tendon healing 1
• Therapeutic ultrasound, corticosteroid iontophoresis, and phonophoresis are of uncertain benefit and should not be prioritized 4

Expected Timeline

• Most patients (80%) recover within 3-6 months with appropriate conservative management 1
• A therapeutic response is sometimes seen in a few days to a week but most often by two weeks 1
• Adverse events from manual therapy and exercise are typically mild and transient, including pain and bruising 3