From the Guidelines
Lateral epicondylitis is best treated with a combination of rest, physical therapy, and pain management, as this approach has been shown to reduce inflammation, promote proper healing of the damaged tendon fibers, and gradually strengthen the affected muscles to prevent recurrence 1. The initial treatment should focus on reducing activities that aggravate the condition and applying 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 1-2 weeks.
- Physical therapy focusing on eccentric strengthening exercises and stretching is crucial for recovery; these should be performed 2-3 times daily with 3 sets of 15 repetitions.
- A counterforce brace worn just below the elbow can provide symptom relief during activities. For persistent cases, corticosteroid injections may provide short-term relief, though they aren't recommended for long-term management due to potential tendon weakening, as noted in a study from 2005 1. Newer treatments like platelet-rich plasma injections might be considered for refractory cases. Most cases resolve within 6-12 months with conservative treatment, and surgery may be indicated for more severe or refractory cases, as suggested by a 2022 study 1. It's essential to note that the natural history of lateral epicondylitis is gradually increasing load-related localized pain coinciding with increased activity, and accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems 1.
From the Research
Treatment Options for Lateral Epicondylitis
- Conservative treatments include steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping 2
- Other conservative measures such as rest, ice, tennis brace, and orthosis can be used initially 3, 4
- Physical therapy modalities like ultrasound, phonophoresis, electrical stimulation, manipulation, soft tissue mobilisation, neural tension, friction massage, and stretching and strengthening exercises can be utilized 3
- Newer modalities like laser, acupuncture, and augmented soft tissue mobilisation (ASTM) are also being used 3
- Interventional therapies including different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, are available for both short-term and long-term outcomes in pain resolution and functional improvement 4
- Biologic enhancement products like bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations 4
Surgical Treatment
- Surgery is indicated if conservative measures fail, and can include open, percutaneous, and arthroscopic approaches 5, 4
- Surgical treatment is usually reserved for chronic or refractory cases of lateral epicondylitis 2, 5
Effectiveness of Platelet-Rich Plasma (PRP) Injections
- PRP injections have been shown to be effective in treating chronic lateral epicondylitis, with significant pain relief and improvement in function and quality of life reported by patients 6
- A single PRP injection may be sufficient, as outcomes did not significantly differ between patients receiving one or multiple injections 6