From the Guidelines
Lateral epicondylitis should be treated with a combination of relative rest, icing, and eccentric strengthening exercises, as most patients fully recover within three to six months with conservative treatment. This approach is supported by the American Family Physician 1, which emphasizes the importance of accurate diagnosis and treatment of overuse tendinopathies, including lateral epicondylitis. The condition is characterized by gradually increasing load-related localized pain coinciding with increased activity, and examination should include thorough inspection, range-of-motion testing, palpation for tenderness, and examination maneuvers that simulate tendon loading and reproduce pain.
Some key points to consider in the treatment of lateral epicondylitis include:
- Relative rest of the affected area to avoid exacerbating the condition
- Icing to reduce pain and inflammation
- Eccentric strengthening exercises to promote recovery and prevent further injury
- Use of topical and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) for acute pain relief, although they should not be recommended in favor of other analgesics 1
- Consideration of corticosteroid injections for temporary relief, although they do not improve long-term outcomes 1
- Surgery as a last resort for patients who have failed conservative therapy
It is also important to note that lateral epicondylitis is a degenerative condition rather than an inflammatory one, and treatment should be focused on promoting recovery and preventing further injury rather than simply reducing inflammation 1. By prioritizing conservative treatment and avoiding unnecessary interventions, patients with lateral epicondylitis can expect to achieve significant improvements in morbidity, mortality, and quality of life.
From the Research
Treatment Options for Lateral Epicondylitis
- Initial treatment for lateral epicondylitis can include rest, ice, tennis brace, and/or injections, with injections being a popular method due to their high success rate 2
- Physical therapy is often initiated when the condition is chronic or not responding to initial treatment, with common rehabilitation modalities including ultrasound, phonophoresis, electrical stimulation, manipulation, soft tissue mobilisation, and stretching and strengthening exercises 2
- Other treatment options include laser, acupuncture, and augmented soft tissue mobilisation (ASTM), which is becoming increasingly popular due to its ability to detect changes in soft tissue texture during rehabilitation 2
- For patients with symptoms refractory to conservative management, surgical intervention has been shown to be a successful treatment modality 3, 4
Effectiveness of Different Treatment Options
- Corticosteroid injections have been shown to provide rapid symptomatic improvement, but with a higher rate of complications and recurrence of symptoms compared to platelet-rich plasma (PRP) injections 5
- PRP injections have been found to provide a longer-term therapeutic effect with fewer complications compared to corticosteroid injections 5
- A "watch-and-wait" approach can be an appropriate treatment option, with symptom resolution occurring in 70% to 80% of patients within the first year 3
Emerging Trends in Treatment
- Newly emerging biologic enhancement products, such as bone marrow aspirate concentrate and autologous tenocyte injectates, are being investigated for the treatment of lateral epicondylitis 6
- Arthroscopic intervention is also being explored as a treatment option for lateral epicondylitis, particularly for patients with persistent debilitating pain 6