From the Guidelines
Lateral epicondylitis, commonly known as tennis elbow, should be treated with a combination of activity modification, rest, icing, and eccentric strengthening exercises, as these measures have been shown to be effective in managing pain and promoting recovery, as noted in the most recent and highest quality study 1.
Treatment Approach
The treatment of lateral epicondylitis begins with avoiding painful movements and resting from aggravating activities. Applying ice for 15-20 minutes several times daily can help reduce inflammation. 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, as suggested by 1 and 1.
Rehabilitation and Management
A counterforce brace worn just below the elbow can reduce tendon strain during activities. Physical therapy focusing on eccentric strengthening exercises is crucial for recovery; these should be performed 3 sets of 15 repetitions daily for 6-12 weeks. Gentle stretching of the wrist extensors (holding each stretch for 30 seconds, repeating 3 times) helps maintain flexibility. Most cases resolve within 6-12 months with conservative treatment, as indicated by 1.
Persistent Cases
For persistent cases, corticosteroid injections may provide temporary relief, though they don't improve long-term outcomes, as noted by 1. Surgery is rarely needed and reserved for cases unresponsive to 6-12 months of conservative treatment. The condition occurs when repetitive wrist extension and gripping activities cause microtears in the extensor carpi radialis brevis tendon, leading to degeneration and pain rather than true inflammation, which explains why recovery often requires time and proper rehabilitation rather than just anti-inflammatory measures, as discussed in 1 and 1.
Key Considerations
It's essential to recognize that lateral epicondylitis is a degenerative condition rather than an inflammatory one, which guides the treatment approach towards rehabilitation and management of symptoms rather than solely focusing on anti-inflammatory measures, as emphasized by the most recent study 1.
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