From the Guidelines
Lateral epicondylitis management should prioritize conservative approaches, including rest, ice, NSAIDs, and physical therapy, before considering invasive interventions, as most cases resolve within 6-12 months with conservative management 1. The initial treatment for lateral epicondylitis should focus on reducing pain and inflammation, with options including:
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily
- Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks A counterforce brace worn just below the elbow can help redistribute forces away from the injured tendon. Physical therapy focusing on eccentric strengthening exercises and stretching of the wrist extensors is crucial for recovery, typically 2-3 sessions weekly for 6-8 weeks. For persistent cases, corticosteroid injections may provide short-term relief, though they can weaken tendons long-term 1. Newer options include platelet-rich plasma injections, which utilize the body's own healing factors. Surgery is rarely needed but may be considered after 6-12 months of failed conservative treatment. Recovery requires patience as the condition results from repetitive microtrauma to the extensor carpi radialis brevis tendon, causing degenerative changes rather than true inflammation, which explains why healing takes time. Imaging, such as radiographs, may be beneficial in assessing chronic elbow pain and guiding treatment, especially when symptoms persist or worsen despite conservative management 1.
From the Research
Lateral Epicondylitis Management Options
Lateral epicondylitis, also known as tennis elbow, is a common cause of elbow pain in the general population. The management options for lateral epicondylitis include:
- Nonsurgical methods such as physiotherapy, infiltrations of cortisone or platelet-rich plasma (PRP) 2, 3
- Rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities 3
- Surgical options such as open débridement, arthroscopic, or percutaneous procedures for patients with recalcitrant disease 3
Injection Therapies
Injection therapies such as corticosteroid injection (CSI), autologous blood (AB), and platelet-rich plasma (PRP) are commonly used to treat lateral epicondylitis. The current best available evidence suggests that:
- CSI improves functional outcomes and pain relief in the short term (<12 weeks) 4
- AB and PRP are the most effective treatments in the intermediate term (12-26 weeks) 4
- PRP seems to be an effective form of treatment for lateral epicondylitis, with both leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) systems being effective 5
Physiotherapy Treatment
Physiotherapy treatment is also an effective management option for lateral epicondylitis. The most beneficial physiotherapeutic treatment methods are: