From the Guidelines
For patients presenting with elbow pain, the initial management should include rest, ice, and over-the-counter anti-inflammatories like ibuprofen (400-600mg every 6-8 hours with food), as well as physical therapy exercises to strengthen supporting muscles, such as wrist curls, reverse wrist curls, and grip strengthening 1.
Initial Assessment and Management
When assessing elbow pain, it's crucial to consider the wide differential diagnosis, including osseous, soft tissue, cartilaginous, and nerve-related abnormalities, with epicondylalgia being the most common cause 1. The management of chronic elbow pain, such as epicondylalgia and osteoarthritis, includes conservative measures like rest, activity modification, analgesia, physical therapy, and corticosteroid injections, with surgery reserved for more severe or refractory cases 1.
Imaging and Further Evaluation
Radiographs are beneficial as the initial imaging for chronic elbow pain, as they may show intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, occult fractures, or osteoarthritis, and they complement subsequent MRI elbow examinations 1. For acute elbow or forearm pain, radiography is usually appropriate for the initial imaging, and in cases with normal or indeterminate radiographs, repeat radiographs in 10 to 14 days or CT without IV contrast may be considered as the next step 1.
Treatment Approaches
Eccentric strengthening is an effective treatment for tendinopathy and may reverse degenerative changes, while NSAIDs are recommended for short-term pain relief but have no effect on long-term outcomes 1. Locally injected corticosteroids may provide acute-phase pain relief but do not alter long-term outcomes, and therapeutic ultrasonography, corticosteroid iontophoresis, and phonophoresis are of uncertain benefit for tendinopathy 1. Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1.
Prevention and Lifestyle Modifications
Proper ergonomics when working and appropriate technique during sports can help prevent many elbow problems, particularly those related to overuse injuries from repetitive arm movements 1. Patient education on activity modification and the importance of gradual return to activity can also play a crucial role in preventing recurrence and promoting recovery.
From the Research
Elbow Conditions
- Elbow tendinopathy is a common cause of pain and disability, with medial and lateral epicondylitis being overuse injuries that respond well to nonoperative management 2
- Chronic elbow tendinitis (medial or lateral epicondylitis and triceps tendinitis) have a good prognosis but require a minimum of 3 to 6 months to resolve 3
Treatment Options
- Nonoperative management, including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis, and physical therapies, is the first line of treatment for lateral epicondylitis 4
- Corticosteroid injections and platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis 2, 4
- Surgical intervention can be undertaken if 6 to 12 months of nonoperative treatment fails 2
- Early mobilization after conservative treatment strategies showed improved range of motion (ROM) compared to immobilization for up to 3 weeks after surgery 5
Elbow Dislocation
- Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation 5
- Surgical approaches showed similar results compared to conservative treatment, leading to improved ROM and Mayo Elbow Performance Score (MEPS) 5
- People with red flags for persistent instability, such as severe bilateral ligament injuries and moderate to severe instability during initial physical examination, should be considered for a primary surgical approach to prevent recurrent posterolateral and valgus instability 5
Elbow Stiffness
- Elbow stiffness is a common consequence following trauma, and conservative treatment, such as exercise and splinting, can be used in the prevention and management of the stiff elbow 6