Treatment of Elbow Strain
For elbow strain (tendon/muscle injury), begin with conservative management including rest, activity modification, analgesia, physical therapy, and consider corticosteroid injections, reserving surgery only for severe or refractory cases. 1
Initial Diagnostic Approach
- Obtain plain radiographs first to rule out fractures, heterotopic ossification, soft tissue calcification, or other bony pathology 2
- If radiographs are normal or indeterminate and tendon/ligament/muscle injury is suspected, proceed with ultrasound or MRI without IV contrast as equivalent next-step imaging options 2
- Ultrasound demonstrates moderate agreement with MRI for common extensor tendon tears (sensitivity 64.52%, specificity 85.19%) 2
Conservative Treatment Protocol
The mainstay of treatment for elbow strain involves non-operative modalities 1, 3:
- Rest and activity modification to reduce repetitive stress on injured structures 1
- Physical therapy focusing on stretching and progressive strengthening 1, 3
- Analgesia for pain control 1
- Corticosteroid injections for persistent symptoms despite initial conservative measures 1
Intermediate Interventions
If initial conservative management fails after adequate trial (typically several weeks to months), consider 3:
- Extracorporeal shockwave therapy 3
- Platelet-rich plasma injections 3
- Prolotherapy 3
- Ultrasound-guided percutaneous tenotomy 3
Surgical Indications
Reserve operative treatment for 4, 3:
- Continued symptoms despite adequate non-operative treatment (typically 3-6 months) 4
- Complete rupture of the common flexor-pronator tendon in high-level athletes 4
- Severe pathology with significant soft tissue involvement 3
The gold standard surgical approach includes tendon debridement and reattachment 4
Critical Evaluation Points
Assess for concomitant pathology during physical examination and workup 4, 3:
- Medial epicondylitis (most common cause of chronic elbow pain, occurring in 1-3% of population) 1
- Ulnar neuritis 3
- Ulnar collateral ligament injury 3
- Snapping medial triceps 3
Common Pitfalls
- Do not immobilize the elbow - early mobilization is critical to prevent stiffness 5
- Obtain follow-up radiographs at day 8-10 if symptoms persist or worsen to identify treatment failure early 5
- Medial elbow complaints are often multifactorial and require broad differential diagnosis 3
- Most patients with common flexor-pronator tendon injuries can be successfully treated non-operatively 4