From the Guidelines
Common extensor tendinosis and enthesopathy, often called tennis elbow or lateral epicondylitis, is best treated with a combination of rest, physical therapy, and anti-inflammatory measures. Initially, reduce activities that aggravate the condition and apply ice for 15-20 minutes several times daily to reduce inflammation, as suggested by the American Family Physician in 2005 1. Take non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) for 1-2 weeks to manage pain and inflammation.
Key Recommendations
- Relative rest and reduced activity prevent further damage and promote healing and pain relief, with evidence rating C, as per the American Family Physician in 2005 1.
- Cryotherapy provides acute relief of tendinopathy pain, with evidence rating B, as per the American Family Physician in 2005 1.
- Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes, with evidence rating B, as per the American Family Physician in 2005 1. Physical therapy focusing on eccentric strengthening exercises is crucial for recovery; start with 3 sets of 15 repetitions daily using light weights and gradually increase. A counterforce brace worn just below the elbow can help reduce strain during daily activities. For persistent cases, corticosteroid injections may provide temporary relief, though they shouldn't be repeated frequently due to potential tendon weakening, as noted in the American Family Physician in 2005 1. Most cases improve within 6-12 months with conservative treatment. This condition occurs when repetitive stress causes microtears in the tendon where forearm extensor muscles attach to the lateral epicondyle of the humerus, leading to degeneration rather than acute inflammation, which explains why long-term rehabilitation is more effective than just anti-inflammatory treatments.
Treatment Options
- Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy, with evidence rating B, as per the American Family Physician in 2005 1.
- Extracorporeal shock wave therapy appears to be a safe, noninvasive, effective but expensive means of pain relief for a number of chronic tendinopathies, with evidence rating B, as per the American Family Physician in 2005 1. It is essential to note that while NSAIDs are recommended for short-term pain relief, they have no effect on long-term outcomes, as stated in the American Family Physician in 2005 1. Topical NSAIDs are effective and may have fewer systemic side effects, but it is unclear whether NSAIDs are better than other analgesics, as per the American Family Physician in 2005 1. Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes, with evidence rating B, as per the American Family Physician in 2005 1.
From the Research
Common Extensor Tendinosis and Enthesopathy
- Common extensor tendinosis, also known as lateral epicondylitis, is a condition characterized by pain and inflammation on the outside of the elbow, where the muscles and tendons of the forearm attach to the lateral epicondyle [(2,3)].
- The condition is often caused by repetitive strain on the extensor tendons, leading to degenerative changes and inflammation [(4,5)].
- Treatment options for common extensor tendinosis include physical therapy, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and regenerative medicine techniques such as platelet-rich plasma injections [(4,3,5)].
- Sonographically guided percutaneous needle tenotomy has been shown to be an effective treatment for refractory lateral elbow tendinosis, with or without corticosteroid injection 2.
- Platelet-rich plasma injections have been found to enable biological healing of the lesion, whereas corticosteroid injections provide short-term, symptomatic relief but may result in tendon degeneration 3.
- The mainstays of treatment for chronic tendon injuries, including common extensor tendinosis, are activity modification, relative rest, pain control, and protection, as well as early initiation of rehabilitative exercises that emphasize eccentric loading 5.