From the Guidelines
Lateral epicondylitis should be treated with a combination of rest, physical therapy, and medication, prioritizing conservative measures over surgical interventions to minimize morbidity and mortality while improving quality of life. When treating lateral epicondylitis, it is essential to consider the most recent and highest quality evidence available. According to the study published in the Journal of the American College of Radiology in 2022 1, conservative measures such as rest, activity modification, analgesia, physical therapy, and corticosteroid injections are recommended for managing epicondylalgia.
Some key considerations for treatment include:
- Reducing activities that cause pain and applying ice to the affected area for 15-20 minutes several times daily
- Taking over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) for pain and inflammation for 1-2 weeks
- Engaging in physical therapy focusing on eccentric strengthening exercises, performed 3 sets of 15 repetitions daily
- Wearing a counterforce brace just below the elbow to reduce strain during activities
- Considering corticosteroid injections (typically methylprednisolone 20-40mg with lidocaine) for temporary relief in persistent cases, although this should not be repeated more than 2-3 times due to potential tendon weakening, as noted in a study from 2005 1.
It is crucial to prioritize conservative treatment approaches, as most cases of lateral epicondylitis resolve within 6-12 months without the need for surgical intervention, thereby minimizing potential morbidity and mortality while improving quality of life.
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
Non-Operative Injection Therapies
- Non-operative treatments for lateral epicondylitis include various types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which can provide both short-term and long-term pain relief and functional improvement 3
- Platelet-rich plasma (PRP) injections have been shown to be effective in treating chronic lateral epicondylitis, with significant pain relief and functional improvement reported by patients 6 months after treatment 4
- A single PRP injection may be sufficient for treating chronic lateral epicondylitis, with no significant difference in outcomes between patients receiving one or multiple injections 4
Comparison of Treatment Options
- Corticosteroid injections provide rapid symptomatic improvement, but symptoms often recur after 6-8 weeks, whereas PRP injections show slower ongoing improvements up to 24-52 weeks 5
- PRP injections have been shown to have a longer-term therapeutic effect and fewer complications compared to corticosteroid injections 5
- Ultrasonographic findings have shown that corticosteroid injections can lead to decreased tendon thickness and increased cortical erosion, whereas PRP injections can lead to increased tendon thickness and reduced common extensor tendon tears 5
Surgical Treatment
- Surgical treatment is often considered for patients with persistent debilitating pain and functional impairment that has not responded to non-operative treatment for more than 6 months 3
- Surgical options include open, percutaneous, and arthroscopic approaches, with the choice of procedure depending on the individual patient's needs and the surgeon's preference 3