Management of Persistent Bilateral Medial Epicondylitis
Diagnostic Approach
- Plain radiographs of the elbow are the most appropriate initial imaging study to rule out other causes of elbow pain and assess for any bony abnormalities, as recommended by the American College of Radiology 1, 2, 3
- MRI may be considered if radiographs are normal or nonspecific and there is suspicion of tendon degeneration or tear, according to the American College of Radiology 4
- Diagnosis is primarily clinical, based on history of pain at the medial epicondyle and pain with resisted wrist flexion, as stated by the American Academy of Family Physicians 5
Treatment Options
Conservative Management
- Relative rest and activity modification to reduce repetitive loading of the damaged tendon is recommended by the American Academy of Family Physicians 6
- Eccentric strengthening exercises to promote tendon healing and increase strength are suggested by the American Academy of Family Physicians 6, 7
- Cryotherapy (ice application) for 10-minute periods can provide acute pain relief, as recommended by the American Academy of Family Physicians 6
- NSAIDs can provide short-term pain relief, though they do not affect long-term outcomes, according to the American Academy of Family Physicians 6, 7
- Counterforce bracing/orthotics may be considered, though evidence for their effectiveness is limited, as noted by the American Academy of Family Physicians 6, 8
Physical Therapy
- Deep transverse friction massage can reduce pain, as recommended by the American Academy of Family Physicians 6
- Progressive strengthening exercises focusing on the flexor-pronator muscle group are suggested by the American Academy of Family Physicians 7
- Stretching exercises for the wrist flexors can be beneficial, as recommended by the American Academy of Family Physicians 7