Epicondilitis Treatment Guidelines

Diagnosis

The diagnosis of epicondilitis is primarily clinical, based on a history of pain in the epicondyle and pain with resisted wrist flexion (medial epicondylitis) or extension (lateral epicondylitis) 1
Simple elbow radiographs are the most appropriate initial imaging study to rule out other causes of pain 1
Magnetic resonance imaging may be considered if radiographs are normal and there is suspicion of tendon degeneration or tear 1

The American Academy of Family Physicians recommends relative rest and modification of activities to reduce repetitive strain on the damaged tendon 1
The application of ice (cryotherapy) for periods of 10 minutes can provide relief of acute pain 1
Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide short-term pain relief, although they do not affect long-term outcomes 2, 1
The use of counterforce orthoses/braces can reduce tension on the tendon origin 1
Eccentric strengthening exercises can promote tendon healing and increase strength 2, 1
Stretching exercises for the wrist flexors or extensors can be beneficial 1
Deep transverse friction massage can reduce pain 1
A progressive strengthening program focused on the affected muscle groups can be effective 1

Ultrasonography may be beneficial as a complementary treatment 3
Local application of heat (e.g., paraffin, warm compresses) can be beneficial, especially before exercise 3

The American Academy of Family Physicians notes that approximately 80% of patients with epicondilitis recover completely within three to six months with conservative treatment 2
Treatment should be tailored according to the location of epicondilitis (lateral or medial), risk factors, presence of inflammation, severity of structural change, and level of pain 3
Local treatments are preferred over systemic treatments, especially for mild to moderate pain and when only a few joints are affected 3

Radiography is the most appropriate initial imaging study to rule out other causes of elbow pain, as recommended by the American College of Radiology 4
If radiographs are normal but tendon injury is suspected, ultrasound or MRI without IV contrast is appropriate for assessment, according to the American College of Radiology and the British Journal of Sports Medicine 4, 5

Manual joint mobilization combined with exercise therapy is more effective than exercise therapy alone, as reported by the British Journal of Sports Medicine 5
Surgery has good clinical outcomes but should not be first-line due to potential complications and because many patients respond well to conservative treatment, as noted by the British Journal of Sports Medicine 5

Paracetamol up to 4g/day can be used as first-line oral analgesia based on extrapolation from musculoskeletal guidelines, as recommended by the European League Against Rheumatism 6