Treatment of Tennis Elbow (Lateral Epicondylitis)

Conservative Management (First-Line)

Relative rest prevents ongoing damage, reduces pain, and promotes tendon healing, though complete immobilization should be avoided to prevent muscular atrophy 1
Activities that don't worsen pain may be continued, but those that aggravate symptoms should be modified or temporarily stopped 1, 3
Eccentric strengthening exercises are beneficial for promoting tendon healing and increasing strength 3
Stretching exercises for the wrist extensors are widely accepted and helpful 1, 3
Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 1
Cryotherapy (ice application) for 10-minute periods through a wet towel provides effective short-term pain relief 1, 2
NSAIDs (oral or topical) effectively relieve pain, though they may not affect long-term outcomes 2, 3
Topical NSAIDs can reduce tendon pain while avoiding the gastrointestinal risks associated with oral NSAIDs 2
Counterforce bracing/orthotics (tennis elbow bands) help reinforce, unload, and protect tendons during activity 2, 3

Locally injected corticosteroids may be more effective than NSAIDs for relief in the acute phase 2
However, they do not tend to alter long-term outcomes and should be used with caution 2, 3
Corticosteroids may inhibit healing and reduce tendon tensile strength, potentially predisposing to spontaneous rupture 2
Therapeutic ultrasound may decrease pain and increase collagen synthesis, though evidence for consistent benefit is weak 2
Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research 2
Deep transverse friction massage can reduce pain 3

If pain persists despite 6-12 months of well-managed conservative treatment, surgical evaluation may be warranted 2
Surgery typically includes excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2

Initial phase (0-4 weeks): Rest, activity modification, ice application, NSAIDs, and bracing 1, 2, 3
Rehabilitation phase (2-8 weeks): Progressive eccentric strengthening exercises, stretching, and continued bracing as needed 3
For persistent symptoms: Consider corticosteroid injection or other second-line modalities 2, 3
For refractory cases (>6-12 months): Surgical consultation 2

Overreliance on corticosteroid injections may lead to tendon weakening and potential rupture 2
Complete immobilization should be avoided as it leads to muscle atrophy and deconditioning 1