Management of Tennis Elbow

Initial Management

The American College of Physicians recommends beginning with conservative management consisting of relative rest with activity modification, cryotherapy, NSAIDs, and a counterforce brace, followed by progressive eccentric strengthening exercises starting at 2-4 weeks 1
Relative rest is essential, and the patient should avoid activities that worsen pain while continuing activities that don't aggravate symptoms 1
Complete immobilization must be avoided as it leads to muscle atrophy and deconditioning 1
Specific movements to avoid include repetitive wrist extension, forceful gripping with simultaneous wrist extension, and activities like shaking hands or opening doors that stress the lateral epicondyle 2

Topical NSAIDs are preferred in elderly patients to provide effective pain relief while avoiding gastrointestinal risks associated with oral NSAIDs 1
Cryotherapy applied for 10-minute periods through a wet towel provides effective short-term pain relief 1

Eccentric strengthening exercises are the cornerstone of rehabilitation, promoting tendon healing and increasing strength through tensile loading that stimulates collagen production 1
Stretching exercises for the wrist extensors should be incorporated and are widely accepted as beneficial 1

Plain radiographs of the elbow are the initial imaging study if structural pathology is suspected, to rule out intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, occult fracture, or osteoarthritis 3
Advanced imaging (MRI) is reserved for cases where radiographs are normal or nonspecific and intra-articular pathology is suspected 3

Surgical evaluation is warranted only if pain persists despite 6-12 months of well-managed conservative treatment 1
Surgery typically includes excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 1