Management of Elbow Pain with Pushing Against Pressure

Clinical Diagnosis

The American College of Radiology suggests that pain worsening with pushing against pressure strongly suggests lateral epicondylitis (tennis elbow) if pain is on the outer elbow, or medial epicondylitis (golfer's elbow) if pain is on the inner elbow, with tenderness directly over the lateral epicondyle and pain reproduced by resisted wrist extension for lateral epicondylitis, and pain at the medial epicondyle with pain on resisted wrist flexion for medial epicondylitis 1, 2, 3

The American College of Radiology recommends plain radiographs of the elbow as the most appropriate initial imaging study to rule out fractures, loose bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, or osteoarthritis, with radiographs often being normal in epicondylitis but essential to exclude other pathology 1, 3, 4, 5

Relative rest prevents ongoing tendon damage and promotes healing, but complete immobilization should be avoided as it causes muscle atrophy, and activity modification and rest should be implemented to prevent ongoing tendon damage 2
Eccentric strengthening exercises are the cornerstone of treatment, promoting tendon healing and increasing strength, and should be combined with stretching exercises for wrist flexors or wrist extensors, and deep transverse friction massage to reduce pain 1, 2
Cryotherapy, such as applying ice for 10-minute periods, provides effective short-term pain relief, and NSAIDs, either oral or topical, provide acute pain relief, though they don't affect long-term outcomes 1, 2

Corticosteroid injections are more effective than NSAIDs in the acute phase for short-term pain relief, but do not alter long-term outcomes and should be used with caution due to potential risks of tendon weakening and rupture 1, 2

Approximately 80% of patients fully recover within 3-6 months with conservative treatment alone, with the majority of patients experiencing significant improvement within this timeframe 3

If pain persists despite 6-12 months of well-managed conservative treatment, surgical evaluation is warranted, with surgery typically including excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 2, 4, 5