Elbow tendinopathy (epicondylitis)
EBM Guidelines
Aug 18, 2023 • Latest change Mar 15, 2024
Table of contents
Extract
- The strain that triggers the symptoms must be identified. Tendinopathy usually recovers spontaneously once the strain is removed.
- Encorage the patient to use the upper extremity normally in everyday life.
- Treat acute pain with topical anti-inflammatory drugs Non-steroidal anti-inflammatory drugs appear to have some effect administered topically or orally for lateral elbow pain.B. Physiotherapy may be considered in chronic cases.
- Glucocorticoid injections should not be used in the treatment of elbow tendinopathies. Even though the injections will alleviate acute pain they will markedly increase the recurrence of the condition Corticosteroid injection therapy may decrease pain [mean difference approximately 31 (23, 40)], increase global improvement [relative risk in different studies from 0.11 (0.04, 0.33) to 0.36 (0.18, 0.71)] and increase pain-free grip strength [mean difference approx. 33 (22, 42)] in short-term (≤ 6 weeks) but not in intermediate or long-term follow up in patients with lateral tendinopathy when compared to placebo.C Corticosteroid injection therapy may decrease pain score, increase global improvement and pain-free grip strength in short-term (≤ 6 weeks) but not in long-term follow up in patients with lateral tendinopathy when compared to physiotherapy.C.
Linked evidence summaries
- Non-steroidal anti-inflammatory drugs appear to have some effect administered topically or orally for lateral elbow pain.B
- Corticosteroid injection therapy may decrease pain [mean difference approximately 31 (23, 40)], increase global improvement [relative risk in different studies from 0.11 (0.04, 0.33) to 0.36 (0.18, 0.71)] and increase pain-free grip strength [mean difference approx. 33 (22, 42)] in short-term (≤ 6 weeks) but not in intermediate or long-term follow up in patients with lateral tendinopathy when compared to placebo.C
- Corticosteroid injection therapy may decrease pain score, increase global improvement and pain-free grip strength in short-term (≤ 6 weeks) but not in long-term follow up in patients with lateral tendinopathy when compared to physiotherapy.C
- Extracorporeal shockwave therapy (ESWT) may present no clinically relevant benefit in treating lateral tendinopathy compared with sham or control treatment in pain intensity, grip strength, and elbow disability at short-term ( lt; 3 months) and seems to have no clinically relevant benefit in terms of pain relief in mid-term follow-up (up to 1 year).C
- Botulinum toxin injection seems to be more effective in reducing pain for patients with lateral tendinopathy (symptoms at least for 3 months) up to 4 months compared with saline injection. Botulinum toxin injection reduces grip strength temporarily.B
- The effectiveness of platelet-rich plasma (PRP) injection therapy for lateral elbow pain and function impairment seems to be equal to the effectiveness of saline or local anesthetic injection both in short and long term.B
Search terms
Cubital joint, Elbow, Elbow joint, Elbow pain, Epicondylitis, Lateral Humeral, Epicondylitis, Medial Humeral, Forearm, Frohse syndrome, Glucocorticoids, Golfer's elbow, Injections, Lateral epicondylitis, M77.0, M77.1, Medial epicondylitis, Occupational Diseases, Orthopaedics, Physical medicine, Steroid injections, Surgery, Tennis Elbow, Thrower's elbow