Most cases of epicondylitis heal on a conservative regimen: decrease in the amount of or avoidance of the activities that elicit the pain . This may mean complete cessation from sports for longer periods, until symptoms have subsided. It is important to minimize the load on the muscles, e.g. by changing to a less tightly strung or lighter racquet or by changing playing technique, e.g. by using two hands instead of one in tennis back hand.
There are a number of conservative treatment options that have some effect on pain, but the long-term effect on the disease process is not well documented. Analgesics, NSAIDs and cryotherapy are first choices. Counterforce bracing reduces the tension on the proximal part of the muscles and can be useful for patients who have symptoms during work [24,25]. Cortico-steroid injection under or over the tendon has been shown to shorten the period with pain, but does not affect the long-term cure rate. Injection under the tendon is probably preferable to avoid wasting of the subcutaneous tissue, which may result from direct contact between the tissue and the corticosteroid. It is safest to insert the needle from distal, obliquely, perforating the muscle and positioning the tip between the epicondyle and the tendon. Injection into the tendon must be avoided, as it is very painful and can cause necrosis.
If conservative therapy fails to cure the athlete of the symptoms of epicondylitis or reduce the pain significantly, operative treatment can be considered. Only about 5% of patients with lateral epicondylitis need surgery . At least 6 months' conservative treatment should precede the decision for operation. Failed conservative treatment should always result in re-examination of the patient. Medial instability may be a reason why medial epicondylitis does not respond to therapy. Laterally, instability and degenerative joint disease are important differential diagnoses.
At operation the cojoined tendon is incised longitudinally and released from the epicondyle. All pathologic tissue (tears in the tendon, granulomatous tissue, synovitis in the lateral joint capsule) is removed, the epicondyle is debrided, and the tendon is reattached. The operation can be performed endoscopically. If a spur has been demonstrated, it should be removed. Results after operation are good, as 85-95% of patients can return to their activities without subjective symptoms [27-29], but objectively all have some degree of persistent muscle weakness . There are no randomized studies of the operative treatment.
Was this article helpful?
Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.