Management of Lateral Epicondylitis
(Part 4)
There is variety of treatment options that have been recommended for Lateral Epicondylitis (LE).
At this time, there are still no widely accepted therapies for LE.
The treatment of LE has the following therapeutic goals, which are: controlling elbow pain, preserving movement of the affected limb, improving grip strength and endurance, restoring normal function of the affected limb, and preventing further health problems.
Nonoperative treatment should be the priority for most patients with LE.
Surgical intervention should be considered for recalcitrant cases, according to experts.
Nonoperative treatment may help alleviate LE symptoms in 90% of cases.
Nonoperative treatment involves activity modification, physiotherapy, nonsteroidal anti-inflammatory medications, the use of braces, extracorporeal shock-wave therapy, and acupuncture. In some cases, biotherapy can also help people with LE.
Pathologic stages of lateral epicondylitis.
Treatments such as autologous blood injections (ABI) and platelet-rich plasma injections (PRP) have been popular for those with LE.
As part of the treatment, activity modification is important, which includes avoidance of overwork.
There are certain exercises that can transfer the force away from the lateral epicondyle to the medial epicondyle and help alleviate the pain on the lateral elbow.
LE patients are advised to correct bad habits and stay away from some activities that may worsen the pain on the affected limb.
Experts recommend the principle of RICE (rest, ice, compression, and elevation) which can help to relieve pain.
There are various physiotherapy modes that are recommended for the treatment of LE.
Some of the treatment options available may include electrotherapeutic and nonelectrotherapeutic modalities, in order to improve the function and reducing pain by strengthening the affected wrist extensors.
In some cases, eccentric exercise (EE) has been used as a treatment for LE.
EE is executed via stretching the musculotendinous unit with an applied load. It has been proven in some studies that the EE can be a great way to treat LE, in comparison with other therapies such as ultrasound, bracing, and a combination of multiple interventions.
The exact mechanisms of EE in treating LE remain uncertain to experts.
It has been known in studies that topical nonsteroidal anti-inflammatory medicines are effective within four weeks to treat LE.
The use of oral nonsteroidal anti-inflammatory drugs (NSAID) may cause gastrointestinal adverse effects. It has been reported that corticosteroid injection was superior than NSAIDs in improving patients’ results within four weeks, without long-term benefits at 12 months.
Other studies show that corticosteroid injection is inferior than watchful waiting or physical therapy at one year follow-up.
Repeated injections of the corticosteroid may result in iatrogenic tendon rupture and muscle atrophy. Corticosteroid injections may be prone to abuse and therefore lead to adverse effects.
In some instances, counterforce bracing has used for the treatment of LE. Using counterforce braces can help alleviate pain.
Next week, we shall continue our discussion about the various treatment modalities that can be used for patients with LE.