In general the evidence base for intervention measures is poor.
Non-specific palliative treatments include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen or aspirin
- Heat or ice
- A counter-force brace or "tennis elbow strap" to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage.
- Vibration therapy can be used for localized pain relief and inflammation with a number of portable devices being available for pain relief
Rest is the tennis player's treatment of choice when the pain first appears; the rest allows the tiny tears in the tendon attachment to heal.), anti-inflammatory drugs, soft tissue massage, stretching exercises, and ultrasound therapy.
In recalcitrant cases surgery may be indicated. Many techniques have been described using open, percutaneous or arthroscopic approaches. Most techniques aim to release the strain on the extensor carpi radialis brevis muscle, remove degenerative tissue and promote healing.
Other treatments with limited scientific support include:
- Acupuncture
- Blood injection (possibly augmented by plateletpheresis)
- Botulinum toxin
- Extra-corporeal shock wave therapy (lithotriptor)
- Heat therapy
- Immobilization of the forearm and elbow using a splint for two to three weeks
- Local injection of cortisone and a numbing medicine
- Low level laser therapy
- Occupational therapy, primarily for stretching and strengthening of the wrist extensor musculature.
- Physical therapy
- Platelet-rich plasma
- Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area
- Sclerotherapy
- Trigger point therapy
There are clinical trials addressing many of these proposed curative treatments, but the quality of these trials is generally poor.
One study has alleged that electrical stimulation combined with acupuncture is beneficial but evaluation studies are inconclusive.
One recent presentation at a scientific meeting described the Tyler Twist Protocol, a physical therapy intervention. Although the study has yet to be published to verify claims made in the newspaper.
Cortisone injections
In four clinical trials comparing corticosteroid injection to placebo (lidocaine) injection that show no effect of the steroids.
Complications from repeated steroid injections include skin problems such as hypopigmentation and fat atrophy leading to indentation of the skin around the injection site.
Further Reading
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"Tennis elbow"
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