epicondylitis

^[1]^[2]

Etiology

see more specific form

generally of no value

not routinely indicated^[2]
may be indicated in cases of severe trauma or in cases not responding to therapy

acute phase
- relative rest
  - eliminate the activity that causes the pain
  - return to activity when symptoms have subsided, generally 1-2 weeks
- continue passive, then active range of motion through pain-free range
- ice reduces swelling, edema & pain
  - 20 minutes 3 times/day
  - contraindicated in patients with Raynaud's disease
- ultrasound
  - may increase rate of tissue healing, reduce tissue swelling & increase elasticity of tendons
  - 2-4 minutes 3 times/week
- high-voltage of galvanic stimulation may increase healing rate
- non-steroidal anti-inflammatory drugs (NSAIDs)
- injection with corticosteroid/local anesthetic
  - conflicting data regarding long-term benefit^[2]
  - avoid glucocorticoid injections^[2]
recovery phase
- continue stretching wrist in flexion & extension
- active resistance exercise initially with elbow flexed, then with increasing degrees of extension
  - wrist flexion
  - wrist extension
  - radial & ulnar deviation
  - forearm pronation & supination
return to sport phase
- continued work on strength
  - isometric & higher resistance exercise to build strength
  - high-repetition exercise to build endurance
- gradual return to sport activity with continued attention to causative factor(s)

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 769-71
↑ ^2.0 ^2.1 ^2.2 ^2.3 Medical Knowledge Self Assessment Program (MKSAP) 17, 18 American College of Physicians, Philadelphia 2015, 2018
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022