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Lateral elbow tendinopathy

Key sources
The following summarized guidelines for the evaluation and management of lateral elbow tendinopathy are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023), the American Physical Therapy Association (APTA 2022), the American College of Radiology (ACR 2022), and the American College of Occupational and Environmental Medicine (ACOEM 2013).
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Guidelines

1.Diagnostic investigations

Clinical assessment: use the diagnosis-specific PRTEE to assess pain/irritability and function and/or the region-specific Disabilities of the Arm, Shoulder and Hand to assess upper extremity function at baseline and at least one other follow-up point including discharge in patients with LET.
A
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  • Diagnostic imaging

2.Medical management

Analgesics: offer topical and oral NSAIDs in patients with lateral elbow pain.
B
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  • Corticosteroid injections

  • Blood product injections

  • Other periarticular injections

3.Nonpharmacologic interventions

Heat or ice
As per APTA 2022 guidelines:
Consider offering cryotherapy to reduce pain in patients with irritable symptoms of LET.
C
Consider offering cryotherapy combined with burst transcutaneous electrical nerve stimulation to reduce pain in the short term in patients with symptoms of LET lasting > 30 days.
C

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  • Physical therapy

  • Manual therapy

  • Orthoses and taping

  • Alternative and complementary therapies (acupuncture and dry needling)

  • Alternative and complementary therapies (ultrasound)

  • Alternative and complementary therapies (laser therapy)

  • Alternative and complementary therapies (phonophoresis and iontophoresis)

  • Alternative and complementary therapies (ergonomic interventions)

  • Alternative and complementary therapies (other therapies)

4.Therapeutic procedures

Transcutaneous electrical nerve stimulation
As per APTA 2022 guidelines:
Consider offering burst transcutaneous electrical nerve stimulation applied to the painful region or high- or low-frequency transcutaneous electrical nerve stimulation applied to acupuncture points for short-term pain relief in patients with LET.
C
Consider offering cryotherapy combined with burst transcutaneous electrical nerve stimulation to reduce pain in the short term in patients with symptoms of LET lasting > 30 days.
C

5.Surgical interventions

Indications for surgery
Offer surgery
A
or radiofrequency microtenotomy
B
in patients inadequately responding to multiple evidence-based treatments.
A
Offer NSAIDs and exercises for postoperative care.
Insufficient evidence to recommend for or against ultrasound-guided percutaneous tenotomy in patients with LET.
I