Lateral Elbow Pain and Muscle Function Impairments

This APTA Orthopedics guideline covers lateral elbow tendinopathy (often called tennis elbow): which outcome measures and physical tests to use, and which treatments the evidence supports.

It recommends tracking patients with the Patient-Rated Tennis Elbow Evaluation or the DASH, plus range of motion, pain-pressure threshold and grip strength. The core of treatment is resisted exercise of the wrist extensors for subacute and chronic cases, combined with other treatments such as manual therapy; shoulder and shoulder-blade strengthening can be added when those areas are weak.

It also supports tendon or trigger-point dry needling, local elbow mobilization or manipulation, mobilization of the neck, upper back or wrist when those regions are impaired, instrument-assisted and other soft-tissue mobilization, rigid or kinesiology taping for short-term relief, laser therapy, cryotherapy with TENS, and ergonomic changes. Evidence was too conflicting for a recommendation on ultrasound alone, deep cross-friction massage or longer-term use of a counterforce brace, though a brace may help pain during activity.