Lateral Epicondylitis — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyLateral EpicondylitisSCE Rheumatology

A 42-year-old bricklayer presents with a 3-week history of pain over the right lateral epicondyle. There was no preceding trauma. The pain is reproduced by resisted wrist extension, and neurological examination is normal. What is the most appropriate initial management?

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Correct answer: E — Load modification, relative rest, exercises and topical NSAID analgesia

This is lateral elbow tendinopathy, identified clinically by lateral epicondylar tenderness and pain on resisted wrist extension in the context of repetitive manual work. Initial treatment is conservative: explain the condition, reduce or modify provocative loading, maintain relative rather than complete rest, introduce progressive stretching and strengthening exercises, and offer analgesia such as a topical NSAID when appropriate. Imaging is unnecessary when the presentation is typical and there are no red flags or diagnostic uncertainties. Corticosteroid injection may produce short-term pain relief but is not routine first-line treatment and symptoms may recur. Plaster immobilisation causes unnecessary stiffness and deconditioning. Surgical release is reserved for persistent, function-limiting symptoms after a prolonged trial of non-operative management.

Reference: NHS. Tennis elbow: Things you can do and treatments for tennis elbow. Last reviewed 31 May 2024. https://www.nhs.uk/conditions/tennis-elbow/