Lateral epicondylalgia — RACGP Fellowship MCQ

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ModerateMusculoskeletal and sportsLateral epicondylalgiaRACGP Fellowship

A 44-year-old carpenter has lateral elbow pain for eight weeks, worse with gripping and resisted wrist extension. There is no neck pain, trauma, swelling or neurological deficit. What is the most appropriate initial management?

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Correct answer: D — Activity modification, education and progressive loading exercises

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

The most appropriate initial management is activity modification, patient education, and progressive loading exercises. RACGP guidance and evidence-based literature confirm that supervised exercise is the first-line intervention for lateral epicondylalgia. Corticosteroid injection (A) is not definitive first-line therapy and carries risk of tendon rupture; physiotherapy is superior economically and clinically. Immobilisation (B) impairs recovery; active loading is required. Arthroscopy (C) has no indication in uncomplicated lateral epicondylalgia with no mechanical dysfunction. Antibiotics (E) are inappropriate; there is no clinical evidence of bursitis or infection in a mechanical overuse injury. The patient should receive activity counselling, NSAIDs, and supervised eccentric/isometric loading exercises for 6–8 weeks before consideration of injection or other interventions.

Reference: Royal Australian College of General Practitioners. Lateral epicondylitis. https://www1.racgp.org.au/getattachment/3e1753b6-8cb6-4b58-83f8-88dd40755ac6/Lateral-epicondylitis.aspx; and RACGP. Physiotherapy: lateral epicondylitis. https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/HANDI/Physiotherapy-lateral-epicondylitis.pdf (January 2016).