First-line treatment of medial epicondylitis

Medial epicondylitis presents as pain and tenderness at the medial elbow, arising from the flexor-pronator group at its humeral origin. This protocol addresses the initial, non-surgical management approach for this condition.

Clinical approach

Management begins with conservative, non-operative measures. The structured regimen combines multiple modalities — addressing both symptom relief and functional recovery — sustained over an appropriate duration before any escalation is considered.

Treatment overview

Conservative management is the established first line. It incorporates activity modification and formal physical therapy alongside anti-inflammatory measures. Additional procedural and mechanical interventions may be introduced depending on the clinical picture. The complete regimen — including the sequencing, specific interventions, and duration thresholds — is available in the full protocol.

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References

DOI: 10.1016/j.jorep.2023.100172

The first line treatment for ME is conservative management.
This includes activity modification and formal physical therapy alongside topical and/or oral non-steroidal anti-inflammatory medications.
Corticosteroid injections, iontophoresis, electrical stimulation, or bracing may be used.
Neutral wrist bracing or counterforce bracing may be used.
On average, patients receive 1–3 corticosteroid injections into the FPG during nonoperative management.
Surgical intervention is typically reserved for patients who do not respond to 3–12 months of conservative management, but the duration of conservative management remains at the discretion of the treating surgeon.

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