Question of the Day
Saturday, November 14, 2026
A 47-year-old man who plays recreational tennis is evaluated for 6 weeks of lateral elbow pain that worsens with gripping and lifting. On physical examination, palpation over the lateral epicondyle and resisted wrist extension reproduce his pain; there is no swelling, instability, or neurologic deficit, and the elbow has full range of motion. Radiographs are normal. He asks for a corticosteroid injection so the problem will resolve quickly. Which of the following is the most appropriate management?
Answer: A. Load management and exercise
The correct answer is A (Load management and exercise). Lateral elbow pain reproduced by palpation of the lateral epicondyle and resisted wrist extension is lateral epicondylosis, a self-limited tendinopathy that resolves in most patients within a year. Activity modification, a counterforce strap, and progressive loading exercises are first-line.
Why not B (Corticosteroid injection): Injection relieves pain in the short term but leads to worse outcomes and more recurrence at 1 year than physiotherapy or wait-and-see.
Why not C (MRI of the elbow): The diagnosis is clinical; imaging is for atypical features or refractory symptoms.
Why not D (Oral glucocorticoid taper): Systemic steroids are not indicated for a localized tendinopathy.
Why not E (Surgical tendon debridement): Surgery is reserved for symptoms refractory to 6 to 12 months of conservative care.
Clinical Pearl: Tennis elbow usually resolves with load management and exercise; corticosteroid injection worsens long-term outcomes.
Just show me the answer
Answer: A. Load management and exercise
The correct answer is A (Load management and exercise). Lateral elbow pain reproduced by palpation of the lateral epicondyle and resisted wrist extension is lateral epicondylosis, a self-limited tendinopathy that resolves in most patients within a year. Activity modification, a counterforce strap, and progressive loading exercises are first-line.
Why not B (Corticosteroid injection): Injection relieves pain in the short term but leads to worse outcomes and more recurrence at 1 year than physiotherapy or wait-and-see.
Why not C (MRI of the elbow): The diagnosis is clinical; imaging is for atypical features or refractory symptoms.
Why not D (Oral glucocorticoid taper): Systemic steroids are not indicated for a localized tendinopathy.
Why not E (Surgical tendon debridement): Surgery is reserved for symptoms refractory to 6 to 12 months of conservative care.
Clinical Pearl: Tennis elbow usually resolves with load management and exercise; corticosteroid injection worsens long-term outcomes.
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