Avoiding activities that provoke pain or stress the elbow is the most effective and safest way to heal elbow tendonitis. Experts recommend that any provoking activities be avoided, particularly during the early phase of the condition. You may notice literature that recommends the "RICE" treatment for tennis elbow. "RICE" stands for rest, ice, compression, and elevation.

Resuming activities too quickly (during the "honeymoon period") just after symptoms improve can cause a relapse in which symptoms worsen. Many people resume activities too soon because they are eager to return to enjoyable recreational activities such as golf, tennis, etc. Experts often recommend waiting for a number of weeks after symptoms resolve, and then gradually increasing the time spent engaged in the elbow stressing activities.

Unfortunately, individuals whose work stresses the elbow do not usually have the luxury of waiting long enough for the condition to heal completely.

Data suggests that elbow pain tends to heal in more than 80% of people by one year.

Studies suggest that ultrasound treatment (iontophoresis) with a local steroid (dexamethasone) improves symptoms of tendonitis. The ultrasound treatment helps the steroid to penetrate locally. Many experts recommend trying this treatment along with anti-inflammatory drugs, rest, and an elbow strap (a type of elbow brace).

A few small studies found that anti-inflammatory drugs that are applied to the skin may improve elbow symptoms in the short-term (first few weeks). Long-term effects are unknown. There are no studies comparing topical (applied to skin) to oral anti-inflammatories (taken by mouth). Topical anti-inflammatories have very few side effects (generally only local skin irritation) compared to oral anti-inflammatories which commonly cause stomach upset/ulcers as well as other side effects. Benzydamine is not available in the US.

Studies suggest that anti-inflammatory drugs (ibuprofen, Advil, Motrin, Aleve, naproxen, aspirin, etc) may relieve elbow symptoms during the first few weeks. There is no data on long-term effectiveness and these drugs can cause significant side effects such as stomach ulcers/gastritis/bleeding when taken over a long period of time. Anti-inflammatories cannot be tolerated by many people because of stomach irritation. They are best taken with milk or food.

Individuals with kidney disease, high blood pressure and those with a history of intestinal bleeding cannot take these drugs.

There are no studies comparing bracing to placebo (sham) treatment. Well-designed studies are needed to assess its effectiveness.

Injections are typically reserved for people with moderate to severe symptoms who need relief right away. There is evidence that people who have the injections may have a higher chance of having a recurrence of symptoms (possibly because they returned too quickly to the activity that caused the problem).

There have been no studies that compare surgical to non-surgical treatment for elbow tendonitis. Therefore it is not possible to know how effective surgery is for this problem compared to medical treatment. A few small flawed studies suggested that approximately 90% of people experienced good to excellent relief from surgery; data on the results of non-surgical treatment suggests that more than 80% of individuals with elbow tendonitis improve despite the type of treatment used. Studies that directly compare the outcome of surgical and non-surgical treatments are needed to draw conclusions about the benefits of surgery.

Experts tend to recommend surgery only for the small percentage of people (5-10%) who still have symptoms after at least 6 months of non-surgical treatment; who also have a problem that can be fixed with surgery; whose pain limits their activities significantly; and who have had an adequate trial of elbow rest.

Sometimes, athletes who require prompt symptom relief opt for surgery. Studies that compare time-to-recovery for surgery versus non-surgical treatment is needed to guide treatment decisions.

There can be serious side effects associated with long-term use of anti-inflammatories including stomach pain, ulcers, and bleeding. People in older age groups should be particularly cautious about using these medications for long periods of time.

Study results of various physical therapy methods including exercises, massage, and ultrasound have been conflicting. More research is needed before any of these methods can be recommended. Because this type of therapy is not harmful, it is considered reasonable to try if other measures such as rest and anti-inflammatory creams are not working.

Some studies have shown acupuncture to be better than placebo (sham) treatment in the short term (few days to weeks) but not in the long term (3-6 months). The studies done thus far are too small and are not of high enough quality to allow any recommendations to be made about acupuncture for tennis elbow.

Studies on shock wave therapy have been conflicting. Some trials have found benefits while others have not. More research is needed before this treatment can be recommended. Most insurance companies consider this treatment to be "experimental" and won't pay for it.

With elbow bursitis (or "olecranon" bursitis) swelling occurs at the tip of the elbow. Bursitis of the elbow is typically caused by chronic elbow irritation or trauma; less commonly, it is caused by an infection.

There have been no studies of the effectiveness of ace wraps, elbow pads or other methods to decrease elbow irritation. Ace wraps or elbow pads are typically recommended by experts, however, and are frequently used.

Aspiration (or removal of fluid from the elbow) is often used for symptom relief (if pain is present); to quicken the time to recovery; to prevent recurrence; and most importantly to diagnose the presence of an infection. Infectious bursitis requires treatment with antibiotics whereas non-infectious bursitis does not.

There is some evidence to suggest that people with elbow bursitis may recover more quickly and experience fewer recurrences after aspiration compared to those who do not have fluid removed from the elbow. Most people with non-infectious bursitis recover, however, despite the type of treatment used and whether or not an aspiration is performed.

There is controversy amoung experts about whether everyone with elbow bursitis should have an elbow aspiration to assess whether or not an infection is present. Proponents of aspiration for everyone base their recommendation on the fact that it can be difficult to distinguish an infectious versus non-infectious bursitis based on physical exam and blood tests alone. Other experts and some published guidelines state that aspiration is only required when bursitis is not improving over time or when infection (or another less common cause such as gout) is suspected. Studies are needed to compare the outcomes of the two approaches to clarify the pros and cons of each.

Sometimes the aspiration (withdrawal of fluid) will need to be repeated if the fluid reaccumulates, especially if the bursitis is due to infection.

There are few studies of anti-inflammatories for treatment of bursitis.

One small study found that steroid injections provided the fastest and most reliable symptom relief, but there were more complications including infection and atrophy (thinning) of the skin.

More data is needed to evaluate the effectiveness and complications of steroid injections.

People with severe infectious bursitis sometimes need to be treated in the hospital with intravenous antibiotics.

Often surgeons will wait until some of the swelling and inflammation goes down before surgically removing the bursa (fluid-containing sack).