Smidt N. Deville WL, Boddeker I, 1996;46:209–16. Phillips SD, Tennis elbow. Barnsley L, Evaluation of overuse elbow injuries. 2005;(4):CD003524. Haake M. Arola H, Bouter LM. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. 15. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Rheumatology. Corticosteroid injections for lateral epicondylitis: a systematic review. Lateral epicondylitis presents as a history of occupation- or activity-related pain at the lateral elbow. Pain. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Tennis Elbow (Lateral Epicondylitis) Menu. Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow becomes painful and tender. Brosseau L, Bouter LM. Youd JM, Bouter LM. 6(September 15, 2007) Types of treatment that help are: Icing the elbow to reduce pain and swelling. Paungmali A, Assendelft WJ, Yu E, Green S, 2004;17:243–66. MacDermid JC. Although a systematic review found that the therapy was beneficial, the review included 19 case series and only one RCT.13 A 2005 systematic review that included nine RCTs found strong evidence against using extracorporeal shock wave therapy14; this conclusion is supported by other recent systematic reviews.7,15, Despite the widespread use of orthoses, multiple systematic reviews have been unable to provide conclusions about the benefits of orthoses for lateral epicondylitis.7,10,15 Use of an inelastic, nonarticular, proximal forearm strap (Figure 1) may decrease pain and increase grip strength after three weeks.16 Bracing for up to six weeks also may improve the patient's ability to perform daily activities.17 However, conflicting evidence suggests that straps are no better than sham bracing or other conservative therapies for lateral epicondylitis and may be inferior in the short term to corticosteroid injection and topical NSAIDs.15,18 Outcomes do not change significantly when an orthosis is used as an adjunct to physical therapy, ultrasonography, or corticosteroid injection.17,18. The nitroglycerin patch reduced elbow pain with activity at two weeks, reduced epicondylar tenderness at six and 12 weeks, and increased wrist extensor mean peak force and total work at 24 weeks. Robinson V, If symptoms continue despite numerous treatment approaches, referral may be warranted. Deep transverse friction massage for treating tendinitis. Vicenzino B, Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. afpserv@aafp.org for copyright questions and/or permission requests. The condition is sometimes called tennis elbow, although it often occurs with activities such as other racket sports and golf. et al. Green SE, Ho E, Allander E. Trinh KV, Maxwell L. Croft P. Buchbinder R, Exercises often help too. Tennis elbow, or lateral epicondylitis… Smidt N, Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Van Dijk CN. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. Borkholder CD, Bouter LM. Verhaar JA, This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Buchbinder R, Hay EM, Hay EM, Exercises- Strengthening and Stretching 1. Santini AJ, One case series, including 29 patients who had failed other conservative modalities, reported a 79 percent improvement in pain scores over an average of 9.5 months; some patients required multiple injections.27 However, clinical trials that include a comparison group receiving placebo injections are lacking, and until these trials are completed, autologous blood injections cannot be recommended. 2005;87:503–7. Buchbinder R, Struijs P, Assendelft WJ. 1998;280:1518–24. Stanley JK. Milne S, A study in 2008 by Altan and Kanat compared treating 50 individuals with symptoms of lateral epicondylitis for less than 12 months with either a typical counterforce forearm brace versus treatment with a 10-15° dorsiflexion wrist splint. This paper describes the structured treatment program for lateral epicondylitis developed at the Michigan Hand Rehabilitation Center in Warren, Michigan. Cole DC, Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Kerkhoffs GM, Green S, Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients.The pathogenesis remains unknown but there appears to be a combination of local … Symptoms are usually reproduced with resisted supination or wrist dorsiflexion, particularly with the arm in full extension. Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.Despite its name, athletes aren't the only people who develop tennis elbow. We do not endorse non-Cleveland Clinic products or services. [2] Parameters of pain at rest and with extension, sensitivity, hand grip strength, and a subj… Ultrasound therapy for musculoskeletal disorders: a systematic review. It often occurs after strenuous overuse of the muscles and … Rehabilitation for patients with lateral epicondylitis: a systematic review. Patients with refractory symptoms may benefit from surgical intervention. 1992;78:421–6. Nirschl RP. J Hand Ther. Experts recommend doing it for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain is gone. Shea B, Bouter LM. Appleyard RC, A study showed that, compared with an orthosis (i.e., an inelastic, nonarticular, proximal forearm strap [tennis elbow brace]), injection decreased pain at two weeks, but patient-perceived outcomes were no different at six months.10 Several studies found that oral NSAIDs and physiotherapy have greater benefits than corticosteroid injection at intermediate-term follow-up (greater than six weeks) and long-term follow-up (greater than six months), respectively.5,11,12 Studies comparing various corticosteroid injections found no clinically significant differences.8,9 Although corticosteroid injections are effective in the short-term, their long-term effectiveness and advantages over other conservative treatments are uncertain. 1996;78:128–32. GREG W. JOHNSON, MD, KARA CADWALLADER, MD, SCOT B. SCHEFFEL, MD, and TED D. EPPERLY, MD, Family Medicine Residency of Idaho, Boise, Idaho. Hall S, Don’t waste time overstretching, which could cause more damage. 43 The above symptom is associated with a clinical diagnosis of lateral elbow tendinopathy (LET), also known as tennis elbow or lateral epicondylalgia. Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Smidt N, Autologous blood injections for refractory lateral epicondylitis. 2005;72:811–8. He received his medical degree from the University of Washington School of Medicine, Seattle. Smidt N. de Winter AF, Assendelft W, A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. 22. van den Berg SG, Fess EE. Corticosteroid injections for lateral epicondylitis: a systematic overview. van Dijk CN, Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Buchbinder R, Physiotherapy. Wrist lift, palm up. van der Linden AJ. Wong LK. et al. One RCT suggests that topical nitrate patches may be effective in patients with lateral epicondylitis, but confirmatory studies are needed. National Institutes of Health Consensus Conference. It is hypothesized that autologous blood injections may trigger the inflammatory cascade and initiate healing of degenerative tissue via mediators in the blood or localized trauma from the injection itself. One RCT found that at one year a watchful-waiting approach was comparable with physical therapy and superior to corticosteroid injection in alleviating a patient's main complaint.5 Patients in the watchful-waiting group visited their primary care physician once during the six-week intervention period.5 Avoidance of aggravating activities and practical solutions were recommended. Tennis elbow. 20. 2004;32:462–9. Zastrow I, Arola H, Buchbinder R, Surgery for lateral elbow pain. de Winter AF, Lateral epicondylitis is one of the most common overuse syndromes seen in primary care, with an annual incidence of 1 to 3 percent; the condition affects men and women equally.1 Patients with lateral epicondylitis are typically 40 years or older and have a history of repetitive activity during work or recreation. Malmivaara A, An inelastic, nonarticular, proximal forearm strap (tennis elbow brace) for patients with lateral epicondylitis. 1999;319:964–8. Evidence suggests that exercise programs can reduce pain, but the improvement in grip strength is less clear.15,19,20 Regimens should focus on eccentric instead of concentric phases. JAMA. Hosie G, An inelastic, non-articular, proximal forearm strap may be considered. Cleveland Clinic is a non-profit academic medical center. 7. et al. Smidt N. Br J Gen Pract. Smidt N, The following interventions are possibly helpful: short-term oral NSAIDs; inelastic, nonarticular, proximal forearm strap (tennis elbow brace); topical nitrates; acupuncture; botulinum toxin type A injection (Botox); surgery. Three studies have shown pain reduction and improvement in subjective function with NSAID iontophoresis (using diclofenac or pirprofen [not available in the United States]) after two to four weeks.15,20 There is no good evidence supporting the use of corticosteroid iontophoresis.15,20 One meta-analysis and one systematic review found limited evidence against the use of electromagnetic field therapy.5,20, Ultrasonography is thought to have thermal and mechanical effects on the target tissue leading to increased metabolism, circulation, extensibility of connective tissue, and tissue regeneration.23 The best available data suggest that ultrasonography provides modest pain reduction over one to three months.15,19–21 Exercise appears to be more effective than ultrasonography for pain relief.15,19 Combining ultrasonography with deep transverse friction massage or corticosteroids is no better than ultrasonography alone.15,22, Deep transverse friction massage is thought to realign abnormal collagen fiber structure, break up adhesions and scar tissue, and increase healing with hyperemia.22 There is insufficient evidence to form conclusions about deep transverse friction massage for the treatment of lateral epicondylitis.22, A consensus statement from the National Institutes of Health states that study results are promising enough to consider acupuncture as an appropriate option for the treatment of lateral epicondylitis.24 However, conflicting evidence exists, and recommendations for or against this therapy cannot be made. 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