Ultrasound therapy for musculoskeletal disorders: a systematic review. 25. Arola H, Deep transverse friction massage for treating tendinitis. Sign up for the free AFP email table of contents. Beller E. Deville WL, Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Cochrane Database Syst Rev. Buchbinder R, Assendelft WJ, Fess EE. Trail IA, General physiotherapy management includes: 1. Barnsley L, 43 The above symptom is associated with a clinical diagnosis of lateral elbow tendinopathy (LET), also known as tennis elbow or lateral epicondylalgia. Smidt N, 28. Typically this occurs as a result of work or sports, classically racquet sports. Walenkamp GH, MacDermid JC. Hay EM, The pain is typically located just distal to the lateral epicondyle over the extensor tendon mass. Tennis elbow. van Mameren H, Buchbinder R, Am Fam Physician. Orthotic devices for the treatment of tennis elbow. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. The majority of cases respond to … Although watchful waiting is a viable option, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) have evaluated the effectiveness of other treatment options such as oral, topical, and injectable medications; physical therapy; and surgery. Trinh KV, There are numerous surgical approaches, including open, percutaneous, and arthroscopic techniques. Advertising on our site helps support our mission. Paoloni JA, 2008;21(4):400-402. Animal studies suggest that nitric oxide stimulates collagen synthesis by wound fibroblasts and, therefore, may play a role in healing extensor tendons. Cochrane Database Syst Rev. Best TM. 1992;78:421–6. Recent review articles have addressed the use of patient history, differential diagnosis, and physical examination in the diagnosis of lateral epicondylitis.3,4. 21. van der Windt DA, Assendelft WJ, It is due to excessive use of the muscles of the back of the forearm. Kerr EW, 2002;(1):CD003525. Education/Advice- on pain control and/or modification of activities 1. Botulinum toxin injection in the treatment of tennis elbow. NSAID = nonsteroidal anti-inflammatory drug, 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. Information from references 15 and 19 through 21. / Vol. GREG W. JOHNSON, MD, KARA CADWALLADER, MD, SCOT B. SCHEFFEL, MD, and TED D. EPPERLY, MD, Family Medicine Residency of Idaho, Boise, Idaho. Brosseau L, Smidt N, Acupuncture. Clin Evid. Specific exercises are helpful for strengthening the muscles of the forearm. 1999;81:257–71. 1974;3:145–53.... 2. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. 2005;(4):CD003524. Shock wave therapy for lateral elbow pain. Korthalsde Bos IB, Nelson J, J Hand Surg. Treatment; Prevention; Tennis elbow is a condition that causes pain around the outside of the elbow. Hall S, Deep transverse friction massage for treating tendinitis. Tennis elbow. Smidt N. Evaluation of overuse elbow injuries. Davidson R, 1999;319:964–8. Trail IA, Smidt N, Corticosteroid injections for lateral epicondylitis: a systematic review. He received his medical degree from the University of Washington School of Medicine and completed a family medicine residency at Madigan Army Medical Center, Fort Lewis, Wash. et al. Haines AT. van der Windt DA, Patients received acetaminophen or a non-steroidal anti-inflammatory drug (NSAID), if necessary, although they were encouraged to wait for spontaneous improvement.5. Over time, the forearm muscles and tendons become damaged from repeating the … Barnsley L, A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Kerkhoffs GM, Local corticosteroid injection has short-term (two to six weeks) benefits in pain reduction, global improvement, and grip strength compared with placebo and other conservative treatments.7–9 However, these benefits do not persist beyond six weeks. Paterson SM, 14. Information from references 15 and 19 through 22. Fess EE. Lateral epicondylitis is considered an overuse injury occurring in the lateral side of the elbow region which can become extremely painful. Duley J, Ho E, Last reviewed by a Cleveland Clinic medical professional on 07/10/2016. Assendelft WJ, Edwards SG, Buchbinder R, In two studies, slow-release diclofenac (Voltaren), 150 mg daily, significantly improved short-term pain and function.6,7 However, there was no difference in pain between naproxen (Naprosyn), 500 mg daily, and placebo.6,7 Patients receiving corticosteroid injections showed greater perception of benefit at four weeks than patients receiving oral NSAIDs, but this benefit did not persist in the longer term.6,7. 11. 2004;17:181–99. The condition affects men and women equally and is more common in persons 40 years or older. Dr. Johnson completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program.... KARA CADWALLADER, MD, is a faculty member at the Family Medicine Residency of Idaho. Botulinum toxin type A (Botox) is thought to facilitate healing by temporarily paralyzing the common extensor origin.28,29 Two small RCTs are available but have conflicting results.28,29 One of these studies found that botulinum toxin type A injection decreases pain scores at four and 12 weeks compared with saline injection28; however, the second study found no difference between the two therapies in pain, quality of life, or grip strength at 12 weeks.29 More data are needed before botulinum toxin type A injection can be recommended to treat lateral epicondylitis. Malmivaara A, Hayton MJ, J Hand Ther. 31. National Institutes of Health Consensus Conference. Assendelft W, Acupuncture for lateral elbow pain. Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. 29. Two systematic reviews and one meta-analysis found that acupuncture leads to short-term (three days to two months) pain reduction.15,20,25 Two additional systematic reviews acknowledge that acupuncture might provide short-term benefit, but they conclude that there is insufficient evidence on the use of acupuncture for the treatment of lateral epicondylitis.7,26. Tennis elbow is usually treated by medical means, and only rarely by surgery. Buchbinder R, If untreated, lateral epicondylitis persists for an average of six to 24 months.2. 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. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Tennis Elbow (Lateral Epicondylitis) Menu. Hall S, Maxwell L. Autologous blood injections for refractory lateral epicondylitis. Graston Technique helps break up scar tissue and enhance tendon healing around the elbow associated with lateral epicondylitis. 4. Robinson V, Casimiro L, 26. Haake M. Verhaar JA, Hui AC, Struijs PA, 1996;78:128–32. 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. Smidt N, Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Poon DW, Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective. Nirschl RP. There are numerous treatment options, but no one single treatment is completely effective. Repetitive wrist dorsiflexion with supination and pronation causes overuse of the extensor tendons of the forearm and subsequent microtears, collagen degeneration, and angiofibroblastic proliferation. GREG W. JOHNSON, MD, is in private practice in Boise, Ida., and is a community faculty member for the Family Medicine Residency of Idaho, Boise. Nelson J, W. Johnson, MD, Idaho Family Physicians, 130 E. Boise Ave., Boise, ID 83706 (e-mail:greg.johnson@fmridaho.org). Yu E, Smidt N. For information about the SORT evidence rating system, see page749 or. Ho E, Assendelft WJ, Calandruccio JH. A double-blind, randomized, controlled, pilot study. Struijs PA, A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Yu E, Pain. White M, Bouter LM. Bouter LM. Bouter LM. Borkholder CD, Home Boddeker I, Korthalsde Bos IB, Scand J Rheumatol. Hill VA, 10. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. It often occurs after strenuous overuse of the muscles and … Brosseau L, ter Riet G, et al. Buchbinder R, de Winter AF, 2000;61:691–700. To see the full article, log in or purchase access. For treating lateral elbow pain Permissions, Access the latest issue of Family! Effectiveness of physiotherapy for lateral epicondylitis short-term oral NSAIDs for lateral epicondylitis: a review! 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