Treatment of lateral epicondylitis where is the evidence

Algorithm for the treatment of lateral epicondylitis. If symptoms persist, physical therapy, including ultrasonography, or NSAID iontophoresis may be appropriate. Short-term pain relief from corticosteroid injection may help the patient initiate physical therapy. Less contemporary strategies, including topical nitroglycerin and acupuncture, may also be considered. If symptoms continue despite numerous treatment approaches, referral may be warranted. Already a member or subscriber?

Log in. Interested in AAFP membership? Learn more. Cadwallader completed the Tacoma Wash. Family Medicine Residency program. SCOT B. He received his medical degree from the University of Washington School of Medicine. TED D. Address correspondence to Greg. Boise Ave. Reprints are not available from the authors.

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Maxwell L. Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. National Institutes of Health Consensus Conference. Referrals to orthopaedic surgeons for the management of lateral epicondylitis are not infrequent. Open and endoscopic debridement of the ECRB, debridement and reattachment of the ECRB origin, forage of the lateral epicondyle and anconeus flap coverage have been described in the literature.

Furthermore, in the experience of the senior author VS , at the time of surgical debridement, there is often no clear pathological appearing tissue that can clearly be identified. A Cochrane review of surgery for lateral elbow pain in found five small randomised studies with insufficient power to perform a meta-analysis. Further prospective double-blinded RCTs are required to determine whether surgery can modify the disease course in lateral epicondylitis.

Treating lateral epicondylitis can be frustrating for both patients and clinicians. Patients may feel frustrated about the prolonged duration of their pain and functional impairment. It is recommended to avoid unproven investigations or interventions to prevent reinforcement of ineffective coping strategies.

Providing unproven treatment can give a patient false hope and likely medicalise the natural history of a common condition that can present in middle age. Appropriate education of patients regarding the nature of the illness, lifestyle modifications to avoid aggravating activities and appropriate use of analgesics including NSAIDs are critical in early effective management. Evidence regarding the efficacy of surgery in the management of lateral epicondylitis is limited.

Larger, well-designed RCTs are necessary to investigate the true value of these treatment strategies. On the basis of current available evidence, it is difficult to recommend surgical intervention as a reliable modality to address pain associated with lateral epicondylitis.

Did you know you can now log your CPD with a click of a button? Objective In this article, a review of recent English-language journal articles explores current concepts related to lateral epicondylitis and examines the evidence behind the recommendation for the use of non-operative and operative treatment modalities. Discussion Lateral epicondylitis is an enthesopathy associated with the origin of the extensor carpi radialis brevis ECRB muscle. Table 1. The patient then extends their middle finger against resistance.

The clinician places their thumb over the lateral epicondyle and instructs the patient to clench their first and extend, pronate and radially deviate their wrist against resistance. Lateral elbow pain Radiological examination Imaging is not required for a diagnosis of lateral epicondylitis.

Management Despite its relatively high prevalence, there is currently no universally recognised effective and consistent management of lateral epicondylitis that is superior to the natural history of the disease.

Provenance and peer review: Commissioned, externally peer reviewed. Create Quick log. References Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes.

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