Am Fam Physician. Murrell GA. Trudel D, Cole DC, Buchbinder R, Short-term oral NSAIDs, strap, topical nitrates, acupuncture, botulinum toxin type A injection: B. 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. Appleyard RC, Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. The condition affects men and women equally and is more common in persons 40 years or older. van der Linden AJ. 15. A double-blind, randomized, controlled, pilot study. A current overview. Assendelft W, Buchbinder R, Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. Bouter LM. Ann Intern Med. Assendelft W, Kerr EW, Don't miss a single issue. Hughes PJ, Information from references 15 and 19 through 21. Kerkhoffs GM, Nelson J, No significant differences were found in grip strength or range of motion, and none of the studies evaluated quality of life or time to return to work. Corticosteroid injections for lateral epicondylitis: a systematic review. Robinson V, Tong PY, Dr. Cadwallader completed the Tacoma (Wash.) Family Medicine Residency program. Paungmali A, Haake M. Smidt N, Barnsley L, Hall S, Hudak PL, afpserv@aafp.org for copyright questions and/or permission requests. Wilson JJ, Address correspondence to Greg. Buchbinder R, NSAID = nonsteroidal anti-inflammatory drug. The efficacy of splinting for lateral epicondylitis: a systematic review. Milne S, 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. van der Heijden GJ, 27. Trail IA, W. Johnson, MD, Idaho Family Physicians, 130 E. Boise Ave., Boise, ID 83706 (e-mail:greg.johnson@fmridaho.org). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. An inelastic, non-articular, proximal forearm strap may be considered. Smidt N. Zastrow I, Assendelft WJ, Hall S, Assendelft WJ, 2002;(1):CD003527. Boddeker I, Tennis elbow is also called lateral epicondylitis. Ultrasound therapy for musculoskeletal disorders: a systematic review. The goals of treatment are to: The type of treatment will depend on several factors, including the person's age, type of other medications being taken, overall health, medical history, and severity of pain. Barnsley L, 2002;(4):CD003528. Kerkhoffs GM, van der Heijden GJ, Treatment; Prevention; Tennis elbow is a condition that causes pain around the outside of the elbow. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Cole DC, The RCT of 86 patients compared a nitroglycerin transdermal patch with a placebo patch. 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. General physiotherapy management includes: 1. Last reviewed by a Cleveland Clinic medical professional on 07/10/2016. 9. van Mameren H, Green S, Home The pain may also extend into the back of the forearm and grip strength may be weak. Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. More advanced treatments may be appropriate depending on the length and severity of your symptoms and may include use of nitrogen products, PRP (patient's own platelets), shockwave, or even surgery. Less contemporary strategies, including topical nitroglycerin and acupuncture, may also be considered. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. van der Windt DA, Orthopade [German]. The following interventions are probably helpful for lateral epicondylitis: watchful waiting, short-term topical NSAIDs, corticosteroid injection (short-term relief), exercise regimens, NSAID iontophoresis, ultrasonography. Acupuncture. Bouter LM. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. 2004;32:462–9. 2008;21(4):400-402. 2003;35:51–62. Copyright © 2007 by the American Academy of Family Physicians. Trinh KV, Your therapist may also... Steroid injections. An inelastic, nonarticular, proximal forearm strap (tennis elbow brace) for patients with lateral epicondylitis. Tennis elbow. Bouter LM. Scand J Rheumatol. Physiotherapy. Steroids, such as cortisone, are very … She received her medical degree from the University of California, San Francisco, School of Medicine. Botulinum toxin injection in the treatment of tennis elbow. For information about the SORT evidence rating system, see page749 orhttps://www.aafp.org/afpsort.xml. 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. Stanley JK. Types of treatment that help are: Icing the elbow to reduce pain and swelling. Assendelft WJ, Tugwell P, A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Davidson R, Struijs PA, American Academy of Orthopaedic Surgeons. J Hand Surg. [2] Parameters of pain at rest and with extension, sensitivity, hand grip strength, and a subj… Ultrasound therapy for musculoskeletal disorders: a systematic review. SCOT B. SCHEFFEL, MD, is director of the Family Medicine Residency of Idaho's Primary Care Sports Medicine Fellowship. Tugwell P, Calandruccio JH. Hay EM, Assendelft WJ. Don’t waste time overstretching, which could cause more damage. Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective. Learn more about the causes, risk factors, symptoms, diagnosis, and treatment for tennis elbow. 1996;78:128–32. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. Repetitive wrist dorsiflexion with supination and pronation causes overuse of the extensor tendons of the forearm and subsequent microtears, collagen degeneration, and angiofibroblastic proliferation. Cochrane Database Syst Rev. Education/Advice- on pain control and/or modification of activities 1. For the minority of people with lateral epicondylitis who do not respond to nonoperative treatment, surgical intervention is an option, but confusion exists because of the plethora of options. Trail IA, In non-athletes, elimination of activities that are painful is key to improvement (eg., repetitive valve … Tennis elbow. Frostick SP, Adshead R, Smidt N. Am Fam Physician. 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