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. 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. Br J Sports Med. 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. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. 25. Smidt N, J Hand Ther. Hay EM, Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. Assendelft WJ. Buchbinder R, Rehabilitation for patients with lateral epicondylitis: a systematic review. Wilson JJ, It often occurs after strenuous overuse of the muscles and … van der Windt DA, Over time, the forearm muscles and tendons become damaged from repeating the … Calandruccio JH. Flatt AE. Advertising on our site helps support our mission. Cole DC, Repetitive activity damages the wrist muscle extensor tendon and leads to … If untreated, lateral epicondylitis persists for an average of six to 24 months.2. Cleveland Clinic is a non-profit academic medical center. Barnsley L, Dr. Scheffel completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program. Davidson R, Haake M. 2007 Sep 15;76(6):843-848. Arola H, Appleyard RC, Paterson SM, Chumbley EM, Autologous blood injections for refractory lateral epicondylitis. Bouter LM. Tennis elbow. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. 2004;(11):1633–44. Get Permissions, Access the latest issue of American Family Physician. Smidt N, 2005;(4):CD003524. Barnsley L, Buchbinder R, Assendelft WJ, Tennis elbow is usually treated by medical means, and only rarely by surgery. Youd JM, 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. Buchbinder R, Symptoms are usually reproduced with resisted supination or wrist dorsiflexion, particularly with the arm in full extension. 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. et al. Botulinum toxin injection in the treatment of tennis elbow. Nirschl RP. Tugwell P, Bouter LM. van Dijk CN, Cochrane Database Syst Rev. Green SE, Shea B, Choose a single article, issue, or full-access subscription. Bouter LM. Assendelft WJ, de Winter AF, 14. 31. 2003;31:915–20. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Struijs PA, Wilson JJ, Best TM. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. Lateral epicondylitis presents as a history of occupation- or activity-related pain at the lateral elbow. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach forearm muscles to the arm bone at the elbow joint. Treatment of tennis elbow can be a frustration for people with this condition, but understand why this occurs and what you can do about it will help to r… CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. 2001;51:924–9. If symptoms continue despite numerous treatment approaches, referral may be warranted. Autologous blood injections for refractory lateral epicondylitis. van der Linden AJ. She received her medical degree from the University of California, San Francisco, School of Medicine. 1996;46:209–16. Assendelft W, NSAID = nonsteroidal anti-inflammatory drug. Smidt N, BMJ. Arola H, Frostick SP, 2004;32:462–9. Dr. Cadwallader completed the Tacoma (Wash.) Family Medicine Residency program. Smidt N, Graston Technique helps break up scar tissue and enhance tendon healing around the elbow associated with lateral epicondylitis. Assendelft WJ. The efficacy of splinting for lateral epicondylitis: a systematic review. 2003;35:51–62. Van Dijk CN. Smidt N, Greens S, Borkholder CD, The majority of cases respond to … O'Connor FG, Education/Advice- on pain control and/or modification of activities 1. Learn more about the causes, risk factors, symptoms, diagnosis, and treatment for tennis elbow. 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. Murrell GA. Trail IA, Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Despite the prevalence of lateral epicondylitis and the numerous treatment strategies available, relatively few high-quality clinical trials support many of these treatment options; watchful waiting is a reasonable option. van den Berg SG, Modalities- Ultrasound, Transcutaneous electrical nerve stimulation (TENS) 1. Most procedures excise abnormal tissue within the origin of the extensor carpi radialis brevis tendon at the lateral epicondyle or release the tendon altogether. van der Heijden GJ, Tong PY, Last reviewed by a Cleveland Clinic medical professional on 07/10/2016. 3. Zastrow I, Kerr EW, van der Windt DA, Lateral Epicondylitis Treatment With your lateral epicondylitis tests results, your doctor will decide the proper treatments options for you. Paoloni JA, Data do not support the use of extracorporeal shock wave therapy for the treatment of lateral epicondylitis. 4. Advertising on our site helps support our mission. Barnsley L, de Winter AF, Kerkhoffs GM, Manual therapy- Mulligan - Mobilisation with movement 1. Physiotherapy. Am Fam Physician. Fess EE. Hay EM, 2000;61:691–700. National Institutes of Health Consensus Conference. Shea B, Hughes PJ, 23. Arola H, Results of the program, as reflected in … non-steroidal anti-inflammatory drugs (NSAIDS), Resting and avoiding any activity that causes pain to the sore elbow, Use of a counter-force brace such as a tennis elbow strap on the forearm for forceful activities. Contact Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Evaluation of overuse elbow injuries. W. Johnson, MD, Idaho Family Physicians, 130 E. Boise Ave., Boise, ID 83706 (e-mail: Allander E. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Assendelft WJ, Milne S, Lateral … 17. Croft P. Tennis elbow. Cochrane Database Syst Rev. Golfer's elbow is a similar condition that affects the inside of the elbow. Green S, Ann Intern Med. The condition usually happens due to over use of the forearm muscles and results in pain of the outside elbow. Arola H, Common overuse tendon problems: a review and recommendations for treatment. For information about the SORT evidence rating system, see page749 or. Smidt N. Short-term pain relief from corticosteroid injection may help the patient initiate physical therapy. et al. A double-blind, randomized, controlled, pilot study. Poon DW, Smidt N, There are numerous surgical approaches, including open, percutaneous, and arthroscopic techniques. et al. et al. 2008;21(4):400-402. 29. [2] Parameters of pain at rest and with extension, sensitivity, hand grip strength, and a subj… Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. We do not endorse non-Cleveland Clinic products or services. The median follow-up period was only two weeks, and long-term outcomes were not reported. Cochrane Database Syst Rev. The surgical techniques for treating lateral epicondylitis can be grouped into three main categories: open, percutaneous, … Bouter LM. Common overuse tendon problems: a review and recommendations for treatment. Smidt N, Fess EE. 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. Green S, Nelson J, van der Heijden GJ, Ho E, MacDermid JC. Verhaar JA, Evidence is conflicting on the use of oral NSAIDs for lateral epicondylitis. If symptoms persist, physical therapy, including ultrasonography, or NSAID iontophoresis may be appropriate. Br J Gen Pract. Haake M. MacDermid JC. Damsma K. ter Riet G, Greens S, Although most cases can be self-healing, the optimal treatment strategy for chronic lateral epicondylitis remains controversial. Tennis elbow is a pain focused on the outside of your arm, where your forearm meets your elbow. Information from references 15 and 19 through 21. Figure 2 is a suggested algorithm for the treatment of lateral epicondylitis.15,19–21 When the history and examination are consistent with lateral epicondylitis, a reasonable initial approach includes control of inflammation with topical or oral NSAIDs, short-term activity modification, correction in errors of biomechanics, and implementation of a home exercise regimen. Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. 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