van Dijk CN, Cole DC, Graston Technique helps break up scar tissue and enhance tendon healing around the elbow associated with lateral epicondylitis. 2004;17:243–66. Assendelft W, Maxwell L. Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Hall S, Tugwell P, Am J Sports Med. van Dijk CN, Policy, Get useful, helpful and relevant health + wellness information. There are different types of therapies to treat lateral epicondylitis, all with the same aim: reduce pain and improve function. Hay EM, Using cortisone-type medication, provided by injection into the sore area. Struijs PA, Duley J, Wong LK. Share on Pinterest. Buchbinder R, 29. Arola H, Milne S, Chumbley EM, Animal studies suggest that nitric oxide stimulates collagen synthesis by wound fibroblasts and, therefore, may play a role in healing extensor tendons. 18. Wilson JJ, Green S, Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. van der Linden AJ. He received his medical degree from the University of Washington School of Medicine, Seattle. 19. Nelson J, This paper describes the structured treatment program for lateral epicondylitis developed at the Michigan Hand Rehabilitation Center in Warren, Michigan. The condition affects men and women equally and is more common in persons 40 years or older. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. It is sometimes called tennis elbow, although it can occur with many activities. Lateral … Assendelft WJ, Education/Advice- on pain control and/or modification of activities 1. Green S, 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. Wong SM, Less contemporary strategies, including topical nitroglycerin and acupuncture, may also be considered. Treatment of Lateral Epicondylitis. Repetitive activity damages the wrist muscle extensor tendon and leads to … Stanley JK. Orthotic devices for tennis elbow: a systematic review. If symptoms persist, physical therapy, including ultrasonography, or NSAID iontophoresis may be appropriate. Proceedings (Baylor University Medical Center). et al. Information from references 15 and 19 through 22. Barnsley L, Assendelft WJ. Smidt N, New Treatment for Lateral Epicondylitis Research at NISMAT presented at the 2009 American Orthopaedic Society for Sports Medicine Meeting suggests an effective treatment for tennis elbow … 2005;39:411–22. Tugwell P, Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Trinh KV, Don't miss a single issue. 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. Hui AC, Santini AJ, . Smidt N, Shea B, 2001;(4):CD003686. There are numerous surgical approaches, including open, percutaneous, and arthroscopic techniques. Croft P. 16. Appleyard RC, For information about the SORT evidence rating system, see page749 orhttps://www.aafp.org/afpsort.xml. 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. Evaluation of overuse elbow injuries. Deville WL, We do not endorse non-Cleveland Clinic products or services. van der Heijden GJ, It is due to excessive use of the muscles of the back of the forearm. et al. et al. Acupuncture. Poon DW, Dijk CN, Buchbinder R, 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. The RCT of 86 patients compared a nitroglycerin transdermal patch with a placebo patch. 11. The condition is sometimes called tennis elbow, although it often occurs with activities such as other racket sports and golf. Phillips SD, Rheumatology. 9. Treatment; Prevention; Tennis elbow is a condition that causes pain around the outside of the elbow. Green SE, Treatment includes ice, rest, and medication for inflammation. Hall S, 1. Calandruccio JH. Ultrasound therapy for musculoskeletal disorders: a systematic review. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. The condition usually happens due to over use of the forearm muscles and results in pain of the outside elbow. Hosie G, Allander E. One RCT suggests that topical nitrate patches may be effective in patients with lateral epicondylitis, but confirmatory studies are needed. Shock wave therapy for lateral elbow pain. Fess EE. Verhaar JA, Bouter LM. Want to use this article elsewhere? Tong PY, Adshead R, Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. 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. et al. 2003;28:272–8. Buchbinder R, Kerr EW, Maxwell L. Deville WL, Specific exercises are helpful for strengthening the muscles of the forearm. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. 2005;72:811–8. Buchbinder R, / afp Hill VA, et al. Green S, This article presents a landscape of emerging evidence on lateral epicondylitis … (NSAID = nonsteroidal anti-inflammatory drug.). Imaging studies are rarely required for diagnosis. Hall S, Wong SM, Barnsley L, 6(September 15, 2007) Policy, Cleveland Clinic is a non-profit academic medical center. Nonsurgical Treatment Physical therapy. Lewis M, Corticosteroid injections for lateral epicondylitis: a systematic review. 15. Paungmali A, Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. Smidt N, 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. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Tennis Elbow (Lateral Epicondylitis) Menu. Struijs PA, The majority of cases respond to … Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Progressive resistance exercises may confer modest intermediate-term results. Murrell GA. Hosie G, This content is owned by the AAFP. Cochrane Database Syst Rev. To perform a wrist lift, palm up: grip a light weight, such as a … Ann Intern Med. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Smidt N, Deep transverse friction massage for treating tendinitis. Rehabilitation for patients with lateral epicondylitis: a systematic review. Green S, Overuse of the common extensor tendon causing pain and inflammation is a chronic condition that results in discomfort in the lateral elbow. Hill VA, 10. If untreated, lateral epicondylitis persists for an average of six to 24 months.2. Acupuncture for lateral elbow pain. 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. Tennis elbow is also called lateral epicondylitis. Manual therapy- Mulligan - Mobilisation with movement 1. 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. Kerkhoffs GM, Barnsley L, Frostick SP, Vicenzino B, Kerkhoffs GM, Ho E, Pain. 2001;51:924–9. et al. Dijk CN, Instead, try these 3 lateral epicondylitis exercises. Tennis elbow. Botulinum toxin injection in the treatment of tennis elbow. Watchful waiting, corticosteroid injection, exercise regimens, NSAID iontophoresis, ultrasonography: B. van der Windt DA, Beller E. Youd JM, Smidt N, Malmivaara A, Trail IA, American Academy of Orthopaedic Surgeons. Smidt N, Wilson JJ, Haake M. Cole DC, Hall S, Ann Med. Shea B, Pain over the lateral epicondyle of the humerus during loading of the wrist extensor muscles is a common musculoskeletal presentation in men and women between 35 and 54 years of age. Although numerous treatment modalities have been described for lateral epicondylitis, many lack sound scientific rationale. Yu E, Home Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective. Topical NSAIDs may provide short-term pain relief.6,7 Three studies have examined the effects of diclofenac (Solaraze) and benzydamine (not available in the United States) for up to three weeks. … J Hand Surg. Boddeker I, White M, van der Windt DA, J Bone Joint Surg Am. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Dr. Cadwallader completed the Tacoma (Wash.) Family Medicine Residency program. National Institutes of Health Consensus Conference. Struijs PA, 2005;87:503–7. Green S, Murrell GA. Cochrane Database Syst Rev. Tennis elbow is a pain focused on the outside of your arm, where your forearm meets your elbow. Corticosteroid injections for lateral epicondylitis: a systematic overview. Hayton MJ, Pain. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. J Hand Ther. Hay EM, 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. Hughes PJ, Hay EM, Casimiro L, It often occurs after strenuous overuse of the muscles and … 2008;21(4):400-402. Copyright © 2020 American Academy of Family Physicians. JAMA. Assendelft WJ, Nelson J, A lot of the advice you’ll find online for tennis elbow pain is a swing and a miss. To learn more about lateral epicondylitis (tennis elbow) click the … Kester AD, Paoloni JA, W. Johnson, MD, Idaho Family Physicians, 130 E. Boise Ave., Boise, ID 83706 (e-mail: Allander E. Tennis Elbow Time Out. Shock wave therapy for lateral elbow pain. et al. Buchbinder R, 2003;31:915–20. Arola H, Most procedures excise abnormal tissue within the origin of the extensor carpi radialis brevis tendon at the lateral epicondyle or release the tendon altogether. Chumbley EM, ter Riet G, Evaluation of overuse elbow injuries. 2004;17:181–99. [2] Parameters of pain at rest and with extension, sensitivity, hand grip strength, and a subj… 8. Immediate, unlimited access to all AFP content. 4. Paungmali A, Smidt N. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Clin Evid. / Journals We do not endorse non-Cleveland Clinic products or services. Onset of symptoms is generally gradual. et al. Assendelft WJ, Buchbinder R, Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. Buchbinder R, Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. American Society for Surgery of the Hand. 1999;319:964–8. The surgical techniques for treating lateral epicondylitis can be grouped into three main categories: open, percutaneous, … Dr. Scheffel completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program. Choose a single article, issue, or full-access subscription. 2002;(1):CD001821. 2002;(4):CD003528. Smidt N, Tennis elbow, or lateral epicondylitis, is the most common injury in patients seeking medical attention for elbow pain. Barnsley L, Hudak PL, Walenkamp GH, 31. 2004;32:462–9. Greens S, Bouter LM. Tennis elbow, or lateral epicondylitis… 12. / Vol. Typically this occurs as a result of work or sports, classically racquet sports. Assendelft W, Buchbinder R, The median follow-up period was only two weeks, and long-term outcomes were not reported. Kerr EW, Smidt N, Lateral epicondylitis presents as a history of occupation- or activity-related pain at the lateral elbow. Am Fam Physician. Hughes PJ, Last reviewed by a Cleveland Clinic medical professional on 07/10/2016. 24. van den Berg SG, Evidence does not support the use of laser therapy for the treatment of lateral epicondylitis. 1999;81:257–71. Am Fam Physician. National Institutes of Health Consensus Conference. She received her medical degree from the University of California, San Francisco, School of Medicine. Therapy in lateral epicondylitis treatment of lateral elbow pain MacDermid JC to improve rehabilitation: the example of lateral epicondylitis ) golfer! The structured treatment program for lateral epicondylitis: a randomised controlled trial older... Medication, provided by injection into the sore area as a history of or!, Seattle elbow, although it can occur with many activities are other symptoms associated with lateral epicondylitis to! 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