The Tennis Elbow

 Clinical question

What is the simplest treatment for tennis elbow?

Results

Despite a wealth of research, there's no true consensus on the foremost efficacious management of lateral epicondylitis especially for effective long-term outcomes. Corticosteroid injections do show large pain-relieving effects within the short term but are related to risks of adverse events and long-term reoccurrence. Advice with a “wait and see” approach is suggested because the first-line treatment in medical care for many cases. within the medium term physiotherapy and or low-level laser therapy could also be effective.

Implementation

Rule out alternative diagnosis. Onward referral could also be indicated if the condition doesn't resolve after 12 months.

Keywords: lateral epicondylitis , corticosteroids, physiotherapy, laser therapy

Tennis elbow

Definition: lateral epicondylitis , also mentioned as lateral epicondylalgia (LE) and sometimes referred to as epicondylitis or tendinopathy clinically,1 features a complex underlying pathophysiology which isn't well understood but is characterized by uncomplicated signs of localized pain over the epicondyle which is formed worse with resisted wrist extension and grip.2 The term epicondylitis has recently been considered a misnomer because a scarcity of inflammatory signs.

Etiology: The annual incidence of lateral epicondylitis is 4 to 7 cases per 1000 patients, predominantly in patients aged 35 to 55 years.3,4 The condition affects between 1% and three of the population,5,6 is typically self-limiting, and lasts between 6 and 24 months.4 one-fifth of cases persist for quite a year.7

Risk factors: Repetitive manual tasks, or handling of heavy loads (>20 kg) or heavy tools (>1 kg).8 Risk is increased by a working posture of arms raised ahead of the body, including repetitive forearm twisting or rotating motions. the danger is further increased by high gripping force.9 LE is additionally related to computer use of quite 20 hours per week, a risk that increases in line with years of use.10

Economics: Up to 30% of patients report work absenteeism.

Level of evidence: Systematic reviews, meta-analyses, general reviews, and randomized controlled trials (RCTs).

Search sources: MEDLINE (PubMed), CINHAL, EMBASE, AMED, Web of data , SPORTDiscus, Cochrane Library, DARE, DHdata, PEDro.

Outcomes: From a patient perspective the most outcomes are:

Pain relief at rest and on activity.

Improved function.

Reduced leave .

Avoidance of adverse events.

These are frequently measured within the short (0 to 12 weeks), intermediate (13 to 26 weeks), and future (≥52 weeks).

Consumer summary: lateral epicondylitis may be a common, painful condition that generally occurs in middle-aged people and sometimes prevents them from working or participating in their usual daily activities. Despite an outsized number of studies investigating an array of interventions, there's no favored evidence-based treatment for lateral epicondylitis that provides anything beyond short-term pain relief. Corticosteroid injections do show large benefits within the short term, but are often painful and are related to an increased risk of long-term recurrence, especially if quite one injection is given. there's some evidence that low-level laser therapy (LLLT) could also be beneficial within the short term, although this is often controversial and not always available as a tretament. Combined physiotherapy treatments give some medium-term relief slightly superior to advice and analgesics alone and show significantly better outcomes than steroid injections within the future . For those patients who don't recover or answer treatment within the future , there's limited low-level support for injecting plasma , or for persistent and severe cases to undergo surgery. Advice with prescribed over-the-counter pain medication is suggested because the first-line treatment for many cases.