Tong PY, / afp White M, Last reviewed by a Cleveland Clinic medical professional on 07/10/2016. Stanley JK. Smidt N, 17. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. Hay EM, 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. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. MacDermid JC. Tennis elbow. 29. He received his medical degree from the University of Washington School of Medicine and completed a family medicine residency at Madigan Army Medical Center, Fort Lewis, Wash. 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. 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. et al. 27. Stanley JK. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Buchbinder R, Orthopade [German]. 2000;61:691–700. Don’t waste time overstretching, which could cause more damage. JAMA. Clin Evid. A study showed that, compared with an orthosis (i.e., an inelastic, nonarticular, proximal forearm strap [tennis elbow brace]), injection decreased pain at two weeks, but patient-perceived outcomes were no different at six months.10 Several studies found that oral NSAIDs and physiotherapy have greater benefits than corticosteroid injection at intermediate-term follow-up (greater than six weeks) and long-term follow-up (greater than six months), respectively.5,11,12 Studies comparing various corticosteroid injections found no clinically significant differences.8,9 Although corticosteroid injections are effective in the short-term, their long-term effectiveness and advantages over other conservative treatments are uncertain. 2001;(4):CD003686. Wong LK. Botulinum toxin injection in the treatment of tennis elbow. Smidt N, Autologous blood injections for refractory lateral epicondylitis. 2004;(11):1633–44. 1999;81:257–71. 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. Assendelft WJ. van Mameren H, 19. American Academy of Orthopaedic Surgeons. Orthotic devices for the treatment of tennis elbow. It is hypothesized that autologous blood injections may trigger the inflammatory cascade and initiate healing of degenerative tissue via mediators in the blood or localized trauma from the injection itself. Lateral … We do not endorse non-Cleveland Clinic products or services. 2005;143:793–7. Kerkhoffs GM, She received her medical degree from the University of California, San Francisco, School of Medicine. NSAID = nonsteroidal anti-inflammatory drug. Arola H, 1996;46:209–16. 2003;28:272–8. Nelson J, Education/Advice- on pain control and/or modification of activities 1. It is sometimes called tennis elbow, although it can occur with many activities. 2003;35:51–62. Maxwell L. Damsma K. 4. Information from references 15 and 19 through 21. (NSAID = nonsteroidal anti-inflammatory drug.). Best TM. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Borkholder CD, Struijs P, Lewis M, Barnsley L, Advertising on our site helps support our mission. Appleyard RC, ter Riet G, The efficacy of splinting for lateral epicondylitis: a systematic review. Cole DC, van der Windt DA, Hughes PJ, Arola H, O'Connor FG, Policy, Get useful, helpful and relevant health + wellness information. Nelson J, Repetitive wrist dorsiflexion with supination and pronation causes overuse of the extensor tendons of the forearm and subsequent microtears, collagen degeneration, and angiofibroblastic proliferation. Smidt N, A current overview. The pain may also extend into the back of the forearm and grip strength may be weak. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Barnsley L, Electrotherapeutic modalities, including electromagnetic field therapy and iontophoresis, are also often employed to treat lateral epicondylitis. Bisset L, van Dijk CN, Tennis elbow. Malmivaara A, More commonly known as tennis elbow, lateral epicondylitis … Acupuncture for lateral elbow pain. Watchful waiting, corticosteroid injection, exercise regimens, NSAID iontophoresis, ultrasonography: B. Robinson V, / Journals Struijs PA, 2004;32:462–9. Flatt AE. Am Fam Physician. Hall S, Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Croft P. Use of an inelastic, nonarticular, proximal forearm strap (tennis elbow brace) may improve function during daily activities. CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. Scand J Rheumatol. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. Assendelft WJ, Barnsley L, Br J Sports Med. Rehabilitation for patients with lateral epicondylitis: a systematic review. Advertising on our site helps support our mission. Hill VA, An inelastic, non-articular, proximal forearm strap may be considered. Tugwell P, et al. Buchbinder R, Both tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are painful conditions caused by overuse. Assendelft W, Hudak PL, Trudel D, Buchbinder R, Struijs P, Buchbinder R, Beller E. Don't miss a single issue. Trinh KV, Walenkamp GH, 2002;359:657–62. van Mameren H, The median follow-up period was only two weeks, and long-term outcomes were not reported. For information about the SORT evidence rating system, see page749 or. Croft P. Boddeker I, Golfer's elbow is a similar condition that affects the inside of the elbow. He received his medical degree from the University of Washington School of Medicine, Seattle. J Hand Surg. Case series have suggested favorable outcomes with few adverse effects.31 Despite these conclusions, no RCTs have been performed.7,31. 21. van der Windt DA, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Tennis Elbow (Lateral Epicondylitis) Menu. Smidt N, et al. One RCT found that at one year a watchful-waiting approach was comparable with physical therapy and superior to corticosteroid injection in alleviating a patient's main complaint.5 Patients in the watchful-waiting group visited their primary care physician once during the six-week intervention period.5 Avoidance of aggravating activities and practical solutions were recommended. White M, Nirschl RP. To see the full article, log in or purchase access. Lateral epicondylitis can be treated with rest and medicines to help with the inflammation. Smidt N. It is due to excessive use of the muscles of the back of the forearm. Want to use this article elsewhere? Acupuncture for lateral elbow pain. Fess EE. Evaluation of overuse elbow injuries. 30. Onset of symptoms is generally gradual. 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. Physiotherapy. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Lateral epicondylitis is a common overuse syndrome of the extensor tendons of the forearm. To perform a wrist lift, palm up: grip a light weight, such as a … Pain. Corticosteroid injections for lateral epicondylitis: a systematic review. Hudak PL, 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. If untreated, lateral epicondylitis persists for an average of six to 24 months.2. Milne S, Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. Paungmali A, Local corticosteroid injection has short-term (two to six weeks) benefits in pain reduction, global improvement, and grip strength compared with placebo and other conservative treatments.7–9 However, these benefits do not persist beyond six weeks. Am Fam Physician. . Calandruccio JH. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. Smidt N, Youd JM, Buchbinder R, Ultrasound therapy for musculoskeletal disorders: a systematic review. TED D. EPPERLY, MD, is chairman and program director of the Family Medicine Residency of Idaho and is a clinical professor at the University of Washington School of Medicine. Am Fam Physician. Shea B, Verhaar JA, Buchbinder R, Patient information: See related handouts on tennis elbow and exercises for tennis elbow, written by the authors of this article. Smidt N, One case series, including 29 patients who had failed other conservative modalities, reported a 79 percent improvement in pain scores over an average of 9.5 months; some patients required multiple injections.27 However, clinical trials that include a comparison group receiving placebo injections are lacking, and until these trials are completed, autologous blood injections cannot be recommended. Van Dijk CN. van der Windt DA, Green S, van den Berg SG, National Institutes of Health Consensus Conference. Tennis Elbow Time Out. Lateral epicondylitis presents as a history of occupation- or activity-related pain at the lateral elbow. Duley J, van der Windt DA, Information from references 15 and 19 through 22. Assendelft WJ. Orthotic devices for tennis elbow: a systematic review. 10. Tennis elbow is also called lateral epicondylitis. Ann Med. There are numerous treatment options, but no one single treatment is completely effective. SCOT B. SCHEFFEL, MD, is director of the Family Medicine Residency of Idaho's Primary Care Sports Medicine Fellowship. Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. Get Permissions, Access the latest issue of American Family Physician. Zastrow I, Paterson SM, Contact Data do not support the use of extracorporeal shock wave therapy for the treatment of lateral epicondylitis. Yu E, Lancet. Address correspondence to Greg. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. van der Windt DA, Poon DW, Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. 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. Smidt N, Dijk CN, Barnsley L, Algorithm for the treatment of lateral epicondylitis. Murrell GA. Haines AT. An inelastic, nonarticular, proximal forearm strap (tennis elbow brace) for patients with lateral epicondylitis. van der Linden AJ. Hall S, Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Instead, try these 3 lateral epicondylitis exercises. Cleveland Clinic is a non-profit academic medical center. Progressive resistance exercises may confer modest intermediate-term results. 13. Am J Sports Med. Casimiro L, This content is owned by the AAFP. Results of the program, as reflected in … A current overview. We do not endorse non-Cleveland Clinic products or services. Phillips SD, Poon DW, A double-blind, randomized, controlled, pilot study. Bisset L, et al. 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. American Society for Surgery of the Hand. Hall S, Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients.The pathogenesis remains unknown but there appears to be a combination of local … To learn more about lateral epicondylitis (tennis elbow) click the … Beller E. 14. Ann Intern Med. 2007 Sep 15;76(6):843-848. Ho E, Buchbinder R, 18. The majority of cases respond to … 5. 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. Although numerous treatment modalities have been described for lateral epicondylitis, many lack sound scientific rationale. In two studies, slow-release diclofenac (Voltaren), 150 mg daily, significantly improved short-term pain and function.6,7 However, there was no difference in pain between naproxen (Naprosyn), 500 mg daily, and placebo.6,7 Patients receiving corticosteroid injections showed greater perception of benefit at four weeks than patients receiving oral NSAIDs, but this benefit did not persist in the longer term.6,7. 24. 28. Assendelft WJ, Sign up for the free AFP email table of contents. Deville WL, Trinh KV, / Vol. MacDermid JC. Tennis elbow is usually treated by medical means, and only rarely by surgery. 2,11 The preferred method of treatment most often is local corticosteroid injection … Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Nonsurgical Treatment Physical therapy. Rehabilitation for patients with lateral epicondylitis: a systematic review. 25. Hui AC, Smidt N, Evidence does not support the use of laser therapy for the treatment of lateral epicondylitis. Braces/Splints/Straps- No clear evidence 1. Shock wave therapy for lateral elbow pain. 2002;(1):CD001821. The nitroglycerin patch reduced elbow pain with activity at two weeks, reduced epicondylar tenderness at six and 12 weeks, and increased wrist extensor mean peak force and total work at 24 weeks. There are different types of therapies to treat lateral epicondylitis, all with the same aim: reduce pain and improve function. Fess EE. Tugwell P, Hosie G, Reprints are not available from the authors. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow becomes painful and tender. Kester AD, 16. Lateral Epicondylitis Treatment With your lateral epicondylitis tests results, your doctor will decide the proper treatments options for you. Malmivaara A, GREG W. JOHNSON, MD, is in private practice in Boise, Ida., and is a community faculty member for the Family Medicine Residency of Idaho, Boise. Less contemporary strategies, including topical nitroglycerin and acupuncture, may also be considered. GREG W. JOHNSON, MD, KARA CADWALLADER, MD, SCOT B. SCHEFFEL, MD, and TED D. EPPERLY, MD, Family Medicine Residency of Idaho, Boise, Idaho. Common overuse tendon problems: a review and recommendations for treatment. Choose a single article, issue, or full-access subscription. Home Walenkamp GH, Smidt N, Assendelft WJ, Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. van der Linden AJ. Tennis elbow, or lateral epicondylitis… 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. Hayton MJ, Smidt N. Murrell GA. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. 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. Orthotic devices for the treatment of tennis elbow. Smidt N, Adshead R, Barnsley L, Immediate, unlimited access to all AFP content. 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. Ultrasound therapy for musculoskeletal disorders: a systematic review. 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… 31. Edwards SG, The surgical techniques for treating lateral epicondylitis can be grouped into three main categories: open, percutaneous, … Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. Treatment; Prevention; Tennis elbow is a condition that causes pain around the outside of the elbow. Buchbinder R, J Bone Joint Surg Br. Buchbinder R, Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. The efficacy of splinting for lateral epicondylitis: a systematic review. 2005;(4):CD003524. 15. Youd JM, He received his medical degree from the University of Washington School of Medicine. Evidence is conflicting on the use of oral NSAIDs for lateral epicondylitis. Specific exercises are helpful for strengthening the muscles of the forearm. / Hay EM, Trail IA, 1992;78:421–6. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Boddeker I, Policy, Cleveland Clinic is a non-profit academic medical center. Assendelft WJ, Exercises often help too. Shock wave therapy for lateral elbow pain. The condition usually happens due to over use of the forearm muscles and results in pain of the outside elbow. Hosie G, Edwards SG, O'Connor FG, 43 The above symptom is associated with a clinical diagnosis of lateral elbow tendinopathy (LET), also known as tennis elbow or lateral epicondylalgia. Smidt N, Appleyard RC, 1998;280:1518–24. Repetitive activity damages the wrist muscle extensor tendon and leads to … Assendelft W, Wrist lift, palm up. Dr. Scheffel completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program. Struijs PA, Haake M. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Greens S, 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. Vicenzino B, Deep transverse friction massage for treating tendinitis. Hui AC, Assendelft WJ. Dr. Johnson completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program.... KARA CADWALLADER, MD, is a faculty member at the Family Medicine Residency of Idaho. Barnsley L, Typically this occurs as a result of work or sports, classically racquet sports. Corticosteroid injections for lateral epicondylitis: a systematic overview. Bouter LM. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Hay EM, 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. Green S, Cochrane Database Syst Rev. Animal studies suggest that nitric oxide stimulates collagen synthesis by wound fibroblasts and, therefore, may play a role in healing extensor tendons. 23. Botulinum toxin type A (Botox) is thought to facilitate healing by temporarily paralyzing the common extensor origin.28,29 Two small RCTs are available but have conflicting results.28,29 One of these studies found that botulinum toxin type A injection decreases pain scores at four and 12 weeks compared with saline injection28; however, the second study found no difference between the two therapies in pain, quality of life, or grip strength at 12 weeks.29 More data are needed before botulinum toxin type A injection can be recommended to treat lateral epicondylitis. et al. afpserv@aafp.org for copyright questions and/or permission requests. Paungmali A, Orthotic devices for tennis elbow: a systematic review. 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. It's clinically known as lateral epicondylitis. Modalities- Ultrasound, Transcutaneous electrical nerve stimulation (TENS) 1. Over time, the forearm muscles and tendons become damaged from repeating the … White M, A recent systematic review found that laser therapy had no effect on pain at six weeks; longer-term results were conflicting.19 Pooled data from six studies on short- and long-term outcomes show no difference between laser therapy and placebo.15 These results are reinforced by another systematic review that found evidence against the use of laser therapy alone or in conjunction with other conservative modalities.20, Table 1 summarizes the physical therapy modalities that are effective for the treatment of lateral epicondylitis.15,19–22, Studies that showed benefits used diclofenac (Solaraze) or pirprofen (not available in the United States), Stretching and strengthening exercises15,19,20, One or more times daily, three days a week, A single instructive session followed by an in-home regimen may suffice; the regimen should focus on eccentric instead of concentric phases, Four to six weeks (eight to 18 treatments), Augmentation with corticosteroids or deep tissue massage provides no additional benefit; ultrasonography is less effective than exercise. 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