Anything For Tennis Elbow?

Summarized by Robert W. Griffith, MD
October 26, 2005

Introduction

Lateral epicondylalgia or lateral epicondylitis are long names for tennis elbow. We'll use the short name, even though it's not 100% unsuitable - while it's common in tennis players, the condition is seen more often in people who's work involves repetitive hand tasks, such as hammering, turning keys, screwdriver use, computer work, or even excessive hand shaking.

Tennis elbow is a very painful condition that causes about 7 of 1000 visits to family practitioners annually. It results in an average 12 weeks' absence from work in a third of those afflicted. Many treatments are proposed and tried, which may suggest that none of them is particularly effective.

Australian scientists have analyzed published reports of different treatments for tennis elbow, and presented their findings in the British Journal of Sports Medicine. We summarize them here.

The method used

All randomized controlled clinical trials that were found were reviewed for their use in this survey. There were 28 out of a total of 76 which met the set criteria; these were:

• a firm diagnosis of tennis elbow (pain on the outside of the elbow joint when the hands face forward, worse on pressure or during trying to bend the wrist back)
• a trial of at least one method of treatment
• scoring a 'pass' on at least 8 of 15 quality standards

The effectiveness of treatments was assessed using pain scores, grip strength (maximum, or pain-free), global assessment, and a patient satisfaction scale. Most studies used a 6-week assessment period, but 4 of the 28 included a six-month follow-up rating.

Types of treatment analyzed

The following types of treatment were included in at least one study, and compared with either placebo or another treatment:

Non-electrotherapy

• Acupuncture (4)
• Manipulation (4)
• Braces (2)
• Taping (1)
• Exercise (1)

Electrotherapy

• Laser therapy (6)
• Ultrasound (5)
• Ionization or magnetic field (4)
• Extracorporeal shock wave therapy (ESWT, 2)

Combined physical treatments

• Deep friction massage with ultrasound and exercises (2)

Results of the analysis

In the first group, it was concluded that:

• 1. Exercise may improve pain but not grip strength
• 2. Manipulation and acupuncture may be effective early on, but not later

In the electrotherapy group, it was concluded that none of the treatments had any clear-cut benefit.

The combined use of different physical treatments were superior to corticosteroid injections after 6 months, but no better than a 'wait-and-see' (i.e. no treatment) approach.

So what works, and what doesn't?

Most of the treatments listed above don't have any evidence supporting their use, and are unlikely to be better than taking a 'wait-and-see' attitude. Steroid injections, manipulation, and exercise may have short-term benefits. And for long-term improvement, look to physical therapy combined with ultrasound, deep-friction massage, and exercise.

But a wait-and-see approach (with occasional analgesics, as necessary) is likely to be quite satisfactory in the majority of cases. For people who have to carry on working, braces or splints may provide relief from pain, but steroid injections are not advisable.

We hope that the unsatisfactory options available for treating tennis elbow will lead to the development of more effective treatments, which will be shown to work well in carefully designed clinical trials.

Source

• A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. BL. Bisset , PA. Paungmali , VB. Vicenzino , BE. Beller , Br J Sports Med, 2005, vol. 39, pp. 411--422

Related Links
Mayo Clinic: Tennis Elbow
Keeping Tennis Elbow at Arm's Length
MedlinePlus: Tennis Elbow

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