Tennis Elbow

Return to Clinical Care Overview

Overview

Articles

(1)

Review Sections

(22)

Tennis Elbow

Similar to plantar fasciitis, lateral epicondylitis (LE) may be a misnomer. The condition is usually the result of degenerative changes rather than an inflammatory process. The patient often presents with tenderness at the lateral epicondyle and pain on resisted wrist extension and grasping tasks. Usually the dominant arm is affected and is commonly found in persons involve in racquet sports (1).

(1) Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician 2005; 72(5):811-818.

Clinical Reviews

Tennis Elbow: Prevention

Few studies have examined risk factors and prevention strategies for lateral epicondylitis (LE).

Tennis Elbow: Diagnosis

Lateral epicondylitis (LE) is a condition that is relatively easy to diagnose based on patient history, observation and physical examination. Few studies have been performed to test the sensitivity and specificity of the diagnostic protocols for LE. The reader should keep in mind the strength of recommendation ratings are based on a very limited number of studies. Similar to plantar fasciitis, it should be noted the diagnostic term lateral epicondylitis is probably an error in terminology as the condition does not appear to be inflammatory in nature. It is usually degenerative, often resulting in thickening of the common extensor origin.

Tennis Elbow: Therapy

One surgeon states in his review of lateral epicondylitis (LE) treatments, “non-operative therapeutic modalities…are unproven at best”. When it comes to surgery he is also concerned about a lack of surgical evidence, yet finds it proper for the surgeon to be “guided by simply our subjective viewpoint”. This paper asks in its title “Is there any science out there?” and that is the heart of the problem when it comes to LE treatment. Good quality randomized controlled trials (RCT) are rare. As with the surgeon, the non-surgical physician must judge what is an acceptable intervention based on “best judgment” using limited scientific evidence.

Medical Subject Heading (MeSH) Information

MeSH Term: Tennis Elbow

Scope Note: A condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists.

MeSH Synonyms:

Tennis Elbow
Elbow, Tennis
Elbows, Tennis
Tennis Elbows
Epicondylitis, Lateral Humeral
Epicondylitides, Lateral Humeral
Humeral Epicondylitides, Lateral
Humeral Epicondylitis, Lateral
Lateral Humeral Epicondylitides
Lateral Humeral Epicondylitis

Applicable MeSH Subheadings:

blood
cerebrospinal fluid
chemically induced
classification
complications
diagnosis
drug therapy
economics
epidemiology
etiology
genetics
history
immunology
metabolism
microbiology
pathology
physiopathology
prevention and control
psychology
radiography
radionuclide imaging
radiotherapy
rehabilitation
surgery
therapy
ultrasonography
urine

One-Click Literature Search

Tennis Elbow AND Prevention

Tennis Elbow AND Diagnosis

Tennis Elbow AND Therapy

Informative Links

MayoClinic.com Tennis Elbow Information

Mayo Clinic Health Solutions' award-winning consumer Web site offers health information and self-improvement tools. MayoClinic.com's medical experts and editorial professionals bring you access to the knowledge and experience of Mayo Clinic for all your consumer health information needs, from cancer, diabetes and heart disease to nutrition, exercise and pregnancy.

MedlinePlus: Elbow Injuries and Disorders

MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

Current Clinical Trials Relating to Tennis Elbow

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

Use of TPD Heat Lamp for Tennis Elbow Pain - a Randomized-controlled Trial

(Status: Terminated)

Effectiveness of Microcurrent for Treatment of Tennis Elbow

(Status: Completed)

Influence of Microcurrent Parameters on Effectiveness in Treatment of Chronic Tennis Elbow

(Status: Completed)

ALGRX 4975 in the Treatment of Tennis Elbow

(Status: Completed)

Treatment of Lateral Epicondylitis: Platelet Rich Plasma Versus Steroid Versus Saline Solution

(Status: Completed)

A Randomized Control Trial to Evaluate the Efficacy of Autologous Blood Injection Versus Local Corticosteroid Injection for Treatment of Lateral Epicondylitis

(Status: Completed)

Effectiveness of Botulinum Toxin Injection in the Tennis Elbow Treatment

(Status: Recruiting)

Efficacy Study of Prolotherapy vs Corticosteroid for Tennis Elbow

(Status: Completed)

Prolotherapy for the Treatment of Chronic Lateral Epicondylitis

(Status: Active, not recruiting)

Tennis Elbow Trial

(Status: Completed)

Dexamethasone Iontophoretic Patch for the Treatment of Pain Associated With Lateral Epicondylitis

(Status: Completed)

Relationships Between Ultrasound Data and the Impact of Lateral Epicondylar Pain

(Status: Not yet recruiting)

Botulinum Toxin Versus Active Strength Training in the Treatment of Lateral Epicondylitis

(Status: Recruiting)

Efficacy of Injection Therapy for Lateral Epicondylosis

(Status: Active, not recruiting)

Randomized Trial of Iontophoresis Versus Injection of Corticosteroids for Lateral Epicondylitis

(Status: Completed)

Platelet-rich-plasma Treating Tennis Elbow

(Status: Completed)

Comparison Between Type A Botulinum Toxin Injection and Corticosteroid Injection in the Treatment of Tennis Elbow

(Status: Recruiting)

Dysport® Injection in the Treatment of Chronic Lateral Epicondylitis

(Status: Completed)

Treatment Study of Steroid Injection and Physical Therapy for Acute Lateral Epicondylitis

(Status: Recruiting)

Phase II Dose-Ranging Study of OrthoDerm Patch for Patients With Tennis Elbow

(Status: Not yet recruiting)

20 Clinical Trials Returned

Therapeutic Ultrasound: A Review of the Literature

Daniel A. Martinez, MA, DC, Research Scientist

Ultrasound (US) has been a widely used and accepted adjunct modality for the management of many musculoskeletal conditions. It was first introduced as a therapeutic modality in the 1950s, when both animal and human studies demonstrated its ability to safely heat tissue several centimeters below the skin. In the late 1960s and 1970s, reports on the non-thermal therapeutic effects of US, primarily in the area of enhanced tissue healing, further bolstered its popularity (1). Despite the years of clinical use, the lack of studies confirming its benefits has led scientists to question the traditional view of its therapeutic benefits (2).

Several papers reviewing the available literature have been published concerning the biophysical effects, application, and efficacy of therapeutic ultrasound, as well as the safety and calibration of ultrasonic equipment (2-7). The purpose of this paper is to present a general overview of these findings.

ChiroACCESS |

October 1, 2010

Acupuncture

(Tennis Elbow: Therapy)

The effect of acupuncture remains somewhat controversial. A Cochrane Review found acupuncture, based on two small trials, to be effective on a short term basis but effects lasted less than 24 hours....

Published On

December 1, 2006

Age

(Tennis Elbow: Prevention)

One study of 266 patients demonstrated being over the age of 40 is a risk factor for LE (5). A review of 5 studies concluded the incidence of LE was 1 to 2% in the general population but it increases....

Published On

December 1, 2006

Corticosteroid Injection

(Tennis Elbow: Therapy)

Use of injections for the treatment of LE is controversial. Virtually all authors state the risk/benefit aspect of this treatment must be considered. The American Family Physician (AFP) is concerned....

Published On

December 1, 2006

Diagnostic Imaging

(Tennis Elbow: Diagnosis)

Although diagnostic imaging is not considered necessary in diagnosing LE, it should be considered if more serious pathology is suspected. Tendon thickening at the lateral epicondyle is often noted on....

Published On

December 1, 2006

Exercise/Stretching

(Tennis Elbow: Therapy)

Only limited investigations of exercise/stretching as an intervention in the treatment of LE have been performed. A recent systematic review and meta-analysis found information lacking but stated....

Published On

December 1, 2006

Extracorporeal Shock Wave Therapy (ESWT)

(Tennis Elbow: Therapy)

A 2006 review of 9 placebo-controlled trials reported ESWT provides little or no benefit for function and lateral elbow pain (30). One RCT of 62 patients demonstrated decreased pain and increased....

Published On

December 1, 2006

Fluoroquinolene Antibiotics

(Tennis Elbow: Prevention)

In a case study of two patients, fluoroquinolene was identified as a cause for severe LE. Symptoms were so severe and intractable that surgical release of the extensor mechanisms was performed (8).

Published On

December 1, 2006

Heredity

(Tennis Elbow: Prevention)

In a single study of 250 twins researchers found a genetic link for LE. Having a family history can increase chances of developing LE up to 3 times (7).

Published On

December 1, 2006

Low Level Laser

(Tennis Elbow: Therapy)

Studies are limited and results are mixed relating to the effectiveness of laser therapy. Two separate reviews found insufficient evidence to warrant the use of laser therapy (16;17). However one....

Published On

December 1, 2006

Mobilization/Manipulation

(Tennis Elbow: Therapy)

A small RCT of 31 patients compared manipulation of the wrist (9 visits over 6 weeks) to a combination of ultrasound, friction massage, exercise and stretching (9 visits over 6 weeks). Manipulation....

Published On

December 1, 2006

Oral NSAID’s

(Tennis Elbow: Therapy)

The Cochrane Review mentioned above found oral NSAID’s possibly effective in the short term (25). The BMJ review listed oral NSAID’s as “”likely to be beneficial” (26).

Published On

December 1, 2006

Orthotic Devices

(Tennis Elbow: Therapy)

Although a very commonly used intervention, a recent review of orthotics wraps and bracing stated “there is no clear evidence for application” yet recommends their use due to low cost and possible....

Published On

December 1, 2006

Overuse

(Tennis Elbow: Prevention)

A consistent risk factor identified throughout the literature available is overuse. This can take the form of repetitive hand movements, especially those requiring increased deviation of the wrist....

Published On

December 1, 2006

Pain Free Grip Strength

(Tennis Elbow: Diagnosis)

Very few diagnostic procedures have been tested for reliability. In a single study pain-free grip strength was found to be highly reliable. The authors of the study recommended pain-free grip....

Published On

December 1, 2006

Patient-Rated Forearm Evaluation Questionnaire (PRFEQ)

(Tennis Elbow: Diagnosis)

This questionnaire has the patient rate, on a 0 to 10 scale, functional loss and pain during the past week. Several studies have been performed to determine its validity and reliability (3-5). All....

Published On

December 1, 2006

Pressure Pain Threshold

(Tennis Elbow: Diagnosis)

Two studies have examined pressure pain threshold with opposite conclusions. One study of 45 patients found a high correlation between pressure pain threshold and Mill’s test (8). A second study....

Published On

December 1, 2006

Resisted Wrist Extension, Mill’s Test

(Tennis Elbow: Diagnosis)

Both of these tests were evaluated in the study noted above. Although they fared well, they were not considered as reliable as pain free grip strength (7).

Published On

December 1, 2006

Surgery

(Tennis Elbow: Therapy)

Only one small RCT with 28 patients was located that compared two different surgical procedures. At the 31 month follow-up, the success rate for both surgeries was only 60% and 7 patients required a....

Published On

December 1, 2006

Tenderness to Palpation

(Tennis Elbow: Diagnosis)

Tenderness to palpation a fingerbreadth distal to the lateral epicondyle is often the first diagnostic test performed in the physician’s office. Although accepted as a reliable and valid procedure,....

Published On

December 1, 2006

Tennis

(Tennis Elbow: Prevention)

Commonly known as “tennis elbow”, LE is a condition that is only caused by tennis in 5% of cases, although 50% of tennis players over 30 are estimated to suffer from the condition (4).

Published On

December 1, 2006

Topical NSAID’s

(Tennis Elbow: Therapy)

Use of topical NSAID’s has demonstrated some benefit in the treatment of LE according to a Cochrane Review (23). A review published in the British Medical Journal (BMJ) found topical NSAID’s to be....

Published On

December 1, 2006

Ultrasound

(Tennis Elbow: Therapy)

Only 1 study was located that demonstrated effectiveness in the treatment of LE. This randomized controlled trial utilizing ultrasound, performed in 1985, showed statistically significant improvement....

Published On