The Conservative Treatment of Lateral Epicondylitis: A Narrative Review
DOI:
https://doi.org/10.31282/joti.v5n3.108Keywords:
Lateral epicondylitis, tennis elbow, tendinosis, repetitive strain, elbow pain, conservative treatmentAbstract
Lateral epicondylitis, also termed "tennis elbow," is the most common cause of elbow pain and dysfunction, mainly due to repetitive gripping or wrist extension during various activities. Although widely known as tennis elbow, LE often develops as a work-related condition. The exact pathogenesis revealed a failed reparative process rather than active inflammation, which results in symptomatic degenerative process of the local tendon. Although in most cases the disease can be self-healing, the optimal treatment strategy for chronic lateral epicondylitis still remains controversial, with conservative treatment is still the first line for lateral epicondylitis. Despite the available treatment, it is still currently debatable as there is still no strong evidence showing the most effective treatment for managing lateral epicondylitis. This article presents an overview of the current knowledge on lateral epicondylitis, with a focus on conservative management of lateral epicondylitis.
Downloads
References
Vicenzino B. Elbow tendinopathy. In: Neck and Arm Pain Syndromes. Elsevier; 2011. p. 312–8.
Allander E. Prevalence, Incidence, And Remission Rates of Some Common Rheumatic Diseases Or Syndromes. Scand J Rheumatol. 1974 Jan 12;3(3):145–53.
Whaley AL, Baker CL. Lateral epicondylitis. Clin Sports Med. 2004 Oct;23(4):677–91.
Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003 Oct;22(4):813–36.
Alfredson H, Ljung BO, Thorsen K, Lorentzon R. In vivo investigation of ECRB tendons with microdialysis technique--no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthop Scand. 2000 Jan 8;71(5):475–9.
Galliani I, Burattini S, Mariani A, Riccio M, Cassiani G, Falcieri E. Morpho-functional changes in human tendon tissue. European Journal of Histochemistry. 2009 Dec 30;46(1):3.
Bales CP, Placzek JD, Malone KJ, Vaupel Z, Arnoczky SP. Microvascular supply of the lateral epicondyle and common extensor origin. J Shoulder Elbow Surg. 2007 Jul;16(4):497–501.
SMITH RW, PAPADOPOLOUS E, MANI R, CAWLEY MID. ABNORMAL MICROVASCULAR RESPONSES IN LATERAL EPICONDYLITIS. Rheumatology. 1994;33(12):1166–8.
Lieber RL, Loren GJ, Friden J. In vivo measurement of human wrist extensor muscle sarcomere length changes. J Neurophysiol. 1994 Mar 1;71(3):874–81.
Lieber RL, Ljung BO, Fridén J. Sarcomere length in wrist extensor muscles Changes may provide insights into the etiology of chronic lateral epicondylitis. Acta Orthop Scand. 1997 Jan 8;68(3):249–54.
LaBan MM, Iyer R, Tamler MS. Occult Periarthrosis of the Shoulder. Am J Phys Med Rehabil. 2005 Nov;84(11):895–8.
Kongmalai P, Chanlalit C. Demographic Causes of Chronic Lateral Elbow Pain along Arthroscopic Criteria. J Med Assoc Thai. 2016;99.
Ma KL, Wang HQ. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Res Manag. 2020;2020.
Pomerance J. Radiographic analysis of lateral epicondylitis. J Shoulder Elbow Surg. 2002 Mar;11(2):156–7.
Levin D, Nazarian LN, Miller TT, O’Kane PL, Feld RI, Parker L, et al. Lateral Epicondylitis of the Elbow: US Findings. Radiology. 2005 Oct;237(1):230–4.
Connell D, Burke F, Coombes P, McNealy S, Freeman D, Pryde D, et al. Sonographic Examination of Lateral Epicondylitis. American Journal of Roentgenology. 2001 Mar;176(3):777–82.
Miller TT, Shapiro MA, Schultz E, Kalish PE. Comparison of sonography and MRI for diagnosing epicondylitis. Journal of Clinical Ultrasound. 2002 May;30(4):193–202.
Martin CE, Schweitzer ME. MR imaging of epicondylitis. Skeletal Radiol. 1998 Mar 13;27(3):133–8.
Steinborn M, Heuck A, Jessel C, Bonel H, Reiser M. Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system. Eur Radiol. 1999 Aug 23;9(7):1376–80.
Pfahler M, Jessel C, Steinborn M, Refior HJ. Magnetic resonance imaging in lateral epicondylitis of the elbow. Arch Orthop Trauma Surg. 1998 Dec 1;118(3):121–5.
Dunn JH, Kim JJ, Davis L, Nirschl RP. Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. American Journal of Sports Medicine. 2008 Feb;36(2):261–6.
Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of Hand Therapy. 2017 Jan;30(1):13–9.
Yoon SY, Kim YW, Shin IS, Moon HI, Lee SC. Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis. Clin Orthop Relat Res. 2020 Oct;478(10):2324–39.
Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of Hand Therapy. 2017 Jan;30(1):13–9.
Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BMA. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013 Nov;47(17):1112–9.
McQueen KS, Powell RK, Keener T, Whalley R, Calfee RP. Role of strengthening during nonoperative treatment of lateral epicondyle tendinopathy. Journal of Hand Therapy. 2021 Oct;34(4):619–26.
Karanasios S, Korakakis V, Whiteley R, Vasilogeorgis I, Woodbridge S, Gioftsos G. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. Br J Sports Med. 2021 May;55(9):477–85.
Eraslan L, Yuce D, Erbilici A, Baltaci G. Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis? Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Mar 24;26(3):938–45.
Balevi ISY, Karaoglan B, Batur EB, Acet N. Evaluation of short-term and residual effects of Kinesio taping in chronic lateral epicondylitis: A randomized, double-blinded, controlled trial. Journal of Hand Therapy. 2021 Nov;
Loew LM, Brosseau L, Tugwell P, Wells GA, Welch V, Shea B, et al. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database of Systematic Reviews. 2014 Nov 8;
Yi R, Bratchenko WW, Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. HAND. 2018 Jan 1;13(1):56–9.
Akbar N, Sharif F, Afzal W, Ahmad A, Gilani SA, Mohyudin SA. Effects of Cyriax Manual Therapy versus Mulligan Technique on Grip Strength and Functional Outcomes in Patients with Lateral Epicondylitis. Journal Riphah College of Rehabilitation Sciences. 2021 Dec 1;09(02):48–52.
Nishizuka T, Iwatsuki K, Kurimoto S, Yamamoto M, Hirata H. Efficacy of a forearm band in addition to exercises compared with exercises alone for lateral epicondylitis: A multicenter, randomized, controlled trial. Journal of Orthopaedic Science. 2017 Mar;22(2):289–94.
Kroslak M, Pirapakaran K, Murrell GAC. Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. J Shoulder Elbow Surg. 2019 Feb;28(2):288–95.
Xiong Y, Xue H, Zhou W, Sun Y, Liu Y, Wu Q, et al. Shock-wave therapy versus corticosteroid injection on lateral epicondylitis: a meta-analysis of randomized controlled trials. Phys Sportsmed. 2019 Jul 3;47(3):284–9.
Yan C, Xiong Y, Chen L, Endo Y, Hu L, Liu M, et al. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2019 Dec 6;14(1):248.
Dedes V, Tzirogiannis K, Polikandrioti M, Dede AM, Mitseas A, Panoutsopoulos GI. Comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. Journal of Medical Ultrasonics. 2020 Apr 7;47(2):319–25.
Chesterton LS, Lewis AM, Sim J, Mallen CD, Mason EE, Hay EM, et al. Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial). BMJ. 2013 Sep 2;347(sep02 4):f5160–f5160.
Baktir S, Razak Ozdincler A, Kaya Mutlu E, Bilsel K. The short-term effectiveness of low-level laser, phonophoresis, and iontophoresis in patients with lateral epicondylosis. Journal of Hand Therapy. 2019 Oct;32(4):417–25.
Turgay T, Gunel Karadeniz P, Sever GB. Comparison of low level laser therapy and extracorporeal shock wave in treatment of chronic lateral epicondylitis. Acta Orthop Traumatol Turc. 2020 Dec 31;54(6):591–5.
Zhou Y, Guo Y, Zhou R, Wu P, Liang F, Yang Z. Effectiveness of Acupuncture for Lateral Epicondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Res Manag. 2020 Mar 21;2020:1–10.
Bostrøm K, Mæhlum S, Cvancarova Småstuen M, Storheim K. Clinical comparative effectiveness of acupuncture versus manual therapy treatment of lateral epicondylitis: feasibility randomized clinical trial. Pilot Feasibility Stud. 2019 Dec 7;5(1):110.
Tosun HB, Gumustas S, Agir I, Uludag A, Serbest S, Pepele D, et al. Comparison of the effects of sodium hyaluronate-chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: a prospective randomized trial. Journal of Orthopaedic Science. 2015;20(5):837–43.
Hsieh LF, Kuo YC, Lee CC, Liu YF, Liu YC, Huang V. Comparison Between Corticosteroid and Lidocaine Injection in the Treatment of Tennis Elbow. Am J Phys Med Rehabil. 2018 Feb;97(2):83–9.
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet. 2010 Nov;376(9754):1751–67.
Lee SY, Kim W, Lim C, Chung SG. Treatment of Lateral Epicondylosis by Using Allogeneic Adipose-Derived Mesenchymal Stem Cells: A Pilot Study. Stem Cells. 2015 Oct 1;33(10):2995–3005.
Farkash U, Avisar E, Volk I, Slevin O, Shohat N, el Haj M, et al. First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow). J Shoulder Elbow Surg. 2019 Mar;28(3):503–9.
Wang A, Mackie K, Breidahl W, Wang T, Zheng MH. Evidence for the Durability of Autologous Tenocyte Injection for Treatment of Chronic Resistant Lateral Epicondylitis. Am J Sports Med. 2015 Jul 23;43(7):1775–83.
Linnanmäki L, Kanto K, Karjalainen T, Leppänen O v., Lehtinen J. Platelet-rich Plasma or Autologous Blood Do Not Reduce Pain or Improve Function in Patients with Lateral Epicondylitis: A Randomized Controlled Trial. Clin Orthop Relat Res. 2020 Aug;478(8):1892–900.
