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Lateral epicondylitis of the elbow: an up-to-date review of management

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Abstract

Lateral epicondylitis, also known as tennis elbow, is an overuse tendinopathy of the common extensor origin of the elbow in patients involved in repetitive movement of the wrist and forearm. Lateral epicondylitis is a self-limiting condition, with operative management only recommended in severe, recalcitrant cases. This article reviews the recent updates on operative and non-operative management of lateral epicondylitis.

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References

  1. Jobe FW, Ciccotti MG (1994) Lateral and medial epicondylitis of the elbow. JAAOS-J Am Acad Orthop Surg 2:1–8

    Article  CAS  Google Scholar 

  2. Sanders TL Jr, Maradit Kremers H, Bryan AJ et al (2015) The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med 43:1066–1071

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kitai E, Itay S, Ruder A, et al (1986) An epidemiological study of lateral epicondylitis (tennis elbow) in amateur male players. In: Annales de Chirurgie de la Main. Elsevier, pp 113–121

  4. Dines JS, Bedi A, Williams PN et al (2015) Tennis injuries: epidemiology, pathophysiology, and treatment. JAAOS-J Am Acad Orthop Surg 23:181–189

    Article  Google Scholar 

  5. Regan W, Wold LE, Coonrad R, Morrey BF (1992) Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 20:746–749

    Article  CAS  PubMed  Google Scholar 

  6. Pomerance J (2002) Radiographic analysis of lateral epicondylitis. J shoulder Elb Surg 11:156–157. https://doi.org/10.1067/mpn.2002.121147

    Article  Google Scholar 

  7. Sims SEG, Miller K, Elfar JC, Hammert WC (2014) Non-surgical treatment of lateral epicondylitis: a aystematic review of randomized controlled trials. Hand 9:419–446

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2017 Mar 13;1(11):391–397. doi: https://doi.org/10.1302/2058-5241.1.000049.10.1097/PRS.0000000000007440

  9. Kroslak M, Pirapakaran K, Murrell GAC (2019) Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. J shoulder Elb Surg 28:288–295

    Article  Google Scholar 

  10. Viswas R, Ramachandran R, KordeAnantkumar P (2012) Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. Sci World J 2012:1–8

  11. Peterson M, Butler S, Eriksson M, Svärdsudd K (2014) A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clin Rehabil 28:862–872

    Article  PubMed  Google Scholar 

  12. Cullinane FL, Boocock MG, Trevelyan FC (2014) Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil 28:3–19

    Article  PubMed  Google Scholar 

  13. Shahabi S, Bagheri Lankarani K, Heydari ST et al (2020) The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Prosthet Orthot Int 44:341–354

    Article  PubMed  Google Scholar 

  14. Jafarian FS, Demneh ES, Tyson SF (2009) The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sport Phys Ther 39:484–489

    Article  Google Scholar 

  15. Zhou Y, Guo Y, Zhou R et al (2020) Effectiveness of acupuncture for lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials. Pain Res Manag 2020:1–10

  16. Gadau M, Zhang SP, Wang FC et al (2020) A multi-center international study of acupuncture for lateral elbow pain-Results of a randomized controlled trial. Eur J Pain 24:1458–1470

    Article  PubMed  Google Scholar 

  17. Pattanittum P, Turner T, Green S, Buchbinder R (2013) Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003686.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  18. Coombes BK, Bisset L, Brooks P et al (2013) Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 309:461–469

    Article  CAS  PubMed  Google Scholar 

  19. Wang D, Rodeo SA (2017) Platelet-rich plasma in orthopaedic surgery: a critical analysis review. JBJS Rev 5:e7

    Article  PubMed  Google Scholar 

  20. Chen XT, Fang W, Jones IA et al (2021) The efficacy of platelet-rich plasma on improving pain and function for lateral epicondylitis: a systematic review and meta-analysis with risk-of-bias assessment. Arthrosc J Arthrosc Relat Surg 37:293–295

    Article  Google Scholar 

  21. Edwards SG, Calandruccio JH (2003) Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am 28:272–278

    Article  PubMed  Google Scholar 

  22. Kazemi M, Azma K, Tavana B et al (2010) Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy: a randomized clinical trial of efficacy. Am J Phys Med Rehabil 89:660–667

    Article  PubMed  Google Scholar 

  23. Massy-Westropp N, Simmonds S, Caragianis S, Potter A (2012) Autologous blood injection and wrist immobilisation for chronic lateral epicondylitis. Adv Orthop 2012:387829. https://doi.org/10.1155/2012/387829

    Article  PubMed  PubMed Central  Google Scholar 

  24. Creaney L, Wallace A, Curtis M, Connell D (2011) Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med 45:966–971

    Article  PubMed  Google Scholar 

  25. Thanasas C, Papadimitriou G, Charalambidis C et al (2011) Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med 39:2130–2134

    Article  PubMed  Google Scholar 

  26. Staples MP, Forbes A, Ptasznik R et al (2008) A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol 35:2038–2046

    PubMed  Google Scholar 

  27. Yao G, Chen J, Duan Y, Chen X (2020) Efficacy of extracorporeal shock wave therapy for lateral epicondylitis: a systematic review and meta-analysis. Biomed Res Int 2020:2064781. https://doi.org/10.1155/2020/2064781

    Article  PubMed  PubMed Central  Google Scholar 

  28. Xiong Y, Xue H, Zhou W et al (2019) Shock-wave therapy versus corticosteroid injection on lateral epicondylitis: a meta-analysis of randomized controlled trials. Phys Sportsmed 47:284–289. https://doi.org/10.1080/00913847.2019.1599587

    Article  PubMed  Google Scholar 

  29. Dunn JH, Kim JJ, Davis L, Nirschl RP (2008) Ten-to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med 36:261–266

    Article  PubMed  Google Scholar 

  30. Lee S, Hong I-T, Lee S et al (2021) Long-term outcomes of the modified Nirschl technique for lateral Epicondylitis: a retrospective study. BMC Musculoskelet Disord 22:205. https://doi.org/10.1186/s12891-021-04079-x

    Article  PubMed  PubMed Central  Google Scholar 

  31. Baker CL Jr, Baker CL III (2008) Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med 36:254–260

    Article  PubMed  Google Scholar 

  32. Kim JW, Chun CH, Shim DM et al (2011) Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication. Knee Surgery, Sport Traumatol Arthrosc 19:1178–1183

    Article  Google Scholar 

  33. Riff AJ, Saltzman BM, Cvetanovich G, et al (2018) Open vs Percutaneous vs Arthroscopic Surgical Treatment of Lateral Epicondylitis: An Updated Systematic Review. Am J Orthop (Belle Mead, NJ) 47

  34. Pierce TP, Issa K, Gilbert BT et al (2017) A systematic review of tennis elbow surgery: open versus arthroscopic versus percutaneous release of the common extensor origin. Arthrosc J Arthrosc Relat Surg 33:1260–1268

    Article  Google Scholar 

  35. Clark T, McRae S, Leiter J et al (2018) Arthroscopic versus open lateral release for the treatment of lateral epicondylitis: a prospective randomized controlled trial. Arthrosc J Arthrosc Relat Surg 34:3177–3184

    Article  Google Scholar 

  36. Barnes DE, Beckley JM, Smith J (2015) Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J shoulder Elb Surg 24:67–73

    Article  Google Scholar 

  37. Seng C, Mohan PC, Koh SBJ et al (2016) Ultrasonic percutaneous tenotomy for recalcitrant lateral elbow tendinopathy: sustainability and sonographic progression at 3 years. Am J Sports Med 44:504–510

    Article  PubMed  Google Scholar 

  38. Valera-Garrido F, Minaya-Muñoz F, Medina-Mirapeix F (2014) Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results. Acupunct Med 32(6):446–454. https://doi.org/10.1136/acupmed-2014-010619

    Article  PubMed  PubMed Central  Google Scholar 

  39. Boden AL, Scott MT, Dalwadi PP et al (2019) Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis. J Shoulder Elb Surg 28:112–119. https://doi.org/10.1016/j.jse.2018.08.032

    Article  Google Scholar 

  40. Baker CL, Jones GL (1999) Arthroscopy of the elbow. Am J Sports Med 27:251–264

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Shoulder and Sports Medicine, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Abdulaziz F. Ahmed & Bashir A. Zikria

  2. Faculty of Medicine, University of Jordan, Amman, Jordan

    Rama Rayyan

  3. Department of Orthopaedic Surgery, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI, 02915, USA

    Motasem Salameh

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  1. Abdulaziz F. Ahmed
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  2. Rama Rayyan
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  4. Motasem Salameh
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Correspondence to Motasem Salameh.

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Ahmed, A.F., Rayyan, R., Zikria, B.A. et al. Lateral epicondylitis of the elbow: an up-to-date review of management. Eur J Orthop Surg Traumatol 33, 201–206 (2023). https://doi.org/10.1007/s00590-021-03181-z

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  • DOI: https://doi.org/10.1007/s00590-021-03181-z

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