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Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials

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Abstract

Background

Non-surgical approaches to treatment of lateral epicondylitis are numerous. The aim of this systematic review is to examine randomized, controlled trials of these treatments.

Methods

Numerous databases were systematically searched from earliest records to February 2013. Search terms included “lateral epicondylitis,” “lateral elbow pain,” “tennis elbow,” “lateral epicondylalgia,” and “elbow tendinopathy” combined with “randomized controlled trial.” Two reviewers examined the literature for eligibility via article abstract and full text.

Results

Fifty-eight articles met eligibility criteria: (1) a target population of patients with symptoms of lateral epicondylitis; (2) evaluation of treatment of lateral epicondylitis with the following non-surgical techniques: corticosteroid injection, injection technique, iontophoresis, botulinum toxin A injection, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, or laser therapy; and (3) a randomized controlled trial design. Lateral epicondylitis is a condition that is usually self-limited. There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief. Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids, and botulinum toxin A is likely to produce concomitant extensor weakness. Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections. Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief. Some studies of low-level laser therapy show superiority to placebo whereas others do not.

Conclusions

There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment.

Level of Evidence

Therapeutic Level II. See Instructions to Authors for a complete description of level of evidence.

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Acknowledgments

John C. Elfar receives funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under the following: “Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number K08AR060164.”

Conflict of Interest

Susan E. G. Sims declares that she has no conflict of interest.

Katherine Miller declares that she has no conflict of interest.

John C. Elfar declares that he has no conflict of interest.

Warren C. Hammert declares that he has no conflict of interest.

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA

    Susan E. G. Sims, John C. Elfar & Warren C. Hammert

  2. University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 601, Rochester, NY, 14642, USA

    Katherine Miller

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  1. Susan E. G. Sims
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Sims, S.E.G., Miller, K., Elfar, J.C. et al. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. HAND 9, 419–446 (2014). https://doi.org/10.1007/s11552-014-9642-x

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