J Bone Joint Surg Am. Hall S, Nirschl RP. Bouter LM. If untreated, lateral epicondylitis persists for an average of six to 24 months.2. There are numerous treatment options, but no one single treatment is completely effective. Arola H, 2004;17:243–66. One case series, including 29 patients who had failed other conservative modalities, reported a 79 percent improvement in pain scores over an average of 9.5 months; some patients required multiple injections.27 However, clinical trials that include a comparison group receiving placebo injections are lacking, and until these trials are completed, autologous blood injections cannot be recommended. Croft P. 1. Assendelft WJ, Arola H, Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. et al. Buchbinder R, 28. Bisset L, 25. Struijs P, We do not endorse non-Cleveland Clinic products or services. Case series have suggested favorable outcomes with few adverse effects.31 Despite these conclusions, no RCTs have been performed.7,31. Imaging studies are rarely required for diagnosis. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both—a randomized clinical trial. 2001;(4):CD003686. Get Permissions, Access the latest issue of American Family Physician. 17. The following interventions are possibly helpful: short-term oral NSAIDs; inelastic, nonarticular, proximal forearm strap (tennis elbow brace); topical nitrates; acupuncture; botulinum toxin type A injection (Botox); surgery. The efficacy of splinting for lateral epicondylitis: a systematic review. Don't miss a single issue. Less contemporary strategies, including topical nitroglycerin and acupuncture, may also be considered. Paungmali A, Corticosteroid injections for lateral epicondylitis: a systematic overview. Dr. Johnson completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program.... KARA CADWALLADER, MD, is a faculty member at the Family Medicine Residency of Idaho. Surgery for lateral elbow pain. Buchbinder R, Kester AD, Van Dijk CN. Arola H, Smidt N. 14. CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. Milne S, Zastrow I, Bouter LM. Struijs P, Acupuncture for lateral elbow pain. Stanley JK. Education/Advice- on pain control and/or modification of activities 1. Autologous blood injections for refractory lateral epicondylitis. Nonsurgical Treatment Physical therapy. Onset of symptoms is generally gradual. van der Windt DA, Bell S, Smidt N, Smidt N, 6. Cochrane Database Syst Rev. Buchbinder R, Vicenzino B, Bouter LM. Treatment; Prevention; Tennis elbow is a condition that causes pain around the outside of the elbow. Contact Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Over time, the forearm muscles and tendons become damaged from repeating the … Lewis M, Three studies have shown pain reduction and improvement in subjective function with NSAID iontophoresis (using diclofenac or pirprofen [not available in the United States]) after two to four weeks.15,20 There is no good evidence supporting the use of corticosteroid iontophoresis.15,20 One meta-analysis and one systematic review found limited evidence against the use of electromagnetic field therapy.5,20, Ultrasonography is thought to have thermal and mechanical effects on the target tissue leading to increased metabolism, circulation, extensibility of connective tissue, and tissue regeneration.23 The best available data suggest that ultrasonography provides modest pain reduction over one to three months.15,19–21 Exercise appears to be more effective than ultrasonography for pain relief.15,19 Combining ultrasonography with deep transverse friction massage or corticosteroids is no better than ultrasonography alone.15,22, Deep transverse friction massage is thought to realign abnormal collagen fiber structure, break up adhesions and scar tissue, and increase healing with hyperemia.22 There is insufficient evidence to form conclusions about deep transverse friction massage for the treatment of lateral epicondylitis.22, A consensus statement from the National Institutes of Health states that study results are promising enough to consider acupuncture as an appropriate option for the treatment of lateral epicondylitis.24 However, conflicting evidence exists, and recommendations for or against this therapy cannot be made. Treatment of Lateral Epicondylitis. Reprints are not available from the authors. Topical NSAIDs may provide short-term pain relief.6,7 Three studies have examined the effects of diclofenac (Solaraze) and benzydamine (not available in the United States) for up to three weeks. Don’t waste time overstretching, which could cause more damage. Struijs PA, Smidt N, Orthotic devices for the treatment of tennis elbow. / afp 5. Although watchful waiting is a viable option, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) have evaluated the effectiveness of other treatment options such as oral, topical, and injectable medications; physical therapy; and surgery. 27. Am Fam Physician. For information about the SORT evidence rating system, see page749 orhttps://www.aafp.org/afpsort.xml. Advertising on our site helps support our mission. Bisset L, Youd JM, 29. Smidt N, Calandruccio JH. Smidt N, Hill VA, ter Riet G, Specific exercises are helpful for strengthening the muscles of the forearm. The median follow-up period was only two weeks, and long-term outcomes were not reported. To perform a wrist lift, palm up: grip a light weight, such as a … Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. Cleveland Clinic is a non-profit academic medical center. Green S, 12. Types of treatment that help are: Icing the elbow to reduce pain and swelling. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. Want to use this article elsewhere? Malmivaara A, Shock wave therapy for lateral elbow pain. Boddeker I, Symptoms are usually reproduced with resisted supination or wrist dorsiflexion, particularly with the arm in full extension. Copyright © 2007 by the American Academy of Family Physicians. Dr. Scheffel completed the Family Medicine Residency of Idaho program and its Primary Care Sports Medicine Fellowship program. 2000;29:463–9. Am J Sports Med. Buchbinder R, Van Dijk CN. The goals of treatment are to: The type of treatment will depend on several factors, including the person's age, type of other medications being taken, overall health, medical history, and severity of pain. 20. Assendelft WJ, An accompanying patient handout includes exercises for lateral epicondylitis. Buchbinder R, Pain. Hui AC, Best TM. 2005;72:811–8. Phillips SD, More commonly known as tennis elbow, lateral epicondylitis … Borkholder CD, JAMA. 2004;32:462–9. Struijs PA, Assendelft WJ, Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. Borkholder CD, Green S, Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Figure 2 is a suggested algorithm for the treatment of lateral epicondylitis.15,19–21 When the history and examination are consistent with lateral epicondylitis, a reasonable initial approach includes control of inflammation with topical or oral NSAIDs, short-term activity modification, correction in errors of biomechanics, and implementation of a home exercise regimen. Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.Despite its name, athletes aren't the only people who develop tennis elbow. Lateral … van den Berg SG, Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Hay EM, Stanley JK. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Am J Sports Med. Smidt N. 7. Evidence suggests that exercise programs can reduce pain, but the improvement in grip strength is less clear.15,19,20 Regimens should focus on eccentric instead of concentric phases. GREG W. JOHNSON, MD, is in private practice in Boise, Ida., and is a community faculty member for the Family Medicine Residency of Idaho, Boise. One RCT found that at one year a watchful-waiting approach was comparable with physical therapy and superior to corticosteroid injection in alleviating a patient's main complaint.5 Patients in the watchful-waiting group visited their primary care physician once during the six-week intervention period.5 Avoidance of aggravating activities and practical solutions were recommended. Cochrane Database Syst Rev. Korthalsde Bos IB, Trudel D, / Vol. Sign up for the free AFP email table of contents. Cole DC, 2008;21(4):400-402. Paterson SM, Lateral Epicondylitis Treatment With your lateral epicondylitis tests results, your doctor will decide the proper treatments options for you. van Mameren H, Hill VA, Experts recommend doing it for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain is gone. Boddeker I, Autologous blood injections for refractory lateral epicondylitis. Kerr EW, Advertising on our site helps support our mission. . The condition is sometimes called tennis elbow, although it often occurs with activities such as other racket sports and golf. Ho E, 2005;87:503–7. Information from references 15 and 19 through 22. Assendelft WJ, Verhaar JA, Smidt N, Reduce or relieve pain and inflammation (swelling) — This is the first step in the treatment process and may include: Resting and avoiding any activity that causes pain to the sore elbow Applying ice to the affected area Using non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen Use … The nitroglycerin patch reduced elbow pain with activity at two weeks, reduced epicondylar tenderness at six and 12 weeks, and increased wrist extensor mean peak force and total work at 24 weeks. 1998;280:1518–24. 9. Murrell GA. Haake M. Cochrane Database Syst Rev. 18. Despite the prevalence of lateral epicondylitis and the numerous treatment strategies available, relatively few high-quality clinical trials support many of these treatment options; watchful waiting is a reasonable option. Poon DW, If symptoms persist, physical therapy, including ultrasonography, or NSAID iontophoresis may be appropriate. At six months, 81 percent of treated patients were asymptomatic during activities of daily living.30, Surgery is often recommended when conservative strategies fail to relieve lateral epicondylitis symptoms after six to 12 months. Arola H, Assendelft W, Hosie G, He received his medical degree from the University of Washington School of Medicine, Seattle. Cochrane Database Syst Rev. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Assendelft WJ, Assendelft WJ. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Davidson R, Maxwell L. Buchbinder R, Treatment includes ice, rest, and medication for inflammation. Beller E. Corticosteroid injections for lateral epicondylitis: a systematic review. Copyright © 2020 American Academy of Family Physicians. 2007 Sep 15;76(6):843-848. 21. van der Windt DA, et al. Maxwell L. Barnsley L, Evaluation of overuse elbow injuries. 22. Tennis elbow. Both tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are painful conditions caused by overuse. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Tennis elbow is usually treated by medical means, and only rarely by surgery. For the minority of people with lateral epicondylitis who do not respond to nonoperative treatment, surgical intervention is an option, but confusion exists because of the plethora of options. van der Heijden GJ, In two studies, slow-release diclofenac (Voltaren), 150 mg daily, significantly improved short-term pain and function.6,7 However, there was no difference in pain between naproxen (Naprosyn), 500 mg daily, and placebo.6,7 Patients receiving corticosteroid injections showed greater perception of benefit at four weeks than patients receiving oral NSAIDs, but this benefit did not persist in the longer term.6,7. Damsma K. 1996;78:128–32. Br J Gen Pract. Typically this occurs as a result of work or sports, classically racquet sports. de Winter AF, An inelastic, nonarticular, proximal forearm strap (tennis elbow brace) for patients with lateral epicondylitis. If symptoms continue despite numerous treatment approaches, referral may be warranted. Lancet. Kerkhoffs GM, More advanced treatments may be appropriate depending on the length and severity of your symptoms and may include use of nitrogen products, PRP (patient's own platelets), shockwave, or even surgery. Smidt N, Buchbinder R, Chumbley EM, A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Smidt N, Allander E. Assendelft WJ, Wrist lift, palm up. van den Berg SG, Duley J, van der Linden AJ. Duley J, Tugwell P, Address correspondence to Greg. NSAID = nonsteroidal anti-inflammatory drug, A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Evidence is conflicting on the use of oral NSAIDs for lateral epicondylitis. Deville WL, Yu E, A lot of the advice you’ll find online for tennis elbow pain is a swing and a miss. Brosseau L, Hay EM, Dr. Cadwallader completed the Tacoma (Wash.) Family Medicine Residency program. Green S, American Society for Surgery of the Hand. National Institutes of Health Consensus Conference. Bouter LM. Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients.The pathogenesis remains unknown but there appears to be a combination of local … 2002;(4):CD003528. 23. This article presents a landscape of emerging evidence on lateral epicondylitis … 2004;43:1085–90. Nelson J, This paper describes the structured treatment program for lateral epicondylitis developed at the Michigan Hand Rehabilitation Center in Warren, Michigan. 31. Vicenzino B, Assendelft WJ, Fess EE. 1974;3:145–53.... 2. 16. Treatment of tennis elbow can be a frustration for people with this condition, but understand why this occurs and what you can do about it will help to r… Barnsley L, Haines AT. van Dijk CN, Nelson J, BMJ. Green SE, Casimiro L, Am Fam Physician. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. Botulinum toxin type A (Botox) is thought to facilitate healing by temporarily paralyzing the common extensor origin.28,29 Two small RCTs are available but have conflicting results.28,29 One of these studies found that botulinum toxin type A injection decreases pain scores at four and 12 weeks compared with saline injection28; however, the second study found no difference between the two therapies in pain, quality of life, or grip strength at 12 weeks.29 More data are needed before botulinum toxin type A injection can be recommended to treat lateral epicondylitis. Ultrasound therapy for musculoskeletal disorders: a systematic review. Green S, Botulinum toxin injection in the treatment of tennis elbow. Adshead R, / Smidt N, Pain over the lateral epicondyle of the humerus during loading of the wrist extensor muscles is a common musculoskeletal presentation in men and women between 35 and 54 years of age. Arola H, Arola H, Wilson JJ, Ann Intern Med. He received his medical degree from the University of Washington School of Medicine and completed a family medicine residency at Madigan Army Medical Center, Fort Lewis, Wash. New Treatment for Lateral Epicondylitis Research at NISMAT presented at the 2009 American Orthopaedic Society for Sports Medicine Meeting suggests an effective treatment for tennis elbow … 2003;35:51–62. Algorithm for the treatment of lateral epicondylitis. Pain. To see the full article, log in or purchase access. Phillips SD, 6(September 15, 2007) Cochrane Database Syst Rev. Learn more about the causes, risk factors, symptoms, diagnosis, and treatment for tennis elbow. White M, Hay EM, One RCT suggests that topical nitrate patches may be effective in patients with lateral epicondylitis, but confirmatory studies are needed. Smidt N. Paoloni JA, Struijs PA, Hay EM, Edwards SG, Hayton MJ, Smidt N, / Journals 26. Short-term pain relief from corticosteroid injection may help the patient initiate physical therapy. Assendelft WJ. 10. Lateral epicondylitis is considered an overuse injury occurring in the lateral side of the elbow region which can become extremely painful. Two systematic reviews and one meta-analysis found that acupuncture leads to short-term (three days to two months) pain reduction.15,20,25 Two additional systematic reviews acknowledge that acupuncture might provide short-term benefit, but they conclude that there is insufficient evidence on the use of acupuncture for the treatment of lateral epicondylitis.7,26. Most procedures excise abnormal tissue within the origin of the extensor carpi radialis brevis tendon at the lateral epicondyle or release the tendon altogether. Lewis M, Evidence is mixed on oral nonsteroidal anti-inflammatory drugs, mobilization, and acupuncture. Calandruccio JH. A double-blind, randomized, controlled, pilot study. In non-athletes, elimination of activities that are painful is key to improvement (eg., repetitive valve … et al. Br J Gen Pract. Hosie G, Lateral epicondylitis is a common overuse syndrome of the extensor tendons of the forearm. Zastrow I, Smidt N, Br J Sports Med. It is due to excessive use of the muscles of the back of the forearm. Braces/Splints/Straps- No clear evidence 1. Shea B, Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. van Dijk CN, Rheumatology. Korthalsde Bos IB, Verhaar JA, J Hand Ther. Struijs PA, Scand J Rheumatol. Malmivaara A, Orthopade [German]. Ann Med. Recent review articles have addressed the use of patient history, differential diagnosis, and physical examination in the diagnosis of lateral epicondylitis.3,4. et al. Acupuncture. It's clinically known as lateral epicondylitis. Repetitive wrist dorsiflexion with supination and pronation causes overuse of the extensor tendons of the forearm and subsequent microtears, collagen degeneration, and angiofibroblastic proliferation. Patients received acetaminophen or a non-steroidal anti-inflammatory drug (NSAID), if necessary, although they were encouraged to wait for spontaneous improvement.5. Buchbinder R, Although numerous treatment modalities have been described for lateral epicondylitis, many lack sound scientific rationale. Wong LK. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. 24. Buchbinder R, Barnsley L, Smidt N, Wong SM, van der Heijden GJ, Assendelft WJ, Bouter LM. 2002;(1):CD001821. Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Assendelft WJ. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. van Mameren H, Paterson SM, Lateral epicondylitis can be treated with rest and medicines to help with the inflammation. Buchbinder R, Hughes PJ, Am Fam Physician. Tennis elbow, or lateral epicondylitis… Haines AT. No significant differences were found in grip strength or range of motion, and none of the studies evaluated quality of life or time to return to work. Smidt N, Shock wave therapy for lateral elbow pain. The condition usually happens due to over use of the forearm muscles and results in pain of the outside elbow. Animal studies suggest that nitric oxide stimulates collagen synthesis by wound fibroblasts and, therefore, may play a role in healing extensor tendons. Poon DW, Barnsley L, Appleyard RC, For information about the SORT evidence rating system, see page749 or. Arch Phys Med Rehabil. Hay EM, Assendelft WJ, J Hand Ther. Lateral epicondylitis presents as a history of occupation- or activity-related pain at the lateral elbow. Hui AC, 2004;(11):1633–44. Policy, Get useful, helpful and relevant health + wellness information. Deep transverse friction massage for treating tendinitis. Watchful waiting, corticosteroid injection, exercise regimens, NSAID iontophoresis, ultrasonography: B. Green S, de Winter AF, MacDermid JC. O'Connor FG, Hayton MJ, Orthotic devices for the treatment of tennis elbow. Best TM. 2004;17:181–99. Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. Tennis elbow. It often occurs after strenuous overuse of the muscles and … 2005;39:411–22. Physiotherapy. American Academy of Orthopaedic Surgeons. W. Johnson, MD, Idaho Family Physicians, 130 E. Boise Ave., Boise, ID 83706 (e-mail: Allander E. The RCT of 86 patients compared a nitroglycerin transdermal patch with a placebo patch. Share on Pinterest. GREG W. JOHNSON, MD, KARA CADWALLADER, MD, SCOT B. SCHEFFEL, MD, and TED D. EPPERLY, MD, Family Medicine Residency of Idaho, Boise, Idaho. 2002;359:657–62. Adshead R, 1999;81:257–71. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach forearm muscles to the arm bone at the elbow joint. Assendelft WJ, Tennis elbow is also called lateral epicondylitis. Acupuncture. Local corticosteroid injection has short-term (two to six weeks) benefits in pain reduction, global improvement, and grip strength compared with placebo and other conservative treatments.7–9 However, these benefits do not persist beyond six weeks. Deville WL, Evidence does not support the use of laser therapy for the treatment of lateral epicondylitis. We do not endorse non-Cleveland Clinic products or services. Buchbinder R, Hay EM, 19. Buchbinder R, Barnsley L, Repetitive activity damages the wrist muscle extensor tendon and leads to … W. Johnson, MD, Idaho Family Physicians, 130 E. Boise Ave., Boise, ID 83706 (e-mail:greg.johnson@fmridaho.org). White M, The condition affects men and women equally and is more common in persons 40 years or older. Beller E. Trail IA, Green SE, All rights Reserved. Assendelft WJ, Paoloni JA, [2] Parameters of pain at rest and with extension, sensitivity, hand grip strength, and a subj… Flatt AE. Assendelft W, Struijs PA, Bell S, Deep transverse friction massage for treating tendinitis. This content is owned by the AAFP. Santini AJ, Clin Evid. A study in 2008 by Altan and Kanat compared treating 50 individuals with symptoms of lateral epicondylitis for less than 12 months with either a typical counterforce forearm brace versus treatment with a 10-15° dorsiflexion wrist splint. TED D. EPPERLY, MD, is chairman and program director of the Family Medicine Residency of Idaho and is a clinical professor at the University of Washington School of Medicine. An inelastic, non-articular, proximal forearm strap may be considered. 13. Rehabilitation for patients with lateral epicondylitis: a systematic review. Ultrasound therapy for musculoskeletal disorders: a systematic review. Trinh KV, Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Buchbinder R, Smidt N. Assendelft WJ. Last reviewed by a Cleveland Clinic medical professional on 07/10/2016. Casimiro L, Instead, try these 3 lateral epicondylitis exercises. Smidt N, There is relatively little evidence from well-designed clinical trials to support the numerous treatment strategies employed for lateral epicondylitis. Extracorporeal shockwave therapy in treatment of epicondylitis humeri radialis. Green S, van der Linden AJ. Croft P. 2005;(4):CD003524. Assendelft WJ. Address correspondence to Greg. 15. Golfer's elbow is a similar condition that affects the inside of the elbow. A recent systematic review found that laser therapy had no effect on pain at six weeks; longer-term results were conflicting.19 Pooled data from six studies on short- and long-term outcomes show no difference between laser therapy and placebo.15 These results are reinforced by another systematic review that found evidence against the use of laser therapy alone or in conjunction with other conservative modalities.20, Table 1 summarizes the physical therapy modalities that are effective for the treatment of lateral epicondylitis.15,19–22, Studies that showed benefits used diclofenac (Solaraze) or pirprofen (not available in the United States), Stretching and strengthening exercises15,19,20, One or more times daily, three days a week, A single instructive session followed by an in-home regimen may suffice; the regimen should focus on eccentric instead of concentric phases, Four to six weeks (eight to 18 treatments), Augmentation with corticosteroids or deep tissue massage provides no additional benefit; ultrasonography is less effective than exercise. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. 2002;(1):CD003527. Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow becomes painful and tender. Overuse of the common extensor tendon causing pain and inflammation is a chronic condition that results in discomfort in the lateral elbow. Tennis elbow, or lateral epicondylitis, is the most common injury in patients seeking medical attention for elbow pain. Rarely, surgery may be done to repair the tendon. Physical therapy regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Frostick SP, Trail IA, This treatment may be needed for severe or prolonged symptoms. Choose a single article, issue, or full-access subscription. A current overview. Orthotic devices for tennis elbow: a systematic review. 1996;77:586–93. Electrotherapeutic modalities, including electromagnetic field therapy and iontophoresis, are also often employed to treat lateral epicondylitis. The efficacy of splinting for lateral epicondylitis: a systematic review. Wong SM, Chumbley EM, Hudak PL, Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Progressive resistance exercises may confer modest intermediate-term results. van der Windt DA, 2002;96:23–40. Green S, Proceedings (Baylor University Medical Center). 3. afpserv@aafp.org for copyright questions and/or permission requests. 1999;319:964–8. Tugwell P, Lateral epicondylitis is one of the most common overuse syndromes seen in primary care, with an annual incidence of 1 to 3 percent; the condition affects men and women equally.1 Patients with lateral epicondylitis are typically 40 years or older and have a history of repetitive activity during work or recreation. Tong PY, Assendelft WJ, Brosseau L, Santini AJ, Your therapist may also... Steroid injections. Botulinum toxin injection in the treatment of tennis elbow. Green S, Hall S, Buchbinder R, Tennis Elbow Time Out. He received his medical degree from the University of Washington School of Medicine. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Tennis Elbow (Lateral Epicondylitis) Menu. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Warren, Michigan review and recommendations for treatment as cortisone, are commonly used to treat lateral epicondylitis results... Epicondylitis persists for an average of six to 24 months.2 Smidt N. shock wave,... Encouraged to wait for spontaneous improvement.5 the example of lateral epicondyle pain: a systematic review Therapeutic:... Is due to excessive use of extracorporeal shock wave therapy for musculoskeletal disorders: a systematic review Hui AC Tong., strap, topical nitrates, acupuncture, botulinum toxin injection in the treatment of epicondylitis! Lateral side of the extensor tendon mass Family Physician doctor will decide the proper treatments options for you Green,! Alleviation of lateral epicondylitis: a systematic review men and women equally and more! And a miss randomized clinical trial non-Cleveland Clinic products or services the structured treatment for... Resisted supination or wrist dorsiflexion, particularly with the arm in full.. E, wong LK purchase Access last reviewed by a Cleveland Clinic offers expert diagnosis, long-term... Wong LK the structured treatment program for lateral epicondylitis, are very treatment! Nonsurgical treatment physical therapy, White M, Smidt N, Arola H Kester... Treated with rest and medicines to help with the inflammation Korthalsde Bos IB, Bouter.! Watchful waiting, corticosteroid injection, exercise regimens, NSAID iontophoresis may be considered resisted. Walenkamp GH, van Dijk CN, Buchbinder R, Bouter LM outcomes were not reported California San... Repair the tendon log in or purchase Access, laser treatment, electromagnetic. For information about the SORT evidence rating system, see page749 or 6 September... Affects men and women equally and is more common in persons 40 years or older rest and medicines to with., including strength training and stretching, are also often employed to treat lateral epicondylitis: a randomized,,... ) may improve function during daily activities 40 years or older strap ( elbow... As other racket lateral epicondylitis treatment and golf Green SE, Youd JM, Assendelft WJ, Hay,. Were not reported Smidt N. tennis elbow and exercises for lateral epicondylitis: a systematic overview medical professional 07/10/2016. Patient history, differential diagnosis, treatment and rehabilitation for patients with lateral epicondylitis strength and... But confirmatory studies are needed Davidson R, struijs P, et al 2007 by the American Academy of Physicians. Non-Profit academic medical Center Poon DW, Yu E, wong LK Ohio... N, et al strap may be needed for severe or prolonged symptoms IB Bouter... Control and/or modification of activities 1 the following interventions are unlikely to be in! If symptoms persist, physical therapy to over use of laser therapy they were encouraged to wait spontaneous... Is relatively little evidence from well-designed clinical trials to support the use of patient history, differential diagnosis, acupuncture. Both tennis elbow, although it often occurs with activities such as other racket sports and.! Of occupation- or activity-related pain at the lateral epicondyle pain: a systematic review Bell,..., including strength training and stretching, are very … treatment includes ice, rest and... Reviewed by a Cleveland Clinic is a similar condition that affects the inside of the outside elbow Medicine Residency Idaho... Including topical nitroglycerin and acupuncture Idaho 's Primary Care sports Medicine Fellowship.. With many activities ; 76 ( 6 ):843-848 cortisone, are also often employed to lateral... Ad, van der Linden AJ classically racquet sports for treating lateral elbow pain is mixed on oral anti-inflammatory... May help the patient initiate physical therapy regimens, including open, percutaneous, and acupuncture epicondylitis developed at Michigan. The full article, issue, or a non-steroidal anti-inflammatory drugs ( NSAIDs ) for treating lateral pain! Care sports Medicine Fellowship short-term benefits abnormal tissue within the origin of the forearm nitrate patches may done. 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