Current Trends for Treating Lateral Epicondylitis

Abstract

Lateral epicondylitis, also known as ‘tennis elbow’, is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.

Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

“…The treatment of LE is mainly conservative and encompasses physiotherapy, stretching or strengthening exercises, local injections (corticosteroid, PDRN, and PRP, etc. ), and ESWT [1][2][3]. Although physical treatment modalities have been mentioned to be effective in the early period of treatment, their long-term effects are not definite [3].…”

“…), and ESWT [1][2][3]. Although physical treatment modalities have been mentioned to be effective in the early period of treatment, their long-term effects are not definite [3]. Corticosteroid injections have been a frequently used treatment option, but its anti-inflammatory nature is reported to have only short-term to intermediate-term efficacies for pain relief.…”

“…The treatment of LE varies from "wait and see, " nonsteroidal anti-inflammatory drugs, physical therapies, extensor muscle strengthening exercises with counterforce braces (EX), injection therapy including glucocorticoid, polydeoxyribonucleotide (PDRN) or platelet rich plasma (PRP), and extracorporeal shockwave therapy (ESWT), and uncommonly as a last option, surgery [1][2][3][4]. Recently, PDRN injections have also been used for LE.…”

Imaging the Postoperative Elbow

“…Tendon repair, including the biceps, triceps, and the common flexor and extensor tendon attachments, is performed for symptomatic and/or mechanically significant tendon tears. [8][9][10][11][12][13][14][15] Sutures through drilled tunnels or suture anchors are typically used for repair of the medial and lateral tendon attachments. Triceps and biceps repair requires a sturdier construct, incorporating a variety of implants, such as larger anchors, EndoButtons, and interference screws (►Fig.…”

Extracorporeal Shock Wave Versus Interferential Current in Tennis Elbow

“…Tennis Elbow (TE) encompasses pain and tenderness due to overuse or injury of the extensor wrist tendons [1]. It is a degenerative rather than inflammatory tendinopathy causing persistent elbow pain [2]. Moreover, TE usually affects 4-7 per 1000 individuals [3].…”