Management of Lateral Epicondylitis: Current Concepts

Calfee, Ryan P.; Patel, Amar; DaSilva, Manuel F.; Akelman, Edward

doi:10.5435/00124635-200801000-00004

Cited by 170 publications

(117 citation statements)

References 68 publications

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“…Management of lateral epicondylitis is initially conservative and includes nonsteroidal antiinflammatory drugs, activity modification, physical therapy, splinting, peritendinous injection of steroid, and injection of autologous blood or platelet-rich plasma (22)(23)(24). However, surgery may be indicated in patients who fail to respond to conservative therapy, with debridement of the diseased portion of the tendon, surgical reattachment to the lateral humeral epicondyle (22,23,25).…”

Section: Lateral Epicondylitismentioning

confidence: 99%

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Magnetic resonance imaging of the elbow

Stevens

2010

Magnetic Resonance Imaging

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Elbow pain is frequently encountered in clinical practice and can result in significant morbidity, particularly in athletes. Magnetic resonance imaging (MRI) is an excellent diagnostic imaging tool for the evaluation of soft tissue and osteochondral pathology around the elbow. Recent advances in magnetic field strength and coil design have lead to improved spatial resolution and superior soft tissue contrast, making it ideal for visualization of complex joint anatomy. This article describes the normal imaging appearances of anatomy around the elbow and reviews commonly occurring ligamentous, myotendinous, neural, and bursal pathology around the elbow.

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Section: Lateral Epicondylitismentioning

confidence: 99%

“…However, surgery may be indicated in patients who fail to respond to conservative therapy, with debridement of the diseased portion of the tendon, surgical reattachment to the lateral humeral epicondyle (22,23,25). More recently radiofrequency microtenotomy of the common extensor tendon has lead to favorable results (24).…”

Section: Lateral Epicondylitismentioning

confidence: 99%

Magnetic resonance imaging of the elbow

Stevens

2010

Magnetic Resonance Imaging

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“…Lateral epicondylitis is thought to be related to overuse of the extensor carpi radialis brevis muscle, producing pain in the lateral elbow and forearm region. Although the role of inflammation in the pathophysiology of this condition is questionable, lateral epicondylitis is postulated to involve degenerative changes in the epicondylar enthesis of the extensor carpi radialis brevis and perhaps also the supporting collateral ligamentous complex and joint capsule [5]. Uncertainty regarding the pathologic basis of lateral epicondylitis underlies, in part, the lack of consensus on optimal management.…”

Section: Introductionmentioning

confidence: 99%

“…The rationale for our meta-analysis is that none of these myriad therapies has proven superior to the others [5]. It also is not known whether nonsurgical treatment of this condition provides any intermediate-to long-term advantage over observation only.…”

Section: Introductionmentioning

confidence: 99%

Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

Sayegh

Strauch

2015

Clinical Orthopaedics &Amp; Related Research

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Background Lateral epicondylitis is a painful tendinopathy for which several nonsurgical treatment strategies are used. Superiority of these nonsurgical treatments over nontreatment has not been definitively established. Questions/purposes We asked whether nonsurgical treatment of lateral epicondylitis compared with observation only or placebo provides (1) better overall improvement, (2) less need for escape interventions, (3) better outcome scores, and (4) improved grip strength at intermediate-to long-term followup. Methods The English-language literature was searched using PubMed and the Cochrane Central Register of Controlled Trials. Randomized-controlled trials (RCTs) comparing any form of nonsurgical treatment with either observation only or placebo at followup of at least 6 months were included. Nonsurgical treatments included injections (corticosteroid, platelet-rich plasma, autologous blood, sodium hyaluronate, or glycosaminoglycan polysulfate), physiotherapy, shock wave therapy, laser, ultrasound, corticosteroid iontophoresis, topical glyceryl trinitrate, or oral naproxen. Methodologic quality was assessed with the Consolidated Standards of Reporting Trials (CONSORT) checklist, and 22 RCTs containing 2280 patients were included. Pooled analyses were performed to evaluate overall improvement; requirement for escape interventions (treatment of any kind, outside consultation, and surgery); outcome scores (Patient-Rated Tennis Elbow Evaluation [PRTEE]; DASH; Pain-Free Function Index [PFFI]; EuroQoL [EQ]-5D; and overall function); and maximum and pain-free grip strength. Sensitivity analyses were performed using only trials of excellent or good quality. Heterogeneity analyses were performed, and funnel plots were constructed to assess for publication bias.

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“…Repetitive movements of wrist extension predispose to the development of this condition whereby the dominant arm is more frequently (70%) involved [18]. Histopathology of the affected extensor carpi radialis brevis (ECRB) attachment demonstrates noninflammatory angiofibroblastic tendinosis with neovascularisation, a disordered collagen scaffold, mucoid degeneration, and microtears [4,11].…”

Section: Introductionmentioning

confidence: 99%

Are “knife and fork” good enough for day case surgery of resistant tennis elbow?

Dwyer

Govindaswamy

Elbouni

et al. 2008

International Orthopaedics (SICOT)

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This observational retrospective study was performed on 22 consecutive patients treated surgically in a day surgery unit for resistant tennis elbow to ascertain the effectiveness of the "knife and fork" procedure. All patients had an unfavourable response to nonsurgical treatment lasting at least six months. A simple and inexpensive "knife and fork" technique yielded excellent results in 90.5% of patients and a high percentage (95.2%) of satisfied patients at an average follow-up of two years. There were no fair or poor results and no complications. We conclude that the "knife and fork" technique is a simple and dependable day case procedure. In the present National Health Service (NHS) era of tariff and "payment by results", this approach is more cost effective than an arthroscopic alternative.

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Management of Lateral Epicondylitis: Current Concepts

Cited by 170 publications

References 68 publications

Magnetic resonance imaging of the elbow

Magnetic resonance imaging of the elbow

Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

Are “knife and fork” good enough for day case surgery of resistant tennis elbow?

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