Lateral Epicondylitis (Tennis Elbow) Questions & Answers

1. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006 Nov 4. 333(7575):939. [Medline]. [Full Text].

2. Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol. 2008 Aug. 27(8):1015-9. [Medline].

3. Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther. 2009 Jun. 39(6):484-9. [Medline].

4. Roetert EP, Brody H, Dillman CJ, Groppel JL, Schultheis JM. The biomechanics of tennis elbow. An integrated approach. Clin Sports Med. 1995 Jan. 14(1):47-57. [Medline].

5. Rossi J, Vigouroux L, Barla C, Berton E. Potential effects of racket grip size on lateral epicondilalgy risks. Scand J Med Sci Sports. 2014 Mar 20. [Medline].

6. Li FX, Fewtrell D, Jenkins M. String vibration dampers do not reduce racket frame vibration transfer to the forearm. J Sports Sci. 2004 Nov-Dec. 22(11-12):1041-52. [Medline].

7. Lebiedziński R, Synder M, Buchcic P, Polguj M, Grzegorzewski A, Sibiński M. A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop. 2015 Nov. 39 (11):2199-203. [Medline].

8. Herquelot E, Guéguen A, Roquelaure Y, Bodin J, Sérazin C, Ha C, et al. Work-related risk factors for incidence of lateral epicondylitis in a large working population. Scand J Work Environ Health. 2013 Nov. 39(6):578-88. [Medline].

9. Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM. Clinical and ultrasonographic results of ultrasonographically guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis. Am J Sports Med. 2011 Nov. 39 (11):2429-35. [Medline].

10. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am. 2003 Mar. 28(2):272-8. [Medline].

11. Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol. 2006 Jun. 35(6):371-7. [Medline].

12. Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am. 2011 Aug. 36(8):1269-72. [Medline].

13. Pattanittum P, Turner T, Green S, Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013. 5:CD003686. [Medline].

14. Nilsson P, Baigi A, Swärd L, Möller M, Månsson J. Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID. Scand J Occup Ther. 2012 Sep. 19(5):404-10. [Medline].

15. Kazemi M, Azma K, Tavana B, Rezaiee Moghaddam F, Panahi A. 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. 2010 Aug. 89(8):660-7. [Medline].

16. Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011 Oct. 39 (10):2130-4. [Medline].

17. Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol. 2008 Aug. 27 (8):1015-9. [Medline].

18. Borkholder CD, Hill VA, Fess EE. The efficacy of splinting for lateral epicondylitis: a systematic review. J Hand Ther. 2004 Apr-Jun. 17(2):181-99. [Medline].

19. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005 Jul. 39(7):411-22; discussion 411-22. [Medline].

20. Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther. 2009 Jun. 39(6):484-9. [Medline].

21. Garg R, Adamson GJ, Dawson PA, Shankwiler JA, Pink MM. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elbow Surg. 2010 Jun. 19(4):508-12. [Medline].

22. Najafi M, Arazpour M, Aminian G, Curran S, Madani SP, Hutchins SW. Effect of a new hand-forearm splint on grip strength, pain, and function in patients with tennis elbow. Prosthet Orthot Int. 2016 Jun. 40 (3):363-8. [Medline].

23. Saremi H, Chamani V, Vahab-Kashani R. A Newly Designed Tennis Elbow Orthosis With a Traditional Tennis Elbow Strap in Patients With Lateral Epicondylitis. Trauma Mon. 2016 Jul. 21 (3):e35993. [Medline].

24. Buchbinder R, Green SE, Youd JM, et al. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev. 2005 Oct 19. CD003524. [Medline].

25. Aydın A, Atiç R. Comparison of extracorporeal shock-wave therapy and wrist-extensor splint application in the treatment of lateral epicondylitis: a prospective randomized controlled study. J Pain Res. 2018. 11:1459-1467. [Medline].

26. Notarnicola A, Quagliarella L, Sasanelli N, Maccagnano G, Fracella MR, Forcignanò MI, et al. Effects of extracorporeal shock wave therapy on functional and strength recovery of handgrip in patients affected by epicondylitis. Ultrasound Med Biol. 2014 Dec. 40 (12):2830-40. [Medline].

27. Bayram K, Yesil H, Dogan E. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis. North Clin Istanb. 2014. 1 (1):33-38. [Medline].

28. Köksal İ, Güler O, Mahiroğulları M, Mutlu S, Çakmak S, Akşahin E. Comparison of extracorporeal shock wave therapy in acute and chronic lateral epicondylitis. Acta Orthop Traumatol Turc. 2015. 49 (5):465-70. [Medline].

29. Lizis P. Analgesic effect of extracorporeal shock wave therapy versus ultrasound therapy in chronic tennis elbow. J Phys Ther Sci. 2015 Aug. 27 (8):2563-7. [Medline].

30. Trentini R, Mangano T, Repetto I, Cerruti P, Kuqi E, Trompetto C, et al. Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis. Musculoskelet Surg. 2015 Sep. 99 Suppl 1:S91-7. [Medline].

31. Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci. 2015 Dec. 27 (12):3755-8. [Medline].

32. Ramsay DJ, Bowman MA, Greenman, PE, et al, for the NIH Consensus Panel. NIH Consensus Conference. Acupuncture. JAMA. 1998 Nov 4. 280(17):1518-24. [Medline].

33. Li X, Zhou K, Zhang E, Qi Z, Sun W, Xu L, et al. Therapeutic effect of electroacupuncture, massage, and blocking therapy on external humeral epicondylitis. J Tradit Chin Med. 2014 Jun. 34 (3):261-6. [Medline].

34. Wong CW, Ng EY, Fung PW, Mok KM, Yung PS, Chan KM. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2017 Jan. 7:21-26. [Medline].

35. Calandruccio JH, Steiner MM. Autologous Blood and Platelet-Rich Plasma Injections for Treatment of Lateral Epicondylitis. Orthop Clin North Am. 2017 Jul. 48 (3):351-357. [Medline].

36. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am]. 2003 Mar. 28(2):272-8. [Medline].

37. Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment of lateral epicondylitis. Orthopedics. 2010 Feb. 33(2):84-91. [Medline].

38. Kazemi M, Azma K, Tavana B, Rezaiee Moghaddam F, Panahi A. 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. 2010 Aug. 89(8):660-7. [Medline].

39. Karimi Mobarakeh M, Nemati A, Fazli A, Fallahi A, Safari S. Autologous blood injection for treatment of tennis elbow. Trauma Mon. 2013 Winter. 17(4):393-5. [Medline]. [Full Text].

40. Bostan B, Balta O, Aşçı M, Aytekin K, Eser E. Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis. Balkan Med J. 2016 Mar. 33 (2):216-20. [Medline].

41. Arik HO, Kose O, Guler F, Deniz G, Egerci OF, Ucar M. Injection of autologous blood versus corticosteroid for lateral epicondylitis: a randomised controlled study. J Orthop Surg (Hong Kong). 2014 Dec. 22 (3):333-7. [Medline].

42. Chen X, Jones IA, Park C, Vangsness CT Jr. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med. 2018 Jul. 46 (8):2020-2032. [Medline].

43. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006 Nov. 34(11):1774-8. [Medline].

44. Creaney L, Wallace A, Curtis M, Connell D. 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. 2011 Sep. 45(12):966-71. [Medline].

45. Raeissadat SA, Sedighipour L, Rayegani SM, Bahrami MH, Bayat M, Rahimi R. Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial. Pain Res Treat. 2014. 2014:191525. [Medline]. [Full Text].

46. Raeissadat SA, Sedighipour L, Rayegani SM, Bahrami MH, Bayat M, Rahimi R. Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial. Pain Res Treat. 2014. 2014:191525. [Medline].

47. Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil. 2014. 6:12. [Medline].

48. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013 Mar. 41(3):625-35. [Medline].

49. Yadav R, Kothari SY, Borah D. Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus. J Clin Diagn Res. 2015 Jul. 9 (7):RC05-7. [Medline].

50. Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong). 2015 Apr. 23 (1):1-5. [Medline].

51. Behera P, Dhillon M, Aggarwal S, Marwaha N, Prakash M. Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg (Hong Kong). 2015 Apr. 23 (1):6-10. [Medline].

52. Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014 Feb. 42(2):463-71. [Medline].

53. Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol. 2016 Jun. 17 (2):101-12. [Medline].

54. Chou LC, Liou TH, Kuan YC, Huang YH, Chen HC. Autologous blood injection for treatment of lateral epicondylosis: A meta-analysis of randomized controlled trials. Phys Ther Sport. 2016 Mar. 18:68-73. [Medline].

55. Montalvan B, Le Goux P, Klouche S, Borgel D, Hardy P, Breban M. Inefficacy of ultrasound-guided local injections of autologous conditioned plasma for recent epicondylitis: results of a double-blind placebo-controlled randomized clinical trial with one-year follow-up. Rheumatology (Oxford). 2016 Feb. 55 (2):279-85. [Medline].

56. Tonk G, Kumar A, Gupta A. Platelet rich plasma versus laser therapy in lateral epicondylitis of elbow. Indian J Orthop. 2014 Jul. 48 (4):390-3. [Medline].

57. Tetschke E, Rudolf M, Lohmann CH, Stärke C. Autologous proliferative therapies in recalcitrant lateral epicondylitis. Am J Phys Med Rehabil. 2015 Sep. 94 (9):696-706. [Medline].

58. Karaduman M, Okkaoglu MC, Sesen H, Taskesen A, Ozdemir M, Altay M. Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study. J Orthop. 2016 Mar. 13 (1):10-4. [Medline].

59. Petrella RJ, Cogliano A, Decaria J, Mohamed N, Lee R. Management of Tennis Elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol. 2010 Feb 2. 2:4. [Medline]. [Full Text].

60. Kumai T, Muneta T, Tsuchiya A, Shiraishi M, Ishizaki Y, Sugimoto K, et al. The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci. 2014 Jul. 19 (4):603-11. [Medline].

61. Zeisig E, Fahlström M, Ohberg L, Alfredson H. Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study. Br J Sports Med. 2008 Apr. 42(4):267-71. [Medline].

62. Branson R, Naidu K, du Toit C, Rotstein AH, Kiss R, McMillan D, et al. Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow. J Sci Med Sport. 2017 Jun. 20 (6):528-533. [Medline].

63. Wong SM, Hui AC, Tong PY, et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2005 Dec 6. 143(11):793-7. [Medline]. [Full Text].

64. Placzek R, Drescher W, Deuretzbacher G, Hempfing A, Meiss AL. Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am. 2007 Feb. 89(2):255-60. [Medline].

65. Hayton MJ, Santini AJ, Hughes PJ, et al. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am. 2005 Mar. 87(3):503-7. [Medline].

66. Guo YH, Kuan TS, Chen KL, Lien WC, Hsieh PC, Hsieh IC, et al. Comparison Between Steroid and 2 Different Sites of Botulinum Toxin Injection in the Treatment of Lateral Epicondylalgia: A Randomized, Double-Blind, Active Drug-Controlled Pilot Study. Arch Phys Med Rehabil. 2017 Jan. 98 (1):36-42. [Medline].

67. Creuzé A, Petit H, de Sèze M. Short-Term Effect of Low-Dose, Electromyography-Guided Botulinum Toxin A Injection in the Treatment of Chronic Lateral Epicondylar Tendinopathy: A Randomized, Double-Blinded Study. J Bone Joint Surg Am. 2018 May 16. 100 (10):818-826. [Medline].

68. Lin YC, Tu YK, Chen SS, Lin IL, Chen SC, Guo HR. Comparison between botulinum toxin and corticosteroid injection in the treatment of acute and subacute tennis elbow: a prospective, randomized, double-blind, active drug-controlled pilot study. Am J Phys Med Rehabil. 2010 Aug. 89 (8):653-9. [Medline].

69. Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2003 Nov-Dec. 31(6):915-20. [Medline].

70. Ozden R, Uruç V, Doğramaci Y, Kalaci A, Yengil E. Management of tennis elbow with topical glyceryl trinitrate. Acta Orthop Traumatol Turc. 2014. 48 (2):175-80. [Medline].

71. Singh A, Gangwar DS, Singh S. Bone marrow injection: A novel treatment for tennis elbow. J Nat Sci Biol Med. 2014 Jul. 5 (2):389-91. [Medline].

72. Wang A, Breidahl W, Mackie KE, Lin Z, Qin A, Chen J, et al. Autologous tenocyte injection for the treatment of severe, chronic resistant lateral epicondylitis: a pilot study. Am J Sports Med. 2013 Dec. 41 (12):2925-32. [Medline].

73. Wang A, Mackie K, Breidahl W, Wang T, Zheng MH. Evidence for the Durability of Autologous Tenocyte Injection for Treatment of Chronic Resistant Lateral Epicondylitis: Mean 4.5-Year Clinical Follow-up. Am J Sports Med. 2015 Jul. 43 (7):1775-83. [Medline].

74. Lee SY, Kim W, Lim C, Chung SG. Treatment of Lateral Epicondylosis by Using Allogeneic Adipose-Derived Mesenchymal Stem Cells: A Pilot Study. Stem Cells. 2015 Oct. 33 (10):2995-3005. [Medline].

75. Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015 Jan. 24 (1):67-73. [Medline].

76. Chesterton LS, Lewis AM, Sim J, Mallen CD, Mason EE, Hay EM, et al. Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial). Br J Sports Med. 2014 Oct. 48 (19):1458. [Medline].

77. Smidt N, Assendelft WJ, Arola H, et al. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med. 2003. 35(1):51-62. [Medline].

78. Dundar U, Turkmen U, Toktas H, Ulasli AM, Solak O. Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci. 2015 Apr. 30 (3):1097-107. [Medline].

79. Salli A, Akkurt E, Izki AA, Şen Z, Yilmaz H. Comparison of High Intensity Laser and Epicondylitis Bandage in the Treatment of Lateral Epicondylitis. Arch Rheumatol. 2016 Sep. 31 (3):234-238. [Medline].

80. Akkurt E, Kucuksen S, Yılmaz H, Parlak S, Sallı A, Karaca G. Long term effects of high intensity laser therapy in lateral epicondylitis patients. Lasers Med Sci. 2016 Feb. 31 (2):249-53. [Medline].

81. Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002. CD003528. [Medline].

82. Sevier TL, Stegink-Jansen CW. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ. 2015. 3:e967. [Medline].

83. Baker CL Jr, Baker CL 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. 2008 Feb. 36(2):254-60. [Medline].

Bryant James Walrod, MD Associate Professor (Clinical), Department of Family and Community Medicine, Ohio State University College of Medicine; Team Physician, OSU Athletic Department

Bryant James Walrod, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

 

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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