The diagnosis and management of lateral epicondylitis

Current Opinion in Orthopaedics

Volumn 17, Issue 2, 2006, Pages 134-138

  Murphy, Kevin P ^a   Giuliani, Jeffrey R ^a   Freedman, Brett A ^a  

^a WALTER REED ARMY MEDICAL CENTER   (United States)

Author keywords

Artroscopic; Lateral epicondylitis; Review; Surgery; Tennis elbow

Indexed keywords

CORTICOSTEROID; NONSTEROID ANTIINFLAMMATORY AGENT;

ARTHROSCOPIC SURGERY; BONE RESECTION; CLINICAL TRIAL; CONSERVATIVE TREATMENT; ECHOGRAPHY; EPICONDYLECTOMY; EXTRACORPOREAL LITHOTRIPSY; HUMAN; IMMOBILIZATION; LIGAMENT SURGERY; LITHOTRIPTOR; MEDICAL INSTRUMENTATION; MINIMALLY INVASIVE SURGERY; NUCLEAR MAGNETIC RESONANCE IMAGING; PRIORITY JOURNAL; REST; REVIEW; TENDON SURGERY; TENNIS ELBOW;

EID: 33646058318     PISSN: 10419918     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.bco.0000192889.74144.ab     Document Type: Review

References (34)

1. Field LD, Savoie FH. Common elbow injuries in sport. Sports Med 1998; 26:193-205.
2. Paoloni JA, Appleyard RC, Murrell GA. The Orthopaedic Research Institute-Tennis Elbow Testing System: a modified chair pick-up test - interrater and intrarater reliability testing and validity for monitoring lateral epicondylosis. J Shoulder Elbow Surg 2004; 13:72-77. This study detailed the ORI-TETS testing device and reported excellent diagnostic accuracy for this device. This device should be considered for use in prospective clinical trials, to provide more accurate and quantitative outcome data.
3. Plancher KD, Halbrecht J, Lourie GM. Medial and lateral epicondylitis in the athlete. Clin Sports Med 1996; 15:283-305.
4. Nirschl NP. The etiology and treatment of tennis elbow. J Sports Med 1974; 2:308-323.
5. Nirschl NP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979; 61 (A):832-839.
6. Kraushaar BS, Nirschl RP. Current Concepts Review. Tendinosis of the elbow (Tennis Elbow). J Bone Joint Surg 1999; 81A (2):259-278.
7. Cyriax JH. The pathology and treatment of tennis elbow. JBJS 1936; 18:921-940.
8. Milz S, Tischer T, Buettner A, et al. Molecular composition and pathology of entheses on the medial and lateral epicondyles of the humerus: a structural basis for epicondylitis. Ann Rheum Dis 2004; 63:1015-1021.
9. Gardner RC. Tennis elbow: Diagnosis, pathology, and treatment. Nine severe cases treated by a new reconstructive option. Clin Ortho 1970; 72:248-253.
10. Paoloni JA, Murrell GA. Identification of prognostic indicators for patient outcomes in extensor tendinopathy at the elbow. Scand J Med Sci Sports 2004; 14:163-167.
11. Struijs PA, Assendelft WJ, Kerkhoffs GM, et al. The predictive value of the extensor grip test for the effectiveness of bracing for tennis elbow. Am J Sports Med Sep 2005; 12 [Epub]. The extensor grip test is effective in identifying those patients who will respond well to counterforce brace therapy for lateral epicondylitis that had been present for at least 6 weeks, but had not received an alternate treatment modality for at least 6 months.
12. Levin D, Nazarian LN, Miller TT, et al. Lateral epicondylitis of the elbow: US findings. Radiology Oct 2005; 237 (1):230-234 (Epub 2005 Aug 18).
13. Aoki M, Wada T, Isogai S, et al. Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment. J Shoulder Elbow Surg 2005; 14:172-177. A unique, but highly successful approach to the treatment of lateral epicondylitis with the aid of MRI direction.
14. Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol 2005; 34:1-18.
15. Chung CB, Chew FS, Steinbach L. MR imaging of tendon abnormalities of the elbow. Magn Reson Imaging Clin N Am 2004; 12:233-245.
16. Savnik A, Jensen B, Norregaard J, et al. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol 2004; 14:964-969.
17. Bredella M, Tirman P, Firtz R, et al. MR imaging findings in patients with lateral epicondylitis. AJR Am J Roentgenol 1999; 173:1379-1382.
18. Kalainov DM, Cohen MS. Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases. J Bone Joint Surg Am 2005; 87:1120-1125. A report of three cases of PLRI co-existing with lateral epicondylitis in middle-aged women with no history of elbow trauma. All three were treated with combined LUCL reconstruction (palmaris longus autograft) and open ECRB debridement. The LUCL and ECRB origin are confluent at the lateral epicondyle. Repeated steroid injections, as was the case in each of these patients, may have contributed to the atraumatic disruption of the LUCL.
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; 39:411-422. The most recent review of the literature concerning nonoperative treatment of lateral epicondylitis, to include ESWT. This study compared results from 28 clinical trials, only eight of which followed patients for greater than 6 months. It highlighted the paucity of critical long-term data on the efficacy of treatment modalities for lateral epicondylitis. In general, no nonoperative modality was proven to be effective.
20. Labelle H, Guibert R, Joncas J, et al. Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis. J Bone Joint Surg Br 1992; 74:646-651.
21. Hay EM, Paterson SM, Lewis M, et al. Pragmatic randomized controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ 1999; 319:964-968.
22. Lewis M, Hay EM, Paterson SM, Croft P. Local steroid injections for tennis elbow: does the pain get worse before it gets better? Results from a randomized controlled trial. Clin J Pain 2005; 21:330-334. Level-1 evidence in support of the efficacy of steroid injections over naproxen or placebo in the first week of treatment. Once again, NSAIDs were shown to be equivalent to placebo. Steroids (20 mg methylprednisolone and 0.5 ml 1% lidocaine), while they caused increased pain for the first 3-4 days, demonstrated significant pain reduction after that point. These same authors had previously shown that pain reduction was significantly better for steroids at 4 weeks but that results were equivalent at 1 -year follow-up.
23. 2 - SONOCUR) for the treatment of lateral epicondylitis. This was a double-blinded, randomized clinical trial with 12-week follow-up. 108 patients participated. Sixty-one patients provided 1-year follow-up. Pain scores (>50% improvement), functional activity scores, activity-specific evaluation and the overall impression of the disease state all showed significant improvement AAA(P < 0.05).
24. Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis. A randomized controlled trial. Am J Sports Med 2004; 32:1660-1667. Level-1 evidence that demonstrated no significant difference in outcomes following ESWT. Both the Petronne and Chung studies were well designed and evaluate similar outcome measures. The conflicting results make it difficult to appreciate the ultimate role for ESWT in the treatment of lateral epicondylitis. At most, it is a second-line agent, to be used in only patients who have been refractory to other nonoperative therapies for at least 6 months.
25. Wang CJ, Chen HS. Shock wave therapy for patients with lateral epicondylitis of the elbow: a one- to two-year follow-up study. Am J Sports Med 2002; 30:422-425.
26. Haake M, Konig I, Decker T. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am 2002; 84:1982-1991.
27. Buchbinder R, Green S, Bell S, et al. Surgery for lateral elbow pain. Cochrane Database Syst Rev 2002 (1) (CD003525).
28. Verhaar J, Walenkamp G, Kester A, et al. Lateral extensor release for tennis elbow. A prospective long-term follow-up study. J Bone Joint Surg Am 1993; 75:1034-1043.
29. Rosenberg N, Henderson I. Surgical treatment of resistant lateral epicondylitis. Follow-up study of 19 patients after excision, release and repair of proximal common extensor tendon origin. Arch Orthop Trauma Surg 2002; 122:514-517.
30. Peart RE, Strickler SS, Schweitzer KM Jr. Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop 2004; 33:565-567. A retrospective case-control study that reported no difference in success rates between open (69%) and arthroscopic (72%) ECRB release.
31. Balk ML, Hagberg WC, Buterbaugh GA, Imbriglia JE. Outcome of surgery for lateral epicondylitis (tennis elbow): effect of worker's compensation. Am J Orthop 2005; 34:122-126 (discussion 126). A retrospective case-control study that found satisfaction and pain relief in more than 92% of worker's compensation and nonworker's compensation patients.
32. Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br 2004; 86:701-704. Evidence from a randomized clinical trial that demonstrated that percutaneous tenotomy provided significant improvements in all outcomes measured - DASH score, pain and return to work. There was no control group, so the placebo effect is not known; however, all patients had symptoms that had failed to respond to at least 6 months of nonoperative therapy.
33. Owens BD, Murphy KP, Kuklo TR. Arthroscopic release for lateral epicondylitis. Arthroscopy 2001; 17:582-587.
34. Jerosch J, Schunck J. Arthroscopic treatment of lateral epicondylitis: Indication, technique and early results. Knee Surg Sports Traumatol Arthrose Aug 2005; 3 [Epub ahead of print]. A case series that demonstrated excellent results in pain reduction and return to activity for 20 patients treated with arthroscopic ECRB release. Forty percent of patients had associated intra-articular pathology identified and/or treated at arthroscopy.