Chronic Lateral Epicondylitis: Survey of current practice in the outpatient departments in Scotland

Abstract

Summary Chronic lateral epicondylitis has been identified as one of the most common lesions of the upper limb ( Thurston, 1999 Thurston AJ ‘Conservative and surgical treatment of tennis elbow: A study of outcome’. Australian and New Zealand Journal of Surgery. 1999; 68: 568-572 Crossref Scopus (22) Google Scholar ). However, a literature search of Medline, Embase (Exerpta Medica) and CINAHL revealed limited published evidence regarding treatment protocols used by physiotherapists in the management of this condition. A survey of opinions of outpatient physiotherapists regarding their current practice of chronic lateral epicondylitis was therefore carried out in a random sample of National Health Service outpatient departments in Scotland. The questionnaire was completed by 120 physiotherapists, giving a response rate of 80%. According to 77.3% of respondents, lateral epicondylitis patients always or frequently present with chronic symptoms. A sizeable proportion of respondents (67.5%) indicated that their chronic lateral epicondylitis patients have a poor understanding of their condition. The importance of joint protection techniques was highlighted with 83.3% of the respondents reporting that they demonstrated protection techniques to patients. Only 1.7%, however, provided written information about these techniques for future reference. Respondents identified pain upon resisted wrist extension (88.3%) and palpation of the wrist extensor origin (63.3%) as diagnostic tests for chronic lateral epicondylitis. Differential diagnosis tests were identified as cervical spine examination and radial nerve tension test by 67.5% and 66.7% of respondents, respectively. Range of motion was the most commonly used outcome measure with 83.3% of respondents using it always or frequently. Only one respondent indicated a defined departmental protocol regarding the management of chronic lateral epicondylitis, although much agreement was found regarding treatment. Progressive stretching (88%) and strengthening exercises (75.8%) were always or frequently used by respondents. This study has provided information regarding current physiotherapeutic approaches to chronic lateral epicondylitis and identified the latest published evidence. However, this condition will continue to be a therapeutic challenge until more evidence regarding best practice is available and physiotherapists acknowledge that it is a multi-factorial condition. Chronic lateral epicondylitis has been identified as one of the most common lesions of the upper limb ( Thurston, 1999 Thurston AJ ‘Conservative and surgical treatment of tennis elbow: A study of outcome’. Australian and New Zealand Journal of Surgery. 1999; 68: 568-572 Crossref Scopus (22) Google Scholar ). However, a literature search of Medline, Embase (Exerpta Medica) and CINAHL revealed limited published evidence regarding treatment protocols used by physiotherapists in the management of this condition. A survey of opinions of outpatient physiotherapists regarding their current practice of chronic lateral epicondylitis was therefore carried out in a random sample of National Health Service outpatient departments in Scotland. The questionnaire was completed by 120 physiotherapists, giving a response rate of 80%. According to 77.3% of respondents, lateral epicondylitis patients always or frequently present with chronic symptoms. A sizeable proportion of respondents (67.5%) indicated that their chronic lateral epicondylitis patients have a poor understanding of their condition. The importance of joint protection techniques was highlighted with 83.3% of the respondents reporting that they demonstrated protection techniques to patients. Only 1.7%, however, provided written information about these techniques for future reference. Respondents identified pain upon resisted wrist extension (88.3%) and palpation of the wrist extensor origin (63.3%) as diagnostic tests for chronic lateral epicondylitis. Differential diagnosis tests were identified as cervical spine examination and radial nerve tension test by 67.5% and 66.7% of respondents, respectively. Range of motion was the most commonly used outcome measure with 83.3% of respondents using it always or frequently. Only one respondent indicated a defined departmental protocol regarding the management of chronic lateral epicondylitis, although much agreement was found regarding treatment. Progressive stretching (88%) and strengthening exercises (75.8%) were always or frequently used by respondents. This study has provided information regarding current physiotherapeutic approaches to chronic lateral epicondylitis and identified the latest published evidence. However, this condition will continue to be a therapeutic challenge until more evidence regarding best practice is available and physiotherapists acknowledge that it is a multi-factorial condition.