Abstract
BackgroundLateral epicondylitis (LE), also known as tennis elbow, is the most common painful elbow condition. It affects approximately 1–3% of adults. There are various possible treatments described in the literature, but evidence to support a gold standard management protocol is lacking. Therefore, the objective of this study was to evaluate how Brazilian orthopaedists diagnose and treat lateral epicondylitis and compare these results with the available evidence.MethodsThis is an observational, analytical, cross-sectional study. A questionnaire was prepared to obtain information from the participants with eight specific questions (2 on diagnosis and 6 on treatment). These questions were answered voluntarily by participants at 3 major congresses of orthopaedists in Brazil in 2018. The results were analysed in accordance with the overall number of responses and were evaluated among groups according to subspecialty.ResultsWe obtained a total of 501 questionnaires. Of these, 33 were excluded. The mean age was 38.67 years. The majority of respondents (91%) were male. We obtained 26.7% from specialists in hand surgery (Hand group), 36.5% from subspecialists in shoulder and elbow (Shoulder and Elbow group), and 36.8% from generalists in orthopaedics or from other subspecialties (General Orthopaedists group). For diagnosis, 24.4% did not initially request any imaging method. The most requested exam was ultrasonography (54.9%). The most prominent indication for initial treatment was physical therapy. For refractory cases, 78.3% of the respondents preferred doing a local infiltration. The most commonly used substance for local infiltrations was corticosteroids (89.6%). With respect to the surgical treatment option, 75.8% of those who recommend it prefer open techniques, and 24.2% prefer arthroscopic treatment. Of the total respondents, 12.8% did not recommend surgical treatment for LE.ConclusionAmong Brazilian orthopaedists, the Cozen test is most frequently chosen, and ultrasound is the most commonly used imaging tool. Nonsurgically, oral nonsteroidal anti-inflammatory drugs (NSAIDs) plus physiotherapy is the most popular initial therapy, and corticosteroids are the most popular type of infiltration agent. Most surgeons recommended surgery after 6 months of nonsurgical treatment, and 75.8% preferred the open technique.
Highlights
Lateral epicondylitis (LE), known as tennis elbow, is the most common painful elbow condition
The Mills test [15] starts with the elbow at 90° of flexion, and the examiner passively flexes the wrist and extends the elbow, while the Maudsley test [16] is performed by resisting extension of the third finger
10 were excluded for presenting three or more incomplete answers; 16 were not included because they were from nonmedical respondents; four were foreigners; and one had been answered by the same person at different congresses
Summary
Lateral epicondylitis (LE), known as tennis elbow, is the most common painful elbow condition. Lateral epicondylitis (LE), or tennis elbow, is widely studied because it is the most common painful condition of the elbow It affects approximately 1–3% of adults [1] and has a higher incidence in patients whose activities require repetitive or excessive efforts [2]; it is an important cause of absenteeism [1], leading to a socioeconomic impact. The Mills test [15] starts with the elbow at 90° of flexion, and the examiner passively flexes the wrist and extends the elbow, while the Maudsley test [16] is performed by resisting extension of the third finger All of these tests are positive in the presence of lateral epicondylar pain [14]. Conventional radiographs, ultrasound, and magnetic resonance imaging can be used to exclude osteoarticular disease, tendon injury, cartilage damage, synovial plica, and loose bodies, but no clinical guidelines are set as the gold standard
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