Management Of Tennis Elbow Research Articles

Role of local corticosteroid in management of tennis elbow

Background: Lateral epicondylitis or tennis elbow is common clinical and functionally limiting condition encountered by orthopedic surgeon having chronic course and its etiology and management is under controversies. The aim of this study is to know the efficacy of local corticosteroids in its management. Materials and methods: The study was conducted in Department of Orthopaedics, RIMS Ranchi from November 2016 to October 2017. Sixty patients of either sex (33 female and 27 male), mean age 38yrs presenting with pain over lateral epicondyle were selected for the study. After written informed consent local steroids (0.5ml methylprednisolone with 0.5ml of 2% lignocaine) were injected over the maximum tender point in elbow. Results: The incidence was more common in females and dominant arm is been involved mostly. Out of 60 patients 42 patients (70%) got almost complete relief from pain in 6 weeks of time. But at the end of 12 weeks, the final follow up only 11 patients (18.33%) were pain free and 30 patients (50%) had recurrence of symptoms. Conclusion: Local corticosteroids are very effective treatment for lateral epicondylitis if used over short term and for early symptomatic relief.

Management of tennis elbow: a survey of UK clinical practice.

Tennis elbow is a common condition in the UK but there are no guidelines on how best to manage the condition. The purpose of the present study was to establish the current UK practice in managing patients with chronic tennis elbow. A cross-sectional online survey of UK surgeons and therapists was conducted in June 2017. In total, 275 responses were received, the majority from consultant surgeons and experienced physiotherapists. In total, 81% recommended exercise-based physiotherapy as the first-line intervention. Second-line treatments varied widely, with corticosteroid injections being the most popular (27%), followed by shockwave therapy, platelet-rich plasma injection, surgery, acupuncture and a wait-and-see policy. There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow. The majority of second-line interventions lack evidence to support their use and, in the case of corticosteroid injections, may even be harmful in the long term. There is a clear need for national guidance based on best evidence to aid clinicians in their treatment approach.

No abatement of steroid injections for tennis elbow in Australian General Practice: A 15-year observational study with random general practitioner sampling.

ObjectiveEvaluate general practitioner (GP) management of tennis elbow (TE) in Australia.MethodsData about the management of TE by GPs from 2000 to 2015 were extracted from the Bettering the Evaluation of Care of Health program database. Patient and GP characteristics and encounter management data were classified by the International Classification of Primary Care, version 2, and reported using descriptive statistics with point estimates and 95% confidence intervals.ResultsTE was managed by GPs 242,000 times per year on average. Patients were mainly female (52.3%), aged between 35 and 64 years (mean: 49.3 yrs), had higher relative risks of concomitant disorders (e.g. carpal tunnel syndrome and other tendonitis) and their TE was 10 times more likely to be work related than problems managed for patients who did not have TE. Use of diagnostic tests was low, implying a clinical examination based diagnosis of TE. Management was by procedural treatments (36 per 100 TE problems), advice, education or counselling (25 per 100), and referral to other health care providers (14 per 100, mainly to physiotherapy). The rate of local injection did not change over the 15 years and was performed at similar rates as physiotherapy referral.ConclusionThe high risk of comorbidities and work relatedness and no abatement in the reasonably high rate of local injections (which is contrary to the evidence from clinical trials) provides support for the development and dissemination of TE clinical guidelines for GPs.

Randomised, prospective, non-blinded pilot study comparing the effect of intramuscular steroid injections and intralesional steroid injections in the management of tennis elbow

BackgroundTennis elbow is an overuse injury affecting people performing repetitive forearm movements. It is a soft tissue disorder that causes significant disability and pain.The aim of the study was to...

Extracorporeal Shock wave Therapy versus Ultrasonic Therapy on Functional Abilities in Children with Tennis Elbow A randomized controlled trial.

Background and Purpose: Extracorporeal shock-wave therapy (ESWT) is low-to medium-energy type of shockwave therapy. The purpose of the study was to compare the effect of extracorporeal shock wave therapy versus ultrasonic therapy in controlling the elbow pain, muscles weakness and limited range of motion due to tennis elbow in children. Design: Randomized controlled trial. Subjects: Thirty children with tennis elbow with the ages ranged from 12 to 16 years were randomly assigned to either group A (n=15) or group B (n=15) had participated in this study. Group A received a designed physical therapy program and ultrasonic therapy, while the group B received the same physical therapy program in addition to shock wave therapy. Both groups received treatment sessions three times per week for two successive months. The elbow pain was measured by Visual Analog Scale (VAS), range of motion of elbow joint was measured with elastic goniometr and hand grip power was measured by hand held dynamometer before as well as after application of the treatment program. Results: The results revealed no significant differences when comparing the pre-treatment mean values of all measuring variables for the two groups, while significant improvement was observed in the two groups when comparing their pre and post treatment mean values. Also, significant difference was also observed when comparing the post treatment results of the two groups in favor of the study group B. Conclusion: The results suggested that the use of ESWT for the management of tennis elbow is safe and effective, leading to a significant reduction in pain and improvement of elbow function after 8 weeks.

A randomized controlled clinical trial evaluating the role of intra-lesional steroids in the management of tennis elbow

Although intra-lesional steroids are widely used in the management of tennis elbow, some recent reports have doubted their usefulness. A prospective double-blinded randomized controlled clinical trial was conducted to evaluate the usefulness of intra-lesional steroid injections in tennis elbow. The study included 78 cases with a mean age of 39.8 years, who were divided into two randomized groups A (experimental) and B (control). Group A received one intra-lesional injection of 10mg triamcinolone acetate(40 mg/ml) mixed with 0.75 ml of 2% plain lignocaine using peppering injection technique, followed by stretching exercises, whereas group B received only stretching exercises. Follow-up was done for 4 months using fortnightly patient-rated tennis elbow evaluation score (PRTEE). Statistical analysis was done using Student t-test. Average PRTEE score in group A and B at beginning were 78 and 80, respectively. After 4 months, average PRTEE score in group A was 24 and in group B was 25 (p value=0.97, insignificant). Nearly 74% group A patients reported mild to severe intensity pain in immediate post-injection period, which subsided in few days with or without medication. It was concluded that the use of intra-lesional injections does not seem to significantly affect the outcome in tennis elbow.

The Effect of Deep Friction Massage versus Stretching of Wrist Extensor Muscles in the Treatment of Patients with Tennis Elbow

Overuse injuries of the elbow and forearm are very common in athletes. This study was conducted to evaluate the effect of muscle stretching and deep friction massage with using wrist joint support during management of tennis elbow. This study included forty patients with tennis elbow divided into two equal groups: the first group with a mean age 38.1 ± 0.294 followed a physical therapy program in form of deep friction massage on the proximal attachment of wrist extensor muscles, the second group with a mean age 37.6 ± 0.253, submitted to stretching exercises of wrist extensors. Both of groups submitted to ultrasonic therapy with wrist splint during treatment period, three sessions per week for six weeks. Outcome measures were universal goniometer, visual analogue scale, and squeezing sphygmomanometer. The results showed that there was a significant improvement in ROM of wrist flexion and wrist extension, and handgrip in second group and it was more than in the first group while no significant difference in pain. This study showed that stretching exercise is more beneficial in the management of patients with tennis elbow.

Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center

Lateral Epicondylitis has been found to be the second most frequently diagnosed musculoskeletal disorder. A wide range of symptomatic treatments are available such as use of anti-inflammatory analgesic drugs, steroids, physiotherapy. This study aims to know about the diagnosis, prescription pattern and current practice on management of tennis elbow in Nepal. This is a hospital based observational study carried out at Bir Hospital, Kathmandu, Nepal. Patients diagnosed with tennis elbow were purposively selected through prospective sampling technique from Orthopedic Department. Questionnaire and patient medication files were used as tools for data collection. A total of 97 patients were found to be suffering from tennis elbow affecting mostly 41-50 years of age group and seen mostly in female (62%). Further, it was found that housewives (31%) were mostly affected. Diagnosis of tennis elbow was done commonly by clinical evaluation (61%) and X-ray (39%). Both Pharmacological and Non-Pharmacological approaches were in practice. Pharmacological treatment include NSAIDS (59% Aceclofenac, 19% Naproxen, 18% Indomethacin, 16% Diclofenac, 6% Piroxicam) and Steroids (23% methylprednisolone acetate and 21% oral prednisolone). Non-Pharmacological treatment was done by lifestyle modification (100%), 78% application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3%) was also done when the conservative management failed. There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect.

Therapeutic management of tennis elbow

Patients with conditions like tennis elbow are frequently referred to physiotherapy. Patients with this condition suffer from pain and tenderness over lateral epicondyle, which hampers their activities of daily living. Lateral epicondylitis (tennis elbow) is the most frequent type of myotendinosis and can be responsible for substantial pain and loss of function of the affected limb. Muscular biomechanics characteristics and equipment are important in preventing the conditions. This article presents on overview of the current knowledge on lateral epicondylitis and focuses on, conservative treatment and recent surgical techniques are outlined. This information should assist health care practitioners to manage symptoms, improve activity and reduce relapse who treat patients with this disorder.

Conservative and Surgical Management of Tennis Elbow

Conservative and Surgical Management of Tennis Elbow

Management of tennis elbow with topical glyceryl trinitrate.

The aim of this study was to evaluate the treatment results of the application of nitric oxide (NO) in the form of topical glyceryl trinitrate (GTN) for the treatment of lateral epicondylitis (LE). The study included 40 patients with LE randomized into 2 equal groups. Selection criteria included the presence of pain, tenderness, and positive pain stimulating maneuvers. Glyceryl trinitrate patches were applied to the area of maximal tenderness once a day in the treatment group and placebo patches in the control group. Outcomes in terms of pain relief was assessed using the visual analog scale (VAS) and were evaluated according to the criteria of Verhaar et al. Excellent or good results were considered successful. Differences in VAS scores between the two groups were calculated using the Mann-Whitney U-test and the chi-square test was used to investigate distributions of categorical variables (sex, affected side) and good and excellent results among groups. There were no significant differences in any of the baseline clinical parameters between groups. At the 3rd week follow-up, there were statistically significant differences in the pain measured using VAS between groups (mean VAS score of the control and treatment groups were 6.45 and 3.15, respectively) (p=0.001). Patients in the GTN group and control group had lower VAS pain scores and reduced elbow pain at 3 weeks (3.15 vs 8.05 in the GTN and 6.45 vs 8.80 in the control group). In the control group, no patient had excellent or good results while 18 (90%) patients in treatment group reported successful treatment. There was statistically significant difference in the VAS measured at 6 months between groups (mean VAS score of the control and treatment groups were 4.85 and 0.70, respectively) (p=0.001). The administration of NO directly over an area of tendinopathy through a GTN patch reduces pain and other symptoms in chronic LE.

Management of tennis elbow by Agnikarma

Tennis elbow is a painful condition and causes restricted movement of forearm which requires treatment for long period. Till date only symptomatic treatments are available like use of anti-inflammatory analgesic drugs, steroids injection, physiotherapy, exercise etc. But none of these provide satisfactory result. Long term use of anti-inflammatory, analgesic drugs and steroids injection is also not free from the adverse effects. Usually, ‘wait-and-see policy’ of treatment guideline is recommended in most of medical texts. According to Ayurveda, snayugata vata can be correlated with the condition of tennis elbow. Sushruta has advised Agnikarma for disorders of snayu (ligaments and tendons), asthi (bone), siddhi (joints) etc. Hence, in this study a case of tennis elbow (snayugata vata) was treated by Agnikarma, along with administration of powder of Ashwagandha and Navajivana Rasa orally, for a period of 03 weeks. This combination therapy provided considerable relief in pain and movement of the elbow joint.

Physiotherapy in the Management of Tennis Elbow: A Review

What is already known on this topic Tennis elbow is a chronic condition that can be challenging to treat. Physiotherapy is often a treatment of choice, but previous reviews have failed to draw any conclusions as to which is the most effective therapeutic modality in the management of this condition. Key messages of this review The best available evidence is for active exercise approaches, possibly supplemented by manual therapy and taping treatments. There is insufficient evidence to recommend the use of passive modalities such as electrotherapy or acupuncture at present. Physiotherapy is a cost effective form of treatment.

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial

Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.Design Single blind randomised controlled trial.Setting Community setting,...

Development of an Undergraduate Module in Evidence-based Physiotherapy Practice

Method Students were divided into four groups of ten with an academic and a clinical facilitator. The aim for each group was to develop evidence-based guidelines in one of four subject areas. These were therapeutic exercise in the management of osteo-arthritic (OA) knees, physiotherapy management of vestibular dysfunction, ultrasound in the management of tennis elbow, and parameters for electrical muscle stimulation. Following the first week of formal lectures the groups met with the facilitators once per week during a five-week period. The specialist subject librarians enabled the students to undertake advanced literature searches using on-line facilities. The module was assessed in two ways: a group submission of a clinical guideline worth 40% of the mark and an individual submission of 2000 words which demonstrated reflection and critical evaluation of the process worth 60% of the mark. Marking guidelines were developed utilising existing methods for assessing clinical guidelines (Cluzeau et al, 1997).

Low-level laser therapy does not aid the management of tennis elbow

The value of low-level laser therapy (LLLT) as a therapy for painful tennis elbow is dubious since evidence for its efficacy is conflicting. This report presents the results of a randomized, double-blind, controlled study on patients with tennis elbow (n = 29) using a gallium aluminium arsenide laser. Two different methods of assessing pain, visual analogue scores and a Marcy Wedge Pro® exerciser, were used. No significant differences were found between the treatment and placebo groups. This suggests that LLLT at the dosage and duratiion used in this study is without benefit in the short-term management of painful tennis elbow.