Efficacy of Nonoperative Treatments for Lateral Epicondylitis: A Systematic Review and Meta-Analysis

Abstract

Background: Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population. Although symptoms may disappear spontaneously within 1 year, the clinical guidelines for conservative treatment are not clear. The authors’ objective was to examine the outcomes of nonsurgical treatments for lateral epicondylitis through a meta-analysis and provide a treatment recommendation using the available evidence. Methods: The authors searched the PubMed, EMBASE, Scopus, and Web of Science databases to identify primary research articles studying conservative treatments (electrophysiotherapy, physical therapy, and injections) for lateral epicondylitis. The authors included randomized controlled trials published in peer-reviewed journals. Data related to outcomes (pain, grip strength, Patient-Rated Tennis Elbow Evaluation score, and Disabilities of the Arm, Shoulder and Hand score) and complications were extracted. Results: Fifty-eight randomized controlled trials were included in the meta-analysis. Electrophysiotherapy was effective in improving pain [mean difference, −10.0 (95 percent CI, −13.8 to −6.1)], Patient-Rated Tennis Elbow Evaluation score [mean difference, −10.7 (95 percent CI, −16.3 to −5.0)], and Disabilities of the Arm, Shoulder and Hand score [mean difference, −11.9 (95 percent CI, −15.8 to −7.9)]; and physical therapy improved pain [mean difference, −6.0 (95 percent CI, −9.7 to −2.3)] and Patient-Rated Tennis Elbow Evaluation scores [mean difference, −7.5 (95 percent CI, −11.8 to −3.2)] compared to placebo. Injections did not improve any outcome measures. Patients who received electrophysiotherapy and injections reported higher adverse effects than physical therapy patients. Conclusions: Patients who received electrophysiotherapy and physical therapy reported statistically and clinically improved scores in pain and function compared to placebo. Injections may put patients at higher risk for adverse effects compared to other conservative treatments. When managing lateral epicondylitis conservatively, electrophysiotherapy and physical therapy should be prioritized before other interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis

“…The findings of the present study are consistent with a recent systematic review and meta-analysis of RCTs by Kim et al that compared nonoperative treatment in lateral epicondylitis. 18 The latter study found that injections did not improve patient-reported outcomes. Our findings indicate that both pain and function were statistically worse in the CSI group.…”

“… 16 In contrast, a recent meta-analysis reported that injections did not confer any treatment benefits compared with placebo, whereas physiotherapy improved pain and functional scores. 18 A meta-analysis by Weber et al concluded that there was insufficient evidence to support physiotherapy for the treatment of tennis elbow. 39 These inconsistent findings make interpretation of the literature difficult and cloud clinicians’ ability to counsel patients effectively.…”

Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis

“…In a recent meta-analysis, a conclusion that injection therapy did not improve pain and functional outcomes but increased risk of adverse events in LET has been made without including DPT in the analysis. 27 Therefore, we conducted this systematic review of randomized control trials (RCTs) to assess and analyze the effectiveness of DPT in LET.…”

Management of Lateral Elbow Pain with Glucopuncture

“…Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population [2]. The typical…”