Management of tennis elbow: a survey of UK clinical practice

Abstract

Background: 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. Methods: A cross-sectional online survey of UK surgeons and therapists was conducted in June 2017. Results: 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, plateletrich plasma injection, surgery, acupuncture and a wait-and-see policy. Conclusions: 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.

Current physiotherapy practice in the management of tennis elbow: A service evaluation

“…This retrospective service evaluation from two UK NHS organizations highlights a broad spectrum of treatment modalities used in the conservative management of patients with tennis elbow. Exercise‐based treatment was most commonly used, and this finding is consistent with results of a recent national UK survey of clinical practice for the management of patients with tennis elbow (Bateman et al, ). All patients whose documentation was complete were prescribed some form of exercise but the specific type of exercise (e.g.…”

“…Many treatment options available to physiotherapists include manual therapy, stretching and strengthening exercises, electrotherapy, taping, shock‐wave therapy, acupuncture and others (Bisset et al, ; Bisset & Vicenzino, ; Coombes et al, ; Raman, MacDermid, & Grewal, ). For persistent tennis elbow, commonly defined as lasting over 6 months (Bateman, Titchener, Clark, & Tambe, ), there is greatest evidence in favour of strengthening exercises but the most effective method and dosing regimen have yet to be established (Coombes et al, ). It is generally recommended that a progressive loading strategy is used, along with patient education regarding sensible management of activity and physical loads to help manage the pain (Coombes et al, ; Peterson, Butler, Eriksson, & Svardsudd, ).…”

The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy

“…4 Overload and repetitive excursion of the wrist extensor muscles, specifically the extensor carpi radialis brevis (ECRB) and the extensor digitorum communis (EDC), which originate on the lateral epicondyle of the humerus, are generally considered as the pathophysiology of LET. 5,6 Although LET is commonly self-limiting and a waitand-see policy is frequently adopted, 7 many treatment strategies, including physiotherapy exercises, acupuncture, extracorporeal shock-wave therapy (ECSW), laser therapy, dry needling, orthoses, injections, and surgery, have been used to relieve pain, alleviate inflammation, and improve grip strength. 6,8,9 Conservative treatments result in clinical improvements in 75%-90% of subjects with LET.…”

“…5,6 Although LET is commonly self-limiting and a waitand-see policy is frequently adopted, 7 many treatment strategies, including physiotherapy exercises, acupuncture, extracorporeal shock-wave therapy (ECSW), laser therapy, dry needling, orthoses, injections, and surgery, have been used to relieve pain, alleviate inflammation, and improve grip strength. 6,8,9 Conservative treatments result in clinical improvements in 75%-90% of subjects with LET. 10 A counterforce brace, which is also known as a "proximal forearm band" or "epicondylitis bandage," is one conventional treatment.…”

Rapid and Successful Rehabilitation and Return to Play for a D1 Gymnast After Treatment for Lateral Epicondylosis with Ultrasound Guided Percutaneous Tenotomy (Tenex)

“…Findings of angiofibroblastic hyperplasia and collagen disarray indicate a poorly healing process rather than an acutely inflamed process of the tendon. [4] Secondary to this, alternative treatments to cortisone have been explored. Sonographic guided percutaneous ultrasonic tenotomy and debridement (Tenex) has emerged as a viable treatment option for this chronic condition.…”