Lateral Epicondylagia – Tennis Elbow

It is important that your medical practitioner, whether physician or physiotherapist does his own evidence based objective examinations. This allows efficacious evidence-based treatment arising from clinical examination.

Together with a series of questions in the subjective examination, the objective examination allows specific testing the ability to come to a specific diagnosis, either through a process of exclusion or positive tests. 

Special tests for Lateral Epicndylitis (Tennis Elbow):

(MacDermid and Michlovitz, 2006)

Treatment strategies:

Ice & compression; Mobilistions, Trigger point therapy. Exercise therapy based on limitations and weaknesses identified in physical examination. Muligan accessory movements and mobilisations can show efficacy (Abbott et al., 2001).

Isolated wrist extensor eccentric exercise showed efficacious results. (Tyler et al., 2010)

(Tyler et al., 2010)

Corticosteroids which is a mainstay of many treatment protocols have very little long-term success. In fact, the results are worse. As can be seen in the chart below, Corticosteroid injections had worse results that both wait and see approaches as well as Mobilisations and exercise treatment protocol (Bisset et al., 2006). The literature is showing that these injections should no longer be used in this condition.

(Bisset et al., 2006)

Anothr Meta-analysis in 2010 also showed worse results from steroid use as compared to other treatments in both the intermediate and long term (Coombes et al., 2010).

Surgical intervention is rserved for those who remain symptomatic for greater than 6 month. Reccurance and chronic condition may be considered for surgery. People with larger tears were also more likely to have inefficient conservative treatment (Clarke, 2010 #389).

ABBOTT, J. H., PATLA, C. E. & JENSEN, R. H. 2001. The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia. Man Ther, 6, 163-9.

BISSET, L., BELLER, E., JULL, G., BROOKS, P., DARNELL, R. & VICENZINO, B. 2006. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Bmj, 333, 939.

COOMBES, B. K., BISSET, L. & VICENZINO, B. 2010. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet, 376, 1751-67.

MACDERMID, J. C. & MICHLOVITZ, S. L. 2006. Examination of the elbow: linking diagnosis, prognosis, and outcomes as a framework for maximizing therapy interventions. J Hand Ther, 19, 82-97.

TYLER, T. F., THOMAS, G. C., NICHOLAS, S. J. & MCHUGH, M. P. 2010. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elbow Surg, 19, 917-22.