Review Article

Surgical and Non-Surgical Management Strategies for Lateral Epicondylitis

Abstract

Lateral epicondylitis (LE) is one of the major causes of elbow pain. Despite being a self-limiting condition, its high incidence can cause a significant socioeconomic burden. Many treatment modalities have been proposed for the treatment, but the optimal strategy is still unknown. In this article, we discuss surgical and non-surgical strategies for the treatment of LE and address the research gaps.

1. Zwerus EL, Somford MP, Maissan F, Heisen J, Eygendaal D, van den Bekerom MP. Physical examination of the elbow, what is the evidence? A systematic literature review. Br J Sports Med. 2018;52(19):1253-60. doi: 10.1136/bjsports-2016-

096712. [PubMed: 28249855].

2. Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: A population study. Am J Epidemiol. 2006;164(11):1065-74. doi: 10.1093/aje/kwj325. [PubMed: 16968862].

3. Haahr JP, Andersen JH. Physical and psychosocial risk factors for lateral epicondylitis: A population based case-referent study. Occup Environ Med. 2003;60(5):322-9. doi: 10.1136/oem.60.5.322. [PubMed: 12709516]. [PubMed Central: PMC1740535].

4. Vaquero-Picado A, Barco R, Antuna SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2016;1(11):391-7. doi: 10.1302/2058-

5241.1.000049. [PubMed: 28461918]. [PubMed Central: PMC5367546].

5. Bisset L, Smidt N, Van der Windt DA, Bouter LM, Jull G, Brooks P, et al. Conservative treatments for tennis elbow do subgroups of patients respond differently? Rheumatology (Oxford). 2007;46(10):1601-5. doi: 10.1093/rheumatology/kem192. [PubMed: 17890274].

6. Smidt N, Lewis M, Van der Windt DA, Hay EM, Bouter LM, Croft P. Lateral epicondylitis in general practice: Course and prognostic indicators of outcome. J Rheumatol. 2006;33(10):2053-9. [PubMed: 16881095].

7. Meunier M. Lateral Epicondylitis/Extensor Tendon Injury. Clin Sports Med. 2020;39(3):657-60. doi: 10.1016/j.csm.2020.03.001. [PubMed: 32446581].

8. Ma KL, Wang HQ. Management of lateral epicondylitis: A narrative literature review. Pain Res Manag. 2020;2020:6965381. doi: 10.1155/2020/6965381. [PubMed: 32454922]. [PubMed Central: PMC7222600].

9. Weber C, Thai V, Neuheuser K, Groover K, Christ O. Efficacy of physical therapy for the treatment of lateral epicondylitis: A meta-analysis. BMC Musculoskelet Disord. 2015;16:223. doi: 10.1186/s12891-015-0665-4. [PubMed: 26303397]. [PubMed Central: PMC4549077].

10. Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015;61(4):174-81. doi: 10.1016/j.jphys.2015.07.015. [PubMed: 26361816].

11. Sevier TL, Stegink-Jansen CW. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ. 2015;3:e967. doi: 10.7717/peerj.967. [PubMed: 26038722]. [PubMed Central: PMC4451036].

12. Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil. 2014;28(1):3-19. doi: 10.1177/0269215513491974. [PubMed: 23881334].

13. Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clin Rehabil. 2014;28(9):862-72. doi: 10.1177/0269215514527595. [PubMed: 24634444].

14. Raman J, MacDermid JC, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis--a systematic review. J Hand Ther. 2012;25(1):5-25. doi: 10.1016/j.jht.2011.09.001. [PubMed: 22075055].

15. Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther. 2005;18(4):411-9, quiz. doi: 10.1197/j.jht.2005.07.007. [PubMed: 16271688].

16. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elbow Surg. 2010;19(6):917-22. doi:

10.1016/j.jse.2010.04.041. [PubMed: 20579907].

17. Ogden JA, Toth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res. 2001;(387):8-17. doi: 10.1097/00003086-200106000-00003. [PubMed: 11400898].

18. Siebert WE, Buch CM. Extracorporeal shock waves in orthopaedics. Berlin, Germany: Springer Berlin Heidelberg; 2012.

19. Crevenna R, Mickel M, Keilani M. Extracorporeal shock wave therapy in the supportive care and rehabilitation of cancer patients. Support Care Cancer. 2019;27(11):4039-41. doi: 10.1007/s00520-019-05046-y. [PubMed: 31446484]. [PubMed Central: PMC6803573].

20. Razavipour M, Azar MS, Kariminasab MH, Gaffari S, Fazli M. The short term effects of shock-wave therapy for tennis elbow: A clinical trial study. Acta Inform Med. 2018;26(1):54-6. doi: 10.5455/aim.2018.26.54-56. [PubMed: 29719315]. [PubMed Central: PMC5869227].

21. Testa G, Vescio A, Perez S, Petrantoni V, Mazzarella G, Costarella L, et al. Functional outcome at short and middle term of the extracorporeal shockwave therapy treatment in lateral epicondylitis: A case-series study. J Clin Med. 2020;9(3):633. doi: 10.3390/jcm9030633. [PubMed: 32120893]. [PubMed Central: PMC7141112].

22. Dedes V, Tzirogiannis K, Polikandrioti M, Dede AM, Mitseas A, Panoutsopoulos GI. Comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. J Med Ultrason (2001). 2020;47(2):319-25. doi: 10.1007/s10396-019-01002-9. [PubMed: 31912320].

23. Guler NS, Sargin S, Sahin N. Efficacy of extracorporeal shockwave therapy in patients with lateral epicondylitis: A randomized, placebo-controlled, double-blind clinical trial. North Clin Istanb. 2018;5(4):314-8. doi: 10.14744/nci.2017.82435. [PubMed: 30859161]. [PubMed Central: PMC6371991].

24. Mastej S, Pop T, Bejer A, Plocki J, Kotela I. Comparison of the effectiveness of shockwave therapy with selected physical therapy procedures in patients with tennis elbow syndrome. Ortop Traumatol Rehabil. 2018;20(4):301-11. doi: 10.5604/01.3001.0012.6464. [PubMed: 30648651].

25. Xiong Y, Xue H, Zhou W, Sun Y, Liu Y, Wu Q, et al. Shock-wave therapy versus corticosteroid injection on lateral epicondylitis: A meta-analysis of randomized controlled trials. Phys Sportsmed. 2019;47(3):284-9. doi: 10.1080/00913847.2019.1599587. [PubMed: 30951399].

26. Yan C, Xiong Y, Chen L, Endo Y, Hu L, Liu M, et al. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: A meta-analysis of randomized controlled trials. J Orthop Surg Res. 2019;14(1):248. doi: 10.1186/s13018-019-1290-y. [PubMed: 31387611]. [PubMed Central: PMC6683364].

27. Ahadi T, Esmaeili Jamkarani M., Raissi GR, Mansoori K, Emami Razavi SZ, Sajadi S. Prolotherapy vs radial extracorporeal shock wave therapy in the short-term treatment of lateral epicondylosis: A randomized clinical trial. Pain Med. 2019;20(9):1745-9. doi: 10.1093/pm/pny303. [PubMed: 30698771].

28. Celik D, Anaforoglu Kulunkoglu B. Photobiomodulation Therapy Versus extracorporeal shock wave therapy in the treatment of lateral epicondylitis. Photobiomodul Photomed Laser Surg. 2019;37(5):269-75. doi: 10.1089/photob.2018.4533. [PubMed: 31084562].

29. Dilek B, Batmaz I, Sariyildiz MA, Sahin E, Ilter L, Gulbahar S, et al. Kinesio taping in patients with lateral epicondylitis. J Back Musculoskelet Rehabil. 2016;29(4):853-8. doi: 10.3233/BMR-160701. [PubMed: 27232082].

30. George CE, Heales LJ, Stanton R, Wintour SA, Kean CO. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport. 2019;40:117-27.

doi: 10.1016/j.ptsp.2019.08.011. [PubMed: 31518778].

31. Zhong Y, Zheng C, Zheng J, Xu S. Kinesio tape reduces pain in patients with lateral epicondylitis: A meta-analysis of randomized controlled trials. Int J Surg. 2020;76:190-9. doi: 10.1016/j.ijsu.2020.02.044. [PubMed: 32165280].

32. Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann

Intern Med. 2002;136(5):374-83. doi: 10.7326/0003-4819-136-5-

200203050-00010. [PubMed: 11874310].

33. Sierpina VS, Frenkel MA. Acupuncture: A clinical review. South

Med J. 2005;98(3):330-7. doi: 10.1097/01.SMJ.0000140834.30654.0F.

[PubMed: 15813160].

34. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med.

1993;328(4):246-52.doi:10.1056/NEJM199301283280406.

[PubMed: 8418405].

35. Cheng KJ. Neurobiological mechanisms of acupuncture for some common illnesses: A clinician's perspective. J Acupunct Meridian Stud. 2014;7(3):105-14. doi: 10.1016/j.jams.2013.07.008. [PubMed: 24929454].

36. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999;80(1-2):1-13. doi: 10.1016/s0304-3959(98)00255-3. [PubMed: 10204712].

37. Haker E, Lundeberg T. Acupuncture treatment in epicondylalgia: A comparative study of two acupuncture techniques. Clin J Pain. 1990;6(3):221-6. doi: 10.1097/00002508-199009000-00009. [PubMed: 2135016].

38. Irnich D, Karg H, Behrens N, Lang M, Schreiber A, Kroling P. Controlled trial on point specificity of acupuncture in the treatment of lateral Epicondylitis (Tennis Elbow).

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2003;13(4):215-9. doi: 10.1055/s-2003-41368.

39. Fink M, Wolkenstein E, Karst M, Gehrke A. Acupuncture in

chronic epicondylitis: A randomized controlled trial.

Rheumatology (Oxford). 2002;41(2):205-9. doi:

10.1093/rheumatology/41.2.205. [PubMed: 11886971].

40. Pattanittum P, Turner T, Green S, Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013;(5):CD003686. doi: 10.1002/14651858.CD003686.pub2. [PubMed: 23728646]. [PubMed Central: PMC7173751].

41. Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, et al. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: Treatment options. J Exp Orthop. 2018;5(1):38. doi: 10.1186/s40634-018-0145-5. [PubMed: 30251203]. [PubMed Central: PMC6153202].

42. Titchener AG, Booker SJ, Bhamber NS, Tambe AA, Clark DI. Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): A survey of current U.K. specialist practice and a call for clinical guidelines. Br J Sports Med. 2015;49(21):1410-3. doi: 10.1136/bjsports-2013-092674. [PubMed: 24195919].

43. Cyriax J, Troisier O. Hydrocortone and soft-tissue lesions. Br Med J. 1953;2(4843):966-8. doi: 10.1136/bmj.2.4843.966. [PubMed: 13094084]. [PubMed Central: PMC2029934].

44. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: A randomized controlled trial. JAMA. 2013;309(5):461-9. doi: 10.1001/jama.2013.129. [PubMed: 23385272].

45. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-67.

doi: 10.1016/S0140-6736(10)61160-9. [PubMed: 20970844].

46. Houck DA, Kraeutler MJ, Thornton LB, McCarty EC, Bravman JT. Treatment of lateral epicondylitis with autologous blood, platelet-rich plasma, or corticosteroid injections: A systematic review of overlapping meta-analyses. Orthop J Sports Med. 2019;7(3):2325967119831052. doi: 10.1177/2325967119831052. [PubMed: 30899764]. [PubMed Central: PMC6419259].

47. Chou LC, Liou TH, Kuan YC, Huang YH, Chen HC. Autologous blood injection for treatment of lateral epicondylosis: A meta-analysis of randomized controlled trials. Phys Ther Sport. 2016;18:68-73. doi: 10.1016/j.ptsp.2015.06.002. [PubMed: 26616689].

48. Qian X, Lin Q, Wei K, Hu B, Jing P, Wang J. Efficacy and safety of autologous blood products compared with corticosteroid injections in the treatment of lateral epicondylitis: A meta-analysis of randomized controlled trials. PM R. 2016;8(8):780-91. doi: 10.1016/j.pmrj.2016.02.008. [PubMed: 26968611].

49. Mi B, Liu G, Zhou W, Lv H, Liu Y, Wu Q, et al. Platelet rich plasma versus steroid on lateral epicondylitis: Meta-analysis of randomized clinical trials. Phys Sportsmed. 2017;45(2):97-104. doi: 10.1080/00913847.2017.1297670. [PubMed: 28276986].

50. Smidt N, Van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: A randomised controlled trial. Lancet. 2002;359(9307):657-62. doi: 10.1016/S0140-6736(02)07811-X. [PubMed: 11879861].

51. Degen RM, Cancienne JM, Camp CL, Altchek DW, Dines JS, Werner BC. Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis: An analysis of 3863 patients. J Shoulder Elbow Surg. 2017;26(4):704-9. doi: 10.1016/j.jse.2016.10.022. [PubMed: 28094190].

52. Park HB, Kam M, Gwark JY. Association of steroid injection with soft-tissue calcification in lateral epicondylitis. J

Shoulder Elbow Surg. 2019;28(2):304-9. doi:

10.1016/j.jse.2018.10.009. [PubMed: 30658775].

53. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41(3):625-35. doi: 10.1177/0363546512472975. [PubMed: 23328738].

54. Smith AG, Kosygan K, Williams H, Newman RJ. Common extensor tendon rupture following corticosteroid injection for lateral tendinosis of the elbow. Br J Sports Med. 1999;33(6):423-4. doi: 10.1136/bjsm.33.6.423. [PubMed: 10597854]. [PubMed Central: PMC1756217].

55. Weinhammer AP, Shields BE, Keenan T. Intralesional corticosteroid-induced hypopigmentation and atrophy. Dermatol Online J. 2020;26(1):13030. [PubMed: 32155037].

56. Calandruccio JH, Steiner MM. Autologous blood and platelet-rich plasma injections for treatment of lateral epicondylitis. Orthop Clin North Am. 2017;48(3):351-7. doi: 10.1016/j.ocl.2017.03.011. [PubMed: 28577784].

57. Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018;15(1):107-10. doi: 10.1016/j.jor.2018.01.040. [PubMed: 29657450]. [PubMed Central: PMC5895908].

58. Xu Q, Chen J, Cheng L. Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials. Int J Surg. 2019;67:37-46. doi: 10.1016/j.ijsu.2019.05.003. [PubMed: 31128316].

59. Tang S, Wang X, Wu P, Wu P, Yang J, Du Z, et al. Platelet-rich plasma Vs autologous blood Vs corticosteroid injections in the treatment of lateral epicondylitis: A systematic review, pairwise and network meta-analysis of randomized controlled trials. PM R. 2020;12(4):397-409. doi: 10.1002/pmrj.12287. [PubMed: 31736257]. [PubMed Central: PMC7187193].

60. Li A, Wang H, Yu Z, Zhang G, Feng S, Liu L, et al. Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(51):e18358. doi: 10.1097/MD.0000000000018358. [PubMed: 31860992]. [PubMed Central: PMC6940118].

61. Simental-Mendia M, Vilchez-Cavazos F, Alvarez-Villalobos N, Blazquez-Saldana J, Pena-Martinez V, Villarreal-Villarreal G, et al. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: A systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol. 2020;39(8):2255-65. doi: 10.1007/s10067-020-05000-y. [PubMed: 32103373].

62. Gao B, Dwivedi S, DeFroda S, Bokshan S, Ready LV, Cole BJ, et al. The therapeutic benefits of saline solution injection for lateral epicondylitis: A meta-analysis of randomized controlled trials comparing saline injections with nonsurgical injection

therapies. Arthroscopy. 2019;35(6):1847-59. doi: 10.1016/j.arthro.2019.02.051. [PubMed: 31072722].

63. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR Jr, et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: A meta-analysis of evidence level 1 studies. Am J Sports Med. 2017;45(11):2647-53. doi: 10.1177/0363546516680607. [PubMed: 28027657].

64. Acosta-Olivo CA, Millan-Alanis JM, Simental-Mendia LE, Alvarez-Villalobos N, Vilchez-Cavazos F, Pena-Martinez VM, et al. Effect of normal saline injections on lateral epicondylitis symptoms: A systematic review and meta-analysis of randomized clinical trials. Am J Sports Med. 2020;48(12):3094-102. doi: 10.1177/0363546519899644. [PubMed: 32045280].

65. Galvin R, Callaghan C, Chan WS, Dimitrov BD, Fahey T. Injection of botulinum toxin for treatment of chronic lateral epicondylitis: Systematic review and meta-analysis. Semin

Arthritis Rheum. 2011;40(6):585-7. doi:

10.1016/j.semarthrit.2011.01.003. [PubMed: 21397930].

66. Jabbari B, Machado D. Treatment of refractory pain with botulinum toxins-an evidence-based review. Pain Med.

2011;12(11):1594-606.doi:10.1111/j.1526-4637.2011.01245.x.

[PubMed: 21958302].

67. Wilhelm A, Gieseler H. Treatment of radiohumeral epicondylitis by denervation. Chirurg. 1962;33:118-22.
[PubMed: 14007004].

68. Boyd HB, McLeod AC Jr. Tennis elbow. J Bone Joint Surg Am. 1973;55(6):1183-7. [PubMed: 4585946].

69. Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832-9. [PubMed: 479229].

70. Baker CL Jr, Murphy KP, Gottlob CA, Curd DT. Arthroscopic classification and treatment of lateral epicondylitis: Two-year clinical results. J Shoulder Elbow Surg. 2000;9(6):475-82. doi: 10.1067/mse.2000.108533. [PubMed: 11155299].

71. Burn MB, Mitchell RJ, Liberman SR, Lintner DM, Harris JD, McCulloch PC. Open, arthroscopic, and percutaneous surgical treatment of lateral epicondylitis: A systematic review. Hand (N Y). 2018;13(3):264-74. doi: 10.1177/1558944717701244. [PubMed: 28720043]. [PubMed Central: PMC5987981].

72. Bateman M, Littlewood C, Rawson B, Tambe AA. Surgery for tennis elbow: A systematic review. Shoulder Elbow. 2019;11(1):35-44. doi: 10.1177/1758573217745041. [PubMed: 30719096]. [PubMed: PMC6348580].

73. Lee JH, Park I, Hyun HS, Shin SJ. A comparison of radiofrequency-based microtenotomy and arthroscopic release of the extensor carpi radialis brevis tendon in recalcitrant lateral epicondylitis: A prospective randomized controlled study. Arthroscopy. 2018;34(5):1439-46. doi: 10.1016/j.arthro.2017.11.029. [PubMed: 29366739].

74. Jacobson JA, Kim SM, Brigido MK. Ultrasound-guided percutaneous tenotomy. Semin Musculoskelet Radiol. 2016;20(5):414-21. doi: 10.1055/s-0036-1597545. [PubMed: 28002863].
75. Altahawi F, Li X, Demarest B, Forney MC. Percutaneous ultrasonic tenotomy with the TX-1 device versus surgical tenotomy for the treatment of common extensor tendinosis. Skeletal Radiol. 2021;50(1):115-24. doi: 10.1007/s00256-020-03540-7. [PubMed: 32647907].

76. Pomerantz ML. Complications of lateral epicondylar release. Orthop Clin North Am. 2016;47(2):445-69. doi: 10.1016/j.ocl.2015.10.002. [PubMed: 26772953].

77. Morrey BF. Reoperation for failed surgical treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg. 1992;1(1):47-55. doi: 10.1016/S1058-2746(09)80016-5. [PubMed: 22958970].

78. Jalovaara P, Lindholm RV. Decompression of the posterior interosseous nerve for tennis elbow. Arch Orthop Trauma

Surg.1989;108(4):243-5.doi:10.1007/BF00936209.

[PubMed: 2774878].
Files
IssueVol 7, No 1 (2021) QRcode
SectionReview Article
DOI https://doi.org/10.18502/jost.v7i1.5958
Keywords
Exercise Therapy; Lateral Epicondylitis; Tennis Elbow; Treatment

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Jafari Kafiabadi M, Sabaghzadeh A, Biglari F, Karami A, Sadighi M, Ebrahimpour A. Surgical and Non-Surgical Management Strategies for Lateral Epicondylitis. J Orthop Spine Trauma. 2021;7(1):1-7.