Chronic lateral epicondylitis: challenges and solutions

Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chroni...

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Bibliographic Details
Published in:Open access journal of sports medicine 2018-01, Vol.9, p.243-251
Main Authors: Lai, Wilson C, Erickson, Brandon J, Mlynarek, Ryan A, Wang, Dean
Format: Article
Language:English
Subjects:
Anti-inflammatory agents
biologics
Bone surgery
Care and treatment
Comparative literature
Corticosteroid drugs
Elbow
injection
Lateral epicondylitis
Nonsteroidal anti-inflammatory drugs
Pain
Pathogenesis
Physical therapy
platelet-rich plasma
Review
shockwave
Stem cell transplantation
Stem cells
Steroids (Organic compounds)
Surgery
Tendons
Tennis
Tennis elbow
Workers compensation
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Summary:Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work.
ISSN:1179-1543
1179-1543
DOI:10.2147/OAJSM.S160974