Although there are important differential diagnoses to be made, lateral elbow tendinopathy is the most common cause of elbow symptoms in patients presenting with elbow pain. In this article, Samantha Nupen explores the literature to provide clinicians with an update on managing lateral elbow tendinopathy.
Athletics - Canada’s Greg Stewart during the Men’s Shot Put F46 Final REUTERS/Issei Kato
Lateral elbow tendinopathy affects 1 – 3% of the population. Tennis players make up only 10% of the tennis elbow patient population, but half of all tennis players experience elbow pain, with 75% presenting with lateral elbow tendinopathy. Tennis elbow is more common in those older than 40, indicating its degenerative nature. Smoking, obesity, and repetitive movement for at least two hours a day are all risk factors(1). Furthermore, poor backhand performance, low racket grip, tight racket strings, or the use of wet and heavy balls are associated with lateral elbow pain symptoms in racket sports athletes(2). Typists, artists, musicians, electricians, mechanics, and others doing repetitive forearm activities are all at risk(2).
The natural course of the condition is favorable, with spontaneous recovery within one to two years in 80-90% of the patients. So, this brings into question the role of physiotherapy(1). Recently, two studies have shown negligible benefits of physiotherapy in managing lateral elbow tendinopathy. One meta-analysis compared only studies that had used the Patient-Rated Tennis Elbow Evaluation (PRTEE) pain score as an outcome measure(3). The authors admit that this is a limitation of their research and may have biased the outcomes.
Moreover, researchers at the University of Chicago concluded that lateral epicondylitis resolves without treatment in six to twelve months. They noted that there were no long-term benefits of treatment and that glucocorticoids provide short-term pain relief but worse long-term outcomes(4). However, the study conclusion recommends physiotherapy as it reduces pain and improves function(5). This is confusing and should prompt a fresh look at how clinicians approach lateral elbow pain.
Clinicians use lateral epicondylitis, lateral elbow tendinopathy, lateral epicondylalgia, and tennis elbow to describe a condition that presents with the following symptoms:
Technically, because of the pathology present, the most accurate term is lateral elbow tendinopathy. Still, patients all understand tennis elbow, so this is the most commonly used term in clinical practice.
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