Epicondylitis

Lateral epicondylitis, more commonly known as tennis elbow, has an annual incidence of 1 to 3 percent in the general population. This condition presents with pain over the lateral epicondyle of the humerus that is made worse with resisted dorsiflexion of the wrist. Currently, multiple treatment strategies are available for this condition. Two commonly used approaches include physical therapy and use of a forearm brace that straps across the muscle belly of the wrist extensors. Despite common use of these modalities, information as to the effectiveness of these treatments is limited. Struijs and colleagues examined the effectiveness of brace-only treatment, physical therapy, and a combination of these two treatments in patients with tennis elbow.

The trial was a randomized study of patients who had a diagnosis of tennis elbow for at least six weeks. Patients were included if they had pain over the lateral epicondyle that was exacerbated by pressure over the area and by resisted dorsiflexion of the wrist. Patients were assessed before the study for personal characteristics, comorbidities, and baseline values of the outcome measures. They were then assigned randomly to receive the forearm brace alone, physical therapy alone, or both.

Those who received the forearm brace were provided with instructions for its use. Those who received physical therapy attended nine sessions over a six-week period. Modalities provided during physical therapy followed a standardized protocol. A blinded assessor evaluated the patients six weeks and one year after randomization. A questionnaire was mailed to participants at week 26 of the study. The main assessment included a global measure of improvement, severity of patients' complaints, score of pain intensity, and scores on a modified Pain Free Function Questionnaire.

The study included 180 patients. The three groups did not differ with regard to baseline characteristics. Physical therapy alone provided better results when compared with the use of the brace alone at six weeks and for pain, disability, and satisfaction. The brace-only group had better results than physical therapy in their ability to perform activities of daily living. The combination group had superior results when compared with the brace-only group in severity of complaints, disability, and satisfaction. However, at 26 and 51 weeks, no significant differences were noted among the three groups with regard to the main outcome measures.

The authors conclude that the brace-only treatment for patients with tennis elbow seems to be useful initially in terms of daily activities, even though the physical therapy group in their study did better with pain, disability, and satisfaction results over the short term. Combination therapy provides better short-term results but no long-term benefits compared with brace-only treatment. They add that the best course may be to start with a brace as supportive therapy after the initial presentation and to reserve physical therapy for use in patients who fail to respond to the brace.

KARL E. MILLER, M.D.

Struijs PA, et al. Conservative treatment of lateral epicondylitis. Brace versus physical therapy or a combination of both--a randomized clinical trial. Am J Sports Med March 2004;32:462-9.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group