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Clinical Review Extracts from Concise Clinical Evidence

Tennis elbow

BMJ 2003; 327 doi: (Published 07 August 2003) Cite this as: BMJ 2003;327:329
  1. Willem Assendelft, head of department of guideline development and research policy (p.assendelft{at},
  2. Sally Green, senior lecturer2,
  3. Rachelle Buchbinder, senior lecturer2,
  4. Peter Struijs, resident in orthopaedic surgery3,
  5. Nynke Smidt, senior researcher4
  1. 1Dutch College of General Practitioners, Utrecht, Netherlands
  2. 2 Institute of Health Services Research, Monash University, Melbourne, Australia
  3. 3Academic Medical Center, Amsterdam, Netherlands
  4. 4Institute for Research in Extramural Medicine, Amsterdam
  1. Correspondence to: W Assendelft



    Tennis elbow has many analogous terms, including lateral elbow pain, lateral epicondylitis, rowing elbow, tendonitis of the common extensor origin, and peritendonitis of the elbow. Tennis elbow is characterised by pain and tenderness over the lateral epicondyle of the humerus and pain on resisted dorsiflexion of the wrist, middle finger, or both. For the purposes of this review, tennis elbow was restricted to lateral elbow pain or lateral epicondylitis.

    What are the effects of treatments for tennis elbow (lateral epicondylitis)?


    Topical non-steroidal anti-inflammatory drugs for short term pain relief

    One systematic review has found that topical non-steroidal anti-inflammatory drugs versus placebo significantly improve pain in the short term. Minor adverse effects have been reported. We found no randomised controlled trials (RCTs) comparing oral versus topical non-steroidal anti-inflammatory drugs.

    Likely to be beneficial

    Oral non-steroidal anti-inflammatory drugs

    One systematic review found limited evidence of a short term improvement in pain and function with an oral non-steroidal inflammatory drug versus placebo. The review found some evidence that fewer people receiving an oral non-steroidal anti-inflammatory drug rather than a corticosteroid injection had self perceived improvement at four weeks, but an oral nonsteroidal anti-inflammatory drug significantly reduced pain at 26 weeks.

    Trade off between benefits and harms

    Corticosteroid injections

    We found one systematic review and two subsequent RCTs of corticosteroid injections, which found limited evidence of a short term improvement in symptoms with steroid injections versus placebo, a local anaesthetic, elbow strapping, or physiotherapy. It found no good evidence on long term effects of corticosteroids versus placebo or local anaesthetic. It found no evidence of a difference with corticosteroid injection versus mobilisation plus massage or elbow strapping in overall improvement at one year. However, one RCT identified by the review found significantly greater improvement in symptoms with physiotherapy versus an injection at 26 and 52 weeks. The review found limited evidence of greater self perceived improvement at four weeks with a corticosteroid injection versus an oral non-steroidal anti-inflammatory drug and found greater improvement in pain at 26 weeks with an oral non-steroidal anti-inflammatory drug.

    Unknown effectiveness


    One systematic review and one subsequent RCT found insufficient evidence to assess the effects of acupuncture (either needle or laser).

    Exercise and mobilisation

    One systematic review found limited evidence of a better outcome with exercise versus ultrasound plus friction massage at eight weeks.

    Extracorporeal shock wave therapy

    One systematic review found conflicting evidence from two RCTs of the effects on symptoms of extracorporeal shock wave therapy versus sham treatment.

    Non-steroidal anti-inflammatory drugs for longer term pain relief

    We found insufficient evidence to assess the longer term effects of oral or topical non-steroidal anti-inflammatory drugs.


    One systematic review found insufficient evidence about the effects of orthoses (braces).


    One systematic review found no RCTs of surgical treatment for tennis elbow.

    Search date August 2002

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