Tennis elbow in primary care

Tennis elbow or lateral humeral epicondylitis is considered to be an overload injury, which occurs after minor and often unrecognised trauma (microtrauma) to the proximal insertion of the extensor muscles of the forearm. The pathological changes often occur in the tendon of the extensor carpi radialis brevis muscle. The annual incidence of tennis elbow in general practice is four to seven cases per 1000 patients, with a peak in patients 35-54 years of age. Lateral epicondylitis is a self limiting condition. The average duration of a typical episode is about six months to two years, but most patients (89%) recover within one year.1 Various conservative interventions exist for the treatment of this condition including pain relieving drugs, corticosteroid injections, physiotherapy, elbow supports, acupuncture, surgery, and shockwave therapy. However, available evidence for the effectiveness of these interventions is limited.2

In this week's BMJ a randomised controlled trial by Bisset and colleagues compares …