Management of lateral epicondylitis (tennis elbow)
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-072574 (Published 18 May 2023) Cite this as: BMJ 2023;381:e072574
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Dear Editor,
When I was working as a GP, I got frequent requests to give steroid injections for lateral epicondylitis. I gave the advice on analgesia, rest, exercises, physio, orthotics, etc.
And, as advice changed I advised that long term results for treatment were better for those not given a steroid injection. Nonetheless many patients still wanted a steroid injection. For some people like plasterers it was their livelihood and they needed a quick fix. And in many cases it kept them working for a while and in some cases e.g. for sport there was a good long lasting effect.
My wife developed tennis elbow and after about 2 to 3 months I advised she should go for physio. After 2-3 weeks of treatment she got better.
Then I got it after litter picking for an hour. I should have changed the heavy bag but was being macho. After a month or two of it not easing and trying physio exercises from an NHS site I went to the same physiotherapist. I was given a stretchy band to do eccentric exercises. I was also advised to carry on as normal rather than resting it. After a few weeks of doing the physio it is over 95% better and I can do whatever I want. The article does not mention eccentric exercises which I think are an important point. Some of the exercises I was doing from the NHS site were unnecessary and the stretch band makes a big difference to it being effective. Just as eccentric exercises can treat Achilles Tendinopathy so they benefit lateral epicondylitis or tendinopathy as my physio pointed out. Dr Alfredson, a Swedish Doctor discovered eccentric exercises in the 1990s. He was told his Achilles Tendinopathy was not bad enough for an operation. So he tried to make his tendinopathy worse by overloading it and found to his surprise after a few weeks it was getting better so he could go back to jogging.
Yours faithfully,
Competing interests: No competing interests
Dear Editor,
I really appreciated this article, it illustrates the problem of lateral elbow tendinopathy ( LET) in a comprehensive and clear way.
I would like to observe that, with reference to the therapeutic means to be adopted for LET, the authors cite Laser therapy in a marginal way and of uncertain clinical efficacy, bringing as a bibliographic source a review of 2008: LASER equipment in the meantime has had further technological advances and the clinical experiences of the operators who use them have also expanded. This review examines low level laser therapy (LLLT), which has a very low power laser beam delivery (typically up to about 0.5 Watts).
Also for my part I can report that I have had good results with an infrared diode LASER, of 0.5 Watts of power, which I used from the 1990s onwards, until ten years ago.
Today I use a class IV diode infrared laser (wavelength 905 nm) that can work at variable powers, reaching power emissions up to 10 Watts, with many variable parameters (including the width of the surface of the light beam emitted).
The advantages are considerable, both in terms of a faster execution of the treatment and effectiveness of the results, with beneficial effects evident already in the first sessions
Certainly it is necessary to consider the response of the individual patient, which also depends on the chronicity of epicondylitis and compliance with a caution of the motor activity of the upper limb in the first days of therapy, remembering to always adopt eye protection measures and to exclude patients who have general conditions contraindicated for Laser therapy.
REFERENCES :
Bjordal JM, Lopes-Martins RA, Joensen J, et al. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord2008;9:75. doi:10.1186/1471-2474-9-75 pmid:18510742CrossRefPubMedGoogle Scholar
Roberts DB, Kruse RJ, Stoll SF. The effectiveness of therapeutic class IV (10 W) laser treatment for epicondylitis. Lasers Surg Med. 2013 Jul;45(5):311-7. doi: 10.1002/lsm.22140. Epub 2013 Jun 3. PMID: 23733499
Competing interests: No competing interests
Re: Management of lateral epicondylitis (tennis elbow)
Dear Editor
Why is this article showing a treatment algorithm with treatments that do not show any long term benefits such as PRP, Dry needling and Surgery. Surgery in particular has no evidence to support it?
Competing interests: No competing interests