A Small Pain at Elbow, A Big Pain in The Neck for Modern Medicine: Tennis Elbow in 1980s - 2022
Lateral elbow pain (LEP), commonly known as tennis elbow, affects many working people. It is often caused by repetitive use of the arm
A Small Painful Spot, A Big Mystery
Compared to low back pain which can happen anywhere in the half of posterior body trunk, LEP is a rather simple disorder as it is localized only to a very small spot at the outside of elbow. But in reality, LEP has been a mystery baffling the entire modern medicine world.
The Modern Names for LEP Driving You Crazy
Simply a painful sensation on the outside of your elbow, the terminology used to refer to this health condition in literature to date has been extremely and awkwardly confusing. Practitioners and researchers adopted at least 13 names to define LEP (Luigi D Filippo et al, 2022):
In this post, I use the plainest name, “lateral elbow pain” (LEP), a name any lay person can easily understand, for this simple ailment.
Diagnostic Tricks Threw You for A Loss
Further interestingly, for merely a penny-sized pain spot in a golf ball-sized area on the elbow, a plethora of manipulative clinical techniques have been developed for identifying the possible causes
But to date no evidence-based consensus has been reached on whether some are better than others. As a practitioner treating a new LEP patient, confronted with a wide variety of testing tricks, what you can do is just “ randomly pick one at your own risk”.
None of Conventional Treatments Works
As early as in 1992, a literature review in Journal of Bone Joint Surgery concluded: No scientific evidence was available for the treatments of LEP (Labelle H et al, 1992).
In 2003, a literature review by researchers from Netherland, Finland and Australia (Smidt N et al, 2003) concluded: Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions (laser, exercises, mobilisation) for lateral epicondylitis (except a weak evidence for ultrasound).
In 2006, a literature review on the efficacy of laser therapy for LEP by Maher S concluded that no evidence of a beneficial effect was found, in either the short or long term (Maher S, 2006).
In 2015, Australian researchers (Coombes BK et al) commented: Lack of consensus
In 2019, Jayson Lian et al evaluated 11 conventional treatment modalities for LEP tested in a total of 36 randomized trials involving 2,746 patients. They reached a conclusion that at best, all treatments provided only insignificant pain relief while increasing the odds of adverse events.
In 2022, a systematic review and meta-analysis
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The review concluded: The available evidence does not support the use of nonoperative treatment options including physiotherapy (strengthening), CSI, PRP, or AB in the treatment of lateral epicondylitis.
The Only One That Worked Is Not Conventional
As early as in 1983, Sweden researcher Gunilla Brattberg reported their finding of the efficacy of acupuncture for LEP. In 34 patients included in the trial, 62 % (21 patients) who were treated with acupuncture became much better--completely free of pain. Many of them had previously been given one or more steroid injections without improvement. In control group (26 patients) who received only steroid injections, only 31% (8 patients) reported a corresponding improvement.
In 2012, Mohd Waseema et al from India in their literature review concluded:
Many treatments are recommended for lateral epicondylitis, such as laser therapy, ice massage, ice packs or ethyl chloride spray, hot packs, whirlpool, ultrasound, shortwave and microwave deathermy.
Unfortunately, no controlled, double blind, and randomized clinical studies
The only modality that shew marked improvement in tennis elbow patients was acupuncture.
References
Coombes B.K., Bisset L., Vicenzino B. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J. Orthop. Sports Phys. Ther. 2015;45:938–949
Jayson Lian et al, Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. The American Journal of Sports Medicine. Volume 47, Issue 12, 2019
Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis. J Bone Joint Surg Br. 1992;74:646-651
Luigi Di Filippo et al, Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews. Healthcare (Basel). 2022 Jun; 10(6): 1095.
Maher S. Is low-level laser therapy effective in the management of lateral epicondylitis? Physical Therapy 86: 1161-7, 2006.
Mohd Waseema et al, Lateral epicondylitis: A review of the literature, Journal of Back and Musculoskeletal Rehabilitation, 2012: 131–142
Peter Lapner et al, Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis, JSES International Vol 6, Iss 2, 2022, P 321-330
Smidt N, Assendelft WJ, Arola H, et al. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med. 2003; 35:51-62.
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