The management of tennis elbow
1 / 9

The management of tennis elbow - PowerPoint PPT Presentation

  • Uploaded on

The management of tennis elbow. BMJ Clinical Review John Orchard, Alex Kountouris. What and who?. Systematic review 2 Australians – Professor in School of Public Health at University of Sydney and the Australian cricket team physio. Cause, presentation.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' The management of tennis elbow' - eytan

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
The management of tennis elbow

The management of tennis elbow

BMJ Clinical Review

John Orchard, Alex Kountouris

What and who
What and who?

  • Systematic review

  • 2 Australians – Professor in School of Public Health at University of Sydney and the Australian cricket team physio

Cause presentation
Cause, presentation

Tendinopathy - not thought to be an inflammatory condition now, so “lateral epicondylitis” no longer favoured.

The clinical features are

  • tenderness at the lateral epicondyle,

  • normal elbow range of motion, and

  • pain on resisted movements (particularly resisted third finger extension).

    If the elbow’s range of motion is restricted, other diagnoses should be considered…


  • Eccentric exercises


  • Steroid/local anaesthetic

  • GTN patch

  • Other injections

  • Surgery

  • Extracorporeal shockwave therapy

  • Wait and see

Treatment eccentric exercises
Treatment - Eccentric exercises

  • Needs to be accompanied by easing off overload - well studied, works well

  • What the physio’s are likely to recommend if you refer patients there

More treatments
More treatments

NSAIDs – topical or oral

  • no clear evidence, but anecdotally useful

    Injections (steroid +/- LA)

  • fine in short term, but harmful in longer term (recurrence more likely), so should generally be avoided

Even more treatments
Even more treatments

GTN patch

  • applied over the painful area act as a local and systemic vasodilator and improved outcomes in the first six months compared with placebo.

  • Longer term results have not shown benefit over placebo, although unlike cortisone injections no long term harm was seen

    Other injections

  • Autologous platelet-rich plasma injections – uncertain results, expensive

  • Hyaluronan gel injections – promising results from one study vs placebo

  • Botulinum toxin A injections (into extensor digitorum longus muscles of 3rd/4th fingers) – paralyses finger extensors for months, so inconvenient

And more
and more…


  • very little evidence to support its use

    Extracorporeal shockwave therapy

  • only potentially useful if there’s calcification in the common extensor tendon

    …and finally…

    Wait and see

Key messages
Key messages

  • Tennis elbow is a tendinopathy of the common extensor origin of the lateral elbow

  • Cortisone injections are harmful in the longer term and are no longer recommended in most cases

  • Rehabilitation (exercise) based treatment is helpful, but to be effective patients must usually remove tendon overload

  • Further research is needed on newer (minimally invasive) treatments, such as platelet-rich plasma injections, hyaluronan gel injections, and nitrate patches

  • Reserve surgery and botulinum toxin injections for the worst cases because patients can take six months to return to full function

  • Many cases of tennis elbow cases will naturally resolve in 6-12 months