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Combination of nonoperative methods may treat tennis elbow
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WAIKOLOA, Hawaii — When treating tennis elbow nonoperatively, surgeons should use a combination of NSAIDs, activity modification, splints and eccentric training, according to a presenter here at Orthopedics Today Hawaii.
Prior to beginning nonoperative treatment, surgeons should confirm that tennis elbow is the cause of a patient’s lateral-sided elbow pain, Joaquin Sanchez-Sotelo, MD, PhD, said here.
“Not every patient with lateral-sided elbow pain has tennis elbow,” Sanchez-Sotelo said. “Of course, [extensor carpi radialis brevis] ECRB tendinopathy is the most common reason, but patients can have instability; they can have entrapment of the [posterior interosseous nerve] PIN; a plica; arthrosis of the radiocapitellar joint or [osteochondritis dissecans] OCD.”
Once tennis elbow has been diagnosed, Sanchez-Sotelo noted nonoperative treatment can include a combination of splints and physical therapy. Surgeons should avoid using a counter pressure brace because it is placed on the posterior interosseous nerve which may cause more pain, according to Sanchez-Sotelo.
“We prefer to use a wrist splint because what you want to do is ... get the idea that [the patient has] to limit the use of wrist extensors,” he said.
Other treatments, such as NSAIDs and modified activities, can be included in nonoperative treatment, but Sanchez-Sotelo said eccentric training works best.
Nonoperative treatments should be continued for 6 months, he noted, with previously published research showing pain at 6 months in about 18% of patients.
“You can tell your patients that there is a high chance, 80% chance, that if you do eccentric training and use the splint, by 6 months you will be fine, but there is a 20% chance that by then you will still have pain,” Sanchez-Sotelo said. “The patients [who have] pain by 6 months, they typically need up to 2 years of care and [that] about 15% end up needing surgery.” – by Casey Tingle
Reference:
Sanchez-Sotelo J. Nonsurgical management of tennis elbow. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosures: Sanchez-Sotelo reports he receives royalties from Stryker, is a consultant for Exactech and Wright Medical, and is a paid speaker for Acumed.