Issue: February 2019
January 15, 2019
1 min read
Save

Combination of nonoperative methods may treat tennis elbow

Issue: February 2019
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Joaquin Sanchez-Sotelo

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.