Epicondylitis

The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis.

Essential Literature

MANIPULATION THERAPY RELIEVED PAIN MORE RAPIDLY THAN ACUPUNCTURE AMONG LATERAL EPICONDYLALGIA (TENNIS ELBOW) PATIENTS
Hsu et. al 2016
Conclusion:
The novel manipulation technique improved pain in patients with lateral epicondylalgia (tennis elbow) during the first few treatments till 8-week follow-up.

THE EFFECTIVENESS OF EXERCISE FOR THE MANAGEMENT OF MUSCULOSKELETAL DISORDERS AND INJURIES OF THE ELBOW, FOREARM, WRIST, AND HAND: A SYSTEMATIC REVIEW
Menta R et. al 2015
Conclusion:
The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.

EFFECTIVENESS OF THE ECCENTRIC EXERCISE THERAPY IN PHYSICALLY ACTIVE ADULTS WITH SYMPTOMATIC SHOULDER IMPINGEMENT OR LATERAL EPICONDYLAR TENDINOPATHY: A SYSTEMATIC REVIEW
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Conclusion:
Eccentric exercise may reduce pain and improve strength in upper limb tendinopathies, but whether its effectiveness is much better than other forms of treatment remains questionable. Further investigations are needed, not only focused on shoulder impingement or epicondylar tendinopathy, but on tendinopathies in other areas of the upper limb.

NEW DEVELOPMENTS IN THE USE OF BIOLOGICS AND OTHER MODALITIES IN THE MANAGEMENT OF LATERAL EPICONDYLITIS
Kahlenberg CA 2015
Conclusion:
Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis. Researchers have recently begun to investigate the use of biologics as potential treatment options for lateral epicondylitis. Autologous blood preparations including platelet rich plasma (PRP) and autologous whole blood injections (ABIs) have been proposed in order to deliver growth factors and other nutrients to the diseased tendon. Stem cell therapies have also been suggested as a method of improving tendon healing. This review discusses the current evidence for the use of PRP, ABI, and stem cell therapies for treatment of lateral epicondylitis. We also review the evidence for nonbiologic treatments including corticosteroids, prolotherapy, botulinum toxin A, and nitric oxide.

ELBOW TENDINOPATHY
Pitzer ME et. al 2014
Conclusion:
Overuse injuries of the lateral and medial elbow are common in sport, recreational activities, and occupational endeavors. They are commonly diagnosed as lateral and medial epicondylitis; however, the pathophysiology of these disorders demonstrates a lack of inflammation. Instead, angiofibroblastic degeneration is present, referred to as tendinosis. As such, a more appropriate terminology for these conditions is epicondylosis. This is a clinical diagnosis, and further investigations are only performed to rule out other clinical entities after conventional therapy has failed. Yet, most patients respond to conservative measures with physical therapy and counterforce bracing. Corticosteroid injections are effective for short-term pain control but have not demonstrated long-term benefit.

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NON-SURGICAL TREATMENT OF LATERAL EPICONDYLITIS: A SYSTEMATIC REVIEW
Sims SE et. al 2014
Conclusion:
There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment.