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Chronic lateral epicondylitis: challenges and solutions

Authors Lai WC, Erickson BJ, Mlynarek RA, Wang D

Received 14 August 2018

Accepted for publication 27 September 2018

Published 30 October 2018 Volume 2018:9 Pages 243—251

DOI https://doi.org/10.2147/OAJSM.S160974

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Andreas Imhoff


Wilson C Lai,1 Brandon J Erickson,2 Ryan A Mlynarek,3 Dean Wang4

1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Rothman Institute, New York, NY, USA; 3IHA Orthopaedic Specialists, Ann Arbor, MI, USA; 4Department of Orthopaedic Surgery, UC Irvine Health, Orange, CA, USA

Abstract: Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work.

Keywords: lateral epicondylitis, tennis elbow, shockwave, injection, biologics, platelet-rich plasma, stem cells, surgery

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