Background Lateral epicondylitis or tennis elbow is an extremely frequent disease, secondary to intratendinous degeneration of the common carpi extensor tendon. However, diagnosis and therapeutic management are still a challenge for the rheumatologist.
Objectives To determine the available evidence regarding the diagnostic, imaging and treatment of epicondylitis.
Methods A systematic review literature was performed.using PUBMED. Only controlled trials, systematic literature reviews and meta-analysis were selected (Jan 1990 to May 2016). The MESH search words were “ Tennis elbow ”,“ Lateral elbow tendinopathy ”, “ Diagnostic imaging” and“ Therapeutics ”.
Results 1314 potential articles were screened; 7 articles of clinical diagnosis, 21 of imaging and 18 of treatment were finally selected.
Diagnostic: No controlled trials were found about the diagnosis of the epicondylitis. The clinical tests employed in the retrieved clinical trials were based upon the experts' recommendation: lateral epicondyle palpation, resisted extension of the carpe and resisted extension of the 3rd and 4th fingers.
Imaging: Among the 21 articles identified, 1 article concerning plain Xray, 1 about scintigraphy, 10 of US and 10 of MRI were selected. One clinical trial, found plain Xrays were not helpful for the initial diagnosis. Ultrasound was found to be a sensitive (64–100%) and specific (36–100%) tool for the diagnosis, in one meta-analysis. Ten studies, within a systematic review, showed MRI was reported to be as sensitive (90–100%) as the ultrasound, with a greater specificity (83–100%). In addition, MRI showed better reliability (0.41–0.53 vs 0.73–1.00). Also, the two techniques showed a good correlation between the observed lesions and symptoms, severity and involvement of other structures. On the contrary, no data was found to support the use of imaging tests for follow-up.
Treatment: Among the 18 articles, 9 articles (within 4 systematic review and 5 randomized clinical trials) about pharmacological treatment, 10 about the non-pharmacologic approach and 1 about surgery were selected. Corticoids injections were found to be effective in one meta-analysis at short-term and preferably for acute epicondylitis (Pain reduction at 1–3 weeks =1.18 (95% CI 0.27–2.09), 4–8 =1.30 (95% CI 0.55–2.04), 12–24 =-0.38 (95% CI -0.85–0.08). Similar results were found for NSAIDs. Five prospective randomized clinical trials, showed braces and carpal extension splints were reported to improve pain at rest and during exercice, in short term. Physical therapy was reported to be efficacious in pain and function too, in a systematic review. Therapies like rich platelet plasma injections, autologous serum and botulinim toxin showed weak evidence.
Conclusions No high quality trials for epicondylitis management were found in this systematic review. The diagnostic was based upon clinical presentation and physical exam. Ultrasounds and MRI seem to play a role on imaging diagnosis but not in follow-up. Corticoids injections and NSAIDs are effective in short term. Other studies are needed to evaluate other therapeutic modalities.
Disclosure of Interest None declared
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