Nonoperative Management of Lateral Epicondyle Tendinopathy: An Umbrella Review

William R. Kinney DC , Brian R. Anderson DC, MPH, MS, PhD
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Abstract

Objective

The primary objective of this review was to summarize systematic reviews and meta-analyses reporting on nonoperative management of lateral epicondyle tendinopathy.

Methods

An umbrella review of all published systematic reviews and meta-analyses was performed. Three databases were searched using the key words “tennis elbow,” “lateral epicondylitis,” “non-operative,” and “non-surgical modalities.” The search was limited to English-language systematic reviews and meta-analyses between the years of 2000 and 2022.

Results

There were 114 systematic reviews/meta-analyses, of which 35 met our inclusion criteria. These articles reviewed the following nonoperative management strategies: ultrasound, shockwave therapy, injection procedures, low-level laser therapy, joint mobilizations, exercise therapy, and electrophysical modalities. Exercise therapy was beneficial in decreasing pain regardless of dosage or type. Conflicting results were seen with ultrasound, laser, and shockwave therapy. Corticosteroid injections provided the most short-term pain relief, and platelet-rich plasma and autologous blood injections were most effective in the long term.

Conclusion

A variety of nonoperative interventions were found to be effective for short- and long-term pain relief as well as functional improvement, with most interventions indicating mixed results. Due to variations in study populations and study quality, results should be interpreted with caution.

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外上髁肌腱病变的非手术治疗:综述
目的本综述的主要目的是总结非手术治疗外侧上髁肌腱病变的系统综述和荟萃分析报告。方法对所有已发表的系统综述和荟萃分析进行综合综述。使用关键词“网球肘”、“外侧上髁炎”、“非手术”和“非手术方式”搜索三个数据库。该研究仅限于2000年至2022年间的英语系统综述和元分析。结果114篇系统评价/荟萃分析,其中35篇符合纳入标准。这些文章回顾了以下非手术治疗策略:超声、冲击波治疗、注射程序、低水平激光治疗、关节活动、运动治疗和电物理模式。无论何种剂量或类型,运动疗法都有利于减轻疼痛。超声、激光和冲击波治疗的结果相互矛盾。皮质类固醇注射提供了最短期的疼痛缓解,而富血小板血浆和自体血液注射是最有效的长期。结论多种非手术干预对短期和长期疼痛的缓解以及功能的改善都是有效的,但大多数干预的结果好坏参半。由于研究人群和研究质量的差异,结果应谨慎解释。
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