Volume 50, Issue 3, March 2021

March 2021 correspondence

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The opinions expressed by correspondents in this column are not endorsed by the editors or The Royal Australian College of General Practitioners.

Additional notes on lateral epicondylitis

Congratulations to Nicholas Johns and Vivek Shridhar for the interesting review on current concepts related to lateral epicondylitis (AJGP November 2020).1 There are a few aspects worth mentioning.

First, the authors wrote, ‘There is no sex bias in this condition’, but a recent meta-analysis by Sayampanathan and colleagues found that apparently more females than males are affected by lateral epicondylitis. The incidence of lateral epicondylitis also appears to be associated with a current or former smoking history (odds ratio: 1.49; 95% confidence interval: 1.18, 1.87, P <0.001).2

Second, regarding the clinical examination, we would like to refer to the widely used Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE) and grip strength test. The 15-item self-reported PRTEE is an easy-to-use, reliable, reproducible and sensitive instrument to measure the patient’s perceived pain and functional disability in lateral epicondylitis. As a result of its strong clinical measurement properties, the PRTEE has been adapted cross-culturally into many languages including Chinese, Dutch, German, French, Greek, Italian, Korean, Persian, Swedish and Turkish.3 The assessment of reduced extension grip strength using a hand-held dynamometer (5-8-10% grip strength decreases from a position of elbow flexion to a position of full extension) seems to be superior to the Maudsley’s and Cozen’s provocation tests mentioned by the authors. In terms of diagnostic accuracy, the sensitivity of the grip strength test ranges from 78% to 85%, while the specificity is between 80% and 90%.4

Third, therapeutic taping is used by many Australian healthcare practitioners in their management of lateral epicondylitis.5 AJGP readers should know: there is moderate evidence that diamond deloading rigid tape and kinesio tape are effective for reducing pain (at rest and during movement) as well as improving grip strength and functional performance in patients with lateral epicondylitis.6–8

Fourth, the authors are absolutely right that stretching and eccentric strengthening exercises of the forearm extensor muscles with adequate intensity and duration significantly speed up the healing process and are a key component of successful management of lateral epicondylitis. A current meta-analysis with the participation of the University of Sydney showed that exercise interventions alleviate symptoms in lateral epicondylitis probably slightly better than passive therapies such as corticosteroid injections.9

Fifth, since the focus of the article was cited as the review of recent articles related to lateral epicondylitis, we were surprised that 22 of the 25 references used are five years old or older.1 Numerous systematic reviews on the subject have been published in recent years. Overall, we think that the good clinical lateral epicondylitis article by Johns and Shridhar can be strengthened by additional discussion.

Martin Hofmeister PhD,
Nutrition Scientist,
Department Food and Nutrition,
Consumer Centre of the German Federal State of Bavaria,
Munich, Germany

Javad Mehrabani PhD,
Assistant Professor,
Exercise Physiology, Department of Exercise Physiology,
Faculty of Physical Education and Sport Sciences,
University of Guilan,
Rasht, Guilan Province, Iran

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  1. Johns N, Shridhar V. Lateral epicondylitis: Current concepts. Aust J Gen Pract 2020;49(11):707–09. doi: 10.31128/AJGP-07-20-5519. Search PubMed
  2. Sayampanathan AA, Basha M, Mitra AK. Risk factors of lateral epicondylitis: A meta-analysis. Surgeon 2020;18(2):122–28. doi: 10.1016/j.surge.2019.08.003. Search PubMed
  3. Macdermid JC, Silbernagel KG. Outcome evaluation in tendinopathy: Foundations of assessment and a summary of selected measures. J Orthop Sports Phys Ther 2015;45(11):950–64. doi: 10.2519/jospt.2015.6054. Search PubMed
  4. Dorf ER, Chhabra AB, Golish SR, McGinty JL, Pannunzio ME. Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am 2007;32(6):882–86. doi: 10.1016/j.jhsa.2007.04.010. Search PubMed
  5. Hill CE, Stanton R, Heales LJ, Kean CO. Therapeutic tape use for lateral elbow tendinopathy: A survey of Australian healthcare practitioners. Musculoskelet Sci Pract 2020;48:102160. doi: 10.1016/j.msksp.2020.102160. Search PubMed
  6. George CE, Heales LJ, Stanton R, Wintour SA, Kean CO. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport 2019;40:117–27. doi: 10.1016/j.ptsp.2019.08.011. Search PubMed
  7. Zhong Y, Zheng C, Zheng J, Xu S. Kinesio tape reduces pain in patients with lateral epicondylitis: A meta-analysis of randomized controlled trials. Int J Surg 2020;76:190–99. doi: 10.1016/j.ijsu.2020.02.044. Search PubMed
  8. Cupler ZA, Alrwaily M, Polakowski E, Mathers KS, Schneider MJ. Taping for conditions of the musculoskeletal system: An evidence map review. Chiropr Man Therap 2020;28(1):52. doi: 10.1186/s12998-020-00337-2. Search PubMed
  9. Karanasios S, Korakakis V, Whiteley R, Vasilogeorgis I, Woodbridge S, Gioftsos G. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: A systematic review and meta-analysis of 2123 subjects in 30 trials. Br J Sports Med 2020:bjsports-2020-102525. doi: 10.1136/bjsports-2020-102525. [ePub ahead of print] Search PubMed

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