This protocol is for patients with lateral epicondylitis whose initial conservative management did not achieve the expected clinical outcomes. A structured next-line approach exists for this situation.
The prior treatment consisted of activity modification with the RICE principle (rest, ice, compression, and elevation), eccentric exercise of the wrist extensors, topical or oral nonsteroidal anti-inflammatory medications applied to the lateral elbow, and counterforce bracing of the forearm.
This line is considered to have failed when the following targets were not reached:
The primary goal of this next-line protocol is short-term lateral elbow pain relief within 4 weeks.
The approach involves targeted interventions directed at the lateral epicondyle, including a procedural option and at least one specialised physical therapy modality.
DOI: 10.1155/2020/6965381
Hay and colleagues reported that corticosteroid injection was superior than NSAIDs in improving patients' outcomes within four weeks, without long-term benefits at 12 months.
Other studies also found that despite of its short-term pain relief, corticosteroid injection is inferior than watchful waiting or physical therapy at one year follow-up.
Extracorporeal shock-wave therapy (ESWT) is one of the commonly used physical therapy modalities for treating LE, in spite of conflicting results in the available literature.
ESWT is not appropriate for acute LE but is recommended when symptoms persist for more than 6 months or when other conservative treatments fail.
three systematic reviews suggest that acupuncture is very effective in relieving LE pain in the short term, with the long-term results remaining unclear.
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