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Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All
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This study reviews lateral elbow tendinopathy (LET) management, highlighting varied prognoses and pathophysiology. It proposes a prognostic factor-based algorithm for targeted physical rehabilitation to improve patient outcomes.
Area of Science:
- Orthopedics
- Sports Medicine
- Physical Therapy
Background:
- Clinical management of lateral elbow tendinopathy (LET) is challenging due to diverse interventions and unpredictable prognoses.
- A limited understanding of LET's complex pathophysiology hinders effective treatment strategies.
- Prognostic variability exists, with some patients experiencing rapid recovery while others face persistent issues.
Purpose of the Study:
- To consolidate evidence and expert opinion on LET pathophysiology, clinical presentation, and differential diagnosis.
- To identify prognostic factors influencing physical rehabilitation for LET.
- To propose clinical recommendations and a preliminary management algorithm for LET subgroups.
Main Methods:
- Collated evidence and expert opinion on LET.
- Examined factors like neck pain, tendon tears, and central sensitization for prognostic value.
- Developed clinical recommendations for exercise, physical therapy, and pharmacotherapy.
Main Results:
- Identified key factors influencing LET prognosis and rehabilitation direction.
- Provided evidence-based clinical recommendations for physical rehabilitation.
- Proposed a preliminary algorithm for subgroup-based LET management.
Conclusions:
- A better understanding of LET pathophysiology is crucial for improved clinical guidelines.
- Prognostic factors can guide targeted interventions and personalized physical rehabilitation strategies.
- Further research is needed to validate the proposed management algorithm and its impact on outcomes and resource allocation.
Abstract:
Synopsis Clear guidelines for the clinical management of individuals with lateral elbow tendinopathy (LET) are hampered by many proposed interventions and the condition's prognosis, ranging from immediate resolution of symptoms following simple advice in some patients to long-lasting problems, regardless of treatment, in others. This is compounded by our lack of understanding of the complexity of the underlying pathophysiology of LET. In this article, we collate evidence and expert opinion on the pathophysiology, clinical presentation, and differential diagnosis of LET. Factors that might provide prognostic value or direction for physical rehabilitation, such as the presence of neck pain, tendon tears, or central sensitization, are canvassed. Clinical recommendations for physical rehabilitation are provided, including the prescription of exercise and adjunctive physical therapy and pharmacotherapy. A preliminary algorithm, including targeted interventions, for the management of subgroups of patients with LET based on identified prognostic factors is proposed. Further research is needed to evaluate whether such an approach may lead to improved outcomes and more efficient resource allocation. J Orthop Sports Phys Ther 2015;45(11):938-949. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5841.
