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Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A
Sarah Dion1, Jessica J Wong, Pierre Côté
1*Department of Graduate Studies ‡Graduate Education and Research Programs §Undergraduate Education #Graduate Education Program ¶¶Division of Clinical Education, Canadian Memorial Chiropractic College †UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College ††Institute for Health Policy, Management and Evaluation, University of Toronto ‡‡Institute for Work and Health, Toronto ∥Canada Research Chair in Disability Prevention and Rehabilitation ¶Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON ∥∥Department of Public Health Sciences and Alberta Centre for Injury Prevention and Research, School of Public Health, University of Alberta, Edmonton, AB §§Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, Montreal, QC, Canada **Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY.
Objective:
To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow.
Methods:
We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis.
Results:
We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis.
Discussion:
Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.