[Nonsurgical treatment of tennis elbow].
OBJECTIVE
To review the literature on nonsurgical treatment of tennis elbow.


METHODS
We searched Medline for all randomized controlled trials (RCTs), controlled clinical trials (CCTs) and literature reviews published from 1966 to December 2003 on nonsurgical treatment of tennis elbow. We used the keys words controlled clinical trial, tennis elbow on lateral epicondylitis, and treatment. We found 46 reports of RCTs and CCTs on 14 nonsurgical treatments and 11 literature reviews.


RESULTS
Corticosteroid injection is the best treatment option for the short term. However, beneficial effects persisted only for a short time, and the long-term outcome could be poor. For the long term, physiotherapy (pulsed ultrasound, deep friction massage and exercise programme) was the best option but was not significantly different from the "wait-and-see" approach. Some support is offered for the use of topical nonsteroid anti-inflammatory drugs, at least for the short term. There is insufficient evidence to support or refute the use of acupuncture, extracorporeal shock wave therapy, manipulation, orthoses, low-energy laser, glycosaminoglycan polysulfate injection, botulinum toxin injection, or topical nitric oxide application.


CONCLUSIONS
Further trials, with use of appropriate methods and adequate sample sizes, are needed before conclusions can be drawn about the effects of many of the treatments for tennis elbow and their ability to change the condition's natural course.
Service de médecine physique et de réadaptation, hôpital Foch, 92150 Suresnes, France. b.boisaubert@hopital-foch.org
B
B
Boisaubert
C
C
Brousse
A
A
Zaoui
J P
JP
Montigny
D015670:Acupuncture Therapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004599:Electric Stimulation Therapy; D006801:Humans; D008405:Massage; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D013716:Tennis Elbow / Q000628:therapy*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal