Lateral Elbow Tendinopathy: Development of a Pathophysiology-Based Treatment Algorithm.
Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. The termtendinopathyis used to describe chronic overuse tendon disorders encompassing a group of pathologies, a spectrum of disease. This review details the pathophysiology of tendinopathy and tendon healing as an introduction for a system grading the severity of tendinopathy, with each of the 4 grades displaying distinct histopathological features. Currently, there are a large number of nonoperative treatments available for lateral elbow tendinopathy, with little guidance as to when and how to use them. In fact, an appraisal of the clinical trials, systematic reviews, and meta-analyses studying these treatment modalities reveals that no single treatment reliably achieves outstanding results. This may be due in part to the majority of clinical studies to date including all patients with chronic tendinopathy rather than attempting to categorize patients according to the severity of disease. We relate the pathophysiology of the different grades of tendinopathy to the basic science principles that underpin the mechanisms of action of the nonoperative treatments available to propose a treatment algorithm guiding the management of lateral elbow tendinopathy depending on severity. We believe that this system will be useful both in clinical practice and for the future investigation of the efficacy of treatments.
Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Gev
G
Bhabra
Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Department of Orthopaedic Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.
Allan
A
Wang
School of Sport Science, Exercise, and Health, University of Western Australia, Perth, Western Australia, Australia.
Jay R
JR
Ebert
School of Sport Science, Exercise, and Health, University of Western Australia, Perth, Western Australia, Australia.
Peter
P
Edwards
Pulse Podiatry, Wembley, Western Australia, Australia.
Monica
M
Zheng
Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Centre for Orthopaedic Translational Research, School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
Ming H
MH
Zheng
biomechanics; elbow; histopathology; lateral; tendinopathy; tendon healing; tendon injury; treatment