Management of Lateral Epicondylitis (Part 5)
We continue this week, with the discussion of the various treatments for Lateral Epicondylitis (LE).
Counterforce bracing is one of the popular treatments for LE for quite some time now. Counterforce braces may dramatically bring down the pain by pressing on the forearm extensor muscles and then inhibiting and dispersing the stress on the origin of affected extensor carpiradialis brevis (ECRB), and facilitating self-repair of the particular portion of the affected arm
In some studies, pieces of evidence have shown that immobilizing the forearm with braces can dramatically lessen the stress on the ECRB origin.
The latest randomized controlled double-blind trial shows that the use of counterforce brace can dramatically bring down the frequency and severity of pain for 2–12 weeks and lead to the improvement of the elbow function at 26 weeks, compared with the placebo group.
In addition to counterforce braces, cock-up wrist braces used during daily activities may limit wrist extension and impact of the ECRB tendon, allowing the healing of the injured tendon.
Extracorporeal shock-wave therapy (ESWT) is one of the commonly utilized treatment modalities for LE, in spite of contradicting results.
ESWT’s mechanism has not been completely clarified, which may include direct stimulation of healing, neovascularization, direct suppressive effects on nociceptors, and a hyperstimulation mechanism blocking the gate control.
ESWT is not the solution when seeking to reverse LE but surely this treatment modality can help improve the symptoms of LE.
Experts do not recommend ESWT to treat acute LE. However, this therapy may help if the symptoms of LE has been persistent for more than six (6) months, if all other conservative treatment modalities have already failed.
Another treatment modality that is great for LE is acupuncture. Acupuncture is a simple, inexpensive, and beneficial treatment for musculoskeletal diseases, especially to address pain.
Yet, present data show conflicting results. Two systematic reviews have not concluded whether or not acupuncture was effective for LE.
In contrast, there are three systematic reviews which suggest that acupuncture is quite effective in relieving pain due to LE.
The long-term results of using acupuncture for LE remain unclear.
There are other treatments that are being used for LE. We will continue with the other treatment modalities in next week’s column.