Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All.

Brooke K Coombes, Leanne Bisset, Bill Vicenzino

Synopsis Clear guidelines for the clinical management of individuals with lateral elbow tendinopathy (LET) are hampered by the proposal of many potential 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. In this paper, 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 and pharmacotherapies. 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 leads to improved outcomes and more efficient resource allocation. J Orthop Sports Phys Ther, Epub 17 Sep 2015. doi:10.2519/jospt.2015.5841.