Background: Lateral epicondylitis affects 1% to 3% of the population annually, with a peak incidence in individuals aged 35 to 55 years. It affects both genders equally and is especially prevalent among individuals in occupations involving repetitive wrist and forearm motions, such as carpenters, painters, plumbers, and computer users. While lateral epicondylitis is self-limiting in many cases, it can significantly impair occupational productivity and quality of life if left untreated. [7] A structured rehabilitation program focusing on biomechanical correction, muscle reconditioning, and gradual return to activity has demonstrated superior outcomes compared to isolated interventions. Materials and Methods This is a Prospective observational study was conducted in the Department of Physiotherapy at Index Physiotherapy College and hospital. Data will be collected from patients attending the outpatient department (OPD) and those referred for physiotherapy with a confirmed clinical diagnosis of lateral epicondylitis. The study will be conducted over a period of 24 months, including recruitment, intervention, and follow-up. Grip strength was assessed using a Jamar hand dynamometer. Measurements were taken in a standardized seated position with the elbow at 90°, forearm in neutral, and wrist slightly extended. Three readings were recorded for each hand, and the average was documented. Results The study included a total of 260 patients diagnosed with lateral epicondylitis. The mean age of participants was 42.3 years, with a fairly balanced gender distribution (53.8% male, 46.2% female). Grip strength increased from 18.3 kg at baseline to 24.8 kg post-intervention, a statistically and clinically meaningful improvement. The majority of patients (nearly 90%) did not experience any adverse effects during the intervention period. The most common complaint was temporary muscle soreness (6.9%), likely attributable to eccentric exercises or manual therapy. A small proportion (3.5%) reported mild skin irritation due to prolonged use of counterforce bracing, which resolved with adjustment or brief discontinuation. Conclusion: Conservative management remains a cornerstone in the treatment of lateral epicondylitis. Its demonstrated efficacy, minimal risk profile, and strong pathophysiological rationale validate its use in primary and tertiary care alike.
Lateral epicondylitis affects 1% to 3% of the population annually, with a peak incidence in individuals aged 35 to 55 years. It affects both genders equally and is especially prevalent among individuals in occupations involving repetitive wrist and forearm motions, such as carpenters, painters, plumbers, and computer users. [1] Recreational and professional athletes, particularly those in racquet sports, are also at increased risk. [2]
Although not routinely necessary, imaging may aid in cases that are chronic, unresponsive to therapy, or suspected to involve differential diagnoses (e.g., radial tunnel syndrome, osteochondritis dissecans). [3] Ultrasound may reveal hypoechoic areas, tendon thickening, or neovascularity. MRI provides detailed evaluation of soft tissue integrity and is considered the most sensitive modality. [4]
Given the frequency of this condition and its impact on functional capacity, particularly in the working-age population, this study aims to evaluate the clinical presentation and effectiveness of conservative treatment strategies employed in a tertiary care setting. [5] It will provide an evidence-based perspective on commonly used therapeutic approaches, assess their impact on pain and functional outcomes, and offer recommendations for clinical practice. [6]
While lateral epicondylitis is self-limiting in many cases, it can significantly impair occupational productivity and quality of life if left untreated. [7] A structured rehabilitation program focusing on biomechanical correction, muscle reconditioning, and gradual return to activity has demonstrated superior outcomes compared to isolated interventions. [8]
There is a growing interest in biologic therapies, regenerative medicine, and preventive strategies to address lateral epicondylitis. Further high-quality randomized controlled trials are needed to establish optimal treatment protocols, determine long-term efficacy of novel modalities, and provide personalized therapeutic approaches based on patient-specific factors.
This is a Prospective observational study was conducted in the Department of Physiotherapy at Index Physiotherapy College and hospital. Data will be collected from patients attending the outpatient department (OPD) and those referred for physiotherapy with a confirmed clinical diagnosis of lateral epicondylitis.
The study will be conducted over a period of 24 months, including recruitment, intervention, and follow-up.
Inclusion Criteria
Exclusion Criteria
Methodology
Upon enrollment, all participants underwent a detailed baseline evaluation comprising the following components:
Grip Strength
Grip strength was assessed using a Jamar hand dynamometer. Measurements were taken in a standardized seated position with the elbow at 90°, forearm in neutral, and wrist slightly extended. Three readings were recorded for each hand, and the average was documented.
Graph 1: Baseline Demographic Characteristics of Participants
The study included a total of 260 patients diagnosed with lateral epicondylitis. The mean age of participants was 42.3 years, with a fairly balanced gender distribution (53.8% male, 46.2% female). The majority of patients (65.4%) had involvement of their dominant hand, and the average symptom duration was 6.2 weeks. Clinical tests revealed a high positivity rate for Cozen’s (92.3%), Mill’s (86.5%), and Maudsley’s (80.8%) tests, confirming the clinical diagnosis. Baseline pain (VAS: 6.8 ± 1.1) and functional disability (PRTEE: 62.4 ± 8.7) were considerably high, while grip strength was reduced (18.3 ± 4.5 kg).
Graph 2: Baseline Clinical Assessment
A significant and consistent reduction in pain levels was observed over the 6-week conservative treatment period. The VAS score decreased from 6.8 at baseline to 0.8 at week 6, indicating excellent pain relief with the physiotherapy protocol. Weekly improvements were steady, particularly in the first 3 weeks.
Graph 3: Weekly PRTEE Score Reduction
Grip strength increased from 18.3 kg at baseline to 24.8 kg post-intervention, a statistically and clinically meaningful improvement.
Graph 4: Subgroup Analysis by Symptom Duration of PRTEE
Graph 5: Adverse Events Reported
The mean PRTEE score of 62.4 ± 8.7 indicates considerable disability in both pain-related and functional domains. As PRTEE is a condition-specific tool, it offers granular insight into the day-to-day limitations caused by lateral elbow pain, including difficulties with lifting, gripping, and wrist motions. These scores mirror data from Vicenzino et al., who reported PRTEE scores averaging between 60–65 in physiotherapy cohorts, confirming its sensitivity to clinical severity. [10]
Adverse events were minimal, with 89.6% of patients experiencing no complications. The most common issues—temporary soreness and minor skin irritation—were self-limiting. This supports the safety of the protocol and mirrors findings from trials that reported low dropout rates and high adherence with similar interventions.
Temporary soreness (6.9%) likely reflects adaptive tissue stress during early phases of eccentric exercise. Skin irritation from counterforce bracing (3.5%) may result from prolonged contact pressure, sweating, or improper fit. No severe or treatment-limiting adverse events were reported, reinforcing the protocol's favorable risk-benefit profile. [11]
Stasinopoulos and Johnson (2005) reported mild soreness in 7–10% of patients undergoing eccentric or stretching exercises, closely mirroring our rate. [12] Coombes et al. (2010) identified transient exercise-related discomfort in ~8% of participants, especially in the first two weeks of rehabilitation. [13] Bisset et al. (2006) emphasized that conservative management had significantly fewer adverse events compared to corticosteroid injections, which often cause rebound pain and skin atrophy. [14] Our study reaffirms these findings, showing that conservative interventions like physiotherapy and bracing have an excellent safety profile with minimal risk of serious side effects. [15]
The conservative therapy protocol used in this study was highly safe and well-tolerated, with only minor, transient adverse effects observed in a small proportion of participants. These findings support the continued use of this approach as a first-line, low-risk treatment option for lateral epicondylitis. Patient education on proper brace usage and expectation of mild soreness can further enhance safety and compliance.
Conservative management remains a cornerstone in the treatment of lateral epicondylitis. Its demonstrated efficacy, minimal risk profile, and strong pathophysiological rationale validate its use in primary and tertiary care alike. Future research should explore the long-term sustainability of these outcomes and evaluate the benefits of integrating newer adjunctive therapies like platelet-rich plasma, shockwave therapy, and biologics for refractory cases.
Download PDF
Download PDF
Download PDF
Download PDF
+91 9063922599
+91 9063922599
editor@healthcare-bulletin.co.uk
Download XML
