Demographics, treatments and outcome measures in the eleven included studies
| Study and year setting and sample size | Women (percentages) | Age (mean if not otherwise stated) | Duration of discomforts (weeks) | Treatment groups | Control group | Outcome measures (excerpts) | Follow-up (weeks) |
|---|---|---|---|---|---|---|---|
| Bisset et al 2006 Outpatient clinic n=198 | 35 | 47.6 (SD 7.8) | 22 (median) (IQR 12–42) | (1) 10 mg Triamcinolone and 1 mL lidocaine against the most painful point repeated after 2 weeks (2) Elbow manipulation (manipulation with movement) and exercise 8 sessions of 30 min duration during a 6 week period and home exercise | Information, wait-and-see | Improvement on 6-point Likert-scale PFGS assessed severity on VAS Pain on VAS Pain-free function questionnaire | 52 |
| Coombes et al 2013 Community setting n=165 | 38 | 49.7 (SD 8.1) | 16 (median) (IQR 10–26) | (1) One injection of 1 mL triamcinolone 10 mL/mL and 1 mL lignocaine 1% against site of greatest palpable tenderness at the common extensor origin (2) Elbow manipulation (manipulation with movement) and exercise 8 sessions of 30 min duration during a 8 week period and home exercise (3) One injection of triamcinolone followed by 8 sessions of elbow manipulation and exercise, home exercise for 8 weeks (not considered in this review) | Placebo injection 0.5 mL 0.9% isotonic saline | Improvement on 6-point Likert-scale 1 year recurrence Pain on VAS PRTEE questionnaire EuroQol-EQ-5D quality-of-life score | 52 |
| Hay et al 1999 General practice n=164 | Group 1:41 (Group 2:53) Control:48 | Age ≥45:(percentages) Group 1:70 (Group 2:68) Control:38 | 9 (mean) Percentage with pain >3 months: Group 1:36 (Group 2:25) Control:31 | (1) One injection of methylprednisolone 20 mg and 0.5 mL 1% lignocaine towards tender spot (2) Naproxen orally 500 mg twice daily for 2 weeks (not considered in this review) | Placebo tablets | Improvement on 5-point Likert-scale Pain on 10-point Likert-scale Function on 10-point Likert-scale Main discomfort on 10-point Likert-scale Disability questionnaire PFGS | 52 |
| Price et al 1991 Outpatient clinic n=88 | Group 1:48 Group 2:43 Control:38 | Group 1:47 Group 2:47 Control:46 (Median) | Group 1:20 (6–150) Group 2:36 (6–154) Control:16 (6–150) (Median and range) | (1) Hydrocortisone 25 mg and 1% lidocaine against tender point (2 mL fluid) (55% received 2 injections) (2) Triamcinolone 10 mg and 1% lidocaine (30% received two injections) | 2 mL 1% lidocaine against tender point | Pain on VAS Tenderness score Pain-weighted grip strength | 24 |
| Smidt et al 2002 General practice n=185 | Group 1:55 (Group 2:44) Control: 53 | Group 1: 47 (Group 2:48) Control: 46 (Median) | Group 1:11 (8–16) (Group 2:11 (8–21)) Control:11 (8–21) (Median and IQR) | (1) 10 mg triamcinolone and 1 mL lidocain against all tender points up to three injections (2) One group received physiotherapy with ultrasound (not considered in this review) | Wait-and-see (some were prescribed naproxen orally 1000 mg daily) | Improvement on 6-point Likert scale Severity of discomfort on scale Questionnaires PFGS Maximum grip strength (MGS) Pressure-pain measurements Satisfaction with treatment | 52 |
| Toker et al 2008 Outpatient clinic n=21 | 43 | 45 (range 19–72) | Not stated | One injection of 1 mL metylprednisolon and 1 mL prilocain with oral diklofenac three tablets (dose not stated) and etofenamate topically | Oral diklofenac three tablets (dose not stated) and etofenamate topically | Perceived absence of pain Absence of pain on palpation over lateral epicondyle and on isometric dorsiflection of wrist pain score | 4 |
| Lindenhovius et al 2008 Outpatient clinic n=64 | Treatment: 63 Control: 60 | Treatment: 50±8 Control: 51±10 | Treatment: 12±4 (2–20) Control: 8±4 (1–20) | 4 mg dexamethasone and 10 mg lidocaine (2 mL fluid) against the most tender spot, fanning of the needle. One injection—but 6 of 64 got 2 injections | 10 mg lidocain, 2 mL fluid total | DASH questionnaire* Pain on VAS Grip strength | 26 |
| Newcomer et al 2001 Outpatient clinic n=39 | 51 | Treatment: 46.0± 7.0 Control: 44.6±7.6 | Treatment: 3.2 (mean) SD 0.8 Control: 3.4 (mean) SD 0.9 | One injection of 5 mL 4:1 0.25% bupivacaine and 6 mg/mL β-methasone against tender point. Home exercises consisting of ice massage, wrist stretching and progressive eccentric and concentric exercises | Placeboinjection of 5 mL bupivacaine Home exercises consisting of ice massage, wrist stretching and progressive eccentric and concentric exercises | Pain on VAS Functional pain questionnaire (PFGS at 4 and 8 weeks) | 26 |
| M-Silvestrini et al 2005 Outpatient clinic n=94 | 47 | 45.5±7.7 | More than 12 | (1) Concentric strengthening 3×10 repetitions once daily and wrist stretching twice daily for 6 weeks (2) Eccentric strengthening 3×10 repetitions once daily and wrist stretching twice daily for 6 weeks | Wrist stretching twice daily for 6 weeks | PFGS Pain on VAS PRFEQ questionnaire Patient's log of training DASH questionnaire* | 6 |
| Peterson et al 2011 General practice n=81 | 42 | 48 | Treatment: 107 Control: 96 | Three-month daily exercise regime performed at home with progressively increasing load on the extensor muscles | Information, wait-and-see | Pain on VAS during contraction and during elongation of forearm muscles Muscle strength with hand-held dynamometer DASH questionnaire | 12 |
| Selvanetti et al 2003 Setting not stated n=62 | Treatment: 45 Control: 48 | Treatment: 41.3 Control: 40.5 | Treatment: 28 (8–40) Control: 29 (12–44) | 4 weeks home-exercise after instruction from physiotherapist consisting of stretching and eccentric exercise Counselling and use of elbow support | Sham ultrasound 20 sessions Counseling and use of elbow support | Ko scoring system (includes clench test, Thomsen test and pain) Verhaar scoring system on global improvement Subjective improvement VAS scale (0–100) | 44 (24–56) |
*DASH questionnaire is an upper extremity specific health status measure.
DASH,Disability of the Arm, Shoulder and Hand; PFGS, Pain-Free Grip Strength;PRFEQ, Patient-rated Forearm Evaluation Questionnaire; PRTEE questionnaire, Patient-Rated Tennis Elbow Score, VAS, Visual Analogue Scale.