PM&R News   •   July 12, 2017

Lateral epicondylitis (tennis elbow) is a common condition that affects many individuals across all activity levels.  Tennis elbow is typically caused by repetitive wrist extension and supination with an underlying malalignment of collagen fibers in the wrist extensor tendons.  Ninety percent of these cases tend to resolve without treatment within 12-18 months. Common treatments consist of rest, NSAIDs, physical therapy, bracing, corticosteroid injection or even surgery. 

Percutaneous needle tenotomy is becoming more popular and little evidence exists to determine its’ effectiveness.  This June 2017 systematic review in  our beloved “purple journal” (PM&R) included six studies demonstrating that percutaneous tenotomy was safe and effective, however, none of these studies were randomized or placebo controlled. Considering studies are of low quality (level II to IV), there is not enough evidence to determine that percutaneous tenotomy is more effective than other treatments or causes improvement prior to the natural history of the condition. 

The generalizability of these results is low because of the small sample sizes and heterogeneity of techniques in the identified studies. Without a randomized, sham-controlled trial, there is no definitive evidence that percutaneous needle tenotomy is intrinsically effective. A randomized controlled trial with a “watchful waiting” control group would be useful, as the natural history of lateral epicondylitis is typically self-limited.

While as physiatrists we are hopeful to add another tool to our toolbox, this review demonstrates the importance of maximizing conservative measures as procedures and surgery do not necessarily demonstrate superior outcomes.