Position statement: nonoperative management of lateral epicondylitis in adults

The term 'physiotherapy' itself may include a multitude of treatment options, including forearm/wrist extensor strengthening, (2) neuromobilization, (3) extracorporeal shock wave therapy, (4) massage, (5) laser therapy (6) and acupuncture. [...]
We sought to compare methods of nonsurgical treatment of lateral epicondylitis in men and women older than 18 years to develop a guideline intended for orthopedic surgeons and other health care providers who assess, counsel and care for these patients. We searched Medline, Embase and Cochrane through to Mar. 9, 2021, and included all English-language studies comparing nonsurgical approaches. We compared physiotherapy versus no active treatment, corticosteroids versus placebo, platelet-rich plasma (PRP) versus placebo, and autologous blood injection versus placebo. Outcomes of interest were pain outcomes (visual analogue scale scores) and functional outcomes. We rated the quality of the evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. This guideline will benefit patients seeking nonsurgical intervention for lateral epicondylitis by improving counselling on nonsurgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various nonsurgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. Nous avons voulu comparer les methodes de traitement non chirurgical de l'epicondylite laterale chez des hommes et des femmes de plus de 18 ans pour creer une ligne directrice a l'intention des chirurgiens orthopedistes et autres professionnels de la sante qui evaluent, conseillent et soignent ces patients. Nous avons interroge les reseaux Medline, Embase et Cochrane jusqu'au 9 mars 2021, et inclus toutes les etudes de langue anglaise qui comparaient des approches non chirurgicales. Nous avons compare la physiotherapie a l'abstention de tout traitement actif, la corticotherapie au placebo, le plasma riche en plaquettes (PRP) au placebo et l'injection de sang autologue au placebo. Les parametres d'interet etaient la douleur (echelle analogique visuelle) et le fonctionnement. Nous avons evalue la qualite des donnees probantes et la solidite des recommandations a l'aide de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Cette ligne directrice proftera aux patients qui cherchent une intervention non chirurgicale pour traiter une epicondylite laterale en ameliorant les consultations sur les options therapeutiques non chirurgicales et les resultats escomptes. Elle aidera aussi les chirurgiens orthopedistes en ameliorant leurs connaissances sur differentes approches non chirurgicales. Les donnees presentees pourraient servir a mettre au point des cadres et des outils pour une prise de decision partagee. Lateral epicondilytis is common, affecting 1%-3% of the population. (1) Nonoperative management is the mainstay of first-line treatment. Nonoperative treatment approaches may include physiotherapy, various types of injections and nonsteroidal anti-inflammatory drugs (NSAIDs).