Management of tennis elbow - a survey of UK clinical practice

Purpose

Tennis elbow is a common condition in the UK but there are no guidelines on how best to manage the condition. The purpose of this study was to establish the current UK practice in managing patients with chronic tennis elbow (symptoms over six months).

Approach

A cross sectional online survey of UK surgeons and therapists was conducted in June 2017, remaining active for one month. This was comprised of 17 questions and was hosted by Google Forms. The questionnaire was distributed to professional contacts and was sent directly to members of the British Society for Surgery of the Hand following review by their research committee. In addition it was advertised via social media and the Chartered Society of Physiotherapy online message board.

Outcomes

275 responses were received from a wide geographical area, the majority from consultant surgeons and experienced physiotherapists. 81% recommended exercise-based physiotherapy as the first line intervention, with 9% recommending corticosteroid injection. Second line treatments varied widely with corticosteroid injections the most popular (27%) followed by shockwave therapy, Platelet-Rich Plasma injection, surgery, acupuncture and a wait-and-see policy. Surgery was advised by 1% as a first line option and 10% as second line.

Implications

There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow. The majority of second line interventions lack evidence to support their use and in the case of corticosteroid injections may even be harmful in the long term. There is a clear need for national guidance based on best evidence to aid clinicians in their treatment approach.

This study highlights the need for national guidance in how best to manage patients with chronic tennis elbow.

Fund acknowledgements

This work was not funded.

Additional notes

Presented at Physiotherapy UK 2018.