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Lateral openbite — Clinical Guidelines

Overview

Lateral epicondylitis, commonly known as tennis elbow, is a chronic painful condition characterized by pain and tenderness at the lateral epicondyle of the humerus, primarily affecting the extensor tendons of the forearm 7.

Diagnosis

Pain localized to the lateral aspect of the elbow, exacerbated by gripping or resisted wrist extension 7

Positive Cozen's test or resisted wrist extension maneuvers 7

Imaging typically normal; MRI may show tendinosis but is not routinely required 7

Management

First-line treatments:

- Physical therapy focusing on stretching and strengthening exercises 2 - Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief 8

Adjunctive treatments:

- Corticosteroid injections, though efficacy may be short-term with high recurrence rates 9 - Extracorporeal shockwave therapy (evidence varies) 8 - Splinting to immobilize the wrist in a neutral position 7

Special Populations

Comorbidities: Hypercholesterolemia may increase risk, with statin treatment potentially relevant 1

No specific recommendations provided for pregnancy, pediatrics, or elderly populations in the given abstracts.

Key Recommendations

Physical therapy should be the primary intervention due to strong evidence supporting its efficacy (Evidence: Strong 2)

Corticosteroid injections can be considered for short-term relief, but their long-term efficacy is limited (Evidence: Moderate 9)

Nonoperative management should precede surgical intervention, reserved for non-responsive cases (Evidence: Expert opinion 4 5)

References

1 Chen Q, Shen P, Zhang B, Chen Y, Zheng C. A meta-analysis of the risk factors for lateral epicondylitis. Journal of hand therapy : official journal of the American Society of Hand Therapists 2024. link 2 Amako M, Arai T, Iba K, Ikeda M, Ikegami H, Imada H et al.. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - Secondary publication. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2022. link 3 Bordachar D. Lateral epicondylalgia: A primary nervous system disorder. Medical hypotheses 2019. link 4 Poehling GG. Editorial Commentary: Elbow Lateral Epicondylitis (Tennis Elbow) Surgery Works, but Is Not Often Indicated. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2017. link 5 Wetzler MJ. Editorial Commentary: Many Ways to Skin a Cat. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2016. link 6 Wolf SJ. You're the Flight Surgeon: lateral epicondylitis. Aerospace medicine and human performance 2015. link 7 Whaley AL, Baker CL. Lateral epicondylitis. Clinics in sports medicine 2004. link 8 Geoffroy P, Yaffe MJ, Rohan I. Diagnosing and treating lateral epicondylitis. Canadian family physician Medecin de famille canadien 1994. link 9 Clarke AK, Woodland J. Comparison of two steroid preparations used to treat tennis elbow, using the hypospray. Rheumatology and rehabilitation 1975. link

Lateral openbite