From: Quality measures for the care of patients with lateral epicondylalgia
Components of care | Evidence-based recommendations | Evidence level / strength recommendation |
---|---|---|
I. Patient exam | Â | |
Physical Examination | 1. IF a patient begins a treatment for lateral epicondylalgia, THEN evidence that the affected tendon was examined should be documented (at least orthopaedic tests). | B / Strong [22] |
Pain and functional assessment | 2. IF a patient has symptomatic lateral epicondylalgia, THEN pain should be assessed (at least the intensity level) upon initiation of a new treatment at least once. | |
3. IF a patient has symptomatic lateral epicondylalgia, THEN functional status should be assessed upon initiation of a new treatment at least once. | ||
II. Educational interventions | Â | |
Education | 4. IF a patient has symptomatic lateral epicondylalgia, THEN education about self-management of risk factors (repetitive movements, etc.) should be given or recommended at least once. | |
III. Therapeutic interventions | Â | |
1. Pharmacological therapy | Â | |
First line | 5. IF a patient is started on pharmacological therapy to treat lateral epicondylalgia, THEN NSAIDs should be tried first. | |
Prophylaxis | 6. IF a patient with a risk factor for GI bleeding (age ≥75, peptic ulcer disease, history of GI bleeding) is treated with a NSAID, THEN he or she should be treated concomitantly with inhibitors (e.g. proton pump inhibitor, misoprostol, etc.). | A / Strong [35] |
2. Physical therapy | Â | |
First line | 7. IF a patient is started on physical therapy to treat lateral epicondylalgia, THEN a program of exercise therapy (training epicondyle muscles excentrically and concentrically) should be tried first. | |
8. IF a patient is started on physical therapy to treat lateral epicondylalgia, THEN manual therapy by mobilization with movement should be tried first. | ||
9. IF a patient is started on physical therapy to treat lateral epicondylalgia, THEN laser therapy should be tried first. | A / Strong [40] | |
Time to referral | 10. IF a patient is treated with corticosteroid injection for lateral epicondylalgia, THEN a multimodal program of physical therapy should be initiated early before 14Â days. | A / Strong [43] |
3. Other therapeutic interventions | Â | |
First line | 11. IF a patient is treated with platelet-rich plasma for lateral epicondylalgia, THEN infiltration into the extensor digitorum communis tendon by peppering technique should be recommended. | |
Surgery | 12. IF a patient was symptomatic after a minimum of 6–12 months of conservative therapies, THEN surgery should be recommended. |