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Emerg Med J. 2007 April; 24(4): 296–297.
PMCID: PMC2658243

Tennis elbow and epicondyle clasp

Tennis elbow and epicondyle clasp

Report by Michael Callaghan, Research Physiotherapist

Search checked by Jenny Holloway, Physiotherapist

Manchester Royal Infirmary, Manchester

A short cut review was carried out to establish whether there is any evidence that an epicondyle clasp can speed and improve recovery from tennis elbow. 149 papers were found using the reported search, of which two answered the clinical question. The authors, patient groups, outcomes results and key weaknesses of this evidence are presented. The clinical bottom line is that there is some weak evidence that any improvement seems to occur soon after the clasp is applied, but this is not maintained after 6 months and 1 year follow up.

Three part question

In [adults with chronic tennis elbow] does [an epicondyle clasp in combination with physiotherapy] improve [pain and function]?

Clinical scenario

A 28‐year‐old female presents with a 4 month history of ‘tennis elbow' (lateral epicondylitis). She receives physiotherapy in the form of manual and electrotherapy and you wonder if there is any benefit from additional use of an epicondyle clasp.

Search strategy

MEDLINE 1966–02/07, CINAHL 1982–02/07, AMED 1985–02/07, SPORTDiscus 1830–02/07, EMBASE 1996–02/07, via the OVID interface. In addition the Cochrane database and PEDro database were also searched

Medline, CINAHL, AMED, EMBASE, SPORTSDiscus: [{(exp Tennis Elbow/ OR (lateral elbow pain OR lateral epicondylitis OR epicondylitis). mp) AND (support OR strapping OR epicondyle clasp OR elbow support OR epicondylitis clasp). mp) LIMIT to human AND English language.

Search outcome

149 papers were retrieved and after reading the abstracts, a total of four papers were considered relevant to the question. One was a Cochrane review that was last updated in October 2001. The other three papers were published since that time, one of which did not use a clasp as an additional treatment to physiotherapy. This was discounted as it did not answer the clinical question. The final paper was an economic evaluation of the Struijs study.

Table thumbnail
Table 2

Comment(s)

The Cochrane review was unable to provide definite conclusions as to the efficacy of an epicondyle clasp in conjunction with physiotherapy (see table). The most recent randomised controlled trial, by the same authors, found short term benefits for a combination of brace and physiotherapy over brace only in three out of eight outcome measures of “severity of complaints”, a “pain free function questionnaire” and “convenience of daily activities”. The same combination was also superior to physiotherapy only in one out of eight outcomes for “pressure pain threshold”. These significant differences are not seen at 6 months or 1 year follow‐up.

There are confounding results concerning the use of an epicondyle clasp in addition to other physiotherapy for chronic tennis elbow.

Clinical bottom line

There is some weak evidence that any improvement seems to occur soon after the clasp is applied, but this is not maintained after 6 months and 1 year follow up

References

  • Struijs P APAA, Arola H, Assendelft W JJ. et al. Orthotic devices for the treatment of tennis elbow. The Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD001821. DOI: 10.1002/14651858.CD001821. [PubMed]
  • Struijs P A, Kerkhoffs G M, Assendelft W J. et al. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. American Journal of Sports Medicine 2004 Mar;32(2):462-9. [PubMed]

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