Long duration of symptoms does not affect prognosis of tennis elbow and does not justify further intervention.
By 12-months of having symptoms 89% of participants had improvement or total recovery, advocating education and reassurance in most cases with persistent tennis elbow symptoms.
There is good evidence that symptoms will spontaneously resolve, regardless of chronicity.
Context
- Current treatment strategies consume considerable resources, and no specific treatment has been found to be effective.
- Surgery may be considered for persistent symptoms; current NICE guidance recommends Orthopaedic referral to be considered after 6-12 months of unresolved symptoms.
- Previous trials with placebo controls reveal rapid symptom decline in 3-6 months, followed by a plateau. This pattern doesn’t imply reduced recovery probability.
- Continuing follow-up for persistent symptoms may still lead to spontaneous resolution, potentially reducing surgical recommendations.
Methods
- Trials included randomised/quasi randomised/controlled trials, with participants diagnosed with tennis elbow, with a control group and a 6-month follow-up duration.
- Control groups included wait-and-see, non-specific exercises, simple analgesics, education and reassurance, placebo and sham treatments.
- 24 randomised controlled trials were included, totalling 1085 participants.
- Outcomes were assessed 1 month, 3 months, 6 months, and 12 months. The primary outcome was global improvement (much improved symptoms or total recover).
Results
- The half-life of symptoms was 2.5-3 months. By 12 months 89% participants had much improvement or total recovery.
- Pain scores halved every 3 to 4 months. 88% achieved resolution after 1 year.
- Disability scores halved every 3 to 4 months approaching 85% improvement relative to baseline values after 1 year.
- Duration of symptoms before enrolling in trials did not affect the course of pain or disability.
