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Lateral epicondylitis, or “tennis elbow,” is a frequently
reported condition in medical care. The complaint is char-
acterized by pain over the lateral epicondyle of the
humerus, which is aggravated with resisted dorsiflexion of
the wrist.5The incidence in general practice is approxi-
mately 4 to 7 per 1000 patients per year with an annual
incidence of 1% to 3% in the general population.1,4 In the
Netherlands, in approximately 10% of the patients the
complaint will result in sick leave, for a mean period of 11
weeks.20 Untreated, the complaint is estimated to last
from 6 months to 2 years.5,9,11 Several treatment options
are available,7including an expectant policy, corticosteroid
injections, orthotic devices, surgery, and physiotherapeutic
modalities such as exercises, ultrasound, laser, massage,
electrotherapy, and manipulations. In Dutch primary care,
21% of the patients with lateral epicondylitis are pre-
scribed an orthotic device as a treatment strategy,20 and
many different types of braces and other orthotic devices
are available for treating tennis elbow.17 The main type is
a band or strap around the muscle belly of the wrist exten-
sors. Theoretically, binding the muscle with a clasp, band,
or brace should limit expansion and thereby decrease the
contribution to force production by muscle fibers proximal
to the band.8,21
A recent trial by Smidt et al15 compared physical thera-
py with an expectant waiting policy and corticosteroid
injections. From the results of this trial, the authors con-
Conservative Treatment of Lateral
Epicondylitis
Brace Versus Physical Therapy or a Combination
of Both—A Randomized Clinical Trial
P. A. A. Struijs,*†PhD, G. M. M. J. Kerkhoffs,†MD, W. J. J. Assendelft,‡MD, PhD, and
C. N. van Dijk,†MD, PhD
From the †Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the
Netherlands, and the ‡Division of Public Health, Department of General Practice, Academic
Medical Center, Amsterdam, the Netherlands
Background: The authors evaluated the effectiveness of brace-only treatment, physical therapy, and the combination of these
for patients with tennis elbow.
Methods: Patients were randomized over 3 groups: brace-only treatment, physical therapy, and the combination of these. Main
outcome measures were success rate, severity of complaints, pain, disability, and satisfaction. Data were analyzed using both
intention-to-treat and per-protocol analyses. Follow-up was 1 year.
Results: A total of 180 patients were ran
domized. Physical therapy was superior to brace only at 6 weeks for pain, disabil-
ity, and satisfaction. Contrarily, brace-only treatment was superior on ability of daily activities. Combination treatment was
superior to brace on severity of complaints, disability, and
satisfaction. At 26 weeks and 52 weeks, no significant differences
were identified.
Conclusion: Conflicting results were found. Brace treatment might be useful as initial therapy. Combination therapy has no addi-
tional advantage compared to physical therapy but is superior to brace only for the short term.
Keywords: tennis elbow; randomized controlled trial; treatment; brace; physical therapy; conservative
* Address correspondence to P. A. A. Struijs, PhD, Academic Medical
Center, Department of Orthopaedic Surgery, Meibergdreef 9, PO Box
2
2660, 1100 DD Amsterdam, the Netherlands (e-mail: paastruijs@hotma
il.
com).
PS planned and coordinated the data collection, analyzed the data,
and wrote the article. WJJA designed the trial and supervised the plan-
ning, coordination, and collection of the data. GK participated in the col-
lection of the data, and CvD contributed to the design of the trial and
discussed clinical issues. All trialists contributed substantially in writing
the article.
The trial was financed by Bauerfeind, manufacturer of orthotic
devices.
The American Journal of Sports Medicine, Vol. 32, No. 2
DOI: 10.1177/0095399703258714
© 2004 American Orthopaedic Society for Sports Medicine
DOI = 10.1177/0095399703258714
