The painful condition known as “tennis elbow” results from overuse of the tendons in the forearm, typically in a patient’s dominant arm. A repetitive stress injury, tennis elbow affects not just athletes, but also tradesmen, food industry workers, manufacturers and office workers—anyone who uses the hands and wrists for hours each day. Numerous treatments are available to the 200,000 new patients diagnosed with tennis elbow in the United States each year, but few high-quality trials have compared these approaches.

In the largest analysis to date, researchers and clinicians at Beth Israel Deaconess Medical Center (BIDMC) have compared the efficacy and safety of non-surgical treatment options for tennis elbow—also called enthesopathy of the extensor carpi radialis brevis (eECRB). Published today in the American Journal of Sports Medicine, the meta-analysis reveals that none of the 11 non-surgical treatment options—including physical therapy, acupuncture, oral anti-inflammatory medications, local botulinum toxin injection therapy, ultrasound, laser therapy and more—performed significantly better than placebo in addressing patients’ pain and that all increased patients’ odds of adverse events.

“All 11 treatment options provided only small pain relief, while increasing the odds of adverse events,” said Ara Nazarian, Ph.D., a principal investigator in the Center for Advanced Orthopaedic Studies at BIDMC and Associate Professor of Orthopaedic Surgery at Harvard Medical School. “More than 90 percent of the patients given placebo experienced pain resolution after four weeks.”

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