January 30, 2016
Michael W. Neumeister, MD
Editor-in-Chief, HAND
Re: Sims SEG, Miller K, Elfar JC, Hammert WC. Hand. 2014;9(4):419-446
Dear Dr. Neumeister,
Sims et al.4 report in the article titled “Non-surgical Treatment of Lateral Epicondylitis: A Systematic Review of Randomized Controlled Studies” that lateral epicondylitis (LE) is a condition that is usually self-limited. I would like to report the following:
LE categorizes the condition according to the site of injury and pathophysiology. The suffix “itis” implies an inflammatory pathology, although a review of the findings of histological immunohistochemical and electron microscopy studies suggests that the condition may be degenerative rather than inflammatory. Hence, the increased presence of fibroblasts, vascular hyperplasia, proteoglycans, and glycosaminoglycans together with disorganized and immature collagen may all take place in the absence of inflammatory cells.3 Furthermore, pathology is not always over the lateral epicondyle but may occur below it, on the facet of the lateral epicondyle.2 Therefore, lateral elbow tendinopathy seems to be the most appropriate term to use in clinical practice because terms such as LE make reference to inappro-priate etiological, anatomical, and pathophysiological terms.5
It is proposed that the natural history of LE was between 6 months and 2 years, which has since been widely cited. In contrast, recent reports have shown that symptoms may persist for many years and recurrence is common. Therefore, LE is not self-limiting and is associated with ongoing pain and disability in a substantial proportion of sufferers.1
A debate on the above 2 topics is most welcome as existing aspects may contribute to misunderstanding and inappropriate treatment.
Sincerely,
Dimitrios Stasinopoulos
Vice-Chairperson / Assistant Professor, Physiotherapy
Coordinator of MSc in Sports Physiotherapy
Coordinator of Physiotherapy Program
Director of Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTR EC)
Physiotherapy Program, Department of Health Sciences, School of Sciences, Nicosia, Cyprus
References
- 1. Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015;61(4):174-181. [DOI] [PubMed] [Google Scholar]
- 2. Khan K, Cook J, Taunton J, Bonar F. Overuse tendinosis, not tendinitis: a new paradigm for a difficult clinical problem. Phys Sportsmed. 2000;28:38-48. [DOI] [PubMed] [Google Scholar]
- 3. Kraushaar B, Nirschl R. Current concepts review—tendinosis of the elbow (tennis elbow). Clinical features and findings of histological immunohistochemical and electron microscopy studies. J Bone Joint Surg Am. 1999;81:259-285. [PubMed] [Google Scholar]
- 4. Sims SEG, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand. 2014;9(4):419-446. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Stasinopoulos D, Johnson MI. “Lateral elbow tendinopathy” is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis. Med Hypotheses. 2006;67(6):1400-1402. [DOI] [PubMed] [Google Scholar]