section name header

Evidence summaries

Orthotic Devices and Splints for Tennis Elbow

Splints can decrease the load at the lateral epicondyle and may be beneficial for patients with lateral epicondylitis. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 5 small-size studies with 7 to 49 patients. No definitive conclusions can be drawn from these studies.

A systematic review 2 abstracted in DARE included 11 studies: 6 parallel-group RCTs (n=213) and 2 repeated measures RCTs (n=64) in patients with lateral epicondylitis, and 5 repeated measures RCTs (n=85) in normal participants. Cast immobilisation (elbow flexion, forearm neutral, wrist neutral) or cast plus NSAIDs for 14 days significantly increased grip strength and function, and reduced pain at 4 weeks (1 RCT, n=128). Splint plus NSAID significantly improved pain compared with splint alone. With elbow flexion restriction splint (1 RCT, n=50) there was no significant difference in pain between splint and no splint. Non-articular proximal forearm non-elastic splint increased grip and wrist extension immediately and at 4 weeks (2 RCTs, n=30). One RCT (n=36) found that splint plus local injection significantly improved grip strength in comparison with splint alone or splint plus NSAID. One trial with non-articular proximal forearm elastic splint (n=33) found no significant difference in wrist extension between splint, topical cream, splint plus topical cream, and manipulation alone.

A subsequent RCT 3 (n= 63) compared a new dynamic extensor brace to no treatment in an open trial. After prestratification for the duration of complaints (i.e., ≤ 3 months and ≥ 3 months), 63 patients initially were assigned randomly to 12 weeks of brace treatment (group 1; n = 30) or no brace treatment (group 2; n = 33). Outcome measures included pain (VAS), pain-free grip strength, maximum grip strength, and functionality of the arm. All outcomes were assessed at 6, 12, 18, and 24 weeks. Brace treatment resulted in significant pain reduction, improved functionality of the arm, and improvement in pain-free grip strength. The beneficial effects of the dynamic extensor brace observed after 12 weeks were significantly different from the treatment group that received no brace. The beneficial effects were sustained for another 12 weeks. No correlation between duration of symptoms and treatment effects of the brace was revealed.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by study quality (lack of blinding).

    References

    • Struijs PA, Smidt N, Arola H, Dijk CN, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev 2002;(1):CD001821. [PubMed]
    • Borkholder CD, Hill VA, Fess EE. The efficacy of splinting for lateral epicondylitis: a systematic review. J Hand Ther 2004 Apr-Jun;17(2):181-99. [PubMed] [DARE]
    • Faes M, van den Akker B, de Lint JA, Kooloos JG, Hopman MT. Dynamic extensor brace for lateral epicondylitis. Clin Orthop Relat Res 2006 Jan;442:149-57. [PubMed]

Primary/Secondary Keywords