Comparative clinical outcomes of monotherapy and combined conservative treatment strategies in lateral epicondylitis: a retrospective cohort study of 420 patients.

INTRODUCTION

Lateral epicondylitis is a common degenerative tendinopathy of the elbow that can significantly impair pain, functional capacity, and grip strength. Although various conservative treatment options are available, evidence comparing different conservative treatment combinations remains limited. This study aimed to compare the clinical outcomes of different conservative treatment strategies in patients with lateral epicondylitis.

STUDY

DESIGN

Retrospective cohort study; Level of Evidence: III.

MATERIALS AND

METHODS

A total of 420 patients with lateral epicondylitis were retrospectively reviewed. Patients were categorized according to the conservative treatment strategy received during routine clinical practice: NSAID therapy alone, NSAID combined with orthotic support, NSAID combined with injection therapy (corticosteroid or platelet-rich plasma [PRP]), and NSAID combined with both orthotic support and injection therapy. Injection therapy in this study included only corticosteroid and PRP injections. Pain, functional outcomes, and grip strength were assessed using the Visual Analog Scale (VAS), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and a Jamar hydraulic hand dynamometer at baseline and at the 6-month follow-up.

RESULTS

Significant improvements were observed in all groups for VAS, PRTEE, and grip strength scores at 6 months (all p<0.001). However, the magnitude of improvement differed significantly among treatment groups (all p<0.001). The greatest reductions in pain (ΔVAS 4.84 ± 2.02) and PRTEE scores (ΔPRTEE 26.31 ± 9.70), as well as the largest increase in grip strength (ΔGrip 14.88 ± 4.12 kgf), were observed in patients treated with combined NSAID, orthotic support, and injection therapy. In contrast, the NSAID-only group demonstrated the smallest improvements across all outcome measures.

CONCLUSION

In this retrospective single-center cohort, combined conservative treatment strategies were associated with greater short-term improvements in pain, functional outcomes, and grip strength at the 6-month follow-up. Because treatment allocation was non-randomized and treatment groups included heterogeneous orthotic and injection modalities, these findings should be interpreted as observational associations rather than evidence of treatment superiority. Prospective randomized studies with standardized treatment protocols are warranted to determine the optimal conservative treatment strategy for lateral epicondylitis.