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December/January 2013/2014 (vol. 10/4)

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Research Plus

Less power to elbow evidence

Updated treatment guidelines from the American College of Occupational and Environmental Medicine include 270 recommendations and 13 diagnoses for elbow disorders, but most are based on expert consensus rather than quality evidence. Nineteen high- and 89 moderate-quality trials were included in the systematic review – 90% addressed lateral epicondylitis (LE – ‘tennis elbow’). Consensus recommendations are used where direct evidence is lacking. For example, for treating LE there is moderate evidence to support the use of topical non-steroidal anti-inflammatory drugs and limited evidence for using ultrasound or glucocorticosteroid injections. However, while the following are recommended, there is inconclusive supporting evidence: restricting work tasks; tennis elbow bands, straps and braces; home exercises; physiotherapy; acupuncture; and self application of heat or cold. Neither manipulation nor mobilisation are recommended (limited evidence). Various ergonomic interventions and return-to-work programmes are recommended, but supporting evidence is insufficient.

ACOEM Practice Guidelines: Elbow Disorders. Journal of Occupational and Environmental Medicine 2013; online first: doi: 10.1097/JOM.0b013e3182a0d7ec.

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Occupational Health at Work December/January 2013/2014 (vol. 10/4) pp45