An information resource for practitioners
The law on consent require health practitioners to inform patients of the benefits and risks of treatment and alternative treatments. This article is part of a series to equip practitioners to inform their patients. It is to be noted that it is difficult to find information on benefits and risks of treatments so please feel free to provide feedback so we can develop this resource.
This list is a generalised list to use a resource and needs to be applied using your osteopathic expertise, based on the patient’s condition, presentation, preferences and understanding.
N.B. this information is written for practitioners with medical knowledge, if you are suffering with shoulder pain please seek advice from a health practitioner.
Differentials – tennis elbow (lateral epicondylitis), golfers elbow (medial epicondylitis), osteoarthritis, olecranon bursitis, neuropathy and referred pain
Time, education and activity modification
Reassurance symptoms will resolve – tissues heal in known time frames – muscles, ligament etc. Advice on activities – gripping, lifting, supination/pronation, work posture, task modification and breaks.
Benefits: low-cost option, possibility of full improvement, empowers patient
Risks: Underlying contributing factors may not be resolved increasing likelihood of recurrence. Yellow flags may be barriers to improvement
Ultrasound, laser therapy massage, exercise.
Benefits: Helps improve range of motion and reduce muscle tension, may help reduce likelihood of recurrence of symptoms. Faster improvement than time and education alone.
Risks: May have increased tenderness after hands-on treatment for 24-48 hours, improvement may take a few sessions (1 in 2). Small risk of nerve compression causing temporary tingling and numbness (1 in 100). Very low risk of long-term nerve damage.
Forearm band or wrist splint – may be more useful in conjunction with manual therapy.
Psychological intervention – CBT
Work-related problems could be a factor with elbow pain.
Benefits: Addresses psychological aspect of pain. Educates and provides long-term management strategies
Risks: Dis-engagement, ineffectiveness
Evidence of benefits is limited and conflicting.
Benefits: Pain reduction
Risks: Infection, pneumothorax, headache, fatigue, bruising
Useful for short-term relief of pain but unlikely to affect long-term outcome.
Benefits: Pain reduction
Risks: infection, tendon rupture, hyperglycaemia in people with diabetes, local tissue atrophy, flushing, menstrual disorders in women
Autologous blood injection
Benefits: more effective than corticosteroid for long-term relief. One study showed 90% participants pain free at six months.
|Paracetamol||No gastrointestinal toxicity, well-tolerated||More effective taken regularly, rather than as required|
|NSAIDs – Ibuprofen
Cardiovascular and renal adverse effects
|Not effective for neuropathic pain
Gastroprotection may be required
|Combined analgesics||Combined beneficial effects
*Reduces number of tablets to be taken.
|Risk of overdose and renal toxicity||*Now recommended to be taken as separate tablets apart from chronic stable pain, although limited evidence|
|Codeine (weak opioid), dihydrocodeine, tramadol||Mild-moderate pain treatment, tramadol may be effective with neuropathic pain||Constipation, aggravate asthma, risk of dependence, drowsiness, renal side-effects
Tramadol – rarely – convulsions, psychiatric reactions.
|Sedative effects can add to psychological factors and exacerbate feelings of helplessness and depression.
|Topical NSAID||Good for single regional pain relief||Less side effects|
90% of elbow pain will resolve with conservative treatment. Surgical management includes percutaneous debridement of degenerative tissue.
NICE Clinical Knowledge Summaries, available at: http://cks.nice.org.uk/#?char=A