Informing patients 3: Elbow Pain – Benefits and Risks and Treatment Alternatives

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.

Elbow Pain

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

Manual Therapy

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.

Orthoses

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

Acupuncture

Evidence of benefits is limited and conflicting.

Benefits: Pain reduction

Risks: Infection, pneumothorax, headache, fatigue, bruising

Corticosteroid injection

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.

Analgesia

Medication Benefits Risks Additional Information
Paracetamol No gastrointestinal toxicity, well-tolerated More effective taken regularly, rather than as required
NSAIDs – Ibuprofen

(naproxen, diclofenac)

Anti-inflammatory Dyspepsia

Gastrointestinal bleeding

Cardiovascular and renal adverse effects

Exacerbate asthma

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

 

Surgery

90% of elbow pain will resolve with conservative treatment.  Surgical management includes percutaneous debridement of degenerative tissue.

References

NICE Clinical Knowledge Summaries, available at: http://cks.nice.org.uk/#?char=A

www.patient.info

radiopedia.org

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