Efficacy of non-steroidal anti-inflammatory drugs in treatment of tennis elbow: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Jinlin ¹ ,  XI Xiaobing ²

1. The North Hospital of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201810, P.R.China;
2. The Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R.China;

Corresponding author：

XI Xiaobing, Email: skxixiaobing@163.com

Keywords：

Non-steroidal anti-inflammatory drug; Tennis elbow; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.202001042

Video：

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Objectives To systematically review the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) on tennis elbow.Methods PubMed, EMbase, The Cochrane Library, VIP, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on NSAIDs for tennis elbow from inception to May 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 8 RCTs involving 595 patients were included. The results of meta-analysis showed that there were no significant differences in the therapeutic effect between NSAIDs and the placebo group (RR=1.10, 95%CI 0.89 to 1.35, P=0.39) or non-placebo control group (RR=0.88, 95%CI 0.77 to 1.00, P=0.06). Compared with non-placebo control group, NSAIDs group had lower VAS score difference (MD=−1.41, 95%CI −2.28 to −0.53, P=0.002).Conclusions Current evidence shows that the effect of NSAIDs on tennis elbow is still uncertain. The improvement of symptoms with NSAIDs may be superior to placebo, but inferior to other treatment methods. Due to the limited quantity and quality of included studies, the above conclusions are required to be verified by more high-quality studies.

Citation： ZHANG Jinlin, XI Xiaobing. Efficacy of non-steroidal anti-inflammatory drugs in treatment of tennis elbow: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1069-1074. doi: 10.7507/1672-2531.202001042 Copy

1.	龙智铨. 顽固性网球肘的治疗研究进展. 中医正骨, 2005, 17(6): 57-58.
2.	Degen RM, Conti MS, Camp CL, <italic>et al</italic>. Epidemiology and disease burden of lateral epicondylitis in the USA: Analysis of 85 318 patients. HSS J, 2018, 14(1): 9-14.
3.	Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br, 2004, 86(5): 701-704.
4.	Amar E, Chechik O, Khashan M, <italic>et al</italic>. Lateral epicondylitis treatment: international survey of surgeons' preferences and literature review. Int J Clin Pract, 2014, 68(11): 1383-1387.
5.	Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am, 1999, 81(2): 259-278.
6.	Chen J, Wang A, Xu J, <italic>et al</italic>. In chronic lateral epicondylitis, apoptosis and autophagic cell death occur in the extensor carpi radialis brevis tendon. J Shoulder Elbow Surg, 2010, 19(3): 355-362.
7.	Khan MH, Li Z, Wang JH. Repeated exposure of tendon to prostaglandin-E2 leads to localized tendon degeneration. Clin J Sport Med, 2005, 15(1): 27-33.
8.	曹洪辉. 肌腱细胞体外牵伸模型建立及不同牵伸负荷对其炎症介质产生的影响. 重庆: 第三军医大学, 2010.
9.	Stasinopoulos D. Comments on the article "Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials". Hand (N Y), 2017, 12(1): 98.
10.	Green S, Buchbinder R, Barnsley L, <italic>et al</italic>. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev, 2002, (2): CD003686.
11.	陈忠德, 何生华, 郝永林. 金骨康远红外磁疗贴治疗肱骨外上髁炎的临床观察. 医疗卫生装备, 2009, 30(12): 69-70.
12.	曹莲瑛, 虞莉青, 张伟, 等. 耳穴压丸结合艾灸治疗肱骨外上髁炎疗效观察. 辽宁中医杂志, 2015, 42(8): 1506-1508.
13.	王海洋, 黄法森, 冯敏山, 等. 拔戳揉捻法改善肱骨外上髁炎VAS疼痛评分的临床观察. 天津中医药大学学报, 2017, 36(4): 271-273.
14.	刘莉, 李洁明. 扶他林乳胶剂耦合超声治疗网球肘疗效观察. 中华理疗杂志, 1998, (3): 183.
15.	Hay EM, Paterson SM, Lewis M, <italic>et al</italic>. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ, 1999, 319(7215): 964-968.
16.	Labelle H, Guibert R. Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group. Arch Fam Med, 1997, 6(3): 257-262.
17.	Polat A, Ekinci O, Berna Terzioglu, <italic>et al</italic>. Treatment of lateral epicondylitis using betahistine dihydrochloride. J Muscul Pain, 2011, 19(4): 201-206.
18.	Bäcker M, Lüdtke R, Afra D, <italic>et al</italic>. Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial. Clin J Pain, 2011, 27(5): 442-447.
19.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
20.	Abate M, Silbernagel KG, Siljeholm C, <italic>et al</italic>. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther, 2009, 11(3): 235.
21.	Richer N, Marchand AA, Descarreaux M. Management of chronic lateral epicondylitis with manual therapy and local cryostimulation: a pilot study. J Chiropr Med, 2017, 16(4): 279-288.
22.	Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am, 1979, 61(6A): 832-839.
23.	邓银栓, 唐康来, 李辉, 等. 伸肌腱止点清理带线锚钉修复治疗顽固性网球肘的近期疗效. 中国修复重建外科杂志, 2013, 27(1): 1-6.
24.	Alfredson H, Ljung BO, Thorsen K, <italic>et al</italic>. In vivo investigation of ECRB tendons with microdialysis technique-no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthop Scand, 2000, 71(5): 475-479.
25.	Oskarsson E, Gustafsson BE, Pettersson K, <italic>et al</italic>. Decreased intramuscular blood flow in patients with lateral epicondylitis. Scand J Med Sci Sports, 2007, 17(3): 211-215.
26.	Khan KM, Maffulli N. Tendinopathy: an Achilles' heel for athletes and clinicians. Clin J Sport Med, 1998, 8(3): 151-154.
27.	张晨, 马骏, 党晓谦, 等. 非甾体抗炎药治疗骨关节炎的研究进展. 中华关节外科杂志(电子版), 2017, 11(2): 66-69.
28.	Evans JP, Porter I, Gangannagaripalli JB, <italic>et al</italic>. Assessing patient-centred outcomes in lateral elbow tendinopathy: a systematic review and standardised comparison of English language clinical rating systems. Sports Med Open, 2019, 5(1): 10.

1. 龙智铨. 顽固性网球肘的治疗研究进展. 中医正骨, 2005, 17(6): 57-58.
2. Degen RM, Conti MS, Camp CL, <italic>et al</italic>. Epidemiology and disease burden of lateral epicondylitis in the USA: Analysis of 85 318 patients. HSS J, 2018, 14(1): 9-14.
3. Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br, 2004, 86(5): 701-704.
4. Amar E, Chechik O, Khashan M, <italic>et al</italic>. Lateral epicondylitis treatment: international survey of surgeons' preferences and literature review. Int J Clin Pract, 2014, 68(11): 1383-1387.
5. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am, 1999, 81(2): 259-278.
6. Chen J, Wang A, Xu J, <italic>et al</italic>. In chronic lateral epicondylitis, apoptosis and autophagic cell death occur in the extensor carpi radialis brevis tendon. J Shoulder Elbow Surg, 2010, 19(3): 355-362.
7. Khan MH, Li Z, Wang JH. Repeated exposure of tendon to prostaglandin-E2 leads to localized tendon degeneration. Clin J Sport Med, 2005, 15(1): 27-33.
8. 曹洪辉. 肌腱细胞体外牵伸模型建立及不同牵伸负荷对其炎症介质产生的影响. 重庆: 第三军医大学, 2010.
9. Stasinopoulos D. Comments on the article "Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials". Hand (N Y), 2017, 12(1): 98.
10. Green S, Buchbinder R, Barnsley L, <italic>et al</italic>. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev, 2002, (2): CD003686.
11. 陈忠德, 何生华, 郝永林. 金骨康远红外磁疗贴治疗肱骨外上髁炎的临床观察. 医疗卫生装备, 2009, 30(12): 69-70.
12. 曹莲瑛, 虞莉青, 张伟, 等. 耳穴压丸结合艾灸治疗肱骨外上髁炎疗效观察. 辽宁中医杂志, 2015, 42(8): 1506-1508.
13. 王海洋, 黄法森, 冯敏山, 等. 拔戳揉捻法改善肱骨外上髁炎VAS疼痛评分的临床观察. 天津中医药大学学报, 2017, 36(4): 271-273.
14. 刘莉, 李洁明. 扶他林乳胶剂耦合超声治疗网球肘疗效观察. 中华理疗杂志, 1998, (3): 183.
15. Hay EM, Paterson SM, Lewis M, <italic>et al</italic>. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ, 1999, 319(7215): 964-968.
16. Labelle H, Guibert R. Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group. Arch Fam Med, 1997, 6(3): 257-262.
17. Polat A, Ekinci O, Berna Terzioglu, <italic>et al</italic>. Treatment of lateral epicondylitis using betahistine dihydrochloride. J Muscul Pain, 2011, 19(4): 201-206.
18. Bäcker M, Lüdtke R, Afra D, <italic>et al</italic>. Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial. Clin J Pain, 2011, 27(5): 442-447.
19. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
20. Abate M, Silbernagel KG, Siljeholm C, <italic>et al</italic>. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther, 2009, 11(3): 235.
21. Richer N, Marchand AA, Descarreaux M. Management of chronic lateral epicondylitis with manual therapy and local cryostimulation: a pilot study. J Chiropr Med, 2017, 16(4): 279-288.
22. Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am, 1979, 61(6A): 832-839.
23. 邓银栓, 唐康来, 李辉, 等. 伸肌腱止点清理带线锚钉修复治疗顽固性网球肘的近期疗效. 中国修复重建外科杂志, 2013, 27(1): 1-6.
24. Alfredson H, Ljung BO, Thorsen K, <italic>et al</italic>. In vivo investigation of ECRB tendons with microdialysis technique-no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthop Scand, 2000, 71(5): 475-479.
25. Oskarsson E, Gustafsson BE, Pettersson K, <italic>et al</italic>. Decreased intramuscular blood flow in patients with lateral epicondylitis. Scand J Med Sci Sports, 2007, 17(3): 211-215.
26. Khan KM, Maffulli N. Tendinopathy: an Achilles' heel for athletes and clinicians. Clin J Sport Med, 1998, 8(3): 151-154.
27. 张晨, 马骏, 党晓谦, 等. 非甾体抗炎药治疗骨关节炎的研究进展. 中华关节外科杂志(电子版), 2017, 11(2): 66-69.
28. Evans JP, Porter I, Gangannagaripalli JB, <italic>et al</italic>. Assessing patient-centred outcomes in lateral elbow tendinopathy: a systematic review and standardised comparison of English language clinical rating systems. Sports Med Open, 2019, 5(1): 10.

Chinese Journal of Evidence-Based Medicine

Efficacy of non-steroidal anti-inflammatory drugs in treatment of tennis elbow: a meta-analysis

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