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Elbow pain interventions: from the Cochrane Library

One of the most important functions of the Cochrane Library is to demonstrate what we do not know. Good quality reviews that find no trials, no good trials, or good trials with no effect, are really important in delimiting the extent of our knowledge (or ignorance). This survey briefly examines a number of negative reviews on elbow pain.


Acupuncture


S Green et al. Acupuncture for lateral elbow pain. Cochrane Database of Systematic Reviews 2002 issue 1.


Clinical bottom line

There were four small trials, including those of low quality. No benefit from acupuncture was demonstrated.


NSAIDs


SE Green et al. Non-steroidal anti-inflammatory drugs for treating of lateral elbow pain in adults. Cochrane Database of Systematic Reviews 2002 issue 1.


Clinical bottom line

There were 14 trials of topical and oral NSAIDs, all small, and several were of poor quality. There is some evidence that topical NSAIDs may be helpful, but there is insufficient evidence to be certain.



Orthotic devices


P Struijs et al. Orthotic devices for treatment of tennis elbow. Cochrane Database of Systematic Reviews 2002 issue 1.


Clinical bottom line

There were five trials, all small, and several did not have outcomes. There is no evidence from randomised trials that these devices are of any help.


Shock wave therapy


R Buchbinder et al. Shock wave therapy for lateral elbow pain. Cochrane Database of Systematic Reviews 2005 issue 4.


Clinical bottom line

There were nine trials with over 1000 participants, but no analysis showed any evidence of benefit.


Surgery


R Buchbinder et al. Surgery for lateral elbow pain. Cochrane Database of Systematic Reviews 2002 issue 1.


Clinical bottom line

There were no controlled trials.