Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis

OBJECTIVES

To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis.

METHODS

We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship.

RESULTS

We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed.

CONCLUSIONS

There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.

Epidemiology of lateral and medial epicondylitis in South Korea: A nationwide population-based study

Few studies have reported the epidemiology of lateral epicondylitis (LE) and medial epicondylitis (ME) in nationwide databases. This study aimed to investigate the epidemiology of LE and ME in South Korea. We analyzed data from the nationwide database of the Korean Health Insurance Review and Assessment Service from 2013 to 2017. We investigated the incidence, prevalence, and surgical trends in patients with LE or ME. Between 2013 and 2017, we identified 2813,431 and 836,610 patients with LE and ME, respectively. LE and ME were more frequently diagnosed in women than in men. During the study period, the mean annual age-adjusted incidence rates of LE and ME were 9.7 per 1000 people and 2.9 per 1000 people, respectively. The incidence of LE did not change significantly during the study period, but the prevalence rate increased significantly. Conversely, the incidence and prevalence rates of ME have significantly increased. Furthermore, 0.8% and 1.0% of patients with LE and ME, respectively, required surgical treatment, showing an annual increase in the number of surgical treatments for LE and ME, respectively. The proportion of arthroscopic surgeries performed for LE did not significantly change during the study period. The prevalence of LE and ME has increased in South Korea. Consequently, the number of surgeries performed annually for LE and ME has increased.