The Epidemiology and Health Care Burden of Tennis Elbow: A Population-Based Study
Abstract
Background: Lateral elbow tendinosis (epicondylitis) is a common condition both in primary care and specialty clinics. Purpose: To evaluate the natural history (ie, incidence, recurrence, and progression to surgery) of lateral elbow tendinosis in a large population. Study Design: Descriptive epidemiology study. Methods: The study population comprised a population-based incidence cohort of patients with new-onset lateral elbow tendinosis between January 1, 2000, and December 31, 2012. The medical records of a 10% random sample (n = 576) were reviewed to ascertain information on patient and disease characteristics, treatment modalities, recurrence, and progression to surgery. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 US population. Results: The age- and sex-adjusted annual incidence of lateral elbow tendinosis decreased significantly over time from 4.5 per 1000 people in 2000 to 2.4 per 1000 in 2012 ( P < .001). The recurrence rate within 2 years was 8.5% and remained constant over time. The proportion of surgically treated cases within 2 years of diagnosis tripled over time, from 1.1% during the 2000-2002 time period to 3.2% after 2009 ( P < .00001). About 1 in 10 patients with persistent symptoms at 6 months required surgery. Conclusion: The decrease in incidence of lateral elbow tendinosis may represent changes in diagnosis patterns or a true decrease in disease incidence. Natural history data can be used to help guide patients and providers in determining the most appropriate course at a given time in the disease process. The study data suggest that patients without resolution after 6 months of onset may have a prolonged disease course and may need surgical intervention.
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Presenteeism was commonplace.
“Although absenteeism was rarely reported, similarly to a prior population-based study [3], presenteeism was commonplace.”
From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [3]
The general consensus has been to prioritize conservative interventions and restrict surgery to the small proportion of patients who have failed conservative care.
“Despite a lack of strong evidence regarding optimal management, the general consensus has been to prioritize conservative interventions [18,19] and restrict surgery to the small proportion of patients who have failed conservative care [3,4,19,20].”
From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [3]
Elbow pain and particularly elbow tendinopathies are highly prevalent, accounting for approximately 20% of work-related MSK conditions, with nearly one million new cases each year in the United States.
“elbow pain (EP) and particularly elbow tendinopathies are highly prevalent, accounting for approximately 20% of work-related MSK conditions [2], with nearly one million new cases each year in the United States (US) [3].”
From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [3]
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- Authors
- Sanders, T. L., Maradit Kremers, H., Bryan, A. J., Ransom, J. E., Smith, J., & Morrey, B. F.
- Affiliations
- Mayo Clinic (US)
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Corresponding author
- Sanders, Thomas L.
- Venue
- The American Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 2015-02-05
- Volume
- 43
- Issue
- 5
- Pages
- 1066-1071
- ISSN
- 0363-5465 (ISSN-L)
- 1552-3365
- OpenAlex
- W2063304669
- Cited by
- 257
- References
- 24
- Citations by year
- 2026: 19 · 2025: 33 · 2024: 27 · 2023: 37 · 2022: 40 · 2021: 22 · 2020: 15 · 2019: 16 · 2018: 20 · 2017: 11 · 2016: 13 · 2015: 4
- FWCI
- 16.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Sports Medicine (publishedVersion)
- Funders
- National Institute on Aging (R01AG034676)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
- Health Sciences › Medicine › Rehabilitation › Elbow and Forearm Trauma Treatment
- Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
- Keywords
- lateral epicondylitis, epicondylitis, incidence, recurrence, surgical treatment, natural history (disease), healthcare burden, persistent symptoms, diagnosis patterns
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