A systematic review included 23 RCTs evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques for epicondylitis. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound.
Ultrasound for epicondylitis was studied in one subsequent RCT (n=55). Patients with epicondylitis of at least 6 weeks' duration were assigned either to low-intensity ultrasound or placebo. Treatment was self-administered daily for 20 min over a 12-week period. In the active group 64% (16/25) achieved at least 50% improvement from baseline in elbow pain at 12 weeks compared with 57% (13/23) in the placebo group (difference of 7%; 95% confidence interval -20 to 35%). However, this was not statistically significant (chi2 = 0.28, P = 0.60).
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and by inconsistency (heterogeneity in interventions and outcomes).