Sixteen RCTs were included (n=1,814). Seven studies were graded as level I and nine as level II. Three studies met all six validity criteria and three studies met at least five criteria. The following results are based on studies meeting at least five of the six validity criteria.
Shockwave therapy (three studies): Two RCTs (n=114 and 78) reported that shockwave therapy improved visual analogue scale scores and function compared to placebo (one study) and improved pain during wrist extension compared to sham shockwave therapy (one study). One RCT (n=60) reported no difference in quality of life, grip strength and pain between shockwave therapy plus a forearm stretching programme and sham shockwave therapy plus the stretching programme.
Corticosteroid versus Cyriax and physiotherapy (physical therapy and elbow manipulation): One RCT (n=198) reported that corticosteroid injection significantly improved outcomes at six weeks compared to physiotherapy, but there was no difference at 52 weeks. One RCT (n=106) reported that corticosteroid injection was better than Cyriax therapy at six weeks, but there was no significant difference at one year.
Cyriax physical therapy versus physical exercise programme (slow progressive eccentric exercises and static wrist stretching exercises) versus Bioptron light: One RCT (n=75) reported that Cyriax physiotherapy improved all outcomes (pain, pain-free grip, function) compared to Bioptron light therapy. The exercise programme had highest scores for every outcome measure.
Other results and recommendations were also reported in the review.