Clinical Case Report

Management of Chronic Elbow Tendinopathy: a Case-Based Discussion

Based on the meeting transcript featuring Alex, a Tennis Elbow System user, and Alain Tranchmontagne, President & CEO of Alleviate

Abstract

This report presents a case of chronic elbow tendinopathy in a physically active individual, detailing the clinical course, management strategies, and outcomes. The discussion includes insights into product usage, app-based rehabilitation, and recommendations for improving patient compliance and product design.

Case Presentation

Patient Background

• Medical History: Physician by training. Former competitive driver, transitioned to golf and strength training due to an eye issue, resulting in the development of symptomatic tendinopathy.
• Injury History: Developed medial epicondylitis ("golfer's elbow") from repetitive golf and weight training, followed by lateral epicondylitis exacerbated by over-speed golf training with weighted clubs. Also experienced De Quervain's tenosynovitis (wrist tendonitis) causing loss of function.

Clinical Findings

• Lateral epicondylitis symptoms: Initial pain estimated at 4/10 due to early intervention. Pull-ups and wrist flexion/extension exercises were painful; serratus exercises were not. Tenderness on palpation.
• Medial epicondylitis symptoms: Persistent discomfort.
• Timeline: Lateral elbow pain persisted for several months before intervention, bordering on chronicity. Medial elbow pain was initially ignored, leading to prolonged symptoms.

Interventions

• Self-Management with Alleviate Tennis Elbow System:
• Early use of brace and massager, increasing frequency from 2–3 times/week to 5 times/week based on positive feedback.
• Home-based app solution found helpful for busy individuals.
• Product/App Usage:
• App recommended rest days to prevent overuse.
• Data analysis showed best results with product use ≥3 times/week.
• Exercises were straightforward, but brace placement required practice initially. App guidance was useful in the process.
• Description for tightening the brace to "70%" was considered vague and needed clarification.

Outcomes

• Pain Management:
• Lateral elbow pain resolved during activity with only mild residual tenderness under palpation after 4 to 6 weeks of exercises; medial side, which is not addressed with the devices, remains symptomatic.
• Motivation to use the brace decreased as symptoms improved, but continued use during high-stress activities.
• Significant improvement typically observed within 4–6 weeks, with possible placebo effect due to motivation at the start of a new regimen.
• Recurrences:
• No recurrence in the current treatment horizon, but risk noted with overuse after symptom resolution.

Outcomes

• Patient Advice: Regular, committed use of the product is necessary; inconsistent use yields poor results.
• Physician Integration: If the product demonstrates benefit and is cost-effective, physicians should consider recommending it to patients, especially for chronic tendinopathy where compliance with at-home therapy is challenging.
• Product Improvement: Main suggestion is to make the app more interactive, with features like rest timers and clearer work volume. Physical equipment (brace, massager and lubricant) deemed satisfactory.
• Market Potential: Lateral elbow tendinopathy is a significant market, affecting up to 24 million Americans.

Discussion

This case highlights the importance of early intervention, consistent use of therapeutic devices, and the role of technology in facilitating rehabilitation. Patient engagement and clear instructions are critical for optimal outcomes. The integration of interactive app features and physician oversight may further enhance compliance and recovery.

External Evidence

• Prevalence and Management of Lateral Epicondylitis: Lateral elbow tendinopathy affects 1–3% of the general population, with most cases resolving within 12–18 months using conservative management such as bracing, physical therapy, and activity modification. Advanced treatments (e.g., corticosteroid injections, PRP) are reserved for refractory cases, but evidence for long-term benefit is limited. [bmj.com]
• De Quervain's Tenosynovitis Treatment: First-line treatment includes corticosteroid injection with thumb spica immobilization for 3–4 weeks, which has shown significant pain-relieving and functional benefits. Ultrasonographic guidance for injections may further improve outcomes.
• Effectiveness of Brace and App-Based Rehabilitation: Progressive loading programs and brace use are effective in tendinopathy rehabilitation. App-based interventions can improve patient engagement and compliance, especially when incorporating interactive features and personalized feedback.
• Patient Compliance in Home-Based Physical Therapy: Adherence to home exercise programs is often poor, with non-adherence rates as high as 50–65%. Clear instructions, manageable exercise volume, and motivational features (such as app reminders and progress tracking) are crucial for improving compliance. 

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References

Internal References

• Meeting transcript: Healthcare Content Discussion, featuring Alex and Alain Tranchemontagne.

External References

• Karbowiak M, Holme T, Thambyrajah J, Di Mascio L. Management of lateral epicondylitis (tennis elbow). BMJ 2023;381:e072574. BMJ Practice Pointer.
• Challoumas D, Ramasubbu R, Rooney E, et al. Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2023;6(10):e2337001. JAMA Network.
• Merry K, MacPherson MM, Whittaker JL, et al. An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study. JMIR Hum Factors 2024;11:e57873. JMIR Human Factors.
• Adherence to Home Exercise Programs - Physiopedia. Physio-Pedia.