Patient case (clinical description): A 17-year-old male comes to the office due to several months of right elbow pain.  The pain is worse with activity and limits his workouts and activities.  He has tried over-the-counter medications with limited relief.  Medical history is notable for eczema, and current medications include a topical hydrocortisone ointment.  He is sexually active with his girlfriend and uses condoms. He does not smoke or drink alcohol. He plays tennis most of the days of the week. The comprehensive evaluation shows pain on the lateral side of the elbow, made worse by pressure applied on the lateral epicondyle of the humerus and when making a fist with the elbow joint straightened. The patient has this pain since last year and had several courses of physical therapy.

Patient's own account: I'm 17, and I had to go to the doctor because I've been suffering from my right elbow for several months. The pain is even worse when I do sports and it kind of limits me for my workouts and activities. I tried over-the-counter medications but it didn't work much. I had eczema before and my medication is ointments that contain cortisone. I am sexually active as a 17-year-old guy, and I have a girlfriend, and we use condoms. I don't smoke or drink. I play tennis most days of the week. I did an exam that showed pain on the side of my elbow and it was worse when they applied some pressure on it and when I was putting my hand as a fist. I have had this pain since last year, and I had several sessions of physical therapy already.

Clinical trial: Dry Needling, Manipulation and Stretching vs. Manual Therapy, Exercise and Ultrasound for Lateral Epicondylalgia

Eligibility criteria:
Inclusion Criteria:

          1. Adult between 18 and 60 years old that is able to speak English.

          2. Report of at least 6 weeks of elbow (i.e. lateral epicondyle) and dorsal forearm pain,
             consistent with lateral epicondylitis:

          3. Patient has not had physical therapy, massage therapy, chiropractic treatment or
             injections for elbow pain in the last 6 months:

          4. Diagnosis of lateral epicondylitis, defined as two of more of the following:

               1. Pain on palpation over the lateral epicondyle and the associated common extensor
                  unit

               2. Pain on gripping a hand dynamometer

               3. Pain with stretching or contraction of the wrist extensor muscles

        Exclusion Criteria:

          1. Report of red flags to manual physical therapy to include: severe hypertension,
             infection, uncontrolled diabetes, peripheral neuropathy, heart disease, stroke,
             chronic ischemia, edema, severe varicosities, tumor, metabolic disease, prolonged
             steroid use, fracture, RA, osteoporosis, severe vascular disease, malignancy, etc.

          2. Report of Previous surgery of the elbow, history of elbow dislocation, elbow fracture
             and/or tendon rupture

          3. Report of systemic neurological disorders and/or neurological deficits to include the
             following:

               1. Nerve root compression (muscle weakness involving a major muscle group of the
                  upper extremity, diminished upper extremity deep tendon reflex, or diminished or
                  absent sensation to pinprick in any upper extremity dermatome)

               2. Cervical spinal stenosis (exhibited bilateral upper extremity symptoms)

               3. Central nervous system involvement (hyperreflexia, sensory disturbances in the
                  hand, intrinsic muscle wasting of the hands, unsteadiness during walking,
                  nystagmus, loss of visual acuity, impaired sensation of the face, altered taste,
                  the presence of pathological reflexes)

               4. History of whiplash injury within the previous 6 weeks

          4. History of surgery to the head/neck or affected upper extremity.

          5. Psychiatric disorders or cognitively impaired

          6. Pregnancy
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 60 Years

Eligibility (NLI label): Contradiction