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: Corticosteroid Injection Verses High Energy Extracorporeal Shock Wave Therapy for Lateral Epicondylitis

Eligibility criteria:
Inclusion Criteria:

          -  All patients presenting to the WRNMMC orthopaedic hand surgery clinic for complaints
             of lateral elbow pain will be evaluated for inclusion in the study. Inclusions
             criteria will be:

          -  Clinical diagnosis of lateral epicondylitis based on primary complaint of lateral
             elbow pain and either (a) tenderness over the lateral epicondyle with direct
             palpation, or (b) exacerbation of pain at the lateral elbow with resisted dorsiflexion
             of the wrist

          -  Failure of previous trial of non-operative management of at least 4wks duration (to
             include rest/light duty, non steroidal anti-inflammatory drugs , physical/occupational
             therapy, home stretching regimen)

        Exclusion Criteria:

          -  Age <18yo

          -  Pregnant or planning to become pregnant during study period (based on verbal
             questioning)

          -  Steroid treatment (oral or injectable) within the previous 3mo

          -  Diagnosis of ipsilateral compressive neuropathy

          -  Allergy to Kenalog, lidocaine, or conductive ultrasound gel

          -  Diagnosis of inflammatory arthropathy or rheumatoid conditions

          -  Diagnosis of fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome,
             or other chronic widespread pain syndromes
No condition on gender to be admitted to the trial.
Accepts Healthy Volunteers
Subject must be at least 18 Years old.


Eligibility (NLI label): Contradiction