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: Acupuncture Plus Fire Needle and Acupuncture on Lateral Epicondylitis

Eligibility criteria:
Inclusion Criteria:

          1. Patients were selected for inclusion if two or more of the following criteria were
             noted on the physical examination form: pain over the lateral aspect of the elbow;
             pain on palpation over the lateral epicondyle or the associated myotendinous junction
             of the common extensor tendon; pain on hand gripping; and pain with either resisted
             static contraction or stretching of the wrist extensor muscles.

          2. symptoms have persisted for at least 2 months

          3. symptoms are unilateral

        Exclusion Criteria:

          1. signs and symptoms suggesting a cause other than overuse (e.g., cervical
             radiculopathy)

          2. osteoarthritis of the elbow joints

          3. pathologic, neurologic, and/or vascular findings in the arms

          4. arthritis (local/generalized polyarthritis)

          5. radiohumeral bursitis

          6. ligamentous sprain

          7. bilateral tennis elbow

          8. painful shoulder

          9. surgery or dislocation of the elbow

         10. coagulopathy

         11. pregnancy

         12. infection

         13. malignancy

         14. Patients who had been treated with other therapies or drugs for lateral epicondylitis
             in the 2 weeks before the start of the trial, those who had received corticosteroid
             injections in the previous 6 months, and those who had received acupuncture and fire
             needle therapy for lateral epicondylitis were also excluded.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.



Eligibility (NLI label): Entailment