Iontophoretic Treatment for Tennis Elbow or Golfer’s Elbow

Tennis elbow, also known as golfer’s elbow, is a joint problem that is not only limited to sport-related lesions. It is clinically named lateral epicondylitis, and it is one of the most common musculoskeletal problems in the upper extremities. Patients with tennis elbow or lateral epicondylitis report a type of pain that becomes worse after performing any activity that involves gripping and using tools such as pincers and pliers or sports equipment as in bats, clubs, and rackets.

Pain in golfer’s elbow is located on the outside area of the elbow, where a small bony prominence is situated, called lateral epicondyle. This pain is often intense and debilitating, and the duration of a single episode of lateral epicondylitis is a minimum of 6 months and up to 2 years. Thus, tennis elbow reduces the capacity of the patient to perform functional movements with the affected arm, the strength of their grip and leads to a significant decrease in working performance and quality of life.

One of the major disadvantages of treating this condition is that a positive outcome often takes very long, and patients often endure pain and discomfort for a long time. For this reason, people with tennis elbow usually try to look for alternative treatments to speed up their recovery. One of these alternative treatments is called iontophoresis, and different from many others, it is backed up by scientific data as a promising tool to improve the symptoms of lateral epicondylitis.

 

Traditional treatments of tennis elbow and their disadvantage

The exact reason why tennis elbow develops is not entirely understood. That is one of the reasons why conventional medical treatments provide a gradual and very slow improvement of the symptoms. The objective of medical treatment is improving the function of the joint and reducing pain symptoms, but there’s no final protocol or optimal treatment to achieve this goal. There’s a variety of treatments including physical therapy, stretching and massaging, hot and cold therapy, and using a variety of painkillers and over-the-counter medications.

However, each one of them has a disadvantage, as noted in the following list:

  • Lifestyle modifications: They may reduce recurrence but do not resolve acute pain episodes.
  • Braces and exercises: They are not for every patient and not for every activity. They do not resolve acute pain episodes.
  • Anti-inflammatory medications: On the long term, they lead to gastrointestinal issues.
  • Cortisone injections: Incorrect technique may lead to inflammation and infection.

For this reason, new treatments are currently under research to improve the symptoms in tennis elbow, and iontophoresis is becoming one of the most promising alternatives.

 

What is iontophoresis, and why is it useful?

Iontophoresis is a procedure included in electrotherapy, a type of physical therapy that consists of using electrical stimulation for various medical purposes. In a session of iontophoresis, the body receives ions through a mild electrical current. Thus, throughout the procedure, it is normal to experience a tingling sensation in the skin. It is not painful, the electrical current is not intense and will not be uncomfortable.

The reason why iontophoresis is interesting in treating tennis elbow is that the procedure is capable of delivering ionized substances through the skin. It is non-invasive and works similar to a topical application and dermal absorption of drugs, but faster, more effective, and with a lower chance of side effects, incorrect handling, and improper technique. It is a popular therapy to improve conditions such as excessive sweating, and it has been found very useful in musculoskeletal problems, including lateral epicondylitis.

In these cases, iontophoresis is applied using a solution of dexamethasone, which helps to control the degenerative process that has been associated with tennis elbow while improving pain symptoms. It is different and better than corticosteroid injections because it is known that steroids directly applied in the articulation may impair the capacity of the tissue to repair itself, aggravating the problem in the long term. Conversely, iontophoresis has not been found to cause this effect, it is safe to use, and provides improvements in various aspects of tennis elbow, including the perceived pain, handgrip strength and reported satisfaction with the patient’s daily activities.

 

Is iontophoresis really effective?

There are many studies and a sufficient body of evidence showing that combining iontophoresis with dexamethasone is an excellent therapeutic option for tennis elbow, and it is effective in reducing pain symptoms. Another drug that may be used for immediate relief is lidocaine, but this one is only a sedative drug with no long-lasting effect.

A recent study compared the effects of iontophoresis with 4% dexamethasone with Cyriax physiotherapy, which consists of a series of exercises and manipulation techniques meant to improve grip strength and relieve pain associated with tennis elbow. The study showed that both iontophoresis with dexamethasone and physiotherapy significantly enhanced the patient’s quality of life, reduced pain, increased grip strength, and resulted in functional improvements and patient satisfaction.

The safety profile of dexamethasone, when applied through an iontophoretic drug delivery device, has a very low incidence of side effects according to studies. Thus, it is possible to say that this is a safe and effective method and a promising way of treating epicondylitis without any invasive procedure or surgical management. One of the proposed mechanisms of pain management is that there is excess glutamic acid in the site of the lateral epicondyle during the acute episode of tennis elbow. This is a neurotransmitter that’s involved in the sensation of pain, and no anti-inflammatory will be able to block this effect. Conversely, corticosteroids block glutamic acid and reduce the sensation of pain. When administered through iontophoresis, their side effects (cortisone flares, inflammation, and infection of the punctured site) are less likely to occur, and it is well-tolerated.

The majority of studies about iontophoresis in tennis elbow are focused on short-term effects, and more research is needed to evaluate the medium and long-term. However, similar to corticosteroid injections, this treatment is meant to improve the pain associated with lateral epicondylitis to reestablish the function and quality of life, providing a foundation for physiotherapy as well as lifestyle and behavioral modifications that will prevent recurrences for long-term recovery.

 

Dr. Gary C. Anderson M.D is a Surgeon who specializes in the treatment of hyperhidrosis. During the past 20 years, he has performed over 2000 sympathectomy procedures on patients with sweating of the underarms, hands, face, scalp or blushing.