Research Article|Articles in Press

A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis

Published:March 12, 2023DOI:


      • Wrist Joint manipulation improves pain in patients with lateral epicondylitis.
      • These effects were seen only in short term follow up.
      • There was no effect seen on wrist ROM.
      • The effect on functional outcomes and grip strength was varied.
      • High quality RCTs are recommended with long term follow up.


      Study Design

      Systematic review.


      Several treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis.

      Purpose of the Study

      To determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis.


      Searches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized.


      A total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM.


      The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended.


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        • Verhaar JAN.
        Tennis elbow.
        Int Orthop. 1994; 18: 263-267
        • Fredberg U
        • Stengaard-Pedersen K.
        Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation.
        Scand J Med Sci Sports. 2008; 18: 3-15
        • Coombes BK
        • Bisset L
        • Brooks P
        • Khan A
        • Vicenzino B.
        Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial.
        Jama. 2013; 309: 461-469
        • Taylor SA
        • Hannafin JA.
        Evaluation and management of elbow tendinopathy.
        Sports Health. 2012; 4: 384-393
        • Shiri R
        • Viikari-Juntura E
        • Varonen H
        • Heliövaara M.
        Prevalence and determinants of lateral and medial epicondylitis: a population study.
        American J epidemiol. 2006; 164: 1065-1074
        • Walker-Bone K
        • Palmer KT
        • Reading I
        • Coggon D
        • Cooper C.
        Prevalence and impact of musculoskeletal disorders of the upper limb in the general population.
        Arthritis Care & Res. 2004; 51: 642-651
        • Allander E.
        Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes.
        Scand J Rheumatol. 1974; 3: 145-153
        • Leclerc A
        • Landre MF
        • Chastang JF
        • Niedhammer .
        • Roquelaure Y
        Work SG on R. Upper-limb disorders in repetitive work.
        Scand J Work Environ Health. 2001; 27: 268-278
        • Hume PA
        • Reid D
        • Edwards T.
        Epicondylar injury in sport.
        Sports Med. 2006; 36: 151-170
        • Sanders Jr, TL
        • Maradit Kremers H
        • Bryan AJ
        • Ransom JE
        • Smith J
        • Morrey BF.
        The epidemiology and health care burden of tennis elbow: a population-based study.
        Am J Sports Med. 2015; 43: 1066-1071
        • Smidt N
        • Lewis M
        • VAN DER Windt DAWM
        • Hay EM
        • Bouter LM
        • Croft P.
        Lateral epicondylitis in general practice: course and prognostic indicators of outcome.
        J Rheumatol. 2006; 33: 2053-2059
        • Vicenzino B
        • Wright A.
        Lateral epicondylalgia I: epidemiology, pathophysiology, etiology and natural history.
        Physical Therapy Rev. 1996; 1: 23-34
        • Bisset LM
        • Vicenzino B.
        Physiotherapy management of lateral epicondylalgia.
        J Physiother. 2015; 61: 174-181
        • Kim YJ
        • Wood SM
        • Yoon AP
        • Howard JC
        • Yang LY
        • Chung KC.
        Efficacy of nonoperative treatments for lateral epicondylitis: a systematic review and meta-analysis.
        Plast Reconstr Surg. 2021; 147: 112-125
        • Dion S
        • Wong JJ
        • Côté P
        • et al.
        Are passive physical modalities effective for the management of common soft tissue injuries of the elbow?: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
        Clin J Pain. 2017; 33: 71-86
        • Thomas E
        • Cavallaro AR
        • Mani D
        • Bianco A
        • Palma A.
        The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review.
        Chiropr Man Therap. 2019; 27: 35
        • Piper S
        • Shearer HM
        • Côté P
        • et al.
        The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.
        Man Ther. 2016; 21: 18-34
        • Lucado AM
        • Dale RB
        • Vincent J
        • Day JM.
        Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis.
        J Hand Ther. 2019; 32 (e1): 262-276
        • Struijs PAA
        • Damen PJ
        • Bakker EWP
        • Blankevoort L
        • Assendelft WJJ
        • van Dijk CN.
        Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study.
        Phys Ther. 2003; 83: 608-616
        • Joshi S
        • Metgud S
        • C E.
        Comparing the effects of manipulation of wrist and ultrasound, friction massage and exercises on lateral epicondylitis: a randomized clinical study.
        Indian J Physiotherapy and Occup Ther - An International J. 2013; 7: 205
        • Cashin AG
        • McAuley JH.
        Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale.
        J Physiother. 2020; 66: 59
        • Matos AP
        • Pegorari MS.
        How to classify clinical trials using the PEDro scale?.
        J Lasers Med Sci. 2020; 11: 1-2
        • Maher CG
        • Sherrington C
        • Herbert RD
        • Moseley AM
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Yamato TP
        • Maher C
        • Koes B
        • Moseley A.
        The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials.
        J Clin Epidemiol. 2017; 86: 176-181
        • Sharma1 S
        • Kumar1 P
        • Chaudhuri2 P
        • Malhotra3 N
        • Narula4 H
        • Chahal5 A.
        Is wrist manipulation and low-level laser therapy collectively beneficial for patients with lateral epicondylitis?.
        Indian J Public Health. 2020; 11: 489-495
        • Manchanda G
        • Grover D.
        Effectiveness of movement with mobilization compared with manipulation of wrist in case of lateral epicondylitis.
        Indian J Physiother Occup Ther. 2008; 2: 16-25
        • Pal T
        • Basak T.
        Comparative efficacy of wrist manipulation.
        Progressive Exercises and Both Treatments in Patients with Tennis Elbow. 2018; 8: 87
        • Patel N.
        Effectiveness of mobilization with movement of elbow compared with manipulation of wrist in patients of lateral epicondylitis.
        International J Physiotherapy Res. 2013; 1: 177-182
        • Goyal M
        • Kumar A
        • Monga M
        • Moitra M.
        Effect of wrist manipulation & cyriax physiotherapy training on pain & grip strength in lateral epicondylitis patients.
        J Exercise Sci Physiotherapy. 2013; 9: 17
        • Lewit K
        Manuelle Medizin: Im Rahmen der Medizinischen Rehabilitation.
        Auflage Johan Ambrosius Barth, Leipzig, Germany1977
        • Heiser R
        • O’Brien VH
        • Schwartz DA.
        The use of joint mobilization to improve clinical outcomes in hand therapy: a systematic review of the literature.
        J Hand Ther. 2013; 26: 297-311
        • Bialosky JE
        • Beneciuk JM
        • Bishop MD
        • et al.
        Unraveling the Mechanisms of manual therapy: modeling an approach.
        J Orthop Sports Phys Ther. 2018; 48: 8-18
        • Jun P
        • Pagé I
        • Vette A
        • Kawchuk G.
        Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review.
        Chiropractic & Manual Ther. 2020; 28: 15
        • Skirven TM
        • Osterman AL
        • Fedorczyk J
        • Amadio PC.
        Rehabilitation of the Hand and Upper Extremity, 2-Volume Set E-Book: Expert Consult.
        Elsevier Health Sciences, St. Louis2011
        • Stratford PW
        • Levy DR.
        Assessing valid change over time in patients with lateral epicondylitis at the elbow.
        Clin J Sport Med. 1994; 4: 88-91
        • Lim ECW.
        Pain free grip strength test.
        J Physiother. 2013; 59: 59
        • Dorf ER
        • Chhabra AB
        • Golish SR
        • McGinty JL
        • Pannunzio ME.
        Effect of elbow position on grip strength in the evaluation of lateral epicondylitis.
        J Hand Surg Am. 2007; 32: 882-886
        • De Smet L
        • Van Ransbeeck H
        • Fabry G.
        Grip strength in tennis elbow : long-term results of operative treatment.
        Acta Orthop Belg. 1998; 64: 167-169
        • Moher D
        • Pham B
        • Jones A
        • et al.
        Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?.
        Lancet. 1998; 352: 609-613