The World Health Organization lists tennis elbow as one of the many conditions known to respond to acupuncture treatment, a form of alternative medicine that uses small needles inserted at precise points to balance the 12 energy pathways along the body.

A study in 2001 to evaluate the clinical efficacy of acupuncture in the treatment of chronic lateral epicondylitis -tennis elbow- was made.

This study uses a small sample of patients, we must continue studies to determine the efficiency of acupuncture for tennis elbow

In a randomized, investigator‐ and patient‐blinded, controlled clinical study, 23 patients were treated with real acupuncture and 22 patients received sham acupuncture. Patients each received 10 treatments, with two treatments per week. The primary outcome variables were maximal strength, pain intensity : verbal rating scale and disability scale
- Disabilities of the Arm,
- Shoulder
- Hand questionnaire.
Patients were examined at baseline 1 week before the start of treatment and at follow‐up 2 weeks and 2 months after the end of treatment.

The real acupuncture treatment for tennis elbow

Traditional Chinese acupuncture regards treatment as consisting of local, regional and specific distant points. For the acupuncture in this study, we selected points which have frequently been recommended for the treatment of epicondylitis.

As local points, we selected one Ash point, LI 10 and LI 11 over the muscular origin of the lateral extensor group of the forearm and Lu 5 in the cubital region.

As regional points we selected LI 4 and SJ 5 for the treatment of pain in the upper limb. In all, six needles were given. The needles were inserted down to the musculature; by twisting the needles at the start of treatment a De Qi sensation was induced. The needles remained in situ for 25 min.

The control acupuncture treatment for tennis elbow

The terminology for reporting acupuncture control interventions has not been standardized. Lewith and Machin used the term "sham acupuncture" to mean needling points which were not those specified by traditional acupuncture.

They used puncture sites which were at least 5 cm away from the classical acupuncture points and their interconnecting lines (meridians) and also clear of painful pressure points (Ah‐Shi or trigger points). The needles were inserted in exactly the same way as in the real group. In all, six needles were given per treatment session. The time frame was the same as in the real acupuncture group.

The frequency of treatment of epicondylitis with acupuncture in published studies lies between once a day and twice a week. In the present study, we used the latter treatment frequency as it is the experience of two of us (MF, EW) that a lower frequency is more effective.

For both treatment groups, identical sets of sterile, disposable steel needles were used (0.25×40 mm, B‐type; Seirin, Neu Isenburg, Germany). The skin at the puncture sites was prepared with a conventional disinfecting agent. Acupuncture was carried out by a physician with sound knowledge of traditional acupuncture techniques.

Result of the tennis elbow treatment with acupuncture

There was no significant difference between the groups at baseline for any outcome parameter. Two weeks and 2 months after the end of treatment, there were significant reductions in pain intensity and improvements in the function of the arm and in maximal strength in both treatment groups.

At the 2 week follow‐up these differences were significantly greater for all outcome parameters in the group treated with real acupuncture.

At 2 months the function of the arm was still better in this group than in the sham acupuncture group; however, the differences in pain intensity and maximal strength between the groups were no longer significant.

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