Duloxetine in treatment of refractory chronic tennis elbow: Two case reports

Two mentally healthy young Asian women aged 32 and 27 years, each with tennis elbow of about 18 months duration continued to suffer pain despite treatment with analgesics, local steroid injections, physiotherapy, cryotherapy, ultrasound, and surgical release, among other interventions. Both showed substantial improvement within 4 to 6 weeks of receiving monotherapy with duloxetine 60 mg/day. Both were pain-free with continued treatment at a 6-month follow-up.Duloxetine may be a useful treatment option in patients with chronic tennis elbow, even those who have failed conventional medical, physiotherapeutic, surgical, and other forms of management.Lateral epicondylalgia or tennis elbow is a common cause of pain and disability; it often develops in non-athletes. It is characterized by pain and tenderness centered around the lateral epicondyle. The source of the pain was initially thought to be due to extensor carpi radialis brevis degeneration. However, it is now recognized that the lateral epicondyle, the annular ligament, the radial head and the capitellum may also contribute to the experience of pain in tennis elbow [1].Several factors have been implicated in the causation of tennis elbow. These include overuse of the affected limb, repetitive forceful movements, training errors, misalignments, flexibility problems, ageing, poor circulation, strength deficits and muscle imbalances [2,3].Tennis elbow can be difficult to treat. The condition is prone to recurrence, and the symptoms may last for several weeks or months, with the average duration of a typical episode reported to be between 6 months and 2 years [4]. Non-operative treatment is successful in effecting a resolution of symptoms in most patients. Such conservative treatment options include analgesics, tennis elbow support, ultrasonic therapy, and splint immobilization. Local corticosteroid injections, local autologous blood infiltration, laser therapy, and nitrogen cryotherapy have been used as semi-conservat