• Roger Menta, Kristi Randhawa, Pierre Côté, Jessica J Wong, Hainan Yu, Deborah Sutton, Sharanya Varatharajan, Danielle Southerst, Kevin D'Angelo, Jocelyn Cox, Courtney Brown, Sarah Dion, Silvano Mior, Maja Stupar, Heather M Shearer, Gail M Lindsay, Craig Jacobs, and Anne Taylor-Vaisey.
• Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
• J Manipulative Physiol Ther. 2015 Sep 1; 38 (7): 507-20.

ObjectiveThe purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand.MethodsWe searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology.ResultsWe identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits.ConclusionThe relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

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