Condition category
Neonatal Diseases
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
Tennis elbow (lateral epicondylalgia) is a condition that results in pain around the outside of the elbow. Sufferers may experience this pain when they bend or lift their arm, when they grip smaller objects (such as a pen) or when twisting the forearm to – for example – turn a doorknob or open a jar. It is caused by overusing the muscles of the elbow. Tennis elbow will eventually get better on its own without treatment, but, for some 20% of cases, symptoms may continue for a year or more. Treatment for the condition often involves a combination of non-pharmacological (drug) therapies. These include corticosteroid injection, iontophoresis, botulinum toxin A, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, and laser therapy; however, the results of these treatments remain inconclusive. Manipulation treatment and acupuncture are usually used to lateral epicondulalgia treatment in Traditional Chinese Medicine but there has been little research into comparing how well they perform. This study investigates whether manipulation treatment is beneficial and provides more satisfactory results when compared with acupuncture treatment in patients with lateral epicondylalgia.

Who can participate?
Patients suffering from tennis elbow for longer than 2 months.

What does the study involve?
Participants are randomly allocated to one of two groups. Those in group 1 receive manipulation treatment twice a week for two weeks. Those in group 2 receive acupuncture treatment twice a week for two weeks. All participants are assessed in terms of how much pain they experience, how hard they can grip and how well their arm is functioning at various periods throughout the study and for up to eight weeks after treatment.

What are the possible benefits and risks of participating?
Possible risks include light hemorrhage or hematoma for participants in the acupuncture group and some pain (during treatment) for those participants in the manipulation group.

Where is the study run from?
Chang Gung Memorial Hospital (Taiwan)

When is the study starting and how long is it expected to run for?
March 2011 to September 2012

Who is funding the study?
Chang Gung Memorial Hospital (Taiwan)

Who is the main contact?
Dr Hsin-Chia Huang

Trial website

Contact information



Primary contact

Dr Hsin-Chia Huang


Contact details

Dinghu Rd
Guishan Township
Taoyuan City

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Comparison of manipulation treatment with acupuncture treatment in pain relief among lateral epicondylalgia


Study hypothesis

We hypothesized that pathological tension in the biceps brachii muscle is related to lateral epicondylalgia.

Ethics approval

Chang-Gung Memorial Foundation, Taipei, Taiwan, ref: IRB No.: 99-1544A3

Study design

Randomized controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use contact details to request a participant information sheet


Lateral epicondylalgia


Participants were randomly allocated to one of two groups:

1. Manipulation group: participants received radial bone adjustment by being rotated internally the radial bone and extended the biceps brachii muscle simultaneously. The physician performed the manipulation procedure twice in 1 minute with an interval of 30 seconds.
2. Acupuncture group: participants received six acupoints on the forearm, according to a study in Rheumatology published by the Hannover Medical School, Germany. The needle was inserted into the muscle layer and twisted until the de qi sensation was felt. The needle remained in situ for 25 minutes.

Both the manipulation and acupuncture groups received the treatments twice per week for 2 weeks.

Intervention type



Drug names

Primary outcome measure

Pain, measured using the pain visual analog scale score (VAS), before treatment in three states, rest, daily activity, and work situations, from the beginning of the study up to 8 weeks following.

Secondary outcome measures

1. Functional impairment, measured by the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, measured at the beginning of treatment as a baseline, the end of treatment, and followed for 2 and 8 weeks after the end of treatment
2. Grip strength (pain- free and maximum), measured using the Jamar hand dynamometer, before treatment in three states, rest, daily activity, and work situations, from the beginning of the study up to 8 weeks following

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. Elbow pain for >2 months
2. Unilateral elbow pain
3. No improvement in the condition despite receiving treatment in previous 4 weeks
4. Visual analog scale(VAS) score> 30

Participant type


Age group




Target number of participants


Participant exclusion criteria

Patients who had:
1. Central or peripheral nervous system diseases
2. Radial nerve entrapment
3. Inflammatory rheumatic disease
4. Gout
5. Radiocapitellar osteoarthritis
6. Undergone a operation for tennis elbow
7. Become pregnant

Recruitment start date


Recruitment end date



Countries of recruitment


Trial participating centre

Chang Gung Memorial Hospital

Sponsor information


Chang Gung Memorial Hospital (R.O.C)

Sponsor details

Dinghu Rd
Guishan Township

Sponsor type

Hospital/treatment centre



Funder type

Hospital/treatment centre

Funder name

Chang Gung Memorial Hospital, Linkou

Alternative name(s)

Funding Body Type

private sector organisation

Funding Body Subtype

other non-profit



Results and Publications

Publication and dissemination plan

We would like to publish our result on the “Orthopedic”, “Rehabilitation” or “Complementary and Alternative Medicine” field in early 2016.

Intention to publish date


Participant level data

Not expected to be available

Basic results (scientific)

Publication list

2016 results in:

Publication citations

Additional files

Editorial Notes

10/08/2017: Internal review. 05/05/2016: Publication reference added.