Lateral epicondylitis and physical exposure at work? A review of prospective studies and meta-analysis

In view of the recent published studies, a meta-analysis was undertaken on prospective studies in order to assess any association between lateral epicondylitis and physical exposure at work.Using the key words: "lateral epicondylitis" and "occupational" and ("cohort", "longitudinal" or "incidence") without limitations on the language or year of publication, original prospective studies were selected from four databases (Pub-Med, Scopus, Web of science, BDSP) after two rounds (valid design, valid association reported, valid work exposure). Relevant associations between physical exposure at work and incident lateral epicondylitis were extracted from the articles and a meta-risk was calculated using the generic variance approach (meta-odds ratios, meta-OR).From 2001 to 2014, 5 prospective studies were included. Among 6,922 included subjects (and 3,449 who were followed), 256 cases of incident lateral epicondylitis were diagnosed 2.5 to 6 years after baseline. All the published studies found a significant estimation of relative risk for a positive association between combined biomechanical exposure involving wrist and/or elbow and incidence of lateral epicondylitis. The overall meta-OR was 2.6 [1.9-3.5], with a low heterogeneity (Q=1.4, P>0.05). Funnel plot and Egger's test did not suggest major publication bias. The results of this meta-analysis strongly support the hypothesis of an association between biomechanical exposure involving wrist and/or elbow at work and incidence of lateral epicondylitis.