Inadequate cervicothoracic assessment is nearly universal for screening participants with lateral elbow tendinopathy: A systematic review of 208 randomized controlled trials

Abstract

Background

Lateral elbow tendinopathy (LET) is the most common musculoskeletal elbow disorder. Evidence suggests that cervicothoracic involvement often contributes to forearm symptoms and that addressing the spine improves clinical outcomes. This review aimed to evaluate screening methods for the cervicothoracic spine in randomized controlled trials (RCTs) that evaluated and treated LET.

Methods

This review included RCTs from PubMed, CINAHL, and CENTRAL (inception to 10 June 2025) that evaluated conservative interventions for adults with a primary diagnosis of LET. Data on cervicothoracic spine screening methods were categorized into three levels: thorough (≥4 screening items), partial (1–3 items), or no screening. Frequencies reported the extent of screening across trials.

Results

A total of 2744 articles were retrieved, and 208 RCTs were included for data extraction. Four (1.9%) RCTs adequately reported a thorough cervicothoracic screening process before diagnosing LET, based on predefined screening criteria. A total of six trials (2.9%) were partially screened, while many (95.2%) reported no screening.

Discussion

Less than 2% of LET RCTs did not perform or explicitly report objective screening of the cervicothoracic region, highlighting a need for standardized screening protocols to better characterize participants in future research and clarify the role of the cervicothoracic spine in LET outcomes.