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1
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Rothschild BM. Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion, as tendon attachment-localized avulsions and stress fracture equivalents. World J Orthop 2024; 15:902-907. [DOI: 10.5312/wjo.v15.i10.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/27/2024] [Accepted: 09/13/2024] [Indexed: 10/11/2024] Open
Abstract
Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions, it seems inappropriate to attribute it to stresses related to a person’s normal activities. Conversely, sudden or unconditioned repetitive stresses appears the more likely culprit. Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy. Clinical evaluation by palpation and manipulation may be as effective as application of radiologic techniques. Recognition of the mechanical nature of the disease, including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.
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Affiliation(s)
- Bruce M Rothschild
- Department of Medicine, Indiana University Ball Memorial Hospital, Muncie, IN 47303, United States
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2
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H M N, R M, Salwan A. A Comparative Study of the Efficacy of Platelet-Rich Plasma (PRP) vs. Other Conservative Treatments for Lateral Epicondylitis. Cureus 2024; 16:e70590. [PMID: 39483595 PMCID: PMC11527516 DOI: 10.7759/cureus.70590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 10/01/2024] [Indexed: 11/03/2024] Open
Abstract
Background Lateral epicondylitis, also known as tennis elbow, is a degenerative condition that affects a significant portion of the adult population, particularly those between the ages of 35 and 55. Conventional treatments, including analgesics, physiotherapy, and bracing, often lead to a high recurrence rate. Platelet-rich plasma (PRP) therapy has emerged as a promising alternative, offering regenerative benefits that may enhance tissue healing. This study evaluates the effectiveness of PRP injections compared to traditional conservative therapies in alleviating pain and improving function in individuals with chronic lateral epicondylitis. Methods This prospective observational study was conducted at Father Muller Medical College Hospital from April 2018 to August 2019. A total of 44 patients aged 18-60 years with chronic lateral epicondylitis were randomly assigned to two groups: PRP (n = 22) and conservative treatment (n = 22). The conservative group received a combination of physiotherapy, analgesics, and a counterforce brace. The primary outcome was measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE) score, assessed at baseline, four weeks, eight weeks, three months, and six months. The PRTEE score includes pain and function subscales. Data was analyzed using appropriate statistical methods, and significance was considered at p < 0.05. Results Both groups significantly improved pain and function during the first eight weeks. However, the PRP group demonstrated superior long-term outcomes. At three and six months, the PRP group had significantly lower pain scores (26.00 ± 3.55 and 19.55 ± 3.33, respectively, p < 0.001) compared to the conservative group (32.23 ± 3.75 and 33.64 ± 3.63). Similarly, the PRP group showed better functional improvement at six months (PRTEE function subscale: 20.00 ± 3.19 in PRP vs. 30.73 ± 4.11 in conservative, p < 0.001). No complications were reported in either group. Conclusions PRP injections provide superior long-term pain relief and functional recovery compared to conservative management in patients with chronic lateral epicondylitis. While conservative treatments are effective in the short term, PRP offers a more durable solution with no reported complications. These findings support the use of PRP as a viable alternative for the long-term management of lateral epicondylitis.
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Affiliation(s)
- Naveena H M
- Orthopedics, Subbaiah Medical College and Hospital and Research Centre, Molecular Biology Virology Laboratory, Shivamogga, IND
| | - Manjunatha R
- Orthopedics, M. S. Ramaiah Medical College, Bengaluru, IND
| | - Ankur Salwan
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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3
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Songur K, Demir ZD, Baysan C, Dilek B. Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study. Arch Phys Med Rehabil 2024; 105:655-663. [PMID: 38163530 DOI: 10.1016/j.apmr.2023.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). DESIGN Randomized controlled single-blind trial. SETTING Outpatient clinic. PARTICIPANTS 159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). INTERVENTIONS One group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. MAIN OUTCOME MEASURES The primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. RESULTS Participants' mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). CONCLUSION Using either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES.
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Affiliation(s)
- Kadir Songur
- Dokuz Eylul University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
| | - Zehra Dinc Demir
- Dokuz Eylul University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Izmir, Turkey
| | - Caner Baysan
- Izmir Democracy University Faculty of Medicine, Department of Public Health, Izmir, Turkey
| | - Banu Dilek
- Dokuz Eylul University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Izmir, Turkey
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4
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Sharma S, Berwal P, Verma N, Pandey AK, Saxena S, Gamad N. Physical therapy intervention versus corticosteroid injection for lateral elbow tendinopathy. Does slow and steady win the race? - A systematic review. Shoulder Elbow 2024; 16:59-73. [PMID: 38425735 PMCID: PMC10901174 DOI: 10.1177/17585732221132545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/05/2022] [Accepted: 09/24/2022] [Indexed: 03/02/2024]
Abstract
Background Lateral elbow tendinopathy is one of the most common chronic and degenerative diseases which significantly affects quality of life and the activities of daily living of a person. The following is a systematic review reporting a comparison between physical therapy intervention and corticosteroid injection for the treatment of lateral elbow tendinopathy. Method PubMed, Web of Science, and Embase were searched using headings related to treatment options for Lateral elbow tendinopathy. The following keywords were used: lateral epicondylitis, physical therapy, and corticosteroid injection. Result We descriptively analyzed and reviewed a total of 12 studies including a total of 1253 patients for lateral elbow tendinopathy. The physical therapy intervention included interventions like electrotherapy, manual therapy, and exercise. The studies included had an overall low to unknown risk of bias. Conclusion Our review suggests corticosteroid injection provides beneficial short-term effects and physical therapy interventions provide intermediate to long-term effects, less additional treatment and low recurrence rate in patients with lateral elbow tendinopathy. Although high-quality randomized control trials are required in order to have a better understanding of both intervention types.
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Affiliation(s)
- Shivam Sharma
- Department of Physical and Rehabilitation Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prerana Berwal
- Department of Physical and Rehabilitation Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishank Verma
- Department of Physical and Rehabilitation Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Avaneesh Kumar Pandey
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Somya Saxena
- Department of Physical and Rehabilitation Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nanda Gamad
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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5
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Lin Z, Lin F, Lin J. A commentary on "Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials" (Int J Surg 2019;67:37-46). Int J Surg 2022; 108:106983. [PMID: 36379424 DOI: 10.1016/j.ijsu.2022.106983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Zhou Lin
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China Department of Gastroenterology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, PR China
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Karjalainen TV, Ponkilainen V, Chong A, Johnston RV, Le TLA, Lähdeoja TA, Buchbinder R. Glucocorticoid injections for lateral elbow pain. Hippokratia 2022. [DOI: 10.1002/14651858.cd001978.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Teemu V Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
- Department of Surgery; Central Finland Hospital Nova; Jyvaskyla Finland
| | - Ville Ponkilainen
- Department of Surgery; Central Finland Hospital Nova; Jyvaskyla Finland
| | - Alphonsus Chong
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- Department of Hand and Reconstructive Microsurgery; National University Hospital; Singapore Singapore
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
| | - Thi Lan Anh Le
- Department of Hand and Reconstructive Microsurgery; National University Hospital; Singapore Singapore
| | - Tuomas A Lähdeoja
- Finnish Center of Evidence based Orthopaedics (FICEBO); University of Helsinki; Helsinki Finland
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
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7
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Effects of splinting and three injection therapies (corticosteroid, autologous blood and prolotherapy) on pain, grip strength, and functionality in patients with lateral epicondylitis. Turk J Phys Med Rehabil 2022; 68:205-213. [PMID: 35989952 PMCID: PMC9366475 DOI: 10.5606/tftrd.2022.8007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/03/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to compare the efficacy of the wrist splint and the injection of corticosteroid, autologous blood, and hypertonic dextrose in the treatment of lateral epicondylitis (LE).
Patients and methods
A total of 120 patients (43 males, 77 females; mean age: 45.7±7.7 years; range, 18 to 65 years) diagnosed with LE between December 2013 and June 2015 were included in the study and randomized into four groups. The first group was administered 20 mg methylprednisolone acetate + 2 mL 2% prilocaine, the second group 2 mL venous blood + 0.5 mL prilocaine, and the third group 2 mL 30% dextrose + 0.5 mL prilocaine injections. A second injection was administered to the third group one month later. The fourth group was recommended to use only a wrist splint. Pre-treatment and post-treatment evaluations of the patients were carried out at one and six months by the Visual Analog Scale (VAS) in terms of pain, by Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire in terms of functional level, and by the Jamar dynamometer in terms of grip strength.
Results
In all groups, VAS values at one and six months after treatment were found to be lower in comparison to baseline. Except for the splint group, a significant improvement was observed in all three injection groups in terms of grip strength and PRTEE values at six months compared to the baseline values. In the comparison of the groups, no significant difference was observed in terms of improvement in VAS scores and grip strength. While corticosteroid injection was significantly effective in terms of PRTEE pain, function, and total scores only at one month, the autologous injection was effective in terms of PRTEE function and total scores at only six months after treatment. There were no significant differences for splint and prolotherapy groups in terms of PRTEE scores.
Conclusion
Corticosteroid injection, autologous blood injection, and prolotherapy are effective and safe long-term methods in LE treatment.
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Ibrahim NH, El Tanawy RM, Mostafa AFS, Mahmoud MF. Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00081-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lateral epicondylitis is one of the commonly noticed disorders of the arm described by agony focused over lateral epicondyle which is the site of wrist extensors origin. The purpose of this work was to compare the efficiency of extracorporeal shock wave therapy and local corticoid injection in management of lateral epicondylitis both clinically and ultrasonographically as well as to assess the role of ultrasound in diagnosis and follow-up of lateral epicondylitis. This study was performed on 30 athletes diagnosed as lateral epicondylitis.
Results
Both corticosteroid injection and shock wave treatment showed a highly significant effectiveness on pain by visual analog scale (VAS). A highly significant difference between before treatment and after 2 as well as 4 weeks of treatment regarding the functional disability parameters as patient-rated tennis elbow evaluation (PRTEE) and quick disabilities of the arm, shoulder, and hand (DASH) was found. Likewise, a statistically significant improvement in favor of shock wave therapy group after 2 weeks was found, inversely insignificant difference after 8 and 12 weeks regarding to VAS occurred. Both PRTEE and Quick DASH test showed a statistically significant difference among groups through all follow-up period.
There was a statistically insignificant difference among the studied groups according to ultrasound (US) changes in the form of focal areas of hypo-echogenicity through follow-up periods. A significant improvement in favor of ESWT group is detected among the studied groups regarding tendon thickening in ultrasonography before treatment and after 2 and 4 weeks. However, the difference was insignificant after 8 and 12 weeks.
Conclusions
Both corticosteroid local injection and shock wave therapy are helpful and effective for lateral epicondylitis treatment. However, a shock wave therapy revealed better improvement on long-term clinical and ultrasonogrphic follow-up than corticosteroid injection. Musculoskeletal ultrasound represents a helpful diagnostic and follow-up tool for lateral epicondylitis.
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Defoort S, De Smet L, Brys P, Peers K, Degreef I. Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy. HAND SURGERY & REHABILITATION 2021; 40:263-267. [PMID: 33636381 DOI: 10.1016/j.hansur.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
Lateral elbow pain caused by tendinopathy - tendinosis - or tennis elbow is a highly prevalent problem. Unfortunately, no treatment method can guarantee clinical success. Inspired by the lithotripsy technique used for kidney stones, extracorporeal shock wave therapy (ESWT) has been introduced as an alternative to surgical treatment 25 years ago. In a randomized prospective study, we compared 15 patients with lateral elbow tendinopathy who were operated and 14 who underwent ESWT. Almost all patients had good or excellent outcomes according to the criteria by Verhaar. Subjective improvement was 57% for the ESWT group and 76% for the surgery group. No significant differences between both groups were found (p = 0.07). We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.
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Affiliation(s)
- S Defoort
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - L De Smet
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - P Brys
- Department of Radiology, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - K Peers
- Department of Physical Medicine and Rehabilitation, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - I Degreef
- Orthopedic Surgery Department - Hand Unit, KU Leuven-University of Leuven, Leuven University Hospitals, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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11
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Ikemoto RY, Almeida LHO, Motta GGB, Kim ASM, Lial CVN, Claros JJ. Comparative Study between Scales: Subjective Elbow Value and Patient-rated Tennis Elbow Evaluation Applied to Patients Affected by Lateral Epicondylitis. Rev Bras Ortop 2020; 55:564-569. [PMID: 33093720 PMCID: PMC7575381 DOI: 10.1055/s-0039-3402465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/28/2019] [Indexed: 11/16/2022] Open
Abstract
Objective
To verify if the subjective elbow value (SEV) scale presents similar results to those of the Patient-rated Tennis Elbow Evaluation (PRTEE) scale in the evaluation of patients with lateral elbow epicondylitis (LEE).
Methods
Thirty-seven patients were diagnosed with LEE in the outpatient service of our hospital through clinical history, physical examination, X-ray, and ultrasonography. The SEV and PRTEE scales were used and their results were compared using a significance level ≥ 5% (
p
≥0.05).
Results
A statistically significant relationship was found between the values of SEV and PRTEE in the group of patients studied (
p
= 0.017).
Conclusion
Subjective elbow value presented similar results to PRTEE in the evaluation of patients with diagnosis of LEE.
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Affiliation(s)
| | | | | | | | | | - Johny James Claros
- Serviço de Ortopedia e Traumatologia, Hospital Ipiranga, São Paulo, SP, Brasil
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Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2064781. [PMID: 32309425 PMCID: PMC7106907 DOI: 10.1155/2020/2064781] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 11/17/2022]
Abstract
Background Lateral epicondylitis (LE) is a common elbow problem. Extracorporeal shock wave therapy (ESWT) was widely used in the treatment of LE and has been shown to relieve the pain and functional impairment (loss of grip strength) caused by tennis elbow. However, the evidence with regard to whether ESWT has better clinical efficacy over other method is not clear. The aim of the study was to compare the effectiveness of ESWT with other techniques in the treatment of LE. Methods Literature searches of PubMed, OVID, Embase, Cochrane Library, and Web of Science were searched up to 30th June, 2019. Only RCTs comparing ESWT with other methods for LE were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results A total of 13 articles with 1035 patients were included. Of which, 501 underwent ESWT and 534 underwent other methods. The result of meta-analysis showed that pooled VAS (P = 0.0004) and grip strength (P < 0.00001) were better in the ESWT group. Conclusion Based on the existing clinical evidence, extracorporeal shock wave therapy can effectively relieve the pain and functional impairment (loss of grip strength) caused by tennis elbow, with better overall safety than several other methods. However, owing to the limited quality and quantity of the included studies, more high-quality RCTs are needed to support the trend towards better functional outcomes with ESWT.
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Testa G, Vescio A, Perez S, Petrantoni V, Mazzarella G, Costarella L, Pavone V. Functional Outcome at Short and Middle Term of the Extracorporeal Shockwave Therapy Treatment in Lateral Epicondylitis: A Case-Series Study. J Clin Med 2020; 9:E633. [PMID: 32120893 PMCID: PMC7141112 DOI: 10.3390/jcm9030633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/16/2022] Open
Abstract
Lateral epicondylitis (LE) of the humerus is a chronic degeneration of wrist extensor tendons at their attachments to the lateral epicondyle of the humerus. There is not a common consensus on a specific therapeutic algorithm, but Extracorporeal Shockwave Therapy (ESWT) is widely used. The purpose of this study is to evaluate the clinical benefits of low dose ESWT in LE-affected patients in short and medium follow-up. Between January 2015 and December 2017, 60 patients (38 male, mean age 52.2 ± 10.1 years, the duration of the disease was 3.6 ± 1.3 months) were clinically evaluated using visual analog scale (VAS) and Patient Rated Tennis Elbow Evaluation Test (PRTEE-I) scores before treatment, at one, three, six and 12 months after treatment. According to the VAS and PRTEE-I scoring systems, all patients achieved an improvement of pain and functional outcome comparing the baseline results with one, six and 12 months values. Low dose ESWT is a safe and effective treatment of LE in the short and middle term. In elderly subjects, patients with a long disease history, or those with occupational and sportive risk factors, a longer persistence of the symptomatology could be observed.
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Affiliation(s)
| | | | | | | | | | | | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (G.T.); (A.V.); (S.P.); (V.P.); (G.M.); (L.C.)
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14
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Testa G, Vescio A, Perez S, Consoli A, Costarella L, Sessa G, Pavone V. Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review. J Clin Med 2020; 9:E453. [PMID: 32041301 PMCID: PMC7074316 DOI: 10.3390/jcm9020453] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Rotator cuff tendinopathy (RCT), subacromial impingement (SAIS), and medial (MEP) and lateral (LEP) epicondylitis are the most common causes of upper limb pain caused by microtrauma and degeneration. There are several therapeutic choices to manage these disorders: extracorporeal shockwave therapy (ESWT) has become a valuable option. METHODS A systematic review of two electronic medical databases was performed by two independent authors, using the following inclusion criteria: RCT, SAIS, MEP, and LEP, ESWT therapy without surgical treatment, with symptoms duration more than 2 months, and at least 6 months of follow-up. Studies of any level of evidence, reporting clinical results, and dealing with ESWT therapy and RCT, SAIS, MEP, and LEP were included. RESULTS A total of 822 articles were found. At the end of the first screening, following the previously described selection criteria, we selected 186 articles eligible for full-text reading. Ultimately, after full-text reading, and reference list check, we selected 26 articles following previously written criteria. CONCLUSIONS ESWT is a safe and effective treatment of soft tissue diseases of the upper limbs. Even in the minority cases when unsatisfied results were recorded, high energy shockwaves were nevertheless suggested in prevision of surgical treatment.
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Affiliation(s)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (S.P.); (A.C.); (L.C.); (G.S.); (V.P.)
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Girgis B, Duarte JA. Efficacy of physical therapy interventions for chronic lateral elbow tendinopathy: a systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1695355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Beshoy Girgis
- CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal
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Duncan J, Duncan R, Bansal S, Davenport D, Hacker A. Lateral epicondylitis: the condition and current management strategies. Br J Hosp Med (Lond) 2019; 80:647-651. [DOI: 10.12968/hmed.2019.80.11.647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lateral epicondylitis or tennis elbow is a common condition estimated to affect between 1 and 3% of adults. As a result of its high prevalence, both primary and secondary care physicians are frequently presented with this problem, so knowledge of its presentation and up-to-date management strategies is essential. This review collates the most recent evidence on lateral epicondylitis to help the clinician perform assessments and make treatment decisions, based on the best current clinical practice.
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Affiliation(s)
- James Duncan
- Trauma and Orthopaedic Specialist Registrar, Department of Trauma and Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LD
| | - Robert Duncan
- Foundation Year Doctor, Department of Acute Medicine, Weston Area Health NHS Trust, Weston-super-Mare
| | - Saksham Bansal
- Final Year Medical Student, University of Birmingham Medical School, Birmingham
| | - Dominic Davenport
- Trauma and Orthopaedic Specialist Registrar, Department of Trauma and Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London
| | - Andrew Hacker
- Trauma and Orthopaedic Upper Limb Consultant, Department of Trauma and Orthopaedic Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes
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Cutts S, Gangoo S, Modi N, Pasapula C. Tennis elbow: A clinical review article. J Orthop 2019; 17:203-207. [PMID: 31889742 DOI: 10.1016/j.jor.2019.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/09/2019] [Indexed: 01/26/2023] Open
Abstract
Lateral epicondylitis, or tennis elbow is a common condition that presents with pain and tenderness around the common extensor origin of the elbow. Tennis elbow is estimated to affect 1-3% of the adult population each year and is more common in the dominant arm. It is generally regarded as an overuse injury involving repeated wrist extension against resistance, although it can occur as an acute injury (trauma to the lateral elbow). Up to 50% of all tennis players develop symptoms due to various factors including poor swing technique the use of heavy racquet. It's also seen in labourers who utilise heavy tools or engage in repetitive gripping or lifting task. In this article, we discuss the existing literature in the field and the current thinking on optimum treatment modalities. We have reviewed the literature available on med line and have discussed the condition with our specialist colleagues in the field.
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Affiliation(s)
- S Cutts
- James Paget Hospital, United Kingdom
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Efficacy of extracorporeal shockwave therapy in patients with lateral epicondylitis: A randomized, placebo-controlled, double-blind clinical trial. North Clin Istanb 2019; 5:314-318. [PMID: 30859161 PMCID: PMC6371991 DOI: 10.14744/nci.2017.82435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/09/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Lateral epicondylitis is a common elbow problem. Although extracorporeal shockwave therapy (ESWT) is widely used in the treatment of lateral epicondylitis, its efficacy is still controversial. Moreover, the number of prospective, randomized, controlled studies in the literature is not sufficient. Here, we intend to investigate the efficacy of ESWT. METHODS: The study was randomized, placebo-controlled, double-blind, and prospectively planned. Forty patients who met the inclusion criteria were divided into two groups, real ESWT (Group 1, n=20) and placebo ESWT (Group 2, n=20), in a 1: 1 randomized closed envelope manner. Patients were evaluated for Patient-Rated Tennis Elbow Evaluation-Turkish Version (PRTEE-T), visual analog scale (VAS) pain scores, and grip and pinching strengths. The evaluation were performed thrice before, at the end of treatment and 1 month after treatment. Both groups were treated with wrist splinting, ice treatment, and rest. RESULTS: There was no statistical difference between sex and dominant hand in both groups. There was no significant difference in the grasp and pinching strength between the measurements of the groups themselves (p>0.05). When examined in terms of VAS scores, only significant changes were found in the actual ESWT group (p<0.05). According to the PRTEE-T scores, both groups showed significant changes (p<0.05). No significant difference was found between post-treatment and control measures in the grip and pinching power between groups, VAS and PRTEE-T scores before treatment (p>0.05). CONCLUSION: Although pain and functional improvement were more prominent in our patients treated with ESWT than placebo, no statistically significant results were found.
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Martínez-Carbonell Guillamón E, Burgess L, Immins T, Martínez-Almagro Andreo A, Wainwright TW. Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review. BMC Geriatr 2019; 19:52. [PMID: 30795740 PMCID: PMC6387499 DOI: 10.1186/s12877-019-1065-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND According to the World Health Organization, the elderly are at the highest risk of injury or death from a fall. Age-related changes in strength, balance and flexibility are degenerative factors that may increase the risk of falling, and an aquatic training may offer a favourable environment to improve these modifiable risk factors. METHODS A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors. Electronic databases and reference lists of pertinent articles published between 2005 and 2018 were searched. Randomized controlled trials (RCTs) that directly or indirectly addressed the effect of aquatic exercise for the prevention of falls in healthy participants were included within the synthesis. Studies were included if they were reported between January 2005 and May 2018 within a population aged between 60 and 90 years old that were without exercise-effecting comorbidities. Data related to participant demographics, study design, methodology, interventions and outcomes was extracted by one reviewer. Methodological quality assessment was independently performed by two reviewers using the PEDro (Physiotherapy Evidence Database) scale. RESULTS Fourteen trials met the inclusion criteria. Exercise intervention duration and frequency varied from 2 to 24 weeks, from 2 to 3 times per week, from 40 to 90 min per session. Fall rate was not reported in any of the studies analysed. However, aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling. CONCLUSIONS There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.
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Affiliation(s)
- Eduardo Martínez-Carbonell Guillamón
- Faculty of Health Science, Catholic University of Murcia, UCAM, Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Louise Burgess
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Andrés Martínez-Almagro Andreo
- Faculty of Health Science, Catholic University of Murcia, UCAM, Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
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20
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Kroslak M, Pirapakaran K, Murrell GAC. Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. J Shoulder Elbow Surg 2019; 28:288-295. [PMID: 30658774 DOI: 10.1016/j.jse.2018.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Counterforce bracing is one of the common treatment modalities for tennis elbow. The objective of this study was to determine whether counterforce bracing offers any additional benefit over placebo bracing in the treatment of tennis elbow. METHODS This prospective, randomized, double-blinded, placebo-controlled clinical trial investigated the use of counterforce bracing (n = 17) compared with placebo bracing (n = 14) in the management of acute tennis elbow. Outcome measures included patient-rated pain and functional outcomes, epicondyle tenderness, and strength at 6 months and long term. Follow-up occurred at 2, 6, 12, and 26 weeks, as well as long term (mean follow-up, 3 years). The study duration was 5 years. RESULTS The 2 groups, counterforce and placebo, were similar in age, sex, hand dominance, and duration of symptoms. Both braces improved patient-rated pain frequency and severity (P < .01), difficulty with picking up objects and twisting motions, and overall elbow function (P < .001) at 6 months and 3 years. Both braces also improved lateral epicondyle tenderness, grip strength (P < .01), and modified ORI-TETS (Orthopaedic Research Institute-Tennis Elbow Testing System) force (P < .05) at 6 months. Significant intergroup differences were detected for frequency of pain at rest at 6 and 12 weeks (P < .05), level of pain at rest at 2 weeks (P < .001), and patient-rated overall elbow function at 26 weeks (P = .041). CONCLUSION The counterforce brace provides significant reduction in the frequency and severity of pain in the short term (2-12 weeks), as well as overall elbow function at 26 weeks, compared with the placebo brace.
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Affiliation(s)
- Martin Kroslak
- Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Kajan Pirapakaran
- Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia.
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21
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Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB. Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis. J Shoulder Elbow Surg 2019; 28:112-119. [PMID: 30551782 DOI: 10.1016/j.jse.2018.08.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Medial epicondylitis and lateral epicondylitis are among the most common elbow pathologies affecting people aged between 40 and 50 years. Although epicondylitis is often a self-limiting condition that improves with conservative treatment, the condition can be difficult to eradicate. The purpose of this study was to compare the effectiveness of platelet-rich plasma (PRP) injections and ultrasound-guided percutaneous tenotomy (Tenex) for the treatment of medial or lateral epicondylitis. Our hypothesis was that the Tenex procedure would not be inferior to PRP injections in the treatment of medial or lateral epicondylitis. METHODS In this retrospective review, 62 of 75 patients were available for contact via phone and e-mail to complete post-procedure patient-reported outcome surveys. Subjective assessment of pain and function included a visual analog scale for pain; the Quick Disabilities of the Arm, Shoulder and Hand questionnaire; and the EuroQol-5D questionnaire. The inclusion criteria included age of 18 years or older and previous failure of nonoperative treatment. RESULTS The average ages in the PRP and Tenex groups were 47 years and 51 years, respectively. The PRP cohort (n = 32) included 10 female and 22 male patients, whereas the Tenex cohort (n = 30) included 12 female and 18 male patients. The PRP and Tenex groups both demonstrated clinical and statistical improvement in visual analog scale pain scores; Quick Disabilities of the Arm, Shoulder and Hand scores; and EuroQol-5D scores. No statistically significant difference was found between the 2 treatment modalities. CONCLUSION The PRP and Tenex procedures were both successful in producing clinically and statistically significant improvements in pain, function, and quality of life.
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22
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Akkurt HE, Kocabaş H, Yılmaz H, Eser C, Şen Z, Erol K, Göksu H, Karaca G, Baktık S. Comparison of an epicondylitis bandage with a wrist orthosis in patients with lateral epicondylitis. Prosthet Orthot Int 2018; 42:599-605. [PMID: 29806569 DOI: 10.1177/0309364618774193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Lateral epicondylitis is one of the most common causes of elbow pain. It is generally observed in people between the ages of 40 and 50 years, and the dominant extremity is more frequently affected. Various noninvasive methods are frequently used; however, studies investigating the effectiveness of the orthoses are limited and with controversial outcomes. OBJECTIVE: To investigate the effectiveness of a hand-wrist resting orthosis and an epicondylitis bandage in lateral epicondylitis. STUDY DESIGN: Randomized controlled trial. METHODS: In total, 82 patients diagnosed with unilateral lateral epicondylitis were enrolled into the study. Hand-wrist resting orthosis was applied to 45 patients and epicondylitis bandage was applied to 41 patients. Patients were evaluated before treatment and at 6 weeks after treatment with a Visual Analogue Scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form 36; and a determination of hand grasping force. RESULTS: Both groups were similar in terms of age, body mass index, gender, frequency of lateral epicondylitis on the dominant side, dominant extremity, and duration of complaints ( p > 0.05). A statistically significant recovery was detected in both groups between the pre-therapy values and the values at the sixth week in terms of Visual Analogue Scale scores; Disabilities of the Arm, Shoulder, and Hand questionnarie scores; hand grasping forces; and the Short Form 36 mental and physical component scores ( p < 0.05). However, there were no significant differences detected between the two therapy methods before the therapy and at the sixth week of treatment in all parameter values ( p > 0.05). CONCLUSION: Our results suggest that both epicondylitis bandage and hand-wrist resting orthosis are effective treatment options for lateral epicondylitis-induced pain, functional status, muscle strength, and quality of life. Furthermore, neither treatment option was superior to the other. Large, randomized studies are necessary for more clear statements. CLINICAL RELEVANCE Epicondylitis bandage and hand-wrist resting orthosis are equally effective treatment options for lateral epicondylitis-induced pain, functional status, muscle strength, and quality of life.
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Affiliation(s)
| | - Hilal Kocabaş
- 2 Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Halim Yılmaz
- 1 Konya Education and Research Hospital, Konya, Turkey
| | - Cemile Eser
- 1 Konya Education and Research Hospital, Konya, Turkey
| | - Zafer Şen
- 1 Konya Education and Research Hospital, Konya, Turkey
| | - Kemal Erol
- 1 Konya Education and Research Hospital, Konya, Turkey
| | - Hamit Göksu
- 1 Konya Education and Research Hospital, Konya, Turkey
| | - Gülten Karaca
- 3 Faculty of Medicine, Kırıkklale University, Kırıkklale, Turkey
| | - Süleyman Baktık
- 2 Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Mamais I, Papadopoulos K, Lamnisos D, Stasinopoulos D. Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review. Laser Ther 2018; 27:174-186. [PMID: 32158063 PMCID: PMC7034252 DOI: 10.5978/islsm.27_18-or-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this umbrella review is to determine the effectiveness of LLLT in the treatment of LET and to provide recommendations based on this evidence. METHODS A comprehensive and systematic review was undertaken using Medline, EBSCO and EMBASE. Systematic reviews or meta-analysis were included if they compared Laser with at least one of the following: (i) placebo, (ii) no treatment, (iii) another treatment, conservative (physical therapy intervention or medical) or operative of LET. Principal outcomes included the assessment of short and long-term effect on functional status, pain, grip strength (pain-free or maximum) and a global measure (overall improvement). RESULTS Seven papers met the inclusion criteria for the umbrella review, Five papers were of moderate and two of low methodological quality. All reviews reported benefits associated with laser therapy Vs other intervention or placebo, however the significance of the identified benefits differed between studies and reviews. No review reported negative effects of laser therapy or harm to patients. All reviews noted significant variance between included studies with 2 reviews citing statistically significant heterogeneity. It is essential to consider this in the interpretation of these data. CONCLUSION This umbrella review found poor results for the effectiveness of LLLT in the management of LET. Therefore, further research with well-designed RCTs is required to provide meaningful evidence on the effectiveness (absolute and relative) of LLLT for the management of LET.
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Affiliation(s)
- Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Konstantinos Papadopoulos
- Department of London Sports Institute, Science and Technology School, Middlesex University of London
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Demetrios Stasinopoulos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
- Director of Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTREC)
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24
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Cho YT, Hsu WY, Lin LF, Lin YN. Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study. BMC Musculoskelet Disord 2018; 19:193. [PMID: 29921250 PMCID: PMC6010177 DOI: 10.1186/s12891-018-2118-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022] Open
Abstract
Background Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to apply in the sport field. In this study we valued the effectiveness of Kinesio taping (KT) on immediate pain control for patients with chronic lateral epicondylitis. Methods We conducted a randomized, double-blinded, cross-over study with 15 patients with chronic lateral epicondylitis. All participants received two taping sessions in a random order with a 3-day interval in between: one with KT and the other with sham taping (ST). Pain perceived during resisted wrist extension and at rest using numeric rating scale (NRS), the pain-free grip strength, and the pressure pain threshold, were measured before and 15 min after the tape was applied. Results A significant reduction of 2.1 ± 1.6 (Z = − 3.081, P = 0.002) and 0.7 ± 0.8 (Z = − 2.428, P = 0.015) was found on a NRS with KT and ST, respectively, indicating that both taping sessions produced immediate pain relief for resisted wrist extension. Both taping sessions significantly improved the pain-free grip strength with increases of 3.31 ± 5.05 (Z = − 2.615, P = 0.009) and 2.43 ± 3.31 (Z = − 2.783, P = 0.005) kg found with KT and ST, respectively. Compared with ST, KT exhibited superiority in controlling pain experienced during resisted wrist extension (Z = − 2.168, P = 0.030). Conclusions Taping produced unneglectable placebo effects on pain relief and painf-free grip strength for patients with lateral epicondylitis, and KT seemed to have additional effects on controlling pain that was elicited by resisted wrist extension. Trial registration ISRCTN13618356 (retrospectively registered on 13/02/2017).
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Affiliation(s)
- Yen-Ting Cho
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, No.111, Hsing-Long Road, Section 3, Taipei, 116, Taiwan
| | - Wen-Yen Hsu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, No.111, Hsing-Long Road, Section 3, Taipei, 116, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, No.111, Hsing-Long Road, Section 3, Taipei, 116, Taiwan. .,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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25
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Pompilio da Silva M, Tamaoki MJS, Blumetti FC, Belloti JC, Smidt N, Buchbinder R. Electrotherapy modalities for lateral elbow pain. Hippokratia 2018. [DOI: 10.1002/14651858.cd013041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Milla Pompilio da Silva
- Universidade Federal de São Paulo; Department of Orthopaedics and Traumatology; R. Borges Lagoa, 783 - 5º Andar ? Vila Clementino São Paulo Brazil 04032-038
| | - Marcel JS Tamaoki
- Universidade Federal de São Paulo; Department of Orthopaedics and Traumatology; R. Borges Lagoa, 783 - 5º Andar ? Vila Clementino São Paulo Brazil 04032-038
| | - Francesco C Blumetti
- Universidade Federal de São Paulo; Department of Orthopaedics and Traumatology; R. Borges Lagoa, 783 - 5º Andar ? Vila Clementino São Paulo Brazil 04032-038
| | - João Carlos Belloti
- Universidade Federal de São Paulo; Department of Orthopaedics and Traumatology; R. Borges Lagoa, 783 - 5º Andar ? Vila Clementino São Paulo Brazil 04032-038
- Escola Paulista de Medicina; São Paulo Brazil
| | - Nynke Smidt
- University Medical Center Groningen, University of Groningen; Department of Epidemiology; Hanzeplein (Entrance 24) Groningen Groningen Netherlands PO Box 30.001, 9700 RB
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute; 4 Drysdale Street Malvern Victoria Australia 3144
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Marwaha V, Pawah AK, Muthukrishnan J, Kumar KVSH. Combined steroid and lignocaine injection in resistant cases of tennis elbow: A prospective, interventional study from India. J Family Med Prim Care 2018; 6:498-501. [PMID: 29416996 PMCID: PMC5787943 DOI: 10.4103/2249-4863.222032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tennis elbow or lateral epicondylitis is a chronic, painful condition and is often resistant to conventional therapy. We evaluated the benefits of a combined steroid and lignocaine injection in resistant cases of tennis elbow. Materials and Methods In this prospective, interventional study, we included chronic lateral epicondylitis patients resistant to analgesics and physiotherapy. The pain was assessed by visual analog scale (VAS), and we included patients with a baseline VAS >4. All patients were given local infiltration at the painful site with methylprednisolone (1 ml) and lignocaine (1 ml) by the peppering technique. The primary outcome was the change in VAS from the baseline at the end of 7 and 28 days. The improvement is classified as good, moderate, or mild based on the reduction in VAS score by 3, 2, 1, respectively. Descriptive statistics and appropriate tests were used to analyze the results. Results The study population (n = 63; male: female - 33:30) had a mean age of 36.2 ± 4.5 years and disease duration of 17.4 ± 5.8 weeks. After 1 week, 55 patients showed good improvement, three patients showed moderate improvement, two patients showed mild improvement, and three patients had no improvement. The improvement persisted till 28 days in all the patients and one patient who had not improved after 7 days did not report for 28 days follow-up. Conclusion Local infiltration with steroids and lignocaine is a useful modality of therapy for tennis elbow, especially in patients where ultrasonic therapy and conservative measures have failed.
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Affiliation(s)
- Vishal Marwaha
- Department of Rheumatology, Amrita University, School of Medicine, Kochi, Kerala, India
| | - A K Pawah
- Department of Medicine, Mayo Institute of Medical Science, Barabanki, Uttar Pradesh, India
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Systematic Review of Assessments That Evaluate Clinical Decision Making, Clinical Reasoning, and Critical Thinking Changes After Simulation Participation. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/jte.0000000000000011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rawal M, Vaishya R, Bachchu Ram K, Chand P, Verma G, Rokaya PK, Chhetri S. Comparative study of injection autologous blood and steroid injection in the treatment of tennis elbow. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J Hand Ther 2017; 30:13-19. [PMID: 27823901 DOI: 10.1016/j.jht.2016.09.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN RCT. INTRODUCTION Lateral elbow tendinopathy is a common clinical condition. eccentric exercises. eccentric-concentric loading and, isometric exercises are indicated to reduce and manage tendon pain. PURPOSE OF THE STUDY To compare the effectiveness of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. METHODS A randomized clinical trial was carried out in a rheumatology and rehabilitation center. A group of 34 patients with later elbow tendinopathy was randomly allocated to Group A (n = 11) who underwent eccentric training, Group B had eccentric-concentric and Group C who had eccentric-concentric and isometric training. All patients received 5 treatments per week for 4 weeks. Pain was evaluated using a visual analog scale and function using a visual analog scale and pain-free grip strength at the end of the 4-week course of treatment (week 4) and 1 month (week 8) after the end of treatment. RESULTS The eccentric-concentric training combined with isomentric contractions produced the largest effect in the reduction of pain and improvement of function at the end of the treatment (P < .05) and at any of the follow-up time points (P < .05). CONCLUSION The eccentric-concentric training combined with isomentric contractions was the most effective treatment. Future well-designed studies are needed to confirm the results of the present trial. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dimitrios Stasinopoulos
- Department of Health Sciences, Physiotherapy Program, School of Sciences, European University Cyprus, Nicosia, Cyprus.
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Mattie R, Wong J, McCormick Z, Yu S, Saltychev M, Laimi K. Percutaneous Needle Tenotomy for the Treatment of Lateral Epicondylitis: A Systematic Review of the Literature. PM R 2016; 9:603-611. [PMID: 27780771 DOI: 10.1016/j.pmrj.2016.10.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/27/2016] [Accepted: 10/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the literature to determine whether controlled studies on percutaneous tenotomy have been published, and if so, to systematically assess the efficacy of percutaneous tenotomy for the treatment of tendinosis at the lateral epicondyle of the elbow. DESIGN Systematic review of the available literature. METHODS Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, CINAHL, and Web of Science databases were searched in November 2015, unrestricted by date. After the initial search, we excluded conference proceedings, theses, reviews, expert opinions, and publications written in languages other than English. Next, 2 independent reviewers screened all of the remaining records with regard to their titles and abstracts, and subsequently, the full texts of identified publications potentially relevant to the present study. RESULTS Six articles focused on percutaneous tenotomy, none of which were controlled against a placebo or conservative treatment group. The absence of true randomized controlled trials created a great deal of heterogeneity between the studies; thus we could not include any of our studies in the intended final quantitative analysis with meta-analysis tools. We describe all 6 studies identified by this systematic review with a detailed analysis of the procedural methods, outcome measures, and conclusions of each study. CONCLUSIONS Percutaneous tenotomy presents an alternative to surgical release of the common extensor tendon for the treatment of chronic tendinosis at the lateral epicondyle of the elbow. Current research supporting the efficacy of this procedure, however, is of low quality (level II to level IV). LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ryan Mattie
- Division of PM&R, Department of Orthopedic Surgery, Stanford University, Redwood City, CA; Stanford University Hospital & Clinics, 450 Broadway Street, Pavilion C, MC 6342, Redwood City, CA 94063(∗).
| | - Joseph Wong
- Division of PM&R, Department of Orthopedic Surgery, Stanford University, Redwood City, CA(†)
| | - Zachary McCormick
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA(‡)
| | - Sloane Yu
- Division of PM&R, Department of Orthopedic Surgery, Stanford University, Redwood City, CA(§)
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland(‖)
| | - Katri Laimi
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland(¶)
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Soeur L, Desmoineaux P, Devillier A, Pujol N, Beaufils P. Outcomes of arthroscopic lateral epicondylitis release: Should we treat earlier? Orthop Traumatol Surg Res 2016; 102:775-80. [PMID: 27591940 DOI: 10.1016/j.otsr.2016.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 05/01/2016] [Accepted: 05/30/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND When managed conservatively, lateral epicondylitis often subsides only after considerable time, during which social and occupational activities are severely disrupted. If conservative management fails, a recently introduced option is arthroscopic release of the extensor carpi radialis brevis (ECRB). The primary objective of this study was to compare clinical outcomes of this procedure according to preoperative symptom duration. HYPOTHESIS Earlier arthroscopic release is associated with better functional outcomes. MATERIAL AND METHOD Consecutive patients with arthroscopically managed lateral epicondylitis were included in a retrospective study. Arthroscopy was performed only after at least 6 months of conservative treatment. The criteria to evaluate the clinical outcomes were the Nirschl and Quick-DASH scores, muscle strength, time to pain relief, and percentage of functional recovery. RESULT Thirty-five patients were evaluated at a median of 4 years (range: 1-12 years) after surgery. Mean preoperative symptom duration was 18 months (range: 6-106 months) with a mean sick leave duration of 2.3±4.9 months. Postoperatively, mean time to recovery was 37.5 days (range: 7 days to 5 years) and mean sick leave duration was 2.4±2.4 months. The mean Quick-DASH score was 15.9±19.1. The Nirschl score improved significantly, from 26.4±7.9 to 66.3±16.3. The initial muscle strength deficit was 10.1±33.2% and muscle strength at last follow-up was increased by 4.3±30.3%. Symptom duration showed no correlations with any of the clinical outcome measures. DISCUSSION AND CONCLUSIONS Outcomes after arthroscopic release were not associated with symptom duration in this study. Nevertheless, the good clinical outcomes support treatment with arthroscopic release after only 6 months of conservative management. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- L Soeur
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Service de chirurgie orthopédique et traumatologique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Desmoineaux
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
| | - A Devillier
- Service de chirurgie orthopédique et traumatologique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - N Pujol
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - P Beaufils
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
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Choung SD, Park KN, Kim SH, Kwon OY. Comparison of muscle activity of wrist extensors and kinematics of wrist joint during wrist extension in automobile assembly line workers with and without lateral epicondylitis. Work 2016; 55:241-247. [PMID: 27612061 DOI: 10.3233/wor-162380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Overuse of the extensor carpi radialis (ECR) may play a role in the development of lateral epicondylitis (LE). However, no studies have investigated the muscle activity ratio between the ECR and extensor carpi ulnaris (ECU) associated with the kinematics during wrist extension in workers with LE. OBJECTIVE We compared the ratio (ECR/ECU) of muscle activity between the ECR and ECU and the kinematics of the wrist during wrist extension between workers with and without LE. METHODS Fifteen automobile assembly line workers with LE and 15 workers without LE participated in this study. The ratio of muscle activity was measured using surface electromyography, and wrist kinematics were measured by a three-dimensional motion analysis system while the workers extended their wrists actively to the maximum range to which they did not feel uncomfortable. RESULTS Significantly greater ratios of muscle activity, ranges of radial deviation, and combined motion of radial deviation and extension (CMDE) were shown in workers with LE compared to those without LE. Also, the range of wrist extension was significantly lower in workers with LE than in those without LE. CONCLUSIONS Quantifying the ratio of muscle activity with altered kinematics of wrist extension may help researchers to understand why overuse of ECR is occurring and explain LE development in automobile assembly line workers.
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Affiliation(s)
- Sung-Dae Choung
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Kyue-Nam Park
- Department of Physical Therapy, College of Medical Science, Jeonju University, South Korea
| | - Si-Hyun Kim
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea
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Erak S, Day R, Wang A. The Role of Supinator in the Pathogenesis of Chronic Lateral Elbow Pain: A Biomechanical Study. ACTA ACUST UNITED AC 2016; 29:461-4. [PMID: 15336750 DOI: 10.1016/j.jhsb.2004.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2004] [Accepted: 06/02/2004] [Indexed: 11/28/2022]
Abstract
The relative contributions of the forearm extensors to the tensile force at the lateral epicondyle were examined by implanting a force transducer in the common extensor tendon of four soft fixed cadaver elbows and sequentially stretching each muscle arising from the lateral epicondye. Extensor carpi radialis brevis and extensor digitorum communis produced the largest increases while the superficial head of supinator produced a moderate increase in tensile force in the common extensor tendon. Extensor carpi radialis longus and extensor carpi ulnaris had no significant effect. Radial tunnel pressure was measured using a balloon catheter in a separate study of five cadaver elbows. Radial tunnel pressure increased on moving the wrist from neutral to a flexion–pronation position. This positional rise in pressure was reduced by supinator musculotendinous lengthening (77%) while lengthening of the extensor carpi radialis brevis and extensor digitorum communis had no effect. This study demonstrates a biomechanical basis for the superficial head of supinator in the aetiology of both lateral epicondylitis and radial tunnel syndrome.
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Affiliation(s)
- S Erak
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Mandalia V, Thomas TL, Crhai R. The Analgesic Effect of Extracorporeal Shock Wave Therapy (ESWT) on Tennis Elbow, Golfer’s Elbow and Plantar Fasciitis: A Preliminary Report. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/1355297x.2002.11736155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shirato R, Wada T, Aoki M, Iba K, Kanaya K, Fujimiya M, Yamashita T. Effect of simultaneous stretching of the wrist and finger extensors for lateral epicondylitis: a gross anatomical study of the tendinous origins of the extensor carpi radialis brevis and extensor digitorum communis. J Orthop Sci 2015; 20:1005-11. [PMID: 26260257 DOI: 10.1007/s00776-015-0758-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulling the wrist into flexion with the elbow in extension and forearm in pronation has been used as the stretching technique of wrist extensors for lateral epicondylitis. Simultaneous stretching of the fingers in addition to the wrist flexion has also been applied. However, the mechanism of this simultaneous stretching has not been clarified. This study is designed to clarify the mechanism underlying this simultaneous stretching technique based on the anatomical features of the origins of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). METHODS Thirty-nine arms from formalin-embalmed Japanese human specimens were dissected. The features of the origins of the ECRB and EDC were macroscopically observed, and the locations of each origin on the lateral epicondyle were measured. RESULTS The ECRB had a long and wide, purely tendinous origin which originated from the anterior slope of the lateral epicondyle. The tendinous origin of the index finger of the EDC (EDC-IF) arose from the posterior aspect of the ECRB tendinous origin, with a coexisting muscular portion observed at the level of the proximal forearm. The middle finger of the EDC (EDC-MF) had a short tendinous origin with an associated muscular portion and originated proximo-laterally to the origin of the ECRB on the lateral epicondyle. In addition, the muscular origin of the EDC-MF arose on the superficial and posterior aspect of the ECRB tendinous origin. In contrast, the ring and little fingers of the EDC originated from the tendinous septum of the extensor digiti minimi and extensor carpi ulnaris, and had no connection with the ECRB tendinous origin. CONCLUSIONS On the basis of our anatomical findings, simultaneous stretching of the wrist extensors by wrist, index and middle fingers flexion could provide stretching force to both the tendinous origins of the ECRB and EDC through the EDC-IF and EDC-MF.
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Affiliation(s)
- Rikiya Shirato
- Department of Orthopaedic Surgery, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8556, Japan.
| | - Takuro Wada
- Department of Orthopaedic Surgery, Saiseikai Otaru Hospital, Otaru, Japan
| | - Mitsuhiro Aoki
- Department of Orthopedics, Health Science University of Hokkaido School of Rehabilitation Sciences, Ishikari, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8556, Japan
| | - Kohei Kanaya
- Department of Orthopaedic Surgery, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8556, Japan
| | - Mineko Fujimiya
- The 2nd Department of Anatomy, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, 060-8556, Japan
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Yadav R, Kothari SY, Borah D. Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus. J Clin Diagn Res 2015; 9:RC05-7. [PMID: 26393174 DOI: 10.7860/jcdr/2015/14087.6213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lateral epicondylitis or Tennis Elbow is one of the most common causes of upper extremity pain with various treatment options. Platelet-rich plasma (PRP) offers a new option for the treatment of lateral epicondylitis. This study was conducted with an aim to compare the efficacy of PRP versus methyl-prednisolone local injection in patients with lateral epicondylitis. MATERIALS AND METHODS Sixty five patients with lateral epicondylitis were included in the study and randomized into two groups. Group A was treated with single injection of 1ml PRP with absolute platelet count of at least 1 million platelets/ mm(3). Group B was treated with single injection of 1ml (40mg) methyl-prednisolone. Pain, grip strength and functional improvements were assessed using visual analogue scale, dynamometer and quick Disabilities of the Arm, Shoulder and Hand scale respectively at baseline, 15 days, 1 month and 3 months. RESULTS Sixty patients completed the follow up. All assessment parameters improved significantly in both the Groups at each follow up compared to baseline. At the end of three months group A showed significantly better improvement as compared to Group B. CONCLUSION PRP and methyl-prenisolone both are effective in the treatment of lateral epicondylitis. However, PRP is a superior treatment option for longer duration efficacy.
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Affiliation(s)
- Raman Yadav
- Post Graduate Student, Department of Physical Medicine and Rehabilitation, VMMC & Safdarjang Hospital , New Delhi, India
| | - S Y Kothari
- Professor (Rtd)., Department of Physical Medicine and Rehabilitation, VMMC & Safdarjang Hospital , New Delhi, India
| | - Diganta Borah
- Associate Professor, Department of Physical Medicine and Rehabilitation, VMMC & Safdarjang Hospital , New Delhi, India
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Gliedt JA, Daniels CJ. Chiropractic treatment of lateral epicondylitis: a case report utilizing active release techniques. J Chiropr Med 2015; 13:104-9. [PMID: 25685118 DOI: 10.1016/j.jcm.2014.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/08/2014] [Accepted: 01/17/2014] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of this report is to describe the chiropractic management of a case of lateral epicondylitis with active release techniques (ART). CLINICAL FEATURES A 48-year-old white man presented to a chiropractic clinic with a complaint of left lateral elbow pain that began 2 years previous with insidious onset. The patient reported an inability to play 18 consecutive holes of golf due to the pain. INTERVENTION AND OUTCOME Treatment consisted of 5 sessions of ART (a soft tissue technique that is applied to muscles, fascia, tendons, ligaments, and nerves) applied to the left elbow soft tissue over a duration of 3 weeks. The patient reported an absence of pain and ability to consistently play 18 consecutive holes of golf up to 3 times per week at 4 and 8 weeks post-treatment. CONCLUSION This patient with lateral epicondylitis responded favorably to chiropractic treatment using the application of ART, as demonstrated by reduced pain and increased functional outcomes.
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Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis. North Clin Istanb 2014; 1:33-38. [PMID: 28058299 PMCID: PMC5175021 DOI: 10.14744/nci.2014.77487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis. METHODS: A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed. RESULTS: Visual analog scale (VAS) scores were significantly lower (p<0.05) and grip strength significantly increased (p<0.05) one month after ESWT treatment. Overall PRTEE-T survey scores decreased significantly at first month (p<0.001) after treatment. Patient’s and physician’s global self-assessment scores were significantly lower after treatment (p<0.05). CONCLUSION: To conclude, ESWT utilization in conservative treatment of lateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.
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Lee S, Ko Y, Lee W. Changes in pain, dysfunction, and grip strength of patients with acute lateral epicondylitis caused by frequency of physical therapy: a randomized controlled trial. J Phys Ther Sci 2014; 26:1037-40. [PMID: 25140091 PMCID: PMC4135192 DOI: 10.1589/jpts.26.1037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/13/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the changes in pain, dysfunction,
and grip strength of patients with acute lateral epicondylitis and to suggest the
appropriate treatment frequency and period. [Subjects] The subjects were divided into
three: 2 days per week group (n=12), 3 days per week group (n=15), and 6 days per week
group (n=13). [Methods] All groups received conventional physical therapy for 40 minutes
and therapeutic exercises for 20 minutes per session during 6 weeks. The outcome
measurements were the visual analogue scale (VAS), Patient-Rated Tennis Elbow Evaluation
(PRTEE), and grip strength. [Results] The results of this study were as follows: at 3
weeks, there were no significant differences in VAS and PRTEE in the 3 groups, but at 6
weeks, 6 days per week group significantly decreased these two outcomes. Grip strength was
significantly increased in 3 and 6 days per week groups at 6 weeks. [Conclusion] In
conclusion, physical therapy is needed 3 days per week for 3 weeks in patients with acute
lateral epicondylitis. After 3 weeks, 6 days per week is the most effective treatment
frequency.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Youngjun Ko
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Wanhee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Abstract
Overuse injuries of the lateral and medial elbow are common in sport, recreational activities, and occupational endeavors. They are commonly diagnosed as lateral and medial epicondylitis; however, the pathophysiology of these disorders demonstrates a lack of inflammation. Instead, angiofibroblastic degeneration is present, referred to as tendinosis. As such, a more appropriate terminology for these conditions is epicondylosis. This is a clinical diagnosis, and further investigations are only performed to rule out other clinical entities after conventional therapy has failed. Yet, most patients respond to conservative measures with physical therapy and counterforce bracing. Corticosteroid injections are effective for short-term pain control but have not demonstrated long-term benefit.
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Affiliation(s)
- Michael E Pitzer
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, State College, PA 16803, USA
| | - Peter H Seidenberg
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, State College, PA 16803, USA.
| | - Dov A Bader
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, State College, PA 16803, USA
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Ellenbecker TS, Nirschl R, Renstrom P. Current concepts in examination and treatment of elbow tendon injury. Sports Health 2014; 5:186-94. [PMID: 24427389 PMCID: PMC3658379 DOI: 10.1177/1941738112464761] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to optimally design treatment programs for rehabilitation and prevention. Evidence Acquisitions: The PubMed database was searched in January 2012 for English-language articles pertaining to elbow tendon injury. Results: Detailed information on tendon pathophysiology was found along with incidence of elbow injury in overhead athletes. Several evidence-based reviews were identified, providing a thorough review of the recommended rehabilitation for elbow tendon injury. Conclusions: Humeral epicondylitis is an extra-articular tendon injury that is common in athletes subjected to repetitive upper extremity loading. Research is limited on the identification of treatment modalities that can reduce pain and restore function to the elbow. Eccentric exercise has been studied in several investigations and, when coupled with a complete upper extremity strengthening program, can produce positive results in patients with elbow tendon injury. Further research is needed in high-level study to delineate optimal treatment methods.
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Affiliation(s)
| | - Robert Nirschl
- Nirschl Orthopaedic Center for Sports Medicine and Joint Reconstruction, Arlington, Virginia
| | - Per Renstrom
- Centre for Sports Trauma Research, Karolinska Institute, Stockholm, Sweden
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Almeida MOD, Saragiotto BT, Yamato TP, Pereira RL, Lopes AD. Tratamento fisioterapêutico para epicondilite lateral: uma revisão sistemática. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000400020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: Embora o tratamento conservador ainda seja a melhor conduta inicial para a epicondilite lateral do cotovelo, há pouca evidência científica de que o tratamento fisioterapêutico altere o curso natural da doença e seja efetiva no tratamento dessa patologia. OBJETIVO: Avaliar a efetividade e a segurança das diversas intervenções fisioterapêuticas utilizadas no tratamento conservador da epicondilite lateral. MATERIAIS E MÉTODOS: Foram incluídos apenas ensaios clínicos aleatorizados e quase aleatorizados que utilizaram pelo menos uma modalidade fisioterapêutica como uma das intervenções. Foi realizada uma busca nas bases de dados eletrônicos MEDLINE; Embase; LILACS e SciELO até dezembro de 2010. Não houve restrição do período de publicação dos artigos. Com o objetivo de aumentar a sensibilidade e a precisão, a estratégia de busca utilizada foi adaptada para cada base de dados. Foi utilizada a pontuação da escala PEDro para avaliação da qualidade metodológica dos ensaios clínicos aleatorizados. RESULTADOS: 26 artigos foram incluídos na revisão sistemática e a avaliação da maioria desses artigos apresentou qualidade metodológica satisfatória (6,4 pontos). Em relação aos aspectos mensurados, todos os artigos avaliaram a dor, 18 (69%) examinaram a força de preensão e 11 (42%) a função dos pacientes. Quanto à duração do acompanhamento dos pacientes apenas nove (35%) artigos realizaram acompanhamento a longo prazo. CONCLUSÃO: A melhor opção para o tratamento da epicondilite lateral parece ser a combinação de modalidades terapêuticas, o que condiz com a realidade clínica do fisioterapeuta. Porém, mais ensaios clínicos com boa qualidade metodológica são necessários para determinar a efetividade da maioria das modalidades terapêuticas encontradas.
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Dimitrios S, Pantelis M. Comparing Two Exercise Programmes for the Management of Lateral Elbow Tendinopathy (Tennis Elbow/Lateral Epicondylitis)—A Controlled Clinical Trial. ACTA ACUST UNITED AC 2013. [DOI: 10.11131/2013/100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stasinopoulos Dimitrios
- Program of Physiotherapy Department of Health Sciences, School of Sciences European University of Cyprus 6, Diogenes Str. Engomi, P.O. Box 22006, 1516, Nicosia, Cyprus
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Cleland JA, Flynn TW, Palmer JA. Incorporation of Manual Therapy Directed at the Cervicothoracic Spine in Patients with Lateral Epicondylalgia: A Pilot Clinical Trial. J Man Manip Ther 2013. [DOI: 10.1179/106698105790824932] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up. Arch Phys Med Rehabil 2013; 94:2068-74. [PMID: 23796685 DOI: 10.1016/j.apmr.2013.05.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/26/2013] [Accepted: 05/31/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the short- and long-term effectiveness of the muscle energy technique (MET) compared with corticosteroid injections (CSIs) for chronic lateral epicondylitis (LE). DESIGN Randomized controlled trial with 1 year of follow-up. SETTING Outpatient clinic of a university's department of physical medicine and rehabilitation. PARTICIPANTS Patients with chronic LE (N=82; 45 women, 37 men). INTERVENTIONS Eight sessions of MET, or a single CSI was applied. MAIN OUTCOME MEASURES Grip strength, pain intensity, and functional status were assessed using the pain-free grip strength (PFGS), a visual analog scale (VAS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, respectively. Measurements were performed before beginning treatment and at 6, 26, and 52 weeks afterward. RESULTS When the baseline PFGS, VAS, and DASH scores were compared with the scores at the 52-week follow-up, statistically significant improvements were observed in both groups over time. The patients who received a CSI showed significantly better effects at 6 weeks according to the PFGS and VAS scores, but declined thereafter. At the 26- and 52-week follow-ups, the patients who received the MET were statistically significantly better in terms of grip strength and pain scores. At 52 weeks, the mean PFGS score in the MET group was significantly higher (75.08±26.19 vs 62.24±21.83; P=.007) and the mean VAS score was significantly lower (3.28±2.86 vs 4.95±2.36; P=.001) than those of the CSI group. Although improvements in the DASH scores were more pronounced in the MET group, the differences in DASH scores between the groups were not statistically significant. CONCLUSIONS This study showed that while both MET and CSI improved measures of strength, pain, and function compared with baseline, subjects receiving MET had better scores at 52 weeks for PFGS and the VAS for pain. We conclude that MET appears to be an effective intervention in the treatment of LE.
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Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 2013; 41:1435-46. [PMID: 22972856 DOI: 10.1177/0363546512458237] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available. PURPOSE To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis. STUDY DESIGN Systematic review and meta-analysis. METHODS Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs). RESULTS Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (-0.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to -0.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to -0.71]) and platelet-rich plasma (-1.13 [-1.77 to -0.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to -0.82]) and hyaluronic acid (-5.58 [-6.35 to -4.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0.38]) showed no effect compared with placebo. The criteria for low risk of bias were only met by the prolotherapy and polidocanol trials. CONCLUSION This systematic review and network meta-analysis of randomized controlled trials found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis.
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Jindal N, Gaury Y, Banshiwal RC, Lamoria R, Bachhal V. Comparison of short term results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study. J Orthop Surg Res 2013; 8:10. [PMID: 23621906 PMCID: PMC3701569 DOI: 10.1186/1749-799x-8-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 04/18/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has been recently reported that local injection of autologous blood in tennis elbow offers a significant benefit by virtue of various growth factors contained therein. The objective of our study was assessment of efficacy of autologous blood injection versus local corticosteroid injection in the treatment of tennis elbow. METHODS AND TRIAL DESIGN A single blinded, prospective parallel group trial was undertaken. 50 consecutive patients of untreated lateral epicondylitis were enrolled. Randomisation was done on alternate basis and two groups were constituted, first one receiving steroid injection and second one injection of autologous blood. Both groups were evaluated at 2 and 6 weeks for pain relief and stage of disease. RESULTS Baseline evaluation showed no difference between the two groups (chi square test, P > 0.05). Between group analysis at 2 weeks showed no difference in pain relief and Nirschl stage (unpaired t test, P > 0.05). Evaluation at 6 weeks demonstrated a significant decrease in pain levels and stage of disease in blood group (unpaired t test, p < 0.05). CONCLUSIONS Autologous blood injection was more effective than steroid injection in the short term follow up in tennis elbow.
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Affiliation(s)
- Nipun Jindal
- Government Medical College and Hospital, Chandigarh, India.
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Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med 2013; 126:357.e1-6. [PMID: 23398951 DOI: 10.1016/j.amjmed.2012.09.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/01/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Repetitive occupational or athletic activities involving wrist extension and supination are thought to be causative. The typical symptoms include lateral elbow pain, pain with wrist extension, and weakened grip strength. The diagnosis is made clinically through history and physical examination; however, a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies. Most patients improve with nonoperative measures, such as activity modification, physical therapy, and injections. A small percentage of patients will require surgical release of the extensor carpi radialis brevis tendon. Common methods of release may be performed via percutaneous, arthroscopic, or open approaches.
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Affiliation(s)
- Rick Tosti
- Department of Orthopaedic Surgery and Sports Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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