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Sciascia AD. Rehabilitation of the painful elbow. J Shoulder Elbow Surg 2024; 33:466-473. [PMID: 37648014 DOI: 10.1016/j.jse.2023.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
Although lateral elbow pain and medial ulnar collateral ligament injury are common musculoskeletal pathologies in overhead athletes, the evidence supporting specific interventions for managing these conditions is scarce. Management of these conditions has been guided mostly by expert opinion rather than empirical evidence, yet the lack of comparative data in the literature has not negatively affected return-to-play rates following surgery. However, an understanding of what is known regarding unimodal and multimodal treatments for lateral elbow pain and medial ulnar collateral ligament injury is needed for clinicians to select evidence-based treatment pathways and highlight what is not known to develop future high-quality investigations.
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Affiliation(s)
- Aaron D Sciascia
- Institute for Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
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Gutiérrez-Espinoza H, Estrella-Flores E, Cuyul-Vásquez I, Jorquera-Aguilera R, Francisco López-Gil J, Araya-Quintanilla F. Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study. J Sport Rehabil 2024; 33:106-113. [PMID: 38167648 DOI: 10.1123/jsr.2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/30/2023] [Accepted: 10/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. METHODS A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. RESULTS A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). CONCLUSION At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.
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Affiliation(s)
| | | | - Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | | | | | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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Kinney WR, Anderson BR. Nonoperative Management of Lateral Epicondyle Tendinopathy: An Umbrella Review. J Chiropr Med 2023; 22:204-211. [PMID: 37644995 PMCID: PMC10461134 DOI: 10.1016/j.jcm.2023.04.004] [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: 06/15/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The primary objective of this review was to summarize systematic reviews and meta-analyses reporting on nonoperative management of lateral epicondyle tendinopathy. Methods An umbrella review of all published systematic reviews and meta-analyses was performed. Three databases were searched using the key words "tennis elbow," "lateral epicondylitis," "non-operative," and "non-surgical modalities." The search was limited to English-language systematic reviews and meta-analyses between the years of 2000 and 2022. Results There were 114 systematic reviews/meta-analyses, of which 35 met our inclusion criteria. These articles reviewed the following nonoperative management strategies: ultrasound, shockwave therapy, injection procedures, low-level laser therapy, joint mobilizations, exercise therapy, and electrophysical modalities. Exercise therapy was beneficial in decreasing pain regardless of dosage or type. Conflicting results were seen with ultrasound, laser, and shockwave therapy. Corticosteroid injections provided the most short-term pain relief, and platelet-rich plasma and autologous blood injections were most effective in the long term. Conclusion A variety of nonoperative interventions were found to be effective for short- and long-term pain relief as well as functional improvement, with most interventions indicating mixed results. Due to variations in study populations and study quality, results should be interpreted with caution.
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Affiliation(s)
| | - Brian R. Anderson
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
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Karbowiak M, Holme T, Thambyrajah J, Di Mascio L. Management of lateral epicondylitis (tennis elbow). BMJ 2023; 381:e072574. [PMID: 37201946 DOI: 10.1136/bmj-2022-072574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
| | - Thomas Holme
- Royal London Hospital/Barts Health NHS Trust, London, UK
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Reuter S. [Physiotherapeutic therapy modalities for lateral epicondyopathy]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:359-364. [PMID: 37069354 DOI: 10.1007/s00132-023-04369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
Physiotherapy interventions can have a positive effect on the symptoms and relief of symptoms of lateral epicondylopathy (LE). However, there is currently no standard physiotherapy protocol for treating LE. Today, a multimodal treatment approach that focuses on progressive exercise therapy is recommended. While in the past, most treatment protocols were based on eccentric training, recent research shows that other forms of training can also improve pain and function in tendinopathies.
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Affiliation(s)
- Sven Reuter
- Campus Stuttgart, SRH Hochschule für Gesundheit, Nißlestr. 22, 70190, Stuttgart, Deutschland.
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Swinton PA, Shim JSC, Pavlova AV, Moss R, Maclean C, Brandie D, Mitchell L, Greig L, Parkinson E, Tzortziou Brown V, Morrissey D, Alexander L, Cooper K. What are small, medium and large effect sizes for exercise treatments of tendinopathy? A systematic review and meta-analysis. BMJ Open Sport Exerc Med 2023; 9:e001389. [PMID: 36865768 PMCID: PMC9972446 DOI: 10.1136/bmjsem-2022-001389] [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] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
Objective To quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains to inform future research and clinical practice through conducting a systematic review with meta-analysis. Design Systematic review with meta-analysis exploring moderating effects and context-specific small, medium and large thresholds. Eligibility criteria Randomised and quasi-randomised controlled trials involving any persons with a diagnosis of rotator cuff, lateral elbow, patellar, Achilles or gluteal tendinopathy of any severity or duration. Methods Common databases, six trial registries and six grey literature databases were searched on 18 January 2021 (PROSPERO: CRD42020168187). Standardised mean difference (SMDpre) effect sizes were used with Bayesian hierarchical meta-analysis models to calculate the 0.25 (small), 0.5 (medium) and 0.75 quantiles (large) and compare pooled means across potential moderators. Risk of bias was assessed with Cochrane's Risk of Bias tool. Results Data were obtained from 114 studies comprising 171 treatment arms 4104 participants. SMDpre effect sizes were similar across tendinopathies but varied across outcome domains. Greater threshold values were obtained for self-reported measures of pain (small=0.5, medium=0.9 and large=1.4), disability (small=0.6, medium=1.0 and large=1.5) and function (small=0.6, medium=1.1 and large=1.8) and lower threshold values obtained for quality of life (small=-0.2, medium=0.3 and large=0.7) and objective measures of physical function (small=0.2, medium=0.4 and large=0.7). Potential moderating effects of assessment duration, exercise supervision and symptom duration were also identified, with greater pooled mean effect sizes estimated for longer assessment durations, supervised therapies and studies comprising patients with shorter symptom durations. Conclusion The effect size of exercise on tendinopathy is dependent on the type of outcome measure assessed. Threshold values presented here can be used to guide interpretation and assist with further research better establishing minimal important change.
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Affiliation(s)
- Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Joanna S C Shim
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | | | - Rachel Moss
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Colin Maclean
- Library Services, Robert Gordon University, Aberdeen, UK
| | | | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Eva Parkinson
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | | | - Dylan Morrissey
- Barts and The London School of Medicine and Dentistry Blizard Institute, London, UK
| | | | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
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7
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Oya-Casero A, Muñoz-Cruzado Barba M, Madera-García M, García-LLorent R, Andrade-Ortega JA, Cuesta-Vargas AI, Roldán-Jiménez C. Effect of Supervised over Self-Performed Eccentric Exercise on Lateral Elbow Tendinopathy: A Pilot Study. J Clin Med 2022; 11:jcm11247434. [PMID: 36556050 PMCID: PMC9782553 DOI: 10.3390/jcm11247434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The efficacy of eccentric exercise self-performed by the patient has not been proved in the treatment of lateral elbow tendinopathy (LET). The aim of this study was to compare the effects of a programme of eccentric exercises applied by a physiotherapist to patients with LET through a structured manual programme compared to its self-performance, guided by an illustrated brochure. Method: A single-blind, pilot, randomised, controlled trial was conducted. Twenty patients were randomised. The intervention group carried out eccentric exercises applied directly by a physiotherapist (10 sessions). The control group carried out eccentric exercises that were self-performed by the patient (10 sessions). Both groups received simulated ultrasounds. Pain (visual analogue scale (VAS)), function (DASH questionnaire) and satisfaction (with a Likert scale) were measured at the beginning of the intervention, immediately after the intervention and 3 months after the intervention. Results: The mean age was 53.17 and 54.25 years old. The experimental group presented a greater tendency to improve function (DASH −15.91) and reduce pain (VAS −2.88) compared to the control group, although these differences were not significant (p > 0.05). Conclusion: Eccentric exercise, both performed by the physiotherapist and self-performed by the patient, improved function and pain in the patients with LET.
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Affiliation(s)
- Antonio Oya-Casero
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
| | - Miguel Muñoz-Cruzado Barba
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
| | - Manuel Madera-García
- Unidad de Rehabilitación Puerta de Andalucía, Hospital Universitario de Jaén, 23007 Jaén, Spain
| | - Rosario García-LLorent
- Unidad de Rehabilitación Puerta de Andalucía, Hospital Universitario de Jaén, 23007 Jaén, Spain
| | | | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Plataforma BIONAND, Grupo de Clinimetría (F-14), 29071 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, QLD 4000, Australia
| | - Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Plataforma BIONAND, Grupo de Clinimetría (F-14), 29071 Málaga, Spain
- Correspondence:
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Low-Load Resistance Training With Blood Flow Restriction Is Effective for Managing Lateral Elbow Tendinopathy: A Randomized, Sham-Controlled Trial. J Orthop Sports Phys Ther 2022; 52:803-825. [PMID: 36099170 DOI: 10.2519/jospt.2022.11211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To evaluate the effect of low-load resistance training with blood flow restriction (LLRT-BFR) when compared to LLRT with sham-BFR in patients with lateral elbow tendinopathy (LET). DESIGN: Randomized controlled trial. METHODS: Forty-six patients with LET were randomly assigned to a LLRT-BFR or a LLRT with sham-BFR treatment group. All patients received soft tissue massage, supervised exercises with BFR or sham intervention (twice a week for 6 weeks), advice, and a home exercise program. The primary outcome measures were pain intensity, patient-rated tennis elbow evaluation (PRTEE) score, pain-free grip strength, and global rating of change, measured at baseline, 6 weeks, and 12 weeks. Between-group differences were evaluated using mixed-effects models with participant-specific random effects for continuous data. Global rating of change was analyzed using logistic regression. RESULTS: Statistically significant between-group differences were found in favor of LLRT-BFR compared to LLRT with sham-BFR in pain intensity at 12-week follow-up (-1.54, 95% CI: -2.89 to -0.18; P = .026), pain-free grip strength ratio at 6-week follow-up (0.20, 95% CI: 0.06 to 0.34; P = .005), and PRTEE at 6- and 12-week follow-up (-11.92, 95% CI: -20.26 to -3.59; P = .006, and -15.23, 95% CI: -23.57 to -6.9; P<.001, respectively). At 6- and 12-weeks, patients in the LLRT-BFR group had greater odds of reporting complete recovery or significant improvement (OR = 6.0, OR = 4.09, respectively). CONCLUSION: Low-load resistance training with blood flow restriction produced significantly better results compared to the LLRT with sham-BFR for all primary outcomes. Considering the clinically significant between-group improvement in function (>11 points in PRTEE) and the better success rates in the LLRT-BFR group, this intervention may improve recovery in LET. J Orthop Sports Phys Ther 2022;52(12):803-825. Epub: 14 September 2022. doi:10.2519/jospt.2022.11211.
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Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther 2022; 52:CPG1-CPG111. [PMID: 36453071 DOI: 10.2519/jospt.2022.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Although often described as a self-limiting condition and likely to resolve on its own, high recurrence rates and extended sick leave frame a need for effective non-surgical treatment for people with lateral elbow tendinopathy. The interrelationship of histological and structural changes to the tendon, the associated impairments in motor control, and potential changes in pain processing may all drive symptoms. This clinical practice guideline covers the epidemiology, functional anatomy and pathophysiology, risk factors, clinical course, prognosis, differential diagnosis, tests and measures, and interventions for managing lateral elbow tendinopathy in the physical therapy clinic. J Orthop Sports Phys Ther 2022;52(12):CPG1-CPG111. doi:10.2519/jospt.2022.0302.
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Effectiveness of High-Intensity Laser Therapy Plus Ultrasound-Guided Peritendinous Hyaluronic Acid Compared to Therapeutic Exercise for Patients with Lateral Elbow Tendinopathy. J Clin Med 2022; 11:jcm11195492. [PMID: 36233361 PMCID: PMC9572841 DOI: 10.3390/jcm11195492] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 12/16/2022] Open
Abstract
Lateral elbow tendinopathy (LET) is a common painful musculoskeletal disorder. Several treatments have been proposed to provide pain reduction and functional recovery, including laser therapy, hyaluronic acid peritendinous injection (Hy-A), and therapeutic exercise (TE). Our study aims to assess the effectiveness of a combined approach with high-intensity laser therapy (HILT) and Hy-A injections compared to TE on pain, muscle strength, and disability in patients with painful LET. A retrospective longitudinal study was carried out by consulting the medical records of patients with a diagnosis of painful LET formulated by clinical and instrumental findings that received functional evaluations, including the Patient-Rated Tennis Elbow Evaluation (PRTEE) and muscle strength measurement at least four times: T0 (“baseline”), 1-month (T1), 3-month (T2), and 6-month follow-ups (T3). Medical records of 80 patients were analyzed. In the HILT + HyA group, the Peak-strength (p < 0.001) and mean strength (p < 0.001) significantly increased compared to the TE group between study times. For the PRTEE-total-score as for the subscales, the HILT + HyA group reported statistically significant reductions only for the comparisons of baseline versus T1 and baseline versus T2. No serious adverse events occurred. Our findings suggest that Hy-A associated with HILT might be more effective than TE for people with LET in the short−medium term.
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Zhu M, Rabago D, Chung VCH, Reeves KD, Wong SYS, Sit RWS. Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2022; 103:2209-2218. [PMID: 35240122 DOI: 10.1016/j.apmr.2022.01.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematic review the effectiveness of hypertonic dextrose prolotherapy (DPT) on pain intensity and physical functioning in patients with lateral elbow tendinosis (LET) compared with other active non-surgical treatments. DATA SOURCES Systematic search of CENTRAL, MEDLINE, EMBASE, Web of Science, PubMed, Dimensions, Global Health, NHS Health Technology Assessment, AMED and OVID nursing database from inception to 15 June 2021, without language restrictions. STUDY SELECTION Two reviewers independently identified parallel or cross-over RCTs that evaluated the effectiveness of DPT in LET. The search identified 245 records; data from 8 studies (354 patients) were included. DATA EXTRACTION Two reviewers independently extracted data and assessed included studies. The Cochrane Risk of Bias 2 tool was used to evaluate risk of bias. The Grading of Recommendation Assessment, Development, and Evaluation approach was used to assess quality of the evidence. DATA SYNTHESIS Pooled results favored the use of DPT in reducing tennis elbow pain intensity compared with active controls at 12 weeks post-enrollment, with standardized mean difference (SMD) of -0.44 (95% CI -0.88 to -0.01, P =0.04) and of moderate heterogeneity (I2= 49%). Pooled results also favored the use of DPT on physical functioning compared with active controls at 12 weeks, with DASH score achieving mean difference (MD) -15.04 (95% CI -20.25 to -9.82, P < 0.001) and of low heterogeneity (I2= 0.0%). No major related adverse events have been reported. CONCLUSIONS DPT is superior to active controls at 12 weeks for decreasing pain intensity and functioning by margins that meet criteria for clinical relevance in the treatment of LET. While existing studies are too small to assess rare adverse events, for LET patients, especially those refractory to first-line treatments, DPT can be considered a non-surgical treatment option in carefully selected patients. Further high-quality trials with comparison with other injection therapies are needed.
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Affiliation(s)
- Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | - David Rabago
- Department of Family and Community Medicine, Pennsylvania State University, United States of America.
| | - Vincent Chi-Ho Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | | | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | - Regina Wing-Shan Sit
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
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Stop Using the Eccentric Exercises as the Gold Standard Treatment for the Management of Lateral Elbow Tendinopathy. J Clin Med 2022; 11:jcm11051325. [PMID: 35268416 PMCID: PMC8911334 DOI: 10.3390/jcm11051325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
The most common tendinopathy in the elbow area is the Lateral elbow tendinopathy (LET) [...].
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Samaras P, Karanasios S, Stasinopoulos D, Gioftsos G. Greek physiotherapists' contemporary knowledge and practice for lateral elbow tendinopathy: An online survey. Musculoskelet Sci Pract 2022; 57:102502. [PMID: 35030537 DOI: 10.1016/j.msksp.2022.102502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate physiotherapists' current knowledge and practice in the management of patients with lateral elbow tendinopathy, to explore associations between the participants' education and management preferences and to identify potential evidence-to-practice gaps by making comparisons with recent research recommendations. DESIGN An on-line cross-sectional survey. SUBJECTS Registered physiotherapists working in Greece with previous experience in the management of lateral elbow tendinopathy. RESULTS Three hundred and seventy eight responses met the inclusion criteria. Most responders (70.4%-91.5%) use pain provocation tests for the diagnosis of the condition, while a limited proportion uses patient rated outcome measures (6.9%-13%). Supervised exercise is the mainstay of rehabilitation (92.6%), followed by adjunctive research recommended treatment techniques such as manual therapy (72%) and advice (59.5%). Up to 83.6% of participants use adjunctive treatment techniques that are not recommended or without research recommendation (such as electrophysical agents, ice etc.). Physiotherapists with post-graduate education in musculoskeletal physiotherapy are almost three times more likely to choose only research recommended treatment approaches. There is a lack of consensus in an optimal exercise programme (type, volume, duration etc.) in patients with lateral elbow tendinopathy. CONCLUSION Despite research recommendations a limited use of patient rated outcome measures in lateral elbow tendinopathy is recorded. Supervised exercise is the first line treatment option for most physiotherapists, although the optimal application is still unclear. A large proportion of physiotherapists apply adjunctive treatment techniques that are either ineffective or poorly researched suggesting a substantial evidence-to-practice gap. Better access to knowledge, organisational and peer-support can potentially help to bridge this gap.
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Affiliation(s)
| | - Stefanos Karanasios
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Greece
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Neuromuscular & Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica, Greece
| | - George Gioftsos
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Greece
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Bateman M, Saunders B, Littlewood C, Hill JC. Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique. BMJ Open 2021; 11:e053841. [PMID: 34949626 PMCID: PMC8712984 DOI: 10.1136/bmjopen-2021-053841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES There are a wide range of physiotherapy treatment options for people with lateral elbow tendinopathy (LET); however, previous studies have reported inconsistent approaches to treatment and a lack of evidence demonstrating clinical effectiveness. This study aimed to combine the best available research evidence with stakeholder perspectives to develop key components of an optimised physiotherapist-led treatment protocol for testing in a future randomised controlled trial (RCT). DESIGN Online consensus groups using nominal group technique (NGT), a systematic approach to building consensus using structured multistage meetings. SETTING UK National Health Service (NHS). PARTICIPANTS 10 physiotherapists with special interest in LET, 2 physiotherapy service managers and 3 patients who had experienced LET. INTERVENTIONS Two consensus groups were conducted; the first meeting focused on agreeing the types of interventions to be included in the optimised treatment protocol; the second meeting focused on specific details of intervention delivery. Participants were sent an evidence summary of available treatments for LET prior to the first meeting. All treatment options were discussed before anonymous voting and ranking of priority. Consensus for inclusion of each treatment option was set at ≥70% based on OMERACT guidelines. Options with 30%-69% agreement were discussed again, and a second vote was held, allowing for a change of opinion. RESULTS The optimised physiotherapist-led treatment package included: advice and education, exercise therapy and orthotics. Specific components for each of these interventions were also agreed such as: condition-specific advice, health-promotion advice, exercise types, exercise into 'acceptable' levels of pain, exercise dosage and type of orthoses. Other treatment options including electrotherapy, acupuncture and manual therapy were excluded. CONCLUSION An optimised physiotherapist-led treatment protocol for people with LET was successfully developed using an online NGT consensus approach. This intervention is now ready for testing in a future pilot/feasibility RCT to contribute much needed evidence about the treatment of LET. TRIAL REGISTRATION NUMBER This is the pre-cursor to the OPTimisE Pilot and Feasibility Randomised Controlled Trial. Registration: https://www.isrctn.com/ISRCTN64444585.
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Affiliation(s)
- Marcus Bateman
- Derby Shoulder Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, Keele University, Stoke-on-Trent, UK
| | | | - Chris Littlewood
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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Balevi ISY, Karaoglan B, Batur EB, Acet N. Evaluation of short-term and residual effects of Kinesio taping in chronic lateral epicondylitis: A randomized, double-blinded, controlled trial. J Hand Ther 2021; 36:13-22. [PMID: 34736818 DOI: 10.1016/j.jht.2021.09.001] [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: 08/19/2020] [Revised: 07/26/2021] [Accepted: 09/13/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Lateral epicondylitis is degenerative tendinosis of the extensor carpi radialis brevis muscle and is the most common work/sports-related chronic musculoskeletal problem affecting the elbow. PURPOSE This study aimed to evaluate the short term and residual effectiveness of the Kinesio taping method on pain, grip force, quality of life, and functionality. STUDY DESIGN Randomized, double-blinded, controlled study. METHODS Subjects were 50 patients diagnosed with chronic unilateral lateral epicondylitis with a symptom duration of at least 12 weeks. During the first four weeks, the study group received a true inhibitor Kinesio taping while the control group received sham taping. In both groups, progressive stretching and strengthening exercises were given as a home program for six weeks. The primary outcome measure was the Numerical Rating Scale (NRS) for self-report of pain intensity; secondary outcome measures were Cyriax resistive muscle test evaluation, maximal grip strength, Patient- Rated Tennis Elbow Evaluation (PRTEE), and Short Form-36 (SF-36). After the treatment, patients were evaluated by the first assessor who was blinded to taping types. RESULTS There was a significant decrease in NRS scores overtime during the first four weeks in both groups (P < .001,) and effect sizes were large. There was no significant difference in Cyriax muscle resistance test maximal grip strength between groups (P > .05). However, there was a significant improvement in muscle strength of elbow extension and pronation in the study group detected in the intragroup analysis. Intragroup comparisons also showed a significant improvement in all subunits of the PRTEE and SF-36 except energy/vitality, social functioning, and pain in both groups (P < .05) with moderate to high effect sizes. PRTEE pain scores were significantly decreased in the study group compared to the placebo group (P < .05, d = 0.48). CONCLUSION The effects of Kinesio taping on muscle strength, quality of life, and function in chronic lateral epicondylitis are not superior to placebo. However, NRS scores showed that in the two weeks after Kinesio taping treatment, pain reduction persisted as a residual effect which may improve the exercise adherence and functionality.
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Affiliation(s)
- Işıl Saadet Yenice Balevi
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Belgin Karaoglan
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Elif Balevi Batur
- Department of Physical Medicine and Rehabilitation, Selcuk University Faculty of Medicine, Konya, Turkey.
| | - Nagihan Acet
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
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Tran T, Harris C, Ciccarelli M. The impact of a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study. J Hand Ther 2021; 36:45-59. [PMID: 34756796 DOI: 10.1016/j.jht.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients' work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. PURPOSES First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. STUDY DESIGN A randomized controlled trial. METHODS Forty-nine participants were randomized to the control group (n = 25) or intervention group (n == 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, "Working Hands-ED," delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. RESULTS There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). CONCLUSION The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace.
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Affiliation(s)
- Thuy Tran
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia.
| | - Courtenay Harris
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marina Ciccarelli
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Stegink-Jansen CW, Bynum JG, Lambropoulos AL, Patterson RM, Cowan AC. Lateral epicondylosis: A literature review to link pathology and tendon function to tissue-level treatment and ergonomic interventions. J Hand Ther 2021; 34:263-297. [PMID: 34167860 DOI: 10.1016/j.jht.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Common treatments for lateral epicondylosis (LE) focus on tissue healing. Ergonomic advice is suggested broadly, but recommendations based on biomechanical motion parameters associated with functional activities are rarely made. This review analyzes the role of body functions and activities in LE and integrates the findings to suggest motion parameters applicable to education and interventions relevant to activities and life roles for patients. PURPOSE This study examines LE pathology, tendon and muscle biomechanics, and population exposure outlining potentially hazardous activities and integrates those to provide motion parameters for ergonomic interventions to treat or prevent LE. A disease model is discussed to align treatment approaches to the stage of LE tendinopathy. STUDY DESIGN Integrative review METHODS: We conducted in-depth searches using PubMed, Medline, and government websites. All levels of evidence were included, and the framework for behavioral research from the National Institutes of Health was used to synthesize ergonomic research. RESULTS The review broadened the diagnosis of LE from a tendon ailment to one affecting the enthesis of the capitellum. It reinforced the continuum of severity to encompass degeneration as well as regeneration. Systematic reviews confirmed the availability of evidence for tissue-based treatments, but evidence of well-defined harm reducing occupational interventions was scattered amongst evidence levels. Integration of biomechanical studies and population information gave insight into types of potentially hazardous activities and provided a theoretical basis for limiting hazardous exposures to wrist extensor tendons by reducing force, compression, and shearing during functional activities. CONCLUSIONS These findings may broaden the first treatment approach from a passive, watchful waiting into an active exploration and reduction of at-risk activities and motions. Including the findings into education modules may provide patients with the knowledge to lastingly reduce potentially hazardous motions during their daily activities, and researchers to define parameters of ergonomic interventions.
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Affiliation(s)
- Caroline W Stegink-Jansen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Julia G Bynum
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Alexandra L Lambropoulos
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rita M Patterson
- Department of Family and Osteopathic Manipulative Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - April C Cowan
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
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Savva C, Karagiannis C, Korakakis V, Efstathiou M. The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review. J Man Manip Ther 2021; 29:276-287. [PMID: 33769226 PMCID: PMC8491707 DOI: 10.1080/10669817.2021.1904348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.
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Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Nicosia, Cyprus
| | | | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Heales LJ, Randall S, Vicenzino B, Coombes BK, Obst S. An evidence-based evaluation of mobile health apps for the management of individuals with lateral elbow tendinopathy using a systematic review framework. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1885584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Luke J. Heales
- School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Samantha Randall
- School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitations Sciences, The University of Queensland, Brisbane, Australia
| | - Brooke K. Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Steven Obst
- School of Health, Medical, and Applied Sciences, Central Queensland University, Bundaberg, Australia
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