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Valgaeren B, Van Snick E, Claikens B. Tendinous Signal Alterations on MRI in the Asymptomatic Elbow: A Retrospective Cross-Sectional Study. J Belg Soc Radiol 2024; 108:69. [PMID: 39036521 PMCID: PMC11259101 DOI: 10.5334/jbsr.3651] [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: 05/22/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives It is clinically relevant to prevent overtreatment of tendinopathy diagnosed solely on imaging. Therefore, the prevalence of presumable asymptomatic signal changes in the common flexor origin, biceps insertion, brachialis insertion, and triceps insertion were assessed. Materials and methods Two hundred and five magnetic resonance imaging (MRI) exams of the elbow with coronal and axial fat-saturated fluid-sensitive sequences between January 1, 2018 and July 31, 2022 were retrospectively identified in our center.Two radiology residents reviewed the exams independently. The elbow tendons were given a score from 0 to 4. Score 0: no signal abnormality; score 1: increased T2-weighted signal around the tendon; score 2: increased T2-weighted signal compared to muscle within the tendon; score 3: partial tear; and score 4: complete tear. Results The common flexor tendon showed signal alterations in 8% of patients; nine patients had an increased signal around the tendon, and eight patients had an increased signal within the tendon. Three patients (1.5%) had an altered signal intensity in the biceps tendon. All triceps tendons showed a linear hyperintense signal, suggesting that it is physiological. There were no partial or complete tears. No signal abnormalities were noted in the brachialis tendon among all patients. Conclusion The prevalence of presumable asymptomatic signal alterations seen in the common flexor origin on MRI is not negligible; therefore, clinical correlation is advised to prevent overtreatment of tendinopathy in these cases. No partial or complete tears were seen.
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Affiliation(s)
- Bjorn Valgaeren
- Department of Radiology, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Elyn Van Snick
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels Health Campus, Laarbeeklaan 101, Jette 1090, Belgium
| | - Bart Claikens
- Department of Radiology, General Hospital Ostend, Gouwelozestraat 100, Ostend 8400, Belgium
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Zhou Z, Meng P, Jia N, Zhang H, Ling R, Liu Y, Li G, Li D, Yin Y, Shao H, Zhang H, Qiu B, Wang D, Zeng Q, Chen J, Zhang D, Mei L, Liu Y, Liu J, Zhang C, Li T, Wang Z. Risk and related factors of elbow musculoskeletal diseases: a nationwide cross-sectional survey in China. J Occup Health 2024; 66:uiae031. [PMID: 38955204 DOI: 10.1093/joccuh/uiae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES Although studies have shown that work-related musculoskeletal disorders (WMSDs) are common and continue to be a major source of disability and work time loss, there are few reports about elbow WMSDs. The aim of this study was to explore the prevalence and associated factors of elbow WMSDs. METHODS The valid questionnaires of 57501 workers from 15 different industries nationwide were collected and the c2 test and logistic regression analysis were applied to reveal the prevalence and risk factors of elbow WMSDs. RESULTS The findings indicated that the overall prevalence of elbow WMSDs among workers was 7.3%. However, the prevalence of elbow WMSDs in toy manufacturing was 21.3%, which was significantly higher than that in other industries (P < .05). Logistic regression analysis showed that age 40 and above, married, very poor health, left-handedness, lifting weights (more than 20 kg each time), work requiring upper limb or hand force, work in an uncomfortable position, repetitive operations within 1 minute, using vibrating tools, work involving cold, cool draughts, or temperature changes, work being completed in the same workshop, work being done outdoors, frequent dealings with customers, 2 shifts, often working overtime, staff shortage, and often working for colleagues were risk factors for elbow WMSDs. A higer education level, monthly income, and enough rest time were protective factors for elbow WMSDs. CONCLUSIONS Toy manufacturing is a high-risk industry for elbow WMSDs. Promotion of education about ergonomics should be strengthened, and workers' ergonomics awareness should be improved to reduce the impact of WMSDs.
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Affiliation(s)
- Zhehua Zhou
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, 314050, China
| | - Pan Meng
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, 314050, China
| | - Ning Jia
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Huadong Zhang
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Ruijie Ling
- Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, Hubei, 430030, China
| | - Yimin Liu
- Guangzhou Twelfth People's Hospital Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, 510620, China
| | - Gang Li
- Liaoning Provincial Health Service Center, Shenyang, Liaoning, 110023, China
| | - Dongxia Li
- Guizhou Province Occupational Disease Prevention and Control Hospital, Guiyang, Guizhou, 610599, China
| | - Yan Yin
- Shanghai Center for Disease Control and Prevention, Shanghai, 200051, China
| | - Hua Shao
- Shandong Academy of Occupational Health and Occupational Medicine, Jinan, Shandong, 255030, China
| | - Hengdong Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Bing Qiu
- Civil Aviation Medical Center, Civil Aviation Administration of China, Beijing, 100010, China
| | - Dayu Wang
- Tianjin Occupational Disease Prevention and Control Hospital, Tianjin, 300011, China
| | - Qiang Zeng
- Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Jianchao Chen
- Fujian Province Occupational Disease and Chemical Poisoning Prevention and Control Center, Fuzhou, Fujian, 350025, China
| | - Danying Zhang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, 510300, China
| | - Liangying Mei
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, 430070, China
| | - Yongquan Liu
- Institute of Occupational Medicine of Jiangxi, Nanchang, Jiangxi, 330006, China
| | - Jixiang Liu
- Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan, Ningxia, 750003, China
| | - Chengyun Zhang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, 610044, China
| | - Tianlai Li
- Shanxi Provincial Center for Disease Control and Prevention, Xi'an, Shanxi, 710054, China
| | - Zhongxu Wang
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
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3
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Konarski W, Poboży T. A Clinical Overview of the Natural Course and Management of Lateral Epicondylitis. Orthopedics 2023; 46:e210-e218. [PMID: 37018622 DOI: 10.3928/01477447-20230329-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Lateral epicondylitis (LE), also often called tennis elbow, is a frequent cause of elbow pain. The most characteristic symptom of LE is pain and burning around the lateral epicondyle of the humerus that may radiate to the forearm or to the upper arm. Ultrasonography is a quick and noninvasive tool used to confirm (or exclude) the diagnosis of LE. Management of LE symptoms should be directed to the management of pain, protection of movement, and improvement of arm performance. Treatment of LE includes nonoperative techniques and surgery. [Orthopedics. 2023;46(4):e210-e218.].
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Greene C, Droppelmann G, García N, Jorquera C, Verdugo A. A New Test for the Advanced Diagnosis of Lateral Elbow Tendinopathy with Concomitant Intrasubstance Tear: Failure to Resist Extension Effort (the Free Test). Orthop Res Rev 2022; 14:495-503. [PMID: 36606066 PMCID: PMC9809378 DOI: 10.2147/orr.s364050] [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: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background Lateral elbow tendinopathy (LET) is one of the most common causes of musculoskeletal pain. The diagnosis is based on the clinical history and different physical maneuvers. Ultrasound (US) is a complementary diagnostic method to detect degenerative tendon changes and intrasubstance tears (IST). To date, there is no available physical maneuver to identify an IST in patients with LET. Aim To evaluate the diagnostic accuracy of an index test to detect an IST confirmed by ultrasound in patients with LET. Methods A diagnostic retrospective study was performed. Patients who presented medical records with LET were recruited. Two orthopaedic surgeons developed the physical maneuver. The index test was considered positive when the position failed to resist the wrist extension maximum effort. Clinical findings were associated with confirmation of IST by US. Data were calculated using diagnostic accuracy, sensitivity, and specificity with 95% confidence intervals. Results Thirty-nine patients (39 elbows) were analyzed, 25 (64%) women and 14 (36%) men, with an average age of 47.7 years. The index test's sensitivity was 0.86 (95% CI, 0.67-0.96). Accuracy was 0.79 (95% CI, 0.64-0.91), and the specificity was 0.64 (95% CI, 0.31-0.89). Conclusion The index test presented very good sensitivity and good accuracy in patients with LET with US diagnostic confirmation of IST. Level of Evidence Diagnostic study, Level III.
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Affiliation(s)
- Cristóbal Greene
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile,Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Guillermo Droppelmann
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile,Health Sciences Ph.D. Program, Universidad Católica de Murcia, Murcia, Spain,Principles and Practice of Clinical Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Correspondence: Guillermo Droppelmann, Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile, Email
| | - Nicolás García
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, Chile
| | - Arturo Verdugo
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile
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5
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İnal Ö, Tunçer B. Telephone-based joint protection education in lateral epicondylitis: A randomized controlled trial. Work 2022; 72:1421-1428. [DOI: 10.3233/wor-211002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Lateral epicondylitis (LE) can occur for many different reasons such as compelling repetitive movements in daily readings, incorrect posture use and work-related factors. Although several treatments are available for LE, the optimal evidence-based treatment remains uncertain. Joint protection techniques have been developed as a self-management intervention to reduce pain and disability and improve functionality by applying ergonomic approaches. OBJECTIVES: This study aimed to investigate the effects of telephone-based follow up on top of a home-based joint protection education programme on pain and functionality in individuals with LE. METHODS: Individuals were randomly assigned into 2 groups; 1) telephone-based group, receiving telephone-based follow-up on top of a home-based joint protection education programme, and 2) home-based group, receiving home-based joint protection education alone. Both groups were given training that increased awareness in LE and home-based exercise programme. In addition, telephone-based group was followed up by telephone three days a week for four weeks. RESULTS: Improvements from baseline to 4th week in Turkish version of the Patient-Rated Tennis Elbow Evaluation-pain (p = 0.001; effect size = 1.11) and function (p < 0.001; effect size = 1.77), Upper Extremity Functional Index (p = 0.001; effect size = 0.85) and The Turkish version of the Joint Protection Behavior Assessment-Short Form (p < 0.001; effect size = 1.54) in the telephone-based group were significantly higher than the improvements in the home-based group. CONCLUSIONS: Telephone-based follow-up in individuals with LE contributed to the awareness of pain, functionality and joint protection methods. Telephone-based joint protection education programmes can offer a health service within the scope of preventive and protective intervention programmes for LE.
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Affiliation(s)
- Özgü İnal
- Department of Occupational Therapy, Faculty of Gülhane Health Science, Health Science University, Ankara, Turkey
| | - Berna Tunçer
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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6
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Martins J, Neto IS, Gonçalves AF, Pereira A, Santiago M, Ferro I, Lopes T, Carvalho JL. Platelet-Rich Plasma Injection Associated With Microtenotomy in Lateral Epicondylitis – is a Tendon Tear Associated with the Therapeutic Response? Cureus 2022; 14:e22425. [PMID: 35371831 PMCID: PMC8941632 DOI: 10.7759/cureus.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029). Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.
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7
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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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8
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Efficacy of Nonoperative Treatments for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2021; 147:112-125. [PMID: 33002980 DOI: 10.1097/prs.0000000000007440] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population. Although symptoms may disappear spontaneously within 1 year, the clinical guidelines for conservative treatment are not clear. The authors' objective was to examine the outcomes of nonsurgical treatments for lateral epicondylitis through a meta-analysis and provide a treatment recommendation using the available evidence. METHODS The authors searched the PubMed, EMBASE, Scopus, and Web of Science databases to identify primary research articles studying conservative treatments (electrophysiotherapy, physical therapy, and injections) for lateral epicondylitis. The authors included randomized controlled trials published in peer-reviewed journals. Data related to outcomes (pain, grip strength, Patient-Rated Tennis Elbow Evaluation score, and Disabilities of the Arm, Shoulder and Hand score) and complications were extracted. RESULTS Fifty-eight randomized controlled trials were included in the meta-analysis. Electrophysiotherapy was effective in improving pain [mean difference, -10.0 (95 percent CI, -13.8 to -6.1)], Patient-Rated Tennis Elbow Evaluation score [mean difference, -10.7 (95 percent CI, -16.3 to -5.0)], and Disabilities of the Arm, Shoulder and Hand score [mean difference, -11.9 (95 percent CI, -15.8 to -7.9)]; and physical therapy improved pain [mean difference, -6.0 (95 percent CI, -9.7 to -2.3)] and Patient-Rated Tennis Elbow Evaluation scores [mean difference, -7.5 (95 percent CI, -11.8 to -3.2)] compared to placebo. Injections did not improve any outcome measures. Patients who received electrophysiotherapy and injections reported higher adverse effects than physical therapy patients. CONCLUSIONS Patients who received electrophysiotherapy and physical therapy reported statistically and clinically improved scores in pain and function compared to placebo. Injections may put patients at higher risk for adverse effects compared to other conservative treatments. When managing lateral epicondylitis conservatively, electrophysiotherapy and physical therapy should be prioritized before other interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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9
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Curti S, Mattioli S, Bonfiglioli R, Farioli A, Violante FS. Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis. J Occup Health 2021; 63:e12186. [PMID: 33534951 PMCID: PMC7857538 DOI: 10.1002/1348-9585.12186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis. METHODS We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship. RESULTS We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed. CONCLUSIONS There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.
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Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Francesco S. Violante
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
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10
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Minimally invasive treatment of lateral epicondylitis. Best Pract Res Clin Anaesthesiol 2020; 34:583-602. [PMID: 33004169 DOI: 10.1016/j.bpa.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022]
Abstract
Lateral epicondylitis (LE), also known as tennis elbow, is the most common cause of elbow pain in adults, with approximately 1-3% of the general population being afflicted. Although the condition is usually self-limiting, pain can be a major hindrance, limiting daily activity and the work capacity of patients. As a result, many treatment options have become available with the aim to shorten the duration of the disease and increase the quality of life. Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE. In this review, we will provide a brief summary of LE and focus on addressing conservative and minimally invasive interventional options for the treatment of LE.
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11
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Abstract
Each year increasing numbers of people participate in a wider variety of athletic endeavors. Unlike previous generations, many patients remain in these activities later into their lives, some well beyond retirement. As the population ages and their activities continue, they are subject to injury of various forms affecting all aspects of their bodies.
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Affiliation(s)
| | - Christina Lin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
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12
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Keijsers R, de Vos RJ, Kuijer PPFM, van den Bekerom MPJ, van der Woude HJ, Eygendaal D. Tennis elbow. Shoulder Elbow 2019; 11:384-392. [PMID: 31534489 PMCID: PMC6739751 DOI: 10.1177/1758573218797973] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 01/19/2023]
Abstract
Tennis elbow is the most common cause of lateral-sided elbow pain with a major socioeconomic impact. The etiology of tennis elbow is not completely understood, but there are many different treatment options. This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation.
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Affiliation(s)
- Renée Keijsers
- Department of Orthopaedic Surgery,
Amsterdam UMC, Amsterdam, the Netherlands
| | | | - P Paul FM Kuijer
- Coronel Institute of Occupational
Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Michel PJ van den Bekerom
- Department of Orthopaedic Surgery, Onze
Lieve Vrouwe Gasthuis (O.L.V.G.), Amsterdam, the Netherlands
| | - Henk-Jan van der Woude
- Department of Radiology, Onze Lieve
Vrouwe Gasthuis (O.L.V.G.), Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery,
Amsterdam UMC, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery,
Amphia Hospital, Breda, the Netherlands
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13
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Keijsers R, Kuijer PPFM, Koenraadt KLM, van den Bekerom MPJ, Gerritsma-Bleeker CLE, Beumer A, Frings-Dresen MHW, Eygendaal D. Effectiveness of standardized ultrasound guided percutaneous treatment of lateral epicondylitis with application of autologous blood, dextrose or perforation only on pain: a study protocol for a multi-center, blinded, randomized controlled trial with a 1 year follow up. BMC Musculoskelet Disord 2019; 20:351. [PMID: 31366332 PMCID: PMC6668105 DOI: 10.1186/s12891-019-2711-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 07/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background In the treatment of Lateral Epicondylitis (LE) no single intervention concerning injection therapies has been proven to be the most effective with regard to pain reduction. In this trial 3 injection therapies (perforation with application of autologous blood, perforation with application of dextrose and perforation only) will be compared in a standardized and ultrasound guided way. The objective is to assess the effectiveness of these 3 injection therapies on pain, quality of life and functional recovery. By conducting this study, we hope to make a statement on the effectiveness of injection therapy in the treatment of LE. Hereby, unnecessary treatments can be avoided, a more universal method of treatment can be established and the quality of the treatment can be improved. Methods/design A multicenter, randomized controlled trial with a superiority design and 12 months follow-up will be conducted in four Dutch hospitals. One hundred sixty five patients will be recruited in the age of 18 to 65 years, with chronic symptomatic lateral epicondylitis lasting longer than 6 weeks, which have concordant pain during physical examination. Patients will be randomized by block randomization to one of the three treatment arms. The treatment will be blinded for patients and outcome assessors. The following three injection therapies are compared: perforation with application of autologous blood, perforation with application of dextrose and perforation only. Injections will be performed ultrasound guided in a standardized and automated way. The primary endpoint is: pain (change in ‘Visual Analogue Scale’). Secondary endpoints are quality of life and functional recovery. These measurements are collected at baseline, 8 weeks, 5 months and 1 year after treatment. Discussion When completed, this trial will provide evidence on the effectiveness of injection therapy in the treatment of lateral epicondylitis on pain, quality of life and functional recovery. In current literature proper comparison of the effectiveness of injectables for LE is questionable, due to the lack of standardization of the treatment. This study will overcome bias due to manually performed injection therapy. Trial registration This study is registered in the Trial Register (www.trialregister.nl) of the Dutch Cochrane centre. Trial ID; NTR4569. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4569
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Affiliation(s)
- Renée Keijsers
- Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, P.O. Box 90158, 4800, RK, Breda, The Netherlands. .,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Meibergdreef 9, Amsterdam, AZ, 1105, The Netherlands.
| | - P Paul F M Kuijer
- Amsterdam University Medical Centers, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, O.L.V.G, Oosterpark 9, P.O. Box 95500, 1090, HM, Amsterdam, The Netherlands
| | | | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Amsterdam University Medical Centers, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Amsterdam University Medical Centers, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Meibergdreef 9, Amsterdam, AZ, 1105, The Netherlands
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Martin JI, Atilano L, Merino J, Gonzalez I, Iglesias G, Areizaga L, Bully P, Grandes G, Andia I. Platelet-rich plasma versus lidocaine as tenotomy adjuvants in people with elbow epicondylopathy: a randomized controlled trial. J Orthop Surg Res 2019; 14:109. [PMID: 31014382 PMCID: PMC6480601 DOI: 10.1186/s13018-019-1153-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the efficacy of platelet-rich plasma (PRP) compared to lidocaine as a tenotomy adjuvant for people with elbow tendinopathy. METHODS Our study was a parallel-group, double-blind, randomized trial involving 71 patients with recalcitrant elbow tendinopathy who received two sessions of ultrasound-guided tenotomy with either PRP or lidocaine in a tertiary public hospital. The primary end point was the percentage of patients with an improvement exceeding 25% reduction in disability (Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires-DASH-E) at 6 and 12 months; the secondary outcome was the percentage of patients exceeding 25% reduction in pain (VAS-P). RESULTS There was no evidence of significant differences in the proportion of patients who experienced clinically relevant improvements. After 6 months, 18 patients (78.59%) in the lidocaine group and 19 patients (73.08%) in the PRP group showed improved function above 25% (unadjusted odds ratio, 0.90; 95% confidence interval [CI], 0.90 (0.17 to 4.60)); 21 patients (72.21%) in the lidocaine group versus 22 patients (84.62%) in the PRP group achieved more than 25% pain reduction (unadjusted odds ratio, 0.48; 95% CI, 0.10 to 2.37). After 12 months, 17 patients (70.83%) in the lidocaine group versus 19 patients (76%) in the PRP group had improved function (unadjusted odds ratio, 0.71; 95% CI, 0.13 to 3.84), and 19 patients (76%) in the lidocaine group versus 20 patients (90.91%) in the PRP group had improved pain above 25% (unadjusted odds ratio, 0.35; 95% CI, 0.06 to 2.51). Hypercholesterolemia and baseline vascularization influenced outcomes. There were no differences between groups in the adjusted odds ratios. CONCLUSION PRP results in similar improvements to those obtained with lidocaine. Selecting patients according to their pretreatment status can improve treatment efficacy. TRIAL REGISTRATION NCT01945528 , EudraCT 2013-000478-32. Registered 18 August 2013, enrolment of the first participant 10 March 2014.
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Affiliation(s)
- Jose Ignacio Martin
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Leire Atilano
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Josu Merino
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Igor Gonzalez
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Gotzon Iglesias
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Luis Areizaga
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Isabel Andia
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.
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Ashton N. Partial avulsion of the ulnaris lateralis and enthesiopathy of the lateral epicondyle of the humerus in a thoroughbred race horse. Ir Vet J 2018; 71:10. [PMID: 29599968 PMCID: PMC5870080 DOI: 10.1186/s13620-018-0120-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 03/12/2018] [Indexed: 01/01/2023] Open
Abstract
Background There is relatively little literature on elbow disease in the horse. The only published reports on soft tissue conditions describe collateral ligament and biceps brachii injuries. Case presentation A three-year old Thoroughbred gelding presented with a history of acute onset right forelimb lameness of less than one week duration, one month after commencing training in a National Hunt racing yard. Physical examination and peri-neural anaesthesia failed to localise the lesion. Lameness was localised to the distal humerus by nuclear scintigraphy and intra-articular anaesthesia. A partial avulsion of the tendinous origin of the ulnaris lateralis and enthesiopathy of the lateral humeral epicondyle was diagnosed on ultrasonography. Ultrasonographic findings were loss of longitudinal fibre pattern, a discrete hypo-echoic region within the ulnaris lateralis tendon of origin, and remodelling of the lateral epicondyle of the right humerus at the site of the origin of the ulnaris lateralis. No abnormalities were identified on radiography. The lameness did not resolve with rest, but was successfully treated with extra corporal shockwave therapy (ECSWT) and intra-lesional corticosteroid injections. Conclusion This is the first report of partial avulsion of the ulnaris lateralis and enthesiopathy of the lateral humeral epicondyle in the horse. In contrast to other reported soft tissue conditions of the elbow, this horse had a successful return to work. This case highlights the value of ultrasonography in assessing peri-articular soft tissues, and the importance of pain relief as treatment in some soft tissue injuries.
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Affiliation(s)
- Neal Ashton
- Oakham veterinary hospital, Ashwell Road, Oakham, Rutland, LE15 7QH UK.,2University of Nottingham Veterinary school, Sutton Bonnington Campus, Nottingham, LE12 5RD UK
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Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis? Knee Surg Sports Traumatol Arthrosc 2018; 26:938-945. [PMID: 28840301 DOI: 10.1007/s00167-017-4691-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. METHODS Forty-five voluntary patients (mean age 48 years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5 days a week for 3 weeks. In the third group, ESWT was applied three times for 3 weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. RESULTS There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment (p < 0.05). Inter-group analysis revealed that the kinesiotaping group yielded better results in decreasing pain intensity than the other groups (p < 0.05). The kinesiotaping group (p < 0.001) and ESWT group (p = 0.002) yielded better results in improving functionality than the physiotherapy group. There were significant differences in recovering pain-free grip strength in the kinesiotaping group (p < 0.05). CONCLUSION Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Gürçay E, Karaahmet ÖZ, Kara M, Onat SS, Ata AM, Ünlü E, Özçakar L. Ultrasonographic Evaluation of the Radial Nerves in Patients with Unilateral Refractory Lateral Epicondylitis. PAIN MEDICINE 2017; 18:396-402. [PMID: 27477582 DOI: 10.1093/pm/pnw181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. Design Cross-sectional study. Setting Three physical medicine and rehabilitation departments. Subjects Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. Methods All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. Results When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P < 0.001). Grip strength values were lower on the affected sides ( P < 0.001). Electrophysiological studies were all normal, and similar between the two sides (all P > 0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P < 0.01). Conclusions Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment.
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Affiliation(s)
- Eda Gürçay
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Özgür Zeliha Karaahmet
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Sule Sahin Onat
- Ankara Physical and Rehabilitation Medicine Education and Research Hospital, Ankara, Turkey
| | - Ayse Merve Ata
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ece Ünlü
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Jeon J, Bussin E, Scott A. Temporal divergence of changes in pain and pain-free grip strength after manual acupuncture or electroacupuncture: an experimental study in people with lateral epicondylalgia. Chin Med 2017; 12:22. [PMID: 28785304 PMCID: PMC5543448 DOI: 10.1186/s13020-017-0143-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background The objective of this study was to examine, in individuals with lateral epicondylalgia (LE), the acute time course of acupuncture-induced hypoalgesia and change in pain-free grip strength (PFGS). Methods This was an experimental study, conducted at a single research center in Vancouver, BC. Twenty-one participants with unilateral LE lasting more than 6 weeks duration were enrolled. Participants received a single treatment of acupuncture (either electroacupuncture, 10–30 Hz, or manual acupuncture, assigned randomly). The primary outcome measure was pain level (0–10) during tendon loading (while making a fist) immediately after treatment, and over a 72 h follow-up period. Secondary outcome measures included pain-free grip strength (N). Results There was a small but statistically significant reduction in participants’ perceived pain level immediately after acupuncture (mean improvement of 1.2, 95% CI 0.45–1.9). This change in pain was not accompanied by a change in PFGS. No difference was observed between the two types of acupuncture at any time point. Conclusions The use of acupuncture or electroacupuncture, as administered in the current study, is unlikely to acutely enhance the ability of people with LE to engage in pain-free rehabilitation exercise. Trial registration Registered February 25, 2015. ISRCTN14667535, http://www.isrctn.com/ISRCTN14667535 Electronic supplementary material The online version of this article (doi:10.1186/s13020-017-0143-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaewon Jeon
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute and Department of Physical Therapy, University of British Columbia, 2635 Laurel Street, Vancouver, BC V5Z3M9 Canada
| | - Erin Bussin
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute and Department of Physical Therapy, University of British Columbia, 2635 Laurel Street, Vancouver, BC V5Z3M9 Canada
| | - Alex Scott
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute and Department of Physical Therapy, University of British Columbia, 2635 Laurel Street, Vancouver, BC V5Z3M9 Canada
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Ammar TAR. Pulsed electromagnetic field versus microcurrent electrical nerve stimulation in patients with lateral epicondylopathy. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.11.519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci 2015; 27:3755-8. [PMID: 26834345 PMCID: PMC4713784 DOI: 10.1589/jpts.27.3755] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal
shock wave therapy and local corticosteroid injection in patients with lateral
epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were
randomly divided into extracorporeal shock wave therapy and steroid injection groups.
Patients were evaluated using hand grip strength, visual analog scale, and short-form
McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both
groups showed statistically significant increase in hand grip strength and decreases on
the visual analog scale and short form McGill pain questionnaire overtime. There was no
statistically significant difference in the percentage of improvement in hand grip
strength and on the short-form McGill pain questionnaire between groups at 4 weeks
post-treatment, whereas the extracorporeal shock wave therapy group showed better results
on the visual analog scale. The percentages of improvements in all 3 parameters were
higher in the extracorporeal shock wave therapy group than in the injection group at 12
weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid
injection were safe and effective in the treatment of lateral epicondylitis. However,
extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at
the long-term follow-up.
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Affiliation(s)
- Münevver Serdaroğlu Beyazal
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Turkey
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Heales LJ, Vicenzino B, MacDonald DA, Hodges PW. Forearm muscle activity is modified bilaterally in unilateral lateral epicondylalgia: A case-control study. Scand J Med Sci Sports 2015; 26:1382-1390. [DOI: 10.1111/sms.12584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- L. J. Heales
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
| | - B. Vicenzino
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
| | - D. A. MacDonald
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
| | - P. W. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
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Alizadehkhaiyat O, Frostick SP. Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis. J Electromyogr Kinesiol 2015; 25:876-86. [DOI: 10.1016/j.jelekin.2015.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/18/2015] [Accepted: 10/23/2015] [Indexed: 11/27/2022] Open
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