Immediate Effects of Counterforce Forearm Brace on Grip Strength and Wrist Extension Force in Patients With Lateral Epicondylosis

Immediate effects of counterforce brace with and without vibration on pain, muscle strength and range of motion in participants with lateral epicondylitis. A pilot study

Lateral epicondylitis is one of the most common elbow problems. Counterforce braces are commonly used to manage lateral epicondylitis. Recent studies showed that vibration can decrease pain and increase muscle strength by improving motor abilities. The aim of this study was to evaluate the effects of a counterforce brace with and without vibration on pain, muscular strength, wrist and elbow joints range of motion in the participants with lateral epicondylitis. In this repeated measure pre-post clinical trial study, 28 participants with lateral epicondylitis were included. Pain were measured with Visual Analogue Scale (VAS), wrist and elbow flexor/extensor muscles strength with digital dynamometer, wrist and elbow flexion/extension range of motion with goniometer in 3 condition baseline, counterforce brace and counterforce brace with vibration. Pain using counterforce bracing with vibration showed a significant reduction as compared with baseline and counterforce bracing (P < 0.001). Wrist flexor muscles strength (P = 0.005), elbow flexor/extensor muscles strength respectively (P = 0.04, P = 0.02), wrist flexion/extension range of motion (P < 0.001) following the use of counterforce bracing with vibration increased significantly compared with baseline. The results show that the counterforce bracing with and without vibration relieves pain and improves range of motion and muscles strength in lateral epicondylitis participants, but this improvement is more significant with the use of vibration.

The Effect of the Powerball Gyroscope as a Treatment Device for Nonspecific Wrist Pain

OBJECTIVE

The aim of this study was to determine the effect of using the Powerball gyroscope as a treatment device on pain and change in endurance in nonspecific wrist pain.

METHODS

This study was a within-participants pre- and postintervention study consisting of 40 participants between ages 18 and 35 with an equal male-to-female ratio. The participants used the Powerball gyroscope for 5 minutes per treatment session. Treatment comprised 12 sessions carried out 3 × per week over a 4-week period. Participants completed objective and subjective data before the first, seventh, and 12th sessions. Objective data were recorded using the Jamar dynamometer to measure grip strength. Subjective data were gathered using the Patient-Rated Wrist Evaluation Questionnaire. Participants then used the Powerball gyroscope in the hand with the affected wrist. The Wilcoxon signed rank test and 1-way repeated-measures analysis of variance were used to analyze the changes.

RESULTS

A significant decrease in pain was noted throughout the study, but the most significant changes occurred between the seventh and 12th treatment sessions (P < .01). A significant increase in grip strength was also noted throughout the study, with the greater increase in grip strength occurring during the first 7 treatments (P < .02).

CONCLUSION

The Powerball gyroscope showed a change in outcome regarding nonspecific wrist pain and grip strength.

Evaluating the immediate effect of forearm and wrist orthoses on pain and function in individuals with lateral elbow tendinopathy: A systematic review

BACKGROUND

Lateral elbow tendinopathy is associated with pain during gripping, with forearm/wrist orthoses prescribed for treatment.

OBJECTIVES

To investigate the immediate effects of forearm and/or wrist orthoses on outcome measures of pain and function in individuals with lateral elbow tendinopathy.

DESIGN

Systematic review METHODS: Four electronic databases were searched to identify randomised controlled trials reporting the immediate effects of forearm and/or wrist orthoses on pain and function in individuals with lateral elbow tendinopathy. The quality of evidence was rated from high to very low, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for the primary outcomes. Where possible, standardised mean difference (SMD) and 95% confidence intervals were calculated to compare post measures between forearm and/or wrist orthoses and control/placebo conditions.

RESULTS

The search revealed 1965 studies, of which, seven randomised crossover trials were included. Using the GRADE approach there was low quality evidence revealing a significant decrease in pain during contraction (SMD range -0.65 to -0.83) with forearm orthoses compared to a control/placebo condition. Low quality evidence revealed improvements in pain-free grip strength with the use of a forearm orthosis (SMD range 0.24-0.38), but not maximal grip strength (SMD range 0.14-0.15). Low quality evidence revealed a static wrist orthosis did not improve pain-free grip strength (SMD -0.08) or maximal grip strength (SMD -0.22).

CONCLUSION

There is low quality evidence that forearm orthoses can immediately reduce pain during contraction and improve pain-free grip strength but not maximal grip strength in individuals with lateral elbow tendinopathy.

Immediate effects of 2 types of braces on pain and grip strength in people with lateral epicondylalgia: a randomized controlled trial

STUDY DESIGN

Repeated-measures, crossover, double-blinded randomized controlled trial.

OBJECTIVES

To compare the immediate effectiveness of 2 types of counterforce braces in improving pain-free grip strength, pressure pain threshold, and wrist angle during a gripping task in individuals with lateral epicondylalgia.

BACKGROUND

Sports medicine management of lateral epicondylalgia often includes application of a counterforce brace, but the comparative effectiveness of different braces is unclear. The most common brace design consists of a single strap wrapped around the proximal forearm. A variation of this brace is the use of an additional strap that wraps above the elbow, which aims to provide further unloading to the injured tissue.

METHODS

Pain-free grip strength, pressure pain threshold, and wrist angle during a gripping task were measured on 34 participants with a clinical diagnosis of lateral epicondylalgia (mean ± SD age, 47.8 ± 8.5 years). Measurements were made without a brace, as well as immediately before and after the application of 2 types of counterforce braces. Each condition was tested during a separate session, with a minimum of 48 hours between sessions. Analysis-of-variance models were used to test the differences within and between conditions.

RESULTS

Pain-free grip strength (17.2 N; 95% confidence interval: 7.5, 26.8) and pressure pain threshold (42.2 kPa; 95% confidence interval: 16.5, 68.0) significantly improved on the affected side immediately following the intervention conditions as well as the control condition. There was no significant difference between braces or the control condition for any outcome.

CONCLUSION

Both types of counterforce braces had an immediate positive effect in participants with lateral epicondylalgia, without differences between interventions and similar to a no-brace control condition. Therefore, while the use of a brace may be helpful in managing immediate symptoms related to lateral epicondylalgia, the choice of which brace to use may be more a function of patient preference, comfort, and cost. Further research is required to investigate the comparative longer-term and clinical effects of the 2 braces.

TRIAL REGISTRATION

ACTRN12609000354280 ( www.anzctr.org.au).

Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow

Background

Tennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow.

Objectives

This study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow.

Patients and Methods

Thirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively.

Results

Among the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001.

Conclusions

The taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients.

FOREARM BAND VERSUS ELBOW TAPING: AS A MANAGEMENT OF LATERAL EPICONDYLITIS

Purpose: There are several treatments available for the management of lateral epicondylitis, but there is a dearth of clinical trials compared to the efficacy of a forearm band over supportive elbow taping technique as an adjunct measure in the management of lateral epicondylitis. Materials and Methods: Totally 45 subjects with the mean age of 30±5 years diagnosed with lateral epicondylitis participated in the study based upon inclusion and exclusion criteria. Subjects were randomly allocated to three groups (n = 15 in each); Group-A (forearm band), Group-B (elbow taping) and Group-C (control), provided with a forearm band, supportive elbow taping technique and as a control group, respectively, although all groups received the conventional physiotherapy in addition to these adjunct measures. The outcome measurements included pain-free grip strength and functional improvement, assessed by using hand-held dynamometer and patient-rated forearm evaluation questionnaire (PRFEQ), respectively. Total duration of study was four weeks. Results: Although all the groups showed improvement with respect to increase in the pain-free grip strength and enhancement of functional independence, however, Group-A has shown the maximum improvement followed by Group-B which in turn proved to be more effective than conventional physiotherapy alone. Conclusion: The application of the forearm band produced a significant increase in the grip strength and function as compared to the elbow taping and control groups. The study implies the potential use of a forearm band in the future in addition to the conventional therapy in the management of patients with lateral epicondylitis.