Tennis Elbow Counterforce Bracing

The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Lateral elbow tendinopathy, also known as "tennis elbow" or "lateral epicondylitis," is a common disease leading to pain in the lateral side of the elbow and disability during hand gripping. A counterforce brace is one of the most conventional treatments. However, its effects on outcomes remain inconclusive.

OBJECTIVES

To investigate the effects of counterforce braces on pain in subjects with lateral elbow tendinopathy. Grip strength was reviewed as a secondary outcome.

STUDY DESIGN

Systematic review and meta-analysis of randomized controlled trials.

METHODS

PubMed, Embase, Scopus, Web of Science, CENTRAL, PEDro, ProQuest, RECAL, and RehabData were searched from January 1, 1995, through June 15, 2019.

RESULTS

Seventeen studies were included with a total of 1145 participants. A small improvement in pain over the short term (standardized mean difference -0.02; 95% confidence interval: -0.85 to 0.80) and a moderate-to-large improvement in pain in subjects 45 years or younger (standardized mean difference -0.86; 95% confidence interval: -2.45 to 0.72) in favor of the brace versus physiotherapy interventions were found. In contrast, over the long-term physiotherapy interventions (standardized mean difference 1.17; 95% confidence interval: -0.00 to 2.34), wrist splint (standardized mean difference 0.35; 95% confidence interval: -0.07 to 0.76), and laser therapy (standardized mean difference 0.58; 95% confidence interval: -0.44 to 1.59) had better effects on pain improvement versus the brace.

CONCLUSION

The results indicated that physiotherapy interventions compared to counterforce braces have better effects, especially over the long-term. However, counterforce braces may have better effects on pain in younger people (<45 years old) over the short term (<6 weeks).

CLINICAL RELEVANCE

The results suggest that counterforce bracing is a reasonable strategy to alleviate pain over the short term. However, the subgroup analysis suggests that factors such as age may have a role in their effectiveness.

The immediate sensorimotor effects of elbow orthoses in patients with lateral elbow tendinopathy: a prospective crossover study

BACKGROUND

Counterforce orthoses are used to manage lateral elbow tendinopathy, and their effectiveness in improving motor function has been documented. Little is known about the impact of bracing on sensory function. The objective of this study was to investigate the immediate effectiveness of 2 counterforce orthoses in improving the sensorimotor abilities of the hand in patients with lateral elbow tendinopathy.

METHODS

In this crossover, randomized controlled trial, elbow proprioception, pain severity, pain-free grip strength, and finger dexterity were measured in 50 participants with a diagnosis of lateral elbow tendinopathy. Outcomes were measured in 3 randomized conditions (no brace, forearm band, or elbow sleeve). Data were analyzed using 1-way repeated-measures analysis of variance for each outcome measure.

RESULTS

Better scores were observed with the forearm band, as compared with no orthosis, for multiple outcomes including joint position reproduction score at 70° of elbow flexion (P = .006), pain (P < .001), grip strength (P = .01), and dexterity (P < .001). The elbow sleeve yielded better scores than no orthosis for the following outcomes: joint position reproduction score at 110° (P < .001), pain (P < .001), and grip strength (P = .012). No statistically significant difference was found between the orthoses' effects on pain reduction and grip strength (P > .05). The forearm band showed better scores on joint position reproduction at 70° compared with the elbow sleeve (P = .006), whereas the elbow sleeve showed better scores at 110° (P < .001).

CONCLUSION

Our results support the mechanisms occurring with the use of either of the described orthotic interventions. Future randomized trials with longer-term outcomes that include sensorimotor mechanisms might enhance our understanding of the comparative effectiveness.

Multimodal approach to rehabilitation of the patients with lateral epicondylosis: a case series

Purpose

The objective of this study was to evaluate the effectiveness of mobilization with movement and kinesiotherapy in the treatment of patients with lateral epicondylosis.

Methods

This cases series included eight volunteers who had chronic lateral epicondylosis. The patients were treated with stretching, massage deep transverse at the lateral epicondyle and mobilization with movement associated with eccentric exercise. The mobilization with movement that consisted of a force of lateral glide of the proximal forearm. We performed twelve sessions, twice a week for 45 min/session. All patients underwent an evaluation with a visual analog scale and functional assessment through questionnaires patient-rated tennis elbow evaluation (PRTEE) and disabilities of the arm, shoulder and hand (DASH), before and after the treatment. Data were analyzed by student’s t test (p < 0.05).

Results

The results showed statistical differences in pain symptoms before and after treatment, in the analysis and functional assessment through both questionnaires comparing the pre and post treatment.

Conclusion

The data obtained in this study demonstrates improvement of the function and pain status of the sample investigated.

A Newly Designed Tennis Elbow Orthosis With a Traditional Tennis Elbow Strap in Patients With Lateral Epicondylitis

BACKGROUND

Lateral epicondylitis is a common cause of pain and upper limb dysfunction. The use of counterforce straps for treatment of lateral epicondylitis is widespread. This kind of orthosis can be modified to have a greater effect on relieving pain by reducing tension on the origin of the extensor pronator muscles.

OBJECTIVES

To determine the immediate effects of a newly designed orthosis on pain and grip strength in patients with lateral epicondylitis.

MATERIALS AND METHODS

Twelve participants (six men and six women) were recruited (mean age = 41 ± 6.7 years) and evaluated for pain and grip strength in three sessions. A 48-hour break was taken between each session. The first session was without any orthosis, the second session was with the new modified tennis elbow orthosis, and the third session was with a conventional tennis elbow strap.

RESULTS

Both counterforce straps were effective. However, significantly more improvement was observed in pain and grip strength after using the newly modified orthosis (P < 0.05).

CONCLUSIONS

The newly designed strap reduces pain more effectively and improves grip strength by causing greater localized pressure on two regions with different force applications (two component vectors versus one).

The influence of different non-articular proximal forearm orthoses (brace) widths in the wrist extensors muscle activity, range of motion and grip strength in healthy volunteers

PURPOSE

The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects.

METHODS

Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM. The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear model with mixed effects.

RESULTS

According to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01).

CONCLUSIONS

A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings.

Effect of a new hand-forearm splint on grip strength, pain, and function in patients with tennis elbow

BACKGROUND

While the effectiveness of orthoses prescribed for tennis elbow has been reported in several studies, the effect of how they may limit movements which aggravate this condition has not yet been explored.

OBJECTIVE

The purpose of this study was to evaluate the effect of a new spiral hand-forearm splint that restricts the movement of the wrist and forearm, on grip strength, pain, and function in patients with tennis elbow.

STUDY DESIGN

Quasi-experimental design.

METHODS

A total of 15 patients with tennis elbow (mean age 43 years) took part in this study. The amount of pain, grip force, and function were compared using a visual analog scale, Jamar dynamometer, and the Disability of the Arm, Shoulder, and Hand questionnaire, respectively. This was performed at baseline and repeated after 4 weeks of splint use. Active motion of the forearm was measured by a goniometer.

RESULTS

The spiral splint significantly relieved pain and improved function and grip force in patients after 4 weeks of application (P < 0.05).

CONCLUSION

The new splint design had a positive effect on the treatment of tennis elbow symptoms which included pain, grip strength, and function. Restriction of rotational movement (e.g. reduction of the supination and pronation of forearm) may have played the main role in this.

CLINICAL RELEVANCE

This new splint design may be considered as a new approach in the conservative treatment and rehabilitation of patients with tennis elbow.

LATERAL EPICONDYLITIS OF THE ELBOW

Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population. The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis and the mechanism of injury is associated with overloading. Nonsurgical treatment is the preferred method, and this includes rest, physiotherapy, cortisone infiltration, platelet-rich plasma injections and use of specific immobilization. Surgical treatment is recommended when functional disability and pain persist. Both the open and the arthroscopic surgical technique with resection of the degenerated tendon tissue present good results in the literature.

The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis

STUDY DESIGN

Controlled laboratory study using a randomized crossover design.

OBJECTIVE

To determine the immediate effect of 3 common types of orthoses (2 elbow counterforce orthoses and a wrist splint) on grip strength in individuals with lateral epicondylosis.

BACKGROUND

Lateral epicondylosis is a common cause of pain and upper limb dysfunction. Although the effectiveness of orthoses has been reported, comparisons of effectiveness among orthoses are limited.

METHODS AND MEASURES

Fifty-two subjects with lateral epicondylosis were recruited (20 men, 32 women; mean +/- SD age, 41 +/- 8 years). Maximum and pain-free grip strength were assessed using a digital hand grip dynamometer immediately after the application of each orthosis. The 4 testing conditions included a placebo orthosis as a control condition, an elbow strap orthosis, an elbow sleeve orthosis, and a wrist splint. Data were analyzed using a 1-way analysis of variance for each outcome measure.

RESULTS

Pain-free grip-strength was greater when using the elbow strap or the elbow sleeve orthosis compared to when using the placebo control orthosis or the wrist splint (P<.02), but there was no difference between the elbow sleeve and strap orthoses (P>.05), nor between the wrist splint and placebo orthosis (P>.05). Maximum grip strength was less when using the wrist splint compared to when tested with the elbow sleeve or the elbow strap (P< or =.003). Use of the elbow strap, elbow sleeve, or wrist splint did not change maximum grip strength compared to the control placebo orthosis condition (P>.05). There was also no difference in maximum grip strength between the elbow strap and the elbow sleeve conditions (P>.05).

CONCLUSION

The use of the 2 types of elbow orthoses (strap and sleeve) resulted in an immediate increase in pain-free grip strength. No differences between the 2 orthoses were found, suggesting that either can be used. A wrist splint produced no immediate change in pain-free or maximum grip-strength, indicating that it should not be used as a first-choice orthosis based on those outcome measures.

Ultrasound-guided, minimally invasive, percutaneous needle puncture treatment for tennis elbow

INTRODUCTION

This report evaluates the efficacy of percutaneous needle puncture under sonographic guidance in treating lateral epicondylitis (tennis-elbow).

METHODS

Ultrasound-guided percutaneous needle puncture was performed on 76 patients who presented with persistent elbow pain. Under a local anesthetic and sonographic guidance, a needle was advanced into the calcification foci and the calcifications were mechanically fragmented. This was followed by a local injection of 25 mg prednisone acetate and 1% lidocaine. If no calcification was found then multiple punctures were performed followed by local injection of 25 mg prednisone acetate and 1% lidocaine. A visual analog scale (VAS) was used to evaluate the degree of pain pre-and posttreatment at 1 week to 24 weeks. Elbow function improvement and degree of self-satisfaction were also evaluated.

RESULTS

Of the 76 patients, 55% were rated with excellent treatment outcome, 32% good, 11% average, and 3% poor. From 3 weeks posttreatment, VAS scores were significantly reduced compared with the pretreatment score (P<0.05) and continued to gradually decline up to 24 weeks posttreatment. Sonography demonstrated that the calcified lesions disappeared completely in 13% of the patients, were reduced in 61% of the patients, and did not change in 26% of the patients. Color Doppler flow signal used to assess hemodynamic changes showed a significant improvement after treatment in most patients.

CONCLUSION

Ultrasound-guided percutaneous needle puncture is an effective and minimally invasive treatment for tennis elbow. Sonography can be used to accurately identify the puncture location and monitor changes.