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Qin Y, Luo D, Qiu H, Zhang J, Yong H, Yu S. A systematic review and meta-analysis of acupuncture for De Quervain's tenosynovitis treatment. Postgrad Med J 2024:qgae057. [PMID: 38932434 DOI: 10.1093/postmj/qgae057] [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: 11/28/2023] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND De Quervain's tenosynovitis (DQt) is a prevalent chronic inflammatory musculoskeletal disorder predominantly affecting the radial aspect of the wrist. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain's tenosynovitis (DQt). Although there is evidence suggesting that acupuncture can alleviate symptoms of DQt-characterized by pain, swelling, and functional impairment-higher-level evidence is still required to further substantiate its efficacy and safety. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain's tenosynovitis (DQt). METHODS By systematically searching databases such as PubMed, Science Direct, Web of Science, Google Scholar, EMbase, PEDro, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chongqing VIP China Science, Technology Journal Database (VIP), we retrieved randomized controlled trial (RCT) literature on acupuncture for DQt, with the search period extending to November 1, 2023. After extracting and assessing data from the included literature, we performed Meta-analysis using RevMan 5.4.1 software. RESULTS The results encompassed 14 RCT papers, involving 851 patients. The Meta-analysis findings indicated that, when compared to topical analgesics, acupuncture demonstrated a significant increase in treatment effectiveness (RR = 1.24; 95% CI = 1.11, 1.39, P = 0.0002) and a notable reduction in VAS pain scores (MD = -1.06; 95% CI = -1.51, -0.61, P < 0.00001). However, no statistically significant difference was observed in conney wrist joint scores. Furthermore, acupuncture was found to reduce VAS pain scores compared to the waiting list group. In comparison to corticosteroid injections (CSI), acupuncture did not show statistical significance in VAS, effectiveness rate, and conney wrist scores. CONCLUSION Acupuncture exhibited a promising trend in alleviating pain associated with DQt and enhancing treatment effectiveness. Nonetheless, due to limitations in the quantity and quality of the included studies, these findings warrant further validation through additional research.
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Affiliation(s)
- Yuxi Qin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 610075, China
- Sichuan Provincial Bayi Rehabilitation Center (Sichuan provincial Rehabilitation Hospital, No. 81, Bayi Road, Yongning Town, Wenjiang District, Chengdu City, Sichuan Province 610075, China
- Affiliated Rehabilitation Hospital of Chengdu University of TCM, No. 81, Bayi Road, Yongning Town, Wenjiang District, Chengdu City, Sichuan Province, China
| | - Dan Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Twelve Bridges Road, Jinniu District, Chengdu, Sichuan Province, China
| | - Heng Qiu
- Orthopedics Department, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Twelve Bridges Road, Jinniu District, Chengdu, Sichuan Province, China
| | - Jingyu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Twelve Bridges Road, Jinniu District, Chengdu, Sichuan Province, China
| | - Huang Yong
- Orthopedics Department, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Twelve Bridges Road, Jinniu District, Chengdu, Sichuan Province, China
| | - Shuguang Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 610075, China
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Alter TH, Romeo PV, Bielicka DL, Monica JT. Distal Intersection Syndrome Between Second and Third Dorsal Compartments of the Wrist. Cureus 2023; 15:e36919. [PMID: 37128523 PMCID: PMC10148692 DOI: 10.7759/cureus.36919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Distal intersection syndrome (DIS) is a rare form of tenosynovitis affecting the second and third dorsal extensor compartments of the wrist, which is rarer and more distal than the classically described intersection syndrome between the first and second compartments. In this report, we present three cases of DIS, their inciting activities, and ensuing treatment courses. Diagnosis of DIS was confirmed via MRI in all cases. Treatment modalities consisted of non-steroidal anti-inflammatory medications and varying durations of immobilization in all three patients, initially. One patient ultimately underwent surgical debridement and partial tenosynovectomy. At the end of follow-up, all patients saw a reduction in symptomatology with a return to baseline activity levels. This case report provides an overview of the possible clinical courses of DIS, as well as treatment strategies that can be implemented. Providers must maintain a high index of suspicion for this condition and treat patients with a great deal of caution, as extensor tendon rupture is possible.
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Effective assessments to identify overuse injuries in unaffected limbs of persons with unilateral upper limb amputations. J Hand Ther 2021; 34:298-308. [PMID: 34148738 DOI: 10.1016/j.jht.2021.05.006] [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] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional study. INTRODUCTION Overuse injuries (OI) present major health problems and oftentimes, permanent disability. Persons with unilateral upper limb diagnoses, such as amputation, are at-risk for developing OI in their unaffected limbs. Measures to identify high-risk populations are needed. PURPOSE OF THE STUDY Scores on 6 OI-assessments were compared for persons with unilateral upper limb amputations (UULA) and healthy participants. Cutoff values were proposed. METHODS Sixty-two persons with UULA and 62 healthy controls completed this study. Scores for hand volume (HV), visual analogue scale (VAS), multi-site Semmes Weinstein Monofilament for median and ulnar nerves (SWM-M/SWM-U), torque range of motion for wrist/finger extension and flexion (TROM-E/TROM-F), intrinsic tightness (IT), and differential flexor tendon gliding (DFTG) were collected before and after 15 minutes of repetitive and resistive exercise. When analyzing collected data, descriptive statistics, and ANOVA were used to identify differences between groups. Receiver operating characteristic curves (ROC), area under the curve (AUC), sensitivity, and specificity were calculated to determine acceptable cutoff scores. Cutoff values with significant AUC ≥ 0.60 and sensitivity ≥ 0.80 were accepted. RESULTS Statistically significant differences were found between HV by gender in both pre-exercise and post-exercise conditions. Gain scores for whole sample HV, female HV, and TROM-E were statistically different although differences were small and not meaningful. Significant AUC and acceptable pre-exercise cutoff values included 375 ml. for female HV (sensitivity 89%, specificity 87%), 505 ml. for male HV (sensitivity 81%, specificity 70%), 82 degrees for TROM-E (sensitivity 92%, specificity 71%), and 73 degrees of TROM-F (sensitivity 90%, specificity 89%). CONCLUSIONS Potential at-risk OI-related populations, especially unaffected limbs of UULA persons, are best identified by pre-exercise cutoff values using HV by gender, TROM, and single-site SWM 2.83.
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Chen Z, Baker NA. Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis. J Hand Ther 2021; 34:18-28. [PMID: 32284219 DOI: 10.1016/j.jht.2020.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Meta-analysis. INTRODUCTION Lateral elbow tendinopathy is a common condition with an annual incidence of up to 3% of the population. Eccentric strengthening has shown promise as a method to treat lateral elbow tendinopathy, but is unclear if it is superior to other forms of treatment. PURPOSE OF THE STUDY The purpose of this study was to investigate the effectiveness of eccentric strengthening compared with other forms of strengthening and pain-relieving modalities on pain, strength, and function in people with lateral elbow tendinopathy. METHODS Five electronic databases were searched. Reference lists of selected articles were hand-searched. Outcomes were defined a priori. Meta-analyses were performed using a random effects model with standardized mean differences, test of heterogeneity, and sensitivity analyses. RESULTS Eight articles were included in this review. When comparing eccentric strengthening to other forms of strengthening and pain-relieving modalities, there were significant large effect size of 1.12 (CI: 0.31-1.93) and 1.22 (CI: 0.25-2.18) in reducing pain and improving function in the short-term, respectively. In long-term, results were inconclusive on all outcomes. DISCUSSION A treatment program using eccentric strengthening of adequate intensity and duration seemed to be most effective for treating lateral elbow tendinopathy. CONCLUSIONS The state of science of best care for lateral elbow tendinopathy is still in its infancy. Large, high-quality randomized controlled trials with clearly defined strengthening regime are needed to determine optimal dosage to maximize treatment effects. Recommendations were provided based on careful synthesis of findings from this review and current evidence in literature.
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Affiliation(s)
- Zhiqing Chen
- Occupational Therapy Department, Singapore General Hospital, Singapore, Singapore; Department of Occupational Therapy, Tufts University, Medford, MA, USA.
| | - Nancy A Baker
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
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Sun X, Shen Y, Zhou Q, Jia Y, Qiu Z, Li S. Comparison between acupotomy and local steroid injection for the management of de Quervain disease: A systematic review protocol. Medicine (Baltimore) 2019; 98:e17765. [PMID: 31725617 PMCID: PMC6867724 DOI: 10.1097/md.0000000000017765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND De Quervain disease (dQD) is a painful condition of the wrist that affects patients' quality of life and work ability. Acupotomy has been widely used in the treatment of dQD. It has been reported in many articles that acupotomy can improve the clinical symptoms of dQD. However, the efficacy has not been evaluated scientifically and systematically. The aim of this systematic review protocol is to evaluate the efficacy and safety of acupotomy treatment compared with local steroid injection in patients with de Quervain disease. METHODS Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, EMBASE, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], SinoMed, Technology Journal [VIP], and the Wanfang Database). Randomized controlled trials (RCTs) of Acupotomy for dQD patients will be identified independently by 2 reviewers by searching the databases from inception to October 2018. Clinical effects will be evaluated as the primary outcome. The VAS (visual analog scale) score will be assessed as a secondary outcome. RevMan V.5.3 will be used to perform a fixed effect meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. Continuous outcomes will be presented as the mean differences or standard mean differences, while dichotomous data will be expressed as relative risks. RESULTS This study will evaluate the effectiveness and safety of acupotomy in the treatment of de Quervain disease in RCTs with high-quality VAS and RM. CONCLUSION This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with de Quervain disease. PROSPERO REGISTRATION NUMBER CRD42018108786.
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Affiliation(s)
- Xiaojie Sun
- Department of Acupuncture-Moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing
| | - Yifeng Shen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Qiaoyin Zhou
- Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China
| | - Yan Jia
- Department of Acupuncture-Moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing
| | - Zuyun Qiu
- Department of Acupuncture-Moxibustion, China-Japan Friendship Hospital
- Beijing University of Chinese Medicine, Beijing
| | - Shiliang Li
- Department of Acupuncture-Moxibustion, China-Japan Friendship Hospital
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Ultrasonography could be used to predict extended insertion of the EPB tendon noninvasively. Surg Radiol Anat 2018; 40:995-999. [PMID: 29948040 DOI: 10.1007/s00276-018-2049-6] [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: 03/12/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION An abnormal distal insertion of the extensor pollicis brevis (EPB) tendon into the thumb interphalangeal joint (IP) has been observed in refractory cases of de Quervain's disease. This is associated with the extensor being wider at the midpoint of the proximal phalanx; however, there is no method to noninvasively measure this. This study evaluated the accuracy of measuring the extensor width using ultrasonography, to establish a noninvasive method for predicting an EPB extending the IP insertion. MATERIALS AND METHODS Of 23 arms from 12 fresh frozen cadavers, the extensor tendon width at the midpoint of the proximal phalanx was measured using ultrasonography and directly at dissection. The association between these values was evaluated using correlation analysis. A cut-off value of extensor tendon width was obtained using receiver operating characteristic analysis. RESULTS A strong correlation was observed between the ultrasonography and the measured values. The EPB tendons were normal in 13 arms (57%) and extended in 10 (43%), with a significant difference between these groups in the mean width of the extensor tendon (6.8 ± 1.1 vs. 8.4 ± 1.0 mm). A cut-off extensor tendon width of 8.0 mm yielded an EPB extending the IP. CONCLUSION An EPB extending the IP tendon can be predicted by measuring the extensor tendon width at the midpoint of the proximal phalanx using ultrasonography. The cut-off tendon width value of ≥ 8.0 mm may be useful for assessments prior to surgery and for conservative care.
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Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons. J Hand Surg Am 2018; 43:558-563. [PMID: 29622410 DOI: 10.1016/j.jhsa.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 04/14/2017] [Accepted: 03/04/2018] [Indexed: 02/02/2023]
Abstract
Corticosteroid injections (CIs) are frequently used by hand surgeons to treat a wide range of pathology including de Quervain tenosynovitis and lateral epicondylitis. Although generally viewed as a benign modality, and a way to potentially avoid or postpone surgical intervention, common complications from CI should be considered and discussed with patients before the procedure. One such complication is local soft tissue atrophy and hypopigmentation after injection. We discuss the incidence of soft tissue-related adverse effects from CI, the pathophysiology and influence of different steroid preparations on soft tissues, and potential treatment options once atrophy has occurred.
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Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis. J Hand Ther 2016; 29:3-11. [PMID: 26705671 DOI: 10.1016/j.jht.2015.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review with meta-analysis. INTRODUCTION Although corticosteroid injections are often cited as best practice in the treatment of de Quervain's disease, no reviews have compared their effectiveness to a multimodal definition of hand therapy. PURPOSE To compare the effectiveness of corticosteroid injections with that of i) hand therapy alone and ii) combined hand therapy/corticosteroid injection approaches in the treatment of de Quervain's disease. METHODS Searches of key databases were performed to identify experimental studies published between January 1950 and November 2014. Outcome measures included treatment success, pain, quality of life, and function. RESULTS Both corticosteroid injections and hand therapy improved pain and function from baseline, but between-group differences were not significant (across 6 studies). However, significantly more participants were treated successfully when combined orthosis/corticosteroid injection approaches were compared to i) orthoses (RR 0.53, 95% CI 0.35-0.80) and ii) injections alone (RR 0.76, 95% CI 0.64-0.89). CONCLUSION Combined orthosis/corticosteroid injection approaches are more effective than either intervention alone in the treatment of de Quervain's disease. LEVEL OF EVIDENCE 1a.
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Affiliation(s)
- Rocco Cavaleri
- Western Sydney University, Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, NSW 2560, Australia
| | - Siobhan M Schabrun
- Western Sydney University, Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, NSW 2560, Australia
| | - Maxine Te
- Western Sydney University, Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, NSW 2560, Australia
| | - Lucy S Chipchase
- Western Sydney University, Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, NSW 2560, Australia.
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Gadau M, Zhang SP, Yip HY, Yeung WF, Bian ZX, Lu AP, Zaslawski C. Pattern Differentiation of Lateral Elbow Pain in Traditional Chinese Medicine: A Systematic Review. J Altern Complement Med 2016; 22:921-935. [DOI: 10.1089/acm.2016.0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marcus Gadau
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Shi-Ping Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Ho-Yin Yip
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zhao-Xiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Ai-Ping Lu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
| | - Chris Zaslawski
- College of TCM, University of Technology Sydney, Sydney, Australia
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Wegener RL, Brown T, O’Brien L. A randomized controlled trial of comparative effectiveness of elastic therapeutic tape, sham tape or eccentric exercises alone for lateral elbow tendinosis. HAND THERAPY 2016. [DOI: 10.1177/1758998316656660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Lateral elbow tendinosis is a condition that is well known to cause difficult challenges for hand therapists due to its long-term recovery and morbidity. Elastic therapeutic tape is commonly used as a treatment modality, despite limited evidence. Methods A randomized controlled trial was conducted to evaluate the effectiveness of elastic therapeutic tape, in conjunction with eccentric exercises, in the treatment of lateral elbow tendinosis. Forty participants with this condition (12 men, 28 women) were randomly allocated to three groups: (i) elastic therapeutic tape and eccentric exercises, (ii) sham tape and eccentric exercises, and (iii) eccentric exercises alone. All groups received education on activity modification techniques. Interventions were undertaken over a 12-week period (four weekly sessions and four fortnightly sessions) and outcome measures were recorded at baseline, three months and six months post randomisation. Results At three and six months, improvements were made in all three groups as assessed with the Patient-Rated Tennis Elbow Evaluation, the Short Form 36, pain-free grip strength, and the Occupational Self Assessment. However, there were no statistically significant differences between groups in any of these measures. There were no significant side effects or symptom exacerbation with using the elastic therapeutic tape. Conclusions Whilst all groups improved on key outcomes, it is possible that exercise alone and/or natural recovery were responsible for improvements. It is positive to note that the use of elastic therapeutic tape was well tolerated by participants and not associated with any significant side effects or symptom exacerbation.
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Affiliation(s)
- Raewyn L Wegener
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, VIC, Australia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, VIC, Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, VIC, Australia
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Taylor RL, Brown T, O'Brien L. Using and prescribing kinesiotape as a treatment modality for musculoskeletal disorders. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.9.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Raewyn L Taylor
- PhD student, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Ted Brown
- Associate professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Lisa O'Brien
- Senior lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Teggeler M, Schmitz M, Fink A, Jansen JACG, Pisters MF. Reliability and agreement of ultrasonographic thickness measurements of the common lateral extensors of the elbow. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1592-1598. [PMID: 25748525 DOI: 10.1016/j.ultrasmedbio.2015.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/10/2015] [Accepted: 01/21/2015] [Indexed: 06/04/2023]
Abstract
In individuals with lateral elbow tendinopathy, the thickness of the common lateral extensors tendon can be evaluated by musculoskeletal ultrasonography (MSU) for diagnostic and evaluative purposes. The reproducibility of these thickness measurements should be established before integrating it into daily practice. A test-retest design was used to determine the reproducibility of these measurements in the longitudinal and transverse planes. Seventy-three healthy participants were measured two times by two raters. Intra-class correlation coefficient values for inter-rater reliability for the longitudinal and transverse planes were 0.67 and 0.49. Intra-class correlation coefficient values for intra-rater reliability varied between 0.73 and 0.92. The smallest detectable change ranged from 0.50 to 0.78 mm and comprised 9.8%-16.3% of the mean thickness. MSU thickness measurement of the common lateral extensors tendon of the elbow has fair to excellent intra- and inter-rater reliability. Additionally, agreement is acceptable, which makes MSU a valuable tool for the evaluation of tendon thickness over time.
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Affiliation(s)
- Marlijn Teggeler
- Physical Therapy Science, Program in Clinical Health Sciences and Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Physical Therapy Practice Emmastraat, Enschede, The Netherlands.
| | - Marc Schmitz
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Alexandra Fink
- Physical Therapy Science, Program in Clinical Health Sciences and Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Hand Therapy Center, Enschede, The Netherlands
| | - Jaap A C G Jansen
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn F Pisters
- Physical Therapy Science, Program in Clinical Health Sciences and Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
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Taylor RL, Brown T, O'Brien L. Knowledge of and willingness to recommend kinesiotape for upper limb overuse injuries: A comparison of therapists', GPs' and surgeons' perspectives. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Upper limb overuse injuries, such as tennis elbow, may be challenging in terms of both diagnosis and management, and there is no consensus on a gold standard intervention. Despite limited evidence in the literature to support the efficacy of kinesiotaping, this new treatment modality has gained popularity among athletes and the general public and is commonly used to treat these conditions. Clinicians are therefore relying on lower levels of evidence and/or expert opinion when deciding whether to use this treatment and it is likely that there are varying perspectives on its potential clinical benefits. The purpose of this study was to compare the opinions of hand therapists, general practitioners (GPs) and hand surgeons on the use of kinesiotape for upper limb overuse injuries. Methods: This cross-sectional study used a self-report survey to gather data from respondents (n=157). Survey questions aimed to identify practice patterns and gain an understanding of clinicians' reasons for either recommending or not recommending this modality. Results: Hand therapists rated their understanding of the use of kinesiotape (Mean±SD = 6.51±1.89) significantly higher than levels reported by GPs (Mean±SD = 3.04± 2.50) and surgeons (Mean±SD = 4.16± 2.52). Hand therapists reported a moderate level of success with the use of kinesiotape (Mean±SD = 6.30±1.59), which was significantly higher than that reported by surgeons (Mean±SD = 4.84±1.21); however, there was no notable difference between hand therapists and GPs (Mean±SD = 5.27± 2.10). Of the three groups, GPs were most likely (69.5%) to indicate that they would not use or recommend kinesiotape, compared with 31% of hand therapists and 38.7% of hand surgeons. Conclusions: Hand therapists are more likely to rate kinesiotaping as successful and recommend its clinical use, indicating that they place greater emphasis on their own clinical experience than research evidence. It is inferred that GPs and surgeons have a higher level of scepticism for interventions without supporting evidence, such as kinesiotaping. More evidence from randomised controlled trials is required to inform practitioners on the potential benefits of this intervention.
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Affiliation(s)
- Raewyn L Taylor
- PhD student, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Ted Brown
- Associate professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Lisa O'Brien
- Senior lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Wegener RL, Brown T, O’Brien L. The use of elastic therapeutic tape and eccentric exercises for lateral elbow tendinosis: a case series. HAND THERAPY 2015. [DOI: 10.1177/1758998315580823] [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]
Abstract
Introduction ‘Lateral elbow tendinosis’ or ‘lateral elbow tendinopathy’ have been suggested to be more appropriate diagnostic terms instead of ‘lateral epicondylitis’ as the condition is degenerative rather than inflammatory. For this reason, it is important that interventions target this degeneration at the common extensor tendon. Methods A descriptive, retrospective review of a series of four patients with lateral elbow tendinosis was conducted to examine functional outcomes with the use of elastic therapeutic tape, eccentric exercises and activity modification techniques. Results All patients recorded improved changes in pain and grip strength within three months of treatment using elastic therapeutic tape, eccentric exercises and activity modification techniques. Conclusions There may be clinical benefit in the use of elastic therapeutic tape, in conjunction with eccentric exercises and activity modification techniques, for the treatment of lateral elbow tendinosis. More rigorous and comprehensive studies are recommended to further investigate this intervention.
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Affiliation(s)
- Raewyn L Wegener
- Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
| | - Ted Brown
- Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
| | - Lisa O’Brien
- Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
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Vicenzino B, Cleland JA, Bisset L. Joint manipulation in the management of lateral epicondylalgia: a clinical commentary. J Man Manip Ther 2011; 15:50-6. [PMID: 19066643 DOI: 10.1179/106698107791090132] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Lateral epicondylalgia or tennis elbow is a prevalent musculoskeletal disorder that is characterized by lateral elbow pain often associated with gripping tasks. The underlying pathology remains to be fully elucidated; however, evidence indicates that the disorder does not involve an inflammatory process but rather impairments of the pain and motor systems as well as morphological changes in the structure of both the extensor carpi radialis brevis muscle and tendon. Although the most efficient management approach remains controversial, there is a growing body of literature reporting the effects and underlying mechanisms of joint manipulation in the management of lateral epicondylalgia. Evidence exists demonstrating that joint manipulation directed at the elbow and wrist as well as at the cervical and thoracic spinal regions results in clinical alterations in pain and the motor system. In addition to presenting this evidence, this paper describes proposed underlying physiological mechanisms of joint manipulation associated with the observed clinical effects. We propose that this information will be useful for the physical therapist in making clinical decisions regarding the selection of treatment technique for the management of patients with lateral epicondylalgia.
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Murgia A, Harwin W, Prakoonwit S, Brownlow H. Preliminary observations on the presence of sustained tendon strain and eccentric contractions of the wrist extensors during a common manual task: Implications for lateral epicondylitis. Med Eng Phys 2011; 33:793-7. [DOI: 10.1016/j.medengphy.2011.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 02/04/2011] [Accepted: 02/05/2011] [Indexed: 11/25/2022]
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Bhargava AS, Eapen C, Kumar SP. Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study. BMC Sports Sci Med Rehabil 2010; 2:22. [PMID: 20822520 PMCID: PMC2944326 DOI: 10.1186/1758-2555-2-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 09/07/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common sports injury of the elbow caused due to altered muscle activation during repetitive wrist extension in many athletic and non-athletic endeavours. The amount of muscle activity and timing of contraction eventually is directly dependent upon joint position during the activity. The purpose of our study was to compare the grip strength in athletes with lateral epicondylalgia in two different wrist extension positions and compare them between involved and uninvolved sides of athletes and non-athletes. METHODS An assessor-blinded case-control study of eight athletes and twenty-two non-athletes was done. The grip strength was measured using JAMAR® hand dynamometer in kilograms-force at 15 degrees (slightly extended) and 35 degrees (moderately extended) wrist extension positions (maintained by wrist splints) on both involved and uninvolved sides of athletes and non-athletes with unilateral lateral epicondylitis of atleast 3 months duration. Their pain was to be elicited with local tenderness and two of three tests being positive- Cozen's, Mill's manoeuvre, resisted middle finger extension tests. For comparisons of grip strength, Wilcoxon signed rank test was used for within-group comparison (between 15 and 35 degrees wrist extension positions) and Mann-Whitney U test was used for between-group (athletes vs. non-athletes) comparisons at 95% confidence interval and were done using SPSS 11.5 for Windows. RESULTS Statistically significant greater grip strength was found in 15 degrees (27.75 ± 4.2 kgms in athletes; 16.45 ± 4.2 kgms in non-athletes) wrist extension than at 35 degrees (25.25 ± 3.53 kgm in athletes and 14.18 ± 3.53 kgm in non-athletes). The athletes had greater grip strength than non-athletes in each of test positions (11.3 kgm at 15 degrees and 11.07 kgm at 35 degrees) measured. There was also a significant difference between involved and uninvolved sides' grip strength at both wrist positions (4.44 ± .95 kgm at 15 degrees and 4.44 ± .86 kgm in 35 degrees) which was significant (p < .05) only in non-athletes. CONCLUSION The grip strength was greater in 15 degrees wrist extension position and this position could then be used in athletes with lateral epicondylalgia for grip strength assessment and designing wrist splint in this population.
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Affiliation(s)
- Arti S Bhargava
- Department of Physiotherapy, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India.
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Jaworski CA, Krause M, Brown J. Rehabilitation of the Wrist and Hand Following Sports Injury. Clin Sports Med 2010; 29:61-80, table of contents. [PMID: 19945587 DOI: 10.1016/j.csm.2009.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Carrie A Jaworski
- Department of Intercollegiate Sports Medicine, Northwestern University, Evanston, IL 60208, USA.
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Barr S, Cerisola FL, Blanchard V. Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review. Physiotherapy 2009; 95:251-65. [DOI: 10.1016/j.physio.2009.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 05/12/2009] [Indexed: 11/27/2022]
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Joensen J, Couppe C, Bjordal JM. Increased palpation tenderness and muscle strength deficit in the prediction of tendon hypertrophy in symptomatic unilateral shoulder tendinopathy: an ultrasonographic study. Physiotherapy 2009; 95:83-93. [DOI: 10.1016/j.physio.2008.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
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Batteson R, Hammond A, Burke F, Sinha S. The de Quervain's screening tool: validity and reliability of a measure to support clinical diagnosis and management. Musculoskeletal Care 2008; 6:168-180. [PMID: 18618462 DOI: 10.1002/msc.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Studies into the effectiveness of interventions for upper limb soft tissue disorders have been hampered by a lack of consistently used diagnostic criteria, meaning that comparison of research results is a problem. To aid homogeneous recruitment into a study of de Quervain's disease, a de Quervain's screening tool (DQST) was developed. This could also be used to facilitate clinical diagnosis and management in practice. AIMS To provide evidence for the content and construct validity and test-retest and inter-rater reliability of the DQST. METHOD The study was conducted in an acute care, outpatient hand unit in a district general hospital. Three convenience samples of: 59 people with de Quervain's disease; 18 with carpal tunnel syndrome (CTS) and 16 with osteoarthritis (OA) of the carpometacarpal (CMC) joint were recruited. The DQST diagnostic criteria were initially generated from a literature review. Content validity was then established by expert doctors with an interest in upper limb musculoskeletal disorders (n = 7) rating the relevance of the seven items included. The DQST was then tested in people either already diagnosed with, or reported as having some of the symptoms of, de Quervain's disease. Construct validity was tested with people with CTS or OA of the CMC joint. RESULTS The median DQST score was 5 (Interquartile range IQR = 4-6) out of a possible seven diagnostic criteria. Inter-rater reliability was excellent (Intra-class coefficient [ICC] = 0.85; 95% confidence interval [CI] = 0.75, 0.91). Test retest reliability was good (ICC = 0.64; 95% CI = 0.20, 0.87). Sensitivity (Se) and specificity (Sp) testing (Se = 1.00; Sp = 1.00) demonstrated that the DQST discriminated between people with de Quervain's disease, CTS or OA of the CMC joint. CONCLUSIONS The DQST is a valid, reliable tool which could be of assistance in aiding correct diagnosis for recruitment to clinical trials and in clinical practice. Future research is recommended to further examine retest reliability with a larger sample size and to identify the commonest diagnostic criteria required for inclusion.
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Affiliation(s)
- Rachel Batteson
- Faculty of Health & Well Being, Sheffield Hallam University, Sheffield, UK.
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Draghi F, Danesino GM, de Gautard R, Bianchi S. Ultrasound of the elbow: Examination techniques and US appearance of the normal and pathologic joint. J Ultrasound 2007; 10:76-84. [PMID: 23396104 DOI: 10.1016/j.jus.2007.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ultrasound studies are frequently requested for the work-up of patients with local elbow pain, which is generally caused by overuse syndromes, trauma, inflammatory diseases, or neuropathies. The technique used to examine this joint will vary to some extent depending on the precise location of the pain and other clinical findings. The aim of this article is to describe the standard technique used for elbow ultrasound, the normal anatomy of the joint, and the appearance on ultrasound of normal elbow anatomy and the alterations associated with some of the more common disorders affecting this joint.
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Affiliation(s)
- F Draghi
- Institute of Radiology, IRCCS Policlinico San Matteo, University of Pavia, Italy
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Woodley BL, Newsham-West RJ, Baxter GD. Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med 2006; 41:188-98; discussion 199. [PMID: 17062655 PMCID: PMC2658941 DOI: 10.1136/bjsm.2006.029769] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies. DATA SOURCES Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966-Jan 2006), CINAHL (1982-Jan 2006), AMED (1985-Jan 2006), EMBASE (1988-Jan 2006), and all EBM reviews--Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric. REVIEW METHODS The PEDro and van Tulder scales were employed to assess methodological quality. Levels of evidence were then obtained according to predefined thresholds: Strong--consistent findings among multiple high-quality RCTs. Moderate--consistent findings among multiple low-quality RCTs and/or clinically controlled trials (CCTs) and/or one high-quality RCT. Limited--one low-quality RCT and/or CCT. Conflicting--inconsistent findings among multiple trials (RCTs and/or CCTs). No evidence-no RCTs or CCTs. RESULTS Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included studies of Achilles tendinopathy (AT), patella tendinopathy (PT) and tendinopathy of the common wrist extensor tendon of the lateral elbow (LET). Limited levels of evidence exist to suggest that EE has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound. Levels of evidence were found to be variable across the tendinopathies investigated. CONCLUSIONS This review demonstrates the dearth of high-quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies. Further adequately powered studies that include appropriate randomisation procedures, standardised outcome measures and long-term follow-up are required.
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Affiliation(s)
- Brett L Woodley
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
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Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther 2006; 18:411-9, quiz 420. [PMID: 16271688 DOI: 10.1197/j.jht.2005.07.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to evaluate the effectiveness of eccentric strengthening. Ninety-four subjects (50 men) with chronic lateral epicondylitis were allocated randomly into three groups: stretching, concentric strengthening with stretching, and eccentric strengthening with stretching. Subjects performed an exercise program for six weeks. All three groups received instruction on icing, stretching, and avoidance of aggravating activities. The strengthening groups received instruction on isolated concentric and eccentric wrist extensor strengthening, respectively. At six weeks, significant gains were made in all three groups as assessed with pain-free grip strength, Patient-rated Forearm Evaluation Questionnaire, Disabilities of the Arm, Shoulder, and Hand questionnaire, Short Form 36, and visual analog pain scale. No significant differences in outcome measures were noted among the three groups. Although there were no significant differences in outcome among the groups, eccentric strengthening did not cause subjects to worsen. Further studies are needed to assess the unique effects of a more intense or longer eccentric strengthening program for patients with lateral epicondylitis.
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Abstract
Randomized controlled trials were evaluated to assess the effectiveness of extracorporeal shock wave treatment in the management of tennis elbow. Five trials had a mediocre methodology and four trials had a high-quality design. Well-designed randomized control trials have provided evidence of the effectiveness of shock wave intervention for tennis elbow.
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