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Uttamchandani SR, Phansopkar P. Conservative Management of Lateral Epicondylalgia: A Review. Cureus 2024; 16:e59875. [PMID: 38854316 PMCID: PMC11157989 DOI: 10.7759/cureus.59875] [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: 09/05/2022] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
A common overuse injury to the elbow is called tennis elbow or lateral epicondylitis (LE). LE is a condition that causes substantial discomfort and dysfunction in the upper extremity. Thermal and electrical agents are examples of conservative techniques. It is a significant public health concern since it frequently occurs due to occupation. It also happens in recurrent upper extremity motions including desktop use, weight training, forceful forearm movements, and repetitive vibratory movements, which are the most common activities performed by an engineer. LE leads to lateral epicondylar pain, which is irritating due to inflammation of the extensor muscle origin, and also activities of daily living are restricted. It is not only seen in players with racquet sports but then most of the males and females are affected in the fourth and fifth decades, leading to limitations in daily work, activity, and household work. Rehabilitation seems the most effective treatment yet in acute and chronic conditions if later the pain does not subside then rest, injectables, and nonsteroidal anti-inflammatory drugs are the options to be taken. Physiotherapeutic rehabilitation plays a significant role in LE.
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Affiliation(s)
- Shivani R Uttamchandani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Campos MGM, Maia LB, Mascarenhas RO, Lourenço BM, Henschke N, Oliveira VC. Effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy: A systematic review and meta-analysis. Braz J Phys Ther 2024; 28:100596. [PMID: 38402668 PMCID: PMC10904251 DOI: 10.1016/j.bjpt.2024.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Lateral elbow tendinopathy is a common musculoskeletal disorder. Effectiveness of non-invasive therapies for this health condition are unclear. OBJECTIVE To investigate the effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy. METHODS Searches were conducted on MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Library, SPORTDiscus and PsycINFO without language or date restrictions up to May 3rd, 2023. Randomized trials investigating the effectiveness of any non-invasive therapy compared with control or other invasive interventions were included. Two independent reviewers screened eligible trials, extracted data, and assessed the risk of bias of included trials and certainty of the evidence. RESULTS Twenty-two different therapies investigated in 47 randomized trials were included in the quantitative analysis. Moderate certainty evidence showed that betamethasone valerate medicated plaster may reduce disability (mean difference -6.7; 95% CI -11.4, -2.0) in the short-term when compared with placebo. Low certainty evidence showed that acupuncture may reduce disability (MD -9.1; 95% CI -11.7, -6.4) in the short-term when compared with sham. Moderate to very low certainty of evidence also showed small to no effect of non-invasive therapies on pain intensity, maximum grip strength, and disability outcomes in the short-term compared to control or invasive interventions. Most therapies had only very low certainty of evidence to support their use. CONCLUSIONS Decision-making processes for lateral elbow tendinopathy should be carefully evaluated, taking into consideration that most investigated interventions have very low certainty of evidence. There is an urgent call for larger high-quality trials.
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Affiliation(s)
- Mariana G M Campos
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Laísa B Maia
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Rodrigo O Mascarenhas
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Bianca M Lourenço
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Vinicius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil.
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Tian Y, He B, Tsymbal A. Comprehensive secondary prevention of lateral epicondylitis in young tennis players. Res Sports Med 2024; 32:160-173. [PMID: 35726857 DOI: 10.1080/15438627.2022.2090252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
The research aims to increase the efficiency of the training process for young tennis players old based on lateral epicondylitis secondary prevention methods. Tennis players with apparent residual effects of lateral epicondylitis were selected for the study and divided into experimental (18 boys and 14 girls) and control groups (18 boys and 13 girls). The experimental group was trained according to the developed technique, and the control group as per standard one. The results of goniometry in the experimental group showed the normalization of the motion amplitude in extension and supination. The motor density of the training session applying the complex technique for the secondary prevention of lateral epicondylitis in the experimental group increased on average from 66.6% to 82.2% in boys and from 65.7% to 80.0% in girls.
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Affiliation(s)
- Yu Tian
- Sports Department, Henan Institute of Technology, Xinxiang, Henan, China
| | - Bing He
- Department of Physical Education, China Pharmaceutical University, NanJing, Jiangsu, China
| | - Alexandr Tsymbal
- Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Pathan AF, Sharath HV. A Review of Physiotherapy Techniques Used in the Treatment of Tennis Elbow. Cureus 2023; 15:e47706. [PMID: 38021828 PMCID: PMC10674892 DOI: 10.7759/cureus.47706] [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: 08/20/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Tennis elbow, a common musculoskeletal disorder also known as lateral epicondylitis, causes pain and tenderness on the outside of the elbow. Although it is frequently linked to repetitive motions, such as those in racquet sports, it can affect people in a variety of occupations and activities. Tennis elbow can be treated conservatively with physiotherapy, which focuses on pain management, functional recovery, and recurrence prevention. The goal of this review is to give a thorough overview of the physiotherapy methods used to treat tennis elbow. In order to determine the most effective treatment options, it is crucial to comprehend the pathophysiology and etiology of tennis elbow from the outset of the study. The assessment and diagnosis of tennis elbow are next covered, emphasizing the importance of physiotherapists in correctly diagnosing the ailment and distinguishing it from other musculoskeletal problems that are comparable to it. This study primarily focuses on the numerous physiotherapy therapies for tennis elbow, which may include but are not limited to, and the section examines the use of manual treatments to treat pain and enhance joint function, including joint mobilizations, soft tissue massage, and myofascial release. Exercise rehabilitation covers the value of tailored workouts to bolster the weak muscles and enhance the elbow joint's biomechanics. Numerous workout regimens are covered, such as eccentric training and progressive resistance exercises, as well as modalities. Therapeutic agents frequently make use of modalities such as ultrasound, laser therapy, and cryotherapy. It may also make use of complementary therapeutic agents such as taping and bracing. In summary, this in-depth analysis highlights the crucial role that physical therapy plays in the treatment of tennis elbow. It seeks to give practitioners a useful tool for enhancing the care and results of patients with this common and crippling ailment by summarizing the most recent research and best practices in physiotherapy approaches.
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Affiliation(s)
- Anam F Pathan
- Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
| | - H V Sharath
- Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research (DU), Wardha, IND
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Özdinçler AR, Baktır ZS, Mutlu EK, Koçyiğit A. Chronic lateral elbow tendinopathy with a supervised graded exercise protocol. J Hand Ther 2023; 36:913-922. [PMID: 36914496 DOI: 10.1016/j.jht.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Prospective Case Series. BACKGROUND Variety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ongoing and very much needed due to the uncertainty of the subject. PURPOSE We aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function. METHODS This study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks. RESULTS Investigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56). CONCLUSIONS The basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.
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Affiliation(s)
- Arzu Razak Özdinçler
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Biruni University, İstanbul, Turkey
| | - Zahide Seda Baktır
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, İstanbul Aydin University, İstanbul, Turkey
| | - Ebru Kaya Mutlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, İstanbul, Turkey
| | - Ahmet Koçyiğit
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Gelisim University, Istanbul, Turkey.
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Özcan F, Gürçay E. Is the information about lateral epicondylitis on the YouTube platform reliable and of good quality? PHYSICIAN SPORTSMED 2023; 51:458-462. [PMID: 36154542 DOI: 10.1080/00913847.2022.2129504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study aimed to investigate the quality and reliability of YouTube videos, as a source of lateral epicondylitis (LE). METHODS In this cross-sectional study, 484 videos were analyzed by searching the YouTube platform with the keyword 'lateral epicondylitis.' Journal of the Medical Association (JAMA) benchmark criteria, modified DISCERN and Global Quality Scale (GQS) were used for quality and reliability assessments. RESULTS A total of 298 videos were evaluated. High quality (GQS 4-5) was identified in 74 videos (24.8%), intermediate quality (GQS 3) in 84 videos (28.2%), and low quality (GQS 1-2) in 140 videos (47%). Of the videos, 57.7% (n = 41) uploaded by physician were of high quality. A significant difference was found between the low-intermediate-high-quality groups in terms of duration, number of views, number of likes, number of comments, likes per day, comments per day, video view ratio, JAMA score and modified DISCERN score (all p < 0.01). In videos uploaded by physicians; views, time since uploaded, JAMA score, modified DISCERN score, and GQS score were significantly higher than videos shared by trainers, health-related web sites, and independent users. The duration and viewing rates of the videos, the number of views, likes, comments, likes per day and comments per day were found to be significantly associated with JAMA, modified DISCERN, and GQS scores (p < 0.01). CONCLUSION About half of YouTube videos for LE were low quality. Most of the high-quality videos have been shared by physicians and these videos have been longer, more viewed, more liked and commented, and more reliable. Healthcare professionals should provide high-quality, unbiased, accurate and instructive information that is accessible to everyone on the YouTube platform.
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Affiliation(s)
- Fatma Özcan
- University of Health Sciences, Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Bilkent, Turkey
| | - Eda Gürçay
- University of Health Sciences, Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Bilkent, Turkey
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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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Ciftci YGD, Tuncay F, Kocak FA, Okcu M. Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study. Arch Phys Med Rehabil 2023; 104:179-187. [PMID: 36243123 DOI: 10.1016/j.apmr.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. DESIGN A double-blind, parallel groups, randomized controlled study. SETTINGS Outpatient Clinic. PARTICIPANTS Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. INTERVENTIONS To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. MAIN OUTCOME MEASURES The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. RESULTS In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P<.05). In Group 3, there was no difference in VAS-R, VAS-A, and handgrip strength at weeks 3 and 12 than baseline (P>.05). CONCLUSION In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study.
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Affiliation(s)
- Yıldız Gonca Dogru Ciftci
- Department of Physical Medicine and Rehabilitation, Sisli Etfal Hamidiye Research Hospital, Istanbul, Turkey.
| | - Figen Tuncay
- Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Fatmanur Aybala Kocak
- Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Mehmet Okcu
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
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Soares MM, Souza PC, Ribeiro AP. Differences in Clinical Tests for Assessing Lateral Epicondylitis Elbow in Adults Concerning Their Physical Activity Level: Test Reliability, Accuracy of Ultrasound Imaging, and Relationship with Energy Expenditure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1794. [PMID: 36767167 PMCID: PMC9914816 DOI: 10.3390/ijerph20031794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Physical activity (PA) can generate physical stress on the musculoskeletal system. Thus, the aim of the current study was to assess the influence of the level of physical activity on clinical tests used in the diagnosis of lateral epicondylitis in adults, intertest reliability and accuracy based on ultrasound imaging, and relationship with energy expenditure. METHODS 102 adults with lateral epicondylitis were assessed via an International Physical Activity Questionnaire and divided according to PA level: low (n = 19) moderate (n = 42) or high (n = 41). Pain (visual analog scale), Cozen's and Mill's clinical tests and ultrasound exams were performed. RESULTS The Cozen's and Mill's tests differed among PA levels. Excellent reliability was found for Mill's test for PA levels and the ultrasound exam (low ICC = 1.0, moderate ICC = 0.82 and high ICC = 0.99). Good reliability was found for Cozen's test (low ICC = 0.80, moderate ICC = 0.74 and high ICC = 0.73), but with significant differences between the ultrasound exams. The Cozen's and Mill's clinical tests had no relationship to the level of energy expenditure for PA levels. CONCLUSION Mill's test was reliable and accurate for the PA levels. Intertest reliability was poor for the PA levels. Mill's test proved to be accurate based on the ultrasound exam. The pain caused by the tests was not related to the level of energy expenditure.
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Affiliation(s)
- Marcos Martins Soares
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Patrícia Colombo Souza
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Ana Paula Ribeiro
- Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
- Medicine and Physical Therapy Department, School of Medicine, University of São Paulo, São Paulo 05360-160, Brazil
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Huang G, Zhang J, Wei Z, Mai Y, Guo J, Jiang L. Ultrasound-Guided Injection of Autologous Platelet-Rich Plasma for Refractory Lateral Epicondylitis of Humerus: Case Series. J Pers Med 2022; 13:jpm13010066. [PMID: 36675727 PMCID: PMC9860542 DOI: 10.3390/jpm13010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Refractory lateral epicondylitis (RLE) is a tendinopathy of the elbow with less effective conservation treatment. Platelet-rich plasma (PRP) is a new treatment option for RLE because of its repair-promoting effect on tissues. Although evidence demonstrates the efficacy of PRP in treating tendinopathies, the therapeutic utility of ultrasound-guided PRP injection for RLE is unknown. Here, we report two cases of RLE treated with PRP. The first patient was a 78-year-old man who received an unknown dose of local glucocorticoid injection at the local community clinic in June 2016. His pain recurred after exertion. The second patient was a 54-year-old woman who received a glucocorticoid injection (0.5 mL of compound betamethasone and 1.5 mL of 0.9% normal saline) in October 2020. Her pain could not be relieved. A physician diagnosed patients with RLE based on their medical history, symptoms, and clinical signs. The doctor injected PRP (the first patient in November 2020, the second in March 2021) under ultrasound guidance into the patient's attachment point of the extensor tendon at the lateral humeral epicondyle. The doctor evaluated the effectiveness of the treatment by ultrasonography, visual analogue scale, and the patient-rated tennis elbow evaluation. After four weeks of treatment, the pain was relieved, and functions continued to improve in the following three months. Moreover, the ultrasonography showed that the damaged tendons were repaired. Together, we demonstrate that ultrasound-guided PRP injection could considerably relieve pain, improve elbow joint functions in patients with RLE, and provide visible evidence that PRP repairs tendon damage.
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Affiliation(s)
- Guohang Huang
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Jiangshan Zhang
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Zhenhai Wei
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Yiying Mai
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Jisheng Guo
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Li Jiang
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: ; Tel.: +86-158-0004-5323
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Bagcaci S, Unuvar BS, Gercek H, Ugurlu I, Sert OA, Yilmaz K. A randomized controlled trial on pain, grip strength, and functionality in lateral elbow pain: Mulligan vs muscle energy techniques. J Back Musculoskelet Rehabil 2022; 36:419-427. [PMID: 36120766 DOI: 10.3233/bmr-220061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lateral elbow tendinopathy (LET) is one of the most common lesions of the upper extremity. The level of evidence from studies on LET treatment protocols is insufficient. OBJECTIVE The aim of this study was to compare the acute effects of mobilization with movement (MWM) and muscle energy technique (MET) on pain, grip strength, and functionality in patients diagnosed with LET. METHODS Forty-five patients with LET aged 30-55 years were enrolled in this study. Patients were divided into three groups: MWM, MET, and control group. The control group received a 4-week home exercise program. In addition to the home exercise program in the MWM group, 12 sessions of MWM and 12 sessions of MET were performed in the MET group. Participants' pain, grip strength, and functionality were assessed before and after the study. RESULTS After the treatment period, greater improvement in pain, grip strength, finger strength, and functionality were observed in the MWM and MET groups than in the control group (p< 0.05), but no statistically significant difference was found between the MWM and MET groups (p> 0.05). CONCLUSIONS This study shows that MWM and MET, used in addition to home exercises, can be used to relieve pain and increase grip strength, finger strength, and functionality.
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Affiliation(s)
- Sinan Bagcaci
- Department of Physiotherapy and Rehabilitation, KTO Karatay University, Konya, Turkey
| | | | - Hasan Gercek
- Department of Therapy and Rehabilitation, KTO Karatay University, Konya, Turkey
| | - Ibrahim Ugurlu
- Department of Medical Services and Techniques, Selcuk University, Konya, Turkey
| | - Ozlem Akkoyun Sert
- Department of Physiotherapy and Rehabilitation, KTO Karatay University, Konya, Turkey
| | - Kamil Yilmaz
- Department of Physiotherapy and Rehabilitation, KTO Karatay University, Konya, Turkey
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Luo D, Liu B, Gao L, Fu S. The effect of ultrasound therapy on lateral epicondylitis: A meta-analysis. Medicine (Baltimore) 2022; 101:e28822. [PMID: 35212276 PMCID: PMC8878842 DOI: 10.1097/md.0000000000028822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Lateral epicondylitis is a common musculoskeletal disorder, and ultrasound therapy is one of the most used treatments in the clinic. The effect remains uncertain, and the present paper aims to figure it out with a meta-analysis. METHODS The Pubmed, Cochrane library, and Embase databases were searched for relevant studies published before Jure 1, 2021. Continuous variables were compared by calculating the standard difference of the means, whereas categorical dichotomous variables were assessed using relative risks. A random-effects model was used if the heterogeneity statistic was significant; otherwise, a fixed-effects model was used. RESULTS Thirteen studies were included in the quantitative analysis, including 442 participants (287 ultrasonic treated patients and 155 controls). The VAS scale decreased markedly after ultrasound therapy (P = .027). However, no statistically significant difference could be found between ultrasound therapy and the control groups at all post-treatment time points. Similarly, no benefits could be found when comparing the pre- and post-treatment grip strength with ultrasonic therapy (P = .324). Moreover, though ultrasound treatment always continues for a long time, the present study demonstrated there were no additional benefits when comparing short- and long-term outcomes. CONCLUSIONS The ultrasound therapy is helpful to relieve pain for LE patients, but no such benefit could be found for grip strength. However, it has no significant advantage against other conservative treatments like rest and brace.
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Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon 2022; 68:101314. [PMID: 34996610 DOI: 10.1016/j.disamonth.2021.101314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.
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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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Evidenced-Based Management of Tennis Elbow. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Trends in Corticosteroid Injections for Treatment of Lateral Epicondylitis: An Analysis of 80,169 Patients. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202109000-00006. [PMID: 34506365 PMCID: PMC8437211 DOI: 10.5435/jaaosglobal-d-21-00186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022]
Abstract
Corticosteroid (CS) injections are a frequently used treatment modality for lateral epicondylitis (LE) despite an increasing number of studies suggesting their lack of efficacy. The objective of this study was to review the annual utilization of CS injections for treatment of LE, as well as that of other nonsurgical treatments and surgical treatments, to understand how recent publications have affected the practice of physicians in treating LE.
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Neyaz O, Vasudeva A, Parihar R, Bharti A, Handa G. Efficacy of a local corticosteroid injection on pain, disability and radial nerve thickness in patients with lateral epicondylitis. J Family Med Prim Care 2021; 10:4502-4508. [PMID: 35280608 PMCID: PMC8884310 DOI: 10.4103/jfmpc.jfmpc_1173_21] [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] [Received: 06/15/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction: The aim of this study was to compare the effect of a steroid injection with conservative therapy (CT) versus CT alone on pain, functional limitations and the cross-sectional area (CSA) of the radial nerve (RN) in patients with lateral epicondylitis (LE). Methods: In this clinical trial, seventy subjects in the age group of 30–60 years with a clinical diagnosis of LE were recruited. Patients received an ultrasound-guided steroid injection and CT (Group A, n = 35) or CT alone (Group B, n = 35). Pain intensity (numeric pain rating scale), functional limitations (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire) and the CSA of RN (mm2) using ultrasound were assessed at baseline, 4 and 12 weeks. Results: There was a significant difference in pain intensity (P < 0.05) at 4 weeks in favour of Group A but not at 12 weeks. A statistically significant difference was not present favouring either group concerning disability at both the follow-ups. The difference in CSA of the RN at the affected side in both groups A and B was not statistically significant at either the spiral groove or the antecubital fossa at baseline or the subsequent follow-ups. Conclusions: The CT with a steroid injection proved to be more efficacious in the short term concerning pain intensity and functional limitations. The RN thickness is not increased in patients with LE, thereby refuting its role to some extent in the pathogenesis of LE.
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18
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Hsu CY, Ke DS, Lin CL, Kao CH. Association between lateral epicondylitis and the risk of herpes zoster development. Postgrad Med 2020; 133:96-101. [PMID: 32853042 DOI: 10.1080/00325481.2020.1816713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diseases burden is associated with herpes zoster (HZ) development. However, the relationship between lateral epicondylitis (LE) and HZ remains unknown. AIM This study investigated the association between LE and the risk of HZ development. METHODS In this study, we collected data from the National Health Insurance Research Database of Taiwan. Patients who were diagnosed as having LE for the first time between 2000 and 2012 were included in the LE cohort. Patients without LE were randomly selected from the same database for inclusion in the control cohort. The outcome of interest was the first diagnosis of HZ during the follow-up period. RESULTS The overall incidence rates of HZ in the LE and control cohort were 8.95 and 7.14 per 1,000 person-years, respectively. After adjustments were made, the LE cohort had a higher hazard ratio of HZ than the control cohort [adjusted hazard ratio (aHR) = 1.23]. The risk of HZ was significantly higher in those aged 50 to 64 years (aHR = 2.05) and in those over the age of 65 years (aHR = 2.50), compared with those aged ≤49 years. The risk of HZ was significantly higher in women (aHR = 1.17). The female patients with LE had a higher risk of HZ development than controls (aHR = 1.27). CONCLUSION Women with LE had a higher risk of HZ development. HZ vaccination may be needed for the female patients with LE.
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Affiliation(s)
- Chao-Yu Hsu
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital , Chia-Yi, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology , Taichung, Taiwan.,Center for General Education, National Taichung University of Science and Technology , Taichung, Taiwan.,The General Education Center, Chaoyang University of Technology , Taichung, Taiwan.,Department of General Education, National Chin-Yi University of Technology , Taichung, Taiwan.,Center for General Education, National Chi Nan University , Puli, Taiwan.,Rural Generalist Program Japan, GENEPRO , Japan
| | - Der-Shin Ke
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital , Chia-Yi, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital , Taichung, Taiwan.,College of Medicine, China Medical University , Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University , Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital , Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University , Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital , Taichung, Taiwan
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Kim HN, Goo B, Nam SS. Acupuncture for lateral epicondylitis: A prisma-compliant protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e22008. [PMID: 32925732 PMCID: PMC7489695 DOI: 10.1097/md.0000000000022008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acupuncture has been widely used for relieving pain associated with musculoskeletal disorders, such as lateral epicondylitis. Although the effect of acupuncture on pain has been demonstrated in previous reviews, it is still under debate. This study is aimed at evaluating the efficacy of acupuncture to treat lateral epicondylitis and establishing the evidence systematically. METHODS Nine databases will be searched from their inception to May 2020 without language or publication status restrictions, including 3 English databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials), 5 Korean databases (Korean Medical Database, KoreaMed, Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System), and 1 Chinese database (China Knowledge Network Database). Only randomized controlled trials will be included. Pain intensity will be considered as the primary outcome. Secondary outcomes will include the grip strength, total effective rate, and adverse events. Two independent researchers will perform the study selection, data extraction, and quality assessment. The methodological quality of the identified studies will be assessed using the Cochrane Collaboration's risk-of-bias tool. In the meta-analysis, continuous data will be expressed as mean and 95% confidence interval, and dichotomous data will be expressed as risk ratio and 95% confidence interval. RESULTS The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION The results of this study would provide the evidence of whether acupuncture is effective for lateral epicondylitis. REGISTRATION NUMBER PROSPERO CRD42020186824.
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Affiliation(s)
- Ha-Na Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu
| | - Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital, Gangdong, Dongnam-ro, Gangdong-gu
| | - Sang-Soo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
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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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