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Rodríguez-Huguet M, Rodríguez-Almagro D, Rosety-Rodríguez MA, Vinolo-Gil MJ, Molina-Jiménez J, Góngora-Rodríguez J. Pulsed negative pressure myofascial vacuum therapy and percutaneous electrolysis in the treatment of lateral epicondylalgia: A single-blind randomized controlled trial. J Hand Ther 2024:S0894-1130(24)00004-8. [PMID: 38453573 DOI: 10.1016/j.jht.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Lateral Epicondylalgia (LE) represents one of the most common injuries of the upper limb. It is necessary to find effective treatments that reduce pain and increase functionality. PURPOSE To determine the effects of an integrated intervention of Pulsed Negative Pressure Myofascial Vacuum Therapy (VT), Percutaneous Electrolysis (PE) and eccentric exercise (EE) in the treatment of LE compared versus Manual Therapy soft tissue mobilization (MT) and Ultrasound therapy (US) and EE. STUDY DESIGN Single-blind randomized controlled trial. METHODS Forty participants, with unilateral LE, were randomly divided into two groups: VT + PE + EE group (n = 20) and MT + US + EE group (n = 20). The VT + PE + EE group received one weekly session for four weeks and a regimen of EE daily at-home, and the MT + US + EE group received 10 sessions over a period of two weeks and a regimen of EE daily at-home. Numerical pain rating scale (NPRS), range of motion (ROM) pressure pain threshold (PPT) and function (PRTEE questionnaire) were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. RESULTS The statistically significant improvements were found post-treatment, favoring the VT + PE group in pain intensity (p < 0.001; ES = 0.408), PRTEE-S Pain (p = 0.001; ES = 0.377), PRTEE-S Specific function (p = 0.004; ES = 0.306) and PRTEE-S Total (p = 0.001; ES = 0.355). The VT + PE + EE treatment showed greater effectiveness than the MT + US + EE treatment at immediate post-treatment, as well as at the one-month and three-months follow-up. CONCLUSIONS VT and PE added to an EE program could be an effective treatment for pain, ROM, PPT, and function in patients with LE.
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Affiliation(s)
| | | | - Miguel Angel Rosety-Rodríguez
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cadiz, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cadiz, Spain; Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, Cadiz, Spain.
| | | | - Jorge Góngora-Rodríguez
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Department of Physiotherapy, Osuna School University, University of Sevilla, Sevilla, Spain
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Rippke JN, Burkhart KJ. [Epicondylosis : Open surgical procedure-when and how for lateral and medial epicondylitis?]. Orthopadie (Heidelb) 2023; 52:394-403. [PMID: 37074370 DOI: 10.1007/s00132-023-04374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Epicondylosis of the elbow are common pathologies, with a higher incidence for radial epicondylosis. Approximately 90% are self-limiting under conservative treatment. TREATMENT Multiple surgical procedures exist for the treatment of refractory cases. Arthroscopic treatment has been described for both radial and medial pathologies. Open and arthroscopic procedures show equivalent results in the surgical treatment of radial epicondylosis. This paper describes the most common open surgical procedures for the treatment of radial epicondylosis. Furthermore, the pros and cons of the arthroscopic versus the open approach are discussed, and the indications for an open surgical procedure for radial pathologies are highlighted. The authors believe that the open technique represents the standard treatment in the surgical treatment of ulnar epicondylosis. LIMITATIONS Arthroscopic procedures have been described, but studies comparing the clinical outcome versus open surgical treatment are lacking. The anatomic proximity of the flexor origin to the ulnar nerve with the risk of iatrogenic damage is another limiting factor. In addition, concomitant pathologies on the ulnar side can better be ruled out preoperatively, so that arthroscopy has a rather low significance in the treatment of ulnar epicondylosis.
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Affiliation(s)
- Jules-Nikolaus Rippke
- Klinik für Orthopädie und Traumatologie, KSA Kantonsspital Aarau, Tellstr. 25, 5001, Aarau, Schweiz.
| | - Klaus J Burkhart
- Arcus Sportklinik, Pforzheim, Deutschland
- Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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Tuntiyatorn P, Taweesakulvashra R, Kanchanathepsak T, Rojpitipongsakorn C, Tawonsawatruk T. Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy. BMC Musculoskelet Disord 2022; 23:803. [PMID: 35996100 DOI: 10.1186/s12891-022-05758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lateral epicondylitis is one of the most common upper extremity problems presented to orthopedic surgeons. Despite a rapid and accurate arrival at a diagnosis by clinical examination, there exists no consensus classification for this condition, which hampers clinical approaches for treatment of the disease based on its severity. Thus, the aim of this study was to propose and valiadate a new magnetic resonance imaging (MRI) classification of lateral epicondylitis, staging by tendinosis, the degree of thickness tears of the common extensor tendon (CET) and bone bruise lesion. METHOD MRI assessment of the elbow of 75 patients (57 women and 18 men; mean age:51.4 years (range,34-73) from Jan 2014 to Jan 2021 who were diagnosed with lateral epicondylitis were included in the study. MR images were reviewed retrospectively by two independent upper extremities orthopedists and one musculoskeletal radiologist. Inter- and intra-observer reliabilities for the classification were calculated using kappa statistics for the analysis of interrater agreement. Correlation between the stage of the disease and the duration of symptom before MRI was calculated using Kruskal-wallis test. RESULTS Various degrees of CET lesions were demonstrated in this population (Stage I-17, IIA-7, IIB-22 and III-29). Intra-observer agreements of MRI staging were substantial to satisfactory. Inter-observer agreements were moderate to substantial. There was no significant correlation between the disease stage and the patient age or the duration of symptom before MRI. CONCLUSION Our MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis. At the end, we have suggeted a clearer direction for understanding the disease pathology as well as an appropriate management protocol for each stage of the disease in line with the recent body of literature.
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Bang JY, Hahn S, Yi J, Lim YJ, Jung HK. Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis. Eur Radiol 2021; 31:6726-6735. [PMID: 33634322 DOI: 10.1007/s00330-021-07791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/26/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE). METHODS GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features. RESULTS Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV. CONCLUSIONS SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis. KEY POINTS • Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis. • There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.
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Affiliation(s)
- Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Hyun Kyung Jung
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
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Arrigoni P, Cucchi D, Luceri F, Zagarella A, Catapano M, Menon A, Bruno V, Gallazzi M, Randelli PS. Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:4067-4074. [PMID: 34455451 PMCID: PMC8595151 DOI: 10.1007/s00167-021-06711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. METHODS Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. RESULTS The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. CONCLUSIONS Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity.
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Affiliation(s)
- Paolo Arrigoni
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Francesco Luceri
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Andrea Zagarella
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Michele Catapano
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Valentina Bruno
- Istituto Clinico San Siro, Via Monreale, 18, 20148 Milan, Italy
| | - Mauro Gallazzi
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,Department of Biomedical Sciences for Health, Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Zhang B, Yuan Y, Zhang HJ, Luo H, Yang C. [Comparison of two different arthroscopic techniques for long head of biceps tendinitis]. Zhongguo Gu Shang 2019; 32:701-706. [PMID: 31533379 DOI: 10.3969/j.issn.1003-0034.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare clinical efficacy of arthroscopic tenodesis and tenotomy in treating biceps long head tendinitis. METHODS From January 2015 to January 2017, 40 patients with long head of the biceps tendinitis were randomly divided into tenotomy group (18 patients) and tenodesis group(22 patients). In tenotomy group, there were 6 males and 12 females with an average age of (62.2±6.1) yeas old, and the average course of disease was (8.5±2.2) months; while in tenodesis group, there were 8 males and 14 females with an average age of(60.5±6.3) years old, and the average course of disease was (8.1±2.3) months. Operative time and deformity of Popeye were compared between two groups, VAS score was used to evaluate degree of pain, and UCLA score was used to assess clinical effects before operation, 3, 6 and 12 months after operation. RESULTS Forty patients were followed up for 12 to 17 months with an average of(14.3±2.1) months. Eight patients occurred Popeye deformity in tenotomy group, and nobody in tenodesis group. There was significant difference between tenotomy group(40.55±7.51) min and tenodesis group(75.33±9.45) min. VAS score after operation at 3, 6 and 12 months were decreased than that of before operation, and VAS score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(P<0.05); while there were no difference in VAS score between two groups at 6 and 12 months after operation(P>0.05). UCLA score at at 3, 6 and 12 months after operation in tenodesis group were increased than that of before operation, and UCLA score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(P<0.05); while there were no difference in UCLA score between two groups at 6 and 12 months after operation(P>0.05). According to UCLA score, 5 got excellent results, 10 moderate and 3 poor in tenotomy group, while 8 got excellent results, 12 moderate and 2 poor in tenodesis group, but without difference between two groups(χ² =0.057, P=0.81). CONCLUSIONS Both of arthroscopic tenotomy and tenodesis in treating long head of the biceps tendinitis could receive good clinical effects, and early functional outcomes by arthroscopic tenotomy was better than that of tenodesis, but no difference in later period.
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Affiliation(s)
- Bo Zhang
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China
| | - Yi Yuan
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China;
| | - Hai-Jun Zhang
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China
| | - Hao Luo
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China
| | - Chao Yang
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China
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George CE, Heales LJ, Stanton R, Wintour SA, Kean CO. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport 2019; 40:117-127. [PMID: 31518778 DOI: 10.1016/j.ptsp.2019.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/17/2019] [Accepted: 08/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To systematically identify, appraise, and examine evidence regarding the effects of therapeutic tape on pain and function in individuals with lateral epicondylalgia (LE). METHODS Five electronic databases were systematically searched up to March 2018. Full-text, peer-reviewed, English-language studies were included if they had an LE population, a standalone tape condition, and an outcome related to pain or function. RESULTS Eight out of 2022 screened studies were included. Three studies demonstrated immediate (i.e. within 1 h) improvements in pain and pain-free grip strength following diamond deloading rigid tape. One study reported immediate improvements in proprioception following transverse rigid tape. The immediate effects of longitudinal kinesiotape were inconsistent. One study reported improvements in pain and pain-free grip strength, while another study reported no effect on pain, strength, or muscle activity. Two studies examined short-term (i.e. within six weeks) kinesiotape application. One study reported two weeks of longitudinal kinesiotape improved pain and maximum grip strength. The other study reported one week of diamond kinesiotape improved patient-reported pain and function, but not maximum grip strength. CONCLUSIONS In individuals with LE, diamond deloading rigid tape may immediately improve pain and strength. There is conflicting evidence regarding kinesiotape effects in both immediate and short-term timeframes.
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Affiliation(s)
- Caitlin E George
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia; School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia; Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Sally-Anne Wintour
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Crystal O Kean
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.
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Martin JI, Atilano L, Merino J, Gonzalez I, Iglesias G, Areizaga L, Bully P, Grandes G, Andia I. Platelet-rich plasma versus lidocaine as tenotomy adjuvants in people with elbow epicondylopathy: a randomized controlled trial. J Orthop Surg Res 2019; 14:109. [PMID: 31014382 PMCID: PMC6480601 DOI: 10.1186/s13018-019-1153-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the efficacy of platelet-rich plasma (PRP) compared to lidocaine as a tenotomy adjuvant for people with elbow tendinopathy. METHODS Our study was a parallel-group, double-blind, randomized trial involving 71 patients with recalcitrant elbow tendinopathy who received two sessions of ultrasound-guided tenotomy with either PRP or lidocaine in a tertiary public hospital. The primary end point was the percentage of patients with an improvement exceeding 25% reduction in disability (Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires-DASH-E) at 6 and 12 months; the secondary outcome was the percentage of patients exceeding 25% reduction in pain (VAS-P). RESULTS There was no evidence of significant differences in the proportion of patients who experienced clinically relevant improvements. After 6 months, 18 patients (78.59%) in the lidocaine group and 19 patients (73.08%) in the PRP group showed improved function above 25% (unadjusted odds ratio, 0.90; 95% confidence interval [CI], 0.90 (0.17 to 4.60)); 21 patients (72.21%) in the lidocaine group versus 22 patients (84.62%) in the PRP group achieved more than 25% pain reduction (unadjusted odds ratio, 0.48; 95% CI, 0.10 to 2.37). After 12 months, 17 patients (70.83%) in the lidocaine group versus 19 patients (76%) in the PRP group had improved function (unadjusted odds ratio, 0.71; 95% CI, 0.13 to 3.84), and 19 patients (76%) in the lidocaine group versus 20 patients (90.91%) in the PRP group had improved pain above 25% (unadjusted odds ratio, 0.35; 95% CI, 0.06 to 2.51). Hypercholesterolemia and baseline vascularization influenced outcomes. There were no differences between groups in the adjusted odds ratios. CONCLUSION PRP results in similar improvements to those obtained with lidocaine. Selecting patients according to their pretreatment status can improve treatment efficacy. TRIAL REGISTRATION NCT01945528 , EudraCT 2013-000478-32. Registered 18 August 2013, enrolment of the first participant 10 March 2014.
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Affiliation(s)
- Jose Ignacio Martin
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Leire Atilano
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Josu Merino
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Igor Gonzalez
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Gotzon Iglesias
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Luis Areizaga
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Isabel Andia
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.
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Abstract
Elbow tendinopathy accounts for the majority of elbow pathology in patients presenting to upper extremity and sports medicine surgeons. With increased participation in overhead sports in an aging population, the incidence of elbow injuries has risen. A comprehensive knowledge of elbow anatomy and biomechanical function of the elbow complex is prerequisite in the assessment of patients with elbow injuries; however, a thorough understanding of alternative and confounding pathologies is essential for accurate diagnosis. Because tendinopathy, tendonitis, and tendon tears have an anatomic basis for their pathology, a targeted history and meticulous physical examination often yields an accurate clinical diagnosis. The importance of physical examination and provocative examination maneuvers must be stressed in a technologically advanced era where clinical diagnosis is too commonly attained solely by advanced imaging modalities. A revived dedication to the physical examination may enhance our ability to correctly diagnose various pathologies about the elbow. Early and accurate clinical diagnosis is the first step in the proper initiation of treatment modalities and improvement in overall patient outcome.
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Affiliation(s)
- Joseph Laratta
- a Department of Orthopedic Surgery , New York Presbyterian/Columbia University Medical Center , New York , USA
| | - Jon-Michael Caldwell
- a Department of Orthopedic Surgery , New York Presbyterian/Columbia University Medical Center , New York , USA
| | - Joseph Lombardi
- a Department of Orthopedic Surgery , New York Presbyterian/Columbia University Medical Center , New York , USA
| | - William Levine
- a Department of Orthopedic Surgery , New York Presbyterian/Columbia University Medical Center , New York , USA
| | - Christopher Ahmad
- a Department of Orthopedic Surgery , New York Presbyterian/Columbia University Medical Center , New York , USA
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Abstract
BACKGROUND Non-surgical approaches to treatment of lateral epicondylitis are numerous. The aim of this systematic review is to examine randomized, controlled trials of these treatments. METHODS Numerous databases were systematically searched from earliest records to February 2013. Search terms included "lateral epicondylitis," "lateral elbow pain," "tennis elbow," "lateral epicondylalgia," and "elbow tendinopathy" combined with "randomized controlled trial." Two reviewers examined the literature for eligibility via article abstract and full text. RESULTS Fifty-eight articles met eligibility criteria: (1) a target population of patients with symptoms of lateral epicondylitis; (2) evaluation of treatment of lateral epicondylitis with the following non-surgical techniques: corticosteroid injection, injection technique, iontophoresis, botulinum toxin A injection, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, or laser therapy; and (3) a randomized controlled trial design. Lateral epicondylitis is a condition that is usually self-limited. There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief. Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids, and botulinum toxin A is likely to produce concomitant extensor weakness. Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections. Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief. Some studies of low-level laser therapy show superiority to placebo whereas others do not. CONCLUSIONS There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions to Authors for a complete description of level of evidence.
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Affiliation(s)
- Susan E. G. Sims
- />Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA
| | - Katherine Miller
- />University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 601, Rochester, NY 14642 USA
| | - John C. Elfar
- />Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA
| | - Warren C. Hammert
- />Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA
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Abstract
Overuse injuries of the lateral and medial elbow are common in sport, recreational activities, and occupational endeavors. They are commonly diagnosed as lateral and medial epicondylitis; however, the pathophysiology of these disorders demonstrates a lack of inflammation. Instead, angiofibroblastic degeneration is present, referred to as tendinosis. As such, a more appropriate terminology for these conditions is epicondylosis. This is a clinical diagnosis, and further investigations are only performed to rule out other clinical entities after conventional therapy has failed. Yet, most patients respond to conservative measures with physical therapy and counterforce bracing. Corticosteroid injections are effective for short-term pain control but have not demonstrated long-term benefit.
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Affiliation(s)
- Michael E Pitzer
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, State College, PA 16803, USA
| | - Peter H Seidenberg
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, State College, PA 16803, USA.
| | - Dov A Bader
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, State College, PA 16803, USA
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