Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

Background

Extensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE.

Methods

Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments.

Results

Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]).

Conclusions

PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

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

BACKGROUND

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

OBJECTIVES

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

STUDY DESIGN

Systematic review and meta-analysis of randomized controlled trials.

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL RELEVANCE

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

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Durable medical equipment: types and indications

There are various treatments for musculoskeletal-related conditions, including the use of durable medical equipment (DME). Numerous DME devices are currently available. This article addresses several of the common DME devices used for treating upper and lower extremity orthopedic conditions.