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Gutiérrez-Espinoza H, Estrella-Flores E, Cuyul-Vásquez I, Jorquera-Aguilera R, Francisco López-Gil J, Araya-Quintanilla F. Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study. J Sport Rehabil 2024; 33:106-113. [PMID: 38167648 DOI: 10.1123/jsr.2023-0071] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/30/2023] [Accepted: 10/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. METHODS A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. RESULTS A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). CONCLUSION At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.
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Affiliation(s)
| | | | - Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | | | | | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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Çelik Ö, Şencan S. Bracing or kinesio taping in the management of lateral elbow tendinopathy: A prospective, randomized single-blinded trial. J Bodyw Mov Ther 2023; 36:235-243. [PMID: 37949566 DOI: 10.1016/j.jbmt.2023.07.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of the study was to compare the effects of forearm counter force brace (FCB) and kinesio taping (KT) on pain severity, grip strength and functionality of patients with lateral elbow tendinopathy (LET). METHODS The study was planned as a prospective, randomized and assessor-blinded study with 1-month follow-up period. Seventy-two patients, diagnosed as LET were randomly assigned to FCB (n = 41) or KT (n = 31) groups. In the FCB group, the patients were informed and instructed to wear the brace for three weeks continuously. In the KT group, tape was applied once a week for four weeks with muscle inhibition and fascia correction techniques. The outcome measures were pain pressure threshold (PPT), maximal pain-free hand grip strength measurement and patient-rated tennis elbow evaluation questionnaire (PRTEE). The assessments were performed at the baseline, immediately after treatment and one month later after treatment. RESULTS PPT and grip strength were significantly increased over time in both groups. Pain, function and total scores of PRTEE were significantly decreased in both FCB and KT groups. The effect size of the improvement in PRTEE function score was within acceptable clinical significance in the KT group. However, there was no significant difference between groups. CONCLUSIONS Pain severity, grip strength and functionality of patients with LET improved over time in both FCB and KT groups. However, neither was superior in the management of LET.
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Affiliation(s)
- Öznur Çelik
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkiye.
| | - Süreyya Şencan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkiye
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Pellegrino R, Di Iorio A, Filoni S, Mondardini P, Paolucci T, Sparvieri E, Tarantino D, Moretti A, Iolascon G. Radial or Focal Extracorporeal Shock Wave Therapy in Lateral Elbow Tendinopathy: A Real-Life Retrospective Study. Int J Environ Res Public Health 2023; 20:4371. [PMID: 36901381 PMCID: PMC10002308 DOI: 10.3390/ijerph20054371] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Lateral elbow tendinopathy (LET) is characterized by pain, poor muscle strength of the wrist ex-tensors, and disability. Among the conservative rehabilitative approaches, focal as well as radial extracorporeal shock wave therapy (ESWT), are considered effective in LET management. The objective of this study was to compare the safety and effectiveness of focal (fESWT) and radial (rESWT) in terms of LET symptoms and the strength of wrist extensors, taking into account potential gender differences. This is a retrospective longitudinal cohort study of patients with LET treated with ESWT that had received a clinical and functional evaluation, including visuo-analogic scale (VAS), muscle strength using an electronic dynamometer during Cozen's test, and the patient-rated tennis elbow evaluation (PRTEE) questionnaire. Follow-ups were carried out weekly in four visits after enrollment, and at 8 and 12 weeks. During the follow-ups, the VAS score decreased in both treatments, even if patients receiving fESWT reported early pain relief compared to those treated with rESWT (time for treatment p-value < 0.001). Additionally, peak muscle strength increased independently of the device used, and again more rapidly in the fESWT group (time for treatment p-value < 0.001). In the stratified analysis for sex and for the type of ESWT, rESWT appears to be less effective in female participants in terms of mean muscle strength and PRTEE scores, without differences according to the type of device used. The rESWT group reported a higher rate of minor adverse events (i.e., discomfort, p = 0.03) compared to fESWT. Our data suggest that both fESWT and rESWT might be effective in improving LET symptoms, even if the higher rate of painful procedures were reported in patients treated with rESWT.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland
| | - Angelo Di Iorio
- Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Innovative Technologies in Medicine & Dentistry, University “G. d’Annunzio”, 66100 Chieti, Italy
| | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy
| | - Paolo Mondardini
- Department of Sport Science, Università di Bologna, 40100 Bologna, Italy
| | - Teresa Paolucci
- Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology, University “G. d’Annunzio”, 66100 Chieti, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Physical Therapy for People with Lateral Elbow Tendinopathy: Using the Evidence to Guide Musculoskeletal Rehabilitation Clinical Practice. J Orthop Sports Phys Ther 2023; 53:5-6. [PMID: 36587262 DOI: 10.2519/jospt.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lateral elbow tendinopathy (LET) is an overuse injury of the common extensor tendon that occurs in active people. Modifiable risk factors include repetitive movements of the elbow, forearm, and hand, and tasks like handling heavy tools, which may overload the tendon. The clinical course of LET varies considerably. Some people experience a single, brief episode of symptoms, whereas others have persistent or recurring episodes of LET. J Orthop Sports Phys Ther 2023;53(1):5-6. doi:10.2519/jospt.2023.0501.
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Abstract
Common flexor-pronator tendon injuries and medial epicondylitis can be successfully treated nonoperatively in most cases. Operative treatment is reserved for patients with continued symptoms despite adequate nonoperative treatment or in high-level athletes with complete rupture of the common flexor-pronator tendon. The physical examination and workup of patients with flexor-pronator tendon injuries should focus on related or concomitant pathologies of the medial elbow. The gold standard for surgical treatment of flexor-pronator tendon ruptures or medial epicondylitis includes tendon debridement and reattachment.
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Affiliation(s)
- Rami George Alrabaa
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA.
| | - Nicholas Dantzker
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA
| | - Christopher S Ahmad
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA
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Lucado AM, Dale RB, Vincent J, Day JM. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J Hand Ther 2020; 32:262-276.e1. [PMID: 29705077 DOI: 10.1016/j.jht.2018.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION No consensus exists as to which are the most effective methods to treat the symptoms associated with lateral elbow tendinopathy (LET). Research has suggested that joint mobilizations may assist in the recovery of patients with LET. PURPOSE OF THE STUDY To determine if joint mobilizations are effective in improving pain, grip strength, and disability in adults with LET. METHODS Searches in 3 databases were performed to identify relevant clinical trials. Reviewers independently extracted data and assessed the methodological quality. Summary measures of quantitative data were extracted or calculated where possible. Appropriate data were pooled for meta-analysis using a random-effects model. RESULTS A total of 20 studies met the inclusion criteria; 7 were included in the meta-analysis. Studies were broadly classified into 3 groups: mobilization with movement (MWM), Mill's manipulation, and regional mobilization techniques. Pooled data across all time periods demonstrated a mean effect size of 0.43 (95% confidence interval [CI]: 0.15-0.71) for MWM on improving pain rating, and 0.31 (95% CI: 0.11-0.51) for MWM on improving grip strength, 0.47 (95% CI: 0.11-0.82) for Mill's manipulation on improving pain rating. A mean effect size of -0.01 (95% CI: -0.27 to -0.26) shows Mill's manipulation did not improve pain free grip strength. Functional outcomes varied considerably among studies. Pain, grip strength, and functional outcomes were improved with regional mobilizations. CONCLUSION There is compelling evidence that joint mobilizations have a positive effect on both pain and/or functional grip scores across all time frames compared to control groups in the management of LET.
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Affiliation(s)
- Ann M Lucado
- Department of Physical Therapy, College of Health Professions, Mercer University, Atlanta, GA, USA.
| | - R Barry Dale
- Department of Physical Therapy, University of South Alabama, Mobile, AL, USA
| | | | - Joseph M Day
- Department of Physical Therapy, University of Dayton, Dayton, OH, USA
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Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surg Sports Traumatol Arthrosc 2018; 26:1984-1999. [PMID: 27665095 DOI: 10.1007/s00167-016-4261-4] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied. METHODS A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies. RESULTS The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative). CONCLUSION Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders. LEVEL OF EVIDENCE Systematic review of level I-IV trials, Level IV.
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Affiliation(s)
- Giuseppe Filardo
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Berardo Di Matteo
- I Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Elizaveta Kon
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giulia Merli
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Maurilio Marcacci
- Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
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Waryasz GR, Tambone R, Borenstein TR, Gil JA, DaSilva M. A Review of Anatomical Placement of Corticosteroid Injections for Uncommon Hand, Wrist, and Elbow Pathologies. R I Med J (2013) 2017; 100:31-34. [PMID: 28246658] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Corticosteroid injections are a common nonsurgical treatment of intersection syndrome, flexor carpi radialis tendonitis, flexor carpi ulnaris tendonitis, and medial epicondylitis. The benefits of corticosteroid injections for these conditions have been well studied and documented in the medical literature. Patients with less common upper extremity complaints usually first present to their primary care provider. A correct anatomical diagnosis will help with early definitive treatment, as the injection must be in the proper location for maximal benefit to the patient. The following review on uncommon upper extremity complaints provides information for a correct diagnosis and treatment plan, followed by a possible injection. This review will hopefully provide high quality care while also cutting health care costs by making the correct diagnosis at the initial presentation. [Full article available at http://rimed.org/rimedicaljournal-2017-03.asp].
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Affiliation(s)
- Gregory R Waryasz
- Department of Orthopaedic Surgery, Brown University/Rhode Island Hospital, Providence, RI
| | | | - Todd R Borenstein
- Department of Orthopaedic Surgery, Brown University/Rhode Island Hospital, Providence, RI
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Brown University/Rhode Island Hospital, Providence, RI
| | - Manuel DaSilva
- Department of Orthopaedic Surgery, Brown University/Rhode Island Hospital, Providence, RI
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