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1.
BMJ Open ; 14(3): e073816, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38485170

RESUMO

OBJECTIVES: To explore the acceptability of an optimised physiotherapy (OPTimisE) intervention for people with lateral elbow tendinopathy (LET) and feasibility of comparing it to usual care in a randomised controlled trial. DESIGN: Semistructured interviews, analysed using thematic analysis and mapped onto the COM-B model of behaviour change. SETTING: Conducted as part of the OPTimisE Pilot & Feasibility randomised controlled trial within physiotherapy departments in the United Kingdom National Health Service. PARTICIPANTS: 17 patients with LET (purposively sampled to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation) and all 8 physiotherapists involved as treating clinicians or site principal investigators. RESULTS: Four themes were identified. First, participants reported the OPTimisE intervention as acceptable. Second, differences between the OPTimisE intervention and usual care were identified, including the use of an orthosis, holistic advice/education including modifiable risk factors, forearm stretches, general upper body strengthening and a more prescriptive exercise-dosing regimen. Third, participants provided feedback related to the trial resources, which were viewed positively, but identified language translation as a need. Fourth, feedback related to trial processes identified the need for changes to outcome collection and reduction of administrative burden. From the perspective of adopting the OPTimisE intervention, we found evidence that participants were able to change their behaviour. Considering the findings through the lens of the COM-B model, the intervention is likely to be deliverable in practice and the trial can be delivered at scale with some additional support for physiotherapists. CONCLUSIONS: Overall, the OPTimisE intervention was found to be different to usual care and acceptable to patients and physiotherapists. The study highlighted the need to refine trial processes and resources prior to a full-scale trial, to reduce administrative burden, increase support for physiotherapists, improve return rate of outcome questionnaires and provide language translation. TRIAL REGISTRATION NUMBER: ISRCTN database 19 July 2021. https://www.isrctn.com/ISRCTN64444585.


Assuntos
Tendinopatia do Cotovelo , Tendinopatia , Humanos , Terapia por Exercício , Medicina Estatal , Estudos de Viabilidade , Modalidades de Fisioterapia , Tendinopatia/terapia
2.
Musculoskelet Sci Pract ; 69: 102905, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38194841

RESUMO

BACKGROUND: The OPTimisE intervention was developed to address uncertainty regarding the most effective physiotherapy treatment strategy for people with Lateral Elbow Tendinopathy (LET). OBJECTIVES: To assess the feasibility of conducting a fully-powered randomised controlled trial (RCT) evaluating whether the OPTimisE intervention is superior to usual physiotherapy treatment for adults with LET. DESIGN: A mixed-methods multi-centred, parallel pilot and feasibility RCT, conducted in three outpatient physiotherapy departments in the UK. METHOD: Patients were independently randomised 1:1 in mixed blocks, stratified by site, to the OPTimisE intervention or usual care. Outcomes were assessed using pre-defined feasibility progression criteria. RESULTS: 50 patients were randomised (22 Female, 28 Male), mean age 48 years (range 27-75). Consent rate was 71% (50/70), fidelity to intervention 89% (16/18), attendance rate in the OPTimisE group 82% (55/67) vs 85% (56/66) in usual care, outcome measure completion 81% (39/48) at six-month follow-up. There were no related adverse events. Patients and physiotherapists reported that the OPTimisE intervention was acceptable but suggested improvements to the trial design. 49 patients were recruited from physiotherapy referrals vs one from primary care records. Outcome measure return rates were higher when completed online (74%) compared to postal questionnaire (50%). Exploratory analysis showed improvements in both groups over time. CONCLUSIONS: It is methodologically feasible to conduct a fully powered RCT comparing the clinical and cost-effectiveness of the OPTimisE intervention versus usual physiotherapy treatment. Considering the similar improvements observed in both groups, careful consideration is needed regarding the priority research question to be addressed in future research.


Assuntos
Tendinopatia do Cotovelo , Doenças Musculoesqueléticas , Tendinopatia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Viabilidade , Modalidades de Fisioterapia , Inquéritos e Questionários , Tendinopatia/terapia , Resultado do Tratamento , Projetos Piloto
3.
J Sport Rehabil ; 33(2): 106-113, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38167648

RESUMO

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.


Assuntos
Tendinopatia do Cotovelo , Tendinopatia , Cotovelo de Tenista , Feminino , Humanos , Adulto , Masculino , Tendinopatia do Cotovelo/terapia , Cotovelo de Tenista/terapia , Cotovelo , Terapia por Exercício/métodos , Tendinopatia/terapia , Tendinopatia/complicações
4.
J Bodyw Mov Ther ; 36: 235-243, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37949566

RESUMO

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.


Assuntos
Fita Atlética , Tendinopatia do Cotovelo , Tendinopatia , Cotovelo de Tenista , Humanos , Tendinopatia do Cotovelo/terapia , Força da Mão/fisiologia , Estudos Prospectivos , Cotovelo de Tenista/terapia , Dor
5.
BMJ Open ; 13(8): e072070, 2023 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-37643850

RESUMO

OBJECTIVES: To explore the lived experience of people with lateral elbow tendinopathy (LET) and its impact on everyday life. DESIGN: Qualitative semi-structured interviews, analysed using thematic analysis. SETTING: Conducted as part of the mixed-methods OPTimisE pilot and feasibility randomised controlled trial of outpatient physiotherapy patients in the UK. PARTICIPANTS: 17 participants with LET, purposively sampled from the trial to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation. RESULTS: Four themes were identified from the participants' responses: (1) cause of onset-typically symptoms were attributed to: sudden changes in activity, repetitive work or compensating for other musculoskeletal conditions; (2) impact on everyday life-which included substantial impacts on quality-of-life, particularly due to pain disturbing sleep and difficulties performing daily tasks (related to work and hobbies) due to pain, although most reported being able to persevere with work; (3) self-help and understanding of the condition-with uncertainty about the appropriateness and potential harm of online advice and confusion from the diagnostic term 'Tennis Elbow' that non-sporting individuals struggled to relate to; (4) healthcare experiences-the treatments received were highly variable and often perceived as ineffectual. CONCLUSIONS: For the first time, the lived experience of people from a range of backgrounds suffering from LET has been explored. Findings suggest that people frequently related the cause to a specific activity. They reported substantial impacts on daily tasks, sleep, work and hobbies. People also reported hesitancy to trust online information without formal healthcare advice, were confused by the common label of 'Tennis Elbow', and perceived the wide array of healthcare treatment options they had received to offer false hope and be largely ineffective. This study provides stimulus for clinicians to consider the advice and treatment provided, and whether the messages conveyed reflect the favourable natural history of the condition. TRIAL REGISTRATION NUMBER: ISRCTN64444585.


Assuntos
Tendinopatia do Cotovelo , Doenças Musculoesqueléticas , Tendinopatia , Cotovelo de Tenista , Humanos , Confusão , Cotovelo , Estudos de Viabilidade , Dor , Tendinopatia/terapia
6.
Med Sci (Basel) ; 11(3)2023 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-37489461

RESUMO

Lateral elbow tendinopathy (LET) is a common upper limb pathology in people involved in manual occupations. The upper extremity functional index (UEFI) was specifically designed to evaluate functional limitations in patients with upper limb pathology. The UEFI was developed in English and has been translated into several languages, including Greek. However, it has been assessed only in patients with shoulder pathology. Thus, the aim of this study was to pilot-test the Greek version of the UEFI (GV-UEFI) questionnaire and assess its measurement properties in patients with LET. Thirty patients with LET were recruited and asked to fill in the GV-UEFI twice and the disabilities of arm, shoulder, and hand questionnaire (DASH) once. The internal consistency and test-retest reliability were examined using Cronbach's alpha and the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated and possible ground or ceiling effects were also examined. Convergent validity was evaluated with the Greek DASH using Pearson's correlation. Lastly, the unidimensionality of the scale was examined through principal component analysis to verify construct validity. Internal consistency was high for the GV-UEFI (Cronbach's a = 0.98) and test-retest reliability was excellent (ICC = 0.98). The SEM was 2.95 and the MDC was 6.85. Test-retest reliability of each item was good (ICC > 0.87). The correlation analysis demonstrated a strong correlation between the GV-UEFI and the DASH. No floor or ceiling effects were found. Principal component analysis verified the construct validity and the unidimensionality of the scale. The GV-UEFI was successfully tested in patients with LET. It seems that the GV-UEFI can be used reliably in Greek-speaking patients with LET. However, the measurement properties of this scale should be examined in a larger sample of LET patients.


Assuntos
Tendinopatia do Cotovelo , Doenças Musculoesqueléticas , Tendinopatia , Humanos , Reprodutibilidade dos Testes , Extremidade Superior , Mãos
7.
Clin Orthop Surg ; 15(3): 454-462, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37274509

RESUMO

Background: Lateral elbow tendinopathy (LET) has an array of modalities described for its management. The present study analyzed two modalities used for managing the condition. Methods: The present study included 64 non-athletes with LET who failed conservative treatment that included avoiding strenuous activities, ice-fomentation, non-steroidal anti-inflammatory drugs, bracing, and physiotherapy for 6 months. A random allocation of the participants was done, with one group injected with platelet-rich plasma (PRP) and the other group with corticosteroids. The procedure was performed by the same blinded orthopedic surgeon after localizing the pathology using ultrasound. Visual analog scale (VAS) scores, disabilities of the arm, shoulder and hand (DASH) scores, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, and handgrip strengths were recorded by blinded observers other than the surgeon administering the injection. Results: The average age of the patients was 40 years. The mean VAS score at the latest follow-up of 2 years in the PRP group was 1.25 and it was significantly better than the score of 3.68 in the steroid group (p < 0.001). The mean DASH score at the latest follow-up of 2 years in the PRP group was 4.00 and it was significantly better than the score of 7.43 in the steroid group (p < 0.001). The mean PRTEE score at the latest follow-up of 2 years in the PRP group was 3.96 and it was significantly better than the score of 7.53 in the steroid group (p < 0.001). The scores were better in the steroid group at a short-term follow-up of 3 months (p < 0.05), while they were better in the PRP group at a long-term follow-up of 2 years (p < 0.05). Hand-grip strength was comparable in the PRP group (84.43 kg force) and steroid group (76.71 kg force) at the end of the 2-year follow-up with no statistically significant difference (p = 0.149). Conclusions: Corticosteroid injections alleviated symptoms of LET over short-term follow-up providing quicker symptomatic relief; however, the effect faded off over the long term. PRP injections provided a more gradual but sustained improvement over the long-term follow-up, indicating the biological healing potential of PRP.


Assuntos
Tendinopatia do Cotovelo , Doenças Musculoesqueléticas , Plasma Rico em Plaquetas , Tendinopatia , Cotovelo de Tenista , Humanos , Adulto , Seguimentos , Força da Mão , Estudos Prospectivos , Tendinopatia/diagnóstico por imagem , Tendinopatia/tratamento farmacológico , Cotovelo de Tenista/diagnóstico por imagem , Cotovelo de Tenista/tratamento farmacológico , Corticosteroides/uso terapêutico , Resultado do Tratamento
8.
Sensors (Basel) ; 23(11)2023 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-37299874

RESUMO

Upper limb tennis injuries are primarily chronic, resulting from repetitive overuse. We developed a wearable device which simultaneously measures risk factors (grip strength, forearm muscle activity, and vibrational data) associated with elbow tendinopathy development resulting from tennis players' technique. We tested the device on experienced (n = 18) and recreational (n = 22) tennis players hitting forehand cross-court at both flat and topspin spin levels under realistic playing conditions. Using statistical parametric mapping analysis, our results showed that all players showed a similar level of grip strength at impact, regardless of spin level, and the grip strength at impact did not influence the percentage of impact shock transfer to the wrist and elbow. Experienced players hitting with topspin exhibited the highest ball spin rotation, low-to-high swing path brushing action, and shock transfer to the wrist and elbow compared to the results obtained while hitting the ball flat, or when compared to the results obtained from recreational players. Recreational players exhibited significantly higher extensor activity during most of the follow through phase compared to the experienced players for both spin levels, potentially putting them at greater risk for developing lateral elbow tendinopathy. We successfully demonstrated that wearable technologies can be used to measure risk factors associated with elbow injury development in tennis players under realistic playing conditions.


Assuntos
Tendinopatia do Cotovelo , Tênis , Humanos , Antebraço/fisiologia , Tênis/fisiologia , Fenômenos Biomecânicos , Músculo Esquelético , Força da Mão
9.
Orthopadie (Heidelb) ; 52(5): 394-403, 2023 May.
Artigo em Alemão | MEDLINE | ID: mdl-37074370

RESUMO

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.


Assuntos
Articulação do Cotovelo , Tendinopatia do Cotovelo , Cotovelo de Tenista , Humanos , Cotovelo de Tenista/cirurgia , Desbridamento/métodos , Cotovelo/cirurgia , Articulação do Cotovelo/cirurgia
10.
Orthopadie (Heidelb) ; 52(5): 365-370, 2023 May.
Artigo em Alemão | MEDLINE | ID: mdl-37079041

RESUMO

Blood flow restriction training, developed in 1966 in Japan, is a training modality that utilizes partial arterial and complete venous blood flow occlusion. Combined with low load resistance training, it aims to induce hypertrophy and strength gains. This makes it particularly suitable for people recovering from injury or surgery, for whom the use of high training loads is unfeasible. In this article, the mechanism behind blood flow restriction training and its applicability for the treatment of lateral elbow tendinopathy is explained. An ongoing prospective, randomized, controlled trial on the treatment of lateral elbow tendinopathy is presented.


Assuntos
Tendinopatia do Cotovelo , Tendinopatia , Doenças Vasculares , Humanos , Terapia de Restrição de Fluxo Sanguíneo , Estudos Prospectivos , Cotovelo , Tendinopatia/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Orthop Surg ; 15(8): 2110-2115, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37052071

RESUMO

OBJECTIVE: Lateral and medial epicondylitis are relatively common diseases, but they do not improve quickly and are known to reduce patients' quality of life. Much research has been done on Platelet-Rich Plasma (PRP) as a treatment for lateral epicondylitis, but research on medial epicondylitis is lacking. The purpose of this study is to compare: (i) the pain intensity; and (ii) the functional outcome between the simultaneous treatment of medial and lateral epicondylitis and the treatment of only lateral or medial epicondylitis using PRP. METHODS: In this retrospective study, 209 patients treated with PRP on epicondylitis between March 2018 and December 2021 were enrolled. Simultaneous treatment was underwent 68 patients (group I). Seventy patients were treated for lateral epicondylitis (group II). The remaining 71 patients were treated for medial epicondylitis (group III). The visual analogue scale for pain (VAS) and the Mayo elbow performance score (MEPS) were evaluated for clinical outcomes at the initial visit and 6 months after injection. RESULTS: VAS for pain and MEPS showed significant improvement in all three groups compared to before treatment. There was no significant difference between three groups on -ΔVAS (P > 0.05). However, in case of ΔMEPS, group III showed significantly lower compared to groups II and III (P < 0.05). No patients showed worsening of symptoms or complications during the treatment. CONCLUSION: PRP injection for the patient with elbow medial and lateral epicondylitis can be treated effectively simultaneously in terms of pain. From a functional point of view, the effect of simultaneous treatment may be lessened than in the case of only lateral and medial treatment.


Assuntos
Tendinopatia do Cotovelo , Plasma Rico em Plaquetas , Cotovelo de Tenista , Humanos , Cotovelo de Tenista/terapia , Cotovelo , Estudos Retrospectivos , Qualidade de Vida , Dor , Resultado do Tratamento
12.
J Hand Ther ; 36(4): 913-922, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36914496

RESUMO

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.


Assuntos
Tendinopatia do Cotovelo , Tendinopatia , Cotovelo de Tenista , Humanos , Exercício Físico , Cotovelo de Tenista/terapia , Terapia por Exercício/métodos , Tendinopatia/terapia , Dor
13.
Artigo em Inglês | MEDLINE | ID: mdl-36901381

RESUMO

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.


Assuntos
Tendinopatia do Cotovelo , Tratamento por Ondas de Choque Extracorpóreas , Tendinopatia , Cotovelo de Tenista , Humanos , Feminino , Estudos Retrospectivos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Tendinopatia do Cotovelo/terapia , Resultado do Tratamento , Estudos Longitudinais , Tendinopatia/terapia , Dor
14.
Clin Rehabil ; 37(8): 1041-1051, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36727206

RESUMO

OBJECTIVE: To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy. STUDY DESIGN: Randomised crossover trial. SETTING: Biomechanics laboratory. SUBJECTS: 27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration. INTERVENTIONS: Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions. MAIN MEASURES: Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions. RESULTS: There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F2,52 = 0.02, p = 0.98; extended position: F2,52 = 2.26, p = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F1,26 = 0.94, p = 0.34; extended position: F1,26 = 0.79, p = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F1.51,39.17 = 0.54, p = 0.54) or across timepoints (affected lateral epicondyle: F1,26 = 0.94, p = 0.34). CONCLUSION: Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist.


Assuntos
Tendinopatia do Cotovelo , Doenças Musculoesqueléticas , Cotovelo de Tenista , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Cross-Over , Cotovelo de Tenista/diagnóstico , Dor/diagnóstico , Dor/etiologia , Cotovelo , Força da Mão
15.
J Orthop Sports Phys Ther ; 53(1): 5-6, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36587262

RESUMO

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.


Assuntos
Tendinopatia do Cotovelo , Doenças Musculoesqueléticas , Tendinopatia , Humanos , Tendinopatia do Cotovelo/terapia , Cotovelo , Tendinopatia/reabilitação , Modalidades de Fisioterapia
16.
Am J Sports Med ; 51(9): 2506-2515, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35658623

RESUMO

BACKGROUND: Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated. PURPOSE/HYPOTHESIS: The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs. RESULTS: Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%. CONCLUSION: This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.


Assuntos
Tendinopatia do Cotovelo , Esportes , Cotovelo de Tenista , Humanos , Masculino , Pessoa de Meia-Idade , Cotovelo de Tenista/cirurgia , Atletas , Tendões
17.
Physiother Theory Pract ; 39(5): 1007-1015, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35114892

RESUMO

BACKGROUND: Pain-free grip strength is an important outcome measure in lateral elbow tendinopathy (LET); yet, the reliability and minimum detectable change (MDC) in functional positions are unknown. PURPOSE: The purpose of this study is to examine the between- and within-session pain-free grip strength reliability and MDC in LET. METHODS: Twenty-three individuals with LET completed three pain-free grip strength trials with the elbow flexed and extended. The first trial and the mean of three trials were analyzed. Between-session data were collected 2-28 days apart. Within-session data were collected 20-30 min apart. RESULTS: Between-session intraclass correlation coefficients (ICCs) were good (ICC2,1 = 0.75) for single trials (flexed), excellent (ICC2,1 = 0.89-0.94) for single trials (extended), and excellent for the mean of three trials (both positions). Within-session ICCs were excellent for single (ICC2,1 = 0.89-0.91) and the mean of three trials (ICC2,3 = 0.96-0.98) in both positions. Between-session flexed MDCs were 133 N (single) versus 90 N (mean) and extended MDCs were 118 N (single) versus 92 N (mean). Within-session flexed MDCs were 79 N (single) versus 52 N (mean) and extended MDCs were 125 N (single) versus 46 N (mean). CONCLUSIONS: Using the mean of three trials is recommended, and clinicians can be confident of true change if between-session differences are >92 N and within-session differences are >52 N.


Assuntos
Tendinopatia do Cotovelo , Tendinopatia , Cotovelo de Tenista , Humanos , Cotovelo , Reprodutibilidade dos Testes , Força da Mão , Tendinopatia/terapia
18.
J Hand Ther ; 36(1): 45-59, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-34756796

RESUMO

BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients' work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. PURPOSES: First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. STUDY DESIGN: A randomized controlled trial. METHODS: Forty-nine participants were randomized to the control group (n = 25) or intervention group (n = 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, "Working Hands-ED," delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. RESULTS: There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). CONCLUSION: The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace.


Assuntos
Tendinopatia do Cotovelo , Tendinopatia , Cotovelo de Tenista , Humanos , Cotovelo de Tenista/terapia , Resultado do Tratamento , Dor , Força da Mão , Local de Trabalho
19.
J Shoulder Elbow Surg ; 32(2): 340-347, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36279988

RESUMO

BACKGROUND: This retrospective study compared the outcomes after open and arthroscopic treatment of chronic medial epicondylitis (ME). METHODS: The study included 44 elbows in 38 patients: 25 (29-72 years) in the open group and 19 (27-70 years) in the arthroscopy group. The indications for ME surgery were failed conservative therapy for more than 3 months, symptom duration exceeding 6 months, and persistent severe pain. We used radiography, ultrasonography, and magnetic resonance imaging assessments. The clinical assessment included operating time, range of motion, grip strength, visual analog scale (VAS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complications. RESULTS: The mean follow-up was 20.2 (12-58) months. The mean operating time was significantly longer in the arthroscopy group (32.5 vs. 23.5 minutes; P = .029). In both groups, all outcome measures improved significantly after surgery and there were no significant differences between the DASH scores (preoperative 44.8 vs. 43.9, postoperative 12.5 vs. 13.2), grip strength (preoperative 72.2 vs. 66.8, postoperative 84.8 vs. 83.6), and VAS scores (preoperative 8.5 vs. 8.2, postoperative 1.0 vs. 1.1) in the open and arthroscopy groups. The outcomes were excellent or good in 20 patients (80%) in the open group and 16 (84%) in the arthroscopy group. The only complication was 1 case of transient ulnar neuropathy in the open group. CONCLUSION: Open and arthroscopic techniques were very effective and comparable for treating chronic ME. The surgeon can choose either technique for treating chronic ME.


Assuntos
Tendinopatia do Cotovelo , Cotovelo de Tenista , Humanos , Estudos Retrospectivos , Desbridamento/métodos , Cotovelo de Tenista/cirurgia , Artroscopia/métodos , Resultado do Tratamento
20.
Aust Occup Ther J ; 70(2): 233-245, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36367158

RESUMO

INTRODUCTION: Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Current treatments for LET focus mainly on the physiological symptoms of pain, grip strength, and function. Recently, a novel workplace-based hand therapy educational intervention, Working Hands-ED, was developed based on the Person-Environment-Occupation- Performance model, International Classification of Functioning, Disability and Health framework and the Australian Clinical Framework for the Delivery of Health Services. Combining a hand therapist's specialised knowledge and skills in upper limb rehabilitation with an approach that considers injured workers' occupations and work environments may provide a more holistic approach to managing work-related LET. To the best of our knowledge, no previous studies have investigated the experiences of hand therapists who perform workplace-based educational interventions for the management of LET. METHOD: An exploratory, descriptive qualitative design using semi-structured interviews was used with hand therapists who delivered the novel hand therapy intervention Working Hands-ED. FINDINGS: Ten occupational therapists working in hand therapy were interviewed. Three main themes and eight subthemes were identified from interview data: Person-centred approach, opportunity for therapists to provide enhanced service, and improved stakeholder engagement in the return-to-work process. Logistical challenges such as the costs and time spent away from the clinical setting were identified. CONCLUSION: All hand therapists reported delivering Working Hands-ED when managing work-related LET was a positive experience for them. They believed that the novel intervention could provide a more holistic approach to care that added value to their service delivery; however, there were some logistical factors to consider including the additional time and costs associated with the intervention.


Assuntos
Tendinopatia do Cotovelo , Terapia Ocupacional , Humanos , Austrália , Extremidade Superior , Local de Trabalho , Terapeutas Ocupacionais
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