The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial.

The aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain, and that laser therapy is more effective than the brace and US treatment in improving grip strength.

Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings.

OBJECTIVE: Although there has been much research about imaging methods for shoulder impingement syndrome, the clinical information and upper limb level of disability have been generally ignored. The purpose of this study was to detect the relationships between clinical, functional, and radiologic variables in patients with shoulder impingement syndrome. DESIGN: A cross-sectional, clinical, and radiologic study was planned and 59 shoulders of 58 consecutive patients waiting for physical therapy because of a clinically suspected shoulder impingement syndrome were included into this study. Comprehensive clinical examination, radiography, shoulder ultrasonography, and magnetic resonance imaging were performed in the same month. RESULTS: Despite the high sensitivities of ultrasonography for diagnosing rotator cuff tears (98.1%) and biceps pathologies (100%), magnetic resonance imaging was superior to ultrasonography in many important shoulder structures such as a glenoid labral tear and subacromial bursal effusion/hypertrophy (P < 0.01). These structures were the determinants of the shoulder's disability measured by disabilities of the arm, shoulder, and hand questionnaire. CONCLUSION: Ultrasonography and magnetic resonance imaging had comparable high accuracy for identifying the biceps pathologies and rotator cuff tears. The basic clinical tests had modest accuracy in both disorders. The choice of which imaging test to perform should be based on the patient's clinical information (regarding lesion of glenoid labrum, joint capsule, muscle, and bone), cost, and imaging experience of the radiology department.