Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial.

OBJECTIVE: The objective of the study was to evaluate the efficacy of Maitland accessory mobilization and neural mobilization in patients with tennis elbow. METHOD: Twenty-five patients meeting the selection criteria were randomly assigned to three experimental groups: Group C (conventional treatment), Group B (neural mobilization), and Group A (Maitland mobilization). Quality of life was assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE), while pain, range of motion, and grip strength were evaluated using the Visual Analog Scale (VAS), a universal goniometer, and a handheld dynamometer. The interventions were administered three times per week for four weeks to the respective groups. RESULTS: Non-parametric tests were employed to analyze the results due to the non-normal distribution of the data (p < 0.05). Both the Wilcoxon signed-rank test and the Kruskal-Wallis test were utilized to assess differences within and between groups. The results of the between-group analysis demonstrated significant differences in pain (p = 0.018) and quality of life (p = 0.045) among the three groups. CONCLUSION: After a 4-week intervention, all three groups exhibited notable improvements in discomfort levels, grip strength, and quality of life. Notably, Group B demonstrated the most substantial increase in range of motion (ROM) compared to Groups A and C. Consequently, incorporating neural mobilization into the treatment plan is recommended for patients experiencing Tennis Elbow.

Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series.

CONTEXT: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. CASE PRESENTATION: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). MANAGEMENT AND OUTCOMES: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. CONCLUSIONS: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.

Physiotherapy treatment of lateral epicondylitis: A systematic review.

BACKGROUND: Lateral epicondylitis is a tendinopathy with a prevalence of between 1-3% of the population aged 35-54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). OBJECTIVE: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. METHODS: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. RESULTS: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. CONCLUSIONS: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.

[Epidemiological profile of lateral epicondylitis in rehabilitation department]. / Profil épidémiologique des épicondylites latérales en milieu de rééducation.

INTRODUCTION: lateral epicondylitis, better known as tennis elbow, falls within the spectrum of upper extremity musculoskeletal disorders and it is a major public health problem. The purpose of our study was to determine the epidemiological and clinical profile and treatment modalities for patients with lateral epicondylitis followed at the Department of Physical Medicine and Rehabilitation. METHODS: we conducted a retrospective study (2012-2017) of patients with lateral epicondylitis referred to the Department of Physical Medicine and Functional Rehabilitation at the Tahar Sfar Mahdia University Hospital over a period of 6 years. Socio-demographic and clinical features as well as treatment modalities were assessed for each patient. RESULTS: fifty patients were enrolled in the study. The average age of patients was 44.82 years, with predominance of the female sex (72%). Half of our patients were active and the majority of them (60%) worked in a traditional office environment. Right upper extremity was most affected (78% of cases). The median duration of symptoms was 14.66 months. Clinical examination showed positive tendon triad in the lateral epicondyle in 96% of cases. Radiological examination was performed in 8 patients, ultrasound in 6 patients. All patients received analgesics, 84% of patients received non-steroidal anti-inflammatory drugs, only 8 patients received corticosteroid injections. One patient underwent surgery after therapeutic failure. Ninety-two percent of patients were scheduled for rehabilitation sessions. Total improvement was noted in 42% of patients, 46% reported transient improvement and 12% progressed to chronicity. CONCLUSION: lateral epicondylitis is a common cause of elbow pain. Its management in physical medicine is based on medical treatment and appropriate functional rehabilitation. However no therapeutic option seems clearly superior to the other.

Tennis elbow, study protocol for a randomized clinical trial: needling with and without platelet-rich plasma after failure of up-to-date rehabilitation.

BACKGROUND: The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial. METHODS: This study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0-10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6, and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons. DISCUSSION: The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol. TRIAL REGISTRATION: ClinicalTrials.gov NCT03987256. Registered on 20 August 2019.

Continuous shortwave diathermy with exercise reduces pain and improves function in Lateral Epicondylitis more than sham diathermy: A randomized controlled trial.

INTRODUCTION: Lateral epicondylitis or tennis elbow, causes significant pain and disability in the upper extremity. Conservative approaches include using thermal and electrical agents. The aim of this study was to explore the effectiveness of shortwave diathermy on pain, function and grip strength of patients with chronic lateral epicondylitis. A randomized placebo-controlled design with concealed allocation, assessor blinding and intention-to-treat analysis was conducted. METHODS: Fifty patients suffering from lateral epicondylitis for more than 3 months, without any systemic diseases or history of other pathologies, were divided into two groups. In both groups, the patients were instructed to perform specific stretching and strengthening exercises. In addition, the patients in the experimental group, received 15 min of 40-60 W, continuous short wave diathermy while sham diathermy was applied for the control group. The primary outcome measure was pain and the secondary outcome measures were functional ability and pain free grip strength. Outcomes were assessed at the base line, after the 5th and the 10th session of treatment as well as after 3 months. RESULTS: Mixed ANOVA analysis showed significant improvement in both groups. Meanwhile, there was a significant interaction effect of time and group on all outcome measures implying the greater improvement in pain, function and grip strength in the group receiving real diathermy. CONCLUSIONS: Adding continuous short wave diathermy to a specific regimen of exercises, reduces pain and improves function in patients suffering from chronic lateral epicondylitis more than sham diathermy and exercise. TRIAL REGISTRATION: IRCT2016042321139N4.

PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity-results from a randomised trial.

PURPOSE: A popular choice for lateral epicondylitis (LE), corticosteroid injections have been associated with prominent side effects, which has led to the conception of modalities like platelet-rich plasma (PRP). This randomised trial aimed to evaluate and compare the 6-week, 3-month and 1-year outcomes with PRP and corticosteroid injections in LE. We hypothesised that PRP would prove more effective in relieving pain and improving function. METHODS: At the sports medicine unit of our tertiary care teaching centre, 80 patients with LE were randomised into either receiving PRP (group A) or corticosteroids (group B) injections. Pre-injection visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Mayo elbow performance score (MEPS) and grip strength score (GSS) were recorded. Common extensor origins were identified and infiltrated with 3 ml of either PRP or corticosteroid (triamcinolone in 2% xylocaine) using a peppering technique. Follow-up scores and extent of pain relief were recorded and compared. RESULTS: At 6 weeks, there were greater improvements in group B versus A in mean VAS (13.8 vs. 44.5; p < 0.001), DASH (64.2 vs. 53.3; p < 0.001), MEPS (88.0 vs. 74.5; p = 0.004) and GSS (89.3 vs. 73.4; p = 0.039). These scores showed a reversed pattern at 3 months when group A outcomes superseded group B (VAS p = 0.002; DASH p < 0.001; MEPS p = 0.002; GSS p = 0.045). At 1-year follow-up, group A continued to enjoy better pain relief and function (VAS p = 0.024; DASH p < 0.001; MEPS p = 0.009; GSS p = 0.028). CONCLUSIONS: Albeit corticosteroid injections show good short-term results at 6 weeks, patients receiving PRP injections fare better at 3 and 12 months.

The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis.

BACKGROUND: Lateral epicondylitis (LE) is a common problem of the arm. Mulligan has proposed the use of mobilization with movement for LE. OBJECTIVES: To investigate the effects of Mulligan's mobilization with movement (MWM) in LE. METHODS: Forty patients were included in the study and randomly assigned to group 1 (n= 20), who received MWM, exercise and cold therapy, or group 2 (n= 20), who received exercise and cold therapy. The sessions were conducted five times a week for two weeks. All measures were conducted at baseline, after treatment, at 1st and 3rd months follow-ups. Mann-Whitney U test, a visual analogue scale (VAS) for pain intensity, Patient-rated Tennis Elbow Evaluation (PRTEE) Questionnaire for pain intensity and functional disability and a dynamometer for hand grip strength were applied. RESULTS: VAS activity pain significantly decreased in group 1 after treatment (p= 0.001), at the 1st (p< 0.001) and 3rd months (p= 0.040). There was a significant decrease in VAS night pain in group 1 (p= 0.024), and a significant increase in pain-free grip strength (p= 0.002) after treatment. PRTEE-Pain scores decreased in group 1 after treatment (p< 0.001), 1st (p< 0.001) and 3rd months (p= 0.001). CONCLUSIONS: MWM plus exercise and cold therapy is a safe and effective alternative with positive effects on elbow pain, functional capacity, and pain-free, maximum grip strength.

Short-Term Effects of Steroid Injection, Kinesio Taping, or Both on Pain, Grip Strength, and Functionality of Patients With Lateral Epicondylitis: A Single-Blinded Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to compare the efficacy of steroid injection and kinesio taping (KT) in the treatment of lateral epicondylitis. DESIGN: A total number of 84 patients were randomized into three groups. Group 1 was given steroid injection, group 2 received KT, and group 3 received both. Pain was measured using a visual analog scale, functional status was measured using a quick form of the Disabilities of Arm, Shoulder and Hand questionnaire, pain-free grip strength was measured using a dynamometer, and the pressure pain threshold was measured using an algometer. All evaluations were performed before treatment and at the third and twelfth weeks after the treatment. RESULTS: Twenty-eight patients were included in each group. A statistically significant difference was found between the pretreatment and posttreatment evaluations of all groups in the third and twelfth weeks after treatment. When group 1 and group 2 were compared, there was a significant difference only in pain-free grip strength measured in the twelfth week. The results of treatment in group 3 patients were significantly better in almost all evaluation parameters compared with the other groups. CONCLUSION: In the treatment of lateral epicondylitis, KT alone was found to be as effective as steroid injection alone. However, co-administration of steroid injection and KT is more effective compared with each treatment alone.

Comparison of the effects of short-duration wrist joint splinting combined with physical therapy and physical therapy alone on the management of patients with lateral epicondylitis.

BACKGROUND: Lateral epicondylitis (i.e., tennis elbow) is a condition caused by overuse of the arm, which can result in elbow pain. Recent evidence has shown wrist joint splinting as an effective intervention for people with lateral epicondylitis. AIM: The purpose of this study was to compare the effect of a 3 week wrist joint splinting and physical therapy intervention versus a standard physical therapy intervention on pain, wrist range of motion (ROM), and grip strength in people with lateral epicondylitis. DESIGN: Randomized clinical trial. SETTING: University hospital outpatient clinics. POPULATION: Forty participants diagnosed with lateral epicondylitis. METHODS: The participants were randomized into 2 groups. The standard care group followed a treatment program consisting of stretching exercises for the wrist extensors, ultrasonic therapy, and deep friction massage on the proximal attachment of the wrist extensor muscles. The intervention group followed a standard wrist joint splinting program in addition to the physical therapy program that the standard care group received. Participants in both groups received treatment 3 times per week for 3 weeks. The outcome measures were pain intensity, wrist extension ROM, wrist flexion ROM, and grip strength. Each outcome measure was assessed at baseline and after completion of the intervention. RESULTS: There were no significant between-group differences at baseline. After the treatment period, the intervention group showed statistically significant improvement in pain intensity. Other outcomes also improved including wrist flexion ROM, wrist extension ROM, and grip strength in comparison to the standard care group. CONCLUSIONS: Using wrist joint splinting in addition to physical therapy for a short duration is effective for improving pain intensity. The evidence from this study indicates that wrist joint splinting and physical therapy may also be effective for improving wrist ROM and grip strength in the treatment of patients with lateral epicondylitis, although more research is need in this area. CLINICAL REHABILITATION IMPACT: Wrist joint splinting is an effective intervention that can be applied in clinical rehabilitation practices for people with lateral epicondylitis.

The Effectiveness of Kinesiotaping, Sham Taping or Exercises Only in Lateral Epicondylitis Treatment: A Randomized Controlled Study.

BACKGROUND: Lateral epicondylitis is a common musculoskeletal condition presenting with pain and tenderness over the lateral epicondyle and dorsal forearm, pain and weakness in gripping and limitations in daily activities. It is proposed that kinesiotaping, a new application of adhesive taping, reduces pain and improves muscle function. OBJECTIVE: To compare efficacy of kinesiotaping, sham taping, or exercises only in the treatment of lateral epicondylitis. DESIGN: Double-blind, randomized, controlled trial. SETTING: Tertiary medical center, university hospital. PARTICIPANTS: Thirty patients with lateral epicondylitis for less than 12 weeks. METHODS OR INTERVENTIONS: Patients were randomized into three groups: kinesiotaping plus exercises (n = 10), sham taping plus exercises (n = 10), and control (exercises only) (n = 10) groups. All recipients were provided a home exercise program including strengthening and stretching exercises. In kinesiotaping and sham taping groups, tapings were performed and changed every 3-4 d for 2 weeks. MAIN OUTCOME MEASURE(S): The primary outcome was the patient-rated tennis elbow evaluation (PRTEE). Pain visual analogue scale (VAS), grip strength, and the disabilities of the arm, shoulder and hand (QuickDASH) scales were secondary outcomes. Evaluations were done at baseline, posttreatment, and at 4 weeks after treatment. The immediate effect was also assessed by VAS and grip strength immediately after real and sham tapings. RESULTS: PRTEE total scores at posttreatment and at 4 weeks after treatment were statistically significantly lower in kinesiotaping plus exercises group compared to sham taping plus exercises group and exercises only group. The effects of kinesiotaping were larger than sham taping and only exercises at posttreatment (d = -1.21, d = -1.33) and at 4 weeks after treatment (d = -1.39, d = -1.34). Repeated-measures anova showed a significant interaction between the time and the groups (F 2950 = 4849; P = .006). Significant between-group differences were found in QuickDASH score and VAS at rest at 4 weeks after treatment, VAS at daily activity at posttreatment and 4 weeks after treatment when kinesiotaping plus exercises and sham taping plus exercises groups and kinesiotaping plus exercises and exercises only groups were compared. Real taping but not sham taping immediately led to an increase in grip strength, decrease in VAS at rest and VAS at daily activity (P = .0017, P = .041, P = .028; respectively). CONCLUSIONS: Kinesiotaping in addition to exercises is more effective than sham taping and exercises only in improving pain in daily activities and arm disability due to lateral epicondylitis. LEVEL OF EVIDENCE: I.

The Prognostic Value of Pain Sensitization in Patients With Lateral Epicondylitis.

PURPOSE: Pain sensitization is a contributing factor to conditions of chronic pain. The aim of this study was to evaluate the influence of pain sensitization on the prognosis of lateral epicondylitis (LE) treated by self-stretching exercises and the use of a counterforce brace. METHODS: We enrolled 131 patients who presented with isolated LE symptoms for less than 6 months. We initially measured pain sensitization by assessing patients' pressure pain thresholds (PPTs) in the contralateral middorsal forearm and administering a pain sensitization questionnaire (PSQ). For outcome assessments, we assessed the self-administered, patient-reported Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire at 6 and 12 months' follow-up. RESULTS: Initial PSQ scores correlated moderately with baseline DASH scores and slightly with symptom duration; PPTs correlated slightly with baseline DASH scores. After we accounted for confounding variables, patient-reported disability was associated with lower PPTs, higher PSQ scores, and manual labor at 6 months. These 3 factors accounted for 36% of variance in the DASH scores; however, at 12 months only the PSQ score was associated with higher DASH scores, accounting for 14% of variance. CONCLUSIONS: Pain sensitization during the early stages of LE correlated with initial symptom severity and duration and was associated with persistently increasing disability after 1 year of nonsurgical treatment. More research is needed to show whether early identification and treatment of pain sensitization will enhance LE treatment outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Epicondilitis en personal de salud. Municipio 10 de Octubre. Diciembre 2017 / Epicondylitis in staff of salud. 10 of October Municipality. December 2017

La epicondilitis, se considera la principal causa de dolor lateral del codo. Se realizó un estudio de intervención a través de la detección temprana, tratamiento y rehabilitación de la epicondilitis en enfermeras del Policlínico-Hospital Raúl Gómez García y el personal asistencial de la Clínica Estomatológica de Septiembre a Noviembre del 2017.Se diagnosticaron 17 casos de epicondilitis donde predominaron los trabajadores de la clínica estomatológica con el 76,4%. En la totalidad de casos con epicondilitis hubo dolor referido y dolor constatado y el signo de Cozen fue positivo en casi la totalidad de ellos. Existía debilidad muscular, en 10 casos de epicondilitis (83,3 %). Se realizararon acciones de prevención con la detección temprana, el tratamiento e indicaciones de rehabilitación en 17 casos. Se impuso tramiento con medidas higiénico-ambientales,medios fisicos, antinflamatorios y ejercicios de rehabilitación y seguimiento de los casos

The epicondylitis, the main cause of lateral pain of the elbow is considered. A study of intervention for the through the premature detection, treatment and rehabilitation the Poly-Clinician Hospital Raúl Gómez García and helping staff of the Stomatological Clinic rehabilitation of September to December 2017. They diagnosed 17 cases of epicondylitis where the workers of the stomatological clinic with the 76.4 % predominated. They verified pain in the totality of cases with epicondylitis and Cozen’s sign was positive in approximately their totality. Atony, in 10 cases of epicondylitis existed (83.3 %). the premature detection, the treatment with measures stipulated rehabilitative indications in 17 casos. He put on treatment with measures hygienic, Half a physiques, antinflamatorios and rehabilitaci’s exercises n and follow-up of the cases

Effects of eight-week "gyroscopic device" mediated resistance training exercise on participants with impingement syndrome or tennis elbow.

BACKGROUND: Rehabilitation of injuries in the upper extremity and reestablishment of muscle strength throughout the range of motion in overhead movements, are the major concerns of athletes and coaches in the sports field. PURPOSE: To determine the effect of eight-week "gyroscopic device" mediated resistance training exercise on grip strength, wrist and shoulder strength and proprioception, and upper extremity performance, in participants with impingement syndrome or tennis elbow. DESIGN AND METHODS: For this study, in a university rehabilitation clinic 45 volleyball players (aged 22-28) purposefully were selected and divided into 3 groups: shoulder impingement (group I), tennis elbow (group II), and control (group III). The experimental groups performed the "gyroscopic device" mediated resistance training, three sessions a week over 8 wks. Grip strength, wrist and shoulder strength and proprioception, and upper extremity performance were measured before and after implementation of the intervention (eight-week resistance training using a "gyroscopic device") using a hand hold dynamometer, isokinetic dynamometer, and Y balance test respectively. RESULTS: After 8 weeks of "gyroscopic device" exercise, improvement in the shoulder, wrist and grip strength, shoulder and wrist proprioception and performance scores of both experimental groups was significant. There were no significant differences between study groups I and II, both groups, however, demonstrated significant differences when compared to the control group, but between group I and the control group, and between group II and the control group, the difference was significant. However, no significant change was seen in the control group. CONCLUSIONS: Due to the significant effects of the "gyroscopic device" mediated exercise on grip strength, wrist and shoulder strength and proprioception, and performance of the upper extremity, use of the exercise can be recommended for subjects with impingement syndrome or tennis elbow impairment in measured variables. More research is needed to confirm the result of this study.

Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study.

BACKGROUND: Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to apply in the sport field. In this study we valued the effectiveness of Kinesio taping (KT) on immediate pain control for patients with chronic lateral epicondylitis. METHODS: We conducted a randomized, double-blinded, cross-over study with 15 patients with chronic lateral epicondylitis. All participants received two taping sessions in a random order with a 3-day interval in between: one with KT and the other with sham taping (ST). Pain perceived during resisted wrist extension and at rest using numeric rating scale (NRS), the pain-free grip strength, and the pressure pain threshold, were measured before and 15 min after the tape was applied. RESULTS: A significant reduction of 2.1 ± 1.6 (Z = - 3.081, P = 0.002) and 0.7 ± 0.8 (Z = - 2.428, P = 0.015) was found on a NRS with KT and ST, respectively, indicating that both taping sessions produced immediate pain relief for resisted wrist extension. Both taping sessions significantly improved the pain-free grip strength with increases of 3.31 ± 5.05 (Z = - 2.615, P = 0.009) and 2.43 ± 3.31 (Z = - 2.783, P = 0.005) kg found with KT and ST, respectively. Compared with ST, KT exhibited superiority in controlling pain experienced during resisted wrist extension (Z = - 2.168, P = 0.030). CONCLUSIONS: Taping produced unneglectable placebo effects on pain relief and painf-free grip strength for patients with lateral epicondylitis, and KT seemed to have additional effects on controlling pain that was elicited by resisted wrist extension. TRIAL REGISTRATION: ISRCTN13618356 (retrospectively registered on 13/02/2017).

Current physiotherapy practice in the management of tennis elbow: A service evaluation.

BACKGROUND: Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting. METHODS: A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1-year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template. RESULTS: A total of 65 patient records were identified, with patients having a mean age 48 years and mean symptom duration of 5.4 months. The mean treatment duration was 64 days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used. CONCLUSIONS: Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.

A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia.

OBJECTIVES: To improve outcomes of physiotherapy treatment for patients with Lateral Epicondylalgia. DESIGN: A systematic audit and quality improvement project over three phases, each of one year duration. SETTING: Salford Royal NHS Foundation Trust Teaching Hospital Musculoskeletal Physiotherapy out-patients department. PARTICIPANTS: n=182. INTERVENTIONS: Phase one - individual discretion; Phase two - strengthening as a core treatment however individual discretion regarding prescription and implementation; Phase three - standardised protocol using high load isometric exercise, progressing on to slow combined concentric & eccentric strengthening. MAIN OUTCOME MEASURES: Global Rating of Change Scale, Pain-free grip strength, Patient Rated Tennis Elbow Evaluation, Tampa Scale of Kinesophobia-11. RESULTS: Phase three demonstrated a reduction in the average number of treatments by 42% whilst improving the number of responders to treatment by 8% compared to phase one. Complete cessation of non-evidence based treatments was also observed by phase three. CONCLUSIONS: Strengthening should be a core treatment for LE. Load setting needs to be sufficient. In phase three of the audit a standardised tendon loading programme using patient specific high load isometric exercises into discomfort/pain demonstrated a higher percentage of responders compared to previous phases.

Comparison of the Effectiveness of Shockwave Therapy with Selected Physical Therapy Procedures in Patients with Tennis Elbow Syndrome.

Wstep. Lokiec tenisisty jest to zespól bólowy tkanek miekkich okolicy nadklykcia bocznego kosci ramiennej. Celem pracy bylo porównanie skutecznosci terapii radialna fala uderzeniowa (RSWT) z zabiegami laseroterapii i ultradzwieków w badanej grupie. Material i metody. Badania przeprowadzono na grupie 77 pacjentów, których poddano terapii radialna fala uderze-niowa (RSWT; grupa pierwsza - 40 osób) vs laser i ultradzwieki (grupa druga - 37 osób). Do pomiaru efektów terapii wy-ko--rzystano testy funkcjonal-ne Milla i Thomsona, kwestionariusz EQ-5D-5L do ogólnej oceny stanu zdrowia oraz specy-ficz-ny kwestiona-riusz Patient - Rated Tennis Elbow Ewaluation (PRTEE) oceny funkcjonalnej pacjentów z "lokciem tenisisty'. Wyniki. Zarówno w pomiarze testem Thomsona i Milla odnotowano istotna statystycznie poprawe wyników w oby-dwu gru-pach. Efekty leczenia istotnie statystycznie róznily sie pomiedzy grupami w pomiarze testem Milla (p=0,006). Efekty terapii mie-rzone w skali PRTEE istotnie statystycznie róznily sie w dwóch badanych grupach w kazdej z kategorii (p<0,001) na korzysc grupy leczonej RSWT. W skali EQ-5D-5L wieksza statystycznie poprawe zaobserwowano w grupie leczonej RSWT jedynie w kategorii samoobslugi (p=0,024). Wnioski. 1. Zarówno leczenie z zastosowaniem laseroterapii i ultradzwieków jak i radialnej fali uderzeniowej istotnie wplywaja na zmniejszenie dolegliwosci bólowych, a tym samym na poprawe funkcji konczyny górnej oraz jakosci zycia osób z zespolem lokcia tenisisty. 2. Wykazano wieksza krótkotrwala skutecznosc terapii z zastosowaniem radialnej fali uderzeniowej w porównaniu do laseroterapii i ultradzwieków w eliminowaniu bólu oraz poprawie funkcji konczyny górnej. 3. Fala uderzeniowa wydaje sie byc skuteczna terapia dla pacjentów z zespolem lokcia tenisisty, niemniej nalezy prowadzic dalsze badania dotyczace dlugotrwalych efektów prezentowanej metody leczenia.