Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study.

OBJECTIVE: This study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). DESIGN: Randomized controlled single-blind trial. SETTING: Outpatient clinic. PARTICIPANTS: 159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). INTERVENTIONS: One group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. MAIN OUTCOME MEASURES: The primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. RESULTS: Participants' mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). CONCLUSION: Using either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES.

Inter-arm bone mass and size asymmetries in children tennis players are maturity status specific: a 9-month study on the effects of training time across pubertal change and somatic growth.

PURPOSE: Bone growth with exercise is best assessed by tennis-induced inter-arm asymmetries. Yet, the effects of training and maturation across puberty were unclear. This study explored arm bone growth across 9 months of training in 46 tennis players 7-14 years (25 boys, 21 girls). METHODS: Bone mineral content (BMC) and bone area (BA) were measured from DXA scans. Pubertal status was assessed by Tanner stage (TS) and somatic growth by maturity offset (MO). Children were grouped as pre- (TS I-I), early (TS I-II), and mid/late pubertal (TS II-III). RESULTS: Training time (TT) change in the three groups was 160-170, 190-230, and 200-220 h, respectively. Bone asymmetries were large in all groups (d > 0.8, P < 0.001): 5-18 g (9-21%) and 9-17 g (17-23%) in girls and boys, respectively, for BMC, and 5-15 cm2 (6-13%) and 9-15 cm2 (12-15%) in girls and boys (10-13%), respectively, for BA. BMC and BA change asymmetry peaked at pre-puberty in girls (56%, 46%) and at early puberty in boys (57%, 43%). Asymmetry gains varied with baseline asymmetry (41%) and change in TT (38%) and TS (17%) in BMC, and with baseline asymmetry (58%) and change in MO (17%) and TS (12%) in BA. CONCLUSION: All bone asymmetries were substantial. Tennis-induced bone gains were higher at pre- to early puberty in girls and at early to mid/late puberty in boys. Training enhanced mostly bone mass and maturity status enhanced mostly bone size; sex was not bone-change modeling impactful. Implications are discussed considering certain limitations.

A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension.

PURPOSE: The goal of this study was to use image analysis recordings to measure the carrying angle of elite male tennis players during the forehand stroke, with the hypothesis that elite tennis players overstress their elbow in valgus over the physiological degree in the frontal plane just before ball contact on forehand groundstrokes. METHODS: The carrying angle of male tennis players ranked in the top 25 positions in the ATP ranking was measured on selected video frames with the elbow as close as possible to full extension just before the ball-racket contact in forehands. These frames were extracted from 306 videos professionally recorded for training purposes by a high-profile video analyst. All measures were conducted by three independent observers. RESULTS: Sixteen frames were finally included. The mean carrying angle was 11.5° ± 4.7°. The intraclass correlation coefficient value was 0.703, showing good reliability of the measurement technique. The measured carrying angle was lower than what has been observed in historical cohorts using comparable measurement methodology, suggesting a possible instant varus accommodation mechanism before hitting the ball. CONCLUSIONS: The observed decrease in the carrying angle is a consequence of an increase in elbow flexion position dictated by the transition from a closed to open, semi-open stances. As the elbow flexes during the preparation phase, it is less constrained by the olecranon and its fossa, increasing the strain on the medial collateral ligament and capsule structures. Moving towards full extension before the ball-racket contact, the elbow is dynamically stabilised by a contraction of the flexor muscles. These observations could provide a new explanation for medial elbow injuries among elite tennis players and drive specific rehabilitation protocols. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level IV.

Comparison of Interventions for Lateral Elbow Tendinopathy: A Systematic Review and Network Meta-Analysis for Patient-Rated Tennis Elbow Evaluation Pain Outcome.

PURPOSE: There is controversy regarding the optimal treatment for lateral elbow tendinopathy (LET), and not all available treatment options have been compared directly with placebo/control. A network meta-analysis was conducted to compare the effectiveness of different LET treatments directly and indirectly against control/placebo based on a validated outcome, the Patient-Rated Tennis Elbow Evaluation (PRTEE) pain score. METHODS: Randomized, controlled trials comparing different treatment methods for LET were included, provided they reported outcome data using the PRTEE pain score. A network meta-analysis with random effect was used to combine direct and indirect evidence between treatments compared with placebo in the short term (up to six weeks) and midterm (more than six weeks and up to six months) after intervention. RESULTS: Thirteen studies with 12 comparators including control/placebo were eligible. The results indicated no significant improvement in PRTEE pain score in the short term across all treatments compared with control/placebo. In the midterm, physiotherapy/exercise showed benefit against placebo (mean difference: -4.32, 95% confidence interval: -7.58 and -1.07). Although steroid injections, dry needling, and autologous blood also exhibited potential treatment effects, it is crucial for the clinician to consider certain pitfalls when considering these treatments. The limited number of small studies and paucity of data call for caution in interpreting the results and need for further evidence. CONCLUSIONS: Patients should be informed that there is currently no strong evidence that any treatment produces more rapid improvement in pain symptoms when compared with control/placebo in the short and medium terms. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Comparison of the activation and mechanical properties of scapulothoracic muscles in young tennis players with and without scapular dyskinesis: an observational comparative study.

BACKGROUND: In tennis athletes with scapular dyskinesis, the activation of the scapulothoracic muscles during serve is not known. Also, the mechanical properties (tone, elasticity, and stiffness) of the scapulothoracic muscles of the tennis athletes with scapular dyskinesis are likely to change. The study aimed to evaluate the activation of the scapulothoracic muscles while performing tennis serve and to determine the changes in the mechanical properties of the same muscles in young tennis athletes with scapular dyskinesis. METHODS: Seventeen tennis athletes with scapular dyskinesis aged between 11 and 18 years (the scapular dyskinesis group) and age- and gender-matched 17 asymptomatic tennis athletes (the control group) were included in the study. Activation of scapulothoracic muscles (descending-transverse-ascending trapezius and serratus anterior) in the 3 phases (preparation, acceleration, and follow-through) of the serve was evaluated using surface electromyography, and the mechanical properties of the same muscles were measured at rest by myotonometry. RESULTS: Ascending trapezius activation in the follow-through phase was lower in the scapular dyskinesis group compared with the control group (mean difference 95% confidence interval: -22.8 [-41.2 to -4.5]) (P = .017). The tone and stiffness of the transverse trapezius (P = .043 and P = .017, respectively) were higher, whereas the same parameters of the ascending trapezius were lower (P = .008 and P = .010, respectively) in the scapular dyskinesis group compared with the control group. CONCLUSIONS: Activation of the ascending trapezius and the tone and stiffness of the transverse-ascending trapezius were altered in tennis athletes with scapular dyskinesis. Implementations to improve these changes can be included in the rehabilitation or training programs of young tennis athletes with scapular dyskinesis.

Energy Expenditure of Elite Male and Female Professional Tennis Players During Habitual Training.

Understanding the daily energy expenditure of athletes during training is important to support recovery, adaptation, and the maintenance of performance. The aim of the current research was to assess the total daily energy expenditure (TDEE) and the acute energy expenditure (EE) of tennis training sessions during habitual training of elite tennis players. Using a cohort study design, 27 (n = 10, male; age; 22.3 ± 3.2 years and n = 17, female; age: 23.8 ± 3.5 years) elite singles tennis players were assessed for TDEE and tennis training EE. Using Actiheart activity monitors during a 2- to 5-day training period, male players were analyzed for 26 days and 33 (1.3 ± 0.5 sessions/day) tennis training sessions, and female players for 43 days and 58 (1.2 ± 0.4 sessions/day) tennis training sessions. Male TDEE (4,708 ± 583 kcal/day) was significantly higher than female (3,639 ± 305 kcal/day). Male absolute and relative tennis training EEs (10.2 ± 2.3 kcal/min and 7.9 ± 1.4 kcal·hr-1·kg-1) were significantly higher than those of females (7.6 ± 1.0 kcal/min and 6.8 ± 0.9 kcal·hr-1·kg-1). The resting metabolic rate was assessed via indirect calorimetry. The physical activity level for both groups was 2.3 AU. The TDEE of male and female players during habitual training now highlights the continual cycle of high energy demands experienced by the elite tennis player. The broad ranges of TDEE and EE reported here suggest individual assessment and nutritional planning be prioritized, with a particular focus on carbohydrate requirements.

Preliminary Application of Infrared Thermography to Monitoring of Skin Temperature Asymmetries in Professional Padel Players.

The aim of the present study was to evaluate skin temperature (Tsk) asymmetries, using infrared thermography, in professional padel players before (PRE), after (POST) and 10 min after training (POST10), and their relationship with perceptual variables and training characteristics. Thermal images were taken of 10 players before, after and 10 min after a standardized technical training. After training, Tsk of the dominant side was higher than before training in the anterior forearm (30.8 ± 0.4 °C vs. 29.1 ± 1.2 °C, p < 0.01; ES = 1.9), anterior shoulder (31.6 ± 0.6 °C vs. 30.9 ± 0.6 °C, p < 0.05; ES = 1.0) posterior arm (29.5 ± 1.0 °C vs. 28.3 ± 1.2 °C, p < 0.05; ES = 1.0), and posterior forearm (30.8 ± 0.9 °C vs. 29.3 ± 1.6 °C, p < 0.05; ES = 1.1). Likewise, these differences were significant POST10 in the anterior arm, anterior forearm, anterior shoulder, posterior arm and posterior forearm. Comparing the different moments of measurement (PRE, POST and POST10), the temperature was higher POST10 in all the regions analyzed except for the shoulder, abdominals, and lower back. Also, correlations were found between fatigue variation and temperature variation between limbs (Tsk dominance), and no correlation was found except between age and posterior thigh (|r| = 0.69; p < 0.05), and between the racket mass and anterior knee (|r| = 0.81; p < 0.01). In conclusion, infrared thermography allows monitoring of skin asymmetries between limbs in professional padel players, but these asymmetries were not related to overall fatigue variation, overall pain variation, years of experience and training hours.

Kinematics of the Tennis Serve Using an Optoelectronic Motion Capture System: Are There Correlations between Joint Angles and Racket Velocity?

The serve is the most important stroke in tennis. It is a complex gesture consisting of numerous rotations with a wide amplitude, which are important to manage for performance. The aim of this study was to investigate whether correlations exist between joint kinematic parameters and racket velocity. A quantitative kinematics analysis of four ranked players (two boys and two girls) was carried out using an optoelectronic system composed of 10 cameras (150 Hz). Five flat serves per player were analyzed. Eighty-two markers were located across the 15 body segments and on the racket. A descriptive statistical analysis including a correlation analysis was carried out between joint angles and racket kinematic parameters (vertical position, velocity, and acceleration) during the cocking and acceleration phases. Ten very high (0.7 < r < 0.9) and three almost perfect (r > 0.9) correlations were found. Shoulder and hip axial rotations, knee flexion, and trunk extension were correlated linearly with racket vertical position and velocity during the cocking phase. For the acceleration phase, elbow flexion, trunk flexion/extension, and trunk axial rotation were linked to racket kinematics. Some of these parameters showed differences between slow and fast serves. These parameters, which are involved in transmitting ball velocity, are important to consider for tennis players and coaches in training programs, education, and performance enhancement.

An Analytical Approach for Naturalistic Cooperative and Competitive EEG-Hyperscanning Data: A Proof-of-Concept Study.

Investigating the neural mechanisms underlying both cooperative and competitive joint actions may have a wide impact in many social contexts of human daily life. An effective pipeline of analysis for hyperscanning data recorded in a naturalistic context with a cooperative and competitive motor task has been missing. We propose an analytical pipeline for this type of joint action data, which was validated on electroencephalographic (EEG) signals recorded in a proof-of-concept study on two dyads playing cooperative and competitive table tennis. Functional connectivity maps were reconstructed using the corrected imaginary part of the phase locking value (ciPLV), an algorithm suitable in case of EEG signals recorded during turn-based competitive joint actions. Hyperbrain, within-, and between-brain functional connectivity maps were calculated in three frequency bands (i.e., theta, alpha, and beta) relevant during complex motor task execution and were characterized with graph theoretical measures and a clustering approach. The results of the proof-of-concept study are in line with recent findings on the main features of the functional networks sustaining cooperation and competition, hence demonstrating that the proposed pipeline is promising tool for the analysis of joint action EEG data recorded during cooperation and competition using a turn-based motor task.

Arthroscopic assessment for lateral collateral ligament complex deficiency of the elbow: a cadaveric study.

PURPOSE: To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy. METHODS: Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow. RESULTS: The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P = .008; Stage 0 vs. Stage 3: P = .010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P = .010; Stage 0 vs. Stage 3: P = .011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P = .157). CONCLUSION: Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more.

Association between Platelet-Derived Growth Factor Receptor Alpha Gene Polymorphisms and Platelet-Rich Plasma's Efficiency in Treating Lateral Elbow Tendinopathy-A Prospective Cohort Study.

Individual differences in the response to platelet-rich plasma (PRP) therapy can be observed among patients. The genetic background may be the cause of this variability. The current study focused on the impact of genetic variants on the effectiveness of PRP. The aim of the present study was to analyze the impact of single nucleotide polymorphisms (SNP) of the platelet-derived growth factor receptor alpha (PDGFRA) gene on the effectiveness of treating lateral elbow tendinopathy (LET) with PRP. The treatment's efficacy was analyzed over time (2, 4, 8, 12, 24, 52 and 104 weeks after the PRP injection) on 107 patients using patient-reported outcome measures (PROM) and achievement of a minimal clinically important difference (MCID). Four SNPs of the PDGFRA gene (rs7668190, rs6554164, rs869978 and rs1316926) were genotyped using the TaqMan assay method. Patients with the AA genotypes of the rs7668190 and the rs1316926 polymorphisms, as well as carriers of the T allele of rs6554164 showed greater effectiveness of PRP therapy than carriers of other genotypes. Moreover, the studied SNPs influenced the platelets' parameters both in whole blood and in PRP. These results showed that PDGFRA gene polymorphisms affect the effectiveness of PRP treatment. Genotyping the rs6554164 and the rs1316926 SNPs may be considered for use in individualized patient selection for PRP therapy.

Return to athletics after total knee arthroplasty: a survey study of 784 recreational athletes across 12 sports.

BACKGROUND: Postoperative return to recreational activity is a common concern among the increasingly active total knee arthroplasty (TKA) patient population, though there is a paucity of research characterizing sport-specific return and function. This study aimed to assess participation level, postoperative return to activity, sport function, and limitations for recreational athletes undergoing TKA. METHODS: A survey of recreational sports participation among primary, elective TKA patients from a single academic center between June 2011 and January 2022 was conducted. Of the 10,777 surveys administered, responses were received from 1,063 (9.9%) patients, among whom 784 indicated being active in cycling (273 [34.8%]), running (33 [4.2%]), jogging (68 [8.7%]), swimming (228 [29.1%]), tennis (63 [8.0%]), skiing (55 [7.0%]), or high-impact team sports (64 [8.2%]) between two years preoperatively and time of survey administration, and were included for analyses. RESULTS: Cycling (62.3% at two years preoperatively vs. 59.0% at latest follow-up) and swimming (62.7% at two years preoperatively vs. 63.6% at latest follow-up) demonstrated the most favorable participation rate changes, while running (84.0% at two years preoperatively vs. 48.5% at latest follow-up) and skiing (72.7% at two years preoperatively vs. 45.5% at latest follow-up) demonstrated the least favorable participation rate changes. The majority of respondents were "satisfied" or "very satisfied" with their return across all sports, though dissatisfaction was highest among runners and joggers. For cycling, running, jogging, and swimming, respondents most commonly reported no change in speed or distance capacity, though among these cyclists reported the highest rates of improved speed and distance. The majority of returning skiers reported improved balance, form, and ability to put on skis. CONCLUSION: Return to sport is feasible following TKA with high satisfaction. Swimming and cycling represent manageable postoperative activities with high return-rates, while runners and joggers face increased difficulty returning to equal or better activity levels. Patients should receive individualized, sports-specific counseling regarding their expected postoperative course based on their goals of treatment.

A meta-analysis of the risk factors for lateral epicondylitis.

BACKGROUND: Very few meta-analyses discussed risk factors for lateral epicondylitis (LE), and previous meta-analyses reached conflicting conclusions with each other on some specific risk factors. PURPOSE: To investigate the risk factors for LE through meta-analysis. STUDY DESIGN: Meta-analysis. METHODS: PubMed, Embase, and Web of Science databases were searched for relevant studies in January 2022. Raw data were extracted into a predefined worksheet, and quality analysis was conducted by the Quality in Prognosis Studies (QUIPS) tool. Pooled effect sizes and 95% confidence intervals were calculated. R package "meta" was used for statistical analysis. RESULTS: 22 studies were included in the meta-analysis. Female sex (odds ratio [OR]=1.33 and p-value<0.05), smoking history (OR=1.46 and p-value<0.001), manual labor (OR=2.39 and p-value<0.001), and hypercholesterolemia (OR=1.67 and p-value<0.05) were significant risk factors for LE. CONCLUSIONS: Female gender, smoking history, manual labor, and hypercholesterolemia could increase the risk of LE. According to an additional literature review, statin treatment for hypercholesterolemia is described as potentially related to the development of LE.

Navigating the Court: A Comparison of Distance Demands between Sexes in Grand Slam Tennis.

This study analysed critical movement demands of tennis match-play to better inform contemporary approaches to athlete preparation and training. HawkEye data from matches during the 2021 and 2022 Australian Open were utilised. Distance was aggregated for movement cycles, points, games, sets, and matches, alongside total shots played. Data was collated for males (best-of-five sets) and females (best-of-three sets) allowing comparisons both within and between sexes. Overall, no differences within sexes were evident for total distance, however males traversed further per match than females (MDE = 809 ± 139m, ES = 0.86). Female players travelled further in their deciding (third) sets compared to set 1 (ES = 0.28) and while this effect wasn't as discernible for males, the deciding (fifth) set showed some evidence of elevated distance requirements and variability. Between sexes, only female set 3 was different to male set 3 (ES = 0.29). Female and male tiebreak games (i.e. game 13) required players travel further distance compared to other games (ES = ~1.45). Between sex differences were observed for tiebreak games compared to games 1 to 12 (female ES = 1.36 and male ES = 1.53). Players from both sexes generally covered similar distances during points and movement cycles, with between-shot distances of 4.2m-4.5m, notably longer than previous reports. Further, total shots and total match distance (r > 0.97; p < 0.01) shared similar linear relationships. These results highlight that the between shot or movement cycle demands of professional hard court tennis are substantially higher than described in the literature (Roetert et al., 2003). The findings also reveal competitiveness as a key influence on set level distance demands during professional tennis match-play, a consideration in player preparation programs.

Arthroscopic release and decortication provide earlier return to work with similar patient satisfaction compared to continued intensive conservative therapy for recalcitrant tennis elbow: a retrospective observational study.

INTRODUCTION: Tennis elbow management has primarily been conservative over the years with over 90% of the cases being managed conservatively. Surgical intervention may be necessary only for symptomatic recalcitrant cases of tennis elbow cases. However, there are gaps in the literature when it comes to comparison of the return to pre-operative return to their work and level of activities among patients who undergo arthroscopic management and those who receive conservative management. METHODS: A retrospective observational study was conducted to compare 23 patients receiving continued intensive conservative (CIC) management in group 1 with 24 patients undergoing arthroscopic release of the extensor carpi radialis brevis and lateral epicondyle decortication (ARD) in group 2. The study had a minimum follow-up period of 3.5 years. The researchers compared the groups in terms of return to work (RTW) at the same intensity or lower level and any changes in their previous work. Objective grip strength and patient-reported outcome measures, such as post-intervention satisfaction level (rated on a scale of 0-100) and visual analog scale (VAS) for residual elbow pain, were also compared between the two groups. RESULTS: Return to work (RTW) occurred significantly earlier in group 2 (mean 6.13 months) compared to group 1 (mean 4.64 months), and a greater number of patients in group 2 (13/24, 54.2%) were able to return to the same of work. Although not statistically significant, the ARD group exhibited comparable patient satisfaction (p = 0.62) and visual analog scale (VAS) scores for residual elbow pain (p = 0.67). Grip strength was comparable (p = 0.084, 0.121) between the affected and unaffected sides of the bilateral upper extremities and among both groups of patients. CONCLUSION: The use of ARD for RTE (recalcitrant tennis elbow) indicates a significantly earlier return to work (RTW) at the same or lower intensity level compared to the standard CIC therapy protocol. Objective grip strength was comparable to the non-affected side and among the two groups of patients receiving two different management modalities. Comparable patient-reported satisfaction and residual lateral elbow pain were also noted among both the groups. LEVEL OF EVIDENCE: Retrospective, comparative study, level III.

Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial.

BACKGROUND: Because lateral epicondylitis is a common musculoskeletal disorder that affects the forearm's extensor tendons, an effective therapeutic approach should reverse the degeneration and promote regeneration. This study aimed to compare the efficacies of autologous blood (AB) injection, corticosteroid (CS) injection, and a combined injection of both in treating lateral epicondylitis (LE), hypothesizing that the combined approach might offer immediate symptom resolution and a lower recurrence. MATERIALS AND METHODS: A total of 120 patients diagnosed with lateral epicondylitis were systematically distributed among three distinct therapeutic injection groups. Those in the AB group were administered 1 ml of autologous venous blood mixed with 2 ml of 2% prilocaine HCl. Participants in the CS category were given 1 ml of 40 mg methylprednisolone acetate mixed with 2 ml of 2% prilocaine HCl. Meanwhile, patients in the combined group received a mixture containing 1 ml each of autologous venous blood and 40 mg methylprednisolone acetate along with 1 ml of 2% prilocaine HCl. Prior to receiving their respective injections, a comprehensive assessment of all participants was carried out. Follow-up assessments were subsequently conducted on days 15, 30, and 90 utilizing metrics of the patient-rated tennis elbow evaluation (PRTEE) and measurements of hand grip strength (HGS). RESULTS: One patient dropped out from the combined group, and 119 patients completed the trial. No complications were recorded during the course of follow-up. By day 15, all groups had demonstrated significant PRTEE improvement, with CS showing the most pronounced reduction (p = 0.001). However, the benefits of CS had deteriorated by day 30 and had deteriorated further by day 90. The AB and AB + CS groups demonstrated sustained improvement, with AB + CS revealing the most effective treatment, achieving a clinically significant improvement in 97.4% of the patients. The improved HGS parallelled the functional enhancements, as it was more substantial in the AB and AB + CS groups (p = 0.001), corroborating the sustained benefits of these treatments. CONCLUSIONS: The study concluded that while AB and CS individually offer distinct benefits, a combined AB + CS approach optimizes therapeutic outcomes, providing swift and sustained functional improvement with a lower recurrence rate. These findings have substantial clinical implications, suggesting a balanced, multimodal treatment strategy for enhanced patient recovery in LE. LEVEL OF EVIDENCE: Randomized clinical trial, level 1 evidence. TRIAL REGISTRATION: NCT06236178.

A table tennis serve versus rally hit elicits differential hemispheric electrocortical power fluctuations.

Human visuomotor control requires coordinated interhemispheric interactions to exploit the brain's functional lateralization. In right-handed individuals, the left hemisphere (right arm) is better for dynamic control and the right hemisphere (left arm) is better for impedance control. Table tennis is a game that requires precise movements of the paddle, whole body coordination, and cognitive engagement, providing an ecologically valid way to study visuomotor integration. The sport has many different types of strokes (e.g., serve, return, and rally shots), which should provide unique cortical dynamics given differences in the sensorimotor demands. The goal of this study was to determine the hemispheric specialization of table tennis serving - a sequential, self-paced, bimanual maneuver. We used time-frequency analysis, event-related potentials, and functional connectivity measures of source-localized electrocortical clusters and compared serves with other types of shots, which varied in the types of movement required, attentional focus, and other task demands. We found greater alpha (8-12 Hz) and beta (13-30 Hz) power in the right sensorimotor cortex than in the left sensorimotor cortex, and we found a greater magnitude of spectral power fluctuations in the right sensorimotor cortex for serve hits than return or rally hits, in all right-handed participants. Surprisingly, we did not find a difference in interhemispheric functional connectivity between a table tennis serve and return or rally hits, even though a serve could arguably be a more complex maneuver. Studying real-world brain dynamics of table tennis provides insight into bilateral sensorimotor integration.NEW & NOTEWORTHY We found different spectral power fluctuations in the left and right sensorimotor cortices during table tennis serves, returns, and rallies. Our findings contribute to the basic science understanding of hemispheric specialization in a real-world context.

Minimal important difference, patient acceptable symptom state and longitudinal validity of oxford elbow score and the quickDASH in patients with tennis elbow.

BACKGROUND: The Oxford Elbow Score (OES) and the short version of Disabilities of Arms, Shoulder and Hand (QuickDASH) are common patient-reported outcomes for people with elbow problems. Our primary objective was to define thresholds for the Minimal Important Difference (MID) and Patient-Acceptable Symptom State (PASS) for the OES and QuickDASH. The secondary aim was to compare the longitudinal validity of these outcome measures. METHODS: We recruited 97 patients with clinically-diagnosed tennis elbow for a prospective observational cohort study in a pragmatic clinical setting. Fifty-five participants received no specific intervention, 14 underwent surgery (11 as primary treatment and 4 during follow-up), and 28 received either botulinum toxin injection or platelet rich plasma injection. We collected OES (0 to 100, higher is better) and QuickDASH (0 to 100, higher is worse), and global rating of change (as an external transition anchor question) at six weeks, three months, six months and 12 months. We defined MID and PASS values using three approaches. To assess the longitudinal validity of the measures, we calculated the Spearman's correlation coefficient between the change in the outcome scores and external transition anchor question, and the Area Under the Curve (AUC) from a receiver operating characteristics (ROC) analysis. To assess signal-to-noise ratio, we calculated standardized response means. RESULTS: Depending on the method, MID values ranged from 16 to 21 for OES Pain; 10 to 17 for OES Function; 14 to 28 for OES Social-psychological; 14 to 20 for OES Total score, and - 7 to -9 for QuickDASH. Patient-Acceptable Symptom State (PASS) cut offs were 74 to 84 for OES Pain; 88 to 91 for OES Function; 75 to 78 with OES Social-psychological; 80 to 81 with OES Total score and 19 to 23 with Quick-DASH. OES had stronger correlations with the anchor items, and AUC values suggested superior discrimination (between improved and not improved) compared with QuickDASH. OES also had superior signal-to-noise ratio compared with QuickDASH. CONCLUSION: The study provides MID and PASS values for OES and QuickDASH. Due to better longitudinal validity, OES may be a better choice for clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT02425982 (first registered April 24, 2015).

Increased Cortical Activity in Novices Compared to Experts During Table Tennis: A Whole-Brain fNIRS Study Using Threshold-Free Cluster Enhancement Analysis.

There is a growing interest to understand the neural underpinnings of high-level sports performance including expertise-related differences in sport-specific skills. Here, we aimed to investigate whether expertise level and task complexity modulate the cortical hemodynamics of table tennis players. 35 right-handed table tennis players (17 experts/18 novices) were recruited and performed two table tennis strokes (forehand and backhand) and a randomized combination of them. Cortical hemodynamics, as a proxy for cortical activity, were recorded using functional near-infrared spectroscopy, and the behavioral performance (i.e., target accuracy) was assessed via video recordings. Expertise- and task-related differences in cortical hemodynamics were analyzed using nonparametric threshold-free cluster enhancement. In all conditions, table tennis experts showed a higher target accuracy than novices. Furthermore, we observed expertise-related differences in widespread clusters compromising brain areas being associated with sensorimotor and multisensory integration. Novices exhibited, in general, higher activation in those areas as compared to experts. We also identified task-related differences in cortical activity including frontal, sensorimotor, and multisensory brain areas. The present findings provide empirical support for the neural efficiency hypothesis since table tennis experts as compared to novices utilized a lower amount of cortical resources to achieve superior behavioral performance. Furthermore, our findings suggest that the task complexity of different table tennis strokes is mirrored in distinct cortical activation patterns. Whether the latter findings can be useful to monitor or tailor sport-specific training interventions necessitates further investigations.

Swimming, better than tennis, develops sensorimotor adaptabilities involved in postural balance in 5-6-year-old children.

PURPOSE: The present study aimed to evaluate the postural balance of young tennis players and young swimming practitioners in static and dynamic conditions. METHODS: Thirty-six children (5-6 years old) participated in 3 groups: 12 tennis players, 12 swimming practitioners and 12 controls. Static and dynamic [in medial lateral (ML) and anterior posterior (AP) planes] postural balance were assessed by the centre of pressure sways using a stabilometric force platform in the eyes opened (EO) and eyes closed (EC) conditions. RESULTS: In the EO condition, swimming practitioners and tennis players had a significantly lower (p < 0.05) centre of pressure mean velocity (CoPVm) compared to controls in both static and dynamic medial-lateral (D-ML) postures. In the D-ML posture, swimming practitioners showed lower CoPVm compared to tennis players. However, in the EC condition, only the swimming practitioners showed better static and D-ML postural balance (p < 0.05) compared to their counterparts. In the static posture, the Romberg index value was significantly higher (p < 0.05) in tennis players compared to the two other groups. CONCLUSION: Tennis players developed a higher reliance on vision to maintain balance, whereas swimming practitioners were more stable in challenging postural conditions. Clinicians should consider incorporating swimming training rather than tennis as an appropriate balance training in fall-prevention programs.