جستجوی مقالات مرتبط با کلیدواژه « Tennis Elbow » در نشریات گروه « پزشکی »

Background & Objectivs: 

Today, despite the existence of numerous treatments for tennis elbow, the search for more effective methods continues due to the limited efficacy of these existing approaches. This study aimed to compare the results of tennis elbow treatment in two groups: patients receiving corticosteroid injection and casting, and patients receiving acupuncture and physiotherapy.

This quasi-experimental study, conducted in Jiroft in 2021, investigated the effectiveness of different treatment approaches for tennis elbow. Fifty patients diagnosed with tennis elbow were randomly divided into two groups of 25 each. One group received a combination of corticosteroids and casts, while the other group received acupuncture and physiotherapy.  A pain line was used to assess pain levels based on VAS criteria. Data were analyzed using SPSS-26 statistical software, employing Chi-square, Fisher's Exact, Mann-Whitney, one-way ANOVA, Kruskal-Wallis, and Kolmogorov-Smirnov tests.

The majority of patients were female (66%) and housewives (46%).  There was a significant difference in pain outcomes between the two groups: physiotherapy alone and physiotherapy combined with corticosteroids and casts. This difference was observed across various conditions (pain at rest, pain during activity, and amount of pain evoked during activity) (p <0.05). In simpler terms, corticosteroids and casts were more effective in reducing pain from tennis elbow compared to acupuncture and physiotherapy.  Additionally, corticosteroids and casts had a greater effect on hand movement (supination, pronation, extension, and flexion) compared to acupuncture and physiotherapy.

Our findings indicate that treatment of tennis elbow with a combination of corticosteroid injection and casting is more effective than acupuncture or physiotherapy alone. Corticosteroid injections themselves are also an effective way to relieve tennis elbow pain.

Tennis elbow or lateral epicondylitis is a common complaint involving about a 3-5% cases in a community. Non-surgical treatment is effective in 80% of cases. Recent studies have shown the effect of autologous blood on improving the pain and function of affected patients. The present study aimed to compare the effectiveness of steroid and autologous blood local injection in controlling pain and disability in the short and long term.

The present study was a clinical trial conducted in Shahid Beheshti Hospital of Babol. A total of 60 patients were divided into 3 groups; A group injected at the site of lateral epicondylitis with steroid (methylprednisolone acetate-40mg) and another group with autologous blood (2ml of venous blood), and the other group used a brace for 3 weeks. Patients were followed-up for 15, 30, and 90 days, and the PRTEE assessment questionnaire assessed their pain and disability.

On the 15th day, there was no statistically significant difference in pain and function in the three groups, although the injectable groups were relatively more effective. On the 30th day, the local corticosteroid was significantly better than the autologous blood group, while on the 90th day, autologous blood was significantly better than the local corticosteroid. The average day, in which 25% improvement was gained, was lower in the autologous blood transfusion group.

Regarding the long-term effect of autologous blood on corticosteroid injections, it was recommended as a lateral epicondylitis treatment.

We hypothesized that there is no difference in the perceived pain and disability when the tennis elbow symptoms recur after a CSI. Consequently, we secondarily aimed to assess the approximate time from CSI until symptom recurrence. Moreover, we aimed to evaluate factors associated with the time to recurrence.

This cross-sectional study was performed during 2018-2019. We enrolled 50 consecutive patients who presented with the recurrence of tennis elbow symptoms and had a history of a single CSI for this condition. We asked the patients to rate the perceived pain and disability by filling the QuickDASH twice, including one by recalling pain and function before the CSI and one for the recent recurrent symptoms to assess the patient’s perceived pain and disability at the two-time points. 

There was a significant difference in perceived pain VAS and disability QuickDASH between pre-injection and recurrence, showing that the patient’s perceived pain and disability were greater when recurred (P<0.001). The mean time between CSI and recurrence of symptoms was 6 (4-7) months, which is shorter than the expected spontaneous resolution of tennis elbow (> 1 year) to offer other invasive treatments. Time to recurrence had no significant association with sex, age, side, education, occupation, pre-injection VAS score, pre-injection QuickDASH, or symptom duration using a linear regression model.

Although CSI seems to relieve or mask the pain in the short term, there is a considerable chance of recurrence, and patients may perceive more significant pain and disability that may lead to subsequent injection or precocious surgery. Time is an effective treatment for this illness. Shared decision-making is paramount, and patients have to be counseled regarding the natural history and expected prognosis of different treatments. Level of evidence: IV

In LE (Lateral Epicondylitis) otherwise known as Tennis Elbow, the Extensor Carpi Radialis Brevis (ECRB) tendon is most commonly involved. In the majority of studies, injections are performed with a lack of standardization. The Instant Tennis Elbow Cure (ITEC) device has been developed to perform reproducible and standardized perforations by multiple needles. The goal of this pilot study was to estimate the accuracy of this ITEC device by means of a cadaveric study and to assess the clinical safety of this procedure.  Ten cadaveric arms were injected using the ITEC device. The location and depth of the ECRB tendon was measured by ultrasound imaging. The accuracy of the infiltration was assessed by locating the injected dye through dissection and arthrotomy of the cadaveric elbow. A prospective clinical pilot study was conducted to assess the safety of the ITEC device in treating patients with chronic LE. An optional infiltration with an injection fluid was carried out?? Primary outcome measures were side effects and complications of the ITEC device occurring within a follow up period of 8 weeks after treatment. In all cadaveric elbows the injection fluid ( in this case an injection fluid) was located at the ECRB tendon. In one cadaver, a minimal amount of dye was found intra-articular and in 3 cadavers a small quantity was located in the surrounding tissue of the ECRB tendon. 122 patients with LE were treated with the ITEC device. No adverse effects or complications were reported at 8-week follow up.  Treatment of LE using the ITEC device appears accurate and safe. It may improve future research since it is reproducible and it can be performed in a standardized way. Level of evidence: IV

We aimed to compare the efficacy of local injection therapies for lateral epicondylitis in a Bayesian framework.

We searched the Embase, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ProQuest, for randomized controlled trials published from inception to February 2021 in any languages. The injection therapies included corticosteroids (CSs), autologous blood (AB), botulinum toxin (BT), and platelet-rich plasma (PRP). Placebo was the reference group for comparison. The study outcomes were pain, function, and strength, at 1, 3 and 6 months after injection.

Thirty-one trials were finally included in this network meta-analysis, comprising 1,948 patients. In the first month of treatment, CS and BT were more efficacious than placebo in terms of pain reduction, and CS was superior to BT. In the same follow-up time, CS was also superior to placebo in terms of functional improvement. In the third month of treatment, BT was the only intervention that was more efficient than placebo in pain relief. With regard to functional improvement, none of the treatments significantly had a higher effectiveness than placebo in the same period. Moreover, no therapies were found to be more efficient than placebo in the sixth month of treatment in terms of any study outcomes. In addition, we did not identify an intervention superior to placebo regarding strength improvement outcome in any times of follow-up.

CSs and BT are efficient in improving clinical outcomes of lateral epicondylitis in the short term. Also, the efficacy of CSs seems to be greater than BT. On the other hand, AB and PRP were not significantly more efficient than placebo in any times of follow-up.

Lateral epicondylitis (LE) is one of the major causes of elbow pain. Despite being a self-limiting condition, its high incidence can cause a significant socioeconomic burden. Many treatment modalities have been proposed for the treatment, but the optimal strategy is still unknown. In this article, we discuss surgical and non-surgical strategies for the treatment of LE and address the research gaps.

The aim of this study was to assess the functional outcomes and time to improve after the modified arthroscopic technique (recession technique) by using a knife to sharply cut the extensor carpi radialis brevis (ECRB) tendon origin in patients with recalcitrant tennis elbow.

In a prospective study, we included 11 consecutive patients. Following the routine elbow arthroscopy and after exposing the ECRB tendon, we used a knife (no. 11 blade) to cut the tendon at the level of radiocapitellar articulation while avoiding the lateral collateral ligament, which is considered a tendon recession as is done in spastic muscles. Patients were followed up for 1, 3, 6, and 12 month intervals and were asked to fill the Mayo Elbow Performance Index (MEPI), Quick Disabilities of the Arm Shoulder Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE).

The mean PRTEE, QuickDASH, and MEPI scores showed significant improvement over time (P<0.001). There were 5 excellent, 5 good and 1 fair results based on MEPI. The patient with fair result was the only patient with existing varus instability on examination under anesthesia although we could not elicit the test positive on clinical examination. Substantial functional and pain improvement was reported almost 6 months after surgery. We did not find any nerve injury or post-operative infection.

Arthroscopic recession surgery by using a knife is a safe and effective way in managing recalcitrant tennis elbow although patients should be informed of the expected time to improve. A simple tendon recession by a sharp cut is a time-saving technique that works effectively and is comparable with the piecemeal shaving. Clinical Relevance: The modified muscle recession technique is a rapid and safe way to manage the recalcitrant tennis elbow arthroscopically while the outcomes are comparable to the routine piecemeal shaving of the pathologic tissue. Level of evidence: IV

Lateral epicondylitis (LE) most commonly affects the Extensor Carpi Radialis Brevis (ECRB) tendon andpatients are generally treated with injection therapy. For optimal positioning of the injection, as well as an estimation ofthe surface area and content of the ECRB tendon to determine the volume of the injectable needed, it is important toknow the exact location of the ECRB in relation to the skin as well as the variation in tendon length and location. Theaim of this study was to determine the variation in location and size of the ECRB tendon in patients with LE. An observational sonographic evaluation of the ECRB tendon was performed in 40 patients with LE. Thelength of the ECRB tendon, distance from the cutis to the center of the ECRB tendon, the length of the osteotendinousjunction at the epicondyle and the distance from cutis to middle of the osteotendinous junction were measured. The average tendon length was 1.68cm (range 1.27-1.98; SD 0.177). Compared to women, the ECRB tendonof men was on average 0.12cm longer. Overall, the average distance from cutis to the center of the ECRB was 0.75cm(range 0.50-1.46cm; SD 0.210), the average length of the junction was 0.55cm (range 0.35-0.87; SD 0.130), and thedistance from cutis to middle of the osteotendinous junction was 0.73cm (range 0.40-1.25cm; SD 0.210). The size and depth of the ECRB tendon in patients with LE is largely variable. While there are no studiesyet suggesting sono-guided injection to be superior to that of blind injection, the anatomic variability of this studysuggests that the accuracy of injection therapy for LE might be compromised when based solely on bony landmarksand therefore not fully reliable. As a result, there is value in further studies exploring the accuracy of the ultrasoundguided injection techniques.Level of evidence: IV

An effective treatment for the elbow recalcitrant lateral epicondylitis is arthroscopic surgery. This studyevaluated the midterm results of treating recalcitrant lateral epicondylitis with arthroscopic surgery. A total of 40 subjects with recalcitrant lateral epicondylitis prepared for arthroscopic surgery on their elbowsparticipated in this study. The elbow function was evaluated using the Quick disabilities of the arm, shoulder, and hand(Quick DASH) score. Pain intensity was assessed before and after the surgery by the visual analog scale (VAS). Gripand pinch strengths were assessed by a dynamometer. In this study, the mean age of the participants was 42.9±6.4 years. The average follow-up time was 42months. The mean of VAS (pain intensities) were 7.05 and 3.20 before and after the surgery, respectively (P=0.001).The Quick DASH score decreased from 63.18 to 25.68 from before to after the surgery (P=0.001). The mean gripstrength of the operated and nonoperated sides was not significantly different after the surgery. Arthroscopic surgery seems to be an effective method with few complications in patients suffering froman elbow recalcitrant lateral epicondylitis in the midterm follow-up.Level of evidence: II

Enthesopathy of the extensor carpi radialis brevis origin [eECRB] is a common idiopathic, noninflammatorydisease of middle age that is characterized by excess glycosaminoglycan production and frequentlyassociated with radiographic calcification of its origin. The purpose of our study was to assess the relationship ofcalcification of the ECRB and advancing age. We included 28,563 patients who received an elbow radiograph and assessed the relationship of calcificationsof the ECRB identified on radiograph reports with patient age, sex, race, affected side, and ordering indication usingmultivariable logistic regression. Calcifications of the ECRB were independently associated with age (OR:1.04; P<0.001); radiographsordered for atraumatic pain (OR2.6; P<0.001) or lateral epicondylitis (OR5.5; P<0.001); and Hispanic ethnicity (OR1.5;P<0.001) and less likely to be found at the left side (OR0.68; P<0.001). Similarly, incidental calcifications of the ECRB,those on radiographs not ordered for atraumatic pain or lateral epicondylitis, were independently associated withage (OR1.03; P<0.001) and Hispanic ethnicity (OR1.5; P<0.024) and less likely to be found on the left side (OR0.71;P<0.001). We observed that about nine percent of people have ECRB calcification by the time they are in their sixthdecade of life and calcifications persist in the absence of symptoms which supports the idea that eECRB is a common,self-limited diagnosis of middle age.Level of evidence: II

Tennis elbow (TE) is a common strain injury or microtrauma that causes sore and tender around the outside of the elbow. Using orthotic devices is one way for rehabilitating this condition. The aim of this study was to investigate the immediate effects of taping technique (TT) and counterforce brace (CB) on hand grip strength and pain in the patients with tennis elbow. In an experimental study with pre-test and post-test stages, 29 subjects with TT on their dominant arm were recruited and randomly divided into two groups: TT group (15 subjects) and CB group (14 subjects). The outcomes of the measurement consisted of pain in the lateral aspect of the elbow, as well as grip strength of hand before and 30 minutes after application of TT in one group and CB in another group. The visual analog scale (VAS) was used to assess pain and dynamometer was also utilized to evaluate grip strength. Following elbow taping, the pain was significantly lower than CB group (P = 0.004). However, grip strength with P = 0.06 showed no significant difference between the two groups. The results revealed a significant difference between after and before interventions, with increases in hand grip strength and wrist extension muscle force in TT and CB groups. According to these findings, the improvement of grip strength was not different between the two methods. However, it seems that TT was more effective than CB in the reduction of pain of lateral aspect related to the elbow in these patients.

Lateral epicondylitis, or tennis elbow, is one of the common disorders in humans. Despite recommended treatments, there is no definite therapy for this disorder. Therefore, the aim of this paper is to review scientific reports on the effects of orthotic devices for treatment (comparing orthoses with other treatments related to lateral epicondylitis parameters), reducing complications, and improving symptoms of this condition. Ovid, Scopus, and Web of science were searched to identify studies which reported the effectiveness of orthotic treatment for lateral epicondylitis from 1996 until 2017. Studies were collected based on the inclusion criteria and a few were selected out of a large number of studies. The PEDro scale was used for the quality assessment of the selected articles. A total of 43 articles were chosen, 16 articles on Orthotics vs. other nonsurgical treatments, 20 articles on the comparison of different orthotics, and 7 reviews. Based on the results of the selected papers, there was not sufficient evidence to decide on the effectiveness among several orthoses or for comparing orthotic treatment with other treatment methods. However, it should be emphasized that the use of orthosis can be an acceptable treatment for improving some symptoms of this condition such as pain, grip, pain-free grip, no pain, grip strength, function, ROM, and proprioception.

Extracorporeal shock wave therapy is a noninvasive, safe, and well- tolerated treatment method which is increasingly used in the treatment of lateral epicondylitis. However, the gold standard treatment protocol is still controversial. This study aimed to investigate and compare the efficacy of two different pneumatic pressure levels of radial extracorporeal shockwave therapy (rESWT) in active patients with lateral epicondylitis, unresponsive to conservative treatment. This retrospective comparative study was carried out in the Department of Orthopedics and Traumatology, Duzce University School of Medicine in 2018. A total of 330 patients with lateral epicondylitis unresponsive to conservative treatment were underwent rESWT during years 2010 - 2017. The patients were divided into two groups of 181 patients (group 1) with a total of 1500 impulses of 10 Hz frequency at 1 bar of air pressure during five treatment sessions at 1 week intervals, and 149 patients (group 2) with a total of 2000 impulses of 10 Hz frequency at 2 bars of air pressure during five treatment sessions at 1 week intervals. Functional and clinical outcomes were assessed just before the treatment, at six weeks and six months after treatment using the visual analogue scale (VAS) and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. The mean VAS score had significantly decreased in group 1 from 8.34 ± 1.22 to 2.59 ± 1.49 (P = 0.0001) and had also in group 2 from 8.56 ± 1.22 to 2.56 ± 1.76 (P = 0.0001). The mean Q-DASH score decreased significantly in both groups; from 58.92 ± 18.48 to 9.27 ± 5.85 (P = 0.0001), and from 65.36 ± 19.32 to 9.25 ± 6.28 (P = 0.0001) in group 1 and group 2, respectively. No significant difference was observed between the pretreatment VAS and the 6-month scores of groups 1 and 2 (P = 0.103). The mean difference in the Q-DASH pretreatment and 6-week scores and between the pretreatment and 6-month scores in group 2 were higher than those in group 1 (P = 0.011, P = 0.003). Although both rESWT treatment regimens caused a decrease in pain and loss of function, the superior treatment protocol for rESWT appears to be five treatment sessions at 1-week intervals, with 2000 impulses per session and 2 bars. rESWT is a good option for treating lateral epicondylitis, as it is safe and effective and leads to no complications.

Lateral epicondylitis (LE) also known as tennis elbow is a common disease of middle-aged population.Surgery is a treatment of choice in patients not responded to the conservative management. Open and arthroscopicrelease are the two main choices for LE surgery; however, an overall consensus is not available. This study was aimedto compare the clinical outcomes after conventional open and arthroscopic procedures. An electronic search of databases including, Medline, Web of Science, Embase, Cochrane Library, andScopus was conducted to identify all eligible studies describing the post-operative clinical outcomes of patients withLE, up to October 2018. All studies considering the non-pediatric cases who received at least 6-month preoperativeconservative treatment and were followed more than 6 months after surgery were included. Data on patient satisfaction,functional outcomes, pain, and complication rates, were extracted for each study. If appropriate, the meta-analysiswas performed to combine the results for all outcomes that were reported in a minimum of 3 studies utilizing the samesurgical technique. A total of 34 eligible articles including 15 open studies, 13 arthroscopic studies, and 6 studies in bothtechniques were enrolled. Studies were from different parts of the world with a whole sample size of 1508 cases.Various outcome measuring methods including Quick DASH and VAS, and different clinical outcomes were reported.The results indicated no significant difference between arthroscopic and open surgery methods in terms of VAS,DASH score, time for returning to work, overall outcomes, and patients’ satisfaction (P >0.05). However, postoperativecomplications were significantly higher in the open group when compared with the arthroscopic procedure (57.3%vs 33.4% P=0.001). The present study suggests that despite no superiority for each techniques regarding the pain relief,subjective function, and better rehabilitation, arthroscopic method have been associated with less complications.Level of evidence: II

Lateral Epicondylitis (LE) or tennis elbow is one of the most frequent complications in the general population. Moreover, it is one of the most common lesions in the work-related upper limb. This disease has a significant impact on the daily activities of individuals and their performance. The most frequent problem in patients with LE is pain in the proximal forearm. The current study evaluated and compared a simple proximal forearm strap and a counterforce brace combined with Low Level Laser Therapy (LLLT). In this quasi-experimental study, 26 patients with LE were selected as samples using non-probability sampling technique (convenience method). They were randomly divided into the two groups of simple brace and brace+LLLT. Jamar Digital Hand Dynamometer, Visual Analog Scale, and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire were used to measure grip strength, pain and the disability of samples, respectively. The comparison of studied parameters was performed by repeated measures Analysis of Variance (ANOVA). The mean pain score significantly decreased in both groups; however, the difference between the two groups was not significant. The simple counterforce brace had no significant effect on grip strength, but in the group who used counterforce brace with LLLT, the grip strength significantly increased. The mean disability scores decreased significantly in both groups; however, the difference was not significant between the two groups. The counterforce brace with LLLT had more effect on the reduction of disability. Both tested braces could affect grip strength, pain, and the disability of patients with LE. The counterforce brace with LLLT was superior to the simple counterforce brace only on grip strength.