Cause Of Lateral Elbow Pain Research Articles

Neuromuscular ultrasound for the differential diagnosis of radial tunnel syndrome and lateral epicondylitis.

Lateral elbow pain is quite common in everyday life. Lateral epicondylitis and radial tunnel syndrome are the most common causes of lateral elbow pain. The aim of this study was to evaluate the sensitivity and specificity of neuromuscular ultrasound examination in the diagnosis of lateral epicondylitis versus radial tunnel syndrome. This was a prospective double-blinded pilot study of 68 elbows in 34 patients with lateral elbow pain. Patients underwent clinical examination and standardized neuromuscular ultrasound evaluation in the first 15days after the initiation of symptoms. Statistical significance was set at p<.001. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sixty-eight radial nerves were examined in 34 healthy controls (16 males; mean age 48.1±8.2years). Pain with palpation over the radial tunnel was found in 25 of 48 elbows (52.1%) compared to the pain over the lateral epicondyle found in 10 of 48 elbows (20.8%). Τhe sensitivity of palpation in differentiating radial tunnel syndrome from lateral epicondylitis was 75.7%, while the specificity was 50% (PPV 71.4%, NPV 51.5%). The sensitivity of neuromuscular ultrasound in differentiating radial tunnel syndrome from lateral epicondylitis was 92.6%, while the specificity was 80% (PPV 92.6%, NPV 80.0%). In most of the patients (25/31), fibrous bands anterior to the radio-capitellar joint were responsible for the nerve entrapment. The present study highlights the importance of the neuromuscular ultrasound's diagnostic role in differentiating radial tunnel syndrome from lateral epicondylitis in the clinical scenario of lateral elbow pain.

Denervation procedure of the lateral epicondyle for refractory lateral epicondylitis

BackgroundLateral epicondylitis is the most common cause of lateral elbow pain in adults, and non-operative treatment is the first-line management modality of choice. Pain refractory to conservative management may improve with surgical interventions involving ECRB débridement or denervation. This investigation was conducted to evaluate the long-term analgesic efficacy, incidence of postoperative sensory deficits, and postoperative elbow functionality in patients who underwent a denervation surgery of the posterior branch of the posterior cutaneous nerve of the forearm (PBPCNF) for refractory lateral epicondylitis. MethodsThis investigation was an IRB-approved, single-center, single-surgeon case series of 22 patients who underwent denervation surgery with an average final follow-up of 4.7 years. Inclusion criteria for surgery were a minimum of 6 months symptom duration refractory to conservative therapies, a minimum of 2 years clinical follow-up, and significant (70-80%) pain relief from the nerve block test. Visual Analog Scale (VAS) pain and Single Assessment Numerical Evaluation (SANE) scores were used to assess pain and function, respectively. The incidence of postoperative sensory deficits was evaluated via clinical exam. ResultsCompared to the preoperative average, the cohort’s mean VAS pain was significantly decreased at all postoperative follow-up intervals, including 2 weeks, 1 year, and final average follow-up of 4.7 years. At the final follow-up, the mean SANE score was 98.8 ± 2.6, and one patient (4.5%), who reported the same sensory deficit preoperatively, reported postoperative sensory deficits. ConclusionsThe PBPCNF denervation procedure is a highly efficacious procedure for achieving long-term pain control in the treatment of refractory lateral epicondylitis. The PBPCNF denervation procedure affords patients a high level of postoperative functionality with a low incidence of sensory deficits.

Comparison of Clinical Outcomes After Different Surgical Approaches for Lateral Epicondylitis: A Systematic Review and Meta-analysis.

Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain. When nonoperative treatment fails, 1 of the 3 surgical approaches-open, percutaneous, or arthroscopic-is used. However, determining which approach has the superior clinical outcome remains controversial. To review the outcomes of different operative modalities for LE qualitatively and quantitatively. Systematic review; Level of evidence, 4. This review was performed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published in PubMed, Medline (via EBSCO), and ScienceDirect databases that treated LE with open, percutaneous, or arthroscopic approaches with at least 12 months of follow-up were included. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Methodological Index for Non-Randomized Studies score. The primary outcome was the success rate of each operative treatment approach-open, percutaneous, and arthroscopic. From an initial search result of 603 studies, 43 studies (n = 1941 elbows) were ultimately included. The arthroscopic approach had the highest success rate (91.9% [95% CI, 89.2%-94.7%]) compared with the percutaneous (91% [95% CI, 87.3%-94.6%]) and open (82.7% [95% CI, 75.6%-89.8%]) approaches for LE surgery with changes in the mean visual analog scale pain score of 5.54, 4.90, and 3.63, respectively. According to the Disabilities of the Arm, Shoulder and Hand score, the functional outcome improved in the arthroscopic group (from 54.11 to 15.47), the percutaneous group (from 44.90 to 10.47), and the open group (from 53.55 to 16.13). The overall improvement was also found in the Mayo Elbow Performance Score, the arthroscopic group (from 55.12 to 90.97), the percutaneous group (from 56.31 to 87.65), and the open group (from 64 to 93.37). Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches of LE surgery.

Comparison of two different orthoses used in the treatment of lateral epicondylitis.

Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain, and orthoses are often used in its conservative treatment. However, the number of studies examining the effectiveness of the orthoses used and their differences compared to each other is limited. To determine the effects of 2 orthoses types, wrist orthosis (WO) and counterforce brace (CB), commonly used in the treatment of lateral epicondylitis on muscle activation, grip strength, hand function, and satisfaction level in healthy individuals. Quasi-experimental study. Thirty-seven healthy individuals were recruited. Muscle activation was evaluated by surface electromyography, and maximum grip strength was evaluated with a handheld dynamometer. Hand function and satisfaction level were evaluated with Jebsen Taylor Hand Function Test and Orthotics and Prosthetics Users Survey, respectively. All evaluations were conducted for each individual in 3 conditions (no orthosis, WO, and CB). Extensor carpi radialis (ECR) muscle activation was greater when using CB compared with that when without orthosis (p = 0.036). There was no significant difference in extensor digitorum communis (EDC) muscle activation and maximum grip strength among the conditions (p > 0.05). Hand function was worse when using the WO compared with the other conditions (p < 0.001). In terms of orthosis satisfaction, individuals were found to be significantly more satisfied with the use of CB (p = 0.001). In our study highlight the use of CB in terms of EDC muscle activity, grip strength, hand function, and satisfaction, while the use of WO is prominent in terms of keeping extensor carpi radialis muscle activity low, which has been shown to be important for LE. To obtain definitive results on the effectiveness of different orthoses in the treatment of LE, more research is needed to compare the muscular activation in the extensor carpi radialis brevis (ECRB) and EDC muscles with objective methods.

Ultrasound-guided tenotomy for lateral epicondylitis with TenJet improves physical functional and decreased pain outcomes at 1 year: a case series review

Common extensor tendinopathy is a common cause of lateral elbow pain. Ultrasound-guided minimally invasive tenotomy (MIT) has been utilized successfully as a treatment for several years, but the use of TenJet device has not been well described. To evaluate the effectiveness and safety of MIT with TenJet who failed nonsurgical management of common extensor tendinopathy in an outpatient setting. A total of 100 patients with common extensor tendinopathy who failed conservative treatment underwent ultrasound-guided MIT with TenJet device in the outpatient setting at a single institution. All 100 patients prior to MIT underwent diagnostic musculoskeletal ultrasound showing common extensor tendinosis. The findings were interpreted by a fellowship-trained and board-certified musculoskeletal radiologist. Patients were evaluated with the Oxford Elbow Score prior to the procedure and at 1-year follow-up. Exclusion criteria included prior corticosteroid injection within the past 6 weeks of the MIT intervention, active local or systemic infection, complete full thickness tear of the common extensor tendon, and pregnancy. Oxford Elbow Score had a statistically significant difference in baseline to 1 year (P<.001). No complications were reported and zero patients went on to require open surgical intervention. MIT with TenJet is a safe, effective, and well-tolerated treatment for common extensor tendinopathy.

Efficiency of low-intensity laser therapy in the treatment of lateral epicondylitis

Aim: Lateral epicondylitis is the most common cause of lateral elbow pain and dysfunction, mainly caused by repetitive gripping or wrist extension during various activities. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore poses an important public health concern. The aim of this study was to investigate the efficacy of laser in the treatment of patients diagnosed with lateral epicondylitis.&#x0D; Material and Method: Patients who received low-intensity laser therapy (LILT) treatment and patients who received placebo LILT while waiting for extracorporeal shock wave therapy (ESWT) treatment with the same diagnosis were included in the study. A total of 60 patients in two groups of 30 were included in the study. The patients who received LILT treatment constituted the treatment group (n=30), and the patients receiving placebo LILT constituted the control group (n=30). VAS for resting and resisted wrist extension, HAQ, PRTEE-T pain, function, and total scales were used to measure patients' pain status and response to treatment. Results were compared by analyzing patient files and recorded data.&#x0D; Results: A total of 48 (80%) subjects were female and 12 (20%) were male. The mean age of the control group was 47.8±7.4 years, and the mean age of the treatment group was 45.7±8.5 years. There was no significant difference between the two groups in terms of age, gender, and occupational distribution (p&gt;0.05). In our study, the group treated with LILT showed statistically significant improvement in all parameters (VAS, HAQ, PRTEE) we investigated compared to the control group (p

A Network Meta-Analysis of Randomized Controlled Trials Directed at Treating Lateral Epicondylalgia

Abstract Background: Lateral epicondylosis is the most prevalent cause of lateral elbow pain, occurring in 4 per 1000 patients. The aim of most treatments is to reduce inflammation even with histological evidence demonstrating that lateral epicondylosis is a non-inflammatory condition. Objective: To determine the relative merits of the different regimens used to diminish lateral epicondylosis pain using a mixed treatment comparison/network meta-analysis (NMA). Methods: A thorough literature search was performed. The eligibility criteria for this mixed treatment comparison were: randomized controlled clinical trials; human subjects; working age population (16 to 70 years); the outcome measure was an objective pain assessment; measured at a 1- to 3-month follow-up. The NMA were performed using the GeMTC user interface for automated NMA utilizing a Bayesian Hierarchical Model of random effects. The evaluation of confidence in the findings from NMA was performed using a semi-automated platform called CINeMA (Confidence in Network Meta-Analysis). Results: The model suggests that articulation technique is the most effective measure for decreasing lateral epicondylalgia followed by topical nitrates, acupuncture, kinesiology taping and low-level laser therapy, respectively. Muscle energy technique, local corticosteroid injection, prolotherapy and counterforce bracing displayed a trend toward being less effective than placebo. Conclusions: The results suggest that the most effective modalities for improving lateral epicondylalgia are those that decrease muscle tone and those that improve circulation, while measures meant to decrease inflammation appear to be of no or limited benefit.

"Annular Ligament Syndrome": A New Differential Diagnosis of Lateral Aspect Elbow Pain

To investigate a potential new syndrome as a cause of lateral elbow pain in working populations

Stem cell therapy for the management of lateral elbow tendinopathy: A systematic literature review

Summary Purpose Lateral elbow tendinopathy is the most common cause of lateral elbow pain with a lifetime prevalence of approximately 40% in the general population. The purpose of this study was to complete a systematic review to identify the potential of stem cell therapy based on the current evidence in the treatment of lateral elbow tendinopathy. Methodology A systematic review through the Ovid, Medline, and Cochrane Review databases was performed with the search terms of lateral epicondylitis, tendinopathy, tennis elbow, stem cell, bone marrow, treatment, and therapy. Results The systematic review initially identified 816 articles from three databases. Five studies met the inclusion criteria. The five studies evaluated four different stem cell preparations including autologous tenocytes, skin-derived tenocyte-like cells, allogeneic adipose-derived mesenchymal stem cells, and bone marrow aspirate. Conclusion While a majority of lateral elbow tendinopathy cases resolve in a timely manner with no or limited intervention, recovery can be a delayed process for a small percentage of patients. The role of emerging treatment options has not been established. Stem cell therapy is an option for refractory cases, but current evidence is poor. Early findings demonstrated significant improvements in imaging and functional outcomes, but findings were limited by lack of control arms or other treatment arms for comparison. Further large, controlled studies are needed to evaluate safety, efficacy in order to establish the role of stem cell therapy in the management of lateral elbow tendinopathy.

Effectiveness of Autologous Blood and Steroid Injection in Tennis Elbow Based on Visual Analog Score Pain Score and Nirschl Stage

Introduction: Lateral epicondylitis or Tennis elbow is one of the most common causes of lateral elbow pain. Local steroid injection is a time tested treatment for providing symptomatic relief. Local injection of autologous blood in a case of lateral epicondylitis provides pain relief due to its cellular and humoral factor and triggers a healing cascade.&#x0D; Aims: This study aims to compare the outcomes of the autologous blood injection and local corticosteroid injection in the treatment of tennis elbow.&#x0D; Methods: This is a Hospital based study on conducted in the Department of Orthopedics at Nepalgunj Medical College from July 2018 to June 2019. 42 patients with unilateral tennis elbow were divided into two groups-Group A-21 patients (Autologous Blood Injection) and Group B-21 patients (Steroid Injection). Group A received 2 ml of autologous venous blood and mixed with 1 ml of 2% lignocaine solution; Group B patients received 80 mg (in 2 ml) of methyl Prednisolone acetate and 1ml of 2% lignocaine solution. Visual Analogue Scale pain score and Nirschl stage of patients were evaluated before injection and at 2, 6, and 12 weeks of injection were noted and analyzed.&#x0D; Results: Preinjection mean VAS pain score was - 7.48±0.75, 7.52±0.68 in Group A, and Group B respectively while the Nirschl stage was 5.62±0.59 and 5.6±0.5 in group A and B, these scores among two group was not statistically significant. At 2 weeks follow up both groups showed improvement without any significant difference between two groups (p=0.84 and 0.549), while group A had better improvement in VAS pain score at 6 weeks (p=0.001). At 12 weeks follow-up within each group, there was significant VAS pain and Nirschl stage improvement (p=0.001) but there was no significant difference between the two groups.&#x0D; Conclusion: Injection of autologous blood and corticosteroid injection is equally effective in the treatment of Tennis elbow at 12 weeks final follow-up.

Role of strengthening during nonoperative treatment of lateral epicondyle tendinopathy

IntroductionLateral epicondyle tendinopathy (LET) is the most common cause of lateral elbow pain. The literature on rehabilitation of the condition encompasses a plethora of interventions with most current evidence indicating that stretches and some form of strengthening are vital components. However, patient outcomes are infrequently reported further than 12 weeks from the start of therapy and it is unclear which components of a home exercise program are necessary to alleviate symptoms up to one year from the initiation of a therapy program. Purpose of the StudyThe purpose of the study is to determine if a therapy program with 4 to 6 visits spaced out over 12 weeks focusing on self-management and strengthening is more effective in reducing pain and improving function long term than the same program without strengthening, for individuals with LET. Study DesignThis is a randomized controlled trial. MethodsNinety-four patients were randomly allocated into two groups: both groups received the interventions of education in pertinent pathoanatomy, stretching, pain management through rest and icing, and activity modification. Group 1 (n = 38) was also provided with a strengthening component to the home exercise program, whereas group 2 did not (n = 21). Our primary outcome measure was pain at rest and pain with activity; our secondary measure was the level of functional impairment as measured by the quick disabilities of arm shoulder and hand. Outcome measurements were assessed at baseline, 6, 12, 24, and 52 weeks after initiation of therapy. ResultsBoth groups demonstrated statistically significant improvement with a moderate to large effect size in pain and function scores when compared with previous time point at 6, 12, and 24 weeks. Pain continued to decrease for both groups from 24 weeks to 52 weeks, but interestingly, there was a significant increase with moderate effect size in the quick disabilities of arm shoulder and hand score at 52 weeks when compared with week 24. No statistically significant difference was found between the two groups at any time point up to 52 weeks from the start of therapy. ConclusionsThis study demonstrates that a therapy program consisting of a low number of visits spaced out over 12 weeks based on education, stretches, activity modification, and pain management techniques is effective at reducing pain and increasing function in patients with LET. The addition of strengthening to this program did not improve outcomes. The therapy approach used in this study is consistent with the International Classification of Function guidelines and focuses on engaging patients in self-management of the condition through patient education and self-empowerment.

Arthroscopic Release of Resistant Tennis Elbow

Background: Lateral epicondylitis is a common cause of lateral elbow pain; characterized as an overuse injury of the forearm and the wrist extensors. The elbow arthroscopy has an important role for diagnosing and treating many elbow disorders. Objective: The aim of this study was to evaluate the effectiveness of the arthroscopic intervention as a minimally invasive procedure in management of resistant cases with tennis elbow after failure of conservative treatment. Material and methods: A prospective study included 30 patients with resistant lateral epicondylitis treated with arthroscopic debridement of extensor carpi radialis brevis tendon. This study was carried out in the period between January 2017 and February 2019 at Al Azhar University Hospitals. The patients were evaluated pre-, intraand post-operatively for their elbow function and pain using the following scores: Mayo Elbow Performance Index (MEPI), Disability of the Arm, Shoulder and Hand (DASH), The Nirschl staging score and visual analog scale (VAS) for pain. Result: A total of 30 patients (12 male and 18 female) were included. The mean of MEPI score improved from 71.33 to 92.55, DASH score from 28.53 to 3.18, Nirschl scale improved from 4.13 to 1.47 and pain VAS improved from 5.27 to 1.47. There was a significant difference between from before to after surgery for the four functional scores. 2 patients complicated with ulnar nerve injury. Conclusion: The arthroscopic treatment of tennis elbow was shown to be an effective therapeutic option when appropriately indicated and performed in refractory cases. It also allowed excellent viewing of joint space for diagnosis and treatment of any associated pathological conditions with a minimally invasive procedure.

Snapping of the annular ligament: a uncommon injury characterised by snapping or locking of the elbow with good surgical outcomes.

Snapping annular ligament is an uncommon cause of lateral elbow pain. The purpose of this case series was to evaluate the clinical presentation and surgical outcomes for snapping annular ligament. Included were 23 patients with snapping annular ligament who received surgical treatment between 2007 and 2016. There were two treatment groups with either resection (arthroscopic or open procedure, n = 15) or open annular ligament reconstruction (n = 8). Patients were assessed with the Mayo Elbow Performance Index and the Oxford Elbow Score. Preoperative and postoperative scores were compared with a paired t test. Pain was located laterally in nine patients (39.1%), anteriorly in three patients (13.0%), anterolaterally in two patients (8.7%), and diffusely in nine patients (39.1%). In total, 16 patients (69.6%) experienced a snapping sensation and ten patients (43.5%) locking of the elbow. According to the patients' reported outcomes, their symptoms improved significantly after both procedures. This is the largest case series in the literature on snapping annular ligament, an uncommon cause of lateral elbow pain. Good treatment results are expected with resection of the interpositioned part of the annular ligament or annular ligament reconstruction. IV.

Prominent synovial plicae in radiocapitellar joints as a potential cause of lateral elbow pain: clinico-radiologic correlation

Thickened synovial plicae in the radiocapitellar joint have been reported as a cause of lateral elbow pain. However, few reports regarding diagnosis based on detailed physical examination and magnetic resonance imaging (MRI) findings are available. The aims of this study were to characterize the clinical manifestations of this syndrome and to investigate the clinical outcomes of arthroscopic surgery. We analyzed 20 patients who received a diagnosis of plica syndrome and underwent arthroscopic débridement between 2006 and 2011. The diagnosis was based on physical examination and MRI findings. Elbow symptoms were assessed using a visual analog scale for pain; the Mayo Elbow Performance Index; and the Disabilities of the Arm, Shoulder and Hand score at a minimum of 2 years after surgery. The thickness of plicae on MRI was compared with the normal data in the literature. Plicae were located on the anterior side in 1 patient, on the posterior side in 15, and on both sides in 4. Radiocapitellar joint tenderness and pain with terminal extension were observed in 65% of patients. MRI showed enlarged plicae consistent with intraoperative findings. The mean plica thickness on MRI was 3.7 ± 1.0 mm, which was significantly thicker than the normal value. The mean lengths (mediolateral length, 9.4 ± 1.6 mm; anteroposterior length, 8.2 ± 1.7 mm) were also greater than the normal values. The visual analog scale score for pain decreased from 6.3 to 1.0 after surgery. The Mayo Elbow Performance Index and Disabilities of the Arm, Shoulder and Hand scores improved from 66 to 89 and from 26 to 14, respectively. Specific findings of the physical examination and MRI provide clues for the diagnosis of plica syndrome. Painful symptoms were successfully relieved after arthroscopic débridement.

A Clinical Test for Diagnosis of Humeroradial Joint Lesions in the Presence of Lateral Elbow Pain: Single-Case Design with Arthroscopic Confirmation

INTRODUCTION: Lateral epicondylosis is a common cause of lateral elbow pain, however, some patients fail conservative management. One reason, many pathologies have similar presentations. There are no valid and reliable clinical tests to differentiate between tendopathy and arthropathy. This single case design looks at the utilization of the humeroradial joint (HRJ) distraction test to diagnose HRJ chondropathy. CASE SUMMARY: 38-year-old male recreational athlete with persistent lateral elbow pain, impaired motion, crepitus and locking. Disability of the Arm Shoulder Hand Questionnaire (DASH): 13.33/100. DASH Sport Module, 68.75/100. Differential Diagnosis: Chondropathy of the HRJ with loose body, based on history of elbow pain and locking, non-capsular pattern of limitation of motion and a positive HRJ distraction test. Intervention: loose body manipulation improved pain free range of motion with continued remarkable HRJ distraction test; referral to orthopedic surgeon. Plain radiographs and CT demonstrated a loose body and marked cartilage thinning within the HRJ. Arthroscopic removal of the loose body and plica resection was performed. Surgical exploration confirmed Grade 3 cartilage lesions within the radial head without involvement of the extensor muscle group. Post-operative physical therapy focused on restoration of accessory joint motion and education on return to functional and recreational activity. OUTCOMES: Full range and normal joint accessory motion, DASH score and DASH Sport Module score reduced to 8.33 and 25, 12-weeks post-operative. CONCLUSION: Arthroscopic exploratory surgery is recommended for chronic lateral elbow pain resistant to conservative management; however, patients who present with pain in the absence of a positive clinical examination and radiographic findings benefit least from arthroscopic evaluation. No clinical test(s) have been validated in the literature to diagnose HRJ lesions. This report is the first to propose the use of a new clinical test for HRJ lesion, with confirmation using imaging and arthroscopy. Level 4 Case Report.

Ultrasonographic Differentiation of Lateral Elbow Pain.

Lateral elbow pain is often attributed to degenerative or posttraumatic impairment of the common extensor tendon. Ultrasonography assesses the soft tissue structures of the lateral elbow, allowing the differentiation between various underlying processes, including angiofibroblastic degeneration, hyaline degeneration, and inflammation, and exclusion of other possible causes of pain such as posterior interosseous and lateral antebrachial nerve compression. Furthermore, the real-time imaging nature of ultrasonography enables the detection of impingement of the lateral synovial fold, degenerative changes in the elbow recess, and elbow posterolateral instability during dynamic maneuvers. Ultrasonography is widely accessible and well tolerated by patients, making it a perfect method for establishing an initial diagnosis and monitoring the healing process. This review describes the possible causes of lateral elbow pain and their ultrasonographic differentiation.

EFFECTIVENESS OF THERAPEUTIC ULTRASOUND WITH AND WITHOUT MULLIGAN MOBILZATION IN LATERAL EPICONDYLITIS

ABSTRACTBackground and Introduction: Mechanical malfunction of elbow joint is the usual cause of lateral elbow pain. Even though varied procedures have suggested for maximizing elbow movements and decreasing elbow pain but mobilization of joints has validated the most efficacious technique. The outcome of manual therapy procedure i.e. Mulligan Mobilization along with Therapeutic ultrasound in lateral epicondylitis to reduce pain and recovery of function had been assimilated in this recent research.Methods: Study is true experimental in nature, randomized control trial adopted to select the subjects with lateral epicondylitis.Thirtypatients 15 in each group having LE were chosen Simple random sampling technique and arranged into two groups as guided by CONSORT (Consolidated Standards of Reporting Trials) guidelines. Group A received Ultrasound therapy with intensity of 1.2 W/cm2 with pulsed mode (3MHZ) and duration is 5 minutes .Group B received Ultrasound therapy with an intensity of 1.2 W/cm with pulsed mode (3MHZ) for 5 minutes and MWM applied on elbow in supine position shoulder positioned as internal rotation, forearm pronation and elbow extension with 10 repetition for 6 seconds with 15 seconds duration of rest.Total 12 sessions was conducted in duration of 4 weeks after including the patient in study. Four questionnaires was asked to fill i.e one after every 3 sessions Pain and functional activities were evaluated by PRTEE. Repeated measure ANOVA was used to compare the significance at different time intervals.Results: The results exhibited that The P-value for PRTEE (patient-rated tennis elbow evaluation) in group A using Therapeutic Ultrasound and was after four weeks of treatment which was less than the level of significance 0.05. So Therapeutic Ultrasound with Mulligan mobilization was more effective than Therapeutic Ultrasound to reduce pain and restoration of function.Conclusion: It was concluded that combination of mobilization of Mulligan and Therapeutic ultrasound was more effective compared with Therapeutic Ultrasound in and PRTEE scores in sufferers of lateral epicondylitisKey Words:Lateral Epicondylitis, Therapeutic Ultrasound, Mulligan mobilization, PRTEE.

Evidence-based treatment of common extensor tendinopathy

Common extensor tendinopathy, or tennis elbow, is the most common cause of lateral elbow pain. While most cases are self-limiting, a percentage will become chronic and lead to substantive time away from work and sport. There is no clear consensus on timing and choice of modality for treatment. There are a multitude of treatment options available including watchful waiting, physical therapy, topical nitroglycerin, extracorporeal shockwave therapy, corticosteroid injection, prolotherapy, neovessel sclerosis, autologous growth factor injections, percutaneous needle tenotomy, and surgery. This article presents a comprehensive review of the current literature on the treatment of common extensor tendinopathy

Epicondylitis: lateral.

Lateral epicondylitis is the most common cause of lateral elbow pain in adults. Although it is typically a self-limiting process, there are many nonsurgical and surgical treatment options available if lateral epicondylitis becomes chronic and continues to cause pain. Its common name, tennis elbow, is somewhat of a misnomer because the condition is often work-related and occurs in athletes and nonathletes alike. Acute onset of symptoms occurs more often in young athletes; chronic, recalcitrant symptoms typically occur in older patients. In this review, we describe the pathogenesis and clinical presentation and the nonsurgical and surgical treatment options currently available.

IMpact of Platelet Rich Plasma OVer Alternative Therapies in Patients with Lateral Epicondylitis (IMPROVE): Protocol for a Multicenter Randomized Controlled Study: A Multicenter, Randomized Trial Comparing Autologous Platelet-Rich Plasma, Autologous Whole Blood, Dry Needle Tendon Fenestration, and Physical Therapy Exercises Alone on Pain and Quality of Life in Patients with Lateral Epicondylitis

Lateral epicondylitis, commonly known as tennis elbow, is the most common cause of lateral elbow pain and the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting. Many therapeutic options, including conservative, surgical, and minimally invasive procedures, have been advocated for the treatment of lateral epicondylitis. Although numerous small studies have been performed to assess the efficacy of various treatments, there are conflicting results with no clear consensus on the optimal treatment. In an economic environment with limited health care resources, it is paramount that optimal cost-effective therapies with favorable patient-important outcomes be identified. This is a protocol paper which outlines a multicenter, multidisciplinary, single-blinded, four-arm randomized controlled trial, comparing platelet-rich plasma (PRP), whole blood injection, dry needle tendon fenestration, and sham injection with physical therapy alone for the treatment of lateral epicondylitis. Patients are screened based on pre-established eligibility criteria and randomized to one of the four study groups using an Internet-based system. The patients are followed at 6-week, 12-week, 24-week, and 52-week time points to assess the primary and secondary outcomes of the study. The primary outcome is pain. Secondary outcomes include health-related quality of life and ultrasound appearance of the common extensor tendon. Two university centers (McMaster University and the University of Michigan) are currently recruiting patients. We have planned a sample size of 100 patients (25 patients per arm) to ensure over 80% power to detect a three-point difference in pain scores at 52weeks of follow-up. This study has ethics approval from the McMaster University Research Ethics Board (REB# 12-146) and the University of Michigan Institutional Review Board (IRB# HUM00067750). Successful completion of this proposed study will significantly impact clinical practice and enhance patients' lives. More broadly, this trial will develop a network of collaboration from which further high-quality trials in ultrasound-guided interventions will follow.