Lateral Epicondylitis Patients Research Articles

Wirksamkeit neurodynamischer Behandlung bei lateraler Epikondylitis: eine systematische Übersichtsarbeit

Abstract Background Lateral epicondylitis, commonly known as “tennis elbow,” is a prevalent musculoskeletal condition affecting up to 3% of the population, primarily in individuals over 40 years old. It leads to pain and dysfunction at the lateral epicondyle, primarily involving the tendons of forearm extensor muscles, innervated by the radial nerve. Recent insights suggest a multifactorial etiology, questioning the traditional tendinopathy model. Neurodynamics, exploring nerve mechanics, emerges as a potential treatment approach. Methods A systematic review following PRISMA guidelines searched multiple databases for clinical trials investigating neurodynamic interventions for lateral epicondylitis. Inclusion criteria involved lateral epicondylitis patients receiving neurodynamic treatment, with pain, disability, and functional improvement as primary outcomes. Results Six studies met the inclusion criteria. Neurodynamic techniques, including radial nerve mobilization and home exercises, showed positive outcomes. Significant pain reduction, improved grip strength, and increased ulnar deviation angle were observed in several studies. However, heterogeneity in study design, follow-up durations, and small sample sizes limit conclusive evidence. Conclusion Neurodynamic treatment, particularly radial nerve mobilization, appears promising in alleviating pain and improving nerve mechanosensitivity in lateral epicondylitis. High-quality research is needed to establish its efficacy, considering the limitations in existing studies. A multidisciplinary approach and standardized patient inclusion criteria should be emphasized to advance the management of this condition.

Efficacy of PowerBall Versus Mulligan Mobilization With Movement on Pain and Function in Patients With Lateral Epicondylitis: A Randomized Clinical Trial.

Background Lateral epicondylitis (LE), sometimes referred to as tennis elbow or lateral elbow tendinopathy (LET), is one of the most common repetitive stress disorders in the elbow joint. Often, this involves the attachment of the extensor carpi radialis brevis muscle. This study's primary focus is on treating people with LE, a condition that causes repetitive movements of the upper extremities. There is currently no research on how PowerBall gadget workouts affect the function and pain of individuals with lateral epicondylitis. Exercises using the "PowerBall device," which appliesboth intrinsic and extrinsic pressure to the wrist, elbow, and shoulder muscles, are thought to be beneficial forms of resistance training. It has been shown that there are improvements in strength, function, range of motion (ROM), discomfort, and quality of life (QOL). On the other side, it has been demonstrated that LE patients have reduced discomfort while using Mulligan Mobilization with Movement (MMWM). Methods The 50 patients with LE were split into two groups for the single-blinded, randomized clinical study after baseline assessment and randomization: Group A was the intervention group, and Group B was the conventional group. The "PowerBall device" exercise was provided to participants in Group A, and MMWM was given to those in Group B. Both groups can benefit from basic workouts and ultrasonography by following the prescribed routine. Quantification of pain, function, grip strength, and range of motion was done at the start and finish of therapy using the Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE), portable dynamometer, and goniometer. Results After therapy, both groups showed considerable improvement (p<0.05). Both descriptive and inferential statistics were employed in the data analysis. Numerous statistical tests were employed, such as the student's paired and unpaired t-test and the chi-square test. From a statistical and clinical perspective, Group A's outcomes were more significant. On the visual analog scale, there was a decrease in pain intensity for wrist and elbow mobility at rest (p<0.0003), activity (p<0.003), PRTEE (p<0.001), grip strength (p<0.03), and range of motion (p<0.01). Both groups' assessments after rehabilitation indicated increases in pain and function; however, Group A (0.03) benefited more and saw early success with the PowerBall device. Conclusion Findings show that a three-week program incorporating resistance training exercises mediated by a "PowerBall device" enhances upper limb performance beyond traditional exercise treatment and increases grip strength, wrist extension strength, internal and external rotator concentric and eccentric strength. The findings and observations indicate that both groups have significantly improved.

Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Corticosteroids (CS) have shown good short-term performance in terms of pain relief and functional improvement. However, the safety and long-term efficacy of this treatment remains controversial. Several studies have reported good results of platelet-rich plasma (PRP) in the treatment of tendinopathies. However, whether its use in the treatment of lateral epicondylitis (LE) is superior to that of CS remains controversial. To perform a systematic review and meta-analysis of original studies to determine whether the prognosis of LE patients treated with PRP is better than that of CS. Meta-analysis; Level of evidence, 2. Two independent reviewers searched online databases from January 2000 to July 2022 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to evaluate prospective studies of PRP versus CS injection for LE. A third author addressed any discrepancies. Evidence quality was assessed using the Cochrane risk of bias tool. Risk ratios for dichotomous variables and mean differences (MDs) for continuous variables were used to compare clinical outcomes. P values <.05 were considered statistically significant. Eleven randomized controlled trials with 730 patients were included in this review. PRP provided a significantly worse short-term (<2 months) improvement in the visual analog scale (VAS) pain score (MD, 0.93 [95% CI, 0.42 to 1.44]; I2 = 85%; P = .0003) and Disabilities of the Arm, Shoulder and Hand (DASH) score (MD, 10.23 [95% CI, 9.08 to 11.39]; I2 = 67%; P < .0001) but better long-term (≥6 months) improvement in the VAS score (MD, -2.18 [95% CI, -3.13 to -1.22]; I2 = 89%; P < .0001), DASH score (MD, -8.13 [95% CI, -9.87 to -6.39]; I2 = 25%; P < .0001), and Mayo Elbow Performance Score (MD, 16.53 [95% CI, 1.52 to 31.53]; I2 = 98%; P = .03) than CS. The medium-term (2-6 months) reduction in the VAS score was not significantly different between the 2 groups. After sensitivity analysis, none of the results changed except for the short-term VAS scores (MD, 0.53 [95% CI, -0.13 to 1.19]; I2 = 78%; P = .12). Both PRP and CS injections are effective treatments for patients with LE. CS provides better short-term (<2 months) functional improvement and may be more advantageous in terms of short-term pain relief, while PRP provides better long-term (≥6 months) functional improvement and better performance regarding long-term pain relief.

Effectiveness of Dry Needling on Lateral Epicondylitis Patient Compared to Ultrasound Therapy

Background: The goal of study is to assess the effectiveness of dry needling and ultrasound therapy on lateralepicondylitis patients.Purpose: To compare the effectiveness of dry needling on lateral epicondylitis patients compared to ultrasoundtherapy.Materials and Methods: Ninety subjects with lateral epicondylitis (both male and female) divided in two groups.Group “A” acquired dry needling two days a week for a period of two weeks and Group “B” acquired ultrasoundtherapy four days a week for a period of two weeks. Visual Analogue Scale, Patient-rated tennis elbow evaluationwere used to assess patients in before and after treatment. Study period: November 2022 to April 2023.Result: Based on data analysis both visual analogue scale and patient rated tennis elbow evaluation values in eachgroup are significantly different in before and after treatment having p&lt;0.0001 for each group. In Group analysisis highly significant with p&lt;0.0001 for VAS, p&lt;0.0001 for PRTEE dry needling is greater in lowering discomfortand increasing mobility.Conclusion: Dry needling is more effective than ultrasound therapy in lateral epicondylitis.

Role of vitamin D in lateral epicondylitis among Egyptians

BackgroundLateral elbow pain is a prevalent musculoskeletal disorder affecting the elbow’s epicondyle region. One form of lateral elbow pain is lateral epicondylitis, which is a degenerative disorder of the musculotendinous system. Adequate levels of vitamin D are essential for maintaining musculoskeletal health. Our study aimed to assess the role of vitamin D in lateral epicondylitis among Egyptians.ResultsOur research revealed that there is a significant correlation between vitamin D deficiency and lateral epicondylitis. Patients with vitamin D deficiency displayed worse patient-rated tennis elbow evaluation score (PTREE), visual analog scale score (VAS), and grip strength. These findings indicate a statistically significant association between lateral epicondylitis patients with deficient vitamin D and each of the PTREE scores (p < 0.001), VAS score (p < 0.001), and hand grip strength (p < 0.001).ConclusionThe etiology of lateral epicondylitis is not yet fully understood. However, our study provides evidence supporting the notion that low levels of vitamin D may be one of the risk factors in the etiology of lateral epicondylitis among Egyptians.

Comparing the efficacy of blind vs. ultrasound-guided injections in Lateral Epicondylitis: A prospective analysis

Lateral epicondylitis is a relatively common non-traumatic elbow disorder. It is a painful musculoskeletal condition that usually follows forceful repetitive pronation and supination. The aim of this study was to evaluate the advantages of ultrasound-guided injection in patients of Lateral Epicondylitis in comparison to non-image-guided blind injections. This comparative observational study was conducted on sixty patients who had clinical diagnosis of Lateral Epicondylitis. They were divided into two groups of thirty each (randomization done on odd even manner), one group underwent US-guided injections and the other group underwent the blind procedure by a specialist. Pain relief using the Visual Analog Scale (VAS) {score of 0–10} was recorded before the procedure, immediately after the procedure, one-week post-procedure, and six weeks post-procedure. Demographic characteristics, chief complaints, duration of symptoms, previous treatment taken, and complications post-procedure were gathered and compared between the two groups. All patients in both groups finished the period of study. Significant improvement in pain score and tenderness was found in both groups immediately after the injection, one-week post-procedure, and after six weeks post-procedure when compared to the baseline value (p value < 0.05). The US-guided group showed a better reduction in VAS scores immediately after the procedure and one-week post-procedure as compared to patients who were given blind injections, however no statistical difference was found at six weeks follow up. This study shows that US-guided injection relatively improves elbow pain and functional activities early and more effectively than blind/non-image-guided injections, although such results fade as time passes by.

Comparative Efficacy of Phonophoresis with Naproxen and Ultrasound Therapy on Pain and Grip Strength in Lateral Epicondylitis

Purpose: Lateral epicondylitis, also referred to as "tennis elbow," is a painful condition resulting from the inflammation of tendons situated along the exterior of the elbow, which serve to connect the muscles of the forearm. The primary aim of this study was to assess and compare the therapeutic effects of phonophoresis with naproxen versus ultrasound therapy in managing pain levels and enhancing grip strength in individuals suffering from lateral epicondylitis&#x0D; Methodology: This quasi-experimental study comprised a sample size of 42 participants, selected through convenient sampling methods over duration of 8 months. The inclusion criteria stipulated that individuals of both genders, aged between 31 and 50 years, experiencing chronic pain in the elbow and forearm for a period exceeding 3 months, and exhibiting a positive response to the Mill's test, were eligible for participation. The participants were divided into two groups, each consisting of 21 subjects. Out of the 42 patients, 21 were assigned to Group 1, which received baseline therapy along with Phonophoresis utilizing naproxen, while the remaining 21 were allocated to Group 2, which received baseline therapy in conjunction with therapeutic ultrasound. Both groups had received baseline treatment of stretching and strengthening exercises. Four sessions of interventions were given per week, for four weeks. Intensity of pain was assessed by Visual analogue scale (VAS) before and after the treatment of 4 week and grip strength was measured by handheld dynamometer. There were two drop outs in group 1 and three in group 2. The collected data was analyzed and interpreted by using SPSS software of version 24.0&#x0D; Findings: Among the 42 participants (with 21 in each group), 67% of patients in Group 1 were male, while 33% were female. In Group 2, 42.9% were male, and 57.1% were female. For Group 1, the median grip strength value before treatment was 60.00, which significantly decreased to 20.00 after treatment. Similarly, in Group 2, the median grip strength value before treatment was 70.00, and it also decreased significantly to 20.00 after treatment. The pre-treatment mean grip strength in Group 1 was 36.46±8.82, which increased to 50.59±11.33 after 4 weeks of treatment. In Group 2, the pre-treatment mean grip strength was 31.12±4.87, and it increased to 52.02±9.70 after treatment. A statistically significant difference was observed in both groups when comparing pre- and post-treatment grip strength values (p&lt;0.001). However, the between-group analysis comparing Group 1 and Group 2 showed no statistically significant difference (p&gt;0.05)..&#x0D; Recommendations: Based on the study's findings, both phonophoresis with naproxen and therapeutic ultrasound are effective in managing pain and improving grip strength for lateral epicondylitis patients. Clinicians should consider incorporating these treatments into their therapeutic regimens for such patients. Future research should consider larger sample sizes and explore other therapeutic modalities to ascertain the most effective treatment option. Additionally, understanding the long-term effects and sustainability of the noted improvements would benefit clinical practice and enhance patient care outcomes.

Long-term effectiveness of conservative management for lateral epicondylitis: a meta-analysis.

To investigate the long-term (>12 months) effectiveness of conservative management for lateral epicondylitis. PubMed and Embase databases were searched for relevant studies from inception to March 2023. Only English-written randomized controlled trial (RCT) with data download as well as follow up ≥12 months were acceptable. Raw data were extracted into a predefined worksheet, and quality analysis was conducted based on the Cochrane risk-of-bias tool version 2 (RoB2). The standardized mean difference (SMD) with 95% confidence interval (CI) were calculated. Extracorporeal shock wave therapy (ESWT) could significantly relive pain for lateral epicondylitis patients in the long term (SMD: -0.19, 95% CI [-0.36, -0.02]); however, there was no significant difference between ESWT and control groups in long-term function outcome (SMD: 0.24, 95% CI [-0.02, -0.49]). No significant difference could be observed between (1) exercise and control groups in pain (SMD: -0.21, 95% CI [-0.60, 0.18]) or function (SMD: 0.06, 95% CI [-0.11, 0.23]), (2) corticosteroids and placebo groups in pain (SMD: 0.70, 95% CI [-0.43, 1.82]) or function (SMD: -0.02, 95% CI [-0.36, 0.31]), and (3) platelet-rich plasma (PRP) in pain (SMD: -0.30, 95% CI [-0.85, 0.25]) and function (SMD: -0.08, 95% CI [-0.78, 0.62]). The present conventional conservative management for lateral epicondylitis, with the exception of ESWT, a lack adequate evidence supporting their long-term effectiveness.

Comparison of the effects of neural therapy injection and extracorporeal shock wave therapy on pain and hand functions in the treatment of lateral epicondylitis

Background/Aim: Lateral epicondylitis (LE), commonly known as “tennis elbow”, is a painful inflammatory condition affecting wrist extensor tendons. Various treatments, such as extracorporeal shockwave therapy (ESWT) and neural therapy injections, have been used to alleviate symptoms of LE. However, there is a limited number of comparative studies available. This study aims to compare the effectiveness of sequential neural therapy injections and ESWT in reducing pain and improving functionality in patients with LE. Methods: A retrospective cohort study analyzed data from 128 LE patients. Among them, 30 patients underwent neural therapy, while 30 underwent ESWT, following the exclusion criteria. Pain levels were measured using the visual analog scale (VAS), and functionality was assessed using the Duruöz hand index (DHI) before and after treatment. Results: Both neural therapy injections and ESWT led to substantial reductions in pain and improvements in functionality, with no notable differences observed between the two treatment methods. Additionally, no significant variations were found based on age, body mass index, gender, or the side of the elbow treated. Conclusion: The findings suggest that both neural therapy injections and ESWT are equally effective in managing symptoms of LE. Treatment choice may depend on patient preference, cost, availability, or other factors. Further research is necessary to examine long-term outcomes, potential side effects, and factors predicting a better response to one treatment.

The Efficacy of Blood Flow Restriction Training for Grip Strength and Disability in Lateral Epicondylitis

Background: Lateral epicondylitis is a work-related musculoskeletal disorder caused by inflammation of the extensor carpi radialis longus and brevis muscles tendons with symptoms of pain in the lateral side of the elbow and decreased range of motion that causes forearm muscle weakness and disability. This study aimed to compare the effectiveness of blood flow restriction (BFR) training with resistance exercise (RE) in increasing grip strength and forearm disability in lateral epicondylitis patients. Methods: This study used the randomized controlled trial design that involved 28 subjects who were divided into intervention and control groups. All subjects received the treatment 3 times per week for 4 weeks, including the standard ultrasound therapy and electro-muscular stimulation interventions for 20 mins with additional treatment of the low-load BFR training for the intervention group and the high-intensity RE for the control group. This study measured grip muscle strength using a handgrip dynamometer, and functional ability was measured using a patient-rated tennis elbow evaluation questionnaire (PrTEEQ) before and after the treatment session. The statistical analyses of paired t-tests and independent t-tests were used in this study. Results: This study found significant differences between pretest and posttest scores in the measurements of forearm muscle strength (change= 20.0~49.0%, p-values &lt;0.001) and PrTEEQ (change= 64.5~70.5%, p-value &lt;0.001) in the intervention and control groups. In addition, the independent t-tests resulted in significant differences in the score changes of forearm muscle strength and PrTEEQ measurement between these groups with p-values &lt;0.001. Conclusion: This study described that BFR training had better effects on grip strength and functional ability than RE in people with lateral epicondylitis.

Ultrasound with shear wave elastography in diagnosis and follow-up of common extensor tendinopathy in cases with lateral epicondylitis: a cross-sectional analytic study

BackgroundLateral epicondylitis (LE) is a common non-traumatic condition. The diagnosis of LE is typically made clinically. Some lateral epicondylitis patients can profit from supplementary imaging for a precise differential diagnosis. Recently, shear wave elastography has been increasingly attracting public attention in evaluation of tendon pathology and tissue elasticity quantitatively. The purpose of our study was to prove that shear wave elastography can be utilized in the diagnosis and follow-up of lateral epicondylitis.ResultsThis cross-sectional analytic study involved 42 patients with unilateral lateral epicondylitis (30 males, 12 females with age range: 30–50 years, mean age: 39.9 ± 6 SD). The patients were reviewed by two radiologists with experience of more than 10 years, blinded to each other's results. Lateral epicnodylitis was diagnosed based on clinical criteria. The thickness of common extensor tendon and shear wave speed (SWS) were acquired in elbows bilaterally, along with values of the involved elbows in pre- and post-treatment phases. The comparison between examined groups, inter-rater and intra-rater concordance, and the diagnostic performance have been investigated with paired t-test, an intraclass correlation coefficients (ICCs), and a receiver operator characteristic curve, respectively. The patients with lateral epicondylitis showed a significantly decreased value of shear wave speed on affected side in comparison to the healthy side (P value: 0.000). The shear wave speed of diseased elbows has increased significantly following non-operative management than before therapy. The inter-rater and intra-rater concordance showed both excellent values (ICCs ranged from 0.939 to 1.000) for shear wave speed measurements. Furthermore, a 10.72 m/s cutoff limit of mean SWS (shear wave speed) for differentiating lateral epicondylitis elbows from healthy elbows showed a sensitivity and specificity of 90.5% for both.ConclusionsShear wave elastography can be of value as a technique with proper reproducibility and proper diagnostic performance for evaluation and monitoring the therapeutic effect in patients with lateral epicondylitis.

Local Corticosteroid Injection Versus Dry Needling in the Treatment of Lateral Epicondylitis.

Background Lateral epicondylitis (LE) is an inflammation or micro-tearing of the tendons that join the forearm muscles on the lateral aspect of the elbow. Primary treatment of LE includes rest from offending activity and corticosteroid therapy for pain control. Dry needling (DN) is a relatively new therapy for LE. This study examined the results of DN therapy with corticosteroid injection. We aimed to compare pain relief and improvements in functional disability of LE patients treated via DN and corticosteroid injection in a tertiary care center. Methodology A prospective randomized control study was conducted among 54 patients in theOrthopaedics Department of R L Jalappa Hospital from January 2022 to May 2022. Patients received either DN or injectable corticosteroid therapy, and treatment groups were randomized using single-blinded randomization with sealed envelopes. Patients were evaluated using the Patient-Related Tennis Elbow Evaluation (PRTEE) score before the intervention and four and eight weeks after the intervention. Results A total of 54 patients were included in the final analysis. The mean age in the DN group was 43.96 ± 8.15 years and 44.74 ± 8.33 years in the corticosteroid group. In the DN group, 17 (62.96%) patients were male, and in the corticosteroid group, 16 (59.26%) patients were male. The differences in the PRTEE score at the fourth and eighth-week follow-up with baseline value (pre-injection) were statistically significant (p < 0.001). Conclusions DN is a low-cost, minimally invasive, and low-risk therapy whereas corticosteroid therapy is costly and produces systemic side effects in the long term. In this study, during the last follow-up visit, the PRTEE score improved in the DN group compared to the corticosteroid group.

FUNCTIONAL OUTCOME OF TENNIS ELBOW (LATERAL EPICONDYLITIS) TREATED BY LOCAL INJECTION OF PLATELET RICH PLASMA

Objective: The aim of the study was to evaluate the efficacy of local injection of platelet rich plasma in management of patients with tennis elbow who failed to respond to conservative management. Methods: This was a prospective and cohort study in which 80 patients with lateral epicondylitis (Tennis elbow) were included on the basis of a predefined inclusion and exclusion criteria. Demographic details were noted. Patients were treated by local injection of autologous platelet rich plasma. Patients were followed up for 6 months. Relief of pain as well as functional improvement was assessed by patient-rated tennis elbow evaluation (PRTEE) score. SSPS 21.0 software was used for statistical analysis and p&lt;0.05 was taken as statistically significant. Results: Out of 80 studied cases, there were 36 (45%) males and 44 (55%) females with a M: F ratio of 1:1.22. The mean age of male (42.77±9.95 years) as well as female (41.06±9.56 years) was found to be comparable. Nineteen (23.75%) patients were involved in plumbing, 16 (20%) patients were involved in activities that required forceful use of screwdrivers such as electric work, 8 (10%) patients were involved in gardening, and 7 (8.75%) patients were involved in production or laying of bricks. Twelve (15%) patients were professional tennis player. The mean PRTEE score was 74.24±9.74 at the time of presentation. There was significant reduction in PRTEE score during follow-up and at the time of last follow-up visit, PRTEE score was found to be 8.32±2.56. Conclusion: Local injection of autologous platelet rich plasma is effective in managing patients of lateral epicondylitis (Tennis elbow) who fail to respond to conservative management.

Open Debridement Alone Versus Open Debridement With Tendon Repair for Lateral Epicondylitis: A Comparison of Complications and 5-Year Reoperation Rates From a Large Insurance Database.

Background:Open debridement (OD) of the extensor carpi radialis brevis tendon, both with and without repair to the lateral epicondyle, are effective treatments for recalcitrant lateral epicondylitis. However, few comparative studies exist within the literature.Purpose:To (1) compare the 5-year reoperation rates of patients who underwent OD alone versus OD with tendon repair (ODR) and (2) identify the 90-day adverse event rates, total same-day reimbursement amounts, and national usage trends for these 2 procedures from 2010 to 2019.Study Design:Cohort study; Level of evidence, 3.Methods:The PearlDiver MUExtr database was reviewed for patients diagnosed with lateral epicondylitis who underwent OD alone and ODR or reattachment between January 2010 and December 2019. These patients were stratified into 2 cohorts: the OD cohort and ODR cohort. The 5-year reoperation rates were assessed and compared, and the incidence of 90-day postoperative complications and risk factors were identified. The number of ODs and ODRs performed each year and the mean same-day reimbursement amounts (in US$) for both procedures were assessed.Results:Overall, 41,932 lateral epicondylitis patients who underwent debridement were identified, with 17,139 OD patients and 24,793 ODR patients. There were no significant changes in the proportion of OD versus ODR procedures performed during the study period (P = .18). A significantly higher incidence of hematoma was seen after OD compared with ODR (0.19% vs 0.12%; P = .04), but ODR had a significantly lower 5-year reoperation rate than OD (2.8% vs 3.9%; P = .006), with an absolute risk reduction of 1.1% and a number needed to treat of 91. Finally, ODR ($1683.17 ± $12.15) had a higher mean same-day reimbursement than OD ($1479.05 ± $15.78) (P = .001).Conclusion:Both OD and ODR had low complication rates. The 5-year reoperation rates were low for both procedures, but they were significantly higher for OD. Over the 10-year study period, there were no significant changes in the relative percentages of OD versus ODR performed. ODR had a significantly higher mean same-day reimbursement.

Effect of oculus guided physical therapy in adjunct to conventional therapy in lateral epicondylitis patients

Tennis elbow, aka as lateral epicondylitis, affects the elbow and results in pain, disability, and a loss of grip strength. Runge first outlined lateral epicondylitis in 1873, and Henry Morris coined the term "Lawn Tennis Arm" in a Lancet article from 1882. The condition is also known as tendinosis, lateral epicondylitis, and angiofibroblastic hyperplasia. . Before the lateral epicondyle, up to 5 mm distally, the most soreness is widely documented. 30 to 50-year-olds are the most often impacted age group. This protocol has been created to address the vital role of physiotherapy in improving pain and joint function in lateral epicondylitis. Virtual reality is a newer concept that can be a beneficial tool to traditional therapy techniques. Studies have indicated some benefit of VR-based techniques for hand dexterity and gait, utilizing both specialist and gaming VR systems. The participants (n=60) with lateral epicondylitis were enlisted in the study and divided into two groups of 30 participants each. One group was treated with traditionally used conventional therapy which includes cryotherapy, ultrasound therapy and some stretching and strengthening exercises; while the other group was treated with oculus quest (virtual reality device) guided therapy along with the conventional therapy. The two games used for this experimental group were "Hand Physics Lab" and "Creed - Rise to glory". The results were interpretated on the basis of VAS, PRTEE, ROM of elbow joint. After the intervention both groups showed significant results in all the mentioned outcome measures. But Group B which received oculus guided physical therapy along with conventional therapy showed statistically more significant improvement at the end of the treatment. The study suggests that, the scope of oculus guided therapy must be expanded in the condition of lateral epicondylitis and other upper extremity related conditions as results show positive trend.

Physiotherapy Interventions in Lateral Epicondylitis

Background: Lateral epicondylitis, commonly called “tennis elbow”, is an overuse injury to the wrist extensor that causes inflammation resulting in degenerative changes such as tendinosis and micro-teared (small tears) in the fibrous tissue. The risk of lateral epicondylitis is highest in workers who lift heavy weights and workers whose work requires repetitive movements of the wrist extensors. Degenerative factors are also one of the factors that can affect the development of lateral epicondylitis. From Magnetic Resonance Imaging (MRI) scans of 369 patients without clinical complaints of lateral epicondylitis, MRI signs consistent with lateral epicondylitis were seen in 5.7% of individuals in the 18-30 years age group and 16% in individuals over 70 years of age.&#x0D; Objective: The purpose of this study is to summarize secondary data related to interventions that can be applied to cases of lateral epicondylitis.&#x0D; Methods: The study method used is a literature study using secondary data in journals related to physiotherapy management in cases of lateral epicondylitis obtained through Google Scholar, Science Direct, and PubMed.&#x0D; Results: Several studies have shown various interventions can be applied to overcome the problems experienced by patients with lateral epicondylitis and provide good results in overcoming pain and gripping muscle weakness.&#x0D; Conclusion: Several interventions can be given to overcome the problems experienced by lateral epicondylitis patients, such as Cyriax, low-level laser therapy, mulligan mobilization with movement, ultrasound, eccentric exercise, concentric exercise, and kinesiotaping. Based on the literature review results, it can be concluded that these interventions can have a good effect in overcoming complaints experienced by patients with lateral epicondylitis.

Hand function and its determinants in patients with lateral epicondylitis

Background: Hand function is an important aspect of most of the activities of daily living. There are many conditions that cause direct impact on hand function but few of musculoskeletal conations indirectly influence the hand function but often ignored in rehabilitation. Objective: The aims of this study were to analyse the hand function among lateral epicondylitis (LE) patients and identify the influence of various parameters (Age, dominance, pain, range of motion (ROM), and chronicity) that may influence the hand function. Methods: Eighty six LE patients participated in this cross sectional study. The hand function was assessed using Perdue peg board along with various other parameters like age, dominance, pain, range of motion, and chronicity. Results: There was a significant difference between the hand function of affected and unaffected extremity (p&lt;0.001, effect size of 0.425). Pain severity, chronicity of LE and wrist extension was strongly related to hand function with R value of -0.910, -0.788 and 0.698 respectively. Conclusions: The results highlight the possible hand function compromise among patients with LE. Out of all the assessed parameters pain severity, wrist extension ROM and chronicity of condition were associated with hand function compromise.

A systematic review on the efficacy of different types of platelet-rich plasma in the management of lateral epicondylitis

Platelet-rich plasma (PRP) is reported as an effective treatment for lateral epicondylitis (LE). Theoretically, different types of PRP have different therapeutic effects. However, there is controversy on the effects of different types of PRP in the treatment of LE. The purpose of this study was to systematically compare pain relief, functional improvement, and the success rate of treatment using 2 different types of PRP by reviewing and summarizing the data available in the current literature on LE after PRP injection. The PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science databases were reviewed. A computerized literature search was performed for related studies published from database inception to August 2021 using the following terms: lateral epicondylitis, tennis elbow, tendinopathy, lateral elbow pain, PRP, and platelet-rich plasma. The PRP patients included in our study were divided into those receiving leukocyte-poor PRP (LP-PRP) and those receiving leukocyte-rich PRP (LR-PRP) according to the different preparation methods. Outcomes of interest included patient characteristics, types and preparations of PRP, clinical outcomes, success rates, and the safety of treatment at short- and long-term follow-up. A total of 33 studies were evaluated in our analysis, including 2420 LE patients. LP-PRP was used in 19 of these studies, LR-PRP was used in 13, and both LP-PRP and LR-PRP were used in 1. Patients in both PRP groups showed significantly improved clinical outcomes after treatment compared with before treatment. The mean visual analog scale scores ranged from 6.1 to 8.0 before treatment, ranged from 1.5 to 4.0 at short-term follow-up, and ranged from 0.6 to 3.3 at long-term follow-up in the LR-PRP group. The mean visual analog scale scores ranged from 4.2 to 8.4 before treatment, 1.6 to 5.9 at short-term follow-up, and 0.7 to 2.7 at long-term follow-up in the LP-PRP group. The Disabilities of the Arm, Shoulder and Hand scores in the LR-PRP and LP-PRP groups ranged from 47.0 to 54.3 and 30.0 to 67.7, respectively, before treatment and ranged from 20.0 to 22.0 and 5.5 to 19.0, respectively, at long-term follow-up. The success rates in the LR-PRP and LP-PRP groups ranged from 70% to 100% and 36% to 100%, respectively. The complication rate was lower in the LP-PRP group (3.9%) than in the LR-PRP group (6.4%, P=.029), with the main complication being temporary pain after PRP treatment. PRP treatment demonstrated significant improvements in terms of pain relief and functional improvement in LE patients regardless of the type of PRP. There were no significant differences in pain relief and functional improvement between LR-PRP and LP-PRP. The main complication was temporary pain after PRP injection, and the complication rate in the LP-PRP group was lower than that in the LR-PRP group.

Clinical Efficacy of High-Intensity Laser Therapy on Lateral Epicondylitis Patients: A Systematic Review and Meta-analysis.

Recently, high-intensity laser therapy has been used in the therapeutic protocols for pain management. We aimed to evaluate the clinical efficacy of high-intensity laser therapy versus other different modalities for improving lateral epicondylitis symptoms. We conducted a systematic review and meta-analysis on prospective randomized controlled trials from PubMed, Embase, Scopus, Web of Science, and Science Direct until June 2021 using relevant key words. We analyzed the data using Review Manager software (RevMan 5.4). Six randomized controlled trials with 344 patients were included. There is low-quality evidence that high-intensity laser therapy generates a small reduction on pain intensity compared with a control group either during activity (mean difference = -0.98, 95% confidence interval = -1.6 to -0.35, P = 0.002) or during rest (mean difference = -0.98, 95% confidence interval = -1.68 to -0.09, P = 0.03). In addition, there is low-quality evidence that high-intensity laser therapy provides small improvements in quality of life (physical component) compared with control (mean difference = 9.76, 95% confidence interval = 2.69 to 16.83, P < 0.0001). High-intensity laser therapy is an effective therapeutic modality to reduce pain and improve quality of life (36-item short form health survey physical component) in patients experiencing persistent symptoms of lateral epicondylitis. However, grip strength, hand function, and quality of life (36-item short form health survey) did not show significant differences between high-intensity laser therapy and other therapies.

Comparison of combined isotonic and deep friction soft tissue techniques on pain and function in patients with chronic lateral epicondylitis

To determine the effects of combined isotonic and deep friction soft tissue techniques on pain and function in patient with chronic lateral epicondylitis. Study Design: Quasi Experimental study. Place and Duration of study: Data was collected from Mednic clinic and services hospital Lahore, for 6 months of duration after the approval of synopsis. Method: Quasi Experimental study was conducted on twenty-two patients of chronic lateral epicondylitis. Participants were allocated to either combined isotonic technique group and deep friction soft tissue technique group, both groups were treated for 12 sessions in 4 weeks. NPRS and PRTEE scale were used to measure the treatment effect before and after treatment of 3 session per week, total 12 sessions in 4 weeks to each participant. Data was analyzed by SPSS 21. Results: Total participants 22 were classified into two groups, Group A (combined isotonic technique) and Group B (deep friction soft tissue technique group). Minimum age was 30, maximum age was 46, mean age 37 and standard deviation was ±4.93. The significance was greater than 0.05 which mean the data is normally distributed as the value of Shapiro wilk test for NPRS .88 and for PTREE was .208, therefore parametric test (paired and independent T test) was applied. The significance values for all statistical tests were set to 0.05. Paired sample T test for NPRS mean difference reading for group A was 2.63 ±.9244 and group B was 1.09 ±.3015 and for PRTEE mean difference for group A was 14.09 ±7.8288 and group B was 5.81 ±3.945 showed that although in both group changes were significant but difference of mean was greater in Combined isotonic technique group. Independent T test comparison of mean score of NPRS and PRTEE between Group A and Group B showed that there was significant difference in value, pretreatment NPRS mean difference was .011 and post treatment NPRS score was 1.54. pretreatment PRTEE mean difference was 1.90 and post treatment NPRS score was 6.36 so combined isotonic technique showed greater mean difference after treatment. Conclusion: The study concluded that combined isotonic exercises group showed better results than deep friction soft tissue technique group for improvement of pain and functional disability in lateral epicondylitis patients