Lateral Epicondylopathy Research Articles

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

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

Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort.

The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores. Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy. Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders. Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.

Infiltration therapies for lateral epicondylopathy

The therapy of the lateral epicondylopathy (tennis elbow) includes drug injection into the extensor tendon insertion in chronic cases. The choice of medication and the type of injection is decisive for the success of therapy. Furthermore, accurate application is indispensable for therapy success (e.g. peppering injection technique, ultrasound-supported injection technique). Corticosteroid injection is often associated with short-term success, so that other options have found their way into everyday practice. Objectification of treatment success is usually defined by Patient-Reported Outcome Measurements (PROM). With the introduction of Minimal Clinically Important Differences (MCID), statistically significant results are put into perspective in terms of clinical significance. Therapy for lateral epicondylopathy was considered effective if the mean difference in score results between baseline and follow-up exceeded 1.5points for the Visual Analogue Scale (VAS), 16points for Disabilities of Arm, Shoulder and Hand Score (DASH), 11points for Patient-Rated Tennis Elbow Evaluation (PRTEE), and 15points for Mayo Elbow Performance Score (MEPS). However, the effectiveness must still be critically questioned according to meta-analytical evaluations, in which healing within 12months was found in 90% of the cases of untreated chronic tennis elbow in the placebo groups. The use of substances, such as Traumeel (Biologische Heilmittel Heel GmbH, Baden-Baden, Germany), hyaluronic acid, botulinum toxin, platelet rich plasma (PRP), autologous blood or polidocanol, are based on various mechanisms. In particular, the use of PRP or autologous blood for the treatment of musculotendinous and degenerative articular pathologies has become popular, although the studies regarding effectiveness are inconsistent. PRP can be divided into leukocyte-rich (LR-PRP) and leukocyte-poor plasma (LP-PRP) according to its preparation. In contrast to LP-PRP, LR-PRP incorporates the middle and intermediate layers, but there is no standardized preparation described in the literature. Conclusive data regarding effective efficacy are still pending.

Evaluation of lateral epicondylopathy, posterior interosseous nerve compression, and plica syndrome as co-existing causes of chronic tennis elbow

PurposeA great number of patients that suffer from lateral epicondylitis, commonly called tennis elbow (TE), are not successfully treated, meaning, not getting adequate therapeutic effects and the main origin of the pain not being handled appropriately. The hypothesis of the present study is that the inefficiency of the treatment of the chronic TE may often be due to underdiagnosis of posterior interosseous nerve (PIN) entrapment or and plica syndrome, as the authors believe that those pathologies can often occur simultaneously.MethodsA prospective cross sectional study was conducted. A total of 31 patients met the required criteria.ResultsThirteen (40.7%) of the patients had more than one source of the lateral elbow pain. Five patients (15.6%) had all three examined pathologies. Six patients (18.8%) had TE and PIN syndrome. Two patients (6.3%) had TE and plica syndrome.ConclusionThe present study demonstrated concomitant potential sources of lateral elbow pain in patients diagnosed with chronic TE. Our analysis shows how important it is to systematically diagnose patients that present with lateral elbow pain. The clinical characteristics of the three most common causes of chronic lateral elbow pain, meaning, TE, PIN compression, and plicae syndrome were also analyzed. Having adequate knowledge about the clinical aspects of these pathologies can help with a more effective differentiation of the etiology of chronic lateral elbow pain, and with that, a more efficient and cost-effective treatment plan.

Physiotherapeutische Möglichkeiten bei lateraler Epikondylopathie

Physiotherapy interventions can have apositive effect on the symptoms and relief of symptoms of lateral epicondylopathy (LE). However, there is currently no standard physiotherapy protocol for treating LE. Today, amultimodal treatment approach that focuses on progressive exercise therapy is recommended. While in the past, most treatment protocols were based on eccentric training, recent research shows that other forms of training can also improve pain and function in tendinopathies.

Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders

Background: Previously reported risk factors for common musculoskeletal disorders (MSDs) have been low in magnitude and with unclear pathophysiological mechanisms. Methods: Data from a nine-year prospective cohort were analyzed. Baseline data included computerized questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy. Monthly follow-ups were conducted to assess symptoms (development, resolution and/or treatments) and to perform physical examinations. Nerve conduction studies were performed every 6 months if any new-onset paresthesias in the prior six-month interval were reported. Results: The relative risk of four different MSDs increased with rising cardiovascular disease risk scores; adjusted relative risks for one or more MSD increased to 3.90 (95% CI, 2.20, 6.90) among those with 10-year cardiovascular risk scores above 15%. The relative risk of multiple MSDs increased more strongly with rising cardiovascular disease risk; adjusted relative risk for four or more MSDs increased to 17.40 (95% CI, 3.85, 78.62) among those with 10-year cardiovascular risk scores above 15%. Conclusions: Cardiovascular disease risk factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger. Further investigations of this new potential line of prevention are needed, as well as the utility of these MSDs to identify the development of silent coronary artery disease. Funding Statement: This work was supported, in part, by grants from the National Institute for Occupational Safety and Health (NIOSH/CDC) grant 1R01OH010474–01 and NIOSH Education and Research Center training grant T42/CCT810426–10. Declaration of Interests: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethics Approval Statement: Institutional review boards of the University of Utah, University of Wisconsin-Milwaukee and Medical College of Wisconsin approved this study.

Dextrose Prolotherapy Versus Normal Saline Injection for the Treatment of Lateral Epicondylopathy: A Randomized Controlled Trial.

Objective: To compare the effect of dextrose prolotherapy (DPT) with saline in the treatment of chronic lateral epicondylopathy (LE). Design: Triple-blinded randomized controlled trial. Setting: Physical medicine and rehabilitation outpatient clinic. Subjects: Sixty cases of chronic LE participants were included in the study. Methods: Participants were randomly divided into two groups as DPT and normal saline. Saline or hypertonic dextrose (15%) was injected at the baseline, and at the end of the 4th and 8th week. Assessments were performed at baseline, and at the end of the 4th, 8th, and 12th week. Outcome measures: Primary outcome measures were Visual Analog Scale (VAS) for pain, Patient Rated Tennis Elbow Evaluation (PRTEE-Total [PRTEE-T], PRTEE-Pain, PRTEE-Function); secondary outcome measures were Disabilities of the Arm, Shoulder, and Hand Score (DASH) and pain-free handgrip strength. Results: Intragroup analysis demonstrated that both groups significantly improved in VAS, PRTEE, DASH scores, and handgrip strength during the study period (p < 0.001, for all outcome measurements in both groups). Intergroup analysis showed that PRTEE-T score changes between baseline-4th and -12th week; VASrest change between baseline and 4th week in the DPT group were significantly higher than the saline group (p = 0.041, p = 0.038, p = 0.013 respectively). There was no significant difference between groups in VAS, DASH scores, and handgrip strength between any time points, in terms of improvement (p > 0.05). Conclusion: Our study results showed that DPT outperformed saline in PRTEE-T score. Although saline seems to be a comparable clinical effect with DPT, further studies comparing the effects of saline injection and DPT are necessary, in chronic LE.

Chronic Intractable Calcific Lateral Epicondylopathy Treated with Ultrasound-Guided Barbotage Combined with Extracorporeal Shock-Wave Therapy

Chronic Intractable Calcific Lateral Epicondylopathy Treated with Ultrasound-Guided Barbotage Combined with Extracorporeal Shock-Wave Therapy

Image-guided versus palpation-guided injections for the treatment of chronic lateral epicondylopathy: a randomized controlled clinical trial.

There have been several studies published comparing the ultrasound-guided with the "blind" infiltrations in the shoulder's area. On the contrary, there is only very limited data regarding the necessity of ultrasound guidance in lateral epicondylitis. A prospective, randomized, blinded at initial and follow-up evaluation, comparative clinical trial was conducted, involving 44 patients with a history of chronic persistent epicondylopathy. The patients were randomly divided into 2 groups of 22 people each. Group A patients underwent three ultrasound-guided betamethazone injections, while group B included those who underwent three "blind" injections, centered at the palpable point of maximum pain. The evaluation was done before and after (4 and 12 weeks) the injections using the Visual Analogue Scale for pain (VAS, 0-10) and the Roles & Maudsley score. There was not any significant statistical difference between the two groups as for mean VAS at 4 weeks (p = 0.150, t-test) and mean VAS at 12 weeks (p = 0.286, t-test). Furthermore, the final success rate, as measured by the Roles & Maudsley score, was slightly superior in group B (67 % of the patients with excellent or good results) when compared with group A (46 % of the patients), but without any statistical difference (p = 0.161, chi-square). Our trial proved that an ultrasound-guided injection is not superior than a palpation-guided injection of corticosteroids in the treatment of lateral epicondylopathy.

Pulsed electromagnetic field versus microcurrent electrical nerve stimulation in patients with lateral epicondylopathy

Background: Lateral epicondylopathy is a frequent overload injury of the common wrist extensor tendons. This study was designed to compare between the effects of the pulsed electromagnetic field (PEMF) and microcurrent electrical nerve stimulation (MENS) on improving pain intensity, threshold, and grip strength in patients with lateral epicondylopathy. Methods: Eighty-four subjects were randomly assigned into three equal groups. Group 1 received PEMF and exercises, group 2 received MENS and exercises, and group 3 received exercises. All subjects received three visits a week for 4 weeks. The visual analogue scale, the disabilities of the arm, shoulder and hand questionnaire and the hand dynamometer were used to measure pain intensity, disability and grip strength. Results: There were improvements in all dependent variables. Also, subjects who received PEMF and exercises had the most significant effects. PEMF may be more effective than MENS in treating lateral epicondylopathy by reducing pain intensity, disability and increasing grip strength. Conclusions: PEMF may be more effective than MENS in treating lateral epicondylopathy by reducing pain intensity, disability and increasing grip strength.

Comparison of Therapeutic Effect of Extracorporeal Shock Wave in Calcific Versus Noncalcific Lateral Epicondylopathy.

ObjectiveTo assess the therapeutic effect of extracorporeal shock wave therapy (ESWT) in lateral epicondylopathy with calcification, and compare it to the effect of ESWT in lateral epicondylopathy without calcification.MethodsA retrospective study was conducted. Forty-three patients (19 with calcific and 24 with noncalcific lateral epicondylopathy in ultrasound imaging) were included. Clinical evaluations included the 100-point score, Nirschl Pain Phase scale before and after ESWT, and Roles and Maudsley (R&M) scores after ESWT. ESWT (2,000 impulses and 0.06–0.12 mJ/mm2) was performed once a week for 4 weeks.ResultsThe 100-point score and Nirschl Pain Phase scale changed significantly over time (p<0.001), but there was no significant difference between groups (p=0.555). The R&M scores at 3 and 6 months after ESWT were not significantly different between groups. In the presence of a tendon tear, those in the calcific lateral epicondylopathy group showed poor improvement of 100-point scores compared to the noncalcific group (p=0.004).ConclusionThis study demonstrated that the therapeutic effect of ESWT in calcific lateral epicondylopathy was not significantly different from that in noncalcific lateral epicondylopathy. When a tendon tear is present, patients with calcific lateral epicondylopathy might show poor prognosis after ESWT relative to patients with noncalcific lateral epicondylopathy.

Whole upper limb strengthening in treatment of lateral epicondylopathy

This case report presents a commonly presenting clinical condition in the context of evidence informed literature on tendinopathy and a systematic applied reasoning (SAR) model of clinical problem solving as an aide-memoire to develop the clinical management of lateral epicondylopathy.

The Elbow-EpiTrainer: a method of delivering graded resistance to the extensor carpi radialis brevis. Effectiveness of a prototype device in a healthy population

BackgroundTennis elbow or lateral epicondylopathy (LE) is experienced as the lateral elbow has a reported prevalence of 1.3%, with symptoms lasting up to 18 months. LE is most commonly attributed...

Sideline Acupuncture for Acute Pain Control

IntroductionAcupuncture is an accepted form of complementary medicine used by many athletes for a variety of reasons including musculoskeletal conditions (8). There is mounting evidence to support the use of acupuncture in treating common sports medicine conditions such as lateral epicondylopathy, p

Operative management of tennis elbow: a quantitative review

The results of operative management of tennis elbow are varied, and the indications for surgery are not well codified. Many operative techniques are reported, but a clear consensus on whether a given surgical procedure is more effective over another is yet to be reached. We conducted a MEDLINE, CINAHL and EMBASE search on all available scientific articles that reported the outcomes of surgery for lateral epicondylopathy. Keywords used were 'tennis elbow', 'lateral epicondylitis', 'lateral epicondylalgia', 'tendinopathy', 'tendonitis' and 'tendon'. Subheadings used were 'surgery', 'outcomes', 'pathology', 'physiology' and 'operation'. All relevant articles were retrieved. Each article was scored using the Coleman methodology score (CMS), a highly repeatable methodology score, by two independent reviewers, followed by data analysis. The mean CMS for the 45 studies identified was 43 +/- 9 (of a possible 100 points), with 'number of patients', 'type of study', 'outcome criteria and assessment' and 'subject selection process' being the major low scorers. Also, there was no improvement in the CMS, and hence study design, over the years (intra-class correlation coefficient = 0.45). There is a dearth of quality evidence available to be able to advocate one operative technique over another. We stress the need for well-designed adequately powered randomized controlled trials to be able to understand which of these operative techniques is really superior to the others.

G. Homann's operation on the elbow--surgical treatment of a symptom?

Lateral epicondylopathy, well known as "tennis elbow", sometimes may only be a symptom of cervical spine and shoulder diseases or may also occur in neuropathy or arthropathy of the elbow or wrist joint. A follow-up of 63 patients, four years after Hohmann's procedure, shows that there really exists an idiopathic form of this disease. Careful differential diagnosis and special consideration of the epidemiology is of prime importance if conservative treatment and surgery is to be successful.