Management Of Tennis Elbow Research Articles

A RANDOMIZED CONTROLLED TRIAL TO COMPARE THE EFFECT OF AG-NIKARMA WITH JAGGERY AND MUSTARD OIL IN TENNIS ELBOW

Tennis elbow or Lateral epicondylitis is a condition characterised by pain and tenderness at the lateral epicon-dyle of the humerus. It is associated with particular occupations and lifestyles. It often arises from the strain of the fibres of the common extensor tendon at its origin from the lateral epicondyle of the humerus. From an Ayurvedic point of view, Tennis elbow may be considered a Snayugathavata Vikara. Acharya Susrutha men-tioned Agnikarma as a treatment of choice for Snayugathavata Vikara. Salaka has been used regularly for this process irrespective of the structure involved or the level of the pathology. The Dahanopakarana mentioned for Snayugathavata Vikara are Guda(jaggery), Kshaudra(honey), Taila(oil), etc., as they have deep heat penetration capacity with a more significant latent heat period. Recently, many clinical research studies have been conduct-ed to discover the most effective and straightforward process in Snayugathavata Vikara, especially in Tennis Elbow. So far, no clinical trial has been undertaken to evaluate the comparative effect of different Snigdha Da-hanopakarana mentioned by Acharyas in Snayugatavata Vikara. The present study compares the impact of Ag-nikarma using Jaggery and Mustard oil in Tennis elbow. A randomised clinical study was conducted with 36 participants of the age group 20-60 years who had tennis elbows from the OP and IP departments of Salyatantra, satisfying inclusion and exclusion criteria. The participants were randomly selected and divided into two groups. Agnikarma with Jaggery in control group A and Agnikarma with Mustard oil in trial group B were done in a sin-gle sitting. Per subjective and objective criteria, participants were assessed before and after treatment. The fol-low-up was done on the 7th and 30th day after treatment. Statistical analysis found a significant difference in the effect of Agnikarma using Mustard oil compared to that of Jaggery in the management of tennis elbow.

Comparing the efficacy of Agnikarma with therapeutic ultrasound in the management of tennis elbow - A randomised controlled preliminary study

BackgroundTennis elbow is a common musculoskeletal disease of elbow and causes restricted movement of forearm. Various treatment modalities like NSAID, corticosteroid injection, counter bracing, physiotherapy, surgery etc are available but safety and efficacy of one treatment over another is under research. Ayurveda classifies this condition as Snayugata vata. According to Sushruta, Agnikarma (thermal cautery) is the one among the treatment modalities for Snayugata vata. Previously published randomised controlled trials have shown that therapeutic ultrasound is safe and effective for tennis elbow. However, the comparative efficacy of these two treatment modalities is unknown. ObjectiveThis study compares the effects of Agnikarma (AGK) with Therapeutic Ultrasound (TUS) in reducing pain, tenderness and restores the ability to do various tasks. Materials and methodsA total of 30 patients were enrolled in the study as an open-label, double-armed, prospectively designed comparative clinical study, with 15 patients in each group. Group AGK received two sittings of Agnikarma and Group TUS received therapeutic ultrasound. To analyze the patients, three outcome measures were adopted: pain intensity, assessed with a Numerical Pain Rating Scale, tenderness – Grade 0 to Grade 4 (mentioned in Hutchinson's clinical methods) and pain and functional Disability assessed with the Patient Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Assessment was done on 0th, 8th, 15th, 30th and 60th day. ResultTennis elbow can be effectively treated with AGK and TUS. (p < 0.001 for pain, tenderness and PRTEE). While comparing between the groups, on 8th day and 15th day statistically significant difference in pain and PRTEE (p < 0.05) was noted between AGK and TUS groups. Agnikarma showed better results than therapeutic ultrasound in pain management and showed an improved quality of life from 8th day onwards and for a period up to 2 months. ConclusionBoth Agnikarma and therapeutic ultrasound have roles in the management of tennis elbow. However, starting on the 8th day and continuing for up to 2 months, Agnikarma showed a significant benefit in pain management and improved status for quality of life.

Kinesiotaping versus counterforce brace in the management of lateral elbow tendinopathy

Purpose: The main purpose of the current study was to assess whether counter force brace (CFB) offers any additional value over Kinesiotaping (KT) in the management of tennis elbow. Materials and Methods: Forty-five females with clinically diagnosed tennis elbow participated in the current study. They were equally assigned into three groups of equal numbers. 12 sessions over 4 weeks of treatment interventions; experimental group A received the traditional physiotherapy program in addition to KT. Group B received the physiotherapy program in addition to the CFB. Group C (Control Group) received the physiotherapy program only. The degree of tennis elbow pain and myoelectrical activities of forearm muscles were measured. Results: There was a statistically significant reduction of pain in the experimental group A (KT) in comparison with the control group (p = 0.000), while a statistically significant reduction of pain (p = 0.000) and improvement of the myoelectrical activities of the forearm muscles (p = 0.000) were detected in the experimental group B (CFB) in comparison with the control group. In addition, the statistically significant reduction of pain (p = 0.000) and improvements in wrist flexors and extensors (p = 0.001 and p = 0.000, respectively) were detected in CFB compared with KT. Conclusion: Compared to KT or a physical therapy program alone, the use of CFB in the treatment of lateral elbow tendinopathy may be beneficial, especially in reducing pain and enhancing the muscle activities of the elbow flexors and extensors.

The Effectiveness of Movement with Mobilization in Management of Tennis Elbow

The Effectiveness of Movement with Mobilization in Management of Tennis Elbow

Open versus Arthroscopic in Management of Tennis Elbow. A Systematic Review

Background Treatment of resistant tennis elbow (lateral epicondylitis) still challenging, which may require surgery in order to gain pain relief and improve function. Aim of the Work The aim of this study is to systematic review and meta-analysis arthroscopic to open surgery for resistant TE regarding ROM, grip strength, DASH score, VAS, and complications. Methodology This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). We included randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies, case series studies and we excluded case reports, cross sectional studies, non English study. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. Results Our systematic review found that the most relevant conclusion from the current study is that there is a significant difference between the 2 operative techniques when examining VAS score, Mayo elbow performance score, grip strength, DASH score and time to return to work in favor of arthroscopic technique. While the arthroscopic surgery had a longer surgical time than the open technique. Additionally, it was found that the complication rates, DASH score, range of motion and failure rates were similar between the arthroscopic and the open technique. Conclusion We found a similar effectiveness of both arthroscopic and open techniques in improving failure risk, complication rate and range of motion postoperative in the treatment of tennis elbow. There is significant difference between arthroscopic and open surgery with regards to self-reported function (DASH), pain intensity (VAS) at follow up, time to return to work and grip strength postoperative in favor of arthroscopic technique. The current meta-analysis found that arthroscopic surgery had a longer surgical time than the open surgery for lateral epicondylitis.

NON-DRUG NON-INVASIVE TREATMENT IN THE MANAGEMENT OF TENNIS ELBOW

Introduction: Tennis elbow is a common disorder of upper extremity. Majority of the patients can be treated conservatively. It is the major cause of disability and time off work, after low back pain. The disease impacts upon activities of daily living ultimately leading to a loss of functional independence and quality of life. Purpose: The main purpose of this study was to assess the results of nondrug non-invasive treatment in the management of tennis elbow. This study was conducted in the department Methods: of Orthopaedics from December 2010 to December 2015. One hundred ten outpatients of tennis elbow with a mean age of 45 years were studied. They were managed with non-invasive treatment and were followed for twelve months. At twelve months follow-up visits, the intensity Results: of tennis elbow pain and disability were assessed by using Quick dash scoring system and Patient-rated elbow evaluation system. Physician global evaluations up to the age of 40 years at twelve months were excellent. At 40 to 60 years of age, it was good to excellent. Over the age of 60 years, it was good. The patient global evaluation was found very good up to the age of 40 years at twelve months follow up, good to very good between 40 to 60 years and over the age of 60 years it was good. Nondrug non-invasive interve Conclusions: ntions can reduce pain and improve function in tennis elbow.

Treatment of Lateral Epicondylitis with Physiotherapy during a Clinical Trial: Comparison of Mobilization Technique and Shock Wave

Objective: The current study aimed to examine effect of ESWT vs. MWM in the management of tennis elbow. Methods: The study was conducted in the physiotherapy department at PAU. Sample of the study consisted of 22 patients aged between 20-50 years. Patients were selected in the orthopedic clinic and randomly separated into 2 groups. The ESWT group included (12) patients, whereas the MWM group included (10) patients. The first group underwent 3 sessions/week and the latter underwent 2 sessions/week for 4 weeks. The demographic data were assessed. VAS was used for pain intensity. A hand-held dynamometer was used for wrist strength and Quick DASH was used for a functional disability. Results: Inter-group analysis was done using t-test. Comparing pre-post treatments using VAS disclosed that there were not significant differences between groups, P= 0.25. Pre-post treatment for wrist strength uncovered that there wasn't a significant difference between groups, P= 0.47. Pre-post QUICK DASH scores, P=0.35. Therefore, there wasn't a statistically significant difference between groups with functional disabilities. Conclusion: The study found that ESWT and MWM were effective in all outcome measures.

Management of Tennis elbow in racket sports – a literature review

Management of Tennis elbow in racket sports – a literature review

Comparative study to evaluate efficacy of prolotherapy using 25% dextrose and local corticosteroid injection in tennis elbow - A prospective study.

Tennis elbow is a common painful condition with a prevalence rate of 1-3%. The condition starts as a micro-tear in extensor carpi radialis brevis and its degeneration because of repetitive overload. Conservative measures are undertaken initially because symptoms in most patients improve with time and rest. Adjunctive treatment includes steroid injection, autologous plasma, exercise, and prolotherapy. Dextrose prolotherapy by virtue of its multi-modal mechanism of action has emerged as a cost-effective treatment option for chronic musculoskeletal and arthritic pain. A total of 260 patients were included in the study and divided in two groups for administration of steroids or dextrose prolotherapy. The Visual Analog Scale (VAS) and Mayo Elbow Performance Scale (MEPS) scores were taken for patients at regular follow-up. All patients showed improvement in VAS score and MEPS score following dextrose prolotherapy as well as patients injected with steroids. Both prolotherapy and steroid injection offer adequate pain relief and functional outcome, although prolotherapy has been shown to be superior and given long-lasting results compared to steroid injection in management of tennis elbow.

AGNIKARMA USING HONEY IN TENNIS ELBOW

Tennis elbow is a condition in which there is pain on the lateral epicondyle. It is a type of repetitive strain injury due to overexertion of the common extensor tendon (snayu), micro-traumas, or its failed healing. Tennis elbow may be correlated with snāyugata vāta in kūrpara sandhi (elbow) which has symptoms of pain, stiffness and restriction of movements. Ācārya Suśruta has mentioned snigdha agnikarma (thermal cautery) in the management of snayugata vata. 16 participants satisfying the diagnostic, inclusion and exclusion criteria were selected for the study. Agnikarma using honey (madhu) was done on the 1st and 8th days. Clinical assessments were done on the 1st, 8th, 15th, 22nd, 29th days. On statistical analysis, it was found that agnikarma using madhu shows 68.22% of effect in the management of tennis elbow. Keywords: Tennis elbow, agnikarma, honey

Evidenced-Based Management of Tennis Elbow

Evidenced-Based Management of Tennis Elbow

Management of tennis elbow

Background and aim Tennis elbow is an abuse condition that out comes in pain over lateral side of elbow, provoked by activities involving gripping and manipulating objects by hand. It is frequently a consequence of participation in activities requiring repetitive manual tasks with awkward wrist positions. Tennis elbow has a variety of treatment options, starting from nonoperative treatment, including conservative treatment, bracing, and physiotherapy, to the last line of treatment being surgical intervention. Materials and methods A systemic review was performed using Google, PubMed, and Medline for a period from 2015 to 2019 comparing three methods of tennis elbow treatment: steroid injection, open surgery, and arthroscopic surgery. Results A total of 21 studies included 2055 patients treated by arthroscopic surgery. Overall, 3638 patients were treated by open surgery and 633 patients were treated by steroid injection. Conclusion This systematic review looked at high-level evidence to compare arthroscopic technique, open surgical technique, and steroid injection. There were no clinically significant differences among the three techniques (open, arthroscopic, and steroid injection) according to postoperative pain intensity (visual analog scale). Steroid injection had the least complication rate, with early return to work, but had higher recurrence rate.

Role of Urdhwashakhagat Ani Marma(vital parts of the body) in Management of Tennis Elbow

Role of Urdhwashakhagat Ani Marma(vital parts of the body) in Management of Tennis Elbow

Efficacy of local corticosteroid Vs Sod. hyaluronate injection in the management of tennis elbow: A prospective randomized comparative study

Background: Lateral elbow pain being the most common cause of medical consultation for non- traumatic elbow disorders and defined as a chronic degenerative condition of extensor tendons (of wrist) involving their attachment to the lateral humeral epicondyle. In our study, we aim to compare the efficacy of local Corticosteroid Vs. Sod. Hyaluronate injection in the management of Tennis Elbow. Material and Methods: A prospective randomized comparative study of 60 patients has been done, with complain of pain on lateral aspect of the elbow, which increased on pressure applied on lateral epicondyle of humerus. Positive results of Cozen’s test and Mill’s test were included in study. Two groups were made through alternate randomization, In Group I (n=30) single injection of 1 ml of Methylprednisolone Acetate (20 mg) mixed with 2 ml of 2% Lidocaine Hydrochloride was injected and In Group II (n= 30) single injection of 2 ml of Sodium Hyaluronate (20 mg) mixed with 2 ml of 2% Lidocaine Hydrochloride was injected. Criteria for evaluation of results are pain (+/-), tenderness (+/-), Cozen’s test (+/-), Mill’s test (+/-) and then reporting it as poor, good, and excellent results. Results: Results were evaluated at the end of 4 weeks. In Group I, 56.66% patient (n=17) had excellent, 36.66% patient (n=11) had good and 6.66% patient (n=2) had poor results respectively. Whereas, in Group II, 33.33% patient (n=10) showed excellent, 43.33% patient (n=13) showed good and 23.33% patient (n=7) had poor outcome. Discussion and Conclusion: As per our study, Corticosteroid injections are effective in reducing pain in the acute condition. Despite of many researches, there are no articles that favours single best treatment of tennis elbow, especially for effective long-term (≥52 weeks) outcomes.

Tennis elbow brace and wrist cock-up splint in the management of tennis elbow: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The purpose of our study was to compare the efficacy of a wrist splint with a forearm counterforce strap brace in the management of tennis elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted between January and December 2018 comprising of 75 patients suffering from lateral epicondylitis managed conservatively with splints. Patients were randomized into three treatment groups, group 1 received tennis elbow forearm brace, group 2 received wrist extension splint, group 3 received both tennis elbow forearm brace and wrist extension splint. The patient-rated tennis elbow evaluation (PRTEE) score and visual analogue scale (VAS) scores were calculated at 0, 3 and 6 weeks of the treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean difference of pre-treatment and post-treatment PRTEE score was significant in all three groups and was maximum for group 3 patients (32.42) followed by group 2 patients (27.04) followed by group 1 patients (20.06). Pre-treatment and post-treatment VAS score difference was maximum for group 3 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Significant symptomatic relief can be achieved in patients with tennis elbow by using either tennis elbow forearm brace or wrist extension splint or both. Provided proper patient selection and compliance, wrist extension splint achieves better symptomatic relief and functional outcome as compared to tennis elbow brace.&lt;/p&gt;

A study on management of tennis elbow by local platelet rich plasma injection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lateral epicondylitis (tennis elbow), a familiar term used to describe myriad symptoms around the lateral aspect of the elbow can occur during activities that require repetitive supination and pronation of the forearm with the elbow in near full extension. This condition can cause severe discomfort to the patient resulting in debilitation and impairment of routine activities. The purpose of this study was to evaluate the effectiveness of local autologous platelet rich plasma injection in the treatment of tennis elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study conducted on 50 patients of either sex with an average age of 45.92 years, presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, NUH, Haryana between November 2016 and February 2018, with a diagnosis of lateral epicondylitis. All the patients were treated with local platelet rich plasma injection and the results were analysed through the assessment of visual analog score (VAS) and disability of arm shoulder and hand (DASH) score. The patients were followed up for a period of 6 months after the local injection of platelet rich plasma.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of the patients had significant relief with this method. The VAS and DASH score improved from the pre-treatment values of 8.7 and 74.6 to 2.6 and 29.8 respectively, which was found to be statistically significant (p&amp;lt;0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus results of our study demonstrate that the local injection of platelet rich plasma is a safe and effective method of treatment of lateral epicondylitis.&lt;/p&gt;

Management of tennis elbow: a survey of UK Clinical Practice

Purpose: Tennis elbow is a common condition in the UK but there are no guidelines on how best to manage the condition. The purpose of this study was to establish the current UK practice in managing patients with chronic tennis elbow (symptoms over six months).

Current physiotherapy practice in the management of tennis elbow: a service evaluation

Background Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting. Methods A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1-year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template. Results A total of 65 patient records were identified, with patients having a mean age 48 years and mean symptom duration of 5.4 months. The mean treatment duration was 64 days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used. Conclusions Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.

Effect of Ift In the Management of Tennis Elbow – Case Study

Effect of Ift In the Management of Tennis Elbow – Case Study

Current physiotherapy practice in the management of tennis elbow: A service evaluation.

Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting. A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1-year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template. A total of 65 patient records were identified, with patients having a mean age 48years and mean symptom duration of 5.4months. The mean treatment duration was 64days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used. Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.