Patient-Rated Tennis Elbow Evaluation Research Articles

Associations Between Partial Common Extensor Tendon Tears and Clinical-Ultrasonographic Findings in Patients with Lateral Epicondylitis

Abstract Objective This study investigates the effect of partial common extensor tendon(CET) tears on demographic, clinical and ultrasound(US) parameters in patients with lateral epicondylitis(LE). The research aimed to provide a comprehensive understanding of how these US-detected partial tears, influence the clinical presentation and imaging findings associated with LE. Design Retrospective cross-sectional study. Records of 227 patients with LE met the inclusion-exclusion criteria were reviewed. The patient-rated tennis elbow evaluation(PRTEE) questionnaire was used as the primary outcome measure. Secondary outcome measures were visual analogue scale for pain, algometric measurements, hand grip strength, and US parameters(maximum tendon thickness measurements from the capitellar-radiocapitellar sides and presence of bone abnormalities). Results Partial CET tears detected using US were present in 22.7%(n = 54) of the patients. Patients with partial CET tears were older(50,31±9,22), had higher PRTEE scores(65,48±12,76), capitellar-radiocapitellar maximum tendon thickness measurements(0,60±0,80/0,60±0,72), and incidence of bone abnormalities(%40.7,n = 32)(p < .05). Logistic regression analysis identified age and PRTEE pain score as associative factors with partial CET tears. Capitellar-radiocapitellar maximum tendon thickness measurements greater than 0.55 cm were associated with an increased probability of partial CET tears. Conclusion US-detected partial CET tears may worsen the clinical and US parameters in patients with LE. Older age, higher PRTEE scores and higher maximum tendon thickness measurements were associated with partial CET tears.

Focal Versus Combined Focal Plus Radial Extracorporeal Shockwave Therapy in Lateral Elbow Tendinopathy: A Retrospective Study.

Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal shockwave therapy (F-ESWT) alone versus a combination of focal and radial pressure waves (F-ESWT+R-PW) in treating chronic lateral epicondylitis. Methods: This retrospective observational study included 45 patients diagnosed with chronic lateral epicondylitis divided into two groups based on the treatment received: group A (F-ESWT, n = 23) and group B (F-ESWT+R-PW, n = 22). Both groups underwent three weekly sessions of their respective treatments. Patients were also given a home exercise protocol. Primary outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for pain and functional impairment at baseline (T0), 4 weeks (T1), 12 weeks (T2), and 24 weeks (T3) post-treatment. Secondary outcomes included grip strength and ultrasonographic measurements of common extensor tendon (CET) thickness and vascularization. Results: Significant improvements in VAS and PRTEE scores were observed in both groups at all follow-up points. Group B showed greater pain reduction at T1 (VAS: 3.0 ± 1.6 vs. 4.43 ± 1.47; p < 0.005) and T2 (VAS: p < 0.030) compared to group A. Functional outcomes (PRTEE) also favored group B at T1 (p < 0.030) and in the pain section at T2 (p < 0.020). Grip strength improved similarly in both groups. CET thickness showed no significant differences at T3. Vascularization decreased significantly in both groups, with a non-significant trend favoring group B. Conclusions: The combined F-ESWT+R-PW therapy proved more effective than F-ESWT alone in the short- to mid-term management of chronic lateral epicondylitis, significantly enhancing pain reduction and functional outcomes. The combination of focal and radial pressure waves offers a superior therapeutic approach, leveraging the distinct mechanisms of each modality for better clinical results. Further research is needed to confirm these findings and establish long-term efficacy.

A Comparative Study of the Efficacy of Platelet-Rich Plasma (PRP) vs. Other Conservative Treatments for Lateral Epicondylitis.

Background Lateral epicondylitis, also known as tennis elbow, is a degenerative condition that affects a significant portion of the adult population, particularly those between the ages of 35 and 55. Conventional treatments, including analgesics, physiotherapy, and bracing, often lead to a high recurrence rate. Platelet-rich plasma (PRP) therapy has emerged as a promising alternative, offering regenerative benefits that may enhance tissue healing. This study evaluates the effectiveness of PRP injections compared to traditional conservative therapies in alleviating pain and improving function in individuals with chronic lateral epicondylitis. Methods This prospective observational study was conducted at Father Muller Medical College Hospital from April 2018 to August 2019. A total of 44 patients aged 18-60 years with chronic lateral epicondylitis were randomly assigned to two groups: PRP (n = 22) and conservative treatment (n = 22). The conservative group received a combination of physiotherapy, analgesics, and a counterforce brace. The primary outcome was measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE) score, assessed at baseline, four weeks, eight weeks, three months, and six months. The PRTEE score includes pain and function subscales. Data was analyzed using appropriate statistical methods, and significance was considered at p < 0.05. Results Both groups significantly improved pain and function during the first eight weeks. However, the PRP group demonstrated superior long-term outcomes. At three and six months, the PRP group had significantly lower pain scores (26.00 ± 3.55 and 19.55 ± 3.33, respectively, p < 0.001) compared to the conservative group (32.23 ± 3.75 and 33.64 ± 3.63). Similarly, the PRP group showed better functional improvement at six months (PRTEE function subscale: 20.00 ± 3.19 in PRP vs. 30.73 ± 4.11 in conservative, p < 0.001). No complications were reported in either group. Conclusions PRP injections provide superior long-term pain relief and functional recovery compared to conservative management in patients with chronic lateral epicondylitis. While conservative treatments are effective in the short term, PRP offers a more durable solution with no reported complications. These findings support the use of PRP as a viable alternative for the long-term management of lateral epicondylitis.

Evaluation and Surveillance of Lateral Elbow Tendinopathy in Manual Workers: Identifying Elbows at Risk

Abstract Background: Manual workers are at risk of developing lateral elbow tendinopathy (LET). We aimed to validate the hypothesis that asymptomatic elbows of manual workers with LET are more likely to have positive physical examination results and morpho-mechanical changes on elbow ultrasonography compared to healthy individuals. Methods: This cross-sectional case–control study included 30 manual workers with unilateral LET (LET group) and 30 age- and sex-matched healthy volunteers (control group). Demographic data collection and functional evaluation were performed using the Disabilities of the Arm, Shoulder, and Hand; Patient-Rated Tennis Elbow Evaluation; and European Quality of Life Five-Dimensions questionnaires. Physical examination of the elbows and evaluation of the common extensor tendon (CET) with B-mode morphology ultrasonography and Young’s modulus elastography were performed. The LET-unaffected and LET-affected elbows in the LET group were compared with the elbows in the control group. Results: The LET-unaffected elbows in the LET group had a higher prevalence of positive chair test results and focal hypoechoic change and microcalcification on ultrasonography than those in the control group (P &lt; 0.05, 0.005, and 0.05, respectively). In addition, LET-affected elbows showed higher focal hypoechoic change, microcalcification, erosive cortex, and neovascularity than elbows in the control group (P &lt; 0.001, 0.001, 0.005, and 0.001, respectively). The unaffected and affected elbows showed greater CET thickness than those in the control group (P &lt; 0.05 and 0.005). Conclusion: The unaffected elbows of manual workers with unilateral LET should be considered at risk of LET. We proposed a risk assessment and surveillance protocol based on chair test results and abnormal ultrasonographic findings.

High Versus Low-Energy Extracorporeal Shockwave Therapy for Chronic Lateral Epicondylitis: A Retrospective Study

Background: Chronic lateral epicondylitis (LE), also known as tennis elbow, affects 1–3% of the population, primarily those over 40 years old. Most cases resolve with conservative treatments, but some require more advanced interventions. Extracorporeal shockwave therapy (ESWT) has emerged as a non-surgical treatment option, utilizing either low- or high-energy levels to alleviate pain and improve function. Objective: This study aimed to compare the efficacy of low-energy versus high-energy ESWT in the treatment of chronic LE, focusing on pain relief and functional improvement. Methods: A retrospective observational study was conducted including patients treated for chronic LE between 2021 and 2024. Participants were divided into two groups: low-energy ESWT (0.10 mJ/mm2) and high-energy ESWT (0.20 mJ/mm2). Both groups received 2400 pulses at a frequency of 6 Hz once a week for three weeks. Pain and functional outcomes were measured using a visual analog scale (VAS) and the Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE) at the baseline, three months (T1), and six months (T2) post-treatment. Results: Forty-six patients participated, with 24 in the low-energy group and 22 in the high-energy group. Baseline demographics and clinical characteristics were similar across groups. At T1 and T2, the low-energy group showed significantly greater reductions in the VAS scores (T1: 4.45 ± 0.8 vs. 3.6 ± 1.7, p = 0.04; T2: 3.2 ± 1.2 vs. 2.1 ± 1.1, p = 0.004) and PRTEE scores (T1: 34.3 ± 6.9 vs. 26.8 ± 11.9, p = 0.03; T2: 25.3 ± 6 vs. 17.6 ± 9, p = 0.005). Significant treatment–time interactions were observed for both the VAS and PRTEE scores, indicating sustained improvements in the low-energy group. Conclusions: Low-energy ESWT was more effective than high-energy ESWT in treating chronic LE, providing greater and longer-lasting pain relief and functional improvement. These findings suggest that low-energy ESWT should be preferred in clinical practice for managing this condition. Future research should focus on larger sample sizes and randomized controlled trials to confirm these results and explore the underlying mechanisms of differential efficacy between energy levels.

Effects of extracorporeal shockwave therapy versus ultrasonic therapy and deep friction massage in the management of lateral epicondylitis: a randomized clinical trial

The study's goal was to compare and evaluate the benefits of deep friction massage and ultrasonic therapy (US) vs extracorporeal shockwave therapy (ESWT) for people with lateral epicondylitis. This double-blind, parallel-arm randomized clinical trial was conducted after ethical approval on a sample of 80 subjects with lateral epicondylitis. Participants were enrolled based on predefined eligibility criteria. They were randomly allocated to groups A and B. Group A received ESWT, while Group B received the US combined with deep friction massage. Data was collected using the Numeric Pain Rating Score (NPRS) and Patient-rated tennis elbow evaluation questionnaire (PRTEE) at baseline, at 3rd, and at 7th week of treatment. On the basis of the normality of the data, a non-parametric test was applied to evaluate between-group and within-group differences. P value ≤ 0.05 was considered significant. There was a significant difference between groups (p < 0.001). Comparisons of PRTEE scores at 3rd week and 7th week of intervention were found significant for both groups (p < 0.001). While considering between-group comparisons based on percentile scores of PRTEE at baseline, 3rd and 7th week of intervention, in group A Median (IQR) at the baseline was 24.00 (5.00), at 3rd week, 10.00 (5.00) and 7th week was 1.50 (2.50) and in group B Median (IQR) at the baseline was 25.00 (4.00), at 3rd week 19.50 (4.50) and at 7th week was 11.50 (2.50). The results were significant in both groups (p = 0.000), but between-group analysis revealed that ESWT is more effective in patients with lateral epicondylitis.

Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial

BackgroundBecause lateral epicondylitis is a common musculoskeletal disorder that affects the forearm's extensor tendons, an effective therapeutic approach should reverse the degeneration and promote regeneration. This study aimed to compare the efficacies of autologous blood (AB) injection, corticosteroid (CS) injection, and a combined injection of both in treating lateral epicondylitis (LE), hypothesizing that the combined approach might offer immediate symptom resolution and a lower recurrence.Materials and methodsA total of 120 patients diagnosed with lateral epicondylitis were systematically distributed among three distinct therapeutic injection groups. Those in the AB group were administered 1 ml of autologous venous blood mixed with 2 ml of 2% prilocaine HCl. Participants in the CS category were given 1 ml of 40 mg methylprednisolone acetate mixed with 2 ml of 2% prilocaine HCl. Meanwhile, patients in the combined group received a mixture containing 1 ml each of autologous venous blood and 40 mg methylprednisolone acetate along with 1 ml of 2% prilocaine HCl. Prior to receiving their respective injections, a comprehensive assessment of all participants was carried out. Follow-up assessments were subsequently conducted on days 15, 30, and 90 utilizing metrics of the patient-rated tennis elbow evaluation (PRTEE) and measurements of hand grip strength (HGS).ResultsOne patient dropped out from the combined group, and 119 patients completed the trial. No complications were recorded during the course of follow-up. By day 15, all groups had demonstrated significant PRTEE improvement, with CS showing the most pronounced reduction (p = 0.001). However, the benefits of CS had deteriorated by day 30 and had deteriorated further by day 90. The AB and AB + CS groups demonstrated sustained improvement, with AB + CS revealing the most effective treatment, achieving a clinically significant improvement in 97.4% of the patients. The improved HGS parallelled the functional enhancements, as it was more substantial in the AB and AB + CS groups (p = 0.001), corroborating the sustained benefits of these treatments.ConclusionsThe study concluded that while AB and CS individually offer distinct benefits, a combined AB + CS approach optimizes therapeutic outcomes, providing swift and sustained functional improvement with a lower recurrence rate. These findings have substantial clinical implications, suggesting a balanced, multimodal treatment strategy for enhanced patient recovery in LE.Level of evidence: Randomized clinical trial, level 1 evidence.Trial registration: NCT06236178.

The Clinical Results of Percutaneous Drilling in the Treatment of Chronic Lateral Epicondylitis.

Lateral epicondylitis is one of the leading orthopedic problems encountered in daily practice. Treatments are more symptomatic than curative. Percutaneous drilling is a minimally invasive method that provides satisfactory results. The aim of this study was to evaluate patients who had undergone percutaneous drilling for chronic lateral epicondylitis. The study included 31 patients who underwent surgical percutaneous drilling because of chronic lateral epicondylitis between 2018 and 2021. The patients were evaluated with respect to demographic characteristics, including age, gender, body mass index (BMI), occupation, education level, hobbies, dominant side, and smoking status. The VAS (Visual Analog Scale) pain scores, PRTEE score (Patient-Rated Tennis Elbow Evaluation - a lateral epicondylitis function scale), and Roles-Maudsly score were examined preoperatively and at one and 12 months postoperatively together with grip strength measured with a Jamar hand dynamometer. Statistically significant improvements were determined in the VAS score during activity from 8.9 preoperatively to 2.06 at 12 months postoperatively (p<0.01), and in the PRTEE score, from 64.12 preoperatively to 20.61 at 12 months postoperatively (p<0.01). The Roles-Maudsly score at 12 months postoperatively was determined to be excellent in 13 (41.9%) patients, and good in 14 (45.2%). Mean grip strength increased from 69.55 before treatment to 90.97 at the end of 12 months postoperatively. Autobiological treatments are at the forefront of current treatments for tendinopathies. Percutaneous drilling is a closed method and can be considered an ideal method in the treatment of tendinosis caused by inflammation and mesenchymal stem cells (MSCs) contained in hematoma. It is also an advantageous treatment method for patients with aesthetic concerns as it does not leave any scar tissue and has a low risk of complications.

Comparison of Mulligan Mobilization with Movement and Progressive Strengthening Exercises in Patient with Lateral Epicondylitis

Background: Lateral epicondylitis, commonly known as tennis elbow, is the most prevalent cause of elbow pain. Both Mulligan Mobilization with Movement (MWM) and Progressive Resistive Exercises (PRE) have shown effectiveness in treating lateral epicondylitis individually. This study aims to compare the effects of these two interventions to determine which is more effective in managing lateral epicondylitis. Objective: To compare the effects of Mulligan Mobilization with Movement and Progressive Resistive Exercises in relieving pain, improving functional disability, and enhancing pain-free grip strength in patients with lateral epicondylitis. Methods: A randomized clinical trial was conducted on 33 patients with symptomatic tennis elbow from July 2020 to January 2021 at the Bone and Joint Center and Khyaban Medical Center. Participants were randomly assigned to Group A (n=16) receiving Mulligan Mobilization with Movement and conventional physiotherapy, and Group B (n=17) receiving Progressive Resistive Exercises and conventional therapy. Patients were assessed using the Visual Analogue Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and hand dynamometer to measure pain intensity, functional status, and grip strength at baseline, after 5 sessions, 10 sessions, and at a 6-week follow-up. Data were analyzed using SPSS version 25. Results: Both groups showed significant improvements within group analyses. Group A showed a more substantial reduction in VAS scores and PRTEE scores, with median VAS scores decreasing from 7 to 2 (p=0.001) and PRTEE scores improving from 41 to 8 (p=0.001). Group B demonstrated greater improvements in pain-free grip strength, with median values increasing significantly at all time points (p&lt;0.05). Between-group analysis revealed that Group A had more significant improvements in VAS and PRTEE scores, while Group B had more significant improvements in pain-free grip strength. Conclusion: Mulligan Mobilization with Movement was more effective in reducing pain and improving functional status in patients with lateral epicondylitis compared to Progressive Resistive Exercises. However, Progressive Resistive Exercises were more effective in enhancing pain-free grip strength. These findings suggest the importance of tailored treatment approaches based on individual patient needs.

The effects of the addition of Mulligan mobilization with movement to exercise on elbow pain and function associated with lateral elbow tendinopathy

BackgroundMulligan mobilization with movement (MWM) and eccentric exercise (EE) have been shown to be effective for the treatment of chronic lateral elbow tendinopathy (LET). However, the addition of MWM to EE effects on LET remained unknown. The objective of the study was to determine the effects of adding of Mulligan mobilization with movement to eccentric exercise for the treatment of LET. MethodsIn this quasi-experimental study, thirty participants with unilateral LET were assigned into two groups: 15 in MWM (received MWM + EE) (7 M and 8 F, mean age 36.8 ± 8.3 years) and 15 in EE (9 M and 6 F, mean age 46 ± 8.1 years). Both groups received education about painful activities and eccentric exercise, while the MWM group received MWM with the same eccentric exercise as the EE group. The visual analog scale (VAS) and the patient-rated tennis elbow evaluation (PRTEE) were used to assess pain and upper limb function, respectively, at baseline and at the end of 4 weeks. The data was analyzed using an independent t-test and a paired t-test. ResultsThere was no significant difference (p > 0.05) between groups at baseline. At the end of 4 weeks, significant and clinically meaningful improvements in pain and function were observed for both groups (p < 0.001); however, MWM group showed much better results in VAS (p < 0.001, d = 1.3) and PRTEE (p < 0.001, d = 5.2) ConclusionThis study showed that adding MWM to eccentric exercise resulted in enhanced pain reduction and improved function of the upper limb.

A Case Report of Ultrasound-guided Hominis Placenta Pharmacopuncture on Lateral epicondylitis

Objectives: This case study aims to demonstrate the efficacy of ultrasound-guided hominis placenta pharmacopuncture in lateral epicondylitis.Methods: A 42-year-old male patient presented with lateral epicondylitis of the right arm of 4 months’ duration. Sonographic findings were tearing of the common extensor tendon at the lateral epicondyle. The patient was treated with ultrasound-guided hominis placenta pharmacopuncture and acupuncture for 9 weeks. The numeric rating scale (NRS) and patient-rated tennis elbow evaluation(PRTEE) were used to assess pain, function and progression. Ultrasound images were compared every 2 weeks.Results: After treatments, NRS and PRTEE were reduced from 7 to 1 and from 106 to 22, respectively. And improvement was observed in the torn region of the common extensor tendon on ultrasound imaging.Conclusion: This case demonstrates that ultrasound-guided hominis placenta pharmacopuncture could improve lateral epicondylitis and tear with minimally invasive methods.

Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography

ObjectiveTo investigate the structural alterations, neovascularity, and elasticity of tendons and the relationship between elasticity and the Patient Rated Tennis Elbow Evaluation score after undergoing US-guided fenestration or surgery in patients with chronic lateral elbow tendinopathy.MethodsParticipants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models.ResultsFenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome.ConclusionsFenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity.Critical relevance statementFenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity’s potential for quantitatively monitoring tendon elasticity during healing.Key PointsReliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking.Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity.Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment.Graphical

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.

Platelet-rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis – A Prospective Randomised Controlled Study

Abstract Introduction: Lateral epicondylitis, commonly known as tennis elbow, is one of the most common chronic disabling painful conditions that affect the forearm’s common extensor tendons. This study aimed to compare the effectiveness of platelet-rich plasma (PRP) versus corticosteroid injection in the treatment of lateral epicondylitis. Aims: The purpose of this study is to compare the efficacy of PRP versus corticosteroid injection in the treatment of lateral epicondylitis, focusing on the early response. Settings and Design: This was a prospective randomised controlled study. Materials and Methods: This study was a prospective randomised control trial of 100 patients, clinically diagnosed with lateral epicondylitis in Karnataka Institute of Medical Sciences Hospital, Hubli. Patients were randomly allocated (1:1) using computer-generated random numbers to two groups. Group A received corticosteroid injection. Group B received PRP injection. Outcome assessment was done using the Oxford Elbow Score (OES), Visual Analogue Scale (VAS), Patient-rated Tennis Elbow Evaluation (PRTEE) and Disabilities of Arm, Shoulder and Hand Score (DASH). All patients were followed up at regular intervals of 2 weeks, 4 weeks, 3 months and 6 months post-injection. Statistical Analysis Used: Using SPSS Statistics version 25 software, statistical analysis was done. Results: Pre–injection, the mean OES, VAS, PRTEE and DASH scores were similar in both the groups with insignificant P value. The mean pre-injection OES, VAS, PRTEE and DASH scores in the corticosteroid group were 11.22, 7.88, 75.950 and 69.364, whereas in the PRP group, it was 10.66, 7.96, 76.170 and 69.466, with P = 0.165, 0.322, 0.834 and 0.869, respectively. At the end of 6 months in the corticosteroid group, the mean score of OES increased from 11.22 ± 1.71 to 38.94 ± 5.17, VAS decreased from 7.88 ± 0.385 to 1.74 ± 1.24, PRTEE decreased from 75.95 ± 4.86 to 24.3 ± 12 and DASH decreased from 69.36 ± 2.90 to 23.31 ± 11.5, with a significant P &lt; 0.005. At the end of 6 months in the PRP group, the mean scores of OES increased from 10.66 ± 2.07 to 45.38 ± 1.41, VAS decreased from 7.96 ± 0.45 to 0.06 ± 0.31, PRTEE decreased from 76.1 ± 5.04 to 7.47 ± 3.16 and DASH decreased from 69.47 ± 3.44 to 7.78 ± 2.65, with a significant P &lt; 0.005. Conclusion: We concluded that patients treated with PRP had significantly reduced pain, increased functional activity, less recurrence and without requirement of any further intervention, outperforming corticosteroid injection effect at the end of 6 months follow up.

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.

Comparison of Interventions for Lateral Elbow Tendinopathy: A Systematic Review and Network Meta-Analysis for Patient-Rated Tennis Elbow Evaluation Pain Outcome

There is controversy regarding the optimal treatment for lateral elbow tendinopathy (LET), and not all available treatment options have been compared directly with placebo/control. A network meta-analysis was conducted to compare the effectiveness of different LET treatments directly and indirectly against control/placebo based on a validated outcome, the Patient-Rated Tennis Elbow Evaluation (PRTEE) pain score. Randomized, controlled trials comparing different treatment methods for LET were included, provided they reported outcome data using the PRTEE pain score. A network meta-analysis with random effect was used to combine direct and indirect evidence between treatments compared with placebo in the short term (up to six weeks) and midterm (more than six weeks and up to six months) after intervention. Thirteen studies with 12 comparators including control/placebo were eligible. The results indicated no significant improvement in PRTEE pain score in the short term across all treatments compared with control/placebo. In the midterm, physiotherapy/exercise showed benefit against placebo (mean difference:-4.32, 95% confidence interval:-7.58 and-1.07). Although steroid injections, dry needling, and autologous blood also exhibited potential treatment effects, it is crucial for the clinician to consider certain pitfalls when considering these treatments. The limited number of small studies and paucity of data call for caution in interpreting the results and need for further evidence. Patients should be informed that there is currently no strong evidence that any treatment produces more rapid improvement in pain symptoms when compared with control/placebo in the short and medium terms. Therapeutic I.

Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial

Objective The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. Design Randomized, single-blinded, multicenter, parallel-group trial. Setting Thirteen outpatient physical therapy clinics in nine different US states. Participants One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. Intervention Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. Main measures The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. Results The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. Conclusions The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy. Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.

Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial

ObjectiveThe objective of the study was to evaluate the efficacy of Maitland accessory mobilization and neural mobilization in patients with tennis elbow. MethodTwenty-five patients meeting the selection criteria were randomly assigned to three experimental groups: Group C (conventional treatment), Group B (neural mobilization), and Group A (Maitland mobilization). Quality of life was assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE), while pain, range of motion, and grip strength were evaluated using the Visual Analog Scale (VAS), a universal goniometer, and a handheld dynamometer. The interventions were administered three times per week for four weeks to the respective groups. ResultsNon-parametric tests were employed to analyze the results due to the non-normal distribution of the data (p < 0.05). Both the Wilcoxon signed-rank test and the Kruskal-Wallis test were utilized to assess differences within and between groups. The results of the between-group analysis demonstrated significant differences in pain (p = 0.018) and quality of life (p = 0.045) among the three groups. ConclusionAfter a 4-week intervention, all three groups exhibited notable improvements in discomfort levels, grip strength, and quality of life. Notably, Group B demonstrated the most substantial increase in range of motion (ROM) compared to Groups A and C. Consequently, incorporating neural mobilization into the treatment plan is recommended for patients experiencing Tennis Elbow.

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.

EFFECTIVENESS OF MULLIGAN TAPING VERSUS KINESIO TAPING WITH COMMON USE OF ULTRASOUND THERAPY IN TENNIS ELBOW OF CRICKET PLAYERS: A RANDOMIZED CLINICAL STUDY

BACKGROUND: The purpose of this study was to compare the effectiveness of Mulligan taping versus kinesio taping with common use of ultrasound therapy in managing tennis elbow. METHODS: Thirty cricketers aged between 25 to 35 years, presenting with tennis elbow with symptom duration within one month, were randomized into two groups. The Group-A received Mulligan taping with ultrasound therapy and Group-B received kinesio taping with ultrasound therapy. Treatment duration was 3 times a weekly four weeks. OUTCOME MEASURES: Data was obtained on pain intensity levels via Visual Analog Scale (VAS) grip strength via measuring Pain Free Grip Strength (PFGS) and functional status measured by the Patient-Rated Tennis Elbow Evaluation (PRTEE). RESULTS: Result shows that significant improvement in VAS (p=.04), PFGS (p=.02) and PRTEE (p=.01). CONCLUSION: The results of this study demonstrate that kinesio taping with ultrasound therapy is a superior treatment approach compared to Mulligan taping with ultrasound therapy in managing tennis elbow.