Patient-Rated Tennis Elbow Evaluation Research Articles

Management of lateral epicondylitis (tennis elbow) by local infiltration of platelet rich plasma an outcome study

<p class="abstract"><strong>Background:</strong> Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.</p><p class="abstract"><strong>Methods:</strong> A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2<sup>nd</sup> week, 4<sup>th </sup>week, 3<sup>rd</sup> month and 6<sup>th</sup> month.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value <0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.</p><p class="abstract"><strong>Conclusions:</strong> An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.</p>

EFFECTIVENESS OF MET V/S MARHYTHE IN INDIVIDUALS WITH CHRONIC LATERAL EPICONDYLITIS: A RANDOMIZED CLINICAL TRIAL

Background: Lateral Epicondylitis is the tendinosis of the extensor musculature of the forearm that has their common origin from the lateral epicondyle of the humerus due to angioblastic degeneration. The study aimed to determine and compare the effectiveness of MET and MaRhyThe in individuals with chronic lateral epicondylitis concerning pain, grip strength, and function.Methods: The study was a randomized clinical trial with 30 subjects divided into two equal groups, with 15 subjects in each group. Group A received MET for seven sessions, and Group B received MaRhyThe for one session. Both the groups received hot moist pack and conventional exercises for seven sessions. Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE) Questionnaire, and Pain-Free Grip Strength (PFGS) were taken as the outcome measures.Results: Within-group paired sample t-test showed statistical significance in VAS at rest, VAS on activity, PRTEE, and PFGS with a p-value of 0.001 for all. However, between-group analysis using independent sample t-test showed statistical significance in VAS on activity and PRTEE with a p-value of 0.049 and 0.029, respectively, and clinical significance for VAS at rest and PFGS for Group B.Conclusion: The study concludes that both MET and MaRhyThe are effective in treating chronic LE concerning pain, improving function, and strength. However, MaRhyThe is more effective in pain reduction and improving functional activities.

Comparison between prolozone therapy and extracorporeal shockwave therapy in management of pain and function in resistant cases of lateral epicondylitis: a randomised controlled trial

Background: Lateral epicondylitis also known as the tennis elbow is a painful condition of the elbow caused by overuse. The disease imparts significant disability to those affected in terms of the quantity and quality of work done.Methods: A randomised controlled trial was conducted in the Department of Physical Medicine and Rehabilitation, RIMS, Imphal for a period of 1 year from February 2017 to January 2018. Eighty-four patients with resistant lateral epicondylitis recruited were divided into 2 groups- group A received Prolozone injection while group B underwent Extracorporeal Shockwave Therapy (ESWT).Results: Assessments of VAS (Visual Analog Scale) and PRTEE (Patient Rated Tennis Elbow Evaluation) were done at 8 weeks and 24 weeks. The mean VAS score in Prolozone group improved from 7.22±0.89 to 4.04±1.01 at 8 weeks to 1.67±0.70 at end of 24 weeks. In ESWT group, mean VAS score improved to 3.91±0.72 at 8 weeks and reduced to 2.3±0.68 at end of 24 weeks. PRTEE improved significantly in both the groups, from 85.33±3.29 to 24.87±2.10 in Prolozone group, and from 85.17±2.83 to 41.89±3.17 in ESWT group.Conclusions: The improvement in pain and disability is better in prolozone group than ESWT (p<0.05) in chronic lateral epicondylitis.

Autologous blood injection works for lateral epicondylitis

Purpose: This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis. Methods: This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and 2 years after injection, using the patient-rated tennis elbow evaluation. Results: 50 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Conclusions: Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.

Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior?

Background: Lateral epicondylitis (LE) is a common musculoskeletal disorder. Although varieties of modalities have been proposed for its treatment, the outcomes are uncertain, and the responses would diminish early by the time passage. The current study was aimed to assess the efficacy of extracorporeal shock wave therapy (ESWT) merely and in combination with topical corticosteroid for the treatment of LE. Materials and Methods: In the current double-blinded randomized clinical trial, 70 patients with the diagnosis of LE were randomly allocated to two intervention groups of ESWT merely (control group) (n=35) or ESWT plus topical corticosteroid (intervention group) (n=35). The ESWT was performed weekly for three weeks. Topical clobetasol was utilized within 30 minutes before ESWT for the intervention group, while Vaseline gel was used in a similar pattern for controls. Pain based on a visual analog scale (VAS), handgrip strength (HGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) were assessed for the patients before the intervention, following the intervention cessation, and within two months post-intervention. Results: Statistically significant improvement was found following both interventions in terms of pain, HGS, and function (P-value<0.001 for all), while the comparison of the two interventions, ESWT, merely versus in combination with topical clobetasol, revealed insignificant difference (P-value>0.05). Conclusion: The findings of our study are in favor of ESWT use either merely or in combination with topical steroids for the treatment of LE, while the comparison of the two techniques revealed insignificant differences.

Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior?

Background: Lateral epicondylitis (LE) is a common musculoskeletal disorder. Although varieties of modalities have been proposed for its treatment, the outcomes are uncertain, and the responses would diminish early by the time passage. The current study was aimed to assess the efficacy of extracorporeal shock wave therapy (ESWT) merely and in combination with topical corticosteroid for the treatment of LE. Materials and Methods: In the current double-blinded randomized clinical trial, 70 patients with the diagnosis of LE were randomly allocated to two intervention groups of ESWT merely (control group) (n=35) or ESWT plus topical corticosteroid (intervention group) (n=35). The ESWT was performed weekly for three weeks. Topical clobetasol was utilized within 30 minutes before ESWT for the intervention group, while Vaseline gel was used in a similar pattern for controls. Pain based on a visual analog scale (VAS), handgrip strength (HGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) were assessed for the patients before the intervention, following the intervention cessation, and within two months post-intervention. Results: Statistically significant improvement was found following both interventions in terms of pain, HGS, and function (P-value0.05). Conclusion: The findings of our study are in favor of ESWT use either merely or in combination with topical steroids for the treatment of LE, while the comparison of the two techniques revealed insignificant differences. [GMJ.2020;9:e1791]

Effect of Functional Task Exercises on Hand Function and Grip Strength in Patients with Lateral epicondylitis

Background: Tennis Elbow is the most common overuse syndrome in the elbow. It is a tendinopathy injury involving the extensor muscles of the forearm. The lateral epicondylitis is characterized by pain and tenderness at the lateral epicondyle of the humerus as there is non-specific inflammation at the origin of the extensor muscles of forearm. As there is pain and inflammation, the grip strength in decreased and hand function is affected. But there are few research done on intervention regarding same. Hence a comparative study was carried on 60 patient, 30 subjects were grouped in Group A which were given functional task exercises and Group B was given Conventional therapy. The stastical analysis showed that out of 30 subjects, mean age of group A patients was 25±6.23 and mean age of group B patients was 27.2±4.8. Grip strength in between Group A (63.5± 14.2) and Group B (60.4± 12.9) with p value 0.04, Patient rated tennis elbow evaluation scale in between Group A (44.1± 6.8) and Group B (43.8±10.6) with p value 0.002 and Michigan hand outcome measures in between Group A (62.5±14.4) and Group B (54.3±14.7) with p value 0.0005. Hence the study concluded that there is significant effect of Functional Task Exercises on Grip strength and Hand function in lateral epicondylitis.

Myofascial Release Technique with Virtual Reality Biofeedback in Lateral Epicondylitis – A Case Report

Background &amp; Aim: Lateral Epicondylitis (LE) also known as Tennis Elbow is a lesion due to chronic overuse injury of wrist extensors which causes damage to the wrist extensor tendons at their origin i.e. lateral epicondyle of the humerus. Thus, the aim of this case report is to report about the efficacy of virtual reality through EMG biofeedback and myofascial release technique in the case of lateral epicondylitis. Methodology: This study reports the efficacy virtual reality through EMG biofeedback and myofascial release technique along with pulsed ultrasound therapy in 37 year old male non-diabetic patient diagnosed with chronic lateral epicondylitis. The main intervention in this case involved virtual reality through EMG biofeedback and myofascial release technique (MFR) along with pulsed ultrasound therapy for 4 weeks. The treatment goal was to reduce inflammation, pain and restore wrist extensor muscle strength to avoid recurrence. The treatment outcome for pain was measured by 11 point Numerical Pain Rating scale, hand grip strength by hand dynamometer &amp; functional score by Patient Rated Tennis Elbow Evaluation. All the outcome measures were taken and analysed at baseline and after end of treatment. Conclusion: Combination of virtual reality through EMG biofeedback and myofascial release technique along with pulsed ultrasound therapy had promising result in rehabilitation of lateral epicondylitis and thus allowing return to work and play as quickly as possible.

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;

Clinical Value of Ultrasonographic Assessment in Lateral Epicondylitis Versus Asymptomatic Healthy Controls

Background: Ultrasonography (US) is often used in the assessment of lateral epicondylitis (LE). The strength of evidence supporting its role is, however, not well-documented. Purpose: To describe and compare the US tendinopathic changes observed in patients with LE and the general population, including any correlation between patient characteristics and US outcomes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Tendon thickness, color Doppler activity, and bone spur were assessed by US in 264 participants with healthy elbows and 60 patients with chronic LE. In addition to patient characteristics, Patient-Rated Tennis Elbow Evaluation (PRTEE) score, pain, and disability were recorded. Results: Depending on the measurement technique used, mean LE tendon thickness increased by 0.53 mm (10.2%) or 0.70 mm (14.5%) as compared with the contralateral arm and 0.40 mm (7.9%) or 0.41 mm (8.5%) as compared with the general population. Mean color Doppler activity (scale, 0-4) was 3.47 in the LE arm versus 0.13 in the contralateral asymptomatic arm and 0.26 in the general population. Bone spur was observed in 78% of the LE arms as opposed to 45% in the contralateral arms and 50% in the general population. In the LE group and the general population, the prevalence of bone spur increases with age. No correlations were observed with pain, disability, PRTEE, and disease duration. Conclusion: Increased common extensor tendon thickness is part of the tendinopathic changes observed in LE. However, given the marked variation in natural tendon thickness and small increases in tendon thickness in patients with LE, this technique cannot be used as a stand-alone diagnostic tool but rather as a supplement to the overall assessment. The contralateral elbow (if asymptomatic) is a better tendon thickness comparator than a general population mean value. Color Doppler activity is an indicator of ongoing tendinopathy and supports the LE diagnosis, but it is not pathognomonic for the condition. Absence of Doppler activity in a patient with suspected LE should raise suspicion of other diagnoses. Identification of a bone spur is of very limited clinical value given the high prevalence in the general population. The important outcomes of pain, disability, PRTEE, and disease duration did not correlate with any of the investigated US techniques.

Platelet-rich plasma use for shoulder epicondylitis treatment

Epicondylitis is the most common cause of elbow pain, affecting up to 3,0% of the adult population. A comparative study of platelet-rich plasma (BTP) and betamethasone (diprospan) in the treatment of epicondylitis of the shoulder. 50 patients received injections of betamethasone 2-fold with an interval of 14 days. The main group-50 patients received 2 injections of BTP with an interval of 14 days. The results were evaluated using the psychometric scale Patient-Rated Tennis Elbow Evaluation (PRTEE) after 1, 6 and 12 months. Patients receiving Betamethasone showed the lowest level of pain after 1 month, with a gradual tendency to reduce the clinical effect after 6 months and the increase in clinical symptoms of the disease after 12 months. after treatment. The clinical effect after the use of BTP increases to 6 months with a slight tendency to reduce the effect to 12 months. Our studies have shown a high, up to 86,0% effectiveness of the applied methods of treatment of internal and external epicondylitis of the shoulder using PRP in comparison with glucorticosteroids.

The Efficacy of Eccentric Training Versus Concentric Training Along With Therapeutic Ultrasound Therapy for Pain and Functioning in Subjects with Lateral Epicondylitis

Background: Lateral Epicondylitis is a disabling musculoskeletal condition leading to pain and/or tenderness around the elbow. A common presentation may show pain and tenderness over the lateral epicondyle of the humerus , the radial head , the fascia , between the origins of extensor muscles as well as radiating into the forearm. Materials &amp; Methodology: Patients with Lateral Epicondylitis (n=20) were included in this study and patients with fracture of upper limb , radiculopathies , undergoing steroid therapy , rheumatoid arthritis were excluded from the study. A comparative study was done where two groups were made , Group A (n=10) received Eccentric exercise along with Ultrasound Therapy and Group B (n=10) received Concentric exercise along with Ultrasound Therapy. Treatment was given for 3 times a week for 3 weeks. Pain was assessed using Numerical Pain Rating Scale and functional disability was assessed using Patient Rated Tennis Elbow Evaluation. Results: Group A showed significant decrease in pain and functioning as compared to Group B. Mean pre NPRS of eccentric subjects was 6.70 which was significantly higher than mean post NPRS 6.30 (p&lt;0.001). Mean pre NPRS of concentric subjects was 6.30 which was significantly higher than mean post NPRS 2.60 (p&lt;0.001). Mean pre PRTEE of eccentric subjects was 53.90 which was significantly higher than mean post PRTEE 12.85 (p&lt;0.001). Mean pre PRTEE of concentric subjects was 55.45 which was significantly higher than mean post PRTEE 23.50 (p&lt;0.001) Conclusion: The study concluded that Eccentric exercise along with Ultrasound Therapy is more effective than Concentric exercise along with Ultrasound Therapy.

Patient-Rated Tennis Elbow Evaluation (PRTEE).

The Patient-Rated Tennis Elbow Evaluation questionnaire (PRTEE) is a specific questionnaire available for assessing the health status of patients with lateral epicondylitis. An official German translation does not yet exist. The aim of this study was to translate and cross-culturally adapt the English version of the PRTEE into German. The translation and cross-cultural adaptation was completed by an expert committee comprising people of varying professional and linguistic backgrounds. According to international guidelines, the English original was first translated into German, then back-translated and the final version was pre-tested on patients. No major difficulties were encountered during the translation process and smaller linguistic discrepancies could be resolved in the expert committee. For the pre-validation testing, 11 patients with extensor repair due to persistent lateral epicondylitis were included. They rated the questionnaire as easy to understand and complete. The final version was approved by the developers of the original questionnaire as the official German translation. Although the measurement properties of the German version were not evaluated in this study, the original shows good reliability, validity and responsiveness. In summary, the PRTEE is a questionnaire quick and easy to complete for patients with lateral epicondylitis. Therefore, it is suitable for the clinical routine assessment of subjective health status or the outcome after an intervention.

Cross-cultural adaptation and measurement properties of the Patient-Rated Tennis Elbow Evaluation for the Persian language

Introduction The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire is a tool designed for self-assessment of forearm pain and disability in patients with tennis elbow. The aims of this study were to translate and cross-culturally adapt the PRTEE questionnaire into Persian and evaluate its reliability and construct validity. Methods The PRTEE questionnaire was translated into and cross-culturally adapted to Persian in 90 consecutive patients with tennis elbow, according to well-established guidelines. Reliability was tested by means of test–retest and internal consistency. The measurement error was measured by calculating the standard error of measurement. Based on the standard error of measurement, the minimum detectable change was calculated. To evaluate construct and convergent validity, correlation with the PRTEE with the Disabilities of the Arm, Shoulder and Hand questionnaire and Visual analogue scale was used. Results In the process of cross-cultural adaptation, two items (6 and 8) were modified. In item 6, the term “door knob” was changed to “turn a key”, and in the item 8, “cup of coffee” was changed to “cup of milk”. Item-total correlations were greater than 0.55 (ranged from 0.55 to 0.76), internal consistency was high (Cronbach’s alpha, 0.94) and a high intraclass correlation coefficient (0.98) indicated excellent reliability of the P-PRTEE. The standard error of measurement and minimum detectable change were 5.40 and 14.24, respectively. The Persian version of the PRTEE questionnaire (P-PRTEE) shows strong construct and convergent validity ( r values = 0.85, p &lt; 0.05). Conclusions The P-PRTEE is valid and reliable in assessing disability and pain in Persian patients with tennis elbow. The excellent psychometric properties of the P-PRTEE endorse the use of this questionnaire in clinical settings.

The Patient-Rated Tennis Elbow Evaluation Questionnaire was successfully translated to Persian

IntroductionThe Patient-Rated Tennis Elbow Evaluation (PRTEE) is designed to evaluate pain and disability in subjects with lateral elbow tendinopathy. This questionnaire is available in Swedish, Italian, and some other languages. A Persian language version of the questionnaire is needed for both research and clinical purposes. Purpose of the StudyThe purpose of this study was to translate and cross-culturally adapt the PRTEE questionnaire into the Persian language and to determine its validity and reliability. MethodsThe PRTEE was translated and culturally adapted from English into Persian (PRTEE-P) according to the established guidelines. The PRTEE-P was completed by 68 Iranian subjects (44 women, 24 men) diagnosed with chronic lateral elbow tendinopathy. To assess test-retest reliability, all subjects filled out the PRTEE-P on a second admission within one week. The intraclass correlation coefficient (ICC) and Cronbach's alpha were measured to report reliability. The validity was determined by correlating the PRTEE-P questionnaire with the Persian version of the Disabilities of the Arm, Shoulder, and Hand questionnaire. ResultsThe Persian version of the PRTEE showed a high internal consistency with a Cronbach's alpha of 0.99, demonstrating good test-retest reliability (ICC = 0.99). It was well correlated with Disabilities of the Arm, Shoulder, and Hand (r = 0.80). ConclusionThe PRTEE-P is a reliable and valid tool designed for measuring pain and disability in subjects with lateral elbow tendinopathy.

The effects of kinesiotaping on wrist extensor strength using an isokinetic device in patients with chronic lateral epicondylitis: A randomized-controlled trial

This study aims to evaluate short-term effects of kinesiotaping (KT) on pain, arm function, grip strength, and wrist extensor strength in patients with chronic lateral epicondylitis (LE). A total of 48 patients (32 females, 16 males years; mean age 47.6 years; range 27 to 67 years) with chronic LE were randomly assigned to either KT group (n=27) or sham group (n=21). Pain intensity with visual analog sclae (VAS), arm pain and function with Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE), grip strength with hand dynamometer, and wrist extensor strength by an isokinetic device were evaluated before and at the end of the treatment. The KT stayed on for five days and the procedure was repeated for three times. Although pain and functional levels of patients with chronic LE were significantly improved both with KT (pain, p=0.001; function, p=0.001) and sham groups (pain, p=0.001; function, p=0.001), no significant difference was observed between the groups. Both KT and sham taping provided similar improvement in pain relief through arm functions in patients with chronic LE.

Functional Outcome at Short and Middle Term of the Extracorporeal Shockwave Therapy Treatment in Lateral Epicondylitis: A Case-Series Study.

Lateral epicondylitis (LE) of the humerus is a chronic degeneration of wrist extensor tendons at their attachments to the lateral epicondyle of the humerus. There is not a common consensus on a specific therapeutic algorithm, but Extracorporeal Shockwave Therapy (ESWT) is widely used. The purpose of this study is to evaluate the clinical benefits of low dose ESWT in LE-affected patients in short and medium follow-up. Between January 2015 and December 2017, 60 patients (38 male, mean age 52.2 ± 10.1 years, the duration of the disease was 3.6 ± 1.3 months) were clinically evaluated using visual analog scale (VAS) and Patient Rated Tennis Elbow Evaluation Test (PRTEE-I) scores before treatment, at one, three, six and 12 months after treatment. According to the VAS and PRTEE-I scoring systems, all patients achieved an improvement of pain and functional outcome comparing the baseline results with one, six and 12 months values. Low dose ESWT is a safe and effective treatment of LE in the short and middle term. In elderly subjects, patients with a long disease history, or those with occupational and sportive risk factors, a longer persistence of the symptomatology could be observed.

Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials.

To compare the effects of platelet-rich plasma (PRP) injection versus placebo (saline injection) on pain and joint function in lateral epicondylitis in randomized placebo-controlled trials. Randomized controlled trials that evaluated pain (visual analog scale [VAS] and patient-rated tennis elbow evaluation [PRTEE]) and/or functional improvement (PRTEE; disability of the arm, shoulder, and hand [DASH]; and Roles-Maudsley score [RMS]) in patients diagnosed with lateral epicondylitis and compared PRP with placebo injections were considered. The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched from inception to October 2019. The assessment of bias was performed using the Cochrane Risk of Bias Tool version 1. The meta-analysis was conducted with a random effects model and generic inverse variance method. Five trials involving a total of 276 individuals were included. They used a parallel study design and saline solution as placebo. The mean age of participants was 48.0 ± 9.3years. Follow-up varied from 2months to 1year. No significant changes were noted for pain (standardized mean difference [SMD], - 0.51 [95% confidence interval (CI), - 1.32 to - 0.30]) nor functional scores (SMD, - 0.07 [95% CI, - 0.46 to 0.33]) between PRP and placebo injections. The most frequent adverse reaction reported in two of the five studies was transient post-injection pain for a few days (from 16 to 20% in the PRP group and from 8 to 16% in the placebo group). PRP injection was not superior to placebo for relieving pain and joint functionality in chronic lateral epicondylitis. However, patients reported improvement after both interventions in such clinical parameters. Further randomized trials are required to determine whether PRP injection is clinically more effective than placebo (saline injection).

Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background: Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis. Purpose: This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria. Study Design: Systematic review and meta-analysis. Methods: MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index. Results: A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months). Conclusion: NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT. Registration: CRD42019127547 (PROSPERO).

The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis.

Lateral epicondylitis (LE) is a common problem of the arm. Mulligan has proposed the use of mobilization with movement for LE. To investigate the effects of Mulligan's mobilization with movement (MWM) in LE. Forty patients were included in the study and randomly assigned to group 1 (n= 20), who received MWM, exercise and cold therapy, or group 2 (n= 20), who received exercise and cold therapy. The sessions were conducted five times a week for two weeks. All measures were conducted at baseline, after treatment, at 1st and 3rd months follow-ups. Mann-Whitney U test, a visual analogue scale (VAS) for pain intensity, Patient-rated Tennis Elbow Evaluation (PRTEE) Questionnaire for pain intensity and functional disability and a dynamometer for hand grip strength were applied. VAS activity pain significantly decreased in group 1 after treatment (p= 0.001), at the 1st (p< 0.001) and 3rd months (p= 0.040). There was a significant decrease in VAS night pain in group 1 (p= 0.024), and a significant increase in pain-free grip strength (p= 0.002) after treatment. PRTEE-Pain scores decreased in group 1 after treatment (p< 0.001), 1st (p< 0.001) and 3rd months (p= 0.001). MWM plus exercise and cold therapy is a safe and effective alternative with positive effects on elbow pain, functional capacity, and pain-free, maximum grip strength.