Treatment Of Lateral Elbow Tendinopathy Research Articles

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.

Editorial: The effect of Cyriax method on the treatment of Lateral Elbow Tendinopathy

Lateral elbow tendinopathy (LET) is the most common chronic disease of the elbow joint [1], affecting almost 1-3% of the general [2, 3]. Its incidence increases with age and is highest in the 35-60 age group [2, 4]. Extensor carpi radialis brevis’ tendon is the most common structure affected by LET [5]. There is a continuous cycle of minor injuries and constant attempts to repair the damage, causing in progressive degeneration [6,7]. Consequently, a domino effect of changes occurs in the peripheral nervous system neurons, ultimately resulting to the sensitization of the central nervous system [3, 8]. Treatment for LET includes a wide variety of techniques, due to the complexity of the condition. Scientific evidence on the efficacy of the various techniques is of poor quality [9], which hampers the choice of the right therapeutic plan [10, 11]. The Cyriax method was empirically developed by James Cyriax as a therapeutic approach to connective tissue damage [12]. It is an inseparable combination of deep transverse friction (DTF) and Mill’s manipulation [13, 14]. This approach aims to the passive mobilization of soft tissues, preparing them to endure load. The regenerative process is boosted and the mobility of the damaged tissue is restored through pain reduction [12, 14]. Despite the fact that clinical experience supports the use of Cyriax method on LET, the results of systematic reviews show that it is not superior to other approaches indicated for this condition [15-17]. At the same time, there is no consensus on how to apply the method, which leads to a lack of standardization of the relative protocols [12]. In addition, great diversity is observed in the methodological design, the instruments and methods of evaluating the variables (pain, functionality) [12]. The disagreement on DTF procedures and the awareness that physiotherapists’ performance may be affected by the lack of understanding of Cyriax’s conclusions motivated the development of this thesis: The primary aim is to analyze the application parameters of the Cyriax method, as well as its effect on the symptoms of LET, by documenting how physiotherapists in Greece use the method. Moreover, and in line with the latest findings [18], a psychometric evaluation of LET will be included in this thesis. Kinesiophobia is an outcome measure that should be considered, as it is affected by LET [18-20].

Efficacy of Ultrasonic Tenotomy and Debridement and Platelet-Rich Plasma Injections for Lateral Elbow Tendinopathy

To determine the efficacy of treatment of lateral elbow tendinopathy (LET) with platelet-rich plasma (PRP) injection and ultrasonic tenotomy and debridement (USTD) as well as risk factors for treatment failure. This was a retrospective study including patients treated for LET with PRP or USTD between January 2018 and December 2021. The efficacy of both procedures was assessed using pain-related patient-reported outcome measures at the 12-week follow-up. Baseline subject characteristics and diagnostic ultrasound findings were analyzed as risk factors for failure of treatment. Failure was classified as a surgical indication for LET within a year of the PRP or USTD. Ultrasonic tenotomy and debridement and PRP both led to significant improvement in patient pain within the 12-week follow-up period. There was no significant difference in efficacy between the two procedures. Common extensor tendon tearing on ultrasound and Worker's Compensation cases were found to be risk factors for failure of USTD. Lateral collateral ligament complex involvement and injection were found to be risk factors for failure of PRP. Platelet-rich plasma and USTD are both effective interventions for LET. They have separate risk factors for failure that should be taken in consideration while deciding the treatment approach. These procedures are minimally invasive alternatives to some of the more invasive surgical options to treat LET. Therapeutic III.

Blood-flow-restriction-Training als Behandlungsoption der Epicondylopathia humeri radialis – eine Studienvorstellung

Blood flow restriction training, developed in 1966 in Japan, is atraining modality that utilizes partial arterial and complete venous blood flow occlusion. Combined with low load resistance training, it aims to induce hypertrophy and strength gains. This makes it particularly suitable for people recovering from injury or surgery, for whom the use of high training loads is unfeasible. In this article, the mechanism behind blood flow restriction training and its applicability for the treatment of lateral elbow tendinopathy is explained. An ongoing prospective, randomized, controlled trial on the treatment of lateral elbow tendinopathy is presented.

Ultrasound guided percutaneous tenotomy for lateral epicondylosis

Lateral elbow tendinopathy is a common condition affecting two to three percent of the population. While non-operative management is the mainstay of treatment, 10-15% remain refractory. Ultrasonic percutaneous tenotomy is a recent therapeutic option for clinicians to treat lateral elbow tendinopathy. The goal of this study was to evaluate the survival rate of ultrasonic percutaneous tenotomy in the treatment of lateral elbow tendinopathy. 83 patients underwent ultrasonic percutaneous tenotomy from September 2015 to August 2018 and met full inclusion criteria to participate. 63 patients consented to enroll in the study, with 50 (79.4%) completing the postoperative questionnaire. Data obtained included range of motion, patients’ report of improvement, Quick Dash Score (Q-Dash), Visual Analogue Scale (VAS) pain, VR 12, Mayo Elbow Performance, patient satisfaction, further post-operative adjunct procedures which included additional steroid injections, platelet-rich plasma (PRP) injections or need for reoperation at a minimum of 12 months post procedure. Overall survival rate for ultrasonic percutaneous tendinopathy was 94% (47/50). Three patients required post-operative adjunct procedures, two received steroid injections and one required PRP injection. Mean VAS score improved from 8.1 to 2.8 in the no failure group vs 7.9 to 2.7 in the failure group. Mean postoperative Mayo Elbow score and Q-DASH score was 89 (range 60 to 100) and 12.7 (range 2.3 to 61.4), respectively. 84 percent of patients were either very satisfied (N=31) or satisfied (N=11) with their procedure. This three year study demonstrates that ultrasonic percutaneous tenotomy appears to be a safe and efficacious therapeutic option with a high survival rate for patients with recalcitrant lateral elbow tendinopathy.

Effect of Supervised over Self-Performed Eccentric Exercise on Lateral Elbow Tendinopathy: A Pilot Study.

The efficacy of eccentric exercise self-performed by the patient has not been proved in the treatment of lateral elbow tendinopathy (LET). The aim of this study was to compare the effects of a programme of eccentric exercises applied by a physiotherapist to patients with LET through a structured manual programme compared to its self-performance, guided by an illustrated brochure. A single-blind, pilot, randomised, controlled trial was conducted. Twenty patients were randomised. The intervention group carried out eccentric exercises applied directly by a physiotherapist (10 sessions). The control group carried out eccentric exercises that were self-performed by the patient (10 sessions). Both groups received simulated ultrasounds. Pain (visual analogue scale (VAS)), function (DASH questionnaire) and satisfaction (with a Likert scale) were measured at the beginning of the intervention, immediately after the intervention and 3 months after the intervention. The mean age was 53.17 and 54.25 years old. The experimental group presented a greater tendency to improve function (DASH -15.91) and reduce pain (VAS -2.88) compared to the control group, although these differences were not significant (p > 0.05). Eccentric exercise, both performed by the physiotherapist and self-performed by the patient, improved function and pain in the patients with LET.

Physical therapy intervention versus corticosteroid injection for lateral elbow tendinopathy. Does slow and steady win the race? - A systematic review.

Lateral elbow tendinopathy is one of the most common chronic and degenerative diseases which significantly affects quality of life and the activities of daily living of a person. The following is a systematic review reporting a comparison between physical therapy intervention and corticosteroid injection for the treatment of lateral elbow tendinopathy. PubMed, Web of Science, and Embase were searched using headings related to treatment options for Lateral elbow tendinopathy. The following keywords were used: lateral epicondylitis, physical therapy, and corticosteroid injection. We descriptively analyzed and reviewed a total of 12 studies including a total of 1253 patients for lateral elbow tendinopathy. The physical therapy intervention included interventions like electrotherapy, manual therapy, and exercise. The studies included had an overall low to unknown risk of bias. Our review suggests corticosteroid injection provides beneficial short-term effects and physical therapy interventions provide intermediate to long-term effects, less additional treatment and low recurrence rate in patients with lateral elbow tendinopathy. Although high-quality randomized control trials are required in order to have a better understanding of both intervention types.

Efficacy of ultrasound therapy for the treatment of lateral elbow tendinopathy (the UCICLET Trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial

IntroductionLateral elbow tendinopathy (LET) is a highly prevalent disease among the middle-aged population, with no consensus on optimal management. Non-operative treatment is generally accepted as the first-line intervention. Ultrasound (US)...

Stem cell therapy for the management of lateral elbow tendinopathy: A systematic literature review

Summary Purpose Lateral elbow tendinopathy is the most common cause of lateral elbow pain with a lifetime prevalence of approximately 40% in the general population. The purpose of this study was to complete a systematic review to identify the potential of stem cell therapy based on the current evidence in the treatment of lateral elbow tendinopathy. Methodology A systematic review through the Ovid, Medline, and Cochrane Review databases was performed with the search terms of lateral epicondylitis, tendinopathy, tennis elbow, stem cell, bone marrow, treatment, and therapy. Results The systematic review initially identified 816 articles from three databases. Five studies met the inclusion criteria. The five studies evaluated four different stem cell preparations including autologous tenocytes, skin-derived tenocyte-like cells, allogeneic adipose-derived mesenchymal stem cells, and bone marrow aspirate. Conclusion While a majority of lateral elbow tendinopathy cases resolve in a timely manner with no or limited intervention, recovery can be a delayed process for a small percentage of patients. The role of emerging treatment options has not been established. Stem cell therapy is an option for refractory cases, but current evidence is poor. Early findings demonstrated significant improvements in imaging and functional outcomes, but findings were limited by lack of control arms or other treatment arms for comparison. Further large, controlled studies are needed to evaluate safety, efficacy in order to establish the role of stem cell therapy in the management of lateral elbow tendinopathy.

Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis

Study DesignMeta-analysis. IntroductionLateral elbow tendinopathy is a common condition with an annual incidence of up to 3% of the population. Eccentric strengthening has shown promise as a method to treat lateral elbow tendinopathy, but is unclear if it is superior to other forms of treatment. Purpose of the StudyThe purpose of this study was to investigate the effectiveness of eccentric strengthening compared with other forms of strengthening and pain-relieving modalities on pain, strength, and function in people with lateral elbow tendinopathy. MethodsFive electronic databases were searched. Reference lists of selected articles were hand-searched. Outcomes were defined a priori. Meta-analyses were performed using a random effects model with standardized mean differences, test of heterogeneity, and sensitivity analyses. ResultsEight articles were included in this review. When comparing eccentric strengthening to other forms of strengthening and pain-relieving modalities, there were significant large effect size of 1.12 (CI: 0.31-1.93) and 1.22 (CI: 0.25-2.18) in reducing pain and improving function in the short-term, respectively. In long-term, results were inconclusive on all outcomes. DiscussionA treatment program using eccentric strengthening of adequate intensity and duration seemed to be most effective for treating lateral elbow tendinopathy. ConclusionsThe state of science of best care for lateral elbow tendinopathy is still in its infancy. Large, high-quality randomized controlled trials with clearly defined strengthening regime are needed to determine optimal dosage to maximize treatment effects. Recommendations were provided based on careful synthesis of findings from this review and current evidence in literature.

The spread of Injectate after ultrasound-guided lateral elbow injection \u2013 a cadaveric study

BackgroundInjections into the tendinous portion of the common extensor origin are a common intervention in the treatment of Lateral Elbow Tendinopathy (LET). Clinical trials report a heterogeneous selection of injectate volumes and delivery techniques, with systematic reviews finding no clear consensus. The aim of this study was to assess the intratendinous distribution and surrounding tissue contamination of ultrasound-guided injections into the Common Extensor Tendon (CET) of the elbow.MethodsTwenty cadaveric elbows were injected by a Consultant Radiologist under Ultrasound guidance. Elbows were randomised to equal groups of 1 or 3 mls of methylene blue injection, delivered using single shot or fenestrated techniques. Following injection, each cadaver underwent a dry arthroscopy and dissection of superficial tissues. The CET was excised, set and divided into 1 mm sections using microtome. Each slice was photographed and analysed to assess spread and pixel density of injectate in four colour graduations. The cross-sectional area of distribution was calculated and compared between groups.ResultsIn all 20 cadaveric samples, contamination of the joint was noted on arthroscopy and dissection. Injectate spread through over 97% of the cross-sectional area. No differences were found in intratendinous spread of injectate between differing volumes or techniques.ConclusionThis study found that commonly used injection volumes and techniques distribute widely throughout cadaveric CETs. There was no improvement when the volume was increased from 1 to 3 mls or between single shot of fenestrated injection techniques. It should be noted that joint contamination using these techniques and volumes may be inevitable.

Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review.

The aim of this umbrella review is to determine the effectiveness of LLLT in the treatment of LET and to provide recommendations based on this evidence. A comprehensive and systematic review was undertaken using Medline, EBSCO and EMBASE. Systematic reviews or meta-analysis were included if they compared Laser with at least one of the following: (i) placebo, (ii) no treatment, (iii) another treatment, conservative (physical therapy intervention or medical) or operative of LET. Principal outcomes included the assessment of short and long-term effect on functional status, pain, grip strength (pain-free or maximum) and a global measure (overall improvement). Seven papers met the inclusion criteria for the umbrella review, Five papers were of moderate and two of low methodological quality. All reviews reported benefits associated with laser therapy Vs other intervention or placebo, however the significance of the identified benefits differed between studies and reviews. No review reported negative effects of laser therapy or harm to patients. All reviews noted significant variance between included studies with 2 reviews citing statistically significant heterogeneity. It is essential to consider this in the interpretation of these data. This umbrella review found poor results for the effectiveness of LLLT in the management of LET. Therefore, further research with well-designed RCTs is required to provide meaningful evidence on the effectiveness (absolute and relative) of LLLT for the management of LET.

Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy

Study DesignRCT. IntroductionLateral elbow tendinopathy is a common clinical condition. eccentric exercises. eccentric-concentric loading and, isometric exercises are indicated to reduce and manage tendon pain. Purpose of the StudyTo compare the effectiveness of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. MethodsA randomized clinical trial was carried out in a rheumatology and rehabilitation center. A group of 34 patients with later elbow tendinopathy was randomly allocated to Group A (n = 11) who underwent eccentric training, Group B had eccentric-concentric and Group C who had eccentric-concentric and isometric training. All patients received 5 treatments per week for 4 weeks. Pain was evaluated using a visual analog scale and function using a visual analog scale and pain-free grip strength at the end of the 4-week course of treatment (week 4) and 1 month (week 8) after the end of treatment. ResultsThe eccentric-concentric training combined with isomentric contractions produced the largest effect in the reduction of pain and improvement of function at the end of the treatment (P < .05) and at any of the follow-up time points (P < .05). ConclusionThe eccentric-concentric training combined with isomentric contractions was the most effective treatment. Future well-designed studies are needed to confirm the results of the present trial. Level of evidenceIII.

Comparing Two Exercise Programmes for the Management of Lateral Elbow Tendinopathy (Tennis Elbow/Lateral Epicondylitis)—A Controlled Clinical Trial

Aim: To compare the effectiveness of supervised exercise programme as proposed by Stasinopoulos and colleagues with home exercise programme as proposed by Pienimaki and his coworkers in the treatment of lateral elbow tendinopathy. Design : Controlled clinical trial. Setting : Physiotherapy and rehabilitation centre. Participants : This trial was carried out with 60 patients, who had lateral elbow tendinopathy. Intervention : Group A ( n = 30) had received supervised exercise programme, once per day for 4 weeks. Group B ( n = 30) was treated with home exercise programme four to six times daily for 8 weeks. Outcome measures : pain, using a visual analogue scale, function, using a visual analogue scale for elbow function and the pain-free grip strength. Patients were evaluated at baseline, at the end of treatment (week 12), and 3 months (week 24) after the end of treatment. Results : Both the supervised and home exercise programme were found to be significantly effective in the reduction of pain and in the improvement of functional status. The supervised exercise programme resulted in significantly different improvement in comparison to those who received home exercise programme. Conclusion : A specific supervised exercise programme is superior to a specific home exercise programme in reducing pain and improving function in patients with LET at the end of the treatment and at the 3 month follow-up. Further research is needed to confirm our results.

Autologous Blood Versus Corticosteroid Local Injection in the Short-Term Treatment of Lateral Elbow Tendinopathy

To compare local corticosteroid with autologous blood injections for the short-term treatment of lateral elbow tendinopathy. A single blind, randomized clinical trial was performed in an outpatient clinic at a university hospital. Sixty patients aged 27-64 yrs with a new episode of tennis elbow were recruited. Thirty patients were randomized to methylprednisolone and 30 to autologous blood group over 1 yr. Severity of pain within last 24 hrs; limb function; pain and strength in maximum grip; disabilities of the arm, shoulder, and hand quick questionnaire (Quick DASH) scores; modified Nirschl scores; and pressure pain threshold were evaluated before injection and at 4 and 8 wks after injection. We analyzed our data with the chi and t test. Within-group analyses showed better results for autologous blood (all P values <0.001 except for grip strength, P = 0.005). In the corticosteroid group, differences in severity of pain (P = 0.008) and grip strength (P = 0.001) were significant. At 4 wks, between-group analyses showed superiority of autologous blood for severity of pain (P = 0.001), pain in grip (P = 0.002), pressure pain threshold (P = 0.031), and Quick DASH questionnaire score (P = 0.004). There were no significant differences in modified Nirschl score, grip strength, and limb function. At 8 wks, autologous blood was more effective in all the outcomes (all P values <0.001). Autologous blood was more effective in short term than the corticosteroid injection.

Comparing the Effects of Exercise Program and Low-Level Laser Therapy with Exercise Program and Polarized Polychromatic Non-coherent Light (Bioptron Light) on the Treatment of Lateral Elbow Tendinopathy

The use of low-level laser therapy (LLLT) and polarized polychromatic non-coherent light as supplements to an exercise program has been recommended for the management of lateral elbow tendinopathy (LET). To investigate whether an exercise program supplemented with LLLT is more successful than an exercise program supplemented with polarized polychromatic non-coherent light in treating LET. Patients with unilateral LET for at least 4 wk were sequentially allocated to receive either an exercise program with LLLT or an exercise program with polarized polychromatic non-coherent light. The exercise program consisted of eccentric and static stretching exercises of wrist extensors. In the LLLT group a 904-nm Ga-As laser was used in continuous mode, and the power density was 130 mW/cm(2), and the dose was 0.585 J/point. In the group receiving polarized polychromatic non-coherent light the Bioptron 2 was used to administer the dose perpendicularly to the lateral epicondyle at three points at an operating distance of 5-10 cm for 6 min at each position. The outcome measures were pain and function and were evaluated at baseline, at the end of the treatment (week 4), and 3 mo after the end of treatment (week 16). Fifty patients met the inclusion criteria. At the end of treatment there was a decline in pain and a rise in function in both groups compared with baseline (p < 0.0005 on the paired t-test). There were no significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the 3-mo follow-up (p > 0.0005 on the independent t-test). The results suggest that the combination of an exercise program with LLLT or polarized polychromatic non-coherent light is an adequate treatment for patients with LET. Further research to establish the relative and absolute effectiveness of such a treatment approach is needed.

An exercise programme for the management of lateral elbow tendinopathy

Background: Home exercise programmes and exercise programmes carried out in a clinical setting are commonly advocated for the treatment of lateral elbow tendinopathy (LET), a very common lesion of the...