A Review of Physiotherapy Techniques Used in the Treatment of Tennis Elbow

Platelet rich plasma versus corticosteroids for lateral epicondylitis: a meta-analysis of randomized clinical trials

BACKGROUND

Lateral epicondylitis, colloquially known as tennis elbow, is a common cause of elbow pain and daily task disability. Caused by repetitive movement, it is typically a degenerative rather than inflammatory event and affects mostly middle-aged patients. Despite its good prognostic nature, its economic burden on the healthcare system encourages research on the efficacity of non-operative injection treatments. This article aims to compare the clinical effectiveness of platelet-rich plasma (PRP) and corticosteroid (CS) injections in managing lateral epicondylitis.

METHODS

PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up to March 2024. Only randomized controlled trials were included. The clinical outcomes evaluated were the visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

RESULTS

Twenty-six randomized controlled trials with 1.877 patients were included in this meta-analysis. In terms of VAS scores, short-term results (<2 months) favored CS over PRP (P=0.03; mean difference [MD], 0.67; 95% CI, 0.05 to 1.28), whereas long-term results (>6 months) favored PRP (P<0.001; MD, -1.60; 95% CI, -2.01 to -1.20]). Intermediate-term results (2-6 months) showed no significant difference between injection treatments. In terms of DASH scores, short- and intermediate-term results showed no significant difference, whereas long-term results favored PRP (P<0.001; MD, -4.87; 95% CI, -7.69 to -2.06).

CONCLUSIONS

CS provides significantly better short-term pain relief, while PRP provides better long-term functional improvement and clinical long-term pain relief. However, future studies should focus on other injection protocols or addition of other non-invasive modalities. Level of evidence: I.

Effectiveness of the Cyriax Technique With Conventional Therapy in the Management of Lateral Epicondylitis: A Case Report

Tennis elbow, medically referred to as lateral epicondylitis, is a common musculoskeletal condition that results in tenderness and pain on the outer side of the elbow. Physiotherapy is a conservative therapy for treating tennis elbow that emphasizes pain control, functional improvement, and recurrence avoidance. The case report examines the case of a 25-year-old woman who experienced a gradual onset of pain and mild swelling in her right elbow. As a result, she had hand trembling during flexion and extension, which was ongoing for the previous two days. As per the case study results, physical therapy has a crucial role in enhancing the endurance of muscles, increasing the range of motion, facilitating regular activities, and improving overall quality of life. According to recently published articles, a physical therapist plays a critical role in healing overuse injuries and helping patients resume their regular activities. For this patient, we developed a four-week treatment plan that includes several advanced therapy approaches, such as the Cyriax technique. The specific intervention used in the treatment was the Cyriax technique, which included intense deep friction massage followed by Mill's manipulation in addition to conventional physiotherapy which includes eight minutes of clinical ultrasound, isometric wrist joint stretches, praying position stretches, stretching exercises, and ice fomentation). For a total of 12 sessions, four weeks, the patient received treatment three days a week. For our patient, who had right-hand lateral epicondylitis, we designed a comprehensive rehabilitation program, and it was remarkably effective. We assessed the efficacy of our end measures using a variety of outcomes, including the Visual Analogue Scale (VAS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale. It was shown that giving patients a Cyriax method approach in addition to a regular physiotherapy treatment would be more advantageous for enhancing their general health and quality of life. To treat lateral epicondylitis, physiotherapists use a variety of manual treatments, such as mobilization, manipulation, and massage.

Persistent Pulmonary Hypertension of Newborns Secondary to Labile Hypoxemia Associated With Cyanosis: A Case Series

Persistent pulmonary hypertension of the newborn (PPHN) is a condition that can be fatal, marked by increased pulmonary vascular resistance that causes blood to shunt from the right to the left. Six infants that present with PPHN due to labile hypoxemia and related cyanosis are examined in this case series. Clinical manifestations, such as premature deliveries, maternal problems, and different reactions to early therapies, are revealed by perinatal and postnatal histories. The newborns' respiratory distress prompted the use of oxygen supplementation and continuous positive airway pressure (CPAP), but intubation was required due to continued hypoxemia. The series aims to establish a way for further study in this crucial area while offering insightful contributions to the clinical subtleties of PPHN and illustrating the importance of specific therapeutic approaches.