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Stasinopoulos D. Letter to the editor regarding "Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis". JSES Int 2023; 7:881-882. [PMID: 37719812 PMCID: PMC10499648 DOI: 10.1016/j.jseint.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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Abstract
This article provides a guidance summary for the management of lateral elbow tendinopathy (LET) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of the rating quality of the literature and grading the strength of available evidence. The process began by assembling a guideline development group of volunteers including orthopaedic surgeons, trainees, physiotherapists, rheumatologists, radiologists and patients. Virtual meetings were organised to set out explicit PICO questions, including specification of all important outcomes (including patient reported tennis elbow evaluation (PRTEE) as an important primary outcome) to determine the clinical effectiveness of common treatment options for LET compared with no treatment or placebo. Clinical librarian searched (date 31 April 2022) for available systematic reviews and randomised controlled trials reviewing the management of the LET January 2011 onwards and evidence was collected and summarized using explicit GRADE criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations were characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of alternative management options. This informative summary provides the quality of available evidence for the management of LET.
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Affiliation(s)
| | - Adam C Watts
- Upper Limb Unit, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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Droppelmann G, Tello M, García N, Greene C, Jorquera C, Feijoo F. Lateral elbow tendinopathy and artificial intelligence: Binary and multilabel findings detection using machine learning algorithms. Front Med (Lausanne) 2022; 9:945698. [PMID: 36213676 PMCID: PMC9537568 DOI: 10.3389/fmed.2022.945698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ultrasound (US) is a valuable technique to detect degenerative findings and intrasubstance tears in lateral elbow tendinopathy (LET). Machine learning methods allow supporting this radiological diagnosis. Aim To assess multilabel classification models using machine learning models to detect degenerative findings and intrasubstance tears in US images with LET diagnosis. Materials and methods A retrospective study was performed. US images and medical records from patients with LET diagnosis from January 1st, 2017, to December 30th, 2018, were selected. Datasets were built for training and testing models. For image analysis, features extraction, texture characteristics, intensity distribution, pixel-pixel co-occurrence patterns, and scales granularity were implemented. Six different supervised learning models were implemented for binary and multilabel classification. All models were trained to classify four tendon findings (hypoechogenicity, neovascularity, enthesopathy, and intrasubstance tear). Accuracy indicators and their confidence intervals (CI) were obtained for all models following a K-fold-repeated-cross-validation method. To measure multilabel prediction, multilabel accuracy, sensitivity, specificity, and receiver operating characteristic (ROC) with 95% CI were used. Results A total of 30,007 US images (4,324 exams, 2,917 patients) were included in the analysis. The RF model presented the highest mean values in the area under the curve (AUC), sensitivity, and also specificity by each degenerative finding in the binary classification. The AUC and sensitivity showed the best performance in intrasubstance tear with 0.991 [95% CI, 099, 0.99], and 0.775 [95% CI, 0.77, 0.77], respectively. Instead, specificity showed upper values in hypoechogenicity with 0.821 [95% CI, 0.82, −0.82]. In the multilabel classifier, RF also presented the highest performance. The accuracy was 0.772 [95% CI, 0.771, 0.773], a great macro of 0.948 [95% CI, 0.94, 0.94], and a micro of 0.962 [95% CI, 0.96, 0.96] AUC scores were detected. Diagnostic accuracy, sensitivity, and specificity with 95% CI were calculated. Conclusion Machine learning algorithms based on US images with LET presented high diagnosis accuracy. Mainly the random forest model shows the best performance in binary and multilabel classifiers, particularly for intrasubstance tears.
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Affiliation(s)
- Guillermo Droppelmann
- Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, RM, Chile
- Health Sciences Ph.D. Program, Universidad Católica de Murcia UCAM, Murcia, Spain
- Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, Boston, MA, United States
- *Correspondence: Guillermo Droppelmann,
| | - Manuel Tello
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Nicolás García
- MSK Diagnostic and Interventional Radiology Department, MEDS Clinic, Santiago, RM, Chile
| | - Cristóbal Greene
- Hand and Elbow Unit, Department of Orthopaedic Surgery, MEDS Clinic, Santiago, RM, Chile
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, RM, Chile
| | - Felipe Feijoo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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Stasinopoulos D. Issues Related to the Effectiveness of Extracorporeal Shock Wave Therapy for the Management of Lateral Elbow Tendinopathy. J Clin Med 2022; 11:5413. [PMID: 36143061 PMCID: PMC9505780 DOI: 10.3390/jcm11185413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
One of the most popular recommended physical therapy modalities for the management of lateral elbow tendinopathy (LET) is extracorporeal shock wave therapy (ESWT) [...]
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Dejnek M, Moreira H, Płaczkowska S, Barg E, Reichert P, Królikowska A. Effectiveness of Lateral Elbow Tendinopathy Treatment Depends on the Content of Biologically Active Compounds in Autologous Platelet-Rich Plasma. J Clin Med 2022; 11:jcm11133687. [PMID: 35806972 PMCID: PMC9267331 DOI: 10.3390/jcm11133687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023] Open
Abstract
Autologous platelet-rich plasma (PRP) injection is an alternative treatment option for patients with lateral elbow tendinopathy. The treatment is supposed to accelerate tissue regeneration by providing high concentrations of growth factors derived from platelets. The aim of the study was to assess the relationship between the content of biologically active compounds in PRP and the clinical effect of the treatment. Thirty patients with lateral elbow tendinopathy treated with a single PRP injection, were evaluated. The pain intensity (measured by a visual analogue scale (VAS)), the pressure pain threshold (PPT), the grip strength and strength of the main arm and forearm muscle groups, and the functional outcome (measured by the Disability of Arm, Shoulder and Hand (DASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaires), were assessed before PRP injection and at one- and three-months follow-up. Flow cytometry measurements of the growth factors and inflammatory cytokines in PRP were performed, and the results were used to establish the relationship between those molecules and the clinical outcome. After three months from the intervention, the minimal clinically important difference in pain reduction and functional improvement was observed in 67% and 83% of patients, respectively. Positive correlations were found between the extent of pain reduction after three months and concentrations in the PRP of platelets, epidermal growth factor (EGF), vascular endothelial growth factor, and platelet-derived growth factors. The concentration of EGF in the PRP significantly correlated with an improvement in grip strength, strength of wrist extensors, and the size of functional improvement measured by the PRTEE. The local injection of PRP is a safe and effective treatment option for lateral elbow tendinopathy, and the clinical outcome is correlated with concentrations of its biologically active compounds.
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Affiliation(s)
- Maciej Dejnek
- Clinical Department of Trauma and Hand Surgery, Department of Trauma Surgery, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-717343800
| | - Helena Moreira
- Department of Medical Science Foundation, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (H.M.); (E.B.)
| | - Sylwia Płaczkowska
- Teaching and Research Diagnostic Laboratory, Department of Laboratory Diagnostics, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Ewa Barg
- Department of Medical Science Foundation, Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland; (H.M.); (E.B.)
| | - Paweł Reichert
- Clinical Department of Trauma and Hand Surgery, Department of Trauma Surgery, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, 50-355 Wroclaw, Poland;
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Stasinopoulos D, Papadopoulou M. Is Lateral Elbow Tendinopathy an Appropriate Clinical Diagnostic Term When the Condition Is Persistent? J Clin Med 2022; 11:2290. [PMID: 35566416 DOI: 10.3390/jcm11092290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
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Chen Z, Baker NA. Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis. J Hand Ther 2021; 34:18-28. [PMID: 32284219 DOI: 10.1016/j.jht.2020.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Meta-analysis. INTRODUCTION Lateral 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 STUDY The 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. METHODS Five 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. RESULTS Eight 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. DISCUSSION A treatment program using eccentric strengthening of adequate intensity and duration seemed to be most effective for treating lateral elbow tendinopathy. CONCLUSIONS The 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.
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Affiliation(s)
- Zhiqing Chen
- Occupational Therapy Department, Singapore General Hospital, Singapore, Singapore; Department of Occupational Therapy, Tufts University, Medford, MA, USA.
| | - Nancy A Baker
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
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Stasinopoulos D. Comments on the article comparing radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. J Med Ultrason (2001) 2021; 48:365-6. [PMID: 33871755 DOI: 10.1007/s10396-021-01087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/17/2021] [Indexed: 11/27/2022]
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Eraslan L, Yuce D, Erbilici A, Baltaci G. Response to the letter to the editor: Comment on "Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis?". Knee Surg Sports Traumatol Arthrosc 2021; 29:1008-1010. [PMID: 30900031 DOI: 10.1007/s00167-019-05454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Leyla Eraslan
- Department of Physiotherapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, 06100, Ankara, Turkey.
| | - Deniz Yuce
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Gul Baltaci
- Department of Physiotherapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, 06100, Ankara, Turkey
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Herald J, Ashraf M, Sundar MS, Rajan DV. Lateral Epicondylitis-Narrative Review on Surgical Options for Recalcitrant Cases. Indian J Orthop 2021; 55:318-324. [PMID: 33927809 PMCID: PMC8046873 DOI: 10.1007/s43465-021-00364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/20/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Lateral epicondylitis or lateral elbow tendinopathy is a common condition which needs to be addressed appropriately. This condition usually responds well to non-operative treatment. However, an orthopaedic physician needs to be aware of the recalcitrant cases and equip surgical armamentarium to provide adequate care. METHODOLOGY The literature search was performed on PubMed, Medline and Google scholar using the keywords Tennis elbow, recalcitrant, thorntons technique, surgical options, for this narrative review. CONCLUSION This article focuses on the causes for recalcitrant tendinopathy and review of its surgical options.
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Affiliation(s)
| | - Munis Ashraf
- Ortho One Orthopaedic Speciality Center, Coimbatore, India
| | | | - David V. Rajan
- Ortho One Orthopaedic Speciality Center, Coimbatore, India
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Mansiz-Kaplan B, Pervane-Vural S, Celik OF, Genc H. Comparison of the effects of using non-steroidal anti-inflammatory drugs with or without kinesio taping on the radial nerve in lateral epicondylitis: A randomized-single blind study. Explore (NY) 2020; 17:327-333. [PMID: 32792245 DOI: 10.1016/j.explore.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is no knowledge about the effects of kinesio taping (KT) on the radial nerve in lateral epicondylitis. OBJECTIVE This study aimed to determine the effects of non-steroidal-anti-inflammatory drugs (NSAIDs) combined with KT on lateral epicondylitis using ultrasonographic findings. METHODS NSAID therapy was administered to the control group for 10 days, and the KT group additionally received KT three times a week for two weeks. Clinical and ultrasonographic evaluations were performed before treatment and at post-treatment at second, sixth and fourteenth weeks. The radial nerve cross sectional area and common extensor tendon thicknesses were measured using ultrasonography. RESULTS The study was completed with 40 patients in each group. Improvements in clinical parameters, common extensor tendon thickness, and cross sectional area values were significant in the KT group (p<0.01). CONCLUSIONS NSAID plus kinesio taping decrease pain intensity while improving functionality and ultrasonographic parameters, including common extensor tendon thickness and radial nerve cross sectional area; therefore, it may be an option treatment in lateral epicondylitis.
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Affiliation(s)
- Basak Mansiz-Kaplan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Secil Pervane-Vural
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Omer Faruk Celik
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hakan Genc
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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Affiliation(s)
- Dimitrios Stasinopoulos
- European University Cyprus,
Nicosia, Cyprus,Cyprus Musculoskeletal and Sports
Trauma Research Centre, Nicosia, Cyprus,Dimitrios Stasinopoulos, European
University Cyprus, 6, Diogenes Street, Engomi, PO Box 22006, 1516
Nicosia, Cyprus.
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Lian J, Mohamadi A, Chan JJ, Hanna P, Hemmati D, Lechtig A, Nazarian A. Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. Am J Sports Med 2019; 47:3019-3029. [PMID: 30380334 DOI: 10.1177/0363546518801914] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous treatment options have been proposed for enthesopathy of the extensor carpi radialis brevis (eECRB). PURPOSE To (1) compare the efficacy and safety of nonsurgical treatment options for eECRB described in randomized placebo-controlled trials at short-term, midterm, and long-term follow-up and (2) evaluate outcomes in patients receiving placebo. STUDY DESIGN Systematic review and meta-analysis. METHODS Following PRISMA guidelines, 4 electronic databases were searched for randomized placebo-controlled trials for eECRB. Studies reporting visual analog scale (VAS) for pain scores and/or grip strength were included. Random- or fixed-effects meta-analysis was employed to compare treatments with at least 2 eligible studies using the standardized mean difference and odds ratio. The study protocol was registered at PROSPERO (ID: CRD42018075009). RESULTS Thirty-six randomized placebo-controlled trials, evaluating 11 different treatment modalities, with a total of 2746 patients were included. At short-term follow-up, only local corticosteroid injection improved pain; however, it was associated with pain worse than placebo at long-term follow-up. At midterm follow-up, laser therapy and local botulinum toxin injection improved pain. At long-term follow-up, extracorporeal shock wave therapy provided pain relief. With regard to grip strength, only laser therapy showed better outcomes in comparison with placebo. While there was no difference among various treatments in the odds ratio of an adverse event, they all increased adverse events compared with placebo. In placebo-receiving patients, a sharp increase in the percentage of patients reporting mild pain or less was observed from 2% at short-term follow-up to 92% at midterm follow-up. CONCLUSION Most patients experienced pain resolution after receiving placebo within 4 weeks of follow-up. At best, all treatments provided only small pain relief while increasing the odds of adverse events. Therefore, if clinicians are inclined to provide a treatment for particular patients, they may consider a pain relief regimen for the first 4 weeks of symptom duration. Patient-specific factors should be considered when deciding on treatment or watchful waiting.
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Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jimmy J Chan
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Phillip Hanna
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Hemmati
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA
| | - Aron Lechtig
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Stasinopoulos D. Comments on "A Survey of Fellowship-Trained Upper Extremity Surgeons on Treatment of Lateral Epicondylitis". Hand (N Y) 2019; 14:698-700. [PMID: 30303689 PMCID: PMC6759975 DOI: 10.1177/1558944718794008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitrios Stasinopoulos
- European University Cyprus,
Nicosia, Cyprus,Dimitrios Stasinopoulos, European
University Cyprus, 6, Diogenes Street, Engomi, PO Box 22006, 1516
Nicosia, Cyprus.
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Giray E, Karali‐Bingul D, Akyuz G. The Effectiveness of Kinesiotaping, Sham Taping or Exercises Only in Lateral Epicondylitis Treatment: A Randomized Controlled Study. PM R 2019; 11:681-693. [DOI: 10.1002/pmrj.12067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Esra Giray
- Department of Physical Medicine and RehabilitationMarmara University School of Medicine Istanbul Turkey
| | - Duygu Karali‐Bingul
- Department of Physical Medicine and RehabilitationMarmara University School of Medicine Istanbul Turkey
| | - Gulseren Akyuz
- Department of Physical Medicine and Rehabilitation and Division of Pain MedicineMarmara University School of Medicine Istanbul Turkey
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Stasinopoulos D. Comments on the article 'Tennis elbow'. Shoulder Elbow 2019; 11:71. [PMID: 30719100 PMCID: PMC6348583 DOI: 10.1177/1758573218812217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitrios Stasinopoulos
- Physiotherapy Program, Department Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus,Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTREC), Nicosia, Cyprus,Stasinopoulos Dimitrios, Physiotherapy Program, Department Health Sciences, School of Sciences, European University of Cyprus, 6, Diogenes Str. Engomi, 1516 Nicosia, Cyprus.
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Mamais I, Papadopoulos K, Lamnisos D, Stasinopoulos D. Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review. Laser Ther 2018; 27:174-186. [PMID: 32158063 PMCID: PMC7034252 DOI: 10.5978/islsm.27_18-or-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE 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. METHODS 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). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Konstantinos Papadopoulos
- Department of London Sports Institute, Science and Technology School, Middlesex University of London
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Demetrios Stasinopoulos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
- Director of Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTREC)
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Alvim DT, Ferreira AS. Pragmatic Combinations of Acupuncture Points for Lateral Epicondylalgia are Unreliable in the Physiotherapy Setting. J Acupunct Meridian Stud 2018; 11:367-374. [PMID: 30092365 DOI: 10.1016/j.jams.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 01/07/2023] Open
Abstract
This study describes the reliability of pragmatic combinations of acupuncture points for lateral epicondylalgia (LE) as prescribed by physiotherapists who were experts in acupuncture. Raters (n = 14; 33-59 years) independently prescribed acupuncture points for 30 simulated human patients with LE who were surveyed via a printed questionnaire. The frequency and cooccurrence of acupuncture points prescribed for patients with lateral epicondylitis were assessed. Absolute agreement and Light's kappa (κLight) with 95% confidence interval (CI) were used to quantify the interrater agreement. Raters prescribed 103 unique acupuncture points in different combinations with a median (min-max) of 5 (0-11) acupuncture points. The most prescribed acupuncture point was LI-11 (297 of 420; 71%), and the most common cooccurring acupuncture points were LI-11 and LI-4 (160 of 420; 38%). The absolute agreement for prescribing the acupuncture points ranged from 70% (point GB-20) to 0% (points LI-10, SP-6, LI-11, GB-34, LI-12, and LI-4). Point LR-3 showed the highest interrater reliability for prescribing the acupuncture points [κLight = 0.112, 95% CI = (0.055-0.194)], whereas point LI-4 showed the lowest reliability [κLight = -0.003, 95% CI = (-0.024 to 0.024)]. These findings suggest that pragmatic prescriptions of acupuncture points for LE are unreliable among physiotherapists who are experts in acupuncture. Explicit, high-level evidence-based rules for prescribing and teaching combinations of acupuncture points for LE are warranted.
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Affiliation(s)
- Danielle T Alvim
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Research Laboratory of Exercise Sciences, Physical Education Center Admiral Adalberto Nunes, Brazilian Navy, Av. Brasil, 10590, Penha, Rio de Janeiro, RJ, 21012-350, Brazil
| | - Arthur S Ferreira
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Salgado de Oliveira University, Rua Marechal Deodoro 263, Centro, Niterói, RJ, 24030-060, Brazil.
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Stasinopoulos D. Comments on the article "Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis?". Knee Surg Sports Traumatol Arthrosc 2018; 26:2547-8. [PMID: 29085982 DOI: 10.1007/s00167-017-4750-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
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Seo JB, Yoon SH, Lee JY, Kim JK, Yoo JS. What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy? Clin Orthop Surg 2018; 10:47-54. [PMID: 29564047 PMCID: PMC5851854 DOI: 10.4055/cios.2018.10.1.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/08/2017] [Indexed: 01/06/2023] Open
Abstract
Background A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography. Methods A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations. Results The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions. Conclusions This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Sung-Hyun Yoon
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Joon-Yeul Lee
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jun-Kyom Kim
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jae-Sung Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
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Stasinopoulos D. Comments on the Article “What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy?”: To the Editor. Clin Orthop Surg 2018; 10:269. [PMID: 29855629 PMCID: PMC5964279 DOI: 10.4055/cios.2018.10.2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dimitrios Stasinopoulos
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J Hand Ther 2017; 30:13-19. [PMID: 27823901 DOI: 10.1016/j.jht.2016.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN RCT. INTRODUCTION Lateral 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 STUDY To compare the effectiveness of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. METHODS A 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. RESULTS The 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). CONCLUSION The 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 EVIDENCE III.
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Affiliation(s)
- Dimitrios Stasinopoulos
- Department of Health Sciences, Physiotherapy Program, School of Sciences, European University Cyprus, Nicosia, Cyprus.
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Affiliation(s)
- Dimitrios Stasinopoulos
- European University of Cyprus, Nicosia, Cyprus,Dimitrios Stasinopoulos, European University of Cyprus, 6, Diogenes Str. Engomi, P.O. Box 22006, 1516, Nicosia, Cyprus.
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Buchanan KA, Maza M, Pérez-Vázquez CE, Yen TY, Kijowski R, Liu F, Radwin RG. Proximal forearm extensor muscle strain is reduced when driving nails using a shock-controlled hammer. Clin Biomech (Bristol, Avon) 2016; 38:22-8. [PMID: 27542101 DOI: 10.1016/j.clinbiomech.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 08/02/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Repetitive hammer use has been associated with strain and musculoskeletal injuries. This study investigated if using a shock-control hammer reduces forearm muscle strain by observing adverse physiological responses (i.e. inflammation and localized edema) after use. METHODS Three matched framing hammers were studied, including a wood-handle, steel-handle, and shock-control hammer. Fifty volunteers were randomly assigned to use one of these hammers at a fatiguing pace of one strike every second, to seat 20 nails in a wood beam. Magnetic resonance imaging was used to scan the forearm muscles for inflammation before the task, immediately after hammering, and one to two days after. Electromyogram signals were measured to estimate grip exertions and localized muscle fatigue. High-speed video was used to calculate the energy of nail strikes. FINDINGS While estimated grip force was similar across the three hammers, the shock-control hammer had 40% greater kinetic energy upon impact and markedly less proximal extensor muscle edema than the wood-handle and steel-handle hammers, immediately after use (p<.05). INTERPRETATION Less edema observed for the shock-control hammer suggests that isolating handle shock can mitigate strain in proximal forearm extensor muscles.
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Affiliation(s)
- Kimberly A Buchanan
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Maria Maza
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Thomas Y Yen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Fang Liu
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert G Radwin
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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Wegener RL, Brown T, O’Brien L. A randomized controlled trial of comparative effectiveness of elastic therapeutic tape, sham tape or eccentric exercises alone for lateral elbow tendinosis. Hand Therapy 2016. [DOI: 10.1177/1758998316656660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Lateral elbow tendinosis is a condition that is well known to cause difficult challenges for hand therapists due to its long-term recovery and morbidity. Elastic therapeutic tape is commonly used as a treatment modality, despite limited evidence. Methods A randomized controlled trial was conducted to evaluate the effectiveness of elastic therapeutic tape, in conjunction with eccentric exercises, in the treatment of lateral elbow tendinosis. Forty participants with this condition (12 men, 28 women) were randomly allocated to three groups: (i) elastic therapeutic tape and eccentric exercises, (ii) sham tape and eccentric exercises, and (iii) eccentric exercises alone. All groups received education on activity modification techniques. Interventions were undertaken over a 12-week period (four weekly sessions and four fortnightly sessions) and outcome measures were recorded at baseline, three months and six months post randomisation. Results At three and six months, improvements were made in all three groups as assessed with the Patient-Rated Tennis Elbow Evaluation, the Short Form 36, pain-free grip strength, and the Occupational Self Assessment. However, there were no statistically significant differences between groups in any of these measures. There were no significant side effects or symptom exacerbation with using the elastic therapeutic tape. Conclusions Whilst all groups improved on key outcomes, it is possible that exercise alone and/or natural recovery were responsible for improvements. It is positive to note that the use of elastic therapeutic tape was well tolerated by participants and not associated with any significant side effects or symptom exacerbation.
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Affiliation(s)
- Raewyn L Wegener
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, VIC, Australia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, VIC, Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, VIC, Australia
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Stasinopoulos D, Papadopoulos C, Antoniadou M, Nardi L. Greek adaptation and validation of the Patient-Rated Tennis Elbow Evaluation (PRTEE). J Hand Ther 2016; 28:286-90; quiz 291. [PMID: 26003013 DOI: 10.1016/j.jht.2014.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 11/30/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE OF THE STUDY To cross-culturally adapt and validate the Greek version of the Patient-Rated Tennis Elbow Evaluation (PRTEE-G) Questionnaire. METHODS Four bi-lingual translators were involved in the translation and cultural adaptation procedures. Eighty-two patients (61 women and 21 men) with Lateral Elbow Tendinopathy (LET) participated in the study. To establish test - retest reliability, the patients were asked to complete the PRTEE-G Questionnaire before and after the first physiotherapy treatment. Internal consistency of the translated instrument was measured using Cronbach 'alpha'. An intraclass correlation coefficient was used to assess the test - retest reliability of the PRTEE-G Questionnaire. Concurrent validity was measured by correlating the PRTEE-G Questionnaire scores with the Greek version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) scores using Pearson's correlation coefficient. RESULTS The Greek PRTEE questionnaire has acceptable internal consistency (Cronbach 'alpha' = 0.95), excellent test - retest reliability (ICC = 0.94) and demonstrates expected concurrent validity (r > 0.72). CONCLUSION The Greek version of PRTEE Questionnaire is a reliable and valid measure when administered to patients with LET.
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Affiliation(s)
- Dimitrios Stasinopoulos
- Physiotherapy Program, Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus.
| | - Costas Papadopoulos
- Physiotherapy Program, Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Maria Antoniadou
- Physiotherapy Program, Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Loutsia Nardi
- Physiotherapy Program, Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
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Wegener RL, Brown T, O’Brien L. The use of elastic therapeutic tape and eccentric exercises for lateral elbow tendinosis: a case series. Hand Therapy 2015. [DOI: 10.1177/1758998315580823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction ‘Lateral elbow tendinosis’ or ‘lateral elbow tendinopathy’ have been suggested to be more appropriate diagnostic terms instead of ‘lateral epicondylitis’ as the condition is degenerative rather than inflammatory. For this reason, it is important that interventions target this degeneration at the common extensor tendon. Methods A descriptive, retrospective review of a series of four patients with lateral elbow tendinosis was conducted to examine functional outcomes with the use of elastic therapeutic tape, eccentric exercises and activity modification techniques. Results All patients recorded improved changes in pain and grip strength within three months of treatment using elastic therapeutic tape, eccentric exercises and activity modification techniques. Conclusions There may be clinical benefit in the use of elastic therapeutic tape, in conjunction with eccentric exercises and activity modification techniques, for the treatment of lateral elbow tendinosis. More rigorous and comprehensive studies are recommended to further investigate this intervention.
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Affiliation(s)
- Raewyn L Wegener
- Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
| | - Ted Brown
- Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
| | - Lisa O’Brien
- Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
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Dones VC, Grimmer K, Thoirs K, Suarez CG, Luker J. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 2014; 14:10. [PMID: 24589069 PMCID: PMC4015882 DOI: 10.1186/1471-2342-14-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Abstract
Background Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Methods Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Results Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. Conclusions The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient’s condition.
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Affiliation(s)
- Valentin C Dones
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia.
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Dimitrios S, Pantelis M. Comparing Two Exercise Programmes for the Management of Lateral Elbow Tendinopathy (Tennis Elbow/Lateral Epicondylitis)—A Controlled Clinical Trial. ACTA ACUST UNITED AC 2013. [DOI: 10.11131/2013/100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stasinopoulos Dimitrios
- Program of Physiotherapy Department of Health Sciences, School of Sciences European University of Cyprus 6, Diogenes Str. Engomi, P.O. Box 22006, 1516, Nicosia, Cyprus
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Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BMA. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med 2013; 47:1112-9. [PMID: 23709519 DOI: 10.1136/bjsports-2012-091990] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Owing to the change in paradigm of the histological nature of epicondylitis, therapeutic modalities as exercises such as stretching and eccentric loading and mobilisation are considered for its treatment. OBJECTIVE To assess the evidence for effectiveness of exercise therapy and mobilisation techniques for both medial and lateral epicondylitis. METHODS Searches in PubMed, Embase, Cinahl and Pedro were performed to identify relevant randomised clinical trials (RCTs) and systematic reviews. Two reviewers independently extracted data and assessed the methodological quality. RESULTS One review and 12 RCTs, all studying lateral epicondylitis, were included. Different therapeutic regimes were evaluated: stretching, strengthening, concentric/eccentric exercises and manipulation of the cervical or thoracic spine, elbow or wrist. No statistical pooling of the results could be performed owing to heterogeneity of the included studies. Therefore, a best-evidence synthesis was used to summarise the results. Moderate evidence for the short-term effectiveness was found in favour of stretching plus strengthening exercises versus ultrasound plus friction massage. Moderate evidence for short-term and mid-term effectiveness was found for the manipulation of the cervical and thoracic spine as add-on therapy to concentric and eccentric stretching plus mobilisation of wrist and forearm. For all other interventions only limited, conflicting or no evidence was found. CONCLUSIONS Although not yet conclusive, these results support the belief that strength training decreases symptoms in tendinosis. The short-term analgesic effect of manipulation techniques may allow more vigorous stretching and strengthening exercises resulting in a better and faster recovery process of the affected tendon in lateral epicondylitis.
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Affiliation(s)
- Peter Hoogvliet
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC-University Medical Center Rotterdam, , Rotterdam, The Netherlands
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Lin MT, Chou LW, Chen HS, Kao MJ. Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies. Evid Based Complement Alternat Med 2012; 2012:142941. [PMID: 23243428 DOI: 10.1155/2012/142941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/14/2012] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis. Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs) due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin's technique. Pain intensity (measured with a numerical pain rating scale), pressure pain threshold (measured with a pressure algometer), and grasping strength (measured with a hand dynamometer) were assessed before, immediately after, and 3 months and 12 months after the treatment. Results. For every individual case, the pain intensity was significantly reduced (P < 0.01) and the pressure pain threshold and the grasping strength were significantly increased (P < 0.01) immediately after the treatment. This significant effectiveness lasts for at least one year. Conclusions. It is suggested that percutaneous soft tissue release can be used for treating chronic recurrent lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain.
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Abstract
Introduction The Patient-rated Tennis Elbow Evaluation (PRTEE) enables quantitative rating by the patient of pain and functional impairment associated with tennis elbow or lateral elbow tendinopathy. When used as an outcome measure in trials of therapies, a minimum clinically important difference (MCID) value is required to interpret trial outcomes. This study aimed to calculate the MCID for a sample of patients diagnosed with lateral elbow tendinopathy (LET). Methods The PRTEE was used as an outcome measure with participants in a trial of a novel therapy for LET. It was administered at baseline and after treatment, three weeks later. Score changes were compared with patient-rated global change scores using receiver operating curve analysis. MCID values were calculated for two different criteria of clinically important difference and the effects of baseline symptom severity on the MCID were investigated. Results Data were available from 57 participants, with PRTEE scores in the range 13–81/100. For clinical significance defined as ‘a little better’ the MCID for the total PRTEE score was 7/100 or 22% of baseline score. For clinical significance defined as ‘much better’ or ‘completely recovered’, the MCID was 11/100 or 37% of baseline score. The MCID value was higher for a subgroup with greater baseline severity. Conclusions Substantial changes in the PRTEE scores are required before they can be considered clinically significant. Clinically significant change varies according to the baseline score. The instrument may be less sensitive to change when used by people who are symptomatic in their non-dominant arm.
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Affiliation(s)
- Leon Poltawski
- Peninsula College of Medicine & Dentistry, Salmon Pool Lane, Exeter EX2 8GW, UK
| | - Tim Watson
- University of Hertfordshire, Hatfield, UK
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Abstract
Overuse related tendon pain is a significant problem in sport and can interfere with and, in some instances, end an athletic career. This article includes a consideration of the biology of tendon pain including a review of tendon anatomy and histopathology, risk factors for tendon pain, semantics of tendon pathology, and the pathogenesis of tendon pain. Evidence is presented to guide the physical therapist in clinical decision-making regarding the examination of and intervention strategies for athletes with tendon pain.
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Affiliation(s)
- Mark Reinking
- Saint Louis University, Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, 3437 Caroline Mall, Saint Louis, MO 63104, USA.
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Abstract
CLINICAL QUESTION What is the best treatment for tennis elbow? RESULTS Despite a wealth of research, there is no true consensus on the most efficacious management of tennis elbow especially for effective long-term outcomes. Corticosteroid injections do show large pain-relieving effects in the short term but are associated with risks of adverse events and long-term reoccurrence. Advice with a "wait and see" approach is recommended as the first-line treatment in primary care for most cases. In the medium term physiotherapy and or low-level laser therapy may be effective. IMPLEMENTATION Rule out alternative diagnosis. Onward referral may be indicated if the condition does not resolve after 12 months.
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Affiliation(s)
- Linda S Chesterton
- Arthritis research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, UK
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Shiri R, Viikari-juntura E. Lateral and medial epicondylitis: Role of occupational factors. Best Pract Res Clin Rheumatol 2011; 25:43-57. [DOI: 10.1016/j.berh.2011.01.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/24/2010] [Accepted: 01/25/2011] [Indexed: 11/23/2022]
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Jaén-Díaz JI, Cerezo-López E, López-de Castro F, Mata-Castrillo M, Barceló-Galíndez JP, De la Fuente J, Balius-Mata R. Sonographic findings for the common extensor tendon of the elbow in the general population. J Ultrasound Med 2010; 29:1717-1724. [PMID: 21098843 DOI: 10.7863/jum.2010.29.12.1717] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To describe structural characteristics and sonographic alterations of the common extensor tendon (CET). METHODS In 240 patients, we determined the body mass index; sonographic CET thickness, morphologic characteristics, and alterations; and color Doppler measurements of the epicondylar artery width and peak systolic velocity. Age, sex, epicondylalgia history, activities (work, sports, and hobbies), and dominant and nondominant elbows were noted. RESULTS The CET was thicker in the dominant elbow (4.77 versus 4.61 mm [P = .023]), male patients (dominant, 5.09 versus 4.46 mm [P < .001]; nondominant, 5.00 versus 4.21 mm [P < .001]), patients involved in risk activities (dominant, 5.21 versus 4.70 mm [P < .001]; nondominant, 5.12 versus 4.53 mm [P < .001]), and those with a history of epicondylalgia (right, 5.27 versus 4.70 mm [P < .001]; left, 4.86 versus 4.60 mm [P = .316]). Thickness correlated weakly with age (dominant, r = 0.284; nondominant, r = 0.215) and moderately with weight (dominant, r = 0.492; nondominant, r = 0.502). The mean epicondylar artery diameter was 1.35 mm (SD, 0.96 mm); mean peak velocity, 13.01 cm/s (SD, 4.90 cm/s). Morphologic abnormalities were found in 79.5% of patients with a history of epicondylalgia; 7.7% with no history had abnormalities; and 55.9% with abnormalities but no history were older than 55 years. Bone spurs (49.2% versus 16.4% [P < .001]), tendon calcifications (21.5% versus 3.9% [P < .001]), and bone cortex abnormalities (12.3% versus 1.7% [P < .001]) were found more often in non-normal elbows; 79.4% of bone spurs in normal elbows occurred in patients older than 55 years. CONCLUSIONS Mild sonographic alterations in the CET and bone spurs should be considered with caution when assessing epicondylar pain, especially in patients older than 55 years and those with a history of epicondylalgia.
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Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med 2009; 43:471-81. [PMID: 19028733 PMCID: PMC2755040 DOI: 10.1136/bjsm.2008.052761] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE). DESIGN Systematic review. DATA SOURCES Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine. SEARCH STRATEGY names and descriptors of the therapies and LE. STUDY SELECTION All human studies assessing the four therapies for LE. MAIN RESULTS Results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood and one platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant (p<0.05) improvement in visual analogue scale primary outcome pain score measures and disease-specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen's d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size. CONCLUSIONS There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies.
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Affiliation(s)
- D Rabago
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, 777 S. Mills St, Madison WI 53715, USA.
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Nayak SR, Ramanathan L, Krishnamurthy A, Prabhu LV, Madhyastha S, Potu BK, Ranade AV. Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis. Surg Radiol Anat 2009; 32:207-11. [DOI: 10.1007/s00276-009-0526-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 05/27/2009] [Indexed: 11/29/2022]
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Stasinopoulos D, Stasinopoulos I, Pantelis M, Stasinopoulou K. 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. Photomed Laser Surg 2009; 27:513-20. [DOI: 10.1089/pho.2008.2281] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dimitrios Stasinopoulos
- Rheumatology and Rehabilitation Centre, Athens, Greece
- School of Health and Human Sciences, Leeds Metropolitan University, Leeds, U.K
- Department of Physiotherapy, TEI Lamias, Lamia, Greece
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Joensen J, Couppe C, Bjordal JM. Increased palpation tenderness and muscle strength deficit in the prediction of tendon hypertrophy in symptomatic unilateral shoulder tendinopathy: an ultrasonographic study. Physiotherapy 2009; 95:83-93. [DOI: 10.1016/j.physio.2008.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
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Hendey GW, Sacchetti A. New Form of Tendinopathy Discovered at Scientific Assembly. Ann Emerg Med 2009; 53:549. [DOI: 10.1016/j.annemergmed.2008.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 11/13/2008] [Accepted: 11/14/2008] [Indexed: 11/30/2022]
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Juul-Kristensen B, Lund H, Hansen K, Christensen H, Danneskiold-Samsøe B, Bliddal H. Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: a cross-sectional study. J Shoulder Elbow Surg 2007; 17:72S-81S. [PMID: 18036844 DOI: 10.1016/j.jse.2007.07.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 07/06/2007] [Indexed: 02/01/2023]
Abstract
Two groups of women, 15 patients with lateral epicondylitis and 21 healthy controls, were studied to compare proprioception in the elbows and knees between the groups. Outcome measures were absolute error and variable error for joint position sense and for threshold to detection of a passive movement. Both absolute error and variable error of threshold to detection of a passive movement were greater in the lateral epicondylitis-diagnosed elbows than in the controls' elbows (lateral epicondylitis, 1.8 degrees vs controls 1.1 degrees, P = .026; lateral epicondylitis, 0.8 degrees vs controls 0.3 degrees, P = .015), and there was a tendency toward a greater absolute error of joint position sense compared with the control elbows (lateral epicondylitis, 8.2 degrees vs controls, 5.6 degrees; P = .078). Absolute error of joint position sense was greater in the elbows than in the knees of the lateral epicondylitis patients, but no group differences were found for knees. Proprioception seems, therefore, to be poorer in elbows with lateral epicondylitis elbows than in the controls' elbows. This needs to be taken into consideration in the management of lateral epicondylitis.
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Affiliation(s)
- Birgit Juul-Kristensen
- Department of Orthopaedic Medicine and Rehabilitation, University Hospital of Copenhagen, Copenhagen, Denmark.
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