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Karjalainen T, Buchbinder R. Is it time to reconsider the indications for surgery in patients with tennis elbow? Bone Joint J 2023; 105-B:109-111. [PMID: 36722063 PMCID: PMC9869705 DOI: 10.1302/0301-620x.105b2.bjj-2022-0883.r1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tennis elbow (lateral epicondylitis or lateral elbow tendinopathy) is a self-limiting condition in most patients. Surgery is often offered to patients who fail to improve with conservative treatment. However, there is no evidence to support the superiority of surgery over continued nonoperative care or no treatment. New evidence also suggests that the prognosis of tennis elbow is not influenced by the duration of symptoms, and that there is a 50% probability of recovery every three to four months. This finding challenges the belief that failed nonoperative care is an indication for surgery. In this annotation, we discuss the clinical and research implications of the benign clinical course of tennis elbow.Cite this article: Bone Joint J 2023;105-B(2):109-111.
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Affiliation(s)
- Teemu Karjalainen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Correspondence should be sent to Teemu Karjalainen. E-mail:
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Amako M, Arai T, Iba K, Ikeda M, Ikegami H, Imada H, Kanamori A, Namba J, Nishiura Y, Okazaki M, Soejima O, Tanaka T, Tatebe M, Yoshikawa Y, Suzuki K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - Secondary publication. J Orthop Sci 2022; 27:514-532. [PMID: 34922804 DOI: 10.1016/j.jos.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The guidelines presented herein provide recommendations for the management of patients with lateral epicondylitis of the humerus. These recommendations are endorsed by the Japanese Orthopaedic Association (JOA) and Japan Elbow Society. METHODS The JOA lateral epicondylitis guideline committee revised the previous guidelines on the basis of the "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which emphasized the importance of the balance between benefit and harm, and proposed a desirable method for preparing clinical guidelines in Japan. These guidelines consist of 11 clinical questions (CQs), 9 background questions (BQs), and 3 future research questions (FRQs). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS The committee proposed recommendations for each CQ by determining the level of evidence and assessing the consensus rate. Physical therapy was the best recommendation with the best evidence. The BQs and FRQs were answered by collecting evidence based on the literature. CONCLUSIONS The guidelines presented herein were reviewed systematically, and recommendations were proposed for each CQ. These guidelines are expected to be widely used not only by surgeons or physicians but also by other healthcare providers, such as nurses, therapists, and athletic trainers.
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Affiliation(s)
- Masatoshi Amako
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Rehabilitation Medicine, National Defense Medical College Hospital, Japan.
| | - Takeshi Arai
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Japan
| | - Kousuke Iba
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Masayoshi Ikeda
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Shonan Central Hospital, Japan
| | - Hiroyasu Ikegami
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Toho University, Japan
| | - Hideaki Imada
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Higashihiroshima Medical Center, Japan
| | - Akihiro Kanamori
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Tsukuba University Hospital, Japan
| | - Jiro Namba
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, Japan
| | - Yasumasa Nishiura
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Tsuchiura Clinical Education and Training Center, Tsukuba University Hospital, Japan
| | - Masato Okazaki
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopedic Surgery, Ogikubo Hospital, Japan
| | - Osamu Soejima
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, Japan
| | - Toshikazu Tanaka
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Kikkoman General Hospital, Japan
| | - Masahiro Tatebe
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Hand Surgery, Nagoya University, Japan
| | - Yasuhiro Yoshikawa
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Komazawa Hospital, Japan
| | - Katsuji Suzuki
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Okazaki Medical Center, Fujita Medical University, Japan
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Ikonen J, Lähdeoja T, Ardern CL, Buchbinder R, Reito A, Karjalainen T. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2022; 480:647-660. [PMID: 34874323 PMCID: PMC8923574 DOI: 10.1097/corr.0000000000002058] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tennis elbow is a common painful enthesopathy of the lateral elbow that limits upper limb function and frequently results in lost time at work. Surgeons often recommend surgery if symptoms persist despite nonsurgical management, but operations for tennis elbow are inconsistent in their efficacy, and what we know about those operations often derives from observational studies that assume the condition does not continue to improve over time. This assumption is largely untested, and it may not be true; meta-analyzing results from the control arms of tennis elbow studies can help us to evaluate this premise, but to our knowledge, this has not been done. QUESTIONS/PURPOSES The aims of this systematic review were to describe the course of (1) global improvement, (2) pain, and (3) disability in participants who received no active treatment (placebo or no treatment) in published randomized controlled trials (RCTs) on tennis elbow. We also assessed (4) whether the duration of symptoms or placebo effect is associated with differences in symptom trajectories. METHODS We searched MEDLINE, Embase, and CENTRAL from database inception to August 12, 2019, for trials including participants with tennis elbow and a placebo or a no-treatment arm and a minimum follow-up duration of 6 months. There were no language restrictions or exclusion criteria. We extracted global improvement, pain, and disability outcomes. We used the Cochrane Risk of Bias tool to assess the risk of bias of included trials. To estimate the typical course of tennis elbow without active treatment, we pooled global improvement (the proportion of participants who reported feeling much better or completely recovered), mean pain, and mean disability using baseline, 1-month, 3-month, 6-month, and 12-month follow-up data. We transformed pain and disability data from the original papers so that at each timepoint the relevant outcome was expressed as change relative to baseline to account for different baseline values. We used meta-regression to assess whether the placebo effect or duration of symptoms before enrollment was associated with differences in symptom trajectories. We included 24 trials with 1085 participants who received no active treatment. RESULTS The number of patients who were not improved decreased exponentially over time. The half-life of global improvement was between 2.5 and 3 months (that is, every 2.5 to 3 months, 50% of the remaining symptomatic patients reported complete recovery or greatly improved symptoms). At 1 year, 89% (189 of 213; 95% CI 80% to 97%) of patients experienced global improvement. The mean pain and disability followed a similar pattern, halving every 3 to 4 months. Eighty-eight percent of pain (95% CI 70% to 100%) and 85% of disability (95% CI 60% to 100%) had resolved by 1 year. The mean duration of symptoms before trial enrollment was not associated with differences in symptom trajectories. The trajectories of the no-treatment and placebo arms were similar, indicating that the placebo effect of the studied active treatments likely is negligible. CONCLUSION Based on the placebo or no-treatment control arms of randomized trials, about 90% of people with untreated tennis elbow achieve symptom resolution at 1 year. The probability of resolution appears to remain constant throughout the first year of follow-up and does not depend on previous symptom duration, undermining the rationale that surgery is appropriate if symptoms persist beyond a certain point of time. We recommend that clinicians inform people who are frustrated with persisting symptoms that this is not a cause for apprehension, given that spontaneous improvement is about as likely during the subsequent few months as it was early after the symptoms first appeared. Because of the high likelihood of spontaneous recovery, any active intervention needs to be justified by high levels of early efficacy and little or no risk to outperform watchful waiting. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Joona Ikonen
- Department of Hand Surgery, Turku University Hospital, Turku, Finland
| | - Tuomas Lähdeoja
- Finnish Centre for Evidence-Based Orthopedics, Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Clare L. Ardern
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Aleksi Reito
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Teemu Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
- Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Ibrahim NH, El Tanawy RM, Mostafa AFS, Mahmoud MF. Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation. Egypt Rheumatol Rehabil 2021. [DOI: 10.1186/s43166-021-00081-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lateral epicondylitis is one of the commonly noticed disorders of the arm described by agony focused over lateral epicondyle which is the site of wrist extensors origin. The purpose of this work was to compare the efficiency of extracorporeal shock wave therapy and local corticoid injection in management of lateral epicondylitis both clinically and ultrasonographically as well as to assess the role of ultrasound in diagnosis and follow-up of lateral epicondylitis. This study was performed on 30 athletes diagnosed as lateral epicondylitis.
Results
Both corticosteroid injection and shock wave treatment showed a highly significant effectiveness on pain by visual analog scale (VAS). A highly significant difference between before treatment and after 2 as well as 4 weeks of treatment regarding the functional disability parameters as patient-rated tennis elbow evaluation (PRTEE) and quick disabilities of the arm, shoulder, and hand (DASH) was found. Likewise, a statistically significant improvement in favor of shock wave therapy group after 2 weeks was found, inversely insignificant difference after 8 and 12 weeks regarding to VAS occurred. Both PRTEE and Quick DASH test showed a statistically significant difference among groups through all follow-up period.
There was a statistically insignificant difference among the studied groups according to ultrasound (US) changes in the form of focal areas of hypo-echogenicity through follow-up periods. A significant improvement in favor of ESWT group is detected among the studied groups regarding tendon thickening in ultrasonography before treatment and after 2 and 4 weeks. However, the difference was insignificant after 8 and 12 weeks.
Conclusions
Both corticosteroid local injection and shock wave therapy are helpful and effective for lateral epicondylitis treatment. However, a shock wave therapy revealed better improvement on long-term clinical and ultrasonogrphic follow-up than corticosteroid injection. Musculoskeletal ultrasound represents a helpful diagnostic and follow-up tool for lateral epicondylitis.
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Yoon SY, Kim YW, Shin IS, Moon HI, Lee SC. Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2020; 478:2324-39. [PMID: 32332245 DOI: 10.1097/CORR.0000000000001246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used in various musculoskeletal disorders, including lateral epicondylitis. However, in 2005, a meta-analysis of randomized controlled trials showed that ESWT provides minimal or no benefit in terms of pain and function in patients with lateral epicondylitis. Since the review, several randomized controlled trials including different types of ESWT such as radial type for lateral epicondylitis have been published. Investigations of the effect modifiers such as symptom and follow-up duration on the effects of ESWT on lateral epicondylitis have not been performed. QUESTIONS/PURPOSES (1) Does ESWT reduce pain and improve grip strength in patients with lateral epicondylitis? (2) Which type of ESWT, radial or focused, is more effective? (3) Is the duration of symptoms associated with the efficacy of ESWT for lateral epicondylitis? (4) Do improvements in pain scores remain in patients with longer follow-up? METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to July 2019 for articles published in English or Korean. Studies were included if patient allocation was randomized, the sample was composed of patients with lateral epicondylitis, interventions were ESWT (focused or radial), comparison group only received sham stimulation or no additional treatment, and the study outcome was pain intensity or grip strength. The quality of the evidence was assessed using the Cochrane risk of bias tool. Twelve studies including 1104 participants fulfilled the inclusion criteria and were included in the meta-analysis. The mean difference for pain reduction and improvement in grip strength was calculated. RESULTS The meta-analysis showed no clinically important difference in the VAS score (2.48 ± 7.55 versus 3.17 ± 9.78, mean difference -0.68 [95% confidence interval -1.17 to -0.19]; p = 0.006) and grip strength (38.02 ± 70.56 versus 34.85 ± 108.26, mean difference 3.33 [95% CI 0.93 to 5.73]; p = 0.007) after ESWT relative to the comparison group's score. Even though radial ESWT showed more improvement than focused, the mean difference for VAS did not exceed the minimal clinically important differences threshold. There were no clinically important effects on the VAS scores of patients with lateral epicondylitis (2.78 ± 5.57 versus 3.92 ± 6.29, mean difference -1.13 [95% CI -1.84 to -0.42]; p = 0.002) and focused ESWT did not improve pain in patients with lateral epicondylitis. In the subgroup analysis, ESWT was effective in patients with a symptom duration of more than 6 months (2.28 ± 8.48 versus 3.31 ± 11.81, mean difference -0.95 [95% CI -1.75 to -0.15]; p = 0.02) but not for those with shorter symptom duration. The effects did not last beyond 24 weeks (2.52 ± 9.19 versus 3.34 ± 5.93, mean difference -0.82 [95% CI -2.57 to 0.93]; p = 0.36). CONCLUSIONS ESWT did not show clinically important improvement in pain reduction and grip strength. Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. Further studies are needed to determine the appropriate protocol and elucidate the effects according to the intervention type and specific disease condition. LEVEL OF EVIDENCE Level I, therapeutic study.
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Zheng C, Zeng D, Chen J, Liu S, Li J, Ruan Z, Liang W. Effectiveness of extracorporeal shock wave therapy in patients with tennis elbow: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21189. [PMID: 32791694 PMCID: PMC7387053 DOI: 10.1097/md.0000000000021189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the effectiveness of Extracorporeal Shock Wave (ECSW) in the treatment of lateral epicondylitis (LE) of humerus. HYPOTHESIS ECSW therapy in people with LE effectively reduces the pain and gains functional rehabilitation. MATERIALS/METHODS Databases of PubMed, EMBASE, Web of Science and the Cochrane Library from inception to April 2020 was searched to identify all relevant RCTs comparing ECSW therapy with any other conservative treatment, including injection and local anesthetic versus placebo or control in patients aged 18 with LE. The primary outcome is the mean overall pain score at 12 weeks after treatment. Another secondary outcome mainly included Thomsen test, 50% pain reduction, grip strength and adverse effect at 12 weeks after treatment. RESULTS Nine studies were included in the meta-analysis. Compared with the placebo group, ECSW cannot significantly reduce the pain score (mean deviation [MD] = -4.23, 95% confidence interval [CI]: -8.78 to 0.32, P = .07), but make more people acquire 50% pain reduction (MD = 1.38, 95% CI: 1.09 to 1.75, P = .008). There was no significant difference between ECSW and control in decreasing the pain score of Thomsen test (MD = -3.22, 95% CI: -14.06 to 7.62, P = .56). ECSW was more effective in Grip strength as compared with control at 12 weeks-3 months (MD = 3.52, 95% CI: 2.43 to 4.60, P < .00001) CONCLUSIONS:: Results suggested that ECSW cannot effectively reduce the mean overall pain, but it showed more people acquire 50% pain reduction and might be a better option for the treatment of LE. Because of study limitations, additional high level of evidence, more rigorously designed large-samples and high-quality randomized controlled trials are needed to guide clinical practice.
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Affiliation(s)
- Chenxiao Zheng
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Dongjie Zeng
- Graduate School of Guangzhou University of Traditional Chinese Medicine, Guangzhou
| | - Jiayi Chen
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Sijing Liu
- Department of Orthopaedics and Traumatology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jianyi Li
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Zhaohai Ruan
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
| | - Wusheng Liang
- Department of Orthopaedics and Traumatology, Zhongshan Hospital of traditional Chinese Medicine, Zhongshan
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Vahdatpour B, Taheri P, Abasi F. Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior? Galen Med J 2020; 9:e1791. [PMID: 34466592 PMCID: PMC8343590 DOI: 10.31661/gmj.v9i0.1791] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/24/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background Lateral epicondylitis (LE) is a common musculoskeletal disorder. Although varieties of modalities have been proposed for its treatment, the outcomes are uncertain, and the responses would diminish early by the time passage. The current study was aimed to assess the efficacy of extracorporeal shock wave therapy (ESWT) merely and in combination with topical corticosteroid for the treatment of LE. Materials and Methods In the current double-blinded randomized clinical trial, 70 patients with the diagnosis of LE were randomly allocated to two intervention groups of ESWT merely (control group) (n=35) or ESWT plus topical corticosteroid (intervention group) (n=35). The ESWT was performed weekly for three weeks. Topical clobetasol was utilized within 30 minutes before ESWT for the intervention group, while Vaseline gel was used in a similar pattern for controls. Pain based on a visual analog scale (VAS), handgrip strength (HGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) were assessed for the patients before the intervention, following the intervention cessation, and within two months post-intervention. Results Statistically significant improvement was found following both interventions in terms of pain, HGS, and function (P-value<0.001 for all), while the comparison of the two interventions, ESWT, merely versus in combination with topical clobetasol, revealed insignificant difference (P-value>0.05). Conclusion The findings of our study are in favor of ESWT use either merely or in combination with topical steroids for the treatment of LE, while the comparison of the two techniques revealed insignificant differences.
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Affiliation(s)
- Babak Vahdatpour
- Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Taheri
- Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Abasi
- Department of Physical Therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
- Correspondence to: Fatemeh Abasi, Department Physical therapy and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran Telephone Number: +989376445992 Email Address:
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Lutter C, Schöffl V, Hotfiel T, Schmitz C, Milz S, Strohm P. Radial extracorporeal shock wave therapy in flexor tendon pathology of the hand: A feasibility study. Technol Health Care 2019; 28:77-83. [PMID: 31282446 DOI: 10.3233/thc-191654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/22/2022]
Abstract
BACKGROUND Radial extracorporeal shock wave therapy (rESWT) is an effective and safe non-invasive therapeutic option for various musculoskeletal pathologies. However, data on possible application of radial extracorporeal shock waves (rESWs) on soft tissue components of fingers is still scarce. OBJECTIVE We now aimed to analyze the feasibility of applying rESWs to human fingers ex vivo. METHODS Fresh frozen human cadaveric fingers were exposed to rESWs of varying energy density. The penetration of the rESWs into the soft tissue was determined using pressure sensitive Fuji films that were placed underneath the flexor tendons and other soft tissue components at the proximal phalanx. Then, rESWs were applied and activation of the Fuji film was recorded. Software based image analysis was performed on all films treated with rESWT under ultrasound gel. RESULTS Penetration of the rESWs through the soft tissue was detected in all settings. Increasing energy density of the rESWs resulted in increasing film activation. Image analysis of films used under ultrasound showed a significant difference among the groups. CONCLUSION The results of this study demonstrate that rESWs can penetrate soft tissues including the flexor tendons of human cadaveric fingers. rESWT should be considered as a valuable potential therapeutic option of different finger pathologies. Further studies focusing on the clinical application of rESWT for finger pathologies are required.
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Affiliation(s)
- Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany.,Department of Orthopedics and Trauma Surgery, Sozialstiftung Bamberg, Germany
| | - Volker Schöffl
- Department of Orthopedics and Trauma Surgery, Sozialstiftung Bamberg, Germany.,Department of Trauma Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Germany.,Orthopedic Surgeon, Department of Orthopedic, Trauma and Hand Surgery, Klinikum Osnabrück, Germany
| | - Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Institute of Anatomy, Ludwig-Maximilian University Munich, Germany
| | - Stefan Milz
- Department of Anatomy II, Ludwig-Maximilian University Munich, Germany
| | - Peter Strohm
- Department of Orthopedics and Trauma Surgery, Sozialstiftung Bamberg, Germany
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Marwaha V, Pawah AK, Muthukrishnan J, Kumar KVSH. Combined steroid and lignocaine injection in resistant cases of tennis elbow: A prospective, interventional study from India. J Family Med Prim Care 2018; 6:498-501. [PMID: 29416996 PMCID: PMC5787943 DOI: 10.4103/2249-4863.222032] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tennis elbow or lateral epicondylitis is a chronic, painful condition and is often resistant to conventional therapy. We evaluated the benefits of a combined steroid and lignocaine injection in resistant cases of tennis elbow. Materials and Methods In this prospective, interventional study, we included chronic lateral epicondylitis patients resistant to analgesics and physiotherapy. The pain was assessed by visual analog scale (VAS), and we included patients with a baseline VAS >4. All patients were given local infiltration at the painful site with methylprednisolone (1 ml) and lignocaine (1 ml) by the peppering technique. The primary outcome was the change in VAS from the baseline at the end of 7 and 28 days. The improvement is classified as good, moderate, or mild based on the reduction in VAS score by 3, 2, 1, respectively. Descriptive statistics and appropriate tests were used to analyze the results. Results The study population (n = 63; male: female - 33:30) had a mean age of 36.2 ± 4.5 years and disease duration of 17.4 ± 5.8 weeks. After 1 week, 55 patients showed good improvement, three patients showed moderate improvement, two patients showed mild improvement, and three patients had no improvement. The improvement persisted till 28 days in all the patients and one patient who had not improved after 7 days did not report for 28 days follow-up. Conclusion Local infiltration with steroids and lignocaine is a useful modality of therapy for tennis elbow, especially in patients where ultrasonic therapy and conservative measures have failed.
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Affiliation(s)
- Vishal Marwaha
- Department of Rheumatology, Amrita University, School of Medicine, Kochi, Kerala, India
| | - A K Pawah
- Department of Medicine, Mayo Institute of Medical Science, Barabanki, Uttar Pradesh, India
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Császár NB, Angstman NB, Milz S, Sprecher CM, Kobel P, Farhat M, Furia JP, Schmitz C. Radial Shock Wave Devices Generate Cavitation. PLoS One 2015; 10:e0140541. [PMID: 26509573 DOI: 10.1371/journal.pone.0140541] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conflicting reports in the literature have raised the question whether radial extracorporeal shock wave therapy (rESWT) devices and vibrating massage devices have similar energy signatures and, hence, cause similar bioeffects in treated tissues. METHODS AND FINDINGS We used laser fiber optic probe hydrophone (FOPH) measurements, high-speed imaging and x-ray film analysis to compare fundamental elements of the energy signatures of two rESWT devices (Swiss DolorClast; Electro Medical Systems, Nyon, Switzerland; D-Actor 200; Storz Medical, Tägerwillen, Switzerland) and a vibrating massage device (Vibracare; G5/General Physiotherapy, Inc., Earth City, MO, USA). To assert potential bioeffects of these treatment modalities we investigated the influence of rESWT and vibrating massage devices on locomotion ability of Caenorhabditis elegans (C. elegans) worms. RESULTS FOPH measurements demonstrated that both rESWT devices generated acoustic waves with comparable pressure and energy flux density. Furthermore, both rESWT devices generated cavitation as evidenced by high-speed imaging and caused mechanical damage on the surface of x-ray film. The vibrating massage device did not show any of these characteristics. Moreover, locomotion ability of C. elegans was statistically significantly impaired after exposure to radial extracorporeal shock waves but was unaffected after exposure of worms to the vibrating massage device. CONCLUSIONS The results of the present study indicate that both energy signature and bioeffects of rESWT devices are fundamentally different from those of vibrating massage devices. CLINICAL RELEVANCE Prior ESWT studies have shown that tissues treated with sufficient quantities of acoustic sound waves undergo cavitation build-up, mechanotransduction, and ultimately, a biological alteration that "kick-starts" the healing response. Due to their different treatment indications and contra-indications rESWT devices cannot be equated to vibrating massage devices and should be used with due caution in clinical practice.
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Thiele S, Thiele R, Gerdesmeyer L. Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy. Int J Surg 2015; 24:165-70. [PMID: 26455532 DOI: 10.1016/j.ijsu.2015.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 06/16/2015] [Revised: 08/29/2015] [Accepted: 09/09/2015] [Indexed: 12/30/2022]
Abstract
Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy.
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Affiliation(s)
- S Thiele
- IZS - Berlin, Internationales Stoßwellenzentrum Berlin, Kurfürstendamm 61, D-10707, Berlin, Germany.
| | - R Thiele
- IZS - Berlin, Internationales Stoßwellenzentrum Berlin, Kurfürstendamm 61, D-10707, Berlin, Germany
| | - L Gerdesmeyer
- Dept. Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, D-24105 Kiel, Germany
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Trentini R, Mangano T, Repetto I, Cerruti P, Kuqi E, Trompetto C, Franchin F. Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis. Musculoskelet Surg 2015; 99 Suppl 1:S91-S97. [PMID: 25957547 DOI: 10.1007/s12306-015-0361-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature. MATERIALS AND METHODS In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated. RESULTS A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %. CONCLUSIONS Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.
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Affiliation(s)
- R Trentini
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - T Mangano
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy.
| | - I Repetto
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - P Cerruti
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - E Kuqi
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
| | - C Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, School of Medicine, University of Genova, Genoa, Italy
| | - F Franchin
- Department of Orthopaedics and Traumatology, School of Medicine, University of Genova, Padiglione 40, Largo Rosanna Benzi 10, 10132, Genoa, Italy
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Weber C, Thai V, Neuheuser K, Groover K, Christ O. Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis. BMC Musculoskelet Disord 2015; 16:223. [PMID: 26303397 PMCID: PMC4549077 DOI: 10.1186/s12891-015-0665-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/10/2015] [Indexed: 01/27/2023] Open
Abstract
Background Physical therapy for the treatment of lateral epicondylitis (LE) often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), low frequency electrical stimulation or pulsed electromagnetic fields. Still, only ECSWT and LLLT have been meta-analytically researched. Methods PUBMED, EMBASE and Cochrane database were systematically searched for randomized controlled trials (RCTs). Methodological quality of each study was rated with an adapted version of the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pain reduction (the difference between treatment and control groups at the end of trials) and pain relief (the change in pain from baseline to the end of trials) were calculated with mean differences (MD) and 95 %-Confidence intervals (95 % CI). Results One thousand one hundred thirty eight studies were identified. One thousand seventy of those did not meet inclusion criteria. After full articles were retrieved 16 studies met inclusion criteria and 12 studies reported comparable outcome variables. Analyses were conducted for overall pain relief, pain relief during maximum handgrip strength tests, and maximum handgrip strength. There were not enough studies to conduct an analysis of physical function or other outcome variables. Conclusions Differences between treatment and control groups were larger than differences between treatments. Control group gains were 50 to 66 % as high as treatment group gains. Still, only treatment groups with their combination of therapy specific and non-therapy specific factors reliably met criteria for clinical relevance. Results are discussed with respect to stability and their potential meaning for the use of non-therapy specific agents to optimize patients’ gain. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0665-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Weber
- Department of Psychology, TU Darmstadt, Alexanderstrasse 10, 64287, Darmstadt, Germany. .,DMB Die MPU Berater GmbH, Bad Nauheimerstrasse 4, 64289, Darmstadt, Germany.
| | - Veronika Thai
- Justizvollzugsanstalt Darmstadt, Marienburgstrasse 74, 64297, Darmstadt, Germany.
| | - Katrin Neuheuser
- Department of Psychology, TU Darmstadt, Alexanderstrasse 10, 64287, Darmstadt, Germany. .,DMB Die MPU Berater GmbH, Bad Nauheimerstrasse 4, 64289, Darmstadt, Germany.
| | - Katharina Groover
- Department of Psychology, TU Darmstadt, Alexanderstrasse 10, 64287, Darmstadt, Germany. .,DMB Die MPU Berater GmbH, Bad Nauheimerstrasse 4, 64289, Darmstadt, Germany.
| | - Oliver Christ
- School of Applied Psychology, University of Applied Sciences and Arts NortherwesternSwitzerland, Riggenbachstrasse 16, 4600, Olten, Switzerland.
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Sayegh ET, Strauch RJ. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin Orthop Relat Res 2015; 473:1093-107. [PMID: 25352261 DOI: 10.1007/s11999-014-4022-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/17/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral epicondylitis is a painful tendinopathy for which several nonsurgical treatment strategies are used. Superiority of these nonsurgical treatments over nontreatment has not been definitively established. QUESTIONS/PURPOSES We asked whether nonsurgical treatment of lateral epicondylitis compared with observation only or placebo provides (1) better overall improvement, (2) less need for escape interventions, (3) better outcome scores, and (4) improved grip strength at intermediate- to long-term followup. METHODS The English-language literature was searched using PubMed and the Cochrane Central Register of Controlled Trials. Randomized-controlled trials (RCTs) comparing any form of nonsurgical treatment with either observation only or placebo at followup of at least 6 months were included. Nonsurgical treatments included injections (corticosteroid, platelet-rich plasma, autologous blood, sodium hyaluronate, or glycosaminoglycan polysulfate), physiotherapy, shock wave therapy, laser, ultrasound, corticosteroid iontophoresis, topical glyceryl trinitrate, or oral naproxen. Methodologic quality was assessed with the Consolidated Standards of Reporting Trials (CONSORT) checklist, and 22 RCTs containing 2280 patients were included. Pooled analyses were performed to evaluate overall improvement; requirement for escape interventions (treatment of any kind, outside consultation, and surgery); outcome scores (Patient-Rated Tennis Elbow Evaluation [PRTEE]; DASH; Pain-Free Function Index [PFFI]; EuroQoL [EQ]-5D; and overall function); and maximum and pain-free grip strength. Sensitivity analyses were performed using only trials of excellent or good quality. Heterogeneity analyses were performed, and funnel plots were constructed to assess for publication bias. RESULTS Nonsurgical treatment was not favored over nontreatment based on overall improvement (risk ratio [RR] = 1.05 [0.96-1.15]; p = 0.32), need for escape treatment (RR = 1.50 [0.84-2.70]; p = 0.17), PRTEE scores (mean difference [MD] = 1.47, [0.68-2.26]; p < 0.001), DASH scores (MD = -2.69, [-15.80 to 10.42]; p = 0.69), PFFI scores (standardized mean difference [SMD] = 0.25, [-0.32 to 0.81]; p = 0.39), overall function using change-from-baseline data (SMD = 0.11, [-0.14 to 0.36]; p = 0.37) and final data (SMD = -0.16, [-0.79 to 0.47]; p = 0.61), EQ-5D scores (SMD = 0.08, [-0.52 to 0.67]; p = 0.80), maximum grip strength using change-from-baseline data (SMD = 0.12, [-0.11 to 0.35]; p = 0.31) and final data (SMD = 4.37, [-0.65 to 9.38]; p = 0.09), and pain-free grip strength using change-from-baseline data (SMD = -0.20, [-0.84 to 0.43]; p = 0.53) and final data (SMD = -0.03, [-0.61 to 0.54]; p = 0.91). CONCLUSIONS Pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment of lateral epicondylitis compared with observation only or placebo. LEVEL OF EVIDENCE Level II, therapeutic study.
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Schmitz C, Császár NBM, Milz S, Schieker M, Maffulli N, Rompe JD, Furia JP. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull 2015; 116:115-38. [PMID: 26585999 PMCID: PMC4674007 DOI: 10.1093/bmb/ldv047] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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] [Accepted: 10/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system. SOURCES OF DATA This systematic review used data derived from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au, 23 October 2015, date last accessed). AREAS OF AGREEMENT ESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate. AREAS OF CONTROVERSY The distinction between radial ESWT as 'low-energy ESWT' and focused ESWT as 'high-energy ESWT' is not correct and should be abandoned. GROWING POINTS There is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome. AREAS TIMELY FOR DEVELOPING RESEARCH Future randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT.
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Affiliation(s)
- Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr. 11, Munich 80336, Germany
| | - Nikolaus B M Császár
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr. 11, Munich 80336, Germany
| | - Stefan Milz
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Pettenkoferstr. 11, Munich 80336, Germany
| | - Matthias Schieker
- Department of Surgery, Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-University of Munich, Nussbaumstr. 20, Munich 80336, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Salerno, Italy Queen Mary University of London, Centre for Sports and Excercise Medicine, Mile End Hospital, Mann Ward, 275 Bancroft Road, London E1 4DG, UK
| | - Jan-Dirk Rompe
- OrthoTrauma Evaluation Institute, Oppenheimer Str. 70, Mainz 55130, Germany
| | - John P Furia
- SUN Orthopaedics and Sports Medicine, Division of Evangelical Community Hospital, 900 Buffalo Road, Lewisburg, PA 17837, USA
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Amar E, Chechik O, Khashan M, Lador R, Rath E. Lateral epicondylitis treatment: international survey of surgeons' preferences and literature review. Int J Clin Pract 2014; 68:1383-7. [PMID: 25040243 DOI: 10.1111/ijcp.12478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Lateral epicondylitis (LE) is a common cause of elbow pain. Despite a relatively high prevalence and morbidity, there is still no single effective ('gold standard') treatment for LE. We hypothesised that a surgeon's experience, country of origin and area of expertise would influence choices concerning patient management. The purpose of this survey was to describe the current trends and common practices in treating LE worldwide. MATERIAL AND METHODS A total of 291 orthopaedic surgeons of 12 subspecialties from 57 countries were surveyed on their choice of LE treatment modalities. Their preferences were analysed according to country of origin, field of expertise and seniority. The results were compared with current published level-1 evidence. RESULTS The most popular modalities of treatment among all of the surveyed orthopaedic surgeons were non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid (CS) injection (38% of recommendations each). The most popular Modalities of treatment among the hand surgeons was NSAIDs (48%) and CS injection (30%). There was no significant difference in recommendations based on geography, seniority or specialisation (i.e., hand surgeons among others). CONCLUSIONS Neither geography, seniority nor medical specialty affects surgeons' preferences in the treatment of LE. There appears to be little correlation between scientific evidence and therapeutic choices for managing LE. LEVEL OF EVIDENCE Level V, Study.
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Affiliation(s)
- E Amar
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bayram K, Yesil H, Dogan E. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis. North Clin Istanb 2014; 1:33-8. [PMID: 28058299 DOI: 10.14744/nci.2014.77487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis. METHODS: A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed. RESULTS: Visual analog scale (VAS) scores were significantly lower (p<0.05) and grip strength significantly increased (p<0.05) one month after ESWT treatment. Overall PRTEE-T survey scores decreased significantly at first month (p<0.001) after treatment. Patient’s and physician’s global self-assessment scores were significantly lower after treatment (p<0.05). CONCLUSION: To conclude, ESWT utilization in conservative treatment of lateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.
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Dingemanse R, Randsdorp M, Koes BW, Huisstede BMA. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med 2013; 48:957-65. [PMID: 23335238 DOI: 10.1136/bjsports-2012-091513] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several treatments are available to treat epicondylitis. Among these are instrumental electrophysical modalities, ranging from ultrasound, extracorporeal shock wave therapy (ESWT), transcutaneous electrical nerve stimulation (TENS) to laser therapy, commonly used to treat epicondylitis. OBJECTIVES To present an evidence-based overview of the effectiveness of electrophysical modality treatments for both medial and lateral epicondylitis (LE). 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. A best-evidence synthesis was used to summarise the results. RESULTS A total of 2 reviews and 20 RCTs were included, all of which concerned LE. Different electrophysical regimes were evaluated: ultrasound, laser, electrotherapy, ESWT, TENS and pulsed electromagnetic field therapy. Moderate evidence was found for the effectiveness of ultrasound versus placebo on mid-term follow-up. Ultrasound plus friction massage showed moderate evidence of effectiveness versus laser therapy on short-term follow-up. On the contrary, moderate evidence was found in favour of laser therapy over plyometric exercises on short-term follow-up. For all other modalities only limited/conflicting evidence for effectiveness or evidence of no difference in effect was found. CONCLUSIONS Potential effectiveness of ultrasound and laser for the management of LE was found. To draw more definite conclusions high-quality RCTs examining different intensities are needed as well as studies focusing on long-term follow-up results.
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Affiliation(s)
- Rudi Dingemanse
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Manon Randsdorp
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bionka M A Huisstede
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands
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George A, Abdulkareem I, Bould M, Spencer R. The use of non-orthopaedic devices for orthopaedic procedures. Surgeon 2012; 11:57-8. [PMID: 22717285 DOI: 10.1016/j.surge.2012.02.004] [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: 11/10/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/25/2022]
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Storheim K, Gjersing L, Bølstad K, Risberg M. Sjokkbølge- og trykkbølgebehandling ved kroniske muskel- og skjelettsmerter. Tidsskriftet 2010; 130:2360-4. [DOI: 10.4045/tidsskr.09.0654] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sharma DP. Current opinion amongst radiologists and urologists in the uk on percutaneous nephrostomy and ureteric stent insertion for acute renal obstruction: results of a postal survey. BJU Int 2007; 99:1549. [PMID: 17537224 DOI: 10.1111/j.1464-410x.2007.06970_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND This review is one in a series of reviews of interventions for lateral elbow pain. OBJECTIVES To determine the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain. SEARCH STRATEGY Searches of the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2004), MEDLINE, EMBASE, CINAHL, and Science Citation Index (SCISEARCH) were conducted in February 2005, unrestricted by date. SELECTION CRITERIA We included nine trials that randomised 1006 participants to ESWT or placebo and one trial that randomised 93 participants to ESWT or steroid injection. DATA COLLECTION AND ANALYSIS For each trial two independent reviewers assessed the methodological quality and extracted data. Methodological quality criteria included appropriate randomisation, allocation concealment, blinding, number lost to follow up and intention to treat analysis. Where appropriate, pooled analyses were performed. If there was significant heterogeneity between studies or the data reported did not allow statistical pooling, individual trial results were described in the text. MAIN RESULTS Eleven of the 13 pooled analyses found no significant benefit of ESWT over placebo. For example, the weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks from a pooled analysis of three trials (446 participants) was -9.42 (95% CI -20.70 to 1.86) and the weighted mean difference for improvement in pain (on a 100-point scale) provoked by resisted wrist extension (Thomsen test) from baseline to 12 weeks from a pooled analysis of three trials (455 participants) was -9.04 (95% CI -19.37 to 1.28). Two pooled results favoured ESWT. For example, the pooled relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo from a pooled analysis of two trials (192 participants) was 2.2 (95% CI 1.55 to 3.12). However this finding was not supported by the results of four other individual trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of pain of 50% from baseline (21/25 (84%) versus 29/48 (60%), p<0.05). Minimal adverse effects of ESWT were reported. Most commonly these were transient pain, reddening of the skin and nausea and in most cases did not require treatment discontinuation or dosage adjustment. AUTHORS' CONCLUSIONS Based upon systematic review of nine placebo-controlled trials involving 1006 participants, there is "Platinum" level evidence that shock wave therapy provides little or no benefit in terms of pain and function in lateral elbow pain. There is "Silver" level evidence based upon one trial involving 93 participants that steroid injection may be more effective than ESWT.
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Affiliation(s)
- R Buchbinder
- Cabrini Hospital and Monash Unversity, Department of Clinical Epidemiology, Suite 41, Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria, Australia 3144.
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