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Introducción: Por más de 20 años la litotricia extracorpórea se ha aplicado con éxito en el mundo. Objetivo: Evaluar la efectividad de la terapia por ondas de choque en el tratamiento a pacientes que presentan lesiones en los tendones y ligamentos del sistema osteomioarticular. Métodos: Se realizó un estudio descriptivo, de corte transversal, con 107 pacientes diagnosticados con lesiones en los tendones y ligamentos del sistema osteomioarticular, los cuales fueron tratados con el equipo Well Wave (ondas de choque extracorpóreas) en el Complejo Científico Ortopédico Internacional Frank País, en el período comprendido entre marzo de 2019 y abril de 2020. Se realizó el análisis de las variables edad, sexo, dolor y discapacidad. Se obtuvieron frecuencias absolutas y relativas, y con ellas se confeccionaron las tablas que resumen la información estadística de la investigación. Resultados: Predominó el sexo femenino (71,9 por ciento), de 51 - 60 años (28 por ciento). El 40,2 por ciento de los pacientes fueron atendidos por presentar una tendinitis del supraespinoso. Todos los pacientes presentaban dolor antes de la aplicación de la terapia. Luego del tratamiento el 78,5 por ciento de los enfermos dejaron de sentirlo y el 71 por ciento presentó ausencia de discapacidad según escala de DASH. Según los criterios de evaluación de la respuesta al tratamiento los resultados fueron satisfactorios en el 56 por ciento de los pacientes. Conclusiones: La terapia con las ondas de choque posibilitó una rápida recuperación de los pacientes atendidos y su incorporación a las actividades diarias(AU)
ABSTRACT Introduction: Over more than 20 years, extracorporeal lithotripsy has been successfully used worldwide. Objective: To evaluate the effectiveness of shock wave therapy in the treatment of patients with injuries to the tendons and ligaments of the osteomioarticular system. Methods: A descriptive, cross-sectional study was carried out with 107 patients diagnosed with injuries to the tendons and ligaments of the osteomioarticular system. These subjects were treated with the Well Wave equipment (extracorporeal shock waves) at Frank País International Orthopedic Scientific Center, from March 2019 to April 2020. The variables age, sex, pain and disability were analyzed. Absolute and relative frequencies were obtained, and the results of statistical information of the investigation was shown in summarizing tables. Results: The female sex prevailed (71.9percent), 51 - 60 years old (28 percent). 40.2 percent of the patients were treated for supraspinatus tendinitis. All patients had pain before the use of therapy. After treatment, 78.5 percent of the patients stopped feeling pain and 71 percent showed no disability according to DASH scale. According to the treatment response evaluation criteria, the results were satisfactory in 56percent of the patients. Conclusions: This therapy enabled rapid recovery of the patients treated and their integration into daily activities(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Traumatismos dos Tendões , Tendões , Resultado do Tratamento , Tratamento por Ondas de Choque Extracorpóreas/métodos , Ligamentos/lesões , Sistema Musculoesquelético , Epidemiologia Descritiva , Estudos TransversaisRESUMO
@#Introduction: Lateral epicondylitis is a common condition causing severe incapacitating pain. Several methods of treatment have been approached for its management. In our study we aim to compare the results of injecting steroid and lignocaine mixture via single injection and peppered injection technique and analyse the outcome in each category. Materials and methods: A prospective randomised study comprising of 25 patients in each group (single vs peppered group) were included in the study after satisfying inclusion and exclusion criteria. Outcome of the treatment was measured in the form of Patient Related Tennis Elbow Evaluation (PRTEE) Questionnaire, Visual analogue score (VAS) and tenderness grading at two weeks, six weeks and six months after injection. Results: Results of our study showed that the mean PRTEE score was 22.36, 18.40 and 14.16 at 2 weeks, 6 weeks and 6 months following peppered injection as compared to 28.96, 21.84 and 25.32 in the single injection group (p value <0.05). VAS score at 2 weeks, 6 weeks and 6 months after the peppered injection was found to be 2.72, 1.72 and 1.36 and in the single injection group was 2.96, 1.92 and 2.72 at 2weeks, 6 weeks and 6 months, respectively (p value <0.05). On comparison of the 2 groups, there was a significant reduction of VAS scores at 6 months post-injection (p value <0.05) and PRTEE score at 6 weeks, 6 months in peppered injection group. Conclusion: The effects of peppered injection technique is seen to be advantageous over the single injection technique in the management of chronic lateral epicondylitis.
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Resumen La valoración médico legal implica establecer un nexo de causalidad entre lo denunciado por los usuarios y los hallazgos encontrados clínica y radiológicamente, esto implica tener un conocimiento amplio de la biomecánica que permita interrelacionar de manera objetiva un mecanismo de trauma que se relacione en su génesis con el movimiento denunciado. En este artículo se realizará una revisión bibliográfica de la epicondilitis, tomando en consideración todos los aspectos de importancia médico legal.
Abstract The forensic evaluation implies establishing the causality between the story and the clinical and radiologic findings, this implies having a broad knowledge of biomechanics that allows an objective interrelation of a trauma mechanism. This article consists in a bibliographical revision about the etiopathogenesis of the epicondylitis and the interpretation of this patology in relation to medico legal analysis.
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Cotovelo de Tenista , Tendinopatia do Cotovelo/diagnóstico , Fenômenos BiomecânicosRESUMO
OBJECTIVE@#To quantitatively study the biomechanical parameters of Bachuorounian manipulation in the treatment of humeral epicondylitis, and discuss the effects of individual characteristics on the biomechanical parameters were discussed.@*METHODS@#From July 2019 to February 2020, 40 patients with external humeral epicondylitis were selected, including 18 males and 22 females, ranging in age from 20 to 50 years old, with an average of (34.37±8.41) years old;and the course of disease ranged from 1 to 11 months, with a mean of (6.05±2.71) months. The biomechanical parameters of the elbow joint of the affected side were measured by using the biomechanical sensor. At thesame time, the individual characteristic parameters of patients were collected to analyze the influence of different individual characteristics of patients on biomechanical parameters.@*RESULTS@#The results of mechanical analysis in each stage of the bachuorounian manipulation were as follows:the rolling back rotation force was (31.17±2.99) N;the buckling bending drawing force was (44.99±2.38) N;the rolling pre rotation force was (31.03±2.75) N;and stretching drawing force was (48.75±2.09) N. The correlation analysis between the parameters showed that there was a significant positive correlation between the buckling bending drawing force and the stretching drawing force parameters, and a significant positive correlation between the rolling force back-rotation force and the rolling pre-rotation force parameters. The multivariate linear regression analysis on the parameters of influencing factors and manipulative biomechanics showed that there was a significant correlation between body weight and rolling back-rotation force, significant correlation between elbow tenderness and the buckling bending drawing force, and significant correlation between disease duration and the stretching drawing force.@*CONCLUSION@#The bachuorounian manipulation of humeral epicondylitis has a certain range of operating force. Manipulation of each stage has a correlation and systematic. The patient's weight, elbow tenderness and disease course are important factors affecting the bachuorounian manipulation.
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Feminino , Humanos , Lactente , Masculino , Fenômenos Biomecânicos , Cotovelo , Articulação do Cotovelo , Úmero , Cotovelo de TenistaRESUMO
Background:Platelet-rich plasma helps in repair because of its growth factor. Platelet-rich plasma has been used in humans for its healing properties. Increased concentration of growth factors and secretory proteins may increase the process of healing on a cellular level.Aim:This study was done to check the effectiveness of PRP injections in patients with chronic lateral epicondylitis.Methodology:This was accomplished in patients visiting the orthopaedic OPD at the Sree Balaji Medical College and Hospital, Chennai, Tamilnadu. There were 40 physicians in this study, among whom 37were homosexual and 87were female. The mean age of the patients was 48.1 years (17-82 years). The study period was 3 months. The analytical method used is a visual analog score.Results:Effective therapy was performed with a decline of more than 20% (24 out of 40 patients) in visual analog score after a dual-month period. After 3 months in boys, the mean VAS score dropped from 6.88 to 9.41.Conclusion:Medication of PRP patients with chronic epicondylitis or PRP tennis elbow reduces pain and increases the flexibility of the affected knee joint
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Background: Lateral Epicondylitis is the tendinosis of the extensor musculature of the forearm that has their common origin from the lateral epicondyle of the humerus due to angioblastic degeneration. The study aimed to determine and compare the effectiveness of MET and MaRhyThe in individuals with chronic lateral epicondylitis concerning pain, grip strength, and function. Methods: The study was a randomized clinical trial with 30 subjects divided into two equal groups, with 15 subjects in each group. Group A received MET for seven sessions, and Group B received MaRhyThe for one session. Both the groups received hot moist pack and conventional exercises for seven sessions. Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE) Questionnaire, and Pain-Free Grip Strength (PFGS) were taken as the outcome measures. Results: Within-group paired sample t-test showed statistical significance in VAS at rest, VAS on activity, PRTEE, and PFGS with a p-value of 0.001 for all. However, between-group analysis using independent sample t-test showed statistical significance in VAS on activity and PRTEE with a p-value of 0.049 and 0.029, respectively, and clinical significance for VAS at rest and PFGS for Group B. Conclusion: The study concludes that both MET and MaRhyThe are effective in treating chronic LE concerning pain, improving function, and strength. However, MaRhyThe is more effective in pain reduction and improving functional activities.
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Lateral epicondylitis (tennis elbow) is a common and often extremely painful musculoskeletal condition. Several non-operative interventions with varying success rates have been described. Systematic reviews suggest that there is no clear and effective cure for pain symptoms in the first six weeks of treatment. There is a strong need for an intervention which is appropriate for patients and ensures effective short-term pain relief without increasing the risk of recurrence. The electrical stimulation using galvanic current is seen to be safe and effective in reducing pain, improving grip strength and promoting functional activities in the treatment of lateral epicondylitis.METHODSFifteen patients with lateral epicondylitis were selected. Electrical stimulation using galvanic current was applied for a period of 30 seconds at each point 3 times for 10 days. Pain, pain-free grip strength and functional status were measured using the Numerical Pain Rating Scale (NPRS), hand dynamometer and Patient Specific Functional Scale (PSFS). Measurements were taken before and after treatment. Data was subjected to statistical analysis.RESULTSMean improvement was observed for pain (NPRS), pain free grip strength and functional status (PSFS) (5.8±0.9, P=0.001), (32.6±2.6, P=0.001) and (5.2±1.7, P=0.001) respectively.CONCLUSIONSApplication of electrical stimulation using galvanic current was effective in reducing pain, improving grip strength and functional status in patients with lateral epicondylitis
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Objective: To compare the effectiveness of steroid therapy with and without physiotherapy for the management of lateral epicondylitis (tennis elbow). Methodology: Patients, who fulfil the inclusion criteria of selection were admitted to study in the Department of Physiotherapy PSRD, Lahore. Each patient received an informed consent. Demographic data including name, age, sex, height and weight were noted. Participating individuals were randomly allocated into two groups by lottery method. Patients of group A were treated by steroidal therapy without physiotherapy manoeuvres and the individuals of group B were treated by combination of steroidal therapy and physiotherapy. The follow-up was carried out for up to 4 weeks.All the information has been collected with pre-defined preforms.Data was interpreted and analysed through SPSS version 22.0. Results: The overall mean age of cases was 38.90±6.97 years and 42.07±7.03 years. There were 38(63.33%) male and 22(36.67%) female in this study. Before treatment the mean pain of participating individuals of group-A and in group-B was 7.40±1.45 and 7.63±1.27 with insignificant difference. After treatment the mean pain in group-A and group-B was 3.40±1.73 and 2.53±1.57 with significantly lower pain in group-B, p-value < 0.05. When we compared mean pain before and after injection was significantly improved in both groups but the improvement was higher in group-B. The mean pain difference in group-A and group-B was 3.77±2.18 and 4.90±1.83 with higher improvement in group-A, p-value < 0.05. Conclusion: Results of study concludesteroid injection with addition to physiotherapy was more effective in reducing pain.We must encourage orthopedic and physiotherapist teamwork to treat tennis elbow.
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Resumen La tendinopatía es una causa importante de morbilidad musculo-esquelética. Tiene una alta incidencia en el ámbito deportivo de 30 a 50 % de las lesiones, en atletas profesionales y recreativos, que pueden comprometer el rendimiento deportivo y causar discapacidad. En gran medida, es causada por una alteración en los orígenes músculo-tendinosos, en los cóndilos humerales. En la mayoría de los casos, se encuentra en población laboralmente activa, por lo cual tiene alto impacto en la reducción de la productividad por ausencias laborales, que de acuerdo con la severidad pueden ser días o semanas. El objetivo general de la investigación consiste en proponer un complejo de ejercicios físicos que contribuyan a la recuperación de dicha lesión en lanzadores de béisbol. Se emplearon los métodos teóricos, empíricos y se determinaron los fundamentos teóricos que componen la rehabilitación de la epicondilitis medial. Se analizó la información obtenida luego de aplicar una entrevista a los entrenadores, con la finalidad de caracterizar el estado actual del proceso de rehabilitación de esta lesión. A partir de los resultados obtenidos, se diseñó un conjunto de ejercicios físicos para rehabilitar dicha lesión en el área de entrenamiento. Los ejercicios diseñados se clasifican en pasivos, activos asistidos, activos libres, activos resistidos; este último dividido en dos grupos. Para facilitar la labor de los entrenadores, se describen la forma de ejecución de los ejercicios, así como las indicaciones metodológicas, músculos implicados, organización y variantes.
Resumo A Tendinopatia é uma das principais causas de morbidade músculo-esquelética. Tem uma alta incidência no ambiente desportivo de 30-50% das lesões em atletas profissionais e recreativos, o que pode comprometer o desempenho desportivo e causar incapacidade. Em grande medida, é causada por uma alteração na origem músculo-tendão nos côndilos umerais. Na maioria dos casos, encontra-se na população ativa, pelo que tem um elevado impacto na redução da produtividade por faltas ao trabalho, que de acordo com a gravidade pode variar de dias a semanas. O objetivo geral da pesquisa é propor um complexo de exercícios físicos que contribuam para a recuperação desta lesão em arremessadores de beisebol. Os métodos teóricos e empíricos foram utilizados e os fundamentos teóricos que compõem a reabilitação da Epicondilite medial foram determinados. As informações obtidas após a entrevista com os treinadores foram analisadas a fim de caracterizar o estado atual do processo de reabilitação para esta lesão. Com base nos resultados obtidos, um conjunto de exercícios físicos foi concebido para reabilitar esta lesão na área de treino. Os exercícios concebidos são classificados em passivos, ativos assistidos, ativos livres e ativos resistidos; sendo estes últimos divididos em dois grupos. Para facilitar o trabalho dos treinadores, é descrita a forma de execução dos exercícios, assim como as indicações metodológicas, músculos envolvidos, organização e variantes.
Abstract Tendinopathy is a major cause of musculoskeletal morbidity. A high incidence of sports-related injuries of 30-50 % in professional and recreational athletes, which can compromise sports performance and cause disability. Mostly, it is caused by an alteration in the muscle-tendontium origins in the humeral condyles. In most cases, it is in the working population, so it has a high impact on reducing productivity due to absences from work, which, depending on the severity, can range from days to weeks. The general objective of the research is to propose a complex of physical exercises that will contribute to the recovery of such injury in baseball pitchers. Theoretical and empirical methods were used and the theoretical foundations for the rehabilitation of medial epicondylitis were determined. The information obtained after interviewing the coaches was analyzed in order to characterize the current state of the rehabilitation process for this injury. Based on the results obtained, a set of physical exercises was designed to rehabilitate this injury in the training area. The exercises designed are classified into passive, assisted active, free active, and resisted active; the latter being divided into two groups. In order to facilitate the work of the trainers, the form of execution of the exercises is described, as well as the methodological indications, muscles involved, organization and variants.
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Mujer de 49 años fue evaluada por desarrollar dolor súbito a nivel de los epicóndilos mediales conjuntamente con entumecimiento y sensación de hormigueo en el cuarto y quinto dedos después de recibir terapia de ondas de choque extracorpóreas radiales (rESWT) como tratamiento para epicondilitis medial bilateral. El examen neurológico reveló signo de Tinel positivo, parestesia y una prueba de discriminación de dos puntos alterada sobre la región cubital del cuarto y quinto dedos. La ultrasonografía de alta resolución demostró hallazgos de lesión nerviosa periférica tales como hipoecogenicidad y aumento del diámetro de ambos nervios cubitales. La paciente mejoró únicamente tras recibir tratamiento conservador, demostrando así una aparente neuropatía compresiva bilateral aguda como resultado de la terapia. ESWT se utiliza como una alternativa prometedora para el tratamiento de diversos trastornos musculoesqueléticos; sin embargo, existe evidencia limitada con respecto a sus efectos secundarios, en particular la mononeuropatía periférica. Según el conocimiento de los autores, este es el primer reporte que demuestra un daño nervioso estructural después de rESWT con el uso de ultrasonografía de alta resolución.
A 49-year old woman was evaluated for developing bilateral acute medial elbow pain, numbness, and tingling sensation in the fourth and fifth fingers after receiving radial extracorporeal shock wave therapy (rESWT) for bilateral medial epicondylitis. Neurologic examination revealed the presence of Tinel's sign, paresthesia and impaired two-point discrimination testing over the ulnar side of the fourth and fifth fingers bilaterally. High-resolution ultrasonography demonstrated findings of nerve injury, such as hypoechogenicity and increased diameter of both ulnar nerves. After conservative treatment, the patient improved her condition demonstrating an apparently acute compressive nerve injury as a result of the therapy. ESWT is used as a promising alternative for the treatment of various musculoskeletal disorders; however, there is limited evidence regarding its side effects, in particular peripheral mononeuropathy. To the authors' knowledge, this is the first report demonstrating structural damage of a nerve after rESWT with the use of high-resolution ultrasonography.
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Objective:To observe the clinical efficacy of Juanbitang iontophoresis combined with warm acupuncture in treatment of wind cold and blocking collaterals syndrome due to external humeral epicondylitis (EH) and the effect on serum oxidative stress index. Method:From January 2018 to October 2019, 180 patients with EH wind cold and blocking collaterals syndrome were randomly divided into the warm acupuncture group, the traditional Chinese medicine（TCM） group and the combination group, with 60 cases in each group. The TCM group was treated with modified Juanbitang combined local iontophoresis at Quchi (affected side), Zhouliao (affected side), Ashi (affected side), 30 min/time/day, while the warm acupuncture group was treated with warm acupuncture once a day, 5 days/week. The combination group was treated with warm acupuncture in addition to the therapy of the TCM group, and the three groups were treated for 4 weeks. JOA’s elbow joint function scale, HSS’ elbow joint score scale and pain visual simulation score (VAS) were used to evaluate the symptoms and signs and the improvement of daily life before and after treatment. Enzyme linked immunosorbent assay（ELISA） method was used to detect the contents of late oxidized protein products (AOPP), malondialdehyde (MDA), superoxide dismutase (SOD) and heme oxygenase-1 (HO-1) in serum of patients before and after treatment. The cure rate, the total effective rate and the recurrence rate of 1 month and 3 months after treatment were compared. Result:Compared with before treatment, JOA and HSS scores increased, whereas VAS scores decreased (P<0.05). AOPP and MDA contents decreased, while SOD and HO-1 contents increased in the combination group and the TCM group (P<0.05). Compared with the TCM group and the warm acupuncture group after treatment, JOA, HSS score and pain R value increased, whereas VAS score decreased (P<0.05). Compared with the warm acupuncture group after treatment, serum AOPP, MDA content decreased, while SOD, HO-1 content increased (P<0.05). After 4 weeks of treatment, the cure rate and the effective rate of combination group were higher than those of the TCM group (χ2cure rate=4.617, χ2effective rate=6.471, P<0.05) and the warming acupuncture group (χ2cure rate=4.207, χ2effective rate=6.775, P<0.05). One month after the treatment, the cure rate and the effective rate of the combination group were higher than those of the TCM group (χ2cure rate=7.617, χ2effective rate=13.347, P<0.05) and the warm acupuncture group (χ2cure rate=4.762, χ2effective rate=6.277, P<0.05). The recurrence rate of the combination group was lower than that of the TCM group (χ2=9.32, P<0.05) and the warm acupuncture group (χ2=3.899, P<0.05). Three months after the treatment, the cure rate and the effective rate of the combination group were higher than those of the TCM group (χ2cure rate=4.789, χ2effective rate=9.643, P<0.05) and the warm acupuncture group (χ2cure rate=4.458, χ2effective rate=9.251, P<0.05). The recurrence rate of the combination group was lower than that of the TCM group (χ2=4.599, P<0.05) and the warm acupuncture group (χ2=4.518, P<0.05). Conclusion:Modified Juanbitang and the warm acupuncture has a good clinical efficacy in the treatment of EH wind cold and blocking collaterals syndrome and is worthy of clinical promotion.
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BACKGROUND: Acupuncture therapy plays a very important role in the treatment of lateral epicondylitis. However, due to the diverse characteristics of acupuncture therapy, the current research mostly focuses on a simple comparison between acupuncture therapy and conventional blocking therapy. OBJECTIVE: To compare the efficacy and visual analogue scale score of different acupuncture therapies for lateral epicondylitis using a Bayesian network meta-analysis. METHODS: Randomized controlled trials on acupuncture therapy for lateral epicondylitis included in PubMed, The Cochrane Library, CNKI, VIP, and WanFang were searched. The search time was from inception until October 2019 in each database. Two researchers independently screened and extracted data according to the inclusion criteria, and then evaluated the quality of the literature. Direct meta-analysis and network meta-analysis of data were performed using ADDIS 1.16.8 software. RESULTS AND CONCLUSION: A total of 2 318 lateral epicondylitis patients were included in 32 randomized controlled trials/controlled clinical trials, concerning 6 treatment measures, including warming needle, fire needle, electroacupuncture, filiform needle acupuncture, Fu’s acupuncture, fire needle plus filiform needle. Network meta-analysis results show that: in terms of efficiency, warming needles are better than electroacupuncture, warming needles are better than filiform needles, fire needles are better than warming needles, fire needles are better than electroacupuncture, fire needles are better than filiform needles, Fu’s acupuncture is better than electroacupuncture, Fu’s acupuncture is better than filiform needles, and fire needle plus filiform needle is better than filiform needles alone. In terms of the visual analogue scale score, warming needles are better than electroacupuncture, warming needles are better than filiform needles, fire needles are better than electroacupunture, fire needles are better than filiform needles, Fu’s acupuncture is better than electroacupuncture, Fu's acupuncture is better than filiform needles, fire needle plus filiform needle is better than electroacupuncture. Efficiencies rank from the best to the worst: Fu’s electroacupuncture>fire needle>fire needle plus filiform needle>warming needle>electroacupuncture needle>filiform needles. The visual analogue scale scores rank as follows: Fu’s acupuncture>fire needle+filiform needle>fire needle>warming needle>filiform needle>electroacupuncture. The direct meta-analysis results are highly consistent with the network meta-analysis results, indicating that there is consistency between the direct and indirect comparison, that is, transitive. In the clinical treatment of lateral epicondylitis, Fu’s acupuncture can be preferentially selected, but each acupuncture therapy has advantages and disadvantages. In clinical practice, the appropriate treatment should be selected in accordance with the actual situation and dialectical Chinese medicine.
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Background: Lateral epicondylitis is an overuse injury of the tendon and involving the extensor muscle of forearm. Induced pain at the upper trapezius (UT) produces an increase in wrist extensor electromyographic activity (EMG) which could potentially lead to overuse injury, such as LE, at the elbow. Some studies found that there is a relation between scapular muscle muscle performance and lateral epicondylitis and loss of grip strength in lateral epicondylitis. There is a lack of literature of similar studies among computer operators. The most common wrong working posture in computer operator is excessive wrist extension it causes to the overuse injury like lateral epicondylitis. The context and purpose of the study: To find out the relationship between scapular muscle performance and grip strength in lateral epicondylitis among computer operators. Result: The correlation between scapular muscle performance and grip strength in LE among computer operators was done using Karl Person correlation coefficient. The result indicated that there is a significant relation between scapular muscle performance and grip strength in lateral epicondylitis. Conclusion: The study showed that there is an impairment of scapular muscle performance and grip strength in lateral epcondylitis among computer operators. Implication: Regular physical activity and proper ergonomics advice can improve quality of life among computer operators.
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Background: Lateral epicondylitis (LE) is a common soft tissue condition treated by many physical therapists. It has poor long-term outcomes for the non-surgical management which suggests a less than optimal rehabilitation process, so there is a need to assess proximal kinetic chain. Objectives: The objective of the study is to compare shoulder rotator muscle strength and shoulder rotation range of motion (ROM) in patients with LE with age-matched healthy individuals. Materials and Methods: An observational study was conducted on 28 subjects with LE (Group A) and 28 age-matched healthy individuals (Group B), selected by convenience sampling. The strength of shoulder rotator muscles was assessed with the use of handheld dynamometer. Shoulder rotation ROM was assessed using standard goniometer. Results: Shoulder external rotators were 9% weaker on dominant side (P = 0.02) while no differences were seen for shoulder internal rotator (IR) strength (P = 0.2). For Group B, shoulder external rotators were 11% stronger on dominant side (P = 0.04), while No dominance difference was seen for shoulder IR strength (P = 0.5). For both Group A and Group B, shoulder rotation ROM showed no significant difference between dominant and non-dominant sides. For between-group analysis, shoulder rotation ROM and shoulder rotator strength showed no statistically significant difference between the Groups A and B. Conclusion: There is muscular imbalance of shoulder rotators in LE.
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ABSTRACT Objective: To evaluate the outcomes of patients that underwent arthroscopic surgery for lateral epicondylitis (LE), after failed conservative treatment. Methods: One hundred four patients with LE treated with arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon were enrolled in this retrospective study. They were evaluated using Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS) and Short Form Health Survey (SF-36) scale. Mean age at surgery was 46.9 years. Duration of symptoms was 2.1 years (range: 6 m to 10 yrs.). Mean follow-up was 34.4 months (range: 6 to 68 m). Results: Mean postoperative scores were: 20.67 points on the DASH; 1.8 points on the VAS at rest, with 48 cases (46%) without pain, 40 (38%) with mild pain, 13 (13%) with moderate pain and 4 (4%) with severe pain; 4.7 points on the VAS in activity, with 21 (20%) without pain, 21 (20%) with mild pain, 35 (34%) with moderate pain and 27 (26%) with severe pain; and SF-36 was 66.8 points. Of the 23 patients who practiced sports regularly or with higher physical demand from the upper limbs, 17 (74%) were able to return to the same activity at the same level. No significant complications were observed postoperatively, except for 3 (2.8%) cases of postoperative superficial infection. Conclusion: Surgical treatment with arthroscopy for recalcitrant LE is effective and safe, presenting positive outcomes in the studied patients. Level of evidence IV, Case Series.
RESUMO Objetivo: Avaliar os resultados dos pacientes submetidos a tratamento cirúrgico artroscópico da epicondilite lateral (EL) refratária depois da falha no tratamento conservador. Métodos: Estudo retrospectivo que incluiu 104 pacientes submetidos a desbridamento artroscópico do tendão extensor radial curto do carpo (ERCC) para tratamento de EL. Os pacientes foram avaliados pelo escore de DASH, pela classificação visual analógica de dor (EVA) e pelo Short-Form 36 (SF36). A média da idade foi de 46,9 anos (variação de 30 a 69 anos). O tempo de sintomas foi de 2,1 anos (variação de 6 meses a 10 anos). O seguimento médio foi de 34,4 meses (variação de 6 - 68 meses). Resultados: A média dos escores pós-operatórios foi de: 20,67 pontos no DASH; 1,8 pontos no EVA de repouso, sendo 48 (46%) sem dor, 40 (38%) com dor leve, 13 casos (13%) com dor moderada e 4 (4%) com dor intensa; 4,7 pontos no EVA em atividade, sendo 21 (20%) sem dor, 21 (20%) com dores leves, 35 (34%) com dores moderadas e 27 (26%) com dores intensas; e SF-36 de 66,8. Dos 23 pacientes em prática constante de esporte ou com maior demanda física nos membros superiores, 17 (74%) conseguiram retornar ao mesmo nível. Não observamos complicações significativas exceto por 3 (2,8%) casos de infecção pós-operatória superficial. Conclusão: O tratamento artroscópico para EL recalcitrante do cotovelo é eficaz e seguro, apresentando resultados positivos. Nível de Evidencia IV, Série de Casos.
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Background: Tennis elbow is a syndrome of insidious onset with tenderness, pain in movement and decline in grip strength. Pulsed Electromagnetic Therapy (PEMF) and ultrasonic therapies (U.S. therapies) are proving adjuncts for enhancing fracture healing, reducing inflammation and symptom relief to varied extent in different reports. The benefit of two therapy regimens in tennis elbow is comparatively evaluated in patient of our region. Methods: 60 patients sequentially enrolled following informed consent were administered either PEMF or ultrasound therapy daily for 6 weeks. Parameters examined were pain score, pressure pain threshold (PPT) and pain free grip strength (PFGS). . Results: It was found that either of the therapies PEMF and U.S.therapy significantly improved the three tested parameters. The relative improvement in pain score between two treatment groups did not significantly differ. PEMF give significantly higher gain in PPT and very marked gain in PFGS as compared to U.S. therapy. Conclusion: PEMF therapy was found to yield significantly superior relief than ultrasound therapy in patient of lateral epicondylitis with respect to pain, pressure pain threshold (PPT) and pain free grip strength (PFGS). Improvement in pain score was similar in two groups.
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Resumen Introducción La epicondilitis o codo de tenista es una enfermedad frecuente en el codo, tiene un perfil ocupacional claro, al igual que otras tendinopatías crónicas de las extremidades superiores, y puede aparecer asociada a ellas simultáneamente. La fricción transversal profunda (o Cyriax) ha sido una de las intervenciones fisioterapéuticas sugeridas para el tratamiento de la tendinopatía. Sin embargo, las conclusiones de las investigaciones han sido inconsistentes. Por lo tanto, este estudio intentó aclarar la asociación entre el tratamiento con Cyriax y el codo de tenista a través de un metaanálisis. Material y métodos Se recuperaron las bases de datos de PubMed y EBSCO para recopilar todas las publicaciones sobre la asociación entre el tratamiento con Cyriax y la epicondilitis. Resultados La búsqueda bibliográfica consistió en 10 artículos (que incluyeron 240 casos y 227 controles) para un análisis cualitativo y seis más (que incluyeron 121 casos y 122 controles) para el cuantitativo. Conclusión Este metaanálisis no pudo apoyar una asociación significativa entre la terapia con Cyriax y la epicondilitis. Por lo tanto, se sugiere implementar esta fisioterapia sólo como un tratamiento complementario.
Abstract Introduction Epicondylitis or tennis elbow is a common disease of the elbow that has a clear occupational profile, like other upper extremity chronic tendinopathies, and can appear associated with them simultaneously. Deep transverse friction (or Cyriax) has been one of the physiotherapy interventions suggested for the management of tendinopathy. However, the conclusions of the investigations have been inconsistent. Therefore, this study aimed to clarify the association between Cyriax treatment and tennis elbow through a meta-analysis. Material and methods The PubMed and EBSCO databases were retrieved to collect all publications on the association between Cyriax treatment and epicondylitis. Results The literature search consisted of 10 articles (that included 240 cases and 227 controls) for a qualitative analysis and six more (that included 121 cases and 122 controls) for the quantitative one. Conclusion This meta-analysis could not support a significant association between Cyriax therapy and epicondylitis. Therefore, it is suggested to implement this physical therapy only as a complementary treatment.
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Objective To explore the clinical efficacy of ultrasound - guided injection of platelet-rich plasma (PRP) for the treatment of recalcitrant lateral epicondylitis. Methods From September 2014 to June 2016, a total of 15 patients with recalcitrant lateral epicondylitis received ultrasound - guided injection of autologous PRP therapy, including via left arm injection (n=2) and via right arm injection (n=13). By using twice centrifugal method, the patient' s own venous whole blood was centrifuged to obtain PRP. All patients underwent PRP injection once a week, a total of 3 treatments were performed for each patient. Results After the first injection of PRP, the patients were followed up for 12 months. One month after the treatment, visual analogue scale (VAS) score was obviously improved, at 3 months after the treatment the improvement of VAS score reached its peak and it remained at this level until 12 months after the treatment. The elbow joint function, which was evaluated with modified MAYO elbow score, was also significantly improved in one month after the treatment, and the clinical effect was sustained to 12 months after the treatment. Conclusion Ultrasound - guided precise injection of PRP can effectively improve the pain and the elbow joint function caused by recalcitrant lateral epicondylitis. (J Intervent Radiol, 2018, 27:238-241)
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La epicondilalgia lateral es una condición músculoesquelética bastante común, que se caracteriza por la presencia de dolor, disminución en la fuerza de prensión y pérdida progresiva de la funcionalidad de la mano. La acupuntura es un método terapéutico derivado de la medicina china tradicional, en donde se realiza estimulación de puntos corporales mediante agujas, con fines terapéuticos o preventivos. Algunos estudios han reportado que la acupuntura produce un beneficio a corto plazo sobre el dolor localizado en el epicóndilo lateral del codo; sin embargo, los beneficios que informan los estudios asociados a esta patología no logran ser concluyentes. Objetivo: resumir la evidencia existente en revisiones Cochrane y no Cochrane, buscando los efectos y beneficios de la acupuntura para el tratamiento del dolor en sujetos que presenten epicondilalgia lateral. Materiales y métodos: se realizó una búsqueda en el registro especializado Cochrane del grupo músculo-esquelético (1980-junio 2015) y en las bases de datos: Medline (1980-septiembre 2015), Pedro (1980- septiembre 2015), Metabuscador Epistemonikos (1980- septiembre 2015), se buscó literatura gris y actas de congresos. La calidad metodológica de las revisiones sistemáticas incluidas fueron evaluadas con AMSTAR y la calidad global de la evidencia mediante GRADE. Resultados: La búsqueda preliminar identificó 92 revisiones sistemáticas, de las cuales 2 cumplieron con los criterios de elegibilidad. Las 2 revisiones sistemáticas fueron categorizadas como de alta calidad metodológica. Conclusión: a pesar de lo poco común de la prescripción y su aplicación en sujetos que presentan epicondilalgia lateral, la acupuntura ha demostrado ser eficaz en el alivio del dolor a corto plazo
Introduction: Epicondylalgia lateral skeletal muscle is a fairly common condition, characterized by the presence of pain, decreased grip strength and progressive loss of function of the hand. Objective: To summarize the evidence in Cochrane and non-Cochrane, looking at the effects and benefits of acupuncture for the treatment of pain in patients who may be le. Methods: A search was conducted in the specialized registry of the Cochrane musculoskeletal group (1980- September 2015) and databases: Medline (1980- September 2015), Pedro (1980- September 2015), Metasearcher Epistemonikos (1980- September 2015), gray literature, conference proceedings was sought. The methodological quality of systematic reviews was evaluated including AMSTAR and the overall quality of the evidence using GRADE. Results: The search identified 92 preliminary systematic reviews, of which two met the eligibility criteria. 2 systematic reviews were categorized as high methodological quality. Conclusion: Despite the rarity of prescription and their application in subjects with lateral epicondylalgia, acupuncture has been proven effective in relieving pain in the short term
A epicondilalgia lateral é uma condição musculoesquelética bastante comum, que se caracteriza pela presença de dor, diminuição na força de preensão e perda progressiva da funcionalidade da mão. A acupuntura é um método terapêutico derivado da medicina chinesa tradicional, onde se realiza estimulação de pontos corporais mediante guias, com fins terapêuticos ou preventivos. Alguns estudos têm reportado que a acupuntura produz um benefício a curto prazo sobre a dor localizada no epicôndilo lateral do cotovelo; no entanto, os benefícios que informam os estudos associados a esta patologia não conseguem ser concluintes. Objetivo: Resumir a evidência existente em revisões Cochrane e não Cochrane, buscando os efeitos e benefícios da Acupuntura para o tratamento da dor em sujeitos que apresentem Epicondilalgia lateral. Materiais e métodos: Realizou-se uma busca no registro especializado Cochrane do grupo musculoesquelético (1980-Junho 2015) e nas bases de dados: Medline (1980-Setembro 2015), PEDro (1980- Setembro 2015), Metabuscador Epistemonikos (1980- Setembro 2015), se buscou literatura cinzenta e atas de congressos. A qualidade metodológica das revisões sistemáticas incluídas foi avaliada com AMSTAR e a qualidade global da evidência mediante GRADE. Resultados: A busca preliminar identificou 92 revisões sistemáticas, das quais 2 cumpriram com os critérios de elegibilidade. As 2 revisões sistemáticas foram categorizadas como de alta qualidade metodológica. Conclusão: Apesar da prescrição e a sua aplicação em sujeitos que apresentam epicondilalgia lateral, a acupuntura tem demonstrado ser eficaz no alívio da dor a curto prazo
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Humanos , Cotovelo de Tenista , Terapêutica , Efetividade , Músculo Esquelético , AcupunturaRESUMO
Medial epicondylitis, also known as “golfer's elbow,” is a common overuse syndrome of the elbow and predominantly affects the origin of the common flexor tendon. We report two unique cases of medial epicondylitis complicated by chronic complete tear of the ulnar collateral ligament and common flexor tendon origin. Physical examination showed a focal huge swelling of medial epicondylar region of the dominant elbow and magnetic resonance imaging revealed complete tear of the ulnar collateral ligament and common flexor tendon and extravasation of intra-articular effusion. Satisfactory results were achieved with ulnar collateral ligament reconstruction and simultaneous repair of the common flexor tendon origin.