Role of dexamethasone iontophoresis in treatment of epicondylitis as evaluated with quantitative high resolution ultrasonography

To evaluate the effect of dexamethasone iontophoresis in treatment of epicondylitis based on high resolution ultrasonography. This study included 25 patients with epicondylitis and 14 healthy controls. Pain intensity was assessed by visual analogue score [VAS] and by patient global assessment [PGA]. Measuring the maximum grip force of the sound side, maximum grip force [MGF] and pain-free grip force [PFGF] of the affected side, using the hand grip dynamometer, were also assessed. Ultrasonographic assessment was performed for the site of complaint either the common extensor origin [CEO] or the common flexor origin [CFO]. Patients received 6 sessions of 4 mg/ml dexamethasone [DXM] iontophoresis on alternating days over a period of two weeks. After the treatment program, the patients were re-assessed both clinically and by ultrasonography. After treatment with dexamethasone iontophoresis, the decrease in the VAS, PGA as well as the changes in MGF and PFGF of the affected side was statistically significant. Regarding diagnostic US, abnormal findings were detected in 11 patients [44%] at the beginning of the study with no abnormal findings in the control group. High resolution ultrasonography proved to be of 48.5% sensitivity. and 65.7% specificity in diagnosing epicondylitis. The improvement of epicondylitis after iontophoresis treatment, though well evident and proved on clinical reassessment, couldn't be detected except in 3 patients out of the 6 patients reassessed by ultrasonography. Dexamethasone iontophoresis could be considered a simple, easy, safe, effective and non-invasive therapeutic option for epicondylitis. High resolution ultrasonography has a role in diagnosing epicondylitis but has no role in follow up

Chronic lateral epicondylitis treatment in King Khaled University Hospital [Saudi Arabia]

Thirty-eight patients suffering from chronic lateral epicondylitis were randomized into two treatment groups. The first group [n=20] was treated with progressive slow, repetitive wrist and forearm stretching, muscle conditioning and occupational exercises which were intensified in four steps. The second group [n =18] was treated with pulsed ultrasound. The effect of six- to eight-week treatment was measured by a pain questionnaire [visual analogue scale], isokinetic muscle performance testing of wrist and forearm and isometric grip strength measurements. In the follow up visit after eight-week, treatment pain at rest and under strain had decreased and subjective ability to work increased in the exercise group significantly more than the ultrasound group. Correspondingly, sleep disturbance was alleviated significantly more in the exercise group. The isokinetic torque of wrist flexion increased by 45% in the exercise group and declined by 4% in the ultrasound group. Maximum isometric grip strength increased 12% in the exercise group and remained unchanged in the ultrasound group. During treatment, six of eight patients in the exercise group and three of nine patients in the ultrasound group became able to work. All clinical manual provocation tests for tennis elbow improved within the exercise group. The results indicated that progressive exercise therapy is more effective than ultrasound in treating chronic lateral epicondylitis, reducing pain and improving patients ability to work