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Search Results for : Lateral Epicondylitis
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions.
Author(s): Valen, PA; Foxworth, J
Journal: Curr Opin Rheumatol 2010 Apr 20; Vol. 22, Issue 2; Page(s) 194-204
[Medline ID - 20010297]

PURPOSE OF REVIEW: To evaluate recent trials and reviews of physical modalities and conservative treatments for selected upper extremity musculoskeletal conditions for evidence supporting their use. RECENT FINDINGS: Recent evidence suggests that many localized tendinopathies are related more to degenerative than inflammatory processes. With this realization, there is increased emphasis on finding new modalities to treat tendinopathies and other localized musculoskeletal conditions that rely on other than anti-inflammatory mechanisms. Although there is good evidence to support the short-term benefits of corticosteroid injections, convincing evidence in support of other conservative treatments and modalities is generally lacking. Extracorpal shock wave therapy may have significant clinical benefit for calcific tendinitis; however, it requires intravenou s sedation in most cases and does not appear to be effective in lateral epicondylitis. The most consistent positive treatment effects for rotator cuff tendinitis were achieved by ultrasound-guided subacromial corticosteroid injection as well as manual therapy in conjunction with therapeutic exercise. SUMMARY: Although there is evidence supporting the use of several different physical modalities and conservative treatments for upper extremity musculoskeletal conditions, there is a strong need for larger, higher quality randomized controlled trials. Although most studies are able to demonstrate short-term benefits, there is a lack of high-quality data demonstrating that these conservative treatments have long-term benefits, particularly, with regard to functional outcomes.

Tennis elbow. There is no proved treatment.
Author(s): Mahaffey, P
Journal: BMJ 2009 Dec 29; Vol. 339; Page(s) b5325
[Medline ID - 19726459]

ABSTRACT NOT AVAILABLE

Tennis elbow. Diagnose and treat the disease.
Author(s): Peall, AF
Journal: BMJ 2009 Dec 29; Vol. 339; Page(s) b5321
[Medline ID - 19726459]

ABSTRACT NOT AVAILABLE

Tennis elbow. Injections for all?
Author(s): Kavalier, F
Journal: BMJ 2009 Dec 29; Vol. 339; Page(s) b5320
[Medline ID - 19726459]

ABSTRACT NOT AVAILABLE

Tennis elbow. Injecting steroids is not good.
Author(s): O'Connor, RF
Journal: BMJ 2009 Dec 29; Vol. 339; Page(s) b5319
[Medline ID - 19726459]

ABSTRACT NOT AVAILABLE

Fascia: A missing link in our understanding of the pathology of fibromyalgia.
Author(s): Liptan, GL
Journal: J Bodyw Mov Ther 2010 Feb 27; Vol. 14, Issue 1; Page(s) 3-12
[Medline ID - 20006283]

Significant evidence exists for central sensitization in fibromyalgia, however the cause of this process in fibromyalgia-and how it relates to other known abnormalities in fibromyalgia-remains unclear. Central sensitization occurs when persistent nociceptive input leads to increased excitability in the dorsal horn neurons of the spinal cord. In this hyperexcited state, spinal cord neurons produce an enhanced responsiveness to noxious stimulation, and even to formerly innocuous stimulation. No definite evidence of muscle pathology in fibromyalgia has been found. However, there is some evidence for dysfunction of the intramuscular connective tissue, or fascia, in fibromyalgia. This paper proposes that inflammation of the fascia is the source of peripheral nociceptive input that leads to central sensitization in fibromyalgia. The fascial dysfunction is proposed to be due to inadequate growth hormone production and HPA axis dysfunction in fibromyalgia. Fascia is richly innervated, and the major cell of the fascia, the fibroblast, has been shown to secrete pro-inflammatory cytokines, particularly IL-6, in response to strain. Recent biopsy studies using immuno-histochemical staining techniques have found increased levels of collagen and inflammatory mediators in the connective tissue surrounding the muscle cells in fibromyalgia patients. The inflammation of the fascia is similar to that described in conditions such as plantar fasciitis and lateral epicondylitis, and may be better described as a dysfunctional healing response. This may explain why NSAIDs and oral steroids have not been found effective in fibromyalgia. Inflammation and dysfunction of the fascia may lead to central sensitization in fibromyalgia. If this hypothesis is confirmed, it could significantly expand treatment options to include manual therapies directed at the fascia such as Rolfing and myofascial release, and direct further research on the peripheral pathology in fibromyalgia to the fascia.

Surgical treatment for lateral epicondylitis: a long-term follow-up of results.
Author(s): Coleman, B; Quinlan, JF; Matheson, JA
Journal: J Shoulder Elbow Surg 2010 Jun 4; Vol. 19, Issue 3; Page(s) 363-7
[Medline ID - 20004594]

HYPOTHESIS: Since its first description, the pathology, natural history, and treatment of lateral epicondylitis have remained controversial. For patients in who conservative management fails, surgery remains an option. The optimal method of surgery remains debatable and is further confounded by a relative lack of long-term follow-up studies. MATERIALS AND METHODS: This study describes a modification of the Nirschl surgical technique and presents its long-term results. Patients undergoing this open technique were reviewed by use of the Hospital for Special Surgery and Mayo elbow performance assessment tools, as well as having grip strength and subjective outcome recorded. RESULTS: From June 1986 to December 2001, 158 consecutive patients (171 elbows) underwent surgery in a single-surgeon series. Of these patients, 137 (86.7%) were available for follow-up at a mean of 9.8 years. The mean age of the group was 42 years. Subjectively, the results were good to excellent in 94.6% of patients and in 92.6% to 94.0% of patients by use of the Hospital for Special Surgery and Mayo scores, respectively. No differences were noted in grip strength. No patient required revision surgery. CONCLUSIONS: This repeatable open technique offers excellent results with a low rate of complications at a mean follow-up of 9.8 years. These results compare favorably in terms of numbers followed up, length of follow-up, and outcome and offer strong evidence of its efficacy.

Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084).
Author(s): Chesterton, LS; van der Windt, DA; Sim, J; Lewis, M; Mallen, CD; Mason, EE; Warlow, C; Vohora, K; Hay, EM
Journal: BMC Musculoskelet Disord 2010 Feb 18; Vol. 10; Page(s) 156
[Medline ID - 20003341]

BACKGROUND: Tennis elbow is a common and often extremely painful musculoskeletal condition, which has considerable impact on individuals as well as economic implications for healthcare utilization and absence from work. Many management strategies have been studied in clinical trials. Whilst corticosteroid injections offer short term pain relief, this treatment is unpleasant and is used with caution due to an associated high risk of pain recurrence in the long term. Systematic reviews conclude that there is no clear and effective treatment for symptoms of pain in the first 6 weeks of the condition. There is a clear need for an intervention that is acceptable to patients and provides them with effective short-term pain relief without increasing the risk of recurrence. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, non-invasive, non-pharmacological form of analgesia that is commonly used in the treatment of pain. TENS has very few contraindications and is simple to apply. It also benefits from being patient controlled, thereby promoting self-management. This study aims to assess the effectiveness, in terms of pain relief, and cost-effectiveness of a self-management package of treatment that includes TENS. METHODS/DESIGN: The design of the study will be a two-group pragmatic randomized clinical trial. 240 participants aged 18 years and over with tennis elbow will be recruited from 20-30 GP practices in Staffordshire, UK. Participants are to be randomized on a 1:1 basis to receive either primary care management (standard GP consultation, medication, advice and education) or primary care management with the addition of TENS, over 6 weeks. Our primary outcome measure is average intensity of elbow pain in the past 24 ho urs (0-10 point numerical rating scale) at 6 weeks. Secondary outcomes include pain and limitation of function, global assessment of change, days of sick leave, illness perceptions, and overall health status. A cost-effectiveness analysis will also be performed. Patient adherence and satisfaction data will be collected at 6 weeks, 6 months and 12 months by postal questionnaire. A diary will also be completed for the first 2 weeks of treatment. Clinical effectiveness and cost-effectiveness analyses will be carried out using an intention-to-treat approach as the primary analysis. DISCUSSION: This paper presents detail on the rationale, design, methods and operational aspects of the trial. TRIAL REGISTRATION: Current Controlled Trials. ISRCTN87141084.

Pressure pain sensitivity mapping in experimentally induced lateral epicondylalgia.
Author(s): Fern; ández-Carnero, J; Binderup, AT; Ge, HY; Fern; ández-de-las-Peñas, C; Arendt-Nielsen, L; Madeleine, P
Journal: Med Sci Sports Exerc 2010 Aug 5; Vol. 42, Issue 5; Page(s) 922-7
[Medline ID - 19996999]

PURPOSE: The aim of this study was to apply topographical techniques to investigate changes in pressure pain sensitivity after induction of delayed onset muscle soreness (DOMS) in the elbow region in healthy subjects. METHODS: Pressure pain thresholds (PPT) were assessed over 12 points forming a 3 x 4 matrix (4 points in the superior part, 4 points in the middle, and 4 points in the lower part around the lateral epicondyle) over the dominant elbow in 13 healthy men, and pressure sensitivity maps were calculated. DOMS, as a model for lateral epicondylalgia (LE), was induced by repetitive high-level eccentric contractions of the wrist extensor muscles. PPT maps were assessed before, immediately after, and 24 h after eccentric exercise (DOMS). RESULTS: The two-way repeated-measure ANOVA detected significant differences in mean PPT for the measurement points (F = 5.96, P < 0.001), with lower PPT over the points located over the extensor carpi radialis brevis muscle. There was also a significant effect of time (F = 121.3, P < 0.001) but no time x point location interaction (F = 0.7, P = 0.8). PPT were lower 24 h after (P < 0.001) but not immediately after (P > 0.05) eccentric exercise. CONCLUSIONS: The study provides new key information regarding mechanical pain hyperalgesia in experimentally induced LE. Topographical pressure pain sensitivity maps from the elbow region revealed heterogeneously distributed mechanical sensitivity before and during DOMS. Th e most sensitive localizations for PPT assessment correspond to the muscle belly of the extensor carpi radialis brevis. Our results support the implication of the extensor carpi radialis brevis muscle in LE.

Posterior interosseous nerve palsy as a complication of friction massage in tennis elbow.
Author(s): Wu, YY; Hsu, WC; Wang, HC
Journal: Am J Phys Med Rehabil 2010 Aug 13; Vol. 89, Issue 8; Page(s) 668-71
[Medline ID - 19966559]

Friction massage is a commonly used physical therapy that is usually safe and without complication. We report an unusual case of posterior interosseous nerve palsy that arose after friction massage. Electrophysiologic findings confirmed a focal neuropathy 4-6 cm distal to the lateral epicondyle. The neurologic symptoms resolved completely 2 mos after discontinuation of friction massage. This case experience broadens the spectrum of etiologies of posterior interosseous nerve palsy. Nerve conduction studies may be a useful adjunct to a thorough physical examination to confirm the diagnosis and is important to prognostic evaluation, if unexplained neurologic symptoms develop after certain physical therapy procedures. Further treatment includes avoiding compression and observation.
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