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Background: Lateral epicondylitis (LE) is characterized by pain, inflammation and local tenderness over the bony prominence of the lateral epicondyle and is exacerbated under stressful and repetitive movements such as prolonged supination and pronation movements, twisting (wringing, turning) and rolling activities (stirring and mixing). Lateral Epicondylitis ranks as the second most commonly diagnosed musculoskeletal condition. Females, especially housewives, are more affected by LE. It can lead to persistent elbow pain, reduced grip strength, limited arm movement, and difficulty performing daily tasks. Results: All of our 150 participants were women aged 25–50 + years. We found that 86% of housewives reported some level of pain (mild, moderate and severe) according to the PRTEE questionnaire but 39.33% (59/150) showed positive lateral epicondylitis cases assessed physically by special test (Cozen, Mills, Maudsley's test). Among the individuals diagnosed with lateral epicondylitis, a significant majority, 71.19% (42 out of 59), reported pain in their right arm while only 16.95% were experiencing pain in their left arm, however, 11.86% (7 out of 59) reported pain in both arms. The odds ratio estimates of age groups suggested that the 25–30 years group had higher odds of getting LE about 0.95 than the reference group. Among the individuals with lateral epicondylitis, 59.32% (35 out of 59) were experiencing chronic pain, while 40.67% (24 out of 59) were dealing with acute pain. 54.24% (32/59) of individuals with lateral epicondylitis experienced functional disability in specific activities, while 28.81% (17/59) reported functional disability in routine activities. Conclusion: We found a high prevalence of 39.33% lateral epicondylitis among housewives. There is a dire need to raise awareness among housewives for changing their lifestyle and activities regimen in order to avoid any such disorders like L.E. Robust studies with larger sample sizes are needed to establish conclusive evidence. [ABSTRACT FROM AUTHOR]

Elbow arthroscopy presents challenges; however, its indications and advantages over traditional open surgery are swiftly evolving. Despite being less widely performed than on other joints such as the knee, shoulder, ankle, and hip, arthroscopic management of the elbow has potential. The goals of this review are to describe and broaden the current applications of elbow arthroscopy. Additionally, we will provide insights and strategies to enhance the effectiveness of elbow arthroscopy. [ABSTRACT FROM AUTHOR]

Background: Lateral and medial elbow tendinopathies are common soft tissue disorders affecting 1–3% of the general population, causing significant pain and functional impairment in the elbow and upper limb. While often associated with overuse and repetitive strain, their exact etiology, including potential associations with prior injuries in adjacent joints, remains unclear. This preliminary study aims to explore the distribution of lateral and medial elbow tendinopathies and investigate the occurrence of previous lesions in adjacent joints among diagnosed individuals, providing foundational insights for future research. Methods: A multicenter cross-sectional observational study was conducted involving 90 subjects diagnosed with lateral and/or medial elbow tendinopathy. The data collection occurred during the initial consultations, including demographic information, clinical assessments, and history of prior injuries in adjacent joints. Results: Among the sample, 44.4% reported prior injuries to adjacent joints in the affected upper limb, with 45.6% of these injuries identified as musculotendinous in nature. The analysis also showed that the type of elbow tendinopathy was significantly associated with sex (p = 0.01) and occupational origin (p = 0.022). Conclusions: While a notable percentage of the subjects reported prior musculoskeletal injuries in the same limb, the study's geographic limitations and reliance on self-reported data introduce potential recall bias. These preliminary findings suggest a possible relationship between prior adjacent joint injuries and elbow tendinopathy. Further research with larger sample sizes and more rigorous study design is needed to confirm these observations and explore the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Medial elbow pain is a common musculoskeletal problem among individuals engaging in repetitive activities. Medial epicondylitis is the predominant cause of this pain. However, other potential causes must be considered as part of the differential diagnosis. This article discusses several etiologies of medial elbow pain, including medial epicondylitis, ulnar neuropathy, snapping triceps syndrome, ulnar collateral ligament injury, medial antebrachial cutaneous neuropathy, and diseases of the elbow joint, with an emphasis on ultrasound (US) findings. Awareness of possible diagnoses and their US features can assist radiologists in establishing a comprehensive diagnosis for medial elbow pain. [ABSTRACT FROM AUTHOR]

Background: The elbow is a common site for overuse injuries in golfers. Tendinopathies, such as medial and lateral epicondylitis, are frequently diagnosed in amateur and professional golfers. The aim of our study was to determine the effect of an ergonomic golf grip on forearm muscle activity during the five phases of the golf swing. Methods: Thirty right-handed golfers with a mean age of 32 years (range, 18–70 years) and a mean handicap of 15 (range, 0–43) performed 10 golf swings with a standard and ergonomic golf grip respectively. The mean and maximum muscle activity of the Musculus (M.) extensor carpi radialis brevis (ECRB), M. flexor carpi ulnaris (FCU), M. pronator teres (PT) and M. biceps brachii (BB) of the lead and trail arms were assessed during the five phases of the golf swing using surface electromyography (EMG). Subgroup analyses were performed regarding sex, playing ability (handicap < 10 vs. ≥10), weekly playing time (≤ 5 h, 5–20 h, > 20 h) and preexisting elbow pain during golfing (VAS < 2 vs. VAS ≥ 2). Significance was set at p < 0.05. Results: An ergonomic golf grip resulted in a reduction in muscle activity in at least one but up to three consecutive phases of the golf swing for the ECRB, FCU and PT of the lead arm and for the PT of the trail arm. Amateurs, a playing time < 20 h per week and golfers without preexisting elbow pain were factors that were associated with greater reductions in muscle activity. Conclusion: Forearm muscle activity can be decreased using an ergonomic golf grip, indicating the possible role of an ergonomic golf grip as a preventive measure against overuse syndromes such as medial and lateral epicondylitis. Trial registration number: This study was retrospectively registered at the German Clinical Trials Register DRKS-ID: DRKS00033732 (01/03/2024). [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the validity and informational value of TikTok content about epicondylitis. The hypothesis tested herein was that TikTok video content would not provide adequate and valid information. Methods: The term "epicondylitis" was used as a keyword to comprehensively search for TikTok videos, and the first 100 videos that were retrieved were subsequently included for analysis. The duration, number of likes, number of shares and number of views were recorded for each video. Furthermore, the videos were categorized on the basis of their source (medical doctor, physiotherapist, or private user), type of information (physical therapy, anatomy, clinical examination, etiopathogenesis, patient experience, treatment, or other), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or voice. Assessments of video content quality and reliability were conducted using the DISCERN tool, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). Results: A total of 100 videos were included in the analysis: 78 (78.0%) were published by physiotherapists, 18 were published by medical doctors (18.0%), and 4 were published by private users (4.0%). Most of the information pertained to physical therapy (75; 75.0%) and most of the content was about rehabilitation (75; 75.0%). The mean length of the videos was 42.51 ± 24.75 seconds; the mean number of views was 193,207.78 ± 1,300,853.86; and the mean number of comments, likes, and shares were 22.43 ± 62.54, 1578.52 ± 8333.11, and 149.87 ± 577.73, respectively. The mean DISCERN score, JAMA score, and GQS were 18.12 ± 5.73, 0.80 ± 0.53, and 1.30 ± 0.52, respectively. Videos posted by medical doctors/private users had higher scores (p < 0.05) than videos posted by physiotherapists. Videos that focused on education or patient experience had higher scores (p < 0.05) than videos based on rehabilitation. Conclusions: TikTok can be an unreliable source of information regarding epicondylitis treatment. It is common to find nonphysicians who share medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Elbow surgeons should advise their patients that treatment recommendations from TikTok may not align with established guidelines. Level of Evidence: Level IV—Cross-sectional study. [ABSTRACT FROM AUTHOR]

People whose jobs involve repetitive motions of the wrist and forearm can suffer from lateral epicondylitis, which is a significant burden on both the individual and the employer due to treatment costs, reduced productivity, and work absenteeism. This paper describes an ergonomic intervention to reduce lateral epicondylitis in the workstation of a textile logistics center. The intervention includes workplace-based exercise programs, evaluation of risk factors, and movement correction. An injury- and subject-specific score was calculated from the motion captured with wearable inertial sensors at the workplace to evaluate the risk factors of 93 workers. Then, a new working movement was adapted to the workplace, which limited the observed risk factors and took into account the subject-specific physical abilities. The movement was taught to the workers during personalized sessions. The risk factors of 27 workers were evaluated again after the intervention to validate the effectiveness of the movement correction. In addition, active warm-up and stretching programs were introduced as part of the workday to promote muscle endurance and improve resistance to repetitive stress. The present strategy offered good results at low cost, without any physical modification of the workplace and without any detriment to productivity. [ABSTRACT FROM AUTHOR]

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Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Focused Clinical Question: What are the effects of the Mulligan Concept combined with traditional physiotherapy on lateral elbow pain and grip strength in adults with lateral epicondylalgia (LE) compared with traditional physiotherapy? Clinical Bottom Line: Grade B evidence supports positive effects of the Mulligan Concept combined with traditional physiotherapy on LE compared with traditional physiotherapy alone. However, the effects of the Mulligan Concept as a standalone intervention in the treatment of LE are not well known. Therefore, additional research is warranted to determine the individual effects of the Mulligan Concept compared with its use in a comprehensive rehabilitation protocol to treat LE in adults. [ABSTRACT FROM AUTHOR]

Copyright of SEMS-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Platelet-rich plasma (PRP) injections may alleviate symptoms of chronic medial or lateral epicondylitis. Methods: We retrospectively analyzed a total of 55 patients with chronic ME or LE who had undergone at least 6 months of any conservative treatment before intervention. The patients were divided into two groups: the PRP group (n = 25), who received a single injection of autologous PRP to the medial or lateral epicondyle, and the PT group (n = 30), who continued with PT and pain medication. The primary outcome measures were pain and functional outcomes measured in terms of the following: Patient Related Tennis Elbow Evaluation (PRTEE), Visual Analogue Scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH), which were detected at preintervention, 6-, 12-, 24-, and 36-month follow-up. Secondary outcomes included complications and the need for any surgery at follow-up. Results: Primary outcome measurements showed significantly better results favoring the PRP group (6-month PRTEE total 43.2 ± 19.2 vs. 62.8 ± 24.0, p < 0.001; 12-month PRTEE total 6.9 ± 15.0 vs. 28.1 ± 24.4, p < 0.001; 24-month PRTEE total 4.8 ± 9.8 vs. 12.7 ± 14.5, p = 0.029), and significantly better results in VAS and DASH sub-scores. The PRP group required significantly fewer surgical procedures (n = 0/0% vs. n = 6/20%, p = 0.027) at follow-up (mean 38.3 ± 12.3 months), and one case of prolonged pain after injection was detected. Conclusions: Patients who underwent PRP injections for epicondylitis resulted in better pain and functional outcomes compared to physiotherapy, and this improvement lasted at least 24 months. They required fewer surgical procedures and achieved faster recovery than the PT group. We recommend PRP for chronic epicondylitis of the elbow before considering surgery when other treatments have failed. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyse women's wrist and elbow acute work injuries together with cumulative trauma disorders, such as carpal tunnel syndrome (CTS) and epicondylitis. Five years records (2015–2019) on women's wrist/elbow acute work injuries and CTS/epicondilytis, from Italian National Compensation Authority, were collected and pooled all together as 'dis-ac' (disorders + acute) events. A statistical analysis was performed in comparing the different female-dominated work sectors. Results showed that hairdressing/laundry sector was associated with the highest risk for wrist acute work injuries and cleaning for elbow while manufacturing for CTS and epicondylitis. Hairdressing/laundry and manufacturing were associated with the highest risk for dis-ac events (hairdressing: wrist dis-ac OR: 4.89; CI 95% 4.22–5.67; elbow dis-ac OR: 3.70; CI 95% 2.99–4.58; manufacturing: wrist dis-ac OR: 3.39; CI 95% 3.13–3.66; elbow dis-ac OR: 2.45; CI 95% 2.20–2.73). The relationship between acute injuries and cumulative trauma disorders is discussed to preserve women's safety and health in ergonomics. Practitioner Summary: Women's wrist and elbow acute work injuries and cumulative trauma disorders (carpal tunnel syndrome and epicondylitis) were analysed and studied all together (dis-ac events) in female-dominated activities. Hairdressing and manufacturing work sectors were associated with the highest risk, showing the need to safeguard the health and safety of female workers. [ABSTRACT FROM AUTHOR]

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Objectives: The purpose of this study was to investigate which cold application is more effective to regulate skin temperature in patients with tennis elbow. Design: Randomized clinical study. Participants: Fifty-four patients with tennis elbow were randomly divided into 2 groups as cooling gel group (n=27) and cold pack group (n=27). Interventions: Cooling gel and cold pack applications were applied on painful lateral epicondyle region for 15 minutes. Main outcome measures: Patients were assessed before and after the application. Assessments included the severity of pain during wrist extension, evaluated by Visual Analog Scale (VAS) and thermal imaging of lateral epicondyle region evaluated by Infrared Thermography (FLIR5 Thermal Camera). Results: There were no significant differences between baseline assessments of pain severity and thermographic measurements in both groups (p>0.05). Significant differences were found between baseline and postapplication measurements at pain and thermographic measurements in both groups (p<0.05). In comparison of cooling gel and cold pack groups, no significant differences were found in means of pain (p=0.095) and thermal imaging results (p=0.333). Conclusion: Both cooling gel and cold pack application are found effective in decreasing skin temperature in patients with tennis elbow and their use should be considered in treatment program. [ABSTRACT FROM AUTHOR]

Background: For most patients, tennis elbow (TE) resolves within 6 months of onset. For those with persistent and painful TE, nonsurgical treatment options are limited. Thousands of studies have tried to find effective treatments for TE but have usually failed. In this study, we tested the hypothesis that injections with hyaluronic acid (HA) would be effective at reducing pain from chronic TE. Methods: Patients with a minimum of six months of pain from TE and with a pain level of 50 or greater (out of 100) were included in the study. They were randomized equally into one of two treatment groups: injection with HA or injection with saline control. Follow-up was conducted at 3, 6 and 12 months from the initial injection. Both the patient and the examiner at the follow-up visits were blinded to the treatment arm. The primary outcome measure was the visual analog scale (VAS pain) score at one year. Additional outcome measures included the shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and Patient Rated Tennis Elbow Evaluation (PRTEE) scores. Results: Eighteen patients were randomized into the HA injection treatment arm, and 17 (94%) completed the study. The average age was 51.9 years, and 10 of the subjects were male. Patients had an average of 28.1 months of pain before entering the study. The VAS score in the HA group decreased from a baseline of 76.4–14.3 at 12 months. All 17 patients in the HA group showed VAS score reductions above the minimal clinically important difference (MCID) of at least 18. The PRTEE score improved from 67 to 28.1. The QuickDASH score improved from 53.7 to 22.5. Follow-up in the saline group was less than 50% and was therefore not used as a comparator. Conclusions: HA injections yielded significant success in pain relief by three months. Patients continued to improve for the 12-month duration of the study. This study indicates that patients with chronic lateral epicondylitis may benefit from receiving injections of hyaluronic acid rather than having to undergo surgery. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) and conventional physical therapy applications on pain, grip strength and functionality in medial and lateral epicondylitis treatment and to compare the results. Materials and Methods: A total of 116 patients diagnosed with medial and lateral epicondylitis were included in the study. The patients were divided into ESWT group and control group. The patients in the control group received a total of 15 sessions of conventional physical therapy (Hotpack, Transcutaneous electrical nerve stimulation (TENS)) once a day for 30 minutes. Whereas, ESWT was applied to the patients in the ESWT group as 2 sessions per week, for a total of 6 sessions. Pain severity of the patients was measured with Visual Pain Scale (VAS), grip strength with a hand dynamometer and functional level with the Patient Based Forearm Assessment Questionnaire (PFEQ). Measurements were made in all groups before treatment, after treatment and 1 month after treatment. Results: In comparisons between groups, there was a significant decrease in VAS and PFEQ values after treatment compared to the control group in the ESWT group (p <0.05). In the evaluation of the hand tightening force, it was observed that the hand tightening force in the ESWT group after treatment (p: 0.043) and 1st month controls increased significantly compared to the control group (p: 0.038). Conclusions: Based on these results, our study demonstrated that the combination of conventional physical therapy and ESWT produced clinically positive effects in patients with epicondylitis. [ABSTRACT FROM AUTHOR]

Background: International consensus is needed on case definitions of work-related musculoskeletal disorders and diseases (MSDs) for use in epidemiological research. We aim to: 1) study what information is needed for the case definition of work-related low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral and medial elbow tendinopathy, and knee and hip osteoarthritis, and to 2) seek consensus among occupational health professionals/researchers regarding the case definitions of these work-related MSDs.Methods: A two-round Delphi study was conducted with occupational health professionals/researchers from 24 countries. Definition of work-related MSDs were composed of a case definition with work exposures. Round 1 included 32 case definitions and round 2, 60 case definitions. After two rounds, consensus required 75% of the panellists to rate a case definition including work exposures ≥7 points on a 9-point rating scale (completely disagree/completely agree).Results: Fifty-eight panellists completed both rounds (response rate 90%). Forty-five (70%) panellists thought that for LBP a case definition can be based on symptoms only. Consensus was only reached for work-related medial elbow tendinopathy, while the lowest agreement was found for knee osteoarthritis. Where consensus was not reached, this was - except for LBP - related to physical examination and imaging rather than disagreement on key symptoms.Conclusion: Consensus on case definitions was reached only for work-related medial elbow tendinopathy. Epidemiological research would benefit from harmonized case definitions for all MSDs including imaging and physical examination for LRS, SAPS, CTS, lateral elbow tendinopathy and hip and knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Purpose: The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. Methods: Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. Results: The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. Conclusions: Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity. [ABSTRACT FROM AUTHOR]

The elbow is the least common of the main joints examined with magnetic resonance imaging (MRI), thus radiologists may be less familiar with writing these reports. This article addresses the main pathologies encountered in and around the elbow, emphasizing the specific features that need reporting and providing examples of terminology to use when describing these abnormalities. [ABSTRACT FROM AUTHOR]

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Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Represents a cause of temporary or even long-term interruption of professional activity. Objectives. Repetitive occupational or athletic activities involving wrist extension and supination are thought to be causative. The typical symptoms include lateral elbow pain, pain with wrist extension, and weakened grip strength. The diagnosis is made clinically through history and physical examination; however, a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies. Most patients improve with nonoperative measures, such as activity modification, physical therapy, and injections. A small percentage of patients will require surgical release of the extensor carpi radialis brevis tendon. Common methods of release may be performed via percutaneous, arthroscopic, or open approaches. Methods of research. A number of 30 patients with this type of tendonitis were studied. The only detectable cause was overuse of the elbow joint by repeated pronosupinatory movements. The initial treatment was exclusively through physical therapy and physical rest. After 14 days we found that 10 patients had complete remission of symptoms. Injectable treatment was required for 18 patients corticosteroid infiltrates (betamethasone or triamcinolone acetonide) associated with PRP to 7 of them. Minimally invasive percutaneous surgery was required in 2 patients. Conclusions. Early recognition of that condition followed by physical therapy/kinetotherapy can lead to complete remission of symptoms and rapid reintegration into sports or professional activity of the person. Delayed presentation to a specialist can lead to invasive treatments such as surgery, that can compromise the skills or even sports or professional performance of the patient. [ABSTRACT FROM AUTHOR]

Background: There are currently a variety of patient-reported outcomes (PROs) for elbow pathology, without any established gold standard. The Single Assessment Numeric Evaluation (SANE) is a single question assessment of the patient's perceived overall function compared with normal. The SANE score has been correlated with PROs from the shoulder and knee literature. Purpose: To correlate the SANE score for a variety of elbow pathologies with a traditionally reported elbow outcome measure, the American Shoulder and Elbow Surgeons–Elbow score (ASES-E). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review was performed of all patients identified at a single center between April 2016 and January 2019 who presented as a new patient with elbow pathology. All patients prospectively completed the ASES-E along with the SANE score for elbow (SANE-E) at the time of initial consultation. Spearman correlations (r) were performed to evaluate the correlation between the ASES-E and the SANE-E score for specific elbow pathology, along with descriptive data such as age, sex, and chronicity of the problem. Results: A total of 555 patients (166 women, 29.9%) with a mean ± SD age of 51.0 ± 11.7 years with the diagnoses of medial epicondylitis (n = 72; 13.0%), lateral epicondylitis (n = 224; 40.4%), biceps tendon rupture (n = 139; 25.0%), triceps tendon rupture (n = 21; 3.8%), and elbow arthritis (n = 99; 17.8%) were included in this analysis. There was moderate correlation between the SANE-E and the ASES-E (r = 0.623; P <.001), with strongest correlation with the visual analog scale (VAS) (r = −0.518; P <.001) compared with any individual question and moderate to strong correlations based on specific diagnoses. SANE-E and ASES-E scores for the entire cohort were 42.9 ± 26.7 and 56.9 ± 21.4, respectively (P <.001). Age (r = 0.027; P =.526), sex (r = 0.026; P =.555), VAS (r = −0.106; P =.013), and chronicity of the problem (r = −0.037; P =.384) were not found to be correlated with differences in ASES-E and SANE-E. Conclusion: The SANE-E score is a simple way to assess patient-perceived function relative to normal. The findings of this study demonstrated moderate to strong correlation between the ASES-E and the SANE-E score for a variety of commonly encountered elbow conditions. [ABSTRACT FROM AUTHOR]

Objectives: To develop a practical step-by-step technique to precisely identify and differentiate tendons and ligaments attaching to the humeral epicondyles, to confirm through gross anatomical study the accurate structure identification provided by this technique and to determine the frequency at which each structure can be identified in healthy volunteers. Materials and methods: First, ten fresh frozen cadavers (6 men, age at death = 58–92 years) were examined by two musculoskeletal radiologists and a step-by-step technique for the identification of tendons and ligaments at the level of humeral epicondyles was developed. Second, the accurate identification of structures was confirmed through gross anatomical study including anatomical sections on five specimens and layer-by-layer dissection technique on five others. Finally, 12 healthy volunteers (6 men, average age = 36, range = 28–52) were scanned by two radiologists following the same technique. Results: An ultrasonographic technique based on the recognition of bony landmarks and the use of ultrasonographic signs to differentiate overlapping structures was developed and validated through gross anatomical study. In healthy volunteers, most tendons and ligaments were identified and well-defined in ≥ 80% of cases, except for the extensor carpi radialis brevis and extensor digiti minimi tendons on the lateral epicondyle (having common attachments with the extensor digitorum communis) and the palmaris longus tendon on the medial epicondyle (absent, or common attachment with the flexor carpi radialis). Conclusion: A step-by-step approach to the ultrasonographic assessment of tendons and ligaments at the humeral epicondyles allowed accurate identification of and differentiation among these structures, in particular those relevant to pathological conditions. [ABSTRACT FROM AUTHOR]

Background: Metabolic factors have been linked to tendinopathies, yet few studies have investigated the association between metabolic factors and lateral epicondylitis. Purpose: To evaluate risk factors for lateral epicondylitis, including several metabolic factors. Study Design: Case-control study; Level of evidence, 3. Methods: We evaluated 1 elbow in each of 937 volunteers from a rural region that employs many agricultural laborers. Each participant received a questionnaire, physical examinations, blood tests, simple radiographic evaluations of both elbows, magnetic resonance imaging of bilateral shoulders, and an electrophysiological study of bilateral upper extremities. Lateral epicondylitis was diagnosed using 3 criteria: (1) pain at the lateral aspect of the elbow, (2) point tenderness over the lateral epicondyle, and (3) pain during resistive wrist dorsiflexion with the elbow in full extension. Multivariable logistic regression analysis was used to calculate the odds ratios (ORs) and 95% CIs for various demographic, physical, and social factors, including age, sex, waist circumference, dominant-side involvement, smoking habit, alcohol intake, and participation in manual labor; the comorbidities of diabetes, hypertension, thyroid dysfunction, metabolic syndrome, ipsilateral biceps tendon injury, ipsilateral rotator cuff tear, and ipsilateral carpal tunnel syndrome; and the serologic parameters of serum lipid profile, glycosylated hemoglobin A1c, level of thyroid hormone, and high-sensitivity C-reactive protein. Results: The prevalence of lateral epicondylitis was 26.1% (245/937 participants). According to the multivariable logistic regression analysis, female sex (OR, 2.47; 95% CI, 1.78-3.43), dominant-side involvement (OR, 3.21; 95% CI, 2.24-4.60), manual labor (OR, 2.25; 95% CI, 1.48-3.43), and ipsilateral rotator cuff tear (OR, 2.77; 95% CI, 1.96-3.91) were significantly associated with lateral epicondylitis (P <.001 for all). No metabolic factors were significantly associated with lateral epicondylitis. Conclusion: Female sex, dominant-side involvement, manual labor, and ipsilateral rotator cuff tear were found to be risk factors for lateral epicondylitis. The study results suggest that overuse activity is more strongly associated with lateral epicondylitis than are metabolic factors. [ABSTRACT FROM AUTHOR]

Copyright of Il Fisioterapista is the property of Edi.Ermes S.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research.Methods: A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O'Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria.Results: In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment.Conclusion: We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria. [ABSTRACT FROM AUTHOR]

This paper presents the most effective ways of early and systematic application of kinetotherapy means and procedures to re-educate the functionality of the elbow. Movement therapy comes into action simultaneously with the other recovery means, within the general therapeutic plan, without excluding other therapies. The treatment of medial epicondylitis caused by overuse of the forearm muscles is a concern for the functional recovery of the elbow. The treatment of functional recovery of the elbow through physiotherapy is based on the functional re-education for the fastest return to the daily activities and sports of the patient. In addition to its curative role, physiotherapy, influencing a series of pathophysiological links, also has a preventive action, by improving the muscle tone of the arm, toning both the muscles of the forearm and the arm and stretching the epicondylis elbow tendons. [ABSTRACT FROM AUTHOR]

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Background: Epicondylitis humeri is a common disease with a prevalence of 1.7%. One of the treatment options is radiotherapy. Most published cases were treated with the orthovoltage technique or with a telecobalt device. Many radiotherapy institutions are nowadays using linear accelerators for treatment of epicondylitis humeri. There is a discussion whether the treatment results with linear accelerators are comparable to the orthovoltage technique. The aim of this study was to analyze the results of radiotherapy with a linear accelerator for epicondylitis humeri.Material and Methods: The analysis was performed on patients of 2 German radiotherapy institutions and included 138 irradiated elbows. Pain was documented with the numeric rating scale (NRS). Evaluation of the NRS was done before and directly after each radiation therapy course as well as for the follow-up of 24 months. The median age of the patients was 49 years with 48.4% male and 51.6% female. In all, 81.0% were suffering from from epicondylitis humeri radialis while 16.7% were treated because of epicondylitis humeri ulnaris. In 65.4% the dominant arm was treated.Results: A significant response to radiotherapy could be found. For the whole sample the median pain was 7 on the NRS before radiotherapy, 4 after 6 weeks and 0 after 12 and 24 months. The percentage of patients with 0 or 1 on the NRS was 64.6% 12 months after radiotherapy. All subgroups, notably those with epicondylitis humeri radialis and epicondylitis humeri ulnaris had a significant reduction of pain.Conclusion: Radiotherapy of epicondylitis humeri with a linear accelerator is an effective treatment without showing side effects. All analyzed subgroups showed a good response to radiotherapy for at least 24 months. [ABSTRACT FROM AUTHOR]

Eccentric training is the most common therapeutic approach for the management of lateral elbow tendinopathy, but it is not the only exercise option. Isometric, concentric-eccentric, stretching-eccentric and isolated eccentric loading may be indicated, and the management of lateral elbow tendinopathy should be based on progressive loading of the distal extremity (kinetic chain), the muscle-tendon unit, and the tendon itself. [ABSTRACT FROM AUTHOR]

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Abstract: Background: Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting. Methods: A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1‐year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template. Results: A total of 65 patient records were identified, with patients having a mean age 48 years and mean symptom duration of 5.4 months. The mean treatment duration was 64 days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used. Conclusions: Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence‐based guidance for physiotherapists treating patients with tennis elbow. [ABSTRACT FROM AUTHOR]

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Purpose: To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation.Materials and Methods: Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies.Results: Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%).Conclusion: Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology.Key Points: • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis. • Combination of B-mode US and SEL in lateral epicondylitis correlates to histology. • Combination of both modalities provides improved sensitivity without loss of specificity. [ABSTRACT FROM AUTHOR]

Elbow tendinopathy accounts for the majority of elbow pathology in patients presenting to upper extremity and sports medicine surgeons. With increased participation in overhead sports in an aging population, the incidence of elbow injuries has risen. A comprehensive knowledge of elbow anatomy and biomechanical function of the elbow complex is prerequisite in the assessment of patients with elbow injuries; however, a thorough understanding of alternative and confounding pathologies is essential for accurate diagnosis. Because tendinopathy, tendonitis, and tendon tears have an anatomic basis for their pathology, a targeted history and meticulous physical examination often yields an accurate clinical diagnosis. The importance of physical examination and provocative examination maneuvers must be stressed in a technologically advanced era where clinical diagnosis is too commonly attained solely by advanced imaging modalities. A revived dedication to the physical examination may enhance our ability to correctly diagnose various pathologies about the elbow. Early and accurate clinical diagnosis is the first step in the proper initiation of treatment modalities and improvement in overall patient outcome. [ABSTRACT FROM AUTHOR]

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Aim: We aimed to reveal whether there are prospective suggestions for effective and standard platelet- rich plasma applications. Methods: We searched for clinical trials and traced all the references of incorporated documents. Results: In literature, there was no study indicating which disease is treated by which mechanism of action, how much dose and content are prepared and applied, when the treatment is applied and how many cures are applied. Conclusion: Guides introducing which concentrations of PRP are used for which diseases are to be prepared immediately by a committee which is comprised of primarily orthopedists, clinical pharmacologists and toxicologists. [ABSTRACT FROM AUTHOR]

Background: Traditional Chinese Medicine (TCM) uses a sophisticated diagnostic system called pattern differentiation, which allows for the tailor-made treatment of individuals. Objective: This study aimed to identify the commonly used TCM patterns for lateral elbow pain (LEP), as well as the clinical features associated with these patterns. Method: Journal literature in 15 major Chinese and English databases and textbooks from five medical libraries as well as Chinamaxx were reviewed. Results: Five hundred and fifty-five full-text journal articles, as well as 465 textbooks, were retrieved for further assessment, but only eight studies and seven books that mentioned LEP patterns could be identified and included in this study. The top four patterns that were identified were the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern, each of which was associated with unique features that were made up of distinct signs and symptoms. Conclusions: The unique features identified for each of the major patterns might be the key to understanding TCM individualized treatment based on pattern differentiation. Furthermore, the approach taken in studying TCM pattern of LEP may also be useful for studying the TCM patterns of other musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

Introduction: The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study.Methods: Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies.Results: A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance.Conclusions: Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders of the elbow, forearm, wrist and hand are associated with pain, functional impairment and decreased productivity in the general population. Combining several interventions in a multimodal program of care is reflective of current clinical practice; however there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand on self-rated recovery, functional recovery, or clinical outcomes in adults or children. Methods: We conducted a systematic review of the literature and best evidence synthesis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from January 1990 to March 2015. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. Results: We screened 5989 articles, and critically appraised eleven articles. Of those, seven had a low risk of bias; one addressed carpal tunnel syndrome and six addressed lateral epicondylitis. Our search did not identify any low risk of bias studies examining the effectiveness of multimodal care for the management of other musculoskeletal disorders of the elbow, forearm, wrist or hand. The evidence suggests that multimodal care for the management of lateral epicondylitis may include education, exercise (strengthening, stretching, occupational exercise), manual therapy (manipulation) and soft tissue therapy (massage). The evidence does not support the use of multimodal care for the management of carpal tunnel syndrome. Conclusions: The current evidence on the effectiveness of multimodal care for musculoskeletal disorders of the elbow, forearm, wrist and hand is limited. The available evidence suggests that there may be a role for multimodal care in the management of patients with persistent lateral epicondylitis. Future research is needed to examine the effectiveness of multimodal care and guide clinical practice. Systematic review registration number: CRD42014009093 [ABSTRACT FROM AUTHOR]

Objective: To assess the therapeutic effect of extracorporeal shock wave therapy (ESWT) in lateral epicondylopathy with calcification, and compare it to the effect of ESWT in lateral epicondylopathy without calcification. Methods: A retrospective study was conducted. Forty-three patients (19 with calcific and 24 with noncalcific lateral epicondylopathy in ultrasound imaging) were included. Clinical evaluations included the 100-point score, Nirschl Pain Phase scale before and after ESWT, and Roles and Maudsley (R&M) scores after ESWT. ESWT (2,000 impulses and 0.06-0.12 mJ/mm²) was performed once a week for 4 weeks. Results: The 100-point score and Nirschl Pain Phase scale changed significantly over time (p<0.001), but there was no significant difference between groups (p=0.555). The R&M scores at 3 and 6 months after ESWT were not significantly different between groups. In the presence of a tendon tear, those in the calcific lateral epicondylopathy group showed poor improvement of 100-point scores compared to the noncalcific group (p=0.004). Conclusion: This study demonstrated that the therapeutic effect of ESWT in calcific lateral epicondylopathy was not significantly different from that in noncalcific lateral epicondylopathy. When a tendon tear is present, patients with calcific lateral epicondylopathy might show poor prognosis after ESWT relative to patients with noncalcific lateral epicondylopathy. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies.Materials and Methods: A group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epicondylitis of the elbow (80 subjects). Each patient had 3 applications with a monthly interval, and was followed up at 1, 6, and 12 months after treatment. Results were evaluated by the numeric rating scale (NRS) in all cases, the Constant Murley Score for the assessment of the shoulder function, the American Orthopaedic Foot and Ankle Society Score for subjects affected by chronic Achilles tendinopathy, and the Oxford Elbow Score for those affected by a lateral epicondylitis of the elbow.Results: One year after treatment, the results were considered satisfactory with an almost complete resolution of symptoms. There were statistically significant results at the 12-month follow-ups regarding the mean NRS score (from 6.25 to 0.2), the Constant Murley Score (from 66.7 to 79.4), the Oxford Elbow Score (from 28 to 46), and the AOFAS (from 71 to 86).Conclusions: Extracorporeal shockwave therapy may be considered a safe, economic, and effective treatment for several chronic musculoskeletal disorders, allowing satisfactory pain relief and improvement of function ability.Level Of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Background: Forceful activities of the wrist were considered to be a risk factor for the epicondylitis. However, there are still conflicting evidence concerning work-relatedness of epicondylitis. The main problem is that there is little information about which forearm postures are capable of withstanding higher torque loads and the extent of the differences in the torques generated by different forearm postures. The objective of this study was to investigate the differences in wrist flexion and extension torques among different forearm positions in healthy subjects.Methods: Twenty wrists of 10 asymptomatic volunteers were evaluated. The apparatus to measure the wrist torque consisted of a handle with a force sensor and a table to place the forearm in different positions. The direction of the handle can change when measuring different forearm positions. The forearm of the examinee was secured to the table. The participants were asked to exert themselves in maximal isometric contraction for wrist flexion or extension, and to maintain it for 5 s. Each evaluation of the flexion and extension torque was conducted twice. Three forearm positions were evaluated: neutral, pronation, and supination. The intra-class correlation coefficients between first and second measurements were evaluated for the maximum torque. The maximum torques and flexion/extension ratio were compared among the positions. In addition, the agility and endurance for the wrist extension/flexion torques were compared among the positions.Results: The intra-class correlation coefficients between first and second measurements were 0.928 and 0.866 for the wrist flexion and extension measurements, respectively. The highest torques for the wrist flexion and extension were observed in the supination and pronation positions, respectively (P < 0.01). There was a higher extension/flexion ratio in the supination position compared to the other positions (P < 0.05). There was a superior agility for the wrist flexion in the supination position compared to the pronation position.Conclusions: The normal balance of the wrist flexion-extension torques in different forearm positions were characterized. This information might aid the provision of advice regarding the optimal positions for performing specific tasks and could help to elucidate the pathophysiology of epicondylitis. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis may cause pain and functional disability in many daily activities. Steroid injection or phonophoresis are the recommended treatments in this regard. In this study, we aim to compare the effect of ultrasound guided local injection of dexamethasone with dexamethasone phonophoresis for treatment of lateral epicondylitis. Materials and Methods: In this clinical trial, patients with lateral epicondylitis were randomely assigned to injection (n=18) and phonophoresis (n=18) groups. Three patients in phonophoresis group dropped out from the study. In injection group, dexamethasone with lidocaine was injected once with the guide of sonography at the base of common extensor tendon. Phonophoresis group received 5 minutes treatment with ultrasound using dexamethasone gel for 10 sessions. Patients' pain in total and in specific and usual activities according to PRTEE questionnaire before, one and three months after treatment was calculated. Results: Injection group compared to phonophoresis had significantly better improvement in pain (p=0.04), but there was no significant difference in serial changes of functional subscale and total score of PRTEE between groups. Injection group compared to phonophoresis had also better pain and total score one month after treatment (p=0.003 and p=0.01, respectively). Conclusion: Dexamethasone injection compared to phonophoresis had significant improvement in patients' pain which was more apparent one month after treatment, but the results were similar between groups three months after treatment. [ABSTRACT FROM AUTHOR]

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Introduction: Chronic lateral epicondylitis is generally treated using nonsurgical methods including physiotherapy and infiltrations of cortisone or platelet-rich plasma (PRP). The latter is known for its simple application as well as associated low risk of adverse events, which lend to its widespread use in treating various musculoskeletal conditions. There is limited evidence on the effectiveness of PRP injections to optimally treat chronic lateral epicondylitis. This study explored the effectiveness of single or repeated injections for patients with symptoms that spanned 6 months or more and were unresponsive to alternate conservative measures.Methods and Materials: Patients with chronic lateral epicondylitis received PRP injections in 4-week intervals that were complemented with standardized physical therapy. Patient-reported outcomes based on the patient-rated elbow evaluation (PREE), quick disabilities of the arm, shoulder and hand (qDASH), and EuroQol (five dimensions) 3-level version (EQ5D3L) questionnaires were documented at each visit including 6 months after the first injection. These outcomes were compared between patients receiving 1 vs. 2 or 3 PRP injections.Results: Sixty-two patients received one (n = 36) or more (n = 26) PRP injections. The mean baseline to 6-month follow-up scores of the PREE and qDASH questionnaires improved significantly from 54.0 to 23.0 and 50.3 to 20.7, respectively. The mean baseline EQ5D3L-visual analogue scale score improved from 62.5 to 82.9 by 6 months post-injection. These outcomes did not significantly differ between the patients who received varying numbers of injections.Conclusions: Patients with chronic lateral epicondylitis reported significant pain relief and gain in function as well as quality of life 6 months after localized PRP treatment. A single PRP injection may be sufficient. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail. Purpose: To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment. Study Design: Case control study; Level of evidence, 3. Methods: A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment. Results: Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from their initial visit. Univariate analysis demonstrated a potential association (P < .10) between operative management and the following factors at initial diagnosis: increased age, body mass index, duration of symptoms, presence of radial tunnel syndrome, prior injection, physical therapy, splinting, smoking, workers’ compensation, a labor occupation, use of narcotics, use of antidepressant medications, and previous orthopaedic surgery. In the final multivariable model, a workers’ compensation claim (odds ratio [OR], 8.1), prior injection (OR, 5.6), the presence of radial tunnel syndrome (OR, 3.1), previous orthopaedic surgery (OR, 3.2), and duration of symptoms >12 months (OR, 2.5) remained significant independent predictors of surgical treatment. Conclusion: This study identifies risk factors for surgical treatment for lateral epicondylitis. While these findings do not provide information regarding causal factors associated with surgery, these patient and disease-specific considerations may be helpful when counseling patients regarding treatment options and the likelihood of the success of continued nonoperative treatment. [ABSTRACT FROM AUTHOR]

Aim. This study compared surface electromyographic (sEMG) signal amplitude during pull-ups with Versa Gripps® to those without grips on the dominant side wrist flexors (WF), wrist extensors (WE), latissimus dorsi (LAT), and infraspinatus (INF) muscles among strength-trained males. Material and Method. Thirty healthy males volunteered to participate in the study. All subjects reviewed, completed, and signed an informed consent form approved by Institutional Review Committees. Surface EMG was computed using the root-mean-square (RMS) of the EMG signal, integrated over 500 milliseconds, and normalized to the maximum voluntary contraction (MVC) for the muscles being investigated. EMG data from the four muscles were analyzed using paired two tailed t-tests for each individual muscle for Grip to No Grip conditions. Results. The comparisons revealed that the WE and WF sEMG were significantly less with the Versa Gripps® compared to No Grip. There were no significant differences between the Grip and No Grip conditions for the LAT and INF. Conclusion. These results suggest that the effort required by the WE and WF can be reduced with the use of Versa Gripps® in strength-trained males while performing a pull-up without inhibiting the recruitment of the LAT and/or the INF. This finding could be beneficial for strength-trained males suffering or recovering from lateral or medial epincondylitis because the decreased activation of the WE muscles during the pull-up exercise may help unload of the WE and WF which may aid in their recovery. [ABSTRACT FROM AUTHOR]