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Lateral epicondylitis is degenerative tendinosis of the extensor carpi radialis brevis muscle and is the most common work/sports-related chronic musculoskeletal problem affecting the elbow.This study aimed to evaluate the short term and residual effectiveness of the Kinesio taping method on pain, grip force, quality of life, and functionality.Randomized, double-blinded, controlled study.Subjects were 50 patients diagnosed with chronic unilateral lateral epicondylitis with a symptom duration of at least 12 weeks. During the first four weeks, the study group received a true inhibitor Kinesio taping while the control group received sham taping. In both groups, progressive stretching and strengthening exercises were given as a home program for six weeks. The primary outcome measure was the Numerical Rating Scale (NRS) for self-report of pain intensity; secondary outcome measures were Cyriax resistive muscle test evaluation, maximal grip strength, Patient- Rated Tennis Elbow Evaluation (PRTEE), and Short Form-36 (SF-36). After the treatment, patients were evaluated by the first assessor who was blinded to taping types.There was a significant decrease in NRS scores overtime during the first four weeks in both groups (P.001,) and effect sizes were large. There was no significant difference in Cyriax muscle resistance test maximal grip strength between groups (P.05). However, there was a significant improvement in muscle strength of elbow extension and pronation in the study group detected in the intragroup analysis. Intragroup comparisons also showed a significant improvement in all subunits of the PRTEE and SF-36 except energy/vitality, social functioning, and pain in both groups (P.05) with moderate to high effect sizes. PRTEE pain scores were significantly decreased in the study group compared to the placebo group (P.05, d = 0.48).The effects of Kinesio taping on muscle strength, quality of life, and function in chronic lateral epicondylitis are not superior to placebo. However, NRS scores showed that in the two weeks after Kinesio taping treatment, pain reduction persisted as a residual effect which may improve the exercise adherence and functionality.

HYPOTHESIS The concentration of leukocytes influences the quality of platelet-rich plasma (PRP). However, there is no consensus on which type of PRP based on the concentration of leukocytes is the best for lateral epicondylitis (LE). METHODS We systematically searched the MEDLINE, Embase, and Cochrane Library databases up to March 1, 2020. Studies involving randomized controlled trials (RCTs), patients with LE, and treatment with PRP injections were included. PRP was classified into leukocyte-poor (LP)-PRP and leukocyte-rich (LR)-PRP. LR-PRP was defined as PRP with a white blood cell (WBC) concentration exceeding that of whole blood (4.0-10.0 per uL3), while LP-PRP was defined as PRP with a lower WBC concentration than whole blood. The efficacy of PRP was assessed using the visual analog scale (VAS) and success rates. RESULTS Eleven RCTs (six LP-PRP and five LR-PRP) were eligible for inclusion in this review. Eight studies were included in the meta-analysis to evaluate the VAS score. Regarding short-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (standard mean difference [SMD], 0.01; 95% confidence interval [CI], -0.29-0.30; p=0.97), with no heterogeneity (I2=0%). There was also no difference in the VAS scores between the LR-PRP and control groups (SMD, -0.19; 95% CI, -0.57-0.20; p=0.34), with substantial heterogeneity (I2=56.7%). Regarding long-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (SMD, -0.73; 95% CI, -1.69-0.23; p=0.134) with substantial heterogeneity (I2=88.4%). The LR-PRP groups had lower VAS scores than the control groups (SMD, -1.06; 95% CI, -2.02--0.09; p=0.032), with substantial heterogeneity (I2=92%). In the LP-PRP group, there was no significant difference in the success rate (odds ratio [OR], 1.08; 95% CI, 0.07-16.47; p=0.956) with substantial heterogeneity (I2=87.7%). In the LR-PRP group, however, the patients who received PRP had a higher success rate than those in the control group (OR, 2.85; 95% CI, 1.67-4.85; p

Background Although most radiologic findings of medial epicondylitis (ME) are normal, up to 25% show calcification, and little is known about the clinical relevance of soft tissue calcification in ME. The purpose of this study was to reveal the characteristics of calcification in ME, and to identify their clinical relevance. Methods This study included 187 patients (222 elbows) who were diagnosed with ME. We classified calcification according to its anatomic location, and further evaluated its distribution. Logistic regression analysis was performed to calculate the odds ratios and 95% confidence intervals for possible factors that may affect calcification in ME: age, sex, laterality, hand dominance, visual analog scale (VAS) pain score, Mayo elbow performance score, symptom duration, history of steroid injection, number of steroid injections, concomitant ulnar neuropathy, and treatment method in terms of conservative treatment or surgery. Results In a total of 222 elbows, 53% (118 of 222 elbows) showed calcification in radiologic findings. The VAS pain score, number of steroid injections, and concomitant ulnar neuropathy were significantly associated with calcification in ME. Calcification was most commonly identified at the anatomical insertion site of the common flexor tendon (33%), followed by the pronator teres (18%), and the medial collateral ligament (10%). Of the total cases of calcification, 45% were distributed at multiple sites, and age was strongly associated with multiple distribution. Conclusions Calcification in ME was more commonly identified than previously reported and was distributed over a relatively broad area. Calcification was associated with a higher VAS pain score, history of steroid injection, and combined ulnar neuropathy. The anatomical insertion site of the common flexor tendon most commonly showed calcification, and age was a strong indicator of a broad distribution of calcification.

Background: Lateral epicondylitis (LE) is a highly prevalent musculoskeletal disorder in workers, often associated with physically demanding work. Knowledge of work-relatedness of LE is crucial to develop appropriate preventive measures. This study investigates the prospective association between work-related physical risk factors and LE. Methods: A systematic literature review was conducted in MedLine using PubMed from January 1, 2010 until February 16, 2021. Published reports were included if: (1) LE was clinically assessed, (2) exposure to work-related physical risk factors was assessed, and (3) associations between LE and work-related physical risk factors were reported in prospective studies. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation. Results: In total, 318 workers with LE from a population of 5036 workers in five studies were included. Meta-analyses revealed high-quality evidence for associations between LE and a Strain Index (SI) score >5.1 (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.11–2.78) and moderate-quality evidence for forearm rotation >4 h/day or forearm rotation ≥45° for ≥45% time (OR: 1.85, 95% CI: 1.10–3.10). Gripping, flexion and extension of the wrist, and repetitive movements showed no significant associations with LE. Conclusion: High-quality evidence was found indicating that a higher SI increased the risk of LE. Moderate-quality evidence was found for an association between forearm rotation and LE. No associations were found between other physical risk factors and LE. Primary preventive interventions should focus on a reduction of the SI and of high forearm rotation in work.

Objective The study objective was to evaluate the safety and efficacy of transcatheter arterial "embolization" (TAE) in the treatment of chronic "musculoskeletal pain" refractory to standard therapy. Methods PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for original research articles evaluating TAE in patients with musculoskeletal conditions from database inception to January 21, 2020. Search terms employed were as follows: "embolization", "pain", "knee osteoarthritis", joint replacement, epicondylitis, tenderness, inflammation, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), microspheres, Embozene, geniculate artery, neovascularity, transcatheter, embolic, imipenem/cilastatin sodium, angiogenesis, and "musculoskeletal". Studies involving particle "embolization" for painful musculoskeletal conditions were included. Studies of TAE for hemarthrosis or malignancy-related "musculoskeletal pain" were excluded. Results The primary search yielded 1,099 sources; 7 articles and 4 abstracts were included for data extraction. All were cohorts or case series, with low risk of bias and moderate to poor level of evidence. Heterogeneity between studies was high, precluding meta-analysis. The reviewed studies reported the safety and efficacy of TAE for the treatment of "knee osteoarthritis"; adhesive capsulitis of the shoulder; tendinopathy/enthesopathy of the knee, shoulder, elbow, and ankle; and cervical myalgia. All TAEs were reported as technically successful without major complications or subsequent serious adverse events, including no reported osteonecrosis, cutaneous ulceration, limb ischemia, cartilage degeneration, or myotendinous injury. TAE significantly reduced pain and improved function for all of the treated conditions, with durable response up to 24 months post procedure. Conclusion TAE appears to be a safe and effective treatment for some types of chronic refractory "musculoskeletal pain". Randomized placebo-controlled studies are necessary to confirm these findings.

Background. The purpose of the study was to evaluate the efficacy and safety of the combination use of Flextra® and extracorporeal shock wave therapy (ESWT) or ESWT alone from the standpoint of clinical and structural evolution of tendinopathies (Achilles and lateral elbow tendinopathy). Materials and methods. The study was conducted at the premises of the Medical Center “European Orthopedics” in Kyiv for 2020–2021. Seventy-four patients (39 women and 35 men, mean age of 42.7 ± 5.4 years) were examined, they were randomly divided into four groups. The first group included patients with Achilles tendinopathy and the second one — those with lateral elbow tendinopathy. Both groups received two Flextra capsules a day for 90 days and underwent a course of ESWT. The third group included individuals with Achilles tendinopathy and the fourth group — patients with lateral epicondylitis, who underwent the same course of ESWT (7 procedures). Results. The study showed that taking Flextra® in combination with ESWT has a statistically significant effect on the structure and clinical symptoms of various tendinopathies. In patients with t.calcaneus tendinopathy and epicondylitis, the drug plays an important role in the healing of tendons, which is reflected in the results of ultrasound examinations. Conclusions. Flextra® is an effective and safe drug in the treatment of Achilles tendinopathy and epicondylitis, and the additional use of ESWT provides high efficiency, especially in the initial stages of the disease., Мета дослідження: оцінити ефективність і безпеку комплексного застосування препарату ­Флекстра® і екстракорпоральної ударно-хвильової терапії (ЕУХТ) або монотерапії у вигляді процедур ЕУХТ з позиції клінічної і структурної еволюції тендинопатій (тендинопатії ахіллового сухожилля і латеральної тендинопатії ліктьового суглоба). Матеріали та методи. Дослідження проведено на базі медичного центру «Європейської ортопедії» м. Києва протягом 2020–2021 рр. Було обстежено 74 пацієнтів (39 жінок і 35 чоловіків, середній вік 42,7 ± 5,4 року), яких було рандомно розподілено на чотири групи. Перша група — пацієнти з тендинопатією ахіллового сухожилля; друга — пацієнти з латеральною тендинопатією ліктьового суглоба. Обидві групи пацієнтів отримували по дві капсули препарату Флекстра® на добу протягом 90 днів і пройшли курс процедур ЕУХТ. Третя група — пацієнти з тендинопатією ахіллового сухожилля, четверта група — пацієнти з латеральним епікондилітом, які пройшли аналогічний курс ЕУХТ із 7 процедур. Результати. Проведене дослідження показало, що прийом препарату Флекстра® в комплексі з ЕУХТ має статистично значущий вплив на структуру й клінічні симптоми різноманітних тендинопатій. У пацієнтів з тендинопатіями t.calcaneus і при епікондиліті прийом препарату відіграє важливу роль у процесах загоєння сухожиль, що відображено у результатах ультразвукових досліджень обстежених пацієнтів. Висновки. Флекстра® є ефективним і безпечним препаратом у менеджменті тендинопатії ахіллового сухожилля та при епікондиліті, а додаткове застосування ЕУХТ забезпечує високу ефективність, особливо на початкових етапах захворювання.

Background Operative management of lateral epicondylitis can be managed with percutaneous, arthroscopic, or open surgical release. Extraarticular arthroscopic release is a new technique, and no study has compared its outcomes and risk profile. Methods A 26-patient cohort was reviewed before and after extraarticular arthroscopic release, which was performed by the senior author. The Mayo Elbow Performance Scores were used as a functional outcome score and obtained via a phone interview. Results were analyzed using a paired t-test with a statistical significance set at P Results Of the 26 patients, 10 were being treated under workers compensation. Preoperative Mayo Elbow Performance Score was 47.5, and the postoperative score was 90.2 with a significant difference of 42.7 (P value = .05). The workers compensation group scored 13.3 points lower postoperatively than the remainder of patients, which was shown to also be significant with a P value of .002. Discussion and Conclusion The advantage of extraarticular arthroscopic release was better visualization of affected structures, which improved accuracy of debridement, and a small capsulotomy, which decreased the risk of a transient radial nerve palsy. Overall, extraarticular arthroscopic results were found to be good and comparable to the results of other operative techniques with the added advantage of a lower risk profile.

Background Lateral epicondylitis is one of the commonly noticed disorders of the arm described by agony focused over lateral epicondyle which is the site of wrist extensors origin. The purpose of this work was to compare the efficiency of extracorporeal shock wave therapy and local corticoid injection in management of lateral epicondylitis both clinically and ultrasonographically as well as to assess the role of ultrasound in diagnosis and follow-up of lateral epicondylitis. This study was performed on 30 athletes diagnosed as lateral epicondylitis. Results Both corticosteroid injection and shock wave treatment showed a highly significant effectiveness on pain by visual analog scale (VAS). A highly significant difference between before treatment and after 2 as well as 4 weeks of treatment regarding the functional disability parameters as patient-rated tennis elbow evaluation (PRTEE) and quick disabilities of the arm, shoulder, and hand (DASH) was found. Likewise, a statistically significant improvement in favor of shock wave therapy group after 2 weeks was found, inversely insignificant difference after 8 and 12 weeks regarding to VAS occurred. Both PRTEE and Quick DASH test showed a statistically significant difference among groups through all follow-up period. There was a statistically insignificant difference among the studied groups according to ultrasound (US) changes in the form of focal areas of hypo-echogenicity through follow-up periods. A significant improvement in favor of ESWT group is detected among the studied groups regarding tendon thickening in ultrasonography before treatment and after 2 and 4 weeks. However, the difference was insignificant after 8 and 12 weeks. Conclusions Both corticosteroid local injection and shock wave therapy are helpful and effective for lateral epicondylitis treatment. However, a shock wave therapy revealed better improvement on long-term clinical and ultrasonogrphic follow-up than corticosteroid injection. Musculoskeletal ultrasound represents a helpful diagnostic and follow-up tool for lateral epicondylitis.

Introduction: Lateral Epicondylitis is a overuse syndrome usually seen in people who perform repeated extension and supination movement of elbow against resistance. Tissue Extensibility Dysfunction (TED) is a term which suggests apparent tightness of the muscle which has occurred due to spasm, lactic acid accumulation, inflammation or over use. Need of The Study: Many Studies involving manual therapy with different techniques have already demonstrated manual therapy is effective in reducing pain in subjects with lateral epicondylitis. Very few studies have focused on Mulligan’s Pain Release Phenomenon (PRP) which is established to reduce pain and improving range of motion. Also, there is dirth in literature related to tissue extensibility dysfunction occurring in subacute variant of tennis elbow and the effect of PRP on TED. Hence this study is been undertaken. Methodology: A total of 50 sample size was randomized into 25 per group. Group A consisted of Conventional therapy and Group B consisted of Conventional therapy with Mulligan’s PRP. Outcome measures were noted pre therapy and on the 7th day that is post therapy and results were tabulated. Results: The results declare that pain (0.05 and 0.001), grip strength (0.001, 0.001) and disability (0.001, 0.001) showed significant improvement in the scores in both the group whereas muscle stiffness (0.341 and 0.001) significantly improved only in Group B. Conclusion: Mulligan’s Pain Release Phenomenon technique can be used to treat Subacute tennis elbow effectively and is known to reduce the muscle stiffness along with pain and disability and improving strength.

Purpose To determine whether platelet-rich plasma (PRP) injection for lateral epicondylitis offers patients comparable outcomes to lateral epicondylar surgery. Methods Embase, Cochrane Library, and MEDLINE databases were searched using the terms lateral epicondylitis, lateral elbow pain, tennis elbow, lateral epicondylalgia, and elbow tendinopathy individually and combined with the terms platelet-rich plasma injections and lateral epicondylar surgery. We compared pain relief, function between the 2 treatment options, and identified whether PRP injection reduced the incidence of lateral epicondylar surgery. Studies must have compared PRP injections with lateral epicondylar surgery for the treatment of lateral epicondylitis; be of Level I, II, or III evidence; and be written in the English language. Results Three studies (1 Level II and 2 Level III) met inclusion criteria. Two of the studies suggested that PRP injections offer similar relief as surgery in the short and mid-term, one study reported that PRP injections and surgery had similar outcomes in pain improvement and return to work, whereas 1 study reported that surgery may be a better long-term solution. Conclusions In comparison with lateral epicondylar surgery, PRP injections offer similar improvements in pain and function for patients suffering from lateral epicondylitis, especially in the short- and mid-term in 2 of the 3 included investigations. Therefore, PRP injections are an appropriate alternative for the treatment of lateral epicondylitis. Level of Evidence Level III, Systematic Review of Level III or greater evidence.

Background: Lateral epicondylitis is the most common clinical condition characterized by pain generally localized around the lateral epicondyle but sometimes radiating distally to the forearm. Objectives: The study's primary objective was to find out the efficacy of multiple therapeutic interventions consisting of wrist manipulation, ultrasound therapy, and stretching exercise on lateral epicondylitis patients. Subjects and methods: A pre-test, post-test experimental study design was used. A criterion-based simple random sampling was used to recruit patients (N=30) diagnosed with lateral epicondylitis, and they were randomized into two treatment groups. The experimental group-1 was exposed to ultrasound therapy and stretching exercises, whereas those assigned to experimental group-II were given ultrasound therapy, stretching exercise, and wrist manipulation for the period of 2 weeks. The efficacy of treatment was measured through visual analogue scale (VAS), manual hand dynamometer, and DASH Scale. Both paired and unpaired ‘t’ test was employed to study the treatment effectiveness. A p-value

Background: Amongst the most frequently repeated stress conditions within the elbow joint includes lateral epicondylitis (LE). The extensor carpi radialis brevis muscle attachment is affected mostly. The management of an individual with LE that manifests itself in repetitive upper extremity motions is the purpose of this research. There seems to be no study on the effects of PowerBall device training on the pain and function in individuals with Lateral Epicondylitis. “PowerBall device” practice is a type of strength training. Methods / Design: After conducting initial evaluations and allocation, the subjects (n=50) with LE will be involved in a randomized controlled study and classified either in an intervention group or a conventional group. The interventional group will do “PowerBall device” exercises, while others in the control group, doing MMWM. These groups will receive basic movements and ultrasound in accordance with the procedures. Discussion: The PRTEE scale measured the intervention's impact on pain and function in patients with LE, and a Hand-held Dynamometer was utilized to quantify grip strength. The findings will give considerable support for the use of the "PowerBall device" exercise and MMWM on LE patients. Conclusion: Conclusion will be drawn post study so as to see whether PowerBall device is more helpful or Mulligan Mobilization with Movement on pain and function in patients with LE. This study will give better approach to the therapist in managing the condition.

Background: Mechanical neck pain (MNP) is the most common type of pain confined in the posterior aspect of neck, also known as nonspecific or simple neck pain affecting two thirds of the general population at some time in their lives. Prevalence: Neck pain is most common muscular skeletal condition affecting up to 70% of individual and 5% to 10% of adults having a disabling neck pain problem. Neck pain is more common in women than men. The prevalence of neck pain in the general population has been reported to be 15% for men and 23% for women. Objectives of the Study: To find out the effect of Post Isometric Relaxation (PIR) along with Deep Neck Flexor (DNF) exercises in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain. To find out the effect of Deep Neck Flexor exercise alone in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain. To compare whether Post Isometric Relaxation (PIR) along with Deep Neck Flexor exercises or Deep Neck Flexor exercises alone are effective in reducing pain and disability and improving ROM in patient with sub-acute mechanical neck pain Methods: Study included 30 patients with lateral epicondylitis between ages 30-50 years. The subjects were randomly divided into 2 groups: Group-A and Group-B. Group A (n = 15) was treated using Cyriax physiotherapy, group B (n = 15) was treated with movement with mobilization. Patients were treated for 3 times a week for 4 weeks. Outcome measures are NPRS (Numeric Pain Rating Scale) and DASH (The Disabilities of the Arm, Shoulder and Hand). Results: The results of the study indicate that there were highly statistically significant improvement in functional disability on NDI, cervical lateral flexion(Right & Left), rotation (Right & Left) ROM and reduction in pain on VAS in Group-A as compared to Group-B. There was no significant difference observed when the groups were compared for cervical flexion and extension ROM. Conclusion: From the result it is concluded that Post isometric relaxation with DNF exercise is effective in mechanical neck pain. Key words: Mechanical neck pain (MNP), Post Isometric Relaxation (PIR), Deep Neck Flexor (DNF) exercise.

Background: Chronic lateral epicondylitis can be a severe disabling condition. There is still lack of consensus on best treatment, as no single intervention has been proven to be superior regarding pain relief and improvement of function. Due to the self-limiting nature of this elbow condition, we are looking for a fast and safe treatment method to break through this pattern of pain and loss of elbow function. Autologous blood injection therapy by means of an automatic injection system, can be a promising new treatment option for this group of patients suffering from chronic lateral epicondylitis. In this study, we evaluated the short-term results of autologous blood injection therapy in a standardized way by using an automatic injection system (=ITEC device) for the treatment of chronic lateral epicondylitis. Methods: A total of 141 patients with chronic lateral epicondylitis (88 female, 53 male) were enrolled in this clinical treatment evaluation being treated with the ITEC device. The mean age of the patients was 50.0 years (19 years-73 years). Numeric rating scale (NRS) and a patient reported outcome measurement tool (Oxford Elbow Score (OES)) were measured at baseline, six weeks and three months follow-up. Results: Pain (NRS, OES) and elbow function / quality of life (OES) were significantly improved within 6 weeks after ITEC treatment. This improvement in NRS and OES sustained during the 3 months follow-up period. Conclusion: Autologous blood injection therapy by means of a new automatic injection system (ITEC device) is a safe and effective treatment method for patients with chronic lateral epicondylitis. More research is necessary to see if this effectiveness sustains in the long-term follow-up.

Background: Lateral epicondylitis (LE) is a very common condition musculoskeletal in nature affecting the elbow, causing significant pain, disability and loss of grip strength. The conservative management program for lateral epicondylitis includes rest, cryotherapy, and ultrasound, stretching and strengthening exercises. The Oculus Quest is a virtual reality headset. The oculus adventure game ‘Hand Physics Lab' encourages you to try virtual reality in a new way by providing you complete control over your hands and fingers. VR is a developing technology that can be a valuable supplement to conventional therapeutic modalities. Methods: In this study, a total of 60 patients with lateral epicondylitis will be included and divided into two groups of 30 participants each of age group 25-45 years. Group A will undergo conservative management of lateral epicondylitis and Group B will undergo oculus therapy by a hand tracking game ‘Hand Physics Lab’ along with the conservative management. Visual analog scale, Range Of Motion, PRTEE scale are used as outcome measures before and after the treatment and results will be analyzed. Discussion: In this study the effect of oculus guided therapy with conventional Physiotherapy over conventional physiotherapy will be investigated in improving functional level and reducing pain in patients with LE. Individuals in mechanical professions or recreational activities with repetitive stress and intensive usage of forearm muscles are more likely to develop lateral epicondylitis. Physical therapy is now widely accepted as a standard treatment option for persistent lateral epicondylitis. Furthermore, this study can be useful in applying recent advancement in virtual reality for the betterment of health. This study can provide virtual reality in tennis elbow patients for improved motion control, improved quality of life and more patient entertainment to encourage motor learning.

Introduction: Lateral epicondylitis commonly referred to as ’tennis elbow,’ is mainly observed in the 3rd and 4th decade of life in around 2% -3% of the population. Treatment modalities for lateral epicondylitis include analgesics, immobilization, tennis elbow brace, local steroid infiltration, and ultrasound therapy. Recent studies have explored the effectiveness of platelet-rich plasma (PRP) injections in lateral epicondylitis. Materials and Methods: We used the block randomization technique. Two groups were prepared with 30 patients in each group. One group of patients received PRP and the other received local steroid injection. Patients were evaluated at the time of procedure and immediately after the procedure, at six weeks, three months, and six months, using the visual analog score and Liverpool’s elbow score. Results: At the end of 6 months, follow-up patients in the PRP injection group show good clinical and functional compare to the steroid group of patients. Conclusion: PRP and local corticosteroid injection provide symptomatic relief in the treatment of lateral epicondylitis. PRP infiltration gives better results in pain relief and functional activities with statically significant values when compared with corticosteroid injections. Keywords: Platelet rich plasma, Steroid injection, Tennis elbow.

Lateral epicondylitis is a painful tendinosis of the lateral epicondyle of the humerus, which is the attachment site for the wrist extensor muscles and tendons. It is most commonly caused by repetitive gripping or wrist extension. Moreover, lateral epicondylitis is one of the most common causes of elbow flank pain in adults. While most patients respond to conservative treatment, surgical treatment is used in some patients. In this study, we reviewed the case of a 68-year-old man who presented to the clinic with elbow pain. In this patient with lateral epicondylitis, who had not responded to various conservative treatments, 0.5 cc prilocaine hydrochloride and 1 cc triamcinolone hexacetonide were injected in the left elbow lateral epicondyle tendon adhesion area. After the injection, the patient’s second, third and fourth fingers dropped. Further, the patient was diagnosed with radial nerve paralysis, and his hand was properly splinted. After 72 hours, in the follow-up to reevaluate the patient’s muscle strength, it was observed that the patient’s complaints after the injection resolved. This review focuses on the treatment methods of lateral epicondylitis and on complications that occur after a lateral epicondyle injection in the context of a case of transient radial nerve paralysis after a very common type of injection.

Background. There is not enough research on the topic of arthroscopic treatment of medial epicondylitis. Topographic studies are needed to justify surgical approaches with minimal trauma to the medial collateral ligament and ulnar nerve. The aim of the study was to optimize the arthroscopic treatment of medial epicondylitis and evaluate its clinical effectiveness based on the results of the topographic and anatomical study. Materials and Methods. The material for the topographic and anatomical study was 12 «fresh» anatomical preparations of the human elbow joint, of which 6 were taken from female cadavers, and 6 — from men. The features of the structure and topography of the elbow medial collateral ligament were studied, and the safety and effectiveness of arthroscopic approaches to the elbow for the flexor carpi radialis release were determined. A prospective cohort comparative study was performed, which included 70 patients. Two comparative groups were formed. In the group I (35 patients) surgical treatment was carried out by the open method. The group II included 35 patients who underwent minimally invasive surgical treatment using arthroscopic technique. The results were evaluated by Mayo Elbow Perfomance Score (MEPS) and VAS before surgery and 1, 6, and 9 weeks after. Results. Functional results in 9 weeks: group I — 81.77 (95% CI 81.13; 82.41); group II — 92.66 (95% CI 91.61–93.70) points. The average score for VAS in the same period: group I — 34.30 (31.89–36.68) points; group II — 1.5 (0.46–2.45) points. Conclusion. The safe zone is located above the midline of the humeroulnaris joint by 2 (1.0–3.2) mm. The risk of the medial ulnar collateral ligament anterior bundle injury is minimal in this area. Treatment of patients with the medial epicondylitis according to the developed arthroscopic technique can significantly improve the patients functional state and quality of life.

Purpose This study was designed to verify whether shear-wave elastography (SWE) can be used to differentiate ulnar neuropathy at the cubital tunnel from asymptomatic ulnar nerve or medial epicondylitis. An additional aim was to determine a cut-off value to identify patients with ulnar neuropathy. Methods This study included 10 patients with ulnar neuropathy at the cubital tunnel as confirmed with electromyography (three women and seven men; mean age, 51.9 years), 10 patients with medial epicondylitis (nine women and one man; mean age, 56.1 years), and 37 patients with asymptomatic ulnar nerve and lateral epicondylitis (21 women and 16 men; mean age, 54.0 years). Each patient underwent SWE of the ulnar nerve at the cubital tunnel, distal upper arm, and proximal forearm. Results Patients with ulnar neuropathy at the cubital tunnel exhibited significantly greater mean ulnar nerve stiffness at the cubital tunnel (66.8 kPa) than controls with medial epicondylitis (21.2 kPa, P=0.015) or lateral epicondylitis (33.9 kPa, P=0.040). No significant differences were observed between patients and controls with regard to ulnar nerve stiffness at the distal upper arm or the proximal forearm. A stiffness of 31.0 kPa provided 100% specificity, 80.0% sensitivity, 100% positive predictive value, and 83.3% negative predictive value for the differentiation between ulnar neuropathy and medial epicondylitis. Conclusion Cubital tunnel syndrome is associated with a stiffer ulnar nerve than lateral or medial epicondylitis. SWE seems to be a new, reliable, and simple quantitative diagnostic technique to aid in the precise diagnosis of ulnar neuropathy at the cubital tunnel.

Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.

Background In painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis. Materials and methods We included 71 patients with painful lateral epicondylitis > 3 months. Interventions: Group A: Proprioceptive training intervention with a Flexibar® (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0-10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork. Results The pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (−33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (−41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, −56%, p < 0.001; B: 27 ± 12 to 12 ± 11, −55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003). Conclusion A 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis. Level of evidence Ib, randomised clinical trial Trial registration German Clinical Trials Register, DRKS00024857, registered on 25 March 2021—retrospectively registered, http://apps.who.int/trialsearch/

Background There is no knowledge about the effects of kinesio taping (KT) on the radial nerve in lateral epicondylitis. Objective This study aimed to determine the effects of non-steroidal-anti-inflammatory drugs (NSAIDs) combined with KT on lateral epicondylitis using ultrasonographic findings. Methods NSAID therapy was administered to the control group for 10 days, and the KT group additionally received KT three times a week for two weeks. Clinical and ultrasonographic evaluations were performed before treatment and at post-treatment at second, sixth and fourteenth weeks. The radial nerve cross sectional area and common extensor tendon thicknesses were measured using ultrasonography. Results The study was completed with 40 patients in each group. Improvements in clinical parameters, common extensor tendon thickness, and cross sectional area values were significant in the KT group (p Conclusions NSAID plus kinesio taping decrease pain intensity while improving functionality and ultrasonographic parameters, including common extensor tendon thickness and radial nerve cross sectional area; therefore, it may be an option treatment in lateral epicondylitis.

To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) for chronic medial epicondylitis (ME) refractory to conservative treatments. This retrospective study included ten patients (14 procedures) who underwent TAE between May of 2018 and April of 2020 to treat chronic ME refractory to conservative treatments for at least 3 months. Imipenem/cilastatin sodium was used in 12 procedures, and quick-soluble gelatin sponge particles were used in the ensuing two procedures as an embolic agent. The visual analogue scale (VAS, 0–10) score and Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores were assessed at baseline and at different post-treatment times (1 day; 1 week; 1, 3, and 6 months; and an open period). The clinical success of the procedure was defined as a decrease of more than 70% in the Quick-DASH scores at 6 months compared to the baseline. Clinical success was achieved in 12 of 14 procedures (85.7%). No major complications were observed during the follow-up periods. The mean VAS scores were significantly decreased at 1 day, 1 week, 1 month, 3 months and 6 months (7.6 at baseline vs. 3.6, 3.6, 3.6, 3, and 0.9 after treatment; all P

Introduction Lateral epicondylitis, otherwise known as the tennis elbow syndrome, occurs in 1–3% of the general population, of which tennis players account for only 10%. It is one of the most common causes of upper limb pain. Currently, due to the lack of uniform and consistent therapeutic methods, various treatment techniques are used. These include techniques such as shock wave therapy, ultrasound and cryotherapy. Aim The aim of the study is to assess the effectiveness of three physiotherapeutic methods – shock wave therapy, ultrasound and cryotherapy – in reducing pain in the course of treating tennis elbow syndrome. The secondary goal is to assess the grip strength of the hand. Material and methods As a result of the review of search engines and databases, such as Polish Medical Bibliography, Google Scholar, PubMed and ScienceDirect, 10 research works from 2010–2019 were used, assessing the effectiveness of shock wave therapy, ultrasound and cryotherapy to treat lateral epicondylitis of the humerus. Results 310 people diagnosed with tennis elbow syndrome participated in the analysis. According to the results, most of the patients were female. The average age of the respondents was 45.2 years. Conclusions The research analysis proves that shock wave therapy, cryotherapy and ultrasound are effective physiotherapeutic methods in the treatment of lateral epicondylitis of the humerus. The shockwave is superior to other forms of treatment due to its shorter sessions and application time. Keywords: tennis elbow, rehabilitation, cryotherapy

Summary Purpose Lateral elbow tendinopathy is the most common cause of lateral elbow pain with a lifetime prevalence of approximately 40% in the general population. The purpose of this study was to complete a systematic review to identify the potential of stem cell therapy based on the current evidence in the treatment of lateral elbow tendinopathy. Methodology A systematic review through the Ovid, Medline, and Cochrane Review databases was performed with the search terms of lateral epicondylitis, tendinopathy, tennis elbow, stem cell, bone marrow, treatment, and therapy. Results The systematic review initially identified 816 articles from three databases. Five studies met the inclusion criteria. The five studies evaluated four different stem cell preparations including autologous tenocytes, skin-derived tenocyte-like cells, allogeneic adipose-derived mesenchymal stem cells, and bone marrow aspirate. Conclusion While a majority of lateral elbow tendinopathy cases resolve in a timely manner with no or limited intervention, recovery can be a delayed process for a small percentage of patients. The role of emerging treatment options has not been established. Stem cell therapy is an option for refractory cases, but current evidence is poor. Early findings demonstrated significant improvements in imaging and functional outcomes, but findings were limited by lack of control arms or other treatment arms for comparison. Further large, controlled studies are needed to evaluate safety, efficacy in order to establish the role of stem cell therapy in the management of lateral elbow tendinopathy.

Summary Background Lateral epicondylitis treatment is still controversial, most of patients managed with conservative measures including rest, NSAIDs and physiotherapy. However, some of them do not respond well and have to be managed surgically. That can be done either open or arthroscopic technique. The aim is to study the technique and functional outcome of arthroscopic management of lateral epicondylitis. Design Prospective study. Methods Between December 2016 and July 2019, 26 (16 female and 10 male) patients aged (28-57) presented with resistant lateral epicondylitis treated with elbow arthroscopy. Functional assessment preoperative and postoperative using VAS and Mayo score was done to all patients. The study included patients with elbow pain and weak grip symptoms with failure of conservative treatment for at least 6 months excluding revision, infected, rheumatoid arthritis patients, and previous steroid injection in past 3 weeks. Results The mean operative time was 65 minutes; the mean follow-up time was 20.3 months. The patients were reintegrated into their activities at 21 days postoperatively. Pain as a sign and capital symptom improved significantly within 12 days of surgery. Mayo score improved postoperatively. The Mean ± SD preoperative Mayo score was 59.5 ± 7.23 and to 96.5 ± 3.03 after follow up for six months. The Mean ± SD preoperative VAS score was 8.9 ± 0.76 and raised to 0.84 ± 0.74 and to 0.5 ± 0.5 after follow up for six months (Table 2). All patients were satisfied because of small wound size with cosmetic suture, rapid return of movement of elbow after operation and rapid improvement of pain level. One patient developed transient forearm neuropraxia that resolved within three weeks with neurotonics. Conclusion Short-term evaluation of arthroscopic release of resistant lateral epicondylitis gives good functional outcome in the form of pain relief, patient satisfaction, and low complication rate.

Study design Cadaveric. Objective The aim of this study was to quantify the amplitude and duration of surgeons' muscle exertion from pedicle cannulation to screw placement using both manual and power-assisted tools in a simulated surgical environment using surface electromyography (EMG). Summary of background data A survey of Scoliosis Research Society members reported rates of neck pain, rotator cuff disease, lateral epicondylitis, and cervical radiculopathy at 3×, 5×, 10×, and 100× greater than the general population. The use of power-assisted tools in spine surgery to facilitate pedicle cannulation through screw placement during open posterior fixation surgery may reduce torque on the upper limb and risk of overuse injury. Methods Pedicle preparation and screw placement was performed from T4-L5 in four cadavers by two board-certified spine surgeons using both manual and power-assisted techniques. EMG-recorded muscle activity from the flexor carpi radialis, extensor carpi radialis, biceps, triceps, deltoid, upper trapezius, and neck extensors. Muscle activity was reported as a percentage of the maximum voluntary exertion of each muscle group (%MVE) and muscle exertion was linked to low- (0-20% MVE), moderate- (20%-45% MVE), high- (45%-70% MVE) and highest- (70%-100% MVE) risk of overuse injury based on literature. Results Use of power-assisted tools for pedicle cannulation through screw placement maintains average muscle exertion at low risk for overuse injury for every muscle group. Conversely with manual technique, the extensor carpi radialis, biceps, upper trapezius and neck extensors operate at levels of exertion that risk overuse injury for 50% to 92% of procedure time. Power-assisted tools reduce average muscle exertion of the biceps, triceps, and deltoid by upwards of 80%. Conclusion Power-assisted technique protects against risk of overuse injury. Elevated muscle exertion of the extensor carpi radialis, biceps, upper trapezius, and neck extensors during manual technique directly correlate with surgeons' self-reported diagnoses of lateral epicondylitis, rotator cuff disease, and cervical myelopathy.Level of Evidence: N/A.

Introduction Carpal tunnel syndrome (CTS) and lateral epicondylitis are both highly prevalent conditions. Our objective was to determine the prevalence of B-mode ultrasound abnormalities of the common extensor tendon (CET) in patients with CTS and establish the relationship between CET stiffness as measured by shear wave elastography (SWE) and CTS severity. Methods Patients without symptoms or signs of lateral epicondylitis were recruited from referrals to a Neurophysiology laboratory for possible CTS. These patients were examined for clinical features of CTS before undergoing electrodiagnostic testing followed by an ultrasound examination, consisting of B-mode, power Doppler and SWE. Results 39 limbs with clinically diagnosed CTS and 20 control limbs were included. 61.5% of CTS limbs had sonographically abnormal CET compared to 35% of controls. The mean CET sonographic abnormality score was higher in CTS patients compared to controls (p=0.006). CTS patients with sonographically abnormal CET had more severe CTS by electrophysiological criteria. The mean CET stiffness in CTS patients was lower than in controls (p=0.033). Discussion Sonographic abnormalities of the CET are common in CTS patients with no clinical evidence of lateral epicondylitis and may relate to common pathogenetic mechanisms. These findings suggest that isolated ultrasound abnormalities in the CET are not diagnostically useful in patients presenting with upper limb pain unless there are clinical features of lateral epicondylitis. This article is protected by copyright. All rights reserved.

The purpose of this study was to evaluate results of the release of extensor carpi radialis brevis (ECRB) in tennis elbow patients. A prospective study including twenty patients with resistant chronic lateral epicondylitis was carried out in the period between June 2018 and June 2019 at Sohag University Hospital. These 20 patients underwent arthroscopic ECRB release. Evaluation of the pain and function included visual analog scale (VAS), Quickdash score, and Nirschl staging score preoperatively, postoperatively, two weeks, four weeks, ten weeks, and six months postoperatively. The patients showed highly statistically and clinically significant differences in the form of clinical improvement indicated by the level of Quickdash, VAS, and Nirschl staging scores at each time interval of the patients follow up. There was minimal postoperative pain, early rehabilitation, and early return to activity could be achieved. Arthroscopic release of the ECRB is an effective method of treatment in patients with resistant tennis elbow.

Background: Based on the controversy over whether the extensor tendon is the only lesion of lateral epicondylitis of the elbow and numerous reports of concomitant lateral collateral ligament involvement, potential damage to the lateral collateral ligament complex should be considered for the treatment. Methods: About 25 elbows in 23 patients (débridement group) and 22 elbows in 20 patients (reconstruction group) who were diagnosed with lateral epicondylitis and had an average of 22 months of symptoms revealing anatomical lesion on MRI were included. The capitellum-sublime tubercle-radial head (CSR) angle was measured on both sides preoperatively, and the visual analog scale (VAS) and Mayo elbow performance score (MEPS) were measured over 12 months, postoperatively. Results: The initial preoperative mean VAS was statistically significant with 4.6 in the débridement group and 6.5 in the reconstruction group (P

Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options - with varying levels of evidence.The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 - 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process.Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure.This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.Die Epicondylopathia humeri radialis (Epicondylitis humeri radialis) ist ein Krankheitsbild, das häufig mit massiven Einschränkungen für die Lebensqualität der betroffenen Patienten einhergeht und für das eine Vielzahl an unterschiedlichen Therapien – mit schwankender Evidenz – existiert.Die nachfolgenden Ausführungen und Empfehlungen basieren auf der aktuellen S2k-Leitlinie Epicondylopathia radialis humeri (AWMF-Registernummer: 033-019). Diese Leitlinie wurde unter Beteiligung aller relevanten Fachgesellschaften, basierend auf einer systematischen Literaturanalyse und durch eine strukturierte Konsensusfindung, erstellt.Die Diagnose sollte klinisch gestellt werden und kann durch bildgebende Verfahren bestätigt werden. Empfehlungen zur klinischen und radiologischen Diagnostik werden durch die Leitlinienkommission gegeben. Das Krankheitsbild entsteht aufgrund eines kumulativen Effekts von mechanischer Überbelastung, neurologischer Irritation und metabolischen Veränderungen. Eine Unterscheidung einer akuten von einer chronischen Form ist sinnvoll. Die Prognose bei konservativer Therapie ist günstig. In der Mehrheit der Fälle kommt es innerhalb von 12 Monaten zur spontanen Beschwerderegredienz. Bei frustranem konservativen Therapieversuch von mindestens 6 Monaten kann bei einem strukturell-morphologischen und klinischen Korrelat über eine operative Therapiealternative diskutiert werden. Eine abschließende Empfehlung für ein spezifisches operatives Verfahren kann aktuell nicht ausgesprochen werden.Der vorliegende Artikel dient einer Zusammenfassung der Leitlinie mit daraus erzielten Auszügen der Empfehlungen und Statements der Autoren zur Pathogenese, Prävention, Diagnostik sowie konservativen und operativen Therapie.

Background The association of the severity of clinical symptoms and level of functional performance with the degree of magnetic resonance imaging abnormalities in patients with lateral epicondylitis has not been fully elucidated. This study aimed to investigate the association between the degree of anatomical abnormalities by evaluating three-dimensional magnetic resonance imaging models of the common extensor tendon and clinical parameters in patients with lateral epicondylitis. Materials and methods A total of 61 patients (24 men and 37 women) with lateral epicondylitis were included in this study. 3-Tesla magnetic resonance imaging was performed for all patients, and clinical parameters, including pain visual analog scale score, Quick Disabilities of Arm, Shoulder and Hand questionnaire score, elbow range of motion, and demographic factors, were evaluated. The proportion of lesion volume of common extensor tendon was adopted for three-dimensional model analysis. To determine the factors associated with clinical parameters, univariate, and multivariate linear regression analyses were performed. Results The proportion of lesion volume of common extensor tendon was not associated with clinical parameters. Gender and muscle edema were independently associated with pain visual analog scale scores. However, demographic factors and magnetic resonance imaging abnormalities were not associated with the Quick Disabilities of Arm, Shoulder, and Hand questionnaire score or elbow range of motion. Conclusions The three-dimensional volumetric lesion size of common extensor tendon was not associated with clinical symptoms and functional performance in patients with lateral epicondylitis. The clinical parameters of lateral epicondylitis may be influenced by several factors.

Lateral epicondylitis, 'tennis elbow', is a common condition seen in general practice. Patients present with lateral elbow pain radiating distally and exacerbated by wrist and finger extension against resistance. Pain is also accompanied with functional impairment of the upper limb and hand. High intensity laser therapy (HILT) is a relatively new pain management modality used for treating musculoskeletal disorder. Aim of the work: To compare the efficacy of therapeutic HILT and ultrasound (US) in pain reduction and functional improvement in patients with chronic lateral epicondylitis. Patients and methods: 45 patients were randomly distributed into three equal groups: Group I treated by HILT and US; Group II treated by HILT only and Group III by US only. Patients were treated day after day for 12 sessions. The hand grip-strength was assessed by the dynamometry, pain measured by visual analogue scale (VAS) and the disorder of arm, shoulder and hand (DASH) scored. The HILT emitted a double wave length (915 nm and 808 nm) at a power of 3.2 Watt (W) and energy density of 5 Joule/cm2 while the US was used at an intensity of 1.5 W/cm2. Results: Patients were 24 females and 21 males with mean age of 44.9 ± 7.3 years. There was a significant improvement in the VAS, DASH and grip-strength for the three groups after sessions (p

The goal was to assess public interest in a wide range of musculoskeletal symptoms and disorders during the coronavirus disease 2019 (COVID-19) pandemic. We searched Google Trends for 118 search queries within the United States. We compared two timeframes of 2020 (March 15–July 4 and July 5–October 31) to similar timeframes over the four prior years (2016–2019). In the early pandemic, March 15–July 4, a statistically significant decrease in relative search volume of the majority of queries (60%) was detected, with a significant increase in only 2 queries (i.e. myalgia and toe swelling). In the phase July through October, a statistically significant decrease was detected in only 22% of search queries; there was no difference for 60% of search queries between 2020 and 2016–2019 suggesting a return to their prior levels for most of search queries. Interestingly, the search volume of 18% of search queries (i.e. fatigue, joint pain, muscle pain, myalgia, spondylosis, radiculopathy, myelopathy, neck pain, neck strain, lower back strain, sciatica, shoulder pain, frozen shoulder, elbow pain, lateral epicondylitis, wrist pain, carpal tunnel, hand pain, finger pain, trigger finger, and Morton’s neuroma) was significantly increased compared with the four prior years. Public interest focused on COVID-19 and sought online information for COVID-19 symptoms in the early pandemic. In the period July through October, there was an upward trend in musculoskeletal symptoms and some colloquial terms/well-known musculoskeletal conditions coupled with a downward trend in general musculoskeletal disorder terms and certain specific diagnoses. This information may help rheumatologists understand public interest in musculoskeletal symptoms and disorders and address the needs of patients to mitigate the negative impact of the pandemic on outcomes.

5:10 % of cases of lateral epicodylitis are resistant to conservative treatment and need surgical intervention.The purpose of this study was to evaluate the clinical outcomes of Modified Nirschl techniques for treatment of tennis elbow .An Prospective case arrangement contemplate might have been intended between february 2019 What's more january 2020 including 20 patients from outpatient facility from claiming Benha school healing center enduring starting with safe horizontal epicondylitis. Nitty gritty therapeutic history, clinical examination and PRTEE score connected will every one patients pre and post-operatively. There were 8 female What's more 12 male patients in the ponder. The mean span about indications in the recent past surgery might have been 14. 3 months. Those Normal span from claiming catch up might have been 28 months. We found that the changed Nirschl system need swaying brings about administration of horizontal epicondylitis clinched alongside (95%) of instances for An imply about 4 weeks period should profit on typical exercises Furthermore 15. 3 weeks will resume overwhelming exercises without agony. Those aggregate PRTEE score moved forward from a mean for 67 focuses to a intend of 6 focuses postoperatively. Those altered Nirschl system allotments almost equivalent comes about for different methods ,although those patients profit to their exercises after the fact over the opposite strategies. Additionally this strategy need favorable element of beneficial visualization of the entire degenerated tissues guaranteeing flawless debridement. Therefore, we recommended this choice following fizzled preservationist oversaw economy of horizontal epicondylitis.

The aim of the present study is to compare the clinical and functional outcome in the patients with Lateral Epicondylitis elbow treated with local Corticosteroid injection vs Platelet Rich Plasma. A total of 74 patients were included in the study, divided into two groups equally. One group comprising of 37 patients with a mean age of 34 years was managed with intralesional autologous platelet rich plasma (PRP) injection and the other 37 patients with mean age of 37.20 years were treated with intralesional injection of 2ml Triamcinolone 40mg diluted with 2ml of 0.5% Bupivacaine. The results were calculated on the basis of the pre and post treatment VAS Score, DASH score and MAYO Elbow Performance score evaluated on 3 occasions post treatment, at 3 months, 6 months and finally at 12 months follow up. This study concludes that PRP injection gives slightly better functional outcome as compared to Corticosteroid injection however pain relief is comparatively similar with the two treatment procedures. A bigger sample size will be required to conclude a significant difference in the outcome of the two methods of management of lateral epicondylitis.

Background/aim The aim of this study was to compare the clinical and sonographic effects of the ultrasound (US) therapy, extracorporeal shock wave therapy (ESWT), and Kinesio taping (KT) in the lateral epicondylitis (LE). Materials and methods A total of 40 patients with LE were included in the present study. The patients were randomly assigned to 3 treatment groups: US (n = 13), ESWT (n = 14), and KT (n = 13) groups. Results The visual analog scale (VAS) scores significantly decreased in all groups (P < 0.05). Grip strength significantly increased after 8 weeks in only the KT group (P < 0.05). The Patient-Rated Tennis Elbow Evaluation Scale (PRTEE) scores significantly decreased after 2 weeks and after 8 weeks in the US group and ESWT groups, and after 8 weeks in the KT group (P < 0.05). Common extensor tendon (CET) thicknesses significantly decreased after 8 weeks in only the ESWT group (P < 0.05). Conclusion The US therapy, KT, and ESWT are effective in reducing pain and improving functionality. However, none of these treatment methods were found to be superior to others in reducing the pain and improving functionality.

Background In this study, we investigated whether substance P (SP) or calcitonin gene-related peptide (CGRP) expression is associated with tendon degeneration in patients with lateral epicondylitis. Methods Twenty-nine patients who underwent surgical treatment for lateral epicondylitis were enrolled in the final analyses. Extensor carpi radialis brevis tendon origins were harvested for histological analysis. Results SP and CGRP immunostaining were negative in healthy tendons but positive in degenerative tendons; moreover, their immunoreactivity increased with degeneration severity. Univariate analysis indicated that variables such as the preoperative visual analog scale (VAS) score or SP or CGRP expression levels were significantly associated with the Movin score. However, multivariate analysis revealed that only higher SP and/or CGRP signals were associated with higher Movin scores. Elevations in SP or CGRP expression were also linked with significantly severe preoperative VAS scores. Conclusion We demonstrated that tendon degeneration severity is associated with increased SP and CGRP expression in the biopsy samples of lateral epicondylitis.

Objective: The study was designed to evaluate the efficacy of Cyriax physiotherapy versus Cyriaxand Low Level Laser Therapy to compare these techniques in reducing pain and improving gripstrength in patients with lateral epicondylitis. Methodology: The study population included 30patients of lateral epicondylitis (signs and symptoms present for more than 6 weeks) diagnosedin outpatient and indoor facilities of MM Hospital, Mullana. The subjects were selected bymeans of simple random sampling. After fulfilling the inclusion and exclusion criteria, thepatients were randomly allocated in two groups: Group A and Group B. Group A received cyriaxphysiotherapy alone whereas Group B patients were subjected to combined Cyriax and low levelLaser therapy. Baseline measurements of pain and grip strength were taken before treatmentand then at 3 weeks respectively. Results: Our findings showed that there was significantlyhigher improvement in pain and grip strength in Group B (patients receiving combination ofcyriax therapy with low dose laser therapy) as compared to Group A (p

In recent years, orthobiologics have been of increasing clinical interest in the treatment of shoulder and elbow pathology. In some conditions, such as rotator cuff injury and lateral epicondylitis, there have been high-quality trials that support the use of platelet-rich plasma in reducing pain, restoring functionality, and improving clinical outcomes. However, as the numbers of both cellular-based biologics and the conditions being augmented by biologics continue to expand, there is a substantial need for high-quality investigations to support their routine use in most shoulder and elbow conditions. The purpose of this review is to summarize the current evidence of orthobiologics in the management of shoulder and elbow injury, as nonoperative treatment and as augments to operative treatment.

We evaluated magnetic resonance imaging (MRI) findings in patients with clinically diagnosed medial epicondylitis (ME) and determined whether any of the MRI findings correlated with the follow-up pain level after nonoperative treatment. We retrospectively reviewed 83 patients who had undergone elbow MRI examinations for clinically diagnosed ME and who were followed-up for more than 6 months. Five categories of MRI findings were selected for qualitative grading: common flexor tendon (CFT) origin signal changes, ulnar collateral ligament (UCL) insufficiency, ulnar neuritis, bony changes of the medial epicondyle, and calcification. The mean follow-up after MRI examination was 21 months. We performed multivariate regression analysis to analyze whether any of these MRI findings were associated with the follow-up pain level after nonoperative treatment. Positive MRI findings included CFT origin signal changes (66%), ulnar neuritis (40%), UCL insufficiency (30%), calcification (27%), and bony changes (18%). Multivariate analysis indicated that CFT origin signal changes were independently associated with the follow-up pain level (β = 3.387; p = 0.004). In patients with clinically diagnosed ME, MRI demonstrated diverse abnormal findings in the CFT origin, ulnar collateral ligament, ulnar nerve, and bone. Among the findings, the severity CFT origin signal changes, which indicates the severity of tendon degeneration in ME, was associated with the follow-up pain level. This information can be helpful in consulting on the prognosis of nonoperative treatment in patients with clinically diagnosed ME.

Background: Elbow instability, particularly posterolateral rotatory instability (PLRI), has been reported in patients with refractory lateral epicondylitis (LE). However, evidence of diagnostic approach and surgical outcomes is lacking. Purpose: To identify (1) the risk factors, clinical and radiologic-diagnostic characteristics, and (2) the treatment options and clinical outcome of LE with PLRI. Study design: Systematic review. Methods: We searched the PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, Scopus, and EMBASE databases using keywords as well as Medical Subject Headings terms and Emtree using “(lateral epicondylitis OR tennis elbow) AND (instability OR posterolateral rotatory instability)” for English-language studies. We conducted a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: In total, 8 articles comprising 6 level 4 and 2 level 3 studies were identified, including 249 patients (254 elbows). The main triggering factor was heavy labor activity (74/172; 43%). A total of 184 patients (73.9%) received either single (4/184; 2.2%) or multiple (180/184; 97.8%) steroid injections. Clinically, instability was always accompanied by pain in 9% of study individuals. Magnetic resonance imaging (MRI) revealed that radial collateral ligament (RCL) and lateral ulnar collateral ligament (LUCL) lesions were most common (18/79; 23%). The most common surgical procedure performed was arthroscopic RCL plication (62/120; 52%) followed by LUCL reconstruction (30/120; 25%). A ligament patholaxity sign was shown intraoperatively for 64% (44/69). Clinical outcomes ranged from good to excellent in all studies. The most common residual symptom was limited range of motion (11/18; 61%). Conclusion: Instability can coexist and may be associated with refractory LE. The risk factors of instability associated with refractory LE are heavy labor and multiple steroid injections. A systematic approach to identify the clinical and MRI presentation of the condition followed by examination under anesthesia are necessary for affirmative diagnosis, as independent presentations may be misleading.

Background: Lateral epicondylitis is common and may negatively impact activities of daily living. Currently, various conservative treatments are available including physiotherapy, pharmacotherapy, and interventional physiatry. Among the interventional procedures, periarticular hyaluronic acid (HA) injection is an emerging treatment option, but it lacks firm evidence to support its use. Objective: The objective of the study was to determine the effectiveness and safety of HA in reducing pain and improving function of patients with lateral epicondylitis. Methods: We conducted a systematic review in January 2020. Randomized controlled trials identified from various electronic databases were included if they involved the following: Adults with lateral epicondylitis, periarticular injection of HA with or without other medications, and reported outcomes on pain, function, and adverse effects. Assessment of risk of bias was performed using the Cochrane Collaboration Tool. Pertinent data were extracted from the eligible studies for data analysis. Results: Among the 42 studies identified, we included two trials with a total of 388 participants followed up within 6–12 months. The trials employed similar techniques in administering HA, although they used different doses and preparations. The control groups used either normal saline or corticosteroid. In both trials, there were statistically significant improvements in pain and function in favor of HA. No serious adverse event was reported. Conclusion: Albeit with promising intermediate and long-term effects for lateral epicondylitis, HA remains to have limited evidence regarding its effectiveness and safety. We recommend further research to determine the most optimal HA preparation, dosage, and technique for lateral epicondylitis that will help standardize our procedures.

Although lateral epicondylitis has become synonymous with tennis, 95% of cases occur in non-tennis-playing individuals. Redundant assignments and developments including the elbow and wrist place a person in danger of creating horizontal epicondylitis. The point of this investigation was to look at results of arthroscopic arrival of extensor carpi radialis brevis with PRP infusion for the board of safe horizontal epicondylitis. Strategies: The examination was led on 42 patients partitioned into 2 gatherings. The main gathering (21 patients) went through arthroscopic debridement of ECRB birthplace, and the other gathering (21 patients) had PRP infusion. All patients had at first nonoperative treatment, including calming drug, rest, action change, active recuperation, propping, and corticosteroid infusions. The usable signs were headstrong manifestations for in any event a half year or irritation of indications in spite of nonoperative treatment for a very long time. Results and end: Our examination discoveries propose the accompanying ends: PRP infusions and arthroscopic ECRB discharge are both powerful in the short and mid term follow up. PRP patients in some cases show helpless outcomes which require extra infusions or elective sort of treatment as arthroscopic discharge. The two techniques ( PRP infusion and arthroscopic discharge) were protected and very much acknowledged by the patients. Longer term follow up might be required for patients to identify any protests repeat particularly in manual and substantial laborers.

Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.