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Lateral epicondylitis is also known as a Tennis elbow is a common disease of middle age which is painful and functionally limiting entity affecting the upper extremity & causes decreased productivity. The rst line treatment for LE is topical and oral anti-inammatory drugs from ice st applications and brace used. If the 1 line treatment fails second line treatment generally invasive are offered and second-line therapeutic regimens include saline, corticosteroid or platelet-rich plasma injections. Dry needling is relatively new for treating the same. We hypothesized that dry needling would be as effective as second-line treatment for LE. Here we compared the outcomes of second-line treatment, local steroids and dry needling. MATERIALS AND METHODS: The study involved 50 patients having LE, dividing into 2 groups. Patients in group 1 received dry needling, where as those in group 2 received second-line treatment, consisting of local corticosteroid injections. The patients were evaluated after 2 and 4 weeks on the bases of Patients – rated tennis elbow evaluation score (PRTEE). RESULTS:Both treatment were equally effective at 2 and 4 weeks. The effectiveness of both are same and both intervals but someone dry needling has low complications rate in compare to local steroids. CONCLUSION: Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE same as the second line treatment of local corticosteroid injections.

Lateral epicondylitis is a chronic disease characterized by inflammation and pain at origin of extensor muscles of forearm. Anti-inflammatory drugs, brace, physiotherapy and curtailing repetitive activities are some of the conservative first line treatment options available. Our study compared the pain relief and the improvement in functional disability with dry needling (group I) as compared to NSAIDS with brace (group II) in lateral epicondylitis patients. Patients were enrolled consecutively and randomized into two groups. After calculating and noting PRTEE (Patient rated tennis elbow evaluation score) scores in both groups, patients in group I were treated with dry needling and patients in group II were given NSAIDS with brace. Patients were instructed not to use any other measure for relief of pain. They were re-evaluated at 3 weeks and 6 months using PRTEE. The statistical analysis was performed using SPSS software. In both groups significant differences were detected at 3 weeks follow up. Dry needling was found to be effective at both 3 weeks and 6 months but the group II (NSAIDS and forearm brace) showed no effects at 6 months follow up. We conclude that dry needling is a viable treatment modality for lateral epicondylitis.

OBJECTIVE: The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) ver-sus low-level laser therapy (LLLT) in treating chronic lateral epicondylitis (CLE). METHODS: In this prospective study, 52 patients (24 males, 28 females; mean age=48 years; age range=30–70 years) with a diagnosis of CLE were included and randomized into two groups (26 in each group): ESWT group (14 males, 12 females; mean age=48±10 years) or LLLT group (10 males, 16 females; mean age=48±11 years). ESWT was applied for 5 weeks with one session per week, while LLLT was applied with 15 sessions on consecutive days. All patients were evaluated using Disability of the Arm, Shoulder and Hand Questionnaire (DASH), Patient-Related Lateral Epicondy-litis Evaluation (PRTEE), and the 36-Item Short-Form Health Survey (SF-36) before and after the treatments. RESULTS: In the comparison of baseline data between treatment groups, significant differences were observed only in SF-Physical functioning and SF-Energy/fatigue scores (p=0.035 and p=0.038, re-spectively), which were 77.1±17.2 and 56.3±17.2 in ESWT group and 66.5±18.0 and 44.8±21.5 in LLLT group, respectively. In the comparison of post-treatment data between groups, there were sig-nificant differences in all scores (p0.05). CONCLUSION: Evidence from this study revealed that although both treatment modalities were effective in the treatment of CLE, ESWT seemed to more effective in pain relief and functional recovery than LLLT. LEVEL OF EVIDENCE: Level II, Therapeutic study

Objective To observe the clinical effect of electroacupuncture(EA) at Zhǒuling (Extra) and Ashi points in combination with blood-letting cupping for the treatment of external humeral epicondylitis (EHE). Methods Thirty EHE patients were treated with EA at Zhǒuling (Extra) and Ashi points in combination with blood-letting cupping, once every 2 days, twice a week, 4 times as one course of treatment, and 2 successive courses of treatment were given. Before treatment, after 1 course of treatment, and after 2 courses of treatment, the visual analogue scale (VAS) score and Mayo elbow performance score (MEPS) were adopted to evaluate the curative effect. Results Before treatment, the VAS score of patients was 7.81±1.39. After 1 course of treatment and after 2 courses of treatment, it was 4.77±1.56 and 2.95±1.23 respectively, lowered than before treatment, and the difference was statistically significant (both P Conclusion EA at Zhǒuling (Extra) and Ashi points and blood-letting cupping used in combination are remarkably effective in the treatment of EHE, being worthy for popularization.

Resumo Objetivo Avaliar se a aplicação das escalas subjective elbow value (SEV) e Patient-rated Tennis Elbow Evaluation (PRTEE) apresentam resultados similares na avaliação de pacientes com epicondilite lateral do cotovelo. Métodos Trinta e sete indivíduos com diagnostic de epicondilite lateral do cotovelo foram avaliados no ambulatório de cirurgia do ombro e cotovelo do nosso hospital. O diagnóstico foi realizado com a história clínica da patologia, exame físico, raio-x, e ultrassonográfia. Foram utilizadas as escalas SEV e PRTEE, e os resultados foram comparados estatisticamente, usando-se como nível de significância 5% (p ≥ 0,05). Resultados Encontramos uma relação estatisticamente significante entre os valores obtidos pelas escalas SEV e PRTEE quando aplicadas no grupo de pacientes portadores de epicondilite lateral (p = 0,017). Conclusão Subjective elbow value apresentou resultados similares ao PRTEE na avaliação de pacientes com diagnóstico de epicondilite lateral do cotovelo.

BACKGROUND Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population. Although symptoms may disappear spontaneously within 1 year, the clinical guidelines for conservative treatment are not clear. The authors' objective was to examine the outcomes of nonsurgical treatments for lateral epicondylitis through a meta-analysis and provide a treatment recommendation using the available evidence. METHODS The authors searched the PubMed, EMBASE, Scopus, and Web of Science databases to identify primary research articles studying conservative treatments (electrophysiotherapy, physical therapy, and injections) for lateral epicondylitis. The authors included randomized controlled trials published in peer-reviewed journals. Data related to outcomes (pain, grip strength, Patient-Rated Tennis Elbow Evaluation score, and Disabilities of the Arm, Shoulder and Hand score) and complications were extracted. RESULTS Fifty-eight randomized controlled trials were included in the meta-analysis. Electrophysiotherapy was effective in improving pain [mean difference, -10.0 (95 percent CI, -13.8 to -6.1)], Patient-Rated Tennis Elbow Evaluation score [mean difference, -10.7 (95 percent CI, -16.3 to -5.0)], and Disabilities of the Arm, Shoulder and Hand score [mean difference, -11.9 (95 percent CI, -15.8 to -7.9)]; and physical therapy improved pain [mean difference, -6.0 (95 percent CI, -9.7 to -2.3)] and Patient-Rated Tennis Elbow Evaluation scores [mean difference, -7.5 (95 percent CI, -11.8 to -3.2)] compared to placebo. Injections did not improve any outcome measures. Patients who received electrophysiotherapy and injections reported higher adverse effects than physical therapy patients. CONCLUSIONS Patients who received electrophysiotherapy and physical therapy reported statistically and clinically improved scores in pain and function compared to placebo. Injections may put patients at higher risk for adverse effects compared to other conservative treatments. When managing lateral epicondylitis conservatively, electrophysiotherapy and physical therapy should be prioritized before other interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.

Lateral epicondylitis (LE), also known as tennis elbow, is the most common cause of elbow pain in adults, with approximately 1-3% of the general population being afflicted. Although the condition is usually self-limiting, pain can be a major hindrance, limiting daily activity and the work capacity of patients. As a result, many treatment options have become available with the aim to shorten the duration of the disease and increase the quality of life. Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE. In this review, we will provide a brief summary of LE and focus on addressing conservative and minimally invasive interventional options for the treatment of LE.

Controversy exists with regards to the etiology and treatment of lateral epicondylitis and the role of the lateral capsule in this pathology. The aim of this study was to compare arthroscopic lateral capsule resection with or without extensor carpi radialis brevis (ECRB) tendon debridement for treatment of lateral epicondylitis. This is a retrospective study of 38 patients who underwent arthroscopic surgery for LE with two different techniques: Eighteen patients were treated with arthroscopic lateral capsular resection (LCR) + ECRB debridement and 20 patients were treated with arthroscopic LCR alone, without ECRB debridement. Both groups were assessed with Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score for function and Visual Analog Scale (VAS) score for pain. Quick DASH scores were 12 $$\pm $$ 5 and 13 $$\pm $$ 4 at Groups 1 and 2, respectively, without any statistically significant difference. VAS pain scores were 15 $$\pm $$ 2 for both groups. VAS function scores were 85 $$\pm $$ 22 and 86 $$\pm $$ 18 at Groups 1 and 2 respectively. Sick leave periods in terms of weeks were 7 $$\pm $$ 5 and 7 $$\pm $$ 4 at Groups 1 and 2, respectively. There was no statistically significant difference in outcome of the two groups compared in terms of VAS pain, function scores, failure (re-operation) rates and sick leave period at the end of final follow-up. Both arthroscopic LCR alone and Arthroscopic LCR with ECRB debridement for the management of refractory LE provide significant improvement in pain and function. Isolated Arthroscopic LCR could be a sufficient surgical treatment for refractory LE. Thus, ECRB debridement or release may not be necessary in every case. IV.

Background: Platelet-rich plasma helps in repair because of its growth factor. Platelet-rich plasma has been used in humans for its healing properties. Increased concentration of growth factors and secretory proteins may increase the process of healing on a cellular level. Aim: This study was done to check the effectiveness of PRP injections in patients with chronic lateral epicondylitis. Methodology: This was accomplished in patients visiting the orthopaedic OPD at the Sree Balaji Medical College and Hospital, Chennai, Tamilnadu. There were 40 physicians in this study, among whom 37 were homosexual and 87 were female. The mean age of the patients was 48.1 years (17-82 years). The study period was 3 months. The analytical method used is a visual analog score. Results: Effective therapy was performed with a decline of more than 20% (24 out of 40 patients) in visual analog score after a dual-month period. After 3 months in boys, the mean VAS score dropped from 6.88 to 9.41. Conclusion: Medication of PRP patients with chronic epicondylitis or PRP tennis elbow reduces pain and increases the flexibility of the affected knee joint.

The most well-known abuse condition is identified with inordinate wrist expansion and generally alluded to as tennis elbow, however it is in reality increasingly regular in non-tennis players. METHODS- A prospective, comparative study was conducted with 50 patients after Ethical approval. Quantitative data is presented with Mean and Standard deviation. Examination among the investigation bunches is finished with the assistance of unpaired t test according to consequences of ordinariness test. Majority of the patients (80%) in Group A and (76%) in Group B were from the age group of 31-40 years. The mean age in Group A was 36.4±5.44 years and in Group B were 36.8±5.87 years. Majority of the patients in both groups were female. There was dominance of right side (68% and 72%) as compared to left side (32% and 28%) in both groups. The mean duration of symptom in Group A was 2.24±0.72 months as compared to 1.92±0.81 months in Group B. 20% and 12% patients in Group A had Diabetes Mellitus and Hypertension respectively whereas 16% and 24% patients in Group B had Diabetes Mellitus and Hypertension respectively. The mean baseline VAS score in Group A was 7.6±0.51 and Group B was 7.7±0.38 which decreased to 5.1±0.81. The mean baseline MGS score in Group A was 74.6±10.32 which increased to 91.6±4.08 in 2 weeks. And in Group B was 74.5±10.31 which increased to 99.8±2.646 in 2 weeks. The MGS score improved more in Group B after 2 weeks (p=0.005), 4 weeks (p=0.002) and 6 weeks (p=0.022). However, toward the finish of 3 months, a half year and a year, improvement in MGS Score was fundamentally better in Group A as compared to Group B.Along these lines, we presumed that PRP as an unrivaled treatment choice in instances of tennis elbow. In any case, keeping in see the constrained time of follow up in the current examination we prescribe longer follow up studies to additionally unite our discoveries and set up the long haul viability of PRP in instances of sidelong epicondylitis.

Lateral epicondylitis is a common disease in orthopaedic practice. Although the majority of cases do not become chronic, patients who do not respond to the initial treatment may suffer from pain in the long term and effective treatment is challenging. The off-label use of botulinum toxin is one of the common potential indications for the substance in orthopaedics and traumatology. In a literature review of 2000 – 2019, eight EBM ≥ level 3 studies evaluating the use of botulinum toxin in lateral epicondylitis were found. Five of these studies evaluated botulinum toxin versus placebo in chronic cases; two other studies compared botulinum toxin with corticosteroids in acute cases and classic Hohmann surgery in chronic cases; the eighth study compared botulinum toxin in two different injection sites and corticosteroids by classic injection. Our findings suggest that the use of this substance may be a treatment option in refractory chronic cases before surgery is indicated. The working group on botulinum toxin in O & T of the International Musculoskeletal Pain Society (IMPS/IGOST) introduced an alternative injection schedule, which combines findings from the recent clinical literature with practical experience in order to reduce the risk of side effects while ensuring treatment effectiveness. Using 2 simple tests of function and, if necessary, sonographic verification, 2 separate injection sites in the extensor carpi radialis or the extensor digitorum can be identified by palpation. The tendon level on the lateral epicondyle acts as the third injection site. With optimal use of the ampoule content, the 3 injection sites can be infiltrated individually, depending on the muscle status. On the one hand, this enables treatment to take place after a dual therapy approach and, on the other hand, the risk of overdose in a muscle with subsequent unnecessary muscle weakening can be reduced.

Epicondylitis causes disability and tends to become chronic. Histologically, degenerative lesions are found in the common extensor tendon, which are visible on ultrasound or magnetic resonance imaging. Several conservative therapeutic measures are available, including corticosteroid infiltration by anatomical landmark. However, these measures sometimes fail, in which case patients are proposed for surgery. Ultrasound is a therapeutic tool that allows procedures on tendons to be performed without skin incisions. The technique of ultrasound-guided percutaneous tenotomy for the treatment of chronic epicondylitis was first reported in 2006. This procedure, demonstrated to date by surgeons and radiologists, attempts to transform a chronic degenerative process with failure to repair into an acute inflammatory process with self-regeneration. The aim of this study was to describe 5 cases of epicondylitis that failed to respond to routine therapeutic measures, in which we used ultrasound-guided percutaneous tenotomy with favourable results.

Lumbar radiculopathy is a major health problem often treated by surgery or guided lumbar epidural steroids for pain relief. Autologous platelet-rich plasma (PRP) injections have been investigated in recent years as an emerging therapy for various musculoskeletal conditions, including lumbar degenerative disc disease. Although PRP has received increasing attention from medical science experts, comprehensive clinical reports of its efficacy are limited to those treating knee osteoarthritis and epicondylitis. In this article we used Platelet Rich Plasma (PRP) a novel therapeutic tool of autologous nature that has emerged strongly in recent years to treat patients of prolapsed intervertebral disc.

Pain over the lateral aspect of the elbow without nerve injury or elbow instability often is diagnosed as lateral epicondylitis or, colloquially, tennis elbow. It is a common complaint, seen most frequently in women between ages 40 and 60, although it is common in men too. Typical presenting symptoms include pain with prolonged wrist extension activities, pain with resisted wrist or elbow extension, and pain at rest radiating from the elbow along the dorsum of the forearm.

Uvod: Terapija udarnim valom (TUV) (od engl. shockwave therapy) je neinvazivna metoda temeljena na mehaničkim pulsovima koji se u obliku vala šire kroz ljudsko tijelo te izazivaju mikroskopske intersticijalne i ekstracelularne biološke učinke među kojima je i regeneracija tkiva. Cilj: Cilj ovog retrospektivnog istraživanja bio je ispitati učinkovitost i razlike u liječenju bola TUV-om u pacijenata s dijagnozama plantarni fascitis, kalcificirajući tendinitis ramena i lateralni epikondilitis lakta nakon upotrebe tri i pet uzastopnih tretmana. Ispitanici i metode: U radu su korišteni podatci pacijenata iz baze podataka Zavoda za fizikalnu i rehabilitacijsku medicinu Kliničkog bolničkog centra u Rijeci, a pri tome su u skladu s Helsinškom deklaracijom ostali anonimni: dob, spol, mjerenja intenziteta bola dobivena uz pomoć vizualno analogne skale (od engl. Visual Analogue Scale, VAS). Ispitanici su podijeljeni u dvije grupe za svaku dijagnozu (TUV3 i TUV5). Ispitivanje je sadržavalo ukupno 148 pacijenata: plantarni fascitis N = 50, kalcificirajući tendinitis ramena N = 50 i lateralni epikondilitis lakta N = 48. Rezultati: Primjena terapije udarnim valom kod pacijenata s dijagnozama plantarni fascitis, kalcificirajući tendinitis ramena i lateralni epikondilits lakta, s ciljem smanjenja intenziteta bola, pokazala se uspješnom. Dobivenim rezultatima utvrđeno je da primjena pet TUV tretmana dovodi do boljih rezultata smanjenja bola u sve tri dijagnoze negoli samo tri primijenjena tretmana (p < 0,001; p < 0,001; p < 0,001). Nadalje je utvrđeno da se nakon tri primijenjena tretmana postigao bolji učinak smanjenja bola kod plantarnog fascitisa negoli kod kalcificirajućeg tendinitisa ramena i lateralnog epikondilitisa lakta, dok nakon pet primijenjena tretmana nije bilo razlike u smanjenju bola među dijagnozama. Zaključak: Ova studija preporučuje primjenu pet tretmana kod sve tri dijagnoze kako bi pacijenti imali bolji učinak smanjenja bola., Introduction: Shock wave therapy (SWT) is a non-invasive method based on mechanical pulses widening through the human body and causing microscopic interstitial and extracellular biological effects, including tissue regeneration. Aim: The aim of this retrospective study was to analyze efficacy and differences in pain treatment with SWT in patients with plantar fasciitis, calcific tendinitis of the shoulder and lateral epicondylitis of the elbow after three and five consecutive treatments. Participants and methods: The patients data were taken from the database at the Departmentof Physical and Rehabilitation Medicine of the Clinical Hospital Center in Rijeka and used only in purpose of this work, and according to the Helsinki Declaration, stayed anonymous: age, sex, pain intensity measurements obtained using the Visual Analogue Scale. The participants were devided into two groups (TUV3 and TUV5). The data were taken from 148 patients: plantar fasciitis N = 50, calcific tendinitis of the shoulder N = 50 and lateral epicondylitis of the elbow N = 48. Results: The therapy with SWT proved to be successful in patients with diagnosis of plantar fasciitis, calcific tendinitis of the shoulder and lateral epicondylitis of the elbow. The analyzed results showed that three or five treatments both resulted in pain reduction in all three diagnosis, with five treatments being more efficient than just three applied treatments (p < 0,001; p < 0,001; p < 0,001). It has also been established that after three applied treatments a better effect of pain reduction is achieved in plantar fascitis than in calcific tendinitis of the shoulder and lateral epicondylitis of the elbow, and after five applied treatments there was no difference in pain reduction between diagnoses. Conclusion: Therefore, this study recommends the application of five treatments in all three diagnoses in order for patients to have better pain relief.

Lateral epicondylitis, also termed as “tennis elbow,” is the most common cause of elbow pain and dysfunction, mainly resulting from repetitive gripping or wrist extension during various activities. The exact pathogenesis remains largely elusive with putative tendinosis, a symptomatic degenerative process of the local tendon. It is usually diagnosed by clinical examinations. Sometimes, additional imaging is required for a specific differential diagnosis. Although most cases can be self-healing, the optimal treatment strategy for chronic lateral epicondylitis remains controversial. This article presents a landscape of emerging evidence on lateral epicondylitis and focuses on the pathogenesis, diagnosis, and management, shedding light on the understandings and treatment for healthcare professionals.

Background Extracorporeal shock wave therapy (ESWT) has been used in various musculoskeletal disorders, including lateral epicondylitis. However, in 2005, a meta-analysis of randomized controlled trials showed that ESWT provides minimal or no benefit in terms of pain and function in patients with lateral epicondylitis. Since the review, several randomized controlled trials including different types of ESWT such as radial type for lateral epicondylitis have been published. Investigations of the effect modifiers such as symptom and follow-up duration on the effects of ESWT on lateral epicondylitis have not been performed. Questions/purposes (1) Does ESWT reduce pain and improve grip strength in patients with lateral epicondylitis? (2) Which type of ESWT, radial or focused, is more effective? (3) Is the duration of symptoms associated with the efficacy of ESWT for lateral epicondylitis? (4) Do improvements in pain scores remain in patients with longer follow-up? Methods The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to July 2019 for articles published in English or Korean. Studies were included if patient allocation was randomized, the sample was composed of patients with lateral epicondylitis, interventions were ESWT (focused or radial), comparison group only received sham stimulation or no additional treatment, and the study outcome was pain intensity or grip strength. The quality of the evidence was assessed using the Cochrane risk of bias tool. Twelve studies including 1104 participants fulfilled the inclusion criteria and were included in the meta-analysis. The mean difference for pain reduction and improvement in grip strength was calculated. Results The meta-analysis showed no clinically important difference in the VAS score (2.48 ± 7.55 versus 3.17 ± 9.78, mean difference -0.68 [95% confidence interval -1.17 to -0.19]; p = 0.006) and grip strength (38.02 ± 70.56 versus 34.85 ± 108.26, mean difference 3.33 [95% CI 0.93 to 5.73]; p = 0.007) after ESWT relative to the comparison group's score. Even though radial ESWT showed more improvement than focused, the mean difference for VAS did not exceed the minimal clinically important differences threshold. There were no clinically important effects on the VAS scores of patients with lateral epicondylitis (2.78 ± 5.57 versus 3.92 ± 6.29, mean difference -1.13 [95% CI -1.84 to -0.42]; p = 0.002) and focused ESWT did not improve pain in patients with lateral epicondylitis. In the subgroup analysis, ESWT was effective in patients with a symptom duration of more than 6 months (2.28 ± 8.48 versus 3.31 ± 11.81, mean difference -0.95 [95% CI -1.75 to -0.15]; p = 0.02) but not for those with shorter symptom duration. The effects did not last beyond 24 weeks (2.52 ± 9.19 versus 3.34 ± 5.93, mean difference -0.82 [95% CI -2.57 to 0.93]; p = 0.36). Conclusions ESWT did not show clinically important improvement in pain reduction and grip strength. Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. Further studies are needed to determine the appropriate protocol and elucidate the effects according to the intervention type and specific disease condition. Level of evidence Level I, therapeutic study.

Objective To compare the effectiveness of platelet-rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis. Type of study Network meta-analysis. Literature survey Randomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library. Methodology Two researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2 ). Publication bias was evaluated by constructing contour-enhanced funnel plots. Stata 15 software was applied for pairwise meta-analysis and network meta-analysis. To explore the efficacy between different follow-up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term. Synthesis Twenty RCTs (n = 1271) were included in this network meta-analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient-Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short-term period. For the long-term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8). Conclusion PRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.

Epicondylitis is the most common cause of elbow pain, affecting up to 3,0% of the adult population. A comparative study of platelet-rich plasma (BTP) and betamethasone (diprospan) in the treatment of epicondylitis of the shoulder. 50 patients received injections of betamethasone 2-fold with an interval of 14 days. The main group-50 patients received 2 injections of BTP with an interval of 14 days. The results were evaluated using the psychometric scale Patient-Rated Tennis Elbow Evaluation (PRTEE) after 1, 6 and 12 months. Patients receiving Betamethasone showed the lowest level of pain after 1 month, with a gradual tendency to reduce the clinical effect after 6 months and the increase in clinical symptoms of the disease after 12 months. after treatment. The clinical effect after the use of BTP increases to 6 months with a slight tendency to reduce the effect to 12 months. Our studies have shown a high, up to 86,0% effectiveness of the applied methods of treatment of internal and external epicondylitis of the shoulder using PRP in comparison with glucorticosteroids.

Objectives: Lateral epicondylitis is a disorder in which the dominant extremity is usually affected, and its prevalence ranges between 1% and 3% in the general population. It appears to be more common and severe in women between ages 30 and 60. Platelet rich plasma (PRP), autologous blood and corticosteroid injections are widely applied treatment modalities with various success rates. We aimed to investigate clinical outcomes of these three injection techniques. Study Design is Prospective randomized clinical trial. Methods: Fifty two patients (19 men, 33 women) whom were diagnosed lateral epicondylitis between the years 2011 and 2013, with a mean age 43,7years (min 18, max 62) were randomized into three groups according to application order. Each group received one of the injection treatments: PRP, autologous blood or corticosteroid. Comparative clinical outcomes evaluated prospectively. Assessments performed by a blind evaluator by visual analog scale (VAS), presence of tenderness, QuickDASH scores, grip strength measurements in pre-injection period and in post-injection first, third and sixth months. Statistical analyses performed in SPSS 21 software by Pearson’s chi-squared, Anova, Kruskar Wallis and McNemar tests. Results: Changes of VAS and QuickDASH scores in each group were significant according to pre-injection and post-injection first, third, sixth month evaluations (p

Background The Patient-Rated Tennis Elbow Evaluation questionnaire (PRTEE) is a specific questionnaire available for assessing the health status of patients with lateral epicondylitis. An official German translation does not yet exist. Objectives The aim of this study was to translate and cross-culturally adapt the English version of the PRTEE into German. Material and Methods The translation and cross-cultural adaptation was completed by an expert committee comprising people of varying professional and linguistic backgrounds. According to international guidelines, the English original was first translated into German, then back-translated and the final version was pre-tested on patients. Results No major difficulties were encountered during the translation process and smaller linguistic discrepancies could be resolved in the expert committee. For the pre-validation testing, 11 patients with extensor repair due to persistent lateral epicondylitis were included. They rated the questionnaire as easy to understand and complete. The final version was approved by the developers of the original questionnaire as the official German translation. Conclusions Although the measurement properties of the German version were not evaluated in this study, the original shows good reliability, validity and responsiveness. In summary, the PRTEE is a questionnaire quick and easy to complete for patients with lateral epicondylitis. Therefore, it is suitable for the clinical routine assessment of subjective health status or the outcome after an intervention.

Background A number of treatments for lateral epicondylitis of the elbow have been described. We have developed a strategy for the treatment of this condition. Methods We diagnosed lateral epicondylitis of the elbow in 86 patients. Conservative treatment resulted in resolution in 71 patients. Surgery was required in the remaining 15 patients. If the posterior branch of the posterior cutaneous nerve of the forearm showed a positive response to local anesthesia (block test), we performed denervation surgery on the posterior branch of the posterior cutaneous nerve of the forearm. Patients were asked to rate the degree of pain and sensory disturbance using a visual analog scale; the 11-item version of the Disabilities of the Arm, Shoulder and Hand measure; and the Patient-Rated Elbow Evaluation. Results A positive response to the block test was seen in 10 elbows (67%). After denervation surgery, pain relief was seen in 9 of 10 elbows (90%). The mean follow-up period was 30.4 months. At final follow-up, the average scores on the visual analog scale, 11-item version of the Disabilities of the Arm, Shoulder and Hand, and Patient-Rated Elbow Evaluation were 4.3 mm, 10.45 points, and 5.9 points, respectively. In the early period after denervation surgery, sensory disturbance was observed in 9 cases (90%). Conclusion Our strategy of denervation surgery for lateral epicondylitis of the elbow was effective for pain relief among patients showing a positive response to the block test.

The aim of this study was to examine pharmacopuncture treatment for lateral epicondylitis, and to contribute to developing a standardized treatment regimen by reviewing trends in clinical trials. Five randomized controlled trials, 1 case-control study, and 8 cohort studies published after 1999, that involved pharmacopuncture for lateral epicondylitis, were selected from Korean and international online databases (n = 8). The type of pharmacopuncture, dose, frequency, efficacy, and adverse events were analyzed. Seven types of pharmacopuncture were used, namely Bee Venom, Illicium henryi Diels, Akebiae Caulis, Angelicae sinensis Diels, Ligusticum chuanxiong Hort, Hominis Placenta, and Salviae Miltiorrhizae Radix. Dose, treatment duration, and treatment frequency varied widely. One study assessed the treatment efficacy according to frequency. Nine studies lacked data on adverse events. The quality of 5 randomized controlled trials was low. Although pharmacopuncture treatment appeared to be effective for lateral epicondylitis, it was difficult to standardize the regimen for lateral epicondylitis.

To compare the effects of platelet-rich plasma (PRP) injection versus placebo (saline injection) on pain and joint function in lateral epicondylitis in randomized placebo-controlled trials. Randomized controlled trials that evaluated pain (visual analog scale [VAS] and patient-rated tennis elbow evaluation [PRTEE]) and/or functional improvement (PRTEE; disability of the arm, shoulder, and hand [DASH]; and Roles–Maudsley score [RMS]) in patients diagnosed with lateral epicondylitis and compared PRP with placebo injections were considered. The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched from inception to October 2019. The assessment of bias was performed using the Cochrane Risk of Bias Tool version 1. The meta-analysis was conducted with a random effects model and generic inverse variance method. Five trials involving a total of 276 individuals were included. They used a parallel study design and saline solution as placebo. The mean age of participants was 48.0 ± 9.3 years. Follow-up varied from 2 months to 1 year. No significant changes were noted for pain (standardized mean difference [SMD], − 0.51 [95% confidence interval (CI), − 1.32 to − 0.30]) nor functional scores (SMD, − 0.07 [95% CI, − 0.46 to 0.33]) between PRP and placebo injections. The most frequent adverse reaction reported in two of the five studies was transient post-injection pain for a few days (from 16 to 20% in the PRP group and from 8 to 16% in the placebo group). PRP injection was not superior to placebo for relieving pain and joint functionality in chronic lateral epicondylitis. However, patients reported improvement after both interventions in such clinical parameters. Further randomized trials are required to determine whether PRP injection is clinically more effective than placebo (saline injection).

Background: Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis. Purpose: This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria. Study Design: Systematic review and meta-analysis. Methods: MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index. Results: A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months). Conclusion: NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT. Registration: CRD42019127547 (PROSPERO).

Posterolateral elbow instability with an insufficiency of the lateral ulnar collateral ligament commonly results from elbow trauma. However, other etiologies such as iatrogenic injuries after primary surgical treatment for lateral epicondylitis or repetitive corticosteroid injections also may lead to a lateral ulnar collateral ligament insufficiency. In these cases, surgical treatment can help to restore posterolateral stability of the elbow. Besides the stabilizing effect of the ligamentous structures, the anconeus muscle is the most import active stabilizer against posterolateral elbow instability. Therefore, the aim of the present technique is to present an anconeus-sparing, minimally invasive approach to restore posterolateral stability. This technique may serve as an alternative for typically used all open access.

Zusammenfassung. Der laterale Ellbogenschmerz ist ein höchst unspezifischer Befund, hinter dem eine Reihe möglicher Differenzialdiagnosen stecken können. Leider wird hier oft «reflexartig» von einer Epikondylopathie, umgangssprachlich Tennisarm, ausgegangen, obwohl gerade in chronischen Fällen eine Instabilität viel häufiger ist. Im vorgestellten Fall handelt es sich um die seltenere Nervenkompression des N. radialis, die gemeinsam mit dem Plicasyndrom, der Osteochondrosis dissecans und der Arthrose des radiokapitellaren Gelenks als Differenzialdiagnose des lateralen Ellbogenschmerzes bedacht werden muss.

Introduction. Timely and adequate diagnosis and treatment of degenerative-dystrophic diseases of the bone and joint apparatus, which include epicondylitis (epicondylosis), including professionally caused, continues to be a serious health problem today, since they cause significant economic damage associated with temporary and persistent disability of the active part of the world’s population. In this regard, the search for methods and methodological approaches to improve the radiation diagnosis of this disease remains relevant. The study is devoted to solution of important medical problems, including occupational diseases-optimization of X-ray of the ulnar epicondylitis based on the use of new methodological approaches quantifying the density of pathological remodeling of bone structures in the subject area, that allow to objectify the direction of changes in monitoring intensity changes in the estimated structures.The aim of the study is to improve the quality of x-ray diagnostics of ulnar epicondylitis based on a precision assessment of the optical density of bone and periarticular tissues using digital radiography.Materials and methods. A comparative analysis of the results of a comprehensive clinical and radiological examination of patients, workers of the main group (fitters and laborers machine-building plants) working age range of 30–50 years with a clinical picture of subacute phase of the ulnar epicondylitis in the absence of a pathognomonic ultrasound findings and x-ray morphological signs of the disease. X-ray studies were performed using digital low-dose x-ray diagnostic devices. Visualization, processing, analysis of medical images and comparison of results in the dynamics of research were carried out using the programs «Lins machaon doctor’s workstation». To measure the conditional optical density of bone and soft tissues, we used the ROI tool (zone of interest), which allows us to determine the desired value in areas of different dimensions. Measurements were performed on digital radiographs and computer monitor screens in the areas of interest: the lateral parts of the humerus condyles and adjacent periarticular tissues with the calculation of the average values of the optical density index (ID) and optical density gradients (IDG) relative to the density of periarticular soft tissues.Results. Analysis of the results of a posteriori osteodensitometry of the distal humerus within the framework of the developed algorithm, which includes the use of absolute and relative indicators of conditional optical density after preliminary color correction of digital x-ray images of bone and paraossal tissue structures, allowed us to expand our understanding of the topography of the distribution of mineral saturation in the condyles of at-risk individuals relative to those of the control group. It was found that the indicators of optical density of bone and paraossal tissues can be a kind of (conditional), sometimes the only indicators of the degree of severity of changes, positive or negative dynamics of pathophysiological processes. Density differences in the distal parts of the right and left humerus (bony and soft -tissue paraossal structures of the condyles) in the control group (conditional norm) in terms of absolute optical density and its gradient, regardless of the assessment area, were insignificant (statistically unreliable), although they were multidirectional. In patients with clinical signs of epicondylitis in the absence of x-ray morphologically detectable structural changes, a decrease in ID and the dynamics of its recovery at various stages of observation were revealed. Even when the ID of the actual bone structure is relatively equal, the IDG differs in different people, since it is largely determined by metabolic processes that are dynamically more labile than in the bones, and thus serve as a kind of indicator of their intensity. Taking into account the relative torpidity of perestroika processes in the structures of the bone tissue of the condyles in epicondylitis, IDG should be considered a more informative indicator of their dynamics. The importance of optical density indicators as predictors of the considered pathology is particularly evident in the process of analyzing the results of its diagnosis and development in the dynamics of observations not so much at the collective as at the individual level of assessment.Conclusions. The application of the developed methodological approach allows us to significantly expand our understanding of the topographical distribution of the density of bone and soft tissue structures of the distal humerus at various stages of examination of patients, including the early subclinical phases of possible pathology, even in the absence of visually detectable x-ray morphological changes. The use of an original algorithm for evaluating tissue density will reduce the negative role of the so-called «human factor» and thus significantly ensure the objectivity of the interpretation of research results.Funding. The study had no funding.Conflict of interests. The authors declare no conflict of interests.

Platelet-rich plasma (PRP), prepared from autologous blood, is commonly used in various pathologies like hip and knee osteoarthritis, rotator cuff pathology, epicondylitis, tendinitis, fracture healing and back pain, for tissue regeneration, wound healing, scar revision, skin rejuvenating effects, and also in treatment of alopecia. It is one of the important products, which is nowadays being used by pain physicians aggressively. But, the preparation protocols vary and there are many factors that influence the composition of PRP. The aim of this review is to find the details of PRP and the standard preparation protocol, if any.

Percutaneous ultrasonic tendon needling has been used to treat persistent lateral epicondylitis, and its efficacy has been demonstrated. However, whether ultrasonography is necessary remains unclear. The purpose of this retrospective study was to evaluate the efficacy of percutaneous tendon needling without ultrasonography for lateral epicondylitis. A total of 36 patients who underwent tendon needling without ultrasonography for lateral epicondylitis were retrospectively included in the study. The tendinotic lesion was needled by fenestration approximately 20-30 times without sonographic assistance. The Visual Analogue Scale (VAS) pain score, the grip strength, and success rates were assessed at baseline and at 1, 3, 6, and 12 months after treatment. The Nirschl tennis elbow score was evaluated at baseline and at 6 and 12 months after the needling procedure. The mean VAS pain score and grip strength at 3, 6, and 12 months significantly improved compared to the baseline values. At 6 and 12 months, the success rates had significantly increased compared to the rates at 1 month. The mean Nirschl scores at 6 and 12 months were significantly better than the baseline value. No severe complications were observed during the study period. Percutaneous tendon needling without ultrasonography is a simple and safe technique. The procedure is effective for lateral epicondylitis that is unresponsive to conventional conservative treatments.

Objective: To determine and compare the effects of Deep Transverse Friction (DTF) Massage and Mill’s manipulation (Cyriax) with Mobilization with movement (MWM) and Taping (Mulligan) in lateral epicondylitis patients. Material & Methods: A Randomized Control Trial (NCT03848117) was conducted in Physiotherapy Department of DHQ Hospital Bahawalnagar after the approval from the competent authority. Non-probability convenient sampling technique was used to collect sample. The n=30 sample size was randomly allocated in two groups as Group A i.e. the Cyriax group (DTF Massage & Mill’s Manipulation) and Group B i.e. the Mulligan group (Taping & MWM), with 15 participants in each group having sub acute lateral epicondylitis. Data was collected in terms of age, gender, BMI and occupation. Patient related tennis elbow evaluation (PRTEE) questionnaire was used to determine the level of pain, functional disability and hand grip strength. Mann Whitney U statistics test was used for between the group analysis and Friedman with Wilcoxon signed ranks test was used for within the group analysis. The significance level was set at p

OBJECTIVES: This study aims to present two major psychological factors, namely depression and somatization, which may occur with high probability in patients with refractory lateral epicondylitis (LE). PATIENTS AND METHODS: This cross-sectional study included 36 patients (11 males, 25 females; mean age 42.6±8.09 years; range 26 to 60 years) diagnosed as refractory LE. Duration of symptoms was >6 months. Each patient completed the Beck Depression Inventory and the Symptom Checklist-90-Revised test evaluating psychosocial status and somatization, respectively. RESULTS: Depression was found in 24 (66.6%) (moderate in 15 [41.7%] and mild in 9 [25%]) and somatization was found in 28 (77.8%) patients. Depression and somatization were significantly more common in females than males (p=0.02 and p=0.04, respectively). CONCLUSION: Depression and somatization may occur frequently in refractory LE patients, particularly in females. Both physical and psychological assessment tools should be incorporated into the clinical evaluation while psychological support should be included in the treatment of refractory LE.

Background Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. Objectives We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Methods Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Results Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. Conclusions BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU injection.