A Comparison of Two Treatment Regimens for Lateral Epicondylitis: A Randomized Trial of Clinical Interventions

1997 ◽  
Vol 6 (3) ◽  
pp. 226-234 ◽  
Author(s):  
Wendy I. Drechsler ◽  
John F. Knarr ◽  
Lynn Snyder-Mackler
Keyword(s):  
Physical Therapy ◽  
Radial Head ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Controlled Clinical Trial ◽  
Treatment Regimens ◽  
Strengthening Exercises ◽  
Positive Results

Eighteen subjects participated in a randomized controlled clinical trial to compare the effectiveness of two physical therapy treatments for tennis elbow. The subjects were divided into two groups: In the neural tension group (NTG), the head of the radius was mobilized and specific physical therapy mobilizations were used to address hypomobility of the radial nerve. The standard treatment group (STG) received ultrasound, transverse friction massage, and stretching and strengthening exercises for the extensors of the wrist. All subjects were treated twice weekly for 6 to 8 weeks. Follow-up data were obtained at 3 months post-treatment. Subjects who received radial head mobilization improved over time (p <.05), while those who did not receive radial head mobilization did not improve. Results of the NTG treatment were linked to the radial head treatment, and isolated effects of the NTG treatment could not be determined. There were no long-term positive results in the STG.

Ten- to 14-Year Follow-up of the Nirschl Surgical Technique for Lateral Epicondylitis

2007 ◽  
Vol 36 (2) ◽  
pp. 261-266 ◽  
Author(s):  
Jonathan H. Dunn ◽  
John J. Kim ◽  
Lonnie Davis ◽  
Robert P. Nirschl
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Scoring Systems ◽  
Intensity Scale ◽  
The Mean ◽  
Mini Open

Background Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques. Hypothesis Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up. Study Design Case series; Level of evidence, 4. Methods Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1 surgeon between 1991 and 1994 were retrospectively reviewed. Eighty-three patients (92 elbows) were available by telephone for a mean follow-up of 12.6 years (range, 10–14 years). Outcome measures included the Numeric Pain Intensity Scale, Nirschl and Verhaar tennis elbow–specific scoring systems, and American Shoulder and Elbow Surgeons elbow form. Preoperative data were collected retrospectively. Results The mean age of the study group was 46 years (range, 23–70 years) with 45 men and 38 women. Eighty-seven of the procedures were primary, and 5 were revision tennis elbow surgeries. Concomitant procedures were performed in 30 patients including ulnar nerve release in 24 patients, medial tennis elbow procedures in 23 patients, shoulder arthroscopy in 2 patients, carpal tunnel release in 1 patient, and triceps debridement and osteophyte excision in 1 patient. The mean duration of preoperative symptoms was 2.2 years (range, 2 months to 10 years). The mean Nirschl tennis elbow score improved from 23.0 to 71.0, and the mean American Shoulder and Elbow Surgeons score improved from 34.3 to 87.7 at a minimum of 10-year follow-up ( P < .05). The Numeric Pain Intensity Scale pain score improved from 8.4 preoperatively to 2.1 ( P < .05). Results were rated as excellent in 71 elbows, good in 6 elbows, fair in 9 elbows, and poor in 6 elbows by the Nirschl tennis elbow score. By the criteria of Verhaar et al, the results were excellent in 45 elbows, good in 32 elbows, fair in 8 elbows, and poor in 7 elbows. Eighty-four percent good to excellent results were achieved using both scoring systems. Ninety-two percent of the patients reported normal elbow range of motion. The overall improvement rate was 97%. Patient satisfaction averaged 8.9 of 10. Ninety-three percent of those available at a minimum of 10-year follow-up reported returning to their sports. Conclusion The mini-open Nirschl surgical technique with accurate resection of the tendinosis tissue remains highly successful in the long term.

scholarly journals Comparison of efficacy of needling and a combination of needling and platelet rich plasma in relieving pain and improving function in patients of tennis elbow: a prospective, randomized, double blinded, placebo controlled clinical trial

2021 ◽  
Vol 7 (2) ◽  
pp. 258
Author(s):  
Vikram Sharma ◽  
Vivek Chandak
Keyword(s):  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Lateral Epicondylitis ◽  
Secondary Outcome ◽  
Controlled Clinical Trial ◽  
Group A ◽  
Group B ◽  
Double Blinded

<p><strong>Background: </strong>Lateral epicondylitis is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. Aim of the study was to examine whether a single injection of platelet-rich plasma (PRP) with needling is more effective than needling with placebo in reducing pain in adults with lateral epicondylitis. Study design used was randomized controlled trial.    </p><p><strong>Methods: </strong>A total of 66 patients with chronic lateral epicondylitis were randomized (1:1) to receive either a blinded injection of PRP (group A) or saline (placebo) group B. The primary end point was a change in pain using the VAS and patient-rated tennis elbow evaluation (PRTEE) questionnaire. The secondary outcome being improvement in function (PRTEE scores).<strong></strong></p><p><strong>Results: </strong>The VAS score and PRTEE score improved significantly in both the groups at all 3 follow-up examinations. Group A had significantly better results than the group B.</p><p><strong>Conclusions: </strong>PRP injection are safe and effective management strategy for lateral epicondylitis</p>

scholarly journals Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study

2003 ◽  
Vol 83 (7) ◽  
pp. 608-616 ◽  
Author(s):  
Peter AA Struijs ◽  
Pieter-Jan Damen ◽  
Eric WP Bakker ◽  
Leendert Blankevoort ◽  
Willem JJ Assendelft ◽  
...  
Keyword(s):  
Success Rate ◽  
Large Scale ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Control Group ◽  
Muscle Stretching ◽  
Strengthening Exercises ◽  
Group 2 ◽  
Group 1

Abstract Background and Purpose. Lateral epicondylitis (“tennis elbow”) is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. Subjects and Methods. Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. Results. Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. Discussion and Conclusion. Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.

Standardized Tendon Fenestration with Injection of Autologous Blood for Treatment of Lateral Epicondylitis

2020 ◽  
Author(s):  
Chul Ki Goorens ◽  
Pascal Wernaers ◽  
Joost Dewaele
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Pain Scale ◽  
Short Term ◽  
Shockwave Therapy ◽  
Other Substances ◽  
Injured Tendon ◽  
Satisfaction Rates

AbstractLateral epicondylitis (LE) of the elbow is often treated with conservative methods. Several techniques including injections with different substances are widely performed. No standardization exists. This prospective study describes the results of the short-term follow-up of 56 patients with mean age 48 years (range: 30–68 years) treated with the Instant Tennis Elbow Cure Medical device, which fenestrates the injured tendon in a standardized way through a holder of 12 small needles. Depth and position of the needles are determined beforehand by ultrasonography. Unprepared autologous blood was injected through the holder in the tendon. Visual analog pain scale (VAS) decreased significantly in rest by 61% and during activity by 47% after 6 weeks. VAS decreased significantly in rest by 79% and during activity by 66% after 3 months. VAS did not remain significantly different after 6 months. Satisfaction rates were 71% after 6 weeks and 82% after 6 months. This suggests that the therapeutical effect sustains and in some cases increases over time. Patient Related Tennis Elbow Evaluation score ameliorated after 3 months by 71%. Comparative studies are needed to confirm this effect versus other techniques as physiotherapy, shockwave therapy, and injections with other substances.

Abstract 16567: Long-Term Vascular Function in CTO Recanalization. A Randomized Clinical Trial of Ticagrelor vs. Clopidogrel

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Juan Jose Rodriguez Arias ◽  
Josep Gomez-Lara ◽  
Juan Caballero-Borrego ◽  
Luis Ortega-Paz ◽  
Luis Teruel ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vascular Function ◽  
Drug Loading ◽  
Controlled Clinical Trial ◽  
Loading Dose ◽  
Clinical Value ◽  
Open Label ◽  
Total Occlusion

Background: Coronary vascular function of a chronic coronary total occlusion (CTO) immediately after recanalization is known to be poor and to be partially improved by pre-treatment with loading dose of ticagrelor vs. clopidogrel. It is unknown if this vascular dysfunction is maintained at long-term follow-up and may be improved by 1-year dual antiplatelet therapy (DAPT) with ticagrelor vs. clopidogrel. Methods: The TIGER is a prospective, open-label, two parallel-group controlled clinical trial, which 1:1 randomized 50 CTO patients to pre-PCI loading dose and subsequent 1-year DAPT with ticagrelor vs. clopidogrel. Coronary blood flow (CBF) under stepwise adenosine infusion was assessed after drug loading dose and at follow-up and compared between the two drug groups, adjusting for time of follow-up. Results: Out of 50 patients with index CBF evaluation, 38 (76%) patients underwent angiographic follow-up (23 and 15 at 1 and 3-year, respectively). A higher CBF area under the curve (AUC), already observed after loading dose in ticagrelor vs. clopidogrel group (p=0.027), was maintained at follow-up (AUC 34815.22±24206.06 vs. AUC 22712.47±13768.95; p=0.071). Specifically, whereas high ticagrelor loading dose-related CBF was sustained at follow-up (p=0.933), clopidogrel loading dose-related CBF increased at follow-up (p=0.039). Conclusion: The TIGER trial showed that DAPT with ticagrelor may maintain a higher CBF in a recanalized CTO as compared to clopidogrel, whose treated patients exhibit a lower CBF immediately after PCI with slight increase at follow-up. The clinical value of such sustained higher coronary flow should be evaluated in a larger group of patients.

scholarly journals Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Alvin Chao-Yu Chen ◽  
Chun-Jui Weng ◽  
Chih-Hao Chiu ◽  
Shih-Sheng Chang ◽  
Chun-Ying Cheng ◽  
...  
Keyword(s):  
Radial Head ◽  
Fracture Dislocation ◽  
Long Term Outcomes ◽  
Periprosthetic Osteolysis ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Injury Group ◽  
Motion Range

Abstract Background Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury. Methods A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of 9 years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups. Results In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS. Conclusions With an average of 9 years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

Su1345 Long Term Increases in Adenoma Detection At Colonoscopy. Follow up of a Randomized Controlled Clinical Trial

2012 ◽  
Vol 75 (4) ◽  
pp. AB300 ◽  
Author(s):  
Vivian Ussui ◽  
Susan G. Coe ◽  
Saowanee Ngamruengphong ◽  
Cynthia Rizk ◽  
Michael B. Wallace
Keyword(s):  
Clinical Trial ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Adenoma Detection
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