scholarly journals Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis—a prospective trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
B. Schiffke-Juhász ◽  
K. Knobloch ◽  
P. M. Vogt ◽  
L. Hoy
Keyword(s):  
Grip Strength ◽  
Prospective Trial ◽  
Lateral Epicondylitis ◽  
Dash Score ◽  
Level Of Evidence ◽  
Link Type ◽  
Significant Difference ◽  
Proprioceptive Training ◽  
Group A ◽  
Group B

Abstract 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/

FOREARM BAND VERSUS ELBOW TAPING: AS A MANAGEMENT OF LATERAL EPICONDYLITIS

2013 ◽  
Vol 16 (01) ◽  
pp. 1350003 ◽  
Author(s):  
Shaji John Kachanathu ◽  
Smriti Miglani ◽  
Deepak Grover ◽  
Abdul R Zakaria
Keyword(s):  
Grip Strength ◽  
Total Duration ◽  
Lateral Epicondylitis ◽  
Functional Independence ◽  
Functional Improvement ◽  
Control Group ◽  
Group A ◽  
Conventional Physiotherapy ◽  
Group B ◽  
Taping Technique

Purpose: There are several treatments available for the management of lateral epicondylitis, but there is a dearth of clinical trials compared to the efficacy of a forearm band over supportive elbow taping technique as an adjunct measure in the management of lateral epicondylitis. Materials and Methods: Totally 45 subjects with the mean age of 30±5 years diagnosed with lateral epicondylitis participated in the study based upon inclusion and exclusion criteria. Subjects were randomly allocated to three groups (n = 15 in each); Group-A (forearm band), Group-B (elbow taping) and Group-C (control), provided with a forearm band, supportive elbow taping technique and as a control group, respectively, although all groups received the conventional physiotherapy in addition to these adjunct measures. The outcome measurements included pain-free grip strength and functional improvement, assessed by using hand-held dynamometer and patient-rated forearm evaluation questionnaire (PRFEQ), respectively. Total duration of study was four weeks. Results: Although all the groups showed improvement with respect to increase in the pain-free grip strength and enhancement of functional independence, however, Group-A has shown the maximum improvement followed by Group-B which in turn proved to be more effective than conventional physiotherapy alone. Conclusion: The application of the forearm band produced a significant increase in the grip strength and function as compared to the elbow taping and control groups. The study implies the potential use of a forearm band in the future in addition to the conventional therapy in the management of patients with lateral epicondylitis.

Comparing the effectiveness of mulligan mobilization versus cyriax approach in the management of patients with subacute lateral epicondylitis

2020 ◽  
pp. 1-11
Author(s):  
Aqeel Ahmed ◽  
Muhammad Ibrar ◽  
Aatik Arsh ◽  
Sonia Wali ◽  
Shoukat Hayat ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Functional Disability ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Evaluation Index ◽  
Pain Subscale ◽  
Significant Difference ◽  
Group A ◽  
Physical Tests ◽  
Group B

Abstract Objective: To determine the effectiveness of Mulligan mobilisation versus Cyriax approach in the management of patients with subacute lateral epicondylitis. Methods: The clinical trial was conducted at the District Headquarter Hospital, Bahawalnagar, Pakistan, from September to December 2018, and comprised lateral epicondylitis patients having symptoms for >2 weeks. The diagnosis was confirmed on the basis of physical tests and musculoskeletal ultrasound. The subjects were randomly allocated to two equal groups A and B. Group A received deep transverse friction and Mill’s manipulation according to Cyriax approach, while group B received Mulligan mobilisation with movement techniques. Patient-related tennis elbow evaluation index was used to collect data which was analysed using SPSS 20. Results: Of the 60 patients, there were 30(50%) in each of the two groups. The overall mean age was 35.27±7.30 years, and 38(63.3%) participants were male.  After 4 weeks of treatment sessions, both groups showed significant improvements (p<0.05) in pain and functional disability scores. Group A showed significantly more improvement (p<0.05) in pain subscale scores compared to group B, while group B showed significant improvement (p<0.05) in functional disability subscale scores compared to group A. There was no significant difference (p>0.05) between the groups on total the patient-related tennis elbow evaluation index score. Conclusion: Both Mulligan mobilisation with movement and Cyriax approach decreased pain and improved functional status in lateral epicondylitis patients. Key Words: Elbow, Lateral epicondylitis, Massage, Mobilisation, Physiotherapy. Continuous..,

scholarly journals EFFECTS OF DEEP FRICTION MASSAGE ON TENDINITIS (LATERAL EPICONDYLITIS) IN COMPARISON TO ULTRASOUND THERAPY

2014 ◽  
Vol 3 (2) ◽  
pp. 36-40
Author(s):  
Jetindar Puri ◽  
Dr Nabiha Ahmed
Keyword(s):  
Grip Strength ◽  
Pain Score ◽  
Tennis Elbow ◽  
Tertiary Care ◽  
Lateral Epicondylitis ◽  
P Value ◽  
Ultrasound Therapy ◽  
Group A ◽  
The Mean ◽  
Group B

OBJECTIVE To compare the effects of deep friction massage and ultrasound therapy in subjects with tennis elbow in terms of pain, grip strength and functional activities. STUDY DESIGN Randomized Control Trial. STUDY SETTINGS AND PARTICIPANTS Study was conducted in Physiotherapy OPD of a tertiary care hospital. A sample of 50 patients were inducted in the study. Sample size calculated through open Epi calculator. OUTCOME MEASURES Patients with the diagnosed lateral epicondylitis (Tennis elbow) presenting to out Patient department of two tertiary care hospitals has been enrolled for study after written informed consent. Subjects were randomly allocated into two groups i.e. group A and group B. Group A = DFM + exercise, Group B = U/S + exercise. RESULTS Total 50 patients were randomized and divided into two groups. Group A: the mean pain score on VAS before treatment was 5.88±1.130 and after treatment 1.80±1.041 p-value=0.006. Group B: the mean pain score on VAS before treatment was 6.56±1.446 and after treatment was 2.72±1.208 p-value=0.006. Group A: the mean grip strength score was 13.92±2.691 and in after treatment was 19.60±5.454 p-value=0.342. Group B: the mean grip strength was 15.12±2.505 and after treatment was 20.92±4.183p-value=0.342. CONCLUSION The present study showed no statistical difference in using deep frictional massage therapy in relieving pain, improving grip strength and functional performance in subject with tennis elbow. KEY WORDS Tennis Elbow, Lateral Epicondylitis, Deep Friction Massage, Hand Held Dynamometer, Ultrasound Therapy, Grip Strength.

scholarly journals Effect of Post Isometric Relaxation with Deep Neck Flexor Exercise in Subacute Mechanical Neck Pain

2021 ◽  
Vol 11 (10) ◽  
pp. 46-59
Author(s):  
Priyanka Chauhan ◽  
Pooja Attrey ◽  
Anand Kumar Singh
Keyword(s):  
General Population ◽  
Neck Pain ◽  
Functional Disability ◽  
Rating Scale ◽  
Lateral Epicondylitis ◽  
Posterior Aspect ◽  
Significant Difference ◽  
Group A ◽  
Numeric Pain Rating Scale ◽  
Group B

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.

Efficacy of Cyriax Physiotherapy versus Cyriax and low level Laser Therapy on pain and grip strength in Lateral Epicondylitis

2021 ◽  
Vol 20 (2) ◽  
pp. 356-360
Author(s):  
Sunita Sharma ◽  
Nitin Gupta ◽  
Sandeep Joshi ◽  
Rosy Bala ◽  
Ruby Sharma
Keyword(s):  
Grip Strength ◽  
Laser Therapy ◽  
Medical Science ◽  
Lateral Epicondylitis ◽  
Low Level Laser Therapy ◽  
Low Level ◽  
Low Level Laser ◽  
Level Laser ◽  
Group A ◽  
Group B

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<0.05). Conclusion:Cyriax physiotherapy and low level laser therapy were effective in reducing pain and improvinggrip strength after the treatment sessions. But benefits of cyriax physiotherapy with low levellaser therapy in lateral epicondylitis patients are significantly higher as compared to cyriaxphysiotherapy alone over a three week period. Hence, cyriax with low level laser therapy isproved to be a better treatment. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.356-360

Survival impact of aggressive treatment on patients with oligometastatic non-small cell lung cancer (NSCLC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20669-e20669
Author(s):  
Camille Gauvin ◽  
Normand Blais ◽  
Mustapha Tehfe ◽  
Marie Florescu
Keyword(s):  
Lung Cancer ◽  
Survival Data ◽  
Prospective Trial ◽  
Primary Lung Cancer ◽  
Disease Stage ◽  
Cancer Disease ◽  
Radical Treatment ◽  
Significant Difference ◽  
Group A ◽  
Group B

e20669 Background: The new 2016lung cancer classification differentiates oligometastatic (M1b) better prognostic from plurimetastatic (M1c) disease. A prospective study presented at 2016 ASCO showed improved PFS in patients with oligometastatic brain disease treated aggressively compared to a more palliative treatment but OS data is pending. Methods: This study is a single-center retrospective study including 643 patients with metastatic lung cancer diagnosed in an University center (CHUM) from 2005-2015 and followed more than 6 months (median follow up 13.3mo) . Only 67 patients (10.4%) were found to have synchronous oligometastatic disease at diagnosis. Results: Amongst the 67 patients, the localization of metastatic disease was as follows: 74% brain (n = 50), 9% adrenal gland (n = 6), 7% contralateral pulmonary lobe (n = 5), 6% bone (n = 4) and 3% liver (n = 2). 29 patients received radical treatment to primary and metastatic site (group A) and 36 patients received non-aggressive treatments (group B). There was no statistically significant difference between the two groups in terms of demographic and histological characteristics. The radical treatment group A had a mOS of 26mo and a mPFS of 12.8m compared to mOS of 5mo (p = 0.0001) and mPFS of 4.8mo (p = 0.010) for group B. This difference was observed when stratifying according to stage of primary lung disease (stage I mOS 42mo vs 16mo, stage II mOS 34mo vs 6mo and stage III mOS 22mo vs 4mo) and according to to oligometastatic site. Interestingly, addressing aggressively the primary lung cancer improved median survival even when the oligometastasis was not resected (26mo v and 24mo respectively), but not when oligometastasis only was resected and primary was treated palliatively (5mo vs 3 mo). Adjuvant chemotherapy given after radical treatment did not improve mPFS or mOS (12.83 vs12.47 months, p = 0.860). Conclusions: Radical treatment of oligometastatic NSCLC in this unselected population improved mPFS and mOS compared to other treatment strategies. As overall survival data of the prospective trial presented at 2016 ASCO meeting is pending, the more radical approach should be emphasized when patients present with oligometastatic lung cancer disease.

Robotic cystectomy histopathology outcomes in patients who have ‘failed’ Bacillus Calmette–Guérin: A case series

2021 ◽  
pp. 205141582097799
Author(s):  
Edward JM Hart ◽  
Liam E Kavanagh ◽  
Alexandra M Guy ◽  
Bronagh Lindsey ◽  
Jo Walters ◽  
...  
Keyword(s):  
Lymph Node ◽  
Case Series ◽  
Invasive Disease ◽  
Bacillus Calmette Guerin ◽  
Level Of Evidence ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Muscle Invasive ◽  
Group B

Objective: Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time. Methods: A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B). Results: A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases. Conclusion: RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients. Level of evidence: Level 4.

scholarly journals Intrathecal Pethidine: An Alternative Anaesthetic for Transurethral Resection of Prostate?

1997 ◽  
Vol 25 (6) ◽  
pp. 650-654 ◽  
Author(s):  
A. T. H. Sia ◽  
M. Y. H. Chow ◽  
C. K. Koay ◽  
J. L. Chong
Keyword(s):  
Heart Rate ◽  
Transurethral Resection ◽  
Motor Block ◽  
Prospective Trial ◽  
Sensory Block ◽  
Transurethral Resection Of Prostate ◽  
Significant Difference ◽  
Group A ◽  
Randomized Prospective Trial ◽  
Group B

We aimed to determine the usefulness of intrathecal pethidine as the sole anaesthetic for transurethral resection of prostate (TURP) while comparing the incidence of hypotension with intrathecal bupivacaine. A double-binded randomized prospective trial was conducted involving 40 patients for TURP. The patients were divided equally into two groups; group A received 2 ml 0.5% bupivacaine intrathecally and group B received 40 mg pethidine intrathecally. Changes in blood pressure and heart rate were measured over the first 30 minutes. The highest sensory block and the time to reach it were documented. The degree of motor blockade was also recorded. There was no significant difference in the incidence of hypotension. The pethidine group had significantly greater reduction in heart rate, a lower degree of motor block, shorter period before requests for postoperative analgesia but a higher incidence of sedation, nausea and vomiting. Intrathecal pethidine did not offer any advantage over intrathecal bupivacaine for TURP.

scholarly journals Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

2014 ◽  
Vol 21 (6) ◽  
pp. 346-353 ◽  
Author(s):  
T Cimilli Ozturk ◽  
O Guneysel ◽  
H Akoglu
Keyword(s):  
Emergency Medicine ◽  
Prospective Trial ◽  
Vital Signs ◽  
Respiratory Compromise ◽  
Intravenous Fentanyl ◽  
Orthopaedic Surgeons ◽  
Dislocation Reduction ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353)

scholarly journals Effects of Ulnar Styloid Fractures on Unstable Distal Radius Fracture Outcomes: A Systematic Review of Comparative Studies

2017 ◽  
Vol 07 (02) ◽  
pp. 172-181 ◽  
Author(s):  
Sami Almedghio ◽  
Fayez Almari ◽  
Indranil Chakrabarti ◽  
Mohammed Arshad
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Distal Radius ◽  
Wrist Pain ◽  
Dash Score ◽  
Ulnar Styloid ◽  
Level Of Evidence ◽  
Significant Difference

Purpose In this literature review, functional outcomes such as Disability of Arm, Shoulder and Hand (DASH) score and the visual analog scale (VAS) of pain along with clinical outcomes such as range of movement and grip strength of treated distal radius fractures (DRF) accompanied with ulnar styloid fractures (USF) will be compared with those with isolated DRF. Materials and Methods We analyzed articles from MEDLINE, Embase, and CINAHL that met our predetermined inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic Reviews and Meta-analysis statements. This resulted in the identification of 464 articles with 18 potentially eligible studies of which 6 were included at the full-text screening stage. The primary outcomes were wrist pain, range of motion, functional outcome and satisfaction, such as VAS, and the DASH questionnaire along with radiological assessment and incidence of complications. Results These studies involved 796 participants with DRF and 806 wrists with DRF; 444 (55%) of DRF had an associated USF. Three studies did not report any statistically significant difference in DASH scores between the DRF patients with or without USF. Two studies reported worse DASH scores in the group with associated USF. Wrist pain was reported to be statistically significantly worse in patients with associated USF in two studies. Grip strength did not exhibit a statistically significant difference in any groups in four studies. On assessing the range of motion of the wrist and forearm, only one study reported a statistically significant difference in flexion at 2 years follow-up, with less flexion in patients with USF. Conclusion This review suggests that there is no significant correlation between a USF and the functional and clinical outcomes of DRF treatment, albeit wrist pain and less flexion were reported in some studies to be associated with USF. There is a need for more robust evidence from large randomized controlled trials to specifically look at the effects of fixation versus nonfixation of USF on DRF, or large prospective cohort studies assessing DRF with and without USF, with a minimum of 12 months follow-up. Level of Evidence Level II—therapeutic.

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