A Network Meta-Analysis of Randomized Controlled Trials Directed at Treating Lateral Epicondylalgia

Background: Lateral epicondylosis is the most prevalent cause of lateral elbow pain, occurring in 4 per 1000 patients. The aim of most treatments is to reduce inflammation even with histological evidence demonstrating that lateral epicondylosis is a non-inflammatory condition. Objective: To determine the relative merits of the different regimens used to diminish lateral epicondylosis pain using a mixed treatment comparison/network meta-analysis (NMA). Methods: A thorough literature search was performed. The eligibility criteria for this mixed treatment comparison were: randomized controlled clinical trials; human subjects; working age population (16 to 70 years); the outcome measure was an objective pain assessment; measured at a 1- to 3-month follow-up. The NMA were performed using the GeMTC user interface for automated NMA utilizing a Bayesian Hierarchical Model of random effects. The evaluation of confidence in the findings from NMA was performed using a semi-automated platform called CINeMA (Confidence in Network Meta-Analysis). Results: The model suggests that articulation technique is the most effective measure for decreasing lateral epicondylalgia followed by topical nitrates, acupuncture, kinesiology taping and low-level laser therapy, respectively. Muscle energy technique, local corticosteroid injection, prolotherapy and counterforce bracing displayed a trend toward being less effective than placebo. Conclusions: The results suggest that the most effective modalities for improving lateral epicondylalgia are those that decrease muscle tone and those that improve circulation, while measures meant to decrease inflammation appear to be of no or limited benefit.

Orthobiologics: Diagnosis and Treatment of Common Tendinopathies

Orthobiologics, including platelet-rich plasma, prolotherapy, and mesenchymal stem cells, are seeing increasing use in the treatment of osteoarthritis (OA), muscle injury, and tendinopathy. This article reviews the biology and applications of orthobiologics in tendons, muscles, and joints, and focuses on platelet-rich plasma (PRP). Clinical evidence-based literature related to the use of PRP in the treatment of rotator cuff injury, lateral epicondylosis, Achilles tendinopathy, plantar fasciitis, knee OA, and acute muscle injury are discussed.

Mets and oscillating energy manual therapy in chronic lateral epicondylosis: a comparative study.

Lateral Epicondylitis (LT) term was used previously thinking that it as an inflammatory condition, but it is tendinosis of Common extensor tendons of the forearm due to overuse. The incidence of the condition is about 4000 - 7000 per year in the general population in the United States. Conventional treatments practiced on the concept of inflammation have shown forty to eighty percent of unsuccessful results. Individuals with lateral epicondylosis may have symptoms like pain during activity, weakness, swelling and functional disability. The primary objective of the study is to find out the effectiveness of oscillating energy manual therapy (OEMT) compared with muscle energy technique (MET) on functional outcome in subjects with lateral epicondylosis. Total of 30 subjects with unilateral lateral epicondylosis was selected and was divided into two groups of 15 each in a group. Group A (received oscillating energy manual therapy) and Group B (received muscle energy technique). NRS (Numerical Rating Scale), Grip Strength and PRTEE (Patient Rated Tennis Elbow Evaluation) scale were measured pre and post-treatment for both the groups and also at follow up of the sixth week. Muscle energy technique group showed improvement in pain levels, muscle strength and functional activities. The statistical analysis demonstrated that results were more significant in group B at 4th week and also at follow up with a mean difference of (2.3) for NRS, (57.4) for PRTEE and (5.9) for grip strength than group A.