Research Article
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Comparison of Clinical Outcomes on Different Treatment Methods for Lateral Epicondylitis

Year 2022, Volume: 6 Issue: 3, 307 - 314, 31.12.2022
https://doi.org/10.30565/medalanya.1214401

Abstract

Aim: In our study, the effectiveness of steroid injection therapy, extracorporeal shock wave therapy (ESWT) and splint use in the treatment of lateral epicondylitis, were compared.

Methods: A total of 97 patients (28 males, 57 females, mean age: 47 years) with a clinical diagnosis of lateral epicondylitis were included in the study. The patients were divided into three treatment groups. Steroid injection was applied to 30 patients, ESWT treatment to 28 patients, and bandage treatment to 29 patients. Patients were evaluated with Visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after treatment.

Results: A decrease in VAS and DASH scores and clinical improvement compared to pre-treatment were observed in all three groups. Although positive results were obtained with all three treatment methods, we found that the most statistically significant treatment method was steroid injection. Better results were obtained in the group that received steroid injection with the peppering technique. (p<0.05).

Conclusion: The results of this study showed that local steroid injection, ESWT application and bandage treatment may be beneficial in the short term in the treatment of patients with lateral epicondylitis. However, it was evaluated that the best improvement in scores was obtained with local steroid injection with the peppering technique, whereas the least improvement was obtained with bandage treatment.

References

  • 1. Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2017;1(11):391-397. Published 2017 Mar 13. doi:10.1302/2058-5241.1.000049
  • 2. George CE, Heales LJ, Stanton R, Wintour SA, Kean CO. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport. 2019 Nov;40:117-27.
  • 3. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006 Dec 1;164(11):1065-74.
  • 4. Kaya SS, Yardımcı G, Göksu H, Genç H. Effects of splinting and three injection therapies (corticosteroid, autologous blood and prolotherapy) on pain, grip strength, and functionality in patients with lateral epicondylitis. Turk J Phys Med Rehabil. 2022 Jun 1;68(2):205-213. doi: 10.5606/tftrd.2022.8007. PMID: 35989952; PMCID: PMC9366475.
  • 5. Guler NS, Sargin S, Sahin N. Efficacy of extracorporeal shockwave therapy in patients with lateral epicondylitis: A randomized, placebo-controlled, double-blind clinical trial. North Clin Istanb. 2018;5(4):314-318. Published 2018 Dec 3. doi:10.14744/nci.2017.82435
  • 6. Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res. 2019 Dec;105(8S):S241-S246. doi: 10.1016/j.otsr.2019.09.004. Epub 2019 Sep 19. PMID: 31543413.
  • 7. Olaussen M, Holmedal Ø, Mdala I, Brage S, Lindbæk M. Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial. BMC Musculoskelet Disord. 2015 May 20;16:122. doi: 10.1186/s12891-015-0582-6. PMID: 25989985; PMCID: PMC4438532.
  • 8. Garg R, Adamson GJ, Dawson PA, Shankwiler JA, Pink MM. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elbow Surg. 2010 Jun;19(4):508-12. doi: 10.1016/j.jse.2009.12.015. Epub 2010 Apr 2. PMID: 20363158.
  • 9. Yürük ZÖ, Kırdı N, Şimşek N. Effects of Radial Extracorporeal Shock Wave Therapy on Pain, Grip Strength,and Functionality in Patients with Lateral Epicondylitis: A RandomizedControlled Study. Clin Exp Health Sci 2016; 6(3): 107-115
  • 10. Tonks JH, Pai SK, Murali SR. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: a prospective randomised controlled trial. Int J Clin Pract. 2007 Feb;61(2):240-6. doi: 10.1111/j.1742-1241.2006.01140.x. PMID: 17166184.
  • 11. Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002 May;(398):127-30. PMID: 11964641.
  • 12. Okçu G, Erkan S, Sentürk M, Ozalp RT, Yercan HS. Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial. Acta Orthop Traumatol Turc. 2012;46(1):26-9. doi: 10.3944/aott.2012.2577. PMID: 22441448.
  • 13. Dogramaci Y, Kalaci A, Savaş N, Duman IG, Yanat AN. Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial. Arch Orthop Trauma Surg. 2009 Oct;129(10):1409-14. doi: 10.1007/s00402-009-0832-x. PMID: 19219442.
  • 14. Kim GM, Yoo SJ, Choi S, Park YG. Current Trends for Treating Lateral Epicondylitis. Clin Shoulder Elb. 2019 Dec 1;22(4):227-234. doi: 10.5397/cise.2019.22.4.227. PMID: 33330224; PMCID: PMC7714311.
  • 15. Erdem İH, Sayıner Çağlar N. Lateral Epikondilit’de Ekstrakorporal Şok Dalga Tedavisinin Etkinliği. Bakırköy Tıp Dergisi 2019;15:345-51 DOI: 10.4274/BTDMJB.galenos.2018.20181001063630
  • 16. Struijs PA, Smidt N, Arola H, Dijk vC, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev. 2002;(1):CD001821. doi: 10.1002/14651858.CD001821. PMID: 11869609.
  • 17. Bisset, Leanne M., Natalie J. Collins, and Sonia S. Offord. "Immediate effects of 2 types of braces on pain and grip strength in people with lateral epicondylalgia: a randomized controlled trial." journal of orthopaedic & sports physical therapy 44.2 (2014): 120-128
  • 18. Belhan O, Karakut L. Humerus Lateral Epikondilit Tedavisinde Lokal Steroid Enjeksiyonu ile Lateral Epikondilit Bandajının Etkinliğinin Karsılastırılması. Fırat Tıp Dergisi 2008;13(1): 24-27
  • 19. Park HB, Gwark JY, Im JH, Na JB. Factors Associated With Lateral Epicondylitis of the Elbow. Orthop J Sports Med. 2021 May 13;9(5):23259671211007734. doi: 10.1177/23259671211007734. PMID: 34036114; PMCID: PMC8127791.
  • 20. Weerakul S, Galassi M. Randomized controlled trial local injection for treatment of lateral epicondylitis, 5 and 10 mg triamcinolone compared. J Med Assoc Thai. 2012 Oct;95 Suppl 10:S184-8. PMID: 23451461.
  • 21. Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci. 2015 Dec;27(12):3755-8. doi: 10.1589/jpts.27.3755. Epub 2015 Dec 28. PMID: 26834345; PMCID: PMC4713784.

Lateral Epikondilitli Hastalarda Farklı Tedavi Yöntemlerinin Klinik Sonuçlarının Karşılaştırılması

Year 2022, Volume: 6 Issue: 3, 307 - 314, 31.12.2022
https://doi.org/10.30565/medalanya.1214401

Abstract

Amaç: Çalışmamızda lateral epikondilit tedavisinde steroid enjeksiyon tedavisi, ekstrakorporeal şok dalga tedavisi (ESWT) ve splint kullanımının etkinliği karşılaştırıldı.

Yöntemler: Klinik olarak lateral epikondilit tanısı alan toplam 97 hasta (28 erkek, 57 kadın, ortalama yaş: 47) çalışmaya dahil edildi. Hastalar üç tedavi grubuna ayrıldı. 30 hastaya steroid enjeksiyonu, 28 hastaya ESWT tedavisi, 29 hastaya bandaj tedavisi uygulandı. Hastalar tedavi öncesi ve sonrası Visual analog scale (VAS) ve Disabilities of the Arm, Shoulder and Hand (DASH) skorları ile değerlendirildi.

Bulgular: Her üç grupta da tedavi öncesine göre VAS ve DASH skorlarında azalma ve klinik düzelme gözlendi. Her üç tedavi yönteminde de olumlu sonuçlar elde edilmesine rağmen istatistiksel olarak en anlamlı tedavi yönteminin steroid enjeksiyonu olduğunu saptadık. Biberleme (peppering) tekniği ile steroid enjeksiyonu yapılan grupta daha iyi sonuçlar alındı. (p<0.05).

Sonuç: Bu çalışmanın sonuçları lateral epikondilitli hastaların tedavisinde lokal steroid enjeksiyonu, ESWT uygulaması ve bandaj tedavisinin kısa dönemde faydalı olabileceğini göstermiştir. Ancak skorlarda en iyi iyileşmenin biberleme tekniği ile lokal steroid enjeksiyonu, en az iyileşmenin ise bandaj tedavisi ile elde edildiği değerlendirildi.

References

  • 1. Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2017;1(11):391-397. Published 2017 Mar 13. doi:10.1302/2058-5241.1.000049
  • 2. George CE, Heales LJ, Stanton R, Wintour SA, Kean CO. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport. 2019 Nov;40:117-27.
  • 3. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006 Dec 1;164(11):1065-74.
  • 4. Kaya SS, Yardımcı G, Göksu H, Genç H. Effects of splinting and three injection therapies (corticosteroid, autologous blood and prolotherapy) on pain, grip strength, and functionality in patients with lateral epicondylitis. Turk J Phys Med Rehabil. 2022 Jun 1;68(2):205-213. doi: 10.5606/tftrd.2022.8007. PMID: 35989952; PMCID: PMC9366475.
  • 5. Guler NS, Sargin S, Sahin N. Efficacy of extracorporeal shockwave therapy in patients with lateral epicondylitis: A randomized, placebo-controlled, double-blind clinical trial. North Clin Istanb. 2018;5(4):314-318. Published 2018 Dec 3. doi:10.14744/nci.2017.82435
  • 6. Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res. 2019 Dec;105(8S):S241-S246. doi: 10.1016/j.otsr.2019.09.004. Epub 2019 Sep 19. PMID: 31543413.
  • 7. Olaussen M, Holmedal Ø, Mdala I, Brage S, Lindbæk M. Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial. BMC Musculoskelet Disord. 2015 May 20;16:122. doi: 10.1186/s12891-015-0582-6. PMID: 25989985; PMCID: PMC4438532.
  • 8. Garg R, Adamson GJ, Dawson PA, Shankwiler JA, Pink MM. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elbow Surg. 2010 Jun;19(4):508-12. doi: 10.1016/j.jse.2009.12.015. Epub 2010 Apr 2. PMID: 20363158.
  • 9. Yürük ZÖ, Kırdı N, Şimşek N. Effects of Radial Extracorporeal Shock Wave Therapy on Pain, Grip Strength,and Functionality in Patients with Lateral Epicondylitis: A RandomizedControlled Study. Clin Exp Health Sci 2016; 6(3): 107-115
  • 10. Tonks JH, Pai SK, Murali SR. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: a prospective randomised controlled trial. Int J Clin Pract. 2007 Feb;61(2):240-6. doi: 10.1111/j.1742-1241.2006.01140.x. PMID: 17166184.
  • 11. Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002 May;(398):127-30. PMID: 11964641.
  • 12. Okçu G, Erkan S, Sentürk M, Ozalp RT, Yercan HS. Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial. Acta Orthop Traumatol Turc. 2012;46(1):26-9. doi: 10.3944/aott.2012.2577. PMID: 22441448.
  • 13. Dogramaci Y, Kalaci A, Savaş N, Duman IG, Yanat AN. Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial. Arch Orthop Trauma Surg. 2009 Oct;129(10):1409-14. doi: 10.1007/s00402-009-0832-x. PMID: 19219442.
  • 14. Kim GM, Yoo SJ, Choi S, Park YG. Current Trends for Treating Lateral Epicondylitis. Clin Shoulder Elb. 2019 Dec 1;22(4):227-234. doi: 10.5397/cise.2019.22.4.227. PMID: 33330224; PMCID: PMC7714311.
  • 15. Erdem İH, Sayıner Çağlar N. Lateral Epikondilit’de Ekstrakorporal Şok Dalga Tedavisinin Etkinliği. Bakırköy Tıp Dergisi 2019;15:345-51 DOI: 10.4274/BTDMJB.galenos.2018.20181001063630
  • 16. Struijs PA, Smidt N, Arola H, Dijk vC, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev. 2002;(1):CD001821. doi: 10.1002/14651858.CD001821. PMID: 11869609.
  • 17. Bisset, Leanne M., Natalie J. Collins, and Sonia S. Offord. "Immediate effects of 2 types of braces on pain and grip strength in people with lateral epicondylalgia: a randomized controlled trial." journal of orthopaedic & sports physical therapy 44.2 (2014): 120-128
  • 18. Belhan O, Karakut L. Humerus Lateral Epikondilit Tedavisinde Lokal Steroid Enjeksiyonu ile Lateral Epikondilit Bandajının Etkinliğinin Karsılastırılması. Fırat Tıp Dergisi 2008;13(1): 24-27
  • 19. Park HB, Gwark JY, Im JH, Na JB. Factors Associated With Lateral Epicondylitis of the Elbow. Orthop J Sports Med. 2021 May 13;9(5):23259671211007734. doi: 10.1177/23259671211007734. PMID: 34036114; PMCID: PMC8127791.
  • 20. Weerakul S, Galassi M. Randomized controlled trial local injection for treatment of lateral epicondylitis, 5 and 10 mg triamcinolone compared. J Med Assoc Thai. 2012 Oct;95 Suppl 10:S184-8. PMID: 23451461.
  • 21. Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. J Phys Ther Sci. 2015 Dec;27(12):3755-8. doi: 10.1589/jpts.27.3755. Epub 2015 Dec 28. PMID: 26834345; PMCID: PMC4713784.
There are 21 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Ahmet Aksoy 0000-0002-9507-3178

Anıl Gülcü 0000-0002-9012-8053

Ahmet Aslan 0000-0001-5797-1287

Publication Date December 31, 2022
Submission Date December 4, 2022
Acceptance Date December 23, 2022
Published in Issue Year 2022 Volume: 6 Issue: 3

Cite

Vancouver Aksoy A, Gülcü A, Aslan A. Comparison of Clinical Outcomes on Different Treatment Methods for Lateral Epicondylitis. Acta Med. Alanya. 2022;6(3):307-14.

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