Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis

Labelle, Hubert; Guibert, R; Joncas, Julie; Newman, N.; Fallaha, Michel; Rivard, Charles‐Hilaire

doi:10.1302/0301-620x.74b5.1388172

Cited by 275 publications

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“…The quality of the selected papers were scored by two researchers (DS and KP). According to Labelle et al [18] it is possible to interpret the results appropriately using this system, especially when there are conflicting results between two studies, or studies with small sample sizes and inconclusive results.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…If the score was below 40% (0-39%), the design of the study was considered low quality, and if it was 40-69%, it was satisfactory [18].…”

Section: Methodological Qualitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known, and more research is needed to discover the most effective treatment in patients with LET [11,[18][19][20].Iontophoresis has attracted much interest in the last 20-25 years as it has been applied to common musculoskeletal conditions such as LET. Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current [11].…”

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confidence: 99%

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Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

Stasinopoulos¹

2012

J Nov Physiother

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Novel Physiotherapies Dimitrios et al., J Nov Physiother 2013, S2 http://dx.doi.org/10.4172/2165 IntroductionLateral elbow tendinopathy (LET), commonly referred to as lateral epicondylitis, lateral epicondylalgia, lateral epicondylosis and/or tennis elbow is one of the most common lesions of the arm. However, LET is the most appropriate term to use in clinical practice because all the other terms make reference to inappropriate a etiological, anatomical and pathophysiological terms [1]. The condition is usually defined as a syndrome of pain in the area of the lateral epicondyle [2][3][4], that may be degenerative or failed healing tendon response rather than inflammatory [5]. Hence, the increased presence of fibroblasts, vascular hyperplasia, proteoglycans and glycosaminoglycans together with disorganized and immature collagen may all take place in the absence of inflammatory cells [5]. The origin of the extensor carpi radialis brevis (ECRB) is the most commonly affected structure [5]. It is generally a work-related or sport-related pain disorder. The dominant arm is commonly affected, the peak prevalence of LET is between 30 and 60 years of age [2,6] and the disorder appears to be of longer duration and severity in women [2,6,7] The main complaints of patients with LET are pain and decreased function [2,[8][9][10][11][12] both of which may affect daily activities. Diagnosis is simple, and a therapist should be able to reproduce this pain in at least one of three ways: (1) digital palpation on the facet of the lateral epicondyle, (2) resisted wrist extension and/or resisted middle-finger extension with the elbow in extension, and (3) by getting the patient to grip an object [1,[8][9][10].Although the signs and symptoms of LET are clear and its diagnosis is easy, to date, no ideal treatment has emerged. Many clinicians advocate a conservative approach as the treatment of choice for LET [2,[8][9][10][11]. Physiotherapy is a conservative treatment that is usually recommended for LET patients [11,13,14]. A wide array of physiotherapy treatments have been recommended for the management of LET [11,[15][16][17]. These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known, and more research is needed to discover the most effective treatment in patients with LET [11,[18][19][20].Iontophoresis has attracted much interest in the last 20-25 years as it has been applied to common musculoskeletal conditions such as LET. Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current [11]. Iontophoresis has several advantages as a treatment technique in than it is a painless, sterile, noninvasive technique for introducing ions into the tissue that has been demonstrated to have positive effect on the healing process [15]. Its effectiveness has been evaluated in two previously published sys...

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Section: Methodological Qualitymentioning

confidence: 99%

“…If the score was below 40% (0-39%), the design of the study was considered low quality, and if it was 40-69%, it was satisfactory [18].…”

Section: Methodological Qualitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

Stasinopoulos¹

2012

J Nov Physiother

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“…It has been suggested that a methodological score of [ literature review ] 70% or greater is needed for a study to be of sound methodological quality. 23 …”

Section: Methodological Quality Evaluationmentioning

confidence: 99%

The Effect of Therapeutic Exercise and Mobilization on Patients With Shoulder Dysfunction: A Systematic Review With Meta-analysis

Brudvig¹,

Kulkarni²,

Shah³

2011

J Orthop Sports Phys Ther

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Shoulder dysfunction is the second most common musculoskeletal problem seen in physical therapy 42 and affects approximately 16% to 21% of the population. 22,43 It is a leading cause of sick days among young adults, 21 and its prevalence in persons 65 years and older is 34%. 24 The direct cost for the treatment of shoulder dysfunction in the United States exceeds $7 billion annually. 30 There are numerous underlying musculoskeletal causes of shoulder dysfunction. These include tendinopathy, bursitis, rotator cuff tear, adhesive capsulitis, avascular necrosis, shoulder impingement syndrome, glenohumeral osteoarthritis, and trauma from injury. Shoulder dysfunction results in a variety of impairments such as pain, stiffness, weakness, postural deviations, and altered glenohumeral rhythm. These impairments, in turn, lead to limitation of activities of daily living such as reaching, lifting, overhead movements, carrying, pushing, pulling, grooming, and sleep.Common approaches to treating individuals with shoulder dysfunction are corticosteroid injections, nonsteroidal anti-inflammatory drugs, manipulation under general anesthesia, arthroscopic surgery, and physical therapy intervention, including therapeutic exercises, manual therapy, and various modalities. Prior studies have shown that medical and surgical interventions are not superior to physical therapy interventions for patients with shoulder dysfunction. 11,15,42 Therapeutic exercise is defined as "the systematic performance or execution of T T STUDY DESIGN: Systematic review with metaanalysis. T T OBJECTIVE:To pool and summarize the published research evidence examining if the combination of therapeutic exercise and joint mobilization is more beneficial than therapeutic exercise alone in patients with shoulder dysfunction. T T BACKGROUND:Therapeutic exercise is an effective intervention for patients with shoulder dysfunction, which is often supplemented by joint mobilization techniques. Numerous studies have examined the effects of the combination of therapeutic exercise and joint mobilization on patients with shoulder dysfunction. T T METHODS:Six databases were searched for randomized controlled trials. All the randomized controlled trials published in English that have studied the effectiveness of therapeutic exercise and joint mobilization on adults with either clinically or radiographically confirmed shoulder dysfunction resulting in pain, restriction of range of motion (ROM), and/or limitation in function, were included in this review. Effect size was calculated in the form of standardized mean difference and 95% confidence interval (CI) for each variable, then combined to represent weighted standardized mean differences (WSMDs) and 95% CIs. T T RESULTS:Seven studies that met the inclusion criteria were identified, with a total of 290 participants. The WSMDs and CIs, which combined the results of all the studies for a particular variable, revealed equivocal results for all variables. The resulting WSMD (95% CI) for each of the variables was 0.2 (-0.68, 1...

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