Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta‐Analysis

Descatha, Alexis; Albo, Francesco; Leclerc, Annette; Carton, Matthieu; Godeau, Diane; Roquelaure, Yves; Petit, Audrey; Aublet-Cuvelier, Agnès

doi:10.1002/acr.22874

Cited by 60 publications

(43 citation statements)

References 30 publications

(51 reference statements)

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“…First, we did not recommend any specific exercise program and did not control activity modification in our patients. Our patient population was mainly composed of manual workers, and continuous physical exposure at work could influence outcomes. Second, this study is merely descriptive, and further investigation with a control group without needle tenotomy is mandatory to confirm these results.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Martín

Atilano

Merino

et al. 2019

PM&R

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Background Elbow tendinopathies are associated with tenderness, pain, and functional disability with ensuing socioeconomic costs. There is lack of consensus regarding the best treatment for patients recalcitrant to first‐line conservative treatments. Percutaneous needle tenotomy is considered a regenerative approach that injures the tendon to elicit a healing response. Objective To investigate whether demographic characteristics, clinical factors, baseline sonographic entities, or their interactions are related to the likelihood of responding positively to needle tenotomy over a 1‐year follow‐up period. Design Prospective case series. Setting Tertiary institutional hospital. Participants Patients with elbow tendinopathy for whom conservative treatments had failed and who had persistent symptoms lasting for at least 3 months. Methods Patients underwent needle tenotomy with or without PRP followed by a lighter needle tenotomy within a 2‐week interval as part of treatment. Main Outcome Measurements Disabilities of the Arm, Shoulder and Hand (DASH) and Visual Analogue Scale for pain (VAS‐P) scores were assessed before intervention (baseline) and at 6 weeks and 3, 6, and 12 months after intervention. A generalized linear mixed effects model was created to examine whether injectate type, clinical, demographic, or pretreatment sonographic entities or their interactions influenced clinical outcomes. Results The authors analyzed 74 elbows (71 patients). At baseline, analyzed patients (mean age: 49.48 years; 51.35% women) scored 43.30 and 5.83 on the DASH and VAS‐P, respectively. Pretreatment tendon vascularization was a predictor of pain (P = .011) and DASH score changes (P = .019). The linear mixed effect model revealed that male gender and hypercholesterolemia were associated with enhanced functional recovery, (P = .020 and P < .001, respectively). Moreover, the interactions between pretreatment vascular status (P = .039), echotexture (P = .037) and enthesophytes (P = .028) influenced the temporal pattern of functional recovery after needle tenotomy. Conclusions Baseline patient characteristics, such as gender and hypercholesterolemia, along with ultrasound features may be predictive of outcomes following needle tenotomy for elbow tendinopathy. Level of Evidence IV (NCT01945528).

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Section: Discussionmentioning

confidence: 99%

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Martín

Atilano

Merino

et al. 2019

PM&R

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“…Lateral epicondylitis (LE) is a commonly occurring condition that affects up to 3% of the adult population while accounting for significant costs related to medical care and lost wages. 14 , 30 , 43 , 53 Often referred to as tennis elbow , the underlying cause of LE involves noninflammatory processes of mucoid degeneration with neovascularization, scarring, and microtearing at the extensor origin at the lateral elbow, collectively termed angiofibroblastic hyperplasia or tendinosis . 1 , 39 As LE is considered to be self-limiting in the majority of patients, first-line treatment options generally focus on addressing the primary symptom of pain and may include oral and/or topical anti-inflammatory drugs and analgesics, bracing, stretching, and other physical therapy measures.…”

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confidence: 99%

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Gaspar

Motto

Lewis

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance.Purpose:To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction.Results:At a mean follow-up of 40 months, significant improvements in VAS-P (mean, –6.1; 95% CI, –6.8 to –5.5; P < .0001), QuickDASH (mean, –46; 95% CI, –52 to –40; P < .0001), and PRTEE (mean, –57; 95% CI, –64 to –50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course.Conclusion:A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.

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“…In contrast, the primary cause of epicondylitis has been reported to be overuse; thus, the condition is common in the 40- to 50-year-old group. 34 Therefore, if epicondylitis is not significantly affected by other factors and is due to overuse, symptoms are likely to be immediately evident and directly affect QOL. In this study, epicondylitis with symptoms was more likely to be selected.…”

Section: Discussionmentioning

confidence: 99%

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas

et al. 2018

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PurposeUpper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL.Materials and MethodsIn 2013–2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs.ResultsThe prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score.ConclusionEpicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.

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Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta‐Analysis

Abstract: The results of this meta-analysis strongly support the hypothesis of an association between biomechanic exposure involving the wrist and/or elbow at work and incidence of lateral epicondylitis.

Cited by 60 publications

References 30 publications

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas

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