Prospective randomized controlled trial in the treatment of lateral epicondylitis with a new dynamic wrist orthosis

Abstract

BackgroundIn the treatment of lateral epicondylitis (LE), the role of a new dynamic wrist orthosis is unclear.Patients and methodsPatients suffering from a LE longer than 3 months were multicentrically and prospectively randomized into a physiotherapeutic group (PT group) and in a physiotherapy group plus wrist orthosis (PT + O group). Physiotherapy consisted of daily eccentric strengthening exercises under initial professional supervision. Inclusion criteria were a Placzek score greater than 4. Exclusion criteria were previous surgery, rheumatic arthritis, elbow instability, radicular symptoms, higher-grade extensor tendon rupture, or cervical osteoarthritis. The clinical evaluation was performed after 12 weeks and 12 months. The Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, Placzek Score, the pain rating (VAS), range of motion and the Subjective Elbow Score were evaluated.ResultsOf the initially 61 patients, 31 were followed up after 12 weeks and 22 after 12 months. Twenty-nine patients (43%) were male, the mean age was 46, and 44 patients (66%) had the right elbow involved. At 12 weeks, there was a pain reduction on the VAS in both groups (PT + O: 6.5–3.7 [p = .001]; PT: 4.7–4.1 [p = .468]), albeit it was only significant for the PT + O group. At 12 months, reduction was significant in both groups (PT + O: 1.1 [p = .000]; PT: 1.3 [p = .000]). The painless maximum hand strength in kg improved in both groups significant after 3 and 12 months. The Placzek score was reduced from 8.25 to 3.5 [p = .001] after 12 weeks for the PT + O group and from 8.1 to 3.8 [p = .000] in the PT group, as well as after 12 months in the PT + O group to 0 [p = .000] and in the PT group to 2.0 [p = .000]. The PRTEE improved in both groups after 12 weeks (PT + O: 52.8––31.3 [p = .002]; PT: 48.6–37.6 [p = .185]) and 12 months (PT + O: 16.15 [p = .000]; PT: 16.6 [p = .000]), although the reduction at 12 weeks was not significant for the PT group.ConclusionThe elbow orthosis appears to accelerate the healing process with respect to the PRTEE and pain on the VAS (12 weeks follow-up), although there is an adjustment after 12 months in both groups and a significant improvement of symptoms is achieved in all endpoints.

Chronic Pain Associated with Lateral Epicondylitis: Treatment with Radiofrequency

“…Physical therapy is a first-line treatment [11,[18][19][20][21], which can be supplemented with wrist orthoses [20].…”

Physiotherapy treatment of lateral epicondylitis: A systematic review

“…However, the use of orthoses did not show positive effects on functionality [28,31], which could be explained lead to muscle disuse; therefore, if orthoses are com- and the synthesis of glycosaminoglycans, thereby de-laying the healing process in the long term [55]. DF improved grip strength after one session [18], thanks to its capacity to improve the mechanical and inflammatory pain of the musculoskeletal system by removing the tissue adhesions and allowing the optimal glide of the myofibrils [52].…”

“…Functionality improved in all the studies in which it 416 was evaluated [15,16,[19][20][21][23][24][25]28,31,32], although 417 SW obtained better effects than US [16], probably due 418 to the fact that the latter showed lower reliability in the 419 application of the selected frequency and presented an 420 unpredictable behavior of their acoustic diffraction [45]. 421 On the other hand, SW are more reliable [39] and their 422 efficacy increases when combined with strength exer-423 cises [46], as was also reported by Aydin et al [17].…”

“…The ROM was only evaluated in the studies that used orthoses [22,31]; this variable was improved in both cases. However, also in both cases, the orthosis was applied in combination with strength exercises [31] or with US, friction and stretching exercises [22], which are techniques known for their improvement effect on joint mobility [11,48,50,57].…”

“…The ROM was only evaluated in the studies that used orthoses [22,31]; this variable was improved in both cases. However, also in both cases, the orthosis was applied in combination with strength exercises [31] or with US, friction and stretching exercises [22], which are techniques known for their improvement effect on joint mobility [11,48,50,57]. In fact, the improvement was greater with the intervention that only included eccentric exercises [31], since this training modality is currently among the most effective techniques in the treatment of tendinopathies [58][59][60].…”