Tendinopathies in the upper extremity:

Ashe, Maureen C.; McCauley, Tracey; Khan, Karim M.

doi:10.1197/j.jht.2004.04.002

Cited by 54 publications

(25 citation statements)

References 29 publications

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“…2,10 Based on this growing body of evidence, Dr K. Khan and colleagues have been urging acceptance of the tendinosis model for several years. 3,11,16 Despite this, the traditional view, perhaps because of its inherent simplicity, has remained entrenched as reflected by the continued use of the term epicondylitis.…”

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confidence: 99%

Lateral Epicondylalgia or Epicondylitis: What's in a Name?

Waugh¹

2005

J Orthop Sports Phys Ther

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T he condition first known as ''tennis elbow'' has been recognized for over a century. Typical signs and symptoms include pain and tenderness over the lateral epicondyle, exacerbated by resisted wrist extension and passive wrist flexion, and impaired grip strength. Although many tennis players may experience this condition, most cases are associated with work-related activities or have no obvious precipitating event. As a result, the term now most widely used is lateral epicondylitis. Yet, this name implies a pathological basis that is contrary to longstanding, albeit evolving, evidence that it is not an inflammatory condition. It is therefore recommended that it is time to adopt a new and more appropriate term, such as epicondylalgia (suffix algia means pain), that does not reflect such underlying pathology. This Journal has recently embraced this terminology. A review of the current histopathological evidence as detailed below provides a strong rationale for this change in nomenclature.The traditional view is that this condition is initiated by macroscopic or microscopic tears at the common tendon of the wrist extensor muscles due to chronic overuse. As these tears attempt to unite, the healing surfaces are pulled apart with continued use of the hand, resulting in self-perpetuating and chronic inflammation. This theory was initially put forward by Dr J. Cyriax in 1936 5 and has since been widely accepted as the most plausible pathophysiological mechanism. Consequently, treatment has focused on controlling the inflammatory response through the use of nonsteroidal anti-inflammatory drugs and physical modalities such as ultrasound and ice. This inflammatory model also led to the use of the term epicondylitis, which was considered an improvement over the colloquial term tennis elbow.Yet this theory has never been substantiated and indeed has been refuted as early as the 1970s by Dr R. Nirschl, based on the histopathological examination of over 600 cases of chronic lateral epicondylalgia. 13,17 His studies consistently demonstrated that the affected tendon (usually the extensor carpi radialis brevis [ECRB] tendon) was characterized by a dense population of fibroblasts, disorganized and immature collagen, and an absence of inflammatory cells. These findings are considered characteristic of a degenerative process, which he called ''angiofibroblastic hyperplasia,'' now commonly known as tendinosis. Further histopathological and magnetic resonance imaging studies have revealed similar histological features and have confirmed the absence of an inflammatory process. 4,[19][20][21] Recently, a study using an in vivo microdialysis technique demonstrated normal levels of E2 prostaglandin, a biochemical marker of inflammation, in ECRB tendons of patients with chronic lateral epicondylar pain.1 Histopathological examination of similar chronic tendon conditions (Achilles, rotator cuff, and patellar tendinopathies) provide further support for the tendinosisdegenerative noninflammatory paradigm for chronic overuse tendon injurie...

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confidence: 99%

Lateral Epicondylalgia or Epicondylitis: What's in a Name?

Waugh¹

2005

J Orthop Sports Phys Ther

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“…Cabe consignar que en el estudio Bisset (23), existe una disminución del dolor a corto plazo atribuida a la inyección de corticoides, pero a largo plazo era favorable al grupo de ejercicios. En cuanto al grip libre de dolor existen diferencias significativas a corto plazo (7,12,19,23,41,46). En los estudios de Struijs (39), Croisier (76) establecen diferencias significativas a favor de la intervenciones que no poseían ejercicios (39) y a la intervención sola (76), en las medidas de resultados de dolor existe una disminución a corto plazo.…”

Section: Discussionunclassified

Ejercicio terapéutico para epicondilalgia lateral: revisión sistemática

Araya-Quintanilla

Gálvez²

2015

Rev. Soc. Esp. Dolor

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The lateral epicondylalgia is one of the most common injuries of the arm; with the muscle extensor carpi radialis brevis (ERCB) affected the structure, repetitive motion, rapids and monotonous, mainly affects between 1-3% of the general population, being more common in women. Therapeutic exercise is one of the key elements in programs designed for the management of this condition.There will be a synthesis of evidence through a systematic review of randomized clinical trials that established the effectiveness of exercise therapy in the management of these patients. The aim of this review is to determine whether there is scientific evidence to support the clinical effectiveness of exercise therapy alone or in a treatment program for adult patients with LE.The search strategy included randomized clinical trials (RCTs) and controlled clinical trials (CCTs) databases were used: Medline, CINAHL, PEDro, Central, Lilacs. The results obtained were thirty-six articles that met our eligibility criteria. We conclude that there is moderate evidence shows that therapeutic exercise alone compared with a single intervention, decreases pain, improves function and increases strength pain free in short, medium and long term. There is strong evidence that exercise therapy reduces pain, increases strength and free from short-term pain. There is strong evidence that exercise therapy reduces pain, increases strength and improves functionality in the short, medium and long term. RESUMENLa epicondilalgia lateral es una de las lesiones más comunes del brazo, siendo el músculo extensor radial corto del carpo (ERCB) la estructura más afectada, por movimientos repetitivos, rápidos y monótonos, principalmente afecta entre 1-3% de la población general, siendo más común en mujeres. El ejercicio terapéutico, es uno de los elementos claves en los programas diseñados para el manejo de esta condición. Se realizará una búsqueda de la evidencia a través de una revisión sistemática de ensayos clínicos aleatorizados que hayan determinado la efectividad del ejercicio terapéutico para el manejo de estos pacientes. El objetivo de esta Revisión es determinar si existe evidencia científica que avale la efectividad clínica del ejercicio terapéutico sólo o dentro de un programa de tratamiento en pacientes adultos con epicondilalgia lateral.La estrategia de bús queda incluyó ensayos clínicos aleatorizados (ECA) y ensayos clínicos controlados (ECC); las bases de datos usadas fueron: Medline, Cinahl, PEDro, Central, Lilacs. Los resultados obtenidos fueron de treinta y seis artículos que cumplían con nuestros criterios de elegibilidad. Se concluye que existe evidencia moderada que el ejercicio terapéutico comparado con una intervención única, disminuye el dolor, mejora la funcionalidad y aumenta la fuerza libre de dolor en corto, medio y largo plazo. Existe evidencia de que el ejercicio terapéutico disminuye el dolor, y aumenta la fuerza sin dolor a corto plazo. Existe evidencia fuerte de que el ejercicio terapéutico disminuye el dolor, aumenta la fuerz...

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“…Dirseğe ek olarak, akut ve kronik dönemde skapula stabilizatörleri (trapez, romboid, levator skapula, serratus anterior) da çalıştırılmalıdır (5). El parmaklarının çalıştırılması için parmak uçlarına bir lastik yerleştirilir.…”

Section: Lateral Epikondilit (Tenisçi Dirseği)unclassified

Exercise Prescription in Forearm, Wrist, and Hand Pain

Kuran¹

2014

Turk J Phys Med Rehab

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The forearm, wrist, and hand are the most frequently used body parts during activities of daily life. Hence, injuries are frequently encountered due to widespread use of computers in modern life, inappropriate ergonomics, mechanical loading during manual weight lifts, and inflammatory and neurological causes. Although pharmacological treatments, physical therapy modalities, and surgical interventions in severe cases are considered as treatments, therapeutic exercise, being cheap and preventive, is the mainstay of evidence-based hand therapy. Different categories of exercises are prescribed to provide nutrition of joint surfaces; to lengthen the shortened, painful periarticular tissue; to increase blood circulation; to stimulate joint proprioceptors to increase joint stability; and to improve muscle power and endurance. During the applications, the physical characteristics of the patient and his daily living needs, pain tolerance, and disease stage, etc., should be considered to hit the right target. In this review, frequently encountered forearm, wrist, and hand pathologies and the exercises prescribed in the treatment of these conditions will be discussed. Key Words: Hand exercises, tennis elbow, De Quervain ÖzetÖn kol, el ve el bileği günlük yaşam aktivitelerinin yerine getirilmesi sırasında en sık kullanılan vücut kısımlarındandır. Günümüzde bilgisayarın yaygın olarak kullanılması, bozuk ergonomi, elle kaldırılan ağırlıklara bağlı mekanik yüklenme, çeşitli inflamatuvar ve nörolojik nedenler sonucu yaralanmalarına sık rastlanır. Semptomların ve fonksiyon bozukluğunun giderilmesinde farmakolojik yaklaşımlar, fizik tedavi uygulamaları ve ileri olgularda cerrahi girişimler yer alsa da egzersiz tedavisi basit, ucuz ve koruyucu olması nedeniyle kanıta dayalı el tedavisinin ayrılmaz bir parçasıdır. Eklem yüzeyinin beslenmesi, eklemin çevresinde boyun ağrı nedeniyle kısalmış dokuların uzaması, kan dolaşımının artması, eklem reseptörlerinin uyarılarak stabilitenin artması, kas kuvvetinin ve dayanıklılığının artması amacıyla değişik egzersiz tipleri uygulanır. Egzersiz uygulamaları sırasında kişinin beden özellikleri, günlük yaşam gereksinimleri, ağrı toleransı, hastalığın evresi vb. özelliklerine göre hedefler belirlenmelidir. Bu yazıda sık rastlanan ön kol, el bilek ve el patolojilerinde uygulanan egzersizler ele alınacaktır. S43El ve el bileği hastalıklarında reçete edilen egzersizlerin amacı hastalığı gidermek veya önlemek, fonksiyonu arttırmak, yaralanma riskini azaltmak ve kişinin genel sağlığına katkıda bulunmaktır. Bu amaçla verilen hareketler veya pozisyonlandırmalar bazı parametrelere ve sonuç ölçeklerine göre değerlendirilirler. Diğer patolojilerde olduğu gibi, el-el bileği hastalıklarında da terapötik egzersiz reçete ederken hastanın tanısı, yaşı, birlikte olan diğer hastalıkları, kullandığı ilaçlar, ağrı toleransı, dominant eli, ev veya işyerinde yapamadıkları, yeti yitimi olup olmadığı sorgulanmalı-dır. Hastalığın hangi evrede (akut/subakut/kronik) olduğu, dalgalanmalar gösterip göstermediği, yar...

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Tendinopathies in the upper extremity:

Cited by 54 publications

References 29 publications

Lateral Epicondylalgia or Epicondylitis: What's in a Name?

Lateral Epicondylalgia or Epicondylitis: What's in a Name?

Ejercicio terapéutico para epicondilalgia lateral: revisión sistemática

Exercise Prescription in Forearm, Wrist, and Hand Pain

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