Kronik lateral dirsek tendinopatili hastalarda steroid enjeksiyonu, proloterapi ve fizyoterapinin kısa dönemdeki etkilerinin karşılaştırılması

Year 2024, , 45 - 54, 23.04.2024

Gökhan Bayrak , Hakan Zora

https://doi.org/10.30569/adiyamansaglik.1407644

Abstract

Amaç: Bu çalışmanın amacı, kronik lateral dirsek tendinopatili (LDT) hastalarda steroid enjeksiyonu (SE), proloterapi ve ev-tabanlı fizyoterapinin kısa dönemde ağrı ve fonksiyon üzerindeki etkilerini karşılaştırmaktır.
Gereç ve Yöntem: 2022-2023 yılları arasında ortopedi kliniğine başvuran kronik LDT’li hastalar SE (n=17), proloterapi (n=17) ve ev-tabanlı fizyoterapi (n=17) gruplarına ayrılmıştır. Tedavi öncesi, ikinci ve altıncı hafta ağrı ve fonksiyon için Görsel Analog Skalası (GAS), Kol, Omuz ve El Sorunları Hızlı Anketi (QuickDASH) ve Sağlık Değerlendirme Ölçeği (SDÖ) karşılaştırıldı.
Bulgular: İkinci ve altıncı hafta GAS, QuickDASH ve SDÖ değerleri SE ve proloterapi grubunda ev-tabanlı fizyoterapi grubuna göre anlamlı şekilde düşüktü (p=0.001). Altıncı haftada GAS, QuickDASH ve SDÖ'de SE grubunda proloterapi ve ev-tabanlı fizyoterapiye göre etkili iyileşme sağlanmıştır (p=0,001, η2=0,30-0,42).
Sonuç: SE, proloterapi ve ev-tabanlı fizyoterapi kısa dönemde dirsek ağrısı ve fonksiyonunu iyileştirmektedir, ancak SE daha etkilidir. SE kronik LDT’li hastalarda kısa dönemde iyileşme için etkili olabilir.

Keywords

Dirsek tendinopatisi, Enjeksiyonlar, Steroidler, Proloterapi, Fizyoterapi

Ethical Statement

Bu çalışmanın etik kurul onayı Muş Alparslan Üniversitesi Bilimsel Araştırma ve Yayın Etiği Kurulundan alınmıştır

Supporting Institution

Bu çalışma herhangi bir kişi veya grup tarafından finansal olarak desteklenmemektedir

Thanks

Yoktur

A Comparison of the short-term effects of steroid injection, prolotherapy and home-based physiotherapy in patients with chronic lateral elbow tendinopathy

Abstract

Aim: This study aims to compare the effects of steroid injection (SI), prolotherapy, and home-based physiotherapy on pain and function in short-term in chronic lateral elbow tendinopathy (LET) patients.
Materials and Methods: Patients with chronic LET admitted to the orthopedic clinic between 2022 and 2023 were divided into SI (n=17), prolotherapy (n=17) and home-based physiotherapy (n=17) groups. Visual Analogue Scale (VAS), Quick Disability Assessment of Arm, Shoulder and Hand Problems (QuickDASH), and Health Assessment Questionnaire (HAQ) for pain and function before, two, and six weeks after treatment were compared.
Results: Second and sixth-week VAS, QuickDASH and HAQ were significantly lower in SI and prolotherapy than home-based physiotherapy group (p=0.001). In the sixth week, sufficient improvement was achieved in VAS, QuickDASH and HAQ in SI compared to prolotherapy and home-based physiotherapy (p=0.001, η2=0.30-0.42).
Conclusion: SI, prolotherapy, and home-based physiotherapy improved elbow pain and function in short-term, but SI was greater effective. SI may be effective for short-term improvement in chronic LET patients.

Keywords

Elbow tendinopathy, Injections, Steroids, Prolotherapy, Physiotherapy

Ethical Statement

Ethics committee approval for this study was obtained from Muş Alparslan University Scientific Research and Publication Ethics Committee.

Supporting Institution

This study is not being financially supported by any individual or group

Thanks

None

References

• Rabago D. Prolotherapy for treatment of lateral epicondylosis. Am Fam Physician. 2009;80(5):441.
• Bretschneider SF, Los FS, Eygendaal D, Kuijer PPFM, van der Molen HF. Work-relatedness of lateral epicondylitis: Systematic review including meta-analysis and GRADE work-relatedness of lateral epicondylitis. Am J Ind Med. 2022;65(1):41-50. doi:10.1002/ajim.23303.
• Gupta GK, Rani S, Shekhar D, Sahoo UK, Shekhar S. Comparative study to evaluate efficacy of prolotherapy using 25% dextrose and local corticosteroid injection in tennis elbow - A prospective study. J Family Med Prim Care. 2022;11(10):6345-6349. doi:10.4103/jfmpc.jfmpc_116_22.
• Viswas R, Ramachandran R, Korde Anantkumar P. Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. ScientificWorldJournal. 2012;2012:939645. doi:10.1100/2012/939645.
• Qi L, Zhu ZF, Li F, Wang RF. MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor tendon an isolated lesion?. PLoS One. 2013;8(11):e79498. doi:10.1371/journal.pone.0079498.
• Bayat M, Raeissadat SA, Mortazavian Babaki M, Rahimi-Dehgolan S. Is Dextrose Prolotherapy Superior To Corticosteroid Injection In Patients With Chronic Lateral Epicondylitis?: A Randomized Clinical Trial. Orthop Res Rev. 2019;11:167-175. doi:10.2147/ORR.S218698.
• Sims SE, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (N Y). 2014;9(4):419-446. doi:10.1007/s11552-014-9642-x.
• Ahmad Z, Siddiqui N, Malik SS, Abdus-Samee M, Tytherleigh-Strong G, Rushton N. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95-B(9):1158-1164. doi:10.1302/0301-620X.95B9.29285.
• Karaca İ, Gül H, Erel S. Comparison of extracorporeal shock wave therapy and high-intensity laser therapy on pain, grip strength, and function in patients with lateral epicondylalgia: a randomized controlled study. Lasers Med Sci. 2022;37(8):3309-3317. doi:10.1007/s10103-022-03631-y.
• Meunier M. Lateral Epicondylitis/Extensor Tendon Injury. Clin Sports Med. 2020;39(3):657-660. doi:10.1016/j.csm.2020.03.001.
• Zhu M, Rabago D, Chung VC, Reeves KD, Wong SY, Sit RW. Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022;103(11):2209-2218. doi:10.1016/j.apmr.2022.01.166.
• Ma KL, Wang HQ. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Res Manag. 2020;2020:6965381. doi:10.1155/2020/6965381.
• Bateman M, Saunders B, Littlewood C, Hill JC. Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique. BMJ Open. 2021;11(12):e053841. doi:10.1136/bmjopen-2021-053841.
• Day JM, Lucado AM, Uhl TL. A Comprehensive Rehabilitation Program For Treating Lateral Elbow Tendinopathy. Int J Sports Phys Ther. 2019;14(5):818-829.
• Gupta S, Biswas A, Equebal A, Neyaz O, Yadav R. A comparative study on the effects of dextrose prolotherapy and local steroid injection in patients with lateral epicondylitis: A randomized controlled trial. Journal of Medicine in Scientific Research. 2022;5(4):423. doi:10.4103/jmisr.jmisr_35_22.
• Ahmed AF, Rayyan R, Zikria BA, Salameh M. Lateral epicondylitis of the elbow: an up-to-date review of management. Eur J Orthop Surg Traumatol. 2023;33(2):201-206. doi:10.1007/s00590-021-03181-z.
• Özdinçler AR, Baktır ZS, Mutlu EK, Koçyiğit A. Chronic lateral elbow tendinopathy with a supervised graded exercise protocol. J Hand Ther. Published online March 11, 2023. doi:10.1016/j.jht.2022.11.005.
• Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther. 2005;18(4):411-420. doi:10.1197/j.jht.2005.07.007.
• Stasinopoulos D, Stasinopoulos I, Pantelis M, Stasinopoulou K. Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med. 2010;44(8):579-583. doi:10.1136/bjsm.2008.049759.
• Söderberg J, Grooten WJ, Ang BO. Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: a randomized-controlled trial. Scand J Med Sci Sports. 2012;22(6):797-803. doi:10.1111/j.1600-0838.2011.01317.x.
• Yoon SY, Kim YW, Shin IS, Kang S, Moon HI, Lee SC. The Beneficial Effects of Eccentric Exercise in the Management of Lateral Elbow Tendinopathy: A Systematic Review and Meta-Analysis. J Clin Med. 2021;10(17):3968. doi:10.3390/jcm10173968.
• Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002;(398):127-130.
• Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med. 2008;18(3):248-254. doi:10.1097/JSM.0b013e318170fc87.
• Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(S11):S240-S252. doi:10.1002/acr.20543.
• Koldaş Doğan Ş, Ay S, Evcik D, Başer Ö. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30(2):185-191. doi:10.1007/s10067-010-1470-y.
• Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5 Suppl 39):S14-S18.
• Krogh TP, Bartels EM, Ellingsen T, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013;41(6):1435-1446. doi:10.1177/0363546512458237.
• Küçükşen S, Yılmaz H, Sallı A, Uğurlu H. Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up. Arch Phys Med Rehabil. 2013;94(11):2068-2074. doi:10.1016/j.apmr.2013.05.022.
• Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. doi:10.1136/bmj.38961.584653.AE.
• Yelland M, Rabago D, Ryan M, et al. Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial. BMC Musculoskelet Disord. 2019;20(1):509. doi:10.1186/s12891-019-2905-5.
• 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;68(2):205-213. doi:10.5606/tftrd.2022.8007.
• Carayannopoulos A, Borg-Stein J, Sokolof J, Meleger A, Rosenberg D. Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial. PM&R. 2011;3(8):706-15. doi:10.1016/j.pmrj.2011.05.011.
• Verhaar JA, Walenkamp GH, van Mameren H, Kester AD, van der Linden AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg Br. 1996;78(1):128-132.
• Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-662. doi:10.1016/S0140-6736(02)07811-X.