Lateral Epikondilitli Hastalarda Ekstrakorporeal Şok Dalga Tedavisi, Ultrason ve Deksametazon İyontoforezinin Karşılaştırılması

Year 2025, Volume: 7 Issue: 1, 1 - 9, 25.02.2025

Pınar Başaran , Ayşe Doğan

https://doi.org/10.52827/hititmedj.1462592

Abstract

Amaç: Bu çalışmanın amacı, lateral epikondilitli hastalarda ekstrakorporeal şok dalga tedavisi (ESWT), ultrason (US) ve deksametazon iyontoforez tedavilerinin ağrı, kavrama gücü, fonksiyonellik ve yaşam kalitesi üzerindeki etkinliğini belirlemek ve hangi tedavinin daha etkili olabileceğini belirlemeyi amaçladık.
Gereç ve Yöntem: Bu tek kör, prospektif, randomize çalışmaya lateral epikondilit tanısı konan 78 hasta dahil edildi. Hastalar üç gruba randomize edildi. Bu tek kör, prospektif, randomize çalışmaya lateral epikondilit tanısı konan 78 hasta dahil edildi. Hastalar üç gruba randomize edildi. Tüm gruplar sıcak paketler, transkütanöz elektriksel sinir stimülasyonu (TENS) ve gözetimli egzersizleri içeren bir fizyoterapi programı uygulandı. Tüm egzersizler deneyimli bir fizyoterapist gözetiminde gerçekleştirildi. 10 günlük fizyoterapi programına ek olarak, 1. gruba her 5 günde bir toplam 3 seans ESWT, 2. gruba 10 gün US ve 3. gruba 10 gün deksametazon iyontoforez tedavisi uygulandı. Değerlendirmeler tedaviden önce ve 1 ayın sonunda yapıldı. Ağrı şiddeti sayısal derecelendirme ölçeği (NRS) ile, özürlülük kol, omuz ve el hızlı özürlülük ölçeği (Quick DASH) ile, yaşam kalitesi Nottingham Sağlık Profili (NHP) ile, kavrama gücü dinamometre ile ve parmak gücü pinchmetre ile ölçüldü.
Bulgular: Gruplar demografik ve klinik özellikler açısından benzerdi. Tedaviden sonraki ilk ayda ağrı şiddeti, özürlülük, kavrama gücü ve yaşam kalitesi açısından üç grupta da anlamlı iyileşme saptandı. Tedavi sonrası birinci ayda bu tedavilerin etkinliği karşılaştırıldığında, deksametazon iyontoforez, ağrı, özürlülük ve yaşam kalitesi açısından US ve ESWT’den istatistiksel olarak üstün olarak saptandı (sırasıyla, p<0.001, p=0.007, p<0.001, p<0.001). Ayrıca, US yaşam kalitesi açısından ESWT’den daha üstün olarak saptandı (p<0.001).
Sonuç: Deksametazon iyontoforezi lateral epikondilitli hastaların tedavisinde fonksiyonel ve klinik iyileşmede daha etkilidir.

Keywords

deksametazon iyontoforezi, ekstrakorporeal şok dalga tedavisi, Lateral epikondilit, tenisçi dirseği, ultrason

Ethical Statement

Çalışma için 14/06/2023 tarihinde Hitit Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır. Karar no: 2023-77.

Supporting Institution

Herhangi bir mali destek alınmamıştır

Comparison of extracorporeal shock wave therapy, ultrasound, and dexamethasone iontophoresis in patients with lateral epicondylitis

Abstract

Objective: The purpose of this study is to determine the effectiveness of extracorporeal shock wave therapy (ESWT), ultrasound (US), and dexamethasone iontophoresis treatments on pain, grip strength, functionality, and quality of life in patients with lateral epicondylitis, and overdetermine the superiority of the treatments to each other.
Material and Method: This single-blind, prospective study included 78 patients who were diagnosed with lateral epicondylitis. The patients were randomized into three groups. The same physiotherapy program consisted of hot packs, transcutaneous electrical nerve stimulation (TENS), and exercises were administered to all groups. All exercises were performed under the supervision of a qualified physiotherapist. In addition to a 10-day physiotherapy program, every 5 days, a total 3 sessions of ESWT were conducted to the 1st group, 10 days of US applied to the 2nd group, and 10 days of dexamethasone iontophoresis therapy to the 3rd group. Evaluations were carried out before, and 1 month after treatment. Pain severity levels were measured using the numeric rating scale (NRS), disability using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), quality of life using the Nottingham Health Profile (NHP), and grip strength using a dynamometer and pinch strength using a pinch meter.
Results: The groups were similar in demographic and clinical characteristics. A significant temporal change was found in three groups in terms of pain severity, disability, grip strength, and quality of life at the first month after treatment. When the efficacy of these treatments was compared after treatment in the first month, dexamethasone iontophoresis was statistically superior to US, and ESWT in terms of pain, and quality of life (p<0.001, p=0.007, p<0.001, p<0.001 respectively). Also, the US was superior to ESWT in terms of quality of life (p<0.001).
Conclusion: Dexamethasone iontophoresis is more effective in functional and clinical improvement in the treatment of patients with lateral epicondylitis.

Keywords

Lateral epicondylitis, ultrasound, dexamethasone iontophoresis, extracorporeal shock wave therapy, tennis elbow

Ethical Statement

Approval for the study was obtained from the Hitit University Clinical Research Ethics Committee on 14/06/2023. Decision no:2023-77.

References

• Altun RD, Incel NA, Cimen OB, Sahin G. Efficacy of ESWT for lateral Epicondylitis treatment: comparison with physical therapy modalities. Journal of Musculoskeletal Research 2018;21(01):1850001.
• Stasinopoulos D, Johnson MI. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. British Journal of Sports Medicine 2004;38(6):675-677.
• Meyer NJ, Walter F, Haines B, Orton D, Daley RA. Modeled evidence of force reduction at the extensor carpi radialis brevis origin with the forearm support band. The Journal of Hand Surgery 2003;28(2):279-287.
• Hsu SH, Moen TC, Levine WN, Ahmad CS. Physical examination of the athlete’s elbow. The American Journal of Sports Medicine 2012;40(3):699-708.
• Yalvaç B, Mesci N, Külcü DG, Yurdakul OV. Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis. Acta Orthopaedica et Traumatologica Turcica 2018;52(5):357-362.
• Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. JBJS. 2007;89(9):1955-1963.
• Murphy KP, Giuliani JR, Freedman BA. The diagnosis and management of lateral epicondylitis. Current Opinion in Orthopaedics 2006;17(2):134-138.
• Beyazal MS, Devrimsel G. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis. Journal of Physical Therapy Science 2015;27(12):3755-3758.
• Faro F, Wolf JM. Lateral epicondylitis: review and current concepts. The Journal of Hand Surgery. 2007;32(8):1271-1279.
• Watson T. Ultrasound in contemporary physiotherapy practice. Ultrasonics 2008;48(4):321-329.
• Wong CWY, Ng EYL, Fung PW, et al. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. The Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 2017;7:21-26.
• Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons Journal 2012;2(1):33-37.
• Brown CD, Lauber CA, Cappaert T. The effect of dexamethasone iontophoresis on decreasing pain and improving function in patients with musculoskeletal conditions. J Sport Rehabil 2015;24:327-331.
• Hjermstad MJ, Fayers PM, Haugen DF, et al. European Palliative Care Research Collaborative (EPCRC). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 2011;41:1073-1093.
• Innes, E. Handgrip Strength testing: A review of the literature. Aust Occup Ther J 1999;46:120-140.
• Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Archives of Physical Medicine and Rehabilitation 1985;66(2):69-74.
• Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clinical Rheumatology 2011;30(2):185-191.
• Kücükdeveci AA, McKenna SP, Kutlay S, Gürsel Y, Whalley D, Arasil T. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res. 2000;23:31-38.
• Marigi EM, Dancy M, Alexander A, et al. Lateral Epicondylitis: Critical Analysis Review of Current Nonoperative Treatments. JBJS Reviews. 2023;11(2):22.
• Degen RM, Conti MS, Camp CL, Altchek DW, Dines JS, Werner BC. Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients. HSS J 2018;14(1):9-14.
• Minetto MA, Giannini A, McConnell R, Busso C, Torre G, Massazza G. Common Musculoskeletal Disorders in the Elderly: The Star Triad J Clin Med. 2020;9:1216.
• Ulusoy I, Kıvrak A. Is blood group a risk factor in lateral epicondylitis? European Review for Medical & Pharmacological Sciences 2023;27(9):3947-3956.
• Yao G, Chen J, Duan Y, Chen X. Efficacy of extracorporeal shock wave therapy for lateral epicondylitis: a systematic review and meta-analysis. BioMed research international. 2020;18:2020:2064781.
• Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J Hand Ther 2017;30:13–19.
• Dimitrios S. Lateral elbow tendinopathy: Evidence of physiotherapy management. World J Orthop 2016;7:463-466.
• da Luz DC, de Borba Y, Ravanello EM, Daitx RB, Döhnert MB. Iontophoresis in lateral epicondylitis: a randomized, double-blind clinical trial. Journal of Shoulder and Elbow Surgery 2019;28(9):1743-1749.
• Apostolos S, Dimosthenis S, Dimitrios S. The influence of dexamethasone with lidocaine hydrochloride iontophoresis in recreational tennis players suffering from lateral elbow tendinopathy. Journal of Novel Physiotherapy and Physical Rehabilitation 2014;2(1):22-27.
• Akhondali Z, Dianat M, Radan M. Iontophoresis versus Cyriax-type exercises in chronic tennis elbow among industrial workers. Electron Physician. 2015;7:1277-1283.
• Baktir S, Ozdincler AR, Mutlu EK, Bilsel K. The short-term effectiveness of low-level laser, phonophoresis, and iontophoresis in patients with lateral epicondylosis. Journal of Hand Therapy 2019;32(4):417-425.
• Buyuksireci, DE, Turk AC. Evaluation of the effectiveness of dexamethasone iontophoresis in patients with subacromial impingement syndrome. Journal of Orthopaedic Science 2021;26(5):786-791.
• Büyükşireci DE, Büyükşireci M, Komut E. Evaluation of the effects of dexamethasone iontophoresis, galvanic current, and conservative treatment on pain and disability in patients with knee osteoarthritis and Baker’s cyst. Turk J Phys Med Rehabil 2022;68(4):509-516.
• Dedes V, Tzirogiannis K, Polikandrioti M, Dede AM, Mitseas A, Panoutsopoulos GI. Comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. Journal of Medical Ultrasonics 2020;47:319-325.
• Kubot A, Grzegorzewski A, Synder M, Szymczak W, Kozłowski P. Radial extracorporeal shockwave therapy and ultrasound therapy in the treatment of tennis elbow syndrome. Ortopedia Traumatologia Rehabilitacja 2017;19(5),415-426.
• Yan C, Xiong Y, Chen L, et al. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research 2019;14(1):1-12.
• Vahdatpour B, Taheri P, Abasi F. Extracorporeal Shock Wave Therapy for Lateral Epicondylitis, Lonely or in Combination with Topical Corticosteroid; Which Approach is Superior? Galen Med J. 2020;9(1):e1791.