An evaluation of treatment options for lateral epicondylitis

Abstract

Aim: Lateral pain in the elbow is a widespread problem in orthopedics and physiotherapy. There are different conservative treatment options available, but there is no consensus on their superiority to each other. The aim of this study was to evaluate the efficacy of three different treatment methods applied to patients followed up with a diagnosis of lateral epicondylitis. Methods: The study included a total of 105 patients who were diagnosed with lateral epicondylitis between 2010 and 2016 and treated conservatively. The patients were separated into three groups according to the treatment administered. In Group 1 (n:28), 1 ml betamethasone dipropionate (Diprospan®, Schering-Plough Corp., Kenilworth, NJ, ABD) was applied with the peppering method. In Group 2 (n:28), the same peppering method was used to apply 1 ml local anesthetic (prilocaine hydrochloride, Citanest®, AstraZeneca plc., London, UK). In Group 3 (n:49), extracorporeal shockwave therapy (ESWT) treatment was performed. Data were evaluated before and at one, three, and six months after treatment. Clinical scores were evaluated according to the Quick Dash (Q-DASH, Quick disabilities of arm, shoulder, and hand) scoring system and VAS (visual analog scale) scores during the daily activities of the patients. Quality of life and patient satisfaction levels were evaluated based on Quick Dash scores. Results: A significant improvement was observed in all three methods in the VAS and quality of life of the patients at one, three, and six months after treatment compared to pre-treatment values (P<0.001). A higher level of patient satisfaction was determined in Groups one and two compared to the ESWT group (P<0.001). Conclusion: Significant rates of satisfaction were determined in all three methods, and the corticosteroid treatment administered with the peppering method was not superior over local anesthetic applied with the same method. Although ESWT was beneficial, it was less effective than the other methods and cost higher.

Keywords

• lateral elbow pain
• peppering
• eswt

Lateral epikondilitte tedavi seçeneklerinin değerlendirilmesi

Öz

Amaç: Dirsek yan ağrısı, ortopedi ve fizik tedavi pratiğinde sık karşılaşılan bir problemdir. Farklı konservatif tedavi seçenekleri mevcut olup, birbirlerine üstünlükleri konusunda fikir birliği yoktur. Bu çalışmada lateral epikondilit tanısıyla takip edilen hastalarda üç farklı tedavi yönteminin etkinliğini değerlendirilmek amaçlanmıştır. Yöntemler: 2010-2016 yılları arasında lateral epikondilit tanısıyla takip edilen ve konservatif olarak tedavi edilen 105 hasta çalışmaya dahil edildi. Hastalar yapılan tedavi metoduna göre 3 gruba ayrıldı. Birinci gruptaki 28 hastaya 1 ml betametazon dipropiyonat (Diprospan®, Schering-Plough Corp., Kenilworth, NJ, ABD), ikinci gruptaki 28 hastaya sadece 1 ml lokal anestezik prilokain hidroklorür (Citanest®, AstraZeneca plc., Londra, Birleşik Krallık), aynı yöntemle 30-40 kez iğne ucu ciltten çıkarılmadan aynı bölgeye batırılıp çıkarılarak (peppering yöntemiyle) uygulandı. Üçüncü gruptaki 49 hastaya Ekstrakorporeal şok dalga terapisi (ESWT) tedavisi uygulandı. Tedavi öncesi ve 1. 3. ve 6. aydaki veriler değerlendirildi. Klinik skorlar Quick Dash (Q-DASH, Quick disabilities of arm, shoulder and hand) skorlama sistemine göre değerlendirilerek, hastaların günlük yaşam aktiviteleri sırasındaki VAS (Visual Analog Scale) skorlarına bakıldı. Yaşam kalitesi ve hasta memnuniyeti düzeyleri Quick Dash skorlarına göre değerlendirildi. Bulgular: Her üç yöntemde tedavi sonrası birinci ay, üçüncü ay ve altıncı aydaki VAS skorunda ve hastanın yaşam kalitesinde tedavi öncesine göre anlamlı olarak iyileşme gözlendi (P<0,001). İlk iki grupta ESWT grubuna göre daha yüksek hasta memnuniyet oranı tespit edildi (P<0,001). Sonuç: Her üç yöntem içinde anlamlı memnuniyet oranları ile karşılaşılmış olup, peppering yöntemiyle uygulanan kortikosteroid (KS) tedavisinin aynı yöntemle uygulanan lokal anesteziklere üstünlüğü olmadığı görülmüştür. Üçüncü yöntemin (ESWT) faydalı olduğu görülse de diğerlerine göre daha az etkili olduğu ve daha maliyetli olduğu sonucuna varıldı.

Anahtar Kelimeler

• Lateral dirsek ağrısı
• Peppering
• ESWT

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