Lateral Dirsek Tendinopatisinde Kavrama Kuvveti ve Subjektif Sonuç Ölçütleri Arasındaki İlişkinin Araştırılması

Year 2024, , 28 - 35, 28.04.2024

Leyla Eraslan , Gül Baltacı

https://doi.org/10.29058/mjwbs.1355492

Abstract

Amaç: Bu çalışmanın amacı lateral dirsek tendinopatili hastalarda kavrama kuvveti değerlerinin
araştırılması ve subjektif sonuç ölçütleri olan ağrı şiddeti ve dirseğin fonksiyonelliği ile ilişkisinin ortaya
konulmasıdır.
Gereç ve Yöntemler: Bu araştırmaya lateral dirsek tendinopatisi tanısı alan 120 hasta (60 kadın, 60
erkek, ortalama yaş: 47,8±4,3 yıl; ortalama VKİ: 27,3±5,5 kg/m2) dahil edildi. Hastaların kavrama kuvveti
ölçümleri dirsek 90° fleksiyon pozisyonunda JAMAR el dinamometresi (Lafayette Instrument Company,
USA) kullanılarak yapıldı. Subjektif değerlendirmede, ağrı şiddeti (istirahat, tekrarlı dirsek fleksiyonu,
ağır cisim kaldırma ve gece) Numerik Derecelendirme Skalası (NRS) ile, dirsek fonksiyonelliği Hasta
Bazlı Önkol Değerlendirme Anketi (PRTEE) ve PRTEE’nin alt skorları kullanılarak yapıldı. İstatistiksel
analizde, etkilenen ve sağlam taraf arasındaki kavrama kuvveti değerleri arasındaki fark “bağımlı
gruplarda t-testi”, kavrama kuvveti ile subjektif sonuç ölçütleri arasındaki ilişki Pearson Korelasyon
Katsayısı kullanılarak analiz edildi.
Bulgular: Hastaların etkilenen ve sağlam taraf kavrama kuvvetleri arasında anlamlı fark vardı (p<0,001).
Etkilenen ekstremite kavrama kuvveti ile NRS’nin alt parametreleri (p<0,001), PRTEE Ağrı alt skoru
(r=-0,486 ve p<0,001), PRTEE Fonksiyon alt skoru (r=-0,580 ve p<0,001) ve toplam skor (r=-0,556 ve
p<0,001) arasında negatif yönlü ve orta güçte bir ilişki vardı.
Sonuç: Lateral dirsek tendinopatili hastalarda etkilenen taraf kavrama kuvvetinin sağlam tarafa
göre azaldığı bulundu. Üstelik, kavrama kuvveti arttıkça ağrı şiddetinin azaldığı ve fonksiyonelliğin
arttığı bulundu. Lateral dirsek tendinopatisinde ağrı şiddeti ve fonksiyonellik gibi subjektif ölçütlerin
kavrama kuvveti değişimlerinin yorumlanmasında klinik görüş sağlanması açısından önemli olduğunu
düşünmekteyiz.

Keywords

tenisçi dirseği, kavrama kuvveti, sonuç ölçütü, objektif, subjektif

Investigation of Association Between Grip-Strength and Subjective Outcome Measures in Lateral Elbow Tendinopathy

Abstract

Aim: This study aimed to investigate grip strength values in patients with lateral elbow tendinopathy
and reveal their relationship with subjective outcome measures (pain intensity and elbow functionality).
Material and Methods: A hundred and twenty patients with lateral elbow tendinopathy (60 females, 60
males, mean age: 47.8±4.3 years old; BMI: 27.3±5.5 kg/m2) were included in this study. Grip strength
was measured using a JAMAR dynamometer (Lafayette Instrument Company, USA) with the elbow in a
90° flexion position. In the subjective evaluation, pain intensity (at rest, repeated elbow flexion, heavy object lifting, and night) was assessed
using the Numeric Rating Scale (NRS), and functionality was assessed using Patient Rated Tennis Elbow Evaluation (PRTEE) and the
subscales of the PRTEE. Statistical analysis was used for comparing the grip strength between the symptomatic and asymptomatic sides
using “a paired sample t-test”. Grip strength and subjective outcome measures were analyzed using “Pearson Correlation Test”.
Results: There was a significant difference between grip strength on the symptomatic and asymptomatic sides (p<0.001). There was a
negative and moderate correlation between the grip strength and sub-parameters of NRS (p<0.001), pain sub-score of PRTEE (r=-0.486 and
p<0.001), function sub-score of PRTEE (r =-0.580 and p<0.001) and the total score (r=-0.556 and p<0.001).
Conclusion: A decreased grip strength was observed in the affected sides compared to the non-affected sides of the patients with lateral
elbow tendinopathy. Moreover, it was also found that while grip strength increased, pain intensity decreased, and functionality improved.
We consider that subjective outcome measures such as pain intensity and functionality are important in providing clinical insight into the
interpretation of grip strength changes in lateral elbow tendinopathy.

Keywords

tennis elbow, grip strength, outcome measure, subjective, objective

References

• 1. Fedorczyk JM. Tennis elbow: blending basic science with clinical practice. Journal of Hand Therapy 2006;19(2):146-153.
• 2. Dimitrios S. Lateral elbow tendinopathy: Evidence of physiotherapy management. World J Orthop 2016;7(8):463-466.
• 3. Stasinopoulos D, Johnson MIJMh. ‘Lateral elbow tendinopathy’is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis. Med Hypotheses 2006;67(6):1400-1402.
• 4. Herquelot E, Bodin J, Roquelaure Y, Ha C, Leclerc A, Goldberg M, Zins M, Descatha A. Work-related risk factors for lateral epicondylitis and other cause of elbow pain in the working population. Am J Ind Med 2013;56(4):400-409.
• 5. Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther 2022;52(12):CPG1- CPG111.
• 6. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology 2012;51(2):305-310.
• 7. MacDermid J, Solomon G, Valdes K. Clinical assessment recommendations: American Society of Hand Therapists 2015.
• 8. Bisset LM, Russell T, Bradley S, Ha B, Vicenzino BT. Bilateral sensorimotor abnormalities in unilateral lateral epicondylalgia. Arch Phys Med Rehabil 2006;87(4):490-495.
• 9. Coombes BK, Bisset L, Vicenzino B. Thermal hyperalgesia distinguishes those with severe pain and disability in unilateral lateral epicondylalgia. Clin J Pain 2012;28(7):595-601.
• 10. Heales L, Lim E, Hodges P, Vicenzino B. Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability—implications for central nervous system involvement: a systematic review with meta-analysis. Brit J Sport Med 2014;48(19):1400-1406.
• 11. Rompe JD, Overend TJ, MacDermid JC. Validation of the patient- rated tennis elbow evaluation questionnaire. J Hand Ther 2007;20(1):3-11.
• 12. Kim YJ, Wood SM, Yoon AP, Howard JC, Yang LY, Chung KC. Efficacy of nonoperative treatments for lateral epicondylitis: a systematic review and meta-analysis. Plast Reconstr Surg 2021;147(1):112-125.
• 13. Bedeir YH, Grawe BM. Patient factors influencing outpatient satisfaction in patients presenting with shoulder pain. J Shoulder Elbow Surg 2018;27(12):e367-e71.
• 14. Döring A-C, Nota SP, Hageman MG, Ring DC. Measurement of upper extremity disability using the patient-reported outcomes measurement information system. J Hand Surg Am 2014;39(6):1160-1165.
• 15. Janse A, Gemke R, Uiterwaal C, Van Der Tweel I, Kimpen J, Sinnema G. Quality of life: patients and doctors don’t always agree: a meta-analysis. J Clin Epidemiol 2004;57(7):653-661.
• 16. Bobos P, Nazari G, Lu Z, MacDermid JC. Measurement properties of the hand grip strength assessment: a systematic review with meta-analysis. Arch Phys Med Rehabil 2020;101(3):553- 565.
• 17. Hill CE, Heales LJ, Stanton R, Kean CO. Effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy: A randomised crossover trial. Clin Rehabil 2023;37(8):1041-1051.
• 18. Eraslan L, Yuce D, Erbilici A, Baltaci G. Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis? Knee Surg Sports Traumatol Arthrosc 2018;26(3):938-945.
• 19. Peolsson A, Hedlund R, Oberg B. Intra- and inter-tester reliability and reference values for hand strength. J Rehabil Med 2001;33(1):36-41.
• 20. Firrell JC, Crain GM. Which setting of the dynamometer provides maximal grip strength? J Hand Surg Am 1996;21(3):397- 401.
• 21. Crosby CA, Wehbé MA. Hand strength: normative values. J Hand Surg Am 1994;19(4):665-670.
• 22. Bohannon RW, Bubela DJ, Magasi SR, Gershon RC. Relative reliability of three objective tests of limb muscle strength. Isokinet Exerc Sci 2011;19(2):77-81.
• 23. Altan L, Ercan İ, Konur S. Reliability and validity of Turkish version of the patient rated tennis elbow evaluation. Rheumatol Int 2010;30:1049-1054.
• 24. Overend TJ, Wuori-Fearn JL, Kramer JF, MacDermid JC. Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther 1999;12(1):31- 37.
• 25. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain 2011;152(10):2399-2404.
• 26. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. 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(6):1073-1093.
• 27. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg 2018;126(5):1763-1768.
• 28. Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, et al. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET)–A systematic review. J Hand Ther 2022;35(4):541-551.
• 29. Pienimäki TT, Siira PT, Vanharanta H. Chronic medial and lateral epicondylitis: a comparison of pain, disability, and function. Arch Phys Med Rehabil 2002;83(3):317-321.
• 30. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health 2012;4(5):384-393.
• 31. Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther 2015;45(11):938-949.
• 32. Pienimäki T, Tarvainen T, Siira P, Malmivaara A, Vanharanta H. Associations between pain, grip strength, and manual tests in the treatment evaluation of chronic tennis elbow. Clin J Pain 2002;18(3):164-170.
• 33. Odabaşı ÖS, Dizdar D. Lateral Epikondilitli Hastalarda Kinesio Bantlama Uygulamasinin Ağrı ve Fonksiyonel Durum Üzerine Etkisi: Ön Çalişma. Bilimsel Tamamlayıcı Tıp Regülasyon ve Nöral Terapi Dergisi 2019;13(1):1-4.
• 34. Macit Mazlum P, Sağlam G, Erdal A. Lateral Epikondilitte Fizik Tedavi ve Steroid Enjeksiyonunun Etkinliğinin Karşılaştırılması. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi 2020;15(3):54-59.
• 35. Karas V, Hussey K, Romeo AR, Verma N, Cole BJ, Mather RC 3rd. Comparison of subjective and objective outcomes after rotator cuff repair. Arthroscopy 2013;29(11):1755-1761.
• 36. Shah KM, Baker T, Dingle A, Hansmeier T, Jimenez M, Lopez S, Marks D, Safford D, Sternberg A, Turner J, McClure PW. Early development and reliability of the timed functional arm and shoulder test. J Orthop Sports Phys Ther 2017;47(6):420-431.
• 37. Allom R, Colegate-Stone T, Gee M, Ismail M, Sinha J. Outcome analysis of surgery for disorders of the rotator cuff: a comparison of subjective and objective scoring tools. J Bone Joint Surg Br 2009;91(3):367-373.
• 38. Cooke N, Obst S, Vicenzino B, Hodges PW, Heales LJ. Upper limb position affects pain‐free grip strength in individuals with lateral elbow tendinopathy. Physiother Res Int 2021;26(3):e1906.
• 39. Dorf ER, Chhabra AB, Golish SR, McGinty JL, Pannunzio ME. Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am 2007;32(6):882-886.
• 40. Chourasia AO, Buhr KA, Rabago DP, Kijowski R, Lee KS, Ryan MP, et al. Relationships between biomechanics, tendon pathology, and function in individuals with lateral epicondylosis. J Orthop Sports Phys Ther 2013;43(6):368-378.
• 41. Chourasia AO, Buhr KA, Rabago DP, Kijowski R, Irwin CB, Sesto ME. Effect of lateral epicondylosis on grip force development. J Hand Ther 2012;25(1):27-37.
• 42. De Smet L, Fabry G. Grip strength in patients with tennis elbow. Influence of elbow position. Acta Orthop Belg 1996;62(1):26- 29.