Lateral Epikondilit mi, Yoksa Fibromiyalji Hassas Noktası mı? Tanısal Yanılgılar ve Gereksiz ESWT Uygulama Riski

Öz

Amaç: Bu çalışmanın amacı, Ekstrakorporeal Şok Dalga Tedavisi (ESWT) tedavisi alan lateral epikondilitli hastalarda fibromiyalji sendromu sıklığını belirlemektir. Gereç ve Yöntemler: Çalışma retrospektif bir çalışmaydı. Ocak 2017 ile Aralık 2023 tarihleri arasında Şehir Hastanesi Fizik Tedavi Ünitesinde ESWT tedavisi gören tüm hastalar geriye dönük olarak taranarak lateral epikondilit tanısı alan hastalar çalışmaya dahil edildi. Hastaların yaş, cinsiyet gibi demografik bilgileri; epikondilit tarafı, ESWT seans sayısı, fatura tutarı, maliyeti ve fibromiyalji sendromu tanısı olup olmadığı kaydedildi. Bulgular: Çalışmaya lateral epikondilit tanısıyla ESWT tedavisi alan toplam 2810 hasta dahil edildi. 1851 hastaya tek taraflı epikondilit tanısı konulurken, 959 hastaya bilateral epikondilit tanısıyla tedavi uygulandı. Tek taraflı epikondilitli hastaların 1319’u (%71,3) kadın iken bilateral epikondilitli hastaların 761’i (%79,4) kadındı ve gruplar arasında anlamlı cinsiyet farklılığı vardı, bilateral epikondilitte kadın cinsiyet daha sık görülüyordu (p: 0,000). Tek taraflı epikondilitli hastaların yaş ortalaması 46,30±12,73 yıl, bilateral epikondilitli hastaların yaş ortalaması 46,54±11,83 yıl olup, yaş ortalamaları açısından gruplar arasında anlamlı fark yoktu (p:0,626). Tek taraflı epikondilit hastalarının 11(0,6)’inde fibromiyalji sendromu bulunurken, bilateral epikondilit hastalarının 184(%19,2)’ünde fibromiyalji sendromu vardı ve fibromiyalji sendromu sıklığı açısından gruplar arasında anlamlı fark vardı, bilateral epikondilitte fibromiyalji sendromu daha sık görülüyordu (p: 0,000). Hem lateral epikondilit hem de fibromiyalji sendromunun kadınlarda ve orta yaşta daha sık görüldüğünü bulduk. Sonuç: Çalışmamız lateral epikondilitte fibromiyalji sendromunu araştıran ilk çalışmadır. Bilateral epikondilitte fibromiyalji sendromu sıklığının normal popülasyon çalışmalarına göre arttığı görüldü. Fibromiyalji Tanı Kriterleri'nde yer alan yaygın ağrı bölgelerinden biri olan lateral epikondil bölgesi tanı karışıklığına yol açabilir ve hastalara aslında fibromiyalji olmasına rağmen yanlışlıkla lateral epikondilit tanısı konulmuş olabilir ve gereksiz yere ESWT tedavisi almış olabilirler. Çalışmamızın sonuçları, lateral epikondilitli hastalarda fibromiyalji sıklığının klinisyenler tarafından göz önünde bulundurulması gerektiğini vurgulamaktadır. Özellikle bilateral lateral epikondilitli hastalarda fibromiyaljinin eşlik edebileceği akılda tutulmalı ve hastalara öncelikle ilaç, egzersiz, yaşam tarzı değişiklikleri, alternatif ve destekleyici tedaviler gibi multidisipliner bir tedavi olan fibromiyalji tedavisi verilmeli ve pahalı ESWT tedavisinin gereksiz yere kullanılmaması konusunda farkındalık yaratılmalıdır.

Anahtar Kelimeler

• Lateral Epikondilit
• Ekstrakorporeal Şok Dalga Tedavisi
• Fibromiyalji Sendromu
• Prevalans

Lateral Epicondylitis or Fibromyalgia Tender Point? Diagnostic Pitfalls and the Risk of Unnecessary ESWT

Öz

Objective: The aim of this study is to determine the frequency of fibromyalgia syndrome in patients with lateral epicondylitis receiving Extracorporeal Shock Wave Therapy (ESWT) treatment. Material and Methods: The study was a retrospective study. All patients who received ESWT treatment in City Hospital Physical Therapy Unit between January 2017 and December 2023 were retrospectively screened and patients with a diagnosis of lateral epicondylitis were included in study. Demographic information of patients such as age and gender; epicondylitis side, number of ESWT sessions, invoice amount, cost and whether have diagnosis of fibromyalgia syndrome were recorded. Results: A total of 2810 patients who received ESWT treatment with the diagnosis of lateral epicondylitis were included in study. While 1851 patients were diagnosed with unilateral epicondylitis, 959 patients were treated with the diagnosis of bilateral epicondylitis. While 1319 (71.3%) of the patients with unilateral epicondylitis were women, 761 (79.4%) of the patients with bilateral epicondylitis were women and there was a significant gender difference between groups, and female gender was more common in bilateral epicondylitis (p: 0.000). The mean age of patients with unilateral epicondylitis was 46.30±12.73 years, while the mean age of patients with bilateral epicondylitis was 46.54±11.83 years, and there was no significant difference between groups in terms of mean age (p:0.626). While 11(0.6) of unilateral epicondylitis patients had fibromyalgia syndrome, 184(19.2%) of bilateral epicondylitis patients had fibromyalgia syndrome and there was a significant difference between groups in terms of fibromyalgia syndrome frequency, and fibromyalgia syndrome was more common in bilateral epicondylitis (p: 0.000). We found both lateral epicondylitis and fibromyalgia syndrome more common in women and middle age. Conclusion: Our study is the first to investigate the fibromyalgia syndrome in lateral epicondylitis. It was observed that frequency of fibromyalgia syndrome increased in bilateral epicondylitis compared to normal population studies. The lateral epicondyle region, one of the common pain areas included in the Fibromyalgia Syndrome Diagnostic Criteria, can lead to diagnostic confusion and patients may have been mistakenly diagnosed with lateral epicondylitis despite actually having fibromyalgia syndrome and may have received unnecessary ESWT treatment. It should be kept in mind that fibromyalgia syndrome may accompany patients with bilateral lateral epicondylitis in particular, and patients should first be given fibromyalgia treatment, which is a multidisciplinary treatment such as medication, exercise, lifestyle changes, alternative and supportive therapies, and awareness should be raised about not using the costly ESWT treatment unnecessarily.

Anahtar Kelimeler

• Lateral Epicondylitis
• Extracorporeal Shock Wave Therapy
• Fibromyalgia Syndrome
• Prevalence

Kaynakça

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