Lateral Epikondilitli Hastalarda Ultrason, Diklofenak ve Hidrokortizonla Yapılan Fonoforezin Etkinliğinin Karşılaştırılması: Çift Kör, Randomize, Plasebo Kontrollü Çalışma

Abstract

Çalışmanın amacı ultrason (US), diklofenakla fonoforez ve hidrokortizonla fonoforezin lateral epikondilit tedavisindeki etkinliğini karşılaştırmaktır. Lateral epikondilit tanı kriterlerini karşılayan 43 hasta tedavi öncesi ve sonrası (2.hafta, 6. hafta ve 3. ay) klinik, fonksiyonellik ve yaşam kalitesi açısından değerlendirildi. Visual Analog Skala (VAS); istirahatte (VAS), gece (VASgece) ve zorlu ekstansiyonda (VAShareket) değerlendirildi. JAMAR® marka el dinamometresi ile grip kuvveti, parmak dinamometresi ile pinç kuvveti bakıldı. Sağlık değerlendirme anketi (HAQ) ve hasta bazlı tenisçi dirseği değerlendirme (PRTEE) anketi yapıldı. PRTEE; PRTEEağrı, PRTEEfonksiyon ve PRTEEtotal olarak değerlendirildi. Hastalar randomize olarak 4 gruba ayrıldı:1.grup: hidrokortizonla fonoforez (n:9), 2.grup: diklofenakla fonoforez (n:13), 3. grup: plasebo US (n:12), 4. grup: US (n:9). Gruplara tedavileri çift kör olarak uygulandı. 1., 2. ve 4.gruba US 1 MHz-1watt/cm²/5' 10 seans, 3.gruba plasebo US 5' 10 seans olarak uygulandı.1.gruba US eşliğinde %0,1 hidrokortizon, 2.gruba US eşliğinde %1 diklofenak jel, 3. ve 4. gruba ise US jeli uygulandı. Hastaların tümüne germe egzersizi verildi. NSAID kullanmalarına izin verilmedi, ağrı kontrolü için lüzum halinde parasetamol önerildi. Yaş ortalaması, cinsiyet, tutulmuş olan taraf, dominant el, ağrı süresi açısından, VAS, VASgece, VAShareket, pinç kuvveti, grip kuvveti, PRTEEağrı, PRTEEfonksiyon ve PRTEEtotal ve HAQ skorları başlangıç değerleri açısından gruplar arasında istatistiksel olarak anlamlı bir farklılık yoktu (p>0,05). HAQ skorlarına bakıldığında 1., 2. ve 4. gruplarda istatistiksel olarak farklılık varken 3.grupta anlamlı bir düzelme mevcut değildi (sırasıyla p:0,02, p:0,03, p:0,06 p:0,01). PRTEEtotal skoru açısından incelendiğinde 1., 2.ve 4. gruplarda istatistiksel olarak anlamlı derecede düzelme mevcuttu (sırasıyla p:0,000, p:0,002, p:0,001). 3.grupta istatistiksel olarak anlamlı düzelme sağlanamadı(p:0,05). Lateral epikondilit tedavisinde kontrol grubu ile karşılaştırıldığında tüm tedavi gruplarında ağrı ve yaşam kalitesi skorlarında iyileşme sağlanmıştır. Her üç tedavi seçeneği lateral epikondilit tedavisinde etkin bir tedavi seçeneği olarak görülebilir.

Keywords

• lateral epikondilit
• fonoforez
• ultrason
• diklofenak
• hidrokortizon

Comparison of the Effectiveness of Ultrasound and Phonophoresis with Diclofenac and Hydrocortisone in Patients with Lateral Epicondylitis: Double Blind, Randomized, Placebo Controlled Study

Abstract

Objective: The purpose of study was to compare the effectiveness of diclofenac phonophoresis, hydrocortisone phonophoresis and ultrasound (US) in lateral epicondylitis (LE) treatment. Methods: Forty-three participants with chronic LE were evaluated for clinical, functional, and quality of life (baseline, week 2, week 6, and months 3). Patients were divided randomly into 4 groups. The patients in the first group (group 1) (n=12) were accepted phonophoresis with hydrocortisone, second group (group 2) (n=13) were accepted phonophoresis with diclofenac, fourth group (group 4) (n=9) were accepted US, third group (group 3) (n=9) were placebo US. The US therapy 1 MHz-1 watt/cm²/5' for ten sections was applied to the first, second, and fourth groups. The placebo US was applied five minutes for ten sections to third group. 0,1 % hydrocortisone gel to the first group, diclofenac gel to the second group and ultrasound gel to the third and fourth group were applied. Results: A statistically considerable difference was found in the 1st, 2nd, and 4th groups, but there was no considerable improvement in the 3rd group in HAQ scores (p=0.02, p=0.03, p=0.06, p=0.01). When examined PRTEEtotal score, there was a statistically significant improvement in the 1st, 2nd, and 4th groups (p=0.000, p=0.002, p=0.001). There was no a statistically significant improvement in the 3rd group (p=0.05). Conclusion: The improvement was achieved in pain and quality of life scores in all treatment groups compared to the control group in lateral epicondylitis. As a result, all three treatment options can be seen as an effective treatment option for lateral epicondylitis treatment.

Keywords

• lateral epicondylitis
• phonophoresis
• ultrasound
• diclofenac
• hydrocortisone

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