LATERAL EPİKONDİLİT TANILI HASTALARDA KLİNİK VE ULTRASONOGRAFİK BULGULAR İLE TEDAVİ DEĞİŞİMİ ARASINDAKİ İLİŞKİ: 6 AYLIK SONUÇLAR

Öz

Amaç Bu çalışmada; lateral epikondilit tedavisinin uzun dönem izleminde hastaların klinik bulgularının, ultrasonografik değerlendirmelerinin ve tedavi değişimlerinin arasındaki ilişkinin belirlenmesi amaçlanmıştır. Yöntem Çalışmaya dahil edilme ve dışlanma kriterlerini karşılayan ve en az 6 ay boyunca takip edilmiş olan 30 lateral epikondilit tanılı hastaların dosyaları retrospektif olarak incelenmiştir. Hastaların demografik özellikleri ile poliklinik izleminde rutin olarak yapılan ve hasta dosyalarına kaydedilmiş olan ağrı-fonksiyon değerlendirme ölçekleri, el sıkma kuvveti değerleri ve ultrasonografik değerlendirmeleri incelenmiş ve kaydedilmiştir. Visual analog skala (VAS) skorları, algometrik ölçümler, dinamometrik ölçümler, Nirschl skoru, Hasta bazlı tenisçi dirseği değerlendirme anketi (PRTEE) skorları, kapitellar bölge maksimum tendon kalınlığı ölçümleri ve total ultrasonografi skalası skorlamaları; hasta değerlendirme parametreleri olarak kullanılmıştır. Hastalarda değişim yapılan tedavi varlığı (atel ve egzersiz yanıtı olmamış ve ESWT, steroid enjeksiyonu, PRP enjeksiyonu vb. tedavilerin uygulandığı) da değerlendirilmiştir. Hastaların tedavi öncesi, tedavi sonrası 1. ay, 3. ay ve 6. ayındaki tüm parametrelerindeki değerler kayıtlanmıştır. Bulgular En az 6 ay boyunca lateral epikondilit tanısıyla takip edilmiş, yaş ortalaması 49.1±9.2 olan 21 kadın ve 9 erkek hastanın verileri değerlendirildi. Hastaların ortalama semptom süresi 3.7±4.2 aydı. Çalışmaya alınan tüm hastaların klinik ve ultrasonografik değerlendirme ölçütlerinde 6 aylık takip sonunda belirgin iyileşme saptandı (p<0.001). Hastaların %40’ında (n=12) konservatif yöntemlere ek tedavi değişikliği yapıldığı saptandı. Demografik veriler açısından tedavi değişimi olanlar ile olmayanlar arasında anlamlı bir farklılık saptanmadı (p>0.05). Tedavi değişimi olanların VAS-istirahat, VAS-Gece, VAS-aktivite ve PRTEE-total skorları tedavi değişimi olmayanlara göre anlamlı olarak yüksekti (sırasıyla p=0.014, p=0.02, p=<0.01, p=0.009). Diğer değerlendirme parametreleri arasında ise anlamlı farklılık saptanmadı (p>0.05). Tartışma ve Sonuç Lateral epikondilitli hastalarda altı aylık takipte konservatif tedavi değişimine katkıda bulunan temel parametrelerin yalnızca VAS (istirahat, gece ve aktivite) ve PRTEE total skorları olduğu bulunmuştur.

Anahtar Kelimeler

• lateral epikondilit
• ultrasonografi
• konservatif tedavi

THE RELATIONSHIP BETWEEN CLINICAL AND ULTRASOUND FINDINGS AND CHANGES IN TREATMENT IN PATIENTS WITH LATERAL EPISCONDYLITIS: 6-MONTH RESULTS

Öz

Objective The aim of this study was to determine the relationship between clinical findings, ultrasonographic evaluations, and treatment changes in the long-term follow-up of patients treated for lateral epicondylitis. Method The files of 30 patients diagnosed with lateral epicondylitis, who met the inclusion and exclusion criteria and were followed for at least 6 months, were retrospectively reviewed. The demographic characteristics of the patients, as well as pain-function assessment scales, grip strength values, and ultrasonographic evaluations routinely performed during outpatient follow-up and recorded in patient files, were examined and recorded. Visual Analog Scale (VAS 0-10 cm) scores, algometric measurements, dynamometric measurements, Nirschl scores, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, maximum tendon thickness measurements in the capitellar region, and Total Ultrasonography Scale scores were used as patient evaluation parameters. The presence of treatment changes (such as application of ESWT, steroid injection, PRP injection, etc., for those who did not respond to splint and exercise) was also evaluated. All parameter values before treatment, at 1 month, 3 months, and 6 months post-treatment were recorded. Results Data from 21 female and 9 male patients, with an average age of 49.1±9.2 years, who were followed for at least 6 months with a diagnosis of lateral epicondylitis were evaluated. The average symptom duration of the patients was 3.7±4.2 months. Significant improvement was observed in the clinical and ultrasonographic evaluation criteria of all patients at the end of the 6-month follow-up (p<0.001). It was found that 40% (n=12) of the patients required additional treatment changes to conservative methods. No significant difference was found between those with and without treatment changes in terms of demographic data (p>0.05). The VAS-rest, VAS-night, VAS-activity, and PRTEE-total scores of those with treatment changes were significantly higher compared to those without treatment changes (p=0.014, p=0.02, p=<0.01, p=0.009 respectively). No significant difference was found between the other evaluation parameters (p>0.05). Discussion and Conclusion It was found that the main parameters contributing to the need for conservative treatment changes in patients with lateral epicondylitis during a six-month follow-up were only VAS (rest, night and activity) and PRTEE total scores.

Anahtar Kelimeler

• lateral epicondylitis
• ultrasonography
• conservative treatment

Kaynakça

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