A Comparison of the Short-Term Efficacy of Physiotherapy Approaches in Patients with Lateral Epicondylitis

Öz

The study aimed to investigate the short-term effects of radial nerve self-mobilization [RNSM], manual therapy [MT], and extracorporeal shock wave therapy [ESWT] on pain, pain-free grip strength, functional status, and patient satisfaction in patients with Lateral Epicondylitis [LE] and to determine the superiority of these methods to each other. 48 patients diagnosed with LE were included in the study and were randomly divided into three groups. RNSM was applied to all patients as a home program. The first group [n=16] received only the RNSM as a home program, the MT group [n=16] received MT combined with RNSM, and the ESWT group [n=16] received ESWT combined with RNSM. The RNSM was applied five days per week, and the MT and ESWT for two sessions per week for three weeks. Pain severity, pain-free handgrip strength, functionality levels, and patient satisfaction were evaluated before and after three weeks of treatment. The pain level significantly decreased, and handgrip strength and functionality increased in all groups after three weeks [p<0.001]. In comparison between the groups, the decrease in pain level, the increase in maximum grip strength, and patients' overall satisfaction scores were found to be higher in the MT group than in the ESWT, and only the RNSM groups [p<0.05]. MT application combined with radial nerve self-mobilization exercises in the treatment of LE appears to be more effective.

Anahtar Kelimeler

• Lateral epicondylitis
• radial nerve mobilization
• manual therapy
• extracorporeal shock wave therapy
• pain

Lateral Epikondilitli Hastalarda Fizyoterapi Yaklaşımlarının Kısa Dönem Etkinliğinin Karşılaştırılması

Öz

Çalışmamızdaki amaç Lateral Epikondilit’te [LE] self radial sinir mobilizasyonu [RSM], manuel terapi [MT], ekstrakorporeal şok dalga tedavisi [ESWT]’nin ağrı, kavrama kuvveti, fonksiyonel durum ve hasta memnuniyeti üzerindeki erken dönem etkilerinin araştırılması ve bu yöntemlerin birbirlerine göre üstünlüğünü belirlemektir. Çalışmaya 48 LE tanılı hasta dahil edildi ve rastgele üç gruba ayrıldı. Tüm hastalara ev programı olarak RSM uygulandı. Birinci grup [n=16] sadece RSM'yi ev programı olarak, MT grubu [n=16] RSM ile birlikte MT ve ESWT grubu [n=16] RSM ile birlikte ESWT aldı. RSM haftada beş gün, MT ve ESWT ise üç hafta boyunca haftada iki seans uygulandı. Üç haftalık tedaviden önce ve sonra ağrı şiddeti, ağrısız kavrama gücü, işlevsellik düzeyleri ve hasta memnuniyeti değerlendirildi. Üç haftalık tedavi sonrasında tüm gruplarda ağrı düzeyi anlamlı olarak azalırken kavrama gücü ve fonksiyonellikte artış oldu [p<0.001]. Gruplar arası karşılaştırmada ise ağrı düzeyindeki azalma, maksimum kavrama gücündeki artış ve hastaların genel memnuniyet skorları MT grubunda ESWT ve sadece RSM gruplarına göre daha yüksek bulundu [p<0.05]. LE tedavisinde RSM egzersizleri ile kombine MT uygulamasının daha etkili olduğu düşünülmektedir.

Anahtar Kelimeler

• Lateral epikondilit
• radial sinir mobilizasyonu
• manuel terapi
• ekstrakorporeal şok dalga tedavisi
• ağrı
• Lateral epicondylitis
• radial nerve mobilization
• manual therapy
• extracorporeal shock wave therapy
• pain

Kaynakça

1. [1] Vaquero-Picado, A., Barco, R., Antuña, SA. 2017. Lateral epicondylitis of the elbow. EFORT Open Rev. 1[11], 391-7.
2. [2] Coombes, BK., Bisset, L., Vicenzino, B. 2015. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther. 45[11], 938-49.
3. [3] Bisset, L., Paungmali, A., Vicenzino, B., Beller, E. 2005. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 39[7], 411-22.
4. [4] Lenoir, H., Mares, O., Carlier, Y. 2019. Management of lateral epicondylitis. Orthop Traumatol Surg Res. 105[8]: 241-6.
5. [5] Weber, C., Thai, V., Neuhauser, K., Groover, K., Christ, O. 2015. Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis. BMC Musculoskelet Disord.16, 223.
6. [6] Marcolino, AM., das Neves, LM., Oliveira, BG., Alexandre, AA., Corsatto, G., Barbosa, RI., de Cássia Registro Fonseca, M. 2016. Multimodal approach to rehabilitation of the patients with lateral epicondylosis: a case series. Springerplus. 5[1], 1718.
7. [7] Hoogvliet, P., Randsdorp, MS., Dingemanse, R., Koes, BW., Huisstede, BM. 2013. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 47[17], 1112-9.
8. [8] Basson, A., Olivier, B., Ellis, R., Coppieters, M., Stewart, A., Mudzi, W. 2017. The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 47[9], 593-615.

9. [9] Yilmaz, K., Yigiter Bayramlar, K., Ayhan, C., Tufekci, O. 2022. Investigating the effects of neuromobilization in lateral epicondylitis. J Hand Ther. 35[1], 97-106.
10. [10] Butler, D. 1989. Adverse Mechanical Tension in the Nervous System: A Model for Assessment and Treatment. Australian Journal of Physiotherapy. 35(4), 227-38.
11. [11] Paungmali, A., O’Leary, S., Souvlis, T., Vicenzino, B. 2003. Hypoalgesic and sympathoexcitatory effects of mobilization with movement for lateral epicondylalgia. Phys Ther. 83[4], 374–83.
12. [12] Lucado, AM., Dale, RB., Vincent, J., Day, JM. 2019. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J Hand Ther. 32[2], 262-76.
13. [13] Ahmed, A., Ibrar, M., Arsh, A., Wali, S., Hayat, S., Abass, S. 2021. Comparing the effectiveness of Mulligan mobilization versus Cyriax approach in the management of patients with subacute lateral epicondylitis. J Pak Med Assoc. 71[1], 12-5.
14. [14] Richer, N., Marchand, AA., Descarreaux, M. 2017. Management of Chronic Lateral Epicondylitis with Manual Therapy and Local Cryostimulation: A Pilot Study. J Chiropr Med. 16[4], 279-88.
15. [15] Dıraçoğlu, D. 2004. Kas-İskelet sistemi hastalıklarında ekstrakorporal şok dalga tedavisi. Turkiye Klinikleri J PM&R, 4, 104-6.
16. [16] Yao, G., Chen, J., Duan, Y., Chen, X. 2020. Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Biomed Res Int.2020:2064781.
17. [17] Bijur, PE., Silver, W., Gallagher, EJ. 2001. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 8[12], 1153-7.
18. [18] Dorf, ER., Chhabra, AB., Golish, SR., McGinty, JL., Pannunzio, ME. 2007. Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am. 32[6], 882–6.
19. [19] Duger, T., Yakut, E., Oksuz, C., Yorukan, S., Bilgutay, B. S., Ayhan, C.2006. Reliability and validity of the Turkish version of the disability of the arm, shoulder and hand-DASH questionnaire. Fizyoterapi Rehabilitasyon.17[3], 99–107.
20. [20] Erden, A., Topbas, M. 2019. Turkish validity and reliability of the Patient Satisfaction Scale in Physiotherapy for Patients with Musculoskeletal Pain. J Back Musculoskelet Rehabil. 32[2], 197–203.
21. [21] IBM SPSS Statistics for Windows, Version 21. 0. Armonk, NY.
22. [22] Yuruk, ZO., Kırdı, N., Sımsek, N. 2016. Effects of Extracorpereal Shock Wave Therapy on Pain, Grip Strenght and Functionality in Patient with Lateral Epicondylitis: A Randomized Controlled Study. Clinical and Experimental Health Sciences. 6[3], 107-15.
23. [23] Villafañe, J. H., Silva, G. B., Bishop, M.D., Fernandez-Carnero, J. 2012. Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil. 93[3], 396–403.
24. [24] Reyhan, A. C., Sindel, D., Dereli, E. E. 2020. The effects of Mulligan’s mobilization with movement technique in patients with lateral epicondylitis. J Back Musculoskelet Rehabil. 33[1], 99–107.
25. [25] Yi, R., Bratchenko, W. W., Tan, V. 2018. Deep friction massage versus steroid injection in the treatment of lateral epicondylitis. Hand.13[1], 56–9.
26. [26] Bialosky, J.E., Bishop, M.D., Price, D.D., Robinson, M.E., George, S.Z. 2009. The mechanisms of manual therapy in treating musculoskeletal pain: a comprehensive model. Man Ther. 14, 531-8.
27. [27] Bialosky, J.E., Beneciuk, J.M., Bishop, M.D., Coronado, R.A., Penza, C.W., Simon, C.B., George, S.Z. 2018. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther. 48(1), 8-18.
28. [28] Capan, N., Esmaeilzadeh, S., Oral, A., Basoglu, C., Karan, A., Sindel, D. 2016. Radial extracorporeal shock wave therapy is not more effective than placebo in the management of lateral epicondylitis: a double-blind, randomized, placebo-controlled trial. American journal of physical medicine & rehabilitation. 95[7], 495–506.
29. [29] Devrimsel, G., Kucukali, T., Turkyilmaz, A., Yildirim, M., Ulaslı, A. M. 2014. A Comparison of Laser and Extracorporeal Shock Wave Therapies in Treatment of Lateral Epicondylitis. Turk J of Phys Med. 60, 194-8.
30. [30] Ibrahim, N.H., El Tanawy, R.M., Mostafa, A. F. S. 2021. Extracorporeal shock wave therapy [ESWT] versus local corticosteroid injection in treatment of lateral epicondylitis [tennis elbow] in athletes: clinical and ultrasonographic evaluation. Egypt Rheumatol Rehabil. 48, 32.
31. [31] Aydin, A., Atic, R. 2018. Comparison of extracorporeal shock-wave therapy and wrist-extensor splint application in the treatment of lateral epicondylitis: a prospective randomized controlled study. Journal of pain research. 11, 1459.
32. [32] Ortega-Castillo, M., Medina-Porqueres, I. 2015. Effectiveness of the eccentric exercise therapy in physically active adults with symptomatic shoulder impingement or lateral epicondylar tendinopathy: A systematic review. J Sci Med Sport. 19(6), 438-53.
33. [33] Oskay, D., Meriç, A., Kirdi, N., Firat, T., Ayhan, C., Leblebicioğlu, G. 2010. Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases. J Manipulative Physiol Ther. 33(2),156-63.