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Mohamed Kohia, John Brackle, Kenny Byrd, Amanda Jennings, William Murray and Erin Wilfong

Objective:

To analyze research literature that has examined the effectiveness of various physical therapy interventions on lateral epicondylitis.

Data Sources:

Evidence was compiled with data located using the PubMed, EBSCO, The Cochrane Library, and the Hooked on Evidence databases from 1994 to 2006 using the key words lateral epicondylitis, tennis elbow, modalities, intervention, management of, treatment for, radiohumeral bursitis, and experiment.

Study Selection:

The literature used included peer-reviewed studies that evaluated the effectiveness of physical therapy treatments on lateral epicondylitis. Future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Data Synthesis:

Shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions.

Conclusions:

There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

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Tristan Rodik and Brendon McDermott

Clinical Scenario:

Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection.

Focused Clinical Question:

Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood?

Summary of Key Findings:

Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood injection with a 6-mo follow-up. The final study included a PrP-injection group and control group. The 2 studies involving PrP vs corticosteroid injections with 2-y and 1-y follow-ups both favored PrP over corticosteroid injection in terms of pain reduction and function increases. The third study favored PrP injections over whole-blood injections at 6 mo regarding pain reduction. All studies demonstrated significant improvements with PrP over comparison injections or no injection.

Clinical Bottom Line:

PrP injections provide more favorable pain and function outcomes than whole blood and corticosteroid injections for 1–2 y after injection.

Strength of Recommendation:

Consistent findings from RCTs suggest level 1b evidence in support of PrP injection as a treatment for LE.

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Wendy I. Drechsler, John F. Knarr and Lynn Snyder-Mackler

Eighteen subjects participated in a randomized controlled clinical trial to compare the effectiveness of two physical therapy treatments for tennis elbow. The subjects were divided into two groups: In the neural tension group (NTG), the head of the radius was mobilized and specific physical therapy mobilizations were used to address hypomobility of the radial nerve. The standard treatment group (STG) received ultrasound, transverse friction massage, and stretching and strengthening exercises for the extensors of the wrist. All subjects were treated twice weekly for 6 to 8 weeks. Follow-up data were obtained at 3 months post-treatment. Subjects who received radial head mobilization improved over time (p < .05), while those who did not receive radial head mobilization did not improve. Results of the NTG treatment were linked to the radial head treatment, and isolated effects of the NTG treatment could not be determined. There were no long-term positive results in the STG.

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Joseph M. Day, Robert Barry Dale and Elizabeth Kennedy

to Guide Search Strategy • P atient/Client group: lateral elbow tendinopathy, tennis elbow, lateral epicondylitis, lateral epicondylalgia • I ntervention: therapy, physical rehabilitation • C omparison: home exercise program • O utcome(s): pain, disability Sources of Evidence Searched • SPORTDiscus

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Blanca de la Cruz Torres

.2165/00007256-199927060-00004 10418074 6. Sharma P , Mafulli N . Tendon injury and tendinopathy: healing and repair . J Bone Joint Surg Am . 2005 ; 87 : 187 – 202 . PubMed ID: 15634833 15634833 7. Qi L , Zhu ZF , Li F , Wang RF . MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor

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Barıs Seven, Gamze Cobanoglu, Deran Oskay and Nevin Atalay-Guzel

reported that the ICC values of the isometric and concentric strength measurements of wrist flexion and extension at 60°/s angular velocity ranged from .643 to .986. A study conducted by Ng and Chan 31 on patients with lateral epicondylitis showed that the intrarater reliability of wrist isometric

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Bassam A. Nabil, Mariam A. Ameer, Azza M. Abdelmohsen, Abeer F. Hanafy, Ahmed S. Yamani, Naglaa M. Elhafez and Salam M. Elhafez

players . Phys Ther Rev . 2010 ; 15 ( 9 ): 55 – 61 . doi: 10.1179/174328810X12647087219036 16. Cohenl M , Motta GR . Lateral epicondylitis of the elbow . Rev Bras Ortop . 2012 ; 47 ( 4 ): 414 – 420 . doi: 10.1590/S0102-36162012000400002 17. Ellenbecker TS , Davies GJ . The application of

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Sergio Jiménez-Rubio, Archit Navandar, Jesús Rivilla-García and Victor Paredes-Hernández

.3047 29. Valera-Garrido F , Minaya-Muñoz F , Medina-Mirapeix F . Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results . Acupunct Med . 2014 ; 32 ( 6 ): 446 – 454 . PubMed ID: 25122629 doi:10.1136/acupmed-2014-010619 25122629 10