PK{:ʇ|9|9refs.MYD `<7 Storm, S. A.2006ZAssessing the instrumentalist interface: modifications, ergonomics and maintenance of play893-903Phys Med Rehabil Clin N Am174]Biomechanics Human Engineering Humans Musculoskeletal System/*injuries/physiopathology *MusicNov Awareness of the tasks required to play a particular instrument requires observation of technique and understanding of the dynamic and static loads placed on the musculoskeletal system to play a particular instrument. Anatomic differences, variation in hand size, gender, instrument choice, and maintainance of the instrument all may play a role in the development of playing-related complaints. Simply observing particular instruments, we can see a variety of positions that are required to play the instrument. Important to the discussion of overuse syndromes, we must evaluate the duration of practice sessions and warm-up and cool down periods, which may help minimize playing-related problems. Avoid absolute rest and opt for relative rest for playing-related problems. Immobilization for more than 3 to 4 weeks may lead to greater risk of injury when playing is resumed. Return to play schedules should start with simple, soft music, doubling minutes of playing every few days, dropping back if pain develops. Practical advice may include building up practice times gradually with 5- to 10-minute intervals in 60- to 90-minutes sessions. This recommendation is supported by the findings of Lutz and colleagues who showed decreased blood flow to the forearm after repetitive hand and wrist activities for 90 minutes. This decrease in blood flow normalized after 5 to 10 minutes of stretching exercises. Players with hypermobility should consider limiting practice sessions to 45 minutes allowing for rest breaks of 10 to 15 minutes. Fry suggested a shift in thinking of ergonomics as sa reactive strategy to one in which we anticipate and prevent problems before they become insidious or severe enough to limit the ability of the instrumentalist to play. Joint protection is important in all musicians, and although youth can be forgiving for many, we must remind our patients about joint protection as it applies to activities of daily living. Instrumentalists rely on their hands and finger joints to allow them to perform. Basic principles that apply to patients with all types of arthritis also apply to our patients when activities that worsen symptoms or place unnecessary stress on joints are identified. Using adaptive equipment to open jars is an obvious example. Overall, engaging the patient to observe routine behaviors may lead to the identification of modifiable activities, which might be aggravating or manifesting as a playing-related discomfort. Although some injury patterns can be associated with particular instruments, remember that your guitar-playing patient may be taking drum lessons on the side, Which could result in lateral epicondylitis that bothers him when he plays the guitar.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17097488 $Journal Article Review United States1047-9651 (Print)=Physical medicine and rehabilitation clinics of North America17097488Michigan State University College of Osteopathic Medicine, Department of Physical Medicine and Rehabilitation, B401 West Fee Hall, East Lansing, MI 48824, USA. seneca.storm@ht.msu.edueng9<7Pascarelli, E. F. Hsu, Y. P.2001tUnderstanding work-related upper extremity disorders: clinical findings in 485 computer users, musicians, and others1-21J Occup Rehabil111Adolescent Adult Aged Arm Back Chronic Disease Computer Terminals Cumulative Trauma Disorders/diagnosis/epidemiology/etiology/*physiopathology Female Humans Joints Male Middle Aged Musculoskeletal Diseases/diagnosis/epidemiology/etiology/*physiopathology Music Neck New York City/epidemiology Occupational Diseases/diagnosis/epidemiology/etiology/*physiopathology Pain/diagnosis/epidemiology/etiology/*physiopathology Physical Examination Thoracic Outlet Syndrome/diagnosis/epidemiology/etiology/*physiopathologyMar Four hundred eighty five patients whose chief complaints were work related pain and other symptoms received a comprehensive upper-body clinical evaluation to determine the extent of their illness. The group had a mean age of 38.5 years. Sixty-three percent of patients were females. Seventy percent were computer users, 28% were musicians, and 2% were others engaged in repetitive work. The time between the onset of symptoms and our initial visit ranged from 2 weeks to over 17 years. A majority sought care within 30 months with the greatest number of them seeking care before 12 months. Fifty nine percent of subjects were still working when seen despite increasing pain and symptoms such as weakness, numbness, tingling, and stiffness. Following a history, a physical assessment utilizing commonly employed clinical tests were performed including evaluation of joint range of motion, hyperlaxity, muscle tenderness, pain, strength, and imbalance. Neurologic tests included Tinel's sign performed in wrist, elbow, tricipital sulcus, and neck and tests for thoracic out syndrome (TOS). Specific tests such as Finkelstein's test for deQuervain's tenosynovitis, Phalen's test for carpal tunnel syndrome and grip strengths were included in the examination protocol. Significant findings included postural misalignment with protracted shoulders (78%), head forward position (71%), neurogenic TOS (70%), cervical radiculopathy (0.03%), evidence of sympathetic dysfunction (20%), and complex regional pain syndrome (RSD) (0.6%). Hyperlaxity of fingers and elbows was found in over 50%, carpal tunnel syndrome in 8%, radial tunnel syndrome in 7%, cubital tunnel in 64%, shoulder impingement in 13%, medial epicondylitis in 60%, lateral epicondylitis in 33%, and peripheral muscle weakness in 70%. We conclude that despite initial presentation distally, work-related upper-extremity disorders are a diffuse neuromuscular illness with significant proximal upper-body findings that affect distal function. While neurogenic TOS remains a controversial diagnosis, the substantial number of patients with positive clinical findings in this study lends weight to the concept that posture related neurogenic TOS is a key factor in the cascading series of physical events that characterize this illness. A comprehensive upper-body examination produces findings that cannot be obtained through laboratory tests and surveys alone and lays the ground work for generating hypotheses about the etiology of work related upper-extremity disorders that can be tested in controlled investigations.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11706773 Journal Article United States1053-0487 (Print)&Journal of occupational rehabilitation11706773{Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA. efp1@columbia.edueng<7Lederman, R. J.2003DNeuromuscular and musculoskeletal problems in instrumental musicians549-61 Muscle Nerve275Humans Musculoskeletal Diseases/*diagnosis/therapy *Music Neuromuscular Diseases/*diagnosis/therapy Occupational Diseases/*diagnosis/therapyMayOver the past 20 years, there has been increasing interest in the medical problems of performing artists. In this review, the major playing-related disorders seen in instrumental musicians are discussed. Among the 1353 instrumentalists personally evaluated, the major diagnoses included musculoskeletal disorders in 64%, peripheral nerve problems in 20%, and focal dystonia in 8%. Of these instrumentalists, 60% were women, although men were the majority in the group with focal dystonia. The average age at the time of evaluation was 37 years for men and 30 years for women. Among musculoskeletal disorders, regional muscle pain syndromes, particularly of the upper limb, upper trunk, and neck, were most common. Specific entities such as tendinitis and ligament sprain were less common. Frequent peripheral nerve disorders included thoracic outlet syndrome, ulnar neuropathy at the elbow, and carpal tunnel syndrome. Each instrument group showed a characteristic distribution of symptoms and signs that appeared to be directly related to the static and dynamic stresses inherent in the playing of the instrument. Electrodiagnostic studies are an important part of the evaluation of these disorders, particularly nerve entrapment syndromes. With carefully designed treatment, the majority of instrumental musicians can return to full and pain-free playing. Nerve entrapment syndromes have the highest treatment success rate, followed by musculoskeletal pain syndromes. Despite some recent innovative approaches, focal dystonia remains largely resistant to therapy.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12707974 $Journal Article Review United States0148-639X (Print)Muscle & nerve12707974Department of Neurology and Medical Center for Performing Artists, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. ledermr@ccf.orgeng<7 Ernst, E.1992%Conservative therapy for tennis elbow55-7Br J Clin Pract461Anti-Inflammatory Agents, Non-Steroidal/therapeutic use Humans Immobilization Prognosis Tennis Elbow/*therapy Ultrasonic TherapySpringTennis elbow is a common overuse syndrome. It is accompanied by degenerative changes in the enthesis of the extensor carpi radialis brevis muscle. It may be best diagnosed clinically by eliminating other possible causes of lateral elbow pain. Physical methods should always be selected as initial treatment. Immobilisation is the initial advice that most doctors give: ultrasound has been shown to be effective in a placebo-controlled, double-blind trial, and low energy laser has been found to reduce objective but not subjective symptoms. Other forms of physical treatment like electrotherapy, thermotherapy and massages can be tried, even though proof of their efficacy needs to be established more firmly. When physical treatments have failed, steroid injections can help. If symptoms still persist, then surgery is called for. There are still many open questions surrounding the syndrome of tennis elbow. Research into this common soft tissue disease should be intensified.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1419555 Journal Article Review England0007-0947 (Print)(The British journal of clinical practice1419555YDepartment of Physical Medicine and Rehabilitation, Medical School, University of Vienna.eng B<7 Field, L. D. Savoie, F. H.1998Common elbow injuries in sport193-205 Sports Med263*Athletic Injuries/diagnosis/therapy Collateral Ligaments/injuries Cumulative Trauma Disorders/*etiology Diagnosis, Differential Elbow Joint/*injuries Glucocorticoids/therapeutic use Humans Osteochondritis Dissecans/diagnosis Tennis Elbow/diagnosis/therapySep Athletes of all ages and skill levels are increasingly participating in sports involving overhead arm motions, making elbow injuries more common. Among these injuries is lateral epicondylitis, which occurs in over 50% of athletes using overhead arm motions. Lateral epicondylitis is characterised by pain in the area where the common extensor muscles meet the lateral humeral epicondyle. The onset of this pathological condition begins with the excessive use of the wrist extensor musculature. Repetitive microtraumatic injury can lead to mucinoid degeneration of the extensor origin and subsequent failure of the tendon. Lateral epicondylitis can almost always be treated nonoperatively with activity modification and specific exercises. If the athlete fails to respond to nonoperative treatment after 6 months to 1 year, they are candidates for surgical intervention. Medial epicondylitis is characterised by pain and tenderness at the flexor-pronator tendinous origin with pathology commonly being located at the interface between the pronator teres and flexor carpi radialis origin. Golfers and tennis players often develop this condition because of the repetitive valgus stress placed on the medial elbow soft tissues. Careful evaluation is important to differentiate medial epicondylitis from other causes of medial elbow pain. As with lateral epicondylitis, patients with medial epicondylitis not responding to an extensive nonoperative programme are candidates for surgical intervention. A less common cause of medial elbow pain is medial ulnar collateral ligament injury. Repetitive valgus stress placed on the joint can lead to microtraumatic injury and valgus instability. When the medial1|7Hoppmann, R. A.1997.Ulnar nerve entrapment in a French horn player290-3J Clin Rheumatol35OctHNerve entrapment syndromes are frequent among musicians. Because of the demands on the musculoskeletal system and the great agility needed to per-form, musicians often present with vague complaints early in the course of entrapment, which makes the diagnosis a challenge for the clinician. Presented here is such a case of ulnar nerve entrapment at the left elbow of a French horn player. This case points out some of the difficulties in establishing a diagnosis of nerve entrapment in musicians. It also supports the theory that prolonged elbow flexion and repetitive finger movement contribute to the development of ulnar entrapment at the elbow. Although surgery is not required for most of the musculoskeletal problems of musicians, release of an entrapped nerve refractory to conservative therapy may be career-saving for the musician.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19078205 WJournal Article United States practical reports on rheumatic & musculoskeletal diseases1076-1608 (Print)19078205}Division of Allergy, Immunology, and Rheumatology, University of South Carolina School of Medicine, Columbia, South Carolina.eng<7*Charness, M. E. Ross, M. H. Shefner, J. M.1996gUlnar neuropathy and dystonic flexion of the fourth and fifth digits: clinical correlation in musicians431-7 Muscle Nerve194Adolescent Adult Dystonia/diagnosis/*physiopathology Electrophysiology Female Fingers/*innervation Humans Male Middle Aged Movement *Music Peripheral Nervous System Diseases/diagnosis/physiopathology Ulnar Nerve/*physiopathologyAprPeripheral nerve lesions are sometimes associated with focal dystonia. We diagnosed ulnar neuropathy in 28 of 73 (40%) cases of occupational cramp in musicians. Focal slowing of ulnar conduction across the elbow was identified in 15 of 19 (79%) patients using the near nerve technique and in 5 of 17 (29%) patients using surface recording. Ulnar neuropathy was present in 24 of 31 (77%) cases with flexion dystonia of the fourth and fifth digits and only 4 of the remaining 42 (10%) cases with other patterns of focal dystonia. Focal dystonia improved in 13 of 14 patients whose ulnar neuropathy improved and appeared or worsened in 2 patients following ulnar nerve injury. These data, together with our recent observation of a dystonic pattern of antagonist bursting in patients with isolated ulnar neuropathy (Muscle Nerve 1995, 18:606-611), suggest that ulnar neuropathy may initiate or sustain a specific dystonia, flexion of the fourth and fifth digits, by inducing a central disorder of motor control.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8622720 Journal Article United states0148-639X (Print)Muscle & nerve8622720LDepartment of Neurology, Harvard Medical School, Boston, Massachusetts, USA.eng-<7Hotchkiss, R. N.19907Common disorders of the elbow in athletes and musicians507-15 Hand Clin63Acute Disease *Athletic Injuries/surgery/therapy Cumulative Trauma Disorders/surgery/therapy Elbow Joint/*injuries Humans *Music *Occupational Diseases/surgery/therapy Tennis Elbow/surgery/therapyAugThis article discusses the importance of the elbow in both sports and performing arts. Functional, painless motion of the elbow is essential to achieve this end because although most objects of play are controlled by the hand, freedom of movement at the elbow allows one to place the hand in space. Anatomy and biomechanics of the wrist as well as common sports-related injuries are highlighted. In addition, wrist disorders affecting musicians are reviewed.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2211860 $Journal Article Review United states0749-0712 (Print) Hand clinics2211860RDepartment of Orthopedics, University of Texas Health Science Center, San Antonio.eng  ulnar collateral ligament is disrupted, abnormal stress is placed on the articular surfaces that can lead to degenerative changes with osteophyte formation. As with other elbow injuries, a strict rehabilitation regimen is first employed; ligament reconstruction is only recommended if the injury fails to improve and only in athletes requiring a high level of performance. Excessive valgus stress can also lead to posteromedial olecranon impingement on the olecranon fossa producing pain, osteophyte and loose body formation. Arthroscopic elbow debridement can often be helpful in improving motion and in reducing pain in such patients.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9802175 "Journal Article Review New zealand0112-1642 (Print)Sports medicine (Auckland, N.Z9802175^Department of Orthopaedic Surgery, University of Mississippi School of Medicine, Jackson, USA.eng<7 PFoye, P. M. Sullivan, W. J. Panagos, A. Zuhosky, J. P. Sable, A. W. Irwin, R. W.2007Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workersS29-33Arch Phys Med Rehabil88 3 Suppl 1GAchilles Tendon Adrenal Cortex Hormones/*administration & dosage Carpal Tunnel Syndrome/drug therapy De Quervain Disease/drug therapy Fasciitis, Plantar/drug therapy Humans Injections, Intra-Articular Musculoskeletal Diseases/*drug therapy Occupational Diseases/*drug therapy Tendinopathy/drug therapy Tennis Elbow/drug therapyMarThis self-directed study module focuses on the use of corticosteroids and other injections in the treatment of lateral epicondylitis, de Quervain's tenosynovitis, carpal tunnel syndrome, Achilles' tendinitis, and plantar fasciitis. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To review the medical literature to help clinicians make treatment decisions regarding corticosteroid and other injections in the upper and lower limbs in injured workers.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17321846 $Journal Article Review United States0003-9993 (Print)0Archives of physical medicine and rehabilitation17321846Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA. Patrick.Foye@UMDNJ.edueng<7 PFoye, P. M. Sullivan, W. J. Sable, A. W. Panagos, A. Zuhosky, J. P. Irwin, R. W.2007Industrial medicine and acute musculoskeletal rehabilitation. 3. Work-related musculoskeletal conditions: the role for physical therapy, occupational therapy, bracing, and modalitiesS14-7Arch Phys Med Rehabil88 3 Suppl 14Carpal Tunnel Syndrome/*rehabilitation Combined Modality Therapy Exercise Therapy Fasciitis, Plantar/*rehabilitation Humans Low Back Pain/*rehabilitation Occupational Diseases/*rehabilitation Orthotic Devices Splints Tendinopathy/*rehabilitation Tennis Elbow/*rehabilitation Whiplash Injuries/*rehabilitationMarThis chapter focuses on the use of modalities, therapeutic exercise, and orthotic devices in the treatment of lateral epicondylitis, carpal tunnel syndrome, plantar fasciitis, neck pain and low back pain. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To review the medical literature that may help clinicians make treatment decisions regarding modalities, therapeutic exercise, and orthotic devices for treating common work-related conditions in the upper and lower limbs.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17321842 $Journal Article Review United States0003-9993 (Print)0Archives of physical medicine and rehabilitation17321842Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey: New Jersey Medical School, Newark, NJ 07103, USA. Patrick.Foye@UMDNJ.edu eng <7 Gieck, J. H. Saliba, E. N.1987.Application of modalities in overuse syndromes427-66Clin Sports Med62Athletic Injuries/*therapy Cryotherapy Cumulative Trauma Disorders/*therapy Electric Stimulation Therapy/methods Exercise Therapy/methods Hot Temperature/therapeutic use Humans Laser Therapy Ultrasonic Therapy/methodsAprcImproper techniques are often the cause of overuse syndromes. Unless the technique is corrected, the patient is doomed to recurrence. The same is true of improper posture, especially in the lower extremity and trunk areas. The pitcher or tennis player should have his or her style analyzed for proper form. The runner should have his or her muscular imbalances corrected by exercise and orthotic appliances. As with all other modalities used for treating painful conditions, proper evaluation of the etiology and the rectification of the cause is important. When athletes are underway in their sports seasons, it is often difficult to convince them to accept the ideal healing conditions needed to eliminate the problem. Management of the condition with any modality while maintaining an active lifestyle often brings about ethical scrutiny. However, it is the belief of the authors that noninvasive modalities do not provide the pain relief that would enable the athlete to tolerate activity beyond a significant injurious stress level. The modalities allow the athlete to regain the criteria for return, strength, and range of motion more successfully. Short-term goal setting is imperative to proper return. Several plateaus should be successfully completed before full return to activity is allowed. Tennis elbow, for example, may be allowed an initial period of 5 minutes on alternate days, gradually increasing to full activity every other day. Patients are often so anxious to return to activity that they overdo, leading to a decrease in function with a rapid return to the results of inflammation. The goals of successful rehabilitation of the overuse syndrome are pain-free range of motion, strength, and endurance. The use of cold, heat, electrotherapy, and exercise allow the athlete to reach his or her goal of returning to activity more quickly with a reduced risk of reinjury.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3319209 $Journal Article Review United states0278-5919 (Print)Clinics in sports medicine3319209ADepartment of Athletics, University of Virginia, Charlottesville.eng O<7 Henry, M. Stutz, C.2006CA unified approach to radial tunnel syndrome and lateral tendinosis200-5Tech Hand Up Extrem Surg104Adult Diagnosis, Differential Female Humans Male Middle Aged Nerve Compression Syndromes/diagnosis/rehabilitation/*surgery Orthopedic Procedures Physical Examination Tennis Elbow/diagnosis/*surgeryDecoTwo of the most common diagnoses assigned to patients presenting with lateral elbow and proximal forearm pain are lateral tendinosis and radial tunnel syndrome. Traditionally, these 2 conditions have been treated as distinct and separate entities with most patients being diagnosed with either one or the other, but not both. The extensor carpi radialis brevis (ECRB) and, to a lesser the degree, a portion of the extensor digitorum communis that form the conjoined lateral extensor tendon are thought to be primarily responsible for the excessive traction that induces lateral tendinosis (a degenerative process of microtears in the tendon with impaired healing), but the supinator blends with these same fibers and shares a role in the pathology. The supinator, primarily the arcade of Frohse, has been thought to play the majority role in compressing the posterior interosseous nerve in radial tunnel syndrome, but the undersurface thick tendon of the ECRB may also cause substantial nerve compression. Reduction of the linear tension transmitted by the ECRB is the common element in the various surgical treatments for lateral tendinosis, performed anywhere from directly at the lateral epicondyle to the distal myotendinous junction. Nerve decompression by division of fascial bands is the goal in surgery for radial tunnel syndrome. These 2 surgical approaches need not be mutually exclusive. In fact, this separation of the 2 clinical entities may play a role in the unpredictable results reported in the literature. This article presents a unified approach to treating both pathologies simultaneously including short-term clinical results.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17159475 $Journal Article Review United States1089-3393 (Print),Techniques in hand & upper extremity surgery17159475Hand and Wrist Center of Houston, Houston, TX Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA. mhenry@houstonhand.comengA<7=Johnson, G. W. Cadwallader, K. Scheffel, S. B. Epperly, T. D.2007"Treatment of lateral epicondylitis843-8Am Fam Physician766Anti-Inflammatory Agents/*therapeutic use Decision Making High-Energy Shock Waves/*therapeutic use Humans *Laser Therapy Orthopedic Procedures/*methods *Orthotic Devices *Physical Therapy Modalities Tennis Elbow/*therapy Treatment OutcomeSep 15Lateral epicondylitis is a common overuse syndrome of the extensor tendons of the forearm. It is sometimes called tennis elbow, although it can occur with many activities. The condition affects men and women equally and is more common in persons 40 years or older. Despite the prevalence of lateral epicondylitis and the numerous treatment strategies available, relatively few high-quality clinical trials support many of these treatment options; watchful waiting is a reasonable option. Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. Use of an inelastic, nonarticular, proximal forearm strap (tennis elbow brace) may improve function during daily activities. Progressive resistance exercises may confer modest intermediate-term results. Evidence is mixed on oral nonsteroidal antiinflammatory drugs, mobilization, and acupuncture. Patients with refractory symptoms may benefit from surgical intervention. Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17910298 $Journal Article Review United States0002-838X (Print)American family physician17910298IFamily Medicine Residency of Idaho, Boise, USA. greg.johnson@fmridaho.orgeng <7 Kamien, M.1990%A rational management of tennis elbow173-91 Sports Med93FHumans Tennis/*injuries Tennis Elbow/*diagnosis/rehabilitation/therapyMar Tennis elbow is due to a torque injury or sudden overstretching of tendons which insert into the epicondyles of the humerus. The predominant lesion is an enthesopathy--a pathological lesion at the insertion of tendon into bone. The most common site is at the lateral epicondyle and this is 3 times as frequent as at the medial epicondyle. Approximately 50% of tennis players can expect to get a tennis elbow at some time during their playing lifetime. In one-third of the players this will be severe enough to interfere with their tasks of daily living. The major unresolved question about the aetiology of tennis elbow is why it has its peak incidence between the ages of 40 and 50 years and why 90% of players then have no further recurrence. Making sense of the literature on the treatment of tennis elbow is difficult because there are few studies that have used the acceptable epidemiological techniques of the prospective randomised controlled trial or case-controlled study. Most papers are based on a collection of highly selected cases which represent the more intractable end of the tennis elbow spectrum and their reported results have been inconsistent. Tennis elbow is largely a self-limiting condition. The prime aim of treatment should be based on Hippocrates' first tenet of medicine--first do no harm. Therapy should start with the simple and conservative before progressing to the more complex and invasive therapies. It should be acceptable to the patient, cost-effective and where invasive therapy is recommended, the potential benefits should clearly outweigh the risks. The principles of therapy for tennis elbow are to relieve pain, microbleeding and inflammation, promote healing, rehabilitate the injured arm and try to prevent recurrence. The most effective modalities of treatment are found to be cryotherapy in the acute stage then nonsteroidal anti-inflammatory drugs and heat in its various modalities including ultrasound. This is combined with rest which is best defined as the absence of painful activity. Injection of a depot preparation of cortisone is effective although patient reports are not as flattering as those of doctors. There is no advantage and in fact considerable disadvantage in using more than 2 such injections. Therapies such as acupuncture and chiropractic have not been evaluated. Nevertheless they cause no harm, may result in good and should be tried before resorting to more invasive therapy. Rehabilitation should run parallel to treatment.(ABSTRACT TRUNCATED AT 400 WORDS)ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2180031 "Journal Article Review New zealand0112-1642 (Print)Sports medicine (Auckland, N.Z2180031GDepartment of General Practice, University of Western Australia, Perth.engT<7,Kalainov, D. M. Makowiec, R. L. Cohen, M. S.2007!Arthroscopic tennis elbow release2-7Tech Hand Up Extrem Surg111zArthroscopy/adverse effects/*methods Humans Joint Capsule/surgery Postoperative Care Tendons/surgery Tennis Elbow/*surgeryMarTennis elbow is a common affliction manifested by symptoms of lateral elbow pain and diminished grip strength. Conservative treatment measures will lead to symptom resolution in most cases. Surgery is reserved for patients with recalcitrant elbow pain unresponsive to nonsurgical management. This article reviews the technique of arthroscopic tennis elbow release surgery, including indications, contraindications, complications, postoperative rehabilitation, and outcome.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17536516 $Journal Article Review United States1089-3393 (Print),Techniques in hand & upper extremity surgery17536516Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. dkalainov@comcast.neteng<7 Kibler, W. B.1994WClinical biomechanics of the elbow in tennis: implications for evaluation and diagnosis1203-6Med Sci Sports Exerc2610dAthletic Injuries/diagnosis Biomechanics Cartilage, Articular/injuries Collateral Ligaments/injuries Cumulative Trauma Disorders/diagnosis/physiopathology Elbow Joint/*injuries/*physiology Humans Muscle, Skeletal/injuries/physiology Radius/injuries Range of Motion, Articular/physiology Stress, Mechanical Tennis/*injuries/*physiology Tennis Elbow/etiologyOctElbow injuries constitute a sizeable percentage of tennis injuries. Biomechanical analysis of the forces, loads, and motions on the elbow in tennis, and the constraint systems operating the control the forces, can lead to an understanding of the pathophysiology of these injuries. A biomechanically based evaluation framework can be used to document all of the clinical symptoms, anatomic alterations, and biomechanical alterations that are associated with the pathological problem.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7799762 Journal Article United states0195-9131 (Print)+Medicine and science in sports and exercise77997623Lexington Clinic, Sports Medicine Center, KY 40504.eng<7BKohia, M. Brackle, J. Byrd, K. Jennings, A. Murray, W. Wilfong, E.2008EEffectiveness of physical therapy treatments on lateral epicondylitis119-36J Sport Rehabil172sEvidence-Based Medicine Humans *Physical Therapy Modalities Tennis Elbow/physiopathology/*therapy Treatment OutcomeMayjOBJECTIVE: 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.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18515912 $Journal Article Review United States1056-6716 (Print)Journal of sport rehabilitation18515912cRockhurst University Physical Therapy Department in Kanas City, MO, USA. mohamedkohia@rockhurst.eduengD<7Leach, R. E. Miller, J. K.1987-Lateral and medial epicondylitis of the elbow259-72Clin Sports Med62*Athletic Injuries/diagnosis/etiology/therapy Cumulative Trauma Disorders Exercise Therapy/methods Humans *Tennis Elbow/diagnosis/etiology/therapyAprTennis elbow is a common condition, with the extensor carpi radialis brevis attachment being the usual site of pain. Conservative care including decreased activity, ice, nonsteroidal anti-inflammatory medications, and muscle strengthening will help most people. The small percentage of cases that require surgery usually benefit from debridement of the damaged portion of the extensor carpi radialis brevis attachment. The postoperative course must include muscle strengthening and a gradual return to activity.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3319203 $Journal Article Review United states0278-5919 (Print)Clinics in sports medicine3319203RDepartment of Orthopedic Surgery, Boston University Medical Center, Massachusetts.eng<7.Lew, H. L. Chen, C. P. Wang, T. G. Chew, K. T.2007TIntroduction to musculoskeletal diagnostic ultrasound: examination of the upper limb310-21Am J Phys Med Rehabil864Carpal Tunnel Syndrome/ultrasonography Humans Muscle, Skeletal/*ultrasonography Peripheral Nerves/ultrasonography Tendon Injuries/ultrasonography Tendons/ultrasonography Tennis Elbow/ultrasonography Terminology as Topic Ultrasonography/instrumentation Upper Extremity/*ultrasonographyAprWith recent advances in computer technology and equipment miniaturization, the clinical application of diagnostic ultrasonography (U/S) has spread across various medical specialties. Diagnostic U/S is attractive in terms of its noninvasiveness, lack of radiation, readiness of use, cost-effectiveness, and its ability to make dynamic examinations possible. Dynamic imaging deserves special emphasis because it is useful in differentiating full-thickness from partial-thickness tendon tears, muscle tears, and tendon and nerve subluxations or dislocations. It is also a quick and easy avenue for side-to-side comparisons. When appropriately used, diagnostic U/S can be considered as an extension of one's physical examination. However, there are limitations of U/S, which will be discussed in this review article. This is part 1 of two articles; this first part will focus on the ultrasound examination of the upper extremity, using selected examples relevant to musculoskeletal medicine. Part 2 will cover common pathologies of the lower extremity.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17413545 $Journal Article Review United States0894-9115 (Print)]American journal of physical medicine & rehabilitation / Association of Academic Physiatrists17413545oDivision of Physical Medicine and Rehabilitation, Stanford University School of Medicine/VA Palo Alto, CA, USA.eng<7Nirschl, R. P.1992Elbow tendinosis/tennis elbow851-70Clin Sports Med114Diagnosis, Differential Elbow/*injuries Humans Pain Measurement *Tendinopathy/pathology/therapy *Tennis Elbow/pathology/therapy Treatment OutcomeOctThe histology of pathologic tennis elbow tissue reveals noninflammatory tissue, thus the term angio-fibroblastic tendinosis. The goal of nonsurgical treatment is a revascularization and collagen repair of this pathologic tissue by rehabilitative exercise. In the event of rehabilitation failure, surgical correction by removal of this pathologic tissue is the surgical technique of choice.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1423702 $Journal Article Review United states0278-5919 (Print)Clinics in sports medicine14237028Virginia Sports Medicine Institute, Arlington, Virginia.eng&<7Nirschl, R. P. Ashman, E. S.2003 Elbow tendinopathy: tennis elbow813-36Clin Sports Med2249Adolescent Adult Aged Aged, 80 and over Arthralgia/classification/etiology Athletic Injuries/complications/*diagnosis/pathology/*therapy Braces Child Humans Middle Aged Orthopedic Procedures/methods/rehabilitation Pain Measurement/methods Tennis Elbow/complications/*diagnosis/pathology/*therapy Treatment OutcomeOct-The pathoanatomy of overuse tendinopathy is noninflammatory angiofibroblastic tendinosis. The areas of elbow abnormality are specific, including the ECRB-EDC complex laterally, the pronator teres, flexor carpi radialis medially, and triceps posteriorly. The goals of nonoperative treatment are to revitalize the unhealthy pain-producing tendinosis tissue. The key to nonoperative treatment is rehabilitative resistance exercise with progression of the exercise program. If rehabilitation fails, the surgical interventions as described are highly successful.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14560549 $Journal Article Review United States0278-5919 (Print)Clinics in sports medicine14560549gGeorgetown University Medical Center, 4000 Reservoir Road, Washington, DC 20057, USA. nirschl@erols.comeng<7:Noteboom, T. Cruver, R. Keller, J. Kellogg, B. Nitz, A. J.1994Tennis elbow: a review357-66J Orthop Sports Phys Ther196Anti-Inflammatory Agents, Non-Steroidal/therapeutic use Cumulative Trauma Disorders/diagnosis/rehabilitation Elbow/*pathology/radiography Exercise Therapy Humans Tennis/*injuries Tennis Elbow/*diagnosis/*rehabilitation Ultrasonic TherapyJunUTennis elbow is a common yet sometimes complex musculoskeletal condition affecting many patients treated by physical therapists. The purpose of this article is to review the anatomy, clinical examination, differential diagnosis, conservative care, and surgical treatment for tennis elbow or lateral epicondylitis. Particular attention is given to determining the precise pathological cause of lateral epicondylitis, with consideration of intrinsic and extrinsic factors associated with this condition. This information should assist health care practitioners who treat patients with this disorder.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8025577 $Journal Article Review United states0190-6011 (Print)6The Journal of orthopaedic and sports physical therapy8025577$Therex Physical Therapy, Denver, CO.eng<7 Ollivierre, C. O. Nirschl, R. P.1996>Tennis elbow. Current concepts of treatment and rehabilitation133-9 Sports Med222uAdult Exercise Therapy Female Humans Male Middle Aged Pain/therapy *Tennis Elbow/diagnosis/etiology/pathology/therapyAugTennis elbow occurs as a result of repetitive microtrauma to the musculotendinous unit causing inflammatory and degenerative tissue damage. A good understanding of the aetiology and pathoanatomy will aid the clinician in preventing and recognising this condition. Early recognition with a quality rehabilitative programme, and the judicious use of surgical intervention usually results in full recovery and excellent functional outcomes.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8857707 "Journal Article Review New zealand0112-1642 (Print)Sports medicine (Auckland, N.Z8857707ILake Centre for Orthopaedics and Sports Medicine, Leesburg, Florida, USA.eng<75Paoloni, J. A. Murrell, G. A. Burch, R. M. Ang, R. Y.2009Randomised, double-blind, placebo-controlled clinical trial of a new topical glyceryl trinitrate patch for chronic lateral epicondylosis299-302Br J Sports Med434AproOBJECTIVE: This study aimed to determine whether a new glyceryl trinitrate patch preparation is effective in treating chronic lateral epicondylosis. DESIGN: Randomised double-blind controlled clinical trial. SETTING: Private practice PATIENTS: 154 adult patients with chronic lateral epicondylosis were recruited, with 136 patients completing the trial. INTERVENTIONS: 8 weeks of glyceryl trinitrate patch application (dosages of 72 mg/24 h, 1.44 mg/24 h, and 3.6 mg/24 h), or placebo patch application. MAIN OUTCOME MEASURES: Subjective global assessment of change in elbow symptoms, patient-rated tennis elbow evaluation, visual analogue pain at rest, visual analogue pain with activity, visual analogue pain intensity, grip strength, and strength testing using the Orthopaedic Research Institute-Tennis Elbow Testing System. RESULTS: At 8 weeks there was a significant decrease in elbow pain with activity in the glyceryl trinitrate 0.72 mg/24 h group compared with placebo (p = 0.04). There were no other significant differences. CONCLUSIONS: Continuous 1.25 mg/24 h topical glyceryl trinitrate treatment, when combined with daily exercise rehabilitation, has previously demonstrated efficacy in treating chronic lateral epicondylosis. There was significantly decreased elbow pain with activity at 8 weeks in the glyceryl trinitrate 0.72 mg/24 h group (p = 0.04). This short-term dose-ranging study did not demonstrate a treatment effect of a new topical glyceryl trinitrate patch in dosages of 1.44 mg/24 h or 3.6 mg/24 h, which conflicts with previous studies on topical glyceryl trinitrate treatment. Trial registration number: NCT00447928.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18971247 Journal Article England1473-0480 (Electronic)"British journal of sports medicine18971247Orthopaedic Research Institute, 2nd Floor, 4 South St, Kogarah, 2217, Research And Education Centre, St George Hospital, Kogarah, Sydney, Australia, 2035. jpaoloni@bigpond.net.aueng .<70Grewal, R. MacDermid, J. C. Shah, P. King, G. J.2009qFunctional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis849-57J Hand Surg Am345May-JunPURPOSE: To evaluate outcomes of arthroscopic tennis elbow release in a population of patients with chronic, recalcitrant symptoms, a large number of workers' compensation claims, and high occupational demands using standardized outcome measures, including a detailed objective assessment of workplace demands. METHODS: We treated 36 patients with chronic lateral epicondylitis with an arthroscopic release. A standardized protocol was used to measure strength, motion, and outcomes (American Shoulder and Elbow Surgeons Elbow [ASES-e] score, Short Form-12, Patient-Rated Tennis Elbow evaluation [PRTEE], and Work Limitations Questionnaire-26). RESULTS: The mean duration of symptoms before surgery was 30 months. A total of 25 of 36 patients were employed in heavy or repetitive occupations and 23 of 36 were involved in a workers' compensation claim. The final overall results were favorable, with 30 of 36 subjects reporting improvement with surgery. The final mean Mayo Elbow Performance Index score was 78.6 +/- 16.5 (22 = good to excellent, 9 = fair, and 5 = poor). The average total PRTEE was 26.2 +/- 24.3 out of 100. The average ASES-e pain score was 16.1 +/- 15.0 and the average ASES-e function score was 27.9 +/- 8.8. Patients in heavy or repetitive occupations and those with workers' compensation claims had significantly worse outcome scores (Mayo Elbow Performance Index, ASES, and PRTEE). Based on Work Limitations Questionnaire-26 scores, patients with workers' compensation claims had significantly greater difficulties with physical (36.8 vs 3.2, p < .001), output (40.8 vs 3.1, p = .002), mental (36.0 vs 9.0, p = .05), and social (27.7 vs 6.3, p = .05) workplace demands. CONCLUSIONS: Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. Patient selection and reported occupational demands have an important role in determining outcomes. More work is required to identify factors predicting outcome in this difficult subgroup.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19410988 Journal Article United States1531-6564 (Electronic)The Journal of hand surgery19410988Division of Orthopedic Surgery, University of Western Ontario, Hand and Upper Limb Center, St Joseph's Health Care, London, Ontario, Canada. rgrewa@uwo.caeng<7'Coombes, B. K. Bisset, L. Vicenzino, B.20091A new integrative model of lateral epicondylalgia252-8Br J Sports Med434AprTennis elbow or lateral epicondylalgia is a diagnosis familiar to many within the general community and presents with an uncomplicated clinical picture in most cases. However, the underlying pathophysiology presents a more complex state and its management has not been conclusively determined. Research on this topic extends across anatomical, biomechanical and clinical literature; however, integration of findings is lacking. We propose that the current understanding of the underlying pathophysiology of lateral epicondylalgia can be conceptualised as encompassing three interrelated components: (i) the local tendon pathology, (ii) changes in the pain system, and (iii) motor system impairments. This paper presents a model that integrates these components on the basis of a literature review with the express aim of assisting in the targeting of specific treatments or combinations thereof to individual patients.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19050004 8Journal Article Research Support, Non-U.S. Gov't England1473-0480 (Electronic)"British journal of sports medicine19050004}Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.eng<7@Staples, M. P. Forbes, A. Ptasznik, R. Gordon, J. Buchbinder, R.2008kA randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow)2038-46 J Rheumatol3510Activities of Daily Living Adult Double-Blind Method Female High-Energy Shock Waves/*therapeutic use Humans Male Middle Aged Tennis Elbow/*therapy Treatment OutcomeOctOBJECTIVE: The aims of this double-blind, randomized, placebo-controlled trial were to determine whether ultrasound-guided extracorporeal shock wave therapy (ESWT) reduced pain and improved function in patients with lateral epicondylitis (tennis elbow) in the short term and intermediate term. METHODS: Sixty-eight patients from community-based referring doctors were randomized to receive 3 ESWT treatments or 3 treatments at a subtherapeutic dose given at weekly intervals. Seven outcome measures relating to pain and function were collected at followup evaluations at 6 weeks, 3 months, and 6 months after completion of the treatment. The mean changes in outcome variables from baseline to 6 weeks, 3 months, and 6 months were compared for the 2 groups. RESULTS: The groups did not differ on demographic or clinical characteristics at baseline and there were significant improvements in almost all outcome measures for both groups over the 6-month followup period, but there were no differences between the groups even after adjusting for duration of symptoms. CONCLUSION: Our study found little evidence to support the use of ESWT for the treatment of lateral epicondylitis and is in keeping with recent systematic reviews of ESWT for lateral epicondylitis that have drawn similar conclusions.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18792997 SJournal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't Canada0315-162X (Print)The Journal of rheumatology18792997TDepartment of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia.eng ^|7>Scarpone, M. Rabago, D. P. Zgierska, A. Arbogast, G. Snell, E.2008EThe efficacy of prolotherapy for lateral epicondylosis: a pilot study248-54Clin J Sport Med183Adolescent Adult Double-Blind Method Drug Combinations Female Humans *Injections Male Middle Aged Ohio Pilot Projects Tennis Elbow/*drug therapy/physiopathology Treatment OutcomeMayOBJECTIVES: To assess whether prolotherapy, an injection-based therapy, improves elbow pain, grip strength, and extension strength in patients with lateral epicondylosis. SETTING: Outpatient Sport Medicine clinic. STUDY DESIGN: Double-blind randomized controlled trial. PARTICIPANTS: Twenty-four adults with at least 6 months of refractory lateral epicondylosis. INTERVENTION: Prolotherapy participants received injections of a solution made from 1 part 5% sodium morrhuate, 1.5 parts 50% dextrose, 0.5 parts 4% lidocaine, 0.5 parts 0.5% sensorcaine and 3.5 parts normal saline. Controls received injections of 0.9% saline. Three 0.5-mL injections were made at the supracondylar ridge, lateral epicondyle, and annular ligament at baseline and at 4 and 8 weeks. OUTCOME MEASURES: The primary outcome was resting elbow pain (0 to 10 Likert scale). Secondary outcomes were extension and grip strength. Each was performed at baseline and at 8 and 16 weeks. One-year follow-up included pain assessment and effect of pain on activities of daily living. RESULTS:: The groups were similar at baseline. Compared to Controls, Prolotherapy subjects reported improved pain scores (4.5 +/- 1.7, 3.6 +/- 1.2, and 3.5 +/- 1.5 versus 5.1 +/- 0.8, 3.3 +/- 0.9, and 0.5 +/- 0.4 at baseline and at 8 and 16 weeks, respectively). At 16 weeks, these differences were significant compared to baseline scores within and among groups (P < 0.001). Prolotherapy subjects also reported improved extension strength compared to Controls (P < 0.01) and improved grip strength compared to baseline (P < 0.05). Clinical improvement in Prolotherapy group subjects was maintained at 52 weeks. There were no adverse events. CONCLUSIONS: Prolotherapy with dextrose and sodium morrhuate was well tolerated, effectively decreased elbow pain, and improved strength testing in subjects with refractory lateral epicondylosis compared to Control group injections.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18469566 tJournal Article Randomized Controlled Trial United States official journal of the Canadian Academy of Sport Medicine1050-642X (Print)18469566WDepartment of Family Medicine, University of Wisconsin-Madison, Madison, WI 53715, USA.eng |7LOken, O. Kahraman, Y. Ayhan, F. Canpolat, S. Yorgancioglu, Z. R. Oken, O. F.2008The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial 63-7; quiz 68 J Hand Ther211Adult Aged *Braces Female Follow-Up Studies Hand Strength Humans *Laser Therapy, Low-Level Male Middle Aged Pain Measurement Prospective Studies Single-Blind Method Tennis Elbow/*therapy Time Factors Treatment Outcome *Ultrasonic TherapyJan-MarThe aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain, and that laser therapy is more effective than the brace and US treatment in improving grip strength.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18215753 Comparative Study Journal Article Randomized Controlled Trial United States official journal of the American Society of Hand Therapists0894-1130 (Print)18215753Ankara Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Division of Hand Rehabilitation, Ankara, Turkey. okenoznur@yahoo.comeng|7Nourbakhsh, M. R. Fearon, F. J.2008}The effect of oscillating-energy manual therapy on lateral epicondylitis: a randomized, placebo-control, double-blinded study 4-13; quiz 14 J Hand Ther211!Adult Aged Double-Blind Method Female Hand Strength/physiology Humans Male Middle Aged Musculoskeletal Manipulations/*methods Pain/etiology/prevention & control Recovery of Function/physiology Reproducibility of Results Tennis Elbow/complications/physiopathology/*therapy Treatment OutcomeJan-Marj Symptoms of lateral epicondylitis (LE) are attributed to degenerative changes and inflammatory reactions in the common extensor tendon induced by microscopic tears in the tissue after repetitive or overload functions of the wrist and hand extensor muscles. Conventional treatments, provided on the premise of inflammatory basis of LE, have shown 39-80% failure rate. An alternative approach suggests that symptoms of LE could be due to active tender points developed in the origin of hand and wrist extensor muscles after overuse or repetitive movements. Oscillating-energy Manual Therapy (OEMT), also known as V-spread, is a craniosacral manual technique that has been clinically used for treating tender points over the suture lines in the skull. Considering symptoms of LE may result from active tender points, the purpose of this study was to investigate the effect of OEMT on pain, grip strength, and functional abilities of subjects with chronic LE. Twenty-three subjects with chronic LE (>3mo) between ages of 24 and 72 years participated in this study. Before their participation, all subjects were screened to rule out cervical and other pathologies that could possibly contribute to their lateral elbow pain. Subjects who met the inclusion criteria were randomized into treatment and placebo treatment groups by a second (treating) therapist. Subjects were blinded to their group assignment. Subjects in the treatment group received OEMT for six sessions. During each treatment session, first a tender point was located through palpation. After proper hand placement, the therapist focused the direction of the oscillating energy on the localized tender point. Subjects in the placebo group underwent the same procedure, but the direction of the oscillating energy was directed to an area above or below the tender points, not covering the affected area. Jamar Dynamometer, Patient Specific Functional Scale (PSFS), and Numeric Rating Scale (NRS) were used to measure grip strength, functional status, and pain intensity and limited activity due to pain, respectively. The screening therapist who was blinded to the subjects' group assignment performed pretest, posttest, and six-month follow-up measurements. Subjects in the treatment group showed both clinically and statistically significant improvement in grip strength (p=0.03), pain intensity (p=0.006), function (p=0.003), and limited activity due to pain (p=0.025) compared with those in the placebo group. Follow-up data, collected after six months, showed no significant difference between posttest and follow-up measurements in functional activity (p=0.35), pain intensity (p=0.72), and activity limitation due to pain (p=0.34). Of all the subjects contacted for follow-up assessment, 91% maintained improved function and 73% remained pain free for at least six months. OEMT seems to be a viable, effective, and efficient alternative treatment for LE.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18215746 uJournal Article Randomized Controlled Trial United States official journal of the American Society of Hand Therapists0894-1130 (Print)18215746Department of Physical Therapy, North Georgia College and State University, Dahlonega, Georgia 30597, USA. mrnourbakhsh@ngcsu.edueng<7 -Luginbuhl, R. Brunner, F. Schneeberger, A. G.2008No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study35-40Chir Organi Mov911 Adult Aged *Braces Elbow Joint/physiology *Exercise Therapy Female Follow-Up Studies Humans Isometric Contraction Male Middle Aged Prospective Studies Range of Motion, Articular Statistics, Nonparametric Tennis Elbow/diagnosis/*therapy Time Factors Treatment OutcomeJanThe objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18320371 CComparative Study Journal Article Randomized Controlled Trial Italy0009-4749 (Print)&La Chirurgia degli organi di movimento18320371aUniklinik Balgrist, Department of Orthopaedic Surgery, University of Zurich, Zurich, Switzerland.enga<7!$Karkhanis, S. Frost, A. Maffulli, N.2008;Operative management of tennis elbow: a quantitative review171-88 Br Med Bull881^Arthroplasty/*methods/standards Humans Tennis Elbow/physiopathology/*surgery Treatment OutcomeINTRODUCTION: The results of operative management of tennis elbow are varied, and the indications for surgery are not well codified. Many operative techniques are reported, but a clear consensus on whether a given surgical procedure is more effective over another is yet to be reached. METHODS: We conducted a MEDLINE, CINAHL and EMBASE search on all available scientific articles that reported the outcomes of surgery for lateral epicondylopathy. Keywords used were 'tennis elbow', 'lateral epicondylitis', 'lateral epicondylalgia', 'tendinopathy', 'tendonitis' and 'tendon'. Subheadings used were 'surgery', 'outcomes', 'pathology', 'physiology' and 'operation'. All relevant articles were retrieved. Each article was scored using the Coleman methodology score (CMS), a highly repeatable methodology score, by two independent reviewers, followed by data analysis. RESULTS: The mean CMS for the 45 studies identified was 43 +/- 9 (of a possible 100 points), with 'number of patients', 'type of study', 'outcome criteria and assessment' and 'subject selection process' being the major low scorers. Also, there was no improvement in the CMS, and hence study design, over the years (intra-class correlation coefficient = 0.45). DISCUSSION: There is a dearth of quality evidence available to be able to advocate one operative technique over another. CONCLUSION: We stress the need for well-designed adequately powered randomized controlled trials to be able to understand which of these operative techniques is really superior to the others.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18819957 Journal Article Review England1471-8391 (Electronic)British medical bulletin18819957Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent ST47QB Staffs, UK.engG<7"2Calfee, R. P. Patel, A. DaSilva, M. F. Akelman, E.20085Management of lateral epicondylitis: current concepts19-29J Am Acad Orthop Surg161Anti-Inflammatory Agents, Non-Steroidal/therapeutic use Arthroscopy Debridement Humans Patient Care/*trends Physical Therapy Modalities Rest Tennis Elbow/*therapyJanLateral epicondylitis, or tennis elbow, is a common cause of elbow pain in the general population. Traditionally, lateral epicondylitis has been attributed to degeneration of the extensor carpi radialis brevis origin, although the underlying collateral ligamentous complex and joint capsule also have been implicated. Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities. For patients with recalcitrant disease, the traditional open debridement technique has been modified by multiple surgeons, with others relying on arthroscopic or even percutaneous procedures. Without a standard protocol (nonsurgical or surgical), surgeons need to keep abreast of established and evolving treatment options to effectively treat patients with lateral epicondylitis.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18180389 $Journal Article Review United States1067-151X (Print);The Journal of the American Academy of Orthopaedic Surgeons18180389EDepartment of Orthopaedic Surgery, University of Cincinnati, OH, USA.eng <7##Baker, C. L., Jr. Baker, C. L., 3rd2008FLong-term follow-up of arthroscopic treatment of lateral epicondylitis254-60Am J Sports Med362Activities of Daily Living Adult *Arthroscopy Female Follow-Up Studies Humans Male Middle Aged Pain Measurement Patient Satisfaction Retrospective Studies Tennis Elbow/*surgery Treatment OutcomeFebBACKGROUND: In a previously published report of the authors' arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients. HYPOTHESIS: Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty patients (42 elbows) with lateral epicondylitis who had not responded to nonoperative management were treated with arthroscopic resection of pathologic tissue. Thirty of these patients (30 elbows) were located for extended follow-up. At a mean follow-up of 130 months (range, 106-173 months), patients were asked to use a numeric scale to rate their elbow pain from 0 (no pain) to 10 (severe pain). Patients were also asked to rate their elbows according to the functional portion of the Mayo Clinic Elbow Performance Index. RESULTS: The mean pain score at rest was 0; with activities of daily living, 1.0; and with work or sports, 1.9. The mean functional score was 11.7 out of a possible 12 points. No patient required further surgery or repeat injections after surgery. One patient continued to wear a counterforce brace with heavy activities. Twenty-three patients (77%) stated they were "much better," 6 patients (20%) stated they were "better," and 1 patient (3%) stated he was the same. Twenty-six patients (87%) were satisfied, and 28 patients (93%) stated they would have the surgery again if needed. CONCLUSION: Arthroscopic removal of pathologic tendinosis tissue is a reliable treatment for recalcitrant lateral epicondylitis. The early high rate of success in patients was maintained at long-term follow-up.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18202296 Journal Article United States1552-3365 (Electronic)'The American journal of sports medicine18202296\The Hughston Clinic, PC, 6262 Veterans Parkway, Columbus, GA 31909, USA. cbaker@hughston.comeng <7$Altan, L. Kanat, E.2008]Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices1015-9Clin Rheumatol278b*Braces Female Humans Male Middle Aged Pain Measurement Recovery of Function Tennis Elbow/*therapyAugWe investigated the effectiveness of braces in the treatment of lateral epicondylitis and compared the effects of two different types of most frequently used braces. A total of 50 patients (seven males and 43 females) with an age range of 34 to 60 who had the diagnosis of lateral epicondylitis were included in the study. The patients were distributed into two groups. In group I, 25 patients (21 females and four males) were given a lateral epicondyle bandage. In group II, 25 patients (22 females and three males) were given a wrist resting splint holding the wrist in slight dorsiflexion. Evaluations of the patients were done before treatment and at the second and sixth weeks of treatment. Evaluation parameters were pain during rest and movement, sensitivity, algometer score, hand grip strength, and evaluation of the response to treatment. The response to treatment was evaluated according to the following categories: excellent, good, medium, and bad. In group I, only pain during rest and movement significantly decreased at 2 weeks while significant improvement was obtained for all parameters at 6 weeks. In group II, all parameters except for algometric sensitivity showed significant improvement at 2 weeks. Significant improvement was obtained for all parameters at 6 weeks in this group. Comparison of the two groups showed significantly better improvement in resting pain in group II at 2 weeks while there was no difference for other parameters including response to treatment at either evaluation stage. Braces might be a good strategy to help wait out the natural course of tennis elbow complaints. Although epicondyle bandage was not found to be superior to wrist splint in our study, we may suggest that it could be favored over splint since it is more practical and cosmetically acceptable.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18365136 8Clinical Trial Comparative Study Journal Article Belgium0770-3198 (Print)Clinical rheumatology18365136Rheumatic Disease and Hydrotherapy Section, Ataturk Rehabilitation Center, Uludag University Medical Faculty, Bursa, Turkey. lalealtan@uludag.edu.treng<7%;Oskarsson, E. Gustafsson, B. E. Pettersson, K. Aulin, K. P.2007IDecreased intramuscular blood flow in patients with lateral epicondylitis211-5Scand J Med Sci Sports173Adult Female Hand Strength Humans Laser-Doppler Flowmetry Male Middle Aged Muscle, Skeletal/*blood supply *Tennis Elbow/ultrasonographyJunQThe purpose of this pilot study was to investigate intramuscular microcirculation in extensor carpi radialis brevis (ECRB) in patients with lateral epicondylitis. Ten patients with unilateral epicondylitis, mean duration of symptoms of 39 (12-96) months participated. The diagnosis was based on clinical examination and none was under treatment for the last 6 months. Isometric handgrip strength, 2-pinch grip strength and muscle strength during radial deviation and dorsal extension were determined. Functional perceived pain was evaluated by a modified behaviour rating scale and perceived pain during contraction by visual analogue scale. Intramuscular and skin blood flow was recorded by a laser-Doppler flowmetry system technique (LDF) during stable temperature condition. Intramuscular blood flow was significantly lower in the affected side, 22.7+/-9.8 perfusion units (PU), as compared with 35.2+/-11.9 PU in the control side (P=0.01). There was no difference in skin blood flow or temperature between the affected and the control side. A positive correlation was found between the duration of symptoms and the difference in intramuscular blood flow between the affected and the control arm (r=0.65, P=0.06). The present data indicate that decreased microcirculation and anaerobic metabolism in ECRB may contribute to the lateral epicondylitis symptoms.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16805786 Journal Article Denmark0905-7188 (Print)4Scandinavian journal of medicine & science in sports16805786\Department of Clinical Medicine, Orebro University, Orebro, Sweden. eva.oskarsson@ikm.oru.seeng<7&Gill, T. J. th Micheli, L. J.1996RThe immature athlete. Common injuries and overuse syndromes of the elbow and wrist401-23Clin Sports Med152FAdolescent *Aging Athletic Injuries/*diagnosis/prevention & control/therapy Biomechanics Child Cumulative Trauma Disorders/*diagnosis/prevention & control/therapy Elbow/*injuries Elbow Joint/*injuries Humans Muscle, Skeletal/physiology Sports/education Tendons/physiology Wrist Injuries/*diagnosis/prevention & control/therapyAprSpecific elbow and wrist injuries are predictable in the skeletally immature athlete based on the biomechanics of the sport and the age of the patient. The physician must be aware of the potential for overuse injuries. Modification in training regimens is essential for recovery. A greater emphasis must be placed on the prevention of these injuries. As a general rule, the young athlete should not progress more than 10% per week in the amount and frequency of training. Correction of muscle-tendon imbalances is accomplished by maintaining strength and flexibility of susceptible tissues. In throwers, a triceps-strengthening program of progressive resisted extension exercises and a forearm flexor/extensor-strengthening program using the French curl technique are helpful. Careful attention to throwing technique and proper coaching are essential. The goal for the young athlete is early recognition of the injury and thereby prevention of a long-term disability.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8726322 $Journal Article Review United states0278-5919 (Print)Clinics in sports medicine8726322bHarvard University, Combined Residency Program in Orthopaedic Surgery, Boston, Massachusetts, USA.eng <7'Kentta, G. Hassmen, P.1998-Overtraining and recovery. A conceptual model1-16 Sports Med261Athletic Injuries/*etiology/physiopathology/rehabilitation Fluid Therapy Humans Nutritional Physiological Phenomena *Physical Education and Training Stress, Psychological/physiopathology Time FactorsJul Fiercer competition between athletes and a wider knowledge of optimal training regimens dramatically influence current training methods. A single training bout per day was previously considered sufficient, whereas today athletes regularly train twice a day or more. Consequently, the number of athletes who are overtraining and have insufficient rest is increasing. Positive overtraining can be regarded as a natural process when the end result is adaptation and improved performance: the supercompensation principle--which includes the breakdown process (training) followed by the recovery process (rest)--is well known in sports. However, negative overtraining, causing maladaptation and other negative consequences such as staleness, can occur. Physiological, psychological, biochemical and immunological symptoms must be considered, both independently and together, to fully understand the 'staleness' syndrome. However, psychological testing may reveal early-warning signs more readily than the various physiological or immunological markers. The time frame of training and recovery is also important since the consequences of negative overtraining comprise an overtraining-response continuum from short to long term effects. An athlete failing to recover within 72 hours has presumably negatively overtrained and is in an overreached state. For an elite athlete to refrain from training for > 72 hours is extremely undesirable, highlighting the importance of a carefully monitored recovery process. There are many methods used to measure the training process but few with which to match the recovery process against it. One such framework for this is referred to as the total quality recovery (TQR) process. By using a TQR scale, structured around the scale developed for ratings of perceived exertion (RPE), the recovery process can be monitored and matched against the breakdown (training) process (TQR versus RPE). The TQR scale emphasises both the athlete's perception of recovery and the importance of active measures to improve the recovery process. Furthermore, directing attention to psychophysiological cues serves the same purpose as in RPE, i.e. increasing self-awareness. This article reviews and conceptualises the whole overtraining process. In doing so, it (i) aims to differentiate between the types of stress affecting an athlete's performance: (ii) identifies factors influencing an athlete's ability to adapt to physical training: (iii) structures the recovery process. The TQR method to facilitate monitoring of the recovery process is then suggested and a conceptual model that incorporates all of the important parameters for performance gain (adaptation) and loss (maladaptation).ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9739537 "Journal Article Review New zealand0112-1642 (Print)Sports medicine (Auckland, N.Z9739537LDepartment of Psychology, Stockholm University, Sweden. gka@psychology.su.seeng]<7(.Stephens, M. B. Beutler, A. I. O'Connor, F. G.20084Musculoskeletal injections: a review of the evidence971-6Am Fam Physician788Adrenal Cortex Hormones/therapeutic use Anesthetics, Local/therapeutic use Carpal Tunnel Syndrome/drug therapy Diabetes Complications Humans *Injections, Intra-Articular/contraindications *Injections, Intramuscular Musculoskeletal Diseases/*drug therapyOct 15}Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18953975 $Journal Article Review United States0002-838X (Print)American family physician18953975bUniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. mstephens@usuhs.milengPKv:I/**refs.FRM 0B< !// !HPRIMARYyearIndex 6ByP/) idreference_type text_stylesauthoryear title pages secondary_title volume numbernumber_of_volumessecondary_authorplace_published publishersubsidiary_authoredition keywords type_of_workdate2)  abstractlabelurltertiary_titletertiary_author notes isbn custom_1 custom_2 custom_3 custom_4alternate_titleaccession_number call_number short_title custom_5 custom_6sectionoriginal_publicationH) reprint_editionreviewed_itemauthor_addressimagecaption custom_7 electronic_resource_number link_to_pdf translated_author translated_titlename_of_databasedatabase_providerresearch_notes language access_datelast_modified_date !! 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