ArticleFactors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy1
Section snippets
Study design and participants
This was a multicenter prospective study with an inception cohort of lateral epicondylitis patients commencing PT treatment. Eighty-six people (49 women, 37 men), who were recruited from 9 urban sports medicine and orthopedic clinics and 2 hospital outpatient departments in Toronto, ON, Canada, over a 14-month period, volunteered to participate.
Participants were considered to have a diagnosis of lateral epicondylitis and were eligible for inclusion in the study if they had tenderness on or near
Participants
Of the 86 participants, 3 were lost to follow-up (96.5% response rate). All analysis was therefore conducted on 83 participants.
Discussion
This study showed that women and self-reported nerve symptoms were associated with higher DASH and VAS scores after 8 weeks of PT management for lateral epicondylitis.
Of the 2 previous studies that specifically investigated sex as a prognostic factor, Gerberich and Priest23 also found that significantly more men reported “complete recovery” than women. This is in contrast to Stratford et al26 who found no difference in recovery between men and women. Stratford measured outcome as a dichotomy of
Conclusions
Certain subgroups of participants who presented with specific demographic, injury, and physical characteristics experienced a poorer outcome after 8 weeks of PT management, as measured by disability and pain levels. In particular, participants who reported symptoms of pins and needles and/or numbness had higher DASH and pain VAS scores than those who reported the more common symptoms of aching or sharp pain. Women had a poorer outcome than did men. This was partly because women were more likely
References (83)
Epidemiology of tennis, squash and racquetball injuries
Clin Sports Med
(1988)Elbow tendinosis/tennis elbow
Clin Sports Med
(1992)- et al.
The elbow
Clin Sports Med
(1997) - et al.
Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitisa randomised controlled trial
Lancet
(2002) - et al.
Understanding prognosis to improve rehabilitationthe example of lateral elbow pain
Arch Phys Med Rehabil
(1996) - et al.
Adverse tension in the neural system. A preliminary study of tennis elbow
Aust J Physiother
(1993) - et al.
Measuring the whole or the parts? Validity, reliability and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity
J Hand Ther
(2001) Outcome evaluation in patients with elbow pathologyissues in instrument development and evaluation
J Hand Ther
(2001)- et al.
Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis
J Hand Ther
(1999) Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale
Pain
(1983)
Comparative reliability and validity of chronic pain intensity measures
Pain
The measurement of clinical pain intensitya comparison of six methods
Pain
A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales
Pain
Manual examinationis pain provocation a major cue for spinal dysfunction?
Aust Physiother
Chronic lateral epicondylitis of the elbowa prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine
Arch Phys Med Rehabil
Everyday life with osteoarthritis or rheumatoid arthritisindependent effects of disease and gender on daily pain and coping
Pain
The relationship of gender to pain, pain behavior and disability in osteoarthritis patientsthe role of catastrophizing
Pain
Gender roles, illness orientation and use of medical services
Soc Sci Med
Radial tunnel syndromea spectrum of clinical presentations
J Hand Surg [Am]
Tennis elbow
Primary Care
Resistant tennis elbow
J Hand Surg [Br]
Prevalence, incidence and remission rates of some common rheumatic diseases and syndromes
Scand J Rheumatol
An epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies
Am J Sports Med
Tennis elbowconservative, surgical, and manipulative treatment
BMJ (Clin Res Ed)
Tennis elbowits course, natural history, conservative and surgical management
J Bone Joint Surg Am
The prevalence and causation of tennis elbow (lateral humeral epicondylitis) in a population of workers in an engineering industry
Ergonomics
The etiology and conservative treatment of humeral epicondylitis
Scand J Rehabil Med
Lateral humeral epicondylitis—a study of natural history and the effect of conservative therapy
Br J Rheumatol
Tennis elbow—a reappraisal
Br J Rheumatol
Tennis elbow. Anatomical, epidemiological and therapeutic aspects
Int Orthop
The etiology and treatment of tennis elbow
J Sports Med
Elbow, forearm and wrist injuries in the athlete
Sports Med
Tennis elbow. Current concepts of treatment and rehabilitation
Sports Med
Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care
BMJ
Cortisone injection with anesthetic additives for radial epicondylalgia (tennis elbow)
Clin Orthop
Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow
J Bone Joint Surg Br
Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis
J Bone Joint Surg Br
A comparative trial of forearm strap and topical anti-inflammatory as adjuncts to manipulative therapy in tennis elbow
Man Med
Treatment for lateral epicondylitisvariables related to recovery
Br J Sports Med
Statistical methods for the identification and use of prognostic factors
Int J Cancer
Glycosaminoglycan polysulfate injections in lateral humeral epicondylalgiaa placebo-controlled double-blind trial
Int J Sports Med
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2016, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :In our experience, 2 to 4 weeks may be sufficient for office workers not using a personal computer all day long, whereas heavy manual workers usually need 8 to 12 weeks, and sometimes more. Worse clinical outcome in women (compared with men) has previously been observed both in conservative37 and surgical treatment of LE.1,38,39 Looking at the follow-up results of this study, one is tempted to draw the same conclusion, although the difference in mean QuickDASH is small (5 points) and probably of little clinical importance.
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