Research proposal of a new clinic model for the interpretation of Lateral Elbow Pain: is it time to change? (original) (raw)
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Background: Lateral elbow pain (LEP) represents a musculoskeletal disorder affecting the epicondyloid region of the elbow. The terminological framework of this problem in literature, to date, is confusing. This systematic review (SR) aims to analyse the panorama of the scientific literature concerning the pathogenetic framework, treatment, and clinical diagnosis of LEP. Methods: We conducted an SR according to the guidelines of the PRISMA statement. We performed research using the electronic Medline, Epistemonikos, and Cochrane Library databases. The research started on 12 January 2022 and finished on 30 April 2022. We included all systematic reviews and meta-analyses published, in English, between 1989 and 2022. The articles’ selection was based on critical appraisal using Amstar 2. In the selected reviews we obtained the etiopathogenic terminology used to describe the symptoms, treatment, and diagnostic criteria of LEP. Results: Twenty-five SRs met the eligibility criteria and wer...
British Journal of Sports Medicine, 2022
Objectives To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies. Methods We implemented a multi-stage mixedmethods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus. Results 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains. Conclusions The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains.
Muscles, ligaments and tendons journal, 2020
LEVEL OF EVIDENCE: 4 SUMMARY Introduction. Lateral Elbow Pain (LEP) represents a disabling condition with a 1-3% prevalence in general population and a low spontaneous resolution rate within a year. This study investigated the methods of assessment and management of LEP in a sample of physiotherapists in relation to their level of experience. Methods. We conducted a cross sectional survey consisting of 12 questions. The investigation lasted 2 months and was disseminated through the informative channels of the Italian Physiotherapists Association and by e-mail. The percentage of responses was expressed for different levels of experience in terms of years of work and number of patients with LEP seen in 1 month. Data were analyzed with the SPSS software. Results. 1405 responses were collected. For LEP management, Psycho-Social Factors (PSFs) are more considered by the interviewees with few years of clinical practice than those who have worked for several years (p < 0.001; χ2=36.795)...
The role of physical examinations in studies of musculoskeletal disorders of the elbow
Occupational and Environmental Medicine, 2007
To present data on pain and physical findings from the elbow region, and to discuss the role of diagnostic criteria in epidemiological studies of epicondylitis. Methods: From a cohort of computer workers a subgroup of 1369 participants, who reported at least moderate pain in the neck and upper extremities, were invited to a standardised physical examination. Two independent physical examinations were performed-one blinded and one not blinded to the medical history. Information concerning musculoskeletal symptoms was obtained by a baseline questionnaire and a similar questionnaire completed on the day of examination. Results: 349 participants met the authors' criteria for being an arm case and 249 were elbow cases. Among the 1369 participants the prevalence of at least mild palpation tenderness and indirect tenderness at the lateral epicondyle was 5.8%. The occurrence of physical findings increased markedly by level of pain score. Only about one half with physical findings fulfilled the authors' pain criteria for having lateral epicondylitis. A large part with physical findings reported no pain at all in the elbow in any of the two questionnaires, 28% and 22%, respectively. Inter-examiner reliability between blinded and not blinded examination was found to be low (kappa value (0.34-0.40)). Conclusion: Very few with at least moderate pain in the elbow region met common specific criteria for lateral epicondylitis. The occurrence of physical findings increased markedly by level of pain score and the associations were strongest with pain intensity scores given just before the examination. Physical signs were commonly found in subjects with no pain complaints. No further impact was achieved if the physical examination was not blinded to the medical history. Furthermore, the authors propose that pain, clinical signs and disability are studied as separate outcomes, and that the diagnoses of lateral epicondylitis should be used only for cases with classical signs of inflammation reflected by severe pain, which for example conveys some disability.
Protocol for the Development of a Core Outcome Set for Lateral Elbow Tendinopathy (COS-LET)
Research Square (Research Square), 2021
Background Lateral elbow tendinopathy (LET) is a common condition that can cause signi cant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019 a working group of international experts, health care professionals and patients, in the eld of tendinopathy (International Scienti c Tendinopathy Symposium Consensus (ICON) Group) published the results of a consensus exercise de ning the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a Core Outcome Set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol we detail the methodological approach to the COS-LET development. Methods This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An International three-stage Delphi Study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi Study candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination lters with a threshold of 70% agreement set for consensus. Conclusions There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English-language studies related to LET. The ndings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences. Key Points There is wide variability in the outcome measures used in lateral elbow tendinopathy research. This protocol outlines the methodology used to derive a standardised set of validated outcome measures. The Core Outcome Set-Lateral Elbow Tendinopathy (COS-LET) will provide guidance on the minimum recommended outcomes to be used in future research, which, If implemented broadly, with
Demographic Causes of Chronic Lateral Elbow Pain along Arthroscopic Criteria
Objective: We conducted this study in order to find out the demographic causes of pathology for chronic lateral elbow pain along arthroscopic criteria. Material and Method: We conducted descriptive study of the medical records of the patients with chronic lateral elbow pain who refractory to conservative treatment. Diagnostic arthroscopy of the elbow was performed by a specialist in elbow surgery at HRH Princess Maha Chakri Sirindhorn Medical Center from March 2011 to October 2014. Results: There were 29 patients who met inclusion criteria in our study. With regard to intra-articular pathologies, we found a radiocapitellaplica in 41% of the patients. In 21% of the patients, we found isolated tennis elbow. The concomitant radiocapitellaplica and tennis elbow were also found in 21% of patients. Cartilage lesion was found in 10% of the patients and plica with posterolateral impingement was found in 7% of patients. Conclusion: Causes of the chronic lateral elbow pain are complex. The diagnosis should be made by precise clinical sign and proper investigations. In our series, the lateral epicondylitis was not the majority cause of chronic lateral elbow pain. The benefits of arthroscopy are not just the minimal invasive approach directly to the lesion, but also the intra-articular and dynamic investigation allow the surgeon to make sure that all pathology were treated.
Pain, Functional Disability, and Psychologic Status in Tennis Elbow
The Clinical Journal of Pain, 2007
Objectives: First to compare pain and functional disability in tennis elbow (TE) patients with healthy controls. Second, to evaluate the relationship between the 2 major psychologic factors (anxiety and depression) and TE. Methods: Sixteen TE patients were recruited from 46 consecutive attendees at an upper limb clinic: inclusion criteria were lateral epicondyle tenderness, pain with resisted wrist and middle finger extension and at least 3 months localized lateral elbow pain. Sixteen healthy controls with no upper limb problem were recruited from students and staff. Participants were given 4 questionnaires, together with instructions for completion: Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, Patient-Rated Wrist Evaluation Questionnaire, and Hospital Anxiety and Depression Scale. The independent t test was used to compare the total and subscale scores between the groups. Results: Significantly higher scores were found in TE for pain and function subscales and also total score for Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, and Patient-Rated Wrist Evaluation Questionnaire. For Hospital Anxiety and Depression Scale, both anxiety and depression subscales (P<0.001) and the total score (P<0.01) were significantly higher in TE. According to the anxiety and depression subscales, 55% and 36% of patients, respectively, were classified as probable cases (score >11). Discussion: TE patients showed markedly increased pain and functional disability. Significantly elevated levels of depression and anxiety pointed out the importance of psychologic assessment in TE patients. In the development of supportive and treatment strategies, we suggest the combination of ''upper limb'' and ''psychologic'' assessment tools.
Innovative publication, 2016
Introduction: Tennis Elbow is very common condition and affects approximately 1% to 3% of the population and is more common (affecting 15%) in individuals involved in repeated forceful activities with forearm. Various methods have been advocated for the treatment of Tennis elbow with variable success. The aim of this study was to compare the functional outcome of commonly available modalities of treatment in patients with Tennis elbow. Methods: 163 Patients diagnosed as Tennis elbow and treated at our institute between July 2013 to February 2015 and those who were followed up in Out Patient Department or on telephone up to February 2016 were retrospectively studied. All patients with a new episode of Tennis elbow were included in the study. Patients with polyarthritis, arthritis of the Elbow, previous fracture of the elbow and patients with neurological condition were excluded. 52 patients were treated with Local Injection of Corticosteroid, 58 patients were treated with Brace and 53 patients were treated with Local Ultrasound Therapy. All Patients were followed as per routine protocol and at each follow up visit functional assessment was done. The end point of the study was 1 year after completion of treatment. Overall success was defined as a 20% difference between treatment groups in the primary outcome measure. We compared groups with χ2 test. Results: In all three groups patient characteristics were comparable. At the end of first week of treatment recovery or improvement was reported in 48 patients (92.3%) in the Injection group, 28 patients (48.2%) in the Brace group and 30 patients (56.6%) in the Local Ultrasound group. At second week Injection group was better than in the Local Ultrasound and Brace groups. After four weeks 4 (7.6%) patients in Injection Group complained of recurrence of pain, 11 (21%) patients complained of moderate pain during work and 8 patients complained of mild pain during work. Pain relief and average functional outcome of Local Ultrasound Group was better as compared to other two groups at 4 weeks follow up examination and thereafter till end point of the study. Conclusions: Our results demonstrated Good Functional outcome in patients treated with Local Ultrasound Therapy and it was sustained over long period of time. Initial results in patients treated with Local Injection of Corticosteroid were better as compared to other modalities of treatment till first 4 weeks of follow up but they were not sustained over further follow up visits till one year.