Research proposal of a new clinic model for the interpretation of Lateral Elbow Pain: is it time to change? (original) (raw)

Abstract

Background. Lateral Elbow Tendinopathy (aka Tennis Elbow or Lateral Elbow Pain), is characterized by a specific pain located in the lateral epicondyle and referred to the dorsal compartment of the forearm. Manual labour and forceful gripping activities can exacerbate pain, by restricting a patient's ability to work, train and perform simple daily tasks. In the framework of an aetiopathogenic complexity, a multimodal approach based upon the exclusive involvement of the common extensor tendon seems to be rather obsolete. This method does not consider any intra-articular pain resulting from micro-instabilities requiring a different approach together with a detection performed in a limited time span, in order to avoid any impairment of the psychosocial condition following the failure of all the proposed conservative treatments. Objectives. The primary objective of this debate was to have elaborated a decisional algorithm called Integrated Approach of Lateral Elbow Pain (I-APPLEp), which could allow the detection of a time-optimized plan for a diagnostic, therapeutic framing. Discussion. Following the above-mentioned research proposal, this clinical approach based upon an evaluative and therapeutic management of patients with LEP allows us to draw some conclusions: 1) using the expression Lateral Elbow Pain (LEP) to refer to this musculoskeletal condition should be preferable, owing to its aetiological and pathophysiological complexity. Moreover, the expression Non-specific Lateral Elbow Pain (NSLEP) in case of suffering of the extra-articular structures (i.e. Tendinopathy) and Specific Lateral Elbow Pain (SLEP) is recommended, within the framework of arthropathy or intra-articular pathology (e.g.: Smile Symptomatic MInor Instabilities of the Lateral Elbpw); 2) an early surgical treatment can be a feasible option in the management of articular micro-instabilities, recalcitrant pathologies and psychosocial profiles with a high risk of unfavorable prognosis. Conclusions. We recommend testing brand-new diagnostic, therapeutic proposals on sampling patients, who must be adequately chosen, in order to estimate the real impact in the short, medium and long term.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (69)

  1. Wiitavaara B, Fahlström M, Djupsjöbacka M. Prevalence, diag- nostics and management of musculoskeletal disorders in prima- ry health care in Sweden -an investigation of 2000 randomly selected patient records. J Eval Clin Pract. 2017;23(2):325-332.
  2. Piano L, Maselli F, Viceconti A, Gianola S, Ciuro A. Direct access to physical therapy for the patient with musculoskeletal disorders, a literature review. J Phys Ther Sci. 2017;29(8):1463- 1471.
  3. Longo UG, Franceschetti E, Rizzello G, Petrillo S, Dena- ro V. Elbow tendinopathy. Muscles Ligaments Tendons J. 2012;2(2):115-120.
  4. Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015;61(4):174-181.
  5. Katz J, Rosenbloom BN, Fashler S. Chronic Pain, Psychopa- thology, and DSM-5 Somatic Symptom Disorder. Can J Psychi- atry. 2015;60(4):160-167.
  6. Sims SEG, Miller K, Elfar JC, Hammert WC. Non-surgi- cal treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (N Y). 2014;9(4):419-446.
  7. Smidt N, Lewis M, VAN DER Windt DAWM, Hay EM, Bouter LM, Croft P. Lateral epicondylitis in general practice: course and prognostic indicators of outcome. J Rheumatol. 2006;33(10):2053-2059.
  8. Das De S, Vranceanu A-M, Ring DC. Contribution of kineso- phobia and catastrophic thinking to upper-extremity-specific disability. J Bone Joint Surg Am. 2013;95(1):76-81.
  9. Lee DO, Gong HS, Kim JH, Rhee SH, Lee YH, Baek GH. The relationship between positive or negative phrasing and patients' coping with lateral epicondylitis. J Shoulder Elbow Surg. 2014;23(4):567-572.
  10. Mallows A, Debenham J, Walker T, Littlewood C. Associa- tion of psychological variables and outcome in tendinopathy: a systematic review. Br J Sports Med. 2017;51(9):743-748.
  11. Coombes BK, Bisset L, Vicenzino B. Management of Later- al Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther. 2015;45(11):938-949.
  12. Day JM, Lucado AM, Uhl TL. A comprehensive rehabilitation program for treating lateral elbow tendinopathy. Int J Sports Phys Ther. 2019;14(5):818-829.
  13. Ljung BO, Forsgren S, Fridén J. Substance P and calcitonin gene-related peptide expression at the extensor carpi radia- lis brevis muscle origin: implications for the etiology of tennis elbow. J Orthop Res. 1999;17(4):554-559.
  14. Wright A. Recent concepts in the neurophysiology of pain. Man Ther. 1999;4(4):196-202.
  15. Alizadehkhaiyat O, Fisher AC, Kemp GJ, Vishwanathan K, Frostick SP. Upper limb muscle imbalance in tennis elbow: a functional and electromyographic assessment. J Orthop Res. 2007;25(12):1651-1657.
  16. Kelley JD, Lombardo SJ, Pink M, Perry J, Giangarra CE. Elec- tromyographic and cinematographic analysis of elbow func- tion in tennis players with lateral epicondylitis. Am J Sports Med. 1994;22(3):359-363.
  17. Rojas M, Mañanas MA, Muller B, Chaler J. Activation of forearm muscles for wrist extension in patients affected by lateral epicondylitis. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:4858-4861.
  18. Vicenzino B, Paungmali A, Buratowski S, Wright A. Specific manipulative therapy treatment for chronic lateral epicondyl- algia produces uniquely characteristic hypoalgesia. Man Ther. 2001;6(4):205-212.
  19. Kwak SH, Lee S-J, Jeong HS, Do MU, Suh KT. Subtle elbow instability associated with lateral epicondylitis. BMC Musculo- skelet Disord. 2018;19(1):136.
  20. Arrigoni P, Cucchi D, D'Ambrosi R, Butt U, Safran MR, Denard P, Randelli P. Intra-articular findings in symptomat- ic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2255-2263. Epub 2017 Mar 24. PubMed PMID: 28341879.
  21. Kniesel B, Huth J, Bauer G, Mauch F. Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability. Arch Orthop Trauma Surg. 2014;134(12):1641-1647.
  22. Bot S, van der Waal JM, Terwee C, van der Windt DAWM, Bouter L, Dekker J. Course and prognosis of elbow complaints: a cohort study in general practice. Ann Rheum Dis. 2005;64(9):1331-1336.
  23. Ring D, Kadzielski J, Fabian L, Zurakowski D, Malho- tra LR, Jupiter JB. Self-reported upper extremity health L. Di FiLippo, D. penneLLa, F. MaseLLi, p. arrigoni status correlates with depression. J Bone Joint Surg Am. 2006;88(9):1983-1988.
  24. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747.
  25. Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med. 2009;43(4):252-258.
  26. Coombes BK, Bisset L, Vicenzino B. Thermal hyperalgesia distinguishes those with severe pain and disability in unilateral lateral epicondylalgia. Clin J Pain. 2012;28(7):595-601.
  27. Au IPH, Fan PCP, Lee WY, et al. Effects of Kinesio tape in individuals with lateral epicondylitis: A deceptive crossover trial. Physiother Theory Pract. 2017;33(12):914-919.
  28. Stratford P, Levy D. Assessing Valid Change over Time in Patients with Lateral Epicondylitis at the Elbow. Clinical Jour- nal of Sport Medicine. 1994;4(2):88-91.
  29. Shamsoddini A, Hollisaz MT. Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow. Trauma Mon. 2013;18(2):71-74.
  30. Vicenzino B, Brooksbank J, Minto J, Offord S, Paungma- li A. Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther. 2003;33(7):400-407.
  31. Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther. 2009;39(6):484-489.
  32. Bisset LM, Collins NJ, Offord SS. Immediate effects of 2 types of braces on pain and grip strength in people with lateral epicondylalgia: a randomized controlled trial. J Orthop Sports Phys Ther. 2014;44(2):120-128.
  33. Altan L, Kanat E. Conservative treatment of lateral epicondy- litis: comparison of two different orthotic devices. Clin Rheu- matol. 2008;27(8):1015-1019.
  34. Shamsoddini A, Hollisaz MT. Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow. Trauma Mon. 2013;18(2):71-74.
  35. Fedorczyk JM. Tendinopathies of the elbow, wrist, and hand: histopathology and clinical considerations. J Hand Ther. 2012;25(2):191-200; quiz 201.
  36. Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther. 2003;8(3):130-140.
  37. Arrigoni P, Cucchi D, Menon A, Randelli P. It's time to change perspective! New diagnostic tools for lateral elbow pain. Musculoskelet Surg. 2017;101(Suppl 2):175-179.
  38. Bot S, van der Waal JM, Terwee C, van der Windt DAWM, Bouter L, Dekker J. Course and prognosis of elbow complaints: a cohort study in general practice. Ann Rheum Dis. 2005;64(9):1331-1336.
  39. Alizadehkhaiyat O, Fisher AC, Kemp GJ, Frostick SP. Pain, functional disability, and psychologic status in tennis elbow. Clin J Pain. 2007;23(6):482-489.
  40. Thiese MS, Hegmann KT, Kapellusch J, et al. Psychoso- cial Factors Related to Lateral and Medial Epicondylitis: Results From Pooled Study Analyses. J Occup Environ Med. 2016;58(6):588-593.
  41. Aben A, De Wilde L, Hollevoet N, et al. Tennis elbow: associated psychological factors. J Shoulder Elbow Surg. 2018;27(3):387-392.
  42. Haahr JP, Andersen JH. Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study. Occup Environ Med. 2003;60(5):322-329.
  43. Bugajska J, Żołnierczyk-Zreda D, Jędryka-Góral A, et al. Psychological factors at work and musculoskeletal disorders: a one year prospective study. Rheumatol Int. 2013;33(12):2975- 2983.
  44. Berglund KM, Persson BH, Denison E. Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain. Man Ther. 2008;13(4):295-299.
  45. Maffulli G, Hemmings S, Maffulli N. Assessment of the Effec- tiveness of Extracorporeal Shock Wave Therapy (ESWT) For Soft Tissue Injuries (ASSERT): An Online Database Protocol. Transl Med UniSa. 2014;10:46-51.
  46. Antuna SA, O'Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy. 2001;17(5):491- 495.
  47. Valdes K, LaStayo P. The value of provocative tests for the wrist and elbow: a literature review. J Hand Ther. 2013;26(1):32-42;
  48. Faculty of physiotherapy, Sri Ramachandra University, Chen- nai, Tamil Nadu, India., Saroja G, Aseer P AL, Reader in phys- iotherapy, Sri Ramachandra University, Chennai, Tamil Nadu, India., P M VS, Professor & Head in Radiology, Sri Ramach- andra University, Chennai, Tamil Nadu, India. Diagnostic accuracy of provocative tests in lateral epicondylitis. IJPR. 2014;2(6):815-823.
  49. Vicenzino B. Physiotherapy for tennis elbow. Evid Based Med. 2007;12(2):37-38.
  50. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384-393.
  51. Wada T, Moriya T, Iba K, et al. Functional outcomes after arthroscopic treatment of lateral epicondylitis. J Orthop Sci. 2009;14(2):167-174.
  52. Jeon I-H, Chun J-M, Lee C-S, et al. Zona conoidea of the elbow: another articulation between the radial head and lateral trochlear of the elbow. J Bone Joint Surg Br. 2012;94(4):517- 522.
  53. Baker CL, Murphy KP, Gottlob CA, Curd DT. Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results. J Shoulder Elbow Surg. 2000;9(6):475-482.
  54. Rajeev A, Pooley J. Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain. J Orthop Surg (Hong Kong). 2015;23(1):11-14.
  55. Kim DH, Gambardella RA, Elattrache NS, Yocum LA, Jobe FW. Arthroscopic treatment of posterolateral elbow impinge- ment from lateral synovial plicae in throwing athletes and golf- ers. Am J Sports Med. 2006;34(3):438-444.
  56. Magee T. Accuracy of 3-T MR arthrography versus conven- tional 3-T MRI of elbow tendons and ligaments compared with surgery. AJR Am J Roentgenol. 2015;204(1):W70-75.
  57. Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol. 2005;34(1):1-18.
  58. Dewan AK, Chhabra AB, Khanna AJ, Anderson MW, Brunton LM. MRI of the elbow: techniques and spectrum of disease: AAOS exhibit selection. J Bone Joint Surg Am. 2013;95(14):e99
  59. 1-13. Research proposal of a new clinic model for the interpretation of Lateral Elbow Pain: is it time to change? 59. Arthroscopic managementof miscellaneous elbow disorders -ScienceDirect. https://www.sciencedirect.com/science/arti- cle/abs/pii/S1060187298800336. Accessed January 22, 2020.
  60. Arrigoni P, Cucchi D, D'Ambrosi R, Menon A, Aliprandi A, Randelli P. Arthroscopic R-LCL plication for symptomat- ic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2264-2270.
  61. Müller A, Spies CK, Unglaub F, Bruckner T, Pötzl W. [Chron- ic lateral epicondylitis : The Nirschl procedure]. Oper Orthop Traumatol. 2015;27(6):525-535.
  62. Phorkhar T, Chanlalit C. Functional Results in Arthroscopic Treatment in Patients with Chronic Lateral Elbow Pain. J Med Assoc Thai. 2015;98 Suppl 10:S130-134.
  63. El Hajj F, Hoteit M, Ouaknine M. Elbow arthroscopy: An alternative to anteromedial portals. Orthopaedics & Traumatol- ogy: Surgery & Research. 2015;101(4):411-414.
  64. Leong NL, Cohen JR, Lord E, Wang JC, McAllister DR, Petri- gliano FA. Demographic Trends and Complication Rates in Arthroscopic Elbow Surgery. Arthroscopy. 2015;31(10):1928- 1932. 65. Smith AR. Manual therapy: the historical, current, and future role in the treatment of pain. ScientificWorldJournal. 2007;7:109-120.
  65. Lorås H, Østerås B, Torstensen TA, Østerås H. Medical Exer- cise Therapy for Treating Musculoskeletal Pain: A Narrative Review of Results from Randomized Controlled Trials with a Theoretical Perspective. Physiother Res Int. 2015;20(3):182- 190.
  66. Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Founda- tions and Techniques. F.A. Davis; 2017.
  67. Manual Therapy: "NAGS", "SNAGS", "MWMS" Etc -Brian R. Mulligan - 69.
  68. Hing W, Bigelow R, Bremner T. Mulligan's Mobilization with Movement: A Systematic Review. Journal of Manual & Manipulative Therapy. 2009;17(2):39E-66E.
  69. Padulo J, Oliva F, Frizziero A, Maffulli N. Muscles, Liga- ments and Tendons Journal -Basic principles and recom- mendations in clinical and field Science Research: 2018 update. Muscle, Ligaments and Tendons Journal. 2018; 8(3): 305 -307.