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"Lateral epicondylitis"

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"Lateral epicondylitis"

Original Articles
Effectiveness of Initial Extracorporeal Shock Wave Therapy on the Newly Diagnosed Lateral or Medial Epicondylitis
Sang Seok Lee, Sangkuk Kang, Noh Kyoung Park, Chan Woo Lee, Ho Sup Song, Min Kyun Sohn, Kang Hee Cho, Jung Hwan Kim
Ann Rehabil Med 2012;36(5):681-687.   Published online October 31, 2012
DOI: https://doi.org/10.5535/arm.2012.36.5.681
Objective

To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection.

Method

An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm2, 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments.

Results

Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week.

Conclusion

The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

Citations

Citations to this article as recorded by  
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Low-energy Extracorporeal Shock Wave Therapy on Chronic Epicondylitis of the Elbow: Clinical and Sonographic Study.
Jung, Kyung Hoon , Hwang, Ji Hye , Chang, Hyun Jung , Yoon, Young Cheol , Park, Min Jong , Yoo, Jae Chul , Park, Won Hah
J Korean Acad Rehabil Med 2009;33(1):77-83.
Objective
To evaluate the effect of extracorporeal shock wave therapy (ESWT) and the improvement of ultrasonographic findings in refractory chronic epicondylitis of the elbow. Method: Twenty seven patients (7 men, 20 women, mean age 47) with minimum 1 year history of chronic epicondylitis of the elbow that was unresponsive to conventional therapy were included. Each patient was treated with 3∼4 sessions of low-energy (0.06∼0.12 mJ/mm2, 2000 impulses) ESWT. A 100-point scoring system, Nirschl score and Roles and Maudsley score were evaluated before treatment and at the 3- and 6-month follow-up. Ultrasonography was performed before treatment and at the 3-month follow-up. Results: Total score of a 100-point scoring system and Nirschl score were significantly improved at the 3- and 6-month follow-up compared to before treatment (p<0.05). Follow up ultrasonography was performed in twenty one patients. Eighteen of 21 patients (85.7%) showed improvement of tendinosis and 4 of 6 patients (66.7%) showed improvement of tear and 3 of 10 patients (30.0%) showed improvement of calcification on ultrasonography. Conclusion: ESWT is safe and effective modality in the treatment of refractory chronic epicondylitis of the elbow. And ultrasonography can be a useful method to evaluate the therapeutic effect of ESWT. (J Korean Acad Rehab Med 2009; 33: 77-83)
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Effect of Low-energy Extracorporeal Shock Wave Therapy on Calcifying Epicondylitis: Sonographic Follow-up.
Hwang, Ji Hye , Lee, Yong Taek
J Korean Acad Rehabil Med 2007;31(6):711-717.
Objective
To evaluate the effect of low-energy extracorporeal shock wave therapy (ESWT) in refractory calcifying epicondylitis. Method: Twelve patients (1 man, 11 women, mean age 49), who suffered from refractory medial or lateral epicondylitis (mean duration 22 months) with sonographically verified calcification, were included. Subjects were classified according to radiologic and sonographic findings of calcification. Visual analogue scale (VAS) at rest and activities of daily living (ADL) as well as Nirschl score were evaluated before and 3 months after low-energy (0.06∼0.12 mJ/mm2, 1,500∼ 2,000 shocks) extracorporeal shock wave therapy (ESWT). Sonographic changes and Roles and Maudsley score were assessed 3 months after ESWT. Results: VAS at rest and ADL as well as Nirschl score were significantly decreased (p<0.05) after ESWT. Roles and Maudsley score was "Good" in six patients (50%), "Acceptable" in 3 (25%) and "Poor" in 3 (25%) after 3 months. In sonographic classification, "Fragmented type" was observed in five (42%), "Nodular" in 3 (25%), "Small" in 4 (33%). All of eight radiologically positive patients (67%) showed sonographic changes of calcification including one complete resorption (8%), 3 disintegration (25%) and 4 decrease of size or number (33%). All of four radiologically negative patients (33%) were "Small type" and did not show any change of calcification on sonography. Conclusion: Low-energy ESWT can help the clinical improvement and resorption of calcification in refractory calcifying medial or lateral epicondylitis. Radio-opaque calcification may be a good indicator of resorption of calcification on sonography after low-energy ESWT. (J Korean Acad Rehab Med 2007; 31: 711-717)
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Ultrasonographic Findings of Chronic Lateral Epicondylitis with Partial Tear before and after Prolotherapy.
Kang, Si Hyun , Seo, Kyung Mook , Kim, Don Kyu , Shin, Ju Yon , Song, In Sup
J Korean Acad Rehabil Med 2004;28(1):88-93.
Objective
To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. Method: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. Results: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. Conclusion: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis. (J Korean Acad Rehab Med 2004; 28: 88-93)
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The Effect of Prolotherapy on Lateral Epicondylitis of Elbow.
Shin, Ju Yon , Seo, Kyung Mook , Kim, Don Kyu , Kim, Baek Kon , Kang, Si Hyun
J Korean Acad Rehabil Med 2002;26(6):764-768.
Objective
To determine the effect of prolotherapy on lateral epicondylitis, and the difference of treatment effect according to the findings of ultrasonography. Method: The subjects were 84 patients who were diagnosed as lateral epicondylitis. The pain score was evaluated by using VAS (Visual Analogue Scale) before treatment and 1 month and 6 months after the 3rd injection. Ultrasonography was done to 49 patients who were suspicious of tendinous tear. Results: In the comparison of the VAS before treatment and after the 3rd injection, it was 6.79⁑0.88, 2.95⁑1.90, respectively, which demonstrated statistical significant decrease (p<0.01). We found more significant reduction of VAS in the subjects without tendinous tear (7.08⁑0.91 to 2.16⁑1.57) than those with partial tendinous tear (6.90⁑0.93 to 3.67⁑1.76) (p<0.01). Among 71 patients whose symptom was improved after the treatment, 57 patients (80.2%) demonstrated sustained improvement at 9 months and 14 patients (19.7%) relapsed at 9 months. Conclusion: Prolotherapy is an effective treatment method in the lateral epicondylitis of elbow. Ultrasonography could be a useful diagnostic method which could predict the effect of prolotherapy. (J Korean Acad Rehab Med 2002; 26: 764-768)
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