Zeliha Özlem YÜRÜK, Nuray KIRDI, Nihal ŞİMŞEK

Lateral Epikondilitli Olgularda Radyal Ekstrakorporeal Şok Dalga Tedavisi Ağrı, Kavrama Kuvveti ve Fonksiyonellik Üzerine Etkisi: Randomize Kontrollü Çalışma

Amaç: Bu çalışmada, lateral epikondilit tanısı konan hastalarda, radyal ekstrakorporeal şok dalga tedavisinin (Radial ekstrakorporeal shock wave therapy- RESWT) ağrı, kavrama kuvveti ve fonksiyonellik üzerine etkisi araştırıldı.Yöntemler: Çalışma 30 hasta üzerinde gerçekleştirildi. Hastalar; RESWT ile egzersiz ve plasebo RESWT ile egzersiz olmak üzere iki gruba ayrıldı. RESWT ve egzersiz grubundaki hastalara 2000 atım, haftada bir kere, 3 seans; plasebo gruba ise 20 atım, haftada bir kere, 3 seans RESWT uygulandı. Her iki gruptaki hastalara germe ve eksentrik kuvvetlendirme egzersizleri verildi. Hastaların palpasyon ve kavrama ile meydana gelen ağrı şiddeti Vizuel Ağrı Skalası (VAS) ile kavrama kuvveti dinamometre ile fonksiyonellik düzeyi ise Hasta Bazlı Önkol Değerlendirme Anketi (HBÖDA) ile tedavi öncesinde, tedavi bitiminde ve tedavi sonrası 6. ve 12. haftalarda değerlendirildi.Bulgular: Palpasyon ile ölçülen VAS değerleri dışındaki tüm parametrelerde gruplar arasında istatistiksel olarak anlamlı fark bulundu (p<0,05). RESWT ve egzersiz grubunda palpasyon ve kavrama ile ölçülen VAS, kavrama kuvveti ve HBÖDA değerlerinde plasebo RESWT ve egzersiz grubuna oranla zamana göre meydana gelen değişimlerin daha fazla olduğu görüldü (p<0,05).Sonuç: Bu sonuçlar ışığında RESWT’nin başta egzersiz olmak üzere diğer konservatif tedavilerle birlikte kullanılmasının etkili olacağını düşünmekteyiz.

Anahtar Kelimeler:

Lateral epikondilit, şok dalga tedavisi, egzersiz, ağrı, fonksiyonellik

Effects of Radial Extracorporeal Shock Wave Therapy on Pain, Grip Strength, and Functionality in Patients with Lateral Epicondylitis: A Randomized Controlled Study

Objective: In this study, the effects of radial extracorporeal shock wave therapy (RESWT) on pain, grip strength, and functionality were investigated in patients with lateral epicondylitis.Methods: The study included 30 patients who were divided into two groups: RESWT and exercise and placebo RESWT and exercise. In the RESWT and exercise group, RESWT was applied at 2000 pulses, once a week, for a total of three sessions, and in the placebo RESWT and exercise group, RESWT was applied at 20 pulses, once a week, for a total of three sessions. Patients in all groups underwent stretching and eccentric strengthening exercises. Patients were evaluated before and after undergoing the treatment and at 6 and 12 weeks after undergoing the treatment using a visual analog scale (VAS) for pain intensity during palpation and gripping, dynamometer for grip strength, and patient-rated tennis elbow evaluation (PRTEE) for functionality.Results: There were statistically significant differences between groups with respect to all parameters, except VAS during palpation (p<0.05). With time, there were more significant changes in VAS during palpation and gripping, grip strength, and PRTEE in the RESWT and exercise group compared with those in the placebo RESWT and exercise group (p<0.05).Conclusion: We concluded that using RESWT combined with other conservative treatments, mostly exercise, could be more effective.

Keywords:

Lateral epicondylitis, shock wave therapy, exercise, pain, functionality,

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Valen PA, Foxworth J. Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions. Curr Opin Rheumatol 2010; 22: 194-204. [CrossRef]
Ihm J. Proximal wrist extensor tendinopathy. Curr Rev Musculoskelet Med 2008; 1: 48-52. [CrossRef]
Faro F, Wolf JM. Lateral epicondylitis: Review and current concepts. J Hand Surg 2007; 32: 1271-9. [CrossRef]
Trumble TE, Budoff JE, Cornwall R. Hand, Elbow and Shoulder, Core Knowledge in Orthopaedics. Philadelphia: Mosby Elsevier; 2006.
Murphy KP, Giuliani JR, Freedman BA. The diagnosis and management of lateral epicondylitis. Curr Opin Orthop 2006; 17: 134-8. [CrossRef]
Chard MD, Hazleman BL. Tennis elbow: A reappraisal. Br J Rheumatol 1989; 28: 186-9. [CrossRef]
Waseem M, Nuhmani S, Ram CS, Sachin Y. Lateral epicondylitis: A review of the literature. J Back Musculoskelet Rehabil 2012; 25: 131-42.
Clinton RE, Murthi AM. Elbow: Lateral epicondylitis. Curr Orthop Pract 2008; 19: 612-5. [CrossRef]
Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (Lateral epicondy- losis). Ups J Med Sci 2011; 116: 269-79. [CrossRef]
Wang CJ. Extracorporeal shock wave therapy in musculoskeletal disor- ders. J Orthop Surg Res 2012; 7: 11. [CrossRef]
Sems A, Dimeff R, Ianotti JP. Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg 2006; 14: 195-204. [CrossRef]
Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, et al. Ef- fectiveness of radial shock wave therapy for calcific tendinitis of the shoulder: Single-blind, randomized clinical study. Phys Ther 2006; 85: 672-782.
Speed C. A systematic review of shockwave therapies in soft tissue conditi- ons: focusing on the evidence. Br J Sports Med 2014; 48: 1538-42. [CrossRef]
Radwan YA, ElSobhi G, Badawy WS, Reda A, Khalid S. Resistant tenis el- bow: Shock wave therapy versus percutaneous tenotomy. Int Orthop 2008; 32: 671-7. [CrossRef]
Chung B, Wiley P. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis. Am J Sport Med 2004; 32: 1160-7. [CrossRef]
Graphpad Software (cited 2011 October 5). Available from: URL: http:// www.graphpad.com/quickcals.
Turk D, Melzack R, editors. Handbook of pain assessment. 2nd ed. New York: The Guilford Press; 1992.
Işıntaş Arık M. Lateral Epikondilitte Değişik Kas Gruplarının Kuvveti ile Ağrı Arasındaki İlişki. H.U. Sağlık Bilimleri Enstitüsü, Yuksek Lisans Tezi. 2004.
Niesen-Vertommen SL, Taunton JE, Clement DB, Mosher RE. The effect of eccentric versus concentric exercise in the management of achilles tendonitis. Clin J Sport Med 1992; 2: 109-13. [CrossRef]
Wuori J, Overend TJ, Kramer JF, MacDermid J. Strength and pain measu- res associated with lateral epicondylitis bracing. Arch Phys Med Rehabil 1998; 79: 832-7. [CrossRef]
Schmidt RT, Tuews JV. Grip strenght as measured by the Jamar dynamo- meter. Arch Phys Med Rehabil 1970; 51: 321-7.
MacDermid J. Update: The patient-rated forearm evaluation questionna- ire is now the Patient-rated tennis elbow evaluation. J Hand Ther 2005; 18: 407-10. [CrossRef]
Altan L, İlker E, Konur S. Reliability and validity of Turkish version of the patient rated tennis elbow evaluation. Rheum Int 2010; 30: 1049-54. [CrossRef]
Stasinopoulos D, Stasinopoulou K, Johnson MI. An exercise programme for the management of lateral elbow tendinopathy. Br J Sport Med 2005; 39: 944-7. [CrossRef]
Shoukri MM, Pause CA, editors. Statistical methods for health sciences. 2nd ed. Florida-USA: CRC Press; 1999.
Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: A prospective randomised controlled single blind study. Euro Medicophys 2005; 41: 17-25.
Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: Results of a confirmatory randomized placebo-controlled multicenter study. Am J Sport Med 2008; 36: 2100-9. [CrossRef]
Rompe JD, Decking J, Schoeliner C, Theis C. Repetitive low energy shock wave treatment for chronic lateral epicondylitis. Am J Sport Med 2004; 32: 734-43. [CrossRef]
Johnson GW, Cadwallader K, Scheffer SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician 2007; 76: 843-8.
Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and me- ta-analysis of clinical trials on physical interventions for lateral epicondy- lalgia. Br J Sports Med 2005; 39: 411-22. [CrossRef]
Buchbinder R, Green SE, Youd JM, Assendelft WJ, Barnsley L, Smidt N. Systematic review of efficacy and safety of shock wave therapy for lateral elbow pain. J Rheumatol 2006; 33: 1351-63.
Stasinopoulos D, Johnson MI. Effectiveness of extracorporeal shock wave therapy for tennis elbow (Lateral epicondylitis). Br J Sports Med 2005; 39: 132-6. [CrossRef]
Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg 2005; 87: 1297-304. [CrossRef]
Stasinopoulos D, Stasinopoulos I, Pantelis M, Stasinopoulou K. Compa- rison of effects of a home exercise programme and a supervised exerci- se programme for the management of lateral elbow tendinopathy. Br J Sports Med 2010; 44: 579-83. [CrossRef]
Haake M, König R, Decker T, Riedel C, Buch M, Müller HH, et al. Extra- corporeal shock wave therapy in the treatment of lateral epicondylitis: A randomized multicenter trial. J Bone Joint Surg 2002; 84: 1982-91.
Chow IHW, Cheing GLY. Comparison of different energy densities of ext- racorporeal shock wave therapy (ESWT) for the management of chronic heel pain. Clin Rehabil 2007; 27: 131. [CrossRef]
Wang CJ, Chen HS. Shock wave therapy for patients with lateral epi- condylitis of the elbow. Am J Sport Med 2002; 30: 422-5.
Lee SS, Kang S, Park NK, Lee CW, Song HS, Sohn MK, et al. Effective- ness of initial extracorporeal shock wave therapy on the newly di- agnosed lateral or medial epicondylitis. Ann Rehabil Med 2012; 36: 681-7. [CrossRef]
Haake M, Böddeker IR, Decker T, Buch M, Vogel M, Labek G, et al. Side-ef- fects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow. Arch Orthop Trauma Surg 2002; 122: 222-8. [CrossRef]