Sign in to use this feature.

Years

Between: -

Subjects

remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline

Journals

Article Types

Countries / Regions

Search Results (23)

Search Parameters:
Keywords = PRTEE

Order results
Result details
Results per page
Select all
Export citation of selected articles as:
17 pages, 2306 KB  
Study Protocol
Effectiveness of High-Intensity Electromagnetic Stimulation Delivered by the Super Inductive System Combined with Therapeutic Exercise and Health Education in Lateral Epicondylalgia: Study Protocol for a Multicenter Randomized Controlled Trial
by María del Carmen Sánchez-Mato, Ramon Arroyo-Aljaro, Jordi Alcaide-Altet, Ana M. Gómez-Gil, Luisa Acosta-Moreno, Sara Izquierdo-Cuesta, Rosa Maria Garcia-Sierra and Anna Escribà-Salvans
Life 2026, 16(10), 1596; https://doi.org/10.3390/life16101596 - 24 Sep 2026
Viewed by 234
Abstract
Background: Lateral epicondylalgia is a common musculoskeletal condition that negatively affects functionality and quality of life, with a clinical and socioeconomic impact. Although therapeutic exercise is considered the first-line conservative treatment, there is no consensus on the most effective strategy, and the role [...] Read more.
Background: Lateral epicondylalgia is a common musculoskeletal condition that negatively affects functionality and quality of life, with a clinical and socioeconomic impact. Although therapeutic exercise is considered the first-line conservative treatment, there is no consensus on the most effective strategy, and the role of electrotherapy techniques remains controversial. Objectives: The objective of this study is to evaluate the effectiveness of the Super Inductive System (SIS) combined with a therapeutic exercise and health education program in patients with lateral epicondylalgia. Methods: A randomized, multicenter, blinded trial is proposed. A total of 120 participants will be randomly assigned to an intervention group (IG) or a control group (CG). Participants in the IG will receive SIS treatment at a therapeutic dose, combined with therapeutic exercise and health education. Participants in the CG will receive SIS at a non-therapeutic dose along with the same exercise and education program. The intervention will consist of eight sessions. The primary outcome will be the PRTEE score. Grip strength, mobility, and quality of life will be assessed at baseline, immediately after treatment, and at 3- and 6-month follow-up assessments. This study will evaluate the effectiveness of SIS in lateral epicondylalgia. Full article
(This article belongs to the Collection Clinical Trials)
►▼ Show Figures

Graphical abstract

14 pages, 1051 KB  
Article
Ultrasound-Guided Collagen Peptides Injections Combined with Focused Extracorporeal Shockwave Therapy and Therapeutic Exercise in Chronic Partial Common Extensor Tendon Tears at Elbow Lateral Epicondyle: A Retrospective Case Series
by Nicolò Vitale, Luca Latini, Marco Di Gesù, Ilias Vurliotis, Marianna Capecci, Valerio Sebastiano Amico, Florentin Ananu Vreju and Emilio Filippucci
Life 2026, 16(9), 1465; https://doi.org/10.3390/life16091465 - 2 Sep 2026
Viewed by 513
Abstract
Background: Lateral elbow tendinopathy (LET) is a common upper-limb musculoskeletal disorder causing pain during gripping activities, reduced work capacity, and functional limitation. LET is currently considered a predominantly degenerative condition characterized by collagen disorganization, extracellular matrix changes, neovascularization, and impaired tendon healing. Objective: [...] Read more.
Background: Lateral elbow tendinopathy (LET) is a common upper-limb musculoskeletal disorder causing pain during gripping activities, reduced work capacity, and functional limitation. LET is currently considered a predominantly degenerative condition characterized by collagen disorganization, extracellular matrix changes, neovascularization, and impaired tendon healing. Objective: To evaluate short-term clinical and functional outcomes of a multimodal protocol including focused extracorporeal shock wave therapy (f-ESWT), ultrasound-guided intralesional injection of low-molecular-weight peptides (LWPs) derived from hydrolyzed bovine collagen and therapeutic exercise in patients with chronic LET unresponsive to standardized conservative therapy. Methods: This retrospective observational study included 11 screened patients; 10 completed follow-up. Eligibility required age ≥ 18 years, symptoms ≥ 3 months, positive provocation tests, ultrasound-confirmed common extensor tendon pathology, and incomplete response to prior treatment. All patients received f-ESWT before ultrasound-guided LWPs injection and performed progressive loading exercises. Outcomes included Patient-Rated Tennis Elbow Evaluation (PRTEE), grip strength, and clinical provocation tests at baseline (T0; Day 0) and at T1 (Day 51, 30 days after injection). Results: PRTEE pain improved by 31.2 points (95% CI 22.2–40.2; Cohen’s d_z = 2.48) and PRTEE function by 32.6 points (95% CI 26.7–38.5; d_z = 3.95). Mean maximal strength and maximal strength improved by 4.61 kg (95% CI 2.89–6.32) and 4.02 kg (95% CI 2.36–5.68), respectively. Clinical test severity decreased by an estimated 2.5 points (95% CI 2.0–3.0). No adverse events were reported. Conclusions: Patients showed clinically meaningful short-term improvements in pain, function, and strength following the sequential multimodal management strategy. However, the retrospective design, small sample, lack of control group, and short follow-up preclude causal attribution and require confirmation in prospective controlled studies. Full article
(This article belongs to the Special Issue Musculoskeletal Medicine in Rheumatic Diseases: 2nd Edition)
►▼ Show Figures

Figure 1

13 pages, 1995 KB  
Case Report
Ultrasound-Guided Pharmacopuncture Targeting the Myotendinous Junction for Refractory Common Extensor Tendinopathy: A Case Series
by Taeseok Ahn, Jihyun Moon, Myungjin Oh, Junyoung Oh, Jung-Yun Ahn, Daeook Lee, Jongha Lee, Changyoung Park and Dong-Woo Lim
Diagnostics 2026, 16(17), 2755; https://doi.org/10.3390/diagnostics16172755 - 28 Aug 2026
Viewed by 419
Abstract
Background: Lateral epicondylalgia (LE) is a prevalent musculoskeletal condition, and a substantial proportion of patients fail to respond to conservative treatment. The myotendinous junction (MTJ) of the common extensor tendon (CET) harbors dense nociceptive nerve endings yet remains an underexplored target in [...] Read more.
Background: Lateral epicondylalgia (LE) is a prevalent musculoskeletal condition, and a substantial proportion of patients fail to respond to conservative treatment. The myotendinous junction (MTJ) of the common extensor tendon (CET) harbors dense nociceptive nerve endings yet remains an underexplored target in pharmacopuncture practice. Case Presentation: In this retrospective case series, three patients with refractory LE (duration 1.5–3 years, with prior treatments including corticosteroid injection, NSAIDs, physical therapy, and prolotherapy) received a structured multicomponent ultrasound-guided pharmacopuncture protocol, of which MTJ-targeted hydrodissection with placenta pharmacopuncture constituted the primary component, administered over ten sessions. A structured three-stage protocol was applied, incorporating placenta pharmacopuncture at the MTJ, Eohyeol pharmacopuncture at LI11, and dry needling at the CET enthesis. Results: All three patients achieved clinically meaningful improvements in PRTEE scores (Case 1: 64→13, −79.7%; Case 2: 73→38, −47.9%; Case 3: 55→11.5, −79.1%), exceeding the MCID threshold of 37% reduction. Qualitative sonographic changes were observed at follow-up assessments conducted 103–270 days after treatment completion. No adverse events were observed. Conclusions: A structured multicomponent ultrasound-guided pharmacopuncture protocol may represent a feasible non-surgical approach for patients with refractory LE. Controlled prospective studies are warranted. Full article
►▼ Show Figures

Figure 1

20 pages, 321 KB  
Article
Association Between Upper Extremity Function and Independence in Activities of Daily Living in Individuals with Motor-Incomplete Tetraplegia: An Exploratory Cross-Sectional Study
by Eleanna Strongylou, Dimitra Karadimitri, Maria Moutzouri, Magdalini Stamou, Christina-Anastasia Rapidi, Yannis Dionyssiotis, Eleni Moumtzi-Nakka and Vasiliki Sakellari
J. Funct. Morphol. Kinesiol. 2026, 11(1), 119; https://doi.org/10.3390/jfmk11010119 - 16 Mar 2026
Viewed by 1936
Abstract
Background: Spinal cord injury (SCI) is a leading cause of chronic disability. Loss of upper extremity (U.E.) function is central to limitations, in mobility, postural control, transfers, and self-care. The aim of this exploratory pilot study was to investigate whether self-reported UE function [...] Read more.
Background: Spinal cord injury (SCI) is a leading cause of chronic disability. Loss of upper extremity (U.E.) function is central to limitations, in mobility, postural control, transfers, and self-care. The aim of this exploratory pilot study was to investigate whether self-reported UE function is associated with independence in activities of daily living (ADLs) in people with motor-incomplete tetraplegia. Methods: Eleven (n = 11) individuals with motor-incomplete tetraplegia (AIS C–D; neurological levels C4–T1; injury duration ≥ 1 year), recruited through convenience sampling from five specialist rehabilitation centres, participated in an exploratory cross-sectional pilot study designed to generate hypotheses rather than test them. U.E. function was assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, selected for its ability to capture pain and task-related functional difficulty in the elbow, wrist, and hand; its application in this neurological population is considered exploratory. Independence in ADLs was evaluated using the Spinal Cord Independence Measure III (SCIM III). Given the small sample, all analyses were primarily descriptive and along with bivariate associations (Spearman correlations). Regression findings are reported strictly for exploratory purposes. Results: The median age was 50 years (interquartile range [IQR] 43–55). A strong negative correlation was observed between PRTEE total score and SCIM III (rs = −0.76). In an exploratory univariate analysis, each 1-point increase in PRTEE total score was associated with a 1.3-point lower SCIM III score (β = −1.3, 95% CI −2.34 to −0.26, p = 0.02). Age also showed a positive association (β = 1.31, 95% CI 0.04 to 2.58, p = 0.05) with SCIM III; however, this finding is highly likely to reflect a statistical artefact of the small and unrepresentative sample. Multivariable regression was not conducted as a primary analysis due to insufficient statistical power. All findings should be treated as strictly exploratory and hypothesis-generating. Conclusions: Self-reported U.E. function appears to be associated with ADL independence in motor-incomplete tetraplegia. U.E. capacity may contribute to functional tasks requiring postural stability and mobility-related activities, but no predictive inferences can be made from this underpowered, convenience sample. Future studies with larger cohorts and performance-based measures are needed to confirm these preliminary observations and clarify the role of U.E. function in rehabilitation planning. Full article
20 pages, 2415 KB  
Systematic Review
Shockwave or Ultrasound Therapy for Tendinopathy? A Systematic Review and Meta-Analysis
by Artur Dudoń and Magdalena Stania
J. Clin. Med. 2026, 15(5), 2007; https://doi.org/10.3390/jcm15052007 - 5 Mar 2026
Cited by 1 | Viewed by 2325
Abstract
Background/Objectives: This systematic review and meta-analysis was designed to examine the efficacy of extracorporeal shock wave therapy (ESWT) and ultrasound therapy in the treatment of upper and lower limb tendinopathies. Methods: The protocol was registered in PROSPERO (CRD420251113976) and conducted in accordance with [...] Read more.
Background/Objectives: This systematic review and meta-analysis was designed to examine the efficacy of extracorporeal shock wave therapy (ESWT) and ultrasound therapy in the treatment of upper and lower limb tendinopathies. Methods: The protocol was registered in PROSPERO (CRD420251113976) and conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic searches were performed in the PubMed, Embase, EBSCOhost, and Ovid MEDLINE databases up to August 2025, to identify randomized controlled trials (RCTs). Mean differences (MDs) and standardized mean differences (SMDs) were calculated with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic, and a random-effects model was applied. Risk of bias was evaluated using the Risk of Bias (RoB 2) tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Fourteen RCTs involving 639 patients with tendinopathies were included. All studies were characterized by a high risk of bias. Very low-certainty evidence suggested that ESWT as monotherapy may reduce pain at rest compared with ultrasound therapy in patients with lateral epicondylitis (MD = −1.51; 95% CI: −2.71 to −0.31; p = 0.01), although the effect was highly heterogeneous (I2 = 89.8%; p = 0.002). In patients with upper- and lower-limb tendinopathy, ESWT combined with pharmacotherapy resulted in significantly lower pain intensity compared with ultrasound therapy combined with pharmacotherapy (SMD = −0.6; 95% CI: −1.07 to −0.14; p = 0.01). No significant differences in PRTEE (Patient-Rated Tennis Elbow Evaluation) scores were observed between ESWT and ultrasound monotherapy in patients with lateral epicondylitis (MD = −1.06; 95% CI: −11.06 to 8.94; p = 0.83; I2 = 75.82%), or between ESWT combined with other conservative treatments and ultrasound combined with other conservative treatments (MD = 0.46; 95% CI: −10.22 to 11.15; p = 0.93; I2 = 0%). Conclusions: Very low-certainty evidence suggests that ESWT may be more effective than ultrasound therapy in reducing pain when used as monotherapy in lateral epicondylitis, despite substantial heterogeneity, and when combined with pharmacotherapy in upper- and lower-limb tendinopathies. In terms of function, ESWT appears to provide improvements comparable to those of ultrasound therapy, as assessed by PRTEE scores, in patients with lateral epicondylitis, both as monotherapy and when combined with other conservative treatments. However, significant methodological limitations substantially limit confidence in these findings. Full article
(This article belongs to the Section Clinical Rehabilitation)
►▼ Show Figures

Figure 1

15 pages, 2253 KB  
Article
A Novel Modification of Anconeus Muscle Flap for Extensor Digitorum Communis-Selective Lateral Epicondylitis: Preliminary Clinical Study
by Ignazio Marcoccio, Jacopo Maffeis, Pasquale Gravina, Carolina Civitenga and Andrea Gervasio
Surgeries 2025, 6(4), 105; https://doi.org/10.3390/surgeries6040105 - 25 Nov 2025
Viewed by 1748
Abstract
Introduction: Lateral epicondylitis (LE) typically affects the extensor carpi radialis brevis (ECRB) tendon, while isolated degeneration of the extensor digitorum communis (EDC) origin is rare and poorly characterized. Surgical debridement of these lesions may result in capsular exposure requiring soft-tissue coverage, which can [...] Read more.
Introduction: Lateral epicondylitis (LE) typically affects the extensor carpi radialis brevis (ECRB) tendon, while isolated degeneration of the extensor digitorum communis (EDC) origin is rare and poorly characterized. Surgical debridement of these lesions may result in capsular exposure requiring soft-tissue coverage, which can be achieved through a vascularized muscle flap to enhance tendon healing potential and reduce recurrence. This study aimed to describe a modification of the anconeus rotation flap as originally described by Almquist in 1998, and to evaluate its clinical and functional outcomes in patients with isolated EDC tendinopathy. The modified technique consists of a simpler muscle advancement (AMA) that preserves the distal vascular pedicle and reduces soft-tissue dissection. Methods: A retrospective study was conducted on 12 consecutive patients with lateral epicondylitis with isolated EDC tendon involvement (10.71% of all operative cases at our Institution between 2019 and 2022), who were surgically treated with the anconeus muscle advancement modification. Clinical outcomes, including the visual analog pain scale (VAS), grip strength and patient-reported outcome measures (PROMs), which include the QuickDASH score, the Mayo Elbow Performance Score (MEPS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) score were assessed. Paired statistical tests with 95% confidence intervals and minimal clinically important difference (MCID) thresholds were applied. Results: At a mean follow-up of 38 months, all outcomes demonstrated statistically significant and clinically meaningful improvements (p < 0.05). Reductions in pain/disability (VAS, QuickDASH, PRTEE scores) and functional gains (Grip strength, MEPS) far exceeded their respective MCID thresholds, with 100% attainment for each outcome. Conclusions: This modified anconeus muscle advancement appears to be a technically feasible option for managing isolated EDC-related lateral epicondylitis, preserving vascular integrity while limiting dissection. Although favorable results were obtained, the small retrospective cohort precludes definitive conclusions regarding efficacy. The findings support the technical feasibility of the proposed modification and warrant further prospective comparative investigations. Full article
(This article belongs to the Special Issue Feature Papers in Hand Surgery and Research)
►▼ Show Figures

Figure 1

16 pages, 3691 KB  
Article
The Association Between Three MMP3 Gene Polymorphisms and the Efficacy of Platelet-Rich Plasma Therapy in the Treatment of Lateral Elbow Tendinopathy—A Prospective Cohort Study
by Alicja Jarosz, Tomasz Nowak, Justyna Wrona, Anna Balcerzyk-Matić, Tomasz Iwanicki, Karol Szyluk, Joanna Iwanicka, Wojciech Kania, Katarzyna Gawron and Paweł Niemiec
Int. J. Mol. Sci. 2025, 26(21), 10579; https://doi.org/10.3390/ijms262110579 - 30 Oct 2025
Viewed by 1394
Abstract
Matrix metalloproteinases (MMPs) are proteolytic enzymes involved in connective tissue remodeling. Matrix metalloproteinase 3 (MMP3) belongs to the MMP family and is associated with the pathogenesis of tendinopathy. Moreover, MMP3 gene polymorphisms have been associated with the risk of tendinopathy development. The goal [...] Read more.
Matrix metalloproteinases (MMPs) are proteolytic enzymes involved in connective tissue remodeling. Matrix metalloproteinase 3 (MMP3) belongs to the MMP family and is associated with the pathogenesis of tendinopathy. Moreover, MMP3 gene polymorphisms have been associated with the risk of tendinopathy development. The goal of this study was to investigate whether this gene polymorphisms could also affect the effectiveness of platelet-rich plasma (PRP) tendinopathy treatment. 107 patients (132 elbows) with lateral elbow tendinopathy underwent PRP injection and were followed for two years at specific follow-up weeks (2, 4, 8, 12, 24, 52, 104). The effectiveness of the therapy was assessed based on patient-reported outcome measures (PROMs) values, specifically visual analogue scale (VAS), quick version of the disabilities of the arm, shoulder and hand (QDASH), patient-rated tennis elbow evaluation (PRTEE), and the achievement of minimal clinically important difference (MCID). Three MMP3 single nucleotide polymorphisms (SNPs) (rs520540, rs591058, rs679620) were genotyped using the TaqMan method. All studied polymorphisms were found to present strong linkage disequilibrium and were associated with the effectiveness of therapy on the VAS scale (week 4) and PRTEE (week 104), as well as with MCID achievement (PRTEE week 4); however, these were not strong associations. The studied SNPs also showed an association with the frequency of hand pain before treatment. MMP3 gene polymorphisms are associated with pain experienced before PRP therapy, but do not show a clear association with treatment effectiveness. Full article
(This article belongs to the Special Issue Genetic Variations in Human Diseases: 2nd Edition)
►▼ Show Figures

Figure 1

14 pages, 4013 KB  
Article
Platelet-Rich Plasma Provides Superior Clinical Outcomes Without Radiologic Differences in Lateral Epicondylitis: Randomized Controlled Trial
by Taha Kizilkurt, Ahmet Serhat Aydin, Taha Furkan Yagci, Ali Ersen, Celal Caner Ercan and Artür Salmaslioglu
Medicina 2025, 61(5), 894; https://doi.org/10.3390/medicina61050894 - 14 May 2025
Cited by 8 | Viewed by 3730
Abstract
Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: [...] Read more.
Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Materials and Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, and saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p = 0.7), but PRP outperformed both of the other groups in DASH and PRTEE scores, with the saline group performing the worst (p < 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p = 0.3 and p = 0.2, respectively). Conclusions: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes. Clinical Relevance: PRP offers a promising treatment option for lateral epicondylitis, with superior functional improvements over other commonly used injections. Radiological assessments of vascularity and SMI may not reliably predict clinical outcomes. Full article
►▼ Show Figures

Figure 1

21 pages, 3173 KB  
Article
Association of the TGFB1 Gene Polymorphisms with Pain Symptoms and the Effectiveness of Platelet-Rich Plasma in the Treatment of Lateral Elbow Tendinopathy: A Prospective Cohort Study
by Alicja Jarosz, Justyna Wrona, Anna Balcerzyk-Matić, Karol Szyluk, Tomasz Nowak, Tomasz Iwanicki, Joanna Iwanicka, Marcin Kalita, Wojciech Kania, Katarzyna Gawron and Paweł Niemiec
Int. J. Mol. Sci. 2025, 26(6), 2431; https://doi.org/10.3390/ijms26062431 - 8 Mar 2025
Cited by 4 | Viewed by 2411
Abstract
The regenerative properties of platelet-rich plasma (PRP) result from the high concentration of growth factors, including transforming growth factor beta 1 (TGF-β1). Nevertheless, this form of therapy may not always be effective due to the variability in genetic factors. In this study, the [...] Read more.
The regenerative properties of platelet-rich plasma (PRP) result from the high concentration of growth factors, including transforming growth factor beta 1 (TGF-β1). Nevertheless, this form of therapy may not always be effective due to the variability in genetic factors. In this study, the association of TGFB1 gene polymorphisms with the effectiveness of lateral elbow tendinopathy (LET) treatment with PRP was investigated. The effectiveness of therapy was assessed using minimal clinically important difference (MCID) and patient-reported outcome measures (PROM), specifically visual analog scale (VAS), quick version of disabilities of the arm, shoulder, and hand score (QDASH), and patient-rated tennis elbow evaluation (PRTEE) for two years (in weeks 2, 4, 8, 12, 24, 52, and 104). The most effective therapy was noticed in CC rs2278422 genotype carriers, whereas carriers of AA, CC, and CC genotypes (rs12461895, rs4803455, rs2241717) showed more severe pain before therapy. Moreover, the analyses revealed an association of studied polymorphisms with such parameters of blood morphology as eosinophils (EOS), neutrophils (NEU), and monocytes (MONO). In conclusion, genotyping of rs2278422 variant may be a valuable diagnostic method for patient selection for PRP therapy, while genotyping of rs12461895, rs4803455, and rs2241717 polymorphisms may be used for prediction of increased risk of pain sensation. Full article
(This article belongs to the Special Issue Latest Advances in Comparative Genomics)
►▼ Show Figures

Figure 1

24 pages, 5559 KB  
Article
Comparative Efficacy of Platelet-Rich Plasma, Corticosteroid, Hyaluronic Acid, and Placebo (Saline) Injections in Patients with Lateral Elbow Tendinopathy: A Randomized Controlled Trial
by Maciej Dejnek, Aleksandra Królikowska, Mateusz Kowal and Paweł Reichert
J. Clin. Med. 2025, 14(2), 472; https://doi.org/10.3390/jcm14020472 - 13 Jan 2025
Cited by 7 | Viewed by 15906
Abstract
Background: Lateral elbow tendinopathy is a common condition that significantly alters the function of the upper extremities. In case of first-line treatment failure, different local injections are usually used. Due to the lack of sufficient evidence to support it, we conducted the [...] Read more.
Background: Lateral elbow tendinopathy is a common condition that significantly alters the function of the upper extremities. In case of first-line treatment failure, different local injections are usually used. Due to the lack of sufficient evidence to support it, we conducted the study to compare the outcomes of different single injections, including Platelet-Rich Plasma (PRP), Corticosteroids (CS), Hyaluronic Acid (HA), and placebo (saline). Methods: Sixty patients with confirmed lateral elbow tendinopathy were enrolled in the study and divided into four groups. Pain intensity (average for the current day, at rest, during provocative tests) measured by Visual Analogue Scale (VAS), pressure pain threshold (PPT), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disability of Arm, Shoulder and Hand (DASH), Subjected Elbow Value (SEV), and strength of selected muscle groups were measured before and during follow-up visits (1, 4, 12, 24, and 52 weeks after treatment). The treatment was considered successful when minimal clinically important difference (MCID) was achieved in primary outcomes (VAS, PRTEE). Results: A significant improvement was achieved in most measurements in all groups. At the final follow-up, MCID for the mean pain reduction measured with VAS and improvement in the PRTEE score were achieved in 52 and 54 patients, respectively. The complete absence of pain was achieved after 1, 4, 12, 24, and 52 weeks in 2, 5, 10, 22, and 40 patients, respectively. The comparison between the groups found a significant difference in pain intensity between CS and other groups one week after injection, between the CS and PRP group in the fourth week, and between PRP and HA in the fourth week (p < 0.05). No other significant differences were found between each group at each follow-up time point. Conclusions: We conclude that each injection treatment provides good long-term clinical outcomes, but not better than placebo. A CS injection might be regarded as a more effective treatment only within the first month post-injection. Full article
(This article belongs to the Section Orthopedics)
►▼ Show Figures

Figure 1

15 pages, 2847 KB  
Article
The VEGFB Gene Variants and the Effectiveness of Platelet-Rich Plasma Treatment of Lateral Elbow Tendinopathy: A Prospective Cohort Study with a Two-Year Follow-Up
by Alicja Jarosz, Tomasz Nowak, Karol Szyluk, Anna Balcerzyk-Matić, Tomasz Iwanicki, Joanna Iwanicka, Marcin Kalita, Katarzyna Gawron, Wojciech Kania and Paweł Niemiec
Int. J. Mol. Sci. 2024, 25(23), 13166; https://doi.org/10.3390/ijms252313166 - 7 Dec 2024
Cited by 2 | Viewed by 2287
Abstract
Platelet-rich plasma (PRP) is an autologous preparation used to accelerate regeneration; however, this form of therapy is not always effective. Vascular endothelial growth factor B (VEGFB), which affects vessel survival, pathological angiogenesis, and muscle development may differentiate the risk and treatment [...] Read more.
Platelet-rich plasma (PRP) is an autologous preparation used to accelerate regeneration; however, this form of therapy is not always effective. Vascular endothelial growth factor B (VEGFB), which affects vessel survival, pathological angiogenesis, and muscle development may differentiate the risk and treatment of lateral elbow tendinopathy (LET). In this study, we analyzed the influence of VEGFB gene polymorphisms on the effectiveness of LET treatment with PRP. Therapeutic effectiveness was analyzed in 107 patients (132 elbows) using patient-reported outcome measures (PROMs), specifically the visual analog scale (VAS); quick version of disabilities of the arm, shoulder, and hand score (QDASH); and patient-rated tennis elbow evaluation (PRTEE), for two years (weeks 2, 4, 8, 12, 24, 52, and 104). The polymorphisms selected for the study were rs72922019, rs12366035, rs4930152, rs594942, and rs595880, being in strong linkage disequilibrium. Patients with TT (rs72922019), TT (rs12366035), AA (rs4930152), CC (rs594942), and GG (rs595880) genotypes showed better treatment effectiveness. Statistically important differences were shown for rs72922019 VAS (week 2), QDASH (weeks 0–4), and PRTEE (week 2); rs12366035 and rs4930152 VAS (week 2), QDASH (week 2), and PRTEE (weeks 2 and 4); and rs594942 and rs595880 VAS (weeks 2 and 4), QDASH (week 2), and PRTEE (weeks 2, 52, and 104). The studied polymorphisms also showed an association with blood morphological parameters, including mean platelet volume, platelet distribution width, and eosinophil levels, as well as some comorbidities (heart failure). Genotyping due to patient selection for therapy may be considered for any of the rs72922019, rs12366035, or rs4930152 polymorphisms. Full article
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
►▼ Show Figures

Figure 1

14 pages, 1405 KB  
Article
Focal Versus Combined Focal Plus Radial Extracorporeal Shockwave Therapy in Lateral Elbow Tendinopathy: A Retrospective Study
by Caterina Delia, Gabriele Santilli, Vincenzo Colonna, Valerio Di Stasi, Eleonora Latini, Antonello Ciccarelli, Samanta Taurone, Antonio Franchitto, Flavia Santoboni, Donatella Trischitta, Sveva Maria Nusca, Mario Vetrano and Maria Chiara Vulpiani
J. Funct. Morphol. Kinesiol. 2024, 9(4), 201; https://doi.org/10.3390/jfmk9040201 - 22 Oct 2024
Cited by 9 | Viewed by 7985
Abstract
Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal [...] Read more.
Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal shockwave therapy (F-ESWT) alone versus a combination of focal and radial pressure waves (F-ESWT+R-PW) in treating chronic lateral epicondylitis. Methods: This retrospective observational study included 45 patients diagnosed with chronic lateral epicondylitis divided into two groups based on the treatment received: group A (F-ESWT, n = 23) and group B (F-ESWT+R-PW, n = 22). Both groups underwent three weekly sessions of their respective treatments. Patients were also given a home exercise protocol. Primary outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for pain and functional impairment at baseline (T0), 4 weeks (T1), 12 weeks (T2), and 24 weeks (T3) post-treatment. Secondary outcomes included grip strength and ultrasonographic measurements of common extensor tendon (CET) thickness and vascularization. Results: Significant improvements in VAS and PRTEE scores were observed in both groups at all follow-up points. Group B showed greater pain reduction at T1 (VAS: 3.0 ± 1.6 vs. 4.43 ± 1.47; p < 0.005) and T2 (VAS: p < 0.030) compared to group A. Functional outcomes (PRTEE) also favored group B at T1 (p < 0.030) and in the pain section at T2 (p < 0.020). Grip strength improved similarly in both groups. CET thickness showed no significant differences at T3. Vascularization decreased significantly in both groups, with a non-significant trend favoring group B. Conclusions: The combined F-ESWT+R-PW therapy proved more effective than F-ESWT alone in the short- to mid-term management of chronic lateral epicondylitis, significantly enhancing pain reduction and functional outcomes. The combination of focal and radial pressure waves offers a superior therapeutic approach, leveraging the distinct mechanisms of each modality for better clinical results. Further research is needed to confirm these findings and establish long-term efficacy. Full article
(This article belongs to the Section Functional Anatomy and Musculoskeletal System)
►▼ Show Figures

Figure 1

13 pages, 1064 KB  
Article
High Versus Low-Energy Extracorporeal Shockwave Therapy for Chronic Lateral Epicondylitis: A Retrospective Study
by Gabriele Santilli, Francesco Ioppolo, Massimiliano Mangone, Francesco Agostini, Andrea Bernetti, Sara Forleo, Sara Cazzolla, Anna Camilla Mannino, Alessio Fricano, Antonio Franchitto, Samanta Taurone, Antonello Ciccarelli and Marco Paoloni
J. Funct. Morphol. Kinesiol. 2024, 9(3), 173; https://doi.org/10.3390/jfmk9030173 - 22 Sep 2024
Cited by 16 | Viewed by 9920
Abstract
Background: Chronic lateral epicondylitis (LE), also known as tennis elbow, affects 1–3% of the population, primarily those over 40 years old. Most cases resolve with conservative treatments, but some require more advanced interventions. Extracorporeal shockwave therapy (ESWT) has emerged as a non-surgical [...] Read more.
Background: Chronic lateral epicondylitis (LE), also known as tennis elbow, affects 1–3% of the population, primarily those over 40 years old. Most cases resolve with conservative treatments, but some require more advanced interventions. Extracorporeal shockwave therapy (ESWT) has emerged as a non-surgical treatment option, utilizing either low- or high-energy levels to alleviate pain and improve function. Objective: This study aimed to compare the efficacy of low-energy versus high-energy ESWT in the treatment of chronic LE, focusing on pain relief and functional improvement. Methods: A retrospective observational study was conducted including patients treated for chronic LE between 2021 and 2024. Participants were divided into two groups: low-energy ESWT (0.10 mJ/mm2) and high-energy ESWT (0.20 mJ/mm2). Both groups received 2400 pulses at a frequency of 6 Hz once a week for three weeks. Pain and functional outcomes were measured using a visual analog scale (VAS) and the Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE) at the baseline, three months (T1), and six months (T2) post-treatment. Results: Forty-six patients participated, with 24 in the low-energy group and 22 in the high-energy group. Baseline demographics and clinical characteristics were similar across groups. At T1 and T2, the low-energy group showed significantly greater reductions in the VAS scores (T1: 4.45 ± 0.8 vs. 3.6 ± 1.7, p = 0.04; T2: 3.2 ± 1.2 vs. 2.1 ± 1.1, p = 0.004) and PRTEE scores (T1: 34.3 ± 6.9 vs. 26.8 ± 11.9, p = 0.03; T2: 25.3 ± 6 vs. 17.6 ± 9, p = 0.005). Significant treatment–time interactions were observed for both the VAS and PRTEE scores, indicating sustained improvements in the low-energy group. Conclusions: Low-energy ESWT was more effective than high-energy ESWT in treating chronic LE, providing greater and longer-lasting pain relief and functional improvement. These findings suggest that low-energy ESWT should be preferred in clinical practice for managing this condition. Future research should focus on larger sample sizes and randomized controlled trials to confirm these results and explore the underlying mechanisms of differential efficacy between energy levels. Full article
(This article belongs to the Section Functional Anatomy and Musculoskeletal System)
►▼ Show Figures

Figure 1

12 pages, 1003 KB  
Article
The Impact of Blood Morphological Parameters on Treatment Outcomes in Tennis Elbow Patients Receiving Platelet-Rich Plasma (PRP) Therapy: A Prospective Study
by Karol Szyluk, Rostyslav Bubnov, Alicja Jarosz, Rafał Reguła, Piotr Grabowski, Joanna Iwanicka, Tomasz Iwanicki, Marcin Gierek, Dominik Sieroń, Andreas Christe and Paweł Niemiec
J. Clin. Med. 2024, 13(1), 77; https://doi.org/10.3390/jcm13010077 - 22 Dec 2023
Cited by 2 | Viewed by 4024
Abstract
Platelet-rich plasma (PRP) therapy holds substantial promise for the treatment of tennis elbow, a complex and challenging musculoskeletal condition. The aim of the study was to assess whether there are correlations between the levels of individual morphotic elements determined in whole blood and [...] Read more.
Platelet-rich plasma (PRP) therapy holds substantial promise for the treatment of tennis elbow, a complex and challenging musculoskeletal condition. The aim of the study was to assess whether there are correlations between the levels of individual morphotic elements determined in whole blood and the outcomes of tennis elbow treatment with PRP injection, as measured using patient-reported outcome measures (PROMs) such as the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE). A prospective analysis was conducted on 107 patients (132 elbows) undergoing lateral epicondylitis treatment with (PRP) injections. Patients completed VAS, PRTEE, and QDASH questionnaires on the day of PRP administration and at established checkpoints (2, 4, 8, 12, 24, 52, and 104 weeks). Minimal clinically important difference (MCID) was employed to assess the treatment effects. Then, correlations were measured within each PROM, and the impact of the concentration of individual blood parameters on the MCID outcomes was assessed. Analyzing the relationships between the MCID+ and MCID− groups, significant correlations for the VAS and QDASH scales were observed. The level of individual morphotic elements in the blood may have influenced the treatment outcome, as measured using specific patient-reported outcome measures (PROMs). Regarding the VAS scale, factors favoring a positive treatment outcome included higher values of eosinophils (EOS) and basophils (BASO). For the QDASH scale, these factors were a lower value of mean corpuscular volume (MCV) and a higher mean corpuscular hemoglobin (MCH). The levels of certain blood parameters, such as EOS and BASO, in the current study influenced the classification of patients into MCID+ or MCID− groups, based on the VAS and QDASH scales. Full article
(This article belongs to the Section Orthopedics)
►▼ Show Figures

Figure 1

9 pages, 475 KB  
Article
The “Selfie Test”: A Novel Test for the Diagnosis of Lateral Epicondylitis
by Shai Factor, Pablo Gabriel Snopik, Assaf Albagli, Ehud Rath, Eyal Amar, Franck Atlan and Guy Morag
Medicina 2023, 59(6), 1159; https://doi.org/10.3390/medicina59061159 - 16 Jun 2023
Cited by 4 | Viewed by 10653
Abstract
Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from [...] Read more.
Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill’s, Maudsley’s, Cozen’s, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test’s active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV). Full article
(This article belongs to the Section Sports Medicine and Sports Traumatology)
►▼ Show Figures

Figure 1

Back to TopTop