Search Results (51)

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

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

Background: Lacertus syndrome, a condition characterized by median nerve compression at the elbow due to anatomical variations, is often misdiagnosed. This case report describes a 53-year-old female patient who presented with severe lateral elbow and shoulder pain, previously diagnosed with cervicalgia and tennis elbow. Methods: Upon admission, she reported significant pain (NRS—Numerical Rating Scale 8/10) and occasional radiating paresthesia in the first three digits of her left hand. Clinical examination revealed weakness in the wrist and finger flexion, which was exacerbated by a positive Cutaneous Scratch Test (CST), while Magnetic Resonance Imaging (MRI) of the cervical spine showed no definitive abnormalities. Electroneurography (ENG) indicated reduced amplitude in the left anterior interosseous nerve. Ultrasound excluded carpal tunnel syndrome but identified nerve flattening beneath the pronator teres muscle. A surgical decompression of the median nerve was performed, resulting in immediate improvement in muscle strength and significant pain reduction (NRS 1/10) postoperatively. Follow-up evaluations confirmed substantial recovery in nerve function and morphology. Conclusions: This case illustrates the atypical presentation of Lacertus syndrome, emphasizing the need for comprehensive diagnostic approaches that include clinical, imaging, and neurophysiological assessments. Awareness of this syndrome is crucial for differential diagnosis in patients exhibiting uncharacteristic symptoms, such as shoulder or elbow pain, to ensure timely and effective treatment. Full article

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

Background: The kinematics of table tennis is a growing topic of scientific research. This study aimed to assess the kinematics and determine the coordination of the movements of most body segments during the execution of two types of serves (short and long) in table tennis, as well as to indicate the main differences between these serves when performed by high-level athletes. Methods: The study involved 15 male table tennis players. Each participant performed two tasks, performing short and long forehand serves with back-sidespin rotation, with up to 10 hits in the designated field for each type. The players’ movements were registered using an IMU system. Results and Conclusion: The research allowed for the development of a model for executing two types of serves in table tennis. The differences between short and long serves were mainly in the ranges of movement and angular velocities (higher for long serves). These were found in the shoulder rotation, elbow joint and wrist joint (primarily the flexion–extension movement), hand supination, and movement in the elbow joint, which also played an important role. Coaches and players should seriously consider these joints and movements in the training process. In the coordinated movement of the performed serves, a phenomenon of movement variability was observed, manifested by a large variability in execution and a low variability in the maximum speeds of the hand with the racket. Full article

The COL1A1 gene encodes the α1 chain of type I collagen, and the data reported so far demonstrate that its polymorphic variants may affect biomechanical properties of bones, muscles, and tendons, and contribute to musculoskeletal disorders. Given, however, limited research on these variants in tendon pathology, we analyzed the impact of COL1A1 polymorphisms on the tendinopathy phenotype and the effectiveness of platelet-rich plasma (PRP) treatment for tennis elbow. Pain perception and therapy outcomes were analyzed from baseline, i.e., before PRP injection to two years post-PRP injection in a cohort of 107 patients. The study focused on seven COL1A1 variants: rs2249492 (C/T), rs2586488 (A/G), rs2075558 (A/C), rs2253369 (C/T), rs35231764 (A/G), rs1800012 (C/A), and rs9898186 (C/T). We demonstrated that carriers of the TT/CT (rs2249492), AA/AC (rs1800012), and TT/CT (rs9898186) genotypes reported pain related to injury more frequently than subjects with other COL1A1 variants, also in the context of performing specific activities and other pain characteristics. These polymorphisms did not significantly influence therapy effectiveness, although rs35231764 showed a moderate effect. In conclusion, the T (rs2249492), A (rs1800012), and T (rs9898186) alleles of COL1A1 gene are risk factors for pain perception in tennis elbow patients, but do not appear to substantially impact PRP treatment outcomes. Full article

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

Background: Lateral epicondylitis impacts 1–3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4–11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking. Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction. Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications. Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection. Full article

In forehand strokes with different grips in tennis, the forearm muscle activities, the distribution and attenuation of the impact loads, and the effects of the muscles on the impact load attenuation exhibited different characteristics. This study aimed to explore these characteristics by analyzing electromyography (EMG) and acceleration data, and comparing the differences between the Eastern and Western grips. Fourteen level II or above tennis players (ten males, aged 22.4 ± 3.6 years; four females, aged 19.8 ± 2.0 years) were recruited and instructed to perform forehand strokes using the Eastern and Western grips, respectively. The EMG of eight forearm muscles and the acceleration data at the ulnar and radial sides of the wrist and elbow were collected. The root mean square (RMS), the peaks of the impact load, the amplitude of impact load attenuation (AC), and the jerk value (Jerk) were calculated. The cross-correlation coefficients and time delays of EMG–EMG, EMG–AC, and EMG–jerk were obtained using the cross-correlation method. The results showed that in the Eastern grip group (group E), the RMS of the flexor carpi ulnaris (FCU) was significantly greater than that in the Western grip group (group W). In group E, the peaks of impact load, AC, and Jerk on the Y axis of the wrist ulnar side were all significantly higher than those in group W. The activity of the extensor digitorum commonis (EDC) had significantly different effects on the amplitude and rate of impact load attenuation at specific locations in different grips, especially at the elbow (p < 0.05). The conclusion indicated that the FCU exhibited higher levels of EMG activity in the Eastern grip. This grip responded to greater impact loads with more substantial and rapid attenuation on the wrist ulnar side. Furthermore, the EDC appeared to contribute more to the amplitude of impact load attenuation in the Western grip and to have a more significant influence on the rate of impact load attenuation in the Eastern grip, especially at the elbow. These results suggest that tennis players and coaches should pay more attention to improving the strength of the EDC and FCU, which can improve sports performance and comfort, as well as prevent sports injuries. Full article

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

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

Background and Objectives: Biodex System^® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation of the human musculoskeletal system, no universal and acceptable protocol for wrist examination has been proposed for patients with wrist pathology. In this study, the authors aim to identify the most appropriate protocol for testing the biomechanical parameters of flexors and extensors of the wrist. Materials and Methods: A group of 20 patients with symptomatic tennis elbow and 26 healthy volunteers were examined using three different protocols: isokinetic, isometric and isotonic. Protocol order for each study participant was assigned at random with a minimum of a 24 h break between protocols. All protocol parameters were set according to data obtained from a literature review and an earlier pilot study. Following completion of each protocol, participants filled out a questionnaire-based protocol, assessing pain intensity during the exam, difficulty with exam performance and post-exam muscle fatigue. Results: The isotonic protocol showed the best patient tolerance and the highest questionnaire score. There was a significant difference (p < 0.05) between the three protocols in average pain intensity reported by study participants. All participants completed the isotonic protocol, but not all patients with symptomatic tennis elbow were able to complete the isometric and isokinetic protocols. The isotonic protocol was deemed “difficult but possible to complete” by study participants. Conclusions: The isotonic protocol is most suitable for testing the flexors and extensors of the wrist. It gives the most biomechanical data of all protocols, is well tolerated by patients and rarely causes pain during examination even in symptomatic participants. Full article

The serve is the most important stroke in tennis. It is a complex gesture consisting of numerous rotations with a wide amplitude, which are important to manage for performance. The aim of this study was to investigate whether correlations exist between joint kinematic parameters and racket velocity. A quantitative kinematics analysis of four ranked players (two boys and two girls) was carried out using an optoelectronic system composed of 10 cameras (150 Hz). Five flat serves per player were analyzed. Eighty-two markers were located across the 15 body segments and on the racket. A descriptive statistical analysis including a correlation analysis was carried out between joint angles and racket kinematic parameters (vertical position, velocity, and acceleration) during the cocking and acceleration phases. Ten very high (0.7 < r < 0.9) and three almost perfect (r > 0.9) correlations were found. Shoulder and hip axial rotations, knee flexion, and trunk extension were correlated linearly with racket vertical position and velocity during the cocking phase. For the acceleration phase, elbow flexion, trunk flexion/extension, and trunk axial rotation were linked to racket kinematics. Some of these parameters showed differences between slow and fast serves. These parameters, which are involved in transmitting ball velocity, are important to consider for tennis players and coaches in training programs, education, and performance enhancement. Full article

Individual differences in the response to platelet-rich plasma (PRP) therapy can be observed among patients. The genetic background may be the cause of this variability. The current study focused on the impact of genetic variants on the effectiveness of PRP. The aim of the present study was to analyze the impact of single nucleotide polymorphisms (SNP) of the platelet-derived growth factor receptor alpha (PDGFRA) gene on the effectiveness of treating lateral elbow tendinopathy (LET) with PRP. The treatment’s efficacy was analyzed over time (2, 4, 8, 12, 24, 52 and 104 weeks after the PRP injection) on 107 patients using patient-reported outcome measures (PROM) and achievement of a minimal clinically important difference (MCID). Four SNPs of the PDGFRA gene (rs7668190, rs6554164, rs869978 and rs1316926) were genotyped using the TaqMan assay method. Patients with the AA genotypes of the rs7668190 and the rs1316926 polymorphisms, as well as carriers of the T allele of rs6554164 showed greater effectiveness of PRP therapy than carriers of other genotypes. Moreover, the studied SNPs influenced the platelets’ parameters both in whole blood and in PRP. These results showed that PDGFRA gene polymorphisms affect the effectiveness of PRP treatment. Genotyping the rs6554164 and the rs1316926 SNPs may be considered for use in individualized patient selection for PRP therapy. Full article

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