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Background Evidence on the effects of exercise training with blood flow restriction (BFR) on upper extremity proprioception and performance is limited. The purpose of this study was to investigate the effects of 6 weeks of low-load elbow flexion exercise training with BFR on upper extremity strength, joint position sense (JPS), and functional performance. Methods Sixty healthy individuals were randomized into the experimental group ( n  = 30) which received low-load training with BFR or the control group ( n  = 30) which received no training. Elbow muscle strength, shoulder and elbow JPS, and upper extremity functional motor performance [Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Functional Throwing Performance Index (FTPI), Single Arm Shot Put Test (SASPT), and Modified Pull-Up Test (MPUT)] were assessed. For normally distributed data, Two-way ANOVA [2 × 2, group (between-participant) X time (within-participant), repeated measures] was used to determine the intervention effects on dependent variables. F value was used based on sphericity assumed. We considered the time-group interaction term in analyses. For non-normally distributed data, we used the Wilcoxon Signed-rank Test to examine the changes in individual groups for the relevant results and the Mann-Whitney U Test to compare changes between two-time intervals between the groups. Results Time by Group showed significant effects for the results of flexor strength, CKCUEST, FTPI, and MPUT in favor of the experimental group (all p  < 0.001). The extensor strength, JPS, and SASPT results also improved in the experimental group compared to the control group ( p  < 0.05). The only change in the control group was a decrease in the FTPI percentile ( p  = 0.017). Conclusions This study adds new information about the effects of BFR on proprioception and performance. Six-week low-load elbow flexion training with BFR improves elbow muscle strength, shoulder and elbow proprioception, and upper extremity functional motor performance. Clinical trial registration NCT03401567 (ClinicalTrials.gov identifier) (Registration Date:23/12/2017).

The aim of this study was to compare—clinically and ultrasonographically—the therapeutic effects of physical therapy modalities (hot pack, ultrasound therapy, and friction massage), local corticosteroid injection, and extracorporeal shock wave treatment (ESWT) in lateral epicondylitis (LE). Fifty-nine elbows of 59 patients with LE were randomized into three treatment groups receiving either physical therapy, a single corticosteroid injection, or ESWT. Visual analogue scale (VAS) was used to assess pain intensity, Jamar hydraulic dynamometer for grip strength, finger dynamometer for pinch strength (before treatment, on the first, third, and sixth months of treatment). All subjects were also evaluated with ultrasonography before and 6 months after treatment. In all groups, VAS scores of the patients were found to decrease significantly on the first, third, and sixth months of treatment. With respect to grip strength evaluations, the increase after treatment was significant only on the first month in group II; on the first and third months in group I; and on the first, third, and sixth months of treatment in group III. Pinch strength and ultrasonographical findings did not change during follow-up in any group. We imply that physical therapy modalities, corticosteroid injection, and ESWT have favorable effects on pain and grip strength in the early period of LE treatment. The increase in grip strength lasts longer with ESWT. On the other hand, ultrasonographic findings do not change in the first six months of these treatment methods.

The aim of the study was to compare the effects of corticosteroid injection, kinesio tape, and counterforce brace on pain intensity, Common Extensor Tendon thickness, grip strength, and functional status in the treatment of lateral epicondylitis. A total number of 51 patients were randomized into three groups. Group 1 was given kinesio tape, group 2 received a corticosteroid injection, and group 3 received a counterforce brace. Pain was measured using a visual analog scale, common extensor tendon thickness was measured with ultrasonography, functional status was measured using the disabilities of arm, shoulder, and hand questionnaire and grip strength was measured using a dynamometer. All evaluations were performed before treatment and at the second and fourth weeks after the treatment. No significant differences between the groups were observed for the visual analog scale scores, common extensor tendon thicknesses, grip strength, and disabilities of arm, shoulder, and hand questionnaire score compared to the baseline (P > 0.05). A statistically significant difference was found between the pretreatment and posttreatment evaluations of pain intensity and common extensor tendon thickness in all groups at the second and fourth weeks after treatment. According to the disabilities of arm, shoulder, and hand questionnaire scale, the condition improved significantly in the brace group and corticosteroid group, whereas it had not improved in the kinesiotaping group compared to before treatment. None of the treatment methods increased the patients' grip strength (P > 0.05). The corticosteroid injection, kinesiotape, and specially counterforce brace effectively reduced pain and tendon thickness. However, none of these treatment methods were superior to the others. This study was registered in the Iranian Registry of Clinical Trials (IRCT20091214002851N7).

Background Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to apply in the sport field. In this study we valued the effectiveness of Kinesio taping (KT) on immediate pain control for patients with chronic lateral epicondylitis. Methods We conducted a randomized, double-blinded, cross-over study with 15 patients with chronic lateral epicondylitis. All participants received two taping sessions in a random order with a 3-day interval in between: one with KT and the other with sham taping (ST). Pain perceived during resisted wrist extension and at rest using numeric rating scale (NRS), the pain-free grip strength, and the pressure pain threshold, were measured before and 15 min after the tape was applied. Results A significant reduction of 2.1 ± 1.6 (Z = − 3.081, P  = 0.002) and 0.7 ± 0.8 (Z = − 2.428, P  = 0.015) was found on a NRS with KT and ST, respectively, indicating that both taping sessions produced immediate pain relief for resisted wrist extension. Both taping sessions significantly improved the pain-free grip strength with increases of 3.31 ± 5.05 (Z = − 2.615, P  = 0.009) and 2.43 ± 3.31 (Z = − 2.783, P  = 0.005) kg found with KT and ST, respectively. Compared with ST, KT exhibited superiority in controlling pain experienced during resisted wrist extension (Z = − 2.168, P  = 0.030). Conclusions Taping produced unneglectable placebo effects on pain relief and painf-free grip strength for patients with lateral epicondylitis, and KT seemed to have additional effects on controlling pain that was elicited by resisted wrist extension. Trial registration ISRCTN13618356 (retrospectively registered on 13/02/2017).

Purpose Simple elbow dislocations are accompanied with lateral ulnar collateral ligament ruptures. For persisting instability, surgery is indicated to prevent chronic posterolateral rotatory instability. After lateral collateral ligament (LCL) complex repair the repair is protected by temporary immobilization, limited range of motion and hinged bracing. Internal bracing is an operative alternative augmenting the LCL repair using non-absorbable suture tapes. However, the stability of LCL repair with and without additional augmentation remains unclear. The hypothesis was that LCL repair with additional suture tape augmentation would improve load to failure. Secondary goal of this study was to evaluate different humeral fixation techniques. A humeral fixation using separate anchors for the LCL repair and the augmentation was not expected to provide superior stability compared to using only one single anchor. Methods Twenty-one elbows were tested. A cyclic varus rotational torque of 0.5–3.5 Nm was applied in 90°, 60°, 30°, and 120° elbow flexion to the intact, torn, and repaired LCLs. The specimens were randomized into three groups: repair alone (group I), repair with additional internal bracing using two anchors (group II), repair using one humeral anchor (group III). A load-to-failure protocol was conducted. Results Load to failure was significantly higher in groups II (26.6 Nm; P  = 0.017) and III (23.18 Nm; P  = 0.038) than in group I (12.13 Nm). No significant difference was observed between group II and III. All specimens lost reduction after LCL dissection by a mean of 4.48° ± 4.99° (range 0.66–15.82). The mean reduction gain after repair was 7.21° ± 4.97° (2.70–21.23; mean over reduction, 2.73°). The laxity was comparable between the intact and repaired LCLs ( n.s .), except for varus movements at 30° in group II ( P  = 0.035) and 30° ( P  = 0.001) and 120° in group III ( P  = 0.008) with significantly less laxity. Inserting the ulnar suture anchor showed failure in the thread in 10 cases. Conclusion LCL repair with additional internal bracing yielded higher load to failure than repair alone. Repair with additional internal bracing for the humeral side using one anchor was sufficient. A higher primary stability would facilitate postoperative management and allow immediate functional treatment. Reducing the number of humeral anchors would save costs.

Purpose Lateral epicondylitis is generally considered an extra-articular condition. The role of minor instability in the aetiology of lateral elbow pain has rarely been considered. The aim of this study was to evaluate the correlation of lateral ligamentous laxity with aspects of intra-articular lateral elbow pathology and investigate the role of minor instability in lateral elbow pain. Methods Thirty-five consecutive patients aged between 20 and 60 years with recalcitrant lateral epicondylitis who had failed conservative therapy and had no previous trauma or overt instability, were included. The presence of three signs of lateral ligamentous patholaxity and five intra-articular findings were documented during arthroscopy. The relative incidence of each of these was calculated, and the correlation between patholaxity and intra-articular pathology was evaluated. Results At least one sign of lateral ligamentous laxity was observed in 48.6% of the studied cohort, and 85.7% demonstrated at least one intra-articular abnormal finding. Radial head ballottement was the most common sign of patholaxity (42.9%). Synovitis was the most common intra-articular aspect of pathology (77.1%), followed by lateral capitellar chondropathy (40.0%). A significant correlation was found between the presence of lateral ligamentous patholaxity signs and capitellar chondropathy ( p  = 0.0409), as well as anteromedial synovitis ( p  = 0.0408). Conclusions Almost one half of patients suffering from recalcitrant lateral epicondylitis display signs of lateral ligamentous patholaxity, and over 85% demonstrate at least one intra-articular abnormality. The most frequent intra-articular findings are synovitis and lateral capitellar chondropathy, which correlate significantly with the presence of lateral ligamentous patholaxity. The fact that several patients demonstrated multiple intra-articular findings in relation to laxity provides support to a sequence of pathologic changes that may result from a symptomatic minor instability of the lateral elbow (SMILE) condition. Level of evidence III.

The radio-humeral joint has traditionally been believed to support most of the loads transmitted through the elbow. Load transfer through the elbow has been a controversial issue since the publication of the first biomechanical studies on the subject, most of which were based on extrinsic forces acting on the extended joint. The present study analyzes load distribution across the six different compartments in the elbow while the joint is flexed, as well as the intrinsic forces generated in the epicondylar and epitrochlear muscles. Ten cadaveric elbows were positioned at 90° of flexion, forearm in a neutral position and wrist at 0°. Tekscan sensors were used for measuring intraarticular pressures. Forces generated by epitrochlear muscles results in a series of loads that affect mainly the anteromedial facet (40%), followed by the posterolateral facet (34%) of the ulnohumeral joint, with the flexor carpi ulnaris generating the heaviest loads (43% on the anteromedial and 38% on the posterolateral facets). Conversely, the forces generated by the epicondylar muscles, similar in behavior but with an opposite direction, convey heavier loads to the elbow’s anterolateral facet (45%), followed by the radiohumeral joint (26%) with the extensor carpi ulnaris generating the heaviest loads (54% on the anterolateral facet and 17% on the radiohumeral joint). Our results indicate that the elbow joint exhibits a characteristic load distribution pattern that depends on the muscles, as intrinsic forces are generated by the epicondylar and epitrochlear muscles. The anterior portion of the ulnohumeral joint is the area bearing the heaviest loads.

Purpose This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. Methods Forty-five voluntary patients (mean age 48 years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5 days a week for 3 weeks. In the third group, ESWT was applied three times for 3 weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. Results There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment ( p  < 0.05). Inter-group analysis revealed that the kinesiotaping group yielded better results in decreasing pain intensity than the other groups ( p  < 0.05). The kinesiotaping group ( p  < 0.001) and ESWT group ( p  = 0.002) yielded better results in improving functionality than the physiotherapy group. There were significant differences in recovering pain-free grip strength in the kinesiotaping group ( p  < 0.05). Conclusion Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. Level of evidence Therapeutic study, Level II.

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.

Background Lateral epicondylitis of the elbow is a frequent condition with long-lasting symptoms. Corticosteroid injection is increasingly discouraged and there is little knowledge on the combined effect of corticosteroid injection and physiotherapy for acute conditions. We wanted to investigate the efficacy of physiotherapy alone and combined with corticosteroid injection for acute lateral epicondylitis. Methods A randomized, controlled study with one-year follow-up was conducted in a general practice setting in Sarpsborg, Norway. We included 177 men and women aged 18 to 70 with clinically diagnosed lateral epicondylitis of recent onset (2 weeks to 3 months). They were randomly assigned to one of three treatments: physiotherapy with two corticosteroid injections, physiotherapy with two placebo injections or wait-and-see (control). Physiotherapy consisted of deep transverse friction massage, Mills manipulation, stretching, and eccentric exercises. We used double blind injection of corticosteroid and single blind assessments. The main outcome measure was treatment success defined as patients rating themselves completely recovered or much better on a six-point scale. Results One hundred fifty-seven patients (89 %) completed the trial. Placebo injection with physiotherapy showed no significant difference compared to control or to corticosteroid injection with physiotherapy at any follow-up. Corticosteroid injection with physiotherapy had a 10.6 times larger odds for success at six weeks (odds ratio 10.60, p < 0.01) compared to control (NNT = 3, 99 % CI 1.5 to 4.2). At 12 weeks there was no significant difference between these groups, but at 26 weeks the odds for success were 91 % lower (OR 0.09, p < 0.01) compared to control, showing a large negative effect (NNT = 5, 99 % CI 2.1 to 67.4). At 52 weeks there was no significant difference. Both control and placebo injection with physiotherapy showed a gradual increase in success. Conclusions Acute lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks. Physiotherapy with deep transverse friction massage, Mills manipulation, stretching, and eccentric exercises showed no clear benefit, and corticosteroid injection gave no added effect. Corticosteroid injections combined with physiotherapy might be considered for patients needing a quick improvement, but intermediate (12 to 26 weeks) worsening of symptoms makes the treatment difficult to recommend. Trial registration ClinicalTrials.gov Identifier: NCT00826462