Sage Journals: Discover world-class research

Abstract

Objective:

To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia.

Design:

Double-blind (patient and evaluator) randomized controlled trial.

Setting:

Primary Care Center of the Spanish NHS.

Subjects:

A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years.

Interventions:

All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis.

Main measures:

Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment.

Results:

Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm²; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm²; SD, 7.86) and to the Control Group (mean, 2.09 km/cm²; SD, 4.45) (P values <0.01 and <0.03, respectively) and also in function (mean, 20.87; SD, 14.25) compared to the Control Group (mean, 4.17; SD, 18.02) (P < 0.01). Subjective assessment was statistically better in the Intervention Group both at the end of treatment (P < 0.01) and three months after treatment (P < 0.03).

Conclusion:

Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients.

Keywords

Tennis elbow manual therapy physiotherapy techniques primary care

Get full access to this article

View all access options for this article.

References

Kannus

Etiology and pathophysiology of chronic tendon disorders in sports. Scand J Med Sci Sports 1997; 7: 78–85.

Rees

Stride

Scott

Tendons–time to revisit inflammation. Br J Sports Med 2014; 48(21): 1553–1557.

Roquelaure

Leclerc

et al . Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum 2006; 55(5): 765–778.

Krogh

Bartels

Ellingsen

et al . Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 2013; 41(6): 1435–1446.

Bisset

Paungmali

Vicenzino

et al . A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med 2005; 39(7): 411–422.

Behrens

Deren

Matson

et al . A review of modern management of lateral epicondylitis. Phys Sportsmed 2012; 40(2): 34–40.

Poulsen

Carr

Hulley

PA.

Protection against glucocorticoid-induced damage in human tenocytes by modulation of ERK, Akt, and forkhead signaling. Endocrinology 2011; 152(2): 503–514.

Poulsen

Watts

Murphy

et al . Glucocorticoids induce senescence in primary human tenocytes by inhibition of sirtuin 1 and activation of the p53/p21 pathway: in vivo and in vitro evidence. Ann Rheum Dis 2014; 73(7): 1405–1413.

Tricás

Lucha

Duby

Fibrolisis Diacutánea Según El Concepto De Kurt Ekman. Zaragoza: Asociación Española de FD, 2010.

10.

Barra López

López de Celis

Fernández Jentsch

et al . Effectiveness of diacutaneous fibrolysis for the treatment of subacromial impingement syndrome: a randomised controlled trial. Man Ther 2013; 18(5): 418–424.

11.

Veszely

Guissard

Duchateau

Contribution à l’étude des effets de la fibrolyse diacutanée sur le triceps sural. Annales De Kinésithérapie 2000; 27(2): 54–59.

12.

Lévénez

Guissard

Veszely

et al . Changes in muscle resting tension, architecture and spinal reflex after hook treatment in healthy subjects. Comput Methods Biomech Biomed Engin 2009; 12: 171–172.

13.

Hernández

Berjillos

Corte

et al . Estudio prospectivo randomizado de comparación de diferentes técnicas de electroterapia en tendinitis de inserción en codo. Patologia Del Aparato Locomotor 2006; 4(2): 131–138.

14.

Price

McGrath

Rafii

et al . The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17(1): 45–56.

15.

MacDermid

Evenhuis

Louzon

Inter-instrument reliability of pinch strength scores. J Hand Ther 2001; 14(1): 36–42.

16.

Bellace

Healy

Besser

et al . Validity of the Dexter Evaluation System’s Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J Hand Ther 2000; 13(1): 46–51.

17.

Hervás

Navarro

Peiró

et al . Adaptación transcultural, fiabilidad, validez y sensibilidad a los cambios. Med Clin 2006; 127(12): 441–447.

18.

Stratford

Binkley

Riddle

DL.

Health status measures: strategies and analytic methods for assessing change scores. Phys Ther 1996; 76: 1109–1123.

19.

Barra

López

Fernández

et al . The immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder: a randomized placebo-controlled pilot study. Clin Rehabil 2011; 25(4): 339–348.

20.

Lachin

JM.

Statistical considerations in the intent-to-treat principle. Control Clin Trials 2000; 21(3): 167–189.

21.

Jaeschke

Singer

Guyatt

GH.

Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10(4): 407–415.

22.

Bisset

Beller

Jull

et al . Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333(7575): 939.

23.

Zamani

Okhovatian

Naimi

et al . Intra-examiner and between-day reliability of algometer for pressure pain threshold and pain sensitivity in upper trapezius muscle in asymptomatic young adult women. J Clin Physio Res 2017; 2(1): 15–20.

24.

Jensen

Chen

Brugger

AM.

Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003; 4(7): 407–414.

25.

Tonks

. Evaluation of short-term conservative treatment in patients with tennis elbow (lateral epicondylitis): a prospective randomised, assessor-blinded trial. Dissertation Thesis (PhD), University of Central Lancashire, Preston, 2012.

26.

Franchignoni

Vercelli

Giordano

et al . Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44(1): 30–39.

27.

Lundquist

Døssing

Christiansen

DH.

Responsiveness of a Danish version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Dan Med J 2014; 61(4): A4813.

28.

Schmitt

Di Fabio

RP.

Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol 2004; 57(10): 1008–1018.

29.

Castellet

Vidal

Conesa

Escalas de valoración en cirugía ortopédica y traumatología. Trauma Fund MAPFRE 2010; 21(Suppl. 1): 34–43.

30.

Peerbooms

Sluimer

Bruijn

et al . Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010; 38(2): 255–262.

31.

Shiri

Viikari-Juntura

Varonen

et al . Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 2006; 164(11): 1065–1074.

32.

Kazemi

Azma

Tavana

et al . Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy: a randomized clinical trial of efficacy. Am J Phys Med Rehabil 2010; 89(8): 660–667.

33.

D’Vaz

Ostor

Speed

et al . Pulsed low-intensity ultrasound therapy for chronic lateral epicondylitis: a randomized controlled trial. Rheumatology 2006; 45(5): 566–570.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.19 MB

Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial