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Medial epicondylalgia (golfer’s elbow) treated by eccentric exercise
Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2012 (English)In: Shoulder & Elbow, ISSN 1758-5732, Vol. 4, no 1, 50-55 p.Article in journal (Refereed) Published
Abstract [en]

Background: Eccentric exercises have been successfully used in the treatment of Achilles and patellar tendinopathies, as well as lateral epicondylalgia. No studies have explored the same treatment for medial epicondylalgia (golfer’s elbow).

Methods: Twenty consecutive adults with a clinical diagnosis of medial epicondylalgia were treated with eccentric exercise over 3 months in this prospective case series. The programme was based on home training. There were 11 women and nine men, with a mean age of 47 years, and a mean duration of symptoms of 19 months. At baseline, at 3 months and after a mean of 11 years, pain was assessed by three independent visual analogue scales (VAS) and grip strength using a Jamar dynamometer (Sammons Preston Inc., Jackson, MI, USA). At the 11-year follow-up, patients also reported their satisfaction on a 100-mm VAS and completed the Disabilities of Arm, Shoulder and Hand questionnaire.

Results: Pain decreased significantly in all measured variables at both assessment occasions (all p < 0.0001). Grip strength in the affected arm/hand increased significantly after 3 months (p = 0.009).

Discussion: Twelve weeks of eccentric training reduced pain and increased grip strength in patients with medial epicondylalgia. It is a safe, uncomplicated and cost-effective method, with only a minimum contribution from a physiotherapist.

Place, publisher, year, edition, pages
London, UK: Sage Publications, 2012. Vol. 4, no 1, 50-55 p.
Keyword [en]
Elbow;tendinopathies;epicondylitis;golfer's elbow;conservative treatment
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-72718DOI: 10.1111/j.1758-5740.2011.00152.xOAI: oai:DiVA.org:liu-72718DiVA: diva2:461774
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2014-06-18Bibliographically approved
In thesis
1. Treatment of Epicondylalgia and Nerve Entrapments around the Elbow
Open this publication in new window or tab >>Treatment of Epicondylalgia and Nerve Entrapments around the Elbow
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Disorders causing pain in the elbow region is a common problem and is one of the most frequent forms of work-related health problems. These conditions are thus of major importance from the public health point of view, as well as from that of the suffering individual. Both sensory and motor function may be impaired, particularly in cases where a nerve is involved, resulting in severely impaired hand function.

“Tennis elbow” (lateral epicondylalgia) has been found to be the second most frequently diagnosed musculoskeletal disorder of the upper extremity in the primary health-care setting. “Golfer’s elbow” (medial epicondylalgia) is not that commonly encountered. It has been stated that tennis or golfer’s elbow syndromes are self-limiting. Even so, clinical experience has shown that there are a few cases where symptoms have a painful and long-lasting course, resistant to many forms of therapy. The outcomes of frequently adopted management regimes for treatment of epicondylalgia or nerve entrapments around the elbow were examined in the following five studies:

I: A randomised, prospective study of 38 patients with tennis elbow (lateral epicondylalgia). Groups were assigned to eccentric exercises or stretching. Eccentric exercise gave somewhat better results.In a second part of the study, a 4-year follow-up of 127 patients who used eccentric exercises for tennis elbow was performed. Patients showed decreased pain and increased grip-strength after 3 months treatment. At the time of publication this study was the first to examine eccentric exercises for this condition.

II: A retrospective analysis of long-term results from 51 patients treated with surgical release of the common extensor origin because of “chronic tennis elbow”. Eighty-seven per cent of the patients rated themselves as completely recovered or improved.

III: A randomised, prospective study of 70 patients with ulnar neuropathy in the forearm (cubital tunnel syndrome). Groups assigned the commonly recommended elbow brace at night or nerve gliding exercises were compared with a control group (information only). The majority of patients improved considerably, both subjectively and objectively, after a 3 months period, regardless of group. The study thus showed the effectiveness of information and expectance, and that orthosis or nerve gliding exercises added nothing further to the result.

IV: A retrospective study of 205 patients treated with surgery for suspected nerve entrapment in the forearm. Followup, almost 4 years later, demonstrated a subjective improvement in two of three patients, but only 3% experienced complete relief of all symptoms.

V: A prospective long-term study on 20 patients with golfer’s elbow (medial epicondylalgia) treated with eccentric exercises over 3 months. The results showed decreased pain and increased gripstrength. This is the first study published on the management of this disorder with eccentric exercises.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 93 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1262
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72719 (URN)978-91-7393-065-9 (ISBN)
Public defence
2012-01-28, Ekensalen, Campus US, Linköpings universitet, Linköping, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2011-12-16Bibliographically approved

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Adolfsson, Lars

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Plastic Surgery, Hand Surgery and BurnsFaculty of Health SciencesDepartment of Hand and Plastic SurgeryOrthopaedics and Sports MedicineDepartment of Orthopaedics in Linköping
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