الفهرس 
Chapter 1: Elbow Joint Anatomy ofOnly 14 pages are availabe for public view
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Abstract
Summary
Lateral epicondylitis (LE) is the most common overuse syndrome and related to excessive wrist extension. It is a tendinosis of the common origin of the tendons of the extensor muscles of the forearm. It causes pain and tenderness at the lateral humeral epicondyle; which is exaggerated by resisted dorsiflexion of the wrist or the middle finger. Imaging is usually not necessary however MRI and ultrasound can reveal tendinopathy.
Several conservative treatment options have been described for the treatment of LE. It can be treated with rest, ice, bracing, or non-steroidal anti-inflammatory drugs. However, when the condition is chronic or does not respond to the initial treatment, physical therapy will be initiated.
The overall success rate of extracorporal shock wave therapy (ESWT) in the management of LE in the literature ranges from 68% to 91%. ESWT has emerged as an acceptable, popular and non-invasive management option for tendinopathy and other pathologies of musculoskeletal system. The mechanism of ESWT may involve the improvement of angiogenetic growth factors, which in turn induce neovascularization and improve blood supply at the tendon–bone junction.
Summary
(147)
Local corticosteroid injection has short-term (two to six weeks) benefits in LE regarding pain reduction, global improvement, and grip strength compared with placebo and other conservative treatments. However, these benefits do not persist beyond six weeks.
Conventional physiotherapy has been commonly used for LE treatment and other musculoskeletal system diseases. There are many studies reporting effectiveness of physiotherapy in LE.
Our study aimed to compare the effectiveness of ESWT versus corticosteroid injection versus conventional physiotherapy as regards improving pain and function in patients with chronic LE.
This study was conducted on forty-five patients diagnosed with LE for more than 3 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the elbow using visual analogue scale (VAS score) , patient related tennis elbow evaluation questionnaire (PRTEE score) and hand grip strength (HGS) measured by a hand dynamometer.
Summary
(148)
The patients were randomly divided into three groups:
group 1: Fifteen patients received a single injection of mixture composed of methylprednisolone acetate (20 mg) and 0.6 ml of lidocaine. group 2: Fifteen patients received 3 sessions of ESWT over the lateral epicondyle with frequency 16 Hz, 1.6 bar energy density, 2000 pulses, once a week for 3 weeks. group 3: Fifteen patients received a total of 12 physiotherapy sessions (3 sessions per week) in the form of TENS for 20 minutes, pulsed ultrasonic therapy (1:1) for 5 minutes and local massage for the common extensor tendon with stretching exercises.
Patients were assessed before treatment, 4 and 12 weeks after treatment by VAS score for pain assessment, PRTEE score for functional assessment and hand grip strength measurement by a hand dynamometer.
Our study revealed that, the three groups were matched as regard age, sex, affected side and duration of illness.
Compared to baseline, the three study groups reported a statistically high significant pain relief, functional improvement and increase of HGS at 4 and 12 weeks of follow up.
Summary
(149)
Upon comparison between the three groups, there was a statistically high significant difference regarding VAS and PRTEE scores as follows:
There was a high significant VAS score reduction in (ESWT group) and (CS group) compared to (PT group) at 4 weeks of follow up indicating the greater short term analgesic effect of ESWT and corticosteroid injection. Meanwhile, there was no significant difference among the three groups at 12 weeks of follow up.
There was a high significant PRTEE score reduction in (ESWT group) than (CS group) and (PT group) at 4 and 12 weeks of follow up indicating the greater long term beneficial effect of ESWT on the function in patients with chronic LE.
There was no significant difference regarding HGS between the three groups at 4 and 12 weeks of follow up.
ESWT offers better therapeutic advantages over a corticosteroid injection and conventional physiotherapy especially at longer term follow up (12 weeks).