What question did this study set out to answer?

This trial aims to assess the effectiveness of a new dynamic wrist orthosis in treating lateral epicondylitis compared to standard physiotherapy.

September 15, 2018Open Access

Prospective randomized controlled trial in the treatment of lateral epicondylitis with a new dynamic wrist orthosis

Key Points

This trial aims to assess the effectiveness of a new dynamic wrist orthosis in treating lateral epicondylitis compared to standard physiotherapy.
Patients with lateral epicondylitis for over 3 months were randomly assigned to physiotherapy alone or physiotherapy plus wrist orthosis.
Clinical evaluations were performed at 12 weeks and 12 months using various pain and function scales.
Inclusion criteria were a Placzek score greater than 4, excluding those with significant comorbidities.
At 12 weeks, pain reduction was significant in the PT + O group (VAS 6.5-3.7, p = .001) but not in the PT group (4.7-4.1, p = .468).
After 12 months, both groups showed significant pain reduction (PT + O: 1.1, p = .000; PT: 1.3, p = .000).
The PT + O group demonstrated significant improvements in the PRTEE and Placzek score at both follow-ups.

Abstract

BACKGROUND: In the treatment of lateral epicondylitis (LE), the role of a new dynamic wrist orthosis is unclear. PATIENTS AND METHODS: Patients suffering from a LE longer than 3 months were multicentrically and prospectively randomized into a physiotherapeutic group (PT group) and in a physiotherapy group plus wrist orthosis (PT + O group). Physiotherapy consisted of daily eccentric strengthening exercises under initial professional supervision. Inclusion criteria were a Placzek score greater than 4. Exclusion criteria were previous surgery, rheumatic arthritis, elbow instability, radicular symptoms, higher-grade extensor tendon rupture, or cervical osteoarthritis. The clinical evaluation was performed after 12 weeks and 12 months. The Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, Placzek Score, the pain rating (VAS), range of motion and the Subjective Elbow Score were evaluated. RESULTS: Of the initially 61 patients, 31 were followed up after 12 weeks and 22 after 12 months. Twenty-nine patients (43%) were male, the mean age was 46, and 44 patients (66%) had the right elbow involved. At 12 weeks, there was a pain reduction on the VAS in both groups (PT + O: 6.5-3.7 p = .001; PT: 4.7-4.1 p = .468), albeit it was only significant for the PT + O group. At 12 months, reduction was significant in both groups (PT + O: 1.1 p = .000; PT: 1.3 p = .000). The painless maximum hand strength in kg improved in both groups significant after 3 and 12 months. The Placzek score was reduced from 8.25 to 3.5 p = .001 after 12 weeks for the PT + O group and from 8.1 to 3.8 p = .000 in the PT group, as well as after 12 months in the PT + O group to 0 p = .000 and in the PT group to 2.0 p = .000. The PRTEE improved in both groups after 12 weeks (PT + O: 52.8--31.3 p = .002; PT: 48.6-37.6 p = .185) and 12 months (PT + O: 16.15 p = .000; PT: 16.6 p = .000), although the reduction at 12 weeks was not significant for the PT group. CONCLUSION: The elbow orthosis appears to accelerate the healing process with respect to the PRTEE and pain on the VAS (12 weeks follow-up), although there is an adjustment after 12 months in both groups and a significant improvement of symptoms is achieved in all endpoints.

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