Type of Article:  Original Research

Volume 9; Issue 5 (October 2021)

Page No.: 4019-4027

DOI: https://dx.doi.org/10.16965/ijpr.2021.182

Efficacy of wrist manipulation in the management of lateral epicondylitis

Aparna Sudhan M 1, Thresiamma V.T. 2, Sreejesh M.S.*3, Arun Vijay Subbarayalu 4.

*1 Associate Professor, Department of Physiotherapy, Co-operative Institute of Health Sciences, Thalassery, Kerala, India.

2 Head, Physiotherapy Department, Caritas Hospital, Kottayam, Kerala, India.

3 Scientific Assistant(physiotherapy), Dept. Of Physical Medicine and Rehabilitation, Govt. Medical College, Kozhikode, Kerala, India.

4 Assistant Professor in Physiotherapy, Chairman of Quality Measurements & Evaluation Department, Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Saudi Arabia.

Corresponding Author: Ms. Aparna Sudhan, Associate Professor, Department of Physiotherapy, Co-operative Institute of Health Sciences, Thalassery, Kerala, India. E-Mail: nadandev@gmail.com


Background: Lateral epicondylitis is the most common clinical condition characterized by pain generally localized around the lateral epicondyle but sometimes radiating distally to the forearm.  

Objectives: The study’s primary objective was to find out the efficacy of multiple therapeutic interventions consisting of wrist manipulation, ultrasound therapy, and stretching exercise on lateral epicondylitis patients. 

Subjects and methods: A pre-test, post-test experimental study design was used. A criterion-based simple random sampling was used to recruit patients (N=30) diagnosed with lateral epicondylitis, and they were randomized into two treatment groups. The experimental group-1 was exposed to ultrasound therapy and stretching

exercises, whereas those assigned to experimental group-II were given ultrasound therapy, stretching exercise, and wrist manipulation for the period of 2 weeks. The efficacy of treatment was measured through visual analogue scale (VAS), manual hand dynamometer, and DASH Scale. Both paired and unpaired ‘t’ test was employed to study the treatment effectiveness. A p-value <0.05 was considered ‘significant’.

Result: The group, which was exposed to the treatment combinations of wrist manipulation, ultrasound therapy, and stretching exercise showed a better reduction in pain intensity (mean difference 1.4) & self-reported upper extremity disability score (mean difference 8.06) and a notable improvement in grip strength (mean difference 4.73) than the other group, that was exposed to the treatment combinations of ultrasound therapy and stretching exercise at 0.05 levels of significance.

Conclusion: There is a significant reduction in pain intensity, improvement in pain-free grip strength, and the overall function of the arm following the application of 2 weeks of wrist manipulation technique along with conventional treatment in Lateral Epicondylitis patients. 

Clinical Implications: Manipulation of the wrist is found to produce a significant effect when combined with conventional methods like ultrasound stretching and strengthening to manage lateral epicondylitis patients.

Key words: Lateral epicondylitis, Ultrasound, Passive stretching, Wrist manipulation.


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Cite this article: Aparna Sudhan M, Thresiamma V.T, Sreejesh M.S, Arun Vijay Subbarayalu.  Efficacy of wrist manipulation in the management of lateral epicondylitis. Int J Physiother Res 2021;9(5):4019-4027. DOI: 10.16965/ijpr.2021.182