IJPR.2021.182

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

ABSTRACT

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.

REFERENCES

[1]. Morris HP. Lawn-tennis elbow. Br Med J 1883; 2: 557.
[2]. Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg 2008; 16(1): 19-29.
[3]. Thomas L. Sanders Jr, Hilal Maradit Kremers, Andrew J. Bryan, Jeanine E. Ransom, Jay Smith, Bernard F. Morrey. The Epidemiology and Health Care Burden of Tennis Elbow: A Population-Based Study. Am J Sports Med 2015; 43(5): 1066–1071.
[4]. Titchener AG, Fakis A, Tambe AA, Smith C, Hubbard RB, Clark DI. Risk factors in lateral epicondylitis (tennis elbow): a case-control study J Hand Surg Eur 2013; 38(2): 159-64.
[5]. Basheer RKB, Subhashchandra Rai, Irshana Balkies AM, Jasim Junaid NP. Incidence of tennis elbow and association of hand grip strength among college students. International Journal of Research in Medical Sciences 2021; 9(1); 177-180.
[6]. Dorf ER, Chhabra AB, Golish SR, McGinty JL, Pannunzio ME. Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am 2007; 32: 882-886
[7]. Amrish O. Chourasia, Kevin A. Buhr, Mary E. Sesto. Effect of Lateral Epicondylosis on Grip Force Development. Journal of Hand Therapy 2012; 25(1): 27-37.
[8]. Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific evidence for the treatment of Lateral epicondylitis of the elbow: an attempted meta-analysis. J Bone Joint Surg Br 1992; 74(5): 646-651.
[9]. Kay NRM. Litigants’ epicondylitis. J Hand Surgery 2003; 28(5): 460-4.
[10]. Thomas De Smedt, Andy de Jong, Wim Van Leemput, Dossche Lieven, Francis Van Glabbeek. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med 2007; 41: 816–819.
[11]. Shaheen H, Alarab A, Ahmad MS. Effectiveness of therapeutic ultrasound and kinesio tape in treatment of tennis elbow. J Nov Physiother Rehabil. 2019; 3: 025-033.
[12]. Rajadurai Viswas, Rejeesh Kumar Ramachandran, Payal Korde Anant Kumar. “Comparison of Effectiveness of Supervised Exercise Program and Cyriax Physiotherapy in Patients with Tennis Elbow (Lateral Epicondylitis): A Randomized Clinical Trial”. The Scientific World Journal 2012; 2012: 939645.
[13]. Maxwell L. Therapeutic ultrasound: its effects on the cellular and molecular mechanisms of inflammation and repair. Physiotherapy 1992; 78(6): 421-26.
[14]. Weber C, Thai V, Neuheuser K, Groover K, Christ O. Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis. BMC Musculoskelet Disord 2015; 16(1): 223.
[15]. Wright A, Vicenzino B. Lateral epicondylalgia II: Therapeutic management. Phys Ther Rev 1997; 2: 39-48.
[16]. Kushner S, Reid D. Manipulation in the treatment of tennis elbow. J Orthop Sports Phys Ther 1986; 7: 264–272.
[17]. Mulligan BR: Spinal mobilization with arm movement adapted by Manual therapy “NAGs”, “SNAGs”, “MWMs”, etc, 5th ed. Wellington: Plane View Services, 2006.
[18]. Vicenzino B, Cleland JA, Bisset L. Joint manipulation in the management of lateral epicondylalgia: A clinical commentary. J Man Manip Ther 2007; 15: 50-56.
[19]. Lewit K. The muscular and articular factor in movement restriction. Manual Medicine 1985; 1: 83-85.
[20]. Basak T, Pal TK, Saha B et al. Comparative efficacy of wrist manipulation, progressive exercises and both treatments in patients with tennis elbow. Int J Health Sci Res 2018; 8(4): 87-94.
[21]. Struijs P, Damen P, Bakker E WP, Blankevoort L, Assendelft W, Niek van Dijk C. Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study. Physical Therapy 2003; 83(7): 608-16.
[22]. Anne M. Boonstra, Henrica R. Schiphorst Preuper, Michiel F. Reneman, Jitze B. Posthumus, Roy E. Stewart. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research 2008; 31: 165–169.
[23]. Ejazi G, Hamdani N, Kumar S. Test-Retest Reliability of Hand Grip Strength Measurement Using a Jamar Hand Dynamometer in Patients with Acute and Chronic Cervical Radiculopathy. International Journal of Physiotherapy 2017; 4(6): 382-388.
[24]. Hugo Maxwell Pereira, Maryela de Oliveira Menacho, Ricardo Hisayoshi Takahashi, Jefferson Rosa Cardoso. Handgrip Strength Evaluation on Tennis Players Using Different Recommendations. Revista Brasileira de Medicina do Esporte 2011; 17(3): 184-188.
[25]. Aya S.M. Khattab, Salwa F. Abd El-Majied, Naser M. Alotaibi, and Maha M. Mohammed. (2020). Validity and Reliability of the Arabic Version of the Quick-Dash Questionnaire for Upper Extremity Disorders. Med. J. Cairo Univ 2020; 88 (5): 2037-2043.
[26]. Lale Altan, Ilker Ercan, Saniye Konur. Reliability and validity of Turkish version of the patient rated tennis elbow evaluation. Rheumatology International 2010; 30: 1049-1054.
[27]. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 2003; 4:11.
[28]. Khandaker MN, Islam S, Emran A, Islam J, Ahmed SM, Khan MM, Salek AKM. The effect of stretching exercise in the management of lateral epicondylitis. Bangladesh Med J. 2014; 43 (2): 61-66.
[29]. Stasinopoulos D, Stasinopoulou K, and Johnson MI. “An exercise programme for the management of lateral elbow tendinopathy,” British Journal of Sports Medicine 2005; 39(12); 944-947.
[30]. Wilkin LD, Mark Merrick Mark, Timothy E. Kirby, Steven T Devor. Influence of Therapeutic Ultrasound on Skeletal Muscle Regeneration Following Blunt Contusion. International Journal of Sports Medicine 2004; 25(1): 73-77.
[31]. Douglas L. Miller, Nadine B. Smith, Michael R. Bailey, Gregory J. Czarnota, Kullervo Hynynen, Inder Raj S. Makin. Overview of Therapeutic Ultrasound Applications and Safety Considerations. Journal of Ultrasound in Medicine 2012; 31: 623-634.
[32]. Elsayed M. Alia, Osama Fekryb, Hany E. Obeyac, Hanan Darweeshd, Ashraf Moharrame. Efficacy of high intensity laser versus ultrasound therapy in the management of patients with lateral epicondylitis. The Egyptian Rheumatologist 2021; 43 (2): 119-123.
[33]. Dinno MA, Dyson M, Young SR, Mortimer AJ, Hart J, Crum LA. (1989). The significance of membrane changes in the safe and effective use of therapeutic and diagnostic ultrasound. Phys Med Biol 1989; 34(11): 1543-52.
[34]. Singh Jagmohan. Ultrasonic Therapy, Manual of Practical Electrotherapy. New Delhi: Jaypee brothers and Medical Publisher; 2011.
[35]. Gregory M, Deane M, Mars M. Ultrastructural Changes in Untraumatized Rabbit Skeletal Muscle Treated with Deep Transverse Friction. Physiotherapy 2003; 89: 408-416.
[36]. Hassan SM, Hafez AR, Seif HE, Kachanathu SJ. The Effect of Deep Friction Massage versus Stretching of Wrist Extensor Muscles in the Treatment of Patients with Tennis Elbow. Open Journal of Therapy and Rehabilitation 2016; 4: 48-54.
[37]. Goyal M, Kumar A, Mogna M, Moitra M. Effect of Wrist Manipulation and Cyriax Physiotherapy Training on Pain and Grip Strength in Lateral Epicondylitis Patients. Journal of Exercise Sciences and Physiotherapy 2013; 9 (1): 17-22.
[38]. Solveborn SA. Radial epicondylalgia (“tennis elbow”)—treatment with stretching or forearm band: a prospective study with long-term follow-up including range-of-motion measurements. Scand J Med Sci Sports 1997; 7: 229-37.
[39]. Schaible HG, Grubb BD. Afferent and spinal mechanisms of joint pain. Pain 1993; 55 (1): 5-54.
[40]. Taylor M, Suvinen T, Reade P. The effect of grade IV distraction mobilization on patients with temporomandibular pain-dysfunction disorder. Physiotherapy Theory and Practices 1994; 10: 129-136.

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