Clinical and ultrasonographic effectiveness of two different splints used in the treatment of lateral epicondylitis: A prospective randomized controlled study

Introduction: This study aims to compare the clinical and ultrasonographic efficacy of two splints, lateral epicondylitis band (LEB) and wrist extensor splint (WES), used in the treatment of lateral epicondylitis. Material and Methods: In this study, 159 patients diagnosed with unilateral epicondylitis because of clinical and ultrasonographic findings who applied to the outpatient clinic of Dokuz Eylul University Faculty of Medicine, Department of Physical Medicine and Rehabilitation in the subacute period (<12 weeks) were included. Of the patients randomized to three groups, WES (n=53) was given to the first group and WES (n=53) to the second group for 6 weeks. The patients in the third group were followed for 6 weeks with a wait-and-see approach (n=53). All patients were evaluated before treatment, at 3 weeks after treatment, and at 6 weeks after treatment. Demographic characteristics of patients, visual analog scale (VAS) scores at rest, night, and movement for pain, algometric measurements for pain sensitivity, dynamometric measurements for hand grip strength, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores for functional status, frequency of analgesic use, evaluation of satisfaction with splint use, capitellar-radiocapitellar region maximum tendon thickness measurements, and total ultrasonography (US) scale score (hypoechogenicity, neovascularity, heterogeneity, bone abnormality) were used as patient evaluation parameters. US evaluation parameters at the 6th week (maximum tendon thickness and total ultrasonography scale score) were described as the primary outcome measure and secondary outcome measures were determined as 6th-week PRTEE scores, VAS score, hand grip strength, and pain sensitivity measures. Results: The mean ± standard deviations of age and symptom duration of 159 (94 female and 65 male) patients included in the study were 46.86 ± 8.63 years and 1.91 ± 0.84 months, respectively. There was no significant difference between the groups concerning age, body mass index, history of attack, and dominant or affected side (p>0.05). There were significant differences between the groups for gender, and the number of female patients in the WES group was significantly higher than in the LEB group (p<0.05). The rate of repetitive activity and the presence of a history of trauma were higher in the Wait-and-See group compared to the other groups (p<0.05). The symptom duration of the patients was significantly longer in the LEB group than in the Wait-and-See group (p<0.05). As a result of the 6-week follow-up of the patients, the superiority of the LEB and WES groups over the Wait-and-See group was demonstrated in algometric measurements, VAS, and PRTEE scores (p<0.05), while no superiority was demonstrated in maximum tendon thickness measurements and total US scale scores (p>0.05). Only the hypoechogenicity score, among the sub-parameters of the total US scale, was significantly lower in the LEB group in the 6th week compared to the Wait-and-See group (p<0.05). In addition, the LEB group was found to be superior to the WES group in hand grip strength measurements and evaluation of satisfaction (p<0.05). The necessity for oral paracetamol treatment was significantly higher in the Wait-and-See group than in both splint groups (p<0.05). Conclusion: In our study, using 6 weeks of both splints (LEB and WES) is an effective method for the treatment of subacute stage lateral epicondylitis. While the effects of LEB and WES on pain, functional status, and pain sensitivity measurements were superior to the wait-and-see method, no superiority could be demonstrated in maximum tendon thickness measurements and total US scale score, except for the hypoechogenicity score. However, it has been determined that LEB has a more positive effect on hand grip strength and patient satisfaction than WES. Keywords: Lateral epicondylitis, lateral epicondylitis band, wrist extensor splint, ultrasonography