A placebo controlled randomised study, that investigated the effects of continue therapeutic ultrasound at the clinical and diagnostic ultrasonographic findings on patients suffering from lateral epicondylitis

SUMMARYObjective:The aim of this study is to evaluate the effectiveness of therapeutic ultrasound on the pain, range of motion of elbow and wrist, grip strength, functional test, quality of life, and ultrasonographic findings in the patients suffering from the lateral epicondylitis.Material Method:40 patients with the diagnosis of lateral epicondylitis were involved in the study. The patients were classified into two groups randomly. One grup (n:20) was given continuous therapeutic ultrasound and the other group (n:20) was given placebo ultrasound therapy. Both of the groups suggested to avoid excessive elbow and wrist movements, heavy weigt litfing, trauma for affected elbow as daily living activity modification. The patient followed up for three months. The elbow pain at rest, during motion and night pain were evaluated with visual analog scale (VAS) with 0-10 cm; elbow and wrist range of motion of the patients were assessed with goniometer; grip strength measured with Jamar dynamometer (when the elbow flexed 90 degree and the elbow extended and forearm pronated), the functional status with the translation of Disabilities of the Arm, Shoulder and Hand Poll, the quality of life with the Turkish form of the short-form 36(SF-36), the thickness of tendon, if there is calcification, bursitis, peritendinous effusion and echogenicity on the lateral epicondyle region with diagnostic ultrasonography. These evaluationswere made before treatment, after treatment (at the 3th week) and at the 3th month.Findings:Before the treatment, there was no significant difference between the groups in age, sex, mean weight, mean height ,mean body mass index, occupation, education level (p>0,05). The symptom duration was significantly longer in control group, than treatment group (p<0,05). There was no significant difference between the groups for the dominant side and affected elbow. Significant recovery was determined in all of the VAS scores of treatment group and the VAS at rest and during motion of control group (p<0,016). But there was no significant difference between the twogroups. In the ultrasound group, significant recovery was determined in the measurement of active elbow flexion at the 3th month comparing to pretreatment and in the measurement of passive elbow flexion at the 3th week and 3th month comparing to pretreatment (p<0,016). Improvement on the passive elbow flexion at the 3th week and pretreatment was significantly better in ultrasound group (p<0,05). There was no difference between two groups at the measurements of elbow active and passive extension, supination and pronation (p>0,05). After the treatment, significantly difference was not determined. Significant recovery was determined in the measurement of active wrist flexion at the 3th month comparing to pretreatment and 3th month comparing to 3th week in the ultrasound group and 3th month comparing to pretreatment in the control group. But there was no difference between the two groups (p>0,05). Significant improvement was determined in themeasurement of passive wrist extension between pretreatment and 3th month in the ultrasound group (p<0,016). But there was no significant difference between two groups (p>0,05). Improvement on the active wrist ulnar deviation at the 3th month comparing to pretreatment and passive wrist ulnar deviation at the 3th week comparing to pretreatment was significantly better in ultrasound group (p<0,05). In the control group on the wrist radial deviation, a decrease at the 3th week comparing to pretreatment and a significant improvement was determined at the 3th monthcomparing to 3th week (p<016). The improvement on the measurement of passive wrist radial deviation, at the 3th week comparing to pretreatment was significantly better in ultrasound group (p<0,05). There was no significant change at the measurement of grip strength while elbow flexed and extended, by treatment (p>0,016). In the ultrasonographic evaluation, in the ultrasound group, at the measurement of the thickness of uninvolved tendon, a significant increase was determined at the 3th month comparing to pretreatment (p<0,016). In the control group calcification was determined on the one patient, at all evaluations. It was not determined significant (p>0,05). Bursitis and effusion were not determined on none of the patients, at all evaluations. On the evaluation of affected elbow of ultrasound group, before treatment and at the 3th week, the elbows of two patients were hypoechoic than univolved side, the elbows of eighteen patient were normal. At the3th month the affected elbows of three patients were hypoechoic than uninvolved side, the elbow of seventeen patients were normal. In the control group before the treatment the affected elbow of one patient was hyperechoic, the affected elbow of one patient was hypoechoic, the elbows of eigtheen patient were normal. After the treatment at the 3th week the affected elbow of two patients were hypoechoic, the elbows of eighteen patients were normal. At the 3th month the affected elbow of three patients were hypoechoic, the elbows of seventeen patients were normal. Thealteration of hypoechogenity before treatment, at the 3th week and 3th month was not determined significant (p>0,05). On the pain sub section of SF-36, at both of the groups, at 3th month comparing to pretreatment and on the mental health sub section in ultrasound group at 3th week comparing to pretreatment a significant improvement was determined (p<0,016). Between the two groups on the general health situation sub section, the improvement was significantly better in ultrasound group at 3th week comparing to pretreatment (p<0,05). On the DASH-T FS score asignificant improvement was determined at the 3th month comparing to pretreatment in the ultrasound group and at the 3th month comparing to pretreatment and 3th month comparing to 3th week in the control group (p<0,016). A significant improvement was determined on the DASH-T W score at the 3th month comparing to pretreatment in the control group (p<0,016). The improvement of DASH-T W score at the 3th week comparing to pretreatment in the ultrasound group was significantly better than control group and the improvement of DASH-T W score atthe 3th month comparing to 3th week was significantly better than ultrasound group (p<0,05).Conclusion:It was determined that in the patients diagnosed lateral epicondylitis, therapeutic ultrasound therapy, increases the passive elbow flexion, passive wrist radial and ulnar deviation, functionality and general health situation sub section of SF-36 after the treatment and increases the active ulnar deviation at the 3th month but it has no effect on pain, grip strength and ultrasonographic findings.Key Words: Lateral epicondylitis, therapeutic ultrasound, diagnostic ultrasound