• Clinics in Shoulder and Elbow
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• v.24 no.4
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• pp.231-238
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• 2021

Background: Extensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE. Methods: Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments. Results: Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]). Conclusions: PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

• Journal of Korean Medicine Rehabilitation
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• v.34 no.2
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• pp.101-134
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• 2024

Objectives The purpose of this study is to observe the effectiveness of acupotomy treatment for lateral epicondylitis by comparing it with various control groups. Methods We searched 11 domestic and international databases for systematic reviews and meta-analysis. The subjects were studies published from January 1, 2017 to September 1, 2023, and only randomised controlled trials were included. Results 208 studies were searched, of which 21 studies were finally selected. Among the studies published after 2017, the largest number of studies was published in 2019. The average number of participants per study was 72.28±20.26 and the average age was in the 40s. The most frequent intervention in the study was acupotomy alone, and the treatment most often mentioned as a control group was local nerve block. The most used evaluation tool is efficiency. Acupotomy+manipulation had statistically better effect than that of local nerve block in terms of pain (standard mean difference -1.87, 95% confidence interval, -2.18 to -1.57, p<0.00001) and elbow joint function (standard mean difference 2.25, 95% confidence interval, 1.65 to 2.86, p<0.00001). Conclusions As a result of the meta-analysis, the effect of acupotomy added manual therapy treatment was statistically significant compared to the local nerve block frequently used for lateral epicondylitis. Based on these results, it appears that more research on combination treatments other than acupotomy treatment will be needed. Also, it appears that more large-scale randomized controlled studies that strictly adhere to the standards for reporting interventions in controlled trials of acupuncture, risk of bias 2 criteria will be needed.

• Journal of Digital Convergence
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• v.11 no.4
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• pp.285-292
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• 2013

This study performed a proprioception improvement training for recurrence prevention of industrial workers with chronic lateral epicondylitis and analysed their pain and proprioception. The subjects of the study were thirty chronic lateral epicondylitis patients working for K company and were divided into elbow exercise program Group made of 15 subjects and proprioception improvement training Group made of 15. As variables for pain, pressure pain, and grip strength were measured and for the propioception, joint position sense of each group was measured before and after the exercise program. To compare differences before and after the program, a paired t-test was used and to compare differences between both groups, an independent samples t-test was used. As a result of the test, it was discovered that pressure pain, grip strength and joint position sense of the both groups were improved statistically significantly. These were statistically differential effect between each group on pressure pain, grip strength and joint position sense. In conclusion, it is suggested that proprioception improvement training should be considered as a method chronic and recurrence prevention lateral epicondylitis of industrial workers.

• Physical Therapy Korea
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• v.27 no.3
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• pp.163-170
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• 2020

Background: The characteristics of lateral epicondylitis (LE) are muscle strength weakness and increased common extensor tendon (CET) thickness. Ultrasonography has recently been used to evaluate tendinopathy. Diamond taping (DT) is commonly used to manage patients with LE. However, no previous studies have investigated the effects of DT on CET thickness. Objects: The aim of this study was to investigate the effects of DT applied around the lateral elbow on CET thickness, grip strength, and wrist extension force in healthy subjects. Methods: The subjects were 26 adults (13 male) in their twenties. First, the CET thickness was measured at rest. The CET thickness was measured by using ultrasonography at two points. The subjects were then instructed to perform maximal grip activities or maximal wrist extension activities before and after DT around the lateral elbow. The DT technique was applied using non-elastic tape. While the subjects performed maximal grip activities, the investigator measured the maximum grip strength (MGS) and CET thickness. Likewise, while the subjects performed maximal wrist extension activities, the investigator measured the maximum wrist extension force (MWEF) and CET thickness. Results: The MGS showed a statistically significant improvement after DT taping application in men (p < 0.05). The MWEF showed a statistically significant improvement after DT application in male (p < 0.01) and female (p < 0.05). When performing the activities, the CET thickness increased compared to that at rest. However, CET thickness didn't show a statistically significant improvement before and after DT. Conclusion: This study shows that DT applied around the lateral elbow is effective in improving MGS and MWEF. However, it does not affect CET thickness.

• Journal of Acupuncture Research
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• v.36 no.4
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• pp.211-219
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• 2019

This review analyzed randomized controlled trials and case reports to identify the effectiveness, and level of evidence showing that acupuncture treatment aids the recovery of patients with tennis elbow. A literature search was performed between $1^{st}$ to $10^{th}$ September, 2019 which used PubMed, the Cochrane library, the Korean databases Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System to retrieve Korean and international studies. Amongst the 243 articles retrieved there were 9 randomized controlled trials and 18 case reports. The level of evidence for the recovery of patients with tennis elbow, for efficacy and safety of acupuncture was low. It was observed that the studies had a high risk of bias, missing acupuncture details, multiple combinations of treatments rather than a single treatment, insufficient indicators of assessment, and lacked robustness. Compliance with international standards such as using consolidated standards of reporting trials, will improve the quality of evidence.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.50-58
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• 2007

Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range $16{\sim}56$ years). All patients had a trial of conservative treatment at least six months (range $6{\sim}16$ months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average(range $12{\sim}24$). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.

• Journal of East-West Nursing Research
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• v.13 no.2
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• pp.160-169
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• 2007

Background: Hwa-Byung is known as a specific Korean cultural syndrome which corresponds to DSM-IV(MMPI). Some Korean women who have experienced heart aching anger(Hwa-Byung) complain physical pains as well as psychological problems. As for these physical pains, upper limb arthropathy(e.g. golf elbow pains, tennis elbow pains, or shoulder-joint pains) have not been paid attentions. In spite of not having done her excessive physical endeavor or exercise, some Korean middle aged women complain those arthropathy pains. And they go round orthopedics, pain clinics, and oriental medicine clinics. Purpose: This study was practiced in Severance Oriental Medicine Clinic. The oriental medicine doctor had a question about the major origin of upper limb pains which were not caused by excessive physical endeavor. To answer the question, this study has been practiced. In the process of interview with some those women, the major cause of those syndromes has been revealed as Hwa-Byung. The purpose of this study is to discover the meanings of the women's life who have been experienced Hwa-Byung with upper limb arthropathy. Results: These upper limb arthropathy can be explained by meridian theory. Shoulder-joint pain and golf elbow with Hwabyung can be explained by Heart meridian of hand-shoyin and the points of these pains are in the flow of this meridian. Tennis elbow with Hwabyung can be explained by Small intestine meridian of hand-taiyang and this point is in the flow of this meridian. The results of interview with 9 middle aged women was analyzed and interpreted according to Spradley's method of ethnography. The analysis revealed three core cultural themes : 1) There are certainly external cause to provoke Hwa-Byung. A patricentric family system, husband's playing around with another woman, cruel treatment by husband's family, or financial failure may be present anteriorly. 2) The chief existing condition is the discord between husband and wife. The stoppage of mutual communication, lacking in understanding, unfeeling, heartless, or unsympathetic is an major phenomenon of married life. So the important factor is not the sexual relations or problems but the discords of communication. 3) The feeling of anger, the sense of nihility, the desire to escape, and the effort to forgiveness coexist together. At a glance, they seemed to be a process. For example, anger seemed to present at first, then nihility seemed at second, then escape seemed at third, and then forgiveness seemed at last. But at point of visiting clinic to be treated, they are mixed up together as if in a jumble.

• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.170-186
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• 2001

Musculoskeletal ultrasound (MSUS) has newly evolved by the mechanical improvement of the machine over past several years, becoming a part of imaging techniques for the evaluation of variable diseases in the musculoskeletal system. MSUS has proven diagnostic superiority in pathologies including rotator cuff disease of the shoulder, lateral epicondylitis of the elbow, diseases of the peripheral nerve, detection of intra-articular loose bodies and soft tissue foreign bodies, and in evaluating small superficial soft tissue tumors such as ganglion, epidermoid cyst, and glomus tumor. Besides, MSUS is very useful for obtaining tissue or fluid via percutaneous fine needle aspiration and/or biopsy for the histopathologic diagnosis. Combining MSUS with MR would play a great role in the field of the diagnostic imaging of the musculoskeletal system. The MSUS examiner should have the knowledge of cross-sectional anatomy, and of the mechanical and physical properties of ultrasound in order to interpret the ultrasound findings accurately and properly, and to avoid diagnostic errors due to variable artifacts subsequently. The goal of this article is to introduce the capabilities of MSUS in certain kinds of clinical situation and to familiarize the reader with MSUS. For the purpose, author intends to describe this article according not to the disease-, or organ-based, but to the clinical problem-based format.

• Physical Therapy Korea
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• v.27 no.2
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• pp.118-125
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• 2020

Background: Lateral epicondylitis (LE) is the most common chronic musculoskeletal pain condition of the upper extremities. LE is often related to forceful grip activities that require isometric contraction of the wrist extensors. A previous study evaluated the effect of the diamond taping technique on grip strength and pain; however, there has been no report on the change in the electromyography (EMG) findings of wrist extensors. Objects: The aim of this study was to investigate the effect of diamond taping technique, using a rigid tape, on the EMG activities of the extensor carpi radialis (ECR) during grip activities. Methods: Twenty-four healthy subjects (mean age = 21.50 ± 2.76 years) volunteered to participate in this study. The subjects were instructed to perform forceful grip activities with and without diamond-type taping on the origin area of the ECR. Grip strength tests were performed at 100%, 75%, 50%, and 25% for maximal isometric contraction force. EMG data were collected from the ECR. Repeated measure analysis of variance was used to analyze the effect of grip force and taping (with and without). Statistical significance levels were set at α = 0.05. Comparison of the results with and without taping at different grip force were analyzed using independent t-test. Statistical significance levels were set at α = 0.01. Results: Statistically significant association was observed between the taping application and forceful grip activity as revealed by the EMG data of the ECR (p < 0.05). EMG of the ECR significantly reduced for all muscle strength levels (p < 0.01) after taping. Conclusion: This study shows an impressive effect of the diamond taping technique, using rigid tape, on wrist extensors during grip activities. Decreasing muscle activity via this taping approach could be utilized to enhance pain-free grip force and reduce pain in patients with LE. Our study suggested that this taping technique could be considered as an effective management strategy of LE.

• Physical Therapy Korea
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• v.28 no.2
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• pp.93-100
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• 2021

Background: Lateral epicondylitis (LE) is the most common chronic musculoskeletal conditions of the upper extremity with pain and wrist extension disability. The tendon which is most affected is the extensor carpi radialis brevis (ECRB). Previous study evaluated the effect of taping technique on patient with LE, but no study investigated the changes of electromyography (EMG) on ECRB when using dynamic taping (DT) technique. Objects: The aim of this study was to investigate the effect of DT technique using dynamic tape on muscle activity of ECRB during wrist isometric extension, isotonic extension and flexion. Methods: Twenty-one healthy subjects volunteered to participate in this study. Subjects were instructed to perform wrist isometric extension, isotonic extension and flexion without and with DT on origin area of ECRB. Wrist isometric extension was performed at 75%, 50% and 25% (%maximal voluntary contraction force), respectively, based on maximum contraction force. Isotonic extension and flexion test used dumbbell. EMG data was collected from ECRB. Results: EMG of ECRB were statistically significant decrease in wrist isotonic extension after DT (p < 0.05). Significant increase in wrist isometric extension during 25% and 50% force task (p < 0.05). Conclusion: This study applied DT technique to suppress the wrist extensor muscles in 21 healthy adults in their twenties. Change in muscle activity was compared in the ECRB muscle during wrist isometric extension, isotonic extension and flexion task. Based on the results of this study, the DT technique applied to the wrist and forearm area can reduce the load on the wrist extensors when the wrist performs various movements during daily life movements or repetitive tasks, and by using these effects, excessive stress is applied to tennis elbow patients.