Therapeutic Ultrasound for Lateral Epicondylitis
Ultrasound therapy for lateral epicondylitis
A first study from Greg W. et al says that ultrasonography is probably helpful for lateral epicondylitis . Ultrasonography is thought to have thermal and mechanical effects on the target tissue leading to increased metabolism, circulation, extensibility of connective tissue, and tissue regeneration. The best available data suggest that ultrasonography provides modest pain reduction over one to three months. Exercise appears to be more effective than ultrasonography for pain relief. Combining ultrasonography with deep transverse friction massage or corticosteroids is no better than ultrasonography alone. Ultrasonography should be done two or three times per week with a duration of four to six weeks.
Lin CL et al investigated thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided radiofrequency thermal lesioning (RTL). Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Conclusions: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.
D'Vaz AP et al. assessed the effectiveness of low-intensity ultrasound therapy (LIUS) vs placebo therapy daily for 12 weeks in patients with chronic lateral epicondylitis (LE) in a randomized, double-blind, placebo controlled trial. In this study LIUS was no more effective for a large treatment effect than placebo for recalcitrant LE. 
Öznur Öken et al evaluated the effects of low-level laser therapy (LLLT) and to compared these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group—brace plus exercise, 2) ultrasound group—US plus exercise, and 3) laser group—LLLT plus exercise. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain, and that laser therapy is more effective than the brace and US treatment in improving grip strength.
Schleicher I et al. concluded that during the acute phase ultrasound is helpful.
We can decide that the evidence for the use of ultrasound in the treatment of a Lateral Epicondylitis is still controversial.
Recent Related Research (from Pubmed)
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- GREG W. et al. Treatment of Lateral Epicondylitis , 2007 Sep 15;76(6):843-848 Am Fam Physician. Level of evidence 1a
- Lin CLet al.; Clinical and ultrasonographic results of ultrasonographically guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis. 2011 Nov;39(11):2429-35. doi: 10.1177/0363546511417096. Am J Sports Med. Case series. Level of evidence: 4.
- D'Vaz AP et al.Pulsed low-intensity ultrasound therapy for chronic lateral epicondylitis: a randomized controlled trial. Rheumatology (Oxford). 2006 May;45(5):566-70. Epub 2005 Nov 22. Level of evidence 1b
- Öznur Öken et al.;The Short-term Efficacy of Laser, Brace, and Ultrasound Treatment in Lateral Epicondylitis: A Prospective, Randomized, Controlled Trial, 2008, Journal of hand therapy. Level of evidence 1b
- 5. Bisset et al; Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial BMJ. 2006 November 4; 333(7575): 939. Level of evidence 1b