Tyler Timothy F, Nicholas Stephen J, Schmitt Brandon M, Mullaney Michael, Hogan Daniel E
Pro Sports Physical Therapy of Westchester Scarsdale, NY USA.
The Nicholas Institute of Sports Medicine and Athletic Trauma New York, NY USA.
Int J Sports Phys Ther. 2014 May;9(3):365-70.
Eccentric training of the wrist extensors has been shown to be effective in treating chronic lateral epicondylosis. However, its efficacy in the treatment of medial epicondylosis has yet to be demonstrated. The objective of this study was to assess the effectiveness of a novel eccentric wrist flexor exercise added to standard treatment for chronic medial epicondylosis in patients who did not respond to previous therapeutic interventions for this disorder.
MATERIALS/METHODS: Patients (13 men, 7 women; age 49±12 yr) with chronic medial epicondylosis who had failed previous treatment for this disorder (physical therapy 7, cortisone injection 7, PRP 1, NSAIDS 15) were prescribed isolated eccentrics in addition to wrist stretching, ultrasound, cross-friction massage, heat and ice. The specific isolated eccentric wrist flexor strengthening exercise performed by the patients involved twisting a rubber bar (Flexbar, Hygenic Corportation, Akron OH) with concentric wrist flexion of the noninvolved arm and releasing the twist by eccentrically contracting the wrist flexors of the involved arm (3 × 15 twice daily). A DASH questionnaire was recorded at baseline and again after the treatment period. Treating clinicians were blinded to baseline DASH scores. Treatment effect was assessed using paired t-test. Based on previous work it was estimated that with a sample of 20 patients there would be 80% power to detect a 13 point improvement in DASH scores (p<.05).
The pathology was in the dominant arm of 18 patients and recurrent in 10. Primary symptomatic activities were golf (14), tennis (2), basketball (1), weight lifting (1), and general activities of daily living (2). There was a significant improvement in outcomes following the addition of isolated eccentrics (Pre DASH 34.7±16.2 vs. Post DASH 7.9±11.1, p<.001). For the 18 patients involved in sports, the sports module of the DASH score improved from 73.9±28.9 to 13.2±25.0, p<.001). Physical therapy visits ranged from 1-22 with an average of 12±6 and, average treatment duration of 6.1±2.5 wks (range 1-10). Home exercise program compliance was recorded for each subject (15 full, 3 mostly, 1 occasionally, 1 none).
The outcome measure for chronic medial epicondylosis was markedly improved with the addition of an eccentric wrist flexor exercise to standard physical therapy. Given the inconsistent outcomes for patients previously treated with chronic medial epicondylosis the addition of isolated eccentrics seems warranted based on the results of this study.
This novel exercise, using an inexpensive rubber bar, provides a practical means of adding isolated eccentric training to the treatment of chronic medial epicondylosis.
2b.
已有研究表明，对腕伸肌进行离心训练在治疗慢性外侧上髁炎方面有效。然而，其在治疗内侧上髁炎方面的疗效尚未得到证实。本研究的目的是评估一种新型的腕屈肌离心运动，添加到标准治疗方案中，对先前针对该疾病的治疗干预无反应的慢性内侧上髁炎患者的有效性。
20名。
材料/方法：患有慢性内侧上髁炎且先前治疗无效的患者（13名男性，7名女性；年龄49±12岁，此前接受过物理治疗7例、皮质类固醇注射7例、富血小板血浆治疗1例、非甾体抗炎药治疗15例），除了进行手腕伸展、超声、交叉摩擦按摩、热疗和冰敷外，还进行了单独的离心训练。患者进行的特定单独腕屈肌离心强化运动包括：用未受累手臂进行同心性腕屈时扭转橡胶棒（Flexbar，Hygenic Corportation，阿克伦，俄亥俄州），然后通过受累手臂的腕屈肌离心收缩来松开扭转（每天两次，每次3组，每组15次）。在基线时和治疗期结束后再次记录DASH问卷。治疗临床医生对基线DASH评分不知情。使用配对t检验评估治疗效果。根据先前的研究，估计20名患者的样本量将有80%的把握检测到DASH评分提高13分（p<0.05）。
18名患者的病变位于优势手臂，10名患者为复发性病变。主要的症状性活动包括高尔夫（14例）网球（2例）、篮球（1例）、举重（1例）和日常生活中的一般活动（2例）。添加单独的离心训练后，结果有显著改善（治疗前DASH评分34.7±16.2，治疗后DASH评分7.9±11.1，p<0.001）。对于18名参与运动的患者，DASH评分的运动模块从73.9±28.9提高到13.2±25.0，p<0.001）。物理治疗就诊次数为1 - 22次，平均为12±6次，平均治疗持续时间为6.1±2.5周（范围1 - 10周）。记录了每个受试者的家庭锻炼计划依从性（15名完全依从，3名大部分依从，1名偶尔依从，1名不依从）。
在标准物理治疗基础上增加腕屈肌离心运动，慢性内侧上髁炎的结局指标有显著改善。鉴于先前接受慢性内侧上髁炎治疗的患者结局不一致，基于本研究结果，添加单独的离心训练似乎是必要的。
这种使用廉价橡胶棒的新型运动，为在慢性内侧上髁炎治疗中添加单独的离心训练提供了一种实用方法。
2b。
