Ikeda Kazuhiro, Ikumi Akira, Onishi Shinzo, Ogawa Takeshi, Kohyama Sho, Yoshii Yuichi
Institute of Clinical Medicine, Department of Orthopedic Surgery, University of Tsukuba, 1-1 Tennodai, Ibaraki Prefecture, 305-8577, Japan.
Department of Orthopedic Surgery, Kikkoman General Hospital, Chiba Prefecture, Japan.
BMC Musculoskelet Disord. 2025 Jul 4;26(1):645. doi: 10.1186/s12891-025-08902-7.
Lateral epicondylitis is a self-limited disease and refractory condition; thus providing optimal treatment is challenging. This study investigated a method for predicting cases that would not improve sufficiently under a wait-and-see policy using clinical indicators obtained during the initial consultation.
Twenty-two patients with lateral epicondylitis prescribed a resting orthosis and followed up for 6 months were included. Grip strength ratios for affected/unaffected side; quick disabilities of the arm, shoulder, and hand (QuickDASH) scores were measured at 6-week intervals. Receiver operating characteristic curves for predicting refractory cases were created from the initial measurement items to determine the cut-off values and prediction accuracy.
The 6-month post-treatment QuickDASH scores for the 14 improved patients and 8 refractory patients were 2.3 ± 4.7 and 25.9 ± 15.4, respectively. Grip strength ratios significantly predicted refractoriness risk with a 0.54 cut-off value. The QuickDASH scores significantly predicted refractoriness risk with a 30-point cut-off value. Meeting either of these cutoff values achieved a sensitivity of 1.0 for predicting refractoriness.
The patients with a grip strength ratio ≤ 0.5 on the affected side or a QuickDASH score ≥ 30 at initial consultation continued having symptoms 6 months after conservative treatment.
外侧上髁炎是一种自限性疾病且难以治愈，因此提供最佳治疗具有挑战性。本研究调查了一种方法，该方法使用初次会诊时获得的临床指标来预测在观察等待策略下病情改善不充分的病例。
纳入22例被开具休息支具并随访6个月的外侧上髁炎患者。每隔6周测量患侧与健侧的握力比、手臂、肩部和手部快速残疾评定量表（QuickDASH）评分。根据初始测量项目绘制预测难治性病例的受试者工作特征曲线，以确定临界值和预测准确性。
14例病情改善患者和8例难治性患者治疗6个月后的QuickDASH评分分别为2.3±4.7和25.9±15.4。握力比以0.54为临界值显著预测难治性风险。QuickDASH评分以30分为临界值显著预测难治性风险。达到这两个临界值中的任何一个，预测难治性的敏感性均为1.0。
初次会诊时患侧握力比≤0.5或QuickDASH评分≥30的患者在保守治疗6个月后仍有症状。
