Research Article
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Comparison of the Effectiveness of Ultrasound and Phonophoresis with Diclofenac and Hydrocortisone in Patients with Lateral Epicondylitis: Double Blind, Randomized, Placebo Controlled Study

Year 2024, Volume: 9 Issue: 3, 304 - 309, 31.12.2024

Tuba Yüksel Aydıner , Havva Talay Çalış , Merve Efe

https://doi.org/10.51754/cusbed.1507036

Abstract

Objective: The purpose of study was to compare the effectiveness of diclofenac phonophoresis, hydrocortisone phonophoresis and ultrasound (US) in lateral epicondylitis (LE) treatment.
Methods: Forty-three participants with chronic LE were evaluated for clinical, functional, and quality of life (baseline, week 2, week 6, and months 3). Patients were divided randomly into 4 groups. The patients in the first group (group 1) (n=12) were accepted phonophoresis with hydrocortisone, second group (group 2) (n=13) were accepted phonophoresis with diclofenac, fourth group (group 4) (n=9) were accepted US, third group (group 3) (n=9) were placebo US. The US therapy 1 MHz-1 watt/cm²/5' for ten sections was applied to the first, second, and fourth groups. The placebo US was applied five minutes for ten sections to third group. 0,1 % hydrocortisone gel to the first group, diclofenac gel to the second group and ultrasound gel to the third and fourth group were applied.
Results: A statistically considerable difference was found in the 1st, 2nd, and 4th groups, but there was no considerable improvement in the 3rd group in HAQ scores (p=0.02, p=0.03, p=0.06, p=0.01).
When examined PRTEEtotal score, there was a statistically significant improvement in the 1st, 2nd, and 4th groups (p=0.000, p=0.002, p=0.001). There was no a statistically significant improvement in the 3rd group (p=0.05).
Conclusion: The improvement was achieved in pain and quality of life scores in all treatment groups compared to the control group in lateral epicondylitis. As a result, all three treatment options can be seen as an effective treatment option for lateral epicondylitis treatment.

Keywords

lateral epicondylitis phonophoresis ultrasound diclofenac hydrocortisone

References

  • Altan L, Ercan I, & Konur S. (2010). Reliability, and validity of Turkish version of the patient rated tennis elbow evaluation. Rheumat Int, 30(8):1049-54. https://doi.org/10.1007/s00296-009-1101-6
  • Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, &Zheng MH. (2016). Lateral elbow tendinopathy: Development of a pathophysiology-based treatment algorithm. Orthop J Sports Med, 4(11):2325967116670635. https://doi.org/10.1177/2325967116670635
  • Binder A, Hodge G, Greenwood AM, Hazleman BL, &Thomas DP. (1985). Is therapeutic ultrasound effective in treating soft tissue lesions? Br Med J, 290(6467):512-4. https://doi.org/10.1136/bmj.290.6467.512
  • Bishai S, &Plancher K. (2006). The basic science of lateral epicondylosis: Update for the future. Techniques in Orthopaedics, 21(4):250-255. https://doi.org/10.1097/01.BTO.0000252115.76643.78
  • Byl NN. (1995). The use of ultrasound as an enhancer for transcutaneous drug delivery: phonophoresis. Phys Ther, 75(6):539-53. https://doi.org/10.1093/ptj/75.6.539
  • Cabak A, Maczewska M, Lyp M, Dobosz J, & Gasiorowska U. (2005). The effectiveness of phonophoresis with ketoprofen in the treatment of epicondylopathy. OrtopTraumatol Rehabil, Dec 30;7(6):660-5
  • Dedes V, Tzirogiannis K, Polikandrioti M, Dede MA, Mitseas A, & Panoutsopoulos I. (2020) Comparison of radial extracorporeal shock wave therapy with ultrasound therapy in patients with lateral epicondylitis. J Med Ultrason, 47(2):319-325. https://doi.org/10.1007/s10396-019-01002-9
  • Klaiman MD, Shrader JA, Danoff JV, Hicks JE, Pesce WJ, & Ferland J. (1998). Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc, 30(9):1349-55. https://doi.org/10.1097/00005768-199809000-00002
  • Kochar M, &Dogra A. (2002). Effectiveness of a specific physiotherapy regimen on patients with tennis elbow. Physiotherapy, 88(6):333-341. https://doi.org/10.1016/S0031-9406(05)60746-8
  • Küçükdeveci AA, Sahin H, Ataman S, Griffiths B, & Tennant A. (2004). Issues in crosscultural validity: Example from the adaptation, reliability, and validity testing of a turkish version of the stan-ford health assessment questionnaire. Arthritis Rheum. 51: 14-9. https://doi.org/10.1002/art.20091
  • Li Y, Li W, Liu X, Liu X, Zhu B, Guo S, Wang C, Wang D, Li S, & Zhang Z. (2023). Effects of low-intensity pulsed ultrasound in tendon injuries. J Ultrasound Med, 42(9):1923-1939. https://doi.org/10.1002/jum.16230
  • Luo D, Lıu B, Gao L, & Fu S. (2022). The effect of ultrasound therapy on lateral epicondylitis: Ameta-analysis. Medicine (Baltimore),101(8). https://doi.org/10.1097/md.0000000000028822
  • Ma KL, & Wang HQ. (2020). Management of lateral epicondylitis: A narrative literature review. Pain Res Manag, 2020:6965381. https://doi.org/10.1155/2020/6965381
  • Martin-Vega J F, Lucena-Anton D, Galán-Mercant A, Perez-Cabezas V, Luque-Moreno C, Vinolo-Gil M J, & Gonzalez-Medina G. (2022). Phonophoresis through nonsteroidal anti-inflammatory drugs for knee osteoarthritis treatment: Systematic review and meta-Analysis. Biomedicines, 10(12):3254. https://doi.org/10.3390/biomedicines10123254
  • Okan S, &Çağlıyan Türk A. (2020). Comparing the efficiency of ultrasound, ketoprofen, and mucopolysaccharide polysulfate phonophoresis in the treatment of lateral epicondylitis: A randomized-controlled clinical study. Turk J Phys Med Rehabil, 66(3):307-315. https://doi.org/10.5606/tftrd.2020.4433
  • Oken O, Kahraman Y, Ayhan F, Canpolat S, Yorgancioglu ZR, & Oken O. (2008). The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial. J Hand Ther, 21(1):63-7. https://doi.org/10.1197/j.jht.2007.09.003
  • Özen Ş, Çağlar N, Tütün Ş, Kavadar G, Özgönenel L, Aytekin E, Çetin E, & Akın T. (2013). Comparison of the effectiveness of ultrasound and phonophoresis treatments in lateral epicondylitis: A prospective single blind randomized trial. İstanbul Med J, 14:20-4. https://doi.org/10.5152/imj.2013.05
  • Özmen T, Koparal SS, Karatas Ö, Eser F, Ozkurt B. (2021). Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy, and kinesio taping in lateral epicondylitis. Turk J Med Sci, 51(1): 76–83. https://doi.org/10.3906/sag-2001-79
  • Pienimäki T, Tarvainen T, Siira P, Malmivaara A, Vanharanta H. (2002). Associations between pain, grip strength, and manual tests in the treatment evaluation of chronic tennis elbow. Clin J Pain May-Jun ;18(3):164-70. https://doi.org/10.1097/00002508-200205000-00005
  • Senerdem N, Gül A, Konice M, Aral O, Ocal L, Inanc M, Yüzbaşıoğlu N. (1999). The use of two different health assessment questionnaires in Turkish rheumatoid population and assessment of associations with disability. Clin Rheumatol, 18(1):33-7. https://doi.org/10.1007/s100670050048
  • Smidt N, Assendelft WJ, Arola H, Malmivaara A, Greens S, Buchbinder R, van der Windt DA Bouter LM. (2003). Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med, 35(1):51-62. https://doi.org/10.1080/07853890310004138
  • Vaquero-Picado A, Barco R, Antuña SA. (2017). Lateral epicondylitis of the elbow. EFORT Open Rev, Mar 13;1(11):391-397. https://doi.org/10.1302/2058-5241.1.000049
  • Vicenzino B. (2003). Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. Man Ther, 8(2):66-79. https://doi.org/10.1016/s1356-689x(02)00157-1
  • Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier CM. (2004). Factors associated with prognosis of lateral epicondylitis after 8 weeks of physicaltherapy. Arch.Phys Med Rehabil, 85(2):308-18. https://doi.org/10.1016/s0003-9993(03)00480-5
  • Wiltink A, Nijweide PJ, Hekkenberg RT, Oosterbaan WA. (1995). Effect of therapeutic ultrasound on endochondral ossification. Ultrasound Med Biol, 21(1):121-7. https://doi.org/10.1016/0301-5629(94)00092-1

Lateral Epikondilitli Hastalarda Ultrason, Diklofenak ve Hidrokortizonla Yapılan Fonoforezin Etkinliğinin Karşılaştırılması: Çift Kör, Randomize, Plasebo Kontrollü Çalışma

Year 2024, Volume: 9 Issue: 3, 304 - 309, 31.12.2024

Tuba Yüksel Aydıner , Havva Talay Çalış , Merve Efe

https://doi.org/10.51754/cusbed.1507036

Abstract

Çalışmanın amacı ultrason (US), diklofenakla fonoforez ve hidrokortizonla fonoforezin lateral epikondilit tedavisindeki etkinliğini karşılaştırmaktır. Lateral epikondilit tanı kriterlerini karşılayan 43 hasta tedavi öncesi ve sonrası (2.hafta, 6. hafta ve 3. ay) klinik, fonksiyonellik ve yaşam kalitesi açısından değerlendirildi. Visual Analog Skala (VAS); istirahatte (VAS), gece (VASgece) ve zorlu ekstansiyonda (VAShareket) değerlendirildi. JAMAR® marka el dinamometresi ile grip kuvveti, parmak dinamometresi ile pinç kuvveti bakıldı. Sağlık değerlendirme anketi (HAQ) ve hasta bazlı tenisçi dirseği değerlendirme (PRTEE) anketi yapıldı. PRTEE; PRTEEağrı, PRTEEfonksiyon ve PRTEEtotal olarak değerlendirildi. Hastalar randomize olarak 4 gruba ayrıldı:1.grup: hidrokortizonla fonoforez (n:9), 2.grup: diklofenakla fonoforez (n:13), 3. grup: plasebo US (n:12), 4. grup: US (n:9). Gruplara tedavileri çift kör olarak uygulandı. 1., 2. ve 4.gruba US 1 MHz-1watt/cm²/5' 10 seans, 3.gruba plasebo US 5' 10 seans olarak uygulandı.1.gruba US eşliğinde %0,1 hidrokortizon, 2.gruba US eşliğinde %1 diklofenak jel, 3. ve 4. gruba ise US jeli uygulandı. Hastaların tümüne germe egzersizi verildi. NSAID kullanmalarına izin verilmedi, ağrı kontrolü için lüzum halinde parasetamol önerildi. Yaş ortalaması, cinsiyet, tutulmuş olan taraf, dominant el, ağrı süresi açısından, VAS, VASgece, VAShareket, pinç kuvveti, grip kuvveti, PRTEEağrı, PRTEEfonksiyon ve PRTEEtotal ve HAQ skorları başlangıç değerleri açısından gruplar arasında istatistiksel olarak anlamlı bir farklılık yoktu (p>0,05).
HAQ skorlarına bakıldığında 1., 2. ve 4. gruplarda istatistiksel olarak farklılık varken 3.grupta anlamlı bir düzelme mevcut değildi (sırasıyla p:0,02, p:0,03, p:0,06 p:0,01).
PRTEEtotal skoru açısından incelendiğinde 1., 2.ve 4. gruplarda istatistiksel olarak anlamlı derecede düzelme mevcuttu (sırasıyla p:0,000, p:0,002, p:0,001). 3.grupta istatistiksel olarak anlamlı düzelme sağlanamadı(p:0,05).
Lateral epikondilit tedavisinde kontrol grubu ile karşılaştırıldığında tüm tedavi gruplarında ağrı ve yaşam kalitesi skorlarında iyileşme sağlanmıştır. Her üç tedavi seçeneği lateral epikondilit tedavisinde etkin bir tedavi seçeneği olarak görülebilir.

Keywords

lateral epikondilit fonoforez ultrason diklofenak hidrokortizon

References

  • Altan L, Ercan I, & Konur S. (2010). Reliability, and validity of Turkish version of the patient rated tennis elbow evaluation. Rheumat Int, 30(8):1049-54. https://doi.org/10.1007/s00296-009-1101-6
  • Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, &Zheng MH. (2016). Lateral elbow tendinopathy: Development of a pathophysiology-based treatment algorithm. Orthop J Sports Med, 4(11):2325967116670635. https://doi.org/10.1177/2325967116670635
  • Binder A, Hodge G, Greenwood AM, Hazleman BL, &Thomas DP. (1985). Is therapeutic ultrasound effective in treating soft tissue lesions? Br Med J, 290(6467):512-4. https://doi.org/10.1136/bmj.290.6467.512
  • Bishai S, &Plancher K. (2006). The basic science of lateral epicondylosis: Update for the future. Techniques in Orthopaedics, 21(4):250-255. https://doi.org/10.1097/01.BTO.0000252115.76643.78
  • Byl NN. (1995). The use of ultrasound as an enhancer for transcutaneous drug delivery: phonophoresis. Phys Ther, 75(6):539-53. https://doi.org/10.1093/ptj/75.6.539
  • Cabak A, Maczewska M, Lyp M, Dobosz J, & Gasiorowska U. (2005). The effectiveness of phonophoresis with ketoprofen in the treatment of epicondylopathy. OrtopTraumatol Rehabil, Dec 30;7(6):660-5
  • Dedes V, Tzirogiannis K, Polikandrioti M, Dede MA, Mitseas A, & Panoutsopoulos I. (2020) Comparison of radial extracorporeal shock wave therapy with ultrasound therapy in patients with lateral epicondylitis. J Med Ultrason, 47(2):319-325. https://doi.org/10.1007/s10396-019-01002-9
  • Klaiman MD, Shrader JA, Danoff JV, Hicks JE, Pesce WJ, & Ferland J. (1998). Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc, 30(9):1349-55. https://doi.org/10.1097/00005768-199809000-00002
  • Kochar M, &Dogra A. (2002). Effectiveness of a specific physiotherapy regimen on patients with tennis elbow. Physiotherapy, 88(6):333-341. https://doi.org/10.1016/S0031-9406(05)60746-8
  • Küçükdeveci AA, Sahin H, Ataman S, Griffiths B, & Tennant A. (2004). Issues in crosscultural validity: Example from the adaptation, reliability, and validity testing of a turkish version of the stan-ford health assessment questionnaire. Arthritis Rheum. 51: 14-9. https://doi.org/10.1002/art.20091
  • Li Y, Li W, Liu X, Liu X, Zhu B, Guo S, Wang C, Wang D, Li S, & Zhang Z. (2023). Effects of low-intensity pulsed ultrasound in tendon injuries. J Ultrasound Med, 42(9):1923-1939. https://doi.org/10.1002/jum.16230
  • Luo D, Lıu B, Gao L, & Fu S. (2022). The effect of ultrasound therapy on lateral epicondylitis: Ameta-analysis. Medicine (Baltimore),101(8). https://doi.org/10.1097/md.0000000000028822
  • Ma KL, & Wang HQ. (2020). Management of lateral epicondylitis: A narrative literature review. Pain Res Manag, 2020:6965381. https://doi.org/10.1155/2020/6965381
  • Martin-Vega J F, Lucena-Anton D, Galán-Mercant A, Perez-Cabezas V, Luque-Moreno C, Vinolo-Gil M J, & Gonzalez-Medina G. (2022). Phonophoresis through nonsteroidal anti-inflammatory drugs for knee osteoarthritis treatment: Systematic review and meta-Analysis. Biomedicines, 10(12):3254. https://doi.org/10.3390/biomedicines10123254
  • Okan S, &Çağlıyan Türk A. (2020). Comparing the efficiency of ultrasound, ketoprofen, and mucopolysaccharide polysulfate phonophoresis in the treatment of lateral epicondylitis: A randomized-controlled clinical study. Turk J Phys Med Rehabil, 66(3):307-315. https://doi.org/10.5606/tftrd.2020.4433
  • Oken O, Kahraman Y, Ayhan F, Canpolat S, Yorgancioglu ZR, & Oken O. (2008). The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial. J Hand Ther, 21(1):63-7. https://doi.org/10.1197/j.jht.2007.09.003
  • Özen Ş, Çağlar N, Tütün Ş, Kavadar G, Özgönenel L, Aytekin E, Çetin E, & Akın T. (2013). Comparison of the effectiveness of ultrasound and phonophoresis treatments in lateral epicondylitis: A prospective single blind randomized trial. İstanbul Med J, 14:20-4. https://doi.org/10.5152/imj.2013.05
  • Özmen T, Koparal SS, Karatas Ö, Eser F, Ozkurt B. (2021). Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy, and kinesio taping in lateral epicondylitis. Turk J Med Sci, 51(1): 76–83. https://doi.org/10.3906/sag-2001-79
  • Pienimäki T, Tarvainen T, Siira P, Malmivaara A, Vanharanta H. (2002). Associations between pain, grip strength, and manual tests in the treatment evaluation of chronic tennis elbow. Clin J Pain May-Jun ;18(3):164-70. https://doi.org/10.1097/00002508-200205000-00005
  • Senerdem N, Gül A, Konice M, Aral O, Ocal L, Inanc M, Yüzbaşıoğlu N. (1999). The use of two different health assessment questionnaires in Turkish rheumatoid population and assessment of associations with disability. Clin Rheumatol, 18(1):33-7. https://doi.org/10.1007/s100670050048
  • Smidt N, Assendelft WJ, Arola H, Malmivaara A, Greens S, Buchbinder R, van der Windt DA Bouter LM. (2003). Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med, 35(1):51-62. https://doi.org/10.1080/07853890310004138
  • Vaquero-Picado A, Barco R, Antuña SA. (2017). Lateral epicondylitis of the elbow. EFORT Open Rev, Mar 13;1(11):391-397. https://doi.org/10.1302/2058-5241.1.000049
  • Vicenzino B. (2003). Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. Man Ther, 8(2):66-79. https://doi.org/10.1016/s1356-689x(02)00157-1
  • Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier CM. (2004). Factors associated with prognosis of lateral epicondylitis after 8 weeks of physicaltherapy. Arch.Phys Med Rehabil, 85(2):308-18. https://doi.org/10.1016/s0003-9993(03)00480-5
  • Wiltink A, Nijweide PJ, Hekkenberg RT, Oosterbaan WA. (1995). Effect of therapeutic ultrasound on endochondral ossification. Ultrasound Med Biol, 21(1):121-7. https://doi.org/10.1016/0301-5629(94)00092-1
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Health Services and Systems (Other)
Journal Section Research Article
Authors

Tuba Yüksel Aydıner 0000-0001-6339-9969

Havva Talay Çalış 0000-0002-8897-8921

Merve Efe 0000-0001-7288-1490

Early Pub Date December 29, 2024
Publication Date December 31, 2024
Submission Date July 12, 2024
Acceptance Date November 15, 2024
Published in Issue Year 2024Volume: 9 Issue: 3

Cite

Vancouver Yüksel Aydıner T, Talay Çalış H, Efe M. Lateral Epikondilitli Hastalarda Ultrason, Diklofenak ve Hidrokortizonla Yapılan Fonoforezin Etkinliğinin Karşılaştırılması: Çift Kör, Randomize, Plasebo Kontrollü Çalışma. J Cumhuriyet Univ Health Sci Inst. 2024;9(3):304-9.
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The Journal of Sivas Cumhuriyet University Institute of Health Sciences is an international, peer-reviewed scientific journal published by Sivas Cumhuriyet University, Institute of Health Sciences.