Orthopedic & Muscular System: Current Research
Open Access
ISSN: 2161-0533
+44-77-2385-9429
ISSN: 2161-0533
+44-77-2385-9429
Michael Yelland1, Leanne Bisset1, Michael Ryan1, David Rabago2, Angus Ng1, Jennifer Whitty3 and Nagarajan Manickaraj1
1Griffith University, Australia 2University of Wisconsin, USA 3University of Queensland, Australia
Scientific Tracks Abstracts: Orthop Muscular Syst
Lateral epicondylosis (LE, â??tennis elbowâ?) is a common, debilitating and expensive tendinopathy of the lateral elbow resistant to many treatments. Two treatment programs addressing the pathology of LE with preliminary evidence of efficacy are hypertonic glucose+lignocaine injections (prolotherapy, PrT) and an elbow joint mobilization and concentric/eccentric exercise guided by a physiotherapist (P/E). This presentation compares the clinical and disease modifying effectiveness, cost-effectiveness and acceptability of prolotherapy (PrT) injections with a physiotherapy/exercise (P/E) program used singly and in combination. It describes a threearm RCT in which adults with moderate to severe LE were randomly assigned to PrT, P/E or PrT + P/E, with 40/group. Primary outcomes of their patient-rated tennis elbow evaluation score and global improvement were followed up at 6, 12, 26 and 52 weeks along with pain severity, recurrence, objective biomechanical measures and costs. Structural and biomechanical changes were followed with serial ultrasounds. Recruitment of 120 participants from 204 clinical assessments was completed in June 2014 with completion of 52 week follow-up due in June 2015. Follow-up rates to date have ranged from 82% to 90%. Baseline characteristics for each group were similar. Blinded analysis of results will be completed by August 2015. This trial should provide valuable evidence to inform practitioners in their choice of the most appropriate treatment of their patients with refractory LE, potentially providing substantial benefits to patients, industry and society. The correlation of clinical, biomechanical and ultrasound outcomes will inform the mechanisms of action of these treatments.
Michael Yelland is the Associate Professor of Primary Health Care at Griffith University and a general and musculoskeletal Medicine Practitioner in Brisbane. His teaching, research and clinical interests focus on evidence-based diagnosis and treatment of musculoskeletal pain. These include tendon disorders and spinal pain. He has conducted RCTs comparing prolotherapy injections and exercises in the treatment of chronic painful musculoskeletal conditions, including low back pain, Achilles tendinosis and tennis elbow. He has also conducted three series of single patient placebo-controlled trials of medications for osteoarthritis and neuropathic pain. He is the President of the Australian Association of Musculoskeletal Medicine.
Email: m.yelland@griffith.edu.au