title: Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study.
abstract: OBJECTIVE
  Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises.
  
  
  METHODS
  Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests.
  
  
  RESULTS
  Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2.
  
  
  CONCLUSIONS
  Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, PO Box 22600, 1100 DD Amsterdam, The Netherlands. paastruijs@hotmail.com
authors.forename: Peter A A
authors.initials: PA
authors.lastname: Struijs
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Damen
authors.forename: Eric W P
authors.initials: EW
authors.lastname: Bakker
authors.forename: Leendert
authors.initials: L
authors.lastname: Blankevoort
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D013716:Tennis Elbow / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D014953:Wrist