Yudu - sportEX medicine - 1999-2010

JOURNAL WATCH Journal Watch

Sixty-two elbows (34 right, 28 left) in 62 patients (30 male, 32 female) with a clinical diagnosis of lateral elbow tendinopathy underwent sonographic evaluation of the common extensor origin after assessment with a validated outcome measure, the Patient-Rated Tennis Elbow Evaluation (PRTEE). After 6 months of non-operative standardised treatment (physiotherapy with eccentric loading), the PRTEE questionnaire was repeated. The mean pre-treatment PRTEE was 78

(range, 51-97) and post-treatment score was 29 (range, 0-91). A positive correlation was identified between the presence of a lateral collateral ligament tear and the size of the largest intrasubstance tear and poor outcome. A negative correlation was identified with

LATERAL ELBOW TENDINOPATHY. CORRELATION OF ULTRASOUND FINDINGS WITH PAIN AND FUNCTIONAL DISABILITY. Clarke AW, Muaaze Ahmad M, et al. American Journal of Sports Medicine 2010;38(6):1209-1214

amount of hypoechogenicity. No correlation was found

with age, sex, side, duration of symptoms, thickness of tendon, or amount of neovascularity.

sportEX comment

The practical uses of ultrasound as a diagnostic tool are beginning to be realised as the devices get more and more portable and therefore more

assessable. The inference here is that size is everything and that the findings can be used to indicate patients who may therefore respond better to non-operative therapy as well as being a guide for more invasive treatment. (Those patients with a large intrasubstance tear are less

likely to respond to nonoperative treatment).

MANAGEMENT OF SHOULDER INJURIES USING DRY NEEDLING IN ELITE VOLLEYBALL PLAYERS. A CASE REPORT. Osborne N. Gatt IT. Acupuncture Medicine 2010;28:42-45

Dry needling of scapulohumeral muscles was carried out on four international female volleyball athletes during a month-long intense competitive phase. Range of

movement, strength and pain were assessed before and after treatment, with a functional assessment of pain immediately after playing and overhead activity, using the short form McGill Pain Questionnaire. All scores were improved post-treatment and the athletes were able to continue overhead activities.

sportEX comment The difference between this and other similar studies was that this includes treatment

during a competitive phase and it supports the use of dry needling in elite athletes at this time for short-term pain relief and improved function in shoulder injuries. It may help maintain rotator cuff balance and strength, reducing further pain and injury.

DRY NEEDLE STIMULATION OF MYOFASCIAL TRIGGER POINTS EVOKES SEGMENTAL ANTI-NOCICEPTIVE EFFECTS. Srbely JZ, Dickey LP, et al. Journal of Rehabilitaion Medicine 2010;42(5)May:463-468

Forty subjects (21 males, 19 females) received intramuscular dry needle

acupuncture to a right supraspinatus trigger point (C4,5); controls received sham intramuscular dry needle puncture. Pain pressure threshold (PPT) readings were recorded from right infraspinatus (C5,6) and right gluteus medius (L4,5S1) trigger

points at 0 (pre-needling baseline), 1, 3, 5, 10 and 15 minutes post-needling and normalised to baseline values. The supraspinatus and infraspinatus trigger points are neurologically linked at C5; the supraspinatus and gluteus medius are segmentally unrelated. The difference between the infraspinatus and gluteus medius PPT values (PPTseg) represents a direct measure of the segmental

anti-nociceptive effects acting at the infraspinatus trigger point. Significant increases in PPTseg were observed in test subjects at 3 and 5 minutes post- needling, compared with controls.

sportEX comment What this is suggesting is that the undoubted pain relief gained from dry needle stimulation may be due to segmental anti-nociceptive effects which if true may be an important consideration in the management of myofascial pain.