Tratamiento Rehabilitador De La Epicondilitis Scmal 12 Octubre 2009 Martin Del Rosario

Tratamiento médico rehabilitador de la epicondilitis Dr. Francisco Manuel Martín del Rosario Servicio de Rehabilitación. Complejo Hospitalario Insular Materno Infantil de Gran Canaria.

Índice ,[object Object],[object Object],[object Object],[object Object],[object Object]

Tratamiento rehabilitador ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epicondilitis-Pronóstico ,[object Object],[object Object],[object Object],[object Object],Smidt N, van der Windt DAWM, Assendelft WJJ, et al. Corticosteroid injections for lateral epicondylitis are superior to physiotherapy and a wait and see policy at short-term follow-up, but inferior at long-term follow-up: results from a randomised controlled trial. Lancet 2002;359:657-62. Hudak P, Cole D, Haines T. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Arch Phys Rehabil 1996;77:568-93. Korthals-de Bos IB, Smidt N, van Tulder MW, Rutten-van Mölken MP, Adèr HJ, van der Windt DA, Assendelft WJ, Bouter LM. Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care. Pharmacoeconomics. 2004;22(3):185-95. Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier MC. Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil. 2004 Feb;85(2):308-18

¿Qué tratamiento es el adecuado?

¿Qué tratamiento es el adecuado? Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician. 2007 Sep 15;76(6):843-8.

Láser ,[object Object],[object Object],[object Object],Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008 May 29;9:75. Basford JR, Sheffield CG, Cieslak KR. Laser therapy: a randomized, controlled trial of the effects of low intensity Nd:YAG laser irradiation on lateral epicondylitis. Arch Phys Med Rehabil. 2000 Nov;81(11):1504-10.

Ultrasonidos terapéuticos y sonoforesis ,[object Object],[object Object],[object Object],Başkurt F, Ozcan A, Algun C. Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis. Clin Rehabil . 2003 Feb;17(1):96-100. Oken O, Kahraman Y, Ayhan F, Canpolat S, Yorgancioglu ZR, Oken OF. The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial. J Hand Ther . 2008 Jan-Mar;21(1):63-7; quiz 68. Erratum in: J Hand Ther. 2008 Jul-Sep;21(3):303. Cabak A, Maczewska M, Lyp M, Dobosz J, Gasiorowska U.The effectiveness of phonophoresis with ketoprofen in the treatment of epicondylopathy. Ortop Traumatol Rehabil . 2005 Dec 30;7(6):660-5. Hoppenrath T, Ciccone CD.Is there evidence that phonophoresis is more effective than ultrasound in treating pain associated with lateral epicondylitis? Phys Ther . 2006 Jan;86(1):136-40. D'Vaz AP, Ostor AJ, Speed CA, Jenner JR, Bradley M, Prevost AT, Hazleman BL. Pulsed low-intensity ultrasound therapy for chronic lateral epicondylitis: a randomized controlled trial. Rheumatology (Oxford). 2006 May;45(5):566-70.

Iontoforesis ,[object Object],[object Object],Nirschl RP, Rodin DM, Ochiai DH, Maartmann-Moe C; DEX-AHE-01-99 Study Group. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. A randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2003 Mar-Apr;31(2):189-95.

Ejercicios ,[object Object],[object Object],[object Object],[object Object],Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther. 2005 Oct-Dec;18(4):411-9 Nilsson P, Thom E, Baigi A, Marklund B, Månsson J. A prospective pilot study of a multidisciplinary home training programme for lateral epicondylitis. Musculoskeletal Care. 2007 Mar;5(1):36-50

Tratamientos sin evidencia científica ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kushner S, Reid DC. Manipulation in the treatment of tennis elbow. J Orthop Sports Phys Ther . 1986;7(5):264-72. Vicenzino B. Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. Man Ther. 2003 May;8(2):66-79. Struijs PA, Damen PJ, Bakker EW, Blankevoort L, Assendelft WJ, van Dijk CN.. Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Phys Ther. 2003 Jul;83(7):608-16.

Masaje transverso profundo de Cyriax ,[object Object],[object Object],[object Object],[object Object],Nourbakhsh MR, Fearon FJ. The effect of oscillating-energy manual therapy on lateral epicondylitis: a randomized, placebo-control, double-blinded study. J Hand Ther . 2008 Jan-Mar;21(1):4-13 Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005 Jul;39(7):411-22 Verhaar JA, Walenkamp GH, van Mameren H, Kester AD, van der Linden AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg Br. 1996 Jan;78(1):128-32 Trudel D, Duley J, Zastrow I, Kerr EW, Davidson R, MacDermid JC. Rehabilitation for patients with lateral epicondylitis: a systematic review. J Hand Ther . 2004 Apr-Jun;17(2):243-66. Stasinopoulos D, Johnson MI. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. Br J Sports Med. 2004 Dec;38(6):675-7 Brosseau L, Casimiro L, Milne S, Robinson V, Shea B, Tugwell P, Wells G. Deep transverse friction massage for treating tendinitis.Cochrane Database Syst Rev . 2002;(4):CD003528.

¿Qué hacer cuando ningún tratamiento funciona?

Ondas de Choque extracorpóreas ,[object Object],[object Object],[object Object],Staples MP, Forbes A, Ptasznik R, Gordon J, Buchbinder R. A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol. 2008 Oct;35(10):2038-46. National Institute for Health and Clinical Excellence. Autologous blood injection for tendinopathy: guidance. 2009 Spacca G, Necozione S, Cacchio A. Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study. Eura Medicophys. 2005 Mar;41(1):17-25. Lebrun CM. Low-dose extracorporeal shock wave therapy for previously untreated lateral epicondylitis. Clin J Sport Med. 2005 Sep;15(5):401-2. Stasinopoulos D, Johnson MI. Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis). Br J Sports Med. 2005 Mar;39(3):132-6.

Toxina botulínica ,[object Object],[object Object],[object Object],[object Object],[object Object],Hayton MJ, Santini AJA, Hughes PJ, et al. Botulinum toxin injections in the treatment of tennis elbow; a double-blind randomized controlled pilot study. J Bone Joint Surg Am 2005; 87:503-507. Wong SM, Hui AC, Tong PY, et al . Treatment of lateral epicondylitis with botulinum toxin. Ann Intern Med 2005; 143:793-797. Placzek R, Drescher W, Deuretzbacher G, Hempfing A, Meiss AL. Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am. 2007 Feb;89(2):255-60

Infiltración de sangre autóloga o plasma rico en plaquetas ,[object Object],[object Object],[object Object],[object Object],Suresh SP, Ali KE, Jones H, Connell DA.Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med. 2006 Nov;40(11):935-9 Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med. 2009 Jul;43(7):471-81

Nitroglicerina transdérmica ,[object Object],[object Object],McCallum SD, Paoloni JA, Murrell GA. Five Year Prospective Comparison Study of Topical Glyceryl Trinitrate Treatment of Chronic Lateral Epicondylosis at the Elbow. Br J Sports Med. 2009 Jun 23. Paoloni JA, Murrell GA, Burch RM, Ang RY. Randomised, double-blind, placebo-controlled clinical trial of a new topical glyceryl trinitrate patch for chronic lateral epicondylosis. Br J Sports Med . 2009 Apr;43(4):299-302. Paoloni JA, Appleyard RC, Nelson J, Murrell GA Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med . 2003 Nov-Dec;31(6):915-20.

Microtenotomía por radiofrecuencia ,[object Object],[object Object],[object Object],[object Object],Meknas K, Odden-Miland A, Mercer JB, Castillejo M, Johansen O. Radiofrequency microtenotomy: a promising method for treatment of recalcitrant lateral epicondylitis. Am J Sports Med. 2008 Oct;36(10):1960-5. Tasto JP, Cummings J, Medlock V, Hardesty R, Amiel D. Microtenotomy using a radiofrequency probe to treat lateral epicondylitis. Arthroscopy . 2005 Jul;21(7):851-60. www.cardiva.com/products/p2104-1.png

Proloterapia ,[object Object],[object Object],[object Object],Mora Amérigo E, Martí Dasi E, Benavent Cervera JV, Real Terrades L. Rehabilitación y Enfoque fisioterápico en las afecciones reumáticas de partes blandas yuxta-articulares. En Mora Amérigo ER. Rehabilitación y Enfoque fisioterápico en afecciones Reumáticas. Grupo Aula Médica. Madrid 2008. pp 111-113. Rabago D. Prolotherapy for treatment of lateral epicondylosis. Am Fam Physician. 2009 Sep 1;80(5):441.

Mesoterapia ,[object Object],[object Object],[object Object],[object Object],Menkès CJ, Laoussadi S, Kac-Ohana N, Lasserre O.. Controlled trial of injectable diclofenac in mesotherapy for the treatment of tendinitis. Rev Rhum Mal Osteoartic . 1990;57(7-8):589-91.

Tratamientos no recomendados ,[object Object],[object Object],Trinh KV, Phillips SD, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology (Oxford). 2004 Sep;43(9):1085-90. Fink M, Wolkenstein E, Karst M, Gehrke A. Acupuncture in chronic epicondylitis: a randomized controlled trial. Rheumatology (Oxford). 2002 Feb;41(2):205-9. Trinh KV, Phillips SD, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology (Oxford). 2004 Sep;43(9):1085-90. Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W. Acupuncture for lateral elbow pain. Cochrane Database Syst Rev. 2002;(1):CD003527.

Tratamientos no recomendados ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bibliografía I ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bibliografía II ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bibliografía III ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bibliografía IV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bibliografía V ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Muchas gracias ¿Alguna pregunta?

Tratamiento Rehabilitador De La Epicondilitis Scmal 12 Octubre 2009 Martin Del Rosario

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