Which Are The Best Measures To Evaluate Rehabilitation Results In Chronic Epicondylitis?

Introduction
Epicondylitis is diagnosed clinically based on a typical history and manual provocation tests. The declined function of
the arm and disability in this disorder can also be evaluated using different kind of questionnaires, pain threshold (PPT),
grip strength and isokinetic performance measurements. Progressive conditioning exercises as well as stretching
techniques have shown beneficial effects on the function of arm. Therefore it is interesting to evaluate which measures
best will indicate a good rehabilitation result.

Methods
The study group consisted of 66 patients, 18 male and 48 females, and mean age 43.3 years, with chronic unilateral
lateral (n=51) and medial (n=15) epicondylitis. The diagnosis was confirmed clinically and using palpation of
epicondyles, resisted wrist extension (RWE) and Mill´s test. A pain questionnaire (PQ) with visual analogue scale
(VAS) with 7 items, a pain drawing (PD), pain thresholds (PPT), isometric grip strength (GRIP) measurement and
concentric isokinetic peak torque (PT) measurements of the wrist and forearm were used in treatment evaluation. The
patients performed an 8-weeks´ progressive four-step upper extremity rehabilitation intervention trained and controlled
by a physiotherapist. The good or excellent rehabilitation result (=HIGH) was expressed using three measures: 1)
isometric grip strength (GRIP) increase >20 %, 2) decrease in pain under strain (PAIN) >3.5 cm on VAS and 3)
negative resisted wrist extension test (RWE). Other patients had a poor or moderate (=LOW) rehabilitation result.

Results
The results are presented in Table 1. The results show that from the measures chosen, negative RWE test had best
correlation with other measure results. Also improvement of pain under strain seems to be well related with good results in other measures, but increase in grip strength not.

Conclusions
The results indicate, that also clinical measure such as RWE test is a very sensitive measure and can successfully be
used to evaluate rehabilitation results and careful pain evaluation also seems to be useful. Grip strength improvement in
this kind chronic condition seems not to express good rehabilitation result and its usefulness can be questioned. The
results of this study are useful when planning rehabilitation interventions for chronic epicondylitis

NOTA: O texto com a iconografia está no anexo.

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