We aim to investigate the effects of adding scapular stabilization exercises to the extracorporeal shock wave therapy (ESWT) protocol in the treatment of lateral epicondylitis on pain, muscle strength, functional status, and quality of life.
Forty eight volunteer participants with lateral epycondilitis aged 18 to 65 years were included in the study. Participants were randomly divided into two groups as study and control group. In the control group, a protocol including ESWT, stretching of the ECRB muscle and wrist extensor muscles, and isometric, eccentric, and concentric strengthening exercises for the wrist extensors will be applied. In the study group, the same protocol will be administered (ESWT, stretching of the ECRB and wrist extensor muscles, and strengthening exercises), with the addition of scapular stabilization exercises. The exercise program will be conducted twice a week for 8 weeks. At the beginning of the treatment and at the end of the eighth week, pain, muscle strength, functional status, and Quality of Life were evaluated between groups
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
48
Participants in the study group will follow a treatment protocol consisting of extracorporeal shock wave therapy (ESWT) - 5 sessions, once per week - combined with stretching exercises for the extensor carpi radialis brevis (ECRB) and wrist extensor muscles, strengthening exercises for the wrist extensors, and an additional scapular stabilization exercise program. This combined program will be performed twice per week for a duration of 8 weeks. The scapular stabilization component will include strengthening exercises targeting the lower and middle trapezius and serratus anterior muscles. The program will consist of scapular clock exercises, wall push-up exercises, and wall slide or ball slide exercises performed on a wall.
Büşra Yalçın
Istanbul, Turkey (Türkiye)
RECRUITINGPain Assessment: Visual Analog Scale (VAS)
Pain will be assessed using the Visual Analog Scale (VAS). On this scale, a score of 0 indicates "no pain" and a score of 10 represents "the worst possible pain." Participants will be asked to mark their perceived pain level on a 10 cm horizontal line, anchored at 0 and 10. The distance from the left end of the line to the participant's mark will be measured in centimeters and recorded. The VAS is a valid and reliable tool for pain assessment. Pain will be evaluated separately at rest, during activity, and at night.
Time frame: From baseline assesment to the end of treatment at 8 weeks
Scapular Position Assessment: (Lateral Scapular Slide Test)
The distance between the inferior angle of each scapula and the nearest spinous process will be measured in three different test positions on both sides using a measuring tape. A side-to-side difference of 1.5 cm or more is considered a positive result and indicates scapular asymmetry.
Time frame: From enrollment to the end of treatment at 8 weeks
Pressure Pain Threshold Measurement
Measurements will be performed with a digital algometer while the participant is seated, with the shoulder abducted at 30°, the elbow flexed at 90°, and the forearm, wrist, and hand supported. Pressure pain threshold will be measured over the lateral epicondyle. Three measurements will be taken at each point using the 1 cm² tip of the algometer, and the average of these three measurements will be recorded.
Time frame: From enrollment to the end of treatment at 8 weeks
Grip Strength
Patients' grip strength will be assessed using a Jamar hand dynamometer, following the protocol recommended by the American Society of Hand Therapists.
Time frame: From enrollment to the end of treatment at 8 weeks
Muscle Strength
Muscle strength of the lower and middle trapezius, serratus anterior, and wrist extensor muscles will be measured using a handheld dynamometer before and after the treatment.
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Time frame: 0 and 8 week
Functional Status
PRTEE (Patient-Rated Tennis Elbow Evaluation): The PRTEE is designed specifically for lateral epicondylitis and consists of 15 items divided into 3 subscales. Each item is scored from 0 to 10. Higher scores on the scale indicate worse functional status. (The subscales assess pain, specific activities, and general daily activities.) JHand: JHand evaluates the functional status of the upper extremity and consists of 25 items. Each item is scored on a scale from 0 (no difficulty) to 4 (unable to perform). Higher scores on this scale also indicate worse functional status.
Time frame: From enrollment to the end of treatment at 8 weeks