The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis

The aim of the present study was to compare the effect of a new prefabricated Thämert forearm/hand splint with the effect of a simple elbow band as a treatment for lateral epicondylitis. Forty-three (43) patients that met the inclusion criteria were randomly assigned to the elbow band group and the splint group. They wore the orthotic devices for 6 weeks. Outcome measures were obtained at baseline and directly after the intervention. These outcome measures were maximal grip strength on the involved side with a pain scale from 1 to 10 to determine the extent of pain during gripping, and the PatientRated Forearm Evaluation Questionnaire (PRFEQ). Analysis of variances with repeated measures, a Mann Whitney test and multiple linear regression analysis were used to compare the two groups. Main effect for time was significant for maximal grip strength and sum scores on the PRFEQ, but no differences between groups were found, even when a distinction between acute and chronic symptoms was made. Change in pain score during gripping did not differ significantly between the groups. A multiple linear regression analysis showed that the use of the splint did not significantly contribute to the prediction of change in maximal grip strength and in overall PRFEQ. All correspondence to be addressed to M.H.G. de Greef, Institute of Human Movement Sciences, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands. Tel: (+31) (0)50 3636499; Fax: (+31) (0)50 3633150; E-mail: [email protected] The conclusion is that the forearm/hand splint is not more effective than the elbow band as a treatment for lateral epicondylitis. Introduction Lateral epicondylitis or tennis elbow is a condition characterized by pain on the lateral epicondyle of the humerus (Assendelft et al., 2002; Verhaar, 1994). Although the symptoms of patients with a tennis elbow are rather similar, the etiology is not uniformly explained (Verhaar, 1994; Haker and Lundeberg, 1993). The suggested causes can be classified into four groups: tendinopathy, intra-articular lesions, compression of the radial nerve and cervical radiculopathy (Verhaar, 1994). Tendinopathy is most often mentioned, and is characterized by a lesion of the common extensor tendon with or without inflammation. The lesion, which may cause the pain, results from overload of the extensors in the wrist. The muscle fibres do not get enough time to restore (Haker and Lundeberg, 1993; Wuori et al, 1998). There are many treatment modalities for tennis elbow; one of the more popular being orthotic devices such as an elbow trap or band. Some advise relief might be effective after a time period, others to wear only during the activities that provoke pain. Orthotic devices are commonly used as a treatment strategy for lateral epicondylitis. Twenty-one percent (21%) of the patients with a tennis elbow in Dutch primary care are prescribed an elbow support (Smidt, 2003). The aim of orthotic devices is primarily to attack the cause of lateral