治疗性运动治疗肘关节外侧肌腱病变

Tozza Claudia
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引用次数: 1

摘要

肘关节外侧肌腱病变是该关节疼痛的最常见原因。虽然它也被广泛地称为“网球肘”,因为它影响了50%的网球运动员,特别是学习单手反手的初学者,但LET通常作为一种与工作有关的疾病发展,因此构成了严重的公共卫生问题:所有受影响的患者中只有10%打网球。典型的临床表现是疼痛和力量和功能的减少,对日常活动有相当大的影响。尽管LET的体征和症状是明确的,以及诊断的定义,但迄今为止尚未出现理想的治疗方法;临床医生主张采用保守方法作为治疗的首选,而物理治疗因其治疗范围广泛,通常被推荐:治疗性运动已显示出良好的临床效果,本综述的目的是评估其在上述临床情况管理中的有效性。为了实现这一修订,参考了报告系统审查的指南PRISMA声明(PRISMA- p核对表)。随机临床试验使用字符串进行识别,这些字符串是在每个使用的数据库:MEDLINE、Cochrane Library和PEDro中专门组成的。在各种数据库中剔除重复文章和不符合纳入标准的研究后,通过阅读标题、摘要和全文进行选择。随后,采用Cochrane Collaboration的Rob 2.0对研究的内部效度进行评估。这些字符串总共产生了1418个条目。在阅读标题、摘要和全文后,只有12篇作品真正与研究问题相关,并且包含了预先设定的纳入标准。治疗性运动被认为是治疗肘关节外侧肌腱病变最安全、最便宜和最有效的方法;所有纳入的试验都精确地概述了不同人群的剂量、类型和应用原则,没有限制症状出现的时间。无监督的等长运动在短期内证明了疼痛和残疾的显著减少。偏心运动是最受关注的运动类型,在减轻疼痛症状和增加握力方面是有效的。拉伸是一种有效的治疗策略,通常与其他干预模式相关,在无痛握力、功能和VAS方面记录了显著的益处,与对照组获得的结果重叠。然而,试验的异质性,包括管理类型,检查样本的大小和考虑的结果类型,使得很难提取客观和明确的临床问题的答案。在LET管理中更好地针对临床实践是未来研究的目标,定义具有统计学和/或临床显着优势的运动计划。
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Therapeutic exercise in the management of lateral elbow tendinopathy
Lateral elbow tendinopathy is the most common cause of pain in this joint. Although it is also widely known as 'tennis elbow' as it affects 50% of tennis players, especially beginners who learn the one-handed backhand, LET often develops as a work-related condition and therefore constitutes a serious public health problem: only 10% of all affected patients play tennis. The typical clinical presentation is characterized by pain and reduction of strength and function with considerable repercussions on daily activities. Although signs and symptoms of LET are clear, as well as the definition of the diagnosis, to date no ideal treatment has yet emerged; clinicians advocate a conservative approach as the first choice of management and physiotherapy, with its wide range of treatments, is commonly recommended: therapeutic exercise has shown good clinical results and the goal of this review is to evaluate its effectiveness in the management of the aforementioned clinical picture. for the realization of this revision was made reference to the guidelines for reporting systematic reviews PRISMA Statement (PRISMA-P checklist). Randomized clinical trials were identified using strings, which were specifically constituted on each used database: MEDLINE, Cochrane Library and PEDro. After the elimination of repeated articles from the search in the various databases and studies that did not meet the inclusion criteria, the selection took place by reading the title, abstract and full text. Subsequently, the evaluation of the internal validity of the studies was carried out with the Rob 2.0 of the Cochrane Collaboration. The strings produced a total of 1418 items. After reading the title, abstract and full text, only 12 works were really relevant to the research question and containing the pre-established inclusion criteria. Therapeutic exercise has been found to be the safest, cheapest and most effective means in the management of lateral elbow tendinopathy; all the included trials have precisely outlined the dosage, type and principle of application in different populations without restrictions of the time of onset of symptoms. Unsupervised isometric exercise demonstrated a considerable reduction in pain and disability in the short term. Eccentric exercise, the most contemplated type, was effective in reducing the painful symptom and increasing the grip strength. Stretching, a valid therapeutic strategy often associated with other modes of intervention, has recorded significant benefits related to painless grip strength, function and VAS, overlapping with the results obtained in the comparison groups. However, the heterogeneity of the trials included for the type administered, the size of the samples examined and the type of outcomes considered, makes it difficult to extract an objective and clear answer to the clinical question. Better targeting clinical practice in LET management is the goal of future research, defining exercise programs with statistically and/or clinically significant superiority.
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