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Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers' elbow.

Authors: Tyler TF, Nicholas SJ, Schmitt BM, Mullaney M, Hogan DE

Eccentric training of the wrist extensors has been shown to be effective in treating chronic lateral epicondylosis. However, its efficacy in the treatment of medial epicondylosis has yet to be demonstrated. The objective of this study was to assess the effectiveness of a novel eccentric wrist flexor exercise added to standard treatment for chronic medial epicondylosis in patients who did not respond to previous therapeutic interventions for this disorder. The authors recruited patients (13 men, 7 women; age 49±12 yr) with chronic medial epicondylosis who had failed previous treatment for this disorder (physical therapy 7, cortisone injection 7, PRP 1, NSAIDS 15). The patients were prescribed isolated eccentrics in addition to wrist stretching, ultrasound, cross-friction massage, heat and ice. The specific isolated eccentric wrist flexor strengthening exercise performed by the patients involved twisting a rubber bar (Flexbar, Hygenic Corporation, Akron OH) with concentric wrist flexion of the noninvolved arm and releasing the twist by eccentrically flexing the involved arm (3 x 15 twice daily). A DASH questionnaire was recorded at baseline and again after the treatment period. Following the isolated eccentric program, there was a significant improvement in outcomes (Pre DASH 34.7±16.2 vs. Post DASH 7.9±11.1, p<.001). For the 18 patients involved in sports, the sports module of the DASH score improved from 73.9±28.9 to 13.2±25.0, p<.001). Therefore, the authors concluded that the outcome measure for chronic medial epicondylosis was markedly improved with the addition of an eccentric wrist flexor exercise to standard physical therapy.

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