@article{Karanasios2021,

title = {Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review},

author = {S. Karanasios and V. Korakakis and M. Moutzouri and E. Drakonaki and K. Koci and V. Pantazopoulou and E. Tsepis and G. Gioftsos },

doi = {doi: 10.1016/j.jht.2021.02.002},

year  = {2021},

date = {2021-09-01},

journal = {J Hand Ther},

abstract = {Background



Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing.

Purpose



To review the diagnostic accuracy of examination tests used in LET.

Design



Systematic review following PRISMA-DTA guidelines.

Methods



We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET.

Results



Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with “unclear” or “high risk” of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%).

Conclusions



Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies.},

keywords = {diagnosis, elbow, sensitivity, specificity, tennis},

pubstate = {published},

tppubtype = {article}

}

@article{Karanasios2021b,

title = {Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials},

author = {S. Karanasios and V. Korakakis and R. Whiteley and I. Vasilogeorgis and S. Woodbridge and G. Gioftsos},

doi = {doi: 10.1136/bjsports-2020-102525},

year  = {2021},

date = {2021-09-01},

journal = {Br J Sports Med},

volume = {55},

number = {9},

pages = {477-485},

abstract = {Objective:

To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.



Design Systematic review and meta-analysis.



Methods:

We used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.



Eligibility criteria RCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.



Results:

30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.



Conclusions:

Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.},

keywords = {elbow, exercise, tendinopathy},

pubstate = {published},

tppubtype = {article}

}