• Journal of the Korean Society of Physical Medicine
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• v.7 no.4
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• pp.525-533
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• 2012

PURPOSE: The purpose of this study was to investigate initial effects of the non-elastic taping technique on grip strength and EMG in female with lateral epicondylalgia. METHODS: Twenty-two participants (mean age SD, $52.8{\pm}10.2$ years) with chronic lateral epicondylalgia (mean duration${\pm}$SD, $13.1{\pm}9.9$ months) participated in a placebo control study of an elbow taping technique. Outcome measures were pain-free grip and EMG taken before, immediately after application of tape. RESULTS: The experimental group were more significantly improved grip strength and muscle activity of forearm than control group. CONCLUSION: This study show that non-elastic taping technique is beneficial intervention for increase grip strength and EMG in female with lateral epicondylalgia.

• Physical Therapy Rehabilitation Science
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• v.5 no.3
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• pp.120-124
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• 2016

Objective: Chronic lateral epicondylitis is a condition which becomes sore and tender on the lateral side of the elbow joint damaged from overuse and repetitive use of the extensor muscles of the forearm. The purpose of this study was to investigate the effects of flexion degrees in the elbow joint on extensor carpi radialis longus and brevis and biceps brachii muscles in individuals with healthy young adults. The main purpose of this study was to suggest the feasibility of optimal elbow angle during therapeutic eccentric exercise with resistance for strengthening of wrist extensors. Design: Cross-sectional study. Methods: Thirty health young adults (male 15, female 15) participated in this study. This study measured muscle activation in four different conditions of elbow flexion, $0^{\circ}$, $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$ during eccentric exercise with weight loading in wrist extensors, extensor carpi radialis longus and brevis and biceps brachii muscles using surface electromyography. Results: The muscle activation of extensor carpi radialis showed a negative relationship with the degrees of elbow joint flexion. With increasing elbow flexion angles, the ECRL muscle activation amount was significantly lower (p<0.05). In contrast, the muscle activation of the ECRB muscle activation amount was significanlty higher (p<0.05). Conclusions: This study suggests that the eccentric exercise of wrist extension with selected activation of wrist extensor muscles according to elbow flexion positions, and suggests that the extensor carpi radialis longus and brevis will need to be strengthened for preventing and treating chronic lateral epicondylitis regardless of degrees of elbow joint flexion.

• Clinics in Shoulder and Elbow
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• v.24 no.4
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• pp.231-238
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• 2021

Background: Extensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE. Methods: Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments. Results: Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]). Conclusions: PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.6 no.2
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• pp.94-100
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• 2013

Musculoskeletal ultrasound has unique advantages that may be free from exposure to radiation, low price compared to MRI, outpatient procedure that can be easily accessible, and better accuracy combined with physical examination. Dynamic ultrasound performed with stress tests are known to be useful for detecting the hidden lesions in the tendons, ligaments, nerves. Ultrasound in the elbow can be used easily in the outpatient for evaluation of the joint surface and synovial space; diagnosis for tendon diseases such as lateral epicondylitis, medial epicondylitis and morbidity of peripheral nerves; guide for anterior-posterior bursal and intra-articular injections.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.57-64
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• 2022

Background: There are various conservative treatment options for lateral epicondylitis (LE). The aim is to evaluate pain, daily functioning, and complications after ultrasound-standardized autologous blood injections in patients with LE. Methods: For this prospective cohort study, consecutive patients (>18 years) diagnosed with LE were included. Autologous blood was injected using a medical device containing an injection disposable with 12 small needles (Instant Tennis Elbow Cure [ITEC]) device. Patient-Rated Tennis Elbow Evaluation (PRTEE), subjective elbow score (SES), palpation and provocation pain, satisfaction, and complications of treatment were measured at baseline and two months after treatment. Paired t-tests and Fisher's exact tests were used for calculating the difference between pre- and post-treatment outcomes. Results: Fifty-five elbows were analyzed. Mean time between pre- and post-treatment was 11.1 weeks (standard deviation [SD], 8.9 weeks). The mean PRTEE score decreased from 68.2 (SD, 15.7) before surgery to 53.2 (SD, 25.9; p<0.001) after. The mean SES improved from 36.9 (SD, 20.8) to 51.7 (SD, 27.4; p<0.001). Despite this improvement, only 44.7% of patients showed relevant clinical improvement in PRTEE, and 37.3% showed significant clinical improvement based on SES. Four patients reported a complication and the injection disposable failed three times. Conclusions: Ultrasound-standardized autologous blood injection using the ITEC device is not an effective tool in reducing symptoms related to LE. This study showed that only half of all patients experienced a positive effect. In this heterogeneous cohort of patients, we showed no added value of ultrasound standardization.

• Physical Therapy Korea
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• v.27 no.3
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• pp.163-170
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• 2020

Background: The characteristics of lateral epicondylitis (LE) are muscle strength weakness and increased common extensor tendon (CET) thickness. Ultrasonography has recently been used to evaluate tendinopathy. Diamond taping (DT) is commonly used to manage patients with LE. However, no previous studies have investigated the effects of DT on CET thickness. Objects: The aim of this study was to investigate the effects of DT applied around the lateral elbow on CET thickness, grip strength, and wrist extension force in healthy subjects. Methods: The subjects were 26 adults (13 male) in their twenties. First, the CET thickness was measured at rest. The CET thickness was measured by using ultrasonography at two points. The subjects were then instructed to perform maximal grip activities or maximal wrist extension activities before and after DT around the lateral elbow. The DT technique was applied using non-elastic tape. While the subjects performed maximal grip activities, the investigator measured the maximum grip strength (MGS) and CET thickness. Likewise, while the subjects performed maximal wrist extension activities, the investigator measured the maximum wrist extension force (MWEF) and CET thickness. Results: The MGS showed a statistically significant improvement after DT taping application in men (p < 0.05). The MWEF showed a statistically significant improvement after DT application in male (p < 0.01) and female (p < 0.05). When performing the activities, the CET thickness increased compared to that at rest. However, CET thickness didn't show a statistically significant improvement before and after DT. Conclusion: This study shows that DT applied around the lateral elbow is effective in improving MGS and MWEF. However, it does not affect CET thickness.

• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.170-186
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• 2001

Musculoskeletal ultrasound (MSUS) has newly evolved by the mechanical improvement of the machine over past several years, becoming a part of imaging techniques for the evaluation of variable diseases in the musculoskeletal system. MSUS has proven diagnostic superiority in pathologies including rotator cuff disease of the shoulder, lateral epicondylitis of the elbow, diseases of the peripheral nerve, detection of intra-articular loose bodies and soft tissue foreign bodies, and in evaluating small superficial soft tissue tumors such as ganglion, epidermoid cyst, and glomus tumor. Besides, MSUS is very useful for obtaining tissue or fluid via percutaneous fine needle aspiration and/or biopsy for the histopathologic diagnosis. Combining MSUS with MR would play a great role in the field of the diagnostic imaging of the musculoskeletal system. The MSUS examiner should have the knowledge of cross-sectional anatomy, and of the mechanical and physical properties of ultrasound in order to interpret the ultrasound findings accurately and properly, and to avoid diagnostic errors due to variable artifacts subsequently. The goal of this article is to introduce the capabilities of MSUS in certain kinds of clinical situation and to familiarize the reader with MSUS. For the purpose, author intends to describe this article according not to the disease-, or organ-based, but to the clinical problem-based format.

• Journal of Acupuncture Research
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• v.36 no.4
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• pp.211-219
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• 2019

This review analyzed randomized controlled trials and case reports to identify the effectiveness, and level of evidence showing that acupuncture treatment aids the recovery of patients with tennis elbow. A literature search was performed between $1^{st}$ to $10^{th}$ September, 2019 which used PubMed, the Cochrane library, the Korean databases Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System to retrieve Korean and international studies. Amongst the 243 articles retrieved there were 9 randomized controlled trials and 18 case reports. The level of evidence for the recovery of patients with tennis elbow, for efficacy and safety of acupuncture was low. It was observed that the studies had a high risk of bias, missing acupuncture details, multiple combinations of treatments rather than a single treatment, insufficient indicators of assessment, and lacked robustness. Compliance with international standards such as using consolidated standards of reporting trials, will improve the quality of evidence.

• Journal of East-West Nursing Research
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• v.13 no.2
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• pp.160-169
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• 2007

Background: Hwa-Byung is known as a specific Korean cultural syndrome which corresponds to DSM-IV(MMPI). Some Korean women who have experienced heart aching anger(Hwa-Byung) complain physical pains as well as psychological problems. As for these physical pains, upper limb arthropathy(e.g. golf elbow pains, tennis elbow pains, or shoulder-joint pains) have not been paid attentions. In spite of not having done her excessive physical endeavor or exercise, some Korean middle aged women complain those arthropathy pains. And they go round orthopedics, pain clinics, and oriental medicine clinics. Purpose: This study was practiced in Severance Oriental Medicine Clinic. The oriental medicine doctor had a question about the major origin of upper limb pains which were not caused by excessive physical endeavor. To answer the question, this study has been practiced. In the process of interview with some those women, the major cause of those syndromes has been revealed as Hwa-Byung. The purpose of this study is to discover the meanings of the women's life who have been experienced Hwa-Byung with upper limb arthropathy. Results: These upper limb arthropathy can be explained by meridian theory. Shoulder-joint pain and golf elbow with Hwabyung can be explained by Heart meridian of hand-shoyin and the points of these pains are in the flow of this meridian. Tennis elbow with Hwabyung can be explained by Small intestine meridian of hand-taiyang and this point is in the flow of this meridian. The results of interview with 9 middle aged women was analyzed and interpreted according to Spradley's method of ethnography. The analysis revealed three core cultural themes : 1) There are certainly external cause to provoke Hwa-Byung. A patricentric family system, husband's playing around with another woman, cruel treatment by husband's family, or financial failure may be present anteriorly. 2) The chief existing condition is the discord between husband and wife. The stoppage of mutual communication, lacking in understanding, unfeeling, heartless, or unsympathetic is an major phenomenon of married life. So the important factor is not the sexual relations or problems but the discords of communication. 3) The feeling of anger, the sense of nihility, the desire to escape, and the effort to forgiveness coexist together. At a glance, they seemed to be a process. For example, anger seemed to present at first, then nihility seemed at second, then escape seemed at third, and then forgiveness seemed at last. But at point of visiting clinic to be treated, they are mixed up together as if in a jumble.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.50-58
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• 2007

Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range $16{\sim}56$ years). All patients had a trial of conservative treatment at least six months (range $6{\sim}16$ months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average(range $12{\sim}24$). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.