Comparing the effects of Manipulation of Wrist and Ultrasound, Friction Massage and Exercises on Lateral Epicondylitis: A Randomized Clinical Study

Background and Purpose: Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises.

Design: A Randomized Clinical Study.

Subjects and Method: Ten subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Follow-up was at 3 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 10-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests.

Results: Differences were found for 2 outcome measures: success rate and decrease in pain at 3 week. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. Also, improvement in pain as measured on a 10-point numeric scale was 5.2 (+ 2.4) in group 1, as compared with 3.2 (+ 2.1) in group 2.

Conclusion: Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up.