scholarly journals MP019: Systematic review of the management of lateral epicondylitis using transdermal nitroglycerin

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S72-S73
Author(s):  
M. Hunter ◽  
A. Bhargava ◽  
E. Lang
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Lateral Epicondylitis ◽  
Comparison Study ◽  
Short Term ◽  
Old Patients ◽  
Patch Use ◽  
Prospective Comparison ◽  
Improved Function

Introduction: Lateral epicondylitis (LE), also known as tennis elbow, is an overuse-underuse tendinopathy originating from the forearm extensor tendons of the elbow. An emerging therapy for the treatment of LE is the use of transdermal nitroglycerin (NTG) patches for pain relief and improved function. Our systematic review assesses 18 to 65 year old patients with clinically diagnosed LE and no structural damage or longstanding elbow injury to determine if transdermal NTG patches provide improved short term and long term pain relief as well as improved function in comparison with placebo. Methods: We included randomised controlled trials (RCT’s) of NTG patch use versus placebo for the treatment of LE. Prospective comparison studies were also eligible for assessing the long term pain relief of NTG patch use. We performed a literature search using MEDLINE, EMBASE, SportDiscus and the Cochrane Database of Systematic Reviews. English language articles were retrieved for review up to November 2015. Risk of bias within the studies was assessed regarding randomisation, allocation sequence concealment, blinding and selective outcome reporting. Results: Three RCT’s were included that compared transdermal NTG patch use (two studies with 1.25mg/24h and one study comparing 0.72, 1.44 and 3.6mg/24h) versus a placebo to treat LE. One prospective comparison study of five years duration was included as a follow-up to one of the included RCT’s to assess pain and function five years after the discontinuation of therapy. Data was not pooled because of heterogeneity in study methods and outcomes. The use of transdermal NTG patches provided short term pain relief (2-6 weeks for dosing of 0.72mg/24h or 1.25mg/24h) compared with placebo as suggested by three RCT’s. Long term pain relief was improved by NTG patch use compared with placebo at six months in one RCT, but not at five years in a prospective comparison study. Function improved in two different RCT’s with NTG patch use at 0.72mg/24h and 1.25mg/24h when compared to placebo. Five years after cessation of treatment, there was no difference between NTG patch and placebo. Conclusion: Overall, the included studies demonstrate that the use of NTG patches compared to placebo improves short term and long term pain relief, as well as elbow function. However, more studies are required to bridge the gaps between the existing studies and reduce heterogeneity between the study designs.

scholarly journals Efficacy of injection of steroids for lateral epicondylitis

1970 ◽  
Vol 32 (3) ◽  
pp. 34-38
Author(s):  
R Maharjan ◽  
G Gurung
Keyword(s):  
Placebo Group ◽  
Pain Relief ◽  
Single Injection ◽  
Tennis Elbow ◽  
Corticosteroid Injection ◽  
Lateral Epicondylitis ◽  
Local Injection ◽  
Long Term Effects ◽  
Short Term

Introduction: Lateral epicondylitis (Tennis elbow) is one of the most common lesions of the arm. Corticosteroid injection has been described as one of the treatment modalities for this disorder with variable clinical benefit. The purpose of this study was to analyze the short-term and long-term effects of the local injection of methylprednisolone to treat lateral epicondylitis. Methods: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from October 2009 to February 2011. Study was undertaken in 40 patients to analyze the short-term and long-term effects of the local injection of methylprednisolone for the treatment of lateral epicondylitis. Twenty patients in each group were included in the study. Patients assigned to experimental group received a single injection of 1 percent lidocaine with forty milligrams of methylprednisolone and control group received a single injection of 1 percent lidocaine with saline solution. Results: Corticosteroid injection gave better pain relief in a shorter time than the placebo group. Pain was significantly improved in steroid group in comparison to placebo group till third successive follow ups with maximum improvement at eighteen weeks (p=0.000). However, the groups did not differ with regards to pain at six months as determined with a clinical pain score and visual analogue scale. Conclusions: Local injections of steroids provide rapid pain relief but only short-term benefits in the treatment of lateral epicondylitis. Key word: Epicondylities; Steroid injection; tennis elbow DOI: http://dx.doi.org/10.3126/joim.v32i3.4958 Journal of Institute of Medicine, December, 2010; 32:3 34-38

scholarly journals Effectiveness of Denervation Therapy on Pain and Joint Function for Patients with Refractory Knee Osteoarthritis: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 4 (22;4) ◽  
pp. 341-352
Author(s):  
Lijuan Lu
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Therapeutic Effect ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Joint Function ◽  
Short Term ◽  
Term Efficacy

Background: Recently, denervation therapy has been applied clinically for the treatment of intractable osteoarthritis (OA). This therapy provides an alternative for patients who are insensitive to conservative therapies or unwilling to receive surgery and general anesthesia. However, therapeutic effect of this method, especially the long-term efficacy, is still controversial. Objectives: The aim of this systematic review was to examine the efficacy of denervation therapy for the treatment of OA, especially on pain alleviation and functional recovery in the short and long term. Study Design: This systematic review and meta-analysis was designed to investigate whether denervation therapy is more useful than conservative methods for achieving clinical outcomes in patients with refractory OA. Methods: A literature search was performed in MEDLINE, EMBASE, and the Cochrane library for studies published from inception to August 2018. From those found meeting the search criteria, manuscripts comparing the clinical efficacy of denervation therapy and control agents, such as conservative therapies or sham operation, were included in this study. After reviewing the titles, abstracts, and the full text, 6 studies were included in the quantitative synthesis. Data, including postoperative pain scores, rate of 50% pain relief, and joint functional scores were extracted and combined to obtain effect size and statistical significance. Results: In terms of postoperative pain intensity, denervation therapy showed significantly better short-term (4, 12, and 24 weeks) pain relief. The rates of 50% pain relief at 12 and 24 weeks after operation were also higher compared with the control group. In terms of joint functional improvement, denervation therapy showed favorable outcomes at 4 and 12 weeks after treatment, but no significant difference was found at 24 weeks after procedure between the groups. Overall, better results were reported in denervation therapy with a relative high-grade of evidence. Limitation: Analyses of long-term (one year and longer) effects could not be conducted owing to a lack of existing studies. Conclusions: Denervation of the knee joint may become a promising therapy for patients with knee OA who are refractory to conservative treatment. This therapy can provide short-term therapeutic effect in pain alleviation for 6 months and joint function recovery for 3 months. The therapeutic effect in joint function may decrease 6 months after operation. The long-term efficacy in pain remission and function improvement is still elusive and controversial; therefore, further research with larger sample sizes are needed in the future. Key words: Osteoarthritis, denervation therapy, radiofrequency, chronic pain, function, systematic review, meta-analysis

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

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe 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 criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 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.ConclusionsLow 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.PROSPERO registration numberCRD42018082703.

scholarly journals Effect of Non-Thermal Atmospheric Plasma on Micro-Tensile Bond Strength at Adhesive/Dentin Interface: A Systematic Review

Materials ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1026
Author(s):  
Mohamed M. Awad ◽  
Feras Alhalabi ◽  
Abdullah Alshehri ◽  
Zaid Aljeaidi ◽  
Ali Alrahlah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bond Strength ◽  
Atmospheric Plasma ◽  
Tensile Bond Strength ◽  
Cochrane Library ◽  
Limited Information ◽  
Short Term ◽  
Etch And Rinse ◽  
Medium Risk

Objective: The objective of this review was to evaluate the effect of non-thermal atmospheric plasma (NTAP) on adhesives resin–dentin micro-tensile bond strength (μTBS) in previously published studies. Methods: Electronic search was conducted using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of NTAP on adhesives μTBS to coronal dentin. Studies that evaluated the effect of NTAP on bond strength to indirect substrates, enamel or root dentin, were excluded. The methodological quality of included studies was assessed. Results: Thirteen studies were included in this systematic review. All the included studies were considered to have a medium risk of bias. NTAP significantly improved μTBS at 24 h or after short-term aging in five studies (38.5%) and both immediate and after long-term aging in 5 studies (38.5%). In two studies (15.4%), NTAP resulted in a short-term material-dependent effect that was not stable after long-term aging. Interestingly, in one study (7.7%), NTAP had a positive effect only in the etch-and-rinse (ER) mode after long-term aging. Conclusion: Within the limitations of this systematic review, NTAP application could enhance resin–dentin μTBS of ER adhesives or universal adhesives (UAs) applied in the ER mode. In the ER mode, the rewetting step after NTAP seems to be unnecessary. Because of the limited information currently available in the literature, further studies are required to evaluate the effect of the NTAP application on self-etch (SE) adhesives or UAs applied in the SE mode.

scholarly journals Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110280
Author(s):  
Camille Daste ◽  
Stéphanie Laclau ◽  
Margaux Boisson ◽  
François Segretin ◽  
Antoine Feydy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Chronic Low Back Pain ◽  
Meta Analysis ◽  
Activity Limitations ◽  
Low Back ◽  
Short Term

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

EP.WE.14Prognostic significance of metabolic syndrome in patients undergoing carotid artery revascularisation: A systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Adverse Events ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Long Term Outcomes ◽  
Short Term ◽  
All Cause Mortality ◽  
Major Adverse Events

Abstract Aims to evaluate prognostic significance of metabolic syndrome (MetS) in patients undergoing carotid artery revascularisation. Methods A systematic review and meta-analysis was performed in compliance with PRISMA standards to evaluate prognostic significance of MetS in patients undergoing carotid endarterectomy or carotid stenting. Short-term (<30 days) postoperative outcomes (all-cause mortality, stroke or transient ischaemic attack (TIA), myocardial infarction, major adverse events) and long-term outcomes (restenosis, all-cause mortality, stroke or TIA, myocardial infarction, major adverse events) were considered as outcomes of interest. Random effects modelling was applied for the analyses. Results Analysis of 3721 patients from five cohort studies showed no difference between the MetS and no MetS groups in terms of the following short-term outcomes: all-cause mortality (OR: 1.67,P=0.32), stroke or TIA (OR: 2.44,P=0.06), myocardial infarction (OR: 1.01,P=0.96), major adverse events (OR: 1.23, P = 0.66). In terms of long-term outcomes, MetS was associated with higher risk of restenosis (OR: 1.75,P=0.02), myocardial infarction (OR: 2.12,P=0.04), and major adverse events (OR: 1.30, P = 0.009) but there was no difference between the two groups in terms of all-cause mortality (OR: 1.11, P = 0.25), and stroke or TIA (OR: 1.24, P = 0.33). The quality and certainty of the available evidence were judged to be moderate. Conclusions The best available evidence suggest that although MetS may not affect the short-term postoperative morbidity and mortality outcomes in patients undergoing carotid revascularisation, it may result in higher risks of restenosis, myocardial infarction and major adverse events in the long-term. Evidence from large prospective cohort studies are required for more robust conclusions.

Short-term and long-term exposures to fine particulate matter constituents and health: A systematic review and meta-analysis

2019 ◽  
Vol 247 ◽  
pp. 874-882 ◽  
Author(s):  
Yang Yang ◽  
Zengliang Ruan ◽  
Xiaojie Wang ◽  
Yin Yang ◽  
Tonya G. Mason ◽  
...  
Keyword(s):  
Systematic Review ◽  
Particulate Matter ◽  
Meta Analysis ◽  
Fine Particulate Matter ◽  
Short Term ◽  
Fine Particulate

scholarly journals Intralymphatic immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
M.P. Hoang ◽  
K. Seresirikachorn ◽  
W. Chitsuthipakorn ◽  
K. Snidvongs
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Specific Ige ◽  
Allergic Rhinoconjunctivitis ◽  
Medium Term ◽  
Short Term ◽  
Intralymphatic Immunotherapy ◽  
Specific Igg4 ◽  
Igg4 Level

BACKGROUND: Intralymphatic immunotherapy (ILIT) is a new route of allergen-specific immunotherapy. Data confirming its effect is restricted to a small number of studies. METHODOLOGY: A systematic review with meta-analysis was conducted. The short-term (less than 24 weeks), medium-term (24-52 weeks), and long-term (more than 52 weeks) effects of ILIT in patients with allergic rhinoconjunctivitis (ARC) were assessed. The outcomes were combined symptom and medication scores (CSMS), symptoms visual analog scale (VAS), disease-specific quality of life (QOL), specific IgG4 level, specific IgE level, and adverse events. RESULTS: Eleven randomized controlled trials and 2 cohorts (483 participants) were included. Compared with placebo, short term benefits of ILIT for seasonal ARC improved CSMS, improved VAS and increased specific IgG4 level but did not change QOL or specific IgE level. Medium-term effect improved VAS. Data on the long-term benefit of ILIT remain unavailable and require longer term follow-up studies. There were no clinical benefits of ILIT for perennial ARC. ILIT was safe and well-tolerated. CONCLUSION: ILIT showed short-term benefits for seasonal ARC. The sustained effects of ILIT were inconclusive. It was well tolerated.

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