LONG-TERM FOLLOW-UP OF CONSERVATIVELY TREATED CHRONIC TENNIS ELBOW PATIENTS - A PROSPECTIVE AND RETROSPECTIVE ANALYSIS

This study aimed to assess the longterm outcome of progressive exercis e and local pulsed ultrasound in the treatment of 30 chronic tennis el bow patients (2 men, 18 women, mean age 42.3 years). The patients were originally randomised into 1) four-step progressive exercise (EX, n = 16) and 2) local pulsed ultrasound (US, n = 14) treatment groups. Bef ore the beginning of the treatment, the groups were similar in terms o f pain scores, sick-leave days and duration of symptoms. The patients underwent an 8-week treatment intervention. Long-term follow-up evalua tion of the patients was performed 1) prospectively using a pain quest ionnaire on VAS and pain drawings classified into 5 categories, and 2) retrospectively with a postal questionnaire (which was sent to the pa tients to fill in. Sick-leave days, medical and physiotherapy visits, operations, early retirements and job relocations were inquired in the postal questionnaire. The diagnosis-related sick-leave days of the pa tients were collected from the Database of the Social Insurance Instit ution of Finland and the number of operations from the local hospital register. Twenty-three patients (12 in the EX group and 11 in the US g roup) responded. The mean follow-up time was 36 months. After the trea tment the patients in the EX group needed significantly less physiothe rapy (p = 0.02), fewer medical consultations (p = 0.005) and other tre atments and had fewer sick-leave days (p = 0.005) than before the trea tment intervention. The patients in the US group had after the treatme nt intervention more 17 medical visits (ns), 291 sick-leave days (ns) and less 95 physiotherapy visits (ns) than before the treatment. Eight patients (67%) in the EX group and 5 (45%) in the US group still held their previous job, while two patients in the US group, but none in t he EX group were absent from work because of the tennis elbow syndrome . The patients in the EX group reported significantly lower pain score s on VAS than those in the US group. The mean pain drawing category wa s 1.5 in the EX group and 2.7 in the US group (p = 0.008). All the pai n scores and pain drawing categories in the EX group had changed to be significantly better than in the US group, where only pain under stra in had significantly improved. Because of resistant symptoms, 5 patien ts were operated in the US group and one in the EX group. Neither spon taneous healing, nor self-limiting of the disorder were noted during t he follow-up period. The progressive exercise evaluated in this study showed beneficial long-term effects compared to ultrasound treatment i n terms of pain alleviation and working ability, and the functional ov erall condition of the exercise patients was also better. Exercise may be able to prevent chronicity and should hence be tried and recommend ed.