Effects of Scapular Strength Exercise for Patients With Lateral Epicondylalgia

Study Overview
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Brief Summary
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the aim of the study is to determine whether a scapular strength exercise program combined with a conventional exercise program in epicondylar region in patients with lateral epicondylalgia produces statistically significant improvements in pain in the short and medium term compared to a conventional exercise program.

Detailed Description
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It is a single-blind clinical trial design, with third-party evaluation. There are two groups, the control group and the experimental group. In the control group, only the conventional exercise program for epicondylar muscles will be performed and the experimental group will also perform a scapular exercise program. Group assignment is randomized using the G* POWER software program, following the inclusion and exclusion criteria. Variables related to pain, functionality, pressure pain threshold, prehensile strength and quality of life will be measured. The study will last 7 months.

Official Title
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Effects of Scapular Strength Exercise for Patients With Lateral Epicondylalgia a Randomized Clinical Trial

Conditions
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Lateral Epicondylitis

Intervention / Treatment
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* Behavioral: Scapular program
* Behavioral: Conventional program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: tenderness over the epicondyle. Clinical diagnosis of LD for at least 3 months. Positive Mills and Maudsley test Exclusion Criteria: Patients with carpal tunnel syndrome, rheumatoid arthritis, cervical root syndrome, rotator cuff tendinopathy. Fractures or surgical history in the shoulder or elbow. History of elbow immobilization. Limitation in range of motion of the shoulder. Having undergone upper limb surgery in the last 6 months Unhealed wound in the region in the treatment area Impairment at a cognitive level that makes understanding with the therapist impossible. Neural entrapment of the radial nerve. Corticosteroid infiltration in the upper limb to be treated.

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There are two groups, the control group and the experimental group. In the control group, only the conventional exercise program for epicondylar muscles will be performed and the experimental group will also perform a scapular exercise program. Group assignment is randomized using the G* POWER software program.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1- Control group<br>They will performer the conventional exercise program por epicondylar muscles. | Behavioral: Conventional program<br>* They will be performing a combination of concentric-eccentric type contractions adding an isometric contraction<br>|
| Experimental: Group 2 - Experimental group<br>The experimental group will perform the conventional exercise program and also a scapular exercise program. | Behavioral: Scapular program<br>* the patient will be in prone. With the elbow extended, begin by raising the shoulder above the head, keeping the upper extremity in line with the fibers of the lower trapezius. The participant will then remain pronated with the elbow flexed at 90 degrees and the shoulder abducted and externally rotated. Starting from this position, you should exert the force towards external rotation and then return to internal rotation. For the last exercise, the subject will be placed in a standing position holding the elastic band with one hand while the other end will fix it to the ground, while stepping on it with the foot. You will start the movement with a shoulder elevation in the plane of the scapula above 120 degrees and then perform the eccentric returning to the starting position.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale for Pain | It will be measured with a 10 cm long horizontal line with descriptors at each end to help subjects identify their level of pain. The participants will mark with a cross the point of the line that most corresponds to the intensity of their symptoms. When interpreting the VAS, the respondent's cross position is usually assigned a score between 0 and 10. If documented on paper, pressures can simply be transferred to a scale of 100 values using a millimeter tape measure, although division into hundredths is considered sensitive enough. | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functionality | measured with the patient-rated tennis elbow evaluation Questionnaire.It is made up of 15 items, 5 focused on pain and the other 10 distributed between activities of daily living (4 items) and more specific activities (6 items). The result of each item is represented on a scale from 0 (totally painless activity) to 10 (maximum pain imaginable), so the total score can vary between 0 and 150. | 4 weeks | 
| grip strength | measured by dynamometer | 4 weeks | 
| The Quality of the lifestyle | measured with The Short Form-36 Health Survey Questionnaire.It is evaluated on a scale from 0 to 100, with the highest score being the maximum possible health and well-being. Finally, a total score is obtained from the questionnaire considering a score of 0-19 = very low, 20-39 = relatively low, 40-59 = average, 60-79 = relatively high and 80-100 = very high. | 4 weeks | 
| pressure threshold | measured by pressure algometer | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lateral epicondylalgia, tennis elbow, lateral epicondylitis, exercise, scapular muscle