An evaluation of treatment options for lateral epicondylitis

Amac: Dirsek yan agrisi, ortopedi ve fizik tedavi pratiginde sik karsilasilan bir problemdir. Farkli konservatif tedavi secenekleri mevcut olup, birbirlerine ustunlukleri konusunda fikir birligi yoktur. Bu calismada lateral epikondilit tanisiyla takip edilen hastalarda uc farkli tedavi yonteminin etkinligini degerlendirilmek amaclanmistir. Yontemler: 2010-2016 yillari arasinda lateral epikondilit tanisiyla takip edilen ve konservatif olarak tedavi edilen 105 hasta calismaya dahil edildi. Hastalar yapilan tedavi metoduna gore 3 gruba ayrildi. Birinci gruptaki 28 hastaya 1 ml betametazon dipropiyonat (Diprospan®, Schering-Plough Corp., Kenilworth, NJ, ABD), ikinci gruptaki 28 hastaya sadece 1 ml lokal anestezik prilokain hidroklorur (Citanest®, AstraZeneca plc., Londra, Birlesik Krallik), ayni yontemle 30-40 kez igne ucu ciltten cikarilmadan ayni bolgeye batirilip cikarilarak (peppering yontemiyle) uygulandi. Ucuncu gruptaki 49 hastaya Ekstrakorporeal sok dalga terapisi (ESWT) tedavisi uygulandi. Tedavi oncesi ve 1. 3. ve 6. aydaki veriler degerlendirildi. Klinik skorlar Quick Dash (Q-DASH, Quick disabilities of arm, shoulder and hand) skorlama sistemine gore degerlendirilerek, hastalarin gunluk yasam aktiviteleri sirasindaki VAS (Visual Analog Scale) skorlarina bakildi. Yasam kalitesi ve hasta memnuniyeti duzeyleri Quick Dash skorlarina gore degerlendirildi. Bulgular: Her uc yontemde tedavi sonrasi birinci ay, ucuncu ay ve altinci aydaki VAS skorunda ve hastanin yasam kalitesinde tedavi oncesine gore anlamli olarak iyilesme gozlendi (P<0,001). Ilk iki grupta ESWT grubuna gore daha yuksek hasta memnuniyet orani tespit edildi (P<0,001). Sonuc: Her uc yontem icinde anlamli memnuniyet oranlari ile karsilasilmis olup, peppering yontemiyle uygulanan kortikosteroid (KS) tedavisinin ayni yontemle uygulanan lokal anesteziklere ustunlugu olmadigi gorulmustur. Ucuncu yontemin (ESWT) faydali oldugu gorulse de digerlerine gore daha az etkili oldugu ve daha maliyetli oldugu sonucuna varildi.

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