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Effectiveness of radial nerve mobilization techniques and their interfaces for treating chronic epicondylalgia
Intervention: This is a randomized controlled clinical trial that will evaluate the effectiveness of adding radial nerve and its interface mobilization techniques to conventional musculoskeletal treatment.
Participants: Patients over 18 years of age with a diagnosis of chronic epicondylalgia and a positive radial nerve neurodynamic test. Those with previous infiltrations, concomitant pathologies, or contraindications will be excluded.
Study Groups:
Primary Outcomes:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Group | Experimental | The subjects in this group will receive a physical therapy protocol based on massage therapy, pressure release of myofascial trigger points, manual mobilization technique (Mulligan), neurodynamic mobilization, and a real Diacutaneous Fibrolysis (instrument-assisted soft tissue mobilization). The intervention will be administered once per week for four weeks. |
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| Control Group | Sham Comparator | The subjects in this group will receive a physical therapy protocol based on massage therapy, pressure release of myofascial trigger points, manual mobilization technique (Mulligan), and a Sham Diacutaneous Fibrolysis (instrument-assisted soft tissue mobilization). The intervention will be administered once per week for four weeks. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Forearm massage | Other | A general massage of the forearm will be performed. The physical therapist perform deep, longitudinal strokes. Pressure will be maintained at a level the patient finds comfortable for 3 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity | Numeric Pain Rating Scale. Score from 0 to 10. Zero is equivalent to no pain and 10 indicates the worst possible pain. | From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain and Functional Disability | Patient-Rated Tennis Elbow Evaluation. Score from 0 to 100. Higher score indicates more pain and functional disability and zero indicates no pain and disability. | From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Handgrip |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universitat Internacional de Catalunya | Barcelona | Spain |
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Treatment protocol based on massage therapy, pressure release of myofascial trigger points, manual mobilization technique (Mulligan), and Diacutaneous Fibrolysis.
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| Pressure release for forearm trigger points | Other | Pressure will be applied to trigger points in the forearm. This will be done in three sets of 30-second applications, with 30 seconds of rest between each. |
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| Mulligan mobilization with movement technique | Other | A lateromedial glide will be performed. The technique will be applied for three sets of 10 repetitions, with 30 seconds of rest between each set. |
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| Radial Nerve Neurodynamic Mobilization | Other | Three sets of 30 nerve glides will be performed at a rhythm of one second of tension followed by one second of rest. There will be 30 seconds of rest between sets. |
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| Diacutaneous fibrolysis (Real) | Other | A real technique of Diacutaneous fibrolysis will be applied to the forearm region for 5 minutes. |
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| Diacutaneous Fibrolysis (Sham) | Other | A sham Diacutaneous Fibrolysis technique (skin pinch) will be applied to the forearm region for 5 minutes. |
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Grip strength is assessed in kilograms. The value used is the average of three repetitions. |
| From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Pressure pain threshold - Elbow | Pressure pain threshold at the elbow. The lowest intensity of pressure that the subject perceives as pain when applied to the lateral epicondyle is recorded. The value used will be in kilograms per square centimeter. | From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Pressure pain threshold - short radial extensor | Pressure pain threshold at the Short radial extensor.The lowest intensity of pressure that the subject perceives as pain when applied to the short radial extensor is used. The value used will be in kilograms per square centimeter. | From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Pressure pain threshold - Radial nerve | Pressure pain threshold at the radial nerve. It is used to record the lowest intensity of pressure that the subject perceives as pain when applied to the radial nerve tunnel. The value used will be in kilograms per square centimeter. | From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Central sensitization syndrome | Central Sensitization Inventory. The questionnaire is scored on a scale from 0 to 100. A score above 40 is considered to indicate central sensitization. | From enrollment to the end of treatment (4 weeks), and to the end of the study at 16 weeks. |
| Subjective perception of clinical evolution | Global Rating of Change scale. The scale consists of 15 points, ranging from -7 ("Much worse") to +7 ("Much better"). For clinical interpretation, values below "Somewhat better" or "Somewhat worse" are considered clinically unchanged. Values greater than or equal to "Somewhat better" are considered clinically improved, and values greater than "Somewhat worse" are considered clinically worsened. | From the 4 week to the end of study at 16 weeks |
| ID | Term |
|---|---|
| D013716 | Tennis Elbow |
| ID | Term |
|---|---|
| D000070639 | Elbow Tendinopathy |
| D052256 | Tendinopathy |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D000092464 | Elbow Injuries |
| D001134 | Arm Injuries |
| D014947 | Wounds and Injuries |
| D013708 | Tendon Injuries |
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| ID | Term |
|---|---|
| D009068 | Movement |
| C005703 | salicylhydroxamic acid |
| ID | Term |
|---|---|
| D010829 | Physiological Phenomena |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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