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Cancela-Cilleruelo, IgnacioAuthorRodriguez-Jimenez, JorgeAuthorFernandez-De-Las-Penas, CesarCorresponding AuthorArias-Buria, Jose LAuthor
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Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case-Control Study

Publicated to:Physical Therapy. 104 (9): pzae075- - 2024-09-24 104(9), DOI: 10.1093/ptj/pzae075

Authors: Cancela-Cilleruelo, Ignacio; Rodriguez-Jimenez, Jorge; Fernandez-de-las-Penas, Cesar; Cleland, Joshua A; Arias-Buria, Jose L

Affiliations

Tufts Univ, Sch Med, Phys Therapy Program, Boston, MA USA - Author
Univ Rey Juan Carlos, Dept Phys Therapy Occupat Therapy Phys Med & Rehab, Alcorcon, Spain - Author
Univ Rey Juan Carlos, Escuela Int Doctorado, Alcorcon, Spain - Author

Abstract

Objective The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE).Methods Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5-C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, and width) of the common wrist extensor tendon and extensor carpi radialis brevis muscle as well as the thickness of the supinator muscle were assessed.Results Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space on the symptomatic side as compared to the nonsymptomatic side (eta 2 from 0.123-0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (eta 2 from 0.268-0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (eta 2 = 0.039; small effects) on the painful side than on the nonpainful side.Conclusions This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE.Impact Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE.

Keywords
AdultCase-control studiesCentral sensitizationComplaintsDisabilityFemaleHumansHyperalgesiaLateral epicondylalgiaMaleMetaanalysisMiddle agedMuscleMuscle, skeletalPainPain measurementPain thresholdPathologPressurePressure pain thresholdReliabilitySex-differencesTendinopathyTendoTendonTendonsTennis elbowThresholdUltrasonographyWrist

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Physical Therapy due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 14/136, thus managing to position itself as a Q1 (Primer Cuartil), in the category Orthopedics. Notably, the journal is positioned above the 90th percentile.

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-09:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 2.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 2 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.5.
  • The number of mentions on the social network X (formerly Twitter): 3 (Altmetric).
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Cancela Cilleruelo, Ignacio) and Last Author (Arias Buría, José Luis).

the author responsible for correspondence tasks has been Fernández de las Peñas, César.