The purpose of this study was to explore the effectiveness of chiropractic manipulative therapy on the wrist, in treating lateral epicondylitis. It also aimed to determine the effectiveness of Mills’ manipulation applied to elbow, and whether adjusting both the elbow and the wrist would be more effective than simply adjusting the elbow or the wrist in isolation. Thirty patients suffering from lateral epicondylitis who conformed to specific diagnostic criteria were accepted for the trial. The patients were stratified according to age and sex and placed into three groups of ten. The first group received chiropractic manipulative therapy directed to the wrist. The second group received chiropractic manipulative therapy directed to the elbow complex, and the third group received chiropractic manipulative therapy directed at both areas. The treatment consisted of four sessions over a period of 2 weeks. The groups were assessed and compared in terms of objective and subjective measurements to determine the most beneficial treatment. The data was collected at the beginning of each treatment session. Subjective data consisted of the Numerical Pain Rating Scale 101 (Vernon in Liebenson, 1996:61) and the short form Mc Gill Pain Questionnaire (Melzack, 1987:192), which assessed patients’ discomfort levels. Objective data was collected by means of the Jamar Grip Strength Dynamometer (Kaufman, 2000:619) and the Pressure Algometer (Fischer, 1987:213), which measured the grip strength and pressure pain threshold respectively. The results showed that both wrist and Mills’ manipulation in isolation as well as in combination are beneficial in treating lateral epicondylitis, in that they all showed subjective and objective improvements. The Mills’ manipulation alone and in combination with wrist manipulations had superior clinical effects compared to the wrist manipulations in isolation. The statistical results of the inter-group analysis revealed that there was no significant difference between the outcomes of the wrist manipulation, Mills’ manipulation and combined treatment protocols and therefore none are expressly recommended above the other. / Dr. C. Yelverton Dr. C. Lyons

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

[Truncated abstract] The aim of the research was to explore the association between wrist guard use and wrist fracture risk in snowboarders in Australia. During the study, the opportunity was also taken to examine the relationship between wearing wrist guards and the severity of wrist and elbow injury. A case-control study was conducted at the Mount Buller Medical Centre, Victoria, Australia. A total of 494 participants was recruited during the 2004 and 2005 ski seasons. Cases were defined as any snowboarder seen at the Clinic with a fractured wrist (N = 119), and controls as any snowboarder seen at the clinic for any reasons other than a fractured wrist (N = 375). Severity of forearm injuries were defined and analysed separately. Study participants completed a questionnaire consisting of: basic demographics (age and sex only); wrist guard use on the day of presentation; normal use of protective equipment; the number of days spent snowboarding that season; the ability of the snowboarder; and ski run difficulty. Risk taking behaviour was assessed by a history of any previous fracture or joint injury and psychometric questions. Clinic medical staff recorded site and severity of fractures and soft tissue injuries. Logistic regression was used to obtain adjusted odds ratios for these risk factors against the main outcome measure. Presence of wrist fracture and injury in snowboarders with and without wrist guards. ... There was a significant association between wrist guard use and soft tissue elbow injuries (adjusted odds ratio = 17.6, p = 0.011, 95% CI: 1.93 – 160.2), but no significant association with elbow fractures (adjusted odds ratio = 1.84, p = 0.385, 95% CI: 0.46 – 7.30). There was thus no evidence in this study that wrist guards increase the occurrence of other severe injuries in the forearm by transferring the impact force away from the protected wrist up the arm. No evidence was found for compensatory risk taking behaviour in participants wearing protective equipment. A local injury prevention strategy was implemented in schools in the Mt Buller district during the course of this study. Education about the protective effects of wrist guards enabled a policy change in the local secondary college so that wrist guard use is now mandatory for all snowboarders in the school ski programme: That policy states: