***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Clinical observations have suggested a relationship between shoulder range of movement ( ROM ) and lateral epicondylalgia . This study reports the effect of a single intervention of a mobilization with movement ( MWM ) applied to the elbow , on shoulder rotation ROM in subjects with lateral epicondylalgia . Twenty-three subjects with lateral epicondylalgia were included . In a one-group pretest-post-test design , ROM of shoulder internal and external rotation were measured by goniometer before and after the application of the MWM , of both the unaffected and the affected limbs . Significant differences in pre-intervention external rotation ROM were found between unaffected and affected shoulders of subjects with lateral epicondylalgia , but no significant difference remained post-intervention . It may be concluded that restriction of shoulder rotation ROM is present in patients with lateral epicondylalgia , probably due to a facilitated level of shoulder rotator muscle tone . Shoulder internal and external rotation ROM increases significantly following MWM to the elbow , in subjects with unilateral lateral epicondylalgia . Surprisingly , these ROM increases are also apparent on the ' unaffected ' limb . These findings suggest that the MWM causes a neurophysiologically mediated decrease in resting muscle tone The treatment of lateral epicondylalgia , a widely-used model of musculoskeletal pain in the evaluation of many physical therapy treatments , remains somewhat of an enigma . The protagonists of a new treatment technique for lateral epicondylalgia report that it produces substantial and rapid pain relief , despite a lack of experimental evidence . A r and omized , double blind , placebo-controlled repeated- measures study evaluated the initial effect of this new treatment in 24 patients with unilateral , chronic lateral epicondylalgia .  Pain-free grip strength was assessed as an outcome measure before , during and after the application of the treatment , placebo and control conditions .  Pressure-pain thresholds were also measured before and after the application of treatment , placebo and control conditions . The results demonstrated a significant and substantial increase in pain-free grip strength of 58 % ( of the order of 60 N ) during treatment but not during placebo and control . In contrast , the 10 % change in pressure-pain threshold after treatment , although significantly greater than placebo and control , was substantially smaller than the change demonstrated for pain-free grip strength . This effect was only present in the affected limb . The selective and specific effect of this treatment technique provides a valuable insight into the physical modulation of musculoskeletal pain and requires further investigation BACKGROUND AND PURPOSE Lateral epicondylitis ( " tennis elbow " ) is a common entity . Several nonoperative interventions , with varying success rates , have been described . The aim of this study was to compare the effectiveness of 2 protocol s for the management of lateral epicondylitis : ( 1 ) manipulation of the wrist and ( 2 ) ultrasound , friction massage , and muscle stretching and strengthening exercises . SUBJECTS AND METHODS Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study . The subjects were r and omly assigned to either a group that received manipulation of the wrist ( group 1 ) or a group that received ultrasound , friction massage , and muscle stretching and strengthening exercises ( group 2 ) . Three subjects were lost to follow-up , leaving 28 subjects for analysis . Follow-up was at 3 and 6 weeks . The primary outcome measure was a global measure of improvement , as assessed on a 6-point scale . Analysis was performed using independent t tests , Mann-Whitney U tests , and Fisher exact tests . RESULTS Differences were found for 2 outcome measures : success rate at 3 weeks and decrease in pain at 6 weeks . Both findings indicated manipulation was more effective than the other protocol . After 3 weeks of intervention , the success rate in group 1 was 62 % , as compared with 20 % in group 2 . After 6 weeks of intervention , improvement in pain as measured on an 11-point numeric scale was 5.2 ( SD=2.4 ) in group 1 , as compared with 3.2 ( SD=2.1 ) in group 2 . DISCUSSION AND CONCLUSION Manipulation of the wrist appeared to be more effective than ultrasound , friction massage , and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up . However , replication of our results is needed in a large-scale r and omized clinical trial with a control group and a longer-term follow-up Abstract Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow . Design Single blind r and omised controlled trial . Setting Community setting , Brisbane , Australia . Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks ' duration , who had not received any other active treatment by a health practitioner in the previous six months . Interventions Eight sessions of physiotherapy ; corticosteroid injections ; or wait and see . Main outcome measures Global improvement , grip force , and assessor 's rating of severity measured at baseline , six weeks , and 52 weeks . Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter ( 47/65 of successes subsequently regressed ) and significantly poorer outcomes in the long term compared with physiotherapy . Physiotherapy was superior to wait and see in the short term ; no difference was seen at 52 weeks , when most participants in both groups reported a successful outcome . Participants who had physiotherapy sought less additional treatment , such as non-steroidal anti-inflammatory drugs , than did participants who had wait and see or injections . Conclusion Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks , providing a reasonable alternative to injections in the mid to long term . The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks , with high recurrence rates , implying that this treatment should be used with caution in the management of tennis elbow Abstract Cyriax and Cyriax advocated the use of deep transverse friction massage in combination with Mill 's manipulation in treating lateral epicondylalgia . Evidence comparing this approach with other physical therapies is lacking . The purpose of this r and omized clinical trial was to compare the effectiveness of deep transverse friction massage with Mill 's manipulation versus phonophoresis with supervised exercise in managing lateral epicondylalgia . Sixty patients age 30 - 60 , presenting with the teno-periosteal variety of lateral epicondylalgia with symptom duration greater than one month , were r and omized into two groups . The control group received phonophoresis with diclofenac gel over the area of the lateral epicondyle for 5 minutes combined with supervised exercise . The experimental group received 10 minutes of deep transverse friction massage followed by a single application of Mill 's manipulation . Both groups received treatment 3 times per week for 4 weeks . Outcomes of interest included pain via visual analog scale ( VAS ) , pain-free grip strength , and functional status measured with the Tennis Elbow Function Scale . Data were analyzed using a one-way ANOVA . Whereas both groups improved significantly from the initiation of treatment , a between-group comparison revealed significantly greater ( p<0.05 ) improvements regarding pain , pain-free grip , and functional status for the experimental group compared to the control group . The results of this study demonstrate that Cyriax physiotherapy is a superior treatment approach compared to phonophoresis and exercise in managing lateral epicondylalgia Objective : To compare the effectiveness of Cyriax physiotherapy , a supervised exercise programme , and polarized polychromatic non-coherent light ( Bioptron light ) in the treatment of lateral epicondylitis . Design : Controlled clinical trial . Setting : Rheumatology and rehabilitation centre . Subjects : This study was carried out with 75 patients who had lateral epicondylitis . They were allocated to three groups by sequential allocation . Interventions : Group A ( n=25 ) was treated with Cyriax physiotherapy . A supervised exercise programme was given to group B ( n=25 ) . Group C ( n=25 ) received polarized polychromatic non-coherent light ( Bioptron light ) . All patients received three treatments per week for four weeks . Outcomes : Pain was evaluated using a visual analogue scale and function using a visual analogue scale and pain-free grip strength at the end of the four-week course of treatment ( week 4 ) , one month ( week 8) , three months ( week 16 ) and six months ( week 28 ) after the end of treatment . Results : The supervised exercise programme produced the largest effect in the reduction of pain and in the improvement of function at the end of the treatment ( P<0.05 ) and at any of the follow-up time points ( P<0.05 ) . Conclusion : The supervised exercise programme should be the first treatment option for therapists when they manage lateral epicondylitis patients . If this is not possible , Cyriax physiotherapy and polarized polychromatic non-coherent light ( Bioptron light ) may be suitable This preliminary study indicates the proportion of patients with lateral epicondylalgia that demonstrate a favourable initial response to a manual therapy technique - the mobilization with movement ( MWM ) for tennis elbow . Twenty-five subjects with lateral epicondylalgia participated . In a one-group pretest - post-test design , we measured ( 1 ) pain with active motion  , ( 2 ) pain-free grip strength and , ( 3 ) maximum grip strength before and after a single intervention of MWM . Results of the study indicate that MWM was effective in allowing 92 % of subjects to perform previously painful movements pain-free , and improving grip strength immediately afterwards . Significant differences were found between the grip strength of the affected and unaffected limbs prior to the intervention . Both pain-free grip strength and maximum grip strength of the affected limb increased significantly following the intervention . Pain-free grip strength increased by a greater magnitude than maximum grip strength . It can be concluded that MWM is a promising intervention modality for the treatment of patients with Lateral Epicondylalgia .  Pain-free grip strength is a more responsive measure of outcome than maximum grip strength for patients with Lateral Epicondylalgia . Further research is warranted to investigate the long-term effectiveness of MWM in the treatment of impairment and disability result ing from Lateral Epicondylalgia BACKGROUND AND PURPOSE Mulligan has proposed the use of mobilization with movement for lateral epicondylalgia . In this study , mobilization with movement for the elbow was examined to determine whether this intervention was capable of inducing physiological effects similar to those reported for some forms of spinal manipulation . PARTICIPANTS Seven women and 17 men ( mean age=48.5 years , SD=7.2 ) with chronic lateral epicondylalgia participated in the study . METHODS A placebo , control , repeated- measures study was conducted to evaluate whether mobilization with movement at the elbow produced concurrent hypoalgesia and sympathoexcitation . RESULTS The treatment demonstrated an initial hypoalgesic effect and concurrent sympathoexcitation . Improvements in pain result ed in increased pain-free grip force and pressure pain thresholds . Sympathoexcitation was indicated by changes in heart rate , blood pressure , and cutaneous sudomotor and vasomotor function . DISCUSSION AND CONCLUSION This study showed that a mobilization with movement treatment technique exerted a physiological effect similar to that reported for some spinal manipulations We performed a prospect i ve , r and omised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow . The main outcome measures were the severity of pain , pain provoked by resisted dorsiflexion of the wrist , and patient satisfaction . At six weeks 22 of 53 patients in the injection group were free from pain compared with only three in the physiotherapy group . In the corticosteroid-treated group 26 patients had no pain on resisted dorsiflexion of the wrist compared with only three in the physiotherapy group . Thirty-five patients who had injections and 14 who had physiotherapy  were satisfied with the outcome of treatment at six weeks . At the final assessment there were 18 excellent and 18 good results in the corticosteroid group and one excellent and 12 good results in the physiotherapy group . There was a significant increase in grip strength in both groups but those with injections had a significantly better result . After one year there were no significant differences between the two groups . Half of the patients , however , had received only the initial treatment , 20 % had had combined therapy and 30 % had had surgery . We conclude that at six weeks , treatment with corticosteroid injections was more effective than Cyriax physiotherapy and we recommend it because of its rapid action , reduction of pain and absence of side-effects Carpal tunnel syndrome is the most common peripheral entrapment neuropathy . There is little literature available that addresses the management of this condition , which may partly explain why physiotherapy is often overlooked as a treatment approach in its management . This study investigated the effects of two manual therapy techniques in the treatment of patients experiencing carpal tunnel syndrome . An experimental different subject design compared three groups of subjects in three different conditions  ( two treatment interventions  and one control group )  . Each group consisted of seven patients . The objectives of the study were : ( 1 ) to investigate differences between treated and untreated groups ; ( 2 ) to investigate differences in the effectiveness of treatment I ( median nerve mobilization ) compared with treatment II ( carpal bone mobilization ) . Measurements were taken applying several measurement tools , including active range of wrist movement ( ROM flexion and extension ) , upper limb tension test with a median nerve bias ( ULTT2a ) , three different scales to evaluate pain perception and function , and lastly numbers of patients continuing to surgery in each group were compared . In visual terms a clear trend was demonstrated between subjects who received treatment compared to those who were not treated , in particular the 
    Output:
    
RESULTS The current evidence provides moderate support for the inclusion of joint mobilizations in the treatment of lateral epicondylalgia ( LE ) .
Other described techniques include those known as Kaltenborn , Cyriax physical therapy , and Maitl and , but the evidence for these techniques is limited .
There is also limited evidence for the joint mobilizations in the treatment of wrist and h and conditions .
The current literature offers limited support for joint mobilizations of the wrist and h and , and moderate support for joint mobilizations of the elbow for LE .
There is moderate support for mobilization with movement .
