151
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Johansson B. [Lateral epicondylitis and the cervical spine]. LAKARTIDNINGEN 1999; 96:1558. [PMID: 10218335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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152
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Sollender JL, Rayan GM. Videotapes in evaluating work-related upper extremity symptoms. THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 1999; 92:109-13. [PMID: 10087671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Thirteen patients with upper extremity symptoms that were claimed to have occurred in the course of employment were evaluated to determine the role of videotapes in their evaluation and management. Videotapes were of two types: work demonstration by patient or coworker (8 tapes) and surveillance tapes obtained by a private investigator (5 tapes). Four of eight work station videotapes demonstrated significant repetitive motion that could have contributed to their symptoms. Four of eight work station videotapes demonstrated that the tasks were neither forceful nor repetitive in nature. Return to work recommendations were made based on both clinical grounds and job site information provided on tape. After viewing five surveillance videotapes, two fraudulent claims were settled soon after medical opinions were rendered. Two patients were declared able to return to work; one returned to work and the other was dismissed. The videotape of patient No. 13 was not crucial for the decision and he was authorized to have surgery. The opinions formed concerning the causality of alleged claims of injury were often altered by viewing the content of the videotapes. Videotapes are a valuable tool and useful adjunct in the overall management of the workers with upper extremity symptoms.
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153
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Baquie P. It's tennis elbow: but what is that? AUSTRALIAN FAMILY PHYSICIAN 1999; 28:266-7. [PMID: 10098307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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154
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Pfahler M, Jessel C, Steinborn M, Refior HJ. Magnetic resonance imaging in lateral epicondylitis of the elbow. Arch Orthop Trauma Surg 1999; 118:121-5. [PMID: 9932184 DOI: 10.1007/s004020050330] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of the study was to determine the changes that might be detected using magnetic resonance imaging (MRI) on patients with chronic lateral epicondylitis of the elbow and to judge its value concerning the clinical treatment. Thirty-four patients with chronic lateral epicondylitis were included in a prospective study. All individuals underwent MRI of the elbow on a 0.2-T dedicated system. The MRI findings were interpreted by an independent radiologist without knowledge of the clinical findings. In 6 surgical cases an additional histological study was done. The biopsy of the extensor tendon was performed for correlation with the MRI. In 21 of 34 symptomatic patients, increased signal changes in T1- and T2-weighted images were seen. In a further 11 cases, the morphology and signal intensity were normal. The histopathological analysis of 6 surgical cases confirmed the preoperative MRI findings by showing either focal fibrous degenerative tendon tissue or microruptures of collagenous fibres. MRI in patients with chronic lateral epicondylitis can help to differentiate the disease and may be of use in clinical management, preoperative planning, and in the evaluation of the degree of degeneration at the common extensor tendon insertion.
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155
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Sölveborn SA. ["Tennis elbow" is usually caused by other than tennis. The earlier the treatment the better; spontaneous remission occurs often within 8-13 months]. LAKARTIDNINGEN 1999; 96:483-5. [PMID: 10064937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Although both the incidence and prevalence of tennis elbow (radial epicondylalgia) are 1(2 per cent among adults, the disorder is attributable to tennis in only about five per cent of cases, even if about 50 per cent of tennis players over thirty are affected. The condition often resolves spontaneously in 8(13 months. The basic diagnostic criteria are tenderness at palpation on the radial epicondyle of the humerus, and radial pain on extension of the wrist against resistance with the elbow extended. Maudsley's middle finger test, Mill's manoeuvre and the chair-lift test will confirm the diagnosis. Treatment outcome is best in first-ever cases with a duration of less than three months. In the absence of satisfactory documentation, there is no consensus as to which non-surgical methods are to be preferred. Local cortisone injection provides good relief initially, though recurrence within three months is common. Surgery, resorted to in cases refractory to other treatment, relatively often yields good results, especially if executed earlier than hitherto has been recommended.
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156
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Fritz RC. MR imaging of sports injuries of the elbow. Magn Reson Imaging Clin N Am 1999; 7:51-72, viii. [PMID: 10067223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Recent clinical experience has shown MR imaging to provide useful information in detecting, assessing, and characterizing sports-related disorders of the elbow. This article discusses features of MR imaging, including noninvasivness; accurate depiction of structures (muscles, ligaments, and tendons), and presence and extent of bone and soft tissue pathology; and visualization (nerves, bone marrow, and hyaline cartilage). The article also reviews ongoing improvements in surface coil design, and newer pulse sequences resulting in MR images that are higher in quality and available more quickly.
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157
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Abstract
This article discusses the origin and histology of conditions causing pain around the elbow as well as possible treatments. Specific conditions examined include epicondylitis and medial, posterior, and anterior musculotendinous injuries.
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158
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Davis TR. Diagnostic criteria for upper limb disorders in epidemiological studies. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1998; 23:567-9. [PMID: 9821594 DOI: 10.1016/s0266-7681(98)80002-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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159
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Halloran L. Bilateral epicondylitis in a karate instructor. Orthop Nurs 1998; 17:28-30. [PMID: 9832884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Epicondylitis can be a debilitating condition that restricts activity and causes pain. Severe cases can require surgical repair. Early and thorough assessment and instituting treatment expeditiously will help prevent lengthy rehabilitation. It is well documented that sports requiring repetitive wrist movements or tension overloading of wrist extensors, such as racquet sports and bowling, are associated with the development of epicondylitis. In this case study, the sport of karate precipitated this condition in a 38-year-old instructor. The significance of karate as a possible risk factor in epicondylitis is important given the proliferation of karate schools, especially those for children.
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160
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De Marco F, Ricci MG, Bonaiuti D. Clinical trials among worker populations: the value and significance of anamnestic findings and clinical and instrumental tests for diagnosing work-related musculoskeletal disorders of the upper limbs (WMSDs). ERGONOMICS 1998; 41:1322-1339. [PMID: 9754034 DOI: 10.1080/001401398186333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors discuss the value and significance of symptoms in WMSDs, in view of the fact that the anamnestic threshold proposed in epidemiological investigations cannot be used as clinical and diagnosing criteria. Some useful clinical procedures are suggested for cases where there is a suspicion of musculoskeletal disorders of the cervical spine and upper limbs, bearing in mind that they are to be applied within the framework of health surveillance programmes undertaken by health care practitioners who are not specialists in orthopaedics, physiatrics or neurology. The recommendations for instrumental tests and specialist referrals are also discussed for the various disorders. The authors also provide flow charts for the diagnostic procedures pertaining to WMSDs. The appendix shows a sample patient chart illustrating the proposed procedures; it also permits the findings to be encoded so that they can be stored in a dedicated database. The codes for diagnosing WMSDs are also reported for the same epidemiological purposes.
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Abstract
Athletes of all ages and skill levels are increasingly participating in sports involving overhead arm motions, making elbow injuries more common. Among these injuries is lateral epicondylitis, which occurs in over 50% of athletes using overhead arm motions. Lateral epicondylitis is characterised by pain in the area where the common extensor muscles meet the lateral humeral epicondyle. The onset of this pathological condition begins with the excessive use of the wrist extensor musculature. Repetitive microtraumatic injury can lead to mucinoid degeneration of the extensor origin and subsequent failure of the tendon. Lateral epicondylitis can almost always be treated nonoperatively with activity modification and specific exercises. If the athlete fails to respond to nonoperative treatment after 6 months to 1 year, they are candidates for surgical intervention. Medial epicondylitis is characterised by pain and tenderness at the flexor-pronator tendinous origin with pathology commonly being located at the interface between the pronator teres and flexor carpi radialis origin. Golfers and tennis players often develop this condition because of the repetitive valgus stress placed on the medial elbow soft tissues. Careful evaluation is important to differentiate medial epicondylitis from other causes of medial elbow pain. As with lateral epicondylitis, patients with medial epicondylitis not responding to an extensive nonoperative programme are candidates for surgical intervention. A less common cause of medial elbow pain is medial ulnar collateral ligament injury. Repetitive valgus stress placed on the joint can lead to microtraumatic injury and valgus instability. When the medial ulnar collateral ligament is disrupted, abnormal stress is placed on the articular surfaces that can lead to degenerative changes with osteophyte formation. As with other elbow injuries, a strict rehabilitation regimen is first employed; ligament reconstruction is only recommended if the injury fails to improve and only in athletes requiring a high level of performance. Excessive valgus stress can also lead to posteromedial olecranon impingement on the olecranon fossa producing pain, osteophyte and loose body formation. Arthroscopic elbow debridement can often be helpful in improving motion and in reducing pain in such patients.
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162
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Friedman PJ. Isokinetic peak torque in women with unilateral cumulative trauma disorders and healthy control subjects. Arch Phys Med Rehabil 1998; 79:816-9. [PMID: 9685097 DOI: 10.1016/s0003-9993(98)90362-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare isokinetic peak torque in the symptomatic and asymptomatic limbs of women with lateral epicondyle or forearm pain due to cumulative trauma disorders (CTDs), and to compare peak torque in women with CTDs to peak torque in healthy women. DESIGN Case control comparison. SETTING Private occupational rehabilitation clinic and a sports science tertiary education center. SUBJECTS Women with CTDs involving one arm (n=17) and a convenience sample of healthy women (n=7) INTERVENTION Subjects performed isokinetic strength testing for wrist extension and flexion, wrist supination and pronation, and knee extension and flexion. MAIN OUTCOME MEASURES Peak torque at 120 degrees/sec on a Biodex isokinetic dynamometer. RESULTS Control subjects had significantly higher peak torque in wrist extension, flexion, supination, and pronation than CTD subjects on the symptomatic side. Control subjects also had significantly higher peak torque of wrist flexion, pronation, and supination than CTD subjects on the asymptomatic side; wrist extension was greater, but this did not reach significance. In addition, control subjects had significantly higher peak torque in knee extension and flexion than CTD subjects. CTD subjects had significantly greater left-right asymmetry in wrist extension torque than did control subjects. CONCLUSIONS Isokinetic peak torque is diffusely reduced in women with unilateral CTDs compared with healthy control subjects, these differences occurring in symptomatic and asymptomatic limbs.
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163
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Gabel GT, Morrey BF. Tennis elbow. Instr Course Lect 1998; 47:165-72. [PMID: 9571414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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164
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Taylor MD. Tennis elbow ... or is it? AUSTRALIAN FAMILY PHYSICIAN 1998; 27:298. [PMID: 9581341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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165
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Harrington JM, Carter JT, Birrell L, Gompertz D. Surveillance case definitions for work related upper limb pain syndromes. Occup Environ Med 1998; 55:264-71. [PMID: 9624281 PMCID: PMC1757569 DOI: 10.1136/oem.55.4.264] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. RESULTS Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diffuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. CONCLUSIONS There was enough consensus between several health professionals from different disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management.
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Abstract
OBJECTIVE To systematically evaluate the MR findings in patients with epicondylitis compared with asymptomatic volunteers. DESIGN AND PATIENTS We imaged 43 elbows: 24 with epicondylitis (22 lateral, 2 medial) diagnosed by clinical examination, and 19 in 16 normal volunteers. MRI was performed at 1.5 T using axial T1-weighted, axial fat-saturated FSE, and coronal or sagittal Fast STIR sequences. Two independent observers evaluated the images for intratendon signal, tendon thickening, periosteal reaction, fluid in the radial head bursa, and anconeus edema. RESULTS All 24 patients with epicondylitis had increased signal on fat-saturated FSE and Fast STIR images. Twenty-two of these patients had increased intratendon T1 signal, and 19 had tendon thickening. No patient demonstrated fluid in the radial head bursa or periosteal reaction. Only two patients had subtle anconeus edema, while three patients unexpectedly had increased T2 signal within the involved epicondyle. One asymptomatic volunteer (high-performance athlete) had increased T1 and T2 signal with tendon thickening. An additional two asymptomatic volunteers had increased T1 signal only. CONCLUSION MRI of epicondylitis demonstrates tendon thickening with increased T1 and T2 signal, but these findings may be seen in a small minority of asymptomatic individuals. Anconeus edema, previously demonstrated on MRI in epicondylitis, was only rarely found, and distension of the radial head bursa, surgically described, was not seen. Increased marrow T2 signal within the involved epicondyle is occasionally seen.
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167
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Thurston AJ. The early history of tennis elbow: 1873 to the 1950s. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:219-24. [PMID: 9563455 DOI: 10.1111/j.1445-2197.1998.tb04751.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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168
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Krischek O, Pompe JD, Hopf C, Vogel J, Herbsthofer B, Nafe B, Bürger R. [Extracorporeal shockwave therapy in epicondylitis humeri ulnaris or radialis--a prospective, controlled, comparative study]. ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE 1998; 136:3-7. [PMID: 9563178 DOI: 10.1055/s-2008-1044642] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM OF THE STUDY Has extracorporal shockwave therapy in chronic golfer's elbow comparable results as in tennis elbow? METHOD 30 patients for extracorporal shockwave therapy who suffered from chronic medial epicondylitis (group I) and 30 patients with persistent tennis elbow (group II) received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. The final follow-up examination was done after 24 weeks. RESULTS Significant differences in relief of pain and improvement of function were observed in favour of group II. Good or excellent outcome was found in only 27% for the epicondylitis humeri ulnaris, but in 60% for epicondylitis humeri radialis. CONCLUSION The indication for extracorporeal shock-wave therapy in medial epicondylitis must be questioned.
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169
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Abstract
This article focuses on the use of magnetic resonance in the evaluation of the soft tissue (tendons, ligaments, muscles, and nerves) and osseous structures of the elbow. The need for high quality, high resolution imaging with attention to positioning, sequence selection, and equipment is emphasized. Normal magnetic resonance anatomy and criteria for pathologic change are presented.
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170
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Ho CP. MR imaging of tendon injuries in the elbow. Magn Reson Imaging Clin N Am 1997; 5:529-43. [PMID: 9219717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tendon injuries are among the more common sources of elbow pain, resulting from occupational and sports activities as well as the activities of daily living. The exquisite soft-tissue contrast resolution and multiplanar capability of MR imaging have proven ideal for evaluating, diagnosing, and managing tendon injuries. Familiarity with normal anatomy, the spectrum of tendon derangement from tendinosis to complete tears, and the typical injury mechanisms involved in tendinopathy about the elbow are all invaluable for appropriate MR imaging examination and interpretation.
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171
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Eshman SJ, Posner MA, Hochwald N, Rosenberg ZS. The role of MR imaging in the management of elbow problems. Magn Reson Imaging Clin N Am 1997; 5:443-50. [PMID: 9219712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the past several years, the role of MR imaging in diagnosing pathologic conditions of the elbow has dramatically increased. Aside from imaging soft-tissue tumors, it can accurately visualize partial and complete tears of tendons and ligaments, as well as displacement of epiphyseal fractures in children. Its role in identifying loose bodies, particularly when they are nonosseous, and areas of osteochondritis dissecans has also increased. The use of MR imaging for diagnosing neuropathies, particularly when electrodiagnostic studies are negative, offers exciting possibilities as additional technical improvements are developed.
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172
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Seegenschmiedt MH, Keilholz L, Martus P, Kuhr M, Wichmann G, Sauer R. [Epicondylopathia humeri. The indication for, technic and clinical results of radiotherapy]. Strahlenther Onkol 1997; 173:208-18. [PMID: 9148433 DOI: 10.1007/bf03039290] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The efficacy of radiotherapy for degenerative-inflammatory disorders is well known, but so far long-term observations and reliable assessment of symptoms according to objective criteria and scores for validation are still missing. PATIENTS AND METHOD From 1986 to 1991, 104 patients with refractory epicondylopathia humeri were irradiated. 85 patients or 93 elbows (due to double-sided symptoms) were documented in long-term follow-up according to objective criteria. All patients had received intensive therapy. Pain symptoms were quantified in "categories" and "grades" prior to and 6 weeks after radiotherapy and at last follow-up. In addition, the elbow score of Morrey et al. [36] was used for long-term evaluation. The onset of pain symptoms was acute in 41 and chronic in 52 cases. The mean symptom duration prior to radiotherapy was 16 months. Pain was mostly triggered off during professional (46) or sportive activities (23) or spontaneously (11). Fifty-one patients were severely disabled in professional or sportive activities. The involved elbow(s) received 2 radiotherapy series of 6 x 1 Gy (total 12 Gy) with 3 fractions per week; the second radiotherapy series was started 6 weeks after the first series. Mean follow-up was 4 +/- 2 (1 to 8) years. RESULTS Forty-three patients (50 elbows) achieved "complete pain relief (CR)" in all pain categories: 59% elbows with pain at strain had "complete pain relief", 79% with pain at night, 84% with permanent pain, 80% with pain at rest and 81% with pain at initiation or morning stiffness. Nineteen elbows gained "major pain relief (PR)", i.e. had minor symptoms (maximum grade 1) in all categories. Thus, a total of 69 (74%) elbows responded to radiotherapy. Seventeen patients (19 elbows) were operated because of persistent symptoms or dissatisfaction in long-term follow-up; 7 of those became completely free of symptoms. The Morrey-Score improved by a mean of 18 points from 78 prior to radiotherapy to 96 points at last follow-up. According to the Morrey-Score only 2 patients became worse in long-term follow-up. Two parameters indicated a negative prognosis in multivariate analysis: long symptom duration prior to radiotherapy and immobilisation with plaster (p < 0.05). CONCLUSIONS Radiotherapy for refractory epicondylopathia humeri is highly effective. Long symptom duration and long-term immobilisation by plaster are negative prognostic factors for treatment outcome. Due to the low side effects and treatment costs, radiotherapy is a good therapeutic option in comparison to conventional treatment methods and surgery in the chronic stage of epicondylopathia humeri.
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Heyd R, Schopohl B, Kirchner J, Strassmann G, Böttcher HD. [Radiotherapy of epicondylopathy of the humerus]. Dtsch Med Wochenschr 1997; 122:247-52. [PMID: 9102289 DOI: 10.1055/s-2008-1047604] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the efficacy of radiotherapy in alleviating pain at rest and on exercise in tennis elbow (humeral epicondylitis). PATIENTS AND METHODS 45 elbow joints in 41 patients were radiated with a telecobalt unit in six sessions at a dose of 1.0 Gy each spread over 3 weeks. Indication for this treatment was pain in the elbow joint at rest, on pressure and on exercise. The patients were re-assessed after a mean follow-up period of 7.5 weeks. They were graded into one of five groups on the basis of their own assessment. Pain on exercise was determined by the Thompson hand-grip, chair test, forced extension and middle-finger stretch test. RESULTS Satisfactory analgesia was achieved in 31 of 45 elbow joints (68.9%). About 50% of patients still had objectifiable pain on exercise. CONCLUSIONS Radiotherapy is a highly efficacious means of pain alleviation in tennis elbow, but the results are better for pain at rest than on exercise. The Thompson hand-grip and chair test, positive in more than 90% of patients, proved to be reliable criteria to assess the indications for radiotherapy and its results.
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Albrecht S, Kleihues H, Cordis R, Noack W. Diagnostic and therapeutic strategies for the operative treatment of radiohumeral epicondylopathy. Arch Orthop Trauma Surg 1997; 116:164-72. [PMID: 9061172 DOI: 10.1007/bf00426066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examined the extent and effect of an assumed neuromuscular transmission disorder by performing a prospective clinical study on 75 patients with therapy-resistant radiohumeral epicondylopathy. Before operating, we diagnosed with electromyography an increased rate of polyphasic potentials of the long wrist extensors as well as a prolonged motor latency of the respective muscles. Disordered neuromuscular recruitment combined with a reduced maximum strength and elasticity corresponding to the suspected damage to the distal part of the motor neuron could be proven. Both effects were significantly reversible (P < 0.001) through operative intervention. We found a significant correlation (> 0.90) between the normalization of the motor latency and increased strength. Subgroups were formed according to different preoperative diagnostic efforts and differing radicality regarding the type of soft-tissue operation performed; thus, the clinical validity of the findings diagnosed in the anatomical/ electrophysiological part of the study was additionally examined. The failure rate varied between 10% and 30%, depending on the radicality of the tenotomy, which could be interpreted as a general indication for a complete extensor carpi radialis brevis tendon release. In this connection it is remarkable that the clinical result of electromyographically localized damage in the area between the epicondyle and arcade of Frohse could not be improved through open neurolysis. Dealing with strictures located on the proximal side of the epicondyle on the other hand, this technique seems to play an important role in the recurrence prophylaxis.
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175
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Nagy L. [The treatment of therapy-resistant lateral epicondylitis]. SWISS SURGERY = SCHWEIZER CHIRURGIE = CHIRURGIE SUISSE = CHIRURGIA SVIZZERA 1997; 3:76-9; discussion 80. [PMID: 9190282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Failed treatment for chronic or refractory lateral epicondylitis can successfully be avoided strictly respecting guidelines in diagnosis, treatment and patient selection. Co-existing or simply other pathologic conditions as radial nerve compression neuropathy or instability of the elbow are evident reasons for failure and have to be treated accordingly to the condition. Inadequate patient selection, lack of compliance in performing therapy as well as ongoing cumulative trauma exposure are further factors compromising correct treatment and have to be ruled out prior to surgical therapy.
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