Disease Burden of Medial Epicondylitis in the USA Is Increasing: An Analysis of 19,856 Patients From 2007 to 2014

Novel Ultrasound-Guided Radiofrequency Ablation of the Medial Epicondylar Sensory Nerve for Recalcitrant Medial Epicondylosis: A Case-Based Technical Report

Recalcitrant medial epicondylosis (ME) is a chronic tendinopathy affecting the common flexor-pronator tendon origin which causes significant pain and functional limitations. Recalcitrant ME is difficult to manage with non-surgical treatment options. The medial epicondylar sensory nerve (MEsn) is a small sensory nerve that travels within the medial intermuscular septum to innervate the osseous-tendinous structures of the medial epicondyle. In this report, we describe a novel technique for the treatment of recalcitrant ME via radiofrequency ablation (RFA) of the MEsn under ultrasound guidance. The MEsn is localized under ultrasound in the medial distal arm, just proximal to the medial epicondyle. Patients with a positive prognostic block of the MEsn subsequently underwent RFA of the MEsn. We have performed this procedure on two patients who have demonstrated improvement in pain and function for up to nearly one year after the procedure. The relief from pain and improvement in function of these patients warrants further investigation and comparative trials with respect to conventional treatment options, as MEsn RFA may be a viable treatment option for recalcitrant ME.

Current concepts of natural course and in management of medial epicondylitis: a clinical overview

Medial epicondylitis (ME), called "golfer's elbow", is not frequent or serious disease but can cause symptoms that are bothersome in everyday life. Therefore knowledge about this condition may improve diagnostic-therapeutic process. In this article detailed information concerning pathophysiology and symptomatology of ME was described. Great attention was paid to issues related to the diagnosis of the disease both in terms of differentiation with other elbow disorders as well as examination techniques. Finally, current therapeutic options were presented in detail and their efficacy was discussed based on the available data.

Elbow conditions: research priorities setting in partnership with the James Lind Alliance

OBJECTIVE

To undertake a UK-based James Lind Alliance (JLA) Priority Setting Partnership for elbow conditions and be representative of the views of patients, carers and healthcare professionals (HCPs).

SETTING

This was a national collaborative study organised through the British Elbow and Shoulder Society.

PARTICIPANTS

Adult patients, carers and HCPs who have managed or experienced elbow conditions, their carers and HCPs in the UK involved in managing of elbow conditions.

METHODS

The rigorous JLA priority setting methodology was followed. Electronic and paper scoping surveys were distributed to identify potential research priority questions (RPQs). Initial responses were reviewed and a literature search was performed to cross-check categorised questions. Those questions already sufficiently answered were excluded and the remaining questions were ranked in a second survey according to priority for future elbow conditions research. Using the JLA methodology, responses from HCP and patients were combined to create a list of the top 18 questions. These were further reviewed in a dedicated multistakeholder workshop where the top 10 RPQs were agreed by consensus.

RESULTS

The process was completed over 24 months. The initial survey resulted in 467 questions from 165 respondents (73% HCPs and 27% patients/carers). These questions were reviewed and combined into 46 summary topics comprising: tendinopathy, distal biceps pathology, arthritis, stiffness, trauma, arthroplasty and cubital tunnel syndrome. The second (interim prioritisation) survey had 250 respondents (72% HCP and 28% patients/carers). The top 18 ranked questions from this survey were taken to the final workshop where a consensus was reached on the top 10 RPQs.

CONCLUSIONS

The top 10 RPQs highlight areas of importance that currently lack sufficient evidence to guide diagnosis, treatment and rehabilitation of elbow conditions. This collaborative process will guide researchers and funders regarding the topics that should receive most future attention and benefit patients and HCPs.

The Weekend Warrior: Common Shoulder and Elbow Injuries in the Recreational Athlete

"Weekend warriors" are recreational athletes who compress their physical activity into 1-2 weekly exercise sessions. These individuals are generally older than the conventionally discussed athlete, and can live otherwise sedentary lifestyles that contribute to limited opportunities for regular exercise. The combination of high-energy physical activity with relative deconditioning, as well as older age and a potential history of competitive athletic play, can predispose these weekend warriors to a plethora of sports injuries. The shoulder and elbow are dynamically involved in a multitude of common recreational sports, such as baseball, softball, tennis, golf, and volleyball, and forms of casual exercise, such as swimming or climbing. A lack of proper conditioning and supplemental training in weekend warriors, particularly in comparison to elite athletes in these respective sports, can contribute to the development of both acute and chronic conditions of the shoulder and elbow. Inconsistency in physical activity can minimize the prominence of symptoms, leading patients to delayed presentations with injuries that severely impact their ability to engage in their exercise of choice, and therefore remain active at all. This narrative review aims to present the etiology, presentation, and management of common shoulder and elbow injuries that may afflict this patient population. Prevention strategies will also be discussed.

Injuries and Conditions Affecting the Elbow Flexor/Pronator Tendons

Common flexor-pronator tendon injuries and medial epicondylitis can be successfully treated nonoperatively in most cases. Operative treatment is reserved for patients with continued symptoms despite adequate nonoperative treatment or in high-level athletes with complete rupture of the common flexor-pronator tendon. The physical examination and workup of patients with flexor-pronator tendon injuries should focus on related or concomitant pathologies of the medial elbow. The gold standard for surgical treatment of flexor-pronator tendon ruptures or medial epicondylitis includes tendon debridement and reattachment.

Elbow Common Flexor Tendon Repair Technique

Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing.

Mobile technology and cumulative trauma symptomology among millennials

Introduction

Technology use among the millennial population is increasing and related postural compromise may lead to cumulative trauma disorder symptomology. The aim of this study was to explore trends of hand-held mobile technology use and upper extremity cumulative trauma disorder symptomology among a sample of millennials.

Methods

A convenience sample of graduate students ( n = 42) was used for the study. Demographic and technology use information was obtained through self-report using the smartphone screen time tracking feature. Cumulative trauma disorder symptomology was assessed through administration of various orthopedic special tests.

Results

On average, participants spent 2 h and 23 min per day using hand-held mobile devices. Out of 42 participants, 54.8% tested positive for at least one orthopedic special test. The symptomatic group spent 2 h and 29 min using hand-held mobile devices, while the asymptomatic group spent 2 h and 4 min. The most common positive orthopedic special tests were Finkelstein’s test ( n = 19; 36%), hyperabduction (Wright’s) test ( n = 13; 25%), and the elbow flexion test ( n = 10; 18.9%), indicating symptoms associated with De Quervain’s tenosynovitis, thoracic outlet syndrome, and cubital tunnel syndrome, respectively.

Discussion

Results were consistent with prior research on time spent using hand-held mobile technology and cumulative trauma disorder among millennials. Additionally, a difference in mean time spent using mobile technology between the asymptomatic and symptomatic groups was found, suggesting a relationship which warrants further research.