Rehabilitation of the Elbow Following Sports Injury

Is multimodal analgesia as effective as postoperative patient-controlled analgesia following upper extremity surgery?

INTRODUCTION

The present prospective study compared the clinical outcomes between a multimodal analgesia group and a patient-controlled analgesia (PCA) group for postoperative pain control in upper extremities surgery.

HYPOTHESIS

Multimodal analgesia including pre-emptive analgesic can provide similar or superior analgesic effects and a lower incidence of adverse reactions than PCA following upper extremity surgery.

PATIENTS AND METHODS

Sixty-one patients undergoing upper extremity surgery were randomized to 2 perioperative analgesic groups (multimodal analgesia and PCA). We compared the clinical outcomes: use of additional pain rescue, opioid-related complication rate, and patient's satisfaction between the 2 groups.

RESULTS

No significant differences on the resting and exercise pain scores between the two groups. Also, there were no differences regarding additional pain rescue during postoperative day (POD) 1, 2 and achievement of rehabilitation protocol in both groups. However, use of additional pain rescue in PCA group was increased significantly after PCA removal. Moreover, there was significant difference in the incidence of opioid-related complications on operation day and at POD 1. At discharge, multimodal analgesia group showed significantly greater satisfaction than PCA group.

DISCUSSION

Perioperative pain management following upper extremity surgery through the multimodal analgesia could be an acceptable alternative method that can provide good results.

Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report

STUDY DESIGN

Case report.

BACKGROUND

Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established.

CASE DESCRIPTION

The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period.

OUTCOMES

Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner.

DISCUSSION

The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia.

LEVEL OF EVIDENCE

Therapy, level 4.

Could forearm Kinesio Taping improve strength, force sense, and pain in baseball pitchers with medial epicondylitis?

OBJECTIVE

To determine short-term effects of applied forearm Kinesio Taping (KT) on pain, wrist flexor strength, and force sense for baseball players with medial epicondylitis (ME).

DESIGN

Case-control repeated measures study.

SETTING

Clinical sports medicine research laboratory in a medical university.

PARTICIPANTS

A group of 10 baseball players with ME (ME group) and another group of 17 healthy collegiate athletes (healthy group).

INTERVENTION

Three taping conditions were applied in both groups: (1) no taping applied, (2) placebo taping applied (PT), and (3) KT applied.

MAIN OUTCOME MEASURES

Three variables were measured including maximal wrist flexor strength, related/absolute force sense errors, and pain scale (pressure pain and pain tolerance) under 3 taping conditions.

RESULTS

No significant relationship was found either in maximal wrist flexor strength or in related force sense errors between the 2 groups with taping applied, except absolute force sense errors (P = 0.037). Both the healthy group and the ME group in absolute force sense measurement significantly decreased the errors in PT and KT conditions. Also, the tolerance of pressure pain also improved in both the healthy group and the ME group when performing PT and KT conditions.

CONCLUSIONS

Forearm KT may enhance absolute force sense and improve pain condition for both healthy athletes and athletes suffering from ME when placebo and KT applied. However, KT did not result in significant changes in maximal wrist flexor strength for either group.