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Cho MJ, Chai JW, Kim DH, Kim HJ, Seo J. Ultrasonographic differential diagnosis of medial elbow pain. Ultrasonography 2024; 43:299-313. [PMID: 39086070 PMCID: PMC11374584 DOI: 10.14366/usg.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/23/2024] [Indexed: 08/02/2024] Open
Abstract
Medial elbow pain is a common musculoskeletal problem among individuals engaging in repetitive activities. Medial epicondylitis is the predominant cause of this pain. However, other potential causes must be considered as part of the differential diagnosis. This article discusses several etiologies of medial elbow pain, including medial epicondylitis, ulnar neuropathy, snapping triceps syndrome, ulnar collateral ligament injury, medial antebrachial cutaneous neuropathy, and diseases of the elbow joint, with an emphasis on ultrasound (US) findings. Awareness of possible diagnoses and their US features can assist radiologists in establishing a comprehensive diagnosis for medial elbow pain.
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Affiliation(s)
- Min Jeong Cho
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Hallym Hospital, Incheon, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Kim JH, Weon YS, Kwon OY. Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis. Work 2024:WOR230725. [PMID: 39093103 DOI: 10.3233/wor-230725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists. OBJECTIVE The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE. METHODS Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors. RESULTS Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups. CONCLUSIONS For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.
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Affiliation(s)
- Jun-Hee Kim
- Department of Physical Therapy, Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Young-Soo Weon
- Department of Physical Therapy, Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
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Konarski W, Poboży T, Poboży K, Domańska J, Konarska K. Current concepts of natural course and in management of medial epicondylitis: a clinical overview. Orthop Rev (Pavia) 2023; 15:84275. [PMID: 37701778 PMCID: PMC10495044 DOI: 10.52965/001c.84275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
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.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Kamil Poboży
- Faculty of Medicine, Medical University of Warsaw, 01-938 Warsaw, Poland
| | - Julia Domańska
- Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland
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Kim BS, Jung KJ, Lee C. Open procedure vs. arthroscopic débridement for chronic medial epicondylitis. J Shoulder Elbow Surg 2023; 32:340-347. [PMID: 36279988 DOI: 10.1016/j.jse.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND This retrospective study compared the outcomes after open and arthroscopic treatment of chronic medial epicondylitis (ME). METHODS The study included 44 elbows in 38 patients: 25 (29-72 years) in the open group and 19 (27-70 years) in the arthroscopy group. The indications for ME surgery were failed conservative therapy for more than 3 months, symptom duration exceeding 6 months, and persistent severe pain. We used radiography, ultrasonography, and magnetic resonance imaging assessments. The clinical assessment included operating time, range of motion, grip strength, visual analog scale (VAS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complications. RESULTS The mean follow-up was 20.2 (12-58) months. The mean operating time was significantly longer in the arthroscopy group (32.5 vs. 23.5 minutes; P = .029). In both groups, all outcome measures improved significantly after surgery and there were no significant differences between the DASH scores (preoperative 44.8 vs. 43.9, postoperative 12.5 vs. 13.2), grip strength (preoperative 72.2 vs. 66.8, postoperative 84.8 vs. 83.6), and VAS scores (preoperative 8.5 vs. 8.2, postoperative 1.0 vs. 1.1) in the open and arthroscopy groups. The outcomes were excellent or good in 20 patients (80%) in the open group and 16 (84%) in the arthroscopy group. The only complication was 1 case of transient ulnar neuropathy in the open group. CONCLUSION Open and arthroscopic techniques were very effective and comparable for treating chronic ME. The surgeon can choose either technique for treating chronic ME.
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Affiliation(s)
- Byung-Sung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do, South Korea.
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do, South Korea
| | - Changeui Lee
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do, South Korea
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Arevalo A, Rao S, Willier DP, Schrock CI, Erickson BJ, Jack RA, Cohen SB, Ciccotti MG. Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A Systematic Review. Am J Sports Med 2022:3635465221095565. [PMID: 35658623 DOI: 10.1177/03635465221095565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated. PURPOSE/HYPOTHESIS The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs. RESULTS Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%. CONCLUSION This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.
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Affiliation(s)
- Alfonso Arevalo
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Donald P Willier
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Robert A Jack
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Park H, Hahn S, Yi J, Bang JY, Kim Y, Jung HK, Baik J. Clinical Assessments and MRI Findings Suggesting Early Surgical Treatment for Patients with Medial Epicondylitis. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:613-625. [PMID: 36238785 PMCID: PMC9432437 DOI: 10.3348/jksr.2020.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/04/2020] [Indexed: 06/16/2023]
Abstract
Purpose To evaluate the MRI findings and clinical factors that are characteristic of patients who ultimately undergo surgery for medial epicondylitis. Materials and Methods Fifty-two consecutive patients who were diagnosed with medial epicondylitis and underwent an elbow MRI between March 2010 and December 2018 were included in this retrospective study. The patients' demographic information, clinical data, and MRI findings were evaluated. All variables were compared between the conservative treatment and surgical treatment groups. Logistic regression analyses were conducted to identify which factors were associated with surgical treatment. Results Common flexor tear (CFT) tear size showed a statistically significant difference in both the transverse and longitudinal planes (p < 0.001, p = 0.013). The CFT abnormality grade significantly differed in both the transverse and longitudinal planes (p = 0.022, p = 0.003). A significant difference was also found in the medial collateral ligament abnormality (p = 0.025). Logistic regression analyses showed that only the transverse diameter of the CFT tear size (odds ratio: 1.864; 95% confidence interval: 1.264-2.750) was correlated with surgical treatment. Conclusion Of patients diagnosed with medial epicondylitis, patients with a larger transverse CFT tear size tend to undergo surgical treatment ultimately.
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Bohlen HL, Schwartz ZE, Wu VJ, Thon SG, Finley ZJ, O'Brien MJ, Savoie FH. Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis. Orthop J Sports Med 2020; 8:2325967120908952. [PMID: 32232070 PMCID: PMC7097873 DOI: 10.1177/2325967120908952] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management. Purpose: To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery. Study Design: Cohort study; Level of evidence, 3. Methods: To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity. Results: The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively (P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores. Conclusion: In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.
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Affiliation(s)
- Hunter L Bohlen
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary E Schwartz
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Victor J Wu
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephen G Thon
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary J Finley
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael J O'Brien
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Wu VJ, Thon S, Finley Z, Bohlen H, Schwartz Z, O'Brien MJ, Savoie FH. Double-Row Repair for Recalcitrant Medial Epicondylitis. Orthop J Sports Med 2020; 7:2325967119885608. [PMID: 31903395 PMCID: PMC6928541 DOI: 10.1177/2325967119885608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective. Purpose: To evaluate the clinical outcomes of a double-row repair for ME. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system. Results: The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively (P < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively (P = .67). Conclusion: A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.
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Affiliation(s)
- Victor J Wu
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephen Thon
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary Finley
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Hunter Bohlen
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary Schwartz
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael J O'Brien
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Mooney M, Andrews K, Rowland A, Jain M, Mustapha AA, Skie M. Clinical outcomes of combined surgical treatment of medial epicondylitis and cubital tunnel syndrome. HAND SURGERY & REHABILITATION 2019; 38:298-301. [PMID: 31404681 DOI: 10.1016/j.hansur.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/21/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
Surgical results for treatment of medial epicondylitis and cubital tunnel syndrome are generally satisfactory when performed alone. However, our experience suggests a combined procedure is associated with inferior outcomes. A retrospective review was conducted of consecutive surgical cases of medial epicondylectomy/debridement and ulnar nerve decompression during a single operation at our institution from March 2008 to February 2017 using CPT codes. Thirty combined procedures were identified in 29 patients. Fourteen patients and 15 elbows returned to clinic for evaluation at average 4.3 years after surgery (8 men, 6 women, mean age 45.1 years). A Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analogue pain scale (VAS), and physical examination were performed. The data was stratified by type of ulnar nerve procedure and analyzed. Three of fifteen elbows underwent in situ ulnar nerve decompression, and twelve of 15 had transposition, five subcutaneous and seven submuscular. The mean DASH score for in situ decompression was significantly higher than that of transposition (68.2 vs. 13.1). The average visual pain score for patients whom underwent in situ decompression was significantly higher than that of those with ulnar nerve transposition (8.0 vs. 1.2). All other physical exam measures demonstrated no significant difference between the two groups. In situ ulnar nerve decompression in the setting of medial epicondylectomy/debridement may be associated with inferior clinical outcomes in comparison to ulnar nerve transposition. Further studies are needed to validate the results of our study and inform management.
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Affiliation(s)
- M Mooney
- The University of Toledo Medical Center, Department of Orthopedic Surgery, 3000, Arlington avenue, Toledo, OH 43614, USA.
| | - K Andrews
- The University of Toledo Medical Center, Department of Orthopedic Surgery, 3000, Arlington avenue, Toledo, OH 43614, USA
| | - A Rowland
- The University of Toledo Medical Center, Department of Orthopedic Surgery, 3000, Arlington avenue, Toledo, OH 43614, USA
| | - M Jain
- Salmon Medical Center, Department of Orthopedic Surgery, 2200, NW Myhre road, Silverdale, WA 98383, USA
| | - A A Mustapha
- The University of Toledo Medical Center, Department of Orthopedic Surgery, 3000, Arlington avenue, Toledo, OH 43614, USA
| | - M Skie
- The University of Toledo Medical Center, Department of Orthopedic Surgery, 3000, Arlington avenue, Toledo, OH 43614, USA
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