1
|
Kim JH, Hoy JF, Smith SR, Sabet A, Fernandez JJ, Cohen MS, Wysocki RW, Simcock XC. Recalcitrant Lateral Epicondylitis: A Systematic Review on Current Nonoperative and Operative Treatment Modalities. JBJS Rev 2024; 12:01874474-202408000-00006. [PMID: 39106325 DOI: 10.2106/jbjs.rvw.24.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
BACKGROUND Lateral epicondylitis is a common cause of elbow pain that is generally self-limiting. For patients who have persistent symptoms refractory to conservative treatment, there is still no clear consensus on the most favorable treatment modality. The purpose of this systematic review was to synthesize the available literature regarding both nonoperative and operative treatment modalities for recalcitrant lateral epicondylitis (RLE) to provide insight into the efficacy of treatment options. METHODS A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, where the PubMed, MEDLINE/Ovid, CINAHL, Cochrane, and Scopus databases were queried to identify studies evaluating treatment options for RLE. RESULTS A total of 27 studies with 1,958 patients were included. Of the reviewed studies, there were a wide variety of treatments including platelet-rich plasma injections, percutaneous tenotomies, and various arthroscopic and open procedures. CONCLUSION There are a wide variety of treatment modalities available for RLE that have promising efficacy in the short, medium, and long terms. A comprehensive approach combining evidence-based and patient-centered care is critical for effective management of refractory symptoms. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jason H Kim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Kholinne E, Singjie LC, Anastasia M, Liu F, Anestessia IJ, Kwak JM, Jeon IH. Comparison of Clinical Outcomes After Different Surgical Approaches for Lateral Epicondylitis: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671241230291. [PMID: 38708009 PMCID: PMC11067684 DOI: 10.1177/23259671241230291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 05/07/2024] Open
Abstract
Background Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain. When nonoperative treatment fails, 1 of the 3 surgical approaches-open, percutaneous, or arthroscopic-is used. However, determining which approach has the superior clinical outcome remains controversial. Purpose To review the outcomes of different operative modalities for LE qualitatively and quantitatively. Study Design Systematic review; Level of evidence, 4. Methods This review was performed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published in PubMed, Medline (via EBSCO), and ScienceDirect databases that treated LE with open, percutaneous, or arthroscopic approaches with at least 12 months of follow-up were included. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Methodological Index for Non-Randomized Studies score. The primary outcome was the success rate of each operative treatment approach-open, percutaneous, and arthroscopic. Results From an initial search result of 603 studies, 43 studies (n = 1941 elbows) were ultimately included. The arthroscopic approach had the highest success rate (91.9% [95% CI, 89.2%-94.7%]) compared with the percutaneous (91% [95% CI, 87.3%-94.6%]) and open (82.7% [95% CI, 75.6%-89.8%]) approaches for LE surgery with changes in the mean visual analog scale pain score of 5.54, 4.90, and 3.63, respectively. According to the Disabilities of the Arm, Shoulder and Hand score, the functional outcome improved in the arthroscopic group (from 54.11 to 15.47), the percutaneous group (from 44.90 to 10.47), and the open group (from 53.55 to 16.13). The overall improvement was also found in the Mayo Elbow Performance Score, the arthroscopic group (from 55.12 to 90.97), the percutaneous group (from 56.31 to 87.65), and the open group (from 64 to 93.37). Conclusion Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches of LE surgery.
Collapse
Affiliation(s)
- Erica Kholinne
- Department of Orthopaedic Surgery, Saint Carolus Hospital, Jakarta, Indonesia
- Faculty Of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Leonard Christianto Singjie
- Department of Orthopaedic Surgery, Saint Carolus Hospital, Jakarta, Indonesia
- Department of Orthopaedic & Traumatology, Hasanuddin University, Makassar, Indonesia
| | - Maria Anastasia
- Department of Orthopaedic Surgery, Saint Carolus Hospital, Jakarta, Indonesia
| | - Felly Liu
- Department of Orthopaedic & Traumatology, Padjajaran University, Bandung, Indonesia
| | | | - Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
3
|
de Klerk HH, Verweij LPE, Sierevelt IN, Priester-Vink S, Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ. Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review. Arthroscopy 2023; 39:2363-2387. [PMID: 37146664 DOI: 10.1016/j.arthro.2023.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To perform a systematic review of complications associated with elbow arthroscopy in adults and children. METHODS A literature search was performed in the PubMed, EMBASE, and Cochrane databases. Studies reporting complications or reoperations after elbow arthroscopy with at least 5 patients were included. Based on the Nelson classification, the severity of complications was categorized as minor or major. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized clinical trials, and nonrandomized trials were assessed using the Methodological Items for Non-randomized Studies (MINORS) tool. RESULT A total of 114 articles were included with 18,892 arthroscopies (16,815 patients). A low risk of bias was seen for the randomized studies and a fair quality for the nonrandomized studies. Complication rates ranged from 0% to 71% (median 3%; 95% confidence interval [CI], 2.8%-3.3%), and reoperation rates from 0% to 59% (median 2%; 95% CI, 1.8%-2.2%). A total of 906 complications were observed, with transient nerve palsies (31%) as the most frequent complication. According to Nelson classification, 735 (81%) complications were minor and 171 (19%) major. Forty-nine studies reported complications in adults and 10 studies in children, showing a complication rate ranging from 0% to 27% (median 0%; 95% CI, 0%-0.4%) and 0% to 57% (median 1%; 95% CI, 0.4%-3.5%), respectively. A total of 125 complications were observed in adults, with transient nerve palsies (23%) as the most frequent complication, and 33 in children, with loose bodies after surgery (45%) as the most frequent complication. CONCLUSIONS Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. Higher complication rates are observed after more complex surgery. The incidence and type of complications can aid surgeons in patient counseling and refining surgical techniques to further reduce the complication rates. LEVEL OF EVIDENCE Level IV; systematic review of Level I-IV studies.
Collapse
Affiliation(s)
- Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, the Netherlands.
| | - Lukas P E Verweij
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Inger N Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Clinics, Orthopedic Department, Amsterdam, the Netherlands; Department of Orthopaedics, Spaarne Gasthuis Academie, Hoofddorp, the Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands
| | - Nick F J Hilgersom
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Ricci V, Cocco G, Mezian K, Chang KV, Naňka O, Tamborrini G, Kara M, Özçakar L. Anatomy and Sonographic Examination for Lateral Epicondylitis: EURO-MUSCULUS/USPRM Approach. Am J Phys Med Rehabil 2023; 102:300-307. [PMID: 36002120 DOI: 10.1097/phm.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study is to define a standardized comprehensive sonographic approach for evaluating the different histoanatomical compartments of the lateral elbow. DESIGN Using high-frequency ultrasound probes, we tried to match the anatomical features of the lateral elbow and its different sonographic patterns in patients with the diagnosis of lateral epicondylitis. Moreover, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS Modern ultrasound equipment seems to provide an extremely detailed sonographic assessment of the different anatomical layers located in the lateral compartment of the elbow. Moreover, high-sensitive color/power Doppler imaging allows for clear visualization of the perfusion patterns in pathological conditions. CONCLUSIONS In clinical practice, high-frequency B-mode and high-sensitive color/power Doppler imaging can be integrated with the clinical findings to better define the pain generator(s) for optimizing the management of patients with lateral epicondylitis.
Collapse
Affiliation(s)
- Vincenzo Ricci
- From the Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy (GC); Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic (KM); Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan (K-VC); Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic (ON); UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland (GT); Rheumatology Clinic, University Hospital of Basel, Basel, Switzerland (GT); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ)
| | | | | | | | | | | | | | | |
Collapse
|
5
|
López-Alameda S, Varillas-Delgado D, De Felipe-Gallego J, González-Granados MG, Hernández-Castillejo LE, García-de Lucas F. Arthroscopic surgery versus open surgery for lateral epicondylitis in an active work population: a comparative study. J Shoulder Elbow Surg 2022; 31:984-990. [PMID: 34973424 DOI: 10.1016/j.jse.2021.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral epicondylitis is common in workers who perform repetitive movements of the entire upper limb. Approximately 85%-90% of patients respond satisfactorily to conservative treatment, but in resistant patients, surgical treatment is considered. Classic open surgery is successful in between 70% and 97% of patients, similarly to more modern techniques such as arthroscopy. We sought to demonstrate the superiority of the Wolff technique in terms of clinical results. The goals of this study were to compare the functional and pain outcomes of arthroscopic surgery with open surgery using fasciotomy via the Wolff technique in the treatment of lateral epicondylitis. METHODS This was a retrospective study of 47 working-age patients with resistant lateral epicondylitis: 27 underwent arthroscopic surgery and 20 underwent open surgery. Visual analog scale scores for pain and function, as well as the QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Mayo Elbow Performance Score, and Broberg and Morrey Rating System score, were collected preoperatively and postoperatively; return to patients' previous work and surgical time were also recorded. RESULTS No statistically significant differences were observed between the groups in the reduction in the visual analog scale score (5.26 in arthroscopy group vs. 5.75 in fasciotomy group, P = .5), QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score (19 vs. 19.4, P = .9), Mayo Elbow Performance Score (82 vs. 81.5, P = .8), or Broberg and Morrey Rating System score (81.9 vs. 82.6, P = .9). The differences in terms of time off were also not statistically significant. The period of work leave corresponded, on average, to 83.78 days in the arthroscopy group and 89.95 days in the Wolff group. The mean surgical time was 44.2 minutes in the group undergoing arthroscopic intervention and 27.5 minutes in the fasciotomy group, showing a statistically significant difference (P < .001). CONCLUSIONS Arthroscopic surgery and open surgery provide similar functional results and pain reduction in the treatment of lateral epicondylitis.
Collapse
|
6
|
Amako M, Arai T, Iba K, Ikeda M, Ikegami H, Imada H, Kanamori A, Namba J, Nishiura Y, Okazaki M, Soejima O, Tanaka T, Tatebe M, Yoshikawa Y, Suzuki K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - Secondary publication. J Orthop Sci 2022; 27:514-532. [PMID: 34922804 DOI: 10.1016/j.jos.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The guidelines presented herein provide recommendations for the management of patients with lateral epicondylitis of the humerus. These recommendations are endorsed by the Japanese Orthopaedic Association (JOA) and Japan Elbow Society. METHODS The JOA lateral epicondylitis guideline committee revised the previous guidelines on the basis of the "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which emphasized the importance of the balance between benefit and harm, and proposed a desirable method for preparing clinical guidelines in Japan. These guidelines consist of 11 clinical questions (CQs), 9 background questions (BQs), and 3 future research questions (FRQs). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS The committee proposed recommendations for each CQ by determining the level of evidence and assessing the consensus rate. Physical therapy was the best recommendation with the best evidence. The BQs and FRQs were answered by collecting evidence based on the literature. CONCLUSIONS The guidelines presented herein were reviewed systematically, and recommendations were proposed for each CQ. These guidelines are expected to be widely used not only by surgeons or physicians but also by other healthcare providers, such as nurses, therapists, and athletic trainers.
Collapse
Affiliation(s)
- Masatoshi Amako
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Rehabilitation Medicine, National Defense Medical College Hospital, Japan.
| | - Takeshi Arai
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Japan
| | - Kousuke Iba
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Masayoshi Ikeda
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Shonan Central Hospital, Japan
| | - Hiroyasu Ikegami
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Toho University, Japan
| | - Hideaki Imada
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Higashihiroshima Medical Center, Japan
| | - Akihiro Kanamori
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Tsukuba University Hospital, Japan
| | - Jiro Namba
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, Japan
| | - Yasumasa Nishiura
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Tsuchiura Clinical Education and Training Center, Tsukuba University Hospital, Japan
| | - Masato Okazaki
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopedic Surgery, Ogikubo Hospital, Japan
| | - Osamu Soejima
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, Japan
| | - Toshikazu Tanaka
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Kikkoman General Hospital, Japan
| | - Masahiro Tatebe
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Hand Surgery, Nagoya University, Japan
| | - Yasuhiro Yoshikawa
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Komazawa Hospital, Japan
| | - Katsuji Suzuki
- Lateral Epicondylitis Clinical Practice Guidelines Development Committee, Japan; Department of Orthopaedic Surgery, Okazaki Medical Center, Fujita Medical University, Japan
| |
Collapse
|
7
|
Hardy R, Tori A, Fuchs H, Larson T, Brand J, Monroe E. To Improve Pain and Function, Platelet-Rich Plasma Injections May Be an Alternative to Surgery for Treating Lateral Epicondylitis: A Systematic Review. Arthroscopy 2021; 37:3360-3367. [PMID: 33957212 DOI: 10.1016/j.arthro.2021.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether platelet-rich plasma (PRP) injection for lateral epicondylitis offers patients comparable outcomes to lateral epicondylar surgery. METHODS Embase, Cochrane Library, and MEDLINE databases were searched using the terms lateral epicondylitis, lateral elbow pain, tennis elbow, lateral epicondylalgia, and elbow tendinopathy individually and combined with the terms platelet-rich plasma injections and lateral epicondylar surgery. We compared pain relief, function between the 2 treatment options, and identified whether PRP injection reduced the incidence of lateral epicondylar surgery. Studies must have compared PRP injections with lateral epicondylar surgery for the treatment of lateral epicondylitis; be of Level I, II, or III evidence; and be written in the English language. RESULTS Three studies (1 Level II and 2 Level III) met inclusion criteria. Two of the studies suggested that PRP injections offer similar relief as surgery in the short and mid-term, one study reported that PRP injections and surgery had similar outcomes in pain improvement and return to work, whereas 1 study reported that surgery may be a better long-term solution. CONCLUSIONS In comparison with lateral epicondylar surgery, PRP injections offer similar improvements in pain and function for patients suffering from lateral epicondylitis, especially in the short- and mid-term in 2 of the 3 included investigations. Therefore, PRP injections are an appropriate alternative for the treatment of lateral epicondylitis. LEVEL OF EVIDENCE Level III, Systematic Review of Level III or greater evidence.
Collapse
Affiliation(s)
- Richard Hardy
- Heartland Orthopedic Specialists, Alexandria, Minnesota, U.S.A..
| | - Aerika Tori
- University of Minnesota Morris, Morris, Minnesota, U.S.A
| | - Hannah Fuchs
- University of Minnesota Morris, Morris, Minnesota, U.S.A
| | - Taiyo Larson
- University of Minnesota Morris, Morris, Minnesota, U.S.A
| | - Jefferson Brand
- Heartland Orthopedic Specialists, Alexandria, Minnesota, U.S.A
| | - Emily Monroe
- Heartland Orthopedic Specialists, Alexandria, Minnesota, U.S.A
| |
Collapse
|
8
|
Arthroscopic lateral capsule resection is enough for the management of lateral epicondylitis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2000-2005. [PMID: 32870386 DOI: 10.1007/s00167-020-06255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Controversy exists with regards to the etiology and treatment of lateral epicondylitis and the role of the lateral capsule in this pathology. The aim of this study was to compare arthroscopic lateral capsule resection with or without extensor carpi radialis brevis (ECRB) tendon debridement for treatment of lateral epicondylitis. METHODS This is a retrospective study of 38 patients who underwent arthroscopic surgery for LE with two different techniques: Eighteen patients were treated with arthroscopic lateral capsular resection (LCR) + ECRB debridement and 20 patients were treated with arthroscopic LCR alone, without ECRB debridement. Both groups were assessed with Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score for function and Visual Analog Scale (VAS) score for pain. RESULTS Quick DASH scores were 12 [Formula: see text] 5 and 13 [Formula: see text] 4 at Groups 1 and 2, respectively, without any statistically significant difference. VAS pain scores were 15 [Formula: see text] 2 for both groups. VAS function scores were 85 [Formula: see text] 22 and 86 [Formula: see text] 18 at Groups 1 and 2 respectively. Sick leave periods in terms of weeks were 7 [Formula: see text] 5 and 7 [Formula: see text] 4 at Groups 1 and 2, respectively. There was no statistically significant difference in outcome of the two groups compared in terms of VAS pain, function scores, failure (re-operation) rates and sick leave period at the end of final follow-up. CONCLUSION Both arthroscopic LCR alone and Arthroscopic LCR with ECRB debridement for the management of refractory LE provide significant improvement in pain and function. Isolated Arthroscopic LCR could be a sufficient surgical treatment for refractory LE. Thus, ECRB debridement or release may not be necessary in every case. LEVEL OF EVIDENCE IV.
Collapse
|
9
|
Kholinne E, Nanda A, Liu H, Kwak JM, Kim H, Koh KH, Jeon IH. The elbow plica: a systematic review of terminology and characteristics. J Shoulder Elbow Surg 2021; 30:e185-e198. [PMID: 33038495 DOI: 10.1016/j.jse.2020.09.011] [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: 03/25/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been a lack of evidence regarding the structure of the elbow plica, or synovial fold. Inconsistency remains regarding the correct terminology, prevalence, and investigation used to understand this anatomic structure. METHODS For this systematic review, we searched the PubMed, Ovid-MEDLINE, Cochrane, Google Scholar, and Embase databases using keywords as well as medical subject headings for English-language studies. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS We included 27 articles in this review. "Plica" was the most commonly used terminology (33%). The prevalence of plicae in asymptomatic and symptomatic patients was 77% and 97%, respectively. Provocative factors were sporting activities (57%), including those performed by professional athletes, and heavy labor (43%). Lateral elbow pain represented the most common symptom (49%). Magnetic resonance imaging was the most commonly used diagnostic modality (64%). On the magnetic resonance imaging scans of symptomatic patients, the most common location of the plica was the posterolateral region (54%) and its thickness was a minimum of 3 mm. In 2 studies that included symptomatic patients, the plica was found to cover more than one-third of the radial head. CONCLUSION Plicae are prevalent in both asymptomatic and symptomatic patients. Consideration of the pathologies associated with an elbow plica helped identify the following: (1) its thickness is >3 mm and (2) its location is in the posterolateral aspect and/or it covers more than one-third of the radial head quadrant.
Collapse
Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia; Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Akriti Nanda
- Medical Sciences Division, John Radcliffe Hospital, Oxford, UK
| | - Hua Liu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
10
|
Leschinger T, Tischer T, Doepfer AK, Glanzmann M, Hackl M, Lehmann L, Müller L, Reuter S, Siebenlist S, Theermann R, Wörtler K, Banerjee M. Epicondylopathia humeri radialis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:329-340. [PMID: 33851405 DOI: 10.1055/a-1340-0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options - with varying levels of evidence. METHOD The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 - 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process. OUTCOMES Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure. CONCLUSION This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.
Collapse
Affiliation(s)
- Tim Leschinger
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Thomas Tischer
- Rostock University Medical Centre, Department of Orthopaedics, Rostock, Germany
| | | | | | - Michael Hackl
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Lars Lehmann
- Department of Trauma and Hand Surgery, ViDia Christliche Kliniken Karlsruhe, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Lars Müller
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Sven Reuter
- SRH Hochschule für Gesundheit, Campus Stuttgart, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralf Theermann
- Joint Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| | - Klaus Wörtler
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marc Banerjee
- Mediapark Klinik, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany
| |
Collapse
|
11
|
Herald J, Ashraf M, Sundar MS, Rajan DV. Lateral Epicondylitis-Narrative Review on Surgical Options for Recalcitrant Cases. Indian J Orthop 2021; 55:318-324. [PMID: 33927809 PMCID: PMC8046873 DOI: 10.1007/s43465-021-00364-y] [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: 12/08/2020] [Accepted: 01/20/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Lateral epicondylitis or lateral elbow tendinopathy is a common condition which needs to be addressed appropriately. This condition usually responds well to non-operative treatment. However, an orthopaedic physician needs to be aware of the recalcitrant cases and equip surgical armamentarium to provide adequate care. METHODOLOGY The literature search was performed on PubMed, Medline and Google scholar using the keywords Tennis elbow, recalcitrant, thorntons technique, surgical options, for this narrative review. CONCLUSION This article focuses on the causes for recalcitrant tendinopathy and review of its surgical options.
Collapse
Affiliation(s)
| | - Munis Ashraf
- Ortho One Orthopaedic Speciality Center, Coimbatore, India
| | | | - David V. Rajan
- Ortho One Orthopaedic Speciality Center, Coimbatore, India
| |
Collapse
|
12
|
Jeon IH, Kwak JM, Zhu B, Sun Y, Kim H, Koh KH, Kholinne E. Arthroscopic Modified Bosworth Procedure for Refractory Lateral Elbow Pain With Radiocapitellar Joint Snapping. Orthop J Sports Med 2020; 8:2325967120929929. [PMID: 32647733 PMCID: PMC7325455 DOI: 10.1177/2325967120929929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Radiocapitellar joint snapping due to the presence of synovial plica has been described as a contributory intra-articular pathology of lateral epicondylitis (LE). Hypothesis: The arthroscopic modified Bosworth technique can provide a safe and favorable outcome for refractory LE with radiocapitellar snapping. Study Design: Case series; Level of evidence, 4. Methods: Patients treated with the arthroscopic modified Bosworth procedure for refractory LE with radiocapitellar joint snapping were included in this study. The sequential surgical procedures included excision of the upper portion of the anterolateral annular ligament, removal of the synovial plicae, and release of the extensor carpi radialis brevis for all patients. Clinical outcomes were measured at a minimum 1-year follow-up. Results: A total of 22 patients with a mean ± SD age of 51.2 ± 10.4 years were included in this study. The mean follow-up was 29.4 ± 7.7 months (range, 21-42 months). The overall visual analog scale score (from preoperative to final follow-up) was 7.5 ± 1.2 vs 2.5 ± 1.8 (P < .001); flexion-extension motion arc was 133.8° ± 11.2° vs 146.4° ± 7.1° (P = .001); pronation-supination motion arc was 101.8° ± 9.2° vs 141.7° ± 10.2° (P = .001); Disabilities of the Arm, Shoulder and Hand score was 54.5 ± 13.2 vs 3.6 ± 4.1 (P < .001); and Mayo Elbow Performance Score was 51.9 ± 12.2 vs 84.3 ± 10.3 (P < .001). Conclusion: Radiocapitellar joint snapping may coexist with LE as a disease spectrum. The arthroscopic modified Bosworth technique provides safe and favorable outcomes for patients with refractory LE associated with radiocapitellar joint snapping.
Collapse
Affiliation(s)
- In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Bin Zhu
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.,Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| |
Collapse
|
13
|
Keijsers R, de Vos RJ, Kuijer PPFM, van den Bekerom MPJ, van der Woude HJ, Eygendaal D. Tennis elbow. Shoulder Elbow 2019; 11:384-392. [PMID: 31534489 PMCID: PMC6739751 DOI: 10.1177/1758573218797973] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 01/19/2023]
Abstract
Tennis elbow is the most common cause of lateral-sided elbow pain with a major socioeconomic impact. The etiology of tennis elbow is not completely understood, but there are many different treatment options. This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation.
Collapse
Affiliation(s)
- Renée Keijsers
- Department of Orthopaedic Surgery,
Amsterdam UMC, Amsterdam, the Netherlands
| | | | - P Paul FM Kuijer
- Coronel Institute of Occupational
Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Michel PJ van den Bekerom
- Department of Orthopaedic Surgery, Onze
Lieve Vrouwe Gasthuis (O.L.V.G.), Amsterdam, the Netherlands
| | - Henk-Jan van der Woude
- Department of Radiology, Onze Lieve
Vrouwe Gasthuis (O.L.V.G.), Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery,
Amsterdam UMC, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery,
Amphia Hospital, Breda, the Netherlands
| |
Collapse
|
14
|
Arthroscopic Treatment of Lateral Elbow Pain Mimicking Lateral Epicondylitis: Long-term Follow-up of a Unique Surgical Protocol. Tech Hand Up Extrem Surg 2018; 23:27-30. [PMID: 30461570 DOI: 10.1097/bth.0000000000000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS AND/OR BACKGROUND The failure rate of extensor carpi radialis brevis debridement for refractory lateral epicondylitis is reported around 15%. Our novel arthroscopic treatment is predicated on the hypothesis that lateral epicondylitis is an intra-articular problem related to a variation of the capsule-meniscal anatomy that impinges on the radiocapitellar joint. We report long-term outcomes of 35 patients treated with a novel arthroscopic resection of their capsulosynovial fringe. METHODS All patients failed nonoperative treatment but had temporary improvement with an intra-articular injection. Arthroscopic treatment involved resecting the meniscus and the proximal edge of the orbicular ligament, followed by a tendon-sparing anterolateral capsulectomy. 35 patients underwent evaluation on average 9.2 years after surgery. Outcome measures included VAS, DASH, and questions on return to sports, satisfaction, and perceived benefit of surgery. RESULTS Median pain scores improved from 8 of 10 preoperatively to 0 of 10 postoperatively. This change was clinically and statistically significant, with 1 patient still requiring pain medication. Median DASH score at final follow-up was 1. Overall, 30 patients rated their postoperative outcome as much better, 5 rated it as better, and 0 reported their symptoms to be unchanged or worsened. All 35 patients stated they were happy they underwent the procedure and perceived a benefit. Totally, 4 of 35 patients had postoperative complications (2 with ulnar nerve symptoms, 2 with persistent pain), with one requiring revision surgery for persistent pain. DISCUSSION AND/OR CONCLUSIONS We report promising long-term clinical and functional results of a novel arthroscopic resection of the capsulosynovial complex in lateral epicondylitis.
Collapse
|
15
|
Lee HI, Koh KH, Kim JP, Jaegal M, Kim Y, Park MJ. Prominent synovial plicae in radiocapitellar joints as a potential cause of lateral elbow pain: clinico-radiologic correlation. J Shoulder Elbow Surg 2018; 27:1349-1356. [PMID: 30016689 DOI: 10.1016/j.jse.2018.04.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/18/2018] [Accepted: 04/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Thickened synovial plicae in the radiocapitellar joint have been reported as a cause of lateral elbow pain. However, few reports regarding diagnosis based on detailed physical examination and magnetic resonance imaging (MRI) findings are available. The aims of this study were to characterize the clinical manifestations of this syndrome and to investigate the clinical outcomes of arthroscopic surgery. METHODS We analyzed 20 patients who received a diagnosis of plica syndrome and underwent arthroscopic débridement between 2006 and 2011. The diagnosis was based on physical examination and MRI findings. Elbow symptoms were assessed using a visual analog scale for pain; the Mayo Elbow Performance Index; and the Disabilities of the Arm, Shoulder and Hand score at a minimum of 2 years after surgery. The thickness of plicae on MRI was compared with the normal data in the literature. RESULTS Plicae were located on the anterior side in 1 patient, on the posterior side in 15, and on both sides in 4. Radiocapitellar joint tenderness and pain with terminal extension were observed in 65% of patients. MRI showed enlarged plicae consistent with intraoperative findings. The mean plica thickness on MRI was 3.7 ± 1.0 mm, which was significantly thicker than the normal value. The mean lengths (mediolateral length, 9.4 ± 1.6 mm; anteroposterior length, 8.2 ± 1.7 mm) were also greater than the normal values. The visual analog scale score for pain decreased from 6.3 to 1.0 after surgery. The Mayo Elbow Performance Index and Disabilities of the Arm, Shoulder and Hand scores improved from 66 to 89 and from 26 to 14, respectively. CONCLUSIONS Specific findings of the physical examination and MRI provide clues for the diagnosis of plica syndrome. Painful symptoms were successfully relieved after arthroscopic débridement.
Collapse
Affiliation(s)
- Hyun Il Lee
- Department of Orthopaedic Surgery, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Seoul Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Pil Kim
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | | | - YoungKyu Kim
- Department of Orthopaedic Surgery, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Min Jong Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sung Kyun Kwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Kim DS, Chung HJ, Yi CH, Kim SH. Comparison of the Clinical Outcomes of Open Surgery Versus Arthroscopic Surgery for Chronic Refractory Lateral Epicondylitis of the Elbow. Orthopedics 2018; 41:237-247. [PMID: 29940054 DOI: 10.3928/01477447-20180621-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/21/2018] [Indexed: 02/03/2023]
Abstract
Numerous surgical options have been introduced for the treatment of chronic refractory lateral epicondylitis of the elbow, but it remains unclear which option is superior. The clinical outcomes of an open surgery group and an arthroscopic surgery group were evaluated, and the results of the 2 procedures were compared. From among patients with lateral epicondylitis refractory to 6 months of conservative treatment, 68 patients satisfying study criteria were recruited. Open surgery was performed in 34 cases (group 1), and arthroscopic surgery was performed in 34 cases (group 2). Compared with preoperatively, the 2 groups had significantly improved values for grip strength, range of motion, and Disabilities of the Arm, Shoulder and Hand score at 12 months postoperatively. Group 1 had significantly greater improvements in grip strength and visual analog scale pain score compared with group 2 (P=.048 vs P=.006). Group 2 had significantly greater (P=.045) improvement in pronation compared with group 1. Group 2 returned to work sooner than group 1. On the questionnaire regarding satisfaction with surgery 24 months postoperatively, 4 patients (12%) in group 2 reported dissatisfaction compared with no patients in group 1. Open surgery and arthroscopic surgery both yielded good clinical results. Nonetheless, for patients requiring muscle strength or having severe pain at work, open surgery would be more effective. [Orthopedics. 2018; 41(4):237-247.].
Collapse
|
17
|
Pierce TP, Issa K, Gilbert BT, Hanly B, Festa A, McInerney VK, Scillia AJ. A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin. Arthroscopy 2017; 33:1260-1268.e2. [PMID: 28412059 DOI: 10.1016/j.arthro.2017.01.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare complications, function, pain, and patient satisfaction after conventional open, percutaneous, or arthroscopic release of the extensor origin for the treatment of lateral epicondylitis. METHODS A thorough review of 4 databases-PubMed, EBSCOhost, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and Scopus-was performed to identify all studies that addressed surgical management of lateral epicondylitis. We included (1) studies published between 2000 and 2015 and (2) studies with clearly defined surgical techniques. We excluded (1) non-English-language manuscripts, (2) isolated case reports, (3) studies with fewer than 10 subjects, (4) animal studies, (5) studies with additional adjunctive procedures aside from release of the extensor origin, (6) clinical or systematic review manuscripts, (7) studies with a follow-up period of 6 months or less, and (8) studies in which less than 80% of patients completed follow-up. Each study was analyzed for complication rates, functional outcomes, pain, and patient satisfaction. RESULTS Thirty reports were identified that included 848 open, 578 arthroscopic, and 178 percutaneous releases. Patients within each release group had a similar age (46 years vs 46 years vs 48 years; P = .9 and P = .4, respectively), whereas there was a longer follow-up time in patients who underwent surgery by an open technique (49.4 months vs 42.6 months vs 23 months, P < .001). There were no differences in complication rates among these techniques (3.8% vs 2.9% vs 3.9%; P = .5 and P = .9, respectively). However, open techniques were correlated with higher surgical-site infection rates than arthroscopic techniques (0.7% vs 0%, P = .04). Mean Disabilities of the Arm, Shoulder and Hand scores were substantially better with both open and arthroscopic techniques than with percutaneous release (19.9 points vs 21.3 points vs 29 points, P < .001). In addition, there was less pain reported in the arthroscopic and percutaneous release groups as opposed to their open counterparts (1.9 points vs 1.4 points vs 1.3 points, P < .0001). There were no differences among the techniques in patient satisfaction rate (93.7% vs 89% vs 88%; P = .08 and P = .07, respectively). CONCLUSIONS Functional outcomes of open and arthroscopic releases may be superior to those of percutaneous release. In addition, patients may report less pain with arthroscopic and percutaneous techniques. Although the risk of complications is similar regardless of technique, patients may be counseled that their risk of infectious complications may be slightly higher with open releases. However, it is important to note that this statistical difference may not necessarily portend noticeable clinical differences. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV evidence.
Collapse
Affiliation(s)
- Todd P Pierce
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Kimona Issa
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Benjamin T Gilbert
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Brian Hanly
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Anthony Festa
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Vincent K McInerney
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A..
| |
Collapse
|
18
|
Abstract
Upper extremity tennis injuries are most commonly characterized as overuse injuries to the wrist, elbow, and shoulder. The complex anatomy of these structures and their interaction with biomechanical properties of tennis strokes contributes to the diagnostic challenges. A thorough understanding of tennis kinetics, in combination with the current literature surrounding diagnostic and treatment methods, will improve clinical decision-making.
Collapse
Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
| | - Meghan E Lark
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| |
Collapse
|
19
|
Cavalheiro CS, Filho MR, Rozas J, Wey J, de Andrade AM, Caetano EB. Anatomical study on the innervation of the elbow capsule. Rev Bras Ortop 2016; 50:673-9. [PMID: 27218079 PMCID: PMC4867934 DOI: 10.1016/j.rboe.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To put forward an anatomical description of the innervation of the elbow capsule, illustrated through morphological analysis on dissections. METHODS Thirty elbows from fresh fixed adult cadavers aged 32-74 years, of both sexes, were dissected. RESULTS Among the dissected arms, we observed that the median nerve did not have any branches in two arms, while it had one branch in five arms, two branches in two arms, three branches in ten arms, four branches in nine arms and five branches in two arms. The radial nerve did not have any branches in two arms, while it had one branch in two arms, two branches in nine arms, three branches in ten arms, four branches in five arms and five branches in two arms. The ulnar nerve did not have any branches in three arms, while it had one branch in six arms, two branches in four arms, three branches in five arms, four branches in seven arms, five branches in four arms and six branches in one arm. CONCLUSIONS We observed branches of the radial, ulnar and medial nerves in the elbow joint, and a close relationship between their capsular and motor branches.
Collapse
Affiliation(s)
- Cristina Schmitt Cavalheiro
- Faculdade de Ciências Médicas e da Saúde de Sorocaba (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Mauro Razuk Filho
- Faculdade de Ciências Médicas e da Saúde de Sorocaba (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - João Rozas
- Faculdade de Ciências Médicas e da Saúde de Sorocaba (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - João Wey
- Faculdade de Ciências Médicas e da Saúde de Sorocaba (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Antonio Marcos de Andrade
- Faculdade de Ciências Médicas e da Saúde de Sorocaba (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Edie Benedito Caetano
- Faculdade de Ciências Médicas e da Saúde de Sorocaba (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, SP, Brazil
| |
Collapse
|
20
|
Abstract
Reported complication rates are low for lateral epicondylitis management, but the anatomic complexity of the elbow allows for possible catastrophic complication. This review documents complications associated with lateral epicondylar release: 67 studies reporting outcomes of lateral epicondylar release with open, percutaneous, or arthroscopic methods were reviewed and 6 case reports on specific complications associated with the procedure are included. Overall complication rate was 3.3%. For open procedures it was 4.3%, percutaneous procedures 1.9%, and arthroscopic procedures 1.1%. In higher-level studies directly comparing modalities, the complication rates were 1.3%, 0%, and 1.2%, respectively.
Collapse
Affiliation(s)
- Michael Lucius Pomerantz
- Synergy Specialists Medical Group, Orthopaedic Surgery, Hand/Upper Extremity Sub-specialization, 955 Lane Ave, Suite #200, Chula Vista, CA 91914, USA.
| |
Collapse
|
21
|
Bostan B, Balta O, Aşçı M, Aytekin K, Eser E. Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis. Balkan Med J 2016; 33:216-20. [PMID: 27403393 DOI: 10.5152/balkanmedj.2016.16807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 06/03/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recalcitrant lateral epicondylitis may be a disabling condition. Treatment of this condition is still controversial. AIMS In the present prospective study, we evaluated the long-term results of autologous blood injection for the treatment of recalcitrant lateral epicondylitis. STUDY DESIGN Prospective clinical study. METHODS A total of 42 elbows of 40 consecutive patients (28 female, 12 male) were enrolled in this prospective study. Seven patients left the study (3 patients moved to another city, 1 patient died in the second week due to a heart condition, 1 patient quit the study because of the resolution of pain in the fourth week and 2 patients did not agree to the second injection). Thirteen patients were lost to third year follow-up. Therefore, a total of 21 elbows of 20 patients with 3 years of follow-up were included in this study. The mean age of the patients was 47.25 years (range, 20-68 years). RESULTS Visual analogue scale (VAS), Nirschl score and grip strength were significantly improved after injections when compared to before treatment. The best improvement in terms of grip strength, Nirschl score and VAS score was detected at the one year follow-up. The improvement in Nirschl and VAS score sustained until the third year. CONCLUSION We suggest that autologous blood injection for the treatment of recalcitrant lateral epicondylitis is an effective, safe and successful procedure in the long-term.
Collapse
Affiliation(s)
- Bora Bostan
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Murat Aşçı
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Kürşad Aytekin
- Department of Orthopaedics and Traumatology, Giresun University School of Medicine, Giresun, Turkey
| | - Enes Eser
- Department of Orthopaedics and Traumatology, Turhal State Hospital, Tokat, Turkey
| |
Collapse
|
22
|
Jiménez I, Marcos-García A, Muratore-Moreno G, Medina J. Four surgical tips in the treatment of epicondylitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
23
|
Cavalheiro CS, Filho MR, Rozas J, Wey J, Andrade AMD, Caetano EB. Estudo anatômico da inervação da cápsula do cotovelo. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
24
|
Jiménez I, Marcos-García A, Muratore-Moreno G, Medina J. [Four surgical tips in the treatment of epicondylitis]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:38-43. [PMID: 26187524 DOI: 10.1016/j.recot.2015.06.001] [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: 03/26/2015] [Revised: 05/15/2015] [Accepted: 06/03/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Lateral epicondylitis is a common injury in the population. Most patients improve with conservative treatment, but in a small percentage surgery is necessary. The aim of this study is to analyse the clinical results obtained by a «4 surgical tips» technique. MATERIALS AND METHOD This is a retrospective study of 35 operated elbows, with a mean follow-up of 5.3 years. In all cases epicondylar denervation, removal of the angiofibroblastic degeneration core, epicondylectomy, and release of posterior interosseous nerve, was performed. Each patient was evaluated using the Broberg and Morrey Rating System (BMRS), Mayo Elbow Performance Score (MEPS), Visual Analogue Scale (VAS), DASH questionnaire, and a survey of subjective assessment. RESULTS BMRS mean score was 97.2 points, with 95.71 points with the MEPS. The mean decrease in VAS was 8.12 points, and the mean score on the DASH was 1.68 points. The results were rated as excellent or very good by 94.3% of patients. There was one recurrence, which resolved with further surgery. Two neuropraxia of the posterior interosseous nerve occurred, which completely recovered in 10 weeks. CONCLUSIONS Using the «4 surgical tips» technique, clinical resolution of symptoms in 97.1% was achieved at the first operation. Therefore, it appears to be an effective, reproducible technique with few complications, in the surgical treatment of lateral epicondylitis resistant to conservative treatment.
Collapse
Affiliation(s)
- I Jiménez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - A Marcos-García
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - G Muratore-Moreno
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - J Medina
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| |
Collapse
|
25
|
Ruch DS, Orr SB, Richard MJ, Leversedge FJ, Mithani SK, Laino DK. A comparison of débridement with and without anconeus muscle flap for treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg 2015; 24:236-41. [PMID: 25457781 DOI: 10.1016/j.jse.2014.09.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/25/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral epicondylitis is a common condition encountered by orthopedic surgeons. Whereas the majority of patients improve with conservative management, a small percentage will require surgery. The purpose of this study was to compare the clinical outcomes of surgical débridement of the common extensor origin alone with débridement combined with rotation of an anconeus muscle flap in patients who failed to respond to conservative management of chronic lateral epicondylitis. METHODS Fifty-seven patients who failed to respond to a minimum of 5 months of conservative treatment for lateral epicondylitis were retrospectively reviewed. Patients in group 1 were treated with open débridement of the common extensor origin. Patients in group 2 were treated with open débridement combined with rotation of an anconeus muscle flap. Outcome measures included elbow range of motion, grip strength, visual analog scale (VAS) for pain score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Statistical analyses were performed by Student's t test with 95% confidence intervals. RESULTS At final follow-up, average DASH scores were significantly lower in group 2. There were no significant differences between the groups with regard to elbow range of motion or grip strength. VAS pain scores were significantly reduced in both groups. Preoperative VAS pain scores were significantly greater in group 2; however, at final follow-up, there was no significant difference between groups. There were no apparent complications in either group. CONCLUSIONS In addition to débridement of the common extensor origin, the rotation of an anconeus muscle flap may improve outcomes in cases of lateral epicondylitis that require operative intervention.
Collapse
Affiliation(s)
- David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven B Orr
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Fraser J Leversedge
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Suhail K Mithani
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | |
Collapse
|
26
|
Jeavons R, Berg AJ, Richards I, Bayliss N. The Boyd-McLeod procedure for tennis elbow: mid- to long-term results. Shoulder Elbow 2014; 6:276-82. [PMID: 27582946 PMCID: PMC4935036 DOI: 10.1177/1758573214540637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tennis elbow is a common condition that usually responds to conservative measures. In refractory cases, surgical intervention is indicated. A plethora of surgical techniques have been described. We report the mid- to long-term outcomes of the Boyd-McLeod procedure for refractory tennis elbow. METHODS A retrospective analysis and current review of patients that had undergone the Boyd-McLeod procedure over a 12-year period was undertaken. Demographics, time to discharge, length of follow-up and outcome scores were collected. RESULTS Seventy patients underwent surgery. Mean time to discharge was 15.35 weeks, with 88% successful outcomes. Fifty-four patients were available for current follow-up at mean of 5.52 years (range 1.17 years to 11.49 years). Range of motion in all patients was unchanged. There were no revision procedures. Mean (SD) Mayo Elbow Performance Score was 90.85 (13.11), with 75.5% returning a good or excellent score and 24.5% a fair outcome. The mean (SD) Oxford Elbow Score was 44.04 (6.92); mean (SD) pain score was 89.5 (17.58); mean (SD) function score was 95.34 (9.59) and mean (SD) socio-psychological score was 91.50 (17.01). Overall, 83% of patients had an Oxford Elbow Score of 43 or greater, suggesting excellent outcome. CONCLUSIONS We show that the Boyd-McLeod procedure is an excellent option over both the short- and long-term for refractory tennis elbow.
Collapse
Affiliation(s)
| | - Andrew J Berg
- Department of Trauma and Orthopaedics, North Tees and
Hartlepool NHS Foundation Trust, Stockton on Tees, UK
| | | | | |
Collapse
|
27
|
Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg 2014; 23:1527-31. [PMID: 25220200 DOI: 10.1016/j.jse.2014.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated recovery from chronic lateral epicondylitis after arthroscopic treatment. METHODS Twenty-three consecutive patients (5 men, 18 women) with chronic lateral epicondylitis underwent arthroscopic surgery. Patients were a mean age of 49 years. Prospective outcome data were collected before the operation and at 1, 2, 3, 6, 12 and 24 months after surgery. Outcomes were assessed using a visual analog scale (VAS: 0-100), grip strength percentage (compared with the unaffected side), the Japanese Orthopaedic Association elbow score, and the Disability of the Arm, Shoulder and Hand questionnaire. RESULTS A mean VAS score at rest of 26 preoperatively improved to 8 (P = .0026), 6, and 3 at 1, 2, and 3 months after surgery, respectively. A mean VAS score during activity improved from 68 preoperatively to 35 (P < .001), 23, and 19 at 1, 2, and 3 months after surgery, respectively. Both VAS scores gradually decreased up to 24 months after surgery. The mean grip strength improved from 66.1% preoperatively to 88.7% at 2 months after surgery (P < .001). The mean Japanese Orthopaedic Association elbow score improved from 38 points preoperatively to 61 points at 1 month after surgery (P < .001). The mean Disability of the Arm, Shoulder and Hand score improved from 32 points preoperatively to 15 points at 3 months after surgery (P < .001). CONCLUSION Arthroscopic surgery for lateral epicondylitis provides significant improvement in pain and functional recovery up to 3 months after surgery. However, it takes more than 6 months for the VAS score during activity to fall below 10 points.
Collapse
|
28
|
|
29
|
Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex. J Orthop 2014; 11:82-6. [PMID: 25104891 DOI: 10.1016/j.jor.2014.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/15/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores. METHODS In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria. RESULTS After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P < 0.05). CONCLUSION Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex.
Collapse
|
30
|
Nimura A, Fujishiro H, Wakabayashi Y, Imatani J, Sugaya H, Akita K. Joint capsule attachment to the extensor carpi radialis brevis origin: an anatomical study with possible implications regarding the etiology of lateral epicondylitis. J Hand Surg Am 2014; 39:219-25. [PMID: 24480683 DOI: 10.1016/j.jhsa.2013.11.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the unique anatomical characteristic of the extensor carpi radialis brevis (ECRB) origin and points of differentiation from other extensors and to clarify the specific relationship of the ECRB to the underlying structures. METHODS We studied the origin of each extensor macroscopically for its muscular and tendinous parts; to identify the relationship between the ECRB origin and the deeper structures, we also examined the attachment of the joint capsule under the ECRB origin. RESULTS The ECRB simply originated as a tendon without any muscle, whereas other extensors originated as a mixture of tendon and muscle. At the anterior part of the ECRB origin, the thin attachment of the joint capsule (average width, 3.3 mm) lay deep to the ECRB and was distinct. However, at the posterodistal portion, the joint capsule, annular ligament, and supinator were intermingled and originated as a single wide sheet from the humerus (average width, 10.7 mm). CONCLUSIONS The anterior part of the ECRB origin was delicate, because the ECRB origin was purely tendinous, and the attachment of the articular capsule was thin compared with that of the posterodistal attachment. This thin attachment could be an initial factor leading to the development of lateral epicondylitis. CLINICAL RELEVANCE The results of the current study may enhance magnetic resonance imaging understanding and may help clarify the etiology of the lateral epicondylitis.
Collapse
Affiliation(s)
- Akimoto Nimura
- Unit of Clinical Anatomy, and the Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo; the Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama; and the Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan
| | - Hitomi Fujishiro
- Unit of Clinical Anatomy, and the Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo; the Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama; and the Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan
| | - Yoshiaki Wakabayashi
- Unit of Clinical Anatomy, and the Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo; the Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama; and the Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan
| | - Junya Imatani
- Unit of Clinical Anatomy, and the Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo; the Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama; and the Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan
| | - Hiroyuki Sugaya
- Unit of Clinical Anatomy, and the Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo; the Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama; and the Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan
| | - Keiichi Akita
- Unit of Clinical Anatomy, and the Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo; the Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama; and the Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine Center, Funabashi, Japan.
| |
Collapse
|
31
|
Byram IR, Kim HM, Levine WN, Ahmad CS. Elbow arthroscopic surgery update for sports medicine conditions. Am J Sports Med 2013; 41:2191-202. [PMID: 23572098 DOI: 10.1177/0363546513482106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity.
Collapse
Affiliation(s)
- Ian R Byram
- Center for Shoulder, Elbow and Sports Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | | | | | | |
Collapse
|
32
|
Sasaki K, Ohki G, Iba K, Kokai Y, Yamashita T, Wada T. Innervation pattern at the undersurface of the extensor carpi radialis brevis tendon in recalcitrant tennis elbow. J Orthop Sci 2013; 18:528-35. [PMID: 23674348 DOI: 10.1007/s00776-013-0406-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 04/19/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE We investigated the general, sensory, and sympathetic innervation patterns at the undersurface of the extensor carpi radialis brevis (ECRB) origin in patients with recalcitrant tennis elbow. METHODS Eight elbows in eight consecutive patients (6 females and 2 males) with tennis elbow who underwent arthroscopic surgery were included in this study. The mean age was 45 years (38-66 years), and the mean duration of symptoms before surgery was 23 months (13-52 months). Operative treatment consisted of an arthroscopic inspection and debridement of the ECRB origin. Control tissues were obtained from biopsy of the ECRB capsule in two patients with osteochondritis dissecance of the capitellum who underwent arthroscopic resection of loose bodies. The tissue specimens were investigated immunohistochemically with antibodies delineating general (PGP9.5), sensory (SP/CGRP), and sympathetic (NPY) nerve patterns. RESULTS In the non-tendinosis control tissue, SP/CGRP and NPY immunoreactions were heterogeneously distributed in association with blood vessels. Pathologic evaluation of the biopsy tissue showed atypical fibrous granulation containing numerous vessels and nerve structures in all eight patients. Marked reactions to PGP 9.5 took the form of nerve fibers associated with arteries and arterioles in the atypical granulation. Most of the perivascular innervation was found to express NPY. The immunoreactions for SP and CGRP were invariably weak. CONCLUSION Increased perivascular sympathetic innervation accompanied with loss of sensory innervation at the undersurface of the ECRB tendon may play a role in chronic pain generation in recalcitrant tennis elbow. LEVEL OF EVIDENCE Diagnostic, Level IV.
Collapse
Affiliation(s)
- Koichi Sasaki
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Sapporo 060-8543, Japan
| | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Rhyou IH, Kim KW. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res 2013; 471:284-90. [PMID: 22965262 PMCID: PMC3528936 DOI: 10.1007/s11999-012-2585-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 08/23/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear. QUESTIONS/PURPOSES We asked if posterior radiocapitellar synovial plica excision made any additional improvement in pain or function after arthroscopic ECRB release. METHODS We retrospectively reviewed 38 patients who had arthroscopic treatment for refractory lateral epicondylitis between November 2003 and October 2009. Twenty patients (Group A) underwent the Baker technique and 18 patients (Group B) underwent a combination of the Baker technique and posterior synovial plica excision. The minimum followup was 36 months (mean, 46 months; range, 36-72 months) for Group A and 25 months (mean, 30 months; range, 25-36 months) for Group B. Postoperatively we obtained VAS pain and DASH scores for each group. RESULTS Two years postoperatively, we found no differences in the VAS pain score or DASH: the mean VAS pain scores were 0.3 points in Group A and 0.4 points in Group B, and the DASH scores were 5.1 points and 6.1 points respectively. CONCLUSIONS The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication.
Collapse
Affiliation(s)
- In Hyeok Rhyou
- Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianity Hospital, Pohang, Kyeongbuk Korea
| | - Kang Wook Kim
- Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianity Hospital, Pohang, Kyeongbuk Korea
| |
Collapse
|
35
|
Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:142941. [PMID: 23243428 PMCID: PMC3518934 DOI: 10.1155/2012/142941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/14/2012] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis. Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs) due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin's technique. Pain intensity (measured with a numerical pain rating scale), pressure pain threshold (measured with a pressure algometer), and grasping strength (measured with a hand dynamometer) were assessed before, immediately after, and 3 months and 12 months after the treatment. Results. For every individual case, the pain intensity was significantly reduced (P < 0.01) and the pressure pain threshold and the grasping strength were significantly increased (P < 0.01) immediately after the treatment. This significant effectiveness lasts for at least one year. Conclusions. It is suggested that percutaneous soft tissue release can be used for treating chronic recurrent lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain.
Collapse
|
36
|
Radiocapitellar cartilage injuries associated with tennis elbow syndrome. J Hand Surg Am 2012; 37:748-54. [PMID: 22365822 DOI: 10.1016/j.jhsa.2012.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE A recent anatomical study has suggested that considerable contact between the undersurface of the extensor carpi radialis brevis (ECRB) and the lateral edge of the capitellum is the cause of tendon injury in lateral epicondylosis. We hypothesized that this contact might concurrently induce cartilage injuries of the capitellum. The purpose of the present study was to determine the prevalence, location, and severity of cartilage lesions of the radiocapitellar joint accompanying lateral epicondylosis and to identify their correlation with ECRB status. METHODS Arthroscopic assessment of the articular cartilage was performed for 31 elbows in 31 patients with lateral epicondylosis who had surgery. The study group consisted of 18 women and 13 men with a mean age of 50 years (range, 35 to 67 y). The relationship between the presence of the cartilage lesions and patient demographics, preoperative pain visual analog scale score, number of cortisone injections, and surgical findings including ECRB tears were investigated. RESULTS Cartilage injuries of the capitellum were found in 20 (65%) and cartilage injuries of the radial head were found in 25 (81%) of 31 elbows. Most of the lesions were located on the lateral aspect of the capitellum and radial head. Multivariate logistic regression analysis revealed that the absence of ECRB tears was independently associated with a higher risk of cartilage injuries of the capitellum. CONCLUSIONS Cartilage injury was frequently found in the lateral edge of the capitellum and radial head. Lesions of the capitellum were related to the absence of ECRB tears. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
|
37
|
Yeoh KM, King GJW, Faber KJ, Glazebrook MA, Athwal GS. Evidence-based indications for elbow arthroscopy. Arthroscopy 2012; 28:272-82. [PMID: 22244102 DOI: 10.1016/j.arthro.2011.10.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/02/2011] [Accepted: 10/13/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions. METHODS A literature search was performed by use of the PubMed database in October 2010. All therapeutic studies investigating the results of treatment with elbow arthroscopy were analyzed for outcomes and complications. The literature specific to common elbow arthroscopy indications was summarized and was assigned a grade of recommendation based on the available evidence. RESULTS There is fair-quality evidence for elbow arthroscopy in the treatment of rheumatoid arthritis of the elbow and lateral epicondylitis (grade B recommendation). There is poor-quality evidence for, rather than against, the arthroscopic treatment of degenerative arthritis, osteochondritis dissecans, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of a plica, and fractures of the capitellum, coronoid process, and radial head (grade C(f) recommendation). There is insufficient evidence to give a recommendation for or against the arthroscopic treatment of posterolateral rotatory instability and septic arthritis (grade I recommendation). CONCLUSIONS The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
Collapse
Affiliation(s)
- Kwan M Yeoh
- Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Neil G Burke
- Department of Orthopaedic Surgery Sports Surgery Clinic, Dublin, Ireland
| | - Hannan Mullett
- Department of Orthopaedic Surgery Sports Surgery Clinic, Dublin, Ireland
| |
Collapse
|
39
|
Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow. Arch Orthop Trauma Surg 2011; 131:383-8. [PMID: 21253755 DOI: 10.1007/s00402-011-1260-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common orthopedic problem. Rest, activity modification, and conservative therapies are generally efficacious in relieving symptoms in the majority of patients; however, a small percentage of people will experience refractory pain and require surgical intervention to alleviate their discomfort. Surgical release of the common extensor origin can be done through an open, percutaneous, or arthroscopic approach. PATIENTS AND METHODS This prospective study includes 33 patients with chronic resistant lateral epicondylitis who had received conservative treatment including modification of activity and 2 injections of 80 mg of hydrocortisone, for more than 6 months, aiming to compare two different techniques of treatment. The first group included 14 patients with a mean age of 42 years treated by arthroscopic release of common extensor origin. The second group included 19 patients with a mean age of 48 years treated by percutaneous tenotomy. The mean follow up was 12 months for the arthroscopic group and 10 months for the percutaneous tenotomy group. RESULTS The results were evaluated according to the Disabilities of the Arm, Shoulder and Hand (DASH) score and the visual analogue scale (VAS). In the first group (treated by arthroscopy), the average DASH score improved from 72 to 48 and the average VAS improved from 9.1 to 2. In the second group (treated by percutaneous tenotomy), the average DASH score improved from 70 to 50 and the average VAS improved from 9 to 2.1. Concerning patient satisfaction after surgery, in the first group 7 patients (50%) were pleased, 6 (42.85%) were satisfied and 1 case (7.14%) was not satisfied. In the second group, 7 patients (36.84%) were pleased, 10(52.63%) were satisfied and 2 cases (10.52%) were not satisfied. CONCLUSION Both arthroscopic and percutaneous release of the common extensor origin can be effective in treatment of lateral epicondylitis. Arthroscopic treatment of lateral epicondylitis gives more favorable results than percutaneous tenotomy. Although technically more difficult than percutaneous tenotomy, arthroscopy has the advantage of visualization of the pathology and much better improvement of elbow functions.
Collapse
|
40
|
|
41
|
Zonno A, Manuel J, Merrell G, Ramos P, Akelman E, DaSilva MF. Arthroscopic technique for medial epicondylitis: technique and safety analysis. Arthroscopy 2010; 26:610-6. [PMID: 20434657 DOI: 10.1016/j.arthro.2009.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The goals of this study are to report on a novel arthroscopic technique for the treatment of medial epicondylitis and to further describe the anatomic relations between the site of arthroscopic debridement and both the ulnar nerve and medial collateral ligament (MCL) complex. METHODS Arthroscopic debridement of the medial epicondyle was performed on 8 fresh-frozen cadaveric specimens. Each specimen was dissected, and the shortest distance from the debridement site to both the ulnar nerve and MCL complex was measured with a 3-dimensional motion-tracking system. RESULTS The mean distance between the debridement site and the ulnar nerve was 20.8 mm (range, 14.4 to 25.1 mm), and the mean distance between the medial debridement site and the origin of the anterior bundle of the MCL was 8.3 mm (range, 5.9 to 10.4 mm). CONCLUSIONS Our results suggest that arthroscopic debridement of the medial epicondyle can be performed with low risk of injury to the ulnar nerve or MCL complex. CLINICAL RELEVANCE This cadaveric study indicates a potential role for elbow arthroscopy in the surgical management of refractory medial epicondylitis.
Collapse
Affiliation(s)
- Alan Zonno
- Department of Orthopaedics, The Warren Alpert School of Medicine at Brown University/Rhode Island Hospital, Providence, Rhode Island 02818, USA
| | | | | | | | | | | |
Collapse
|
42
|
Surgical treatment for lateral epicondylitis: a long-term follow-up of results. J Shoulder Elbow Surg 2010; 19:363-7. [PMID: 20004594 DOI: 10.1016/j.jse.2009.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 08/08/2009] [Accepted: 09/10/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Since its first description, the pathology, natural history, and treatment of lateral epicondylitis have remained controversial. For patients in who conservative management fails, surgery remains an option. The optimal method of surgery remains debatable and is further confounded by a relative lack of long-term follow-up studies. MATERIALS AND METHODS This study describes a modification of the Nirschl surgical technique and presents its long-term results. Patients undergoing this open technique were reviewed by use of the Hospital for Special Surgery and Mayo elbow performance assessment tools, as well as having grip strength and subjective outcome recorded. RESULTS From June 1986 to December 2001, 158 consecutive patients (171 elbows) underwent surgery in a single-surgeon series. Of these patients, 137 (86.7%) were available for follow-up at a mean of 9.8 years. The mean age of the group was 42 years. Subjectively, the results were good to excellent in 94.6% of patients and in 92.6% to 94.0% of patients by use of the Hospital for Special Surgery and Mayo scores, respectively. No differences were noted in grip strength. No patient required revision surgery. CONCLUSIONS This repeatable open technique offers excellent results with a low rate of complications at a mean follow-up of 9.8 years. These results compare favorably in terms of numbers followed up, length of follow-up, and outcome and offer strong evidence of its efficacy.
Collapse
|
43
|
Outcome of Boyd-McLeod procedure for recalcitrant lateral epicondylitis of elbow. Rheumatol Int 2010; 31:1081-4. [DOI: 10.1007/s00296-010-1450-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
|
44
|
Sonography of the lateral ulnar collateral ligament of the elbow: study of cadavers and healthy volunteers. AJR Am J Roentgenol 2010; 193:1615-9. [PMID: 19933656 DOI: 10.2214/ajr.09.2812] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the utility of high-resolution sonography in identification and characterization of the size and echogenicity of the lateral ulnar collateral ligament of the elbow in cadavers and healthy volunteers. SUBJECTS AND METHODS The lateral ulnar collateral ligaments of four cadaveric elbows were imaged with a high-resolution linear-array ultrasound transducer. On localization, the ligaments were injected with 0.1% methylene blue under sonographic guidance. For confirmation of identification of the ligaments, the elbows were immediately dissected to reveal the exact location of the stain. The ligaments of both elbows of 35 healthy adult volunteers were imaged. RESULTS Surgical dissection confirmed injection of methylene blue into all four cadaveric ligaments. The lateral ulnar collateral ligament was identified bilaterally over the radial head in all 35 volunteers. The mean thickness of the ligament at this point was 1.2 mm in women and men. The proximal attachment of the ligament to the humerus was well visualized bilaterally in 94.3% of volunteers. The mean thickness at this point was 1.7 mm in women and 1.6 mm in men. The distal attachment on the ulna was well visualized in 90% of elbows. The ligament was hyperechoic in relation to muscle in all volunteers. Differences in ligament measurements with regard to sex and hand dominance were not significant. Ligament thickness correlated weakly with volunteer weight, height, body mass index, and age. CONCLUSION High-resolution ultrasound imaging is accurate for identification and measurement of normal lateral ulnar collateral ligaments. Therefore, ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments.
Collapse
|
45
|
Radiofrequency Microtenotomy for the Treatment of Chronic Insertional Tendinopathy: Comparison of 2 Surgical Techniques and Preliminary Results. TECHNIQUES IN SHOULDER & ELBOW SURGERY 2009. [DOI: 10.1097/bte.0b013e3181b22e65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Abstract
Arthroscopy is emerging as an invaluable tool for diagnosing and treating elbow pathology. In addition to the advantages of less scarring, decreased risk of infection, less postoperative pain, and a more thorough visualization of the elbow joint, arthroscopy is particularly well suited to the treatment of athletes trying to minimize rehabilitation and inactivity. Indications for elbow arthroscopy now extend well beyond diagnosis and loose body removal, and include the treatment of impingement, arthritis, contractures, fragment stabilization for osteochondritis dessicans, and treatment of certain fractures. This article reviews the basic principles and techniques of elbow arthroscopy and their application to common sports-related conditions, such as valgus overload syndrome, medial collateral ligament insufficiency, and the various causes of lateral elbow pain. Newer applications of elbow arthroscopy in fracture care are addressed as well.
Collapse
|
47
|
Functional outcomes after arthroscopic treatment of lateral epicondylitis. J Orthop Sci 2009; 14:167-74. [PMID: 19337808 DOI: 10.1007/s00776-008-1304-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 11/04/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate surgical outcomes of arthroscopic débridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes. METHODS A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of débridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months). RESULTS After surgery, according to the patients' reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P < 0.0001), and that during activity improved from 7.8 points to 0.9 points (P < 0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P < 0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P = 0.02) and receiving public assistance (P = 0.01) were significantly associated with worse DASH scores. CONCLUSIONS Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score.
Collapse
|
48
|
Abstract
Arthroscopy of the elbow was originally considered to be an unsafe procedure because of the small size of the elbow joint capsule and its proximity to several crucial neurovascular structures. Over the past decade, however, the procedure has become safer and more effective. These improvements can be attributed to a better understanding of elbow anatomy and of the disorders about the elbow as well as to advances in arthroscopic equipment and surgical technique. The most common indications for elbow arthroscopy include removal of loose bodies, synovectomy, débridement and/or excision of osteophytes, capsular release, and the assessment and treatment of osteochondritis dissecans. More recent advances have expanded the indications of elbow arthroscopy to include fracture management (eg, radial head fractures) and the treatment of lateral epicondylitis.
Collapse
|
49
|
Abstract
BACKGROUND In a previously published report of the authors' arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients. HYPOTHESIS Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS Forty patients (42 elbows) with lateral epicondylitis who had not responded to nonoperative management were treated with arthroscopic resection of pathologic tissue. Thirty of these patients (30 elbows) were located for extended follow-up. At a mean follow-up of 130 months (range, 106-173 months), patients were asked to use a numeric scale to rate their elbow pain from 0 (no pain) to 10 (severe pain). Patients were also asked to rate their elbows according to the functional portion of the Mayo Clinic Elbow Performance Index. RESULTS The mean pain score at rest was 0; with activities of daily living, 1.0; and with work or sports, 1.9. The mean functional score was 11.7 out of a possible 12 points. No patient required further surgery or repeat injections after surgery. One patient continued to wear a counterforce brace with heavy activities. Twenty-three patients (77%) stated they were "much better," 6 patients (20%) stated they were "better," and 1 patient (3%) stated he was the same. Twenty-six patients (87%) were satisfied, and 28 patients (93%) stated they would have the surgery again if needed. CONCLUSION Arthroscopic removal of pathologic tendinosis tissue is a reliable treatment for recalcitrant lateral epicondylitis. The early high rate of success in patients was maintained at long-term follow-up.
Collapse
Affiliation(s)
- Champ L Baker
- The Hughston Clinic, PC, 6262 Veterans Parkway, Columbus, GA 31909, USA.
| | | |
Collapse
|
50
|
Abstract
Lateral epicondylitis, or tennis elbow, is a common cause of elbow pain in the general population. Traditionally, lateral epicondylitis has been attributed to degeneration of the extensor carpi radialis brevis origin, although the underlying collateral ligamentous complex and joint capsule also have been implicated. Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities. For patients with recalcitrant disease, the traditional open débridement technique has been modified by multiple surgeons, with others relying on arthroscopic or even percutaneous procedures. Without a standard protocol (nonsurgical or surgical), surgeons need to keep abreast of established and evolving treatment options to effectively treat patients with lateral epicondylitis.
Collapse
|