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
|
Mirvish AB, Fowler JR. Surgical Management of Lateral Epicondylitis: A Retrospective Review of Technique Success. Hand (N Y) 2024; 19:715-719. [PMID: 36752081 PMCID: PMC11284991 DOI: 10.1177/15589447231151432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Lateral epicondylitis usually stems from overuse and failed tendon healing. Following attempt of conservative management, surgery is often considered, although there is variation in techniques and outcomes cited in the literature. METHODS This retrospective review analyzed 293 operative patients for lateral epicondylitis following conservative management. The primary outcome was change in pain from preoperative status, including pain-free, improved, unchanged, or worse. Positive outcomes included pain-free or improved symptoms postoperatively. Negative outcomes were unchanged or worse pain. Patients returned 2 weeks, 6 weeks, and 3 months postoperatively. We analyzed patients' profession, handedness, operating surgeon, surgical technique, sex, magnetic resonance imaging findings, concomitant procedures, age, race, revisions, and complications. One surgeon repaired the common extensor using a suture anchor, whereas 2 surgeons performed a side-side repair of the extensor carpi radialis longus and extensor digitorum communis interval. RESULTS By the 3-month visit, 41% were pain-free and 52% improved compared with preoperatively. None were worse, and 7% were unchanged. Mean pain scores at the 2-week, 6-week, and 3-month visits were 4.22/10, 3.61/10, and 3.44/10, respectively. There were 7 revisions (2.4%) and 6 complications (2%). Manual laborers experienced more negative outcomes than sedentary workers (P = .04). The remaining parameters were insignificant, including the operative technique. CONCLUSIONS Surgery is successful for both techniques, with 93% positive outcomes by 3 months. There was no statistical difference in postoperative pain between patients who had suture repair versus anchor repair. Therefore, surgeons should consider suture-only repair given the cost of anchors.
Collapse
|
3
|
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
|
4
|
Yang X, Ying L, Ying L, Zhang Q, Han D, Zhou X. Modified arthroscopic tenotomy of the extensor carpi radialis brevis for refractory lateral epicondylitis: a cohort study. J Shoulder Elbow Surg 2024; 33:536-543. [PMID: 37944746 DOI: 10.1016/j.jse.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Different arthroscopic techniques exist for managing the extensor carpi radials brevis (ECRB) when treating refractory lateral epicondylitis. The purpose of this study is to compare the outcomes of a standard arthroscopic débridement with ECRB tendon release to an arthroscopic ECRB tenotomy distal to its insertion without débridement using a retrospective cohort study design. METHODS This study included patients underwent arthroscopic treatment of lateral epicondylitis during 2 different time periods: 2016-2019 (débridement) and 2019-2021 (modified tenotomy without débridement). Patients were assessed preoperatively and at the last follow-up with Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale of pain. RESULTS A total of 69 patients completed the follow-up (38 in the débridement group and 31 in the tenotomy group). Patients in both groups showed significant improvements were found in MEPS, DASH, and Visual Analog Scale after surgery. Patients in the tenotomy group had higher MEPSs and reported less pain with a minimum 2 year follow-up after surgery. DASH scores between groups were similar at all time periods. CONCLUSION Arthroscopic modified tenotomy of the ECRB without débridement improves function and pain significantly for patients with refractory lateral epicondylitis, which is not inferior to arthroscopic débridement technique.
Collapse
Affiliation(s)
- Xiangdong Yang
- The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Li Ying
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Liwei Ying
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Qingguo Zhang
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Dawei Han
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China.
| |
Collapse
|
5
|
Hanson ZC, Stults WP, Lourie GM. Failed surgical treatment for lateral epicondylitis: literature review and treatment considerations for successful outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:33-40. [PMID: 38323205 PMCID: PMC10840577 DOI: 10.1016/j.xrrt.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Lateral epicondylitis is a common cause of elbow pain in the general population. It is recognized as a degenerative tendinopathy of the common extensor origin believed to be multifactorial, involving elements of repetitive microtrauma associated with certain physiologic and anatomic risk factors. Methods Initial treatment typically involves a combination of conservative treatment measures, with up to 90% success at 12-18 months. Surgical treatment is reserved for recalcitrant disease; traditionally involving open surgical débridement of the common extensor origin with reported success rates greater than 90%. Results Failure of surgical treatment can be multifactorial and present a challenge in determining the optimum management. Residual symptoms may be due to an incorrect initial diagnosis, inadequate surgical débridement, new pathology as a complication of the initial surgery and/or other patient-related and physician- related factors. Even more of a challenge is the possibility that etiology can be due to a combination of listed factors. Discussion In this review, we review the classification scheme for evaluating failed surgical treatment of LE first proposed by Morrey and expand on this classification system based on the senior author's experience. We present the senior author's preferred systematic approach to evaluation and management of these patients, as well as a salvage surgery technique used by the senior author to address the most common etiologies of surgical failure in these patients.
Collapse
Affiliation(s)
- Zachary C. Hanson
- Dept. of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA
| | - William P. Stults
- Dept. of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA
| | - Gary M. Lourie
- Dept. of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA
- The Hand & Upper Extremity Center of Georgia, Atlanta, GA, USA
| |
Collapse
|
6
|
Li Y, Guo S, Li S, Yang G, Lu Y. Is There any Difference in Clinical Outcome between Open and Arthroscopic Treatment for Tennis Elbow? A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:1931-1943. [PMID: 36444948 PMCID: PMC10432432 DOI: 10.1111/os.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
There is considerable controversy regarding the optimal approach (open vs arthroscopic) of releasing and/or debridement for the treatment of tennis elbow (TE). The aim of this study was to determine the clinical outcomes of the two techniques by quantitatively synthesizing outcome data. The study was performed by searching the PubMed, EMBASE, Ovid, and Elsevier databases between January 1995 and April 2022 for a minimum follow-up of 6 months. The searching strategy was "(tennis elbow [Title/Abstract] OR lateral epicondylitis [Title/Abstract]) AND (open [Title/Abstract] OR arthroscopic [Title/Abstract] OR release [Title/Abstract] OR debridement [Title/Abstract] OR surgery [Title/Abstract])". The quality of each study was investigated using the Coleman Methodology Score. In total, 1411 (693 open, 718 arthroscopic) elbows in 1392 patients who underwent releasing and debridement for tennis elbow were identified. The mean Coleman Methodology Score for the included studies was 55.2 ± 8.6 (open: 55.0 ± 9.4, arthroscopic: 55.8 ± 8.2). Improved clinical results were achieved after treatment with either open or arthroscopic treatment. The surgical success rate was 95.6% in open surgery and 92.4% in arthroscopic management. The complication rates were 2.2% and 1.5% for open and arthroscopic procedures, respectively. Similar subjective and objective outcomes, and surgical success rate were observed in patients with both techniques. Patients who had undergone arthroscopic release seemed to return to work earlier (5.3 weeks vs 7.1 weeks). To draw more definite conclusions, high-quality long-term follow-up randomized controlled trials are needed.
Collapse
Affiliation(s)
- Yue Li
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Siyi Guo
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Shangzhe Li
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Guang Yang
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Yi Lu
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| |
Collapse
|
7
|
Konarski W, Poboży T. A Clinical Overview of the Natural Course and Management of Lateral Epicondylitis. Orthopedics 2023; 46:e210-e218. [PMID: 37018622 DOI: 10.3928/01477447-20230329-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Lateral epicondylitis (LE), also often called tennis elbow, is a frequent cause of elbow pain. The most characteristic symptom of LE is pain and burning around the lateral epicondyle of the humerus that may radiate to the forearm or to the upper arm. Ultrasonography is a quick and noninvasive tool used to confirm (or exclude) the diagnosis of LE. Management of LE symptoms should be directed to the management of pain, protection of movement, and improvement of arm performance. Treatment of LE includes nonoperative techniques and surgery. [Orthopedics. 2023;46(4):e210-e218.].
Collapse
|
8
|
Lappen S, Siebenlist S. [Arthroscopic debridement of the extensor carpi radialis brevis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:387-393. [PMID: 37059831 DOI: 10.1007/s00132-023-04373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/16/2023]
Abstract
Surgical treatment of lateral epicondylitis is reserved for patients who, despite extensive conservative therapy, do not experience satisfactory relief of symptoms. As an alternative to the open procedure, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) muscle is a simple and standardized procedure. The arthroscopic approach also enables the additional treatment of intra-articular pathologies such as loose bodies or osteochondral lesions. After diagnostic arthroscopy, the attachment of the ECRB is visualized via the anteromedial portal, so that under visual control the debridement of the tendon fibers of the ECRB and its bony insertion site can be performed via the anterolateral portal. Postoperatively, there is no restriction of movement of the elbow joint. The outcome after arthroscopic ECRB debridement described in the literature is equivalent to that of other surgical techniques.
Collapse
Affiliation(s)
- Sebastian Lappen
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Sebastian Siebenlist
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| |
Collapse
|
9
|
Lateral epicondylitis of the elbow: an up-to-date review of management. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:201-206. [PMID: 35031850 DOI: 10.1007/s00590-021-03181-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
Lateral epicondylitis, also known as tennis elbow, is an overuse tendinopathy of the common extensor origin of the elbow in patients involved in repetitive movement of the wrist and forearm. Lateral epicondylitis is a self-limiting condition, with operative management only recommended in severe, recalcitrant cases. This article reviews the recent updates on operative and non-operative management of lateral epicondylitis.
Collapse
|
10
|
Bhaskaran S, Kumar G, Thadathil N, Piekarz KM, Mohammed S, Lopez SD, Qaisar R, Walton D, Brown JL, Murphy A, Smith N, Saunders D, Beckstead MJ, Plafker S, Lewis TL, Towner R, Deepa SS, Richardson A, Axtell RC, Van Remmen H. Neuronal deletion of MnSOD in mice leads to demyelination, inflammation and progressive paralysis that mimics phenotypes associated with progressive multiple sclerosis. Redox Biol 2023; 59:102550. [PMID: 36470129 PMCID: PMC9720104 DOI: 10.1016/j.redox.2022.102550] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Neuronal oxidative stress has been implicated in aging and neurodegenerative disease. Here we investigated the impact of elevated oxidative stress induced in mouse spinal cord by deletion of Mn-Superoxide dismutase (MnSOD) using a neuron specific Cre recombinase in Sod2 floxed mice (i-mn-Sod2 KO). Sod2 deletion in spinal cord neurons was associated with mitochondrial alterations and peroxide generation. Phenotypically, i-mn-Sod2 KO mice experienced hindlimb paralysis and clasping behavior associated with extensive demyelination and reduced nerve conduction velocity, axonal degeneration, enhanced blood brain barrier permeability, elevated inflammatory cytokines, microglia activation, infiltration of neutrophils and necroptosis in spinal cord. In contrast, spinal cord motor neuron number, innervation of neuromuscular junctions, muscle mass, and contractile function were not altered. Overall, our findings show that loss of MnSOD in spinal cord promotes a phenotype of demyelination, inflammation and progressive paralysis that mimics phenotypes associated with progressive multiple sclerosis.
Collapse
Affiliation(s)
- Shylesh Bhaskaran
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Gaurav Kumar
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, OK, USA
| | - Nidheesh Thadathil
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, OK, USA
| | - Katarzyna M Piekarz
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Sabira Mohammed
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Rizwan Qaisar
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Dorothy Walton
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Jacob L Brown
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA; Oklahoma City VA Medical Center, Oklahoma City, OK, USA
| | - Ashley Murphy
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, OK, USA
| | - Debra Saunders
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, OK, USA
| | - Michael J Beckstead
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA; Oklahoma City VA Medical Center, Oklahoma City, OK, USA
| | - Scott Plafker
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Tommy L Lewis
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA
| | - Rheal Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, OK, USA
| | - Sathyaseelan S Deepa
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, OK, USA; Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Arlan Richardson
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, OK, USA; Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma City VA Medical Center, Oklahoma City, OK, USA
| | - Robert C Axtell
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, OK, USA.
| | - Holly Van Remmen
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, OK, USA; Oklahoma City VA Medical Center, Oklahoma City, OK, USA.
| |
Collapse
|
11
|
Hohmann E. Editorial Commentary: Arthroscopic Debridement of Tennis Elbow Nonresponsive to Nonoperative Measures Is a Good Option and Clinical Outcomes Are Associated With Radiographic Outcomes. Arthroscopy 2022; 38:3130-3132. [PMID: 36462778 DOI: 10.1016/j.arthro.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Chronic lateral epicondylitis, or "tennis elbow," is rare and affects 1% to 3% of adults annually. The initial treatment should be nonoperative and include physical therapy, nonsteroidal anti-inflammatory medication, rest, bracing, extracorporeal shock wave therapy, and injection therapy with various agents such as autologous blood, dextrose, corticosteroids, or platelet-rich plasma. The condition is self-limited, and approximately 80% of cases resolve. In refractory cases, arthroscopic release with debridement is a good surgical option but is not superior to open or percutaneous techniques. Recent research shows that a reduction in magnetic resonance imaging signal intensity in patients who respond to arthroscopic treatment correlates with pain reduction and functional outcome improvement.
Collapse
|
12
|
Li H, Yang XD, Xue X, Zhang Q, Ye L, Hua Y, Zhou X. Arthroscopic Extensor Carpi Radialis Brevis Tenotomy and Debridement Versus Debridement Alone for Refractory Lateral Epicondylitis: Clinical and MRI Evaluation. Orthop J Sports Med 2022; 10:23259671221092733. [PMID: 35958292 PMCID: PMC9358579 DOI: 10.1177/23259671221092733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon is a widely accepted procedure used in refractory lateral epicondylitis. However, residual pain occurs in some patients. Purpose: To investigate the clinical effectiveness of arthroscopic extended debridement (ECRB tenotomy and debridement) in the treatment of lateral epicondylitis. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with refractory lateral epicondylitis were consecutively recruited for this study. They underwent traditional ECRB debridement (control group) or extended ECRB debridement (ED group) under arthroscopy. The Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) for pain, and Mayo Elbow Performance Score (MEPS) were used to compare elbow function between the groups at 3, 6, and 12 months postoperatively. Magnetic resonance imaging (MRI) was also performed to evaluate pathology at 12 months. Results: A total of 69 patients participated in the study (33 patients in the ED group and 36 in the control group). After surgery, all patients showed improvement on all 3 outcome scores. Compared with the control group, the ED group had significantly better postoperative MEPS and VAS scores at 3 months (P ≤ .001 for both) and 6 months (P ≤ .03 for both) but similar values at 12 months. DASH scores between groups were similar at all time periods. At the 12-month follow-up, no patients in the ED group reported pain with strenuous work. Return-to-work (RTW) times were also shorter in the ED group compared with the controls (8 ± 4 vs 18 ± 8 weeks; P < .001). Postoperative MRI assessments revealed no high signal intensities on the lateral epicondyle in the ED group, while there was an increased internal signal intensity on the lateral epicondyle in 83% of the controls. Conclusion: Collectively, the extended ECRB debridement technique resulted in enhanced pain relief in the early postoperative period as well as providing faster RTW times compared with the traditional debridement technique. At 1 year follow-up, there were no differences in outcome measures between groups, but residual abnormal MRI findings were more common in the traditional debridement group.
Collapse
Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Xiang Dong Yang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| | - XiaoAo Xue
- Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Qingguo Zhang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| | - Lingchao Ye
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| |
Collapse
|
13
|
Lin KM, Ellenbecker TS, Safran MR. Rehabilitation and Return to Sport Following Elbow Injuries. Arthrosc Sports Med Rehabil 2022; 4:e1245-e1251. [PMID: 35747663 PMCID: PMC9210377 DOI: 10.1016/j.asmr.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022] Open
Abstract
Elbow injuries are frequently seen in throwing and overhead athletes. This review provides a framework for diagnosis, treatment, and particularly rehabilitation of common elbow pathologies, including ulnar collateral ligament injury, valgus extension overload, and medial and lateral epicondylitis. Advanced rehabilitation facilitates complete return to functional sport-specific activity and is based on objective criteria. As diagnostic and therapeutic modalities improve our understanding of elbow pathologies in the athletic patient, continued research will further elucidate objective evidence-based rehabilitation techniques.
Collapse
Affiliation(s)
- Kenneth M. Lin
- Stanford University Department of Orthopaedic Surgery, Sports Medicine Service, Palo Alto, California
- Address correspondence to Kenneth M. Lin, M.D., 450 Broadway, MC 6342, Redwood City, CA 94063, U.S.A.
| | | | - Marc R. Safran
- Stanford University Department of Orthopaedic Surgery, Sports Medicine Service, Palo Alto, California
| |
Collapse
|
14
|
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
|
15
|
Karabinov V, Georgiev GP. Lateral epicondylitis: New trends and challenges in treatment. World J Orthop 2022; 13:354-364. [PMID: 35582153 PMCID: PMC9048498 DOI: 10.5312/wjo.v13.i4.354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Lateral epicondylitis (LE) is a chronic aseptic inflammatory condition caused by repetitive microtrauma and excessive overload of the extensor carpi radialis brevis muscle. This is the most common cause of musculoskeletal pain syndrome in the elbow, inducing significant pain and limitation of the function of the upper limb. It affects approximately 1-3% of the population and is frequently seen in racquet sports and sports associated with functional overload of the elbow, such as tennis, squash, gymnastics, acrobatics, fitness, and weight lifting. Typewriters, artists, musicians, electricians, mechanics, and other professions requiring frequent repetitive movements in the elbow and wrists are also affected. LE is a leading causation for absence from work and lower sport results in athletes. The treatment includes a variety of conservative measures, but if those fail, surgery is indicated. This review summarizes the knowledge about this disease, focusing on risk factors, expected course, prognosis, and conservative and surgical treatment approaches.
Collapse
Affiliation(s)
| | - Georgi P Georgiev
- Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia 1527, Bulgaria
| |
Collapse
|
16
|
Abstract
With advances in the understanding of elbow anatomy, pathologies of the elbow, arthroscopic instrumentation, and surgical techniques over recent decades, elbow arthroscopy has become a valuable treatment modality for a variety of conditions. Elbow arthroscopy has gained utility for treating problems such as septic arthritis, osteoarthritis, synovitis, osteophyte and loose body excision, contracture release, osteochondral defects, select fractures, instability, and lateral epicondylitis. Accordingly, precise knowledge of the neurovascular anatomy, safe arthroscopic portal placement, indications, and potential complications are required to maximize patient outcomes and assist in educating patients. This comprehensive review provides the reader an understanding of the potential complications associated with arthroscopic procedures of the elbow and to describe strategies for prevention and management.
Collapse
|
17
|
Fahmy FS, ElAttar M, Salem HF. Hand-Grip Strength and Return to Heavy Manual Work at a Mean 5-Year Follow-up After Arthroscopic Release of Recalcitrant Lateral Epicondylitis. Orthop J Sports Med 2022; 10:23259671221078586. [PMID: 35252465 PMCID: PMC8891850 DOI: 10.1177/23259671221078586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Lateral epicondylitis of the elbow is a common degenerative disorder in middle-aged patients. Surgery is reserved for patients who do not respond to nonoperative treatment. Purpose: To evaluate hand-grip strength and return to heavy manual activities in patients engaged in work requiring heavy lifting after arthroscopic release of refractory lateral epicondylitis. Study Design: Case series; Level of evidence, 4. Methods: The study included consecutive patients who underwent arthroscopic release of the extensor carpi radialis brevis tendon to treat recalcitrant lateral epicondylitis of the elbow, with a minimum 48-month follow-up. Functional outcome measures included assessment of hand-grip strength, visual analog scale for pain, and Mayo elbow performance score. The recorded measurements were compared at postoperative 1 and 6 months and the final assessment. Pre- and postoperative data were compared using the paired t test, and the various postoperative assessments were compared using 1-way analysis of variance. Results: A total of 22 patients (mean ± SD; age, 34.6 ± 5.9 years) with a mean follow-up of 60.5 ± 4.7 months were included in our study. There were highly significant improvements between preoperative and 1-month postoperative results regarding hand-grip strength (17.5 ± 4.1 kg to 34.4 ± 6.8 kg), visual analog scale score for pain (7.86 ± 1.2 to 1.8 ± 1.09), and Mayo score (57.1 ± 7.9 to 89.3 ± 4.9; P < .00001 for all). Significant improvements were found on all 3 functional measures between 1 and 6 months postoperatively (P ≤ .05 was statistically significant), and there were nonsignificant improvements on all measures from 6-month to final follow-up. The patients regained 96.4% of their hand strength as compared with the unaffected side and returned to their previous activities without reporting serious complications. Conclusion: Minimally invasive arthroscopic release of recalcitrant lateral epicondylitis of the elbow provided a satisfactory functional result, as shown by regaining of hand-grip strength in patients engaged in heavy manual occupations without significant morbidities.
Collapse
Affiliation(s)
- Fahmy Samir Fahmy
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Mohamed ElAttar
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Hossam Fathi Salem
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| |
Collapse
|
18
|
Kim CH, Park YB, Lee JS, Jung HS. Platelet-rich plasma injection vs. operative treatment for lateral elbow tendinosis: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:428-436. [PMID: 34656779 DOI: 10.1016/j.jse.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. METHODS MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. RESULTS We included 5 studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely, 2 months (mean difference [MD] 1.11, 95% confidence interval [CI] -2.51 to 4.74, P = .55, I2 = 94%), 6 months (MD 0.80, 95% CI -2.83 to 4.42, P = .67, I2 = 92%), and 12 months (MD -0.92, 95% CI -4.63 to 2.80, P = .63, I2 = 93%) postintervention and in the Patient-Related Tennis Elbow Evaluation scores at 12 weeks (MD -1.86, 95% CI -22.30 to 18.58, P = .86, I2 = 81%), 24 weeks (MD -3.33, 95% CI -21.82 to 15.17, P = .72, I2 = 74%), and 52 weeks (MD -3.64, 95% CI -19.65 to 12.37, P = .66, I2 = 69%) postintervention. CONCLUSIONS Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates.
Collapse
Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lee
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seok Jung
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
19
|
Shim JW, Jeon N, Jang MC, Park MJ. Clinical Outcomes of Arthroscopic Debridement for Lateral Epicondylitis with Partial Injury of the Lateral Collateral Ligament Complex. Clin Orthop Surg 2022; 14:434-440. [PMID: 36061854 PMCID: PMC9393269 DOI: 10.4055/cios21220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jae Woo Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Neunghan Jeon
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Min Chang Jang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Daniels SP, De Tolla JE, Azad A, Fritz J. Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles. Semin Musculoskelet Radiol 2021; 25:589-599. [PMID: 34706389 DOI: 10.1055/s-0041-1731790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.
Collapse
Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jadie E De Tolla
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Ali Azad
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| |
Collapse
|
21
|
Kheiran A, Pandey A, Pandey R. Common tendinopathies around the elbow; what does current evidence say? J Clin Orthop Trauma 2021; 19:216-223. [PMID: 34150494 PMCID: PMC8190485 DOI: 10.1016/j.jcot.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/21/2023] Open
Abstract
Tendinopathies are common causes of pain around the elbow resulting in significant functional impairment in athletes or the working-age population. Patients complain of a gradual onset pain with or without any specific trauma. Tissue histology shows chronic fibroblast and vascular proliferation, with a disorganized collagen pattern and absence of inflammatory mediators. Currently, numerous treatment options are described, but many of these are only supported by a heterogenous evidence base. Thus, management guidelines are difficult to define. Surgery is mostly indicated in selected cases that have failed non-operative management. This article reviews the pathophysiology and natural history of lateral and medial elbow tendinopathies, as well as distal biceps and triceps tendinopathies, and their current treatment options.
Collapse
Affiliation(s)
- Amin Kheiran
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK
| | - Aditi Pandey
- University College of London Hospital, London, UK
| | - Radhakant Pandey
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK,Corresponding author. University Hospitals of Leicester Leicester, LE5 4PW, UK
| |
Collapse
|
22
|
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
|
23
|
Carlier Y, Bonichon F, Peuchant A. Recalcitrant lateral epicondylitis: Early results with a new technique combining ultrasonographic percutaneous tenotomy with platelet-rich plasma injection. Orthop Traumatol Surg Res 2021; 107:102604. [PMID: 33358122 DOI: 10.1016/j.otsr.2020.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/22/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Surgical treatment of recalcitrant lateral epicondylitis [LE] remains difficult, with suboptimal results. This prospective study aimed to determine whether percutaneous epicondylar tenotomy combined with PRP injection under ultrasonography control would optimize the surgery results, with an early gain on pain and strength and a rapid return to professional activities at 3 months. The secondary objective was to determine whether clinical or biological risk factors (e.g., composition of the PRP) affected the outcomes. METHODS A total number of 261 Patients with recalcitrant LE underwent percutaneous epicondylar tenotomy under ultrasonography control, coupled with PRP injection. All patients were clinically assessed using VAS pain scale, the functional scores: QuickDASH [Disabilities of the Arm, Shoulder and Hand], Patient-Rated Tennis Elbow Evaluation [PRTEE] and MEPS [Mayo Elbow Performance Score]; Elbow Self-Assessment Score [ESAS]; grip strength; and return to work. RESULTS At 3-month follow-up, the VAS score decreased by 3.4 points (SD 2.2; p<0.0001), the QuickDASH decreased by 32.9 points (SD 18.9, range 56.1-23.1; p<0.0001), the PRTEE decreased by 14.8 points (SD 19.1, 49.8-26.4; p=0.017), and the MEPS increased by 19.4 points (SD 13.1, 67.4-86.9; p<0.0001); grip strength increased to 8.3kg (SD 10.7; p<0.0001) and increased by 26% (SD 0.60, 0.7-0.96; p<0.0001) as compared with the opposite side. The ESAS showed 78.3% improvement. CONCLUSION Treatment of recalcitrant LE by percutaneous tenotomy combined with PRP injection under ultrasonography control provides rapid recovery in terms of pain and strength, with a high level of satisfaction and a high rate of early return to work. STUDY DESIGN Case series.
Collapse
Affiliation(s)
- Yacine Carlier
- Department of orthopaedics, centre de l'arthrose de Mérignac (CAM), clinique du sport Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France.
| | - Françoise Bonichon
- Department of statistics, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Alain Peuchant
- Department of biology, clinique du sport Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| |
Collapse
|
24
|
Altahawi F, Li X, Demarest B, Forney MC. Percutaneous ultrasonic tenotomy with the TX-1 device versus surgical tenotomy for the treatment of common extensor tendinosis. Skeletal Radiol 2021; 50:115-124. [PMID: 32647907 DOI: 10.1007/s00256-020-03540-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare outcomes in patients treated for chronic common extensor tendinosis with percutaneous ultrasonic tenotomy (TX-1 device) versus surgical tenotomy. MATERIALS AND METHODS Outcomes from consecutive patients who underwent percutaneous tenotomy with the TX-1 device were compared with outcomes from consecutive patients who underwent surgical tenotomy. Patients were contacted to retrospectively assess their outcomes at 4 time points: before treatment, 2 weeks after treatment, 3 to 6 months after treatment, and 12 months after treatment. Outcomes were assessed using the quick disabilities of the arm, shoulder, and hand score (QuickDASH) and the Oxford elbow score (OES). Student's t tests were used to compare postprocedural versus preprocedural scores and percutaneous versus surgical tenotomy scores. RESULTS Response rates were 23 of 43 and 10 of 47 for surveyed percutaneous and surgical tenotomy patients, respectively. There were significant improvements from preprocedural scores in all primary outcome measures at 3-to-6-month and 12-month time points for both procedures. No significant changes from preprocedural scores were seen for either procedure at 2 weeks after treatment or between percutaneous and surgical tenotomy in preprocedural or postprocedural scores for any outcome measure. At 2 weeks, improved percutaneous tenotomy scores approached significance compared with percutaneous preprocedural QuickDASH (p = 0.060) and surgical 2-week OES function domain (p = 0.074) scores. CONCLUSION Ultrasonic percutaneous tenotomy with the TX-1 device and surgical tenotomy have similar outcomes for chronic common extensor tendinosis, with significant symptomatic improvement occurring after 3 to 6 months. Larger studies are needed to assess for differences at 2 weeks.
Collapse
Affiliation(s)
- Faysal Altahawi
- Section of Musculoskeletal Imaging, Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH, 44195, USA
| | - Xin Li
- Pennsylvania Hospital, University of Pennsylvania, 800 Spruce Street, Philadelphia, PA, 19107, USA
| | - Brittani Demarest
- Section of Musculoskeletal Imaging, Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH, 44195, USA
| | - Michael C Forney
- Section of Musculoskeletal Imaging, Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH, 44195, USA.
| |
Collapse
|
25
|
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
|
26
|
Ma KL, Wang HQ. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Res Manag 2020; 2020:6965381. [PMID: 32454922 PMCID: PMC7222600 DOI: 10.1155/2020/6965381] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/14/2019] [Accepted: 04/22/2020] [Indexed: 01/26/2023]
Abstract
Lateral epicondylitis, also termed as "tennis elbow," is the most common cause of elbow pain and dysfunction, mainly resulting from repetitive gripping or wrist extension during various activities. The exact pathogenesis remains largely elusive with putative tendinosis, a symptomatic degenerative process of the local tendon. It is usually diagnosed by clinical examinations. Sometimes, additional imaging is required for a specific differential diagnosis. Although most cases can be self-healing, the optimal treatment strategy for chronic lateral epicondylitis remains controversial. This article presents a landscape of emerging evidence on lateral epicondylitis and focuses on the pathogenesis, diagnosis, and management, shedding light on the understandings and treatment for healthcare professionals.
Collapse
Affiliation(s)
- Kun-Long Ma
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, Chongqing 402160, China
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an 712046, Shaanxi Province, China
| |
Collapse
|
27
|
Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res 2019; 105:S241-S246. [PMID: 31543413 DOI: 10.1016/j.otsr.2019.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
Lateral epicondylitis is the most common cause of lateral elbow pain. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore constitutes a major public health issue. This article reviews the pathophysiological factors involved in lateral epicondylitis, as well as the tools available for establishing the diagnosis and ruling out other causes of lateral elbow pain. Finally, the non-operative and surgical treatment options are discussed in detail.
Collapse
Affiliation(s)
- Hubert Lenoir
- Chirurgie de l'épaule, du coude et de la main, Centre Ostéo-articulaires des Cèdres, Parc Sud Galaxie, 5, rue des tropiques, 38130 Echirolles, France
| | - Olivier Mares
- Centre hospitalier universitaire Nîmes-Caremeau, place du professeur Robert-Debré, 30029 Nîmes, France
| | - Yacine Carlier
- Centre de l'Arthrose, Clinique du sport Bordeaux-Mérignac, 2, rue George-Négrevergne, 33700 Mérignac, France.
| |
Collapse
|
28
|
Colombi R, Bevand A, Devillier A, Baulot E, Ezzahoui A, Martz P. Exclusive Posterolateral Arthroscopic and Endoscopic Approaches Used in the Treatment of Lateral Epicondylitis. Orthopedics 2019; 42:e521-e527. [PMID: 31587076 DOI: 10.3928/01477447-20191001-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023]
Abstract
Complications following arthroscopy of the elbow for the treatment of lateral epicondylitis are essentially related to the anterior arthroscopic approach. The principal aims of this study were to describe and evaluate the mixed arthroscopic and endoscopic surgical technique using posterolateral approaches exclusively. This was a retrospective study of consecutive patients operated on between 2005 and 2014 for lateral epicondylitis following more than 6 months of ineffective medical treatment. The exploration was arthroscopic via a distal posterolateral portal. The extensor carpi radialis brevis was disinserted via a proximal extra-articular posterolateral endoscopic portal. The postoperative clinical follow-up included subjective (visual analog scale, Nirschl) and objective (Mayo Clinic Elbow Performance Score) evaluations of pain, the time to return to work, the level of satisfaction, complications, and failures. Thirty-seven patients underwent the procedure, including 3 lost to follow-up. Mean±SD follow-up was 32.8±24.7 months. Mean±SD visual analog scale scores were 0.8±0.8 at rest, 2.4±1.3 during everyday activities, and 3.1±1.5 during effort. Mean±SD Mayo Clinic Elbow Evaluation Score was 10.1±1.0 of 12 and mean±SD Mayo Clinic Elbow Performance Score was 91.9±12.5 of 100. Mean±SD Nirschl score was 67.5±9.6 of 80. Mean±SD time to return to work was 2.0±2.6 months. The level of satisfaction was 94.1%. The failure rate was 2.9%, with no neurological lesions. With equivalent or even better results than those already published, this surgical procedure enables the treatment of lateral epicondylitis via posterolateral portals alone, thus avoiding the complications inherent to anterior and medial arthroscopic approaches. [Orthopedics. 2019; 42(6):e521-e527.].
Collapse
|
29
|
Wang W, Chen J, Lou J, Shentu G, Xu G. Comparison of arthroscopic debridement and open debridement in the management of lateral epicondylitis: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17668. [PMID: 31689781 PMCID: PMC6946356 DOI: 10.1097/md.0000000000017668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/05/2019] [Accepted: 09/27/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previous studies have reported that both arthroscopic debridement (AD) and open debridement (OD) of extensor carpi radialis brevis are effective in the treatment of lateral epicondylitis. Despite this, few studies have focused on the comparative outcomes of these 2 procedures. The aim of this study was to assess whether AD is superior to OD in managing lateral epicondylitis. METHODS A systematic search of the literature was conducted to identify relevant articles that were published in MEDLINE, Embase, and Cochrane Library databases during January 2019. All studies comparing the efficacy of AD and OD in terms of failure rate, complication rate, and clinical outcome measures were included. Statistical analysis was performed using Review Manager. RESULTS Six clinical trials were included in the current meta-analysis. There was no significant difference with regard to disabilities of the arm, shoulder, and hand scores, visual analog scale, and failure rate. There was a statistically significant difference in surgical time in favor of the OD (mean difference [MD], -11.45, 95% confidence interval [CI], -12.45 to -10.44, I = 0%, P < .001). There was no significant difference of complication rate between the OD group (0.6%) and the AD group (1.0%) (MD, 0.62; 95% CI, 0.12-3.06; P = .55) CONCLUSION:: There was no significant difference between arthroscopic and open surgery with regards to failure rate, functional outcome score, and complication rate. The current meta-analysis found that arthroscopic surgery had a longer surgical time than open surgery for lateral epicondylitis.
Collapse
|
30
|
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
|
31
|
Cutts S, Gangoo S, Modi N, Pasapula C. Tennis elbow: A clinical review article. J Orthop 2019; 17:203-207. [PMID: 31889742 DOI: 10.1016/j.jor.2019.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/09/2019] [Indexed: 01/26/2023] Open
Abstract
Lateral epicondylitis, or tennis elbow is a common condition that presents with pain and tenderness around the common extensor origin of the elbow. Tennis elbow is estimated to affect 1-3% of the adult population each year and is more common in the dominant arm. It is generally regarded as an overuse injury involving repeated wrist extension against resistance, although it can occur as an acute injury (trauma to the lateral elbow). Up to 50% of all tennis players develop symptoms due to various factors including poor swing technique the use of heavy racquet. It's also seen in labourers who utilise heavy tools or engage in repetitive gripping or lifting task. In this article, we discuss the existing literature in the field and the current thinking on optimum treatment modalities. We have reviewed the literature available on med line and have discussed the condition with our specialist colleagues in the field.
Collapse
Affiliation(s)
- S Cutts
- James Paget Hospital, United Kingdom
| | | | | | | |
Collapse
|
32
|
Lateral Epicondylitis Debridement and Repair Using Knotless Suture Anchor. Arthrosc Tech 2019; 8:e775-e779. [PMID: 31485406 PMCID: PMC6714886 DOI: 10.1016/j.eats.2019.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/13/2019] [Indexed: 02/03/2023] Open
Abstract
Lateral epicondylitis, or tennis elbow, involves degeneration of the extensor carpi radialis brevis tendon and is often self-limiting, with surgery reserved for recalcitrant cases. Surgical management of tennis elbow consists primarily of either debridement alone or debridement with repair. Surgical repair is often performed using either a suture or a suture anchor. Good outcomes have been reported using standard repair methods; however, complications exist. Complications include potential loss of grip strength with debridement alone, as well as soft-tissue irritation caused by a prominent suture or knot stack after suture repair and suture anchor techniques. We describe a technique for debridement and repair of the extensor carpi radialis brevis tendon to the lateral epicondyle of the humerus using a knotless suture anchor, allowing for a watertight anatomic repair, maximum preservation of grip strength, and absence of a knot stack and resultant suture prominence.
Collapse
|
33
|
do Nascimento AT, Claudio GK, Rocha PB, Zumárraga JP, de Camargo OP. ARTHROSCOPIC TREATMENT FOR LATERAL EPICONDYLITIS: OUTCOMES IN 104 CASES OF A SINGLE INSTITUTION. ACTA ORTOPEDICA BRASILEIRA 2019; 27:156-159. [PMID: 31452612 PMCID: PMC6699394 DOI: 10.1590/1413-785220192703216249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the outcomes of patients that underwent arthroscopic surgery for lateral epicondylitis (LE), after failed conservative treatment. METHODS One hundred four patients with LE treated with arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon were enrolled in this retrospective study. They were evaluated using Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS) and Short Form Health Survey (SF-36) scale. Mean age at surgery was 46.9 years. Duration of symptoms was 2.1 years (range: 6 m to 10 yrs.). Mean follow-up was 34.4 months (range: 6 to 68 m). RESULTS Mean postoperative scores were: 20.67 points on the DASH; 1.8 points on the VAS at rest, with 48 cases (46%) without pain, 40 (38%) with mild pain, 13 (13%) with moderate pain and 4 (4%) with severe pain; 4.7 points on the VAS in activity, with 21 (20%) without pain, 21 (20%) with mild pain, 35 (34%) with moderate pain and 27 (26%) with severe pain; and SF-36 was 66.8 points. Of the 23 patients who practiced sports regularly or with higher physical demand from the upper limbs, 17 (74%) were able to return to the same activity at the same level. No significant complications were observed postoperatively, except for 3 (2.8%) cases of postoperative superficial infection. CONCLUSION Surgical treatment with arthroscopy for recalcitrant LE is effective and safe, presenting positive outcomes in the studied patients. Level of evidence IV, Case Series.
Collapse
Affiliation(s)
| | | | - Pedro Bellei Rocha
- Hospital Orthoservice, Shoulder and Elbow Group, São José dos Campos, SP, Brazil
| | - Juan Pablo Zumárraga
- Escuela de Medicina, Colégio de Ciências de la Salud, Universidad San Francisco de Quito (USFQ), Quito, Ecuador
- Hospital de los Valles, Orthopedics and Traumatology Department, Quito, Ecuador
| | - Olavo Pires de Camargo
- Universidade de São Paulo, Faculdade de Medicina, Orthopedics and Traumatology Department, São Paulo, SP, Brazil
| |
Collapse
|
34
|
Arthroscopic treatment of work-related lateral epicondylitis – prognostic factors. HAND SURGERY & REHABILITATION 2019; 38:24-27. [DOI: 10.1016/j.hansur.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022]
|
35
|
A Novel Technique for the Surgical Management of Chronic Lateral Epicondylitis. Tech Hand Up Extrem Surg 2019; 23:65-69. [PMID: 30694885 DOI: 10.1097/bth.0000000000000227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in most cases. However, when conservative treatment fails, surgery is required for resistant cases. In this study, we describe a novel technique for the management of chronic lateral epicondylitis. The advantage of our technique is that all the 3 major components of the disease (as also all types of failure described by Morrey) are simultaneously dealt with, that is, pathology of the tendon, posterior interosseous nerve compression and intra-articular pathology are all addressed. We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated with our technique at our Institute from 2008 to 2013 with a minimum 2 years follow up. We included patients between 18 and 65 years of age who in addition to lateral epicondylitis also had an intra-articular pathology along with symptoms/signs suggestive of posterior interosseous nerve compression and had undergone a conservative trial of atleast 12 months. Excluded were those cases with localized infection and severe ankylosis, whereas previous surgery on the same elbow was a relative contraindication. Postoperatively all patients showed improvement in the VAS score and grip strength. Twelve of the 14 patients (85.7%) in our series had good to excellent functional outcomes on the Mayo Elbow Performance Index. This technique can therefore be recommended for wider surgical use; however, prospective randomized studies with a longer follow-up would add further evidence about the effectiveness of our technique.
Collapse
|
36
|
Cogné M, Creuzé A, Petit H, Delleci C, Dehail P, de Seze M. Number of botulinum toxin injections needed to stop requests for treatment for chronic lateral epicondylar tendinopathy. A 1-year follow-up study. Ann Phys Rehabil Med 2019; 62:336-341. [PMID: 30639581 DOI: 10.1016/j.rehab.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/24/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Epicondylar tendinopathy ("tennis elbow") is a serious issue in manual labourers. Symptoms can persist over months or even more than 1 year, even when treated with trinitrine patches, acupuncture, sclerosis of neovessels, shock-wave therapy, autologous blood injections, platelet-rich plasma or hyaluronic acid. Botulinum toxin (BoNT-A) injections showed promising short-term results, but the long-term beneficial effects are not yet known. OBJECTIVE We aimed to assess the long-term effect, side effects and recurrence rate after BoNT-A injections on chronic lateral epicondylar tendinopathy during 1 year. METHODS This open study followed a 3-month randomized controlled trial. We included 50 patients followed at day 0 (V0), 90 (V1), 180-270 (V2) and 365 (V3). The main judgment criterion was the number of BoNT-A injections required to achieve pain relief with no further request for treatment by the patient. RESULTS After one BoNT-A injection, 22/50 (44%) patients did not ask for further treatment during follow-up because of complete pain relief, and 20/50 (40%) asked for a second BoNT-A injection. For 20 patients with a second injection, 18 (90%) did not ask for further treatment during follow-up. Only 1 patient had a recurrence of pain after an initial pain relief of greater than 75%. Quality of life, and painful and maximal gripping force improved significantly at V1, V2 and V3 as compared with V0, and repercussions on daily and professional activities decreased significantly (P<0.05). CONCLUSIONS One or 2 BoNT-A injections has favourable results for chronic epicondylar tendinopathy.
Collapse
Affiliation(s)
- Mélanie Cogné
- Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France; EA4136 Handicap, Activité, Cognition, Santé, Bordeaux University, 33076 Bordeaux, France; University Hospital of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - Alexandre Creuzé
- Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France
| | - Hervé Petit
- Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France
| | - Claire Delleci
- Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France
| | - Patrick Dehail
- Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France; EA4136 Handicap, Activité, Cognition, Santé, Bordeaux University, 33076 Bordeaux, France
| | - Mathieu de Seze
- Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France; EA4136 Handicap, Activité, Cognition, Santé, Bordeaux University, 33076 Bordeaux, France
| |
Collapse
|
37
|
Field LD. Editorial Commentary: Dealer's Choice for Arthroscopic Versus Open Lateral Epicondylitis Release? It's Not That Simple. Arthroscopy 2018; 34:3185-3186. [PMID: 30509428 DOI: 10.1016/j.arthro.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
The most efficacious treatment for patients with persistent lateral epicondylitis who have not adequately improved despite undergoing extended nonoperative measures may be arthroscopic. One advantage is the capability of the surgeon to fully assess the elbow intra-articularly. Second, the incision is often considered less appealing to both patients and surgeons than portal-site incisions. A final potential benefit is the opportunity for the occasional elbow arthroscopist to take advantage of a "best-case" clinical setting to perform a thorough arthroscopic diagnostic evaluation of both the anterior and posterior elbow compartments and improve his or her elbow arthroscopic skills, because patients with lateral epicondylitis rarely have advanced arthritis or capsular contractures and have infrequently undergone prior elbow surgery. Moreover, if technical difficulties arise during an arthroscopic release, the procedure can be easily converted to a standard open release technique without compromising the patient's condition or the procedure.
Collapse
|
38
|
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
|
39
|
Shim JW, Yoo SH, Park MJ. Surgical management of lateral epicondylitis combined with ligament insufficiency. J Shoulder Elbow Surg 2018; 27:1907-1912. [PMID: 30170794 DOI: 10.1016/j.jse.2018.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/03/2018] [Accepted: 06/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral collateral ligament (LCL) insufficiency may occur in patients with chronic lateral epicondylitis (LE). We report on 14 consecutive patients with chronic LE and LCL insufficiency. METHODS We performed a retrospective review of 14 patients with LE and LCL insufficiency diagnosed between 2006 and 2015. The patients had undergone débridement for LE and ligament reconstruction for LCL insufficiency. The study included 9 men and 5 women with an average age of 53 years (range, 41-69 years). The mean follow-up period was 36 months (range, 24-97 months). We analyzed the pain visual analog scale score; Mayo Elbow Performance Score; Disabilities of the Arm, Shoulder and Hand score; range of motion; and posterolateral rotatory drawer test. We compared histories of steroid injection, trauma, and surgery. RESULTS The pain visual analog scale score, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand score were significantly improved postoperatively and improved in all patients. Three patients had mild instability on the stress test at final follow-up. All patients had a history of steroid injection, 2 had a history of trauma, and 3 had a history of surgery. The number of steroid injections and the number of cases receiving steroid injections more than 3 times were significantly higher in patients with LCL insufficiency. CONCLUSIONS Assessment of stability is important in patients with chronic LE and risk factors such as multiple steroid injections. Simultaneous surgical treatment including open débridement and ligament reconstruction provides satisfactory pain relief and functional improvement in patients with LE and LCL insufficiency.
Collapse
Affiliation(s)
- Jae Woo Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Si Hoon Yoo
- Department of Orthopedic Surgery, Inseong Hallym Hospital, Incheon, Republic of Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
40
|
Gaspar MP, Motto MA, Lewis S, Jacoby SM, Culp RW, Lee Osterman A, Kane PM. Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques. Orthop J Sports Med 2017; 5:2325967117742077. [PMID: 29238734 PMCID: PMC5721972 DOI: 10.1177/2325967117742077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design Cohort study; Level of evidence, 3. Methods A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P < .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P < .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.
Collapse
Affiliation(s)
- Michael P Gaspar
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Darden School of Business, University of Virginia, Charlottesville, Virginia, USA
| | - Michael A Motto
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Lewis
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Orthopaedics, Southern California Permanente Medical Group, Fontana, California, USA
| | - Sidney M Jacoby
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Randall W Culp
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - A Lee Osterman
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick M Kane
- Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
41
|
|
42
|
Wang D, Degen RM, Camp CL, McGraw MH, Altchek DW, Dines JS. Trends in Surgical Practices for Lateral Epicondylitis Among Newly Trained Orthopaedic Surgeons. Orthop J Sports Med 2017; 5:2325967117730570. [PMID: 29051902 PMCID: PMC5637978 DOI: 10.1177/2325967117730570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Much controversy exists regarding the optimal surgical intervention for lateral epicondylitis because of a multitude of options available and the lack of comparative studies. Knowledge of the current practice trends would help guide the design of comparative studies needed to determine which surgical technique results in the best outcome. Purpose: To review the latest practice trends for the surgical treatment of lateral epicondylitis among newly trained surgeons in the United States utilizing the American Board of Orthopaedic Surgery (ABOS) database. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The ABOS database was utilized to identify surgical cases for lateral epicondylitis submitted by Part II board certification examination candidates from 2004 through 2013. Inclusion criteria were predetermined using a combination of International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Cases were organized by open and arthroscopic treatment groups and by fellowship training and were analyzed to determine differences in surgical techniques, complication rates, and concomitant procedures. Results: In total, 1150 surgeons submitted 2106 surgical cases for the treatment of lateral epicondylitis. The number of surgical cases for lateral epicondylitis performed per 10,000 submitted cases significantly decreased from 26.7 in 2004 to 21.1 in 2013 (P = .002). Among all cases, 92.2% were open and 7.8% were arthroscopic, with no change in the incidence of arthroscopic surgeries over the study period. Shoulder and elbow (18.1%) and sports medicine (11.4%) surgeons were more likely to perform surgery arthroscopically compared with hand surgeons (6.1%) (P < .001). There was no difference in overall self-reported complication rates between open (4.4%) and arthroscopic (5.5%) procedures (P = .666). Percutaneous tenotomy, debridement only, and debridement with tendon repair comprised 6.4%, 46.3%, and 47.3% of open treatment, respectively. Sports medicine, hand, and shoulder and elbow surgeons were more likely to repair the tendon after debridement compared with other surgeons, who were more likely to perform debridement alone (P < .001). Hand surgeons were most likely to perform concomitant procedures, of which the majority were neuroplasties. Conclusion: Although comparative studies are ultimately necessary for determining the optimal surgical technique, researchers should be mindful of the differences in practices according to training and the extent to which concomitant procedures are being performed, as both these factors may confound any future results.
Collapse
Affiliation(s)
- Dean Wang
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Ryan M Degen
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Christopher L Camp
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Michael H McGraw
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - David W Altchek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
43
|
|
44
|
Ciccotti MG, Pollack KM, Ciccotti MC, D'Angelo J, Ahmad CS, Altchek D, Andrews J, Curriero FC. Elbow Injuries in Professional Baseball: Epidemiological Findings From the Major League Baseball Injury Surveillance System. Am J Sports Med 2017; 45:2319-2328. [PMID: 28575638 DOI: 10.1177/0363546517706964] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Elbow injuries cause significant disability for the throwing athlete. Scant data are available on the distribution and characteristics of these injuries in elite baseball players. No study exists that focuses solely on the epidemiological characteristics of elbow injuries in professional baseball players using a comprehensive injury surveillance system. HYPOTHESIS Professional baseball players have a high occurrence of elbow injuries influenced by factors including length of time playing, time period within the annual baseball season, and specific position played. STUDY DESIGN Descriptive epidemiological study. METHODS Data on elbow injuries occurring during the 2011-2014 seasons were collected from Major League Baseball's Health Injury and Tracking System, a comprehensive injury surveillance system. Each specific type of elbow injury was evaluated with respect to overall injury rate, years as a professional player, mechanism of injury, treatment, average time lost, and return to play. RESULTS During the study period, 3185 elbow injuries (n = 430 Major League; n = 2755 Minor League) occurred. The mean number of days missed and percentage requiring surgery were similar between Major and Minor League players. Overall, 20.0% (650/3185) of the injuries required surgical treatment. Pitchers were the most likely to incur an elbow injury (40.0% of injured athletes were pitchers), were the most likely to require surgery (34.2% of injured pitchers required surgery), and had the greatest mean number of days missed when treated nonsurgically (33.2 days). Medial injuries composed 42.1% (1342/3185) of all elbow injuries. Of all elbow surgeries performed during the study period, the highest percentage involved ligaments (372/650; 57.2%). CONCLUSION Elbow injuries are a considerable source of disability in professional baseball players. Pitchers are most likely to incur these injuries, are most likely to require surgery, and have the highest mean number of days missed when treated nonsurgically. The most common injuries involve the medial elbow, with ligament injuries most often requiring surgery. This study represents the only investigation to date using a comprehensive injury surveillance system to examine elbow injuries in professional baseball players. It provides a basis for injury prevention and treatment recommendations, establishes the most thorough framework for determining elbow injury risk, and focuses continued research on elbow injury prevention in the elite baseball player.
Collapse
Affiliation(s)
- Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Keisha M Pollack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael C Ciccotti
- Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, USA
| | | | - Christopher S Ahmad
- Columbia University Medical Center, Department of Orthopaedic Surgery, New York, New York, USA
| | - David Altchek
- Hospital for Special Surgery, New York, New York, USA
| | - James Andrews
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
| | - Frank C Curriero
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
45
|
Merolla G, Dellabiancia F, Ricci A, Mussoni MP, Nucci S, Zanoli G, Paladini P, Porcellini G. Arthroscopic Debridement Versus Platelet-Rich Plasma Injection: A Prospective, Randomized, Comparative Study of Chronic Lateral Epicondylitis With a Nearly 2-Year Follow-Up. Arthroscopy 2017; 33:1320-1329. [PMID: 28433443 DOI: 10.1016/j.arthro.2017.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 02/02/2017] [Accepted: 02/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this prospective, randomized study was to compare the efficacy of autologous platelet-rich plasma (PRP) injections and arthroscopic lateral release in treating chronic lateral epicondylitis (LE). METHODS Patients who had a clinical diagnosis of LE confirmed by ultrasound (US) were included in this study. A total of 101 patients received arthroscopic release (n = 50) or US-guided PRP injections (n = 51). Outcomes were assessed using a visual analog scale for pain, the Patient-Rated Tennis Elbow Evaluation (PRTEE), and a calibrated hand dynamometer for grip strength. RESULTS Both patient groups experienced significant improvement in all measures. Between-group comparisons showed a significantly higher value in the PRP group only for grip strength at week 8 (P = .0073); all other significant differences were in favor of arthroscopy: overall pain (P = .0021), night pain (P = .0013), and PRTEE score (P = .0013) at week 104 and grip strength at weeks 24, 52, and 104 (all P < .0001). Consumption of rescue pain medication was not significantly different between the groups. CONCLUSIONS The present findings suggest that (1) PRP injections and arthroscopic extensor carpi radialis brevis release are both effective in the short and medium term; (2) PRP patients experienced a significant worsening of pain at 2 years; (3) arthroscopic release ensured better long-term outcomes in terms of pain relief and grip strength recovery; and (4) both procedures were safe and well accepted by patients. LEVEL OF EVIDENCE: Level II, prospective comparative study.
Collapse
Affiliation(s)
- Giovanni Merolla
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy; "Marco Simoncelli" Biomechanics Laboratory, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy.
| | - Fabio Dellabiancia
- "Marco Simoncelli" Biomechanics Laboratory, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy
| | - Annamaria Ricci
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy
| | - Maria Pia Mussoni
- Haematology and Blood Transfusion Unit, "Infermi" Hospital, Rimini-AUSL della Romagna, Ambito Territoriale di Rimini, Italy
| | - Simonetta Nucci
- Haematology and Blood Transfusion Unit, "Infermi" Hospital, Rimini-AUSL della Romagna, Ambito Territoriale di Rimini, Italy
| | | | - Paolo Paladini
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy
| | - Giuseppe Porcellini
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Territoriale di Rimini, Italy
| |
Collapse
|
46
|
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
|
47
|
Abstract
Lateral epicondylitis, also known as ‘tennis elbow’, is a very common condition affecting mainly middle-aged patients. The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. The diagnosis is usually clinical but some patients may benefit from additional imaging for a specific differential diagnosis. The disease has a self-limiting course of between 12 and 18 months, but in some patients, symptoms can be persistent and refractory to treatment. Most patients are well-managed with non-operative treatment and activity modification. Many surgical techniques have been proposed for patients with refractory symptoms. New non-operative treatment alternatives with promising results have been developed in recent years.
Cite this article: Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev 2016;1:391-397. DOI: 10.1302/2058-5241.1.000049.
Collapse
Affiliation(s)
| | - Raul Barco
- Hospital Universitario La Paz, Madrid, Spain
| | | |
Collapse
|
48
|
Abstract
Tendinopathies of the elbow and in particular of the common extensor origin are a common cause of elbow pain. Part one of this two part review of tendinopathies of the elbow will focus on the pathophysiology and management of lateral elbow tendinopathy, frequently referred to as tennis elbow. Lateral elbow tendinopathy is a common condition with an incidence of 1 – 2%. The pathology arises from the origin of extensor carpi radialis brevis where changes, consistent with all tendinopathies, of angiofibroblastic hyperplasia occur secondary to repetitive micro trauma. It is not an inflammatory condition. Clinical history and examination is usually sufficient for diagnosis although MRI and ultrasound can be used. The many treatment options that have been proposed have a mixed quality of supporting evidence. Thus management protocols are difficult to define. Treatment depends on the length of symptoms. Acute presentation is managed through conservative measures including activity modification, topical NSAIDs and physiotherapy. For patients with recalcitrant symptoms, injection therapy with, for example, platelet rich plasma can be used. Alternatively surgical excision of the diseased tissue can be performed. This review article will consider the available evidence in order to identify both treatments that are effective and those that are not.
Collapse
|
49
|
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
|
50
|
Nascimento ATD, Claudio GK. Arthroscopic surgical treatment of recalcitrant lateral epicondylitis - A series of 47 cases. Rev Bras Ortop 2017; 52:46-51. [PMID: 28194381 PMCID: PMC5290077 DOI: 10.1016/j.rboe.2016.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/18/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. METHODS A retrospective study of 44 patients (47 elbows) who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analog scale of pain (VAS), and ShortForm 36 (SF-36). The mean age at surgery was 44.4 years (32-60). The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years). Mean follow-up was 18.6 months (range of 6-31.9). RESULTS The mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain) and 3.0 points at activity, of which 31 (66%) cases presented mild pain, 10 (21%) moderate pain, and six (13%) severe pain; mean SF-36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. CONCLUSIONS Arthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.
Collapse
|