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
|
Kruse RC, Volfson E. Ultrasonic Fasciotomy for the Treatment of Chronic Plantar Fasciopathy: A Prospective Study. Clin J Sport Med 2024; 34:335-340. [PMID: 38407211 DOI: 10.1097/jsm.0000000000001215] [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: 08/28/2023] [Accepted: 01/05/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the long-term efficacy and safety of an ultrasonic fasciotomy for plantar fasciopathy. DESIGN Prospective observational study. SETTING Tertiary care academic medical center. PARTICIPANTS Patients with chronic plantar fasciopathy refractory to standard, conservative treatments were included in this study. INTERVENTIONS Patients underwent ultrasonic fasciotomy of the plantar fascia. MAIN OUTCOME MEASURES The primary outcome measures were change in visual analog scale at 12 and 52 weeks post-procedure compared with baseline as well as patients' self-reported satisfaction with the procedure. RESULTS Sixty-seven patients were included. There was a significant improvement in visual analog scale at all follow-up time points, with an average overall improvement of 5.87 ( P < 0.0001). 94% of patients reported satisfaction with the outcomes of their procedure at 12 and 52 weeks. No procedural complications were seen. CONCLUSIONS This study demonstrates that an ultrasonic fasciotomy is a safe and effective treatment option for chronic plantar fasciopathy, with continued symptom improvement and a high degree of patient satisfaction up to 52 weeks post-procedure. CLINICAL RELEVANCE These findings suggest that an ultrasonic fasciotomy should be considered for patients with chronic plantar fasciopathy refractory to conservative treatments.
Collapse
Affiliation(s)
- Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa
| | - Elena Volfson
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| |
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
|
Umapathy S, Miller M, Chen YT. Novel Ultrasound-Guided Radiofrequency Ablation of the Epicondylar Branch of the Posterior Cutaneous Nerve of the Forearm for Recalcitrant Lateral Epicondylosis. Cureus 2024; 16:e61222. [PMID: 38939254 PMCID: PMC11210423 DOI: 10.7759/cureus.61222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
This report describes a novel technique for the treatment of recalcitrant lateral epicondylosis (LE) by radiofrequency ablation (RFA) of the epicondylar branch of the posterior cutaneous nerve of the forearm (PCNF-BrEpi). Here, we describe two patients suffering from recalcitrant LE who were treated with ultrasound-guided RFA of the PCNF-BrEpi in the outpatient pain clinic setting. Patient follow-up was made at eight weeks, five months, and seven months. Numerical pain rating (NPR) for pain and Upper Extremity Functional Index-15 (UEFI-15) were obtained at baseline and at each of the follow-ups. Both patients reported significant improvement in their pain and function quickly. RFA may be a viable treatment option for recalcitrant LE. Larger comparative trials and further investigation are needed to establish results in comparison to conventional treatments and to validate RFA as a treatment option in recalcitrant LE.
Collapse
Affiliation(s)
- Siddardth Umapathy
- Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, USA
| | - Matthew Miller
- Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, USA
| | - Yin-Ting Chen
- Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, USA
| |
Collapse
|
5
|
Hiett A, Li S, Segal NA. A rare complication of percutaneous ultrasonic tenotomy in a 66-year-old man with calcific Achilles tendinopathy. PM R 2024; 16:194-196. [PMID: 37229567 DOI: 10.1002/pmrj.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Andrew Hiett
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Susan Li
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Neil A Segal
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
6
|
Hall MM, Kliethermes SA, Henning PT, Hoffman DF, Mautner K, Obunadike E, Onishi K, Pourcho AM, Sellon JL, Chimenti R. Three-Month Complication Rate of Ultrasound-Guided Soft Tissue Surgical Procedures Across Six Sports Medicine Clinics. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2629-2641. [PMID: 37376744 DOI: 10.1002/jum.16298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications. METHODS A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates. RESULTS Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified. CONCLUSION This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.
Collapse
Affiliation(s)
- Mederic M Hall
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Stephanie A Kliethermes
- Department of Orthopaedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - P Troy Henning
- Sports and Performance Medicine, Swedish Medical Center, Seattle, Washington, USA
| | - Douglas F Hoffman
- Departments of Orthopaedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Kenneth Mautner
- Department of Orthopedics and Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Ezi Obunadike
- Department of Orthopedics and Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Adam M Pourcho
- Elite Sports Performance Medicine, Seattle, Washington, USA
| | - Jacob L Sellon
- Department of Orthopedic Surgery, Sports Medicine Division, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
7
|
Rupe MW, Fleury IG, Glass N, Kruse R, Buckwalter V JA. Efficacy of Ultrasonic Tenotomy and Debridement and Platelet-Rich Plasma Injections for Lateral Elbow Tendinopathy. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:667-672. [PMID: 37790822 PMCID: PMC10543797 DOI: 10.1016/j.jhsg.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose To determine the efficacy of treatment of lateral elbow tendinopathy (LET) with platelet-rich plasma (PRP) injection and ultrasonic tenotomy and debridement (USTD) as well as risk factors for treatment failure. Methods This was a retrospective study including patients treated for LET with PRP or USTD between January 2018 and December 2021. The efficacy of both procedures was assessed using pain-related patient-reported outcome measures at the 12-week follow-up. Baseline subject characteristics and diagnostic ultrasound findings were analyzed as risk factors for failure of treatment. Failure was classified as a surgical indication for LET within a year of the PRP or USTD. Results Ultrasonic tenotomy and debridement and PRP both led to significant improvement in patient pain within the 12-week follow-up period. There was no significant difference in efficacy between the two procedures. Common extensor tendon tearing on ultrasound and Worker's Compensation cases were found to be risk factors for failure of USTD. Lateral collateral ligament complex involvement and injection were found to be risk factors for failure of PRP. Conclusions Platelet-rich plasma and USTD are both effective interventions for LET. They have separate risk factors for failure that should be taken in consideration while deciding the treatment approach. These procedures are minimally invasive alternatives to some of the more invasive surgical options to treat LET. Type of study/level of evidence Therapeutic III.
Collapse
Affiliation(s)
- Marshall W. Rupe
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA
| | | | - Natalie Glass
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Ryan Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA
| | | |
Collapse
|
8
|
Dakkak M, Patel V, King D, Genin J. Ultrasound-guided tenotomy for lateral epicondylitis with TenJet improves physical functional and decreased pain outcomes at 1 year: a case series review. JSES Int 2023; 7:872-876. [PMID: 37719823 PMCID: PMC10499850 DOI: 10.1016/j.jseint.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Common extensor tendinopathy is a common cause of lateral elbow pain. Ultrasound-guided minimally invasive tenotomy (MIT) has been utilized successfully as a treatment for several years, but the use of TenJet device has not been well described. Purpose To evaluate the effectiveness and safety of MIT with TenJet who failed nonsurgical management of common extensor tendinopathy in an outpatient setting. Methods A total of 100 patients with common extensor tendinopathy who failed conservative treatment underwent ultrasound-guided MIT with TenJet device in the outpatient setting at a single institution. All 100 patients prior to MIT underwent diagnostic musculoskeletal ultrasound showing common extensor tendinosis. The findings were interpreted by a fellowship-trained and board-certified musculoskeletal radiologist. Patients were evaluated with the Oxford Elbow Score prior to the procedure and at 1-year follow-up. Exclusion criteria included prior corticosteroid injection within the past 6 weeks of the MIT intervention, active local or systemic infection, complete full thickness tear of the common extensor tendon, and pregnancy. Results Oxford Elbow Score had a statistically significant difference in baseline to 1 year (P < .001). No complications were reported and zero patients went on to require open surgical intervention. Conclusion MIT with TenJet is a safe, effective, and well-tolerated treatment for common extensor tendinopathy.
Collapse
Affiliation(s)
- Michael Dakkak
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Vikas Patel
- Cleveland Clinic Primary Sports Medicine, Department of Orthopaedics, Cleveland, OH, USA
| | - Dominic King
- Cleveland Clinic Primary Sports Medicine, Department of Orthopaedics, Cleveland, OH, USA
| | - Jason Genin
- Cleveland Clinic Primary Sports Medicine, Department of Orthopaedics, Cleveland, OH, USA
| |
Collapse
|
9
|
Silva FD, Zorzenoni F, da Silva LNM, Dos Reis Teixeira Neto A, Gonzalez MT, Filho AGO, Guimarães JB. Tendon injections - upper extremity. Skeletal Radiol 2023; 52:979-990. [PMID: 36050573 DOI: 10.1007/s00256-022-04174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 02/02/2023]
Abstract
Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.
Collapse
Affiliation(s)
- Flávio Duarte Silva
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
| | - Fernando Zorzenoni
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
| | | | | | - Marco Tulio Gonzalez
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
| | | | | |
Collapse
|
10
|
Prabhakar G, Kanawade V, Ghali AN, Dutta AK, Brady CI, Morrey BF. Medial Elbow Pain Syndrome: Current Treatment Strategies. Orthopedics 2023; 46:e81-e88. [PMID: 35876779 DOI: 10.3928/01477447-20220719-06] [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: 02/03/2023]
Abstract
Medial elbow pain is a common presentation that can be a challenge to appropriately treat for the orthopedic surgeon. Causes include medial epicondylitis, ulnar neuritis, ulnar collateral ligament injury, flexor pronator strain, or snapping medial triceps. A good outcome is typically achieved with adequate treatment of tendon degeneration at the common flexor tendon origin. Mainstay treatment is nonoperative modalities such as stretching, rest, activity modification, therapy, and injections. If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted. Surgical treatments are dictated based on the severity of the pathology, involvement of soft tissues, and concomitant pathology. Medial elbow complaints can be multifactorial and require a broad differential diagnosis. [Orthopedics. 2023;46(2):e81-e88.].
Collapse
|
11
|
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
|
12
|
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
|
13
|
Martins J, Neto IS, Gonçalves AF, Pereira A, Santiago M, Ferro I, Lopes T, Carvalho JL. Platelet-Rich Plasma Injection Associated With Microtenotomy in Lateral Epicondylitis – is a Tendon Tear Associated with the Therapeutic Response? Cureus 2022; 14:e22425. [PMID: 35371831 PMCID: PMC8941632 DOI: 10.7759/cureus.22425] [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] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029). Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.
Collapse
|
14
|
Bodor M, Uribe Y, Srikumaran U. Ultrasonic aspiration for vaccination-related shoulder dysfunction. Heliyon 2021; 7:e08442. [PMID: 34901499 PMCID: PMC8642614 DOI: 10.1016/j.heliyon.2021.e08442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic shoulder pain occurs rarely after a vaccination and is hypothesized to arise from the effects of unintentional vaccine injection into the subacromial bursa, rotator cuff, capsule or underlying bone. The avascular nature of the rotator cuff, as well as unknown genetic and environmental factors, may predispose to the persistence of pain and disability, referred to as vaccination-related shoulder dysfunction and shoulder injury related to vaccine administration (SIRVA). Methods Ultrasonography, sonopalpation and ultrasound-guided anesthetic injections were used to locate the anatomical source of chronic (mean 20, range 8–42 months) shoulder pain after a vaccination in a consecutive series of 5 patients. Subsequently ultrasound-guided ultrasonic aspiration and debridement was performed using a 2.1 mm outer cannula with an inner needle vibrating at 28 kHz. Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) scale at 2, 4, 12, 24 weeks and 1 year. Results The distal infraspinatus and teres minor tendons, their insertions and or the adjacent bone were the source of pain in all 5 patients. The mean QDASH score improved from 65 points to 11 points at 2 weeks (P = 0.001), and to 1 point at 4 weeks after the procedures (P = 0.003). Improvements in pain and function remained stable at 1 year in 3 patients, for at least 24 weeks in 1 patient who died of unrelated causes, and 1 year in 1 patient for posterior shoulder pain who after a pain free interval developed anterior shoulder pain related to his previously asymptomatic osteoarthritis (P = 0.013). Conclusion The distal infraspinatus and teres minor tendons, their insertions and adjacent bone are a common source of chronic shoulder pain after a vaccination. Ultrasound-guided ultrasonic aspiration and debridement is a potentially effective treatment for resolving pain and restoring function.
Collapse
Affiliation(s)
- Marko Bodor
- Bodor Clinic, 3421 Villa Lane, Napa, CA, 94558, USA.,Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Physical Medicine and Rehabilitation, University of California Davis, 4860 Y Street, Sacramento, CA, 95817, USA.,Napa Medical Research Foundation, 3421 Villa Lane, Napa, CA, 94558, USA
| | - Yvette Uribe
- Napa Medical Research Foundation, 3421 Villa Lane, Napa, CA, 94558, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| |
Collapse
|
15
|
Abstract
Utilization of musculoskeletal ultrasound, in particular for sports medicine, has dramatically increased in recent years. Ultrasound is an important adjunct tool to physical examination and other imaging methods in the evaluation and management of the injured athlete. It offers unique advantages in specific clinical scenarios. Dedicated training and a standardized scanning technique are important to overcome the inherent operator dependence and avoid diagnostic pitfalls. Ultrasound guidance can also improve accuracy in targeted percutaneous injection therapies. This article reviews the general ultrasound appearance of muscle, tendon, ligament, and nerve abnormalities in the athlete with a focus on sport-specific injuries.
Collapse
|
16
|
Ang BFH, Mohan PC, Png MA, Allen JC, Howe TS, Koh JSB, Lee BP, Morrey BF. Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months. Am J Sports Med 2021; 49:1854-1860. [PMID: 33956537 DOI: 10.1177/03635465211010158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years' follow-up. PURPOSE To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon. STUDY DESIGN Case series; Level of evidence, 4. METHODS The same cohort of 20 patients was recalled after 7 years, and visual analog scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction were assessed. They were also reassessed using ultrasound imaging of the brevis and the common extensor tendon to evaluate tendon hypervascularity, tendon thickness, and the progress or the recurrence of the hypoechoic scar tissue. RESULTS We successfully scored 19 patients and performed ultrasound on 16 patients with a median follow-up of 90 months (range, 86-102 months). There were no adverse outcomes and satisfaction remained at 100% (6 patients, satisfied; 13 patients, very satisfied). No patient developed a recurrence of symptoms and signs of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained (P < .001 for all). At 90 months, there was a significant improvement in VAS scores and DASH-Compulsory scores compared with preprocedure scores and all follow-up times until 3 months. There was no difference in VAS scores and DASH-Compulsory scores at 90 months compared with 6 and 36 months. For DASH-Work scores, there was a significant improvement at 90 months compared with preprocedure scores, but there was no difference between DASH-Work scores at 90 months and scores at all other points of follow-up. At 90 months, hypervascularity remained resolved in 79% of patients, while all patients had reduced tendon swelling and sustained resolution or reduction of the hypoechoic lesion. CONCLUSION At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrated good durability of pain relief and functional recovery that was previously achieved. This was accompanied by sustained sonographic tissue healing with no significant deterioration.
Collapse
Affiliation(s)
- Benjamin F H Ang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - P Chandra Mohan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Meng Ai Png
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Joyce S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Brian P Lee
- Orthopaedic Associates Mount Elizabeth Hospital, Singapore
| | - Bernard F Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopaedic Surgery, University of Texas Health Center, San Antonio, Texas, USA
| |
Collapse
|
17
|
Lavallee M, Bush C. Ultrasound-Guided Percutaneous Tenotomy and Its Associated Pain Reduction and Functionality Outcomes in Nonelite Active Adults. Am J Phys Med Rehabil 2021; 100:349-353. [PMID: 33727517 DOI: 10.1097/phm.0000000000001570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate changes in pain and functionality after ultrasound-guided percutaneous tenotomy (USGPT) for treatment of tendinopathy. DESIGN This was a prospective cohort study of patients undergoing USGPT as an alternative to surgery. Nonelite, active adults completed pain and functionality assessments before USGPT. The visual analog scale (VAS) was used to quantify pain. The Lower Extremity Functionality Scale and the Disabilities of the Arm, Shoulder, and Hand were used to evaluate functionality. Repeat VAS scores were obtained at 1 wk, 1 mo, 2 mos, 3 mos, 6 mos, and 1 yr postprocedure, and repeat functionality assessments, at 1 yr postprocedure. Changes in VAS and functionality were analyzed with paired-sample t-tests. RESULTS A total of 103 subjects (61 women, 42 men) underwent USGPT in the following tendons: Achilles, patellar, plantar fascia, flexor carpi ulnaris, extensor carpi radialis brevis, and supraspinatus. Subjects experienced statistically significant decreases in VAS and functionality scores at all time points. The mean VAS score decreased from 7.3 to 3.8 (P < 0.0001) 1 wk postprocedure, with a 5.8-point mean decrease at 1 yr (P < 0.0001). Lower Extremity Functionality Scale scores improved from 42.5 to 65.8 (P < 0.001) and Disabilities of the Arm, Shoulder, and Hand scores improved from 41.5 to 10.4 (P < 0.001) at 1 yr. CONCLUSION Recipients of USGPT procedures can expect to benefit from less invasive procedures and improved pain and functionality without invasive surgical procedures.
Collapse
|
18
|
Patel H, Lala S, Helfner B, Wong TT. Tennis overuse injuries in the upper extremity. Skeletal Radiol 2021; 50:629-644. [PMID: 33009583 DOI: 10.1007/s00256-020-03634-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Tennis is a popular sport with high levels of participation. This article aims to describe how upper extremity overuse injuries occur in relation to tennis biomechanics and to review their imaging characteristics and implications for management. In particular, we will review the imaging patterns of internal impingement, scapular dyskinesis, lateral and medial epicondylitis, ulnar collateral ligament insufficiency, valgus extension overload, capitellar osteochondritis dissecans, extensor carpi ulnaris tendinosis and instability, tenosynovitis, triangular fibrocartilage complex injuries, and carpal stress injuries. CONCLUSION Tennis is a complex and physically demanding sport with a wide range of associated injuries. Repetitive overloading commonly leads to injuries of the upper extremity. An understanding of the underlying mechanisms of injury and knowledge of these injury patterns will aid the radiologist in generating the correct diagnosis in both the professional and recreational tennis athlete.
Collapse
Affiliation(s)
- Hanisha Patel
- New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA.
| | - Sonali Lala
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Brett Helfner
- Zwanger and Pesiri Radiology, 150 Sunrise Hwy, Lindenhurst, New York, NY, 11757, USA
| | - Tony T Wong
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| |
Collapse
|
19
|
Wahezi S, Yerra S, Rivelis Y, Sitapara K, Gonzalez D, Downie S, Jain R, Deer T, Abd-Elsayed A, Gulati A. Sonographically Guided Percutaneous Sectioning of the Coracohumeral Ligament for the Treatment of Refractory Adhesive Capsulitis: Proof of Concept. PAIN MEDICINE 2020; 21:3314-3319. [PMID: 32869096 DOI: 10.1093/pm/pnaa262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Treatment options are limited for nonsurgical chronic refractory cases of adhesive capsulitis. We describe a novel percutaneous tenotomy technique for coracohumeral ligament interruption with cadaveric validation. OBJECTIVE The objective of this study was to describe and validate a novel technique for percutaneous interruption of the coracohumeral ligament. DESIGN Cadaveric study. SETTING Academic tertiary care center. METHODS Eight cadavers underwent ultrasound (US)-guided percutaneous incision of the coracohumeral (CHL) ligament. Performance of the procedure requires that the practitioner make oscillatory motions with a needle that uses ultrasound energy to cut through tissue. Each pass removes a pinhead-sized amount of tissue. The number of passes and the cutting time are recorded during the procedure. As a standard for this procedure does not exist, the authors created their own based on the preclinical information presented here. Postprocedure dissection was performed to assess the extent of CHL interruption and injury to surrounding tissue. RESULTS The average resection time was seven minutes, requiring 500 passes. The technique described in this paper completely interrupted the CHL in all subjects. Cadaveric analysis demonstrated interruption of the CHL with respect to control shoulders requiring an average of seven minutes of cutting time and ∼500 micro-perforations. CONCLUSION US-guided percutaneous CHL ligament sectioning is possible with a commercially available ultrasonic probe.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Tim Deer
- The Spine and Nerve Centers of Virginias, Charleston, West Virginia
| | | | - Amit Gulati
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| |
Collapse
|
20
|
Hattori S, Onishi K, Yano Y, Kato Y, Ohuchi H, Hogan MV, Kumai T. Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate. Orthop J Sports Med 2020; 8:2325967120967322. [PMID: 33354581 PMCID: PMC7734515 DOI: 10.1177/2325967120967322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background Arthroscopic repair is a widely accepted surgical treatment for chronic ankle instability; however, recent studies have shown that arthroscopic repair is nonanatomic in its anchor placement and resultant biomechanics. Ultrasound may improve the accuracy of the anchor placement. Hypothesis Our hypothesis was that the accuracy of anchor placement in sonographically guided anterior talofibular ligament (ATFL) repair will be comparable with that in open ATFL repair. Study Design Cohort study; Level of evidence, 3. Methods The study included 26 patients who received surgical treatment between April 2012 and October 2019 for chronic ankle instability. Fifteen patients underwent open modified Broström repair and 11 underwent sonographically guided ATFL repair. The distance between the anchor hole and the fibular obscure tubercle was measured using 3-dimensional computed tomography and was compared between the operative procedures. For comparison, a noninferiority trial was employed, with open modified Broström repair as the reference surgery. The noninferiority margin was defined as 5 mm. Results The mean ± SD distance between the anchor and fibular obscure tubercle was 6.0 ± 2.7 mm in open repair and 5.6 ± 3.3 mm in sonographically guided repair. The mean difference in distance between the techniques (open repair - sonographically guided repair) was 0.37 mm (95% CI, -2.1 to 2.9 mm). The lower margin of the confidence interval was within the noninferiority margin (-5 to 5 mm). Conclusion Anchor placement under sonographically guided ATFL repair was equivalent to that of open ATFL repair and can be considered anatomic and accurate.
Collapse
Affiliation(s)
- Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Foot and Ankle Injury Research Group, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuji Yano
- Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Foot and Ankle Injury Research Group, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuki Kato
- Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan
| | - MaCalus V Hogan
- Foot and Ankle Injury Research Group, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| |
Collapse
|
21
|
Vajapey S, Ghenbot S, Baria MR, Magnussen RA, Vasileff WK. Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic Review. Sports Health 2020; 13:258-264. [PMID: 33252310 DOI: 10.1177/1941738120951764] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Chronic tendinopathy is a challenging problem that can lead to significant disability and limitation in not only athletics but also activities of daily living. While there are many treatment techniques described for this overuse injury, no single modality has been proven superior to all others. With recent advances in medical technology, percutaneous ultrasonic tenotomy (PUT) for tendinosis has gained traction with promising results. OBJECTIVE To examine the data published on PUT for treatment of tendinopathy, analyze the outcomes of the procedure, including duration of pain relief and patient-reported outcomes, and assess the rate of complications associated with the procedure. DATA SOURCES PubMed, MEDLINE, EMBASE, and Google Scholar. STUDY SELECTION The following combination of keywords was entered into the electronic search engines: ultrasonic tenotomy, ultrasound tenotomy, Tenex, and ultrasonic percutaneous tenotomy. The search results were screened for studies relevant to the topic. Only English-language studies were considered for inclusion. Studies consisting of level 4 evidence or higher and those involving human participants were included for more detailed evaluation. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Articles meeting the inclusion criteria were sorted and reviewed. Type of tendinopathy studied, outcome measures, and complications were recorded. Both quantitative and qualitative analyses were performed on the data collected. RESULTS There were a total of 7 studies that met the inclusion criteria and quality measures-5 studies involving the treatment of elbow tendinopathy and 1 study each involving the management of Achilles tendinopathy and plantar fasciitis. PUT resulted in decreased pain/disability scores and improved functional outcome scores for chronic elbow tendinopathy and plantar fasciitis. Results for Achilles tendinopathy showed modest improvement in the short term, but long-term data are lacking. CONCLUSION PUT is a minimally invasive treatment technique that can be considered in patients with tendinopathy refractory to conservative treatment measures. Further higher quality studies are necessary to accurately assess the comparative effectiveness of this treatment modality.
Collapse
Affiliation(s)
- Sravya Vajapey
- Sports Medicine Research Institute, Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| | - Sennay Ghenbot
- The Ohio State University School of Medicine, Columbus, Ohio
| | - Michael R Baria
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Robert A Magnussen
- Sports Medicine Research Institute, Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| | - W Kelton Vasileff
- Sports Medicine Research Institute, Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| |
Collapse
|
22
|
[Ultrasound-guided percutaneous tenotomy in chronic wrist extensor enthesopathy]. Rehabilitacion (Madr) 2020; 54:211-214. [PMID: 32563618 DOI: 10.1016/j.rh.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
Abstract
Epicondylitis causes disability and tends to become chronic. Histologically, degenerative lesions are found in the common extensor tendon, which are visible on ultrasound or magnetic resonance imaging. Several conservative therapeutic measures are available, including corticosteroid infiltration by anatomical landmark. However, these measures sometimes fail, in which case patients are proposed for surgery. Ultrasound is a therapeutic tool that allows procedures on tendons to be performed without skin incisions. The technique of ultrasound-guided percutaneous tenotomy for the treatment of chronic epicondylitis was first reported in 2006. This procedure, demonstrated to date by surgeons and radiologists, attempts to transform a chronic degenerative process with failure to repair into an acute inflammatory process with self-regeneration. The aim of this study was to describe 5 cases of epicondylitis that failed to respond to routine therapeutic measures, in which we used ultrasound-guided percutaneous tenotomy with favourable results.
Collapse
|
23
|
Percutaneous ultrasonic tenotomy effectively debrides tendons of the extensor mechanism of the knee: A technical note. Knee 2020; 27:649-655. [PMID: 32563419 DOI: 10.1016/j.knee.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 03/12/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous ultrasonic tenotomy (PUT) is a minimally-invasive method of treating patellar tendinosis, but its immediate effect on tendon structure has never been studied. Given the crucial nature of the extensor mechanism of the knee, it is important to understand the procedure's effect on tendon structure prior to clinical implementation. The aim of this study was to analyze the tendon structure of the extensor mechanism of the knee after PUT in a cadaveric model. METHODS Four fresh-frozen cadaveric specimens (two patellar and two quadriceps tendons) underwent PUT. The tendons were then sectioned and stained with hematoxilin & eosin (H&E). The sections were analyzed for a clear area of debridement. The area of debridement was calculated as an average of three measurements. RESULTS All four tendons demonstrated a clear area of debridement limited to the treatment area without damaging any surrounding tissue. The area of debridement for the patellar and quadriceps tendons treated was 2.89 mm2, 1.5 mm2, 2.98 mm2 and 7.29 mm2, respectively. CONCLUSIONS Percutaneous ultrasonic tenotomy effectively debrided the treatment area in all tendons without damaging surrounding tissue. Further work is needed to report clinical outcomes, assess the risk of post-procedure tendon rupture and define return-to-sport progression.
Collapse
|
24
|
Abstract
Orthobiologics are exciting tools providing promising results for difficult orthopedic conditions. In the elbow there is high-level evidence for their use in lateral epicondylopathy and encouraging evidence for other elbow pathologies. This article provides an in-depth review of the current literature for the use of orthobiologics in elbow injuries.
Collapse
Affiliation(s)
- Cleo D Stafford
- Department of Orthopaedics and Rehabilitation Medicine, Emory University School of Medicine, 49 Jessie Hill Junior Drive Southeast 3rd Floor, Atlanta, GA 30303, USA. https://twitter.com/CleoStaffordMD
| | - Ricardo E Colberg
- Andrews Sports Medicine and Orthopedic Center, American Sports Medicine Institute, 805 St Vincent's Drive Suite 100, Birmingham, AL 35205, USA.
| | - Hunter Garrett
- American Sports Medicine Institute, 805 St Vincent's Drive Suite 100, Birmingham, AL 35205, USA
| |
Collapse
|
25
|
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
|
26
|
Abstract
Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described. Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months). Results: The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 (P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 (P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) (P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures. Conclusion: PUT is an effective treatment, with good results for patients with gluteal tendinopathy.
Collapse
Affiliation(s)
| | - J Ryan Mahoney
- Jack Hughston Memorial Hospital, Phenix City, Alabama, USA
| |
Collapse
|
27
|
Boettcher BJ, Hollman JH, Stuart MJ, Finnoff JT. Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study. PM R 2020; 12:1113-1119. [DOI: 10.1002/pmrj.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | - John H. Hollman
- Department of Physical Medicine and Rehabilitation Mayo Clinic College of Medicine and Science Rochester MN
| | - Michael J. Stuart
- Department of Orthopedic Surgery Mayo Clinic College of Medicine and Science Rochester MN
| | - Jonathan T. Finnoff
- Department of Physical Medicine and Rehabilitation Mayo Clinic College of Medicine and Science Rochester MN
| |
Collapse
|
28
|
Tang S, Wang X, Wu P, Wu P, Yang J, Du Z, Liu S, Wei F. Platelet-Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta-Analysis of Randomized Controlled Trials. PM R 2020; 12:397-409. [PMID: 31736257 PMCID: PMC7187193 DOI: 10.1002/pmrj.12287] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022]
Abstract
Objective To compare the effectiveness of platelet‐rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis. Type of Study Network meta‐analysis. Literature Survey Randomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library. Methodology Two researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2). Publication bias was evaluated by constructing contour‐enhanced funnel plots. Stata 15 software was applied for pairwise meta‐analysis and network meta‐analysis. To explore the efficacy between different follow‐up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term. Synthesis Twenty RCTs (n = 1271) were included in this network meta‐analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient‐Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short‐term period. For the long‐term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8). Conclusion PRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.
Collapse
Affiliation(s)
- Siqi Tang
- The Eight Year Program, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xiaoshuai Wang
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Peihui Wu
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peiqi Wu
- The Five-Year Program, School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jiaming Yang
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Zefeng Du
- The Five-Year Program, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Fuxin Wei
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| |
Collapse
|
29
|
Stover D, Fick B, Chimenti RL, Hall MM. Ultrasound-guided tenotomy improves physical function and decreases pain for tendinopathies of the elbow: a retrospective review. J Shoulder Elbow Surg 2019; 28:2386-2393. [PMID: 31471243 PMCID: PMC6874924 DOI: 10.1016/j.jse.2019.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tendinopathy is a common cause of elbow pain in the active population. Ultrasound-guided tenotomy (USGT) is a minimally invasive treatment option for cases recalcitrant to conservative management. Several case studies have shown promising preliminary results of USGT for common extensor tendinopathy and common flexor tendinopathy, but none have included USGT for triceps tendinopathy. This larger retrospective study evaluates the effectiveness and safety of USGT for all elbow tendinopathy sites at short- and long-term follow-up. METHODS Retrospective chart review identified 131 patients (144 procedures; mean age ± standard deviation [SD], 48.1 ± 9.8 years; mean body mass index ± SD, 32.2 ± 7.7; 59% male) with elbow tendinopathy (104 common extensor tendinopathy, 19 common flexor tendinopathy, 8 triceps tendinopathy) treated with USGT over a 6-year period by a single physician. Pain and quality-of-life measures were collected at baseline. Pain, quality-of-life, satisfaction with outcome, and complications were collected at short-term (2-, 6-, and 12-week) and long-term (median 2.7 years, interquartile range = 2.0-4.0 years) follow-up. RESULTS Overall, USGT for elbow tendinopathy decreased pain from moderate/severe at baseline to mild/occasional at short- and long-term follow-up (P < .01). Quality-of-life assessments showed significant improvement in physical function at short- and long-term follow-up (P < .01). The majority (70%) of patients were satisfied with the procedure. There was a 0% complication rate. CONCLUSION Benefits of USGT include pain relief, improved physical function, and high patient satisfaction. USGT is a safe, minimally invasive treatment for refractory elbow tendinopathy.
Collapse
Affiliation(s)
- Daniel Stover
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Benjamin Fick
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Mederic M. Hall
- Department of Orthopedics & Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| |
Collapse
|
30
|
Hattori S, Alvarez CAD, Canton S, Hogan MV, Onishi K. Ultrasound-Guided Ankle Lateral Ligament Stabilization. Curr Rev Musculoskelet Med 2019; 12:497-508. [PMID: 31749104 PMCID: PMC6942111 DOI: 10.1007/s12178-019-09592-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Ultrasound (US) is an increasingly popular imaging modality currently used both in clinics and operating rooms. The purpose of this review is to appraise literature describing traditional lateral ankle stabilization techniques and discuss potential advantages of US-guided ankle lateral ligament stabilization. In addition, albeit limited, we will describe our experiences in perfecting this technique. RECENT FINDINGS To date, the modified open Broström-Gould technique remains as the gold standard surgical treatment for chronic ankle instability (CAI). In the past decade, modifications of this technique have been done, from a combination of arthroscopic and open procedure to an all-inside arthroscopic technique with a goal of minimizing wound complications, better outcomes, and earlier return to activity. Recently, the use of US as an adjunct to surgical procedures has gained popularity and several novel techniques have been described. The use of US in lateral ankle stabilization could allow accurate placement of the suture anchor at the anatomical attachment of the anterior talofibular ligament (ATFL) without iatrogenic damage to the neurovascular structures such as anterolateral malleolar artery, superficial peroneal nerve, and sural nerve. In summary, the use of US in ankle lateral ligament stabilization is a promising new micro-invasive technique. The theoretical advantages of US-guided ankle lateral ligament stabilization include direct visualization of desired anatomical landmarks and structures which could increase accuracy, decrease iatrogenic neurovascular damage, minimize wound complications, and improve outcomes.
Collapse
Affiliation(s)
- Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, 2968602, Japan.
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Carlo Antonio D Alvarez
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, 2968602, Japan
| | - Stephen Canton
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Macalus V Hogan
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kentaro Onishi
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| |
Collapse
|
31
|
Sussman WI, Hofmann K. Treatment of Insertional Peroneus Brevis Tendinopathy by Ultrasound-Guided Percutaneous Ultrasonic Needle Tenotomy: A Case Report. J Foot Ankle Surg 2019; 58:1285-1287. [PMID: 31679682 DOI: 10.1053/j.jfas.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/13/2019] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
Insertional peroneus brevis tendinopathy is uncommon and treatment options for recalcitrant insertional lesions are rarely described in the literature. Ultrasound-guided percutaneous ultrasonic needle tenotomy has been described for the treatment of recalcitrant tendinopathy in the elbow, knee, and plantar fascia, but has not been described for the treatment of peroneal tendinopathy. We report a case of recalcitrant insertional peroneus brevis tendinopathy successfully treated with an ultrasound-guided percutaneous ultrasonic needle tenotomy. The treatment resulted in a rapid recovery, and the patient remained asymptomatic at the 6-month follow up. No complications were observed during follow up and the minimally invasive percutaneous procedures offers clear advantage over open techniques.
Collapse
Affiliation(s)
- Walter I Sussman
- Assistant Professor, Department of Physical Medicine & Rehabilitation, Tufts University, Boston, MA; Physician, Orthopedic Care Physician Network, North Easton, MA.
| | - Kurt Hofmann
- Physician, Orthopedic Care Physician Network, North Easton, MA; Assistant Professor, Department of Orthopedics, Tufts University, Boston, MA
| |
Collapse
|
32
|
Boettcher BJ, Hollman JH, Stuart MJ, Finnoff JT. Ultrasound-Guided Cutting Wire Release of the Proximal Adductor Longus Tendon: A Feasibility Study. Orthop J Sports Med 2019; 7:2325967119866010. [PMID: 31489333 PMCID: PMC6710695 DOI: 10.1177/2325967119866010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Adductor longus tendinopathy is a well-known etiology of chronic groin pain in elite athletes. Surgery is indicated for those who fail conservative treatment. No studies to date have evaluated the feasibility of an ultrasound-guided release of the proximal adductor longus tendon. Purpose/Hypothesis: The primary aim of this study was to determine the feasibility of an ultrasound-guided selective adductor longus release with a cutting wire. A secondary aim was to determine safety by avoiding injury to adjacent structures. We hypothesized that the proximal adductor longus tendon can be released under ultrasound guidance with a cutting wire without injury to adjacent neurovascular or genitourinary structures. Study Design: Descriptive laboratory study. Methods: Ten adductor longus tendons (5 cadaveric specimens) from 4 males and 1 female between 76 and 89 years of age with a mean body mass index of 21.9 kg/m2 (range, 16.8-29.6 kg/m2) were used during this study. A single experienced physician sonographer performed ultrasound-guided proximal adductor longus tendon releases on all cadaveric specimens using a cutting wire. Dissection was performed by a second physician to determine the completeness of the tendon transections and to detect injury to adjacent neurovascular or genitourinary structures. Results: All 10 adductor longus tendons were transected. Eight of 10 transections were complete, whereas in 2 transections, >99% of the tendon was transected. There were no injuries to adjacent genitourinary or neurovascular structures. Conclusion: Ultrasound-guided adductor tendon release is feasible and safe in a cadaveric model. Further translational research should be performed to determine whether these results can be replicated in the clinical setting. Clinical Relevance: Adductor longus tendinopathy frequently requires surgical intervention and prolonged time away from sport. The present study suggests that a selective adductor longus tendon release can be performed with ultrasound guidance. This procedure warrants further translational research to explore its use in clinical practice.
Collapse
Affiliation(s)
| | - John H Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| |
Collapse
|
33
|
Bazzocchi A, Aparisi Gómez MP, Spinnato P, Marinelli A, Napoli A, Rotini R, Catalano C, Guglielmi G. Imaging the Postsurgical Upper Limb: The Radiologist Perspective. Radiol Clin North Am 2019; 57:977-1000. [PMID: 31351545 DOI: 10.1016/j.rcl.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Imaging has a paramount role in postsurgical assessment. Radiologists need to be familiar with the different surgical procedures to be able to identify expected postsurgical appearances and also detect potential complications. This article reviews the indications, normal expected postsurgical appearances, and complications of the most frequently used surgical procedures in the shoulder, elbow, and wrist. The emphasis is on points that should not be overlooked in the surgical planning.
Collapse
Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, National Women's Hospital, Auckland City Hospital, Greenlane Clinical Center, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Ultrasound, National Women's Hospital, Auckland City Hospital, Greenlane Clinical Center, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, Hospital Nisa Nueve de Octubre, Calle Valle de la Ballestera, 59, Valencia 46015, Spain
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Alessandro Napoli
- Department of Radiologic, Oncologic and Pathologic Sciences, La Sapienza University of Rome, V.le Regina Elena 324, Rome 00180, Italy
| | - Roberto Rotini
- Shoulder and Elbow Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Carlo Catalano
- Department of Radiologic, Oncologic and Pathologic Sciences, La Sapienza University of Rome, V.le Regina Elena 324, Rome 00180, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| |
Collapse
|
34
|
Chimenti RL, Stover DW, Fick B, Hall M. Percutaneous Ultrasonic Tenotomy Reduces Insertional Achilles Tendinopathy Pain With High Patient Satisfaction and a Low Complication Rate. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1629-1635. [PMID: 30280399 PMCID: PMC6461537 DOI: 10.1002/jum.14835] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/13/2018] [Indexed: 05/22/2023]
Abstract
Due to the novelty of percutaneous ultrasonic tenotomy, the risks and benefits of this minimally invasive procedure for insertional Achilles tendinopathy pain have only been examined in case studies and retrospective chart reviews for other diagnoses. This retrospective chart review over a 3.5-year period identified 34 patients with insertional Achilles tendinopathy who had percutaneous ultrasonic tenotomy (mean age ± SD, 52.2 ± 11.6 years; mean body mass index, 32.9 ± 7.5 kg/m2 ; 62% female). This procedure reduced the rate of moderate/severe pain from 68% at baseline to 15% at the long-term follow-up and had a satisfaction rate of 70%. There was 1 minor complication out of 40 procedures in 34 patients.
Collapse
Affiliation(s)
- Ruth L. Chimenti
- University of Iowa, Department of Physical Therapy and Rehabilitation Science
- Corresponding author: , Phone: 319-335-7013, Address: University of Iowa, 2116 Westlawn, Iowa City, IA 52245
| | | | - Ben Fick
- University of Iowa, College of Medicine
| | - Mederic Hall
- University of Iowa, Department of Orthopaedics and Rehabilitation
| |
Collapse
|
35
|
Kamineni S, Ruggles A, Ashfaq H. Ultrasonic debridement with stem cell therapy of suspensory branch desmitis in an equine patient. Open Vet J 2019; 9:54-57. [PMID: 31086767 PMCID: PMC6500858 DOI: 10.4314/ovj.v9i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/31/2019] [Indexed: 11/29/2022] Open
Abstract
Ultrasonic debridement as a treatment for tendinopathy and desmitis is a relatively new approach in orthopedic surgery. Previously only used in limited cases, this procedure shows promise for treating ligament-bone and tendon-bone interface injuries. We present a case study of a 2-yr-old thoroughbred male horse, unable to train due to recalcitrant symptoms after extensive conservative management of suspensory branch desmitis. It was then treated with ultrasonic debridement and concurrent manubrial stem cell autograft injection, to treat the ultrasound visualized lesion. Post-surgically, the patient recovered quickly, began training within 16 wk, and went onto win several races. Repeat ultrasound imaging reveals a complete restoration of the internal fiber architecture of the ligament. With a 3-yr follow-up, there has been consistent training and race performance with no re-injury. This study is the first to document the successful outcome of ultrasonic debridement with concurrent stem cell injection in the treatment of equine desmitis.
Collapse
Affiliation(s)
- Srinath Kamineni
- Department of Orthopedic Surgery and Sports Medicine, Elbow Shoulder Research Center, College of Medicine, University of Kentucky, Lexington KY, USA
| | - Alan Ruggles
- Rood and Riddle Equine Hospital, Lexington KY, USA
| | - Hamza Ashfaq
- Department of Orthopedic Surgery and Sports Medicine, Elbow Shoulder Research Center, College of Medicine, University of Kentucky, Lexington KY, USA
| |
Collapse
|
36
|
Abstract
Tendinopathy carries a large burden of musculoskeletal disorders seen in both athletes and aging population. Treatment is often challenging, and progression to chronic tendinopathy is common. Physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections have been the mainstay of treatment but are not optimal given that most tendon disorders seem to involve degenerative changes in addition to inflammation. The field of regenerative medicine has taken the forefront, and various treatments have been developed and explored including prolotherapy, platelet rich plasma, stem cells, and percutaneous ultrasonic tenotomy. However, high-quality research with standardized protocols and consistent controls for proper evaluation of treatment efficacy is currently needed. This will make it possible to provide recommendations on appropriate treatment options for tendinopathy.
Collapse
|
37
|
Efficacy of Percutaneous Ultrasonic Ablation of Soft Tissue (Tenex) in Tendinopathy and Fasciopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0186-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
38
|
Lin CY, Ooi CC, Chan E, Chew KT. Emerging Technological Advances in Musculoskeletal Ultrasound. PM R 2018; 10:112-119. [PMID: 29413117 DOI: 10.1016/j.pmrj.2017.08.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Cindy Y Lin
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Chin Chin Ooi
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Eric Chan
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Kelvin T Chew
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| |
Collapse
|
39
|
Mead MP, Gumucio JP, Awan TM, Mendias CL, Sugg KB. Pathogenesis and Management of Tendinopathies in Sports Medicine. TRANSLATIONAL SPORTS MEDICINE 2017; 1:5-13. [PMID: 31131372 DOI: 10.1002/tsm2.6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective Tendinopathy is a major clinical problem in sports medicine and is often difficult to treat. Traditional therapeutic approaches have focused on reducing inflammation, yet research suggests that little to no inflammation is present in the tendons that fail to heal. The purpose of this review was to evaluate the effectiveness of the available treatment options for tendinopathy and to inform best clinical practices. Design A narrative review. Methods A comprehensive search of electronic databases (PubMed, Google Scholar and Web of Science) was conducted to identify relevant studies through June 2016. Studies were deemed relevant if they were published in English and contained original research on the management of tendinopathy in humans. Results Studies varied in methodological quality and were often limited by small sample size and lack of sufficient control groups. Critical evaluation of the literature suggests that physical therapy with or without eccentric exercise should be considered a first-line treatment. Corticosteroids and nonsteroidal anti-inflammatory drugs provide short-term symptomatic relief, but long-term efficacy has not been demonstrated. Inconsistent results do not support the routine use of prolotherapy, platelet-rich plasma injections and topical nitric oxide patches. Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present. Conclusions While numerous therapeutic modalities exist for tendinopathy in the athlete, the ideal treatment protocol has not been clearly defined. The development of new targeted therapies for tendinopathy is likely to follow a greater understanding of the cellular and molecular mechanisms that underlie its pathogenesis.
Collapse
Affiliation(s)
- Matthew P Mead
- Departments of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jonathan P Gumucio
- Departments of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI.,Departments of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI
| | - Tariq M Awan
- Departments of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Christopher L Mendias
- Departments of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI.,Departments of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI
| | - Kristoffer B Sugg
- Departments of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI.,Departments of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI.,Departments of Surgery, Section of Plastic & Reconstructive Surgery, University of Michigan Medical School, Ann Arbor, MI
| |
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
|
Lateral epicondylitis: Associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements. Eur Radiol 2017; 28:972-981. [PMID: 29027008 DOI: 10.1007/s00330-017-5084-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/14/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We assessed the implications of MR imaging with clinical history in lateral epicondylitis management by evaluating imaging and clinical features in patients with lateral epicondylitis treated conservatively or operatively. METHODS Sixty patients with lateral epicondylitis treated conservatively (n = 38) or operatively (n = 22) from 2011-2015 were included. MR imaging findings of common extensor tendon (CET), lateral collateral ligament (LCL) complex, muscle oedema, ulnar nerve and elbow joint were reviewed. Clinical data recorded were frequency, duration and intensity of pain, history of trauma and injection therapy, range of motion. RESULTS MRI-assessed CET and LCL complex abnormalities, muscle oedema, radiocapitellar joint widening, joint effusion/synovitis, pain frequency and intensity differed significantly between the two groups (p < .05) with increased severity in operative group. Persistent pain (OR 12.2, p < .01), CET abnormality on longitudinal plane (OR 7.5, p = .03 for grade 2; OR 22.4, p < .01 for grade 3) and muscle oedema (OR 6.7, p = .03) were major factors associated with operative treatment. Area under the ROC curve of predicted probabilities for combination of these factors was 0.83. CONCLUSION MR imaging, combined with clinical assessment, could facilitate appropriate management planning for patients with lateral epicondylitis. KEY POINTS • MRI can reflect different disease severity between patients treated conservatively/operatively. • CET abnormality, muscle oedema were major MRI findings with operative treatment. • Patients in operative group were more likely to experience persistent pain. • MRI plus clinical symptoms could facilitate appropriate management for lateral epicondylitis.
Collapse
|
43
|
Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current Concepts Review Update: Insertional Achilles Tendinopathy. Foot Ankle Int 2017; 38:1160-1169. [PMID: 28789557 PMCID: PMC5956523 DOI: 10.1177/1071100717723127] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Chris C. Cychosz
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mederic M. Hall
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA,Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
44
|
Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy After Failed Open Surgical Release: A Report of Two Cases. PM R 2017; 10:313-316. [DOI: 10.1016/j.pmrj.2017.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 01/26/2023]
|
45
|
Smith WB, Melton W, Davies J. Midsubstance Tendinopathy, Percutaneous Techniques (Platelet-Rich Plasma, Extracorporeal Shock Wave Therapy, Prolotherapy, Radiofrequency Ablation). Clin Podiatr Med Surg 2017; 34:161-174. [PMID: 28257672 DOI: 10.1016/j.cpm.2016.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of this article is to present the current options available for noninvasive and percutaneous treatment options for noninsertional Achilles tendinopathy. An attempt is made to offer recommendations for both the treatment techniques as well as postprocedure protocols to be considered. Additionally, because there are numerous treatment options in this category, the different techniques are summarized in a chart format with a short list of pros and cons as well as the levels of evidence in the literature to support the different modalities.
Collapse
Affiliation(s)
- William Bret Smith
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA.
| | - Will Melton
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA
| | - James Davies
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA
| |
Collapse
|
46
|
Hall MM, Woodroffe L. Ultrasonic Percutaneous Tenotomy for Recalcitrant Calcific Triceps Tendinosis in a Competitive Strongman. Curr Sports Med Rep 2017; 16:150-152. [DOI: 10.1249/jsr.0000000000000353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
47
|
Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral Elbow Tendinopathy: Development of a Pathophysiology-Based Treatment Algorithm. Orthop J Sports Med 2016; 4:2325967116670635. [PMID: 27833925 PMCID: PMC5094303 DOI: 10.1177/2325967116670635] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. The term tendinopathy is used to describe chronic overuse tendon disorders encompassing a group of pathologies, a spectrum of disease. This review details the pathophysiology of tendinopathy and tendon healing as an introduction for a system grading the severity of tendinopathy, with each of the 4 grades displaying distinct histopathological features. Currently, there are a large number of nonoperative treatments available for lateral elbow tendinopathy, with little guidance as to when and how to use them. In fact, an appraisal of the clinical trials, systematic reviews, and meta-analyses studying these treatment modalities reveals that no single treatment reliably achieves outstanding results. This may be due in part to the majority of clinical studies to date including all patients with chronic tendinopathy rather than attempting to categorize patients according to the severity of disease. We relate the pathophysiology of the different grades of tendinopathy to the basic science principles that underpin the mechanisms of action of the nonoperative treatments available to propose a treatment algorithm guiding the management of lateral elbow tendinopathy depending on severity. We believe that this system will be useful both in clinical practice and for the future investigation of the efficacy of treatments.
Collapse
Affiliation(s)
- Gev Bhabra
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Allan Wang
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Department of Orthopaedic Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Jay R Ebert
- School of Sport Science, Exercise, and Health, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Edwards
- School of Sport Science, Exercise, and Health, University of Western Australia, Perth, Western Australia, Australia
| | - Monica Zheng
- Pulse Podiatry, Wembley, Western Australia, Australia
| | - Ming H Zheng
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.; Centre for Orthopaedic Translational Research, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
48
|
Manipulation Therapy Relieved Pain More Rapidly Than Acupuncture among Lateral Epicondylalgia (Tennis Elbow) Patients: A Randomized Controlled Trial with 8-Week Follow-Up. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:3079247. [PMID: 27143983 PMCID: PMC4837265 DOI: 10.1155/2016/3079247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 12/16/2022]
Abstract
Radial bone adjustment manipulation treatment may be effective to reduce pain rapidly in lateral epicondylalgia patients and the pathological tension in the biceps brachii muscle is highly concerned. To prove this hypothesis, we conducted a randomized controlled trial and included 35 patients with lateral epicondylalgia for more than 2 months. Either manipulation treatment (n = 16) or acupuncture (n = 19) was given to these patients for 2 weeks and all patients' symptoms were followed up for 8 weeks after treatment. Both groups demonstrated changes in pain VAS score, grip strength, and DASH questionnaire. Lateral epicondylalgia patients who received manipulation treatment felt pain relief sooner than those who had acupuncture treatments during the first few treatments. However, both acupuncture and manipulation are effective, while the difference has no significance at the 8-week follow-up. The trial was registered with Current Controlled Trials ISRCTN81308551 on 5 February 2016.
Collapse
|