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Dragisic MV, Hanlon MK, Merrell GA. Mapping Origins of Tendons on the Medial Epicondyle to Improve Treatment of Medial Epicondylitis: Anatomical Study. J Hand Surg Am 2024:S0363-5023(24)00200-4. [PMID: 38934996 DOI: 10.1016/j.jhsa.2024.04.008] [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: 10/14/2023] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Medial epicondylitis is a tendinosis found commonly in throwing and golfing athletes. Although there are choices for nonsurgical treatments, when these fail, surgical intervention can be considered. When surgical treatment is performed, the objective is to debride the diseased tissue from the epicondyle. The purpose of this study was to clarify the locations and size of the common flexor tendons and medial collateral ligament (MCL) relative to each other and to the posterior ridge of the medial epicondyle. METHODS The common flexor tendons and MCL were dissected and reflected their origin on the medial epicondyle in six cadaver elbows. Measurements were taken from the posterior and distal ridges of the medial epicondyle with respect to the humerus. Each origin was also measured for its height and width. RESULTS The flexor carpi ulnaris origin starts at a mean of 4.2 mm from the posterior ridge of the medial epicondyle and extends anteriorly an average of 4.8 mm. The flexor carpi radialis starts at a mean of 4.2 mm from the posterior ridge and extends anteriorly an average of 7.4 mm. The pronator teres begins at a mean of 4.6 mm from the posterior ridge and extends an average of 5.7 mm anteriorly. The MCL starts at an average of 10.4 mm from the posterior ridge and extends 5.2 mm anteriorly. CONCLUSIONS The measurements found have allowed the creation of a map of the specific common flexor tendon origins and their sizes on the medial epicondyle, as well as their position relative to the MCL. CLINICAL RELEVANCE A surgeon may debride 1 cm anteriorly from the posterior ridge of the medial epicondyle to safely address the affected tissues and ensure the safety and integrity of the MCL.
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Tummala SV, Lin E, Gill V, Renfree KJ. Musculofascial Z-Lengthening for the Management of Chronic Medial Epicondylitis: Technique and Early Results. Tech Hand Up Extrem Surg 2024; 28:106-109. [PMID: 37968994 DOI: 10.1097/bth.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Medial epicondylitis is a common elbow pathology secondary to flexor-pronator tendinosis associated with repetitive wrist flexion activities. Though often responsive to nonoperative management, recalcitrant symptomatology is not uncommon. Surgical intervention for chronic medial epicondylitis most commonly involves open debridement of degenerative tendon which can be difficulty to identify and with a notably risk of iatrogenic complication. We present a reproducible musculofascial z-lengthening of the flexor-pronator mass for management of chronic medial epicondylitis and report the mid-term results of this intervention.
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Lazzaretti Fernandes T, Taraballi F, Shao Z, Roessler PP, Cardona-Ramírez S. Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Elbow and Upper Extremity: An Orthoregeneration Network Foundation Review. Arthroscopy 2024:S0749-8063(24)00326-8. [PMID: 38723874 DOI: 10.1016/j.arthro.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/10/2024]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the elbow and upper extremity, including the tendons (lateral epicondylitis, medial epicondylitis, biceps tendonitis, triceps tendonitis), articular cartilage (osteoarthritis, osteochondral lesions), and bone (fractures, nonunions, avascular necrosis, osteonecrosis). Promising and established treatment modalities include hyaluronic acid; botulinum toxin; corticosteroids; leukocyte-rich and leukocyte-poor platelet-rich plasma; autologous blood; bone marrow aspirate comprising mesenchymal stromal cells (alternatively termed medicinal signaling cells and frequently mesenchymal stem cells [MSCs]) and bone marrow aspirate concentrate; MSCs harvested from adipose and skin (dermis) sources; vascularized bone grafts; bone morphogenic protein scaffold made from osteoinductive and conductive β-tricalcium phosphate and poly-ε-caprolactone with hydrogels, human MSCs, and matrix metalloproteinases; and collagen sponge. Autologous blood preparations such as autologous blood injections and platelet-rich plasma show positive outcomes for nonresponsive tendinopathy. In addition, cellular therapies such as tissue-derived tenocyte-like cells and MSCs show a promising ability to regulate degenerative processes by modulating tissue response to inflammation and preventing continuous degradation and support tissue restoration.
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Affiliation(s)
- Tiago Lazzaretti Fernandes
- Sports Medicine Division, Institute of Orthopaedics and Traumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Francesca Taraballi
- Center for Musculoskeletal Regeneration, Orthopedics and Sports Medicine, Houston, Texas, U.S.A.; Methodist Hospital, Houston Methodist Academic Institute, Houston, Texas, U.S.A
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Philip P Roessler
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Gelenkzentrum Mittelrhein, Koblenz, Germany
| | - Sebastián Cardona-Ramírez
- Grupo de Investigación OHVRI, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
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Roubea I, Korakakis V. Rehabilitation following ulnar collateral ligament injury of the elbow in a female acrobatic athlete: A case report. J Bodyw Mov Ther 2024; 38:329-338. [PMID: 38763577 DOI: 10.1016/j.jbmt.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The mechanism of injury and the conservative rehabilitation of the ulnar collateral ligament of the elbow (UCL) are well studied and reported in overhead athletes, while research on gymnastic athletes is sparse. Evidence suggests exercise as the mainstay in UCL injury rehabilitation. With this report, we aimed to provide a complete rehabilitation protocol following a partial UCL tear of an acrobatic athlete, where exercise and adjunct treatments, such as manual therapy, were used in a progressive staged rehabilitation. CASE DESCRIPTION A 16-year-old female acrobatic athlete was diagnosed with partial tear of the anterior band of UCL. The rehabilitation included progressive exercise loading in conjunction with manual therapy for 10 sessions in 8 weeks. Pain, UCL special tests, the Disabilities of Arm, Shoulder and Hand Score Questionnaire (DASH), and the Upper Limb Functional Index (ULFI) were assessed and administered at baseline and at 3, 6, 10 weeks, and 3 months. RESULTS Improvement in all outcome measures was noted at the 3-month follow-up indicating a substantial reduction in pain and disability, and an increase in stability of the elbow joint. Return to training was achieved at 8 weeks from the initial visit, while return to sport at the pre-injury level was achieved at 3 months. CONCLUSION Progressive exercise loading along with the addition of manual therapy is an effective intervention for the rehabilitation and return to sport following a partial UCL tear. A progressive staged rehabilitation guideline for acrobatic athletes with UCL injuries has been provided to be used and guide clinical practice. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Iliana Roubea
- Physiotherapy Department, University of West Attica, Egaleo, Athens, Greece; Hellenic Orthopaedic Manipulative Therapy Education (HOMT Edu), Athens, Greece.
| | - Vasileios Korakakis
- Hellenic Orthopaedic Manipulative Therapy Education (HOMT Edu), Athens, Greece; Department of Health Sciences, School of Life Sciences and Health Sciences, PhD in Physiotherapy Program, University of Nicosia, Cyprus
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5
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Zhang C, Ma JT, Wang WS. Arthroscopic Medial Bi-portal Extra-articular Debridement for Recalcitrant Medial Epicondylitis. Arthrosc Tech 2024; 13:102876. [PMID: 38584625 PMCID: PMC10995642 DOI: 10.1016/j.eats.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/01/2023] [Indexed: 04/09/2024] Open
Abstract
Medial epicondylitis, or golfer's elbow, is characterized by pain and tenderness at the tendon insertion points of the pronator teres and flexor carpi radialis. Conservative treatment is sufficient for most patients, whereas surgical treatment is the best choice for intractable medial epicondylitis. With open surgery or arthroscopic surgery, good clinical results have been reported. However, there is still no consensus on which surgical technique is more ideal. We describe our technique of arthroscopic medial bi-portal extra-articular debridement, which is a safe and effective technique that allows more accurate debridement and maximum protection of the ulnar nerve while reducing surgical scars, relieving postoperative pain, reducing the probability of elbow infection and ankylosis, and shortening the recovery time.
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Affiliation(s)
- Chuan Zhang
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Jiang-Tao Ma
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Wen-Sheng Wang
- Shoulder and Elbow Surgery Center, Luoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan Province, Zhengzhou, China
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Jagow DM, Chen YT. Novel Ultrasound-Guided Radiofrequency Ablation of the Medial Epicondylar Sensory Nerve for Recalcitrant Medial Epicondylosis: A Case-Based Technical Report. Cureus 2023; 15:e50131. [PMID: 38186435 PMCID: PMC10771279 DOI: 10.7759/cureus.50131] [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: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Recalcitrant medial epicondylosis (ME) is a chronic tendinopathy affecting the common flexor-pronator tendon origin which causes significant pain and functional limitations. Recalcitrant ME is difficult to manage with non-surgical treatment options. The medial epicondylar sensory nerve (MEsn) is a small sensory nerve that travels within the medial intermuscular septum to innervate the osseous-tendinous structures of the medial epicondyle. In this report, we describe a novel technique for the treatment of recalcitrant ME via radiofrequency ablation (RFA) of the MEsn under ultrasound guidance. The MEsn is localized under ultrasound in the medial distal arm, just proximal to the medial epicondyle. Patients with a positive prognostic block of the MEsn subsequently underwent RFA of the MEsn. We have performed this procedure on two patients who have demonstrated improvement in pain and function for up to nearly one year after the procedure. The relief from pain and improvement in function of these patients warrants further investigation and comparative trials with respect to conventional treatment options, as MEsn RFA may be a viable treatment option for recalcitrant ME.
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Affiliation(s)
- Devin M Jagow
- Department of Orthopedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, USA
| | - Yin-Ting Chen
- Department of Orthopedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, USA
- Department of Rehabilitation, Uniformed Services University of Health Science, Bethesda, USA
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Konarski W, Poboży T, Poboży K, Domańska J, Konarska K. Current concepts of natural course and in management of medial epicondylitis: a clinical overview. Orthop Rev (Pavia) 2023; 15:84275. [PMID: 37701778 PMCID: PMC10495044 DOI: 10.52965/001c.84275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Medial epicondylitis (ME), called "golfer's elbow", is not frequent or serious disease but can cause symptoms that are bothersome in everyday life. Therefore knowledge about this condition may improve diagnostic-therapeutic process. In this article detailed information concerning pathophysiology and symptomatology of ME was described. Great attention was paid to issues related to the diagnosis of the disease both in terms of differentiation with other elbow disorders as well as examination techniques. Finally, current therapeutic options were presented in detail and their efficacy was discussed based on the available data.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Kamil Poboży
- Faculty of Medicine, Medical University of Warsaw, 01-938 Warsaw, Poland
| | - Julia Domańska
- Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland
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9
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Gencarelli P, Mittal R, Yi R, Lee JM. Olympic Elbow Comprising Lateral Epicondylitis, Cubital Tunnel Syndrome, and Distal Biceps Tendon Rupture. Cureus 2023; 15:e45902. [PMID: 37885501 PMCID: PMC10599087 DOI: 10.7759/cureus.45902] [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: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
There is a wide range of elbow injuries including chronic injuries such as lateral epicondylitis, medial epicondylitis, and cubital tunnel syndrome, or acute injuries such as elbow fracture-dislocations and distal biceps tendon ruptures. Combinations of acute and chronic elbow injuries have been reported including country club elbow and terrible triad of the elbow which are important to identify to properly treat. Thus, we report for the first time a new elbow injury triad termed Olympic elbow in a 65-year-old man comprising lateral epicondylitis, cubital tunnel syndrome, and a distal biceps tendon rupture. After initially failing conservative management, the patient was successfully treated with surgery and has returned to full physical activity at four and a half years postoperatively.
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Affiliation(s)
- Pasquale Gencarelli
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Rahul Mittal
- Health Informatics, Rutgers University, Newark, USA
| | - Rosemary Yi
- Department of Orthopedic Surgery, Emanate Health Medical Group, West Covina, USA
| | - James M Lee
- Department of Orthopaedic Surgery, Orange Orthopaedic Associates, West Orange, USA
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10
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Schmidt-Horlohé K. [Treatment of lateral and medial epicondylopathy : Are platelet-rich plasma, shock wave therapy, etc. effective for both?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:371-378. [PMID: 37052648 DOI: 10.1007/s00132-023-04372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
Lateral and medial epicondylopathy (epicondylitis), which are common and in most cases self-limiting, frequently result in relevant reduction of quality of life and may also affect the ability to work. Recently, the use of orthobiologics, such as platelet-rich plasma (PRP), has been proposed to promote tendon regeneration and is supposed to be a valuable treatment option. However, scientific data are conflicting and the short- and long-time results are controversial. The use of stem cells is new approach and preliminary clinical data are promising. Shock wave therapy is widely used and part of the daily routine in treating lateral epicondylopoathy, although it is questionable for medial epicondylopathy.
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Affiliation(s)
- Kay Schmidt-Horlohé
- Orthopaedicum Wiesbaden - Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Friedrichstr. 29, 65185, Wiesbaden, Deutschland.
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11
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Uzun O. Assessment of Reliability and Quality of Videos on Medial Epicondylitis Shared on YouTube. Cureus 2023; 15:e37250. [PMID: 37168186 PMCID: PMC10166569 DOI: 10.7759/cureus.37250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Video-sharing websites, especially YouTube search engine, have become popular sources for obtaining health information over the years. The reliability and quality of contents on YouTube are unpredictable and questionable. The purpose of this study was to evaluate the reliability and quality of videos on medial epicondylitis shared on the YouTube platform. Methods A YouTube search with the keywords "medial epicondylitis" and "golfer's elbow" was conducted. After typing each keyword, the first 50 videos that appeared in the first three pages were evaluated. The titles and duration of the videos, the uploading sources, the time passed since the upload, number of total views, likes, dislikes and comments were recorded. All videos were analyzed and scored using the DISCERN scoring system, modified DISCERN (mod-DISCERN) scale, and the Global Quality Score (GQS). Results Eighty-eight videos met the inclusion criteria and were included in the study. The mean DISCERN score, mod-DISCERN score and GQS were 40.68±10.5, 1.81±0.76, and 2.72±0.9, respectively. Most of the videos had poor and very poor quality content according to the DISCERN instrument, the mod-DISCERN scale and GQS tool. The main upload sources were doctors (36.4%), physiotherapists (25%), patients (2.2%), and other (36.4%). The videos uploaded by doctors had higher quality scores than other uploading sources. Of the 88 videos, 10 were about diagnosis alone, 39 were on treatment alone, and 39 contained information about both of diagnosis and treatment. The mean DISCERN score, mod-DISCERN score and GQS of the videos on "both" were significantly higher than those "diagnosis alone" and "treatment alone" groups. Conclusion Nearly 80% of YouTube videos on medial epicondylitis according to the DISCERN and GQS tool, and also 97.7% of videos according to the mod-DISCERN scale had medium or poor quality. YouTube videos on medial epicondylitis could not be considered as accurate and reliable sources. Because the videos uploaded by doctors had higher quality scores, the physicians should prepare and upload more reliable and quality contents with detailed information on YouTube.
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Affiliation(s)
- Oznur Uzun
- Physical Medicine and Rehabilitation, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ministry of Health, Ankara, TUR
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12
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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.].
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13
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Abadin AA, Orr JP, Lloyd AR, Henning PT, Pourcho A. An Evidence-Based Approach to Orthobiologics for Tendon Disorders. Phys Med Rehabil Clin N Am 2023; 34:83-103. [DOI: 10.1016/j.pmr.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Elhage KG, Yedulla NR, Cross AG, Mehta N, Guo EW, Bernstein DN, Makhni E. Forearm Flexor Tendon Injury in Adolescent Athletes: Risk Factors, Treatment, and Prevention. Curr Sports Med Rep 2022; 21:443-447. [PMID: 36508600 DOI: 10.1249/jsr.0000000000001017] [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: 12/15/2022]
Abstract
ABSTRACT Injury to the flexor pronator mass is a common condition that is especially prevalent in overhead throwing athletes. The increasing incidence of these injuries has promoted considerable efforts in research to better understand the pathology, risk factors, and potential mechanisms to prevent injury in these athletes. While there are numerous intrinsic and extrinsic factors associated with injury, a common theme involves chronic overuse and microtrauma with inadequate resting intervals between performances. The purpose of this review is to discuss medial elbow injuries in young athletes with a particular focus on the flexor pronator mass.
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Affiliation(s)
| | | | | | - Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Eric W Guo
- Department of Orthopaedic Surgery, University of Michigan Medicine, Ann Arbor, MI
| | | | - Eric Makhni
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI
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15
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Postoperative MR Imaging of the Elbow. Magn Reson Imaging Clin N Am 2022; 30:629-643. [DOI: 10.1016/j.mric.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Alzahrani WM. Platelet-Rich Plasma Injections as an Alternative to Surgery in Treating Patients With Medial Epicondylitis: A Systematic Review. Cureus 2022; 14:e28378. [PMID: 36171858 PMCID: PMC9508787 DOI: 10.7759/cureus.28378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
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17
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Konarski W, Poboży T, Kotela A, Hordowicz M, Poboży K. Ultrasound in the Differential Diagnosis of Medial Epicondylalgia and Medial Elbow Pain-Imaging Findings and Narrative Literature Review. Healthcare (Basel) 2022; 10:healthcare10081529. [PMID: 36011187 PMCID: PMC9407887 DOI: 10.3390/healthcare10081529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Medial epicondylalgia (ME), commonly known as “the golfer’s elbow”, typically develops in individuals who perform repetitive forearm movements and weight-bearing activities. It accounts for up to 20% of all epicondylitis cases and is most prevalent in particular sports and occupations. Though the diagnosis can be made based on sole clinical examination, additional imaging might be essential for confirmation of medial epicondylitis and excluding other pathologies of the medial epicondyle region. US imaging, with a sensitivity and specificity of 95% and 92%, respectively, remains a practical and accessible alternative to MRI. However, its diagnostic efficacy highly depends on the operator’s experience and requires proper technique. This article describes the ultrasound examination and technique for adequate visualization of elbow joint structures. It also discusses the differential diagnosis of other common and less-known pathologies of the medial compartment of the elbow, including snapping triceps, medial collateral ligament injury, and cubital tunnel neuropathy.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
- Correspondence:
| | - Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warszawa, Poland
| | - Martyna Hordowicz
- 3rd Department of General Psychiatry, Independent Public Regional Mental Health Care Facility Complex of Dr. Barbara Borzym, 26-600 Radom, Poland
| | - Kamil Poboży
- Faculty of Medicine, Medical University of Warsaw, 01-938 Warsaw, Poland
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18
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Lin KM, Ellenbecker TS, Safran MR. Rehabilitation and Return to Sport Following Elbow Injuries. Arthrosc Sports Med Rehabil 2022; 4:e1245-e1251. [PMID: 35747663 PMCID: PMC9210377 DOI: 10.1016/j.asmr.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022] Open
Abstract
Elbow injuries are frequently seen in throwing and overhead athletes. This review provides a framework for diagnosis, treatment, and particularly rehabilitation of common elbow pathologies, including ulnar collateral ligament injury, valgus extension overload, and medial and lateral epicondylitis. Advanced rehabilitation facilitates complete return to functional sport-specific activity and is based on objective criteria. As diagnostic and therapeutic modalities improve our understanding of elbow pathologies in the athletic patient, continued research will further elucidate objective evidence-based rehabilitation techniques.
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Affiliation(s)
- Kenneth M. Lin
- Stanford University Department of Orthopaedic Surgery, Sports Medicine Service, Palo Alto, California
- Address correspondence to Kenneth M. Lin, M.D., 450 Broadway, MC 6342, Redwood City, CA 94063, U.S.A.
| | | | - Marc R. Safran
- Stanford University Department of Orthopaedic Surgery, Sports Medicine Service, Palo Alto, California
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Kang KB, Cheon SH, Lee HD. Radiologic evaluation and clinical effect of calcification in medial epicondylitis. J Shoulder Elbow Surg 2022; 31:375-381. [PMID: 34610463 DOI: 10.1016/j.jse.2021.08.031] [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: 05/14/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although most radiologic findings of medial epicondylitis (ME) are normal, up to 25% show calcification, and little is known about the clinical relevance of soft-tissue calcification in ME. The purposes of this study were to reveal the characteristics of calcification in ME and to identify their clinical relevance. METHODS This study included 187 patients (222 elbows) with a diagnosis of ME. We classified calcification according to its anatomic location and further evaluated its distribution. Logistic regression analysis was performed to calculate the odds ratios and 95% confidence intervals for possible factors that may affect calcification in ME: age, sex, laterality, hand dominance, visual analog scale (VAS) pain score, Mayo Elbow Performance Score, symptom duration, history of steroid injection, number of steroid injections, concomitant ulnar neuropathy, and treatment method in terms of conservative treatment or surgery. RESULTS Of a total of 222 elbows, 53% (118 of 222 elbows) showed calcification in radiologic findings. The VAS pain score, the number of steroid injections, and concomitant ulnar neuropathy were significantly associated with calcification in ME. Calcification was most commonly identified at the anatomic insertion site of the common flexor tendon (33%), followed by the pronator teres (18%) and the medial collateral ligament (10%). Of the total cases of calcification, 45% were distributed at multiple sites, and age was strongly associated with multiple-site distribution. CONCLUSIONS Calcification in ME was more commonly identified than previously reported and was distributed over a relatively broad area. Calcification was associated with a higher VAS pain score, a history of steroid injection, and combined ulnar neuropathy. The anatomic insertion site of the common flexor tendon most commonly showed calcification, and age was a strong indicator of a broad distribution of calcification.
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Affiliation(s)
- Kyu Bok Kang
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Republic of Korea
| | - Seung Hee Cheon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Republic of Korea
| | - Hee Dong Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Republic of Korea.
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20
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Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon 2022; 68:101314. [PMID: 34996610 DOI: 10.1016/j.disamonth.2021.101314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.
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21
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Cyr A. Cervical Spine, Upper Extremity Neuropathies, and Overuse Injuries in Cyclists. Phys Med Rehabil Clin N Am 2021; 33:187-199. [PMID: 34798999 DOI: 10.1016/j.pmr.2021.08.013] [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: 10/20/2022]
Abstract
Upper extremity nerve injuries in cyclists include carpal tunnel syndrome and ulnar neuropathy at the wrist. Electromyography and nerve conduction studies aid in the diagnosis of neuropathies. Diagnostic ultrasonography or MRI can also be helpful for evaluation. Overuse injuries in the upper extremity includes biker's elbow, or a tendinopathy of the common flexor or extensor tendons, which is more common in mountain biking. Neck pain is also a common issue for cyclists. Treatment of these conditions varies from conservative management to surgical options, but a bicycle fit assessment is recommended for any ongoing symptoms.
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Affiliation(s)
- Andrea Cyr
- Department of Family Medicine, University of Illinois - College of Medicine, UIC Sports Medicine Center, Flames Athletic Center, 839 Roosevelt Road. Suite 102, Chicago, IL 60608, USA. https://twitter.com/@AndreaCyrDO
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22
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Daniels SP, De Tolla JE, Azad A, Fritz J. Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles. Semin Musculoskelet Radiol 2021; 25:589-599. [PMID: 34706389 DOI: 10.1055/s-0041-1731790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jadie E De Tolla
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Ali Azad
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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23
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Bae KJ, Park C, Ahn JM, Kang Y, Gong HS. Magnetic resonance imaging evaluation of patients with clinically diagnosed medial Epicondylitis. Skeletal Radiol 2021; 50:1629-1636. [PMID: 33483771 DOI: 10.1007/s00256-021-03720-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We evaluated magnetic resonance imaging (MRI) findings in patients with clinically diagnosed medial epicondylitis (ME) and determined whether any of the MRI findings correlated with the follow-up pain level after nonoperative treatment. MATERIALS AND METHODS We retrospectively reviewed 83 patients who had undergone elbow MRI examinations for clinically diagnosed ME and who were followed-up for more than 6 months. Five categories of MRI findings were selected for qualitative grading: common flexor tendon (CFT) origin signal changes, ulnar collateral ligament (UCL) insufficiency, ulnar neuritis, bony changes of the medial epicondyle, and calcification. The mean follow-up after MRI examination was 21 months. We performed multivariate regression analysis to analyze whether any of these MRI findings were associated with the follow-up pain level after nonoperative treatment. RESULTS Positive MRI findings included CFT origin signal changes (66%), ulnar neuritis (40%), UCL insufficiency (30%), calcification (27%), and bony changes (18%). Multivariate analysis indicated that CFT origin signal changes were independently associated with the follow-up pain level (β = 3.387; p = 0.004). CONCLUSION In patients with clinically diagnosed ME, MRI demonstrated diverse abnormal findings in the CFT origin, ulnar collateral ligament, ulnar nerve, and bone. Among the findings, the severity CFT origin signal changes, which indicates the severity of tendon degeneration in ME, was associated with the follow-up pain level. This information can be helpful in consulting on the prognosis of nonoperative treatment in patients with clinically diagnosed ME.
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Affiliation(s)
- Kee Jeong Bae
- Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chulhee Park
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Gyeonggi-do, Seongnam-si, 463-707, South Korea.
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24
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Verstuyft L, Caekebeke P, van Riet R. Postoperative rehabilitation in elbow surgery. J Clin Orthop Trauma 2021; 20:101479. [PMID: 34262846 PMCID: PMC8254033 DOI: 10.1016/j.jcot.2021.101479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022] Open
Abstract
Postoperative rehabilitation plays a crucial role in the treatment of elbow pathology. Depending on the type of surgery, the elbow may need to be protected. As a general rule, the elbow should not be immobilized for a prolonged period after surgery. A removable splint can be used to protect the soft-tissues immediately postoperative and the patient is encouraged to remove the splint several times daily to mobilize the elbow. Dynamic articulated braces can be used to encourage movement while ligament or tendon repairs are being protected. Literature on postoperative elbow rehab is scarce. In this paper we provide practical guidelines for specific surgical procedures.
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Affiliation(s)
| | - Pieter Caekebeke
- Ziekenhuis Oost-Limburg, Department of Orthopaedics Surgery and Traumatology, Schiepse Bos 6, 3600, Genk, Belgium
| | - Roger van Riet
- AZ Monica, Orthoca, Stevenslei 20, 2100, Antwerp, Belgium,University Hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium,Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Corresponding author.
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25
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Shannon N, Cable B, Wood T, Kelly J. Common and Less Well-known Upper-limb Injuries in Elite Tennis Players. Curr Sports Med Rep 2021; 19:414-421. [PMID: 33031207 DOI: 10.1249/jsr.0000000000000760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.
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Affiliation(s)
| | - Brian Cable
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Timothy Wood
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - John Kelly
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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26
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Curti S, Mattioli S, Bonfiglioli R, Farioli A, Violante FS. Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis. J Occup Health 2021; 63:e12186. [PMID: 33534951 PMCID: PMC7857538 DOI: 10.1002/1348-9585.12186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis. METHODS We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship. RESULTS We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed. CONCLUSIONS There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.
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Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Francesco S. Violante
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
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27
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Alrabaa RG, Dantzker N, Ahmad CS. Injuries and Conditions Affecting the Elbow Flexor/Pronator Tendons. Clin Sports Med 2020; 39:549-563. [PMID: 32446574 DOI: 10.1016/j.csm.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Common flexor-pronator tendon injuries and medial epicondylitis can be successfully treated nonoperatively in most cases. Operative treatment is reserved for patients with continued symptoms despite adequate nonoperative treatment or in high-level athletes with complete rupture of the common flexor-pronator tendon. The physical examination and workup of patients with flexor-pronator tendon injuries should focus on related or concomitant pathologies of the medial elbow. The gold standard for surgical treatment of flexor-pronator tendon ruptures or medial epicondylitis includes tendon debridement and reattachment.
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Affiliation(s)
- Rami George Alrabaa
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA.
| | - Nicholas Dantzker
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA
| | - Christopher S Ahmad
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA
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28
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Bohlen HL, Schwartz ZE, Wu VJ, Thon SG, Finley ZJ, O'Brien MJ, Savoie FH. Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis. Orthop J Sports Med 2020; 8:2325967120908952. [PMID: 32232070 PMCID: PMC7097873 DOI: 10.1177/2325967120908952] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management. Purpose: To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery. Study Design: Cohort study; Level of evidence, 3. Methods: To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity. Results: The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively (P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores. Conclusion: In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.
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Affiliation(s)
- Hunter L Bohlen
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary E Schwartz
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Victor J Wu
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephen G Thon
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary J Finley
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael J O'Brien
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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29
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Testa G, Vescio A, Perez S, Consoli A, Costarella L, Sessa G, Pavone V. Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review. J Clin Med 2020; 9:E453. [PMID: 32041301 PMCID: PMC7074316 DOI: 10.3390/jcm9020453] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Rotator cuff tendinopathy (RCT), subacromial impingement (SAIS), and medial (MEP) and lateral (LEP) epicondylitis are the most common causes of upper limb pain caused by microtrauma and degeneration. There are several therapeutic choices to manage these disorders: extracorporeal shockwave therapy (ESWT) has become a valuable option. METHODS A systematic review of two electronic medical databases was performed by two independent authors, using the following inclusion criteria: RCT, SAIS, MEP, and LEP, ESWT therapy without surgical treatment, with symptoms duration more than 2 months, and at least 6 months of follow-up. Studies of any level of evidence, reporting clinical results, and dealing with ESWT therapy and RCT, SAIS, MEP, and LEP were included. RESULTS A total of 822 articles were found. At the end of the first screening, following the previously described selection criteria, we selected 186 articles eligible for full-text reading. Ultimately, after full-text reading, and reference list check, we selected 26 articles following previously written criteria. CONCLUSIONS ESWT is a safe and effective treatment of soft tissue diseases of the upper limbs. Even in the minority cases when unsatisfied results were recorded, high energy shockwaves were nevertheless suggested in prevision of surgical treatment.
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Affiliation(s)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy; (G.T.); (S.P.); (A.C.); (L.C.); (G.S.); (V.P.)
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30
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Wu VJ, Thon S, Finley Z, Bohlen H, Schwartz Z, O'Brien MJ, Savoie FH. Double-Row Repair for Recalcitrant Medial Epicondylitis. Orthop J Sports Med 2020; 7:2325967119885608. [PMID: 31903395 PMCID: PMC6928541 DOI: 10.1177/2325967119885608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective. Purpose: To evaluate the clinical outcomes of a double-row repair for ME. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system. Results: The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively (P < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively (P = .67). Conclusion: A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.
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Affiliation(s)
- Victor J Wu
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephen Thon
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary Finley
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Hunter Bohlen
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Zachary Schwartz
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael J O'Brien
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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31
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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.
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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
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Abstract
Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing.
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Shin M, Hahn S, Yi J, Lim YJ, Bang JY. Clinical Application of Real-Time Sonoelastography for Evaluation of Medial Epicondylitis: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:246-254. [PMID: 30352727 DOI: 10.1016/j.ultrasmedbio.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to evaluate the diagnostic potential of real-time sonoelastography (RSE) in medial epicondylitis by comparing clinically diagnosed patients and patients without medial elbow pain. From July 2016 to December 2017, gray-scale sonographic findings (swelling, cortical irregularity, hypo-echogenicity, calcification and tear), color Doppler findings (hyperemia) and sonoelastographic findings (elastographic grade on a 3-point visual scale and strain ratio from two regions of interest) for 63 elbows of 56 patients were compared. Twenty-four patients with 29 imaged elbows were clinically diagnosed with medial epicondylitis, and 32 patients with 34 imaged elbows had no medial elbow pain. Cortical irregularity, hypo-echogenicity, calcification, elastographic grade and strain ratio revealed significant differences (p < 0.05). Among these, strain ratio had the highest diagnostic performance (area under the curve: 0.985). Real-time sonoelastography, which can obtain both elastographic grade and strain ratio, is valuable as a supplementary tool in the diagnosis of medial epicondylitis.
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Affiliation(s)
- Minwoo Shin
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea.
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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Abstract
Physical examination of the elbow is a critical component in formulating an accurate diagnosis. Various special physical examinations have been described to improve the clinician's ability to establish an accurate diagnosis. A comprehensive approach to the physical examination of the elbow, including special tests, may facilitate improved diagnosis of elbow pathology.
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Wiggins AJ, Cancienne JM, Camp CL, Degen RM, Altchek DW, Dines JS, Werner BC. Disease Burden of Medial Epicondylitis in the USA Is Increasing: An Analysis of 19,856 Patients From 2007 to 2014. HSS J 2018; 14:233-237. [PMID: 30258326 PMCID: PMC6148579 DOI: 10.1007/s11420-018-9617-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medial epicondylitis (ME), or "golfer's elbow," is often treated initially by conservative means. Up to 15% of recalcitrant cases require surgical intervention, according to small sample populations, but no national study has determined the incidence of the diagnosis or corroborated the rate of surgical intervention. PURPOSE/QUESTION We sought to review the annual incidence of ME, surgical rates, and health care costs in a population setting. METHODS A national database was queried for ME from 2007 to 2014. Annual rates and the percentage of diagnosed cases subjected to surgical intervention were recorded. Epidemiologic data was reported with descriptive statistics, and the significant trends over time were analyzed using linear regression. RESULTS We identified 19,856 cases of ME in the study period. There was a significant increase in the annual incidence and overall incidence per 10,000 patients. The proportion of diagnoses in patients under 65 years of age decreased significantly, while the proportion in those 65 years of age or older significantly increased. The annual number of surgical interventions significantly increased over the study period, although the annual proportion of diagnosed cases proceeding to surgery remained constant. The proportion of patients 65 years of age or older undergoing surgery significantly increased. Total reimbursement for the management of ME during the study period was $1,877,189. While there was a significant increase in the total annual reimbursement, annual per-patient reimbursement did not change significantly. CONCLUSIONS While the annual incidence of ME and surgical treatment of ME increased significantly from 2007 to 2014, the proportion of cases treated surgically did not. Notably, the proportion of patients 65 years of age or older diagnosed with and being surgically treated for ME has increased in recent years. Total reimbursement for ME has steadily risen, although per-patient reimbursement rates have not significantly changed.
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Affiliation(s)
- Anthony J. Wiggins
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, PO Box 800159, Charlottesville, VA 22908 USA
| | - Jourdan M. Cancienne
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, PO Box 800159, Charlottesville, VA 22908 USA
| | - Christopher L. Camp
- Department of Orthopedics, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 USA
| | - Ryan M. Degen
- Division of Orthopaedic Surgery, The University of Western Ontario, 1151 Richmond St N, London, ON N6A 3K7 Canada
| | - David W. Altchek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Main Campus, 525 East 71st Street, 1st Floor, New York, NY 10021 USA
| | - Joshua S. Dines
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Main Campus, 525 East 71st Street, 1st Floor, New York, NY 10021 USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, PO Box 800159, Charlottesville, VA 22908 USA
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Arthroscopic Release of the Pronator-Flexor Origin for Medial Epicondylitis. TECHNIQUES IN SHOULDER & ELBOW SURGERY 2018. [DOI: 10.1097/bte.0000000000000135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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do Nascimento AT, Claudio GK. Arthroscopic surgical treatment of medial epicondylitis. J Shoulder Elbow Surg 2017; 26:2232-2235. [PMID: 29054383 DOI: 10.1016/j.jse.2017.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The study purpose was to evaluate the outcomes of patients who received arthroscopic surgical treatment for medial epicondylitis refractory to conservative treatment. METHODS This was a retrospective study of 7 patients who underwent arthroscopic surgical débridement of the common flexor tendon for treatment of medial epicondylitis refractory to conservative treatment. The patients were assessed using the Disabilities of the Arm, Shoulder and Hand score; visual analog scale for pain; and Short Form 36 Health Survey. The mean age at the time of surgery was 50 years (range, 36-67 years). The mean duration of symptoms before surgery was approximately 2 years (range, 8 months to 4 years). The mean follow-up duration was 17 months (range, 6-48 months). RESULTS The average postoperative scores were 17 points on the Disabilities of the Arm, Shoulder and Hand outcome measure; 2 points on the visual analog scale at rest for 6 subjects (86%) with slight pain and 1 (14%) with moderate pain; and 78 on the Short Form 36 Health Survey. No significant complications were observed when the procedure was performed via arthroscopy. CONCLUSION Arthroscopic surgical treatment for medial epicondylitis of the elbow exhibits good outcomes and is safe and effective.
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Affiliation(s)
- Alexandre Tadeu do Nascimento
- Shoulder and Elbow Group, Orthoservice Hospital, São José dos Campos, SP, Brazil; Medical Department, Brazilian Rugby Confederation, São Paulo, SP, Brazil.
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Degen RM, Cancienne JM, Camp CL, Altchek DW, Dines JS, Werner BC. Patient-related risk factors for requiring surgical intervention following a failed injection for the treatment of medial and lateral epicondylitis. PHYSICIAN SPORTSMED 2017; 45:433-437. [PMID: 28862069 DOI: 10.1080/00913847.2017.1374811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To identify risk factors for failure of a therapeutic injection leading to operative management of both medial and lateral epicondylitis. METHODS A national database was used to query Medicare Standard Analytic Files from 2005-2012 for patients treated with therapeutic injections for medial or lateral epicondylitis using CPT codes for injections associated with corresponding ICD-9 diagnostic codes (726.31 and 726.32, respectively). Those who subsequently underwent surgical treatment following injection were identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for requiring surgery within 2 years after therapeutic injection. RESULTS 1,837 patients received therapeutic injections for medial epicondylitis. 52 (2.8%) required ipsilateral surgery at a mean of 429 ± 28 days post-injection. Risk factors for requiring surgical intervention included age <65, obesity, and morbid obesity. 6,561 patients received therapeutic injections for lateral epicondylitis. 201 (3.1%) required subsequent surgery at a mean of 383 ± 128 days' post-injection. Risk factors included age <65, tobacco use, diabetes mellitus and peripheral vascular disease. CONCLUSION The incidence of surgical intervention following a failed therapeutic injection for medial or lateral epicondylitis is low (~3%). Risk factors for failing a therapeutic injection include age <65 years and obesity (BMI > 30) for medial epicondylitis and age <65 years, smoking, diabetes mellitus and peripheral vascular disease for lateral epicondylitis. Patients with these identified risk factors presenting with medial or lateral epicondylitis should be cautioned that they carry a higher risk of subsequent surgical treatment. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Ryan M Degen
- a Sports Medicine and Shoulder Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Jourdan M Cancienne
- b Department of Orthopedic Surgery , University of Virginia Health System , Charlottesville , VA , USA
| | - Christopher L Camp
- a Sports Medicine and Shoulder Surgery , Hospital for Special Surgery , New York , NY , USA
| | - David W Altchek
- a Sports Medicine and Shoulder Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Joshua S Dines
- a Sports Medicine and Shoulder Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Brian C Werner
- b Department of Orthopedic Surgery , University of Virginia Health System , Charlottesville , VA , USA
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Abstract
Medial elbow pain is uncommon when compared with lateral elbow pain. Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain. Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain. Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders. Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event. This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies.
Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006
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Affiliation(s)
- Raul Barco
- Shoulder & Elbow Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Samuel A Antuña
- Shoulder & Elbow Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid 28046, Spain
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Comorbidity in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Nationwide Population-Based Cohort Study. PSYCHOSOMATICS 2017; 58:533-543. [PMID: 28596045 DOI: 10.1016/j.psym.2017.04.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previous studies have shown evidence of comorbid conditions in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). OBJECTIVE To estimate the prevalence of comorbidities and assess their associations using a nationwide population-based database of a Spanish CFS/ME cohort. METHOD A nationally representative, retrospective, cross-sectional cohort study (2008-2015) assessed 1757 Spanish subjects who met both the 1994 Centers for Disease Control and Prevention/Fukuda definition and 2003 Canadian Criteria for CFS/ME. Sociodemographic and clinical data, comorbidities, and patient-reported outcome measures at baseline were recorded. A cluster analysis based on baseline clinical variables was performed to classify patients with CFS/ME into 5 categories according to comorbidities. A multivariate logistic regression analysis was conducted adjusting for potential confounding effects such as age and sex; response and categorical predictor variables were also assessed. RESULTS A total of 1757 CFS/ME patients completed surveys were collected. We identified 5 CFS/ME clusters: group 1-fibromyalgia, myofascial pain, multiple chemical hypersensitivity, sicca syndrome, epicondylitis, and thyroiditis; group 2-alterations of ligaments and subcutaneous tissue, hypovitaminosis D, psychopathology, ligamentous hyperlaxity, and endometriosis. These 2 subgroups comprised mainly older women, with low educational level, unemployment, high levels of fatigue, and poor quality of life; group 3-with hardly any comorbidities, comprising mainly younger women, university students or those already employed, with lower levels of fatigue, and better quality of life; group 4-poorly defined comorbidities; and group 5-hypercholesterolemia. CONCLUSION Over 80% of a large population-based cohort of Spanish patients with CFS/ME presented comorbidities. Among the 5 subgroups created, the most interesting were groups 1-3. Future research should consider multidisciplinary approaches for the management and treatment of CFS/ME with comorbid conditions.
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Kani K, Porrino J, Dahiya N, Taljanovic M, Mulcahy H, Chew F. Visualization of the Soft Tissues at the Lateral and Medial Epicondyles of the Elbow. PM R 2016; 9:533-539. [PMID: 27816532 DOI: 10.1016/j.pmrj.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Kimia Kani
- Virginia Radiology Associates, P.C., Manassas, VA(∗)
| | - Jack Porrino
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195(†).
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic - Scottsdale, Phoenix, AZ(‡)
| | | | - Hyojeong Mulcahy
- Department of Radiology, University of Washington, Seattle, WA(¶)
| | - Felix Chew
- Department of Radiology, University of Washington, Seattle, WA(#)
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Ikpe S, Lesniak B. Biologics and Cell-Based Treatments for Upper Extremity Injuries. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.oto.2016.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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