Treatment Options for Tennis Elbow - An Umbrella Review

INTRODUCTION

The main goal of the present umbrella review was to provide the most up-to- date and evidence-based results regarding the various treatment options for tennis elbow (TE), which hopefully will significantly decrease the confusions existing in the literature. Furthermore, our study differs from past analytical studies because, as to the best of the authors' knowledge, is the first to provide independent (not in comparison to other treatment) statistical results regarding the effectiveness of each TE treatment.

MATERIALS AND METHODS

Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO were searched. The overall search process was conducted in 3 stages.

RESULTS

A total of 40 studies met the inclusion criteria and were included in this study. Out of those 40 meta-analyses, a total of 160 primary studies were screened in order to extract the data and perform a statistical analysis.

CONCLUSION

The present umbrella review underlines the efficiency of injection therapies, especially autologous blood, and platelet-rich plasma, while simultaneously proving the ineffectiveness of acupuncture and shock wave therapy as treatments for TE. Furthermore, the value of other known conservative treatment modalities, such as physical therapy, has been demonstrated.

Arthrofibrosis - a myth or true joint disorder?

Authors, mostly specialists on rehabilitation and orthopedic surgery prove that arthrofibrosis is a commonly overlooked phenomenon, which may lead to serious limitation in the range of movement, leading to limitation in patients quality of functioning. The main goal of this article is to emphasize the importance of understanding a such complex condition. Non typical patomechanism, lack of biomarkers dedicated to this dysfunction and general lack of understanding in this pathology causes that risk factors and the most effective strategies remain vastly unknown. Pathophysiology of the arthrofibrosis in the joints is definitely multifactorial, but intense production of collagen seems to be the main factor. Most modern pharmacological methods concentrate on the regulation of collagen fiber production and reducing the inflammation. Inflammation from joint contractures stimulates the proliferation of activated cells that results in the production of extracellular matrix macromolecules to form fibrotic tissue that is deposited into the capsule, thereby resulting in fibrosis. Lack of unified classification scale is caused by relatively high variation of the functions fulfilled by particular joints and each treatment plan should be constructed individually. Quality of surgical treatment and physical therapy play a major role in both prevention and treatment of such complex condition as arthrofibrosis. Both iatrogenic mistakes and overly aggressive manual therapy are some of main factors increasing the risk of this pathological condition. Introducing properly conducted physical therapy treatment in the early stage is crucial to main the range of movement and preventing this significant problem.

Anatomy of the deep brachial artery - general overview (cadaveric study) - discussion on terminology

There are only very few studies on the anatomy of the deep brachial artery - DBA (arteria profunda brachii), both regarding its course, branching pattern and contribution to the cubital rete. Most of the textbooks are based on data which remain unchanged for years. The aim of this article was to summarize the current knowledge on this vessel, based on the anatomical and clinical studies and other sources available including also own cadaveric study. We tried to present also some controversies regarded to the nomenclature of the branches of the DBA.

Incorporation of the sphenoid sinuses' septum / septa in the carotid canal - evaluation before the FESS

The purpose of the research was to define the frequency prevalence of the incorporation of sphenoid sinuses' septum / septa in the carotid canal of the adult population.

MATERIALS AND METHODS

296 computed tomography (CT) scans of the patients (147 females, 149 males), who did not present any pathology in the sphenoid sinuses, were evaluated in this retrospective analysis. Spiral CT scanner - Siemens Somatom Sensation 16 - was used to glean the medical images. Standard procedure applied in the option Siemens CARE Dose 4D. No contrast medium was administered. Multiplans reconstruction (MPR) tool was used in order to obtain frontal and sagittal planes from the transverse planes previously received.

RESULTS

Bilateral incorporation of the main septum (MS) in the carotid canal was not present in any of the patients, whereas unilateral incorporation was noticed in 21.96% of the patients (17.68% females, 26.17% males). On the right side it occurred in 11.82% of cases (10.88% females, 12.75% males), and on the left side in 10.14% of cases (6.8% females, 13.42% males). Bilateral incorporation of the additional septum (AS) was found in 8.45% of the patients (4.08% females, 12.75% males), whereas unilateral incorporation was noted in 28.37% of the patients. It was seen on the right side in 11.82% of cases (12.93% females, 10.74% males), and on the left side in 16.55% cases (15.65% females, 17.45% males). The most common variant was the incorporation of only one of the septa (either the MS or the AS) in the wall of the carotid canal unilaterally. Such situation took place in 30.07% of the patients (29.25% females, 30.87% males). Incorporation of two septa on the same side was noticed in 4.39% of cases (4.08% females, 4.7% males), and incorporation of three septa in 0.34% of cases (0.7% males).

CONCLUSIONS

The anatomy of the paranasal sinuses is varied to a great extent, hence performing a CT scan is crucial before the scheduled surgery, as it may lessen the unforeseeable surgical complications, that may result from the high prevalence of variants in the sinuses.

Electrode ingrowths revealed during cadaveric dissection of a 5y old implanted pacemaker - the case report

Increasing numbers of implanted cardiovascular electronic devices, results in a need for lead extractions, which has increased to an annual volume of over 10,000 worldwide. We present a cadaveric dissection body with a single chamber pacemaker implanted 5y before death.

The median nerve penetrating through the radial head of the flexor digitorum superficialis muscle: Case report

The forearm is a body region of numerous anatomical variations. Due to its favorable anatomy flexor digitorum superficialis muscle (FDS) is commonly used in tendon transfer surgeries. In this study a unique combination of abnormalities was found in a single forearm: the flexor digitorum superficialis muscle penetrated by the median nerve, one of the flexor digitorum superficialis tendons early division and absence of the palmaris longus muscle. Described variation potentially may lead to the clinical manifestation of the median nerve compression and should be also considered during FDS surgery.

IMPACT OF MINIMALLY INVASIVE DECOMPRESSION SURGERY ON THE QUALITY OF LIFE OF PATIENTS WITH LUMBAR SPINAL STENOSIS – A 2 YEAR FOLLOW-UP STUDY

Background: Lumbar spinal stenosis (LSS) may result in a progressive narrowing of the spinal canal leading to compression of the nerve roots. The advantages of minimally invasive surgical approaches to the lumbar spine have been rigorously evaluated, however, the long-term impact on the health-related quality-of-life (HRQoL) of patients with LSS that have undergone minimally invasive decompression surgery is uncertain. To this end, the aim of our study was to evaluate the impact of this procedure on the HRQoL of patients with LSS. Methods: Enrolled patients were recruited to this prospective study at two orthopedic centers in Krakow, Poland. Patients eligible for inclusion were above 18 years of age, had been qualified for spine surgery of the lumbar region due to either discopathy or non-traumatic spinal stenosis, had uni- or bilateral neurogenic claudication, and verified spinal stenosis. During the interview, each patient completed the Polish version of the SSSQ (P-SSSQ), SF-36, and a demographic data questionnaire. Apart from the preoperative assessment the patients were again approached to fill in the questionnaires 6, 12, 18, and 24 months postoperatively. Results: One hundred and seventy-one consecutive patients with a mean age of 59 years were included in the study. This study found that LSS decompression statistically significantly increases HRQoL in a 2-year observation. There was a significant difference between the preoperative and postoperative SF-36 and P-SSSQ scores. The largest increase in HRQoL is between the preoperative period and 6 months post-op (p<0.0001). Starting from around 18 months post-op, further changes in HRQoL are minimal. Late complications (persistent pain, the need for revision surgery) may decrease HRQoL at around 24 months post-op. Conclusions: Minimally invasive decompression surgery for elderly patients with LSS significantly improves their HRQoL

Gastroscopy in patients with hiatal hernia with and without gastroesophageal mucosal prolapse

There are still many doubts in the literature regarding gastroesophageal mucosal prolapse (GEMP) and its clinical course. We still do not know what determines mucosal wedging in esophagogastric junction, and what is the role of the anatomy of that site. To investigate that problem we performed 120 upper digestive tract endoscopies in which a hiatal hernia was diagnosed. Patients referred to our unit with different complaints most frequently of typical or atypical gastroesophageal (GE) reflux symptoms. The aim of that study was to assess hernia dimensions in patients with and without GEMP diagnosed during endoscopy. Additionally we analyzed the type and prevalence of gastrointestinal symptoms reported by patients to confirm the observation that GEMP symptoms differ from gastroesophageal reflux disease (GERD) symptoms.

METHODS

One-hundred and twenty patients were included in this study. All of the patients were diagnosed with a hiatal hernia during routine gastroscopy. Using standardized methodology the region of the hiatal hernia was photographed, and hernia longitudinal and transverse dimensions were measured.

RESULTS

The study group comprised 57 females (52.5%) and 63 males - mean age (SD) 58.5 ± 18.4. Most of the patients had standard GERD symptoms (n = 96; 80%). The average length of hiatus, in patients with GEMP (n = 24; 20%) was 3.56 ± 0.59 cm, and the average width was 2.32 ± 0.62 cm (n = 96; 80%) vs. 4.64 ± 0.74 cm and 2.98 ± 0.68 cm respectively in patients without GEMP (p <0.001).

CONCLUSIONS

GEMP occurs in smaller sized hiatal hernias. We confirmed that disease symptoms of the majority of patients with GEMP differ from patient with GERD but without GEMP. However this difference was not significant enough to allow to differentiate between diagnoses based solely on the symptoms.

Validation of the Polish version of the EORTC Head and Neck module (QLQ-H&N35)

AIM

The aim of this study was to psychometrically validate the EORTC translated, Polish version of the EORTC QLQ-H&N35 questionnaire to support using it in the Polish clinical setting in patients with head and neck malignancies.

MATERIALS AND METHODS

Patients with histologically confirmed head and neck malignancies were included in the study. All patients filled in the Polish version of the EORTC QLQ-C30, the EORTC QLQ-H&N35 module, and a demographic questionnaire. Standardized validity and reliability analyses were performed.

RESULTS

During the recruitment period a total of 176 patients (82 females - 46.6%) were enrolled into the study, with a mean age of 54.3 ± 11.2 years. Cronbach alpha values ranged from 0.71 to 0.87. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen.

CONCLUSIONS

The Polish version of the EORTC QLQ-H&N35 module is a reliable and valid tool for measuring HRQoL in Polish patients with head and neck malignancies. It can be fully recommended for use in the Polish clinical setting.

Blood vessels of the shin - posterior tibial artery - anatomy - own studies and review of the literature

Anatomy of the vascular system of the leg was studied using classical anatomical dissection methods. Based also on literature we have reviewed the current knowledge on the vascularization of the lower leg and its embryological background with special respect toward the posterior tibial artery and its branches.

Cross cultural adaptation of the English version of the IOF-QLQ to Polish, to assess the health-related quality-of-life of patients after a distal radius fracture

BACKGROUND

A distal radius fracture (DRF) is a common injury that can cause significant pain and lead to a prolonged decrease in physical, emotional, and social functioning. In modern randomized clinical trials, assessing outcomes after a DRF, health-related quality-of-life (HRQoL) is a "must-be" endpoint. Additionally, HRQoL assessments are essential in the clinical decision-making process. The aim of this study to cross-culturally adapt the International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ) for patients with a DRF to Polish.

METHODS

A standard forward-backward translation procedure and pilot-testing were used to prepare the Polish version of the IOF QLQ for use in this case-control study. Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. The study group was gender and aged matched with healthy controls. All DRF patients filled out the Polish version of the IOF QLQ, the SF-36 and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, 3, 6, 12, and 18 months after the fracture. Standard validity and reliability analyses were performed.

RESULTS

Ninety-seven patients (73 women - 75.3%) with a mean age of 62.4 ± 7.1 years agreed to take part in the study. The control group consisted of 81 patients (60 women - 74.1%) with a mean age 63.9 ± 8.2 years. No significant differences were found between the mean age of patients and controls (p = 0.19). Cronbach's alpha coefficients showed positive internal consistency (0.79-0.89). The interclass correlations for the IOF QLQ domains and the overall score ranged from 0.85 to 0.92. Satisfactory convergent and discriminant validity of the IOF QLQ was seen.

CONCLUSIONS

The Polish version of the IOF QLQ for patients with a DRF is a reliable and valid tool for measuring HRQoL. It can be fully recommended for use in clinical settings in the Polish population. When combined with the SF-36 the IOF QLQ allows to obtain a comprehensive HRQoL assessment in patients with a DRF.

Main health-related quality-of-life issues in patients after a distal radius fracture

AIM

The aim of this study was to identify and assess the degree and clinical course of the main health-related quality-of-life (HRQoL) issues in patients after a distal radius fracture (DRF).

MATERIALS AND METHODS

Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. All patients filled out the Polish version of the IOF QLQ, the SF-36 and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, 3 months, and 6 after the fracture. Standard statistical analyses were performed.

RESULTS

During the 16 month recruitment period a total of 71 patients (55 women - 77.5%), with a mean age of 64.1 ± 12.4 years, were included in the study group. All patients suffered from Colles type fractures. Attrition to follow-up was acceptable. At baseline, basing on the IOF QLQ scale scores, DRF patients had the most significant problems with physical function (82.8/100; with 100 representing the worst possible HRQoL), and general health (78.1/100). Basing on SF-36 scale scores patients most significant problems were associated with role limitations due to physical health problems (15.1/100; with 100 representing the best possible HRQoL), and bodily pain (39.5/100).

CONCLUSIONS

Concluding, this study shows that the main issues with which patients with and extra-articular DRF struggle the most are pain of the fractured extremity and physical dysfunction. These symptoms are most pronounced in the early post-injury period, and in the majority of patients steadily decrease over a period of six months.

Preliminary validation of the IOF QLQ and comparison with the SF-36 in patients after a distal radius fracture

AIM

The aim of this study was to report preliminary validation data on the Polish version of the International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ) for patients with a distal radius fracture (DRF).

MATERIALS AND METHODS

Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. All patients filled out the Polish version of the IOF QLQ, the Short Form 36 (SF-36) and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, and 3 months after the fracture. Standard va- lidity and reliability analyses were performed.

RESULTS

Fifty-eight patients (42 women - 72.4%) agreed to take part in the study (mean age of the group 65.7 ± 9.3 years). Cronbach's alpha coefficients showed positive internal consistency (0.82- 0.87). The interclass correlations for the IOF QLQ domains and the overall score ranged from 0.82 to 0.93. Satisfactory convergent and discriminant validity of the IOF QLQ was seen.

CONCLUSIONS

Preliminary data show that the Polish version of the IOF QLQ for patients with a DRF is a reliable and valid tool for measuring health-related quality-of-life (HRQoL). However, further studies are needed to demonstrate the full psychometric and clinical properties of the IOF QLQ in patients with a fracture of the wrist.

Preliminary psychometric validation of the Polish version of the EORTC elderly module (QLQ-ELD14)

AIM

The aim of our study was to report preliminary validation data on the EORTC translated, Polish version of the EORTC QLQ-ELD14 questionnaire to show that this tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish elderly patients with cancer.

MATERIALS AND METHODS

Patients with histological confirmation of primary cancer were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-ELD14 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardized validity and reliability analyses were performed.

RESULTS

Sixty-five patients (41 females - 63.1%) were enrolled into the study, with a mean age of 76.4 ± 5.7 years. Cronbach alpha coefficients, range 0.70-0.84, showed positive internal consistency. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. Strong correlations were observed between the EORTC QLQ-ELD14 (especially mobility and burden of illness), and the EORTC QLQ-C30 (r = -0.30-(-0.83); p <0.001).

CONCLUSIONS

Basing on the preliminary data from this study, the Polish version of the EORTC QLQ-ELD14 module is a reliable and valid tool for measuring HRQoL in elderly cancer patients. However further research is needed to establish the full psychometric properties of the described module, especially in regards to test-retest and responsiveness over time.

Empathy level differences between Polish surgeons and physicians

AIM

The aim of this study was to assess the levels of empathy among Polish physicians and surgeons.

MATERIALS AND METHODS

Ninety-two physicians took part in the study. The physicians were either employed in hospitals, outpatient clinics or university departments in Krakow. The participants were asked to fill out a personal questionnaire, the Emotional Empathy Scale (EES), as well as describe four chosen tables from the Thematic Apperception Test (TAT).

RESULTS

The study group consisted of 92 physicians, including 25 women (27.2%) and 67 men, in the mean age of 42 ± 16.3 years (age span: 27-68 years). The physicians have been divided into two subgroups - non-surgical specialists (52 people - 56.5%) and surgical specialists (40 people - 43.5%). There were no gender differences, as to the level of empathy, in the study group (p >0.05). Non-surgical specialists displayed a higher level of empathy (p=0.03) than their surgical counterparts. There was a positive correlation between age and the level of empathy. This was seen both among non-surgical (r = 0.41; p < 0.0001) and surgical specialists (r = 0.59; p < 0.0001). No correlation was seen between the number of years of experience working as a doctor and the level of empathy (p > 0.05).

CONCLUSIONS

Empathy is an essential element in the physician-patient relationship. This study has shown that non-surgical specialists display a higher level of empathy. We have also shown that years of experience working as a doctor do not influence the level of empathy, while age is a beneficial factor.

Empathy and burnout among physicians of different specialities

AIM

The aim of this study was to assess the level of empathy and burnout among physicians of different specialization, as well as to determine whether a correlation existed between the level of empathy and burnout.

MATERIALS AND METHOD

Seventy-one physicians took part in the study - 25 women (35.2%) and 46 men (age between 25 to 68 years). The physicians were either employed in hospitals, outpatient clinics or university departments in Krakow. The participants were asked to fill out a personal questionnaire, the Maslach Burnout Inventory (MBI) and the Emotional Empathy Scale (EES) as well as describe four chosen tables from the Thematic Apperception Test (TAT).

RESULTS

The average empathy score for the whole group was 14.3 (SD ± 6.4). The average levels of each of the burnout (according to MBI) elements for the whole group were 21.72 for emotional exhaustion, 9.62 for depersonalization and 29.07 for loss of personal accomplishment. For the whole group a negative correlation was noted between loss of personal accomplishment (according to MBI) and the level of empathy (according to EES) (r = -0.23, p <0.05). For the whole group negative correlations were noted between the level of emotional exhaustion, depersonalization and the total level of burnout (according to MBI) and the level of empathy (according to TAT) (r = -0.30, p <0.05; r = -0.39, p <0.01; p = -0.32, p <0.01 respectively).

CONCLUSIONS

Concluding, medical specialists have a significantly higher level of empathy than surgeons and family physicians. It is imperative to remember that increasing depersonalization and emotional exhaustion can have a negative impact on empathy.

Preliminary psychometric validation of the Polish version of the EORTC head and neck module (QLQ-H&N35)

AIM

The aim of our study was to report preliminary validation data on the EORTC translated, Polish version of the EORTC QLQ-H&N35 questionnaire to show that this tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish patients with head and neck malignancies.

MATERIALS AND METHODS

Patients with histological confirmation of head and neck malignancies were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-H&N35 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardized validity and reliability analyses were performed.

RESULTS

Fifty-one patients (23 females - 45.1%) were enrolled into the study, with a mean age of 51.3 ± 12.9 years. Cronbach alpha coefficients, range 0.72-0.85, showed positive internal consistency. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen.

CONCLUSIONS

Basing on the preliminary data from this report, one can say that the Polish version of the EORTC QLQ-H&N35 module is a reliable and valid tool for measuring HRQoL in patients with head and neck malignancies. However further research is needed to establish the full psychometric properties of the described module, especially test-retest and responsiveness over time.