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Kim JH, Hoy JF, Smith SR, Sabet A, Fernandez JJ, Cohen MS, Wysocki RW, Simcock XC. Recalcitrant Lateral Epicondylitis: A Systematic Review on Current Nonoperative and Operative Treatment Modalities. JBJS Rev 2024; 12:01874474-202408000-00006. [PMID: 39106325 DOI: 10.2106/jbjs.rvw.24.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
BACKGROUND Lateral epicondylitis is a common cause of elbow pain that is generally self-limiting. For patients who have persistent symptoms refractory to conservative treatment, there is still no clear consensus on the most favorable treatment modality. The purpose of this systematic review was to synthesize the available literature regarding both nonoperative and operative treatment modalities for recalcitrant lateral epicondylitis (RLE) to provide insight into the efficacy of treatment options. METHODS A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, where the PubMed, MEDLINE/Ovid, CINAHL, Cochrane, and Scopus databases were queried to identify studies evaluating treatment options for RLE. RESULTS A total of 27 studies with 1,958 patients were included. Of the reviewed studies, there were a wide variety of treatments including platelet-rich plasma injections, percutaneous tenotomies, and various arthroscopic and open procedures. CONCLUSION There are a wide variety of treatment modalities available for RLE that have promising efficacy in the short, medium, and long terms. A comprehensive approach combining evidence-based and patient-centered care is critical for effective management of refractory symptoms. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jason H Kim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Yang X, Ying L, Ying L, Zhang Q, Han D, Zhou X. Modified arthroscopic tenotomy of the extensor carpi radialis brevis for refractory lateral epicondylitis: a cohort study. J Shoulder Elbow Surg 2024; 33:536-543. [PMID: 37944746 DOI: 10.1016/j.jse.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Different arthroscopic techniques exist for managing the extensor carpi radials brevis (ECRB) when treating refractory lateral epicondylitis. The purpose of this study is to compare the outcomes of a standard arthroscopic débridement with ECRB tendon release to an arthroscopic ECRB tenotomy distal to its insertion without débridement using a retrospective cohort study design. METHODS This study included patients underwent arthroscopic treatment of lateral epicondylitis during 2 different time periods: 2016-2019 (débridement) and 2019-2021 (modified tenotomy without débridement). Patients were assessed preoperatively and at the last follow-up with Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale of pain. RESULTS A total of 69 patients completed the follow-up (38 in the débridement group and 31 in the tenotomy group). Patients in both groups showed significant improvements were found in MEPS, DASH, and Visual Analog Scale after surgery. Patients in the tenotomy group had higher MEPSs and reported less pain with a minimum 2 year follow-up after surgery. DASH scores between groups were similar at all time periods. CONCLUSION Arthroscopic modified tenotomy of the ECRB without débridement improves function and pain significantly for patients with refractory lateral epicondylitis, which is not inferior to arthroscopic débridement technique.
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Affiliation(s)
- Xiangdong Yang
- The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Li Ying
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Liwei Ying
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Qingguo Zhang
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Dawei Han
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai, China.
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Ben H, Kholinne E, Zeng CH, Alsaqri H, Lee JB, So SP, Koh KH, Jeon IH. Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy. Am J Sports Med 2023; 51:3401-3408. [PMID: 37804157 DOI: 10.1177/03635465231198862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
BACKGROUND Arthroscopic techniques aim to reduce complications and accelerate recovery of the elbow after treatments for posttraumatic stiffness, arthritis diseases, lateral epicondylitis, ligament reconstruction, and elbow trauma. However, data on the true prevalence and characteristics of heterotopic ossification (HO) formation after elbow arthroscopy are limited. PURPOSE To investigate the prevalence, timing, locational distribution, and risk factors of HO after elbow arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS Data on 205 patients undergoing elbow arthroscopy by a single senior elbow surgeon at a single institution between May 2011 and January 2022 were retrospectively reviewed. The patients were evaluated at 2 weeks, 8 weeks, 6 months, and then annually after surgery or more frequently if HO developed, with a minimum of 1 year of postoperative follow-up. Postoperative anteroposterior and lateral elbow radiographs were taken at 2 weeks to rule out fracture and at 8 weeks to identify HO. The clinical outcomes were evaluated based on the pain visual analog scale; the shortened version of the Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and the Single Assessment Numeric Evaluation scores before and after surgery. Bivariate logistic regression analyses were used to determine factors affecting HO prevalence. RESULTS Thirteen (12 male, 1 female) of 205 (6.3%) patients developed HO, with 10 (76.9%) with HO that formed on the medial compartment of the elbow. Ten (76.9%) patients were diagnosed at 8 weeks after arthroscopic surgery, 1 (7.7%) at 6 months after surgery, and 2 (15.4%) at 12 months after surgery. HO was not found at 2 weeks after surgery in any patient. The mean follow-up time was 3.5 years (range, 1.0-11.8 years). Eleven asymptomatic patients were treated nonoperatively, and 2 symptomatic patients underwent HO excision arthroscopically or had a combination of open surgery and arthroscopy. Age was a protective factor for HO formation (odds ratio [OR], 0.953; 95% CI, 0.910-0.999; P = .047). The risk factors for HO formation were tourniquet time (OR, 1.042; 95% CI, 1.019-1.065; P < .001) and surgical time (OR, 1.026; 95% CI, 1.011-1.041; P < .001). CONCLUSION Among 205 patients who underwent elbow arthroscopy, HO was a minor complication of elbow arthroscopy, with a prevalence rate of 6.3%, and was usually located on the medial compartment of the elbow. Although the presence of HO may not affect the clinical outcomes in most patients, it should be carefully monitored for a minimum of 8 weeks postoperatively. Younger age, longer tourniquet time, and longer surgical time contributed to HO formation after elbow arthroscopy.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lateral epicondylitis of the elbow: an up-to-date review of management. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:201-206. [PMID: 35031850 DOI: 10.1007/s00590-021-03181-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
Lateral epicondylitis, also known as tennis elbow, is an overuse tendinopathy of the common extensor origin of the elbow in patients involved in repetitive movement of the wrist and forearm. Lateral epicondylitis is a self-limiting condition, with operative management only recommended in severe, recalcitrant cases. This article reviews the recent updates on operative and non-operative management of lateral epicondylitis.
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Li H, Yang XD, Xue X, Zhang Q, Ye L, Hua Y, Zhou X. Arthroscopic Extensor Carpi Radialis Brevis Tenotomy and Debridement Versus Debridement Alone for Refractory Lateral Epicondylitis: Clinical and MRI Evaluation. Orthop J Sports Med 2022; 10:23259671221092733. [PMID: 35958292 PMCID: PMC9358579 DOI: 10.1177/23259671221092733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon is a widely accepted procedure used in refractory lateral epicondylitis. However, residual pain occurs in some patients. Purpose: To investigate the clinical effectiveness of arthroscopic extended debridement (ECRB tenotomy and debridement) in the treatment of lateral epicondylitis. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with refractory lateral epicondylitis were consecutively recruited for this study. They underwent traditional ECRB debridement (control group) or extended ECRB debridement (ED group) under arthroscopy. The Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) for pain, and Mayo Elbow Performance Score (MEPS) were used to compare elbow function between the groups at 3, 6, and 12 months postoperatively. Magnetic resonance imaging (MRI) was also performed to evaluate pathology at 12 months. Results: A total of 69 patients participated in the study (33 patients in the ED group and 36 in the control group). After surgery, all patients showed improvement on all 3 outcome scores. Compared with the control group, the ED group had significantly better postoperative MEPS and VAS scores at 3 months (P ≤ .001 for both) and 6 months (P ≤ .03 for both) but similar values at 12 months. DASH scores between groups were similar at all time periods. At the 12-month follow-up, no patients in the ED group reported pain with strenuous work. Return-to-work (RTW) times were also shorter in the ED group compared with the controls (8 ± 4 vs 18 ± 8 weeks; P < .001). Postoperative MRI assessments revealed no high signal intensities on the lateral epicondyle in the ED group, while there was an increased internal signal intensity on the lateral epicondyle in 83% of the controls. Conclusion: Collectively, the extended ECRB debridement technique resulted in enhanced pain relief in the early postoperative period as well as providing faster RTW times compared with the traditional debridement technique. At 1 year follow-up, there were no differences in outcome measures between groups, but residual abnormal MRI findings were more common in the traditional debridement group.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Xiang Dong Yang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| | - XiaoAo Xue
- Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Qingguo Zhang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| | - Lingchao Ye
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Zhejiang, China
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Kim CH, Park YB, Lee JS, Jung HS. Platelet-rich plasma injection vs. operative treatment for lateral elbow tendinosis: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:428-436. [PMID: 34656779 DOI: 10.1016/j.jse.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. METHODS MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. RESULTS We included 5 studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely, 2 months (mean difference [MD] 1.11, 95% confidence interval [CI] -2.51 to 4.74, P = .55, I2 = 94%), 6 months (MD 0.80, 95% CI -2.83 to 4.42, P = .67, I2 = 92%), and 12 months (MD -0.92, 95% CI -4.63 to 2.80, P = .63, I2 = 93%) postintervention and in the Patient-Related Tennis Elbow Evaluation scores at 12 weeks (MD -1.86, 95% CI -22.30 to 18.58, P = .86, I2 = 81%), 24 weeks (MD -3.33, 95% CI -21.82 to 15.17, P = .72, I2 = 74%), and 52 weeks (MD -3.64, 95% CI -19.65 to 12.37, P = .66, I2 = 69%) postintervention. CONCLUSIONS Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lee
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seok Jung
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea.
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Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res 2019; 105:S241-S246. [PMID: 31543413 DOI: 10.1016/j.otsr.2019.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
Lateral epicondylitis is the most common cause of lateral elbow pain. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore constitutes a major public health issue. This article reviews the pathophysiological factors involved in lateral epicondylitis, as well as the tools available for establishing the diagnosis and ruling out other causes of lateral elbow pain. Finally, the non-operative and surgical treatment options are discussed in detail.
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Affiliation(s)
- Hubert Lenoir
- Chirurgie de l'épaule, du coude et de la main, Centre Ostéo-articulaires des Cèdres, Parc Sud Galaxie, 5, rue des tropiques, 38130 Echirolles, France
| | - Olivier Mares
- Centre hospitalier universitaire Nîmes-Caremeau, place du professeur Robert-Debré, 30029 Nîmes, France
| | - Yacine Carlier
- Centre de l'Arthrose, Clinique du sport Bordeaux-Mérignac, 2, rue George-Négrevergne, 33700 Mérignac, France.
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Kim GM, Yoo SJ, Choi S, Park YG. Current Trends for Treating Lateral Epicondylitis. Clin Shoulder Elb 2019; 22:227-234. [PMID: 33330224 PMCID: PMC7714311 DOI: 10.5397/cise.2019.22.4.227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
Lateral epicondylitis, also known as 'tennis elbow', is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.
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Affiliation(s)
- Gyeong Min Kim
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Jin Yoo
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sungwook Choi
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Colombi R, Bevand A, Devillier A, Baulot E, Ezzahoui A, Martz P. Exclusive Posterolateral Arthroscopic and Endoscopic Approaches Used in the Treatment of Lateral Epicondylitis. Orthopedics 2019; 42:e521-e527. [PMID: 31587076 DOI: 10.3928/01477447-20191001-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023]
Abstract
Complications following arthroscopy of the elbow for the treatment of lateral epicondylitis are essentially related to the anterior arthroscopic approach. The principal aims of this study were to describe and evaluate the mixed arthroscopic and endoscopic surgical technique using posterolateral approaches exclusively. This was a retrospective study of consecutive patients operated on between 2005 and 2014 for lateral epicondylitis following more than 6 months of ineffective medical treatment. The exploration was arthroscopic via a distal posterolateral portal. The extensor carpi radialis brevis was disinserted via a proximal extra-articular posterolateral endoscopic portal. The postoperative clinical follow-up included subjective (visual analog scale, Nirschl) and objective (Mayo Clinic Elbow Performance Score) evaluations of pain, the time to return to work, the level of satisfaction, complications, and failures. Thirty-seven patients underwent the procedure, including 3 lost to follow-up. Mean±SD follow-up was 32.8±24.7 months. Mean±SD visual analog scale scores were 0.8±0.8 at rest, 2.4±1.3 during everyday activities, and 3.1±1.5 during effort. Mean±SD Mayo Clinic Elbow Evaluation Score was 10.1±1.0 of 12 and mean±SD Mayo Clinic Elbow Performance Score was 91.9±12.5 of 100. Mean±SD Nirschl score was 67.5±9.6 of 80. Mean±SD time to return to work was 2.0±2.6 months. The level of satisfaction was 94.1%. The failure rate was 2.9%, with no neurological lesions. With equivalent or even better results than those already published, this surgical procedure enables the treatment of lateral epicondylitis via posterolateral portals alone, thus avoiding the complications inherent to anterior and medial arthroscopic approaches. [Orthopedics. 2019; 42(6):e521-e527.].
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Unal M, Budeyri A, Ercan S, Serbest O, Dogan O, Demir HM, Cetin C. Arthroscopic chronic tennis elbow surgery preserves elbow proprioception. Orthop Traumatol Surg Res 2019; 105:329-334. [PMID: 30773342 DOI: 10.1016/j.otsr.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 05/15/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Retrospective cohort study. INTRODUCTION A new method of accurately assessing the compromised elbow's proprioception was developed for this postsurgical population using information from previous neurophysiologic proprioception studies of healthy elbows. HYPOTHESIS This retrospective cohort study investigated the patterns and the degree of proprioceptive impairment and recovery following arthroscopic surgery for chronic lateral epicondylitis. MATERIAL AND METHODS Participants had undergone arthroscopic elbow surgery two years prior to this study (n=15). Healthy, non-injured volunteers with similar demographics (n=15) served as controls. Both groups were evaluated using quantitative measures of joint position sense for proprioceptive functioning. In order to obtain the most accurate proprioceptive measurements, interindividual interaction and visual input biases were eliminated. Retrospective chart reviews were performed to compare qualitative self-reported measures of proprioceptive function in arthroscopic surgery patients before surgery and two years post-surgery. RESULTS Active and passive joint repositioning outcome measurements were similar between groups (p>0.05). No significant differences were found among any angles except one: passive joint position sense at 120° of flexion (p<0.05). At this angle, the arthroscopy group showed greater deviation from target angles than the control group. The novel proprioceptive testing method we developed was found to be accurate and reliable. DISCUSSION Outcomes of arthroscopic treatment of chronic lateral epicondylitis with no decortication yielded outcomes measure similar to those of healthy controls. The sole significant difference was at 120° flexion passive joint repositioning, with a higher negative angular deviation from the target point. We propose that our study results and specific proprioception method may have implications for improving accuracy of future elbow arthroscopy and proprioceptive recovery in this population. LEVEL OF EVIDENCE II, low-powered prospective randomized trial.
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Affiliation(s)
- Meric Unal
- Sports Medicine Department, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Aydin Budeyri
- Orthopaedics and Traumatology Department, Faculty of Medicine, SANKO University, Gaziantep, Turkey
| | - Sabriye Ercan
- Sports Medicine Department, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Onur Serbest
- Sports Medicine Department Aydın State Hospital, Aydın, Turkey
| | - Onur Dogan
- Special Physiotherapy Center, Eskisehir, Turkey
| | - Hilmi Mustafa Demir
- Sports Medicine Department, Van Education and Research Hospital, Van, Turkey
| | - Cem Cetin
- Sports Medicine Department, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized, Double-Blinded Trial. J Hand Surg Am 2019; 44:216-221. [PMID: 30057223 DOI: 10.1016/j.jhsa.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 05/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to examine the result of lateral epicondylitis surgery with and without posterior interosseous nerve release. METHODS We conducted a prospective, randomized, double-blind single-center clinical trial in 54 patients treated surgically for lateral epicondylitis, without any EMG or imaging sign of compression of the posterior interosseous nerve at the arcade of Frohse. The patients were equally divided into intervention (supplemental radial nerve release) and control groups (no radial nerve release). Clinical symptoms and disability related to the upper extremity were assessed by a blinded assessor prior to surgery, using both the Quick Disabilities of the Arm, Shoulder, and hand (QuickDASH) and Mayo Elbow Performance Score (MEPS) and again at 1-, 3-, and 6-month intervals after surgery. RESULTS Significant improvement was observed in both groups from the first month after surgery and for the whole evaluation period for both the MEPS and the QuickDASH scores. CONCLUSIONS Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Pierce TP, Issa K, Gilbert BT, Hanly B, Festa A, McInerney VK, Scillia AJ. A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin. Arthroscopy 2017; 33:1260-1268.e2. [PMID: 28412059 DOI: 10.1016/j.arthro.2017.01.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare complications, function, pain, and patient satisfaction after conventional open, percutaneous, or arthroscopic release of the extensor origin for the treatment of lateral epicondylitis. METHODS A thorough review of 4 databases-PubMed, EBSCOhost, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and Scopus-was performed to identify all studies that addressed surgical management of lateral epicondylitis. We included (1) studies published between 2000 and 2015 and (2) studies with clearly defined surgical techniques. We excluded (1) non-English-language manuscripts, (2) isolated case reports, (3) studies with fewer than 10 subjects, (4) animal studies, (5) studies with additional adjunctive procedures aside from release of the extensor origin, (6) clinical or systematic review manuscripts, (7) studies with a follow-up period of 6 months or less, and (8) studies in which less than 80% of patients completed follow-up. Each study was analyzed for complication rates, functional outcomes, pain, and patient satisfaction. RESULTS Thirty reports were identified that included 848 open, 578 arthroscopic, and 178 percutaneous releases. Patients within each release group had a similar age (46 years vs 46 years vs 48 years; P = .9 and P = .4, respectively), whereas there was a longer follow-up time in patients who underwent surgery by an open technique (49.4 months vs 42.6 months vs 23 months, P < .001). There were no differences in complication rates among these techniques (3.8% vs 2.9% vs 3.9%; P = .5 and P = .9, respectively). However, open techniques were correlated with higher surgical-site infection rates than arthroscopic techniques (0.7% vs 0%, P = .04). Mean Disabilities of the Arm, Shoulder and Hand scores were substantially better with both open and arthroscopic techniques than with percutaneous release (19.9 points vs 21.3 points vs 29 points, P < .001). In addition, there was less pain reported in the arthroscopic and percutaneous release groups as opposed to their open counterparts (1.9 points vs 1.4 points vs 1.3 points, P < .0001). There were no differences among the techniques in patient satisfaction rate (93.7% vs 89% vs 88%; P = .08 and P = .07, respectively). CONCLUSIONS Functional outcomes of open and arthroscopic releases may be superior to those of percutaneous release. In addition, patients may report less pain with arthroscopic and percutaneous techniques. Although the risk of complications is similar regardless of technique, patients may be counseled that their risk of infectious complications may be slightly higher with open releases. However, it is important to note that this statistical difference may not necessarily portend noticeable clinical differences. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV evidence.
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Affiliation(s)
- Todd P Pierce
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Kimona Issa
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Benjamin T Gilbert
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Brian Hanly
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Anthony Festa
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Vincent K McInerney
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A..
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Hegmann KT, Thiese MS, Kapellusch J, Merryweather A, Bao S, Silverstein B, Wood EM, Kendall R, Foster J, Drury DL, Garg A. Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts. BMC Musculoskelet Disord 2017; 18:227. [PMID: 28558776 PMCID: PMC5450050 DOI: 10.1186/s12891-017-1593-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/22/2017] [Indexed: 01/10/2023] Open
Abstract
Background The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Methods Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. Results There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. Conclusions These data suggest a potentially modifiable disease mechanism for LE.
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Affiliation(s)
- Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA.
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA
| | - Jay Kapellusch
- Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, 1495 East 100 South, Salt Lake City, UT, 84112, USA
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, 243 Israel Road SE Bldg 3, Tumwater, WA, 98501, USA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program, 243 Israel Road SE Bldg 3, Tumwater, WA, 98501, USA
| | - Eric M Wood
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA
| | - Richard Kendall
- Physical Medicine and Rehabilitation, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - James Foster
- United Occupational Medicine, 9555 76th St., Pleasant Prairie, WI, 53158, USA
| | - David L Drury
- Clement J Zablocki VA Medical Center, Compensation & Pension Department, 5000 W National Avenue, Milwaukee, WI, 53295, USA
| | - Arun Garg
- Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA
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Sahu RL. Liberação percutânea do cotovelo de golfista sob anestesia local: um estudo prospectivo. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kwon BC, Kim JY, Park KT. The Nirschl procedure versus arthroscopic extensor carpi radialis brevis débridement for lateral epicondylitis. J Shoulder Elbow Surg 2017; 26:118-124. [PMID: 27810264 DOI: 10.1016/j.jse.2016.09.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/01/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Nirschl technique and arthroscopic débridement are common surgical procedures for chronic lateral elbow tendinopathy. The purpose of this study was to compare outcomes following the use of these techniques to treat chronic lateral elbow tendinopathy. METHODS We retrospectively reviewed 59 elbows of 55 patients who did not improve after conservative treatment. Twenty-nine elbows of 26 patients were treated with the Nirschl procedure (Nirschl group), and 30 elbows of 29 patients were treated with arthroscopic débridement (arthroscopy group). Outcomes were assessed subjectively with the quick Disabilities of the Arm, Shoulder and Hand questionnaire and the visual analog scale (VAS) for pain in 3 domains (overall pain, pain at rest, and pain during hard work) and objectively with pain-free grip strength. RESULTS The Nirschl and arthroscopy groups showed significant improvements in subjective and objective outcomes at a mean of 28.5 months and 31 months, respectively (P <.05). No significant between-group differences were found in postoperative outcomes, including quick Disabilities of the Arm, Shoulder and Hand questionnaire scores; pain-free grip strength; and VAS scores for overall pain and pain at rest (P > .05). However, a small but significant difference was found in the postoperative VAS score for pain during hard work (1.6 ± 1.3 for Nirschl group vs 2.2 ± 2.0 for arthroscopy group, P = .042). CONCLUSIONS Both techniques are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy. Although the Nirschl technique provides slightly superior pain relief during hard work, the effect size is very small and the difference does not appear to be clinically important.
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Affiliation(s)
- Bong Cheol Kwon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea.
| | - Jin Young Kim
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kun-Tae Park
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
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Soeur L, Desmoineaux P, Devillier A, Pujol N, Beaufils P. Outcomes of arthroscopic lateral epicondylitis release: Should we treat earlier? Orthop Traumatol Surg Res 2016; 102:775-80. [PMID: 27591940 DOI: 10.1016/j.otsr.2016.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 05/01/2016] [Accepted: 05/30/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND When managed conservatively, lateral epicondylitis often subsides only after considerable time, during which social and occupational activities are severely disrupted. If conservative management fails, a recently introduced option is arthroscopic release of the extensor carpi radialis brevis (ECRB). The primary objective of this study was to compare clinical outcomes of this procedure according to preoperative symptom duration. HYPOTHESIS Earlier arthroscopic release is associated with better functional outcomes. MATERIAL AND METHOD Consecutive patients with arthroscopically managed lateral epicondylitis were included in a retrospective study. Arthroscopy was performed only after at least 6 months of conservative treatment. The criteria to evaluate the clinical outcomes were the Nirschl and Quick-DASH scores, muscle strength, time to pain relief, and percentage of functional recovery. RESULT Thirty-five patients were evaluated at a median of 4 years (range: 1-12 years) after surgery. Mean preoperative symptom duration was 18 months (range: 6-106 months) with a mean sick leave duration of 2.3±4.9 months. Postoperatively, mean time to recovery was 37.5 days (range: 7 days to 5 years) and mean sick leave duration was 2.4±2.4 months. The mean Quick-DASH score was 15.9±19.1. The Nirschl score improved significantly, from 26.4±7.9 to 66.3±16.3. The initial muscle strength deficit was 10.1±33.2% and muscle strength at last follow-up was increased by 4.3±30.3%. Symptom duration showed no correlations with any of the clinical outcome measures. DISCUSSION AND CONCLUSIONS Outcomes after arthroscopic release were not associated with symptom duration in this study. Nevertheless, the good clinical outcomes support treatment with arthroscopic release after only 6 months of conservative management. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- L Soeur
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Service de chirurgie orthopédique et traumatologique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Desmoineaux
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
| | - A Devillier
- Service de chirurgie orthopédique et traumatologique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - N Pujol
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - P Beaufils
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
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Sahu RL. Percutaneous golfer's elbow release under local anesthesia: a prospective study. Rev Bras Ortop 2016; 52:315-318. [PMID: 28702390 PMCID: PMC5497005 DOI: 10.1016/j.rboe.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
Objectives To evaluate the results of percutaneous golfer's elbow release under local anesthesia. Methods From December 2010 to December 2013, 34 elbows in 34 patients (10 males and 24 females) that presented golfer's elbow for over one year were recruited from the outpatient department. All patients were operated under local anesthesia and were followed-up for 12 months. The functional outcome was evaluated through the Mayo Elbow Performance Index (MEPI). Results Pain relief was achieved on average eight weeks after surgery. The results were excellent in 88.23% (30/34) cases and good in 11.76% (4/34) cases. Neither wound-related complications nor ulnar nerve complications were observed. On subjective evaluations, 88.23% (30/34) patients reported full satisfaction and 11.76% (4/34) patients reported partial satisfaction with the results of treatment. Conclusion Percutaneous golfer's elbow release under local anesthesia is a minimally invasive procedure that can be performed in an outpatient setting. This procedure is easy, quick, and economical, presenting a low complication rate with good results.
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Abstract
Reported complication rates are low for lateral epicondylitis management, but the anatomic complexity of the elbow allows for possible catastrophic complication. This review documents complications associated with lateral epicondylar release: 67 studies reporting outcomes of lateral epicondylar release with open, percutaneous, or arthroscopic methods were reviewed and 6 case reports on specific complications associated with the procedure are included. Overall complication rate was 3.3%. For open procedures it was 4.3%, percutaneous procedures 1.9%, and arthroscopic procedures 1.1%. In higher-level studies directly comparing modalities, the complication rates were 1.3%, 0%, and 1.2%, respectively.
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Affiliation(s)
- Michael Lucius Pomerantz
- Synergy Specialists Medical Group, Orthopaedic Surgery, Hand/Upper Extremity Sub-specialization, 955 Lane Ave, Suite #200, Chula Vista, CA 91914, USA.
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Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg 2015; 24:67-73. [PMID: 25306494 DOI: 10.1016/j.jse.2014.07.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/18/2014] [Accepted: 07/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elbow tendinopathy is the most common cause of elbow pain affecting active populations. Surgical excision is reserved for patients with refractory symptoms. Percutaneous ultrasonic tenotomy performed under local anesthesia also removes degenerated tissue and therefore provides an alternative treatment option to surgical excision. This investigation prospectively documented the safety and 1-year efficacy of ultrasonic percutaneous tenotomy performed by a single operator. METHODS Nineteen patients, aged 38 to 67 years, in whom >6 months of conservative management for medial (7) or lateral (12) elbow tendinopathy had failed were prospectively studied. All patients were treated with percutaneous ultrasonic tenotomy of the elbow by a single operator. Visual analog scale (VAS) for pain, the 11-item version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) index, and the Mayo Elbow Performance Score (MEPS) were assessed by an independent observer before treatment and at 6 weeks, 3 months, 6 months, and 12 months after treatment. RESULTS No procedural complications occurred. Total treatment time was <15 minutes, and ultrasonic energy time averaged 38.6 ± 8.8 seconds per procedure. Average VAS scores were significantly improved from 6.4 to 2.6 at 6 weeks and were 0.7 at 12 months (P < .0001). Similar improvement occurred with the Quick DASH (pretreatment, 44.1; 12 months, 8.6, P < .0001) and MEPS (pretreatment, 59.1; 12 months, 83.4; P < .0001). CONCLUSION Percutaneous ultrasonic tenotomy performed under local anesthesia appears to be a safe and effective treatment option for chronic, refractory lateral or medial elbow tendinopathy up to 1 year after the procedure.
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Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int 2014; 35:1015-20. [PMID: 25549600 DOI: 10.1007/s00296-014-3201-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/19/2014] [Indexed: 02/07/2023]
Abstract
To translate and culturally adapt the Mayo Elbow Performance Score (MEPS), a widely used instrument for evaluating disability associated with elbow injuries, into Turkish (MEPS-T) and to determine psychometric properties of the translated version. The MEPS was translated into Turkish using published methodological guidelines. The measurement properties of the MEPS-T (construct validity and floor and ceiling effects) were tested in 91 patients with elbow pathology. The reproducibility of the MEPS-T was tested in 59 patients over 7-14 days. The responsiveness of the MEPS-T was tested in a subgroup of 46 patients diagnosed with lateral epicondylitis and who received conservative treatment for 6 weeks. The interclass correlation coefficient (ICC) was used to estimate the test-retest reliability. The construct validity was analyzed with the disabilities of the arm, shoulder and hand (DASH), Visual Analog Scale (VAS) and the Short Form 36 (SF-36). Effect size (ES) was used to assess the responsiveness. The distribution of floor and ceiling effects was determined. The MEPS-T showed very good test-retest reliability (ICC 0.89). The correlation coefficients between the MEPS-T and DASH and VAS were -0.61 and -0.53, respectively (p < 0.001). The highest correlations were between the MEPS-T and the mental component summary (r = 0.47, p = 0.001) and role emotional (r = 0.45, p = 0.001). The MEPS-T ES, 0.50, was moderate (95% CI 0.33-0.62). We observed no ceiling or floor effects. The MEPS-T represents a valid, reliable and moderately responsive instrument for evaluating patients with elbow disease.
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Affiliation(s)
- Derya Celik
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, 34740, Bakırköy, Istanbul, Turkey,
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Stiefel EC, Field LD. Arthroscopic lateral epicondylitis release using the "bayonet" technique. Arthrosc Tech 2014; 3:e135-9. [PMID: 24749034 PMCID: PMC3986618 DOI: 10.1016/j.eats.2013.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/06/2013] [Indexed: 02/03/2023] Open
Abstract
Most patients diagnosed with lateral epicondylitis respond well to conservative management. For patients who do not respond to nonoperative modalities, surgical treatment represents a viable option for long-term symptomatic relief. The arthroscopic surgical technique described in this article has been consistently used by the senior author for the treatment of recalcitrant lateral epicondylitis for more than 5 years (198 patients) without the occurrence of any major complications and appears to be a safe, reliable, and efficacious surgical intervention for the management of lateral epicondylitis.
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Affiliation(s)
- Eric C. Stiefel
- Upper Extremity Service, Mississippi Sports Medicine & Orthopaedic Center, Jackson, Mississippi, U.S.A
| | - Larry D. Field
- Upper Extremity Service, Mississippi Sports Medicine & Orthopaedic Center, Jackson, Mississippi, U.S.A
- Department of Orthopaedic Surgery, University of Mississippi School of Medicine, Jackson, Mississippi, U.S.A
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Martynetz FA, Faria FF, Superti MJ, Filho SM, Oliveira LMM. Evaluation of patients submitted to the arthroscopic treatment of the lateral epicondylitis refractory to the conservative treatment. Rev Bras Ortop 2014; 48:532-537. [PMID: 31304165 PMCID: PMC6565965 DOI: 10.1016/j.rboe.2013.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 04/09/2013] [Indexed: 11/30/2022] Open
Abstract
Objective to evaluate the results of the arthroscopic treatment of the lateral epicondylitis. Methods we evaluated 14 patients (15 elbows) submitted to the arthroscopic treatment of the lateral epicondylitis refractory to the conservative treatment, which was realized for a minimum period of 18 months. Beyond the demographic data collection, patients were evaluated according to the arthroscopic classification of Baker et al., the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Score (MEPS). The patients’ ages ranged between 23 and 56 years (average 46 years) (eight males and six females). Of the 15 elbows, 12 were the dominant and one patient had bilateral lesion. The follow-up after surgery was minimum 24 months and maximum 72 months (average 41 months). Results we found, according to the arthroscopic classification of Baker et al., two patients with type I lesions, nine with type II lesions and three with type III lesions. We found the following complications: one patient with altered sensitivity in the region of the lateral portal, one with a deficit of ten degrees in length, one with synovial plica and one with synovitis in the lateral compartment. Our score on the DASH questionnaire was minimum of 32 points and maximum of 120 points (average 57 points) and the scale of MEPS had a minimum score of 60 points and a maximum of 100 points (average 90 points). Conclusion the arthroscopic treatment of the lateral epicondylitis, plus insurance, provides satisfactory results.
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Affiliation(s)
- Fábio Alexandre Martynetz
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.,Institute of Orthopedics and Traumatology of Toledo, Toledo, PR, Brazil.,Orthopedics and Traumatology Service, Cajuru University Hospital, Curitiba, PR, Brazil
| | - Fernando Ferraz Faria
- Orthopedics and Traumatology Service, Cajuru University Hospital, Curitiba, PR, Brazil
| | - Mauro José Superti
- Orthopedics and Traumatology Service, Cajuru University Hospital, Curitiba, PR, Brazil
| | - Salim Mussi Filho
- Orthopedics and Traumatology Service, Cajuru University Hospital, Curitiba, PR, Brazil
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Martynetz FA, Faria FF, Superti MJ, Filho SM, Oliveira LMM. Avaliação de pacientes submetidos ao tratamento artroscópico da epicondilite lateral refratária ao tratamento conservador. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Solheim E, Hegna J, Øyen J. Arthroscopic versus open tennis elbow release: 3- to 6-year results of a case-control series of 305 elbows. Arthroscopy 2013; 29:854-9. [PMID: 23388420 DOI: 10.1016/j.arthro.2012.12.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 12/08/2012] [Accepted: 12/13/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the outcome of arthroscopic and open tendon release in tennis elbow (TE). METHODS We compared the outcome of patients treated by an open tendon release in the period from 2002 to 2005 (n = 80) with that of patients treated by an arthroscopic release of the extensor carpi radialis brevis in the period from 2005 to 2008 (n = 225). In both groups the inclusion criteria were symptomatic TE refractory to conservative care for a minimum of 6 months and a clinical follow-up of at least 3 years. The diagnosis was based on a typical history and positive clinical findings. Patients with previous surgery in the elbow, chondral or osteochondral lesions, osteoarthritis, or free bodies were excluded. To have a similar follow-up period in the 2 groups (median, 4 years), the follow-up was conducted at 2 different time points. RESULTS The groups did not differ significantly with regard to the age of the patients, distribution of gender, distribution of affected side, duration of symptoms, or baseline score on the short version of Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). We did not observe any major complications. The failure rate was not significantly different between the 2 groups. At follow-up, the mean QuickDASH score was statistically significantly better (P = .004) in the arthroscopic group (11.6 points; SD, 15.6 points) compared with that in the open group (17.8 points; SD, 19.4 points). The percentage of elbows with an excellent outcome at follow-up (QuickDASH score <20 points) was significantly higher in the arthroscopic group (78%) than in the open group (67%) (P = .04). CONCLUSIONS Both a traditional open approach and the newer arthroscopic method provide an effective treatment of recalcitrant TE without major complications. The arthroscopic method offers a small, but not insignificant, improvement in the outcome as evaluated by the QuickDASH score. LEVEL OF EVIDENCE Level III, therapeutic case-control study.
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Koh JSB, Mohan PC, Howe TS, Lee BP, Chia SL, Yang Z, Morrey BF. Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: early clinical experience with a novel device for minimally invasive percutaneous microresection. Am J Sports Med 2013; 41:636-44. [PMID: 23302261 DOI: 10.1177/0363546512470625] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal choice for intervention for recalcitrant lateral elbow tendinopathy remains unclear as various treatment modalities have documented comparable results in the literature. PURPOSE To explore the safety, tolerability, and early efficacy of a new minimally invasive mode of treatment that delivers focused, calibrated ultrasonic energy, effectively microresecting the pathological tendon and removing only pathological tissue. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seven male and 13 female patients aged 33 to 65 years averaging 12.5 months (range, 4-48) of failed nonoperative therapy underwent the ultrasonic microresection procedure in an outpatient clinic setting. The procedure involved a sterile, ultrasound-guided percutaneous microresection with a proprietary device (TX1) performed through a stab incision under local anesthesia. The duration of the procedure and complications of the device or procedure were assessed. Outcome parameters included patient satisfaction; visual analog scale (VAS) pain scores; Disabilities of the Arm, Shoulder and Hand (DASH) scores at 1, 3, 6, and 12 months; and ultrasound assessment at 3 and 6 months. RESULTS The median duration for the sterile confirmatory ultrasound examination (phase 1) was 88.5 seconds (range, 39-211; SD, ±47.6), the median duration of the procedure proper (phase 2) was 10.1 minutes (range, 4.1-19.4; SD, ±3.7), and the median energy time (duration the TX1 device was activated) was 32.5 seconds (range, 18-58; SD, ±11.0). No complications were encountered. A significant improvement in VAS score (from 5.5 to 3.3; P < .001) occurred by 1 week, and significant improvements in both DASH-Compulsory (from 21.7 to 11.3; P = .001) and DASH-Work (from 25.0 to 6.3; P = .012) scores occurred by 1 month. The VAS scores further improved at 3, 6, and 12 months (from 2.0 to 1.0 to 0.50; P = .003 and .023). The DASH-Compulsory score improved significantly from 3 to 6 months (from 8.6 to 4.6; P = .003), and both the DASH-Compulsory and DASH-Work scores were sustained by 12 months. Sonographically reduced tendon thickness (19 patients), resolved or reduced hypervascularity (17 patients), and reduced hypoechoic area (18 patients) occurred by 6 months. Nineteen of the 20 patients (95%) expressed satisfaction with the procedure, with 9 patients being very satisfied with their overall experience at 6 months after the procedure, 10 patients somewhat satisfied, and 1 patient neutral. CONCLUSION Ultrasonic microresection of diseased tissue with the TX1 device provides a focally directed, safe, specific, minimally invasive, and well-tolerated treatment for recalcitrant lateral elbow tendinopathy in an office-based or ambulatory surgical setting with good evidence of some level of efficacy in 19 of 20 patients (95%) that is sustained for at least 1 year.
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Affiliation(s)
- Joyce S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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Rhyou IH, Kim KW. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res 2013; 471:284-90. [PMID: 22965262 PMCID: PMC3528936 DOI: 10.1007/s11999-012-2585-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 08/23/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear. QUESTIONS/PURPOSES We asked if posterior radiocapitellar synovial plica excision made any additional improvement in pain or function after arthroscopic ECRB release. METHODS We retrospectively reviewed 38 patients who had arthroscopic treatment for refractory lateral epicondylitis between November 2003 and October 2009. Twenty patients (Group A) underwent the Baker technique and 18 patients (Group B) underwent a combination of the Baker technique and posterior synovial plica excision. The minimum followup was 36 months (mean, 46 months; range, 36-72 months) for Group A and 25 months (mean, 30 months; range, 25-36 months) for Group B. Postoperatively we obtained VAS pain and DASH scores for each group. RESULTS Two years postoperatively, we found no differences in the VAS pain score or DASH: the mean VAS pain scores were 0.3 points in Group A and 0.4 points in Group B, and the DASH scores were 5.1 points and 6.1 points respectively. CONCLUSIONS The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication.
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Affiliation(s)
- In Hyeok Rhyou
- Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianity Hospital, Pohang, Kyeongbuk Korea
| | - Kang Wook Kim
- Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianity Hospital, Pohang, Kyeongbuk Korea
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Behrens SB, Deren ME, Matson AP, Bruce B, Green A. A review of modern management of lateral epicondylitis. PHYSICIAN SPORTSMED 2012; 40:34-40. [PMID: 22759604 DOI: 10.3810/psm.2012.05.1963] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lateral epicondylitis, or tennis elbow, is the most common cause of elbow pain. This degenerative condition can manifest as an acute process lasting < 3 months or a chronic process often refractory to treatment. Symptom resolution occurs in 70% to 80% of patients within the first year. A "watch-and-wait" approach can be an appropriate treatment option, although physical therapy has been shown to be an effective first-line therapy. Corticosteroids, while providing relief of pain in the acute setting, may be detrimental to recovery in the long term. Platelet-rich plasma injections, although recently well publicized, have not been proven by well-controlled clinical trials to be effective therapy. For patients with symptoms refractory to conservative management, surgical intervention has shown to be a successful treatment modality.
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Affiliation(s)
- Steve B Behrens
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02905, USA.
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