Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months

2021 ◽  
pp. 036354652110101
Author(s):  
Benjamin F.H. Ang ◽  
P. Chandra Mohan ◽  
Meng Ai Png ◽  
John Carson Allen ◽  
Tet Sen Howe ◽  
...  
Keyword(s):  
Pain Relief ◽  
Extensor Tendon ◽  
Tissue Healing ◽  
Lateral Elbow ◽  
Percutaneous Tenotomy ◽  
Vas Scores ◽  
The Common ◽  
Lateral Elbow Tendinopathy

Background: In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years’ follow-up. Purpose: To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon. Study Design: Case series; Level of evidence, 4. Methods: The same cohort of 20 patients was recalled after 7 years, and visual analog scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction were assessed. They were also reassessed using ultrasound imaging of the brevis and the common extensor tendon to evaluate tendon hypervascularity, tendon thickness, and the progress or the recurrence of the hypoechoic scar tissue. Results: We successfully scored 19 patients and performed ultrasound on 16 patients with a median follow-up of 90 months (range, 86-102 months). There were no adverse outcomes and satisfaction remained at 100% (6 patients, satisfied; 13 patients, very satisfied). No patient developed a recurrence of symptoms and signs of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained ( P < .001 for all). At 90 months, there was a significant improvement in VAS scores and DASH–Compulsory scores compared with preprocedure scores and all follow-up times until 3 months. There was no difference in VAS scores and DASH–Compulsory scores at 90 months compared with 6 and 36 months. For DASH–Work scores, there was a significant improvement at 90 months compared with preprocedure scores, but there was no difference between DASH–Work scores at 90 months and scores at all other points of follow-up. At 90 months, hypervascularity remained resolved in 79% of patients, while all patients had reduced tendon swelling and sustained resolution or reduction of the hypoechoic lesion. Conclusion: At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrated good durability of pain relief and functional recovery that was previously achieved. This was accompanied by sustained sonographic tissue healing with no significant deterioration.

scholarly journals Ultrasound-guided Percutaneous Tenotomy Shows Sustained Clinical and Sonographic Outcomes for Recalcitrant Lateral Elbow Tendinopathy at 7.5 Years

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Joyce Koh ◽  
Meng Ai Png ◽  
Tet Sen Howe ◽  
Brian Lee ◽  
Bernard Morrey ◽  
...  
Keyword(s):  
Pain Relief ◽  
Adverse Outcomes ◽  
Ultrasound Guided ◽  
Secondary Intervention ◽  
Tissue Healing ◽  
Lateral Elbow ◽  
Percutaneous Tenotomy ◽  
Lateral Elbow Tendinopathy

Objectives: In our previously published study, 20 patients who underwent ultrasound-guided percutaneous tenotomy for recalcitrant lateral elbow tendinopathy were followed up clinically and sonographically for 3 years, demonstrating sustained pain relief and functional improvement, with sonographic evidence of tissue healing. We aim to explore the long-term clinical and sonographic results of ultrasound-guided percutaneous tenotomy. Methods: The same cohort of patients were recalled at 7-8 years and assessed for visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction. They were also reassessed with ultrasound imaging to evaluate tendon hypervascularity, tendon thickness, and the progress or recurrence of the hypoechoic scar tissue. Results: We successfully scored 19 subjects and performed ultrasound on 16 subjects, with a follow up of 90 (median±standard deviation: 90±2.7; range: 86-94) months. Among them, one patient had subsequently undergone surgical fixation for an ipsilateral radial head fracture 6 years after ultrasound-guided percutaneous tenotomy, and was thus excluded from the study. There were no adverse outcomes and satisfaction remained at 100% (6 satisfied, 12 very satisfied). No patient developed a recurrence of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained as seen in figure 1. There was no significant change in VAS score (median±SD: 0±1.0; range: 0-4) at 7.5 years, compared to 3 years (0±0.9; 0-3) (p=1.000) or DASH-Compulsory score (0±4.51; 0-13.3) at 7.5 years compared to 3 years (0±0.644; 0-2) (p=0.627) or DASH-Work score (0±6.61; 0-25) at 7.5 years compared to 3 years (0±0; 0)(p=1.000), although there were isolated cases of increased DASH scores due to rotator cuff issues, as described by the patients, which were consistent with degeneration. DASH-Sports/performing arts had too few responses for analysis. At current, hypervascularity remained resolved in 13/16 (81%) subjects, 16/16 (100%) subjects had reduced tendon swelling, and 15/16 (94%) had sustained resolution or reduction of the hypoechoic lesion (Figure 2). Conclusion: At long term follow up, ultrasound-guided percutaneous tenotomy, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrates good sustainability of pain relief and functional recovery that was previously achieved, accompanied with sonographic evidence of tissue healing at 7.5 years. [Figure: see text][Figure: see text]

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

scholarly journals Proximal Disinsertion of the Common Extensor Tendon for Lateral Elbow Tendinopathy

2013 ◽  
Vol 21 (1) ◽  
pp. 100-102 ◽  
Author(s):  
Xavier Cusco ◽  
Montserrat Alsina ◽  
Roberto Seijas ◽  
Oscar Ares ◽  
Pedro Alvarez-Diaz ◽  
...  
Keyword(s):  
Extensor Tendon ◽  
Lateral Elbow ◽  
The Common ◽  
Lateral Elbow Tendinopathy

scholarly journals Thermal and Current Flow Effects of a Capacitive–Resistive Electric Transfer Application Protocol on Chronic Elbow Tendinopathy. A Cadaveric Study

2021 ◽  
Vol 18 (3) ◽  
pp. 1012
Author(s):  
Carlos López-de-Celis ◽  
Jacobo Rodríguez-Sanz ◽  
César Hidalgo-García ◽  
Simón A. Cedeño-Bermúdez ◽  
Daniel Zegarra-Chávez ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Current Flow ◽  
Tennis Elbow ◽  
Treatment Protocol ◽  
Extensor Tendon ◽  
Cross Sectional ◽  
Lateral Elbow ◽  
The Common ◽  
Lateral Elbow Tendinopathy ◽  
A Current

Lateral elbow tendinopathy, or “tennis elbow,” is a pathology that affects around 1.3% of the general population. Capacitive–resistive electric transfer therapy aims to provoke temperature and current flow changes in superficial and deep tissues. The aim of this in vitro study was to analyze the thermal behavior and transmission of electric current on the superficial and deep tissues of the elbow during the application of different modalities of a capacitive–resistive electric transfer treatment protocol for chronic elbow tendinopathy. A cross-sectional study was designed; five fresh cryopreserved cadavers (10 elbows) were included in this study. A 30 min intervention was performed based on a protocol commonly used in clinics for the treatment of chronic lateral elbow tendinopathy by diathermy using the “T-Plus.” Common extensor tendon, radiohumeral capsule, and superficial temperatures were registered after each application for the duration of the 30 min treatment protocol. During all applications, we observed a current flow of over 0.03 A. The protocol showed a statistically significant increase in superficial temperature by 24% (5.02°) (p < 0.005), the common extensor tendon by 19.7% (4.36°) (p < 0.007), and the radiohumeral joint capsule by 17.5% (3.41°) (p < 0.005) at the end of the 30 min protocol compared with the baseline temperature. The different applications of the protocol showed specific effects on the temperature and current flow in the common extensor tendon and radiohumeral capsule. All applications of the protocol produced a current flow that is associated with the generation of cell proliferation. These results strengthen the hypothesis of cell proliferation and thermal changes in deep and distal structures. More studies are needed to confirm these results.

SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 175-178 ◽  
Author(s):  
A. S. C. Bidwai ◽  
F. Cashin ◽  
A. Richards ◽  
D. J. Brown
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Case Series ◽  
High Rate ◽  
Wound Breakdown ◽  
Radial Forearm ◽  
Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

Spinal Cord Stimulation in Treatment of Chronic Benign Pain: Challenges in Treatment Planning and Present Status, a 22-Year Experience

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. 481-496 ◽  
Author(s):  
Krishna Kumar ◽  
Gary Hunter ◽  
Denny Demeria
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Pain Clinic ◽  
Axial Component

Abstract OBJECTIVE: To present an in-depth analysis of clinical predictors of outcome including age, sex, etiology of pain, type of electrodes used, duration of pain, duration of treatment, development of tolerance, employment status, activities of daily living, psychological status, and quality of life. Suggestions for treatment of low back pain with a predominant axial component are addressed. We analyzed the complications and proposed remedial measures to improve the effectiveness of this modality. METHODS: Study group consists of 410 patients (252 men, 58 women) with a mean age of 54 years and a mean follow-up period of 97.6 months. All patients were gated through a multidisciplinary pain clinic. The study was conducted over 22 years. RESULTS: The early success rate was 80% (328 patients), whereas the long-term success rate of internalized patients was 74.1% (243 patients) after the mean follow-up period of 97.6 months. Hardware-related complications included displaced or fractured electrodes, infection, and hardware malfunction. Etiologies demonstrating efficacy included failed back syndrome, peripheral vascular disease, angina pain, complex regional pain syndrome I and II, peripheral neuropathy, lower limb pain caused by multiple sclerosis. Age, sex, laterality of pain or number of surgeries before implant did not play a role in predicting outcome. The percentage of pain relief was inversely related to the time interval between pain onset and time of implantation. Radicular pain with axial component responded better to dual Pisces electrode or Specify-Lead implantation. CONCLUSION: Spinal cord stimulation can provide significant long-term pain relief with improved quality of life and employment. Results of this study will be effective in better defining prognostic factors and reducing complications leading to higher success rates with spinal cord stimulation.

Treatment of Morton's neuroma as a nerve compression. The role for neurolysis

1992 ◽  
Vol 82 (8) ◽  
pp. 399-402 ◽  
Author(s):  
AL Dellon
Keyword(s):  
Pain Relief ◽  
Surgical Approach ◽  
Crush Injury ◽  
Digital Nerve ◽  
Custom Made ◽  
Athletic Activities ◽  
Good Pain Relief ◽  
The Common ◽  
The Mean

The almost universal surgical approach for the treatment of Morton's metatarsalgia is to resect the neuroma through a dorsal incision. Considering that the mechanism for the metatarsalgia is chronic repetitive compression of the common plantar digital nerve between the metatarsal heads, this report explores the use of neurolysis in five patients with 11 involved nerves. In surgery, the intermetatarsal ligament is divided, intrinsic fibrosis is released, and the epineurium is opened. The mean follow-up period is 33 months. Complete pain relief was achieved in four of the five patients, with the fifth patient, 13 years after a crush injury to the foot, achieving good pain relief. All five patients resumed their usual jobs and athletic activities. One patient wears sneakers instead of regular shoes. The patient with the crush injury wears custom-made shoes.

LONG TERM RESULTS OF MATCHED HEMIRESECTION INTERPOSITION ARTHROPLASTY FOR DRUJ ARTHRITIS IN RHEUMATOID PATIENTS

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 119-125 ◽  
Author(s):  
Syed Kamran Ahmed ◽  
Jason Pui Yin Cheung ◽  
Boris Kwok-Keung Fung ◽  
Wing-Yuk Ip
Keyword(s):  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Long Term Results ◽  
Complete Relief ◽  
Average Increase ◽  
Interposition Arthroplasty ◽  
Long Term Follow Up ◽  
Motion Assessment

Introduction: The distal radioulnar joint (DRUJ) is commonly affected in rheumatoid arthritis and is associated with significant functional morbidity. The aim of our study is to review our results with matched hemi-resection interposition arthroplasty in patients with DRUJ arthritis. Methods: This was a retrospective study of 39 patients with 51 wrists that were treated at Queen Mary Hospital in Hong Kong from 1989 to 2007. All patients underwent matched hemi-resection interposition arthroplasty and dorsal wrist synovectomy. Long arm hinged elbow brace was used for three weeks followed by intensive rehabilitation up to twelve weeks. The indicators of outcome included range of motion assessment, pain, wrist stiffness, grip of strength and need for revision assessed during follow-up. Statistical analysis was performed with student t-test. Results: The average age of patients was 50.5 years (25 to 77 years) and there was a 35:4 female to male ratio. The average follow up was 4.5 years ranging from 1 to 18 years. Associated extensor tendon ruptures were found in 31.4% patients. The average increase in supination was from 73 degrees preoperatively to 81 degrees at long term follow up (p = 0.10 at 1 year and 0.13 at long term follow-up). The average increase in pronation was from 68 degrees preoperatively to 74 degrees on long term follow up (p = 0.57 at 1 year and 0.02 at long term follow-up). There was evidence of painless, relatively stiff but functional wrist in 37.25% of patients. There was an increase in grip strength from an average of 6.1 kilogram force preoperatively to an average of 11.5 kilogram force at follow-up (p = 0.004 at 1 year and 0.15 at long term follow-up). Complete relief of ulnar sided pain was seen in 43 wrists (84%), partial relief was seen in 7 wrists (13.7%) and no relief was found in one wrist (1.9%). Conclusions: DRUJ arthroplasty is a rewarding procedure and most of the patients obtain pain free movement.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

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