How one treats lateral epicondylitis – a survey among Brazilian orthopedists

Abstract Background Lateral epicondylitis (LE), also known as tennis elbow, is the most common painful elbow condition. It affects approximately 1–3% of adults. There are various possible treatments described in the literature, but evidence to support a gold standard management protocol is lacking. Therefore, the objective of this study was to evaluate how Brazilian orthopaedists diagnose and treat lateral epicondylitis and compare these results with the available evidence. Methods This is an observational, analytical, cross-sectional study. A questionnaire was prepared to obtain information from the participants with eight specific questions (2 on diagnosis and 6 on treatment). These questions were answered voluntarily by participants at 3 major congresses of orthopaedists in Brazil in 2018. The results were analysed in accordance with the overall number of responses and were evaluated among groups according to subspecialty. Results We obtained a total of 501 questionnaires. Of these, 33 were excluded. The mean age was 38.67 years. The majority of respondents (91%) were male. We obtained 26.7% from specialists in hand surgery (Hand group), 36.5% from subspecialists in shoulder and elbow (Shoulder and Elbow group), and 36.8% from generalists in orthopaedics or from other subspecialties (General Orthopaedists group). For diagnosis, 24.4% did not initially request any imaging method. The most requested exam was ultrasonography (54.9%). The most prominent indication for initial treatment was physical therapy. For refractory cases, 78.3% of the respondents preferred doing a local infiltration. The most commonly used substance for local infiltrations was corticosteroids (89.6%). With respect to the surgical treatment option, 75.8% of those who recommend it prefer open techniques, and 24.2% prefer arthroscopic treatment. Of the total respondents, 12.8% did not recommend surgical treatment for LE. Conclusion Among Brazilian orthopaedists, the Cozen test is most frequently chosen, and ultrasound is the most commonly used imaging tool. Nonsurgically, oral nonsteroidal anti-inflammatory drugs (NSAIDs) plus physiotherapy is the most popular initial therapy, and corticosteroids are the most popular type of infiltration agent. Most surgeons recommended surgery after 6 months of nonsurgical treatment, and 75.8% preferred the open technique.

Download Full-text

How One Treats Lateral Epicondylitis - A Survey Among Brazilian Orthopedists

10.21203/rs.3.rs-154000/v1 ◽

2021 ◽

Author(s):

Rafael Fuchs Lazarini ◽

Renato Aroca Zan ◽

João Carlos Belotti ◽

Ildeu Afonso de Almeida Filho ◽

Luiz Fernando Sartori Centenaro ◽

...

Keyword(s):

Surgical Treatment ◽

Physical Therapy ◽

Tennis Elbow ◽

Lateral Epicondylitis ◽

Hand Surgery ◽

Cross Sectional Study ◽

Imaging Method ◽

Cross Sectional ◽

Painful Condition ◽

Management Protocol

Abstract Background: Lateral epicondylitis (LE) or tennis elbow is the most common elbow painful condition. It affects around 1 to 3% of adults. There are various possibilities of treatment described in the literature, without evidence to support a gold standard management protocol. Therefore, the objective of this study is to evaluate how the Brazilian orthopedist diagnoses and treats lateral epicondylitis, to compare these results with the available evidence. Methods: This is an observational, analytical, cross-sectional study. A questionnaire has been prepared for information to the participants and with eight specific questions (2 on diagnosis and 6 on treatment). These had been answered voluntarily by participants at 3 major congresses of orthopedists in Brazil in 2018. The results were analyzed in accordance with the overall number of responses, and were evaluated among groups according to subspecialty. Results: We obtained a total of 501 questionnaires. Of these, 33 were excluded. The mean age was 38.67 years. The majority of respondents (91%) were male. We obtained 26.7% from specialists in hand surgery (Hand group), 36.5% from subspecialists in shoulder and elbow (Shoulder and Elbow group), and 36.8% were from generalists in orthopedics or from other subspecialties (General Orthopedists group). For diagnosis, 24.4% have not initially requested any imaging method. The most requested exam was ultrasonography (54.9%). The most prominent indication for initial treatment was physical therapy. For refractory cases, 78.3% of the respondents prefer doing a local infiltration. The most commonly used substance for local infiltrations is corticosteroids (89.6%). With respect to the surgical treatment option, 75.8% of those who recommend it prefer open techniques and 24.2% arthroscopic treatment. Of the total respondents, 12.8% do not recommend surgical treatment for LE. Conclusion: Most orthopedists begin the treatment of lateral epicondylitis with the use of non-steroidal anti-inflammatory drugs, physical therapy, and an indication of rest, but there is great variability between their recommendations. The use of corticosteroids for infiltration remains the main choice among Brazilian orthopedists, although evidence shows a better effect in the short term and a worse effect in the medium and long term, compared to other treatments.

Download Full-text

Diagnostic Clues and Management of ectopic Pregnancy in Sir Salimullah Medical College and Mitford Hospital, Dhaka

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v33i1.43545 ◽

2020 ◽

Vol 33 (1) ◽

pp. 49-53

Author(s):

Nazia Islam

Keyword(s):

Surgical Treatment ◽

Ectopic Pregnancy ◽

Expectant Management ◽

Cross Sectional Study ◽

Abdominal Pregnancy ◽

Sectional Study ◽

Cross Sectional ◽

Medical College ◽

Ectopic Pregnancies ◽

Condition Diagnosis

Background: Ectopic pregnancy is a common clinical condition. Diagnosis and managementof this condition is necessary in due to day practice. Methods: A cross sectional study on ectopic pregnancy was conducted in Sir SalimullahMedical College and Mitford Hospital (SSMC & MH) , Dhaka, with the objective to analyzethe risk factors and assess the results of management with respect to maternal morbidityand mortality of ectopic pregnancy during the last two years. Result: Fifty patients were admitted with ectopic pregnancy from 1st January 2008 to 31stDecember 2010.Frequency of ectopic pregnancy were 1.5% of total 3252 pregnancies. Riskfactors were found in 45% of cases. Surgical treatment were performed in total 43 patients.There was one heterotrophic pregnancy and one case of abdominal pregnancy. Four patientswere given intramuscular Methotrexate and two un-ruptured ectopics resolved spontaneouslyafter by expectant management. Conclusion: Conservative management was an option but surgical treatment was donemore often because of late referrals. Screening of high risk cases, early diagnosis and earlyintervention would reduce the morbidity in ectopic pregnancies. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 49-53

Download Full-text

Tennis elbow. The surgical treatment of lateral epicondylitis.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198062020-00025 ◽

1980 ◽

Vol 62 (2) ◽

pp. 313-314 ◽

Cited By ~ 4

Author(s):

C C Gunn

Keyword(s):

Surgical Treatment ◽

Tennis Elbow ◽

Lateral Epicondylitis

Download Full-text

Is strict adherence to the nonoperative management protocol associated with better outcome in patients with blunt splenic injuries?: A retrospective comparative cross-sectional study

International Journal of Surgery ◽

10.1016/j.ijsu.2019.07.033 ◽

2019 ◽

Vol 69 ◽

pp. 116-123 ◽

Cited By ~ 2

Author(s):

Ting-Min Hsieh ◽

Chun-Ting Liu ◽

Bei-Yu Wu ◽

Ching-Hua Hsieh

Keyword(s):

Nonoperative Management ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Strict Adherence ◽

Management Protocol

Download Full-text

Do neuroendocrine carcinomas and mixed neuroendocrine–non-neuroendocrine neoplasm of the gastrointestinal tract have the same prognosis? A SEER database analysis of 12,878 cases

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018820938304 ◽

2020 ◽

Vol 11 ◽

pp. 204201882093830

Author(s):

Huiying Shi ◽

Cuihua Qi ◽

Lingjun Meng ◽

Hailing Yao ◽

Chen Jiang ◽

...

Keyword(s):

Prognostic Factors ◽

Surgical Treatment ◽

Cross Sectional Study ◽

Tnm Stage ◽

Neuroendocrine Neoplasm ◽

Gi Tract ◽

Cross Sectional ◽

Primary Tumor Site ◽

Survival Difference ◽

Neuroendocrine Carcinomas

Background: Neuroendocrine carcinomas (NECs) and mixed neuroendocrine–non-neuroendocrine neoplasm (MiNEN) in the gastrointestinal (GI) tract are both rare and malignant; however, it is unclear whether their prognosis is the same. Methods: In this cross-sectional study, a total of 12,878 patients with NEC or MiNEN in the GI tract were reviewed retrospectively by searching the Surveillance, Epidemiology, and End Results ( SEER) program database. Next, we compared the characteristics and survival between patients with NEC or MiNEN and further analyzed the prognostic factors for the patients. Results: The data showed that patients with MiNEN had a worse prognosis as compared with patients with pure NEC in the small intestine (SI) and appendix, whereas there was no significant survival difference between NEC and MiNEN in the other parts of the GI system. On the whole, age ⩾55 years ( p < 0.0001), male ( p = 0.002), being diagnosed at TNM Stage II–IV ( p < 0.0001) or not receiving surgical treatment ( p < 0.0001) were the independent negative prognostic factors for NEC patients, whereas age ⩾55 years ( p = 0.003), being diagnosed at TNM Stage III–IV ( p < 0.001) or not receiving surgical treatment ( p < 0.001) were identified as the independent negative prognostic factors for the MiNEN patients. Furthermore, when NECs or MiNENs were classified based on the primary tumor site, the results showed that the prognostic factors for NEC and MiNEN varied between the tumor sites. Conclusion: The prognostic differences between NECs and MiNENs in the GI tract are heterogeneous and site-related. Patients with appendiceal or SI MiNEN have a poorer prognosis than patients with pure appendiceal or SI NEC. Therefore, we should pay more attention to patients with MiNEN in the SI and appendix and monitor them more closely.

Download Full-text

Rotational Three-dimensional OCTA: a Notable New Imaging Tool to Characterize Type 3 Macular Neovascularization

Scientific Reports ◽

10.1038/s41598-019-53307-x ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Enrico Borrelli ◽

Riccardo Sacconi ◽

Gerd Klose ◽

Luis de Sisternes ◽

Francesco Bandello ◽

...

Keyword(s):

3D Visualization ◽

Three Dimensional ◽

Cross Sectional Study ◽

Age Related Macular Degeneration ◽

Volume Data ◽

Cross Sectional ◽

Imaging Tool ◽

Age Related ◽

Treatment Naïve ◽

Type 3

AbstractThis study explored whether rotational three-dimensional (3D) visualization of optical coherence tomography angiography (OCTA) volume data may yield valuable information regarding type 3 macular neovascularization (MNV). In this retrospective, cross-sectional study, we collected data from 15 eyes (13 patients) with treatment-naïve type 3 MNV in their post-nascent stage and age-related macular degeneration (AMD). Subjects were imaged with the SS-OCT system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). The OCTA volume data were processed with a prototype volume projection removal algorithm and then analyzed using volumetric visualization techniques in order to obtain a 3D visualization of the region occupied by type 3 MNV. The two-dimensional and three-dimensional OCTA images were investigated. Mean ± SD age was 75.1 ± 7.4 years. BCVA was 0.42 ± 0.21 LogMAR in the study eyes. Considering the cohort of analyzed eyes, on rotational 3D OCTA images, a total of 35 neovascular lesions (vs 22 lesions detected on 2D OCTA images) rising from the deep vascular complex and variably spanning the outer retinal layers and eventually reaching the RPE/sub-RPE space were detected. Nine of 35 lesions had a saccular shape, while the remaining cases had a filiform shape. On rotational 3D OCTA images, these lesions were inclined on the three planes, instead of perpendicular to the RPE/Bruch’s membrane. In conclusion, this study used an algorithm to obtain rotational three-dimensional visualization of type 3 MNV. This approach seems to increase the detection rate for these lesions and to be useful to offer new insight into type 3 MNV.

Download Full-text

Mirizzi syndrome grades III and IV: surgical treatment

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016004005 ◽

2016 ◽

Vol 43 (4) ◽

pp. 243-247 ◽

Cited By ~ 1

Author(s):

RONALD REVERDITO ◽

ANDRÉ DE MORICZ ◽

TÉRCIO DE CAMPOS ◽

ADHEMAR MONTEIRO PACHECO JÚNIOR ◽

RODRIGO ALTENFELDER SILVA

Keyword(s):

Surgical Treatment ◽

Preoperative Diagnosis ◽

Anastomotic Stricture ◽

Cross Sectional Study ◽

Biliary Fistula ◽

Mirizzi Syndrome ◽

Cross Sectional ◽

Biliodigestive Anastomosis ◽

Type Iv

ABSTRACT Objective : to evaluate the epidemiology and outcomes of surgical treatment of patients with Mirizzi Syndrome (MS) grades III and IV, the most advanced according to Csendes classification. Methods : we conducted a retrospective, cross-sectional study by reviewing records of thirteen patients with grades III and IV MS operated from December 2001 to September 2013, among the 3,691 cholecystectomies performed in the period. Results : the incidence of MS was 0.6% (23 cases) and grades III and IV amounted to 0.35% of this number. There was a predominance of type IV (12 cases). The preoperative diagnosis was possible in 53.8% of cases. The preferred approach was biliary-digestive derivation (10 cases), and "T" tube drainage with suture of the bile duct was the choice in three special occasions. Three patients had biliary fistula resolved with clinical management, and one coliperitoneum case required reoperation. In the outpatient follow-up of patients who underwent biliodigestive anastomosis (eight), 50% are asymptomatic, 25% had anastomotic stricture and 25% lost follow-up. The mean follow-up was 41.8 months. Conclusion : MS in advanced degrees has low incidence, preoperative diagnosis in only half of cases, and has the biliodigestive anastomosis as the best conduct, but not without morbidity.

Download Full-text