scholarly journals Ultrasound findings in lateral elbow tendinopathy: A retrospective analysis of radiological tendon features

F1000Research ◽  
2022 ◽  
Vol 11 ◽  
pp. 44
Author(s):  
Guillermo Droppelmann ◽  
Felipe Feijoo ◽  
Cristobal Greene ◽  
Manuel Tello ◽  
Julio Rosales ◽  
...  

Background: Lateral elbow tendinopathy (LET) is prevalent in the upper extremity, with various therapeutic options. Understanding the types and the relations between the radiological tendon features would help to develop more specific treatments. This study reviewed ultrasound exams of LET to investigate the types of degenerative findings and the relationships between them in one of the most prominent sports medicine clinics in Latin America. Methods: A retrospective study was performed. We evaluated 4335 ultrasonographic exams with LET from 2017 and 2018. Five principal degenerative ultrasound criteria with subtypes were selected: hypoechogenicity, neovascularity, calcification, enthesopathy, and intrasubstance tear. A multiple linear regression model was conducted to explore the association between the findings, sex, and age. Results: Overall, 4324 ultrasound exams were analyzed; 2607 (60.29%) were males. Multiple degenerative tendon findings were found in adults (≥18 years) with LET. Hypoechogenicity (67.77%) and neovascularity (37.8%) were the most frequent. The mean length of a tendon tear in both sexes was 4.44 (± 2.81) millimeters. Mild hypoechogenicity (P < .001), and depth intrasubstance tear (P < .01) were statistically significant between them. Severe hypoechogenicity was associated with an increase in all tendon tear dimensions for length 1.37 ([95% Confidence interval (CI), 0.57, 2.17]; P < .001), for width 1.10 ([95% CI, 0.33, 1.87]; P < .01) and for depth 1.64 ([95% CI, 0.40, 2.88]; P < .01). Additional findings associated with an increase in the length dimension were 0.42 associated with focal neovascularity ([95% CI, 0.19, 0.65]; P < .001), and 0.71 associated with multiple neovascularity ([95% CI, 0.27, 1.15]; P < .01). Conclusions: Hypoechogenicity and neovascularity findings presented a positive association with the size of tendon tear in patients with LET. This study reaffirms the increased predominance of tendon tear during the 4th to 6th decades of life.

2014 ◽  
Vol 50 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Kenneth M. Rassnick ◽  
Dennis B. Bailey ◽  
Erin K. Malone ◽  
Andrea B. Flory ◽  
Michael A. Kiselow ◽  
...  

This retrospective study describes toxicity associated with a protocol of lomustine (CCNU) and cyclophosphamide (CTX) in dogs with lymphoma. CCNU was administered per os (PO) at a targeted dosage of 60 mg/m2 body surface area on day 0, CTX was administered PO at a targeted dosage of 250 mg/m2 divided over days 0 through 4, and all dogs received prophylactic antibiotics. Ninety treatments were given to the 57 dogs included in the study. Neutropenia was the principal toxic effect, and the overall frequency of grade 4 neutropenia after the first treatment of CCNU/CTX was 30% (95% confidence interval, 19–43%). The mean body weight of dogs with grade 4 neutropenia (19.7 kg ± 13.4 kg) was significantly less than the mean body weight of dogs that did not develop grade 4 neutropenia (31.7 kg ± 12.4 kg; P = .005). One dog (3%) developed hematologic changes suggestive of hepatotoxicity. No dogs had evidence of either renal toxicity or hemorrhagic cystitis. Adverse gastrointestinal effects were uncommon. On the basis of the findings reported herein, a dose of 60 mg/m2 of CCNU combined with 250 mg/m2 of CTX (divided over 5 days) q 4 wk is tolerable in tumor-bearing dogs.


Author(s):  
Ersin Nazlican ◽  
Neshat Yucel ◽  
Saime Paydas ◽  
Ilker Unal

OBJECTİVE: Kidney transplant recipients (KTRs) may have increased serum uric acid (SUA) level due to presence of existing greft dysfunction and used immunosuppressives. In this retrospective study, we evaluated effect of high SUA levels and allopurinol therapy in KTRs on renal functions. PATIENTS and METHODS: 113 KTRs of 233 KTRs included, had elevated SUA level (G1). Fiftyseven of G1 received allopurinol treatment (G1A+) and 56 patients (G1A-) did not. 56 of 118 patients who were followed for five years (G5) were hyperuricemic (G5-1) and 26 of G5-1 treated with allopurinol (G5-1A+) and 30 of them did not (G5-1A-). 62 patients were normourisemic (G5-2). RESULTS: Of the 233 patients included the mean age was 42.8±11.6 (17-76), 164 were male (70.0%). In 2. year graft loss developed in 9 (7.5 %) and 18 (15.9%) of G2 and G1 respectively (p = 0.045). According to allopurinol therapy 10 of the graft loss occurred in the G1A+ and 8 in the G1A- (p=0,330). Graft loss occurred in 12 (21%) and 9 (14%) in G5-1 and G5-2 respectively (p = 0.62). Graft loss occurred in 7 (23 %) and 5 (19%) in G5-1A+ and G5-1A- respectively P = 0.71). Considering the first 2 in G5; in G5-1 graft loss was higher than in the G5-2 (p = 0.023), and higher SUA levels increased the graft loss by 3.6 times compared to normal SUA levels (95% confidence interval: 1,2-12.70). CONCLUSION: There was a significant relationship between high SUA levels and graf loss in kidney transplant recipients in 2 years and 5 years. Treatment of high SUA with alIopurinol therapy had protective effect on renal functions. So that hyperuricemia should be treated and low dose allopurinol can be option for treatment of hyperuricemia therefore prevention of loss of kidney function in kidney transplant recipients.


2020 ◽  
Vol 44 (5) ◽  
pp. 341-354
Author(s):  
Saeed Shahabi ◽  
Kamran Bagheri Lankarani ◽  
Seyed Taghi Heydari ◽  
Maryam Jalali ◽  
Sulmaz Ghahramani ◽  
...  

Background: Lateral elbow tendinopathy, also known as “tennis elbow” or “lateral epicondylitis,” is a common disease leading to pain in the lateral side of the elbow and disability during hand gripping. A counterforce brace is one of the most conventional treatments. However, its effects on outcomes remain inconclusive. Objectives: To investigate the effects of counterforce braces on pain in subjects with lateral elbow tendinopathy. Grip strength was reviewed as a secondary outcome. Study design: Systematic review and meta-analysis of randomized controlled trials. Methods: PubMed, Embase, Scopus, Web of Science, CENTRAL, PEDro, ProQuest, RECAL, and RehabData were searched from January 1, 1995, through June 15, 2019. Results: Seventeen studies were included with a total of 1145 participants. A small improvement in pain over the short term (standardized mean difference −0.02; 95% confidence interval: −0.85 to 0.80) and a moderate-to-large improvement in pain in subjects 45 years or younger (standardized mean difference −0.86; 95% confidence interval: −2.45 to 0.72) in favor of the brace versus physiotherapy interventions were found. In contrast, over the long-term physiotherapy interventions (standardized mean difference 1.17; 95% confidence interval: −0.00 to 2.34), wrist splint (standardized mean difference 0.35; 95% confidence interval: −0.07 to 0.76), and laser therapy (standardized mean difference 0.58; 95% confidence interval: −0.44 to 1.59) had better effects on pain improvement versus the brace. Conclusion: The results indicated that physiotherapy interventions compared to counterforce braces have better effects, especially over the long-term. However, counterforce braces may have better effects on pain in younger people (<45 years old) over the short term (<6 weeks). Clinical relevance The results suggest that counterforce bracing is a reasonable strategy to alleviate pain over the short term. However, the subgroup analysis suggests that factors such as age may have a role in their effectiveness.


2017 ◽  
Vol 4 (4) ◽  
pp. 998
Author(s):  
Raju H. Badiger ◽  
Santosh B. Desai ◽  
Ravindra Kantamanenin ◽  
Chetana K. Kavatkopp ◽  
Joel George ◽  
...  

Background: Potassium is an extremely crucial element in maintaining the normal charge between intracellular and extracellular space. Normal cellular function is maintained through potassium homeostasis. The normal range of plasma potassium is 3.5 to 5.1 mmol/L. The deviation both hypo and hyperkalaemia are associated with cardiovascular diseases especially cardiac arrhythmia. The objective was to study the association of hypokalaemia on cardiovascular diseases.Methods: During this one year of retrospective study socio-demographic profile of the patients were collected from the medical record section of hospital. The participants were grouped into four classes based on the serum potassium levels as, Group A: < 2 mmol/L, group B: 2-2.49 mmol/l, group C: 2.5 - 2.9 mmol/L, group D: 3 - 3.49 mmol/L and group E (control group) 3.5 to 5.1 mmol/L. The participants were also grouped as those suffering from cardiovascular diseases and those with non-cardiovascular diseases.Results: In our study 4818 records were categorized into 5 groups including control group. Males (61.35%) were slightly more than female (38.65%). The mean age group was 43±4 years. Results revealed that there was positive association between the sexes. Females were more commonly associated as compared to males. Hypokalaemia among cardiovascular diseases was only 22.2% as compared to non-cardiovascular diseases. The mean systolic (142±8) and diastolic Blood pressure (92±2) among cardiovascular diseases was slightly higher as compared with the non-cardiovascular diseases.Conclusions: Hypokalaemia is significantly associated with myocardial infarction when compared with other disorders. Hypokalaemia was more commonly associated with cardiovascular diseases as compared with non-cardiovascular diseases.  


Author(s):  
J. Terrence Jose Jerome

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.


2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  

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.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nana-Kwadwo Biritwum ◽  
Dziedzom K. de Souza ◽  
Odame Asiedu ◽  
Benjamin Marfo ◽  
Uche Veronica Amazigo ◽  
...  

Abstract Background The control of onchocerciasis in Ghana started in 1974 under the auspices of the Onchocerciasis Control Programme (OCP). Between 1974 and 2002, a combination of approaches including vector control, mobile community ivermectin treatment, and community-directed treatment with ivermectin (CDTI) were employed. From 1997, CDTI became the main control strategy employed by the Ghana OCP (GOCP). This review was undertaken to assess the impact of the control interventions on onchocerciasis in Ghana between 1974 and 2016, since which time the focus has changed from control to elimination. Methods In this paper, we review programme data from 1974 to 2016 to assess the impact of control activities on prevalence indicators of onchocerciasis. This review includes an evaluation of CDTI implementation, microfilaria (Mf) prevalence assessments and rapid epidemiological mapping of onchocerciasis results. Results This review indicates that the control of onchocerciasis in Ghana has been very successful, with a significant decrease in the prevalence of infection from 69.13% [95% confidence interval) CI 60.24–78.01] in 1975 to 0.72% (95% CI 0.19–1.26) in 2015. Similarly, the mean community Mf load decreased from 14.48 MF/skin snip in 1975 to 0.07 MF/skin snip (95% CI 0.00–0.19) in 2015. Between 1997 and 2016, the therapeutic coverage increased from 58.50 to 83.80%, with nearly 100 million ivermectin tablets distributed. Conclusions Despite the significant reduction in the prevalence of onchocerciasis in Ghana, there are still communities with MF prevalence above 1%. As the focus of the GOCP has changed from the control of onchocerciasis to its elimination, both guidance and financial support are required to ensure that the latter goal is met.


2021 ◽  
pp. 036354652110101
Author(s):  
Benjamin F.H. Ang ◽  
P. Chandra Mohan ◽  
Meng Ai Png ◽  
John Carson Allen ◽  
Tet Sen Howe ◽  
...  

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.


2020 ◽  
pp. 088506662098250
Author(s):  
Chad M. Conner ◽  
William H. Perucki ◽  
Andre Gabriel ◽  
David M. O’Sullivan ◽  
Antonio B. Fernandez

Introduction: There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset. Methods: We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student’s t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest. Results: Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR’s < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR’s in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR. Conclusion: During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.


Sign in / Sign up

Export Citation Format

Share Document