PROSPECTIVE EVALUATION OF PERIARTICULAR HYALURONIC ACID INFILTRATION FOR THE TREATMENT OF LATERAL EPICONDYLITIS

ABSTRACT Objective: To prospectively, clinically and functionally follow-up patients previously diagnosed with lateral epicondylitis after periarticular application of hyaluronic acid and analyze the results. Methods: All patients were previously treated conservatively and had no clinical improvement. Data such as age, positivity for specific tests (Cozen and Mill), visual analogue pain scale (VAS) before and during dorsiflexion of the wrist with resistance, diagnosis time, Mayo Elbow Performance Score was collected. Patients were reevaluated 30 and 90 days after application. Results: The positivity rates for Cozen and Mill tests were identical, starting at 100%, dropping to 50% after one month, and ending at 41.7% after 3 months. The initial Mayo Elbow Score average was 61.3 points; 85.8 in the first month, remaining at 85 in the third month. VAS in active force situations had the initial average of 8.1; after one month it dropped to 3.8, and 3.6 after three months. At rest, the initial average was 5.9; after one month it decreased to 3 and ended at 2.1 in three months. Conclusion: Patients showed improvement in pain parameters, in the Mayo Elbow Performance Score standard, but with 25% of failure in satisfaction. Level of evidence IV, Case series.

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Evaluation of the clinical-radiographic results of patients undergoing arthroscopic metatarsal-phalangeal arthrodesis of the hallux

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1583 ◽

2021 ◽

Vol 15 (3) ◽

pp. 223-228

Author(s):

Rogério de Andrade Gomes ◽

Bruno Jannotti Pádua ◽

Anderson Humberto Gomes ◽

João Murilo Brandão Magalhães ◽

Wagner Vieira da Fonseca ◽

...

Keyword(s):

Pathological Condition ◽

Case Series ◽

Pain Scale ◽

Hallux Rigidus ◽

Functional Score ◽

Visual Analogue Pain Scale ◽

Level Of Evidence ◽

Visual Analogue Pain ◽

Advanced Stages ◽

Low Incidence

Introduction: Hallux rigidus (HR) is a frequent pathological condition of the foot, responsible for marked functional impairment. Metatarsal-phalangeal arthrodesis is an excellent treatment alternative for advanced stages of the disease, usually performed as an open surgery. Forefoot arthroscopy had its greatest development in the last decade, with a progressive expansion of indications, yielding encouraging results. Objective: To present the clinical and radiographic results of patients undergoing arthroscopic metatarsal-phalangeal arthrodesis of the hallux, depicting the technique and reporting complications. Methods: This study involves a series of cases, we operated 9 patients (10 feet), all with advanced HR (grades 3 and 4 - Coughlin-Shurnas). The patients underwent an arthroscopic procedure through two dorsal portals, small joints instruments. We assessed the results using the AOFAS functional score and the visual analogue pain scale. The radiographic parameters we used to analyze were the metatarsal-phalangeal angulation in the anteroposterior (pre- and postoperative) and lateral (post-operative) views, and we measured the radius shortening. Conclusion: Arthroscopic metatarsal-phalangeal arthrodesis is an excellent treatment option in advanced stages of hallux rigidus, with minimal disruption and providing excellent results, in addition to a low incidence of complications. Level of Evidence IV; Therapeutic Studies; Case Series

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Percutaneous Bunionette Correction: Retrospective Case Series

Foot & Ankle Specialist ◽

10.1177/1938640020937501 ◽

2020 ◽

pp. 193864002093750

Author(s):

Gustavo Nunes ◽

Tiago Baumfeld ◽

Caio Nery ◽

Daniel Baumfeld ◽

Paulo Carvalho ◽

...

Keyword(s):

Case Series ◽

Distal Region ◽

Pain Scale ◽

Invasive Technique ◽

Visual Analogue Pain Scale ◽

Retrospective Case ◽

Visual Analogue Pain ◽

Significant Difference ◽

American Orthopaedic

Introduction. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. Methods. This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. Results. The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference ( P < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. Conclusion. Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette. Levels of Evidence: Therapeutic studies, Level IV: Case series

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Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

European Journal of Plastic Surgery ◽

10.1007/s00238-021-01855-9 ◽

2021 ◽

Author(s):

Renata Migliardi ◽

Alessandra Modugno ◽

Fabrizio Chirico ◽

Nicola Zerbinati ◽

Giovanni Francesco Nicoletti ◽

...

Keyword(s):

Hyaluronic Acid ◽

Case Series ◽

Outpatient Setting ◽

Level Of Evidence ◽

Upper Eyelid ◽

Filler Injection ◽

Tear Trough Deformity ◽

Vasovagal Response ◽

Superior Sulcus ◽

Therapeutic Study

Abstract Background One of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry. Methods Thirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed. Results No complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection. Conclusions Hyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome. Level of evidence: Level IV, therapeutic study.

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Incidence and management of inguinodynia after inguinal plasty

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204211 ◽

2020 ◽

Vol 8 (10) ◽

pp. 3432

Author(s):

Juan J. Granados-Romero ◽

Jesus C. Ceballos-Villalva ◽

Israel García-Olivo ◽

Cruz Escobar Jonathan E. ◽

María J. Corona-Torres ◽

...

Keyword(s):

Hospital Costs ◽

Laparoscopic Approach ◽

Systematic Investigation ◽

Pain Scale ◽

Diagnostic Methods ◽

Visual Analogue Pain Scale ◽

Open Approach ◽

Cross Sectional ◽

Visual Analogue Pain ◽

Quality Life

Background: Hernia is defined as a defect of fascial and muscle-aponeurotic structures, allowing the protrusion of elements. The most frequent is inguinal region, prevailing in men 3:1 vs female. The most frequent complications are persistent chronic pain.Methods: A descriptive, prospective and cross-sectional study was performed in postoperative inguinal plasty patients, using a laparoscopic approach and open approach, the presence or absence of inguinodynia was studied using the visual analogue pain scale (VAS) and the Semmes-Weinstein monofilament, in addition to a systematic investigation in the following PubMed, Medline, Clinical Key and Index Medicus databases, with articles from July 2019 to April 2020.Results: Inguinodynia was present in laparoscopic surgery and open approach, 58 patients had inguinodynia at two weeks associated with the inflammatory response of the tissues and the presence of a foreign body (mesh), 77% of the patients with persistence of pain at 3 months reported mild pain (VAS 1-4), 21% moderate pain that did not limit their daily activities (VAS 5-8) and 2% of the patients reported severe pain which limited physical activity and effort (VAS 9-10).Conclusions: Inguinodynia has an impact on hospital costs and quality life, we consider it is essential to domain the anatomical variants of the region. We propose an extensive follow-up of this group of patients, to make a comparison of diagnostic methods, as well as conservative management vs. modern techniques for pain control.

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Buccal Mucosal Grafts for Urethroplasty: Comparison of Postoperative Oral and Perineal Morbidity

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x391875 ◽

2009 ◽

Vol 91 (2) ◽

pp. 116-117 ◽

Cited By ~ 4

Author(s):

Khalid Abdel-Galil ◽

Ian Eardley ◽

Richard Loukota

Keyword(s):

Donor Site ◽

Pain Scale ◽

Perineal Pain ◽

Visual Analogue Pain Scale ◽

Urethral Reconstruction ◽

Visual Analogue Pain ◽

Buccal Mucosa Graft ◽

Buccal Mucosal Graft ◽

Graft Harvest ◽

Scale Scores

INTRODUCTION A prospective study of postoperative oral and perineal pain experienced by a group of patients undergoing buccal mucosal graft harvest for urethral reconstruction. PATIENTS AND METHODS A consecutive group of 24 male patients undergoing buccal mucosa graft harvest for urethral recon8truction of stricture disease was prospectively studied between June 2006 and December 2008. All patients were examined pre-operatively and entered into the study prospectively. After surgery, all patients were reviewed at 24 h and 48 h. On both occasions, they were asked to complete a proforma containing visual analogue pain scales for both the oral donor site as well as the perineum. RESULTS A statistically significant higher level of pain was experienced from the perineum than the oral donor site on both the first and second postoperative days. CONCLUSIONS Comparative analysis of visual analogue pain scale scores between oral donor site and perineum showed that patients experience significantly more pain from the latter postoperatively.

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Arthroscopic Modified Bosworth Procedure for Refractory Lateral Elbow Pain With Radiocapitellar Joint Snapping

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120929929 ◽

2020 ◽

Vol 8 (6) ◽

pp. 232596712092992

Author(s):

In-Ho Jeon ◽

Jae-Man Kwak ◽

Bin Zhu ◽

Yucheng Sun ◽

Hyojune Kim ◽

...

Keyword(s):

Case Series ◽

Lateral Epicondylitis ◽

Visual Analog Scale Score ◽

Annular Ligament ◽

Level Of Evidence ◽

Lateral Elbow Pain ◽

Disease Spectrum ◽

Flexion Extension ◽

Articular Pathology

Background: Radiocapitellar joint snapping due to the presence of synovial plica has been described as a contributory intra-articular pathology of lateral epicondylitis (LE). Hypothesis: The arthroscopic modified Bosworth technique can provide a safe and favorable outcome for refractory LE with radiocapitellar snapping. Study Design: Case series; Level of evidence, 4. Methods: Patients treated with the arthroscopic modified Bosworth procedure for refractory LE with radiocapitellar joint snapping were included in this study. The sequential surgical procedures included excision of the upper portion of the anterolateral annular ligament, removal of the synovial plicae, and release of the extensor carpi radialis brevis for all patients. Clinical outcomes were measured at a minimum 1-year follow-up. Results: A total of 22 patients with a mean ± SD age of 51.2 ± 10.4 years were included in this study. The mean follow-up was 29.4 ± 7.7 months (range, 21-42 months). The overall visual analog scale score (from preoperative to final follow-up) was 7.5 ± 1.2 vs 2.5 ± 1.8 ( P < .001); flexion-extension motion arc was 133.8° ± 11.2° vs 146.4° ± 7.1° ( P = .001); pronation-supination motion arc was 101.8° ± 9.2° vs 141.7° ± 10.2° ( P = .001); Disabilities of the Arm, Shoulder and Hand score was 54.5 ± 13.2 vs 3.6 ± 4.1 ( P < .001); and Mayo Elbow Performance Score was 51.9 ± 12.2 vs 84.3 ± 10.3 ( P < .001). Conclusion: Radiocapitellar joint snapping may coexist with LE as a disease spectrum. The arthroscopic modified Bosworth technique provides safe and favorable outcomes for patients with refractory LE associated with radiocapitellar joint snapping.

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Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton’s Neuroma

Foot & Ankle International ◽

10.1177/1071100717739578 ◽

2017 ◽

Vol 39 (2) ◽

pp. 201-204 ◽

Cited By ~ 3

Author(s):

Kang Lee ◽

Il-Yeong Hwang ◽

Chang Hyun Ryu ◽

Jae Woo Lee ◽

Seung Woo Kang

Keyword(s):

Hyaluronic Acid ◽

Case Series ◽

Functional Improvement ◽

X Rays ◽

Ultrasound Guided ◽

Morton’S Neuroma ◽

Level Of Evidence ◽

Hyaluronic Acid Injection ◽

Acid Injection ◽

Morton's Neuroma

Background: Morton’s neuroma is one of the common causes of forefoot pain. In the present study, hyaluronic acid injection was performed on patients to determine the efficacy and adverse effects of hyaluronic acid in management of Morton’s neuroma. Methods: Eighty-three patients with Morton’s neuroma in their third intermetatarsal space with definite Mulder’s click were included in the study. Those with severe forefoot deformities such as forefoot cavus or hallux valgus on plain X-rays were excluded. Ultrasound-guided hyaluronic acid injections were performed on all patients weekly for 3 weeks. Pain during walking using visual analogue scale (VAS) and AOFAS Forefoot Scale were prospectively evaluated preinjection, and at 2, 4, 6, 12 months postinjection. Results: Significant improvement in VAS and AOFAS Forefoot Scale were seen overall at 2 months after hyaluronic acid injections ( P < .05). Then, there were almost no changes after 4 months, continuing until 12 months. The mean VAS was decreased from 73.1 initially to 23.0 at 12 months and AOFAS Forefoot Scale was increased from 32.2 to 86.5. There were no complications which occurred. Conclusion: In the present study, ultrasound-guided hyaluronic injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton’s neuroma. However, numbness associated with Morton’s neuroma should be addressed more cautiously since it may persist without much improvement. Level of Evidence: Level IV, retrospective case series.

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Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis

The American Journal of Sports Medicine ◽

10.1177/0363546511417096 ◽

2011 ◽

Vol 39 (11) ◽

pp. 2429-2435 ◽

Cited By ~ 20

Author(s):

Cheng-Li Lin ◽

Jung-Shun Lee ◽

Wei-Ren Su ◽

Li-Chieh Kuo ◽

Ta-Wei Tai ◽

...

Keyword(s):

Minimally Invasive ◽

Grip Strength ◽

Surgical Intervention ◽

Current Trend ◽

Case Series ◽

Lateral Epicondylitis ◽

Extensor Tendon ◽

Level Of Evidence ◽

Vas Score

Background: In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. Purpose: The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Study Design: Case series: Level of evidence, 4. Methods: Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Results: At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition ( P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly ( P < .01). The MMCPI score improved from “poor” to “excellent.” The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient. Conclusion: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.

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Transcutaneous Electrical Stimulation and Postoperative Total Knee Arthroplasty Pain

Pain Research and Management ◽

10.1155/1998/683535 ◽

1998 ◽

Vol 3 (2) ◽

pp. 101-104

Author(s):

Mohamed N Mahomed ◽

Gianni L Maistrelli ◽

Ayoob Mossanen ◽

Derek Glazier

Keyword(s):

Electrical Stimulation ◽

Total Knee Replacement ◽

Range Of Motion ◽

Pain Scale ◽

Control Group ◽

Visual Analogue Pain Scale ◽

Transcutaneous Electrical Stimulation ◽

Visual Analogue Pain ◽

Total Knee ◽

Analgesic Use

OBJECTIVE: To determine the efficacy of the Synaptic 2000 in reducing total knee replacement postoperative pain in a prospective randomized controlled trial.DESIGN: Patients were prospectively randomly assigned to two groups, one receiving seven days of transcutaneous electrical stimulation (TES) therapy in addition to standard postoperative care, and the other receiving standard postoperative care. Both groups received postoperative patient-controlled analgesia and were switched to oral opiates.SETTING: Patients were treated at a university teaching hospital for elective primary unilateral total knee replacement.PATIENTS: All patients consented to enter the study. All had primary osteoarthritis. Fifteen patients were entered into each arm of the study, and all patients completed the study. The mean age of patients was 64 years for treatment and 71 years for controls.OUTCOME MEASURES: Outcome measures were analgesic consumption, return of knee range of motion and score on a visual analogue pain scale.RESULTS: No significant differences were noted in postoperative analgesic use, knee range of motion, length of stay or visual analogue pain scale score. Mean total analgesic use of morphine was 148 mg in the TES group and 108 mg in the control group. The TES group mean knee range of motion on postoperative day 7 was 75.3°; it was 73.6° in the control group. Group mean length of stay was 9.5 days in the TES group and 8.3 days in the control group.

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Epidural Morphine plus Bupivacaine for Relief of Postoperative Pain following Harrington Rod Insertion for Correction of Idiopathic Scoliosis

Journal of International Medical Research ◽

10.1177/030006059502300309 ◽

1995 ◽

Vol 23 (3) ◽

pp. 211-217 ◽

Cited By ~ 6

Author(s):

Y Adu-Gyamfi

Keyword(s):

Side Effects ◽

Idiopathic Scoliosis ◽

Pain Score ◽

Epidural Catheter ◽

Epidural Morphine ◽

Pain Scale ◽

Injection Pain ◽

Visual Analogue Pain Scale ◽

Visual Analogue Pain ◽

Harrington Rod

The aim of this study was to assess the efficacy of epidural morphine plus bupivacaine for post-operative pain control following Harrington rod insertion. In 22 scoliotic patients, studied prospectively, the epidural catheter was positioned under direct vision, intra-operatively before wound closure. Post-operatively, the patients received 2 mg morphine in 4 ml of 0.25% bupivacaine through the epidural catheter whenever they complained of pain. The pain score was assessed before and after every injection, using the Visual Analogue Pain Scale, and side-effects were monitored. All patients had adequate pain relief following analgesic administration. The mean (± SD) pre-injection pain score decreased from 2.5 ± 0.15 on the first post-operative day to 0.7 ± 0.2 by the fourth day. The side-effects, including nausea, vomiting and pruritus, were minimal. It is concluded that morphine, in 0.25% bupivacaine administered through an intra-operatively placed epidural catheter, provides a safe and effective post-operative analgesia in patients undergoing Harrington rod insertion for idiopathic scoliosis.

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