Tennis elbow. The surgical treatment of lateral epicondylitis.

1980 ◽  
Vol 62 (2) ◽  
pp. 313-314 ◽  
Author(s):  
C C Gunn
Keyword(s):  
Surgical Treatment ◽  
Tennis Elbow ◽  
Lateral Epicondylitis

scholarly journals How one treats lateral epicondylitis – a survey among Brazilian orthopedists

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rafael Fuchs Lazarini ◽  
Renato Arouca Zan ◽  
João Carlos Belloti ◽  
Ildeu Afonso de Almeida Filho ◽  
Luiz Fernando Sartori Centenaro ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Hand Surgery ◽  
Initial Therapy ◽  
Cross Sectional Study ◽  
Imaging Method ◽  
Cross Sectional ◽  
Imaging Tool ◽  
Management Protocol

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.

Ten- to 14-Year Follow-up of the Nirschl Surgical Technique for Lateral Epicondylitis

2007 ◽  
Vol 36 (2) ◽  
pp. 261-266 ◽  
Author(s):  
Jonathan H. Dunn ◽  
John J. Kim ◽  
Lonnie Davis ◽  
Robert P. Nirschl
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Scoring Systems ◽  
Intensity Scale ◽  
The Mean ◽  
Mini Open

Background Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques. Hypothesis Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up. Study Design Case series; Level of evidence, 4. Methods Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1 surgeon between 1991 and 1994 were retrospectively reviewed. Eighty-three patients (92 elbows) were available by telephone for a mean follow-up of 12.6 years (range, 10–14 years). Outcome measures included the Numeric Pain Intensity Scale, Nirschl and Verhaar tennis elbow–specific scoring systems, and American Shoulder and Elbow Surgeons elbow form. Preoperative data were collected retrospectively. Results The mean age of the study group was 46 years (range, 23–70 years) with 45 men and 38 women. Eighty-seven of the procedures were primary, and 5 were revision tennis elbow surgeries. Concomitant procedures were performed in 30 patients including ulnar nerve release in 24 patients, medial tennis elbow procedures in 23 patients, shoulder arthroscopy in 2 patients, carpal tunnel release in 1 patient, and triceps debridement and osteophyte excision in 1 patient. The mean duration of preoperative symptoms was 2.2 years (range, 2 months to 10 years). The mean Nirschl tennis elbow score improved from 23.0 to 71.0, and the mean American Shoulder and Elbow Surgeons score improved from 34.3 to 87.7 at a minimum of 10-year follow-up ( P < .05). The Numeric Pain Intensity Scale pain score improved from 8.4 preoperatively to 2.1 ( P < .05). Results were rated as excellent in 71 elbows, good in 6 elbows, fair in 9 elbows, and poor in 6 elbows by the Nirschl tennis elbow score. By the criteria of Verhaar et al, the results were excellent in 45 elbows, good in 32 elbows, fair in 8 elbows, and poor in 7 elbows. Eighty-four percent good to excellent results were achieved using both scoring systems. Ninety-two percent of the patients reported normal elbow range of motion. The overall improvement rate was 97%. Patient satisfaction averaged 8.9 of 10. Ninety-three percent of those available at a minimum of 10-year follow-up reported returning to their sports. Conclusion The mini-open Nirschl surgical technique with accurate resection of the tendinosis tissue remains highly successful in the long term.

scholarly journals How One Treats Lateral Epicondylitis - A Survey Among Brazilian Orthopedists

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.

Standardized Tendon Fenestration with Injection of Autologous Blood for Treatment of Lateral Epicondylitis

2020 ◽  
Author(s):  
Chul Ki Goorens ◽  
Pascal Wernaers ◽  
Joost Dewaele
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Pain Scale ◽  
Short Term ◽  
Shockwave Therapy ◽  
Other Substances ◽  
Injured Tendon ◽  
Satisfaction Rates

AbstractLateral epicondylitis (LE) of the elbow is often treated with conservative methods. Several techniques including injections with different substances are widely performed. No standardization exists. This prospective study describes the results of the short-term follow-up of 56 patients with mean age 48 years (range: 30–68 years) treated with the Instant Tennis Elbow Cure Medical device, which fenestrates the injured tendon in a standardized way through a holder of 12 small needles. Depth and position of the needles are determined beforehand by ultrasonography. Unprepared autologous blood was injected through the holder in the tendon. Visual analog pain scale (VAS) decreased significantly in rest by 61% and during activity by 47% after 6 weeks. VAS decreased significantly in rest by 79% and during activity by 66% after 3 months. VAS did not remain significantly different after 6 months. Satisfaction rates were 71% after 6 weeks and 82% after 6 months. This suggests that the therapeutical effect sustains and in some cases increases over time. Patient Related Tennis Elbow Evaluation score ameliorated after 3 months by 71%. Comparative studies are needed to confirm this effect versus other techniques as physiotherapy, shockwave therapy, and injections with other substances.

scholarly journals Identifying and Evaluating Vocation-Related Neuro-Musculoskeletal Deficiencies in Professional Musicians: A Review

2021 ◽  
Vol 11 (5) ◽  
pp. 2035
Author(s):  
Joseph Mizrahi
Keyword(s):  
Myofascial Pain ◽  
Tennis Elbow ◽  
Traumatic Injury ◽  
Lateral Epicondylitis ◽  
Upper Extremities ◽  
Upper Body ◽  
Professional Musicians ◽  
Shoulder Muscles ◽  
Repetitive Movements ◽  
Tunnel Syndrome

A combination of factors exposes musicians to neuro-musculoskeletal disorders, which lead to pain and damage. These involve overuse due to long playing hours, containing repetitive movements under stressful conditions, usually performed in an unnatural posture. Although the evoked disorders are usually non-traumatic, they may often lead to prolonged or even permanent damage. For instance, in upper string players, these include bursitis and tendinopathies of the shoulder muscles, tendonitis of the rotator cuff, injury at the tendon sheaths, medial or lateral epicondylitis (also known as tennis elbow), myofascial pain, and wrist tendonitis (also known as carpal tunnel syndrome, or De Quervein’s syndrome). In cases of intensive performance, a traumatic injury may result, requiring drastic means of intervention such as surgery. It should be pointed out that the upper body and upper extremities are the most commonly affected sites of playing musicians. This review provides a description of the playing-related motor disorders in performing musicians, and of the methodologies used to identify and evaluate these disorders, particularly for violinists and other upper string players.

scholarly journals Effects of intralesional platelet-rich plasma in the patients with lateral epicondylitis of elbow

2019 ◽  
Vol 12 (3) ◽  
pp. 138-141
Author(s):  
Mohammad Tariqul Islam ◽  
M. A. Shakoor ◽  
Afsana Mahjabin ◽  
Md. Ali Emran
Keyword(s):  
Visual Analogue Scale ◽  
Daily Living ◽  
Analogue Scale ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Lateral Epicondylitis ◽  
Activity Of Daily Living ◽  
Evaluation Tool ◽  
Plasma Injection ◽  
The Difference

Lateral epicondylitis (tennis elbow) is a major cause of musculoskeletal pain involving common extensor origin of the forearm. This study was done to determine the effects of platelet-rich plasma on 15 patients with lateral epicondylitis. Selected patients were given intralesional platelet-rich plasma injection, activity of daily living instructions and paracetamol. Patients were assessed every 14 days interval by visual analogue scale, and the patient rated tennis elbow evaluation. Treatment response according to visual analogue scale and patient rated tennis elbow evaluation tool, the difference of improvement was found in respect to time, from pretreatment W1 (just before 1st Intervention) score to W11 score in every alternate week (p<0.005). This indicates that intralesional platelet-rich plasma is effective in the patients with lateral epicondylitis of elbow.

scholarly journals Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Nicola Massy-Westropp ◽  
Stuart Simmonds ◽  
Suzanne Caragianis ◽  
Andrew Potter
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Contralateral Limb ◽  
Cortisone Injection ◽  
Autologous Blood Injection ◽  
Blood Injection ◽  
And Function ◽  
Prospective Longitudinal ◽  
Extensor Carpi Radialis

Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis.Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation.Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not.Conclusions. Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.

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