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Ishibashi S, Kodama A, Tokumoto M, Yokomachi K, Shinomiya R, Adachi N. Quantitative assessment of ECRB tendon degeneration in lateral epicondylitis using CT hounsfield units: correlation with histological and MRI findings. BMC Musculoskelet Disord 2025; 26:367. [PMID: 40241023 PMCID: PMC12001386 DOI: 10.1186/s12891-025-08346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/23/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Lateral epicondylitis (LE) is characterized by enthesopathy and tendon degeneration of the extensor carpi radialis brevis (ECRB) attachment. Although magnetic resonance imaging (MRI) can reveal pathological changes, quantitative evaluation methods remain limited. This study aimed to quantify ECRB tendon degeneration on computed tomography (CT) using Hounsfield unit (HU) values. METHODS We analyzed 24 elbows (12 males, 12 females; mean age: 53.7 years) in the LE group and 25 control elbows (16 males and 9 females; mean age: 56.7 years). All the patients in the study group underwent preoperative CT, MRI, and subsequent ECRB tendon resection. The tendon was divided into proximal, middle, and distal regions. The mean HU values were measured on reconstructed coronal CT images and analyzed in relation to the control group measurements, MRI findings, and histological evaluations. RESULTS The mean HU values were significantly lower in the LE group than in the controls in the proximal (49.7 vs. 65.4 HU, P < .0001) and middle regions (58.9 vs. 67.1 HU, P = 0.024) but not in the distal region (66.1 vs. 70.8 HU, P = 0.192). The ECRB tendon showed the greatest histological degeneration proximally, demonstrating a strong negative correlation with HU values (Spearman ρ = -0.612, P < .0001). Proximal region HU values showed a moderate negative correlation with MRI grades (Spearman ρ = -0.517, P = 0.020). CONCLUSION HU values provide a quantitative method for evaluating ECRB tendon degeneration in LE, correlating well with histological and MRI findings. This technique offers an objective measure of tendon pathology that may complement the current diagnostic approaches. EVIDENCE FROM THE STUDY Level III.
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Affiliation(s)
- Shigeki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Akira Kodama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan.
- Division of Regenerative Medicine for Musculoskeletal System Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
| | - Maya Tokumoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kazushi Yokomachi
- Division of Diagnostic Imaging, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Rikuo Shinomiya
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
- Department of Musculoskeletal Traumatology and Reconstructive Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
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Ghandour M, AL Salloum D, Jaber MH, Abou Orm G, Ghosn A, Jaber S, Abd El Nour H, Chalfoun A, Dagher T, Hanna B. A comparative meta-analysis of the efficacy and safety of arthroscopic versus open surgery in patients with lateral epicondylitis. J Orthop 2025; 59:41-50. [PMID: 39351266 PMCID: PMC11439539 DOI: 10.1016/j.jor.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 10/04/2024] Open
Abstract
Background Lateral epicondylitis frequently necessitates surgical management when non-surgical treatments are ineffective. Anecdotal evidence suggests comparable efficacy between arthroscopic and open surgical repair; however, it is limited by the scarcity of data. This meta-analysis compares between both procedures regarding functional recovery, pain intensity, complications, and return-to-work time. Methods A detailed systematic review and meta-analysis of research published until February 2024 were performed, comparing arthroscopic and open surgery methods for lateral epicondylitis. The studies were sourced from PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The included studies examined outcomes such as functional recovery, pain intensity, complication rates, and time to return to work. The risk of bias was evaluated using the Cochrane tool for randomized studies and the ROBINS-I tool for non-randomized studies. Results The meta-analysis included 19 studies with a total of 20,409 participants. The analysis found no significant differences in postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores (Mean Difference [MD] = 0.06; 95 % Confidence Interval [CI]: 0.81 to 0.94; P = 0.89) or Mayo Elbow Performance Scores (MD = 0.31; 95 % CI: 2.33 to 2.95; P = 0.80) between the arthroscopic and open surgical methods. The rates of good-to-excellent recovery, surgical failures, and complications were similar across both techniques. Nevertheless, arthroscopic surgery was associated with a significantly shorter return-to-work period (MD = -1.64 months; 95 % CI: 2.60 to -0.68; P = 0.001) and a temporary increase in grip strength six months after surgery (MD = -1.50 kg; 95 % CI: 2.67 to -0.33; P = 0.012). Conclusions Arthroscopic and open release techniques for lateral epicondylitis provide similar functional outcomes and complication rates. However, arthroscopic surgery may allow for a quicker return to work, suggesting a potential advantage in the early postoperative period. These findings highlight the need for individualized surgical decision-making based on patient-specific factors and surgeon expertise.
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Affiliation(s)
- Maher Ghandour
- Department of Orthopedic Surgery, CHU Grenoble Alpes, Grenoble, France
| | - Diaa AL Salloum
- Department of Orthopedic Surgery, CHU Grenoble Alpes, Grenoble, France
| | | | - Ghadi Abou Orm
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Ali Ghosn
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Sadek Jaber
- Department of Orthopedic Surgery, Saint Georges University Medical Center, Beirut, Lebanon
| | - Hicham Abd El Nour
- Department of Orthopedic Surgery, Saint Georges University Medical Center, Beirut, Lebanon
| | - Anthony Chalfoun
- Department of Orthopedic Surgery, Saint Georges University Medical Center, Beirut, Lebanon
| | - Tanios Dagher
- Department of Orthopedic Surgery, Hopital Ambroise-Paré, Paris, France
| | - Bashour Hanna
- Orthopaedic Department, CHU Grenoble Alpes, Grenoble, France
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Lazzaretti Fernandes T, Taraballi F, Shao Z, Roessler PP, Cardona-Ramírez S. Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Elbow and Upper Extremity: An Orthoregeneration Network Foundation Review. Arthroscopy 2024; 40:2897-2909. [PMID: 38723874 DOI: 10.1016/j.arthro.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/10/2024]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the elbow and upper extremity, including the tendons (lateral epicondylitis, medial epicondylitis, biceps tendonitis, triceps tendonitis), articular cartilage (osteoarthritis, osteochondral lesions), and bone (fractures, nonunions, avascular necrosis, osteonecrosis). Promising and established treatment modalities include hyaluronic acid; botulinum toxin; corticosteroids; leukocyte-rich and leukocyte-poor platelet-rich plasma; autologous blood; bone marrow aspirate comprising mesenchymal stromal cells (alternatively termed medicinal signaling cells and frequently mesenchymal stem cells [MSCs]) and bone marrow aspirate concentrate; MSCs harvested from adipose and skin (dermis) sources; vascularized bone grafts; bone morphogenic protein scaffold made from osteoinductive and conductive β-tricalcium phosphate and poly-ε-caprolactone with hydrogels, human MSCs, and matrix metalloproteinases; and collagen sponge. Autologous blood preparations such as autologous blood injections and platelet-rich plasma show positive outcomes for nonresponsive tendinopathy. In addition, cellular therapies such as tissue-derived tenocyte-like cells and MSCs show a promising ability to regulate degenerative processes by modulating tissue response to inflammation and preventing continuous degradation and support tissue restoration. LEVEL OF EVIDENCE: Level V, expert opinion.
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Affiliation(s)
- Tiago Lazzaretti Fernandes
- Sports Medicine Division, Institute of Orthopaedics and Traumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Francesca Taraballi
- Center for Musculoskeletal Regeneration, Orthopedics and Sports Medicine, Houston, Texas, U.S.A.; Methodist Hospital, Houston Methodist Academic Institute, Houston, Texas, U.S.A
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Philip P Roessler
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Gelenkzentrum Mittelrhein, Koblenz, Germany
| | - Sebastián Cardona-Ramírez
- Grupo de Investigación OHVRI, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
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Lapegue F, André A, Lafourcade F, Filiole A, Lambeaux C, Van VT, Adamski E, Bachour R, Goumarre C, Chiavassa H, Faruch Bilfeld M, Sans N. Ultrasound of Lateral Epicondylitis. Semin Musculoskelet Radiol 2024; 28:683-693. [PMID: 39561750 DOI: 10.1055/s-0044-1791510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
Clinical findings are generally sufficient to make the diagnosis of lateral epicondylitis of the elbow. Ultrasound (US), in conjunction with standard radiography, is a simple and cost-effective way to confirm the diagnosis, and it is also useful for eliminating most differential diagnoses and guiding treatment.US analysis of the muscle bodies and tendon laminae of the lateral epicondyle muscles, starting distally at the wrist and extending up to the lateral epicondyle, assists in understanding the complex fibrous architecture of the proximal tendons inserting on the lateral epicondyle. Pain when the US probe passes over an area of hypoechoic tendinosis, hyperemia in Doppler mode, and an intratendinous split are the signs to look for in patients. US helps guide needling or injection by targeting pathologic areas.Other examinations (computed tomography arthrogram and magnetic resonance imaging) are used as a second line of defense, particularly in cases of bone or joint pathology.
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Affiliation(s)
- Franck Lapegue
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
- Clinique MEDIPOLE Garonne, Toulouse, France
- ELSAN, Clinique Occitanie, Muret, France
| | - Aymeric André
- Clinique MEDIPOLE Garonne, Toulouse, France
- Laboratoire d'anatomie, Faculté de Médecine de Toulouse, Toulouse, France
| | - François Lafourcade
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Antoine Filiole
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Constance Lambeaux
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Viet-Tam Van
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Elorie Adamski
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Rafy Bachour
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Céline Goumarre
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Hélène Chiavassa
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Marie Faruch Bilfeld
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
| | - Nicolas Sans
- Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
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Kwak JM, Kholinne E, Jeon IH. Lateral collateral ligament complex insufficiency in recalcitrant lateral epicondylitis: MRI evaluation with arthroscopic findings. INTERNATIONAL ORTHOPAEDICS 2024; 48:2903-2909. [PMID: 39249531 DOI: 10.1007/s00264-024-06305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 08/27/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To evaluate the concomitant pathology in recalcitrant LE using MRI with arthroscopic finding correlation. METHODS A total of 49 patients were diagnosed with chronic recalcitrant LE and divided into two: LCL complex-intact and LCL complex-involved groups by evaluating MRI as confirmed by a radiologist. Patient information for the history of steroid injection and symptom duration was extracted from the medical records. Arthroscopic images taken during arthroscopic extensor carpi radialis brevis release were evaluated to assess the quality of lateral capsule and concomitant plica. RESULTS A total of 24 and 25 patients were included in the LCL-intact and LCL-involved groups, respectively. Among them, seven had complete RCL tears recorded in the LCL-involved group. Symptom duration (15 ± 9 vs. 22 ± 13, p = 0.029) and the number of steroid injections (3 ± 2 vs. 5 ± 3, p = 0.040) were significantly higher in the LCL-involved group than that in the LCL-intact group. A capsular tear was detected for 5 (20%) patients in the LCL-intact and 14 (56%) in the LCL-involved group (p = 0.027). Concomitant plica was observed in 15 (62%) patients in LCL-intact and seven (28%) in the LCL-involved group (p = 0.015). RC joint widening was observed in four patients in the LCL-involved group. CONCLUSION The recalcitrant LE is highly a concomitant pathology including LCL complex insufficiency and pathologic elbow plica lesion. The risk factors of LCL insufficiency associated with refractory LE may include multiple steroid injections. Arthroscopic finding such as capsular tears and elbow drive-through signs can be suspected signs for LCL complex insufficiency.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, College of Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
| | - Erica Kholinne
- Faculty of Medicine, Department of Orthopedic Surgery, Universitas Trisakti, St. Carolus Hospital, Jakarta, Indonesia
| | - In-Ho Jeon
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, Ulsan University, 88 Olympic-ro 43 gil, Pungnap 2(i)-dong, Songpa-gu, Seoul, 05505, Korea.
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Rodríguez-Huguet M, Rodríguez-Almagro D, Rosety-Rodríguez MA, Vinolo-Gil MJ, Molina-Jiménez J, Góngora-Rodríguez J. Pulsed negative pressure myofascial vacuum therapy and percutaneous electrolysis in the treatment of lateral epicondylalgia: A single-blind randomized controlled trial. J Hand Ther 2024; 37:644-652. [PMID: 38453573 DOI: 10.1016/j.jht.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Lateral Epicondylalgia (LE) represents one of the most common injuries of the upper limb. It is necessary to find effective treatments that reduce pain and increase functionality. PURPOSE To determine the effects of an integrated intervention of Pulsed Negative Pressure Myofascial Vacuum Therapy (VT), Percutaneous Electrolysis (PE) and eccentric exercise (EE) in the treatment of LE compared versus Manual Therapy soft tissue mobilization (MT) and Ultrasound therapy (US) and EE. STUDY DESIGN Single-blind randomized controlled trial. METHODS Forty participants, with unilateral LE, were randomly divided into two groups: VT + PE + EE group (n = 20) and MT + US + EE group (n = 20). The VT + PE + EE group received one weekly session for four weeks and a regimen of EE daily at-home, and the MT + US + EE group received 10 sessions over a period of two weeks and a regimen of EE daily at-home. Numerical pain rating scale (NPRS), range of motion (ROM) pressure pain threshold (PPT) and function (PRTEE questionnaire) were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. RESULTS The statistically significant improvements were found post-treatment, favoring the VT + PE group in pain intensity (p < 0.001; ES = 0.408), PRTEE-S Pain (p = 0.001; ES = 0.377), PRTEE-S Specific function (p = 0.004; ES = 0.306) and PRTEE-S Total (p = 0.001; ES = 0.355). The VT + PE + EE treatment showed greater effectiveness than the MT + US + EE treatment at immediate post-treatment, as well as at the one-month and three-months follow-up. CONCLUSIONS VT and PE added to an EE program could be an effective treatment for pain, ROM, PPT, and function in patients with LE.
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Affiliation(s)
| | | | - Miguel Angel Rosety-Rodríguez
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cadiz, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cadiz, Spain; Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, Cadiz, Spain.
| | | | - Jorge Góngora-Rodríguez
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Department of Physiotherapy, Osuna School University, University of Sevilla, Sevilla, Spain
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Inagaki K, Ochiai N, Hashimoto E, Hiraoka Y, Ise S, Ohtori S. Magnetic Resonance Imaging Findings of Extensor Carpi Radialis Brevis Origin and Synovial Fold in Lateral Epicondylitis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:654-658. [PMID: 39381394 PMCID: PMC11456623 DOI: 10.1016/j.jhsg.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 10/10/2024] Open
Abstract
Purpose Magnetic resonance imaging (MRI) is the most widely used imaging to diagnose lateral epicondylitis (LE). However, the importance of MRI findings in LE remains unclear. This study aimed to classify the signal intensity changes of the extensor carpi radialis brevis origin and the shape and length of the synovial fold using MRI and compare them with clinical symptoms. We hypothesized that MRI findings in LE are not associated with clinical symptoms. Methods Two hundred and forty-three patients (261 elbows, mean age: 51.2 ± 8.5 years, mean duration of LE: 18.2 ± 11.3 months) who were evaluated using pretreatment MRI were included. The signal change of the extensor carpi radialis brevis origin was classified using coronal T2-weighted (T2) imaging and coronal fat-suppressed proton density T2 imaging, and the shape and length of the synovial folds were evaluated using coronal and sagittal T2 imaging. Furthermore, MRI findings were compared with clinical symptoms at the first visit. Results The number of elbows with high signal intensity on fat-suppressed proton density T2 was 252 of 261 (96.5%), and those on T2 were 207 of 261 (79.3%). Synovial folds were observed in 231 of 261 (88.5%) of the elbows, and synovial folds having a dull shape were observed in 95 of 261 (36.4%) elbows. The length of the synovial fold was >1/3 of the radial head in 87 of 261 (33.3%) of the elbows. There was no statistically significant correlation between the MRI findings and clinical symptoms. Conclusions A high rate of high signal intensity changes of the extensor carpi radialis brevis origin was observed, and fat-suppressed proton density T2 could detect finer signal changes than T2. Furthermore, synovial folds were found in many cases of LE. However, there was no association between MRI findings and clinical symptoms at first visit. Type of study/level of evidence Prognostic IV.
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Affiliation(s)
- Kenta Inagaki
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan
| | - Nobuyasu Ochiai
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan
| | - Eiko Hashimoto
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan
| | - Yu Hiraoka
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan
| | - Shohei Ise
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan
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Saeki M, Yoneda H, Yamamoto M. Lateral elbow magnetic resonance imaging findings in patients without pain complaints. JPRAS Open 2024; 41:159-165. [PMID: 39040144 PMCID: PMC11261295 DOI: 10.1016/j.jpra.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/09/2024] [Indexed: 07/24/2024] Open
Abstract
Magnetic resonance imaging (MRI) can help evaluate lateral epicondylitis; however, abnormal findings on MRI are not always consistent with the symptoms. The occurrence of such abnormal MRI findings at the lateral side of the elbow in patients without pain remains unclear. Therefore, the purpose of this study was to investigate the MRI findings of the lateral elbow joint in patients with no complaints of pain in the elbow joint. We retrospectively identified 152 patients who had undergone MRI of the area including the elbow from July 2015 to January 2022. We excluded patients with pain in the elbow area and those with diagnosis of diseases that could affect MRI findings at the lateral elbow. The presence of lateral collateral ligament complex (LCLC) and common extensor tendon (CET) lesions on MRI was assessed by two reviewers. In total, 22 patients (12 men and 10 women) were included in the analysis. The mean age of the patients was 54 years. Five patients, all ≥65 years old, had abnormal findings related to the LCLC or CET on MRI. Abnormal LCLC and CET findings on MRI can be encountered in older patients even in the absence of elbow pain.
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Affiliation(s)
- Masaomi Saeki
- Department of Human Enhancement & Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Human Enhancement & Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Human Enhancement & Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Cho MJ, Chai JW, Kim DH, Kim HJ, Seo J. Ultrasonographic differential diagnosis of medial elbow pain. Ultrasonography 2024; 43:299-313. [PMID: 39086070 PMCID: PMC11374584 DOI: 10.14366/usg.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/23/2024] [Indexed: 08/02/2024] Open
Abstract
Medial elbow pain is a common musculoskeletal problem among individuals engaging in repetitive activities. Medial epicondylitis is the predominant cause of this pain. However, other potential causes must be considered as part of the differential diagnosis. This article discusses several etiologies of medial elbow pain, including medial epicondylitis, ulnar neuropathy, snapping triceps syndrome, ulnar collateral ligament injury, medial antebrachial cutaneous neuropathy, and diseases of the elbow joint, with an emphasis on ultrasound (US) findings. Awareness of possible diagnoses and their US features can assist radiologists in establishing a comprehensive diagnosis for medial elbow pain.
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Affiliation(s)
- Min Jeong Cho
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Hallym Hospital, Incheon, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Xu Y, Li T, Wang L, Yao L, Li J, Tang X. Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2024; 52:2646-2656. [PMID: 38357713 DOI: 10.1177/03635465231213087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Corticosteroids (CS) have shown good short-term performance in terms of pain relief and functional improvement. However, the safety and long-term efficacy of this treatment remains controversial. Several studies have reported good results of platelet-rich plasma (PRP) in the treatment of tendinopathies. However, whether its use in the treatment of lateral epicondylitis (LE) is superior to that of CS remains controversial. PURPOSE To perform a systematic review and meta-analysis of original studies to determine whether the prognosis of LE patients treated with PRP is better than that of CS. STUDY DESIGN Meta-analysis; Level of evidence, 2. METHODS Two independent reviewers searched online databases from January 2000 to July 2022 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to evaluate prospective studies of PRP versus CS injection for LE. A third author addressed any discrepancies. Evidence quality was assessed using the Cochrane risk of bias tool. Risk ratios for dichotomous variables and mean differences (MDs) for continuous variables were used to compare clinical outcomes. P values <.05 were considered statistically significant. RESULTS Eleven randomized controlled trials with 730 patients were included in this review. PRP provided a significantly worse short-term (<2 months) improvement in the visual analog scale (VAS) pain score (MD, 0.93 [95% CI, 0.42 to 1.44]; I2 = 85%; P = .0003) and Disabilities of the Arm, Shoulder and Hand (DASH) score (MD, 10.23 [95% CI, 9.08 to 11.39]; I2 = 67%; P < .0001) but better long-term (≥6 months) improvement in the VAS score (MD, -2.18 [95% CI, -3.13 to -1.22]; I2 = 89%; P < .0001), DASH score (MD, -8.13 [95% CI, -9.87 to -6.39]; I2 = 25%; P < .0001), and Mayo Elbow Performance Score (MD, 16.53 [95% CI, 1.52 to 31.53]; I2 = 98%; P = .03) than CS. The medium-term (2-6 months) reduction in the VAS score was not significantly different between the 2 groups. After sensitivity analysis, none of the results changed except for the short-term VAS scores (MD, 0.53 [95% CI, -0.13 to 1.19]; I2 = 78%; P = .12). CONCLUSION Both PRP and CS injections are effective treatments for patients with LE. CS provides better short-term (<2 months) functional improvement and may be more advantageous in terms of short-term pain relief, while PRP provides better long-term (≥6 months) functional improvement and better performance regarding long-term pain relief.
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Affiliation(s)
- Yang Xu
- Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Cocco G, Ricci V, Corvino A, Abate M, Vaccaro A, Bernabei C, Cantisani V, Vallone G, Caiazzo C, Caulo M, Pizzi AD. Musculoskeletal disorders in padel: from biomechanics to sonography. J Ultrasound 2024; 27:335-354. [PMID: 38578364 PMCID: PMC11178742 DOI: 10.1007/s40477-023-00869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024] Open
Abstract
Padel is a racket sport, combining high-frequency and low-intensity athletic gestures, that has been gaining growing scientific interest in recent years. Musculoskeletal injuries are very common among padel players with an incidence rate of 3 per 1000 h of training and 8 per 1000 matches. To the best of our knowledge, a comprehensive collection describing the most common sonographic findings in padel players with musculoskeletal injuries is lacking in the pertinent literature. In this sense, starting from the biomechanical features of padel-specific gestures we have reported the ultrasonographic patterns of most frequent injuries involving the upper limb, the trunk, and the lower limb. Indeed, comprehensive knowledge of the biomechanical and clinical features of musculoskeletal injuries in padel is paramount to accurately perform a detailed ultrasound examination of the affected anatomical site. So, the present investigation aims to provide a practical guide, simple and ready-to-use in daily practice, to optimize the sonographic assessment of padel players by combining it with the clinical findings and the biomechanical features of athletic gestures.
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Affiliation(s)
- Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, 6610, Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
| | - Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy.
| | - Michele Abate
- IRCSS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Adele Vaccaro
- Department of Radiology, SS. Annunziata Hospital of Chieti, University "G. D'Annunzio", Chieti, Italy
| | - Carlotta Bernabei
- Department of Radiology, SS. Annunziata Hospital of Chieti, University "G. D'Annunzio", Chieti, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology, Sapienza-University of Rome, Anatomo-Pathology, Rome, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, 6610, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University "G. D'Annunzio", Chieti, Italy
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Hortz BV, Falsone S. Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series. J Sport Rehabil 2024; 33:301-306. [PMID: 38531344 DOI: 10.1123/jsr.2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 03/28/2024]
Abstract
CONTEXT Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. CASE PRESENTATION Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). MANAGEMENT AND OUTCOMES The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. CONCLUSIONS This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.
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Affiliation(s)
- Brian V Hortz
- Structure and Function Education, Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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Koukos C, Kotsapas M, Sidiropoulos K, Traverso A, Bilsel K, Montoya F, Arrigoni P. A Novel Surgical Treatment Management Algorithm for Elbow Posterolateral Rotatory Instability (PLRI) Based on the Common Extensor Origin Integrity. J Clin Med 2024; 13:2411. [PMID: 38673685 PMCID: PMC11051432 DOI: 10.3390/jcm13082411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon's point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO's condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.
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Affiliation(s)
- Christos Koukos
- Medical Center Wuppertal, 42329 Wuppertal, Germany;
- Sports Trauma and Pain Ιnstitute, 54655 Thessaloniki, Greece
| | - Michail Kotsapas
- Orthopaedic Department, General Hospital of Naousa, 59200 Naousa, Greece
| | - Konstantinos Sidiropoulos
- Medical School of Patras, University of Patras, 26504 Patras, Greece
- Emergency Department, Papageorgiou General Hospital of Thessaloniki, 54635 Thessaloniki, Greece
| | - Aurélien Traverso
- Orthopaedic Department, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
- ASST Pini-CTO, 20122 Milan, Italy
| | - Kerem Bilsel
- Faculty of Medicine, Acibadem Mehmet Ali Aydınlar University, 34752 Instanbul, Turkey;
- Orthopaedics and Traumatology Department, FulyaAcibadem Hospital, 34349 Instanbul, Turkey
| | - Fredy Montoya
- Sanatorio Aleman Clinic, Universidad de Concepcion, Concepcion 4070386, Chile;
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Saeki M, Yoneda H, Yamamoto M. Posterior Translation of the Radial Head in Magnetic Resonance Imaging of Lateral Epicondylitis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5746. [PMID: 38633509 PMCID: PMC11023611 DOI: 10.1097/gox.0000000000005746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Background Posterolateral rotatory instability is produced by disruption of the lateral collateral ligament complex (LCLC); it is commonly induced by trauma, with few cases reported due to lateral epicondylitis. We examined the amount of posterior transition of the radial head with or without LCLC injury, common extensor tendon (CET) injury, and Baker classification in lateral epicondylitis. Methods We retrospectively studied patients with lateral epicondylitis of the humerus who underwent surgery between April 2016 and July 2021. Fifteen elbows with coronal and sagittal images on preoperative magnetic resonance imaging (MRI) were included. We investigated the amount of posterior transition of the radial head in sagittal MRI images of the elbow, which were compared based on LCLC and CET lesion. Results The mean age of patients was 49 years. The lesions in four, nine, and two patients were classified as LCLC0, LCLC1, and LCLC2, respectively. The mean radio-humeral distance values among the LCLC lesions were 0.65, 2.46, and 2.22 mm in LCLC0, LCLC1, and LCLC2, respectively, with the RHD between LCLC0 and LCLC1 differing significantly. In five, six, and four patients, the lesions were classified as CET1, CET2, and CET3, respectively. The mean RHD values among the CET lesions were 1.33, 2.68, and 1.48 mm in CET1, CET2, and CET3, respectively. Conclusions Our results showed that posterior transition of the radial head is greater in patients with lateral epicondylitis with LCLC lesions on MRI than those with normal findings of LCLC.
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Affiliation(s)
- Masaomi Saeki
- From the Department of Human Augmentation and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemasa Yoneda
- From the Department of Human Augmentation and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- From the Department of Human Augmentation and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Thiele K, Unmann A, Geyer S, Siebenlist S, Scheibel M, Seemann R, Lerchbaumer M, Schoch C, Mader K. Evaluation of the efficiency of an ultrasound-supported infiltration technique in patients with tennis elbow applying the ITEC medical device: a multicenter study. JSES Int 2024; 8:361-370. [PMID: 38464435 PMCID: PMC10920118 DOI: 10.1016/j.jseint.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The treatment of lateral epicondylitis remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months. Methods In a prospective, nonrandomized, multicenter study design, 68 patients with chronic lateral epicondylitis and symptoms lasted for at least 6 weeks were included. Each hospital has been assigned for Traumeel (A), autologous whole blood (B), or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient-related outcome parameter, and dorsal wrist extension strength were documented. Preinterventional (obligate) and after 6 months (optional) radiological evaluation (magnetic resonance imaging) was performed. Results The Visual Analog Scale showed a significant reduction after 6 months in all groups (A. 4.8-2.5, B. 6.2-2.3, C. 5.8-2.4). Similar results could be observed with Subjective elbow value, Disabilities of Arm, Shoulder, and Hand Score, Mayo Elbow Performance Score, and Patient Rated Tennis Elbow Evaluation. The loss of strength could be completely compensated after about 6 months. Magnetic resonance imaging did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A = 11, B = 8, C = 4). Switching to surgical intervention was most frequently observed in group C (A = 2, B = 1, C = 5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method. Conclusion The primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.
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Affiliation(s)
- Kathi Thiele
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
| | - Annemarie Unmann
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Trauma Department, LKH Feldbach, Feldbach, Austria
| | - Stephanie Geyer
- Department of Shoulder and Elbow Surgery, St. Vinzenz Klinik Pfronten, Pfronten, Germany
- Sektion Sportorthopädie, Klinikum rechts der Isar, München, Germany
| | | | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Ricarda Seemann
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Zentrum für Orthopädie&Unfallchirurgie Tettnang, Tettnang, Germany
| | | | - Christian Schoch
- Sektion Sportorthopädie, Klinikum rechts der Isar, München, Germany
| | - Konrad Mader
- Zentrum für Orthopädie&Unfallchirurgie Tettnang, Tettnang, Germany
- Division Hand, Forearm and Elbow Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Keijsers R, Kuijer PPFM, Gerritsma-Bleeker CLE, Kleinlugtenbelt YV, Beumer A, The B, Landman EBM, de Vries AJ, Eygendaal D. In the Treatment of Lateral Epicondylitis by Percutaneous Perforation, Injectables Have No Added Value. Clin Orthop Relat Res 2024; 482:325-336. [PMID: 37594385 PMCID: PMC10776141 DOI: 10.1097/corr.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND No single injection therapy has been proven to be superior in the treatment of lateral epicondylitis. In most studies, the injection technique is not standardized, which makes it challenging to compare outcomes. QUESTIONS/PURPOSES (1) Does injection with autologous blood, dextrose, or needle perforation only at the extensor carpi radialis brevis tendon origin produce better VAS pain scores during provocation testing at 5 months of follow-up? (2) Which percutaneous technique resulted in better secondary outcome measures: VAS during rest and activity, VAS during maximum grip, Oxford elbow score (OES), QuickDASH, Patient-related Tennis Elbow Evaluation (PRTEE), or EuroQol-5D (EQ-5D)? METHODS In this multicenter, randomized controlled trial performed from November 2015 to January 2020, 166 patients with lateral epicondylitis were included and assigned to one of the three treatment groups: autologous blood, dextrose, or perforation only. Complete follow-up data were available for the primary outcome measures at the 5-month follow-up interval for 77% (127 of 166) of patients. Injections of the extensor carpi radialis brevis tendon were conducted in an accurate and standardized way. The three groups did not differ in terms of key variables such as age, gender, duration of symptoms, smoking habits, pain medication, and physiotherapy use. Data were collected at baseline and 8 weeks, 5 months, and 1 year after treatment and compared among the groups. The primary endpoint was the VAS pain score with provocation at 5 months. Our secondary study outcomes were VAS pain scores during rest, after activity, and after maximum grip strength; functional recovery; and quality of life. Therefore, we report the VAS pain score (0 to 100, with higher scores representing more-severe pain, minimum clinically important difference [MCID] 10), OES (0 to 48, with higher scores representing more satisfactory joint function, MCID 10), QuickDASH (0 to 100, with higher scores representing more severe disability, MCID 5.3), PRTEE (0 to 100, with higher scores representing more pain or more disability, MCID 20), EQ-5D/QALY (EQ-5D sumscore 0 to 1, with the maximum score of 1 representing the best health state, MCID 0.04), and EQ-5D VAS (0 to 100, with higher scores representing the best health status, MCID 8). For analysis, one-way analysis of variance and a linear mixed-model analysis were used. The analyses were performed according to the intention-to-treat principle. Four patients from the perforation group opted to crossover to autologous blood after 5 months. RESULTS No injection therapy proved to be superior to any other in terms of VAS pain scores during the provocation test at 5 months of follow-up (VAS for perforation: 25 ± 31; autologous blood: 26 ± 27; dextrose: 29 ± 32; p = 0.35). For the secondary outcomes, only a clinically important difference was found for the QuickDASH score. Both the perforation-only group (-8 [98% CI -4 to -12]) and autologous blood (-7 points [98% CI -3 to -11]) had improved QuickDASH scores over time compared with the dextrose group (MCID 5.3; p < 0.01). For the other outcomes, no clinically important differences were found. CONCLUSION There is no benefit to injectable autologous blood and dextrose over perforation alone to treat lateral epicondylitis, and they are therefore not indicated for this condition. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
| | | | | | | | - Annechien Beumer
- Amphia, Orthopedics, Breda, the Netherlands
- Amsterdam UMC, Public and Occupational Health, Amsterdam, the Netherlands
| | | | | | | | - Denise Eygendaal
- Erasmus Medical Center, Orthopedics and Sports Medicine, Rotterdam, the Netherlands
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Ustabaşıoğlu F, Günay B, Samancı C, Emre Ustabaşıoğlu F. Assessment of common extensor tendon vascularization using superb microvascular imaging: a potential tool in the evaluation of extracorporeal shock wave therapy and therapeutic ultrasound effectiveness in lateral epicondylitis. Acta Radiol 2023; 64:2828-2835. [PMID: 37553907 DOI: 10.1177/02841851231191069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Lateral epicondylitis, also known as tennis elbow, is the most common elbow pain in the adult age group. PURPOSE To evaluate common extensor tendon (CET) vascularity with superb microvascular imaging (SMI) before and after extracorporeal shock wave therapy (ESWT) and ultrasound (US) treatment in patients with lateral epycondylitis and to compare the effects of two different treatments on tendon vascularity. MATERIAL AND METHODS Patients with lateral epycondylitis were divided into two groups; 30 patients were treated with ESWT (group 1) and 30 patients were treated with therapeutic US (group 2). We performed a high-frequency (14-MHz) linear array transducer to evaluate tendon anatomy and vascularity before and after treatment in both groups. RESULTS The decrease in Patient-Rated Tennis Elbow Evaluation (PRTEE) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). Likewise, the decrease in visual analog scale (VAS) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). A significant difference was found between the CET SMI values of group 1 and group 2 after treatment, according to the chi-square test (P < 0.001). In the post-treatment VAS and PRTEE comparison of both groups, the score reduction in group 1 was higher than in group 2, and this decrease was statistically significant (P < 0.001). CONCLUSION We can evaluate CET vascularization with the SMI method as a new potential diagnostic tool in comparing the effectiveness of different treatments in cases of lateral epicondylitis.
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Affiliation(s)
- Fatma Ustabaşıoğlu
- Department of Physical Medicine and Rehabilitation, Edirne Sultan 1st Murat State Hospital, Edirne, Turkey
| | - Burak Günay
- Department of Radiology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Cesur Samancı
- Department of Radiology, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Özcan F, Gürçay E. Is the information about lateral epicondylitis on the YouTube platform reliable and of good quality? PHYSICIAN SPORTSMED 2023; 51:458-462. [PMID: 36154542 DOI: 10.1080/00913847.2022.2129504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study aimed to investigate the quality and reliability of YouTube videos, as a source of lateral epicondylitis (LE). METHODS In this cross-sectional study, 484 videos were analyzed by searching the YouTube platform with the keyword 'lateral epicondylitis.' Journal of the Medical Association (JAMA) benchmark criteria, modified DISCERN and Global Quality Scale (GQS) were used for quality and reliability assessments. RESULTS A total of 298 videos were evaluated. High quality (GQS 4-5) was identified in 74 videos (24.8%), intermediate quality (GQS 3) in 84 videos (28.2%), and low quality (GQS 1-2) in 140 videos (47%). Of the videos, 57.7% (n = 41) uploaded by physician were of high quality. A significant difference was found between the low-intermediate-high-quality groups in terms of duration, number of views, number of likes, number of comments, likes per day, comments per day, video view ratio, JAMA score and modified DISCERN score (all p < 0.01). In videos uploaded by physicians; views, time since uploaded, JAMA score, modified DISCERN score, and GQS score were significantly higher than videos shared by trainers, health-related web sites, and independent users. The duration and viewing rates of the videos, the number of views, likes, comments, likes per day and comments per day were found to be significantly associated with JAMA, modified DISCERN, and GQS scores (p < 0.01). CONCLUSION About half of YouTube videos for LE were low quality. Most of the high-quality videos have been shared by physicians and these videos have been longer, more viewed, more liked and commented, and more reliable. Healthcare professionals should provide high-quality, unbiased, accurate and instructive information that is accessible to everyone on the YouTube platform.
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Affiliation(s)
- Fatma Özcan
- University of Health Sciences, Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Bilkent, Turkey
| | - Eda Gürçay
- University of Health Sciences, Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Bilkent, Turkey
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Michaud F, Pazos R, Lugrís U, Cuadrado J. The Use of Wearable Inertial Sensors and Workplace-Based Exercises to Reduce Lateral Epicondylitis in the Workstation of a Textile Logistics Center. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115116. [PMID: 37299843 DOI: 10.3390/s23115116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
People whose jobs involve repetitive motions of the wrist and forearm can suffer from lateral epicondylitis, which is a significant burden on both the individual and the employer due to treatment costs, reduced productivity, and work absenteeism. This paper describes an ergonomic intervention to reduce lateral epicondylitis in the workstation of a textile logistics center. The intervention includes workplace-based exercise programs, evaluation of risk factors, and movement correction. An injury- and subject-specific score was calculated from the motion captured with wearable inertial sensors at the workplace to evaluate the risk factors of 93 workers. Then, a new working movement was adapted to the workplace, which limited the observed risk factors and took into account the subject-specific physical abilities. The movement was taught to the workers during personalized sessions. The risk factors of 27 workers were evaluated again after the intervention to validate the effectiveness of the movement correction. In addition, active warm-up and stretching programs were introduced as part of the workday to promote muscle endurance and improve resistance to repetitive stress. The present strategy offered good results at low cost, without any physical modification of the workplace and without any detriment to productivity.
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Affiliation(s)
- Florian Michaud
- Laboratory of Mechanical Engineering, Campus Industrial de Ferrol, Universidade da Coruña, 15403 Ferrol, Spain
| | | | - Urbano Lugrís
- Laboratory of Mechanical Engineering, Campus Industrial de Ferrol, Universidade da Coruña, 15403 Ferrol, Spain
| | - Javier Cuadrado
- Laboratory of Mechanical Engineering, Campus Industrial de Ferrol, Universidade da Coruña, 15403 Ferrol, Spain
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Kim BS, Jung KJ, Lee C. Open procedure vs. arthroscopic débridement for chronic medial epicondylitis. J Shoulder Elbow Surg 2023; 32:340-347. [PMID: 36279988 DOI: 10.1016/j.jse.2022.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND This retrospective study compared the outcomes after open and arthroscopic treatment of chronic medial epicondylitis (ME). METHODS The study included 44 elbows in 38 patients: 25 (29-72 years) in the open group and 19 (27-70 years) in the arthroscopy group. The indications for ME surgery were failed conservative therapy for more than 3 months, symptom duration exceeding 6 months, and persistent severe pain. We used radiography, ultrasonography, and magnetic resonance imaging assessments. The clinical assessment included operating time, range of motion, grip strength, visual analog scale (VAS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complications. RESULTS The mean follow-up was 20.2 (12-58) months. The mean operating time was significantly longer in the arthroscopy group (32.5 vs. 23.5 minutes; P = .029). In both groups, all outcome measures improved significantly after surgery and there were no significant differences between the DASH scores (preoperative 44.8 vs. 43.9, postoperative 12.5 vs. 13.2), grip strength (preoperative 72.2 vs. 66.8, postoperative 84.8 vs. 83.6), and VAS scores (preoperative 8.5 vs. 8.2, postoperative 1.0 vs. 1.1) in the open and arthroscopy groups. The outcomes were excellent or good in 20 patients (80%) in the open group and 16 (84%) in the arthroscopy group. The only complication was 1 case of transient ulnar neuropathy in the open group. CONCLUSION Open and arthroscopic techniques were very effective and comparable for treating chronic ME. The surgeon can choose either technique for treating chronic ME.
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Affiliation(s)
- Byung-Sung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do, South Korea.
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do, South Korea
| | - Changeui Lee
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon-si, Gyeonggi-do, South Korea
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21
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Singh K, Hosseini N, Pooyan A, Zadeh FS, Chalian M. Imaging Tendon Disorders in Athletes. Clin Podiatr Med Surg 2023; 40:223-238. [PMID: 36368845 DOI: 10.1016/j.cpm.2022.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Imaging plays a critical role in evaluating pathology affecting athletes from various fields. Tendon pathology manifests in terms of mechanical, degenerative, enthesitis, neoplastic, and overuse diseases. Tendon pathologies in athletes usually involve injuries to commonly injured tendons such as the tendons involving the ankle, elbow, rotator cuff, hip abductors, patellar tendon, and Achilles tendon. For the purposes of this article, the focus will be on the tendons involving the ankle such as the tibialis posterior and peroneal tendons. The 2 most common imaging modalities used for the evaluation of tendons are ultrasound (US) and magnetic resonance imaging (MRI). There are several emerging imaging techniques such as T2 mapping, ultra-short echo time MRI, and sonoelastography. These novel imaging techniques are all in research phase and have not been adapted to routine clinical practice.
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Affiliation(s)
- Kanwardeep Singh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA
| | - Nastaran Hosseini
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/Nas_Hosseini
| | - Atefe Pooyan
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/AtefePooyan
| | - Firoozeh Shomal Zadeh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/FiroozehShomal
| | - Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA.
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22
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Oya-Casero A, Muñoz-Cruzado Barba M, Madera-García M, García-LLorent R, Andrade-Ortega JA, Cuesta-Vargas AI, Roldán-Jiménez C. Effect of Supervised over Self-Performed Eccentric Exercise on Lateral Elbow Tendinopathy: A Pilot Study. J Clin Med 2022; 11:jcm11247434. [PMID: 36556050 PMCID: PMC9782553 DOI: 10.3390/jcm11247434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The efficacy of eccentric exercise self-performed by the patient has not been proved in the treatment of lateral elbow tendinopathy (LET). The aim of this study was to compare the effects of a programme of eccentric exercises applied by a physiotherapist to patients with LET through a structured manual programme compared to its self-performance, guided by an illustrated brochure. Method: A single-blind, pilot, randomised, controlled trial was conducted. Twenty patients were randomised. The intervention group carried out eccentric exercises applied directly by a physiotherapist (10 sessions). The control group carried out eccentric exercises that were self-performed by the patient (10 sessions). Both groups received simulated ultrasounds. Pain (visual analogue scale (VAS)), function (DASH questionnaire) and satisfaction (with a Likert scale) were measured at the beginning of the intervention, immediately after the intervention and 3 months after the intervention. Results: The mean age was 53.17 and 54.25 years old. The experimental group presented a greater tendency to improve function (DASH −15.91) and reduce pain (VAS −2.88) compared to the control group, although these differences were not significant (p > 0.05). Conclusion: Eccentric exercise, both performed by the physiotherapist and self-performed by the patient, improved function and pain in the patients with LET.
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Affiliation(s)
- Antonio Oya-Casero
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
| | - Miguel Muñoz-Cruzado Barba
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
| | - Manuel Madera-García
- Unidad de Rehabilitación Puerta de Andalucía, Hospital Universitario de Jaén, 23007 Jaén, Spain
| | - Rosario García-LLorent
- Unidad de Rehabilitación Puerta de Andalucía, Hospital Universitario de Jaén, 23007 Jaén, Spain
| | | | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Plataforma BIONAND, Grupo de Clinimetría (F-14), 29071 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane, QLD 4000, Australia
| | - Cristina Roldán-Jiménez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucía Tech., Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Plataforma BIONAND, Grupo de Clinimetría (F-14), 29071 Málaga, Spain
- Correspondence:
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23
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Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy. BMC Musculoskelet Disord 2022; 23:803. [PMID: 35996100 PMCID: PMC9396854 DOI: 10.1186/s12891-022-05758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lateral epicondylitis is one of the most common upper extremity problems presented to orthopedic surgeons. Despite a rapid and accurate arrival at a diagnosis by clinical examination, there exists no consensus classification for this condition, which hampers clinical approaches for treatment of the disease based on its severity. Thus, the aim of this study was to propose and valiadate a new magnetic resonance imaging (MRI) classification of lateral epicondylitis, staging by tendinosis, the degree of thickness tears of the common extensor tendon (CET) and bone bruise lesion. METHOD MRI assessment of the elbow of 75 patients (57 women and 18 men; mean age:51.4 years (range,34-73) from Jan 2014 to Jan 2021 who were diagnosed with lateral epicondylitis were included in the study. MR images were reviewed retrospectively by two independent upper extremities orthopedists and one musculoskeletal radiologist. Inter- and intra-observer reliabilities for the classification were calculated using kappa statistics for the analysis of interrater agreement. Correlation between the stage of the disease and the duration of symptom before MRI was calculated using Kruskal-wallis test. RESULTS Various degrees of CET lesions were demonstrated in this population (Stage I-17, IIA-7, IIB-22 and III-29). Intra-observer agreements of MRI staging were substantial to satisfactory. Inter-observer agreements were moderate to substantial. There was no significant correlation between the disease stage and the patient age or the duration of symptom before MRI. CONCLUSION Our MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis. At the end, we have suggeted a clearer direction for understanding the disease pathology as well as an appropriate management protocol for each stage of the disease in line with the recent body of literature.
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Suzuki T, Hayakawa K, Nakane T, Fujita N. Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis. J Shoulder Elbow Surg 2022; 31:1581-1587. [PMID: 35247575 DOI: 10.1016/j.jse.2022.01.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The efficacy of platelet-rich plasma (PRP) for lateral epicondylitis has been demonstrated. However, the healing process monitored by repeated magnetic resonance imaging (MRI) is unclear. The purpose of this study was to evaluate sequential changes using MRI in patients with lateral epicondylitis treated by PRP injection at 6 follow-up visits over a 2-year period. METHODS Thirty patients who underwent PRP treatment for lateral epicondylitis and sequential MRI evaluation were prospectively enrolled. The MRI scores (ranging from 0 to 3) and clinical scores, including the visual analog scale (VAS) pain score and Patient-Rated Tennis Elbow Evaluation (PRTEE) score, were measured at baseline (before treatment) and 1, 3, 6, 12, 18, and 24 months after the procedure. Sequential changes in the MRI scores and clinical scores during the treatment period were evaluated. In addition, the associations between MRI scores and clinical scores were assessed. RESULTS The mean MRI score at baseline was 2.30, and the mean MRI scores at 1, 3, 6, 12, 18, and 24 months after the procedure were 1.97, 1.77, 1.13, 0.73, 0.60, and 0.33, respectively. Significant improvements in the MRI scores occurred by 3 months and continued over a period of 24 months. Regarding the clinical scores, the mean VAS pain scores were 72 at baseline, 48 at 1 month, 34 at 3 months, 28 at 6 months, 15 at 12 months, 14 at 18 months, and 11 at 24 months and the mean PRTEE scores were 56, 36, 26, 18, 8, 9, and 6, respectively. Significant improvements in the VAS pain score and PRTEE score occurred by 1 month and continued over a period of 12 months. There was little association between the MRI scores and clinical scores. CONCLUSIONS Continuous tendon recovery assessed by MRI was found during a 2-year period after PRP treatment. Improvements in the MRI scores followed and continued longer than improvements assessed by the clinical scores.
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Affiliation(s)
- Taku Suzuki
- Department of Orthopaedic Surgery, Aiko Orthopaedic Surgery Hospital, Nagoya, Aichi, Japan.
| | - Katsuhiko Hayakawa
- Department of Orthopaedic Surgery, Aiko Orthopaedic Surgery Hospital, Nagoya, Aichi, Japan
| | - Takashi Nakane
- Department of Orthopaedic Surgery, Aiko Orthopaedic Surgery Hospital, Nagoya, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
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25
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Li X, Zhao Y, Zhang Z, Zheng T, Li S, Yang G, Lu Y. Correlations of magnetic resonance imaging classifications with preoperative functions among patients with refractory lateral epicondylitis. BMC Musculoskelet Disord 2022; 23:690. [PMID: 35858883 PMCID: PMC9297620 DOI: 10.1186/s12891-022-05651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the correlations between three magnetic resonance imaging (MRI) classifications and preoperative function in patients with refractory lateral epicondylitis (LE). Methods We retrospectively reviewed patients with refractory LE who underwent arthroscopic treatment. Signal changes in the origin of the extensor carpi radialis brevis (ERCB) were evaluated based on three different MRI classification systems. Spearman’s rank correlation analysis was used to analyse the correlation between each MRI classification and the preoperative functional and visual analogue scale (VAS). The lateral collateral ligament complex (LCL) in all patients was evaluated using both MRI and arthroscopy. The Mann–Whitney U test was used for the comparison of preoperative VAS and all functional scores between patients with refractory LE combined with LCL lesions, and those without. Results There were 51 patients diagnosed with refractory LE between June 2014 to December 2020, all of whom were included in this study. The patients included 32 women and 19 men with a mean age of 49.1 ± 7.6 years (range, 39–60 years). The average duration of symptoms was 21.1 ± 21.2 months (range, 6–120 months). The intra-observer agreements for Steinborn et al.’s classification were 77.9%, 76.0%, and 76.7%, respectively. The inter-observer reliabilities of the three classifications were 0.734, 0.751, and 0.726, respectively. The average intra-observer agreement for the diagnosis of abnormal LCL signal was 89.9%, with an overall weighted kappa value of 0.904. The false-positive rate was 50%, and the false-negative rate was 48% for LCL evaluation on MRI. Spearman's rank correlation analysis did not find significant correlation between any of the three MRI classifications and preoperative VAS or any functional scores (all P > 0.05). There were no significant differences in the VAS and functional scores between patients with abnormal LCL signals on MRI and those without LCL lesions (all P > 0.05). Conclusions Preoperative MRI findings in patients with refractory LE cannot reflect the severity of functional deficiency. Preoperative MRI grading of the origin of the ERCB and preoperative MRI for LCL signal change cannot assist the surgical plan for the treatment of patients with refractory LE.
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Affiliation(s)
- Xu Li
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Yang Zhao
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Zhijun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Shangzhe Li
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Guang Yang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Yi Lu
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.
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Di Filippo L, Vincenzi S, Pennella D, Maselli F. Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews. Healthcare (Basel) 2022; 10:1095. [PMID: 35742152 PMCID: PMC9222841 DOI: 10.3390/healthcare10061095] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Lateral elbow pain (LEP) represents a musculoskeletal disorder affecting the epicondyloid region of the elbow. The terminological framework of this problem in literature, to date, is confusing. This systematic review (SR) aims to analyse the panorama of the scientific literature concerning the pathogenetic framework, treatment, and clinical diagnosis of LEP. Methods: We conducted an SR according to the guidelines of the PRISMA statement. We performed research using the electronic Medline, Epistemonikos, and Cochrane Library databases. The research started on 12 January 2022 and finished on 30 April 2022. We included all systematic reviews and meta-analyses published, in English, between 1989 and 2022. The articles’ selection was based on critical appraisal using Amstar 2. In the selected reviews we obtained the etiopathogenic terminology used to describe the symptoms, treatment, and diagnostic criteria of LEP. Results: Twenty-five SRs met the eligibility criteria and were included in the study. From these SRs, 227 RCT articles were analysed and different treatments proposals were extracted, such as exercise, manipulation corticosteroid injection, and surgery. In the selected articles, 10 different terms emerged to describe LEP and 12 different clinical tests. The most common treatments detected in this SR were a conservative multimodal approach (e.g., eccentric exercises, manual therapy, acupuncture, ultrasound), then surgery or other invasive treatments (e.g., corticosteroid injection, tenotomy). The most common term detected in this SR was “lateral epicondylitis” (n = 95, 51.6%), followed by “tennis elbow” (n = 51, 28.1%) and “lateral epicondylalgia” (n = 18, 9.4%). Among the diagnostic tests were painful palpation (n = 101, 46.8%), the Cozen test (n = 91, 42.1%), the pain-free grip-strength test (n = 41, 19.0%), and the Maudsley test (n = 48, 22.2%). A total of 43.1% of RCTs (n = 96) included subjects with LEP > 3 months, 40.2% (n = 85) included patients with LEP < 3 months, and 16.7% of the items (n = 35) were not specified by the inclusion criteria on the onset of symptoms. Conclusions: In this SR, a considerable terminological heterogeneity emerged in the description of LEP, associated with the lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain.
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Affiliation(s)
- Luigi Di Filippo
- Medicine Department, University of Rome “Tor Vergata”, 00133 Rome, Italy; (L.D.F.); (S.V.); (D.P.)
- FisioAnalysis Mædica, 15121 Alessandria, Italy
- Department Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Simone Vincenzi
- Medicine Department, University of Rome “Tor Vergata”, 00133 Rome, Italy; (L.D.F.); (S.V.); (D.P.)
- Department Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Centro Moove, 47042 Cesenatico, Italy
| | - Denis Pennella
- Medicine Department, University of Rome “Tor Vergata”, 00133 Rome, Italy; (L.D.F.); (S.V.); (D.P.)
- Department Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Manual Therapy Lab Clinic, 70123 Bari, Italy
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Filippo Maselli
- Department Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Manual Therapy Lab Clinic, 70123 Bari, Italy
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
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Klifto KM, Colbert SH, Richard MJ, Anakwenze OA, Ruch DS, Klifto CS. Platelet-rich plasma vs. corticosteroid injections for the treatment of recalcitrant lateral epicondylitis: a cost-effectiveness Markov decision analysis. J Shoulder Elbow Surg 2022; 31:991-1004. [PMID: 35031496 DOI: 10.1016/j.jse.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both platelet-rich plasma (PRP) and corticosteroid injections may be used to treat lateral epicondylitis. We evaluated the cost-effectiveness of PRP injections vs. corticosteroid injections for the treatment of recalcitrant lateral epicondylitis. METHODS Markov modeling was used to analyze the base-case 45-year-old patient with recalcitrant lateral epicondylitis, unresponsive to conservative measures, treated with a single injection of PRP or triamcinolone 40 mg/mL. Transition probabilities were derived from randomized controlled trials, quality-of-life (QOL) values from the Tufts University Cost-Effectiveness Analysis Registry reported using Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and costs from institution financial records. Analyses were performed from health care and societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICERs), reported as US dollars / quality-adjusted life-year (USDs/QALY) and net monetary benefit (NMB) to represent the values of an intervention in monetary terms. Willingness-to-pay thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed over 10,000 iterations. RESULTS Both PRP and triamcinolone 40-mg/mL injections were considered cost-effective interventions from a health care and societal perspective below the WTP threshold of $50,000. From a health care perspective, PRP injections were dominant compared with triamcinolone 40-mg/mL injections, with an ICER of -$5846.97/QALY. PRP injections provided an NMB of $217,863.98, whereas triamcinolone 40 mg/mL provided an NMB of $197,534.18. From a societal perspective, PRP injections were dominant compared to triamcinolone 40-mg/mL injections, with an ICER of -$9392.33/QALY. PRP injections provided an NMB of $214,820.16, whereas triamcinolone 40 mg/mL provided an NMB of $193,199.75. CONCLUSIONS Both PRP and triamcinolone 40-mg/mL injections provided cost-effective treatments from health care and societal perspectives. Overall, PRP injections were the dominant treatment, with the greatest NMB for recalcitrant lateral epicondylitis over the time horizon of 5 years.
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Affiliation(s)
- Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Stephen H Colbert
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Oke A Anakwenze
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
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Peng Y, Li X, Wu W, Ma H, Wang G, Jia S, Zheng C. Effect of Mechanical Stimulation Combined With Platelet-Rich Plasma on Healing of the Rotator Cuff in a Murine Model. Am J Sports Med 2022; 50:1358-1368. [PMID: 35188809 DOI: 10.1177/03635465211073339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mechanical stimulation and platelet-rich plasma (PRP) have been shown to be beneficial for healing of the bone-tendon interface (BTI), but few studies have explored the efficacy of a combination of these applications. We investigated the effect of mechanical stimulation combined with PRP on rotator cuff repair in mice. HYPOTHESIS Mechanical stimulation combined with PRP can enhance BTI healing in a murine model of rotator cuff repair. STUDY DESIGN Controlled laboratory study. METHODS A total of 160 C57BL/6 mice were used. Overall, 40 mice were used to prepare PRP, while 120 mice underwent acute supraspinatus tendon (SST) repair. The animals were randomly assigned to 4 groups: control group, mechanical stimulation group, PRP group, and mechanical stimulation combined with PRP group (combination group). At 4 and 8 weeks postoperatively, animals were sacrificed, the eyeballs were removed to collect blood, and the SST-humeral complexes were collected. Histological, biomechanical, immunological, and bone morphometric tests were performed. RESULTS Histologically, at 4 and 8 weeks after surgery, the area of the fibrocartilage layer at the BTI in the combination group was larger than in the other groups. The content and distribution of proteoglycans in this layer in the combination group were significantly greater than in the other groups. At 8 weeks postoperatively, trabecular number, and trabecular bone thickness of the subchondral bone area of interest at the BTI of the combination group were greater than those of the other groups, bone volume fraction of the combination group was greater than the control group. On biomechanical testing at 4 and 8 weeks after surgery, the failure load and ultimate strength of the SST-humeral complex in the combination group were higher than in the other groups. Enzyme-linked immunosorbent assay results showed that, at 4 weeks postoperatively, the serum concentrations of transforming growth factor beta 1 and platelet-derived growth factor (PDGF) in the combination group were significantly higher than in the other groups; at 8 weeks, the PDGF-AB concentration in the combination group was higher than in the control and mechanical stimulation groups. CONCLUSION Mechanical stimulation combined with PRP can effectively promote the early stage of healing after a rotator cuff injury. CLINICAL RELEVANCE These findings imply that mechanical stimulation combined with PRP can serve as a potential therapeutic strategy for rotator cuff healing.
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Affiliation(s)
- Yundong Peng
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Xiaomei Li
- College of Health Science, Wuhan Sports University, Wuhan, China.,Medical College, Huainan Union University, Huainan, China
| | - Wenxia Wu
- College of Health Science, Wuhan Sports University, Wuhan, China.,Department of Rehabilitation Therapy, Jinci College of Shanxi Medical University, Taiyuan, China
| | - Haozhe Ma
- College of International Education, Wuhan Sports University, Wuhan, China
| | - Guanglan Wang
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- Hubei Provincial Collaborative Innovation Center for Exercise and Health Promotion, College of Health Science, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Cho Y, Yeo J, Lee YS, Kim EJ, Nam D, Park YC, Ha IH, Lee YJ. Healthcare Utilization for Lateral Epicondylitis: A 9-Year Analysis of the 2010–2018 Health Insurance Review and Assessment Service National Patient Sample Data. Healthcare (Basel) 2022; 10:healthcare10040636. [PMID: 35455814 PMCID: PMC9030966 DOI: 10.3390/healthcare10040636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023] Open
Abstract
This retrospective cross-sectional study examined healthcare utilization among 213,025 patients with lateral epicondylitis over a nine-year period using the 2010–2018 Health Insurance Review and Assessment Service (HIRA) data (ICD code M771). Healthcare utilization, types of treatment, and the route of the visit were analyzed with frequency analysis for Western medicine (WM) and Korean medicine (KM). The findings revealed that the number of patients visiting WM and KM facilities for lateral epicondylitis rose every year from 2010 to 2018. Over this period, the age distribution of patients was 45–54 years (39.93%), 55–64 (23.12%), and 35–44 years (21.07%), and there were slightly more female patients (53.66%) than male patients (46.34%). The number of claims for lateral epicondylitis tended to increase with decreasing average monthly temperature; an increased proportion of middle-aged patients (45–64 years) was the most evident. The most frequently performed interventions in WM were subcutaneous or intramuscular injection (injection), deep heat therapy (physical therapy), and spinal peripheral nerve block-axillary nerve block (treatment/operation); the most frequently performed intervention in KM was acupuncture (injection). For pharmacological treatment, analgesics and anti-inflammatory medications were most frequently prescribed. The findings can be useful for health policymakers and as foundational data for clinicians and researchers.
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Affiliation(s)
- Yujin Cho
- Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea;
| | - Jiyoon Yeo
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
| | - Eun Jung Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju 13601, Korea;
| | - Dongwoo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea;
| | - Yeon-Cheol Park
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea;
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
- Correspondence:
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MRI of the Elbow: Interpretation of Common Orthopaedic Injuries. J Am Acad Orthop Surg 2022; 30:e573-e583. [PMID: 34979530 DOI: 10.5435/jaaos-d-21-00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023] Open
Abstract
MRI is a valuable diagnostic tool that has become an essential part of an orthopaedic surgeon's practice. When acquired in the appropriate clinical setting, an MRI can direct patient management as surgical versus nonsurgical, guide surgical decision making, and even predict patient outcomes. The quality of MRI obtained and quality of the radiology report received varies. Ultimately, the orthopaedic surgeon must interpret the available imaging and apply these findings to treat the patient. The current day practicing orthopaedic surgeon should be familiar with interpreting common MRIs. Although subspecialized orthopaedic surgeons usually have experience and understanding of MRIs in their field, the general orthopaedic surgeon and those in-training will encounter the gamut of musculoskeletal MRIs. This review focuses on common injuries that can occur in the elbow and provides an approach to minimize missed findings.
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Martins J, Neto IS, Gonçalves AF, Pereira A, Santiago M, Ferro I, Lopes T, Carvalho JL. Platelet-Rich Plasma Injection Associated With Microtenotomy in Lateral Epicondylitis – is a Tendon Tear Associated with the Therapeutic Response? Cureus 2022; 14:e22425. [PMID: 35371831 PMCID: PMC8941632 DOI: 10.7759/cureus.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029). Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.
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Kang KB, Cheon SH, Lee HD. Radiologic evaluation and clinical effect of calcification in medial epicondylitis. J Shoulder Elbow Surg 2022; 31:375-381. [PMID: 34610463 DOI: 10.1016/j.jse.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although most radiologic findings of medial epicondylitis (ME) are normal, up to 25% show calcification, and little is known about the clinical relevance of soft-tissue calcification in ME. The purposes of this study were to reveal the characteristics of calcification in ME and to identify their clinical relevance. METHODS This study included 187 patients (222 elbows) with a diagnosis of ME. We classified calcification according to its anatomic location and further evaluated its distribution. Logistic regression analysis was performed to calculate the odds ratios and 95% confidence intervals for possible factors that may affect calcification in ME: age, sex, laterality, hand dominance, visual analog scale (VAS) pain score, Mayo Elbow Performance Score, symptom duration, history of steroid injection, number of steroid injections, concomitant ulnar neuropathy, and treatment method in terms of conservative treatment or surgery. RESULTS Of a total of 222 elbows, 53% (118 of 222 elbows) showed calcification in radiologic findings. The VAS pain score, the number of steroid injections, and concomitant ulnar neuropathy were significantly associated with calcification in ME. Calcification was most commonly identified at the anatomic insertion site of the common flexor tendon (33%), followed by the pronator teres (18%) and the medial collateral ligament (10%). Of the total cases of calcification, 45% were distributed at multiple sites, and age was strongly associated with multiple-site distribution. CONCLUSIONS Calcification in ME was more commonly identified than previously reported and was distributed over a relatively broad area. Calcification was associated with a higher VAS pain score, a history of steroid injection, and combined ulnar neuropathy. The anatomic insertion site of the common flexor tendon most commonly showed calcification, and age was a strong indicator of a broad distribution of calcification.
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Affiliation(s)
- Kyu Bok Kang
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Republic of Korea
| | - Seung Hee Cheon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Republic of Korea
| | - Hee Dong Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Republic of Korea.
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3D isotropic spine echo MR imaging of elbow: How it helps surgical decisions. Eur J Radiol Open 2022; 9:100410. [PMID: 35281319 PMCID: PMC8904410 DOI: 10.1016/j.ejro.2022.100410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/01/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
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Sierra M SD, Garcia A DE, Otálora S, Arias-Castro MC, Gómez-Rodas A, Múnera M, Cifuentes CA. Assessment of a Robotic Walker in Older Adults With Parkinson's Disease in Daily Living Activities. Front Neurorobot 2022; 15:742281. [PMID: 34970132 PMCID: PMC8712754 DOI: 10.3389/fnbot.2021.742281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
The constant growth of the population with mobility impairments, such as older adults and people suffering from neurological pathologies like Parkinson's disease (PD), has encouraged the development of multiple devices for gait assistance. Robotic walkers have emerged, improving physical stability and balance and providing cognitive aid in rehabilitation scenarios. Different studies evaluated human gait behavior with passive and active walkers to understand such rehabilitation processes. However, there is no evidence in the literature of studies with robotic walkers in daily living scenarios with older adults with Parkinson's disease. This study presents the assessment of the AGoRA Smart Walker using Ramps Tests and Timed Up and Go Test (TUGT). Ten older adults participated in the study, four had PD, and the remaining six had underlying conditions and fractures. Each of them underwent a physical assessment (i.e., Senior Fitness, hip, and knee strength tests) and then interacted with the AGoRA SW. Kinematic and physical interaction data were collected through the AGoRA walker's sensory interface. It was found that for lower limb strength tests, older adults with PD had increases of at least 15% in all parameters assessed. For the Sit to Stand Test, the Parkinson's group evidenced an increase of 23%, while for the Chair Sit and Reach Test (CSRT), this same group was only 0.04 m away from reaching the target. For the Ramp Up Test (RUT), the subjects had to make a greater effort, and significant differences (p-value = 0.04) were evidenced in the force they applied to the device. For the Ramp Down Test (RDT), the Parkinson's group exhibited a decrease in torque, and there were statistically significant differences (p-value = 0.01) due to the increase in the complexity of the task. In the Timed Up and Go Test (TUGT), the subjects presented significant differences in torque (p-value of 0.05) but not in force (p-value of 0.22) due to the effect of the admittance controller implemented in the study. Finally, the results suggested that the walker, represents a valuable tool for assisting people with gait motor deficits in tasks that demanded more physical effort adapting its behavior to the specific needs of each user.
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Affiliation(s)
- Sergio D Sierra M
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Daniel E Garcia A
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Sophia Otálora
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | | | - Alejandro Gómez-Rodas
- Programa de Fisioterapia, Fundación Universitaria del Área Andina, Pereira, Colombia.,Programa Ciencias del Deporte y la Recreación, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Carlos A Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
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Jiang K, Li Y, Xiang C, Xiong Y, Jia J. TGF-β3 regulates adhesion formation through the JNK/c-Jun pathway during flexor tendon healing. BMC Musculoskelet Disord 2021; 22:843. [PMID: 34592976 PMCID: PMC8485513 DOI: 10.1186/s12891-021-04691-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The injured flexor tendon has poor healing ability, which is easy to cause tendon adhesion. It can affect the recovery of tendon function, which is still a long-term and difficult task for surgeons. Transforming growth factor β (TGF-β) has been widely considered to play an important role in flexor tendon repair in recent years. AIM This work was to investigate the anti-adhesion and anti-inflammatory effects of TGF-β3 on flexor digitorum longus (FDL) tendon repair rats. METHOD Anastomosis models of tendon laceration in the flexion toes of rats were delivered with no treatment, vehicle, or TGF-β3 -overexpressed adenovirus vector (ad-TGF-β3) locally to the injured tendon area from day 3 to 8. Subsequently, the expression of TGF-β3, TGF-β1/2, Smad3, Smad7, JNK, phosphorylation (p)-JNK, c-Jun, and phosphorylation (p)-c-Jun were detected by western blot, the expression of Mmp9 and Mmp2 by RT-qPCR, the Range of motion (ROM) and gliding resistance by adhesion formation testing, the mechanical strength of tendon healing by biomechanical testing, the pathologic changes of flexor tendon tissues by HE staining, the expression of collagen type III by immunohistochemical staining, and the levels of IL-6, TNF-α, COX2 and IL-1β in serum by ELISA, respectively. RESULTS Rat models treated with no treatment showed a lower elevation of TGF-β3 and Smad7 expression, and a higher elevation of TGF-β1/2 and Smad3 expression, during day 14 to day 28. Besides, under the treatment of ad-TGF-β3, a significantly increase was reflected in the expression of TGF-β3 and Smad7, ROM, as well as mechanical strength of flexor tendon, whereas significantly reduction was shown in gliding resistance, the content of inflammatory cytokines, the ratio of p-JNK/JNK, p-c-Jun/c-Jun, as well as the expression of TGF-β1/2, Smad3, Mmp9, and Mmp2 genes, as compared to those from vehicle treatment. Meanwhile, TGF-β3 demonstrated a better pathologic recovery process with no obvious necrosis or fracture of collagen fibers. Besides, TGF-β3 revealed a significant reduction of collagen type-III expression in the flexor tendon healing tissues. CONCLUSION These findings suggested that TGF-β3 effectively protected against flexor tendon injury via regulating adhesion formation.
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Affiliation(s)
- Ke Jiang
- Department of Orthopaedics, Affilliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, 637000, People's Republic of China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, 571199, People's Republic of China
| | - Yuling Li
- Department of Orthopaedics, Affilliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, 637000, People's Republic of China.
| | - Chao Xiang
- Department of Orthopaedics, Affilliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, 637000, People's Republic of China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jiameng Jia
- Department of Rehabilitation, Affilliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, People's Republic of China
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Bae KJ, Park C, Ahn JM, Kang Y, Gong HS. Magnetic resonance imaging evaluation of patients with clinically diagnosed medial Epicondylitis. Skeletal Radiol 2021; 50:1629-1636. [PMID: 33483771 DOI: 10.1007/s00256-021-03720-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We evaluated magnetic resonance imaging (MRI) findings in patients with clinically diagnosed medial epicondylitis (ME) and determined whether any of the MRI findings correlated with the follow-up pain level after nonoperative treatment. MATERIALS AND METHODS We retrospectively reviewed 83 patients who had undergone elbow MRI examinations for clinically diagnosed ME and who were followed-up for more than 6 months. Five categories of MRI findings were selected for qualitative grading: common flexor tendon (CFT) origin signal changes, ulnar collateral ligament (UCL) insufficiency, ulnar neuritis, bony changes of the medial epicondyle, and calcification. The mean follow-up after MRI examination was 21 months. We performed multivariate regression analysis to analyze whether any of these MRI findings were associated with the follow-up pain level after nonoperative treatment. RESULTS Positive MRI findings included CFT origin signal changes (66%), ulnar neuritis (40%), UCL insufficiency (30%), calcification (27%), and bony changes (18%). Multivariate analysis indicated that CFT origin signal changes were independently associated with the follow-up pain level (β = 3.387; p = 0.004). CONCLUSION In patients with clinically diagnosed ME, MRI demonstrated diverse abnormal findings in the CFT origin, ulnar collateral ligament, ulnar nerve, and bone. Among the findings, the severity CFT origin signal changes, which indicates the severity of tendon degeneration in ME, was associated with the follow-up pain level. This information can be helpful in consulting on the prognosis of nonoperative treatment in patients with clinically diagnosed ME.
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Affiliation(s)
- Kee Jeong Bae
- Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chulhee Park
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Gyeonggi-do, Seongnam-si, 463-707, South Korea.
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Kim YS, Kim ST, Lee KH, Ahn JM, Gong HS. Radiocapitellar incongruity of the radial head in magnetic resonance imaging correlates with pathologic changes of the lateral elbow stabilizers in lateral epicondylitis. PLoS One 2021; 16:e0254037. [PMID: 34234369 PMCID: PMC8263266 DOI: 10.1371/journal.pone.0254037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Post-traumatic posterolateral rotatory instability (PLRI) can be shown as radiocapitellar incongruity or posterior translation (PT) of the radial head in magnetic resonance imaging (MRI). We aimed to evaluate whether PT correlated with pathologic changes of lateral elbow stabilizers in patients with lateral epicondylitis. MATERIALS AND METHODS In MRIs of 160 patients with lateral epicondylitis, we measured PT of the radial head in the sagittal images. We qualitatively graded five lesions of the lateral elbow structures that included common extensor tendon (CET) lesion (grade 1-3), lateral collateral ligament complex (LCLC) insufficiency (grade 0-2), and absence or presence of bone marrow signal change, osteochondral lesion, and calcification. We analyzed whether the PT correlated with pathologic changes of the lateral elbow stabilizers and evaluated the diagnostic value of the PT for severe lesions. RESULTS The average PT was 1.9 mm. The PT correlated with both the CET lesion (p < 0.001) and LCLC insufficiency (p < 0.001). The optimal cutoff values of the PT for grade 3 CET lesion and grade 2 LCLC lesion were 2.6 and 2.8 mm, respectively. When potential PLRI was defined as the PT of > 3.4mm as suggested for post-traumatic PLRI, 21 patients had potential PLRI. The positive predictive values of the PT > 3.4mm were 76% for grade 3 CET lesions and 67% for grade 2 LCLC insufficiency. CONCLUSION This study demonstrates that PT of the radial head correlates with pathological changes of the lateral elbow stabilizers. As radiocapitellar incongruity is easy to measure quantitatively, it can be used for screening potential PLRI in patients with lateral epicondylitis.
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Affiliation(s)
- Yeun Soo Kim
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Sung Taeck Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyoung Hwan Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- * E-mail:
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Tomsan H, Grady MF, Ganley TJ, Nguyen JC. Pediatric Elbow: Development, Common Pathologies, and Imaging Considerations. Semin Roentgenol 2021; 56:245-265. [PMID: 34281678 DOI: 10.1053/j.ro.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hanna Tomsan
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA
| | - Matthew F Grady
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Theodore J Ganley
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jie C Nguyen
- University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.
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Patel V, Esfahani A, Ahmadi R, Forney M, Apiafi M, King D, Genin J. Interrater and Intrarater Reliability of Musculoskeletal Ultrasonographic Findings for the Common Extensor Tendon of the Elbow. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211005743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This retrospective case study evaluated the interrater and intrarater reliability of seven common extensor tendon pathologic features on musculoskeletal ultrasonography (MSK-US). Materials and Methods: A cohort of 50 patients were imaged due to presenting with atraumatic nonradicular lateral elbow pain. Three experienced and two novice readers rated the images on two separate occasions, and AC1 and kappa coefficients were calculated for each feature. Results: The interrater reliability was fair with respect to fascial thickening/scarring (AC1 = 0.26), tearing (AC1 = 0.35), tendon thickening (AC1 = 0.38), and intratendinous calcification (AC1 = 0.33); substantial for enthesophytes (AC1 = 0.80); and near complete for hyperemia (AC1 = 0.83) and hypoechogenicity (AC1 = 0.92). Intrarater reliability was moderate for fascial thickening/scarring (κ = 0.48), tearing (κ = 0.41), tendon thickening (0.47), intratendinous calcification (κ = 0.56), and hypoechogenicity (κ = 0.47); substantial for hyperemia (κ = 0.71); and almost perfect for enthesophytes (κ = 0.86). Conclusion: MSK-US may be a reliable tool to determine soft tissue changes in common extensor tendon pathology.
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Affiliation(s)
- Vikas Patel
- Cleveland Clinic Sports Medicine, Cleveland, OH, USA
| | - Ali Esfahani
- Cleveland Clinic Sports Medicine, Cleveland, OH, USA
| | | | | | | | - Dominic King
- Cleveland Clinic Sports Medicine, Cleveland, OH, USA
| | - Jason Genin
- Cleveland Clinic Sports Medicine, Cleveland, OH, USA
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Park H, Hahn S, Yi J, Bang JY, Kim Y, Jung HK, Baik J. Clinical Assessments and MRI Findings Suggesting Early Surgical Treatment for Patients with Medial Epicondylitis. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:613-625. [PMID: 36238785 PMCID: PMC9432437 DOI: 10.3348/jksr.2020.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/04/2020] [Indexed: 06/16/2023]
Abstract
Purpose To evaluate the MRI findings and clinical factors that are characteristic of patients who ultimately undergo surgery for medial epicondylitis. Materials and Methods Fifty-two consecutive patients who were diagnosed with medial epicondylitis and underwent an elbow MRI between March 2010 and December 2018 were included in this retrospective study. The patients' demographic information, clinical data, and MRI findings were evaluated. All variables were compared between the conservative treatment and surgical treatment groups. Logistic regression analyses were conducted to identify which factors were associated with surgical treatment. Results Common flexor tear (CFT) tear size showed a statistically significant difference in both the transverse and longitudinal planes (p < 0.001, p = 0.013). The CFT abnormality grade significantly differed in both the transverse and longitudinal planes (p = 0.022, p = 0.003). A significant difference was also found in the medial collateral ligament abnormality (p = 0.025). Logistic regression analyses showed that only the transverse diameter of the CFT tear size (odds ratio: 1.864; 95% confidence interval: 1.264-2.750) was correlated with surgical treatment. Conclusion Of patients diagnosed with medial epicondylitis, patients with a larger transverse CFT tear size tend to undergo surgical treatment ultimately.
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Yang YP, Yuan S, Cui GQ, An N, Ao YF. Extracapsular subcutaneous endoscopic treatment for refractory lateral epicondylalgia: technique, retrospective results, and prognostic factors. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:782. [PMID: 34268395 PMCID: PMC8246197 DOI: 10.21037/atm-20-6799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/26/2021] [Indexed: 12/03/2022]
Abstract
Background The extracapsular subcutaneous endoscopic treatment is a new and under-researched approach to the endoscopic treatment of refractory lateral epicondylalgia. We aimed to introduce the techniques of the method and the mid-long term clinical effects. Furthermore, we intended to identify demographic and surgical-related factors correlated with prognosis of extracapsular subcutaneous method. Methods Patients with a minimum of 6 months of conservative treatment for lateral epicondylalgia were recruited from March 2012 to July 2018. Key surgical techniques including microfracture and endoscopic suture were used. Visual analog scale (VAS), Mayo Elbow Performance Score (MEPS), and Disability of Arm (Shoulder and Hand, DASH) scores were used to evaluate clinical results. Univariable analysis and multivariable logistic regression were used to analyze effects of demographic characteristics and treatment techniques on prognosis. Results Seventy-eight patients were treated with modified subcutaneous extracapsular surgery. No serious complications such as neurovascular injury or infection occurred. Postoperative VAS, MEPS, and DASH scores significantly improved (P<0.001). Age was associated with prognosis regarding VAS score (P=0.023). Older age was an independent relevant factor for poor prognosis regarding VAS score (OR =0.914, 95% CI: 0.842–0.993, P=0.033), and microfracture during surgery related to poor prognosis for DASH score (OR =0.056, 95% CI: 0.004–0.783, P=0.032). Plaster fixation was an independent factor related to good prognosis regarding DASH score (OR =11.156, 95% CI: 1.009–123.363, P=0.049). Conclusions Extracapsular subcutaneous method of refractory lateral epicondylalgia has satisfactory and stable clinical results with high safety. Techniques of extracapsular method include debridement, microfracture, and tendon suture under endoscope. Young age, no microfracture, and postoperative plaster fixation were associated with good long-term prognosis.
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Affiliation(s)
- Yu-Ping Yang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Shuo Yuan
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Guo-Qing Cui
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Ning An
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Ying-Fang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Leschinger T, Tischer T, Doepfer AK, Glanzmann M, Hackl M, Lehmann L, Müller L, Reuter S, Siebenlist S, Theermann R, Wörtler K, Banerjee M. Epicondylopathia humeri radialis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:329-340. [PMID: 33851405 DOI: 10.1055/a-1340-0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options - with varying levels of evidence. METHOD The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 - 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process. OUTCOMES Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure. CONCLUSION This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.
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Affiliation(s)
- Tim Leschinger
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Thomas Tischer
- Rostock University Medical Centre, Department of Orthopaedics, Rostock, Germany
| | | | | | - Michael Hackl
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Lars Lehmann
- Department of Trauma and Hand Surgery, ViDia Christliche Kliniken Karlsruhe, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Lars Müller
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Sven Reuter
- SRH Hochschule für Gesundheit, Campus Stuttgart, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralf Theermann
- Joint Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| | - Klaus Wörtler
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marc Banerjee
- Mediapark Klinik, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany
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Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, Tsepis E, Gioftsos G. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review. J Hand Ther 2021; 35:541-551. [PMID: 33814224 DOI: 10.1016/j.jht.2021.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. PURPOSE To review the diagnostic accuracy of examination tests used in LET. DESIGN Systematic review following PRISMA-DTA guidelines. METHODS We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. RESULTS Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). CONCLUSIONS Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020160402.
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Affiliation(s)
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | - Eleni Drakonaki
- Medical School of the European University Cyprus, Engomi, Nicosia Cyprus
| | - Klaudia Koci
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | | | - Elias Tsepis
- Physiotherapy Department, University of Patras, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Egaleo, Greece
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Bang JY, Hahn S, Yi J, Lim YJ, Jung HK. Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis. Eur Radiol 2021; 31:6726-6735. [PMID: 33634322 DOI: 10.1007/s00330-021-07791-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/26/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE). METHODS GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features. RESULTS Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV. CONCLUSIONS SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis. KEY POINTS • Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis. • There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.
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Affiliation(s)
- Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Hyun Kyung Jung
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
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Herald J, Ashraf M, Sundar MS, Rajan DV. Lateral Epicondylitis-Narrative Review on Surgical Options for Recalcitrant Cases. Indian J Orthop 2021; 55:318-324. [PMID: 33927809 PMCID: PMC8046873 DOI: 10.1007/s43465-021-00364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/20/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Lateral epicondylitis or lateral elbow tendinopathy is a common condition which needs to be addressed appropriately. This condition usually responds well to non-operative treatment. However, an orthopaedic physician needs to be aware of the recalcitrant cases and equip surgical armamentarium to provide adequate care. METHODOLOGY The literature search was performed on PubMed, Medline and Google scholar using the keywords Tennis elbow, recalcitrant, thorntons technique, surgical options, for this narrative review. CONCLUSION This article focuses on the causes for recalcitrant tendinopathy and review of its surgical options.
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Affiliation(s)
| | - Munis Ashraf
- Ortho One Orthopaedic Speciality Center, Coimbatore, India
| | | | - David V. Rajan
- Ortho One Orthopaedic Speciality Center, Coimbatore, India
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El-Badawy MA, El-Nagaar HA, Mohammed MM, Assaf NY, EL-Mallah RMEED. Musculoskeletal ultrasonographic evaluation of perineural injection therapy versus therapeutic ultrasound in chronic lateral epicondylitis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-020-00050-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lateral epicondylitis (LE) is a common disorder causing pain and functional limitations especially in athletes and manual workers. There is a growing interest in regenerative injection therapies in chronic LE. One of those suggested is perineural injection (PNI) therapy. The present study aims to find out the efficacy of PNI therapy in the treatment of chronic LE as compared to therapeutic ultrasound (TUS) and to detect if any changes have happened after treatment to the common extensor tendon (CEO) as detected by diagnostic ultrasound (US) examination.
Results
Statistical analysis between the 2 groups at the start of the study as regards age, sex, and clinical parameters including visual analog scale (VAS), tenderness grading scale, and Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire revealed a non-significant difference between both groups (p > 0.05). After 12 weeks, within-group analysis showed significant improvement in all clinical outcome measures in both groups compared to the initial assessment.
Between-group analysis after 12 weeks showed that the tenderness grading scale and PRTEE score had more significant improvement in the PNI therapy group. However, the two groups were comparable regarding VAS. Within-group US evaluation at the 12th week post-treatment showed a highly significant decrease in hypoechoic areas (p < 0.001) and a decrease in distributed fibrillar pattern in PNI group, while the TUS group demonstrated a significant decrease in hypoechoic areas and tendon thickness (p < 0.005). Between-group US evaluation after 12 weeks showed no significant difference in all assessed US parameters. No complications were observed in both groups.
Conclusions
A short-term follow-up regimen of 1 session/week of PNI therapy is significantly more effective than 3 sessions/week of TUS regarding the improvement of pain and functional status. Yet both therapeutic modalities were able to produce significantly positive structural changes in the CEO. The current study highlights the neurogenic inflammation as the primary pain generator in chronic LE and the advantage of its treatment with PNI therapy in chronic and refractory cases.
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Curti S, Mattioli S, Bonfiglioli R, Farioli A, Violante FS. Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis. J Occup Health 2021; 63:e12186. [PMID: 33534951 PMCID: PMC7857538 DOI: 10.1002/1348-9585.12186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis. METHODS We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship. RESULTS We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed. CONCLUSIONS There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.
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Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Francesco S. Violante
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
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Leochico CD, Calupitan R, Senolos G, Rey-Matias R. The effectiveness of hyaluronic acid injection in the treatment of lateral epicondylitis among adults: A systematic review. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dixit A, Dandu N, Hadley CJ, Nazarian LN, Cohen SB, Ciccotti M. Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Elbow Sports Injuries. JBJS Rev 2020; 8:e19.00219. [PMID: 33186208 DOI: 10.2106/jbjs.rvw.19.00219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Ultrasonography is a valuable diagnostic imaging tool because of its availability, tolerability, low cost, and utility in real-time dynamic evaluation. Its use in diagnosing elbow injuries has expanded recently and continues to do so. In particular, stress ultrasonography represents a unique imaging technique that directly visualizes the ulnar collateral ligament (UCL) and allows the assessment of ligament laxity, offering an advantage over magnetic resonance imaging and magnetic resonance arthrography in this patient population. Furthermore, ultrasonography has shown particular usefulness in instances where invasive techniques might be less desirable. This is particularly important in athletes since more invasive procedures potentially result in lost time from their sport. Ultrasonography is an important imaging tool that complements a thorough history and physical examination in the evaluation of elbow injuries in athletes. The use of ultrasonography in orthopaedic sports medicine has been investigated previously; however, to our knowledge, there has been no comprehensive review regarding the utility of ultrasonography for common elbow injuries in athletes. The current study provides a comprehensive, detailed review of the utility and indications for the use of ultrasonography for common elbow injuries in athletes.
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Affiliation(s)
- Anant Dixit
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Pasadena, California
| | - Navya Dandu
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Christopher J Hadley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Levon N Nazarian
- Thomas Jefferson University Hospital at Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Steven B Cohen
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Ismael MMM, Arafa MM, El Zohiery AAK, Ibrahim SE. Comparative effectiveness of extracorporeal shock wave therapy, local corticosteroid injection, and conventional physiotherapy in treatment of chronic lateral epicondylitis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lateral epicondylitis (LE) is a popular overuse syndrome involving the forearm’s extensor tendons. Corticosteroid (CS) injection is the popular injection used for management of LE. Extracorporeal shockwave therapy (ESWT) is a noninvasive alternative inducing the neovascularization, tendon repairing, and decreasing pain. Our study aimed to compare the effectiveness of ESWT versus local CS injection versus conventional physiotherapy (PT) in management of chronic LE.
Results
Our results revealed that the three groups displayed a significant decrease of VAS score, decrease of PRTEE score, and increase of grip strength compared to baseline (P < 0.05) at 4 weeks and 12 weeks of follow-up. However, there was a significant decrease of VAS score in ESWT and CS groups more than PT group at 4 weeks follow-up (P < 0.05) while ESWT group displayed a considerable improvement in functional disability score (decrease in PRTEE score) more than CS and PT groups at 4 and 12 weeks of follow-up (P < 0.05), with no considerable change in HGS between the three groups.
Conclusion
ESWT, local CS injection, and conventional PT were efficient in management of chronic LE at 12 weeks of follow-up but ESWT had a higher effect decreasing pain and improving functional disability in daily life activity at short and long term follow-up.
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