A Novel Modification of Anconeus Muscle Flap for Extensor Digitorum Communis-Selective Lateral Epicondylitis: Preliminary Clinical Study

Background: Whether the use of platelet-rich plasma (PRP) as an adjuvant to extensor carpi radialis brevis (ECRB) repair in recalcitrant lateral epicondylitis (RLE) promotes tendon healing and improves clinical outcomes remains unclear. Purpose: To evaluate the tendon healing and clinical outcomes of arthroscopic ECRB repair combined with PRP injection and compared with arthroscopic ECRB repair alone at early-term follow-up in patients with RLE. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 80 patients with RLE were enrolled and randomized to the PRP group (arthroscopic ECRB repair followed by 1 PRP injection; n = 40) and the control group (arthroscopic ECRB repair alone; n = 40). Magnetic resonance imaging was performed to assess tendon healing at 3, 6, and 12 months. The visual analog scale (VAS) for pain, the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, range of motion, and muscle strength were evaluated at preoperative and follow-up points. The time to return to work was also compared between the 2 groups. Patients and assessors were blinded to the intervention. Results: A total of 80 patients who met the inclusion criteria were enrolled between July 2020 and July 2023, and 73 patients completed follow-up. The PRP group contained 35 patients, 11 men and 24 women, with a mean age of 47.8 ± 8.8 years. The control group contained 38 patients, 13 men and 25 women, with a mean age of 44.5 ± 5.8 years. No significant differences were found in magnetic resonance imaging classification and functional scores between groups at preoperative and follow-up periods. VAS, MEPS, DASH, and PRTEE scores and muscle strength showed significant improvement at 12 months in both groups (P < .001). However, the PRP group showed a significant improvement in grip and wrist extension muscle strength at 6 weeks postoperatively (P = .008 and P < .001, respectively), whereas the control group did not (P = .583 and .056). No complications were associated with PRP injection. Conclusion: PRP used as an adjuvant to ECRB repair did not show a difference in tendon healing and functional outcomes compared with ECRB repair alone for RLE at 12-month follow-up. However, PRP treatment showed a difference in muscle strength at 6-week follow-up compared with ECRB repair alone. Registration: NCT04556825 (ClinicalTrials.gov).

This study investigates the effect of partial common extensor tendon tears on demographic, clinical and ultrasound parameters in patients with lateral epicondylitis. The research aimed to provide a comprehensive understanding of how these ultrasound-detected partial tears influence the clinical presentation and imaging findings associated with lateral epicondylitis. This is a retrospective cross-sectional study. Records of 227 patients with lateral epicondylitis met the inclusion-exclusion criteria were reviewed. The patient-rated tennis elbow evaluation questionnaire was used as the primary outcome measure. Secondary outcome measures were visual analog scale for pain, algometric measurements, hand grip strength, and ultrasound parameters (maximum tendon thickness measurements from the capitellar-radiocapitellar sides and presence of bone abnormalities). Partial common extensor tendon tears detected using ultrasound were present in 22.7% ( n = 54) of the patients. Patients with partial common extensor tendon tears were older (50,31 ± 9,22), had higher patient-rated tennis elbow evaluation scores (65,48 ± 12,76), capitellar-radiocapitellar maximum tendon thickness measurements (0,60 ± 0,80/0,60 ± 0,72), and incidence of bone abnormalities (40.7%, n = 32) ( P < 0.05). Logistic regression analysis identified age and patient-rated tennis elbow evaluation pain score as associative factors with partial common extensor tendon tears. Capitellar-radiocapitellar maximum tendon thickness measurements greater than 0.55 cm were associated with an increased probability of partial common extensor tendon tears. Ultrasound-detected partial common extensor tendon tears may worsen the clinical and ultrasound parameters in patients with lateral epicondylitis. Older age, higher patient-rated tennis elbow evaluation scores, and higher maximum tendon thickness measurements were associated with partial common extensor tendon tears.

BACKGROUND We assessed the treatment outcomes of patients assigned by sequential randomization to 3 groups: epicondylitis bandaging, wrist dorsiflexion splinting, and kinesio taping. MATERIAL AND METHODS Fifty-four patients diagnosed with lateral epicondylitis were included in the study and randomly divided into 3 groups (n=18): epicondylitis bandage, wrist dorsiflexion splint, and kinesio tape. Patients were evaluated using a visual analog score (VAS), Disabilities of the Arm, Shoulder (DASH) score, PRTEE (Patient-Rated Tennis Elbow Evaluation) score, and hand grip strength at baseline and at 3 and 6 weeks. RESULTS Lateral epicondylitis was diagnosed in the right elbow in 40 patients and the left elbow in 14 patients. Lateral epicondylitis was on the dominant side in 39 patients and on the opposite side in 15. When the VAS, PRTEE, DASH, and wrist grip strengths of the patients who used epicondylitis bandage, wrist dorsiflexion splint, and kinesio tape in the treatment were compared, no significant difference was found between the results before treatment and at 3 and 6 weeks after treatment. CONCLUSIONS We found no significant differences between conservative treatment of lateral epicondylitis via epicondylitis bandage, wrist dorsiflexion splint, and kinesio tape at baseline and at 3 and 6 weeks after treatment as assessed by VAS, DASH score, PRTEE score, and hand grip strength.

Background: Lateral epicondylitis is a serious condition affecting 1 to 3% of adult population between the age group of 30 to 50 year old. This group represents the working force and tennis elbow causes debilitating pain and patients are unable to perform the affected limb functions of lifting or holding anything. The main cause for tennis elbow is the tendinopathy of the extensor carpi radialis brevis muscle (ECRB). There are multiple treatment measures to relieve the pain and bring back the function of the limb to normalcy as early as possible. The elbow brace is used to reduce the expansion of the ECRB and thereby reducing the symptoms of tennis elbow. It was hypothesized that wrist splints would reduce the activation of the ECRB muscle and thereby will reduce the symptoms of the tennis elbow. Streek et al performed a study using the wrist splint with 20-30 degrees extension and mentioned in limitations the changing the degree of extension may improve outcomes as compared to elbow braces. On that hypothesis we used a brace with only 5-10 degrees of extension. Aims: 1) To study the symptomatic and functional outcome of the elbow brace. 2) To study the symptomatic and functional outcome of the wrist splint. 3) To compare the symptomatic and functional outcomes between the wrist splint and the elbow brace. Material &amp; Methods: The patients included in the study were divided into Group A receiving the wrist splint and group B elbow brace. The patient rated tennis elbow evaluation score (PRTEE), grip strength and pain visual assisted (VAS) score on the day of enrolment and 6 weeks after using either the elbow brace or wrist splint was noted. We used Mann-Whitney U test to calculate P-value intergroup and for P-value intra-group we used Wilcoxon’s signed rank test. Result: Group A distribution of median 6 weeks PRTEE score improved significantly compared to median baseline PRTEE score (P-value&lt;0.001). The VAS score, grip strength and improvement in PRTEE score at 6 weeks is relatively better in Group A compared to Group B, however the difference did not reach statistical significance (P-value&gt;0.05).Conclusion: The use of wrist splint significantly improved the symptoms of the tennis elbow. The outcome is comparable to use of tennis elbow brace. The outcome is not statistically significant if compared between the two groups.

Background:The effectiveness of platelet-rich plasma (PRP) injection in the treatment of lateral epicondylitis remains debatable.Purpose:To evaluate the effectiveness of PRP in lateral epicondylitis treatment using minimal clinically important difference (MCID) values as a reference and to investigate if leukocyte content can influence the effectiveness of the therapy.Study Design:Systematic review; Level of evidence, 4.Methods:Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the Medline and Scopus databases for studies on lateral epicondylitis and PRP therapy that used the following patient-reported outcome measures (PROMs): visual analog scale (VAS) for pain; Disabilities of the Arm, Shoulder and Hand (DASH); Patient-Rated Tennis Elbow Evaluation (PRTEE); and Mayo Clinic Performance Index (MAYO). The weighted arithmetic means for the PROMs were calculated at baseline (week 0) and follow-up weeks 4, 8, 12, 24, 52, and 104. The mean differences in outcomes (ΔVAS, ΔDASH, ΔPRTEE, and ΔMAYO) were compared with the MCID values at each follow-up point. In addition, the effectiveness of leukocyte-rich PRP (LR-PRP) versus leukocyte-poor PRP (LP-PRP) was also compared. The Student t test was used in all analyses.Results:A total of 26 studies were included in the analysis. After PRP injection, all PROM scores improved with time. The scores improved significantly from baseline to each follow-up time (P < .0001), with the exception of the PRTEE (no significant difference at follow-up weeks 12 and 52). The mean difference in scores from baseline exceeded the respective MCIDs from weeks 4 to 104 for the VAS and DASH, from weeks 4 to 52 for the MAYO, and from weeks 8 to 52 for the PRTEE. The MCID for each of the PROMs was exceeded at almost every observation period in both the LR-PRP and the LP-PRP systems.Conclusion:Based on comparisons with the MCID values of commonly used outcome scores, PRP seems to be an effective form of treatment for lateral epicondylitis. Both the LR- PRP and the LP- PRP systems were effective in the context of meeting the MCID.

Introduction The Patient-rated Tennis Elbow Evaluation (PRTEE) enables quantitative rating by the patient of pain and functional impairment associated with tennis elbow or lateral elbow tendinopathy. When used as an outcome measure in trials of therapies, a minimum clinically important difference (MCID) value is required to interpret trial outcomes. This study aimed to calculate the MCID for a sample of patients diagnosed with lateral elbow tendinopathy (LET). Methods The PRTEE was used as an outcome measure with participants in a trial of a novel therapy for LET. It was administered at baseline and after treatment, three weeks later. Score changes were compared with patient-rated global change scores using receiver operating curve analysis. MCID values were calculated for two different criteria of clinically important difference and the effects of baseline symptom severity on the MCID were investigated. Results Data were available from 57 participants, with PRTEE scores in the range 13–81/100. For clinical significance defined as ‘a little better’ the MCID for the total PRTEE score was 7/100 or 22% of baseline score. For clinical significance defined as ‘much better’ or ‘completely recovered’, the MCID was 11/100 or 37% of baseline score. The MCID value was higher for a subgroup with greater baseline severity. Conclusions Substantial changes in the PRTEE scores are required before they can be considered clinically significant. Clinically significant change varies according to the baseline score. The instrument may be less sensitive to change when used by people who are symptomatic in their non-dominant arm.

Objective: The aim of the study was to evaluate the efficacy of local injection of platelet rich plasma in management of patients with tennis elbow who failed to respond to conservative management. Methods: This was a prospective and cohort study in which 80 patients with lateral epicondylitis (Tennis elbow) were included on the basis of a predefined inclusion and exclusion criteria. Demographic details were noted. Patients were treated by local injection of autologous platelet rich plasma. Patients were followed up for 6 months. Relief of pain as well as functional improvement was assessed by patient-rated tennis elbow evaluation (PRTEE) score. SSPS 21.0 software was used for statistical analysis and p&lt;0.05 was taken as statistically significant. Results: Out of 80 studied cases, there were 36 (45%) males and 44 (55%) females with a M: F ratio of 1:1.22. The mean age of male (42.77±9.95 years) as well as female (41.06±9.56 years) was found to be comparable. Nineteen (23.75%) patients were involved in plumbing, 16 (20%) patients were involved in activities that required forceful use of screwdrivers such as electric work, 8 (10%) patients were involved in gardening, and 7 (8.75%) patients were involved in production or laying of bricks. Twelve (15%) patients were professional tennis player. The mean PRTEE score was 74.24±9.74 at the time of presentation. There was significant reduction in PRTEE score during follow-up and at the time of last follow-up visit, PRTEE score was found to be 8.32±2.56. Conclusion: Local injection of autologous platelet rich plasma is effective in managing patients of lateral epicondylitis (Tennis elbow) who fail to respond to conservative management.

To evaluate and compare the effects of radial and focused types of extracorporeal shock wave therapy (ESWT) on lateral epicondylitis. A randomised sham-controlled trial. Place and Duration of the Study: Department of Sports Medicine, Yuzuncu Yil University Hospital, Van, Turkiye, from August 2019 to April 2020. Patients with acute lateral epicondylitis were randomised into focused, radial, and sham ESWT groups. The ESWT was applied for three sessions at 2-4 days intervals. All the subjects were evaluated at baseline (week 0), week 5, and 13. Patient-rated tennis elbow evaluation (PRTEE) scores were used as outcome measures. At weeks 5 and 13, all PRTEE scores (pain, function, and total) were remarkably improved in the focused and radial groups (p<0.001), but not in the sham group (p>0.05). Focused ESWT was superior to radial ESWT for the change of pain scores from baseline to week 5 (18.8±13.9 vs. 11.8±9.1; p=0.026) and week 13 (17.8±13.1 vs. 11.7±10.5, p=0.084). Focused ESWT was more effective than radial ESWT for the change of function scores from baseline to weak 5 (17.9±12.5 vs. 11.2±9.5; p=0.025) and week 13 (16.9±11.6 vs. 10.7±10.1; p=0.032). Focused ESWT was superior to radial ESWT for the change of total scores from baseline to week 5 (36.7±25.9 vs. 23.0±17.2; p=0.021) and week 13 (34.7±24.3 vs. 22.4±18.5; p=0.044). Focused and radial ESWT are effective in lateral epicondylitis. The focused ESWT is superior to the radial ESWT. Thus, focused ESWT should be preferred in lateral epicondylitis. Lateral epicondylitis, Shock wave, Randomised sham-controlled trial.

Results of Platelet-Rich Plasma (PRP) Applications for Chronic Lateral Elbow Epicondylitis That are Resistantto Corticosteroid Injections.Aim: The main goal of the study is to present 1-year follow-up results of patients with chronic lateralepicondylitis that are resistant to corticosteroid injections in whom we applied platelet rich plasma (PRP).Material and Methods: We applied PRP once to the patients who did not benefit from corticosteroid injections.We prospectively evaluated patients between 2010 and 2012. We evaluated patients with visual analog score(VAS) and patient rated tennis elbow evaluation (PRTEE) score at the pre-treatment once, post-treatment1st, 3rd, 6th and 12th month follow-ups. Results: Nine patients were female, three was male. The mean ageof patients was 48.6. The average pre-treatment VAS and PRTEE scores were 8.7 and 83 respectively. Theaverage VAS scores improved to 6.6, 3.8, 1.85, 1.47 at the post-treatment 1st, 3rd, 6th, and 12th month followups respectively. The average PRTEE scores improved to 61.3, 34.9, 19.8, 17.9 at the post-treatment 1st, 3rd,6th and 12th month follow-ups respectively. At the 12th month follow-up, six patients rated their treatmentas excellent, five as good, and one as poor. Discussion: There are promising results in the literature regardingPRP applications for lateral epicondylitis, plantar fasciitis, and chondral lesions. In this study, we observedthat pain and function scores of patients that are resistant to corticosteroid injections improved after PRPapplication

Lateral epicondylitis (LE) is a musculoskeletal disorder characterized by pain around the lateral epicondyle. Posterior interosseous nerve syndrome (PINS), a rare neuropathy caused by radial nerve compression, can mimic or coexist with LE, complicating diagnosis. This study aimed to evaluate the electrophysiological presence of PINS in LE and determine its impact on symptoms. This prospective study included 62 patients diagnosed with LE and 54 healthy controls. Electrophysiological examinations were performed on all patients in the LE group to investigate the presence of PINS. Subsequently, PINS-positive and PINS-negative patients within the LE group underwent a detailed clinical evaluation, including provocative tests, joint range of motion (ROM), hand grip strength, and symptom scoring using the Visual Analog Scale (VAS) and Patient-Rated Tennis Elbow Evaluation (PRTEE). PINS was identified in 19.4% of LE patients and 1.9% of controls (p < 0.05). There were no significant differences between PINS-positive and PINS-negative patients in the LE group regarding provocative tests, joint ROM, grip strength, VAS, or PRTEE scores. The diagnosis of PINS was made solely based on electrophysiological findings. This study highlights the importance of electrophysiological evaluation in the differential diagnosis of PINS and LE, especially in treatment-resistant cases. Although PINS did not significantly impact clinical parameters such as grip strength or symptom scores, its notable prevalence in LE patients underscores the need for its consideration in refractory LE cases. Further large-scale, controlled studies are needed to explore this relationship comprehensively.

This retrospective comparative study aims to evaluate the clinical outcomes, cost-effectiveness, and complication rates associated with two minimally invasive surgical techniques: extended arthroscopic debridement and 18-gauge percutaneous tenotomy. The study included 31 patients with resistant lateral epicondylitis who underwent either arthroscopic debridement (n=14) or percutaneous tenotomy (n=17) between January 2019 and June 2023. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) at preoperative, 3-month, 6-month, and 12-month intervals. Additionally, a detailed cost analysis was performed to compare the economic implications of both surgical techniques. The results demonstrated significant improvements in both groups at 3 and 6 months postoperatively. However, by the 12-month follow-up, the arthroscopic group maintained stable clinical outcomes, while the percutaneous group showed a decline in MEPS and PRTEE scores, suggesting a potential regression in long-term efficacy. Despite this, the percutaneous tenotomy group benefited from a shorter procedure time, fewer complications, and a quicker return to work, making it a highly cost-effective alternative. In conclusion, while extended arthroscopic debridement offers sustained clinical benefits, particularly in long-term follow-up, 18-gauge percutaneous tenotomy emerges as a viable primary intervention due to its simplicity, low complication rate, and significant cost savings. Future studies with larger cohorts and longer follow-up periods are warranted to further elucidate the long-term effectiveness and patient satisfaction associated with these techniques.

Platelet-rich plasma (PRP) therapy holds substantial promise for the treatment of tennis elbow, a complex and challenging musculoskeletal condition. The aim of the study was to assess whether there are correlations between the levels of individual morphotic elements determined in whole blood and the outcomes of tennis elbow treatment with PRP injection, as measured using patient-reported outcome measures (PROMs) such as the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE). A prospective analysis was conducted on 107 patients (132 elbows) undergoing lateral epicondylitis treatment with (PRP) injections. Patients completed VAS, PRTEE, and QDASH questionnaires on the day of PRP administration and at established checkpoints (2, 4, 8, 12, 24, 52, and 104 weeks). Minimal clinically important difference (MCID) was employed to assess the treatment effects. Then, correlations were measured within each PROM, and the impact of the concentration of individual blood parameters on the MCID outcomes was assessed. Analyzing the relationships between the MCID+ and MCID- groups, significant correlations for the VAS and QDASH scales were observed. The level of individual morphotic elements in the blood may have influenced the treatment outcome, as measured using specific patient-reported outcome measures (PROMs). Regarding the VAS scale, factors favoring a positive treatment outcome included higher values of eosinophils (EOS) and basophils (BASO). For the QDASH scale, these factors were a lower value of mean corpuscular volume (MCV) and a higher mean corpuscular hemoglobin (MCH). The levels of certain blood parameters, such as EOS and BASO, in the current study influenced the classification of patients into MCID+ or MCID- groups, based on the VAS and QDASH scales.

Aim:To compare the outcomes between the arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon alone and repairs to the ECRB tendon with suture anchor for the treatment of refractory lateral epicondylitis (LE).Methods:We retrospectively reviewed our patients who underwent arthroscopic surgical treatment for refractory LE by a single surgeon from January 2008 to June 2018 with a minimum follow-up of 12 months. The visual analog scale (VAS), the Mayo Elbow Performance Score (MEPS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, the Verhaar scoring system and the time of back to work were compared between two groups.Results:Both groups showed a significant postoperative improvement regarding the VAS, MEPS, DASH, PRTEE and the Verhaar scoring system (p < 0.05). The repair group showed better results regarding the MEPS, DASH, PRTEE and Verhaar scoring system comparing with the debridement group, which were statically significant (p < 0.05). There were no significant differences between the two groups regarding the VAS both at rest and activity at the final follow-up. There were no significant differences for the average time for return to work (p = 0.229). There were 11 patients in the debridement group and six patients in the repair group, who completed the MRI evaluation at 6 months postoperatively.Conclusion:Compared with arthroscopic release and debridement of the ECRB tendon, arthroscopic suture anchor repairing of the origin of the ECRB tendon provides better outcomes when addressing the refractory LE.Level of Evidence:Case Series: Level IV

Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study

Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis.