Elbow Pain Research Articles

Effects of Physical Activity Level and Sedentary Behavior on the Musculoskeletal System in Young Adults

Aim: The aim of this study is to investigate the relationship between the level of physical activity and sedentary behavior in young adults aged 18-35 and to evaluate the effects of this relationship on musculoskeletal pain, posture, muscle shortness, and trunk muscle endurance. Methods: In this cross-sectional descriptive study, conducted at the Faculty of Health Sciences of a university between March 2018 and August 2018, 219 students were included. Data were obtained by using the case report form which determines the demographic characteristics and sedentary behavior of the students, The International Physical Activity Index - short form, posture analysis form, muscle shortness evaluation form, and trunk muscle endurance evaluation form. Results: In the study, 66.2% of patients were female and 33.8% were male. In the evaluation of physical activity level, the ratio of highly active individuals in males, and inactive and insufficiently active individuals in females was significantly higher (p <0.05). Musculoskeletal pain was significantly higher in inactive and insufficiently active individuals (p<0.001). A negative correlation existed between physical activity level and pain frequency, duration, and scores (p<0.001). There was a positive correlation between trunk endurance tests and physical activity and exercise participation. Non-exercisers showed shortening of lumbar extensor muscles and gastrosoleus, with increased thoracic kyphosis (p<0.05). Daily sitting time correlated positively with elbow, wrist, and knee pain, and lumbar lordosis (p<0.05). Those spending more time at the computer experienced higher levels of head-neck and elbow pain, pain duration, muscle shortness, thoracic kyphosis, shoulder protraction, and anterior head tilt (p<0.05). Conclusion: In young adults, increasing physical activity and reducing daily sitting time are necessary to prevent musculoskeletal pain and reduce postural deformities. Keywords: Musculoskeletal diseases, musculoskeletal pain, physical exertion, posture, sedentary behavior, trunk muscular endurance, young adult.

Prevalence of lateral epicondylitis among housewives in Lahore: a cross-sectional study

BackgroundLateral epicondylitis (LE) is characterized by pain, inflammation and local tenderness over the bony prominence of the lateral epicondyle and is exacerbated under stressful and repetitive movements such as prolonged supination and pronation movements, twisting (wringing, turning) and rolling activities (stirring and mixing). Lateral Epicondylitis ranks as the second most commonly diagnosed musculoskeletal condition. Females, especially housewives, are more affected by LE. It can lead to persistent elbow pain, reduced grip strength, limited arm movement, and difficulty performing daily tasks.ResultsAll of our 150 participants were women aged 25–50 + years. We found that 86% of housewives reported some level of pain (mild, moderate and severe) according to the PRTEE questionnaire but 39.33% (59/150) showed positive lateral epicondylitis cases assessed physically by special test (Cozen, Mills, Maudsley’s test). Among the individuals diagnosed with lateral epicondylitis, a significant majority, 71.19% (42 out of 59), reported pain in their right arm while only 16.95% were experiencing pain in their left arm, however, 11.86% (7 out of 59) reported pain in both arms. The odds ratio estimates of age groups suggested that the 25–30 years group had higher odds of getting LE about 0.95 than the reference group. Among the individuals with lateral epicondylitis, 59.32% (35 out of 59) were experiencing chronic pain, while 40.67% (24 out of 59) were dealing with acute pain. 54.24% (32/59) of individuals with lateral epicondylitis experienced functional disability in specific activities, while 28.81% (17/59) reported functional disability in routine activities.ConclusionWe found a high prevalence of 39.33% lateral epicondylitis among housewives. There is a dire need to raise awareness among housewives for changing their lifestyle and activities regimen in order to avoid any such disorders like L.E. Robust studies with larger sample sizes are needed to establish conclusive evidence.

Comparison between Effects of Intralesional Platelet Rich Plasma and Corticosteroid Injection on Pain and Functional Outcome in Patients with Lateral Epicondylitis of Elbow

Background: A debilitating and painful elbow problem is lateral epicondylitis. Objective: In this study, pain and functional outcomes were examined in relation to intralesional platelet-rich plasma (PRP) and corticosteroid injections patients with lateral epicondylitis. Methodology: This randomized experimental study was done in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2017 to February 2018. Thirty patients with diagnosed lateral epicondylitis, aged between 21- 60 years and had been ill for more than a month were enrolled and randomly assigned into two groups. In Group A received two doses of intralesional PRP injection, and Group B received two doses of intralesional corticosteroid injection. Pain and functional outcomes were evaluated by using a visual analog scale (VAS) for pain and a patient-rated tennis elbow assessment (PRTEE) questionnaire, respectively. In the lateral epicondylar region, intralesional PRP or corticosteroids were administered during the first (week 1=W1) and fourth (week 7=W7) treatment visits. Results: The findings revealed a statistically significant decline in pain over time, as well as improvements of functional outcomes in both groups as evidenced by significantly lower VAS scores and lower PRTEE scores up to 11 weeks post-injection. There was no discernible difference in progress between the two groups up until W1 to W9 scores, however at the eleventh week, group A showed greater improvement than group B (p<00.5). Conclusions: Intralesional PRP injection is a promising therapy option for lateral epicondylitis, offering sustained pain relief and improved functional outcomes over time compared to corticosteroid injection. Journal of Monno Medical College June, 2024; 10 (1):30-35

Neuromuscular ultrasound for the differential diagnosis of radial tunnel syndrome and lateral epicondylitis.

Lateral elbow pain is quite common in everyday life. Lateral epicondylitis and radial tunnel syndrome are the most common causes of lateral elbow pain. The aim of this study was to evaluate the sensitivity and specificity of neuromuscular ultrasound examination in the diagnosis of lateral epicondylitis versus radial tunnel syndrome. This was a prospective double-blinded pilot study of 68 elbows in 34 patients with lateral elbow pain. Patients underwent clinical examination and standardized neuromuscular ultrasound evaluation in the first 15days after the initiation of symptoms. Statistical significance was set at p<.001. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sixty-eight radial nerves were examined in 34 healthy controls (16 males; mean age 48.1±8.2years). Pain with palpation over the radial tunnel was found in 25 of 48 elbows (52.1%) compared to the pain over the lateral epicondyle found in 10 of 48 elbows (20.8%). Τhe sensitivity of palpation in differentiating radial tunnel syndrome from lateral epicondylitis was 75.7%, while the specificity was 50% (PPV 71.4%, NPV 51.5%). The sensitivity of neuromuscular ultrasound in differentiating radial tunnel syndrome from lateral epicondylitis was 92.6%, while the specificity was 80% (PPV 92.6%, NPV 80.0%). In most of the patients (25/31), fibrous bands anterior to the radio-capitellar joint were responsible for the nerve entrapment. The present study highlights the importance of the neuromuscular ultrasound's diagnostic role in differentiating radial tunnel syndrome from lateral epicondylitis in the clinical scenario of lateral elbow pain.

Cochrane Corner

The Cochrane Collaboration has produced three new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner. These are relevant to a wide range of musculoskeletal specialists, and include reviews in lateral elbow pain, osteoarthritis of the big toe joint, and cervical spine injury in paediatric trauma patients.

Acute-Onset Elbow Pain in a 14-year-old Football Quarterback.

Acute-Onset Elbow Pain in a 14-year-old Football Quarterback.

Arthroscopic lateral collateral ligament imbrication for the treatment of posterolateral rotatory elbow instability

ObjectivesPosterolateral rotatory elbow instability (PLRI) is commonly treated with open lateral collateral ligament (LCL) reconstruction techniques. This cohort study evaluates the efficacy of a less invasive arthroscopic LCL imbrication technique for reducing grade I or II PLRI. MethodsForty-three patients with stage I or II PLRI, unresponsive to conservative therapy, were included. Diagnoses were based on chronic post-traumatic pain (11 patients), chronic atraumatic lateral elbow pain (20), and previous open tennis elbow surgery (12). Following clinical and arthroscopic diagnosis confirmation, the LCL imbrication technique was performed. The Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were assessed preoperatively and postoperatively using the Shapiro-Wilk test and Wilcoxon signed rank test, respectively, with a minimum 12-month follow-up (range 12-48 months). ResultsMEPS increased significantly from a median of 45 points preoperatively to 90 (range 80–100) at three months and 95 (range 80-100) at 12 months follow-up (p < 0.001). Postoperative median flexion reached 140°, and extension was 0°. At 12 months, two patients experienced a 10° extension deficit; 95.3% (41/43) achieved full ROM. Knot irritation occurred in four patients (out of the first ten of this cohort, 9.3%), three of them requiring knot removal. Switching to a PDS 1 suture eliminated this complication. One patient underwent arthroscopic arthrolysis for adhesions after 14 months. ConclusionArthroscopic LCL imbrication offers favorable outcomes for grade I or II PLRI from the third postoperative month, with minimal complications. A slight restriction in ROM and transient knot discomfort were the main issues, the latter resolved by switching to a thinner PDS suture.

The efficacy of Botulinum Toxin in Tennis Elbow: a meta-analysis of randomized clinical trials.

This study aims to assess the efficacy of botulinum toxin type A (BT-A) in treating tennis elbow. We systematically reviewed the literature and included full-text randomized clinical trials (RCTs) published until June 2024, available in PubMed, Scopus, Embase, and Cochrane CENTRAL databases. Eligible studies involved patients with tennis elbow and compared BT-A with placebo or other injectable treatments. Primary outcomes included pain relief, while secondary outcomes assessed quality of life, adverse effects, and grip strength. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Seven RCTs with a total of 381 patients were included. The participants were predominantly middle-aged (mean age 46.64 ± 7.72 years) and diagnosed with chronic tennis elbow. BT-A doses ranged from 20U to 60U. Compared to placebo, BT-A effectively reduced pain at two to four weeks (MD = -1.37; 95% CI = -2.18 to -0.57) and at eight to 12 weeks (MD = -1.13; 95% CI = -1.62 to -0.65). Grip strength was comparable between the BT-A and placebo groups at both time points (2 to 4 weeks: SMD = -0.86; 95% CI -1.78 to 0.05; 8 to 12 weeks: SMD = 0.00; 95% CI = -0.95 to 0.95). This meta-analysis suggests that BT-A reduces pain in tennis elbow within two to 12 weeks compared to placebo. Findings are limited by study size, and further research is needed to confirm its efficacy and safety.

Lateral Open Wedge Osteotomy and Lateral Condyle Fusion In Situ for Children With Condyle Nonunion and Cubitus Valgus Deformity.

Long-term nonunion of the lateral humeral condyle (LHC) can result in progressive cubitus valgus, elbow pain, instability, and delayed ulnar nerve palsy. Various techniques have been proposed for correction, each with its own advantages and disadvantages. The purpose of this study was to introduce a lateral open wedge osteotomy (LOWO) procedure combined with in situ osteosynthesis of nonunited LHC for the treatment of long-term LHC nonunion with cubitus valgus deformity. We evaluated 18 pediatric patients who had a cubitus valgus deformity greater than 10 degrees after nonunion of the LHC for more than 2 years. The LHC was fixed in situ with 1 or 2 cancellous screws, and the LOWO was fixed with a locking plate. All patients underwent clinical and radiologic evaluation, and the pre- and postoperative carrying angle (CA), range of motion (ROM), and Mayo elbow performance score (MEPS) were analyzed. Eighteen patients, with a mean age of 9.9 ± 3.9 years, underwent treatment for LHC nonunion and cubitus valgus deformity after a mean interval of 61.6 ± 24.1 months from the initial injury. The mean follow-up period was 57.6 ± 22.8 months. Union of the LHC and LOWO was achieved in all patients. The mean CA decreased significantly from 31.6 ± 4.8 degrees before surgery to 10.4 ± 2.2 degrees after surgery (P<0.001). Surgery did not decrease elbow range of motion (P=0.202). The mean MEPS increased significantly from a preoperative value of 55 ± 4.9 to a postoperative value of 91.1 ± 5.6 (P<0.001). No significant complications were observed. LOWO combined with in situ fixation of nonunited LHC is an effective approach for treating long-term LHC nonunion associated with cubitus valgus deformity.

Monobloc vs. Modular Radial-Head Arthroplasty for Complex Elbow Trauma: Long-Term Follow-Up and Comparative Evaluation.

Introduction: Mason Type 3 radial-head fractures are typically treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA). Prosthetic options include traditional monobloc implants and newer modular implants designed to match patient anatomy. While short- and medium-term outcomes of metallic RHA are generally favorable, this study aims to compare the long-term outcomes of patients treated with monobloc versus modular implants. Methods: The medical records of all the patients who underwent RHA at a level I trauma center between 2000 and 2011 were retrospectively reviewed. Patients who were available for follow-up were invited for reassessment, which included physical examination, questionnaires for the assessment of elbow pain and function, and follow-up radiographs. Results: Out of 35 patients who had RHA, 13 (37%) had a monobloc prosthesis and 22 (63%) had a modular prosthesis. Out of the patients that could be traced, 4 patients from the monobloc group and 10 patients from the modular group agreed to participate in the study. The mean follow-up time was 15 years in the monobloc group and 12.4 years in the modular group. Patients in the modular group demonstrated superior functional outcomes compared to the monobloc group, with statistically significant improvements in MEPS and DASH scores and a non-significant trend towards better ASES scores and VAS scores. Physical examination revealed a decline in function in the operated arm for both groups, with statistically significant differences favoring the modular group in elbow flexion and extension. Radiographic analysis showed varying degrees of implant loosening, with the modular group exhibiting less loosening compared to the monobloc group. Mild degenerative changes and heterotopic ossification were also observed, predominantly in the modular group. Conclusions: The results suggest that modular implants offer superior functional outcomes compared to monobloc implants. The modular group showed statistically significant improvements in elbow flexion and extension. These findings indicate that modular implants may be a more favorable option for enhancing patient outcomes. Further research with larger sample sizes is recommended to confirm these trends and to better understand the long-term benefits of modular implants.

How do manual therapy and/or prescribed exercises compare with minimal intervention for adults with lateral elbow pain?

How do manual therapy and/or prescribed exercises compare with minimal intervention for adults with lateral elbow pain?

Anconeus Exertional Compartment Syndrome and Posterolateral Rotatory Elbow Instability: A Clinical Association and Rare Cause of Elbow Pain

Background: Anconeus compartment syndrome is a rarely reported compartment syndrome in the anconeus muscle compartment of the forearm. It has anatomic and pathophysiological associations with posterolateral rotatory instability (PLRI) of the elbow. Purpose: To present the history, management, and outcomes of 4 patients with anconeus compartment syndrome. Secondary aims were to (1) establish normative anconeus pressures and (2) measure the volume of this compartment with and without PLRI in cadavers. Study Design: Case series; Level of evidence, 4. Methods: Four patients with clinical signs of anconeus compartment syndrome (2 gymnasts, 1 swimmer, and 1 footballer/weightlifter) were identified over a 3-year period (2015-2017 inclusive). Patient history, sporting activity, physical examination, anconeus compartment pressures, and treatment outcomes were recorded. Manometry of the anconeus compartment in 2 healthy male controls was performed to establish normative compartment pressures. Anconeus volumetric anatomy and the effect of creating PLRI on compartment volume was investigated in 4 cadaveric elbows. Results: All 4 patients had microtraumatic PLRI, and 2 patients had anconeus hypertrophy. Anconeus compartment pressures at rest and at 2-minutes postexercise were median 28.0 and 67.5 mm Hg, respectively, in the patients and mean 16.5 and 18 mm Hg, respectively, in the controls. Simultaneous fasciotomy and PLRI reconstructive procedures were performed in 2 patients, with outcomes showing full return to competition. Fasciotomy alone was performed in 2 patients to allow return to competition, with both requiring later reconstruction to address PLRI. Cadaver dissection revealed that the anconeus compartment was extremely small and that creation of PLRI reduced the direct volume of the compartment and increased the distance between the anconeus origin and insertion. Conclusion: Our case series demonstrated that anconeus compartment syndrome can occur in upper limb-dominant athletes in the presence of PLRI and anconeus hypertrophy. Pain is relieved by fasciotomy, but definitive treatment of the underlying instability prevents further symptomatology.

Ultrasonographic differential diagnosis of medial elbow pain.

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.

An Ergonomic Golf Grip Leads to Lower Forearm Muscle Activity - A Prospective Case Series of 30 Right-Handed Amateur and Professional Golfers

BackgroundThe elbow is a common site for overuse injuries in golfers. Tendinopathies, such as medial and lateral epicondylitis, are frequently diagnosed in amateur and professional golfers. The aim of our study was to determine the effect of an ergonomic golf grip on forearm muscle activity during the five phases of the golf swing.MethodsThirty right-handed golfers with a mean age of 32 years (range, 18–70 years) and a mean handicap of 15 (range, 0–43) performed 10 golf swings with a standard and ergonomic golf grip respectively. The mean and maximum muscle activity of the Musculus (M.) extensor carpi radialis brevis (ECRB), M. flexor carpi ulnaris (FCU), M. pronator teres (PT) and M. biceps brachii (BB) of the lead and trail arms were assessed during the five phases of the golf swing using surface electromyography (EMG). Subgroup analyses were performed regarding sex, playing ability (handicap < 10 vs. ≥10), weekly playing time (≤ 5 h, 5–20 h, > 20 h) and preexisting elbow pain during golfing (VAS < 2 vs. VAS ≥ 2). Significance was set at p < 0.05.ResultsAn ergonomic golf grip resulted in a reduction in muscle activity in at least one but up to three consecutive phases of the golf swing for the ECRB, FCU and PT of the lead arm and for the PT of the trail arm. Amateurs, a playing time < 20 h per week and golfers without preexisting elbow pain were factors that were associated with greater reductions in muscle activity.ConclusionForearm muscle activity can be decreased using an ergonomic golf grip, indicating the possible role of an ergonomic golf grip as a preventive measure against overuse syndromes such as medial and lateral epicondylitis.Trial registration numberThis study was retrospectively registered at the German Clinical Trials Register DRKS-ID: DRKS00033732 (01/03/2024).

Persistent lateral elbow pain from overlooked posterolateral impingement of the elbow: a literature review and guidance for treatment.

Posterolateral impingement is sometimes diagnosed as a cause of refractory elbow pain, often after other treatments have been tried for common conditions such as lateral epicondylitis (tennis elbow) or subtly different conditions common in throwing athletes, such as valgus extension overload syndrome. Arthroscopic surgical treatment is effective when targeting abnormal anatomy such as plical folds. Partial excision of the olecranon must be undertaken with caution because it can lead to instability. This systematic review of the current literature uses a narrative synthesis to identify anatomical morphological variations of the olecranon, humeral and capitellar geometry, and overloading of the lateral part of the elbow as causative factors for this condition and discusses how arthroscopic techniques can resolve symptoms. Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies.

Outcomes following humeral head autograft glenoid reconstruction in primary reverse total shoulder arthroplasty

Patients with severe glenoid bone loss are at increased risk for poor implant fixation, scapular notching, dislocation, joint kinematic disturbances, and prosthetic failure following reverse total shoulder arthroplasty (rTSA). Glenoid bone grafting has proven useful when performing rTSA in patients with inadequate glenoid bone stock, although the current literature is limited. The purpose of this study is to evaluate clinical outcomes in patients with significant glenoid deformity undergoing primary rTSA with one-stage glenoid reconstruction using a humeral head autograft. A database of prospectively enrolled patients was reviewed to identify patients who underwent primary rTSA with humeral head autograft (n=40) between 2008 and 2020 by 6 high-volume shoulder arthroplasty surgeons with a minimum 2-year follow-up. Variables studied included demographics, medical comorbidities, range of motion, Constant score, American Shoulder and Elbow Surgeons score, pain score, patient satisfaction, glenoid deformity, revisions, and complications. Preoperative glenoid deformity was characterized using glenoid version and beta-angles, measured on computed tomography. Improvement at final follow-up was compared to a matched control group of 120 standard primary rTSA patients. Following the post hoc Bonferroni correction, an adjusted alpha value of 0.004 was used to define statistical significance. Forty patients were included with a mean follow-up of 5.3 (range, 2.0-13.2) years. Patients exhibited a mean preoperative glenoid retroversion and beta-angle of 29° and 80°, respectively. At final follow-up, patients who received a graft exhibited lower mean scores for active external rotation (25° vs. 39°; P=.001) in comparison to those who did not receive a graft. No differences were observed in active abduction (P=.029), active forward elevation (P=.009), active internal rotation (P=.147), passive external rotation (P=.082), Global Shoulder Function score (P=.157), Constant score (P=.036), American Shoulder and Elbow Surgeons score (P=.009), or pain score (P=.186) between groups. Seven patients (17.5%) exhibited complications of which the most common being aseptic glenoid loosening (15%). This study demonstrates that patients undergoing primary rTSA with autogenous humeral head autograft for severe glenoid deficiency experience postoperative improvements in range of motion and functional outcome scores that exceeded the minimal clinically important difference and substantial clinical benefit but inferior to matched controls. This suggests that glenoid reconstruction using a resected humeral head autograft is an effective strategy when conducting primary rTSA in patients with significant glenoid deformity.

Recalcitrant Lateral Epicondylitis: A Systematic Review on Current Nonoperative and Operative Treatment Modalities.

Lateral epicondylitis is a common cause of elbow pain that is generally self-limiting. For patients who have persistent symptoms refractory to conservative treatment, there is still no clear consensus on the most favorable treatment modality. The purpose of this systematic review was to synthesize the available literature regarding both nonoperative and operative treatment modalities for recalcitrant lateral epicondylitis (RLE) to provide insight into the efficacy of treatment options. A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, where the PubMed, MEDLINE/Ovid, CINAHL, Cochrane, and Scopus databases were queried to identify studies evaluating treatment options for RLE. A total of 27 studies with 1,958 patients were included. Of the reviewed studies, there were a wide variety of treatments including platelet-rich plasma injections, percutaneous tenotomies, and various arthroscopic and open procedures. There are a wide variety of treatment modalities available for RLE that have promising efficacy in the short, medium, and long terms. A comprehensive approach combining evidence-based and patient-centered care is critical for effective management of refractory symptoms. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Minimally invasive needle tenotomy vs. platelet rich plasma injection in the treatment of chronic elbow epicondylitis

BackgroundMedial and lateral epicondylitis, characterized by repetitive microtraumas to common flexor and extensor tendons respectively, are common causes of elbow pain in adults. Though symptoms generally are self-limiting, 10% of cases are refractory to conservative management, persisting for greater than 18 months and leading to surgery, which can have increased risk of complications. There is minimal data on sustained pain relief and functional benefit for newer non-surgical management options such as minimally invasive needle tenotomy (MINT) via Tenjet and platelet-rich plasma (PRP) for chronic elbow epicondylitis. Additionally, no previously established correlation exists between MRI severity of chronic epicondylitis with pain and functional improvement in MINT and PRP-treated patients. MethodsA retrospective review of 51 adults (n=23 for Tenjet; n=28 for PRP) was conducted to investigate long-term outcomes in pain relief (via Visual Analog Scale or VAS) and improvements in upper extremity function (via Quick Disability of the Arm, Shoulder, and Hand questionnaire or qDASH). These outcomes were correlated with radiographic evidence of epicondylitis severity, assessed by grade of epicondylitis and percentage thickness of tendon tears. ResultsThere were significant improvements in pain (VAS) but no significant differences in function (qDASH) following MINT and PRP. On average, VAS score improved by 2.6 (p<0.001) post-Tenjet and by 3.8 (p<0.001) post-PRP, combined for all follow-up time points. No adverse events were reported over the entire study. A significantly higher percentage of patient-reported pain relief was noted post-Tenjet at all follow-up time points. VAS and qDASH outcomes post-Tenjet and post-PRP were not correlated with initial MRI severity of epicondylitis. ConclusionsThere are multifactorial benefits of both Tenjet and PRP as safe, non-open surgical modalities that can be used, despite MRI severity, to provide sustained pain relief for patients with refractory elbow epicondylitis.

Ultrasound-Guided Perineural Hydrodissection for the Treatment of Lacertus Fibrosus Syndrome in a Baseball Player: A Case Report.

Lacertus fibrosus Syndrome (LFS) is a rare cause of persistent medial elbow pain in baseball players, often not considered in the initial diagnostic considerations. This case report details a 19-year-old collegiate baseball player who presented with insidious left anterior medial elbow pain, initially diagnosed as biceps tendonitis. The patient did not experience pain relief after six months of conservative management. Sonopalpation during diagnostic ultrasound localized the source of pain to the median nerve at the level of the lacertus fibrosus, and the decision was made to perform ultrasound-guided hydrodissection of the median nerve at this level. The procedure resulted in rapid and sustained symptom relief without the scarring that has been associated with traditional surgical techniques. To date, there has been no study investigating the use of ultrasound-guided hydrodissection targeting lacertus fibrosus. This report highlights the importance of considering LFS in throwing athletes with persistent elbow pain, and advocates for considering ultrasound-guided hydrodissection as a management option for patients with clinical suspicion of LFS.

Prevalence and sex differences in endoscopy-related injuries: comprehensive systematic review and meta-analysis

Background and AimsGastroenterologists are at risk for endoscopy-related injury (ERI). The aim of this meta-analysis was to assess the prevalence, characteristics, and burden of ERI. MethodsWe searched PubMed/Embase/Web of Science databases for studies reporting ERI prevalence among gastrointestinal (GI) endoscopists. The primary outcome was to pool ERI prevalence. We also assessed ERI types and treatments. We compared ERI based on gender. Finally, we compared musculoskeletal injury (MSI) prevalence between GI endoscopists and non-endoscopists. The pooled rates were generated using a proportion meta-analysis with the random-effects model. Prevalence ratios (PR) with the corresponding confidence intervals (CI) were used for comparative data. ResultsWe included 26 studies with 6,246 endoscopists. Overall, ERI prevalence was 67.9% (60.7-74.4). ERI prevalence was 77.8% (55.1-90.9) in advanced endoscopists. A higher trend of ERI prevalence was observed in recent studies (after 2015), 71.7% (63.3-78.9). Neck pain (36.7%) was the most common ERI, followed by low back pain (35.6%) and thumb pain (33.1%). While females reported higher De Quervain tenosynovitis and carpal tunnel syndrome, wrist, thumb, shoulder, and neck pain, males reported higher elbow pain. GI endoscopists had a higher MSI prevalence than non-endoscopists, PR 1.56 (1.01-2.41). Female endoscopists reported higher ERI, PR 1.21 (1.10-1.32). Only 19.1% of endoscopists reported receiving prior ergonomic training. ConclusionsERI is increasingly prevalent in gastroenterology, particularly in female gastroenterologists with significant gender disparities in ERI types noted. These findings underscore the significance of incorporating ergonomic principles into gastroenterology practices to mitigate ERI risks, particularly considering the shortage of gastroenterologists.