Lateral Elbow Pain Research Articles

Gross anatomical and histological orientation of the lateral intermuscular septum of the upper arm: a descriptive study

Objectives: The lateral intermuscular septum (LIS) is dense and opaque in gross cadaver dissection. It was suggested as source of pain in elbows with lateral epicondylalgia (LE). The study aimed to measure the length of LIS and to describe the fascia orientation and density of LIS in upper extremities of human cadavers. . Methods: 19 upper extremities of 10 formalin preserved human cadavers were dissected using the fascia sparing approach. The LIS was measured from the level of the lateral epicondyle up to the upper arm. The LIS was harvested 5 cm above and below the lateral epicondyle and submitted to a laboratory for histological staining. Prepared slides containing stained LIS were observed under high power microscope. Results: In 17 out of the 19 upper extremities, the LIS attached from the brachioradialis to middle deltoid with a mean of 14.5 (13.8-15.1) cm. 68 out of the 72 fascia images of LIS were linearly oriented in relation to the lateral epicondyle. The LIS was dense on its distal (16/18) and loose (12/16) on its medial sides. Conclusion: The fibers of LIS were linearly arranged near the lateral epicondyle in the upper arm connecting the brachioradialis and the deltoid. The LIS was dense and loose on its distal and medial sides, respectively. Considering the arrangement, connection and density of LIS in the upper arm, the LIS contributes to the inherent tightness of the elbow that may be important in handgrip activities. The connection between brachioradialis and middle deltoid by LIS is important in considering the changes in shoulder movement associated with lateral elbow pain in LE. Keywords: brachioradialis muscle; lateral intermuscular septum; upper arm

Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma.

Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.

Delphi study for developing consensus of physical attribute in pressure pulse waveform and preliminary study of its next study

Purpose: Multisite studies are not commonly used for acupuncture research, especially international studies that involve international partners. This presentation looks at a recent example of monitoringmultiple international sites in a randomised controlled trial of acupuncture for the treatment of lateral elbow pain. Methods: The use of technologies allows a unique way to record, upload and evaluate procedures required to be standardised to ensure common protocols and procedures. Results: A review of this novel approach to trial monitoring showed some effective strategies using cloud and digital technologies but also some problems. Conclusion: International multisite clinical trials should consider the use of emerging technologies such as digital clouds to monitor compliance with protocols and standardisation of procedures. Contact: Christopher Zaslawski, Chris.Zaslawski@uts. edu.au

Green tea for prevention of digestive tract cancer: an updated evidence summary of randomized and non-randomized studies

Purpose: Multisite studies are not commonly used for acupuncture research, especially international studies that involve international partners. This presentation looks at a recent example of monitoringmultiple international sites in a randomised controlled trial of acupuncture for the treatment of lateral elbow pain. Methods: The use of technologies allows a unique way to record, upload and evaluate procedures required to be standardised to ensure common protocols and procedures. Results: A review of this novel approach to trial monitoring showed some effective strategies using cloud and digital technologies but also some problems. Conclusion: International multisite clinical trials should consider the use of emerging technologies such as digital clouds to monitor compliance with protocols and standardisation of procedures. Contact: Christopher Zaslawski, Chris.Zaslawski@uts. edu.au

Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain.

To review the outcome of 121 patients who underwent arthroscopic resection of a humeroradial synovial plica for persistent lateral elbow pain. 92 men and 29 women aged 24 to 56 (mean, 38) years with chronic lateral elbow pain underwent arthroscopic resection of a humeroradial synovial plica using a motorised soft tissue shaver, followed by intensive physiotherapy. The modified elbow score and range of motion were assessed, as were wound healing, infection, soft tissue swelling or effusion, tenderness, ligamentous instability, and motor strength. No patient had any ligamentous instability. 80 patients were pain-free at 3 months; only 3 patients were taking pain medication at 6 months. All patients had full pronation and supination; the mean range of motion was 3º to 135º of flexion. The mean modified elbow score at 12 months was 93.2 (range, 72-100). The percentages of patients with excellent, good, fair, and poor score were 70%, 17%, 8%, and 5% at 3 months, 74%, 20%, 3%, and 3% at 6 months, and 76%, 18%, 3%, and 3% at 12 months, respectively. A humeroradial synovial plica is one of the causes of chronic lateral elbow pain. Arthroscopic resection of the synovial plica followed by intensive physiotherapy achieved good outcome.

Evidence-based treatment of common extensor tendinopathy

Common extensor tendinopathy, or tennis elbow, is the most common cause of lateral elbow pain. While most cases are self-limiting, a percentage will become chronic and lead to substantive time away from work and sport. There is no clear consensus on timing and choice of modality for treatment. There are a multitude of treatment options available including watchful waiting, physical therapy, topical nitroglycerin, extracorporeal shockwave therapy, corticosteroid injection, prolotherapy, neovessel sclerosis, autologous growth factor injections, percutaneous needle tenotomy, and surgery. This article presents a comprehensive review of the current literature on the treatment of common extensor tendinopathy

Radial nerve mobilization reduces lateral elbow pain and provides short-term relief in computer users.

Study Design : Prospective Experimental Study.Background : Computer users may be at risk of lateral elbow pain. It is theorized that adverse mechanical tension can arise in the radial nerve with sustained keyboarding due to sustained static work of the elbow extensor muscles. Neural mobilization has been suggested as a potential treatment.Purpose : The purpose of this study was to evaluate the effect of neural mobilization of the radial nerve on a single occasion in terms of its ability to reduce lateral elbow pain.Methods and Analysis : Forty-one computer professionals (Mean age 46.7; S.D. 12.77), who had experienced lateral elbow pain for a mean of 2.87 months were recruited. The participants rated the pain using a verbal, numeric rating scale (NRS). Radial nerve tension was tested using the Upper limb Tension Test (ULTT) for radial nerve in both upper extremities. The radial nerve was mobilized using a series of 8 oscillations and repeated 3 times with a one minute rest in between. The NRS and ULLT were repeated after treatment and the scores compared using a paired t-test by the first author.Results : The mean NRS scores decreased significantly from 5.7 (1.1) to 3.8 (1.4) (p<0.000; t value=8.07).Conclusion : A single session of 3 neural mobilization resulted in a reduction of pain in computer users with lateral elbow pain. A long-term randomized trial is needed to determine the effects sustained over-time.

Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability

In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy. We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction. Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation. Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate. Level III.

A Comparison of Laser and Extracorporeal Shock Wave Therapies in Treatment of Lateral Epicondylitis

Objective: Lateral epicondylitis (LE) is a common painful problem of the elbow. This study was conducted to evaluate and compare the effectiveness of extracorporeal shock wave therapy (ESWT) and lowintensity laser therapy in LE treatment. Material and Methods: The study included 60 LE patients. Subjects were divided into two groups randomly. Group 1 received ESWT, while group 2 received laser therapy. Presence of lateral epicondyle tenderness, elbow pain, and hand grip strength (HGS) were evaluated at the beginning and at 4 and 12 weeks. Elbow pain was evaluated with the Short-Form McGill pain questionnaire (SF-MPQ). Results: The patients with tender lateral epicondyle were not significantly different between groups at each time point. Both groups had improvement on HGS evaluated at the 4th and 12th weeks, but in the ESWT group, the improvement was significantly higher. All SFMPQ parameters improved significantly after each therapy evaluated at the 4th and 12th weeks. However, mean visual analog scale, present pain intensity, affective pain subscale, and total pain scale scores were significantly lower in the ESWT group at the 4th and 12th weeks. Conclusion: Both ESWT and laser therapy are effective and safe treatment options for LE; however, ESWT seems to be more efficient in pain reduction and improvement of functions.

Arthroscopic and open management of posterolateral rotatory instability of the elbow.

Posterolateral rotatory instability (PLRI) is the most common cause of residual instability following a simple elbow dislocation. PLRI may result from trauma or iatrogenic injury to the radial ulnohumeral ligament during treatment for other conditions, such as lateral epicondylitis. PLRI can be identified through a combination of history and physical examination, and confirmed with magnetic resonance imaging arthrography. Once diagnosed, surgery is necessary to correct persistent instability. Instability can be confirmed arthroscopically through several findings, including subluxation of the radial head on the capitellum and the arthroscopic "drive through sign of the elbow." Acute repairs, both open and arthroscopic, heal with excellent patient outcomes. In the chronic setting, graft reconstruction may be required. This report describes arthroscopic repair of the radial ulnohumeral ligament and open reconstruction with associated outcomes. A high index of suspicion is necessary to correctly diagnosis this condition in patients with lateral elbow pain and feelings of instability.

Epicondylitis: lateral.

Lateral epicondylitis is the most common cause of lateral elbow pain in adults. Although it is typically a self-limiting process, there are many nonsurgical and surgical treatment options available if lateral epicondylitis becomes chronic and continues to cause pain. Its common name, tennis elbow, is somewhat of a misnomer because the condition is often work-related and occurs in athletes and nonathletes alike. Acute onset of symptoms occurs more often in young athletes; chronic, recalcitrant symptoms typically occur in older patients. In this review, we describe the pathogenesis and clinical presentation and the nonsurgical and surgical treatment options currently available.

Sonography of the lateral antebrachial cutaneous nerve with magnetic resonance imaging and anatomic correlation.

Abnormalities of the lateral antebrachial cutaneous nerve (LABCN) are associated with antecubital elbow conditions, such as distal biceps brachii tendon tears and traumatic cephalic vein phlebotomy. These can lead to lateral forearm, elbow, and wrist symptoms that can mimic other disease processes. The purpose of this study was to characterize the sonographic appearance of the LABCN using cadaveric dissection and retrospective analysis of sonographic examinations of symptomatic patients with magnetic resonance imaging correlation. For the first part of this study, a cadaveric elbow specimen was examined, and sonography was performed after dissection to identify the LABCN. Subsequently, 26 elbows in 13 patients with LABCN abnormalities were identified with sonography and retrospectively evaluated to characterize the appearance of the LABCN in both symptomatic and asymptomatic elbows. The symptomatic LABCNs showed fusiform enlargement, increased echogenicity, and loss of the normal fascicular echo texture. The mean cross-sectional area of the symptomatic nerves was 12.0 mm(2) (range, 6.1-17.2 mm(2)), with a maximum thickness of 3.5 mm (range, 2.3-5.9 mm), compared to 3.3 mm(2) (range, 1.9-5.2 mm(2)), with a maximum thickness of 1.3 mm (range, 0.9-2.2 mm), in the contralateral normal elbows. The close proximity of the LABCN to the distal biceps tendon and the cephalic vein makes it vulnerable to compression and injury in the setting of distal biceps tendon tears and traumatic phlebotomy, which may cause nerve enlargement and increased echogenicity. Awareness of the location and appearance of the LABCN on sonography is important for determining potential causes of lateral elbow and forearm pain.

IMpact of Platelet Rich Plasma OVer Alternative Therapies in Patients with Lateral Epicondylitis (IMPROVE): Protocol for a Multicenter Randomized Controlled Study: A Multicenter, Randomized Trial Comparing Autologous Platelet-Rich Plasma, Autologous Whole Blood, Dry Needle Tendon Fenestration, and Physical Therapy Exercises Alone on Pain and Quality of Life in Patients with Lateral Epicondylitis

Lateral epicondylitis, commonly known as tennis elbow, is the most common cause of lateral elbow pain and the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting. Many therapeutic options, including conservative, surgical, and minimally invasive procedures, have been advocated for the treatment of lateral epicondylitis. Although numerous small studies have been performed to assess the efficacy of various treatments, there are conflicting results with no clear consensus on the optimal treatment. In an economic environment with limited health care resources, it is paramount that optimal cost-effective therapies with favorable patient-important outcomes be identified. This is a protocol paper which outlines a multicenter, multidisciplinary, single-blinded, four-arm randomized controlled trial, comparing platelet-rich plasma (PRP), whole blood injection, dry needle tendon fenestration, and sham injection with physical therapy alone for the treatment of lateral epicondylitis. Patients are screened based on pre-established eligibility criteria and randomized to one of the four study groups using an Internet-based system. The patients are followed at 6-week, 12-week, 24-week, and 52-week time points to assess the primary and secondary outcomes of the study. The primary outcome is pain. Secondary outcomes include health-related quality of life and ultrasound appearance of the common extensor tendon. Two university centers (McMaster University and the University of Michigan) are currently recruiting patients. We have planned a sample size of 100 patients (25 patients per arm) to ensure over 80% power to detect a three-point difference in pain scores at 52weeks of follow-up. This study has ethics approval from the McMaster University Research Ethics Board (REB# 12-146) and the University of Michigan Institutional Review Board (IRB# HUM00067750). Successful completion of this proposed study will significantly impact clinical practice and enhance patients' lives. More broadly, this trial will develop a network of collaboration from which further high-quality trials in ultrasound-guided interventions will follow.

Chiropractic Treatment of Lateral Epicondylitis: A Case Report Utilizing Active Release Techniques

ObjectiveThe purpose of this report is to describe the chiropractic management of a case of lateral epicondylitis with active release techniques (ART). Clinical featuresA 48-year-old white man presented to a chiropractic clinic with a complaint of left lateral elbow pain that began 2 years previous with insidious onset. The patient reported an inability to play 18 consecutive holes of golf due to the pain. Intervention and outcomeTreatment consisted of 5 sessions of ART (a soft tissue technique that is applied to muscles, fascia, tendons, ligaments, and nerves) applied to the left elbow soft tissue over a duration of 3 weeks. The patient reported an absence of pain and ability to consistently play 18 consecutive holes of golf up to 3 times per week at 4 and 8 weeks post-treatment. ConclusionThis patient with lateral epicondylitis responded favorably to chiropractic treatment using the application of ART, as demonstrated by reduced pain and increased functional outcomes.

THU0340 Efficacy of Transcutaneous Electrical Stimulation (TENS) and Kinesiotaping in Patients with Lateral Epicondylitis

BackgroundLateral epicondylitis (LE) is one of the most common conditions affecting elbow [1]. Primary aims of treatment are pain relief and restoration of muscle condition [2]. There is a wide...

Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials.

Non-surgical approaches to treatment of lateral epicondylitis are numerous. The aim of this systematic review is to examine randomized, controlled trials of these treatments. Numerous databases were systematically searched from earliest records to February 2013. Search terms included "lateral epicondylitis," "lateral elbow pain," "tennis elbow," "lateral epicondylalgia," and "elbow tendinopathy" combined with "randomized controlled trial." Two reviewers examined the literature for eligibility via article abstract and full text. Fifty-eight articles met eligibility criteria: (1) a target population of patients with symptoms of lateral epicondylitis; (2) evaluation of treatment of lateral epicondylitis with the following non-surgical techniques: corticosteroid injection, injection technique, iontophoresis, botulinum toxin A injection, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, or laser therapy; and (3) a randomized controlled trial design. Lateral epicondylitis is a condition that is usually self-limited. There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief. Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids, and botulinum toxin A is likely to produce concomitant extensor weakness. Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections. Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief. Some studies of low-level laser therapy show superiority to placebo whereas others do not. There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment. Therapeutic Level II. See Instructions to Authors for a complete description of level of evidence.

Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials.

BackgroundAcupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP.MethodsRevised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included.ResultsAll studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone.ConclusionModerate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.

Radial neck fracture presenting to a Chiropractic clinic: a case report and literature review

ObjectiveThe purpose of this case report is to describe a patient that presented with a Mason type II radial neck fracture approximately three weeks following a traumatic injury.Clinical featuresA 59-year old female presented to a chiropractic practice with complaints of left lateral elbow pain distal to the lateral epicondyle of the humerus and pain provocation with pronation, supination and weight bearing. The complaint originated three weeks prior following a fall on her left elbow while hiking.Intervention and outcomePlain film radiographs of the left elbow and forearm revealed a transverse fracture of the radial neck with 2mm displacement--classified as a Mason Type II fracture. The patient was referred for medical follow-up with an orthopedist.ConclusionThis report discusses triage of an elbow fracture presenting to a chiropractic clinic. This case study demonstrates the thorough clinical examination, imaging and decision making that assisted in appropriate patient diagnosis and management.

Humeral Lateral Epicondylitis Complicated by Hydroxyapatite Dihydrite Deposition Disease: A Case Report

ObjectiveThe aim of this case report is to differentiate the recovery timeline expected for patients with simple lateral epicondylitis from an abnormal recovery period, in which case an underlying condition should be suspected. Clinical featuresA 49-year-old woman presented to a chiropractic clinic with posterolateral right elbow pain. The history included chronic recurrent lateral elbow pain, followed by a traumatic event leading to sustained pain and disability. Intervention and outcomesFollowing a trial of conservative therapy including activity restrictions, soft tissue therapy, joint mobilizations, and therapeutic ultrasonography that led to no significant improvement, the patient was referred for diagnostic imaging that revealed hydroxyapatite dihydrite deposition disease. ConclusionThis report describes a case for which lateral epicondylitis symptoms failed to resolve because of an underlying condition (hydroxyapatite dihydrite deposition disease). This case emphasizes that primary care practitioners treating lateral epicondylitis should consider referral for further investigations when positive results are not achieved.

Autologous blood and platelet rich plasma injection therapy for lateral elbow pain

Autologous blood and platelet rich plasma injection therapy for lateral elbow pain