Lateral Epicondylitis Of Elbow Research Articles

Volumetric assessment of ulnar nerves in cubital tunnel syndrome with 3D modeling of the MRI and its relationship with electrodiagnostic findings

BackgroundThickened nerve cross-sectional areas (CSA) have been investigated in compressive neuropathy, but the longitudinal extent of nerve swelling has yet to be evaluated. We did a volumetric assessment of the ulnar nerve in cubital tunnel syndrome (CuTS) with three-dimensional (3D) magnetic resonance imaging (MRI) modeling and investigated this relationship with clinical and electrodiagnostic parameters. MethodsWe compared 40 CuTS patient elbow MRIs to 46 patient elbow MRIs with lateral elbow epicondylitis as controls. The ulnar nerve was modeled with Mimics software and was assessed qualitatively and quantitatively. The CSA and ulnar nerve volumes were recorded, and the area under the receiver operating characteristic (ROC) curve was calculated for diagnostic performance. We analyzed clinical and electrodiagnostic parameters to investigate their relationship with the 3D ulnar nerve parameters. ResultsFor the diagnosis of CuTS, the area under the curve value was 0.915 for the largest CSA and 0.910 for the volume in the ROC curve. The optimal cut-off was 14.53 mm2 and 529 mm3 respectively. When electrodiagnostic parameters were investigated, the 3D ulnar nerve volume was significantly inversely associated with motor conduction velocity, although there was no association between the largest CSA and any of the electrodiagnostic parameters. ConclusionsThe 3D ulnar nerve volume, which is an integration or multilevel measurement of CSAs, showed diagnostic usefulness similar to CSA, but it correlated better with conduction velocity, indicating demyelination or early-to-moderate nerve damage in CuTS.

Percutaneous Tenotomy for Chronic Tennis Elbow: A Minimally Invasive Technique with Better Outcomes - A Case Series.

Tennis elbow (lateral epicondylitis elbow) is a self-limiting disease of indeterminate pathogenesis. Conservative therapy is the treatment of choice. In chronic tennis elbow with failure of conservative therapy; surgical treatment is a method of choice. Percutaneous tenotomy of extensor origin for patients with chronic tennis elbow is a minimally invasive technique with better long-term outcomes. Ten patients (six males, four females) presented with chronic tennis elbow, who did not respond to conservative treatment/non-surgical intervention for more than 6 months underwent percutaneous tenotomy in an outpatient setting. Two patients were lost to follow-up at 2 months' post-operative. The remaining eight patients were evaluated at a mean follow-up of 3 years and assessed using the numerical rating scale, disabilities of the arm, shoulder and hand questionnaire ,and Oxford elbow score. These scores had a statistically significant difference in baseline to 3-year follow-up values (P < 0.05). No adverse outcomes, recurrence of symptoms, and signs of lateral epicondylitis elbow were noted and none required open surgical release. Percutaneous tenotomy, a minimally invasive technique is an effective and well-tolerated treatment for chronic tennis elbow and gives good pain relief and functional recovery.

Arthroscopic Extensor Carpi Radialis Brevis Muscle Resection for Chronic Elbow Lateral Epicondylitis

Recalcitrant elbow lateral epicondylitis presents a difficult challenge for both the patient and the doctor. Surgical treatment consists of open resection and debridement of the extensor carpi radialis brevis muscle. However, advances in arthroscopic surgery provide for a more elegant method. There are several comparative studies between arthroscopic and open treatment that have shown equivalent outcomes. There is no consensus on which treatment is better and no defined indications of when to choose one over the other. This article presents our technique for arthroscopic extensor carpi radialis brevis muscle resection.

Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet rich plasma at 1 month but platelet rich plasma is more effective at 6 months: An updated systematic review and meta-analysis of level 1 and 2 studies.

The purpose of this study was to perform a systematic review and meta-analysis of studies comparing local injections of either platelet-rich plasma (PRP) or corticosteroid for the treatment of lateral elbow epicondylitis. A systematic review of Medline, Embase, Scopus, and Google Scholar was performed, and all level 1 and 2 randomized studies from 2000 to 2022 were included. Clinical symptoms, patient perceived outcomes, and pain were assessed by the DASH (disabilities of the arm, shoulder and hand questionnaire) and pain by the VAS (visual analog scale). Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. The modified Coleman Methodology Score (CMS) and the GRADE system were used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. Thirteen studies were included in the analysis. Five studies had a high risk of bias, and the risk of bias across studies was assessed as unclear. There was no publication bias identified. Two of the four GRADE domains (inconsistency of results, imprecision of results) were downgraded to low quality, and the final GRADE assessment was downgraded to a low quality of evidence. The mean CMS score was 62.8, indicating fair quality. The pooled estimate for VAS at 1 month favored corticosteroids (p=0.75), but favored PRP at three (p=0.003) and six months (p=0.0001). The pooled estimate for the DASH score favored corticosteroids at 1 month (p=0.028), but favored PRP at three (p=0.01) and six months (p=0.107) CONCLUSION: The results of this meta-analysis suggest that PRP has no advantage over steroid injections within the first month of treatment, but that it is superior to steroids at both 3 and 6 months. These results also suggest that corticosteroids have a short-term beneficial effect during the early treatment period, although the quality of the available evidence is not very robust in support of this finding. However, these findings must all be viewed with caution as the high risk of bias and moderate to low quality of the included studies may not justify a recommendation of one treatment over another.

Differences in Clinical Tests for Assessing Lateral Epicondylitis Elbow in Adults Concerning Their Physical Activity Level: Test Reliability, Accuracy of Ultrasound Imaging, and Relationship with Energy Expenditure.

Physical activity (PA) can generate physical stress on the musculoskeletal system. Thus, the aim of the current study was to assess the influence of the level of physical activity on clinical tests used in the diagnosis of lateral epicondylitis in adults, intertest reliability and accuracy based on ultrasound imaging, and relationship with energy expenditure. 102 adults with lateral epicondylitis were assessed via an International Physical Activity Questionnaire and divided according to PA level: low (n = 19) moderate (n = 42) or high (n = 41). Pain (visual analog scale), Cozen's and Mill's clinical tests and ultrasound exams were performed. The Cozen's and Mill's tests differed among PA levels. Excellent reliability was found for Mill's test for PA levels and the ultrasound exam (low ICC = 1.0, moderate ICC = 0.82 and high ICC = 0.99). Good reliability was found for Cozen's test (low ICC = 0.80, moderate ICC = 0.74 and high ICC = 0.73), but with significant differences between the ultrasound exams. The Cozen's and Mill's clinical tests had no relationship to the level of energy expenditure for PA levels. Mill's test was reliable and accurate for the PA levels. Intertest reliability was poor for the PA levels. Mill's test proved to be accurate based on the ultrasound exam. The pain caused by the tests was not related to the level of energy expenditure.

Long-Term Functional Outcomes Following Radiofrequency Microtenotomy for Lateral Epicondylitis of Elbow.

Background Lateral epicondylitis or 'Tennis elbow'is a common cause of elbow pain in the middle-aged group caused by tendinosis of the common extensor origin of the forearm muscles. Though no obvious aetiology is identified in most cases, it could be attributed to repetitive overuse of wrist extensors or supinator muscles. This condition is generally self-limiting but may become persistent in a few cases. Radiofrequency microtenotomy (RFM) is a minimally invasive surgical procedure for recalcitrant lateral epicondylitis of the elbow. This involves targeted coblation of pathological tissue at significantly lower temperatures. Objectives The aim of this study was to evaluate the therapeutic efficacy and report long-term results and recurrences in patients treated with RFM. Methods We present long-term results with a mean eight-year follow-up in a case series of 19 patients. All patients had a minimum of six months (mean 23.25 months and range: 6-36 months) of conservative management which included steroid injections prior to being offered RFM. This was a retrospective case series of 20 elbows (in 19 patients) who underwent RFM.The majority of patients (65%) were females. The operation was carried out in the dominant arm in 55% of patients. Results Results were analysed by comparing pre-operative and post-operative QuickDASH scores (Disabilities of the Arm, Shoulder and Hand Score) obtained at one year and eight years post-operatively. We found an improvement in QuickDASH scores from a mean of 61.7 pre-operatively to 18.9 (p-value < 0.0001) and 8.5 (p-value < 0.0001) at one year and eight years, respectively. The mean pain component of the QuickDASH scores decreased from 4.8 to 2.0 and 1.5, respectively, at one year and eight years (p-value < 0.0001). More than 83% of the patients had excellent to good functional improvement. Conclusion RFMis a reliable modality for treating recalcitrant lateral epicondylitis of the elbow with excellent long-term results.

Prevalence and factors of work-related musculoskeletal disorders among hand surgeons.

BACKGROUNDThe nature of tasks required by hand surgeons require both forceful and repetitive maneuvers, thus subjecting these surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice.AIMTo assess the prevalence, characteristics and impact of MSK disorders among hand surgeons.METHODSA modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.RESULTSOf the 578 respondents, 60.4% reported that they had sustained a work-related MSK injury, of which the most common diagnoses were lateral elbow epicondylitis (18.7%), low back pain (17.1%) and carpal tunnel syndrome (15.6%). Among those that reported an injury, 73.1 % required treatment and 29.2 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (P < 0.003), increasing years in practice (P < 0.001) and higher case load (P < 0.05). CONCLUSIONTo our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence. These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries, thus minimizing the financial and psychological burden on these surgeons and the healthcare system.

Platelet-rich plasma (PRP) on orthopedic clinical daily practice: a literature review

The use of PRP (platelet-rich plasma) is beneficial and even more important in the future. The most common indications were tendon damage (77%), osteoarthritis (68%), muscle damage (57%) and cartilage damage (51%). It is a purified autologous blood product with a higher platelet concentration than whole blood. It is rich in various cytokines and growth factors and has been shown to initiate and enhance healing by stimulating cell migration, cell proliferation, angiogenesis, and matrix synthesis. In rotator cuff injury, PRP injection led to significant long-term pain relief but not in functional improvements. In Osteoarthritis, PRP injection is associated with long-term pain relief and function improvements. PRP injection has a better outcome in VAS (visual analog scale) and DASH (The Disabilities of the Arm, Shoulder and Hand) scores in elbow ulnar collateral ligament pathologies, including lateral elbow epicondylitis. In medial epicondylitis, a paucity of studies causing therapeutic modality for PRP has not yet been established. In acute muscle injury, PRP used has no differences in imaging, pain, ROM (range of motion), muscle strength, and muscle function. In Achilles Tendinopathy, PRP injection has been associated with improvement in VAS, but no difference in VISA-A (The Victorian Institute of Sports Assesment – Achilles Questionnaire) score. However, the majority of published literature is secondary and tertiary evidence. Future studies could provide important information about the optimal concentrations of growth factors, platelets and leukocytes required for the desired effect in many specific tissues, as well as the appropriate method of administration and timing of drug application.

In vitro effect of triamcinolone and platelet-rich plasma on cytokine levels of elbow lateral epicondylitis-derived cells

BackgroundThe pathogenesis and treatment of lateral elbow epicondylitis (LEE) are still controversial. The purpose of the current study was to evaluate the production of inflammatory cytokines by LEE-derived cells and to compare the anti-inflammatory effect of triamcinolone acetonide with platelet-rich plasma (PRP) on cytokines production in primary culture of these cells.MethodsThird passage cells from primary cultures of LEE were assessed for the production of the cytokines IL-1β, IL-6, IL-8, IL-10 and TNF-α by immune-enzymatic assay (ELISA), after the treatment with 1, 10 and 100 μM triamcinolone compared to no treated controls at the time points 6, 12, 18, 24, 48, 72 and 96 h, and to PRP at 48, 72 and 96 h.ResultsThe cytokines IL-6 and IL-8 were produced in high concentrations by LEE cells. One, 10 and 100 μM triamcinolone induced significant decrease in the production of IL-6 and IL-8 at 48, 72 and 96 h, adding the time point 12 h for IL-8. Compared to controls, PRP caused a significant increase in the production of IL-6 and IL-8 and there was a significant increase in IL-10 production with the use of 100 μM triamcinolone at 48 h. The production of IL1-β and TNF-α was very low and did not change when the cultures were treated with triamcinolone or PRP.ConclusionLEE-derived cells produce IL-6 and IL-8, confirming the inflammatory nature of this condition. While triamcinolone inhibited the production of IL-6 and IL-8 by LEE cells, PRP induced an increase in these cytokines compared with controls.

Work-related musculoskeletal injuries among upper extremity surgeons: A web-based survey.

BACKGROUNDWork-related injuries have gained recent attention, especially in the orthopaedic literature. As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers, these surgeons can be at increased risk of acquiring work-related musculoskeletal (MSK) disorders during their years in practice. AIMTo assess the prevalence, characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.METHODSA modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant. RESULTSOf the 142 respondents, 90.8% were males and the majority were younger than 55 years old (65.5%). A work-related MSK injury was reported by 89.4% of respondents, of which the most common diagnoses were low back pain (26.1%) and lateral elbow epicondylitis (18.3%). Among those that reported an injury, 82.7% required treatment and 26% required time off work as a direct result of their injury. The need to undergo treatment due to the injury was associated with increased number of injuries (P < 0.01). Moreover, surgeons were more likely to require time off work when they had been in practice for > 21 years (P < 0.05). CONCLUSIONA high proportion of surgeons in our survey reported MSK injuries, with more than one quarter of surgeons reported requiring time off work due to an MSK injury. The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care. Awareness of operative ergonomics, irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.

Management of lateral epicondylitis elbow treated with corticosteroid versus platelet rich plasma injection at a tertiary care centre: A comparative study of the functional outcome

The aim of the present study is to compare the clinical and functional outcome in the patients with Lateral Epicondylitis elbow treated with local Corticosteroid injection vs Platelet Rich Plasma. A total of 74 patients were included in the study, divided into two groups equally. One group comprising of 37 patients with a mean age of 34 years was managed with intralesional autologous platelet rich plasma (PRP) injection and the other 37 patients with mean age of 37.20 years were treated with intralesional injection of 2ml Triamcinolone 40mg diluted with 2ml of 0.5% Bupivacaine. The results were calculated on the basis of the pre and post treatment VAS Score, DASH score and MAYO Elbow Performance score evaluated on 3 occasions post treatment, at 3 months, 6 months and finally at 12 months follow up. This study concludes that PRP injection gives slightly better functional outcome as compared to Corticosteroid injection however pain relief is comparatively similar with the two treatment procedures. A bigger sample size will be required to conclude a significant difference in the outcome of the two methods of management of lateral epicondylitis.

Early Results of Kinesio Taping and Steroid Injections in Elbow Lateral Epicondylitis: A Randomized, Controlled Study.

Background and objectives: This study prospectively compares early results of Kinesio tape (KT) as an alternative method for the treatment of lateral epicondylitis with those of corticosteroid injection and the rest-and-medication group (RMG). Materials and methods: Among the fifty patients (53 elbows), KT was applied to 20 patients (21 elbows), and corticosteroid injection (CSI) was applied to 15 patients (17 elbows). Fifteen patients were included in the RMG. Patients in the RMG were informed about their condition, and necessary warnings were given. No oral or topical treatments were recommended. If needed, paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed. Patients were classified according to the Nirschl scores and evaluated with visual analog scale (VAS); Quick Disability of Arm, Shoulder and Hand (QDASH); and the Turkish version of the Patient Related Elbow Evaluation (PREE-T). Results: Improvements in all scores were statistically significant in all groups at the end of the second week. At the end of the fourth week, there was also a statistically significant improvement in all three groups, but these improvements were not as high as they were in the first 2 weeks. There was a slight deterioration in the functional scores in the RMG and CSI groups, while the improvement in the KT group continued. In the KT group, the average QDASH score was 18.1 (4.5–35), the VAS score was 2 (1–3), the VAS score in resisted wrist extension was 4 (2–5) and the Nirschl score was 2 (1–3) at the fourth week. The KT group had significant superiority in these parameters over the RMG (p = 0.035, p = 0.035, p = 0.029, p = 0.035, respectively). However, there was no significant difference between the KT, the RMG and the CSI groups at the fourth week. Conclusions: CSI, KT and rest-and-medication treatments were all effective in terms of pain reduction and functional scores at the end of week 2, and the only treatment that continued to be effective in the final week was KT.

Comparative study of peppering versus single injection technique in treatment of chronic lateral epicondylitis elbow

Aim: To compare the effectiveness of peppering technique with single injection technique by using steroid along with local anaesthetic injection in the treatment of chronic lateral epicondilitis(LE) of Elbow. Materials and Methods: In this prospective randomized study, conducted among 66 patients. All patients were divided into two equal groups: peppering technique group (PRI) and single injection technique group (SNI), based on the injection technique. The patients in both groups were treated with local injection of a steroid(1ml Methylprednisolone) and local-anesthetic agent(1ml lignocaine). The effect was measured by change in elbow pain intensity as per Visual Analogue Scale (VAS) for pain. We included patients with Chronic LE of at least 6months duration while patients who have taken previous local steroid injections and uncontrolled diabetes were excluded. Patients were followed up at 2weeks, 6weeks and 6months. The Statistical Package for the Social Sciences (SPSS) version 24 software was used for all statistical calculations. Results: In this study, 66 patients were included (34 male & 32 female) with the most affected between 30-60 years. In our study, there was considerably lesser VAS score at 2 weeks, at 6 weeks and at 6 months follow-ups in both the groups comparing to the pre-injection VAS. At 6-months, the good results were 90%(n=30) in the PRI group compared to 72%(n=24) in SNI group. Thus the success rate for Peppering technique is significantly higher than the single-injection technique. Conclusion: In our study we conclude that peppering injection technique is better than single injection technique in terms of reduced pain which was assessed by VAS in the treatment of chronic lateral epicondylitis of elbow in the long-term follow up. Keywords: Tennis elbow treatment, Local injection, Corticosteroid, Chronic lateral epicondylitis, Peppering technique

Comparative Study between Scales: Subjective Elbow Value and Patient-rated Tennis Elbow Evaluation Applied to Patients Affected by Lateral Epicondylitis.

Objective To verify if the subjective elbow value (SEV) scale presents similar results to those of the Patient-rated Tennis Elbow Evaluation (PRTEE) scale in the evaluation of patients with lateral elbow epicondylitis (LEE). Methods Thirty-seven patients were diagnosed with LEE in the outpatient service of our hospital through clinical history, physical examination, X-ray, and ultrasonography. The SEV and PRTEE scales were used and their results were compared using a significance level ≥ 5% ( p ≥0.05). Results A statistically significant relationship was found between the values of SEV and PRTEE in the group of patients studied ( p = 0.017). Conclusion Subjective elbow value presented similar results to PRTEE in the evaluation of patients with diagnosis of LEE.

Management of lateral epicondylitis (tennis elbow) by local infiltration of platelet rich plasma an outcome study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2&lt;sup&gt;nd&lt;/sup&gt; week, 4&lt;sup&gt;th &lt;/sup&gt;week, 3&lt;sup&gt;rd&lt;/sup&gt; month and 6&lt;sup&gt;th&lt;/sup&gt; month.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value &amp;lt;0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.&lt;/p&gt;

Characteristic MRI findings of shoulder, elbow, and wrist joints in wheelchair user.

Wheelchair users frequently utilize their upper extremities for moving around in their daily life. Therefore, it is likely they may develop conditions of overuse in their joints, which could affect their activity and daily life. The purpose of this study is to clarify the actual conditions of the joints of wheelchair users using MRI. Twenty-five wheelchair users and twenty able-bodied control volunteers participated in this study. We scanned MRI images of their right and left shoulders, elbows, and wrists. Two radiologists interpreted the images and made diagnoses for each of the joints. The number of diseases for each joint was compared between wheelchair users and able-bodied volunteers. The number of supraspinatus tendon tears was higher in wheelchair users than controls in the right (Rt.) (P < 0.05), left (Lt.) (P < 0.05), and bilateral (Bil.) (P < 0.05) shoulders. The number of elbow LP lesions (Rt. (P < 0.01), Lt. (P < 0.01), and Bil. (P < 0.05)) and the number of elbow lateral epicondylitis cases (Rt. [P < 0.05] and Lt. [P < 0.05]) were also higher in wheelchair users than that of control volunteers. Additionally, the number of wrist TFCC injuries in wheelchair users (Rt. [P < 0.01], Lt. [P < 0.01], and Bil. [P < 0.01]) was more than that of control volunteers. Our results suggest that there are several types of overuse injury in each joint. However, we hypothesize that these are not induced by driving wheelchairs, but instead by the "push up" movement characteristic for wheelchair users, according to the situations caused by each injury.

Is Wrist Manipulation and Low-Level Lasertherapy Collectively Benificial for Patients with Lateral Epicondylitis?

Aim: The goal of the study is to find the effectiveness of Wrist Manipulation and Low- Level Laser Therapy, Flexibility and Endurance training to reduce pain and improve grip strength in patients with lateral epicondylitis of elbow. Method: A total of 30 subjects with Lateral Epicondylitis (LE),both male and female, between 25 to 50 years were selected and randomly further separated among 2 groups. The 2 separate groups comprised of 15 subjects each (male=7; female=8). Group A received Low-Level Laser Therapy(LLTT), Flexibility and Endurance training and Group B received Low-Level Laser Therapy along with wrist manipulation, flexibility and endurance training for 3 days per week. For both groups, total period of treatment was 4 weeks. Numeric Pain Rating Scale(NPRS) and Grip Strength (GS) were used as pre and post outcome measures. Results: Result of the study suggests improvement in mean value of NPRS and Grip Strength for groups A and B following treatment. The treatment was statically more significant in group B than group A. Conclusion: The study concludes that patients affected with Lateral Epicondylitisreceiving wrist manipulation along with Low-Level Laser Therapy, Flexibility and Endurance training demonstrates significant improvement.

테니스 동호인의 주관절 외측상과염의 발생원인과 증상정도에 관한 연구

테니스 동호인의 주관절 외측상과염의 발생원인과 증상정도에 관한 연구

Outcome analysis of percutaneous tenotomy in chronic lateral epicondylitis elbow

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lateral epicondylitis elbow is a self-limiting condition with an unclear pathology. Conservative therapy is treatment of choice in lateral epicondylitis elbow but chronic lateral epicondylitis elbow (&amp;gt;6 month) is a condition difficult to treat. Percutaneous extensor tendon release can be a viable treatment option in such conditions.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted in 2016 to 2017 at the Department of Orthopaedics Surgery in a tertiary care institute. 30 patients were treated by percutaneous tenotomy. The outcome was assessed at follow ups using numerical rating scale (NRS), disabilities of the arm, shoulder, and hand questionnaire (DASH) and Oxford scores.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 30 elbows were included in this study. They were managed by percutaneous method (PT; n=30). The mean age of patients was 41.74 years (range 26-67 years). Females were affected more than males in both groups (3:1). Dominant limb was involved in 86% of patients.73% of females were house wives exposed to household chores and manual activities while 40% of males were manual workers. Mean hospital stay was 35 minutes (range 20-43 minutes). Patients were followed up at 3 month and 6 month post intervention. NRS, DASH, Oxford score assessment showed that all the scores were significantly decreased (p&amp;lt;0.05) at 3 month and 6 month in patients undergoing percutaneous tenotomy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Lateral epicondylitis &amp;gt;6 month duration is difficult to treat. Percutaneous tenotomy is effective modality of treatment in such conditions.&lt;/p&gt;

Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis.

Objective:The aim of this meta-analysis was to compare the effectiveness of platelet-rich plasma (PRP) vs corticosteroids for treatment of patients with lateral elbow epicondylitis.Methods:A literature search was performed in EMBASE, Medline, the Cochrane Library and PubMed. Randomized controlled studies comparing PRP with corticosteroids for the treatment of epicondylitis were included. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the methodological quality of the included trials. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. The overall effect size of each anesthetic was calculated as the weighted average of the inverse variance of the study-specific estimates.Results:Seven randomized controlled trials were included in this review. The data from 2 studies were unavailable for meta-analysis, and the systematic review criteria were just achieved. Local corticosteroid injection yielded a significantly superior Disabilities of the Arm, Shoulder and Hand (DASH) score at 4 weeks (WMD, 11.90; 95% CI: 7.72 to 16.08; P < .00001; heterogeneity, χ2 = 0, I2 = 0%, P = 1.00) and 8 weeks (WMD, 6.29; 95% CI: 2.98 to 9.60; P = .0002, χ2 = 0, I2 = 0%, P = 1.00). Otherwise, it was noteworthy that a significantly lower VAS score (WMD, −2.61; 95% CI: −5.18 to −0.04; P = .05; heterogeneity, χ2 = 29.85, I2 = 97%, P < .00001) and DASH score (WMD, −7.73; 95% CI: −9.99 to −5.46; P < .00001, χ2 = 0.20, I2 = 0%, P = .66) existed in the PRP regimen than in the steroid regimen at the 24-week follow-up. More effective treatments were achieved in the PRP-treated patients than in the patients treated with corticosteroids (WMD, 3.33; 95% CI: 1.81 to 6.14; P = .000; heterogeneity, χ2 = 0.43, I2 = 0%, P = .51).Conclusions:Local corticosteroid injections demonstrated favorable outcomes compared with those of local PRP treatments for lateral elbow epicondylitis during the short-term follow-up period (4 weeks and 8 weeks post-treatment). Otherwise, at the long-term follow-up (24 weeks post-treatment), PRP injections had improved pain and function more effectively than corticosteroid injections.