Percutaneous release of the common extensor origin for tennis elbow

Thirty patients (32 elbows) who had surgery for tennis elbow were examined. Symptoms were present an average of 18 months before surgery. The operation was done percutaneously through an incision just distal to the lateral epicondyle, through which the common extensor origin was released. The followup period was 6 to 61 months, with an average of 26 months. Twenty-nine elbows had good or excellent results. In these 29, the pain was relieved an average of 9 weeks after surgery. Three elbows did not improve significantly, and treatment was considered a failure. The grip strength improved from an average of 60% of the opposite side before surgery to 90% after surgery.     

Extracorporal shock wave therapy in patients with tennis elbow and painful heel

The aim of this study was to evaluate the effect of extracorporal shock wave therapy (ESWT) in tennis elbow and painful heel. Nineteen patients with tennis elbow and 44 patients with painful heel in which conservative treatment had failed underwent ESWT. Both groups received 3000 shock waves of 0.12 mJ/mm2 three times at weekly intervals. After a follow-up of 5 and 6 months respectively, pain measured on a visual analogue scale (VAS) decreased significantly in both groups. The success rate (excellent and good results) was 63% in tennis elbows and 70% in painful heels. ESWT seems to be a useful conservative alternative in the treatment of both conditions.     

The Outerbridge-Kashiwaghi procedure in elbow arthroscopy

We evaluated the results of the arthroscopic Outerbridge-Kashiwaghi procedure in a retrospective review of 20 elbows in 19 patients with a mean followup of 2 years (range : 6 months - 4 years). Range of motion improved from 94 degrees (range: 15 degrees-140 degrees) to 123 degrees (range: 110 degrees-140 degrees). Visual analogue scales for pain improved from 5.8 (range: 2 -8) to 1.8 (range: 0-8). The Mayo Performance Index increased from 54 (range: 15-85) to 88 (range: 45-100). The results were good to excellent in 16 elbows, fair in two and poor in two. Seventeen patients were better (85%), 3patients remained unchanged (15%). In elbows with severe arthritis, pain relief was minimal. The arthroscopic Outerbridge-Kashiwaghi procedure appeared in this study as a good surgical option in mild to moderate elbow arthritis, with significant pain relief and increased elbow mobility and function.     

Coonrad-Morrey半限制型假体全肘关节置换的临床应用

目的 探讨Coonrad-Morrey型半限制型假体全肘关节置换术的疗效.方法 2003年12月至2008年4月采用Coonrad-Morrey半限制型假体治疗肘部疾患30例(31肘),其中新鲜肱骨髁间骨折18例,髁间骨折内固定失效或骨折不愈合9例,类风湿性肘关节炎(RA)2例(3肘),骨性关节炎(OA)1例;其中男性8例,女性22例;年龄47～78岁,平均66岁.结果 20例(21肘)获得随访,均为骨折患者,平均随访35个月(12～52个月),术前因疼痛无法判断Mayo肘关节功能评分(MEPS评分),术后MEPS评分平均为84分;21肘中,6肘优(28%),11肘良(52%),2肘可(10%),2肘差(10%).优良率80%.并发症:1例术后发生"针-针系统"失效,1例术后切口迟延愈合,1例尺神经支配区域感觉减退,2例异位骨化.结论 全肘关节置换治疗肘关节损伤可解除疼痛、恢复稳定性及改善活动范围.对于老年肱骨髁间粉碎性骨折及骨折不愈合,严格选择病例,可获得较满意疗效.     

Treatment of painful heel syndrome with shock waves

In a prospective clinical study, the effectiveness of shock waves on painful heel syndrome in 80 patients (20 men and 60 women) with an average age of 48 years was investigated. Six patients had bilateral treatments. Each treatment consisted of 1,000 impulses of shock waves at 14 kV. A 100-point scoring system (70 points for pain and 30 points for function) was used for evaluation. The intensity of pain was measured with a visual analog scale from 0 to 10. The overall results were no complaints in 20.6%, significantly better in 52.9%, slightly better in 17.6%, and unchanged in 8.8% of 64 patients (68 heels) with 12 weeks followup; no complaints in 59.3%, significantly better in 27.7 %, slightly better in 13% of 52 patients (54 heels) with 6 months followup. None of patients' symptoms became worse. Seventeen patients (18 heels) who did not respond favorably to the first treatment had significantly better results after a second treatment. There were no device-related problems, and no systemic or local complications. Shock wave treatment is a new modality of therapy that is safe and effective in the treatment of patients with painful hell syndrome.     

Arthroscopic synovectomy of the elbow in rheumatoid arthritis

BACKGROUND: The purpose of this study was to investigate the results of arthroscopic synovectomy for the treatment of elbows affected by rheumatoid arthritis. METHODS: Arthroscopic synovectomy was performed on twenty-nine elbows (twenty-seven patients) between 1984 and 1996. Twenty-one elbows (twenty patients), followed for a minimum of forty-two months, were evaluated clinically with use of the Mayo elbow performance score and radiographic findings. The mean duration of follow-up was ninety-seven months. With use of the system of Larsen et al., we classified all elbows into three groups--Grades 1 and 2, Grade 3, and Grade 4--according to the preoperative radiographic findings. These groups were then compared. RESULTS: The mean Mayo elbow performance score improved from 48.3 points preoperatively to 77.5 points (an excellent result in two elbows, a good result in thirteen, a fair result in six, and a poor result in none) at two years after the operation and 69.8 points (an excellent result in two elbows, a good result in seven, a fair result in seven, and a poor result in five) at the final follow-up evaluation. The mean score for pain improved from 9.3 points preoperatively to 31.4 points at two years after the operation and 27.9 points at the final follow-up evaluation. Clinically apparent synovitis recurred in five of the twenty-one elbows, and two of the five required total elbow arthroplasty. Among the three groups, only elbows with Larsen Grade-1 or 2 arthritis had a favorable long-term result with regard to total function. The postoperative results were unsatisfactory for Larsen Grade-4 elbows. CONCLUSIONS: Arthroscopic synovectomy in an elbow affected by rheumatoid arthritis is a reliable procedure that can alleviate pain. Our results suggest that one of the most favorable indications for arthroscopic synovectomy is a preoperative radiographic rating of Grade 1 or 2.     

Elbow synovectomy on patients with juvenile rheumatoid arthritis

Twenty-four primary elbow synovectomies were done between 1991 and 1998 at the authors' institution on 19 patients (15 females, four males) with juvenile rheumatoid arthritis. Five bilateral and 14 unilateral procedures were done. The mean age of the patients was 29 years (range, 11-64 years) at the time of surgery and the mean disease duration was 19 years (range, 2-51 years). Preoperatively radiographic destruction of Larsen Grade 1 was detected in 21% of elbows, Grade 2 in 54%, and Grade 3 in 4%. In 21% of elbows no radiographic destruction was present (Grade 0). The cumulative survival rate of elbow synovectomy was 84% (95% confidence interval, 68-98) at 5 years. Four resynovectomies and two elbow replacement arthroplasties were done during the followup period. Complete pain relief was documented in 44% of patients and subjective outcome was excellent or good in 72% of patients. No significant improvement was observed in functional ability or range of motion in extension and flexion or pronation and supination. The results of the current study (mean followup, 5 years; range, 2-9 years) are slightly worse compared with the short-term results of elbow synovectomy in patients with adult-onset rheumatoid arthritis.     

Outcome of release of the lateral extensor muscle origin for epicondylitis.

Fifty-five elbows in 53 patients affected by lateral epicondylitis for more than a year were operated on with lateral extensor release. Fifty-one patients (53 elbows) were followed-up 90 months postoperatively by two independent observers using Verhaar's score and the subjective grading scheme described by Svernl?v and Adolfsson. According to Verhaar's score 26 (49%) were excellent or good and 27 (51%) fair or poor. Women had significantly worse results than men (p<0.005). In the self-assessment there was no significant difference between men and women and 20 (40%) of the patients rated their elbows as completely recovered, 26 (47%) as improved, 7 (13%) as unchanged, and none as worse. Patients whose symptoms remained unchanged after operation were re-examined and found to have other conditions that were likely to have caused the pain. Lateral release can reduce symptoms in chronic lateral epicondylitis but some residual pain can be anticipated.     

Safety and efficacy of extracorporeal shock wave therapy for chronic lateral epicondylitis

Efficacy and safety of extracorporeal shock wave therapy (ESWT) were investigated in 36 patients with chronic lateral epicondylitis--9 patients receiving and 27 patients not receiving worker's compensation. All patients were treated with a single application of 3200 shock waves. Twelve weeks after treatment, the mean visual analog scale score for the entire group improved from 8.0 to 2.5 (P < .05), and the mean RAND 36-Item Health Survey (Physical Functioning) score improved from 65.6 to 88.0 (P < .05). Outcomes for 28 elbows (77.8%) were rated excellent or good on the Roles and Maudsley scale. There were no significant differences in outcome measures among the subgroups. There were no significant complications. ESWT is an effective treatment for chronic lateral epicondylitis. Worker's compensation status did not affect outcomes.