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1.
Koichi Sasaki Gosuke Ohki Kosuke Iba Yasuo Kokai Toshihiko Yamashita Takuro Wada 《Journal of orthopaedic science》2013,18(4):528-535
Purpose
We investigated the general, sensory, and sympathetic innervation patterns at the undersurface of the extensor carpi radialis brevis (ECRB) origin in patients with recalcitrant tennis elbow.Methods
Eight elbows in eight consecutive patients (6 females and 2 males) with tennis elbow who underwent arthroscopic surgery were included in this study. The mean age was 45 years (38–66 years), and the mean duration of symptoms before surgery was 23 months (13–52 months). Operative treatment consisted of an arthroscopic inspection and debridement of the ECRB origin. Control tissues were obtained from biopsy of the ECRB capsule in two patients with osteochondritis dissecance of the capitellum who underwent arthroscopic resection of loose bodies. The tissue specimens were investigated immunohistochemically with antibodies delineating general (PGP9.5), sensory (SP/CGRP), and sympathetic (NPY) nerve patterns.Results
In the non-tendinosis control tissue, SP/CGRP and NPY immunoreactions were heterogeneously distributed in association with blood vessels. Pathologic evaluation of the biopsy tissue showed atypical fibrous granulation containing numerous vessels and nerve structures in all eight patients. Marked reactions to PGP 9.5 took the form of nerve fibers associated with arteries and arterioles in the atypical granulation. Most of the perivascular innervation was found to express NPY. The immunoreactions for SP and CGRP were invariably weak.Conclusion
Increased perivascular sympathetic innervation accompanied with loss of sensory innervation at the undersurface of the ECRB tendon may play a role in chronic pain generation in recalcitrant tennis elbow.Level of evidence
Diagnostic, Level IV. 相似文献2.
3.
Mesut Tahta Ramazan Akmeşe Zekiye Nisa Özberk Özlem Öner Coşkun Çetin Işık Feza Korkusuz Murat Bozkurt 《Archives of orthopaedic and trauma surgery》2013,133(12):1711-1718
Background
The purpose of this study was to examine outcomes following arthroscopic Bankart repair with the focus on strength after the repair.Methods
56 shoulders with Bankart lesion were operated on arthroscopically. Gender, mechanism of the first dislocation, number of dislocations, dominant side, operated side and the number of anchors used for surgery were recorded. DASH and Oxford instability scoring systems were applied preoperatively and compared to scores at the 24-month follow-up. The scoring systems were also applied to contralateral shoulders at the 24th month of follow-up. Range of motion was measured with a goniometer. Muscle strength was analyzed with a dynamometer simultaneously with the muscle activity of four perishoulder muscles. The data were recorded with surface EMG. Range of motion, muscle strength and activity were evaluated according to the contralateral shoulder at the 24th month of follow-up.Results
Male/female ratio was 42/14 with a mean age of 32 years. The mean number of dislocations was 3 ± 1 and all were traumatic dislocations. The number of mean anchors used was 3.1 and the mean follow-up period was 24 months. In clinical evaluation, the preoperative and postoperative results of the DASH and Oxford instability scores of the unstable shoulders were significantly different. In the comparison between the operated and contralateral shoulders, there was no significant difference in DASH and Oxford instability scores at the 24th month of follow-up. There was no significant loss of range of motion. Only internal rotation strength was significantly reduced and there was no significant change in the EMG patterns.Conclusions
Although good clinical results can be achieved, internal rotation strength is reduced after arthroscopic surgery, but daily activities are not affected. There is no guarantee for patients of excellent recovery.Level of evidence
Level III cohort study. 相似文献4.
Eloy Cardenas-Montemayor Jan Felix Hartl Maya B. Wolf Franck Marie Leclère Jens Dreyhaupt Peter Hahn Frank Unglaub 《Archives of orthopaedic and trauma surgery》2013,133(2):287-293
Purpose
The purpose of this study was to determine functional and subjective results of patients who received arthroscopic debridement for their TFCC Palmer 1B lesions and to compare their results with those of arthroscopic suture repair.Methods
Between March 2007 and August 2011, 36 patients were diagnosed with Palmer type 1B tears and underwent arthroscopic debridement. 31 patients (15 males and 16 females) were followed up for an average of 26.7 months (±17.4 months) postoperatively. Their average age was 36.7 years (±12.7 years). Follow-up included the determination of range of motion (ROM), grip strength, pain, and wrist scores (modified Mayo wrist score (MMWS), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)).Results
Postoperative ROM averaged 99.2 % for the extension/flexion arc, 95.5 % for the radial/ulnar deviation arc, and 99.4 % for the pronation/supination arc of motion when compared with the contralateral wrist. The MMWS was rated excellent in 48 % of patients, good in 39 %, fair in 13 %, and poor in 0 %. The average DASH score was 17.02 (±14.92). There was a significant reduction in pain. The grip strength was 96.7 % (±15.8), pulp-to-pulp pinch 101.9 % (±17.4), and the ulnar variance ?0.12 ± 1.69 mm.Conclusions
Arthroscopic debridement of Palmer type 1B lesions in stable DRUJ yields satisfactory to excellent results. Our study showed similar results compared with the studies of arthroscopic suture repair with shorter postoperative care and fewer complications. 相似文献5.
Marc Schnetzke Felix Porschke Ulrich Kneser Stefan Studier-Fischer Paul-Alfred Grützner Thorsten Guehring 《Obere Extremit?t》2018,13(3):204-210
Background
The current study investigated the clinical outcome of open elbow dislocations, focusing on the influence of associated soft tissue and bone injury.Patients and methods
From October 2008 to August 2015, 230 patients with elbow dislocations were treated at the study center. Our retrospective study comprised 21 cases of open elbow dislocations. The mean age of patients was 49 years (20–83 years); there were six (29%) female and 15 (71%) male patients. The range of motion (ROM) of the injured and uninjured elbow was measured, and the Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS), and Disability of Arm, Shoulder and Hand (DASH) score were assessed. Complications and revision surgeries were recorded. The influence of the severity of soft tissue injury (I°/II° open vs. III° open) and type of dislocation (simple vs. complex) was evaluated.Results
After a 57-month follow-up (range, 24–98 months), the mean DASH score was 20?±?15, the MEPS was 82?±?11, and the MWS was 74?±?22. The ROM of the injured elbow was significantly decreased compared with the uninjured one (arc of ulnohumeral motion: 104° vs. 137°; p?=?0.001). Patients with I°/II° open elbow dislocations had a better clinical outcome according to the MEPS (86?±?11 vs. 76?±?9; p?=?0.045) and a comparable outcome according to the DASH score (19?±?18 vs. 21?±?9; p?=?0.238). In all, 11 patients (52%) had postoperative complications and 11 patients underwent at least one revision surgery. Complex elbow dislocations had significantly more complications and revision surgeries than simple dislocations (77% vs. 13%; p?=?0.008).Conclusion
Favorable clinical outcomes can be achieved after treatment of open elbow dislocations. These injuries are prone to neurovascular damage and complex dislocations are linked to high rates of complications and revision surgeries.6.
7.
Yu-Cheng Bao Yu-Lin Li Guang-Zhi Ning Qiang Wu Shi-Qing Feng 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(6):857-862
Background
Elbow tuberculosis (TB) is not rare in China. Most patients are diagnosed when it is at an advanced stage and with bony ankylosis complications. For a developing country, such as China, it is important for there to be safe and cost-effective procedures.Materials and methods
A retrospective study was designed to assess the effects of improved forked excision arthroplasty for treating elbow TB. There were 20 patients (average age, 48.45 years). For all patients, the preoperative diagnosis was elbow TB at an advanced stage. All patients underwent forked excision arthroplasty. Patients were evaluated preoperatively and postoperatively with the Mayo’s elbow performance score (MEPS). Mean follow-up was at 74.4 months.Results
At the last follow-up, the mean postoperative MEPS was 83.7 compared with the preoperative MEPS of 20.25. Results of Mayo’s elbow performance index were excellent in seven patients, good in 12 and fair in one, and none were poor. The range of elbow motion also improved significantly.Conclusion
This study of forked elbow excision arthroplasty has shown promising results for treating elbow TB. Most patients had ideal postoperative outcomes and exhibited painless elbow joints, with satisfactory functional recovery at medium-term follow-up. Further studies with longer follow-up are warranted.Level of evidence
III. 相似文献8.
Introduction
Open reduction and internal fixation of multifragmentary intra-articular fractures of the distal humerus often do not provide satisfactory results in elderly patients with osteoporosis.Method
From December 2001 to January 2008 a total elbow arthroplasty (Coonrad-Morrey, Zimmer, USA) was performed on 12 patients (average age 81±9 ears) who presented with a type C distal humeral fracture. The mean time of follow-up with clinical and radiological assessment was 28±17 months.Results
The Mayo score showed a good functional result with an average of 81±9 out of 100. DASH and SECEC scores showed a fair result with respect to elbow function (43±8 and 68±7 points, respectively). The average range of motion of all patients was 120-33-0°. Heterotopic ossifications were found by X-ray examination in 4 cases and asymptomatic radiolucent lines in 4 cases.Conclusion
Primary total elbow arthroplasty for complex intra-articular distal humerus fractures in elderly patients has good functional results and is an alternative to osteosynthesis. 相似文献9.
Purpose
To determine the prevalence of remaining horizontal instability in high-grade acromioclavicular joint (ACJ) injuries surgically managed by means of four different surgical strategies and to assess its relation to the clinical outcomes and the quality of life.Methods
In this multicentric non-randomized retrospective study, 53 patients with high-grade ACJ injuries surgically managed (by means of open or arthroscopic surgery) were clinically and radiographically assessed at 24 months or more after shoulder surgery. The presence of post-surgical remaining horizontal instability was evaluated by means of Alexander or axillary X-ray views. The study population was divided into two groups: patients with evidence of post-surgical remaining horizontal instability and patients without evidence of post-surgical remaining horizontal instability at the last follow-up visit. The relationship between remaining horizontal instability and the quality-of-life questionnaires was analyzed.Results
18.87% (10/53) of the Alexander or axillary X-rays views showed post-surgical remaining horizontal instability at the last follow-up visit (INSTAB-group). Results of the questionnaires were: (1) physical SF36 score (INSTAB-group 57.02 ± 3.17? and NO-INSTAB-group 57.66 ± 3.30, p = 0.583); (2) mental SF36 score (INSTAB-group 53.95 ± 3.98? and NO-INSTAB-group 55.71 ± 3.30, p = 0.150); (3) NRS for pain (INSTAB-group 1.30 ± 1.49 and NO-INSTAB-group 0.83? ± 1.08, p = 0.260); (4) DASH questionnaire (INSTAB-group 5.27 ± 5.42 and NO-INSTAB-group 3.06 ± 2.30, p = 0.049); (5) Constant score (INSTAB-group 93.4 ± 3.5 and NO-INSTAB-group 94.83? ± 4.3, p = 0.333); and Global satisfaction (INSTAB-group 8.7? ± 0.95 and NO-INSTAB-group 8.64 ± 1.03, p = 0.874).Conclusion
Independently of the type of procedure, post-surgical remaining horizontal instability was present in almost one-fifth of the patients, and this group of patients showed a significantly worse DASH score. The addition of an acromioclavicular augmentation might have to be considered, taking into account that its absence may have a negative impact in terms of shoulder disabilities.Level of evidence
Level IV, prognostic case series.10.
Mohsen Mardani-Kivi Mahmoud Karimi-Mobarakeh Ali Karimi Niloofar Akhoondzadeh Khashayar Saheb-Ekhtiari Keyvan Hashemi-Motlagh Farzaneh Bahrami 《Archives of orthopaedic and trauma surgery》2013,133(6):757-763
Introduction
This study seeks to compare two treatment methods of lateral epicondylitis: corticosteroid injection (CSI) and a local anesthetic injection (LAI).Materials and methods
In this single-blinded randomized clinical trial, 138 patients with the diagnosis of lateral epicondylitis were assigned either into CSI group receiving methylprednisolone 1 ml (49 patients) or LAI group (51 patients) receiving procaine 1 ml 2 % in a single dose at the maximal point tenderness site. The primary outcome measure was elbow disability using Quick DASH, and secondary outcome measures were pain intensity using Visual Analogue Scale (VAS) and recurrence rate at pretreatment visit and at 3-, 6- and 12-week post-treatment visits.Results
There were no significant differences between the patients in both groups for demographic factors including age, gender, dominant hand, involved hand, and work pressure. Before treatment, the patients in both groups were suffering from the same rates of elbow disability and pain as measured by Quick DASH and VAS, respectively, (p > 0.05). In general, the recovery rate (comparison between pretreatment visit and last post-treatment visit) was significantly more effective and higher in CSI than LAI. CSI was dramatically more effective at 3-week visit, but less and less effective at 6- and 12-week visits. At 12-week visit the recurrence rate was 34.7 % (17 patients) in CSI group.Conclusion
For lateral epicondylitis, CSI has the best short-term treatment results yet the highest recurrent rates. The combination of CSI with other treatment option or with a change in injection technique from single injection to peppering injection may be promising. 相似文献11.
Purpose
To analyze the clinical and radiographic characteristics, treatment, and outcome of patients with elbow osteoblastoma.Patients and methods
We present 13 patients (7 males and 6 females; mean age, 28 years) diagnosed and treated for an elbow osteoblastoma from 1975 to 2012. Mean follow-up was 29 months (range 12–60 months). Clinical presentation, imaging, surgical treatment, complications, range of elbow motion, and functional outcome were evaluated. The MSTS, DASH, and OXFORD scores were used.Results
Main symptom was pain (all patients) accompanied by stiffness (8 patients) and swelling or tumefaction (7 patients), with a median duration of symptoms of 32 months (range 6–96 months). Distal humerus was affected in 10 patients, proximal ulna in 2 patients, and proximal radius in one patient. All patients underwent surgical therapy that consisted of curettage of the lesion (7 patients), curettage and bone allografting (3 patients), wide resection (2 patients; total distal humerus and resection of the radial head), and radiofrequency thermal ablation (1 patient). One patient experienced a recurrence after surgical treatment. The mean MSTS score after treatment was 87% (range 50–100%), which corresponds to excellent results.Conclusions
Intralesional surgery is successful in tumor control in most patients with osteoblastoma of the elbow. Thermal ablation may be successful for smaller lesions. Most of the patients had a good-to-excellent functional outcome even if they had tumor-related elbow stiffness at diagnosis.Level of evidence
Therapeutic study, Level IV-1.12.
13.
Objective
Re-establishment of radial stability within the elbow joint in cases of arthroscopically or clinically confirmed posterolateral rotatory instability.Indications
Posttraumatic or chronic degenerative posterolateral rotatory instability at least grade I–II according to O’Driscoll.Contraindications
Elbow stiffness or elbow arthritis and lateral epicondylitis, if a posterolateral rotatory instability has been excluded as the reason for the symptoms.Surgical technique
Reconstruction or augmentation of the insufficient lateral ulnar collateral ligament (LUCL) with an autologous triceps tendon graft. A stripe of the triceps tendon is fixed at the epicondylus humeri radialis and at the base of the annular ligament at the proximal radial ulna with tenodesis screws or buttons, then the extensor origins, which were detached before are fixated as well.Postoperative management
Postoperative treatment with an elbow orthesis for 6 weeks, in the first 4 weeks limitation of complete extension and flexion, full weight bearing after 3 months.Results
Retrospective analysis of 47 LUCL reconstructions from 2008–2010 with good results concerning pain reduction and acceptance, improvement of the Mayo Elbow Performance Score from 49 to 82, low complication rate with one elbow stiffness, one temporary ulnar nerve lesion, and one recurrent instability. 相似文献14.
Michael Hackl Kilian Wegmann Tim Leschinger Alexander Borda Lars Peter Müller 《Obere Extremit?t》2016,11(3):172-177
Background
Arthroscopic arthrolysis is a minimally invasive but technically demanding treatment option for elbow stiffness. Prospective clinical data are limited thus far.Objectives
The aim was to analyze the clinical short-term results of arthroscopic elbow arthrolysis and to evaluate factors predictive of the outcome.Materials and methods
28 patients (16 men, 12 women) following arthroscopic arthrolysis were enrolled in this study. The VAS (visual analogue scale) score, range of motion (ROM), and DASH score were obtained preoperatively as well as 6 weeks and 12 months after surgery. Posttraumatic elbow stiffness was present in 15 cases, elbow stiffness was due to primary osteoarthritis in 10 cases and due to other reasons in 3 cases. Osteoarthritis was absent in 1 case, grade 1 osteoarthritis was present in 7 cases, grade 2 in 9 cases and grade 3 in 11 cases according to the Broberg and Morrey classification.Results
The VAS score was 5.3 ± 2.4 points preoperatively and decreased to 2.8 ± 2.7 points after 6 weeks and 1.6 ± 1.8 points after 12 months (p ≤ 0.001). The ROM increased from 86± 30° to 106± 28° after 6 weeks and to 121± 18° 12 months postoperatively (p ≤ 0.01). The DASH score improved from 39.3 ± 17.8 points to 23.8 ± 15.7 points after 6 weeks and to 11.3 ± 8.7 points 12 months postoperatively (p ≤ 0.001). Sex, age, grade of osteoarthritis and cause of elbow stiffness were not predictive of the clinical outcome. Complications were seen in 2 patients (7?%).Conclusions
Arthroscopic arthrolysis represents an effective treatment method for elbow stiffness, which increases the range of motion, decreases pain levels and thus improves the functionality of the affected extremity regardless of sex, age, severity of osteoarthritis and etiology of elbow stiffness.15.
Luigi Adriano Pederzini Luigi Milandri Massimo Tosi Mauro Prandini Fabio Nicoletta 《Journal of orthopaedics and traumatology》2013,14(2):109-114
Background
Loss of motion of the elbow joint is a common finding after elbow trauma. It has been shown that arthroscopic treatment leads to excellent restoration of elbow motion, although it is still a demanding procedure. The aim of our cohort study was to assess clinical outcomes following treatment of posttraumatic elbow stiffness using arthroscopic arthrolysis with or without the associated use of a hyaluronan anti-adhesion gel.Materials and methods
A cohort of 36 consecutive patients undergoing elbow arthroscopic arthrolysis were enrolled: 17 patients in the hyaluronan gel group and 19 in the control group. The patients underwent prospective control visits 30 and 75 days after surgery. Functional outcome was measured by the range of motion and the Liverpool elbow score (LES), whereas pain and quality of life were evaluated using the visual analogue scale and the SF-36 questionnaire, respectively.Results
The range of motion and the overall LES score increased over time in both groups. The mean increase over time was statistically significant (p < 0.001) in both groups and there was no difference between the groups. There was also no interaction between time and treatment. The percentage of patients who reported pain decreased significantly over time (p = 0.0419) in the hyaluronan-treated group (suggesting limited contractions and better comfort during rehabilitation), but not in the control group. The intensity of pain decreased significantly over time in both groups (p < 0.0001) without any significant difference between the groups. All the changes in patient quality of life as measured by the SF-36 questionnaire were similar for the two groups of patients. No adverse event or complication related to the application of hyaluronan gel occurred.Conclusions
Our preliminary clinical experience showed promising results upon the use of hyaluronan gel, considering that it significantly reduced pain in the short term, facilitating a more comfortable rehabilitation. These findings should be confirmed by larger studies. 相似文献16.
Michael Christoph Glanzmann Andreas B. Imhoff Hans-Kaspar Schwyzer 《International orthopaedics》2013,37(12):2403-2408
Purpose
Musculoskeletal tumours are rare in the daily practice of an orthopaedic surgeon or even a shoulder and elbow specialist. Patient complaints are often related to secondary changes to the underlying disease making the correct diagnosis challenging. The goal of this study is to identify key symptoms and findings which should give rise to suspicion of an osteoid osteoma.Methods
This retrospective study analyses the diagnostic pathway, surgical treatment and clinical outcome of six patients who underwent resection of an osteoid osteoma of the shoulder or elbow joint.Results
Average follow-up was 24 months (range 16–36 months). The neoplasm was often associated with synovitis mimicking a frozen joint causing marked delay in tumour identification. Misdiagnosis led to surgery without addressing the tumour in two cases, making further surgical intervention necessary. Once the tumour was identified and removed the pain resolved rapidly.Conclusions
In cases of chronic shoulder or elbow pain without an adequate clinical history an underlying cause including rarities such as an osteoid osteoma or other musculoskeletal tumours should be taken into consideration. Particularly in young patients, a magnetic resonance imaging (MRI)-proven hot spot of unknown origin should prompt a computed tomography examination to further clarify the source of pain and stiffness.Level of evidence
IV, case series 相似文献17.
Aim
Is arthroscopic revision of shoulder instabilities using suture anchors a viable alternative treatment to open revision surgery? Successful surgical stabilization of the shoulder is still a challenging problem. Many, mostly arthroscopic treatments using suture anchors are established for the initial surgery. In the literature, recurrence rates up to 49% are reported. Until now, the gold standard for these difficult recurrence cases was open revision surgery.Materials and methods
From 2001 to 2007, 21 patients were retrospectively examined after arthroscopic revision surgery of the shoulder using suture anchors. The mean follow-up was 2.8 years (6 months to 6.2 years). Mean age at surgery was 27.8 years (17 to 34 years). An MRI of the shoulder was used preoperatively for diagnosis in all patients. All patients were clinically followed up, including a physical examination and MRI. Furthermore, the Diabilities oft the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES), and modified Constant Murley Score (CMS) were obtained. The MRI results were evaluated by an independent radiologist.Results
A statistically significant difference between pre- and postoperative stability was found. There was no statistically significant correlation between the number of dislocations, the time interval between dislocation and stabilization surgery, and clinical outcome. The MRI showed good reconstruction of the labrum. The CMS rose from 72 preoperatively to 90 postoperatively, the ASES score from 59 to 88. The DASH score decreased from 42 to 9. There were no further dislocations until follow-up in this group. In a questionnaire, all patients would have surgery again.Conclusion
The clinical outcome of the selected group at follow-up after arthroscopic revision surgery of the shoulder is equal to results published in the literature after open revision surgery. The procedure is in our view a viable alternative to open surgery by using an appropriate arthroscopic technique. 相似文献18.
Background
The aim of this study was to evaluate the clinical and radiological results of 37 consecutive patients (Ø age 37.9; 4♀, 33♂) following arthroscopically assisted and image intensifier-controlled AC joint reconstruction using the double TightRope? technique for acute AC joint separations grade V according to Rockwood.Material and methods
After 12 months 30 patients with a mean age of 38.8 years (range 18.6–65.8 years) could be included. The postoperative assessment included the Subjective Shoulder Value (SSV), Constant Score (CS), and Taft Score (TF) as well as radiological evaluation using bilateral stress views and bilateral Alexander views for determining vertical and horizontal AC joint instability.Results
The clinical scores reached 91.4±9.8% for SSV, 87.8±5.2 for CS, and 10.1±2.1 points for TF. The initial coracoclavicular distance (CCD) was 22.1±5.6 mm and could be reduced to 8.6±2.8 mm postoperatively (p<0.05). The CCD increased at final follow-up to 12.8±2.4 mm. The difference of the CCD compared to the contralateral side was initially 13.7±4.8 mm; postoperatively it was 0.3±3.0 mm with an increase at final follow-up to 3.6±3.5 mm. A posterior instability on the Alexander view occurred in 53.3% of patients. A correlation between inferior clinical results and horizontal instability could be detected. Only one patient was slightly tender to palpation at the AC joint.Conclusion
Following arthroscopic AC joint stabilization using the double TightRope? technique, despite partial recurrent instability, favorable clinical results can be expected. 相似文献19.