scholarly journals The three-portal technique in arthroscopic lateral epicondylitis release

2017 ◽  
Vol 8 (4) ◽  
Author(s):  
Ashok Gowda ◽  
Gannon Kennedy ◽  
Stacey Gallacher ◽  
Jennie Garver ◽  
Theodore Blaine
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Arthroscopic Technique ◽  
Lateral Epicondyle ◽  
Extensor Muscles ◽  
The Common ◽  
One Year ◽  
Extensor Carpi Radialis ◽  
Portal Technique ◽  
Lower Morbidity

Lateral epicondylitis, commonly referred to as tennis elbow, is a syndrome characterized by pain over the origin of the common extensor muscles of the fingers, hand and wrist at the lateral epicondyle. Reports of 70-90% response to conservative treatment at one year have been documented in the literature though refractory cases often require surgical management. Arthroscopic treatment of lateral epicondylitis allows for intra-articular visualization for concomitant pathology and localization of the Extensor Carpi Radialis Brevis tendon. Additionally, compared to the open technique, the arthroscopic technique has a lower morbidity and an earlier return to work and activity. Here we describe a three portal technique for improved visualization in arthroscopic lateral epicondylitis release.

ANATOMIC AND CLINICAL STUDY OF A NEUROVASCULAR CAUSE OF LATERAL EPICONDYLITIS

2009 ◽  
Vol 12 (01) ◽  
pp. 11-19
Author(s):  
Xin-Ru Du ◽  
Ling-Xiu Zhao
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Triceps Brachii ◽  
Tissue Samples ◽  
Lateral Epicondyle ◽  
The Common ◽  
Pass Through ◽  
The Right ◽  
Neurovascular Bundles

Because of few anatomic reports investigating the mechanism of lateral epicondylitis (tennis elbow), we performed cadaveric and clinical studies to investigate the involvement of neurovascular bundles passing through the common extensor origin. We dissected and observed under a light microscope tissue samples of neurovascular bundles passing through the common extensor tendon from 40 upper left and right limbs from cadavers. Tissue samples were prepared by hematoxylin & eosin and Weil's myelin staining. We also investigated the records of 20 patients who had been treated for lateral epicondylitis between 1991 and 2004. From cadavers, we found 60 bundles in the common extensor tendon, each 0.5 to 1.0 mm in diameter, with more bundles in the right than left limbs. Twenty-four of these bundles passed over the vertex of the lateral epicondyle of the humerus, and most of the bundles contained only one artery each. The bundles mostly originated from the radial recurrent artery, passing through the aponeurosis of the extensor corpi radialis brevis, but in some cases originated from the radial collateral artery, passing through the aponeurosis of the triceps brachii muscle. The bundles had a membranous covering when passing through the aponeurosis and produced a hiatus. Histological analysis of resected common extensor tendon tissue, 1 cm in diameter, of patients showed hyaline degeneration and fibrosis formation infiltration. Neurovascular bundles passed through the common extensor tendon in nine cases; six cases showed pulsing bleeding. After a mean follow-up of two years (6–48 months), 16 cases showed excellent results, two showed good results and two showed reliefs. Lateral epicondylitis could be caused by damage to neurovascular bundles when they pass through the common extensor origin; one cause of pain is the neurovascular bundle being compressed when passing through the common extensor tendon, secondary to the pathologic degeneration of the origin of the common extensor tendon.

A Review of the Evaluation, Treatment, and Rating of Lateral Epicondylitis

2016 ◽  
Vol 21 (1) ◽  
pp. 10-13
Author(s):  
Justin J. Arnett ◽  
Steven Mandel ◽  
Steve M. Aydin ◽  
Christopher R. Brigham
Keyword(s):  
Daily Living ◽  
Nonoperative Management ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Wrist Flexion ◽  
Full Extension ◽  
Lateral Epicondyle ◽  
Sixth Edition ◽  
Lateral Elbow ◽  
Extensor Carpi Radialis

Abstract Lateral epicondylitis, often called “tennis elbow,” is a musculoskeletal condition characterized by pain around the lateral elbow and adjacent forearm with resisted wrist extension or passive terminal wrist flexion with the elbow in full extension, plus tenderness over and/or just distal to the lateral epicondyle. The name is a misnomer because the pathology is neither inflammatory nor located in the lateral epicondyle but rather represents a chronic tendinosis with disorganized tissue and neovessels of the tendon originating from the extensor carpi radialis brevis muscle and less commonly the extensor digitorum communis muscle, which originate on the lateral epicondyle. Clinical assessment involves understanding the chronology, precipitating activities, current symptoms, and interference with activities of daily living. Physical examination is performed bilaterally and includes palpitation provocative testing, measuring elbow and wrist motions, and neurological evaluation. Many treatments have been proposed, but little quality evidence supports any specific approach; more than 90% of cases are managed nonoperatively. Severe cases that have failed at least months of nonoperative management may warrant surgical assessment, but studies of surgical results for treatment of lateral epicondylitis are limited. Impairment rating may be necessary in a minority of cases and involves using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, based on diagnosis-based impairment and using Table 15-4, Elbow Regional Grid: Upper Extremity Impairments.

scholarly journals Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Nicola Massy-Westropp ◽  
Stuart Simmonds ◽  
Suzanne Caragianis ◽  
Andrew Potter
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Contralateral Limb ◽  
Cortisone Injection ◽  
Autologous Blood Injection ◽  
Blood Injection ◽  
And Function ◽  
Prospective Longitudinal ◽  
Extensor Carpi Radialis

Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis.Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation.Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not.Conclusions. Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.

The Role of the Extensor Digitorum Communis Muscle in Lateral Epicondylitis

2002 ◽  
Vol 27 (5) ◽  
pp. 405-409 ◽  
Author(s):  
S. M. FAIRBANK ◽  
R. J. CORLETT
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Middle Finger ◽  
Clinical Findings ◽  
Extensor Digitorum ◽  
Common Finding ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
High Prevalence ◽  
Pain Ratings

A common finding in tennis elbow is pain in the region of the lateral epicondyle during resisted extension of the middle finger (Maudsley’s test). We hypothesized that the pain is due to disease in the extensor digitorum communis muscle, rather than to compression of the radial nerve or disease within extensor carpi radialis brevis. Thirteen human forearm specimens were examined. It was found that the extensor digitorum communis was separable into four parts. The part to the middle finger originated from the lateral epicondyle, but the muscle slips to the other fingers originated more distally. Pain ratings were measured in ten patients diagnosed with lateral epicondylitis during isometric finger and wrist extension tests. The results confirmed the high prevalence of a positive Maudsley’s test in lateral epicondylitis, and also that the patients with tenderness at the site of origin of the extensor digitorum communis slip to the middle finger had the greatest pain during middle finger extension. These anatomical and clinical findings clarify the anatomy of extensor digitorum communis, and suggest that this muscle forms the basis for the Maudsley’s test. The muscle may play a greater role in tennis elbow than previously appreciated.

Resistant Tennis Elbow

1984 ◽  
Vol 9 (1) ◽  
pp. 64-66 ◽  
Author(s):  
G. H. HEYSE-MOORE
Keyword(s):  
Radial Nerve ◽  
Tennis Elbow ◽  
Anatomical Study ◽  
Nerve Entrapment ◽  
Posterior Interosseous Nerve ◽  
Lateral Epicondyle ◽  
Adjacent Structures ◽  
Extensor Carpi Radialis ◽  
Symptoms And Signs ◽  
Results Of Surgery

Fifty cases of resistant tennis elbow were studied, thirty seven of these had been treated by lengthening the tendon of extensor carpi radialis brevis, and thirteen by decompression of the radial tunnel. The two groups were well matched in terms of age, sex and pre-operative symptoms and signs. It was found that the results of surgery were very similar in the two groups and this observation is explained by anatomical study showing that surgical division of the fibrous arch of the superficial leaf of supinator will relieve tension on the lateral epicondyle and its adjacent structures thus allowing relief of symptoms independently of radial or posterior interosseous nerve decompression. This elaborates previously published work showing that there is no clinical or electrical evidence of radial nerve entrapment in resistant tennis elbow.

scholarly journals Extensor Carpi Radialis brevis: Review of Anatomy and Clinical Significance to Orthopedics

2019 ◽  
Vol 2 (1) ◽  
pp. 01-08
Author(s):  
Jennifer L Smith ◽  
Jacob B Stirton ◽  
Nabil A Ebraheim
Keyword(s):  
Clinical Significance ◽  
Radial Nerve ◽  
Lateral Epicondylitis ◽  
Extensor Digitorum ◽  
Surgical Approaches ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
The Third ◽  
Proper Management ◽  
Extensor Carpi Radialis

The extensor carpi radialis brevis (ECRB) muscle is an integral extensor and abductor of the wrist. It originates from the lateral epicondyle of the humerus, laying deep to the extensor carpi radialis longus and extensor digitorum communis, and superficial to the supinator. Insertion occurs at the base of the third metacarpal. The radial nerve or a derivative supplies innervation. Its significance in orthopedics is highlighted by its involvement in multiple surgical approaches, such as the Thompson and Kaplan approaches for exposure of the radius, as well as its association with several routinely observed pathologies. Many of the associated syndromes, such as lateral epicondylitis, arise from repetitive gripping motions or overuse and are frequently seen in the orthopedic clinic. This review seeks to provide a comprehensive summary of the relevance of the ECRB to the orthopedic setting to broaden knowledge of its anatomy and increase recognition and proper management of associated pathologies.

Perineural injection as an alternative treatment of resistant lateral elbow pain

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanaa Ahmed Hany Abd Eldayem Ahmed El-Naggar ◽  
Mona Mansour Mohammed Hasab El-Naby ◽  
Naglaa Youssef Mohammed Assaf ◽  
Mohja Ahmed Abd El-Fattah Elbadawy
Keyword(s):  
Clinical Improvement ◽  
Tennis Elbow ◽  
Functional Limitations ◽  
Lateral Epicondylitis ◽  
Elbow Pain ◽  
Lateral Epicondyle ◽  
Lateral Elbow Pain ◽  
Perineural Injection ◽  
Lateral Elbow ◽  
Tendon Thickness

Abstract Background Lateral elbow pain (LEP) or lateral epicondylitis (LE) is a common problem affecting both males and females. Multiple therapeutic modalities are used with different outcomes. Objective The current study aimed at description of the effectiveness of a newly introduced modality, Perineural Injection (PNI) therapy in comparison to the already used therapeutic ultrasound (TUS) as a conventional modality in the treatment of resistant LEP (LE). Patients and methods This is a longitudinal interventional study. Thirty patients of both sexes aged between 21 to 62 years old who had LE were randomly allocated into two groups (15 each). In PNI group, 5% buffered dextrose was injected subcutaneously around the lateral epicondyle once weekly for 8 weeks. In TUS group, continuous US was used 3 sessions per week for 4 weeks. Tenderness grading scale, visual analogue scale (VAS), Patient- Rated Tennis Elbow Evaluation Questionnaire (PRTEE) score, and ultrasonographic evaluation were used before and 12 weeks after treatment. Results In both groups, there was a high significant clinical improvement at 12th week after treatment. However, the improvement was better in the PNI group than the TUS group. By US evaluation at 12th week after treatment, there was a significant decrease in hypoechoic areas and disturbed fibrillar pattern in PNI group compared to before therapy (p < 0.001 and = 0.025) respectively. But in TUS group, there was decrease in hypoechoic areas and tendon thickness compared to before treatment (p = 0.02 and 0.026) respectively. Conclusion Both PNI and TUS therapies for LE gave clinical improvement for pain, functional limitations and some ultrasonographic findings (as echogenity, fibrillar pattern and tendon thickness). However, PNI therapy gave better outcome as compared to TUS.

Lateral Epicondylitis: A Common Cause of Elbow Pain in Primary Care

2021 ◽  
pp. 34-38
Author(s):  
Jeffrey Fleming ◽  
Christian Muller Muller ◽  
Kathryn Lambert Lambert
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Tennis Elbow ◽  
Imaging Modality ◽  
Treatment Options ◽  
Lateral Epicondylitis ◽  
Repetitive Motion ◽  
Lateral Epicondyle ◽  
Magnetic Resonance Imaging Mri ◽  
Standard Radiographs

Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.

scholarly journals A Comparative study to evaluate the efficacy of Supervised Exercise Program and Cyriax Physiotherapy on pain and function in Lateral Epicondylitis

2021 ◽  
Author(s):  
Gouri Kalaskar ◽  
R. K. Sinha ◽  
Pratik Phansopkar
Keyword(s):  
Tennis Elbow ◽  
Exercise Program ◽  
Lateral Epicondylitis ◽  
Exercise Programme ◽  
Functional Improvement ◽  
Lateral Epicondyle ◽  
Supervised Exercise ◽  
Time Period ◽  
Elbow Function ◽  
And Function

Abstract Background: A typical musculotendinous degenerative condition of the extensors cause at the humerus lateral epicondyle is known as Lateral epicondylitis. Various treatment methods are used in treating lateral epicondylitis. Methods: Thirty Participants with Lateral Epicondylitis shall be recruited in a comparative experimental study. Subjects will be randomized to either (1) Supervised Exercise Programme group, or (2) Cyriax Physiotherapy group. Over a 4-week time period, a 3 times in week for the total of 12 sessions, immediately following baseline assessment and randomization, subjects in both groups will receive Extensor Carpi Radialis Brevis muscle’s static stretching along with the wrist extensor’s eccentric strengthening and Ultrasound and transverse deep friction massage for 10 min with Mill’s manipulation and Ultrasound respectively. Discussion: Effectiveness of the interventions on the pain and the functional improvement will be assessed by visual analogue scale and the Tennis Elbow Function Scale respectively.

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