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Background: Based on the controversy over whether the extensor tendon is the only lesion of lateral epicondylitis of the elbow and numerous reports of concomitant lateral collateral ligament involvement, potential damage to the lateral collateral ligament complex should be considered for the treatment. Methods: About 25 elbows in 23 patients (débridement group) and 22 elbows in 20 patients (reconstruction group) who were diagnosed with lateral epicondylitis and had an average of 22 months of symptoms revealing anatomical lesion on MRI were included. The capitellum-sublime tubercle-radial head (CSR) angle was measured on both sides preoperatively, and the visual analog scale (VAS) and Mayo elbow performance score (MEPS) were measured over 12 months, postoperatively. Results: The initial preoperative mean VAS was statistically significant with 4.6 in the débridement group and 6.5 in the reconstruction group (P

Lateral epicondylitis, 'tennis elbow', is a common condition seen in general practice. Patients present with lateral elbow pain radiating distally and exacerbated by wrist and finger extension against resistance. Pain is also accompanied with functional impairment of the upper limb and hand. High intensity laser therapy (HILT) is a relatively new pain management modality used for treating musculoskeletal disorder. Aim of the work: To compare the efficacy of therapeutic HILT and ultrasound (US) in pain reduction and functional improvement in patients with chronic lateral epicondylitis. Patients and methods: 45 patients were randomly distributed into three equal groups: Group I treated by HILT and US; Group II treated by HILT only and Group III by US only. Patients were treated day after day for 12 sessions. The hand grip-strength was assessed by the dynamometry, pain measured by visual analogue scale (VAS) and the disorder of arm, shoulder and hand (DASH) scored. The HILT emitted a double wave length (915 nm and 808 nm) at a power of 3.2 Watt (W) and energy density of 5 Joule/cm2 while the US was used at an intensity of 1.5 W/cm2. Results: Patients were 24 females and 21 males with mean age of 44.9 ± 7.3 years. There was a significant improvement in the VAS, DASH and grip-strength for the three groups after sessions (p

Background A number of treatments for lateral epicondylitis of the elbow have been described. We have developed a strategy for the treatment of this condition. Methods We diagnosed lateral epicondylitis of the elbow in 86 patients. Conservative treatment resulted in resolution in 71 patients. Surgery was required in the remaining 15 patients. If the posterior branch of the posterior cutaneous nerve of the forearm showed a positive response to local anesthesia (block test), we performed denervation surgery on the posterior branch of the posterior cutaneous nerve of the forearm. Patients were asked to rate the degree of pain and sensory disturbance using a visual analog scale; the 11-item version of the Disabilities of the Arm, Shoulder and Hand measure; and the Patient-Rated Elbow Evaluation. Results A positive response to the block test was seen in 10 elbows (67%). After denervation surgery, pain relief was seen in 9 of 10 elbows (90%). The mean follow-up period was 30.4 months. At final follow-up, the average scores on the visual analog scale, 11-item version of the Disabilities of the Arm, Shoulder and Hand, and Patient-Rated Elbow Evaluation were 4.3 mm, 10.45 points, and 5.9 points, respectively. In the early period after denervation surgery, sensory disturbance was observed in 9 cases (90%). Conclusion Our strategy of denervation surgery for lateral epicondylitis of the elbow was effective for pain relief among patients showing a positive response to the block test.

Posterolateral elbow instability with an insufficiency of the lateral ulnar collateral ligament commonly results from elbow trauma. However, other etiologies such as iatrogenic injuries after primary surgical treatment for lateral epicondylitis or repetitive corticosteroid injections also may lead to a lateral ulnar collateral ligament insufficiency. In these cases, surgical treatment can help to restore posterolateral stability of the elbow. Besides the stabilizing effect of the ligamentous structures, the anconeus muscle is the most import active stabilizer against posterolateral elbow instability. Therefore, the aim of the present technique is to present an anconeus-sparing, minimally invasive approach to restore posterolateral stability. This technique may serve as an alternative for typically used all open access.

Purpose: To compare the short-term outcomes between arthroscopic and open procedures for the treatment of lateral epicondylitis. Because a significant portion of patients have worker’s compensation (WC), the outcomes in these subgroups were separately analyzed. Methods: A retrospective analysis of patients who had surgical treatment of lateral epicondylitis by a single surgeon from 2010 to 2017 was performed. Patients who were symptomatic after 9 months of conservative treatments including nonsteroidal medications, steroid injections, and physical therapy were offered surgical intervention. The type of surgery was selected after detailed consultation with the patient. Charts were reviewed for preoperative pain, grip strength as measured by dynamometer, smoking status, and WC status. Postoperative assessments included pain and grip strength at 6 weeks and time taken to return to full duty. Two groups were compared using unpaired t test and chi-squared tests. Results were compared with similar studies in the literature. Results: The study included 30 patients in the arthroscopic debridement group and 42 patients in the open tenotomy and reinsertion group. Eighteen patients (25%) had WC. Compared with the open group, the arthroscopic group had earlier return to full duty (mean 7.13 weeks, confidence interval [CI] 6.21 to 8.05 versu mean of 12.22 weeks, CI 11.21 to 13.24; P < .001) and less time for complete pain relief (mean 7.4 weeks, CI 7.02 to 7.93 versus 9.5 , CI 8.68 to 10.44; P = .043). No difference was seen among the groups in terms of unfavorable outcome (persistent pain and recurrence of pain), JAMAR hand dynamometer score at 6 weeks, and visual analog score at 6 weeks. A total of 11 patients (15%) had unfavorable outcome. Incidence of unfavorable outcomes was more in patients with WC insurance (36% in WC versus 7% in non-WC; P = .023). No association was seen with smoking status. WC patients also had a longer time to return to full duty (16.68 weeks for WC versus 7.65 weeks for non-WC; P < .001) and a longer time to get complete pain relief (12.4 weeks for WC versus 7.5 weeks for non-WC; P < .001). Conclusion: The arthroscopic technique offers advantages of earlier return to work and shorter recovery period along with additional advantages of joint inspection and ability to treat coexisting pathologies. WC patients had a longer time to return to full duty and time for complete pain relief. Level of Evidence: Level III, retrospective comparative study.

Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing.

Background Lateral epicondylitis (LE)1 affects between 1 and 3% of the population. Recently, platelet-rich plasma (PRP)2 has gained popularity. Aim Assess the long-term outcomes of PRP for patients with refractory LE. Methods We assessed 31 patients who had failed conservative management using the Oxford Elbow Score (OES).3 Results Mean follow-up: 5.2 years (range 4.2–6.1 years). 87.1% exhibited minimum clinically important difference (MCID)4 in pain scores between pre-op and long-term. 90.3% displayed MCID in function and psycho-social domains. Two patients had a repeat injection and six underwent open release. Discussion PRP is successful in treating refractory LE in most patients and avoiding surgery.

Radial tunnel syndrome is a painful syndrome caused by compression of the posterior interosseous nerve at the proximal forearm. There are no specific radiologic or electrodiagnostic findings. Nonsurgical treatment is recommended initially; if not successful, surgical decompression is indicated, releasing all the potential sites of entrapment. Surgical treatment has usually good outcomes; however, workers’ compensation patients or those who have coexisting lateral epicondylitis have less successful results.

Acute sprains and strains are common musculoskeletal injuries seen in the urgent care setting. It is most important to rule out other diagnoses that could present similarly. It is also important to know the initial steps in management and diagnosis. This section focuses on Achilles tendonitis, quadriceps strain, lateral epicondylitis, and patellar tendonitis.

Lateral elbow pain is a common issue amongst adult populations today, and the most common factors that causes the pain is lateral epicondylitis. The pathogenesis of the disease originates from the extensor carpi radialis brevis tendon (ERCB), but their are other concomitant structures that can cause the lateral pain. Injury to the ERCB is diagnosed using a history, physical examination, and imaging consisting of MRI, radiographs, and ultrasonography. Most patients diagnosed with lateral epicondylitis are able to be healed through conservative treatment including braces, antiinflammatories, and injections. When non-surgical treatment fails, surgical intervention is required, and the novel technique of ultrasonography ablation is proving to be highly successful. The disease causes pain in the ECRB region, but the positive outlook for patients is that either non-surgical or surgical management is likely going to create a satisfactory result.

The flexor-pronator muscle mass at the medial side of the elbow provides stabilization against valgus forces. Medial epicondylitis of the flexor-pronator muscle mass is most often caused by repetitive eccentric loading of the muscles performing wrist flexion and forearm pronation, combined with valgus overload at the elbow. The injury can also be named “tennis elbow” or “golfer’s elbow” due to the extensive valgus force on the elbow while striking the ball. Non-operative management utilizing nonsteroidal antiinflammatory drugs and corticosteroid injections is the most common way of treating medial epicondylitis. Surgical treatment is reserved for patients with persistent symptoms despite an aggressive non-surgical regimen for 4-6 weeks. Return to sport is dependent upon the sport played by the patient, and it can be enhanced by improved technique and equipment.

The 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.A 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.Following 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.This 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.