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Lateral epicondylitis is the most common cause of lateral elbow pain. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore constitutes a major public health issue. This article reviews the pathophysiological factors involved in lateral epicondylitis, as well as the tools available for establishing the diagnosis and ruling out other causes of lateral elbow pain. Finally, the non-operative and surgical treatment options are discussed in detail.

BACKGROUND: Tendinopathy is a common cause of elbow pain in the active population. Ultrasound Guided Tenotomy (USGT) is a minimally invasive treatment option for cases recalcitrant to conservative management. Several case studies have shown promising preliminary results of USGT for common extensor tendinopathy and common flexor tendinopathy, but none have included USGT for triceps tendinopathy. This larger retrospective study evaluates the effectiveness and safety of USGT for all elbow tendinopathy sites at short and long-term follow-up. METHODS: Retrospective chart review identified 131 patients [144 procedures] (mean age ± SD, 48.1 ± 9.8 years; mean body mass index ± SD, 32.2 ± 7.7 kg/m(2); 59% male) with elbow tendinopathy (104 common extensor tendinopathy; 19 common flexor tendinopathy; 8 triceps tendinopathy) treated with USGT over a 6-year period by a single physician. Pain and quality of life measures were collected at baseline. Pain, quality of life, satisfaction with outcome, and complications were collected at short-term (2, 6, 12 week) and long-term (median 2.7 years IQR= 2.0 to 4.0 years) follow-up. RESULTS: Overall, USGT for elbow tendinopathy decreased pain from moderate/severe at baseline to mild/occasional at short-term and long-term follow-up (p< 0.01). Quality of life assessments showed significant improvement in physical function at short and long-term follow-up (p< 0.01). The majority (70%) of patients were satisfied with the procedure. There was a 0% complication rate. CONCLUSION: Benefits of USGT include pain relief, improved physical function, and high patient satisfaction. USGT is a safe minimally invasive treatment for refractory elbow tendinopathy.

Objective This report describes the case of a patient with chronic radial nerve entrapment symptoms managed with chiropractic care. We propose a complementary functional neurologic assessment of muscle function in different positions that could reveal muscle dysfunctions absent with standard test position. Clinical Features A 45-year-old man presented to a private chiropractic clinic with a throbbing pain 5 cm above the right lateral elbow epicondyle radiating onto the back of the lower arm and increasing after using a mouse when working on a computer. A Mill test and a Cozen test created pain near the lateral epicondylitis. The use of complementary functional neurologic assessment for radial nerve entrapment showed changes in manual muscle testing after tests were done in different positions to increase the compression on the nerve. Intervention and Outcome Chiropractic management was performed, including myofascial therapy, spinal and proximal radioulnar joint adjustments, neural mobilization, and the use of a splint. After 7 days (2 treatments), the patient showed no elbow pain even if he worked on his computer using a mouse. After a 2-year follow-up, no recurrence was reported. Conclusion In this case of radial nerve entrapment symptoms, the patient benefited from chiropractic management using standard chiropractic, applied kinesiology, and neural mobilization techniques. The complementary functional neurologic assessment of radial nerve entrapment proposed revealed muscles dysfunctions absent with the standard test position. These changes in manual muscle testing were useful to determine the possible sites of entrapment in order to direct the therapeutic efforts to these locations.

Introduction: the article describes the most common variants of paraarticular tissue pathology (PTP) - enthesitis of the upper and lower extremities, back. The issues of enthesitis etiology, pathogenesis, clinic presentation, diagnosis, differential diagnosis are considered. The historical background, technique and mechanism of action of perifocal syringe injections are presented.Objective of the study: evaluate the clinical efficacy of perifocal syringe injection of Alflutop in patients with enthesitis of the upper and lower extremities and back.Materials and methods of the study:76 patients with shoulder joint enthesitis (30 patients), epicondylitis (10), back pain (14), trochanteritis (13), anseritis of the knee joints (9) received treatment with perifocal injections of Alflutop as a course of 5 injections with an interval of 1 injection every 2 -3 days. We evaluated general well-being, local pain at rest, during palpation and movement, range of motion. The diagnosis was established clinically, and using the results of x-ray examination, ultrasound, MRI.The results of treatment: significant outcomes in patients, which included improved well-being, reduced pain, increased range of motion. 69 of 76 patients demonstrated significant improvement and improvement - the effectiveness of therapy was 90.8% with high tolerability of the drug.

Lateral epicondylitis, also known as ‘tennis elbow’, is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.

Chronic inflammation leading to musculoskeletal pain has garnered interest in the past decade with the success of genicular artery embolization for knee pain secondary to osteoarthritis. Outside the knee joint, musculoskeletal embolization has been applied to other anatomical locations, mainly shoulder pain secondary to adhesive capsulitis and elbow pain secondary to lateral epicondylitis. The success of these early trials and other case reports highlights the efficacy of musculoskeletal embolization and its future potential.

Introduction: The use of cell-based therapies in the management of sports injuries of the upper limb is increasingly popular despite the limited scientific evidence available for their use. We aim to evaluate the evidence for the use of cell-based therapies in these injuries and recommend areas for further research.\ud \ud Areas covered: In accordance with a published protocol (PROSPERO; Registration No. CRD42020193258), a comprehensive search of the literature was performed using the MEDLINE and EMBASE databases from inception to June 2020. All human studies reporting on the clinical, histological, or radiological outcomes following the use of cell-based therapies in the management of epicondylitis or rotator cuff pathology were included in this study. This resulted in 22 studies being included in this review, all of which underwent risk of bias assessments.\ud \ud Expert opinion: The evidence for the use of cell-based therapies in upper limb sports injuries is limited and generally of low quality. Given the heterogeneity in the cell types used, their harvesting methods and cell amounts, future research should be targeted at developing standardization of the reporting of these studies and more direct comparative studies looking at the efficacy of the different cell types.

Background Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. Methods Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. Results Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. Conclusions There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO registration number CRD42020148650.

Despite the increasing popularity of table tennis worldwide, few studies have focused on table tennis injuries. This study aimed to investigate the injury profiles, including the injury rate, types, locations, and risk factors, among nonprofessional collegiate table tennis athletes in Taiwan. We performed an online investigation among collegiate table tennis athletes of the nonprofessional category in the 2019 National Intercollegiate Athletic Games in Taiwan. Participants provided general information, and data on the characteristics of their play style, training, and injuries were collected. We then categorized these participants into injured and noninjured groups. Injuries were classified as mild, moderate, and severe, based on the time loss in playing table tennis. The risk factors for table tennis-related sports injuries were then identified through between-group comparisons. In total, 150 participants responded to the questionnaire. The average participant age was 21.3 years. Gender differences existed in age categories, forehand rubber, backhand style of play, and average days of training per week. Over the 6 months before the study, 76 of 150 participants experienced at least one injury. The handedness for play was associated with the occurrence of injury. Factors associated with injury severity included using rubber other than inverted rubber for the forehand and not qualifying for the national round of the team category of the National Intercollegiate Athletic Games. With a considerably high injury rate among nonprofessional collegiate athletes, further studies are required on table tennis-related injuries. Playing styles such as handedness and type of rubber used might be associated with the injury. The lower limb was the most common site of injury. These results may provide insights into trainers and coaches for further measures on injury prevention.

Background: Platelet-rich plasma (PRP) injections may alleviate symptoms of chronic medial or lateral epicondylitis. Methods: We retrospectively analyzed a total of 55 patients with chronic ME or LE who had undergone at least 6 months of any conservative treatment before intervention. The patients were divided into two groups: the PRP group (n = 25), who received a single injection of autologous PRP to the medial or lateral epicondyle, and the PT group (n = 30), who continued with PT and pain medication. The primary outcome measures were pain and functional outcomes measured in terms of the following: Patient Related Tennis Elbow Evaluation (PRTEE), Visual Analogue Scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH), which were detected at preintervention, 6-, 12-, 24-, and 36-month follow-up. Secondary outcomes included complications and the need for any surgery at follow-up. Results: Primary outcome measurements showed significantly better results favoring the PRP group (6-month PRTEE total 43.2 ± 19.2 vs. 62.8 ± 24.0, p < 0.001; 12-month PRTEE total 6.9 ± 15.0 vs. 28.1 ± 24.4, p < 0.001; 24-month PRTEE total 4.8 ± 9.8 vs. 12.7 ± 14.5, p = 0.029), and significantly better results in VAS and DASH sub-scores. The PRP group required significantly fewer surgical procedures (n = 0/0% vs. n = 6/20%, p = 0.027) at follow-up (mean 38.3 ± 12.3 months), and one case of prolonged pain after injection was detected. Conclusions: Patients who underwent PRP injections for epicondylitis resulted in better pain and functional outcomes compared to physiotherapy, and this improvement lasted at least 24 months. They required fewer surgical procedures and achieved faster recovery than the PT group. We recommend PRP for chronic epicondylitis of the elbow before considering surgery when other treatments have failed.

Pulmonary embolism after elbow arthroscopy is extremely rare, and no cases have been reported in the literatures. We report the case of a 67-year-old woman who presented by pulmonary embolism after elbow arthroscopy for debridement of medial epicondylitis. Early detection and proper management with Heparin therapy were essential for saving this patient. Physicians must be alert to the possibility of pulmonary embolism after elective elbow arthroscopic procedures.

Previously Injection of corticosteroids was thought to be the gold standard treatment in lateral epicondylitis. The autologus blood injection and different types of open and arthroscopic operative treatment are also advised for lateral epicondylitis recently. At present, platelet rich plasma (PRP) is considered as an ideal biological autologous blood derived component. All patients seen and clinically diagnosed as lateral epicondylitis and satisfying the inclusion criteria are selected. After obtaining written consent by simple random sampling alternatively patient received steroid injections and platelet rich plasma injections under strict aseptic precautions and were divided into group A group B respectively. In this study PRP and Corticosteroid treated groups had pre injection GRIP STRENGTH of 26.7 and 26.8 respectively with P=0.9. Post injection at 1 month follow up GRIP STRENGTH showed a significant increase in Corticosteroid group (30) as compared to PRP group (29).

Background For most patients, tennis elbow (TE) resolves within 6 months of onset. For those with persistent and painful TE, nonsurgical treatment options are limited. Thousands of studies have tried to find effective treatments for TE but have usually failed. In this study, we tested the hypothesis that injections with hyaluronic acid (HA) would be effective at reducing pain from chronic TE. Methods Patients with a minimum of six months of pain from TE and with a pain level of 50 or greater (out of 100) were included in the study. They were randomized equally into one of two treatment groups: injection with HA or injection with saline control. Follow-up was conducted at 3, 6 and 12 months from the initial injection. Both the patient and the examiner at the follow-up visits were blinded to the treatment arm. The primary outcome measure was the visual analog scale (VAS pain) score at one year. Additional outcome measures included the shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and Patient Rated Tennis Elbow Evaluation (PRTEE) scores. Results Eighteen patients were randomized into the HA injection treatment arm, and 17 (94%) completed the study. The average age was 51.9 years, and 10 of the subjects were male. Patients had an average of 28.1 months of pain before entering the study. The VAS score in the HA group decreased from a baseline of 76.4–14.3 at 12 months. All 17 patients in the HA group showed VAS score reductions above the minimal clinically important difference (MCID) of at least 18. The PRTEE score improved from 67 to 28.1. The QuickDASH score improved from 53.7 to 22.5. Follow-up in the saline group was less than 50% and was therefore not used as a comparator. Conclusions HA injections yielded significant success in pain relief by three months. Patients continued to improve for the 12-month duration of the study. This study indicates that patients with chronic lateral epicondylitis may benefit from receiving injections of hyaluronic acid rather than having to undergo surgery.

The physical–chemical, structural, hydrodynamic, and biological properties of hyaluronic acid within tendons are still poorly investigated. Medical history and clinical applications of hyaluronic acid for tendinopathies are still debated. In general, the properties of hyaluronic acid depend on several factors including molecular weight. Several preclinical and clinical experiences show a good efficacy and safety profile of hyaluronic acid, despite the absence of consensus in the literature regarding the classification according to molecular weight. In in vitro and preclinical studies, hyaluronic acid has shown physical–chemical properties, such as biocompatibility, mucoadhesivity, hygroscopicity, and viscoelasticity, useful to contribute to tendon healing. Additionally, in clinical studies, hyaluronic acid has been used with promising results in different tendinopathies. In this narrative review, findings encourage the clinical application of HA in tendinopathies such as rotator cuff, epicondylitis, Achilles, and patellar tendinopathy.

Placebo injections actually improve lateral epicondylitis at high rates. No other injections convincingly improve it better than placebo.Corticosteroid injection is not superior to saline or anesthetic injection (strength of recommendation [SOR] A, systematic review of randomized controlled trials [RCTs]). Platelet-rich plasma (PRP) injection is not superior to saline injection (SOR A, meta-analysis of RCTs).Botulinum toxin injection, compared to saline injection, modestly improved pain in lateral epicondylitis, but with short-term grip-strength weakness (SOR A, meta-analysis of RCTs). Prolotherapy injection, compared to saline injection, improved pain at 16-week, but not at 8-week, follow-up (SOR B, one small pilot RCT).Hyaluronic acid injection, compared to saline injection, resulted in a statistically significant pain reduction (6%) but did not achieve the minimum clinically important difference (SOR B, single RCT).Autologous blood injection, compared to saline injection, did not improve disability ratings (SOR B, one small RCT).

Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.

The diagnostic cascade for elbow complaints starts with the physical examination and radiographs that already can clarify or rule out many causes. Depending on the suspected pathology, additional imaging is necessary. Magnetic resonance imaging (MRI) has the advantage of accurately demonstrating a broad spectrum of diseases. The main indication for noncontrast MRI of the elbow is chronic epicondylitis. For magnetic resonance (MR) arthrography, it is suspected chondral and osteochondral abnormalities. Indirect MR arthrography is an option when direct arthrography is not practicable. MR arthrography of the elbow with traction is feasible, with promising results for the assessment of the radiocapitellar cartilage.

This study aimed to compare the peloid therapy and kinesio tape treatments in chronic lateral epicondylitis. While home exercise program and cold application were applied to the control group, peloid therapy (5 days a week for 3 weeks at 45 °C for 30 min each day, a total of 15 treatment days) was applied in addition to the first group, and kinesio taping (6 treatment days 2 times a week) was applied to the second group. Patients were evaluated with visual analog scale (VAS), grip strength with Jamar hydraulic dynamometer, Arm, Shoulder, and Hand Disabilities (DASH), quality of life in Short Form-36 (SF-36), and Patient-Rated Forearm Evaluation Questionnaire (PRFEQ) was recorded before treatment, after treatment (third week), and 1 month after the end of treatment. In this study, 156 patients with chronic lateral epicondylitis were included. In the follow-up of the patients, there was a statistically significant improvement in the hand grip strength, DASH, PRFEQ, VAS, and SF-36 scores in the 1st month follow-up after the treatment compared to the pre-treatment control in all groups (p

Arthroscopic tennis elbow release is a procedure with good pain relief but uncertain strength recovery. Tennis elbow reconstruction may improve strength, but the role of posterior interosseous nerve compression in the release makes it important to have a release available for the surgical procedure. This chapter describes a technique that limits exposure but achieves decompression of the posterior interosseous nerve during tennis elbow reconstruction through minimal extension of the incision.

Common extensor tendinopathy (lateral epicondylitis/tennis elbow) is an overuse enthesopathy of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) tendons. Refractory lateral epicondylitis with disabling symptoms often necessitates an open or arthroscopic debridement of the pathology. The arthroscopic anatomic insertional release (AAIR) procedure devised by the author involves accurate identification and release of ECRB and EDC tendon insertional footprints, and associated intra-articular pathology can be identified and treated simultaneously.

BACKGROUND: Lateral epicondylitis is a tendinopathy with a prevalence of between 1–3% of the population aged 35–54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). OBJECTIVE: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. METHODS: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. RESULTS: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. CONCLUSIONS: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.

Objective: This study aimed to compare the effectiveness of a supervised and home-based physiotherapy program in the reduction of pain and in improving functional status and quality of life in patients with lateral epicondylitis. Method: Patients diagnosed with lateral epicondylitis and referred to the physiotherapy clinic were evaluated retrospectively. A total of 32 patients were separated into two groups as supervised and home-based physiotherapy groups. All the patients received standard physiotherapy program consisting of static stretching exercises of the ECRB tendon, eccentric exercises of the wrist extensors and cold application, for 3 weeks. The groups were compared in terms of pain severity, range of motion, functional status (Quick-DASH) and quality of life (SF-36) after treatment. Results: Fifteen patients (12 females, 3 males) with a mean age of 44.20±7.35 years were included in the supervised physiotherapy group, and 17 patients (15 females, 2 males) with a mean age of 48.65±12.33 years in the home-based physiotherapy group. There was no statistically significant difference in activity (p=0.980) and rest pain (p=0.483), wrist flexion (p=0.775) and extension (p=0.838) range of motion, functionality (p=0.346) and quality of life (p=0.923) between groups. Conclusion: Patients participating in a home-based physiotherapy program had similar clinical outcomes in terms of pain intensity, range of motion, functionality, and quality of life as patients participating in a supervised physiotherapy. Further prospective randomized studies can be conducted by increasing the sample size and comparing with cost analyzes to determine the rehabilitation regimen that will provide the best outcomes in lateral epicondylitis rehabilitation.

Purpose This study aims to test the effects of Celliant armbands on grip strength in subjects with chronic wrist and elbow pain. Celliant® is a functional textile fabric containing minerals that emit infrared radiation (IR) in response to body heat. IR-emitting fabrics have biological effects including the reduction of pain and inflammation and the stimulation of muscle function. Design/methodology/approach A randomized placebo-controlled trial recruited 80 subjects (40 per group) with a six-month history of chronic wrist or elbow pain (carpal tunnel syndrome, epicondylitis or arthritis) to wear an armband (real Celliant or placebo fabric) on the affected wrist or elbow for two weeks. Grip strength was measured by a dynamometer before and after the two-week study. Findings For the placebo group, the mean grip strength increased from 47.95 ± 25.14 (baseline) to 51.69 ± 27.35 (final), whereas for the Celliant group, it increased from 46.3 ± 22.02 to 54.1 ± 25.97. The mean per cent increase over the two weeks was +7.8% for placebo and +16.8% for Celliant (p = 0.0372). No adverse effects was observed. Research limitations/implications Limitations include the wide variation in grip strength in the participants at baseline measurement, which meant that only the percentage increase between baseline and final measurements showed a significant difference. Moreover, no subjective measurements of pain or objective neurophysiology testes was done. Practical implications Celliant armbands are easy to wear and have not been shown to produce any adverse effects. Therefore, there appears to be no barrier to prevent widespread uptake. Social implications IR-emitting textiles have been studied for their beneficial effects, both in patients diagnosed with various disorders and also in healthy volunteers for health and wellness purposes. Although there are many types of textile technology that might be used to produce IR-emitting fabrics, including coating of the fabric with a printed layer of ceramic material, incorporating discs of mineral into the garment, the authors feel that incorporating ceramic particles into the polymer fibers from which the fabric is woven is likely to be the most efficient way of achieving the goal. Originality/value Celliant armbands appear to be effective in painful upper limb inflammatory disorders, and further studies are warranted. The mechanism of action is not completely understood, but the hypothesis that the emitted IR radiation is absorbed by nanostructured intracellular water provides some theoretical justification.

Introduction: Corticosteroid (CS) injections are a frequently used treatment modality for lateral epicondylitis (LE) despite an increasing number of studies suggesting their lack of efficacy. The objective of this study was to review the annual utilization of CS injections for treatment of LE, as well as that of other nonsurgical treatments and surgical treatments, to understand how recent publications have affected the practice of physicians in treating LE. Methods: Patients with LE from 2010 to 2017 were identified within a national insurance database and grouped by treatment modalities of CS injections, physical therapy, bracing treatment, and surgery. Epidemiologic and demographic data were reported using descriptive statistics. The number of patients receiving each treatment and the number of CS injections per patient were quantified for each year, and annual trends were analyzed using logistic regression. Results: Among 80,169 qualifying patients, 16,476 received CS injections, 12,180 received physical therapy, 1,874 received bracing treatment, and 2,650 underwent surgery, with patients receiving multiple modalities being members of each respective group. We found a significant decrease in the proportion of patients with LE receiving CS injections from 23.3% in 2010 to 18.8% in 2017 (R2 = 0.956, P < 0.001). Interestingly, the number of CS injections per patient increased during this period from 1.33 to 1.83 (R2 = 0.843, P = 0.001). No notable changes in utilization trends for other modalities were found. Discussion: Overall, our data support a decline in the use of CS injection as a treatment modality for LE from 2010 to 2017. Although correlational, this trend may reflect the increasing body of published evidence demonstrating the ineffectiveness of CS injections for the treatment of LE. In addition, the increasing number of injections per patient among those who received injections contrasts with the overall decrease in steroid utilization among all patients. Further study is needed to fully understand the mechanisms behind these trends.

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.

Background Lateral epicondylitis (LE), also known as tennis elbow, is the most common painful elbow condition. It affects approximately 1–3% of adults. There are various possible treatments described in the literature, but evidence to support a gold standard management protocol is lacking. Therefore, the objective of this study was to evaluate how Brazilian orthopaedists diagnose and treat lateral epicondylitis and compare these results with the available evidence. Methods This is an observational, analytical, cross-sectional study. A questionnaire was prepared to obtain information from the participants with eight specific questions (2 on diagnosis and 6 on treatment). These questions were answered voluntarily by participants at 3 major congresses of orthopaedists in Brazil in 2018. The results were analysed in accordance with the overall number of responses and were evaluated among groups according to subspecialty. Results We obtained a total of 501 questionnaires. Of these, 33 were excluded. The mean age was 38.67 years. The majority of respondents (91%) were male. We obtained 26.7% from specialists in hand surgery (Hand group), 36.5% from subspecialists in shoulder and elbow (Shoulder and Elbow group), and 36.8% from generalists in orthopaedics or from other subspecialties (General Orthopaedists group). For diagnosis, 24.4% did not initially request any imaging method. The most requested exam was ultrasonography (54.9%). The most prominent indication for initial treatment was physical therapy. For refractory cases, 78.3% of the respondents preferred doing a local infiltration. The most commonly used substance for local infiltrations was corticosteroids (89.6%). With respect to the surgical treatment option, 75.8% of those who recommend it prefer open techniques, and 24.2% prefer arthroscopic treatment. Of the total respondents, 12.8% did not recommend surgical treatment for LE. Conclusion Among Brazilian orthopaedists, the Cozen test is most frequently chosen, and ultrasound is the most commonly used imaging tool. Nonsurgically, oral nonsteroidal anti-inflammatory drugs (NSAIDs) plus physiotherapy is the most popular initial therapy, and corticosteroids are the most popular type of infiltration agent. Most surgeons recommended surgery after 6 months of nonsurgical treatment, and 75.8% preferred the open technique.

Objectives To develop a practical step-by-step technique to precisely identify and differentiate tendons and ligaments attaching to the humeral epicondyles, to confirm through gross anatomical study the accurate structure identification provided by this technique and to determine the frequency at which each structure can be identified in healthy volunteers. Materials and methods First, ten fresh frozen cadavers (6 men, age at death = 58–92 years) were examined by two musculoskeletal radiologists and a step-by-step technique for the identification of tendons and ligaments at the level of humeral epicondyles was developed. Second, the accurate identification of structures was confirmed through gross anatomical study including anatomical sections on five specimens and layer-by-layer dissection technique on five others. Finally, 12 healthy volunteers (6 men, average age = 36, range = 28–52) were scanned by two radiologists following the same technique. Results An ultrasonographic technique based on the recognition of bony landmarks and the use of ultrasonographic signs to differentiate overlapping structures was developed and validated through gross anatomical study. In healthy volunteers, most tendons and ligaments were identified and well-defined in ≥ 80% of cases, except for the extensor carpi radialis brevis and extensor digiti minimi tendons on the lateral epicondyle (having common attachments with the extensor digitorum communis) and the palmaris longus tendon on the medial epicondyle (absent, or common attachment with the flexor carpi radialis). Conclusion A step-by-step approach to the ultrasonographic assessment of tendons and ligaments at the humeral epicondyles allowed accurate identification of and differentiation among these structures, in particular those relevant to pathological conditions.

Background: There are currently a variety of patient-reported outcomes (PROs) for elbow pathology, without any established gold standard. The Single Assessment Numeric Evaluation (SANE) is a single question assessment of the patient’s perceived overall function compared with normal. The SANE score has been correlated with PROs from the shoulder and knee literature. Purpose: To correlate the SANE score for a variety of elbow pathologies with a traditionally reported elbow outcome measure, the American Shoulder and Elbow Surgeons–Elbow score (ASES-E). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review was performed of all patients identified at a single center between April 2016 and January 2019 who presented as a new patient with elbow pathology. All patients prospectively completed the ASES-E along with the SANE score for elbow (SANE-E) at the time of initial consultation. Spearman correlations ( r) were performed to evaluate the correlation between the ASES-E and the SANE-E score for specific elbow pathology, along with descriptive data such as age, sex, and chronicity of the problem. Results: A total of 555 patients (166 women, 29.9%) with a mean ± SD age of 51.0 ± 11.7 years with the diagnoses of medial epicondylitis (n = 72; 13.0%), lateral epicondylitis (n = 224; 40.4%), biceps tendon rupture (n = 139; 25.0%), triceps tendon rupture (n = 21; 3.8%), and elbow arthritis (n = 99; 17.8%) were included in this analysis. There was moderate correlation between the SANE-E and the ASES-E ( r = 0.623; P < .001), with strongest correlation with the visual analog scale (VAS) ( r = −0.518; P < .001) compared with any individual question and moderate to strong correlations based on specific diagnoses. SANE-E and ASES-E scores for the entire cohort were 42.9 ± 26.7 and 56.9 ± 21.4, respectively ( P < .001). Age ( r = 0.027; P = .526), sex ( r = 0.026; P = .555), VAS ( r = −0.106; P = .013), and chronicity of the problem ( r = −0.037; P = .384) were not found to be correlated with differences in ASES-E and SANE-E. Conclusion: The SANE-E score is a simple way to assess patient-perceived function relative to normal. The findings of this study demonstrated moderate to strong correlation between the ASES-E and the SANE-E score for a variety of commonly encountered elbow conditions.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-10-05T18:10:30Z No. of bitstreams: 1 Marcelo Ferreira Duarte de Oliveira.pdf: 4663198 bytes, checksum: a94168d6974d9a61b1273a3e6c5e1cea (MD5) Made available in DSpace on 2021-10-05T18:10:30Z (GMT). No. of bitstreams: 1 Marcelo Ferreira Duarte de Oliveira.pdf: 4663198 bytes, checksum: a94168d6974d9a61b1273a3e6c5e1cea (MD5) Previous issue date: 2021-06-23 Lateral epicondylitis (EL) is one of the most frequently encountered lesions in the upper extremity and is the most common cause of adult elbow pain known as tennis elbow. This clinical condition has a significant impact on the health sector and society at large. Treatment options include therapeutic exercises, orthotics, shock waves or ultrasound, in addition to corticosteroid injections. The photobiomodulation therapy (PBMT) has been presenting satisfactory results in the stimulation of tendon healing, obtaining favorable results in the tendon repair process. PBMT can be used as a therapeutic tool for the management of epicondylitis, however, further investigations are necessary to establish the optimal parameters of use. Therefore, the purpose of this study was to investigate the efficacy of two different PBMT devices (MR5TM Active Pro and LEAP SportsPodTM) in relieving pain and associated sensitivity in patients with lateral epicondylitis. To this end, a randomized, placebo controlled, triple blind trial was conducted, for which 75 adults of both genders was randomly assigned to three experimental groups. Individuals received photobiomodulation therapy at 4 points of the epicondyle region. Thirty days after treatment with phototherapy participants was evaluated with the degree of pain classification (visual analogue scale VAS), grip strength evaluation, in addition to satisfaction with the overall result of the study. There was a decrease in the level of pain in more than 30% of the group treated with the MR5® Active Pro device compared to placebo.TFBM with LEAP SportsPodTM (IR Pad) and TFBM/CM with MR5TM Active Pro (Activ Pro) were effective in relieving pain and tenderness in patients with lateral epicondylitis. However, no differences were observed regarding the effectiveness of the therapies to assess the grip strength of these patients. A epicondilite lateral (EL) é uma das lesões mais frequentes encontradas na extremidade superior e é a causa mais comum de dor no cotovelo em adultos, com um impacto significativo no setor de saúde e na sociedade em geral. A terapia de fotobiomodulação (TFBM), um recurso que vem apresentando resultados favoráveis no processo de reparo de tendões, pode ser uma ferramenta terapêutica promissora no manejo da epicondilite. Entretanto, mais investigações são necessárias para o estabelecimento de parâmetros ideais de utilização. Assim, o objetivo deste estudo foi investigar a eficácia de dois dispositivos para TFBM (MR5® Active Pro e LEAP SportsPod®) no alívio da dor e sensibilidade associada em pacientes com epicondilite lateral. Para isso foi conduzido um ensaio clínico randomizado, placebo controlado e triplo-cego, no qual foram recrutados 75 adultos, de ambos os gêneros. Os pacientes foram distribuídos aleatoriamente em três grupos (n=25), submetidos à terapia com os dispositivos MR5® Active Pro e LEAP SportsPod®, ativa e placebo, 2 vezes por semana com intervalo de 3 a 4 dias entre as sessões durante 3 semanas. As avaliações contaram com os testes para avaliação da força de preensão, a Escala Visual Analógica (EVA), além da satisfação com o resultado geral do estudo, foram realizadas previa e posteriormente ao protocolo de tratamento, e 30 dias após a realização do último tratamento. Houve diminuição do nível da dor em mais de 30% do grupo tratado com o dispositivo MR5® Active Pro comparado com o placebo. A TFBM com o LEAP SportsPod® (IR Pad) e a TFBM/CM com MR5® Active Pro (Activ Pro) foram eficazes no alívio da dor e sensibilidade em pacientes com epicondilite lateral. No entanto, não foram observadas diferenças quanto à eficácia das terapias para a avaliação de força de preensão desses pacientes.