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Sample records for acute lateral epicondylitis

  1. Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report.

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    Dzugan, Sergey S; Savoie, Felix H; Field, Larry D; O'Brien, Michael J; You, Zongbing

    2012-12-01

    Lateral elbow pain has multiple etiologies; most common is lateral epicondylitis. Radio-capitellar arthritis, posterolateral rotatory instability (PLRI), plica and radial tunnel syndromes may produce similar pain. The purpose of this study is to report on a rare subset of patients who had an acute injury during treatment for chronic lateral epicondylitis, exacerbating symptoms and lessening function. Indications for surgery were a failure of another round of nonoperative management and diagnosis of a new injury to the lateral ligaments in addition to the lateral epicondylitis. Surgical intervention revealed the acute injury to the radial ulno-humeral ligament (RUHL) complex, superimposed on chronic lateral epicondylitis, which we believe caused worsening of symptoms. Surgical repair of both lesions provided satisfactory results. Seven patients (range, 29-46 years; mean, 40.7) being treated for chronic lateral epicondylitis each sustained an acute elbow injury resulting in PLRI. Study data, including Andrews-Carson Elbow Score (ACES) and Mayo Elbow Performance Score (MEPS), were collected in the initial evaluation and at regular postoperative intervals, with a follow-up period of 12-24 months. Indications for surgery were pain, functional impairment, and failure of other treatments. All surgeries were performed on an outpatient basis under general anesthesia in the prone position. All patients showed arthroscopic evidence of chronic lateral epicondylitis and acute RUHL injury. All showed significant improvement in total ACES and MEPS after repair of both lesions, full range of motion, and objective improvement in strength and function, with no adverse effects or complications. Patients with chronic lateral epicondylitis who sustain an acute injury may damage the RUHL complex. Early recognition of this additional injury may allow surgical repair of both injuries with satisfactory results. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees

  2. [Lateral epicondylitis: conservative - operative].

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    Altintas, Burak; Greiner, Stefan

    2016-10-01

    Lateral epicondylitis is a common disease of the common extensor origin at the lateral humerus. Despite its common self-limitation it can lead to chronic therapy-resistant pain with remarkable functional disability of the affected arm. Different conservative and operative treatment options of lateral epicondylitis are described and compared regarding benefits and risks. Additionally, recent surgical techniques and their complications are mentioned. Based on the current literature, it is shown which treatment option can be recommended. This review was based on the literature analysis in PubMed regarding "conservative and operative therapy of lateral epicondylitis" as well as the clinical experience of the authors. Conservative treatment is the primary choice for the treatment of lateral epicondylitis if concomitant pathologies such as instability among others can be excluded. It should include strengthening against resistance with eccentric stretching of the extensor group. In persistent cases, operative treatment is warranted. Resection of the pathologic tissue at the extensor origin with debridement and refixation of the healthy tendinous tissue yields good results. Most patients with lateral epicondylitis can be treated conservatively with success. Radiological evaluation should be performed in therapy-resistant cases. In the case of partial or complete rupture of the extensor origin, operative therapy is indicated.

  3. Lateral epicondylitis of the elbow.

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    Tosti, Rick; Jennings, John; Sewards, J Milo

    2013-04-01

    Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Repetitive occupational or athletic activities involving wrist extension and supination are thought to be causative. The typical symptoms include lateral elbow pain, pain with wrist extension, and weakened grip strength. The diagnosis is made clinically through history and physical examination; however, a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies. Most patients improve with nonoperative measures, such as activity modification, physical therapy, and injections. A small percentage of patients will require surgical release of the extensor carpi radialis brevis tendon. Common methods of release may be performed via percutaneous, arthroscopic, or open approaches. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Lateral epicondylitis of the elbow.

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    Vaquero-Picado, Alfonso; Barco, Raul; Antuña, Samuel A

    2016-11-01

    Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients.The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment.The diagnosis is usually clinical but some patients may benefit from additional imaging for a specific differential diagnosis.The disease has a self-limiting course of between 12 and 18 months, but in some patients, symptoms can be persistent and refractory to treatment.Most patients are well-managed with non-operative treatment and activity modification. Many surgical techniques have been proposed for patients with refractory symptoms.New non-operative treatment alternatives with promising results have been developed in recent years. Cite this article: Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev 2016;1:391-397. DOI: 10.1302/2058-5241.1.000049.

  5. Radiographic and Clinical Analysis of Lateral Epicondylitis.

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    Shillito, Matthew; Soong, Maximillian; Martin, Nicholas

    2017-06-01

    The literature suggests that radiographs may be unnecessary in the initial evaluation of lateral epicondylitis because treatment is rarely altered as a result of the radiographic findings. The most commonly reported radiographic finding is calcification at the lateral epicondyle. Our goal was to perform a quantitative and qualitative analysis of this finding to determine its importance and possible relationship with various clinical factors and patient-reported measures. All patients diagnosed with lateral epicondylitis by a single surgeon during a 5-year period were retrospectively reviewed. Age, sex, laterality, hand dominance, pain visual analog scale, duration of symptoms, Quick-Disability of the Arm, Shoulder, and Hand questionnaire score, and history of steroid injection were recorded. Calcifications on standard elbow radiographs, acquired digitally and viewed at 200% magnification on a 24-inch monitor, were characterized by size and relationship with the lateral epicondyle. We reviewed 245 patients diagnosed with lateral epicondylitis. A total of 115 elbows (47%) demonstrated lateral epicondyle calcifications. Patients with and without calcifications were similar with regard to clinical factors, as were patients with larger or smaller lesions. Eighty-five elbows (35%) had additional radiographic findings. Treatment was not altered by the radiographic findings in any case. Lateral epicondyle calcifications are much more common in lateral epicondylitis than previously reported, possibly owing to modern digital radiography and magnification, although they do not appear to be related to clinical factors including patient-reported measures. Thus, patients and surgeons should be careful to avoid overinterpretation of such findings. Although radiographs may be helpful in ruling out additional pathology, we did not find other clinically important contributions to the initial evaluation and management of this condition, and thus we do not recommend their routine use

  6. Ultrasonographic findings of lateral epicondylitis of humerus

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    Choi, Joon Hyuk; Ha, Doo Heo

    2002-01-01

    To evaluate the ultrasonographic findings of lateral epicondylitis and their relationship with clinical outcome. The findings of ultrasonographic examinations of eighteen elbow joints in 15 patients (M:F=5:10; age:38-65(mean, 47.6) years) with lateral epicondylitis were reviewed. Two patients underwent surgery, two were not treated, and the remaining 11 were treated conservatively. Symptomatic improvement was noted 1 week after conservative treatment in two cases, at 2 weeks in five cases, at 3 weeks in three cases, and at 5 weeks in one case. With patients in the 90 degree flexed elbow position and in a supinated wrist, weexamined the extensor carpi radialis brevis (ECRB) tendon around the lateral epicondyle using ultrasound equipment with a 7-11 MHz linear transducer. The findings were assessed in terms of swelling of the tendon, changes in its echotexture, the presence of calcification of cystic degeneration, loss of the hypoechoic band between the tendon and bony cortex of the lateral epicondyle, cortical irregularity of the lateral epicondyle, and fluid collection around the tendon. Any relationships between each ultrasonographic finding and the treatment interval after which symptomatic improvement was noted were evaluated. In the 18 joints, change was heterogeneous hypoechogenicity in 13, and heterogeneous mixed echogenicity in three. Other ultrasonographic findings were swelling of the tendon in ten cases, loss of the hypoechoic band in 14, cortical irregularity in five, calcification in four, cystic degeneration in nine, and fluid collection around the tendon in four. In patients treated conservatively, there was no statistically significant difference between each ultrasonographic finding and the treatment interval after which symptomatic improvement was noted. Ultrasonography can be used to assess changes in the ECRB tendon and lateral epicondyle occurring in lateral epicondylitis, but fails to provide information on the rapidity of symptomatic

  7. Ultrasonographic findings of lateral epicondylitis of humerus

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    Choi, Joon Hyuk; Ha, Doo Heo [Pundang CHA Univ., Seongnam (Korea, Republic of)

    2002-03-01

    To evaluate the ultrasonographic findings of lateral epicondylitis and their relationship with clinical outcome. The findings of ultrasonographic examinations of eighteen elbow joints in 15 patients (M:F=5:10; age:38-65(mean, 47.6) years) with lateral epicondylitis were reviewed. Two patients underwent surgery, two were not treated, and the remaining 11 were treated conservatively. Symptomatic improvement was noted 1 week after conservative treatment in two cases, at 2 weeks in five cases, at 3 weeks in three cases, and at 5 weeks in one case. With patients in the 90 degree flexed elbow position and in a supinated wrist, weexamined the extensor carpi radialis brevis (ECRB) tendon around the lateral epicondyle using ultrasound equipment with a 7-11 MHz linear transducer. The findings were assessed in terms of swelling of the tendon, changes in its echotexture, the presence of calcification of cystic degeneration, loss of the hypoechoic band between the tendon and bony cortex of the lateral epicondyle, cortical irregularity of the lateral epicondyle, and fluid collection around the tendon. Any relationships between each ultrasonographic finding and the treatment interval after which symptomatic improvement was noted were evaluated. In the 18 joints, change was heterogeneous hypoechogenicity in 13, and heterogeneous mixed echogenicity in three. Other ultrasonographic findings were swelling of the tendon in ten cases, loss of the hypoechoic band in 14, cortical irregularity in five, calcification in four, cystic degeneration in nine, and fluid collection around the tendon in four. In patients treated conservatively, there was no statistically significant difference between each ultrasonographic finding and the treatment interval after which symptomatic improvement was noted. Ultrasonography can be used to assess changes in the ECRB tendon and lateral epicondyle occurring in lateral epicondylitis, but fails to provide information on the rapidity of symptomatic

  8. Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial.

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    Olaussen, Morten; Holmedal, Øystein; Mdala, Ibrahimu; Brage, Søren; Lindbæk, Morten

    2015-05-20

    Lateral epicondylitis of the elbow is a frequent condition with long-lasting symptoms. Corticosteroid injection is increasingly discouraged and there is little knowledge on the combined effect of corticosteroid injection and physiotherapy for acute conditions. We wanted to investigate the efficacy of physiotherapy alone and combined with corticosteroid injection for acute lateral epicondylitis. A randomized, controlled study with one-year follow-up was conducted in a general practice setting in Sarpsborg, Norway. We included 177 men and women aged 18 to 70 with clinically diagnosed lateral epicondylitis of recent onset (2 weeks to 3 months). They were randomly assigned to one of three treatments: physiotherapy with two corticosteroid injections, physiotherapy with two placebo injections or wait-and-see (control). Physiotherapy consisted of deep transverse friction massage, Mills manipulation, stretching, and eccentric exercises. We used double blind injection of corticosteroid and single blind assessments. The main outcome measure was treatment success defined as patients rating themselves completely recovered or much better on a six-point scale. One hundred fifty-seven patients (89 %) completed the trial. Placebo injection with physiotherapy showed no significant difference compared to control or to corticosteroid injection with physiotherapy at any follow-up. Corticosteroid injection with physiotherapy had a 10.6 times larger odds for success at six weeks (odds ratio 10.60, p lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks. Physiotherapy with deep transverse friction massage, Mills manipulation, stretching, and eccentric exercises showed no clear benefit, and corticosteroid injection gave no added effect. Corticosteroid injections combined with physiotherapy might be considered for patients needing a quick improvement, but intermediate (12 to 26 weeks) worsening of symptoms makes the treatment difficult to

  9. Corticosteroid injections for lateral epicondylitis: a systematic review.

    NARCIS (Netherlands)

    Smidt, Nynke; Assendelft, Willem J J; van der Windt, Danielle A W M; Hay, Elaine M; Buchbinder, Rachelle; Bouter, Lex M

    Patients with lateral epicondylitis (tennis elbow) are frequently treated with corticosteroid injections, in order to relieve pain and diminish disability. The objective of this review was to evaluate the effectiveness of corticosteroid injections for lateral epicondylitis. Randomised controlled

  10. Dynamic extensor brace for lateral epicondylitis.

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    Faes, M.C.; Akker, B. van den; Lint, J.A. de; Kooloos, J.G.M.; Hopman, M.T.E.

    2006-01-01

    Lateral epicondylitis (tennis elbow) is a common, often disabling ailment. Based on the failure of current therapies, a new dynamic extensor brace has been developed. In this study, the effects of application of this brace for 3 months on the most important and disabling symptoms of patients with

  11. Kinesio taping in patients with lateral epicondylitis.

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    Dilek, Banu; Batmaz, Ibrahim; Sarıyıldız, Mustafa Akif; Sahin, Ebru; Ilter, Leman; Gulbahar, Selmin; Cevik, Remzi; Nas, Kemal

    2016-11-21

    Lateral epicondylitis (LE) is a painful condition that affects the tendinous tissue of the lateral epicondyle of the humerus and leads to loss of function of the affected limb. Therefore it can have a major impact on the patient's social and personal life. Many treatments are recommended for lateral epicondylitis; unfortunately the evidence is limited. The aim of study was to investigate the effect of kinesio taping (KT) on pain, grip strength and function in patients LE. Thirty-one (23 females, 8 males) patients with LE were included. KT was applied twice a week for 2 weeks. Pain at rest, activity of daily living (ADL), night and palpation on lateral epicondyle was evaluated with the visual analog scale (VAS 0-10 cm), and the grip strength was measured with a hand held dynamometer. The stage of the disease was evaluated by the Nirschl score and the functional status was assessed with Patient-Rated Forearm Evaluation Questionnaire (PRTEQ) score. These parameters were evaluated before, at 2 weeks and 6 weeks after treatment. Patients' satisfaction was also recorded on a Likert scale after treatment at 2 weeks and 6 weeks. The average age of the patients was 43.58 ± 9.02. The dominant limb was affected in 64.5% (20) of the patients. After the application of KT on lateral epicondyle, there was a significant improvement in all parameters in terms of pain, Nirschl score, hand grip strength, patient satisfaction, and PRTEQ scores at 2 and 6 weeks. Kinesio taping can be an effective treatment method in LE. This application improves pain, grip strength and functional status of the patients with LE.

  12. Changes in pain, dysfunction, and grip strength of patients with acute lateral epicondylitis caused by frequency of physical therapy: a randomized controlled trial.

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    Lee, Soyoung; Ko, Youngjun; Lee, Wanhee

    2014-07-01

    [Purpose] The purpose of this study was to investigate the changes in pain, dysfunction, and grip strength of patients with acute lateral epicondylitis and to suggest the appropriate treatment frequency and period. [Subjects] The subjects were divided into three: 2 days per week group (n=12), 3 days per week group (n=15), and 6 days per week group (n=13). [Methods] All groups received conventional physical therapy for 40 minutes and therapeutic exercises for 20 minutes per session during 6 weeks. The outcome measurements were the visual analogue scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and grip strength. [Results] The results of this study were as follows: at 3 weeks, there were no significant differences in VAS and PRTEE in the 3 groups, but at 6 weeks, 6 days per week group significantly decreased these two outcomes. Grip strength was significantly increased in 3 and 6 days per week groups at 6 weeks. [Conclusion] In conclusion, physical therapy is needed 3 days per week for 3 weeks in patients with acute lateral epicondylitis. After 3 weeks, 6 days per week is the most effective treatment frequency.

  13. Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis.

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    Rose, Nicholas E; Forman, Scott K; Dellon, A Lee

    2013-02-01

    Chronic lateral epicondylitis remains a treatment challenge. Traditional surgical treatments for lateral epicondylitis involve variations of the classic Nirschl lateral release. Anatomic studies reveal that the posterior branch or branches of the posterior cutaneous nerve of the forearm consistently innervate the lateral humeral epicondyle. We undertook the present study to determine the effectiveness of denervation of the lateral humeral epicondyle in treating chronic lateral epicondylitis. An institutional review board-approved prospective study included 30 elbows in 26 patients. Inclusion criteria included failure to respond to nonoperative treatment for more than 6 months and improvement in grip strength and in visual analog pain scale after diagnostic nerve block of the posterior branches of the posterior cutaneous nerve of the forearm proximal to the lateral humeral epicondyle. We excluded patients who had undergone previous surgery for lateral epicondylitis. Outcome measures included visual analog pain scale and grip strength testing. Denervation surgery involved identification and transection of the posterior cutaneous nerve of the forearm branches with implantation into the triceps. The presence of radial tunnel syndrome was noted but did not affect inclusion criteria; if it was present, we did not correct it surgically. We used no postoperative splinting and permitted immediate return to activities of daily living. At a mean of 28 months of follow-up, the average visual analog scale score decreased from 7.9 to 1.9. Average grip strength with the elbow extended improved from 13 to 24 kg. A total of 80% of patients had good or excellent results, as defined by an improvement of 5 or more points on the visual analog scale for pain. Denervation of the lateral epicondyle was effective in relieving pain in 80% of patients with chronic lateral epicondylitis who had a positive response to a local anesthetic block of the posterior branches of the posterior

  14. Arthroscopic treatment for chronic lateral epicondylitis

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    Bernardo Barcellos Terra

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVE: To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC in patients with chronic lateral epicondylitis that was refractory to conservative treatment. METHODS: Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS for pain. RESULTS: A total of 15 patients (9 men and 6 women were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100. The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used ( p 0.05. CONCLUSION: Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

  15. Arthroscopic treatment for chronic lateral epicondylitis.

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    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

    2015-01-01

    To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p  0.05). Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

  16. Autologous proliferative therapies in recalcitrant lateral epicondylitis.

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    Tetschke, Elisa; Rudolf, Margit; Lohmann, Christoph H; Stärke, Christian

    2015-09-01

    This study investigates the clinical effects of autologous conditioned plasma (ACP) injections and low-level laser application as therapy options for chronic lateral epicondylitis. A total of 52 patients with chronic lateral epicondylitis were evaluated in this study; 26 of these patients received three ACP injections and the control group, with 26 patients, received 12 laser applications, with standardized physical therapy for all patients afterward. Control examinations took place before treatment, after 2 and 6 mos, and in the 1 yr final follow-up. The control examination included the visual analog scale for pain and Disabilities of the Arm, Shoulder and Hand outcome measure scores. The analysis at final follow-up after 1 yr showed that both treatment options resulted in successful therapy outcome for the patients. In total, 63.5 % were successfully treated. Successful treatment was defined as more than 30% improvement in the visual analog score and more than 10.2 points in the Disabilities of the Arm, Shoulder and Hand score. Both groups showed a significant improvement in time response. This study demonstrates the beneficial effects of autologous proliferative therapies in the treatment of lateral epicondylitis. The data show that laser application and ACP therapy lead to a clinical improvement in epicondylopathia. Especially the new treatment with ACP can be highlighted as an alternative and as an easy-to-apply therapy option for clinical practice.

  17. Effect of Acupotomy Therapy on Lateral Epicondylitis Diagnosed by Ultrasonography

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    Lim Nara

    2011-06-01

    Full Text Available Purpose: This observation was to report the clinical effects of acupotomy in treating lateral epicondylitis. Methods: Three patients diagnosed with lateral epicondylitis were treated with acupotomy. Two were male and one was female. The improvement of symptom were evaluated by visual analog scale (VAS and self-consciousness symptoms of Cozen test. Results: After one treatments, patient's chief complaint and the pain near the lateral epicondyle while cozen test were notably improved. Conclusions: This study demonstrates that oriental medical treatment with acuputomy therapy has significant effect in improving symptoms of lateral epicondylitis. As though we had not wide experienced in this treatment, more research is needed.

  18. Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: A protocol for a randomised, placebo-controlled study

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    Holmedal Øystein

    2009-12-01

    Full Text Available Abstract Background Lateral epicondylitis is a painful condition responsible for loss of function and sick leave for long periods of time. In many countries, the treatment guidelines recommend a wait-and-see policy, reflecting that no conclusions on the best treatment can be drawn from the available research, published studies and meta-analyses. Methods/Design Randomized double blind controlled clinical trial in a primary care setting. While earlier trials have either compared corticosteroid injections to physical therapy or to naproxen orally, we will compare the clinical effect of physiotherapy alone or physiotherapy combined with corticosteroid injection in the initial treatment of acute tennis elbow. Patients seeing their general practitioner with lateral elbow pain of recent onset will be randomised to one of three interventions: 1: physiotherapy, corticosteroid injection and naproxen or 2: physiotherapy, placebo injection and naproxen or 3: wait and see treatment with naproxen alone. Treatment and assessments are done by two different doctors, and the contents of the injection is unknown to both the treating doctor and patient. The primary outcome measure is the patient's evaluation of improvement after 6, 12, 26 and 52 weeks. Secondary outcome measures are pain, function and severity of main complaint, pain-free grip strength, maximal grip strength, pressure-pain threshold, the patient's satisfaction with the treatment and duration of sick leave. Conclusion This article describes a randomized, double blind, controlled clinical trial with a one year follow up to investigate the effects of adding steroid injections to physiotherapy in acute lateral epicondylitis. Trial Registration ClinicalTrials.gov Identifier: NCT00826462

  19. Comparative effectiveness of injection therapies in lateral epicondylitis

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    Krogh, Thøger Persson; Bartels, Else Marie; Ellingsen, Torkell Juulsgaad

    2013-01-01

    Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available.......Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available....

  20. Epidemiology of lateral and medial epicondylitis in a military population.

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    Wolf, Jennifer Moriatis; Mountcastle, Sally; Burks, Robert; Sturdivant, Rodney X; Owens, Brett D

    2010-05-01

    To determine the epidemiology of lateral and medial epicondylitis in the U.S. military. The Defense Medical Epidemiology Database was queried for ICD-9 codes 726.32 (lateral epicondylitis) and 726.33 (medial epicondylitis) for the years 1998-2006. Multivariate Poisson regression was used to calculate incidence rates (IR) and rate ratios (RR) among demographic groups. The IRs for lateral and medial epicondylitis were 2.98 and 0.81 per 1000 person-years. For lateral epicondylitis, women had a higher incidence (RR = 1.22, 95% CI 1.19-1.26). In both groups, analysis by age showed higher incidence in the > or = 40-year-old group. White compared with black race was a risk factor for both lateral (RR = 1.68, 95% CI, 1.63-1.74) and medial epicondylitis (RR = 1.11, 95% CI 1.05-1.17). Female gender was a risk factor for lateral but not medial epicondylitis. Age greater than 40 and white race were significant risk factors for both conditions.

  1. The three-portal technique in arthroscopic lateral epicondylitis release

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    Ashok Gowda

    2017-01-01

    Full Text Available 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.

  2. The Three-Portal Technique in Arthroscopic Lateral Epicondylitis Release.

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    Gowda, Ashok; Kennedy, Gannon; Gallacher, Stacey; Garver, Jennie; Blaine, Theodore

    2016-11-17

    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.

  3. Corticosteroid injections for lateral epicondylitis : A systematic overview

    NARCIS (Netherlands)

    Assendelft, Willem J J; Hay, Elaine M.; Adshead, Ross; Bouter, Lex M.

    1996-01-01

    Background. Lateral epicondylitis (tennis elbow) is a common complaint, for which corticosteriod injections are a frequently applied therapy. However, there were no up-to date reviews available that systematically addressed the effectiveness and adverse effects, including questions concerning

  4. Effectiveness of physiotherapy for lateral epicondylitis : a systematic review

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    Smidt, Nynke; Assendelft, Willem J J; Arola, Heikki; Malmivaara, Antti; Greens, Sally; Buchbinder, Rachelle; van der Windt, Daniëlle A W M; Bouter, Lex M

    2003-01-01

    AIM: To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow. METHOD: Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers

  5. Counterforce Orthosis In The Management Of Lateral Epicondylitis.

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    Vellilappilly, Daison Varghese; Rai, Heroor Ravindranath; Varghese, Jaison; Renjith, Vishnu

    2017-01-01

    Lateral Epicondylitis (LE), is a condition characterized by the pain and tenderness over the lateral epicondyle of the humerus. LE is commonly seen among people who are involved in sports such as tennis and golf. Any activity that repeatedly overstrains the extensor carpi radialis brevis tendon can lead to LE. The management of lateral epicondylitis generally involves the use of counterforce orthosis. The aim of this review is to summarize the evidence regarding the effectiveness of counterforce orthoses on the clinical outcomes of patients with lateral epicondylitis. The PubMed, Ovid, and ProQuest databases were searched for potential studies which explored the use of counterforce orthosis in the management of lateral epicondylitis. To have a better understanding of the effectiveness of various types of orthoses, the review is organized into four sections. The first section explores the use of a single orthotic device, the second section focuses on the combined use of orthotic devices, the third section explore studies that compared the effect of local steroid injection along with orthosis and the last section narrate the studies that compared various types of orthotic devices. The studies support the use of orthotic devices as a treatment modality for lateral epicondylitis. There is rising evidence which supports the use of a comprehensive approach, (by combining routine physiotherapy with orthotic devices) in the management of LE. Orthosis alone or in combination with routine physical therapy can be considered as an evidence-based treatment strategy for patients with lateral epicondylitis. However, on the basis of the literature review conducted, the authors recommend that further high-quality clinical trials regarding the management of lateral epicondylitis are necessary to strengthen the evidence-based physiotherapy practice.

  6. Lateral and medial epicondylitis: role of occupational factors.

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    Shiri, Rahman; Viikari-Juntura, Eira

    2011-02-01

    Epicondylitis is a common upper-extremity musculoskeletal disorder. It is most common at the age of 40-60 years. Epicondylitis seems to affect women more frequently than men. Diagnosis of epicondylitis is clinical and based on symptoms and findings of physical examination. The prevalence of lateral epicondylitis in the general populations is approximately 1.0-1.3% in men and 1.1-4.0% in women and that of medial epicondylitis is nearly 0.3-0.6% in men and 0.3-1.1% in women. The incidence rate of medical consultations has been estimated at 0.3-1.1 for lateral and 0.1 for medial epicondylitis per year per 100 subjects of general practice populations. Of occupational risk factors, forceful activities, high force combined with high repetition or awkward posture and awkward postures are associated with epicondylitis. The number of studies is limited to work-related psychosocial factors and the effects are not as consistent as those of physical load factors. Topical non-steroidal anti-inflammatory drugs, corticosteroid injections and acupuncture provide short-term beneficial effects. Workload modification should be considered, especially in manually strenuous jobs. According to clinical case series, surgical treatment has shown fair to good results; however, the efficacy of surgical treatment has not been evaluated in randomised controlled trials. Poorer prognosis of epicondylitis has been reported for individuals with high level of physical strain at work, non-neutral wrist postures during work activity and for those with the condition on the dominant elbow. Modification of physical factors could reduce the risk or improve the prognosis of epicondylitis. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Acupuncture for Lateral Epicondylitis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Hongzhi Tang

    2015-01-01

    Full Text Available Objective. This systematic review aimed to assess the effectiveness and safety of acupuncture for lateral epicondylitis (LE. Methods. Seven databases and the WHO International Clinical Trials Registry Platform Search Portal were searched to identify relevant studies. The data were extracted and assessed by two independent authors, and Review Manager Software (V.5.3 was used for data synthesis with effect estimate presented as standard mean difference (SMD and mean difference (MD with a 95% confidence interval. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE was used to assess the level of evidence. Results. Four RCTs with 309 participants were included with poor methodological quality. Participants who received acupuncture and acupuncture plus moxibustion with material insulation were likely to have an improvement in elbow functional status and/or myodynamia. The overall quality rated by GRADE was from very low to low. Two studies reported that the needle pain would be the main reason for the dropout. Conclusion. For the small number of included studies with poor methodological quality, no firm conclusion can be drawn regarding the effect of acupuncture of elbow functional status and myodynamia for LE. This trial is registered with CRD42015016199.

  8. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline

    DEFF Research Database (Denmark)

    Krogh, Thøger Persson; Fredberg, Ulrich; Stengaard-Pedersen, Kristian

    2013-01-01

    Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown.......Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown....

  9. Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis.

    Science.gov (United States)

    Desai, Mihir J; Ramalingam, Hari; Ruch, David S

    2017-05-01

    Heterotopic ossification (HO) is a well-known complication following the surgical treatment of fractures and dislocations about the elbow but it is not commonly discussed as a complication following arthroscopy. We present a case of a young athlete who developed HO after the arthroscopic treatment of lateral epicondylitis. This is a case report chart review of a 24 year old male with lateral epicondylitis. After failing conservative measures, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) origin ensued. The treatment and patient's final disposition were reported. The patient developed heterotopic ossification of the elbow follow arthroscopic debridement of the ECRB origin. Further surgery was required to excise the heterotopic ossification. Good recovery of motion was achieved. To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. As the use of elbow arthroscopy continues to grow, there is a need for identification of the risk factors and primary prophylaxis for HO.

  10. Lateral Epicondylitis and Tobacco Use: A Case-Control Study.

    Science.gov (United States)

    Michienzi, Avery E; Anderson, Christopher P; Vang, Sandy; Ward, Christina M

    2015-01-01

    Although lateral epicondylitis (LE) is a very common tendinopathy, we understand little about the etiology of the disease. Tobacco use has been associated with other tendinopathies, and the purpose of this study is to determine if there is an association between the incidence of lateral epicondylitis and tobacco use. We performed a retrospective cohort study of adult patients diagnosed with lateral epicondylitis. Patients from a single orthopaedic surgeon's practice with LE were matched to control patients with other common upper extremity conditions based on age, gender, and occupation. A total of 65 case patients and 217 control patients were included in the study. The incidence of smoking in patients with lateral epicondylitis was compared to the incidence of smoking in the control group. Of the LE patients, 30/65 (46.2%) were non-smokers, 23/65 (35.4%) were former smokers, and 12/65 (18.5%) were current smokers. Of the control patients, 121/217 (55.8%) were non-smokers, 45/217 (20.7%) were former smokers, and 51/217 (23.5%) were current smokers. The odds of LE patients being former or current smokers compared to control patients were 1.45 times higher, but this was not statistically significant. Among people who did not smoke at the time of presentation, the odds of being a former smoker were 2.28 times higher in LE patients than in controls, which was statistically significant. The odds of being a former smoker were significantly higher in patients with lateral epicondylitis compared to patients with other upper extremity conditions. Although it did not reach statistical significance, the odds of being former or current smokers were also higher in the LE group. These results suggest a relationship between smoking history and incidence of lateral epicondylitis, though more research is needed to determine the exact nature of the relationship. Prognostic, Level III.

  11. Epicondilite lateral do cotovelo Lateral epicondylitis of the elbow

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    Marcio Cohen

    2012-01-01

    Full Text Available A epicondilite lateral, também conhecida como cotovelo do tenista, é uma condição comum que acomete de 1 a 3% da população. O termo epicondilite sugere inflamação, embora a análise histológica tecidual não demonstre um processo inflamatório. A estrutura acometida com mais frequência é a origem do tendão extensor radial curto do carpo e o mecanismo de lesão está associado à sua sobrecarga. O tratamento incruento é o de escolha e inclui: repouso, fisioterapia, infiltração com cortisona ou plasma rico em plaquetas e a utilização de imobilização específica. O tratamento cirúrgico é recomendado quando persistem impotência funcional e dor. Tanto a técnica cirúrgica aberta quanto a artroscópica com ressecção da área tendinosa degenerada apresenta bons resultados na literatura.Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population. The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis and the mechanism of injury is associated with overloading. Nonsurgical treatment is the preferred method, and this includes rest, physiotherapy, cortisone infiltration, platelet-rich plasma injections and use of specific immobilization. Surgical treatment is recommended when functional disability and pain persist. Both the open and the arthroscopic surgical technique with resection of the degenerated tendon tissue present good results in the literature.

  12. Current advances in the treatment of medial and lateral epicondylitis.

    Science.gov (United States)

    Tarpada, Sandip P; Morris, Matthew T; Lian, Jayson; Rashidi, Sina

    2018-03-01

    Despite advances elucidating the causes of lateral and medial epicondylitis, the standard of care remains conservative management with NSAIDs, physical therapy, bracing, and rest. Scar tissue formation provoked by conservative management creates a tendon lacking the biomechanical properties and mechanical strength of normal tendon. The following review analyzes novel therapies to regenerate tendon and regain function in patients with epicondylitis. These treatments include PRP injection, BMAC, collagen-producing cell injection, and stem cell treatments. While these treatments are in early stages of investigation, they may warrant further consideration based on prospects of pain alleviation, function enhancement, and improved healing.

  13. Factors associated with failure of nonoperative treatment in lateral epicondylitis.

    Science.gov (United States)

    Knutsen, Elisa J; Calfee, Ryan P; Chen, Raymond E; Goldfarb, Charles A; Park, Kevin W; Osei, Daniel A

    2015-09-01

    Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail. To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment. Case control study; Level of evidence, 3. A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment. Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from their initial visit. Univariate analysis demonstrated a potential association (P 12 months (OR, 2.5) remained significant independent predictors of surgical treatment. This study identifies risk factors for surgical treatment for lateral epicondylitis. While these findings do not provide information regarding causal factors associated with surgery, these patient and disease-specific considerations may be helpful when counseling patients regarding treatment options and the likelihood of the success of continued nonoperative treatment. © 2015 The Author(s).

  14. Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis.

    Science.gov (United States)

    Lee, Min Hee; Cha, Jang Gyu; Jin, Wook; Kim, Byung Sung; Park, Jai Soung; Lee, Hae Kyung; Hong, Hyun Sook

    2011-06-01

    The purpose of this article is to evaluate prospectively the utility of sonographic measurements of the common extensor tendon for diagnosing lateral epicondylitis. Forty-eight patients with documented lateral epicondylitis and 63 healthy volunteers were enrolled and underwent ultrasound of the elbow joint. The common extensor tendon overlying the bony landmark was scanned transversely, and the cross-section area and the maximum thickness were measured. Clinical examination was used as the reference standard in the diagnosis of lateral epicondylitis. Data from the patient and control groups were compared with established optimal diagnostic criteria for lateral epicondylitis using receiver operating characteristic curves. Qualitative evaluation with grayscale ultrasound was also performed on patients and healthy volunteers. The common extensor tendon was significantly thicker in patients with lateral epicondylitis than in control subjects (p lateral epicondylitis. For qualitative evaluation with gray-scale ultrasound, overall sensitivity, specificity, and accuracy values in the diagnosis of lateral epicondylitis were 76.5%, 76.2%, and 76.3%, respectively. The quantitative sonographic measurements had an excellent diagnostic performance for lateral epicondylitis, as well as good or excellent interreader agreement. A common extensor tendon cross-section area greater than or equal to 32 mm(2) and a thickness of 4.2 mm correlated well with the presence of lateral epicondylitis. However, further prospective study is necessary to determine whether quantitative ultrasound with these cutoff values can improve the accuracy of the diagnosis of lateral epicondylitis.

  15. ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW

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    M. R. Salikhov

    2017-01-01

    Full Text Available In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р<0,05. VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р<0,05. Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and

  16. Medium-Term Results After Treatment of Recalcitrant Lateral Epicondylitis

    Science.gov (United States)

    Meknas, Khaled; Al Hassoni, Thabit N.; Odden-Miland, Åshild; Castillejo, Miguel; Kartus, Jüri

    2013-01-01

    Background: Recalcitrant lateral epicondylitis (elbow extensor–origin tendinosis) is a common cause of elbow pain with many treatment options. In the present study, the medium-term results after open release and radiofrequency microtenotomy are reported. Hypothesis: Microtenotomy would provide long-term pain relief that was as good as the open release method. Study Design: Prospective, randomized trial. Methods: Twenty-four patients randomized to either open release or microtenotomy were assessed after 5 to 7 years. Clinical examination and dynamic infrared thermography (DIRT) of both elbows were performed preoperatively and at the medium-term follow-up. Magnetic resonance imaging (MRI) of both elbows was performed at the medium-term follow-up. Results: Significant pain reduction was found using a visual analog scale (VAS) at the medium-term follow-up in both groups compared with the preoperative assessment (P lateral epicondylitis. The hypothesis was thus verified. PMID:26535247

  17. Prolotherapy Interventions in Treatment of Chronic Lateral Epicondylitis

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    Aydan Örsçelik

    2016-12-01

    Material and Method: Sixteen recreational athletes between the ages of 35 to 51 (mean age: 44.6 years with chronic lateral epicondylitis for more than 3 months and refractory to conservative treatment were enrolled. Prolotherapy solution was injected on to the lateral epicondyle with “peppering” technique along the insertion part of the tendon and annular ligament at the tender areas. 3 weeks of intervals were given between injections. All patients were prescribed with a standard home exercise program. The outcome measures of Visual Analogue Scale (VAS and DASH (The Disability of the Arm, Shoulder and Hand scales were assessed at baseline and 3 months after last injections. Results: 12 patients received a triple, 1 patient received a double and 3 patients received a single injection according to healing process. The VAS scores revealed a significant improvement; the baseline score of 8.1(±1.3 decreased to 1.2(±1.2 (p

  18. Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis

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    Bora Bostan

    2016-04-01

    Full Text Available Background: Recalcitrant lateral epicondylitis may be a disabling condition. Treatment of this condition is still controversial. Aims: In the present prospective study, we evaluated the long-term results of autologous blood injection for the treatment of recalcitrant lateral epicondylitis. Study Design: Prospective clinical study. Methods: A total of 42 elbows of 40 consecutive patients (28 female, 12 male were enrolled in this prospective study. Seven patients left the study (3 patients moved to another city, 1 patient died in the second week due to a heart condition, 1 patient quit the study because of the resolution of pain in the fourth week and 2 patients did not agree to the second injection. Thirteen patients were lost to third year follow-up. Therefore, a total of 21 elbows of 20 patients with 3 years of follow-up were included in this study. The mean age of the patients was 47.25 years (range, 20-68 years. Results: Visual analogue scale (VAS, Nirschl score and grip strength were significantly improved after injections when compared to before treatment. The best improvement in terms of grip strength, Nirschl score and VAS score was detected at the one year follow-up. The improvement in Nirschl and VAS score sustained until the third year. Conclusion: We suggest that autologous blood injection for the treatment of recalcitrant lateral epicondylitis is an effective, safe and successful procedure in the long-term.

  19. Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis

    Science.gov (United States)

    Qi, Liang; Zhang, Yu-Dong; Yu, Rong-Bin; Shi, Hai-Bin

    2016-01-01

    Abstract The aim of the study is to determine the inter-reliability and intra-observer reliability of magnetic resonance imaging (MRI) for lateral epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom. The study group comprised 96 consecutive patients (46 men and 50 women) with a clinical diagnosis of chronic lateral epicondylitis, which were examined on 3.0 T MR. An MRI scoring system was used to grade the degree of tendinopahty. Three independent musculoskeletal radiologists, who were blinded to the patients’ clinical information, scored images separately. Clinical symptoms were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE). Of all the patients, total 96 elbows had MRI-assessed tendinopathy, including 38 (39.6%) with grade 1, 31 (32.3%) with grade 2, and 27 (28.1%) with grade 3. Inter-observer reliability and intra-observer agreement for MRI interpretation of the grades of tendinopathy was good, and a positive correlation between the grades of tendinopathy and PRTEE was determined. MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signal changes positively correlate with the patient's clinical symptom. PMID:26844506

  20. Autologous blood injection in the treatment of lateral epicondylitis.

    Science.gov (United States)

    Amin, Qazi Muhammad; Ahmed, Ijaz; Aziz, Amer

    2014-12-01

    To determine mean decrease in visual analogue pain score after autologous blood injection in patients with lateral epicondylitis. The quasi-experimental study was conducted at Ghurki Trust Hospital, Lahore, from December 10, 2012, to June 8, 2013, and comprised patients having lateral epicondylitis of elbow. Pre-procedure baseline visual analogue score was measured. Under aseptic conditions, 2ml of autologous blood was drawn from the contra-lateral antecubital fossa of the patient and slowly injected into the site of maximum tenderness. Patients were advised to continue their normal daily activities and were followed up at third and sixth week for assessment of pain intensity. Mean decrease was calculated by subtracting the post-procedure visual analogue score from the baseline value.SPSS 11 was used for data analysis. Of the 150 patients in the study, there were 127(84.7%) males and 23(15.3%) females. Male-to-female ratio was 5.5:1 Overall mean age of was 33.91±10.23 years. The mean pre-injection pain score was 8.97±1.02 and post-injection was 3.59±1.58. Mean decrease in VAS pain score was 5.37±1.80. Autolgous blood injection was found to be an effective way to treat patients of epicondylitis elbow.

  1. Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis.

    Science.gov (United States)

    Bostan, Bora; Balta, Orhan; Aşçı, Murat; Aytekin, Kürşad; Eser, Enes

    2016-03-01

    Recalcitrant lateral epicondylitis may be a disabling condition. Treatment of this condition is still controversial. In the present prospective study, we evaluated the long-term results of autologous blood injection for the treatment of recalcitrant lateral epicondylitis. Prospective clinical study. A total of 42 elbows of 40 consecutive patients (28 female, 12 male) were enrolled in this prospective study. Seven patients left the study (3 patients moved to another city, 1 patient died in the second week due to a heart condition, 1 patient quit the study because of the resolution of pain in the fourth week and 2 patients did not agree to the second injection). Thirteen patients were lost to third year follow-up. Therefore, a total of 21 elbows of 20 patients with 3 years of follow-up were included in this study. The mean age of the patients was 47.25 years (range, 20-68 years). Visual analogue scale (VAS), Nirschl score and grip strength were significantly improved after injections when compared to before treatment. The best improvement in terms of grip strength, Nirschl score and VAS score was detected at the one year follow-up. The improvement in Nirschl and VAS score sustained until the third year. We suggest that autologous blood injection for the treatment of recalcitrant lateral epicondylitis is an effective, safe and successful procedure in the long-term.

  2. Arthroscopic Treatment of Lateral Epicondylitis: Tenotomy Versus Debridement.

    Science.gov (United States)

    Solheim, Eirik; Hegna, Janne; Øyen, Jannike; Inderhaug, Eivind

    2016-04-01

    To compare the outcome of 2 arthroscopic techniques for treating recalcitrant lateral epicondylitis. The study included patients undergoing arthroscopic treatment of lateral epicondylitis during 2 different time periods: April 2005 to October 2007 (tenotomy) and May 2009 to June 2010 (debridement). By using a patient-administered form, baseline information including QuickDASH (disabilities of the arm, shoulder and hand) score (primary outcome), visual analog scale (VAS) of pain, and VAS of function was recorded prospectively. To have the same follow-up period of minimum 4 years in the 2 groups, the follow-up was conducted at 2 different points of time. Of a total of 326 patients fulfilling the requirements for inclusion in the study, 283 patients (87%) were followed up (144 male and 139 female, median age 46 [21 to 65] years), 204 (87%) in the tenotomy group and 79 (88%) in the debridement group. In both groups, a significant improvement in the QuickDASH was found at the follow-up compared with baseline: from 60 to 12 in the debridement group (P lateral epicondylitis Debridement only is a potentially less costly procedure, and the current finding of a mean 2 weeks shorter sick leave in the debridement only group proposes a substantial cost saving in a societal perspective. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. THE IMPACT OF LATERAL EPICONDYLITIS ON QUALITY OF LIFE

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    Kavita Sudhakar

    2015-08-01

    Full Text Available Background: Lateral epicondylitis is a work related disorder which is considered to be due to over-use or over-stress of the wrist extensors of the forearm. The patient suffers from pain and decreased function which affects the basic activities in daily life. This reduction in function leading to disability may affect the quality of life as it includes items related to self care, usual activities, emotional problems, pain etc. The present study was conducted to study the impact of Lateral epicondylitis on quality of life. Methods: 52 subjects diagnosed with Lateral epicondylitis were included in the study according to the inclusion and exclusion criteria. Outcome measures were: pain using Visual analog scale, functional disability using Patient rated tennis elbow evaluation and health-related quality of life using Short Form 36. Results: A significant positive correlation was found between pain and functional disability (p<.001. A significant negative correlation between pain and physical (p=.014 and mental (p=.052 component summary scores of quality of life was found. A significant negative correlation was found between functional disability and physical (p=.002 and mental (p=.015 component summary scores of quality of life. Also a significant correlation was found between physical and mental component summary scores of quality of life (p<.001. Conclusions: Significant correlation was seen between pain, functional disability and quality of life. This suggests that with an increase in severity of pain there is increase in functional disability with lower QOL both physically and mentally.

  4. Functional outcomes after arthroscopic treatment of lateral epicondylitis

    International Nuclear Information System (INIS)

    Wada, Takuro; Moriya, Tamami; Iba, Kosuke; Ozasa, Yasuhiro; Sonoda, Tomoko; Aoki, Mitsuhiro; Yamashita, Toshihiko

    2009-01-01

    The purpose of this study was to evaluate surgical outcomes of arthroscopic debridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes. A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of debridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months). After surgery, according to the patients' reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P<0.0001), and that during activity improved from 7.8 points to 0.9 points (P<0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P<0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P=0.02) and receiving public assistance (P=0.01) were significantly associated with worse DASH scores. Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score. (author)

  5. Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis.

    Science.gov (United States)

    Khaliq, Abdul; Khan, Imran; Inam, Muhammad; Saeed, Mohammad; Khan, Husnain; Iqbal, Malik Javed

    2015-11-01

    To compare the treatment modalities of lateral epicondylitis in terms of pain relief. The randomised controlled study was conducted at Hayatabad Medical Complex, Peshawar, Pakistan, from April 2013 to March 2014, and comprised cases of lateral epicondylitis. The patients were selected through consecutive sampling from the outpatient department and were randomly allocated to two equal groups; group A receiving corticosteroid injections, and group B receiving injection of platelet-rich plasma. The patients were followed up for three weeks to determine the effectiveness of intervention. The 102 patients in the study were divided into two groups of 51(50%) each. The over mean age was 33.9±10.3 years. Mean age of patients in the corticosteroid group was 34.2±10.2 years and in the other group it was 33.6±10.5 years. Mean baseline visual analogue score in group A were 6.5±1.2 and in group B it was 6.7±1.4. In group A, 74.5% of patients presented in moderate pain category and 25.5% presented in severe pain category. In group B, 70.6% presented in moderate with 29.4% presented in severe pain category. On follow-up, the mean pain score in group A was 4.0±2.6 and in group B it was 3.5±2.61. Group A showed effectiveness in 52.9% patients and group B showed effectiveness in 82.3% (p=0.001). PRP is an effective alternate to corticosteroid in the treatment of lateral epicondylitis (tennis elbow).

  6. Platelet rich plasma versus laser therapy in lateral epicondylitis of elbow

    Directory of Open Access Journals (Sweden)

    Gyaneshwar Tonk

    2014-01-01

    Conclusions: Treatment of patients with chronic lateral epicondylitis with PRP extract reduced pain and significantly increased function, exceeding the effect of low level laser therapy on long term followup. Low-level laser therapy is better in the short term period, but on long term followup injection PRP therapy is better than laser therapy in lateral epicondylitis.

  7. Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature

    OpenAIRE

    Saccomanni, Bernardino

    2010-01-01

    Lateral epicondylitis or tennis elbow is a painful and functionally limiting entity affecting the upperextremity and is frequently treated by hand surgeons. Corticosteroid injection is one of the most common interventions for lateral epicondylitis or tennis elbow. Here, a review of the medical literature on this treatment is presented.

  8. Manipulation of the wrist for management of lateral epicondylitis: A randomized pilot study

    NARCIS (Netherlands)

    Struijs, Peter A. A.; Damen, Pieter-Jan; Bakker, Eric W. P.; Blankevoort, Leendert; Assendelft, Willem J. J.; van Dijk, C. Niek

    2003-01-01

    Background and Purpose. Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation

  9. EFFECTIVENESS OF MEDIAL TO LATERAL TAPING WITH EXERCISE PROGRAMME IN SUBJECTS WITH LATERAL EPICONDYLITIS

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    Bhavana Dattaram Desai

    2014-06-01

    Full Text Available Background: Medial to lateral tapping and exercise programme has been found to be effective in Lateral epicondylitis. The purpose to find the combined effect of Medial to lateral tapping with exercise programme for subjects with lateral epicondylitis on pain intensity and functional ability. Method: An experimental study design, selected 40 subjects with Lateral epicondylitis randomized 20 subjects each into Study and Control group. Control group received only exercise programme while study group received combined medial to lateral tapping with exercise programme thrice a week for 4 weeks. Pain intensity was measured using Visual analogue scale and functional ability was measured using Patient Rated Tennis Elbow Evaluation questionnaire before and after 4 weeks of treatment. Results: When the post-intervention means were compared between Study and Control group after 4 weeks of treatment found statistically significant difference in the improvement in outcomes measures in means of VAS and PRTEE before and after intervention within the groups. Conclusion: It is concluded that the Medial to lateral tapping with exercise programme is more effective than the exercise programme in reduction of pain and improve functional abilities for subjects with Lateral epicondylitis.

  10. Risk factors in lateral epicondylitis (tennis elbow): a case-control study.

    Science.gov (United States)

    Titchener, A G; Fakis, A; Tambe, A A; Smith, C; Hubbard, R B; Clark, D I

    2013-02-01

    Lateral epicondylitis is a common condition, but relatively little is known about its aetiology and associated risk factors. We have undertaken a large case-control study using The Health Improvement Network database to assess and quantify the relative contributions of some constitutional and environmental risk factors for lateral epicondylitis in the community. Our dataset included 4998 patients with lateral epicondylitis who were individually matched with a single control by age, sex, and general practice. The median age at diagnosis was 49 (interquartile range 42-56) years . Multivariate analysis showed that the risk factors associated with lateral epicondylitis were rotator cuff pathology (OR 4.95), De Quervain's disease (OR 2.48), carpal tunnel syndrome (OR 1.50), oral corticosteroid therapy (OR 1.68), and previous smoking history (OR 1.20). Diabetes mellitus, current smoking, trigger finger, rheumatoid arthritis, alcohol intake, and obesity were not found to be associated with lateral epicondylitis.

  11. Common extensor origin release in recalcitrant lateral epicondylitis - role justified?

    Directory of Open Access Journals (Sweden)

    Mukundan Cibu

    2010-05-01

    Full Text Available Abstract The aim of our study was to analyse the efficacy of operative management in recalcitrant lateral epicondylitis of elbow. Forty patients included in this study were referred by general practitioners with a diagnosis of tennis elbow to the orthopaedic department at a district general hospital over a five year period. All had two or more steroid injections at the tender spot, without permanent relief of pain. All subsequently underwent simple fasciotomy of the extensor origin. Of forty patients thirty five had improvement in pain and function, two had persistent symptoms and three did not perceive any improvement. Twenty five had excellent, ten had well, two had fair and three had poor outcomes (recurrent problem; pain at rest and night. Two patients underwent revision surgery. Majority of the patients had improvement in pain and function following operative treatment. In this study, an extensor fasciotomy was demonstrated to be an effective treatment for refractory chronic lateral epicondylitis; however, further studies are warranted.

  12. Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Nicola Massy-Westropp

    2012-01-01

    Full Text Available 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.

  13. Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

    Science.gov (United States)

    Massy-Westropp, Nicola; Simmonds, Stuart; Caragianis, Suzanne; Potter, Andrew

    2012-01-01

    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. PMID:23251809

  14. Efficacy Of A Single-Injection Sodium Hyaluronate Treatment In Lateral Epicondylitis.

    Science.gov (United States)

    Khan, Inam Ullah; Awan, Abdus Saboor; Khan, Aimal Sattar; Marwat, Imran; Meraj, Muhammad

    2018-01-01

    Lateral epicondylitis or tennis elbow is a disease of tendons arising from common extensor origin at the lateral epicondyle of elbow and is commonly characterized by pain on supination of forearms as well as extension of fingers and wrists. This descriptive case series aims to determine the efficacy of a single-injection sodium hyaluronate treatment for lateral epicondylitis. The study was conducted at the Department of Orthopaedics. Ayub Teaching Hospital Abbottabad. From February 1 to August 31, 2014. Patients diagnosed with lateral epicondylitis were administered 1 cc of 1% Sodium hyaluronate 1 cm from the lateral epicondyle into the soft tissue. Hyaluronic acid is more effective in patients with moderate pain of lateral epicondylitis (VAS score ≤7 than in patients with severe pain (VAS score >7). Paired sample t-test was used to compared the means of the pre- and post-procedure VAS score and the difference was found to be statistically very significant (p=0.00) with a mean±SD change in VAS of 2.31±1.35 at 4 weeks. A single injection of sodium hyaluronate is effective in management of moderate, but not severe pain of lateral epicondylitis.

  15. Outcomes of arthroscopic lateral epicondylitis release: Should we treat earlier?

    Science.gov (United States)

    Soeur, L; Desmoineaux, P; Devillier, A; Pujol, N; Beaufils, P

    2016-10-01

    When managed conservatively, lateral epicondylitis often subsides only after considerable time, during which social and occupational activities are severely disrupted. If conservative management fails, a recently introduced option is arthroscopic release of the extensor carpi radialis brevis (ECRB). The primary objective of this study was to compare clinical outcomes of this procedure according to preoperative symptom duration. Earlier arthroscopic release is associated with better functional outcomes. Consecutive patients with arthroscopically managed lateral epicondylitis were included in a retrospective study. Arthroscopy was performed only after at least 6 months of conservative treatment. The criteria to evaluate the clinical outcomes were the Nirschl and Quick-DASH scores, muscle strength, time to pain relief, and percentage of functional recovery. Thirty-five patients were evaluated at a median of 4 years (range: 1-12 years) after surgery. Mean preoperative symptom duration was 18 months (range: 6-106 months) with a mean sick leave duration of 2.3±4.9 months. Postoperatively, mean time to recovery was 37.5 days (range: 7 days to 5 years) and mean sick leave duration was 2.4±2.4 months. The mean Quick-DASH score was 15.9±19.1. The Nirschl score improved significantly, from 26.4±7.9 to 66.3±16.3. The initial muscle strength deficit was 10.1±33.2% and muscle strength at last follow-up was increased by 4.3±30.3%. Symptom duration showed no correlations with any of the clinical outcome measures. Outcomes after arthroscopic release were not associated with symptom duration in this study. Nevertheless, the good clinical outcomes support treatment with arthroscopic release after only 6 months of conservative management. IV, retrospective study. Copyright © 2016. Published by Elsevier Masson SAS.

  16. Autologous Blood and Platelet-Rich Plasma Injections for Treatment of Lateral Epicondylitis.

    Science.gov (United States)

    Calandruccio, James H; Steiner, Murphy M

    2017-07-01

    Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy). Autologous blood injections and platelet-rich plasma injections are the two most frequently used orthobiologic techniques in the treatment of lateral epicondylitis. Studies of the effectiveness of autologous blood injections and platelet-rich plasma report varying outcomes, some citing significant clinical relief and others reporting no beneficial effect. More research is needed to determine how to best use orthobiologics in the treatment of lateral epicondylitis. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

    International Nuclear Information System (INIS)

    Kotnis, Nikhil A.; Chiavaras, Mary M.; Harish, Srinivasan

    2012-01-01

    The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis. (orig.)

  18. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kotnis, Nikhil A. [McMaster University, Departments of Radiology, Hamilton, ON (Canada); Sheffield Teaching Hospitals, Department of Medical Physics and Medical Imaging, Sheffield (United Kingdom); Chiavaras, Mary M. [McMaster University, Departments of Radiology, Hamilton, ON (Canada); Harish, Srinivasan [McMaster University, Departments of Radiology, Hamilton, ON (Canada); St. Joseph' s Healthcare, Department of Diagnostic Imaging, Hamilton, ON (Canada)

    2012-04-15

    The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis. (orig.)

  19. Management of Chronic Lateral Epicondylitis With Manual Therapy and Local Cryostimulation: A Pilot Study.

    Science.gov (United States)

    Richer, Nadia; Marchand, Andrée-Anne; Descarreaux, Martin

    2017-12-01

    The purpose of this pilot study was to evaluate the feasibility and efficacy of adding cryostimulation to manual therapy in patients with chronic lateral epicondylitis. The control group (n = 19) was treated with manual therapy consisting of soft-tissue therapy and radial head mobilizations. The experimental group (n = 18) received cryostimulation in addition to manual therapy care similar to that for the control group. Both protocols consisted of 8 treatments over a 4-week period. Outcome measures included pain intensity (visual analog scale), pain-free grip strength (handheld dynamometer), and functional index (Patient-Rated Tennis Elbow Evaluation questionnaire). Assessments were performed at baseline, postintervention, and 3-month follow-up. Adherence and dropout rates were also considered. Both groups exhibited significant improvements in pain intensity and functional index at postintervention assessments, which were maintained at follow-up. All participants attended the prescribed number of treatments, but 27% were lost at follow-up. Minor adverse events were reported after cryostimulation in 4 cases. This study indicated that it is feasible to complete a clinical trial evaluating the efficacy of adding cryostimulation to manual therapy in patients with chronic lateral epicondylitis. On the basis of these preliminary data, the combination of cryostimulation and manual therapy care did not provide any additional benefits in both the short term and the long term. Manual myofascial point treatment and mobilization techniques yielded positive outcomes in chronic lateral epicondylitis. Further studies should focus on the sole therapeutic effect of cryostimulation in both patients with acute and those with chronic conditions.

  20. Autologous platelet lysate local injections for the treatment of refractory lateral epicondylitis.

    Science.gov (United States)

    Tan, Xun-xiang; Ju, Hai-yang; Yan, Wei; Jiang, Hong-jiang; Su, Jin-ping; Dong, Hua-jun; Wang, Ling-shuang; Zou, De-bao

    2016-01-25

    The purpose of this study was to investigate the efficacy and safety of autologous platelet lysate (APL) local injections in reducing pain and improving function in patients with refractory lateral epicondylitis. A total of 56 patients with refractory lateral epicondylitis were enrolled in this study. All the patients received three injections in one course of treatment. Subjective assessments include visual analog scale (VAS) pain score and Mayo elbow score before injection (baseline) and at 1, 6, and 12 months after injection. Significant differences were observed in VAS and Mayo scores at baseline and at 1, 6, and 12 months after injection. Overall, the injections of APL improved local symptoms and all the patients recovered to normal elbow function with 12 months follow-up. Local injections of APL resulted in favorable clinical outcomes for the treatment of lateral epicondylitis. APL could be clinically effective in the treatment of lateral epicondylitis.

  1. The Clinical Report on 2 Cases of Lateral Epicondylitis Treated by Scolopendrid Aquacupucture Therapy

    Directory of Open Access Journals (Sweden)

    Jang-Woo Park

    2006-12-01

    Full Text Available Objective : The purpose of this study is to examine if scolopendrid acuacupucture may be effective to the lateral epicondylitis. Methods : Using scolopendrid aquacupucture, we injected a small dose of it to the affected area and operated 2 pre and post treatment test; VAS(visual analogue scale, PPT(pressure pain threshold. Results : The scolopendrid aquacupucture treatment led to improvement in the pain and symptom of lateral epicondylitis by all efficacy measures. After scolopendrid aquacupucture treatment, there was improvement in VAS, PPT. Conclusion : This results suggest that scolopendrid aquacupucture is good method for treatment of lateral epicondylitis. so we suggest the possibility to use this new remedy for the lateral epicondylitis.

  2. Investigation Of Wrist Flexor/Extensor Muscle Strength Following Arthroscopic Surgical Treatment Of Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Mustafa Onur SERBEST

    2016-03-01

    Full Text Available Objective: Lateral epicondylitis is a common disease of elbow joint. Repetitive wrist activities and activities that requires strength are risk factors. Wrist extensor muscle strength are decreased in patients with lateral epicondylitis. Materials and Methods: Eight patients with a diagnosis of lateral epicondylitis enrolled to study. Wrist flexor and extensor muscle strength of patients who were completed one year after surgery were measured by isokinetic dynamometer. Results: There were no statistically significant differences between the flexor and extensor muscle strength of the patients (p>0.05. Conclusion: In this study, arthroscopic extensor carpi radialis brevis tendon release in lateral epicondylitis has shown no negative effect on flexor and extensor wrist muscle stregth.

  3. Lateral epicondylitis in general practice : Course and prognostic indicators of outcome

    NARCIS (Netherlands)

    Smidt, Nynke; Lewis, Martyn; Van Der Windt, Daniëlle A.W.M.; Hay, Elaine M.; Bouter, Lex M.; Croft, Peter

    2006-01-01

    Objective. To investigate the course of lateral epicondylitis and identify prognostic indicators associated with short- and longterm outcome of pain intensity. Methods. We prospectively followed patients (n = 349) from 2 randomized controlled trials investigating conservative interventions for

  4. An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study

    NARCIS (Netherlands)

    Nourbakhsh, Mohammad Reza; Fearon, Frank J.

    Objective: To investigate the effect of noxious level electrical stimulation on pain, grip strength and functional abilities in subjects with chronic lateral epicondylitis. Design: Randomized, placebo-control, double-blinded study. Setting: Physical Therapy Department, North Georgia College and

  5. Role of Ultrasound Guided Platelet-Rich Plasma (PRP Injection in Treatment of Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Enass M. Khattab

    2017-06-01

    Conclusion: We concluded that US-guided platelet-rich plasma (PRP injection for treatment of lateral epicondylitis was a safe, minimally invasive and effective procedure in improving the sonographic and pathological changes of common extensor tendon (CET.

  6. New Developments in the Use of Biologics and Other Modalities in the Management of Lateral Epicondylitis.

    Science.gov (United States)

    Kahlenberg, Cynthia A; Knesek, Michael; Terry, Michael A

    2015-01-01

    Lateral epicondylitis is a common source of elbow pain. Though it is often a self-limited condition, refractory lateral epicondylitis can lead to problems with activities of daily living and sometimes requires sick leave from work. Therefore prompt treatment is essential. Histopathologic studies have suggested that lateral epicondylitis is a tendinopathy, associated with apoptosis and autophagy, rather than a tendonitis associated with inflammation. Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis. Researchers have recently begun to investigate the use of biologics as potential treatment options for lateral epicondylitis. Autologous blood preparations including platelet rich plasma (PRP) and autologous whole blood injections (ABIs) have been proposed in order to deliver growth factors and other nutrients to the diseased tendon. Stem cell therapies have also been suggested as a method of improving tendon healing. This review discusses the current evidence for the use of PRP, ABI, and stem cell therapies for treatment of lateral epicondylitis. We also review the evidence for nonbiologic treatments including corticosteroids, prolotherapy, botulinum toxin A, and nitric oxide.

  7. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy.

    Science.gov (United States)

    Wong, Clara Wing-Yee; Ng, Elaine Yin-Ling; Fung, Pui-Wa; Mok, Kam-Ming; Yung, Patrick Shu-Hang; Chan, Kai-Ming

    2017-01-01

    Lateral epicondylitis is one of the most common overuse injuries, and has been reported to reduce function and affect daily activities. There is no standard therapy for lateral epicondylitis. In Hong Kong, acupuncture and extracorporeal shockwave therapy (ESWT) have been popular in treating lateral epicondylitis in recent years. This study is to compare the treatment effects of acupuncture and ESWT on lateral epicondylitis. In this study, we evaluated 34 patients (34 elbows) with lateral epicondylitis. Seventeen patients were treated by 3-week ESWT, one session per week. Another 17 were treated by 3-week acupuncture therapy, two sessions per week. The outcome measures included pain score by visual analogue scale, maximum grip strength by Jamar dynamometer, and level of functional impairment by disability of arms, shoulders, and hands questionnaire. Participants were assessed at three time points: baseline; after treatment; and 2-week follow-up. The two treatments showed no significant difference at any assessment time-point. Both treatment groups had significant improvement in pain score in longitudinal comparisons. No significant difference was found in maximum grip strength and functional impairment in either treatment group, but a trend of improvement could be observed. In addition, improvement in pain relief stopped when treatment ended for either groups. The treatment effects of acupuncture and ESWT on lateral epicondylitis were similar. The pain relief persisted for at least two weeks after treatment.

  8. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis.

    Science.gov (United States)

    Bayram, Korhan; Yesil, Hilal; Dogan, Erdal

    2014-01-01

    Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis. A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed. Visual analog scale (VAS) scores were significantly lower (plateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.

  9. US National Practice Patterns in Ambulatory Operative Management of Lateral Epicondylitis.

    Science.gov (United States)

    Buller, Leonard T; Best, Matthew J; Nigen, David; Ialenti, Marc; Baraga, Michael G

    2015-12-01

    Lateral epicondylitis is a common cause of elbow pain, frequently responsive to nonoperative management. There are multiple operative techniques for persistently symptomatic patients who have exhausted conservative therapies. Little is known regarding US national trends in operative management of lateral epicondylitis. We conducted a study to investigate changes in use of ambulatory procedures for lateral epicondylitis. Cases of lateral epicondylitis were identified using the National Survey of Ambulatory Surgery and were analyzed for trends in demographics and use of ambulatory surgery. Between 1994 and 2006, the population-adjusted rate of ambulatory surgical procedures increased from 7.29 to 10.44 per 100,000 capita. The sex-adjusted rate of surgery for lateral epicondylitis increased by 85% among females and decreased by 31% among males. Most patients were between ages 40 and 49 years, and the largest percentage increase in age-adjusted rates was found among patients older than 50 years (275%) between 1994 and 2006. Use of regional anesthesia increased from 17% in 1994 to 30% in 2006. Private insurance remained the most common payer. Awareness of the increasing use of ambulatory surgery for lateral epicondylitis may lead to changes in health care policies and positively affect patient care.

  10. New Developments in the Use of Biologics and Other Modalities in the Management of Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Cynthia A. Kahlenberg

    2015-01-01

    Full Text Available Lateral epicondylitis is a common source of elbow pain. Though it is often a self-limited condition, refractory lateral epicondylitis can lead to problems with activities of daily living and sometimes requires sick leave from work. Therefore prompt treatment is essential. Histopathologic studies have suggested that lateral epicondylitis is a tendinopathy, associated with apoptosis and autophagy, rather than a tendonitis associated with inflammation. Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis. Researchers have recently begun to investigate the use of biologics as potential treatment options for lateral epicondylitis. Autologous blood preparations including platelet rich plasma (PRP and autologous whole blood injections (ABIs have been proposed in order to deliver growth factors and other nutrients to the diseased tendon. Stem cell therapies have also been suggested as a method of improving tendon healing. This review discusses the current evidence for the use of PRP, ABI, and stem cell therapies for treatment of lateral epicondylitis. We also review the evidence for nonbiologic treatments including corticosteroids, prolotherapy, botulinum toxin A, and nitric oxide.

  11. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials.

    Science.gov (United States)

    Sims, Susan E G; Miller, Katherine; Elfar, John C; Hammert, Warren C

    2014-12-01

    Non-surgical approaches to treatment of lateral epicondylitis are numerous. The aim of this systematic review is to examine randomized, controlled trials of these treatments. Numerous databases were systematically searched from earliest records to February 2013. Search terms included "lateral epicondylitis," "lateral elbow pain," "tennis elbow," "lateral epicondylalgia," and "elbow tendinopathy" combined with "randomized controlled trial." Two reviewers examined the literature for eligibility via article abstract and full text. Fifty-eight articles met eligibility criteria: (1) a target population of patients with symptoms of lateral epicondylitis; (2) evaluation of treatment of lateral epicondylitis with the following non-surgical techniques: corticosteroid injection, injection technique, iontophoresis, botulinum toxin A injection, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, or laser therapy; and (3) a randomized controlled trial design. Lateral epicondylitis is a condition that is usually self-limited. There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief. Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids, and botulinum toxin A is likely to produce concomitant extensor weakness. Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections. Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief. Some studies of low-level laser therapy show superiority to placebo whereas others do not. There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method

  12. Dry needling in lateral epicondylitis: a prospective controlled study.

    Science.gov (United States)

    Uygur, Esat; Aktaş, Birol; Özkut, Afşar; Erinç, Samet; Yilmazoglu, Emime Gül

    2017-11-01

    Lateral epicondylitis (LE), a common disease, especially in middle age, causes decreased productivity and economic losses. The first-line treatment for LE is conservative and consists of topical and oral anti-inflammatory drugs, ice application, and brace use. If the first-line treatment fails, second-line treatment modalities, which are generally invasive, are offered. Second-line therapeutic regimens include saline, corticosteroid, or platelet-rich plasma injections. Dry needling is relatively new. We hypothesized that dry needling would be at least as effective as first-line treatment for LE. We compared the outcomes of first-line treatment and dry needling. The study allocated 110 patients into groups using online randomization software. After completing the Patient-rated Tennis Elbow Evaluation (PRTEE), patients in group I received dry needling, whereas those in group II received first-line treatment, consisting of ibuprofen 100 mg twice a day and a proximal forearm brace. The patients were evaluated after three weeks and six months. The study ultimately analyzed 92 patients. Although both treatment methods were effective at three weeks, dry needling was significantly more effective than the first-line treatment at six months. Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE.

  13. Corticosteroid injection in early treatment of lateral epicondylitis.

    Science.gov (United States)

    Newcomer, K L; Laskowski, E R; Idank, D M; McLean, T J; Egan, K S

    2001-10-01

    To analyze whether a corticosteroid injection in combination with rehabilitation early in the course of lateral epicondylitis (LE) alters the outcome up to 6 months after injection compared with a control injection and rehabilitation. Randomized, controlled, double-blind study. Sports medicine center in a tertiary care center. Subjects with a diagnosis of LE whose symptoms had been present less than 4 weeks were included. Subjects were recruited by word of mouth and through advertising. The 39 subjects who were recruited were 18 to 65 years old. 19 subjects were randomized to receive rehabilitation and a sham injection, and 20 were randomized to receive rehabilitation and a corticosteroid injection. At 4 and 8 weeks, they were reevaluated and their treatment programs were modified, if indicated. Outcome measurements were performed at baseline, 4 weeks, 8 weeks, and 6 months, and included a functional pain questionnaire and a visual analogue pain scale. Painless grip strength on the affected side and maximal grip strength bilaterally were measured at baseline, 4 weeks, and 8 weeks. There were no significant differences in outcome between the two groups with the exception of an improvement in the visual analogue pain scale in the corticosteroid group from 8 weeks to 6 months. Outcome measurements in both groups improved significantly over time; more than 80% of subjects reported improvements from baseline to 6 months for all scales. A corticosteroid injection does not provide a clinically significant improvement in the outcome of LE, and rehabilitation should be the first line of treatment in patients with a short duration of symptoms.

  14. Prevalence and risk factors of lateral epicondylitis in a mountain village in Japan.

    Science.gov (United States)

    Tajika, Tsuyoshi; Kobayashi, Tsutomu; Yamamoto, Atsushi; Kaneko, Tetsuya; Takagishi, Kenji

    2014-08-01

    To determine the prevalence and risk factors of lateral epicondylitis in a mountain village in Japan. 176 men and 246 women aged 24 to 86 (mean, 61) years from a mountain village in Japan underwent regular medical examination and completed a self-administered questionnaire with items related to gender, weight, height, dominant hand, heaviness of labour (no job, light, intermediate, and heavy), presence of elbow pain 2 weeks before examination, and smoking and drinking experience. The diagnosis of lateral epicondylitis was based on self-reported symptoms and clinical signs. The prevalence of lateral epicondylitis in a mountain village in Japan was 3.8% (95% confidence interval [CI], 2.2%-6.1%). Of the 422 subjects, 47 had elbow pain and 16 of them were diagnosed to have definite lateral epicondylitis. 15 of them were right-handed and had involvement of the left (n=8) and right (n=7) sides; the remaining one was left-handed and had involvement of the left side. The dominant hand was not associated with the affected side (p=1.00). Heaviness of labour was not associated with the elbow pain scores. The prevalence was highest in subjects aged 50 to 59 years (9% [95% CI, 3.8%-17.1%]) and those with no job (14% [95% CI, 1.1%-44.1%]). Lateral epicondylitis was not associated with gender, age, body mass index, dominant hand, heaviness of labour, smoking, or drinking.

  15. Work-related risk factors for incidence of lateral epicondylitis in a large working population.

    Science.gov (United States)

    Herquelot, Eleonore; Guéguen, Alice; Roquelaure, Yves; Bodin, Julie; Sérazin, Celine; Ha, Catherine; Leclerc, Annette; Goldberg, Marcel; Zins, Marie; Descatha, Alexis

    2013-11-01

    This study aims to estimate the association between repeated measures of occupational risk factors and the incidence of lateral epicondylitis in a large working population. A total of 3710 workers in a French region were included in 2002-2005, and among them 1046 had a complete follow-up in 2007-2010. At both stages, occupational health physicians assessed the presence of lateral epicondylitis and workers self-reported their occupational exposures. Poisson models were performed to assess the incidence rate ratios (IRR) separately by sex using multiple imputed data. The annual incidence rate of lateral epicondylitis was estimated as 1.0 [95% confidence interval (95% CI) 0.7-1.3] per 100 workers among men and 0.9 (95% CI 0.6-1.3) among women. Workers aged >45 years had higher incidence than those aged 2 hours/day) was a risk factor, with an age-adjusted IRR of 3.2 (95% CI 1.5-6.4) for workers exposed at both questionnaires [3.3 (95% CI 1.4-7.6) among women]. This study highlights the importance of temporal dimensions for occupational risk factors on the incidence of lateral epicondylitis. Further research should evaluate the risk associated with the duration and repetition of occupational exposure on the incidence of lateral epicondylitis.

  16. Cost effectiveness of interventions for lateral epicondylitis - Results from a randomised controlled trial in primary care

    DEFF Research Database (Denmark)

    Korthals-de Bos, I.B.C.; Smidt, N.; van Tulder, M.W.

    2004-01-01

    Objective: Lateral epicondylitis is a common complaint, with an annual incidence between 1% and 3% in the general population. The Dutch College of General Practitioners in The Netherlands has issued guidelines that recommend a wait- and-see policy. However, these guidelines are not evidence based....... Design and setting: This paper presents the results of an economic evaluation in conjunction with a randomised controlled trial to evaluate the effects of three interventions in primary care for patients with lateral epicondylitis. Patients and interventions: Patients with pain at the lateral side...... versus the wait- and-see policy. Conclusions: The results of this economic evaluation provided no reason to update or amend the Dutch guidelines for GPs, which recommend a wait-and-see policy for patients with lateral epicondylitis....

  17. Psychosocial Factors Related to Lateral and Medial Epicondylitis: Results From Pooled Study Analyses.

    Science.gov (United States)

    Thiese, Matthew S; Hegmann, Kurt T; Kapellusch, Jay; Merryweather, Andrew; Bao, Stephen; Silverstein, Barbara; Tang, Ruoliang; Garg, Arun

    2016-06-01

    The goal is to assess the relationships between psychosocial factors and both medial and lateral epicondylitis after adjustment for personal and job physical exposures. One thousand eight hundred twenty-four participants were included in pooled analyses. Ten psychosocial factors were assessed. One hundred twenty-one (6.6%) and 34 (1.9%) participants have lateral and medial epicondylitis, respectively. Nine psychosocial factors assessed had significant trends or associations with lateral epicondylitis, the largest of which was between physical exhaustion after work and lateral epicondylitis with and odds ratio of 7.04 (95% confidence interval = 2.02 to 24.51). Eight psychosocial factors had significant trends or relationships with medial epicondylitis, with the largest being between mental exhaustion after work with an odds ratio of 6.51 (95% confidence interval = 1.57 to 27.04). The breadth and strength of these associations after adjustment for confounding factors demonstrate meaningful relationships that need to be further investigated in prospective analyses.

  18. Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: a cross-sectional study

    DEFF Research Database (Denmark)

    Juul-Kristensen, B.; Lund, H.; Hansen, K.

    2008-01-01

    Two groups of women, 15 patients with lateral epicondylitis and 21 healthy controls, were studied to compare proprioception in the elbows and knees between the groups. Outcome measures were absolute error and variable error for joint position sense and for threshold to detection of a passive...... movement. Both absolute error and variable error of threshold to detection of a passive movement were greater in the lateral epicondylitis-diagnosed elbows than in the controls' elbows (lateral epicondylitis, 1.8 degrees vs controls 1.1 degrees, P = .026; lateral epicondylitis, 0.8 degrees vs controls 0.......3 degrees, P = .015), and there was a tendency toward a greater absolute error of joint position sense compared with the control elbows (lateral epicondylitis, 8.2 degrees vs controls, 5.6 degrees; P = .078). Absolute error of joint position sense was greater in the elbows than in the knees of the lateral...

  19. Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta-Analysis.

    Science.gov (United States)

    Descatha, Alexis; Albo, Francesco; Leclerc, Annette; Carton, Matthieu; Godeau, Diane; Roquelaure, Yves; Petit, Audrey; Aublet-Cuvelier, Agnès

    2016-11-01

    In view of recent published studies, a meta-analysis was undertaken on prospective studies in order to assess any association between lateral epicondylitis and physical exposure at work. Using the key words "lateral epicondylitis" AND "occupational" AND ("cohort" OR "longitudinal," OR "incidence") without limitations on the language or year of publication, original prospective studies were selected from 4 databases (PubMed, Scopus, Web of Science, and Base de Données de Santé Publique) after 2 rounds (valid design, valid association reported, and valid work exposure). Relevant associations between physical exposure at work and incident lateral epicondylitis were extracted from the articles, and a meta-risk was calculated using the generic variance approach (meta-odds ratios [meta-ORs]). From 2001 to 2014, 5 prospective studies were included. Among 6,922 included subjects (and 3,449 who were followed), 256 cases of incident lateral epicondylitis were diagnosed 2.5-6 years after baseline. All the published studies found a significant estimation of relative risk for a positive association between combined biomechanic exposure involving the wrist and/or elbow and incidence of lateral epicondylitis. The overall meta-OR was 2.6 (95% confidence interval 1.9-3.5), with a low heterogeneity (Q = 1.4, P > 0.05). Funnel plots and Egger's test did not suggest major publication bias. The results of this meta-analysis strongly support the hypothesis of an association between biomechanic exposure involving the wrist and/or elbow at work and incidence of lateral epicondylitis. © 2016, American College of Rheumatology.

  20. Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy.

    Science.gov (United States)

    Thiele, S; Thiele, R; Gerdesmeyer, L

    2015-12-01

    Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy. Copyright © 2015. Published by Elsevier Ltd.

  1. Pulsed radiofrequency on radial nerve under ultrasound guidance for treatment of intractable lateral epicondylitis.

    Science.gov (United States)

    Oh, Dae Seok; Kang, Tae Hyung; Kim, Hyae Jin

    2016-06-01

    Lateral epicondylitis is a painful and functionally limiting disorder. Although lateral elbow pain is generally self-limiting, in a minority of people symptoms persist for a long time. When various conservative treatments fail, surgical approach is recommended. Surgical denervation of several nerves that innervate the lateral humeral epicondyle could be considered in patients with refractory pain because it denervates the region of pain. Pulsed radiofrequency is a minimally invasive procedure that improves chronic pain when applied to various neural tissues without causing any significant destruction and painful complication. This procedure is safe, minimally invasive, and has less risk of complications relatively compared to the surgical approach. The radial nerve can be identified as a target for pulsed radiofrequency lesioning in lateral epicondylitis. This innovative method of pulsed radiofrequency applied to the radial nerve has not been reported before. We reported on two patients with intractable lateral epicondylitis suffering from elbow pain who did not respond to nonoperative treatments, but in whom the ultrasound-guided pulsed radiofrequency neuromodulation of the radial nerve induced symptom improvement. After a successful diagnostic nerve block, radiofrequency probe adjustment around the radial nerve was performed on the lateral aspect of the distal upper arm under ultrasound guidance and multiple pulsed treatments were applied. A significant reduction in pain was reported over the follow-up period of 12 weeks.

  2. Chronic hyperglycemia increases the risk of lateral epicondylitis: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS).

    Science.gov (United States)

    Otoshi, Kenichi; Takegami, Misa; Sekiguchi, Miho; Onishi, Yoshihiro; Yamazaki, Shin; Otani, Koji; Shishido, Hiroaki; Fukuhara, Shunichi; Kikuchi, Shinichi; Konno, Shinichi

    2015-01-01

    Although humeral epicondylitis is a common health problem, there have been no reports that describe its prevalence in Japanese general population, and relatively little is known about its etiology and associated risk factors. This study aimed to clarify the prevalence of humeral epicondilitis in Japanese general population, and investigate the associated risk factors using the data from a cross-sectional study of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). A total of 1,777 participants who participated in health checkups conducted at rural area in Japan in 2010 were enrolled. The prevalence of lateral and medial epicondylitis was investigated. Logistic regression models were performed to examine the relationship between lateral epicondylitis and correlated factors such as occupational status, smoking and alcohol preferences, and medical characteristics. The overall prevalence of lateral and medial epicondylitis was 2.5 % and 0.3 %, respectively. A shortened version of the disabilities of the arm, shoulder and hand (The QuickDASH) score was significantly higher in subjects with lateral epicondylitis than in those without (15.0 ± 12.7 vs 8.5 ± 11.1). Subjects with definite chronic hyperglycemia (HbA1c ≥ 6.5) showed a 3.37-times higher risk of lateral epicondylitis than those with favorable glycemic control (HbA1c lateral epicondylitis. Lateral epicondylitis influences activities of daily living. Chronic hyperglycemia might be one of the risk factor for lateral epicondylitis. Chronic hyperglycemia is significantly associated with lateral epicondylitis.

  3. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow

    International Nuclear Information System (INIS)

    Savnik, Anette; Jensen, Bente; Noerregaard, Jesper; Danneskiold-Samsoee, Bente; Bliddal, Henning; Egund, Niels

    2004-01-01

    The purpose of this study was to investigate the treatment response in lateral epicondylitis (tennis elbow) by MRI. Magnetic resonance imaging was obtained in 30 patients with clinical symptoms of lateral epicondylitis of the elbow using T1-, T2- and T2-weighted fat-saturated (FS) sequences. The patients were randomised to either i.m. corticosteroid injection (n=16) or immobilisation in a wrist splint (n=14). Magnetic resonance imaging of the elbow was performed on a 1.5-T MR system at baseline and after 6 weeks. The extensor carpi radialis (ECRB) tendon, the radial collateral ligament, lateral humerus epicondyle at tendon insertion site, joint fluid and signal intensity changes within brachio-radialis and anconeus muscles were evaluated on the MR unit's workstation before and after 6 weeks of treatment. The MRI was performed once in 22 healthy controls for comparison and all images evaluated by an investigator blinded to the clinical status of the subjects. The MR images showed thickening with separation of the ECRB tendon from the radial collateral ligament and abnormal signal change in 25 of the 30 patients on the T1-weighted sequences at inclusion. The signal intensity of the ECRB tendon was increased in 24 of the 30 patients with lateral epicondylitis of the elbow on the T2-weighted FS sequences. (orig.)

  4. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow

    Energy Technology Data Exchange (ETDEWEB)

    Savnik, Anette [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg (Denmark); Department of Radiology, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg (Denmark); Hovmarksvej 39, 2920, Charlottenlund (Denmark); Jensen, Bente; Noerregaard, Jesper; Danneskiold-Samsoee, Bente; Bliddal, Henning [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg (Denmark); Egund, Niels [Department of Radiology, Aarhus University Hospital, 8000, Aarhus C (Denmark)

    2004-06-01

    The purpose of this study was to investigate the treatment response in lateral epicondylitis (tennis elbow) by MRI. Magnetic resonance imaging was obtained in 30 patients with clinical symptoms of lateral epicondylitis of the elbow using T1-, T2- and T2-weighted fat-saturated (FS) sequences. The patients were randomised to either i.m. corticosteroid injection (n=16) or immobilisation in a wrist splint (n=14). Magnetic resonance imaging of the elbow was performed on a 1.5-T MR system at baseline and after 6 weeks. The extensor carpi radialis (ECRB) tendon, the radial collateral ligament, lateral humerus epicondyle at tendon insertion site, joint fluid and signal intensity changes within brachio-radialis and anconeus muscles were evaluated on the MR unit's workstation before and after 6 weeks of treatment. The MRI was performed once in 22 healthy controls for comparison and all images evaluated by an investigator blinded to the clinical status of the subjects. The MR images showed thickening with separation of the ECRB tendon from the radial collateral ligament and abnormal signal change in 25 of the 30 patients on the T1-weighted sequences at inclusion. The signal intensity of the ECRB tendon was increased in 24 of the 30 patients with lateral epicondylitis of the elbow on the T2-weighted FS sequences. (orig.)

  5. A Survey of Fellowship-Trained Upper Extremity Surgeons on Treatment of Lateral Epicondylitis.

    Science.gov (United States)

    Niedermeier, Steven R; Crouser, Nisha; Speeckaert, Amy; Goyal, Kanu S

    2018-04-01

    The aim of the study is to investigate current management strategies for lateral epicondylitis by fellowship-trained upper extremity surgeons. A 17-question survey of treatment approaches and outcomes related to lateral epicondylitis was sent to 3354 surgeons using the American Society for Surgery of the Hand and American Shoulder and Elbow Surgeons member databases. Six hundred twelve upper extremity surgeons completed the survey. The 6 most frequently prescribed nonoperative treatments for lateral epicondylitis were home exercise program/stretching (81%), nonsteroidal anti-inflammatory drugs (75%), steroid injection (71%), counterforce bracing (68%), formal physical therapy (65%), and wrist brace (47%). Less commonly performed nonoperative treatment measures included platelet-rich plasma injection (16%), Tenex procedure (6%), and iontophoresis (2%). There is a lack of consensus in the literature for the management of lateral epicondylitis, which is reflected by individual variation in clinical treatment among the experts. Future prospective randomized control studies are needed to establish evidence-based practice standards for this common diagnosis.

  6. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review.

    Science.gov (United States)

    Cullinane, Frances L; Boocock, Mark G; Trevelyan, Fiona C

    2014-01-01

    To establish the effectiveness of eccentric exercise as a treatment intervention for lateral epicondylitis. ProQuest, Medline via EBSCO, AMED, Scopus, Web of Science, CINAHL. A systematic review was undertaken to identify randomized and controlled clinical trials incorporating eccentric exercise as a treatment for patients diagnosed with lateral epicondylitis. Studies were included if: they incorporated eccentric exercise, either in isolation or as part of a multimodal treatment protocol; they assessed at least one functional or disability outcome measure; and the patients had undergone diagnostic testing. The methodological quality of each study was assessed using the Modified Cochrane Musculoskeletal Injuries Group score sheet. Twelve studies met the inclusion criteria. Three were deemed 'high' quality, seven were 'medium' quality, and two were 'low' quality. Eight of the studies were randomized trials investigating a total of 334 subjects. Following treatment, all groups inclusive of eccentric exercise reported decreased pain and improved function and grip strength from baseline. Seven studies reported improvements in pain, function, and/or grip strength for therapy treatments inclusive of eccentric exercise when compared with those excluding eccentric exercise. Only one low-quality study investigated the isolated effects of eccentric exercise for treating lateral epicondylitis and found no significant improvements in pain when compared with other treatments. The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy programme for improved outcomes in patients with lateral epicondylitis.

  7. Open, Arthroscopic, and Percutaneous Surgical Treatment of Lateral Epicondylitis: A Systematic Review.

    Science.gov (United States)

    Burn, Matthew B; Mitchell, Ronald J; Liberman, Shari R; Lintner, David M; Harris, Joshua D; McCulloch, Patrick C

    2017-03-01

    Approximately 10% of patients with lateral epicondylitis go on to have surgical treatment; however, multiple surgical treatment options exist. The purpose of this study was to review the literature for the clinical outcomes of open, arthroscopic, and percutaneous treatment of lateral epicondylitis. The authors hypothesized that the clinical outcome of all 3 analyzed surgical treatments would be equivalent. A systematic review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar in July 2016 to compare the functional outcome, pain, grip strength, patient satisfaction, and return to work at 1-year follow-up for open, arthroscopic, and percutaneous treatment of lateral epicondylitis. Six studies (2 Level I and 4 Level II) including 179 elbows (83 treated open, 14 arthroscopic, 82 percutaneous) were analyzed. Three outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH] score, visual analog scale [VAS], and patient satisfaction) were reported for more than one category of surgical technique. Of these, the authors noted no clinically significant differences between the techniques. This is the first systematic review looking at high-level evidence to compare open, percutaneous, and arthroscopic techniques for treating lateral epicondylitis. There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up.

  8. Platelet rich plasma versus laser therapy in lateral epicondylitis of elbow.

    Science.gov (United States)

    Tonk, Gyaneshwar; Kumar, Anish; Gupta, Amit

    2014-07-01

    Platelet rich plasma (PRP) extract has shown to be a general stimulation for repair and currently used widely in various sports injury. A prospective observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow, and compare the result with low level laser therapy. The trial was conducted at a tertiary care center for a period of 2 years. Eighty-one patients with chronic lateral epicondylitis were divided into two groups. PRP group (n = 39) and laser therapy group (n = 42). The primary analysis included Nirschl pain score, local tenderness, pain on wrist extension, grip strength, elbow swelling were clinically assessed at different interval of followup (minimum followup: 52 weeks) and; clinical and functional outcome evaluated at final followup. The statistical analysis were done. The mean Nirschl pain score decreased significantly from baseline in PRP when compared with low level laser therapy (P ≤ 0.05). Treatment of patients with chronic lateral epicondylitis with PRP extract reduced pain and significantly increased function, exceeding the effect of low level laser therapy on long term followup. Low-level laser therapy is better in the short term period, but on long term followup injection PRP therapy is better than laser therapy in lateral epicondylitis.

  9. Cost effectiveness of interventions for lateral epicondylitis - Results from a randomised controlled trial in primary care

    NARCIS (Netherlands)

    Korthals-de Bos, I.B.C.; Smidt, N.; van Tulder, M.W.; Rutten-van Molken, M.P.M.H.; Ader, H.J.; van der Windt, D.A.W.M.; Assendelft, W.J.J.; Bouter, L.M.

    2004-01-01

    Objective: Lateral epicondylitis is a common complaint, with an annual incidence between 1% and 3% in the general population. The Dutch College of General Practitioners in The Netherlands has issued guidelines that recommend a wait- and-see policy. However, these guidelines are not evidence based.

  10. Work-related risk factors for lateral epicondylitis and other cause of elbow pain in the working population.

    Science.gov (United States)

    Herquelot, Eleonore; Bodin, Julie; Roquelaure, Yves; Ha, Catherine; Leclerc, Annette; Goldberg, Marcel; Zins, Marie; Descatha, Alexis

    2013-04-01

    This study was designed to assess the relationship between work-related combined physical and psychosocial factors and elbow disorders (lateral epicondylitis and non-specific disorders without lateral epicondylitis) in the working population. A total of 3,710 workers (58% men) in a French region in 2002-2005 participated in physical examinations by occupational health physicians and assessed their personal factors and work exposure by self-administered questionnaire. Statistical associations between elbow disorders and risks factors were analyzed using multinomial logistic regression. A total of 389 (10.5%) workers had elbow pain without lateral epicondylitis and 90 (2.4%) workers had lateral epicondylitis. Age, body mass index (>25), and low social support (only for men) were significant risks factors. Hard perceived physical exertion combined with elbow flexion/extension (>2 hr/day) and wrist bending (>2 hr/day) was a strong significant risk factor for elbow pain and epicondylitis: among men, adjusted Odds Ratio (ORa) = 2.6 (1.9-3.7) and ORa = 5.6 (2.8-11.3), respectively; among women, ORa = 1.4 (0.9-2.2) and ORa = 2.9 (1.3-6.5). This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral epicondylitis. Certain observed differences in associations with lateral epicondylitis and elbow pain only indicate the need for additional longitudinal studies on different stages of elbow disorders and known risk factors. Copyright © 2012 Wiley Periodicals, Inc.

  11. The effect of autologous platelet rich plasma in treatment lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    İsmail Ağır

    2011-03-01

    Full Text Available Lateral epicondylitis (tennis elbow is the most commonly diagnosed cause of lateral elbow pain. The aim of this study was to compare the effect of single dose corticosteroid and autologous platelet rich plasma (PRP injection in the treatment of tennis elbow.Materials and methods: The 15 elbow of 15 patients (6 male and 9 female was included in the study, who applied to our clinic with lateral elbow pain and diagnosed as lateral epicondylitis. A single dose of 0,5 ml Bethametasone and 0,5 ml Prilocaine mixture was applied to first group and single dose 1 ml autologous PRP was locally applied to the second group.Results: In the early follow-ups the results of corticosteroid group were better than latter follow-ups, however in PRP group the results were worst in early follow-ups but better results were obtained in later follow-ups according to Verhaar scoring system.Conclusion: According to our results, the beneficial effects of PRP injection in lateral epicondylitis increases over time but further studies with more patients and longer follow up durations should done in order to more clarified this subject.

  12. Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Sirico, Felice; Ricca, Flavia; DI Meglio, Franca; Nurzynska, Daria; Castaldo, Clotilde; Spera, Rocco; Montagnani, Stefania

    2017-06-01

    Lateral epicondylitis is a common painful elbow disorder. Several approaches to treatment have been proposed, with a local injection of corticosteroids being the most frequently used. Recent insights into the pathophysiology encouraged the introduction of autologous blood injections as an alternative treatment method. The aim of this meta-analysis is to summarize quantitatively the evidence regarding the efficacy of corticosteroids and autologous blood injections for treatment of pain in lateral epicondylitis. Studies were considered eligible based on the following inclusion criteria: adult human, diagnosis of lateral epicondylitis, randomized controlled trials comparing corticosteroids versus autologous blood injections, pain assessment. Exclusion criteria were previous surgery for lateral epicondylitis or for other elbow disorders, concurrent treatment with drugs or physiotherapy, diagnosis of musculoskeletal systemic disorder. A systematic search of literature was performed according to the PRISMA statement. Effect size of each included study was calculated and analyzed in a random-effects model. Four studies, enrolling total of 218 patients (139 females and 79 males), were included in quantitative analysis. At 2 weeks, there was a trend towards a reduction of VAS score in the corticosteroid group (WMD=2.12 [95% CI: 4.38 to 0.14], P=0.07). No significant differences were recorded in the medium-term (4-12 weeks; WMD=0.85 [95% CI: -0.44 to 2.15], P=0.19) and long-term (24 weeks; WMD=0.63 [95% CI: -2.40 to 3.66], P=0.68) follow-up. Few high-quality trials compare the efficacy of corticosteroid and autologous blood injections in the control of pain related to lateral epicondylitis. Available data indicate that corticosteroids tend to reduce VAS score in short-term follow-up, although these data are not statistically significant. No differences were recorded in the medium and long term. Contrary to popular opinion among medical professionals, and despite

  13. Chiropractic treatment of lateral epicondylitis: a case report utilizing active release techniques.

    Science.gov (United States)

    Gliedt, Jordan A; Daniels, Clinton J

    2014-06-01

    The purpose of this report is to describe the chiropractic management of a case of lateral epicondylitis with active release techniques (ART). A 48-year-old white man presented to a chiropractic clinic with a complaint of left lateral elbow pain that began 2 years previous with insidious onset. The patient reported an inability to play 18 consecutive holes of golf due to the pain. Treatment consisted of 5 sessions of ART (a soft tissue technique that is applied to muscles, fascia, tendons, ligaments, and nerves) applied to the left elbow soft tissue over a duration of 3 weeks. The patient reported an absence of pain and ability to consistently play 18 consecutive holes of golf up to 3 times per week at 4 and 8 weeks post-treatment. This patient with lateral epicondylitis responded favorably to chiropractic treatment using the application of ART, as demonstrated by reduced pain and increased functional outcomes.

  14. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis.

    NARCIS (Netherlands)

    Smidt, N.; Windt, A. van der; Assendelft, W.J.; Mourits, A.J.; Devillé, W.L.; Winter, F. de; Bouter, L.M.

    2002-01-01

    Objective: To evaluate the interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis in primary care. Design: Two physiotherapists assessed independently, and in randomized order, the severity of

  15. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis

    NARCIS (Netherlands)

    Smidt, N; van der Windt, DA; Assendelft, WJ; Mourits, AJ; Deville, WL; de Winter, AF; Bouter, LM

    Objective: To evaluate the interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis in primary care. Design: Two physiotherapists assessed independently, and in randomized order, the severity of

  16. Platelet rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention.

    Science.gov (United States)

    Hastie, Graham; Soufi, Mazen; Wilson, James; Roy, Bibhas

    2018-03-01

    We aimed to assess the effectiveness of PRP injections in lateral epicondylitis of the elbow as it was felt after PRP introduction the numbers of patients requiring surgery for had reduced. We conducted a retrospective review of cases from the 1 st January 2008 to 31st December 2015. The numbers of patients undergoing surgical release and the numbers of patients requiring PRP injections were recorded each year and the numbers of patients requiring surgery was compared pre and post PRP injection to ascertain if PRP introduction reduced surgical intervention. Prior to PRP, a yearly mean of 12.75 patients underwent surgery, since PRP this reduced to 4.25 patients, P lateral epicondylitis of the elbow, not only a safe but also very effective tool in reducing symptoms and have shown it has reduced the need for surgical intervention in this difficult cohort of patients.

  17. Favorable Responsiveness of the Hand10 Questionnaire to Assess Treatment Outcomes for Lateral Epicondylitis.

    Science.gov (United States)

    Nishizuka, Takanobu; Iwatsuki, Katsuyuki; Kurimoto, Shigeru; Yamamoto, Michiro; Onishi, Tetsuro; Hirata, Hitoshi

    2018-06-01

    The aim of our study was to compare the responsiveness of the Hand10 questionnaire and the Pain visual analogue scale (VAS) for the assessment of lateral epicondylitis. The standardized response mean and effect size were used as indicators of responsiveness, measured at baseline and after 6 months of treatment. Among the 54 patients enrolled, 28 were treated using a forearm band, compress and stretching, with the other 26 patients treated using compress and stretching. The standardized response mean and the effect size were 1.18 and 1.38, respectively, of the Hand10 and 1.39 and 1.75, respectively, for the Pain VAS. The responsiveness of both tests was considered to be large, based on Cohen's classification of effect size, supporting the use of the Hand10 questionnaire to assess treatment outcomes for lateral epicondylitis.

  18. Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Sita Dhakal

    2016-10-01

    application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3% was also done when the conservative management failed.  Conclusion: There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect. Keywords: lateral epicondylitis; NSAIDs; physiotherapy; steroid; tennis elbow.

  19. The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis.

    Science.gov (United States)

    Ahmad, Zafar; Brooks, Roger; Kang, Sertaz-Niel; Weaver, Holly; Nunney, Ian; Tytherleigh-Strong, Graham; Rushton, Neil

    2013-11-01

    To evaluate the evidence for application of platelet-rich plasma (PRP) in lateral epicondylitis. We carried out a systematic review of the current evidence on the effects of PRP in lateral epicondylitis on clinical outcomes. We performed a comprehensive search of the PubMed, Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase databases using various combinations of the commercial names of each PRP preparation and "lateral epicondylitis" (with its associated terms), looking specifically at human studies. Data validity was assessed and collected on clinical outcome. Nine studies met the inclusion criteria, of which 5 were randomized controlled trials. Two cohort studies showed that PRP improved clinical satisfaction scores. One case-control study showed that PRP yielded a significantly greater improvement in symptoms compared with bupivacaine. Two randomized controlled trials compared the effect of injections of PRP and blood. Only 1 of the studies noted a significant difference at the 6-week time point. Three randomized controlled trials compared corticosteroids with PRP. Two of the smaller trials, which had follow-up periods of 6 weeks and 3 months, showed no significant difference between treatment groups. The largest randomized controlled trial found that PRP had significant benefit compared with corticosteroids with regard to pain and Disabilities of the Arm, Shoulder and Hand scores at 1- and 2-year time points. This review highlights the limited but evolving evidence for the use of PRP in lateral epicondylitis; however, further research is required to understand the concentration and preparation that facilitate the best clinical outcome. Characterizing the timing of the intervention would optimize the health economics behind the decision to treat for the patient and health care provider. Level III, systematic review of Level I to III studies. Copyright © 2013 Arthroscopy Association of North America. Published by

  20. Platelet-rich plasma for chronic lateral epicondylitis: is one injection sufficient?

    Science.gov (United States)

    Glanzmann, Michael C; Audigé, Laurent

    2015-12-01

    Chronic lateral epicondylitis is generally treated using nonsurgical methods including physiotherapy and infiltrations of cortisone or platelet-rich plasma (PRP). The latter is known for its simple application as well as associated low risk of adverse events, which lend to its widespread use in treating various musculoskeletal conditions. There is limited evidence on the effectiveness of PRP injections to optimally treat chronic lateral epicondylitis. This study explored the effectiveness of single or repeated injections for patients with symptoms that spanned 6 months or more and were unresponsive to alternate conservative measures. Patients with chronic lateral epicondylitis received PRP injections in 4-week intervals that were complemented with standardized physical therapy. Patient-reported outcomes based on the patient-rated elbow evaluation (PREE), quick disabilities of the arm, shoulder and hand (qDASH), and EuroQol (five dimensions) 3-level version (EQ5D3L) questionnaires were documented at each visit including 6 months after the first injection. These outcomes were compared between patients receiving 1 vs. 2 or 3 PRP injections. Sixty-two patients received one (n = 36) or more (n = 26) PRP injections. The mean baseline to 6-month follow-up scores of the PREE and qDASH questionnaires improved significantly from 54.0 to 23.0 and 50.3 to 20.7, respectively. The mean baseline EQ5D3L-visual analogue scale score improved from 62.5 to 82.9 by 6 months post-injection. These outcomes did not significantly differ between the patients who received varying numbers of injections. Patients with chronic lateral epicondylitis reported significant pain relief and gain in function as well as quality of life 6 months after localized PRP treatment. A single PRP injection may be sufficient.

  1. Arthroscopic surgical treatment of recalcitrant lateral epicondylitis - A series of 47 cases

    Directory of Open Access Journals (Sweden)

    Alexandre Tadeu do Nascimento

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. METHODS: A retrospective study of 44 patients (47 elbows who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analog scale of pain (VAS, and ShortForm 36 (SF-36. The mean age at surgery was 44.4 years (32-60. The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years. Mean follow-up was 18.6 months (range of 6-31.9 . RESULTS: The mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain and 3.0 points at activity, of which 31 (66% cases presented mild pain, 10 (21% moderate pain, and six (13% severe pain; mean SF-36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. CONCLUSIONS: Arthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.

  2. EFFICACY OF CYRIAX PHYSIOTHERAPY VERSUS ECCENTRIC STRENGTHENING AND STRETCHING EXERCISES IN CHRONIC LATERAL EPICONDYLITIS PATIENTS

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    Madhusmita Koch

    2015-10-01

    Full Text Available Background: Lateral Epicondylitis is the most common lesion of the elbow, affecting the tendinous origin of the wrist extensors. Although conservative treatment of this condition has been the subject of numerous studies, there is no agreement as to the most effective management strategy. Therefore, this study was designed to compare the efficacy of Cyriax physiotherapy Versus Eccentric Strengthening and Stretching exercises in reducing the pain and improving the grip strength and functional status of the affected extremity in chronic lateral epicondylitis. Method: An experimental study design, 60 subjects meeting the inclusion criteria were selected for the study and were randomly assigned into two groups: Group A (N=30 received Cyriax Physiotherapy and Group B(N=30 received Eccentric strengthening and static stretching of Extensor Carpi Radialis Brevis. Low Level Laser Therapy was a common treatment for both the groups. After 4 weeks of treatment, assessment was performed using Visual Analogue Scale (VAS, Hand Held Dynamometer (HHD and Patient Rated Tennis Elbow Evaluation Questionnaire (PRTEE at 0 week and at the end of 4 weeks. Results: Data analysis revealed that there is no statistically significant difference between the groups in VAS, HHD and PRTEE scores i.e. average improvement post treatment in both the groups are equal, but within group comparisons showed significant improvements in both the groups. Conclusion: The efficacy of Cyriax Physiotherapy is equal to Eccentric Strengthening and Stretching Exercises in chronic lateral epicondylitis.

  3. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis.

    Science.gov (United States)

    Yi, Rosemary; Bratchenko, Walter W; Tan, Virak

    2018-01-01

    The aim of the study was to determine the efficacy of deep friction massage in the treatment of lateral epicondylitis by comparing outcomes with a control group treated with splinting and therapy and with an experimental group receiving a local steroid injection. A randomized clinical trial was conducted to compare outcomes after recruitment of consecutive patients presenting with lateral epicondylitis. Patients were randomized to receive one of 3 treatments: group 1: splinting and stretching, group 2: a cortisone injection, or group 3: a lidocaine injection with deep friction massage. Pretreatment and posttreatment parameters of visual analog scale (VAS) pain ratings, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and grip strength were measured. Outcomes were measured at early follow-up (6-12 weeks) and at 6-month follow-up. There was a significant improvement in VAS pain score in all treatment groups at early follow-up. DASH score and grip strength improved in the cortisone injection group and the deep friction massage group at early follow-up; these parameters did not improve in the splinting and stretching group. At 6-month follow-up, only patients in the deep friction massage group demonstrated a significant improvement in all outcome measures, including VAS pain score, DASH score, and grip strength. Deep friction massage is an effective treatment for lateral epicondylitis and can be used in patients who have failed other nonoperative treatments, including cortisone injection.

  4. Arthroscopic surgical treatment of recalcitrant lateral epicondylitis - A series of 47 cases.

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    Nascimento, Alexandre Tadeu do; Claudio, Gustavo Kogake

    2017-01-01

    To evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. A retrospective study of 44 patients (47 elbows) who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analog scale of pain (VAS), and ShortForm 36 (SF-36). The mean age at surgery was 44.4 years (32-60). The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years). Mean follow-up was 18.6 months (range of 6-31.9). The mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain) and 3.0 points at activity, of which 31 (66%) cases presented mild pain, 10 (21%) moderate pain, and six (13%) severe pain; mean SF-36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. Arthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.

  5. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis.

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    Lee, Sang Seok; Kang, Sangkuk; Park, Noh Kyoung; Lee, Chan Woo; Song, Ho Sup; Sohn, Min Kyun; Cho, Kang Hee; Kim, Jung Hwan

    2012-10-01

    To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm(2), 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

  6. Anatomy of the lateral antebrachial cutaneous nerve in relation to the lateral epicondyle and cephalic vein.

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    Wongkerdsook, Wachara; Agthong, Sithiporn; Amarase, Chavarin; Yotnuengnit, Pattarapol; Huanmanop, Thanasil; Chentanez, Vilai

    2011-01-01

    The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve supplying the lateral aspect of forearm. Because of its close proximity to the biceps brachii tendon (BBT), the lateral epicondyle (LE), and the cephalic vein (CV), surgery and venipuncture in the cubital fossa can injure the LACN. Measurement data regarding the relative anatomy of LACN are scarce. We, therefore, dissected 96 upper extremities from 26 males and 22 females to expose the LACN in the cubital fossa and forearm. The LACN consistently emerged from the lateral margin of BBT. It then pierced the deep fascia distal to the interepicondylar line (IEL) in 84.4% with mean distances of 1.8 ± 1.1 and 1.2 ± 0.9 cm (male and female, respectively). At the level of IEL, the LACN in all cases was medial to the LE (5.9 ± 1.1 cm male and 5.2 ± 0.9 cm female). Two types of branching were observed: single trunk (78.1%) and bifurcation (21.9%). Asymmetry in the branching pattern was observed in 6 males and 1 female. Concerning the relationship to the CV, the LACN ran medially within 1 cm at the level of IEL in 78.7%. Moreover, in 10 specimens, the LACN was directly beneath the CV. In the forearm, the LACN tends to course medial to the CV. Significant differences in the measurement data between genders but not sides were found in some parameters. These data are important for avoiding LACN injury and locating the LACN during relevant medical procedures. Copyright © 2010 Wiley-Liss, Inc.

  7. Trends in Surgical Practices for Lateral Epicondylitis Among Newly Trained Orthopaedic Surgeons.

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    Wang, Dean; Degen, Ryan M; Camp, Christopher L; McGraw, Michael H; Altchek, David W; Dines, Joshua S

    2017-10-01

    Much controversy exists regarding the optimal surgical intervention for lateral epicondylitis because of a multitude of options available and the lack of comparative studies. Knowledge of the current practice trends would help guide the design of comparative studies needed to determine which surgical technique results in the best outcome. To review the latest practice trends for the surgical treatment of lateral epicondylitis among newly trained surgeons in the United States utilizing the American Board of Orthopaedic Surgery (ABOS) database. Cross-sectional study; Level of evidence, 3. The ABOS database was utilized to identify surgical cases for lateral epicondylitis submitted by Part II board certification examination candidates from 2004 through 2013. Inclusion criteria were predetermined using a combination of International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Cases were organized by open and arthroscopic treatment groups and by fellowship training and were analyzed to determine differences in surgical techniques, complication rates, and concomitant procedures. In total, 1150 surgeons submitted 2106 surgical cases for the treatment of lateral epicondylitis. The number of surgical cases for lateral epicondylitis performed per 10,000 submitted cases significantly decreased from 26.7 in 2004 to 21.1 in 2013 ( P = .002). Among all cases, 92.2% were open and 7.8% were arthroscopic, with no change in the incidence of arthroscopic surgeries over the study period. Shoulder and elbow (18.1%) and sports medicine (11.4%) surgeons were more likely to perform surgery arthroscopically compared with hand surgeons (6.1%) ( P < .001). There was no difference in overall self-reported complication rates between open (4.4%) and arthroscopic (5.5%) procedures ( P = .666). Percutaneous tenotomy, debridement only, and debridement with tendon repair comprised 6.4%, 46.3%, and 47.3% of open treatment, respectively. Sports

  8. Lateral epicondylitis: Associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements.

    Science.gov (United States)

    Jeon, Ji Young; Lee, Min Hee; Jeon, In-Ho; Chung, Hye Won; Lee, Sang Hoon; Shin, Myung Jin

    2018-03-01

    We assessed the implications of MR imaging with clinical history in lateral epicondylitis management by evaluating imaging and clinical features in patients with lateral epicondylitis treated conservatively or operatively. Sixty patients with lateral epicondylitis treated conservatively (n = 38) or operatively (n = 22) from 2011-2015 were included. MR imaging findings of common extensor tendon (CET), lateral collateral ligament (LCL) complex, muscle oedema, ulnar nerve and elbow joint were reviewed. Clinical data recorded were frequency, duration and intensity of pain, history of trauma and injection therapy, range of motion. MRI-assessed CET and LCL complex abnormalities, muscle oedema, radiocapitellar joint widening, joint effusion/synovitis, pain frequency and intensity differed significantly between the two groups (p lateral epicondylitis. • MRI can reflect different disease severity between patients treated conservatively/operatively. • CET abnormality, muscle oedema were major MRI findings with operative treatment. • Patients in operative group were more likely to experience persistent pain. • MRI plus clinical symptoms could facilitate appropriate management for lateral epicondylitis.

  9. Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study.

    Science.gov (United States)

    Descatha, Alexis; Dale, Ann Marie; Jaegers, Lisa; Herquelot, Eléonore; Evanoff, Bradley

    2013-09-01

    Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate and mostly based on cross-sectional studies. Suspected physical exposures were tested over a 3-year period in a large longitudinal cohort study of workers in the USA. In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables. Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%) and 16 workers who had both. After adjusting for age, lack of social support and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (ORs 2.8 (1.2 to 6.2) and 3.6 (1.2 to 11.0) in men and women, respectively). Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved.

  10. Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus.

    Science.gov (United States)

    Yadav, Raman; Kothari, S Y; Borah, Diganta

    2015-07-01

    Lateral epicondylitis or Tennis Elbow is one of the most common causes of upper extremity pain with various treatment options. Platelet-rich plasma (PRP) offers a new option for the treatment of lateral epicondylitis. This study was conducted with an aim to compare the efficacy of PRP versus methyl-prednisolone local injection in patients with lateral epicondylitis. Sixty five patients with lateral epicondylitis were included in the study and randomized into two groups. Group A was treated with single injection of 1ml PRP with absolute platelet count of at least 1 million platelets/ mm(3). Group B was treated with single injection of 1ml (40mg) methyl-prednisolone. Pain, grip strength and functional improvements were assessed using visual analogue scale, dynamometer and quick Disabilities of the Arm, Shoulder and Hand scale respectively at baseline, 15 days, 1 month and 3 months. Sixty patients completed the follow up. All assessment parameters improved significantly in both the Groups at each follow up compared to baseline. At the end of three months group A showed significantly better improvement as compared to Group B. PRP and methyl-prenisolone both are effective in the treatment of lateral epicondylitis. However, PRP is a superior treatment option for longer duration efficacy.

  11. Natural course in tennis elbow--lateral epicondylitis after all?

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    Zeisig, Eva

    2012-12-01

    Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.

  12. CLINICAL ASSESSMENT OF FUNCTIONAL OUTCOME IN LATERAL EPICONDYLITIS MANAGED BY LOCAL INFILTRATION OF AUTOLOGOUS BLOOD

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    Dr. Ajay Bharti

    2010-01-01

    Full Text Available Lateral epicondylitis is a well known elbow disorder known to affect a variety of population. Though the disorder is expected to affect a lot of sports personnel, the incidence is not uncommon in persons of household activities. The management comprises of conservative to operative with a dilemma of what to be done in most of the affected population. A large number of interventions have been tried to delineate the best modality but none of them proved to be conclusive. The aim of the present study was to prove the efficacy of cheapest possible interventional modality autologous blood for treatment of Lateral Epicondylitis. Twenty five patients of Tennis elbow were included in this study who have attended the OPD of GSVM Medical College and associated LLR Hospital, Kanpur from November 2007 to April 2008 and fulfilled inclusion and exclusion criteria. 78% were females, mostly housewives involved in regular household activities. All the patients were infiltrated autologous blood with local anaesthetic infiltration. Patients were deprived of regular activities for 3 weeks after infiltration. Follow up was done at weekly interval for 2 weeks and then at 6th week and 12th week. Assessment was done using Visual Analogue Scale ( VAS and Verhaar et al scoring system. Total follow up period was 3 months. We observed that the mean VAS score improved from preinfiltrative 6.40±1.22 to 0.48±1.53 with p value being < .001. 64% patients showed excellent results and 32% showed good results as per Verhaar et al scoring system on 12 weeks follow up. One patient did not respond to this procedure and showed poor result as per Verhaar et al score. Therefore, autologous blood infiltration is a safe and effective modality in treatment of Lateral Epicondylitis.

  13. The relationship between positive or negative phrasing and patients' coping with lateral epicondylitis.

    Science.gov (United States)

    Lee, Dong Oh; Gong, Hyun Sik; Kim, Jeong Hwan; Rhee, Seung Hwan; Lee, Young Ho; Baek, Goo Hyun

    2014-04-01

    Research suggests that phrases with negative content can affect patients' response to medical procedures and how they cope with medical illnesses. We hypothesized that patients with lateral epicondylitis who describe their condition in positive phrases cope better than those who do not. We prospectively followed up 91 patients with lateral epicondylitis for 12 months. The patients indicated their baseline coping status based on the Pain Catastrophizing Scale (PCS) and were discharged with a wait-and-see policy. During follow-up interviews, the patients described the nature of their condition in their own words and were then categorized into either positive or negative phrasing groups. We compared these two groups regarding current coping status and whether they had sought additional treatment. We also analyzed for the factors associated with these outcomes. There were no significant differences in baseline PCS scores between the two groups. At follow-up, patients in the positive phrasing group (n = 62) had significantly lower PCS scores and were less likely to seek additional treatment than those in the negative phrasing group (n = 29). Multivariable analyses showed that positive phrasing and low pain levels were independently associated with improvement in PCS scores and that negative phrasing and depression were independently associated with patients' seeking additional treatment. Patients' positive phrasing about their condition are associated with improvement in their coping status and with less use of medical resources in the case of lateral epicondylitis. This study suggests that patients with more positive attitudes toward their illness cope and comply better when a wait-and-see treatment is recommended by their physicians. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  14. The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management.

    Science.gov (United States)

    Brkljac, Milos; Kumar, Shyam; Kalloo, Dale; Hirehal, Kiran

    2015-12-01

    We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed. We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes. 88.2% improved their OES. 8.8% reported symptom progression. One patient had no change. No patients suffered adverse reactions. Two patients underwent an open release procedure. One had the injection repeated. An injection of PRP improves pain and function in patients suffering from LE where conservative management has failed.

  15. Percutaneous Soft Tissue Release for Treating Chronic Recurrent Myofascial Pain Associated with Lateral Epicondylitis: 6 Case Studies

    Science.gov (United States)

    Lin, Ming-Ta; Chou, Li-Wei; Chen, Hsin-Shui; Kao, Mu-Jung

    2012-01-01

    Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis. Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs) due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin's technique. Pain intensity (measured with a numerical pain rating scale), pressure pain threshold (measured with a pressure algometer), and grasping strength (measured with a hand dynamometer) were assessed before, immediately after, and 3 months and 12 months after the treatment. Results. For every individual case, the pain intensity was significantly reduced (P lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain. PMID:23243428

  16. Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis.

    Science.gov (United States)

    Yoo, Sang Ho; Cha, Jang Gyu; Lee, Bo Ra

    2018-01-01

    To determine the clinical efficacy of sonographically-guided percutaneous bone drilling of the lateral epicondyle (LE) for the treatment of patients with LE. We included 24 patients with LE who reported pain in this study. All patients underwent sonographically-guided percutaneous bone drilling of the lateral epicondyle. Follow-up sonography and physical examinations were performed 1, 3 and 6 months after the procedure. The outcome measures included sonographic findings, visual analogue scale (VAS) score, maximum voluntary grip strength (MVGS) and patient-related tennis elbow evaluation (PRTEE) score. None of the patients had immediate complications during the procedure. The area of the extensor carpi radialis brevis (ECRB) tears decreased significantly at 1 month and declined gradually over the remaining 5 months of the study (p LE that can be performed in an outpatient setting. • Percutaneous drilling of the lateral condyle is effective for the treatment of LE. • The area of ECRB tears can be measured by US-guided saline injection. • US-guided percutaneous drilling is a quick and safe treatment option for LE.

  17. Efficacy of peloid therapy in patients with chronic lateral epicondylitis: a randomized, controlled, single blind study

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    Ökmen, Burcu Metin; Eröksüz, Rıza; Altan, Lale; Aksoy, Meliha Kasapoğlu

    2017-11-01

    The aim of this study was to assess the effect of peloid on pain, functionality, daily life activities, and quality of life of lateral epicondylitis (LE) patients. In this randomized, controlled, single-blind study, 75 patients who were diagnosed with chronic LE were enrolled to the study. Patients were randomized into two groups using the random number table. The patients in the first group (group 1) ( n = 33), were given lateral epicondylitis band (LEB) (during the day for 6 weeks) + peloid therapy (five consecutive days a week for 2 weeks), and the second group (group 2) ( n = 32), received LEB treatment alone. The patients were assessed by using Patient Rated Tennis Elbow Evaluation (PRTEE) and Nottingham Health Profile (NHP). The data were obtained before treatment (W0), immediately after treatment (W2), and 1 month after treatment (W6). In analysis of the collected data, the Wilcoxon signed rank test for intra-group comparisons and Mann-Whitney U test for comparisons between groups were used. Both in groups 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0 ( p 0.05), a statistically significant difference was found in favor of group 1 for all the evaluation parameters at W6 ( p < 0.05). Our results have shown that peloid treatment could be effective in providing improvement in pain relief, function, daily life activities, and quality of life in LE patients.

  18. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial

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    Evandro Pereira Palacio

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the effects of platelet-rich plasma (PRP infiltration in patients with lateral epicondylitis of the elbow, through analysis of the Disabilities of the Arm, Shoulder and Hand (DASH and Patient-Rated Tennis Elbow Evaluation (PRTEE questionnaires. METHODS: Sixty patients with lateral epicondylitis of the elbow were prospectively randomized and evaluated after receiving infiltration of three milliliters of PRP, or 0.5% neocaine, or dexamethasone. For the scoring process, the patients were asked to fill out the DASH and PRTEE questionnaires on three occasions: on the day of infiltration and 90 and 180 days afterwards. RESULTS: Around 81.7% of the patients who underwent the treatment presented some improvement of the symptoms. The statistical tests showed that there was evidence that the cure rate was unrelated to the substance applied (p = 0.62. There was also intersection between the confidence intervals of each group, thus demonstrating that the proportions of patients whose symptoms improved were similar in all the groups. CONCLUSION: At a significance level of 5%, there was no evidence that one treatment was more effective than another, when assessed using the DASH and PRTEE questionnaires.

  19. Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients.

    Science.gov (United States)

    Degen, Ryan M; Conti, Matthew S; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

    2018-02-01

    National rates of lateral epicondylitis and surgical treatment are poorly defined. Disease burden of lateral epicondylitis (LE) continues to increase annually. Further study is necessary to optimize treatment algorithms to reduce associated health-care expenditures. The purpose of this study is to review the annual incidence of LE, surgical rates, and associated health-care costs in a population setting. A national database was queried for LE from 2007 to 2014. Surgical cases were identified and annual rates were recorded. Demographic and epidemiologic data were reported with descriptive statistics, while trends over time were analyzed using linear regression. Eighty-five thousand three hundred eighteen cases of LE were identified. The annual incidence per 10,000 patients remained constant ( p  = 0.304). The proportion of diagnoses in patients 65 years diagnosed with, and receiving surgical treatment for, LE has significantly increased in recent years. Total reimbursement and average per-patient reimbursement have steadily risen, demonstrating the increasing burden of cost on the health-care system.

  20. Patient-related risk factors for requiring surgical intervention following a failed injection for the treatment of medial and lateral epicondylitis.

    Science.gov (United States)

    Degen, Ryan M; Cancienne, Jourdan M; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

    2017-11-01

    To identify risk factors for failure of a therapeutic injection leading to operative management of both medial and lateral epicondylitis. A national database was used to query Medicare Standard Analytic Files from 2005-2012 for patients treated with therapeutic injections for medial or lateral epicondylitis using CPT codes for injections associated with corresponding ICD-9 diagnostic codes (726.31 and 726.32, respectively). Those who subsequently underwent surgical treatment following injection were identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for requiring surgery within 2 years after therapeutic injection. 1,837 patients received therapeutic injections for medial epicondylitis. 52 (2.8%) required ipsilateral surgery at a mean of 429 ± 28 days post-injection. Risk factors for requiring surgical intervention included age lateral epicondylitis. 201 (3.1%) required subsequent surgery at a mean of 383 ± 128 days' post-injection. Risk factors included age lateral epicondylitis is low (~3%). Risk factors for failing a therapeutic injection include age  30) for medial epicondylitis and age lateral epicondylitis. Patients with these identified risk factors presenting with medial or lateral epicondylitis should be cautioned that they carry a higher risk of subsequent surgical treatment. Therapeutic, III.

  1. Lateral epicondylitis. Associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements

    International Nuclear Information System (INIS)

    Jeon, Ji Young; Lee, Min Hee; Chung, Hye Won; Lee, Sang Hoon; Shin, Myung Jin; Jeon, In-Ho

    2018-01-01

    We assessed the implications of MR imaging with clinical history in lateral epicondylitis management by evaluating imaging and clinical features in patients with lateral epicondylitis treated conservatively or operatively. Sixty patients with lateral epicondylitis treated conservatively (n = 38) or operatively (n = 22) from 2011-2015 were included. MR imaging findings of common extensor tendon (CET), lateral collateral ligament (LCL) complex, muscle oedema, ulnar nerve and elbow joint were reviewed. Clinical data recorded were frequency, duration and intensity of pain, history of trauma and injection therapy, range of motion. MRI-assessed CET and LCL complex abnormalities, muscle oedema, radiocapitellar joint widening, joint effusion/synovitis, pain frequency and intensity differed significantly between the two groups (p <.05) with increased severity in operative group. Persistent pain (OR 12.2, p <.01), CET abnormality on longitudinal plane (OR 7.5, p =.03 for grade 2; OR 22.4, p <.01 for grade 3) and muscle oedema (OR 6.7, p =.03) were major factors associated with operative treatment. Area under the ROC curve of predicted probabilities for combination of these factors was 0.83. MR imaging, combined with clinical assessment, could facilitate appropriate management planning for patients with lateral epicondylitis. (orig.)

  2. Lateral epicondylitis. Associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements

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    Jeon, Ji Young [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Gachon University, Department of Radiology, Incheon (Korea, Republic of); Lee, Min Hee; Chung, Hye Won; Lee, Sang Hoon; Shin, Myung Jin [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Jeon, In-Ho [University of Ulsan College of Medicine, Department of Orthopedic Surgery, Seoul (Korea, Republic of)

    2018-03-15

    We assessed the implications of MR imaging with clinical history in lateral epicondylitis management by evaluating imaging and clinical features in patients with lateral epicondylitis treated conservatively or operatively. Sixty patients with lateral epicondylitis treated conservatively (n = 38) or operatively (n = 22) from 2011-2015 were included. MR imaging findings of common extensor tendon (CET), lateral collateral ligament (LCL) complex, muscle oedema, ulnar nerve and elbow joint were reviewed. Clinical data recorded were frequency, duration and intensity of pain, history of trauma and injection therapy, range of motion. MRI-assessed CET and LCL complex abnormalities, muscle oedema, radiocapitellar joint widening, joint effusion/synovitis, pain frequency and intensity differed significantly between the two groups (p <.05) with increased severity in operative group. Persistent pain (OR 12.2, p <.01), CET abnormality on longitudinal plane (OR 7.5, p =.03 for grade 2; OR 22.4, p <.01 for grade 3) and muscle oedema (OR 6.7, p =.03) were major factors associated with operative treatment. Area under the ROC curve of predicted probabilities for combination of these factors was 0.83. MR imaging, combined with clinical assessment, could facilitate appropriate management planning for patients with lateral epicondylitis. (orig.)

  3. Does the quality, accuracy, and readability of information about lateral epicondylitis on the internet vary with the search term used?

    Science.gov (United States)

    Dy, Christopher J; Taylor, Samuel A; Patel, Ronak M; McCarthy, Moira M; Roberts, Timothy R; Daluiski, Aaron

    2012-12-01

    Concern exists over the quality, accuracy, and accessibility of online information about health care conditions. The goal of this study is to evaluate the quality, accuracy, and readability of information available on the internet about lateral epicondylitis. We used three different search terms ("tennis elbow," "lateral epicondylitis," and "elbow pain") in three search engines (Google, Bing, and Yahoo) to generate a list of 75 unique websites. Three orthopedic surgeons reviewed the content of each website and assessed the quality and accuracy of information. We assessed each website's readability using the Flesch-Kincaid method. Statistical comparisons were made using ANOVA with post hoc pairwise comparisons. The mean reading grade level was 11.1. None of the sites were under the recommended sixth grade reading level for the general public. Higher quality information was found when using the terms "tennis elbow" and "lateral epicondylitis" compared to "elbow pain" (p lateral epicondylitis is available online, especially from specialty societies. However, the quality and accuracy of information vary significantly with the search term, website author, and order of search results. This leaves less educated patients at a disadvantage, particularly because the information we encountered is above the reading level recommended for the general public.

  4. The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis

    NARCIS (Netherlands)

    van de Streek, M.D.; van der Schans, C.P.; de Greef, M.H.G.; Postema, K.

    2004-01-01

    The aim of the present study was to compare the effect of a new prefabricated Thamert forearm/hand splint with the effect of a simple elbow band as a treatment for lateral epicondylitis. Forty-three (43) patients that met the inclusion criteria were randomly assigned to the elbow band group and the

  5. Clinical and ultrasonographic results of ultrasonographically guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis.

    Science.gov (United States)

    Lin, Cheng-Li; Lee, Jung-Shun; Su, Wei-Ren; Kuo, Li-Chieh; Tai, Ta-Wei; Jou, I-Ming

    2011-11-01

    In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Level of evidence, 4. Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition (P lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.

  6. The strain index and TLV for HAL: risk of lateral epicondylitis in a prospective cohort.

    Science.gov (United States)

    Garg, Arun; Kapellusch, Jay M; Hegmann, Kurt T; Thiese, Matthew S; Merryweather, Andrew S; Wang, Ying-Chih; Malloy, Elizabeth J

    2014-03-01

    This study's objective was to quantify exposure-response relationships between job physical exposure (JPE) and incidence of lateral epicondylitis (LE). A cohort of 536 workers was enrolled from 10 manufacturing facilities and followed monthly for 6 years to ascertain changes in JPE and health status. JPE was individually measured and quantified using the Strain Index (SI) and TLV for HAL. Worker demographics, medical history, psychosocial factors, and current musculoskeletal disorders were obtained. Fifty-six workers developed LE. In multivariate models JPE, age, family problems, and swimming were associated with increased risk of LE. SI showed an exposure-response relationship with maximum hazard ratio (HR) of 4.5(P = 0.04). TLV for HAL showed a non-statistically significant trend for increased risk of LE (P = 0.19). JPE is associated with increased risk of LE. The SI and TLV for HAL are useful metrics for estimating JPE. © 2013 Wiley Periodicals, Inc.

  7. The effects of KinesioTape on the treatment of lateral epicondylitis.

    Science.gov (United States)

    Shakeri, Hassan; Soleimanifar, Manijeh; Arab, A M; Hamneshin Behbahani, Shirin

    Randomized clinical trial. KinesioTape (KT) is a noninvasive method to treat pain and muscular dysfunction. To investigate the effect of KT with and without tension on pain intensity, pain pressure threshold, grip strength and disability in individuals with lateral epicondylitis, and myofacial trigger points in forearm muscles. Thirty women with lateral epicondylitis and myofacial trigger point in forearm muscles were randomly assigned to KT with tension and placebo (KT without tension). The treatment was provided 3 times in one week, and outcome measures were assess pre-post treatment. The mean score of visual analogue scale (VAS) during activity decreased significantly from 6.4 and 6 pretest to 2.53 and 4.66 posttest, respectively, for the KT with and without tension groups. The mean score of Disabilities of the Arm, Shoulder and Hand decreased significantly from 16.82 and 22.79 pretest to 8.65 and 8.29 posttest, respectively, for the KT with and without tension groups. A paired t-test revealed a significant reduction in VAS during activity and Disabilities of the Arm, Shoulder and Hand before and after treatment in both groups (P < .05). Pain pressure threshold, grip strength, and VAS using an algometer revealed no significant differences. The study showed no significant difference in variables immediately after intervention. Improvements in functional disability were superior when KT was used with tension, than obtained with a placebo-no tension application. The application of KT produces an improvement in pain intensity and upper extremity disability in subjects with LE and MTP in forearm muscles, and KT with tension was more effective than placebo group. NA. 100-216. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  8. Motor unit potential morphology differences in individuals with non-specific arm pain and lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    McLean Linda

    2008-12-01

    Full Text Available Abstract Background The pathophysiology of non-specific arm pain (NSAP is unclear and the diagnosis is made by excluding other specific upper limb pathologies, such as lateral epicondylitis or cervical radiculopathy. The purpose of this study was to determine: (i if the quantitative parameters related to motor unit potential morphology and/or motor unit firing patterns derived from electromyographic (EMG signals detected from an affected muscle of patients with NSAP are different from those detected in the same muscle of individuals with lateral epicondylitis (LE and/or control subjects and (ii if the quantitative EMG parameters suggest that the underlying pathophysiology in NSAP is either myopathic or neuropathic in nature. Methods Sixteen subjects with NSAP, 11 subjects with LE, eight subjects deemed to be at-risk for developing a repetitive strain injury, and 37 control subjects participated. A quantitative electromyography evaluation was completed using decomposition-based quantitative electromyography (DQEMG. Needle- and surface-detected EMG signals were collected during low-level isometric contractions of the extensor carpi radialis brevis (ECRB muscle. DQEMG was used to extract needle-detected motor unit potential trains (MUPTs, and needle-detected motor unit potential (MUP and surface detected motor unit potential (SMUP morphology and motor unit (MU firing rates were compared among the four groups using one-way analysis of variance (ANOVA. Post hoc analyses were performed using Tukey's pairwise comparisons. Results Significant group differences were found for all MUP variables and for MU firing rate (p p p p p Conclusion The size-related parameters suggest that the NSAP group had significantly smaller MUPs and SMUPs than the control and LE subjects. Smaller MUPs and SMUPs may be indicative of muscle fiber atrophy and/or loss. A prospective study is needed to confirm any causal relationship between smaller MUPs and SMUPs and NSAP as found

  9. Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis?

    Science.gov (United States)

    Eraslan, Leyla; Yuce, Deniz; Erbilici, Arzu; Baltaci, Gul

    2018-03-01

    This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. Forty-five voluntary patients (mean age 48 years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5 days a week for 3 weeks. In the third group, ESWT was applied three times for 3 weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment (p kinesiotaping group yielded better results in decreasing pain intensity than the other groups (p kinesiotaping group (p kinesiotaping group (p Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. Therapeutic study, Level II.

  10. Evaluation of patients submitted to the arthroscopic treatment of the lateral epicondylitis refractory to the conservative treatment

    Directory of Open Access Journals (Sweden)

    Fabio Alexandre Martynetz

    2013-12-01

    Full Text Available Objective: to evaluate the results of the arthroscopic treatment of the lateral epicondylitis. Methods: we evaluated 14 patients (15 elbows submitted to the arthroscopic treatment of the lateral epicondylitis refractory to the conservative treatment, which was realized for a minimum period of 18 months. Beyond the demographic data collection, patients were evaluated according to the arthroscopic classification of Baker et al., the Disabilities of the Arm, Shoulder, and Hand (DASH questionnaire and the Mayo Elbow Performance Score (MEPS. The patients' ages ranged between 23 and 56 years (average 46 years (eight males and six females. Of the 15 elbows, 12 were the dominant and one patient had bilateral lesion. The follow-up after surgery was minimum 24 months and maximum 72 months (average 41 months. Results: we found, according to the arthroscopic classification of Baker et al., two patients with type I lesions, nine with type II lesions and three with type III lesions. We found the following complications: one patient with altered sensitivity in the region of the lateral portal, one with a deficit of ten degrees in length, one with synovial plica and one with synovitis in the lateral compartment. Our score on the DASH questionnaire was minimum of 32 points and maximum of 120 points (average 57 points and the scale of MEPS had a minimum score of 60 points and a maximum of 100 points (average 90 points. Conclusion: the arthroscopic treatment of the lateral epicondylitis, plus insurance, provides satisfactory results.

  11. A comparison of débridement with and without anconeus muscle flap for treatment of refractory lateral epicondylitis.

    Science.gov (United States)

    Ruch, David S; Orr, Steven B; Richard, Marc J; Leversedge, Fraser J; Mithani, Suhail K; Laino, Daniel K

    2015-02-01

    Lateral epicondylitis is a common condition encountered by orthopedic surgeons. Whereas the majority of patients improve with conservative management, a small percentage will require surgery. The purpose of this study was to compare the clinical outcomes of surgical débridement of the common extensor origin alone with débridement combined with rotation of an anconeus muscle flap in patients who failed to respond to conservative management of chronic lateral epicondylitis. Fifty-seven patients who failed to respond to a minimum of 5 months of conservative treatment for lateral epicondylitis were retrospectively reviewed. Patients in group 1 were treated with open débridement of the common extensor origin. Patients in group 2 were treated with open débridement combined with rotation of an anconeus muscle flap. Outcome measures included elbow range of motion, grip strength, visual analog scale (VAS) for pain score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Statistical analyses were performed by Student's t test with 95% confidence intervals. At final follow-up, average DASH scores were significantly lower in group 2. There were no significant differences between the groups with regard to elbow range of motion or grip strength. VAS pain scores were significantly reduced in both groups. Preoperative VAS pain scores were significantly greater in group 2; however, at final follow-up, there was no significant difference between groups. There were no apparent complications in either group. In addition to débridement of the common extensor origin, the rotation of an anconeus muscle flap may improve outcomes in cases of lateral epicondylitis that require operative intervention. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. A Newly Designed Tennis Elbow Orthosis With a Traditional Tennis Elbow Strap in Patients With Lateral Epicondylitis

    Science.gov (United States)

    Saremi, Hossein; Chamani, Vahid; Vahab-Kashani, Reza

    2016-01-01

    Background Lateral epicondylitis is a common cause of pain and upper limb dysfunction. The use of counterforce straps for treatment of lateral epicondylitis is widespread. This kind of orthosis can be modified to have a greater effect on relieving pain by reducing tension on the origin of the extensor pronator muscles. Objectives To determine the immediate effects of a newly designed orthosis on pain and grip strength in patients with lateral epicondylitis. Materials and Methods Twelve participants (six men and six women) were recruited (mean age = 41 ± 6.7 years) and evaluated for pain and grip strength in three sessions. A 48-hour break was taken between each session. The first session was without any orthosis, the second session was with the new modified tennis elbow orthosis, and the third session was with a conventional tennis elbow strap. Results Both counterforce straps were effective. However, significantly more improvement was observed in pain and grip strength after using the newly modified orthosis (P < 0.05). Conclusions The newly designed strap reduces pain more effectively and improves grip strength by causing greater localized pressure on two regions with different force applications (two component vectors versus one). PMID:28180116

  13. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

    Science.gov (United States)

    Beyazal, Münevver Serdaroğlu; Devrimsel, Gül

    2015-12-01

    [Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

  14. The diagnostic test accuracy of ultrasound for the detection of lateral epicondylitis: a systematic review and meta-analysis.

    Science.gov (United States)

    Latham, S K; Smith, T O

    2014-05-01

    The purpose of this study was to determine the diagnostic test accuracy of ultrasound for the detection of lateral epicondylitis. An electronic search of databases registering published (MEDLINE, EMBASE, CINAHL, AMED, Cochrane Library, ScienceDirect) and unpublished literature was conducted to January 2013. All diagnostic accuracy studies that compared the accuracy of ultrasound (index test) with a reference standard for lateral epicondylitis were included. The methodological quality of each of the studies was appraised using the QUADAS tool. When appropriate, the pooled sensitivity and specificity analysis was conducted. Ten studies investigating 711 participants and 1077 elbows were included in this review. Ultrasound had variable sensitivity and specificity (sensitivity: 64%-100%; specificity: 36%-100%). The available literature had modest methodological quality, and was limited in terms of sample sizes and blinding between index and reference test results. There is evidence to support the use of ultrasound in the detection of lateral epicondylitis. However, its accuracy appears to be highly dependent on numerous variables, such as operator experience, equipment and stage of pathology. Judgement should be used when considering the benefit of ultrasound for use in clinical practice. Further research assessing variables such a transducer frequency independently is specifically warranted. Level II. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  15. A Newly Designed Tennis Elbow Orthosis With a Traditional Tennis Elbow Strap in Patients With Lateral Epicondylitis.

    Science.gov (United States)

    Saremi, Hossein; Chamani, Vahid; Vahab-Kashani, Reza

    2016-07-01

    Lateral epicondylitis is a common cause of pain and upper limb dysfunction. The use of counterforce straps for treatment of lateral epicondylitis is widespread. This kind of orthosis can be modified to have a greater effect on relieving pain by reducing tension on the origin of the extensor pronator muscles. To determine the immediate effects of a newly designed orthosis on pain and grip strength in patients with lateral epicondylitis. Twelve participants (six men and six women) were recruited (mean age = 41 ± 6.7 years) and evaluated for pain and grip strength in three sessions. A 48-hour break was taken between each session. The first session was without any orthosis, the second session was with the new modified tennis elbow orthosis, and the third session was with a conventional tennis elbow strap. Both counterforce straps were effective. However, significantly more improvement was observed in pain and grip strength after using the newly modified orthosis (P < 0.05). The newly designed strap reduces pain more effectively and improves grip strength by causing greater localized pressure on two regions with different force applications (two component vectors versus one).

  16. Effect of Metabolic Syndrome on the Functional Outcome of Corticosteroid Injection for Lateral Epicondylitis: Retrospective Matched Case-Control Study.

    Science.gov (United States)

    Roh, Young Hak; Oh, Minjoon; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

    2017-09-07

    Both obesity and diabetes mellitus are well-known risk factors for tendinopathies. We retrospectively compared the efficacy of single corticosteroid injections in treating lateral epicondylitis in patients with and without metabolic syndrome (MetS). Fifty-one patients with lateral epicondylitis and MetS were age- and sex-matched with 51 controls without MetS. Pain severity, Disability of the Arm, Shoulder, and Hand score, and grip strength were assessed at base line and at 6, 12 and 24 weeks post-injection. The pain scores in the MetS group were greater than those in the control group at 6 and 12 weeks. The disability scores and grip strength in the MetS group were significantly worse than those of the control group at 6 weeks. However, there were no significant differences at 24 weeks between the groups in terms of pain, disability scores and grip strengths. After 24 weeks, three patients (6%) in the control group and five patients (10%) in the MetS group had surgical decompression (p = 0.46). Patients with MetS are at risk for poor functional outcome after corticosteroid injection for lateral epicondylitis in the short term, but in the long term there was no difference in outcomes of steroid injection in patients with and without MetS.

  17. Comparison of Initial Effect of Taping Techniqe and Counterforce Brace on Pain and Grip Strength of Patients with Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Ali Reza Shamsoddini

    2006-04-01

    Full Text Available Objective: In patients with lateral epicondylitis present of pain and decrease of grip strength are essential problems. Use of splint have major rule in treatment these patients that causes relief of pain and increase of grip strength. Both taping technique and counterforce brace are two methods of treatments of lateral epicondylitis patients but we were not sure which method could be more useful and Answer of this question is magor aim of this study. Materials & Methods: This study is a Quasi experimental. We selected 30 patients between 30-55 years conveniently and divided them in two groups simple randomized.  Results: In grip strength test, the average difference between two methods was t = 1/92 which showed there is not significant. So, there isn't any difference between two methods on grip strength. In assessment of pain, we tested patients in two positions: first patient's hand was in comfort position, second in which when wrist of hand was in extension position. In both of position, that average difference between two methods (first t = 3/78 and secondary t = 3/2 found to be significant. Choose of method in such treatment is considered to be important. Conclusion: taping technique is more effective than counterforce brace to relief of pain of patients with lateral epicondylitis, but in grip strength no difference between two methods.

  18. Percutaneous Soft Tissue Release for Treating Chronic Recurrent Myofascial Pain Associated with Lateral Epicondylitis: 6 Case Studies

    Directory of Open Access Journals (Sweden)

    Ming-Ta Lin

    2012-01-01

    Full Text Available Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis. Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin’s technique. Pain intensity (measured with a numerical pain rating scale, pressure pain threshold (measured with a pressure algometer, and grasping strength (measured with a hand dynamometer were assessed before, immediately after, and 3 months and 12 months after the treatment. Results. For every individual case, the pain intensity was significantly reduced (P<0.01 and the pressure pain threshold and the grasping strength were significantly increased (P<0.01 immediately after the treatment. This significant effectiveness lasts for at least one year. Conclusions. It is suggested that percutaneous soft tissue release can be used for treating chronic recurrent lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain.

  19. Outcome of Boyd-McLeod procedure for recalcitrant lateral epicondylitis of elbow.

    Science.gov (United States)

    Reddy, V R M; Satheesan, K S; Bayliss, N

    2011-08-01

    Various surgical procedures including percutaneous and open release and arthroscopic procedures have been described to treat recalcitrant tennis elbow. We present the outcome of Boyd-McLeod surgical procedure for tennis elbow resistant to non-operative treatment in twenty-seven patients (twenty-nine limbs). Boyd McLeod procedure involves excision of the proximal portion of the annular ligament, release of the origin of the extensor muscles, excision of the bursa if present, and excision of the synovial fringe. The average time interval from the onset of symptoms of tennis elbow until surgery was 28 months (range 8-72 months). Of those patients, 91% reported complete relief of symptoms with return to full normal activities including sports. Average post-operative time for return to professional/recreational activity was 5 weeks. One case developed pain secondary to ectopic bone formation after surgery, which settled after excision, and in another there was no pain relief with Boyd McLeod procedure. Two patients had scar tenderness that did not affect the final outcome. We conclude that Boyd-McLeod procedure is an effective treatment option in patients with resistant lateral epicondylitis.

  20. The effects of a new designed forearm orthosis in treatment of lateral epicondylitis.

    Science.gov (United States)

    Forogh, Bijan; Khalighi, Mohsen; Javanshir, Mohammad Ali; Ghoseiri, Kamiar; Kamali, Mohammad; Raissi, Gholamreza

    2012-07-01

    This paper reports on the design and testing of a new designed forearm orthosis and explores its efficacious in comparison to the standard counterforce orthosis in patients with lateral epicondylitis. Twenty-four patients were enrolled in this assessor-blinded clinical trial and randomly assigned to two parallel treatment groups. The measures of pain and function, the pain threshold and grip strength were compared using patient rated tennis elbow evaluation (PRTEE) form, algometer and dynamometer respectively at baseline and 4 weeks after treatment. Paired and independent t-test statistical methods recruited for within and between groups comparisons respectively. The both orthoses, counterforce and new-designed, significantly relieved pain, and improved function, pain threshold and grip strength of all patients after 4 weeks application. The new-designed orthosis seemed to be more effective than the counterforce orthosis in pain relief, but there was not any significant difference in efficacious of two types of orthoses regarding function. The new-designed orthosis can significantly relieve pain, improve function, increase pain threshold and grip strength after application. This orthosis seemed to be more effective than counterforce orthosis in relieving pain and increasing the pain threshold probably due to the limitation of forearm supination.

  1. Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study

    DEFF Research Database (Denmark)

    Haahr, J. P.; Andersen, JH

    2003-01-01

    AIMS: To assess the importance of physical and psychosocial risk factors for lateral epicondylitis (tennis elbow). METHODS: Case-referent study of 267 new cases of tennis elbow and 388 referents from the background population enrolled from general practices in Ringkjoebing County, Denmark. RESULTS......: Manual job tasks were associated with tennis elbow (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.9 to 5.1). The self reported physical risk factors "posture" and "forceful work" were related to tennis elbow. Among women, work involving performing repeated movements of the arms was related...... index was established based on posture, repetition, and force. The adjusted ORs for tennis elbow at low, medium, and high strain were 1.4 (CI 0.8 to 2.7), 2.0 (CI 1.1 to 3.7), and 4.4 (CI 2.3 to 8.7). Low social support at work, adjusted for physical strain, was a risk factor among women (OR 2.4, CI 1...

  2. Acupuncture for lateral epicondylitis (tennis elbow): study protocol for a randomized, practitioner-assessor blinded, controlled pilot clinical trial.

    Science.gov (United States)

    Shin, Kyung-Min; Kim, Joo-Hee; Lee, Seunghoon; Shin, Mi-Suk; Kim, Tae-Hun; Park, Hyo-Ju; Lee, Min-Hee; Hong, Kwon-Eui; Lee, Seungdeok; Choi, Sun-Mi

    2013-06-14

    Lateral epicondylitis is the most frequent cause of pain around the elbow joint. It causes pain in the region of the elbow joint and results in dysfunction of the elbow and deterioration of the quality of life. The purpose of this study is to compare the effects of ipsilateral acupuncture, contralateral acupuncture and sham acupuncture on lateral epicondylitis. Forty-five subjects with lateral epicondylitis will be randomized into three groups: the ipsilateral acupuncture group, contralateral acupuncture group and the sham acupuncture group. The inclusion criteria will be as follows: (1) age between 19 and 65 years with pain due to one-sided lateral epicondylitis that persisted for at least four weeks, (2) with tenderness on pressure limited to regions around the elbow joint, (3) complaining of pain during resistive extension of the middle finger or the wrist, (4) with average pain of NRS 4 or higher during the last one week at a screening visit and (5) voluntarily agree to this study and sign a written consent. Acupuncture treatment will be given 10 times in total for 4 weeks to all groups. Follow up observations will be conducted after the completion of the treatment, 8 weeks and 12 weeks after the random assignment. Ipsilateral acupuncture group and contralateral acupuncture group will receive acupuncture on LI4, TE5, LI10, LI11, LU5, LI12 and two Ashi points. The sham acupuncture group will receive treatment on acupuncture points not related to the lateral epicondylitis using a non-invasive method. The needles will be maintained for 20 minutes. The primary outcome will be differences in the visual analogue scale (VAS) for elbow pain between the groups. The secondary outcome will be differences in patient-rated tennis elbow evaluation (PRTEE), pain-free/maximum grip strength (Dynamometer), pressure pain threshold, clinically relevant improvement, patient global assessment, and the EQ-5D. The data will be analyzed with the paired t-test and ANCOVA (P <0.05). The

  3. Relationship of cytokine levels and clinical effect on platelet-rich plasma-treated lateral epicondylitis.

    Science.gov (United States)

    Lim, Wonbong; Park, Sang H; Kim, Bora; Kang, Sin W; Lee, Jung W; Moon, Young L

    2018-03-01

    Lateral epicondylitis (LE) is difficult to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) for painful tendons has received attention, but its efficacy remains controversial. This study aimed to investigate the clinical effects of PRP and its biological components. A total of 156 patients with LE were randomly divided into group 1, treated with a single injection of 2-ml autologous PRP, and group 2, treated with a control received only physical therapy without injection. Both groups used a tennis elbow strap and performed stretching and strengthening exercises during 24 weeks' follow-up. Pain and functional improvements were assessed using the visual analog scale (VAS), Modified Mayo Clinic Performance Index for the elbow, and magnetic resonance imaging (MRI). White blood cell count, platelet count, and levels of platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, transforming growth factor-β (TGF-β), vascular endothelial growth factor, epithelial growth factor, and interleukin-1 β in PRP were measured and investigated for statistical correlation with the clinical score. At 24 weeks, all pain and functional variables, including VAS score, Mayo Clinic performance scores, and MRI grade, improved significantly in group 1 (p < 0.05). PDGF-AB, PDGF-BB, and TGF-β levels were more significantly increased in PRP than in whole blood. TGF-β level significantly correlated with Mayo Clinic performance score and MRI grade improvement. Thus, TGF-β level in PRP is considered to play a pivotal role in tendon healing. These results may contribute to identifying the best protocol for PRP application in tendinopathies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:913-920, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. Open release versus radiofrequency microtenotomy in the treatment of lateral epicondylitis: a prospective randomized controlled trial.

    Science.gov (United States)

    Hamlin, Katharine; Munro, Christopher; Barker, Scott L; McKenna, Sean; Kumar, Kapil

    2018-01-01

    Optimal surgical treatment of lateral epicondylitis remains uncertain. Recently, radiofrequency microtenotomy (RFMT) has been proposed as a suitable treatment. We compared RFMT with standard open release (OR) in this prospective randomized controlled trial. In total, 41 patients with symptoms for at least 6 months were randomized into two groups: 23 patients had RFMT and 18 had OR. Two patients from RFMT withdrew. Each patient underwent Numerical Rating Scale (NRS) pain score, grip strength and Disabilities of the Arm, Shoulder and Hand (DASH) scores pre-operatively and at 6 weeks. Pain and DASH scores were repeated at 6 months and 12 months. NRS pain scores improved by 4.8 points for RFMT and by 3.9 points for OR. There was a significant improvement in both groups from pre-operative scores, although there was no statistically significant difference between the groups at 1 year. Grip strength improved by 31% in the RFMT group compared to 38% in OR. There was no significant difference between the initial and 6 weeks scores or between treatments. At 1 year, DASH was 39.8 points for RFMT and 24.4 points for OR. There was a significant improvement in both groups from pre-operative scores, although there was no statistically significant difference between the groups at 1 year. Both groups showed significant improvements and similar benefit to the patient. The results of the present study do not show any benefit of RFMT over the standard OR. As a result of the extra expense of RFMT, we therefore recommend that OR is offered as the standard surgical management.

  5. Ultrasonographic Evaluation of the Radial Nerves in Patients with Unilateral Refractory Lateral Epicondylitis.

    Science.gov (United States)

    Gürçay, Eda; Karaahmet, Özgür Zeliha; Kara, Murat; Onat, Sule Sahin; Ata, Ayse Merve; Ünlü, Ece; Özçakar, Levent

    2017-03-01

    To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. Cross-sectional study. Three physical medicine and rehabilitation departments. Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P   0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P  < 0.01). Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  6. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture.

    Directory of Open Access Journals (Sweden)

    Su-Ya Lee

    Full Text Available The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP, radial deviation (RD, and ulnar deviation (UD. The root mean square (RMS of the electromyographic signal in the extensor digitorum communis (EDC, normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.

  7. The Effect of Impactful Articles on Clinical Practice in the United States: Corticosteroid Injection for Patients with Lateral Epicondylitis.

    Science.gov (United States)

    Fujihara, Yuki; Huetteman, Helen E; Chung, Ting-Ting; Shauver, Melissa J; Chung, Kevin C

    2018-05-01

    Following publication of high-level evidence demonstrating that it is not an effective treatment for lateral epicondylitis, a reduction in the corticosteroid injection rate would be expected. The authors aimed to clarify current clinical practice pattern for lateral epicondylitis and identify factors that influence the introduction of evidence into clinical practice. In this administrative claims analysis, the authors used 2009 to 2015 Truven MarketScan data to extract claims for corticosteroid injection, physical therapy, platelet-rich plasma injection, and surgery for lateral epicondylitis. The authors performed multivariable analysis using a generalized estimating equation model to identify the variables that potentially affect the odds of receiving a given treatment. Among 711,726 claims, the authors found that the odds of receiving a corticosteroid injection increased slightly after publication of contradictory evidence (OR, 1.7; 95 percent CI, 1.04 to 1.11 in 2015). Being male (OR, 1.21; 95 percent CI, 1.19 to 1.23), older (OR, 1.16; 95 percent CI, 1.13 to 1.19), and having managed care insurance (OR, 1.15; 95 percent CI, 1.13 to 1.18) significantly contributed to increased odds of receiving corticosteroid injections. Patients seen at facilities in the South (OR, 1.33; 95 percent CI, 1.30 to 1.36 compared with the Northeast) and by plastic/orthopedic surgeons (OR, 2.48; 95 percent CI, 2.43 to 2.52) also had increased odds of receiving corticosteroid injection. Corticosteroid injection use did not decrease after publication of impactful articles, regardless of provider specialty or other patient-related factors. This finding emphasizes that there are various barriers for even high-level evidence to overcome the inertia of current practice.

  8. Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system

    International Nuclear Information System (INIS)

    Steinborn, M.; Heuck, A.; Bonel, H.; Reiser, M.; Jessel, C.

    1999-01-01

    The purpose of this study was to evaluate MR imaging findings of the common extensor tendon in patients with lateral epicondylitis and asymptomatic volunteers studied on a 0.2-T dedicated system. In 23 patients (age range 29-58 years, mean age 47 years) with clinical symptoms of lateral epicondylitis MR imaging was performed using T1-, T2- and contrast-enhanced T1-weighted spin-echo sequences. In addition, the elbows of seven healthy volunteers (age range 22-29 years, mean age 25 years) and the symptom-free contralateral elbow of 11 of the 23 patients (age range 29-58 years, mean age 47 years) were studied as controls. Five patients were surgically treated after the MR examination and the results of histopathology were correlated with MR findings. Of the patients, 95.6 % showed intratendinous signal intensity changes on T1-weighted images on the symptomatic side. In 69.6 % signal alterations were observed on T2-weighted sequences and in 56.5 % an intratendinous contrast enhancement was present. Histopathology showed fibrovascular proliferation and fatty degeneration in patients with distinct signal intensity changes and contrast enhancement. Patients with only minor signal intensity changes on T1- and T2-weighted sequences and no contrast enhancement demonstrated fibrosclerotic degeneration and intratendinous cartilage formation in histopathology. The contralateral elbow showed signal intensity changes in 6 of 11 (54.5 %) cases on T1-weighted images and in 3 of 11 (27.3 %) on T2-weighted images. In the group of healthy volunteers minor signal intensity changes of the common extensor tendon could be seen in only 1 case. In patients with lateral epicondylitis of the elbow the type and extent of pathologic changes within the common extensor tendon can be evaluated using a dedicated low-field MR system. On the basis of MR imaging findings a more specified therapy planning among the variety of treatment modalities can be achieved. (orig.)

  9. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results

    Science.gov (United States)

    Valera-Garrido, Fermín; Minaya-Muñoz, Francisco; Medina-Mirapeix, Francesc

    2014-01-01

    Background Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle. Objective To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time. Methods A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates. Results All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks. Conclusions Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. Trial registration number ClinicalTrials.gov identifier: NCT02085928. PMID:25122629

  10. USG-guided injection of corticosteroid for lateral epicondylitis does not improve clinical outcomes: a prospective randomised study.

    Science.gov (United States)

    Gulabi, Deniz; Uysal, Mehmet Ali; Akça, Ahmet; Colak, Ilker; Çeçen, Gultekin Sıtkı; Gumustas, Seyitali

    2017-05-01

    Corticosteroid injection used to be the treatment of choice for lateral epicondylitis. Most injections are performed blindly. In the blinded technique, it could be difficult to determine the exact pathological localisation. The purpose of this single-blinded, randomised controlled clinical study was to compare the clinical therapeutic effects of blinded and USG-guided corticosteroid injection therapy in lateral epicondylitis. Forty patients with chronic lateral epicondylitis were included in this clinical trial. The patients were randomly allocated to blinded group or USG-guided injection group according to a computer-generated randomisation list. All blinded injections were administered by an orthopaedic surgeon and all ultrasound-guided injections were made by a radiologist experienced in this technique. All patients were injected under aseptic conditions using 40 mg/2 mL methylprednisolone acetate. The outcomes of both treatments were assessed by an independent assessor at pre-injection, then at 6-week and 3- and 6-month follow-up assessments. The assessor evaluated the q-DASH, VAS, and grip strength scores. No statistically significant difference was determined between the groups in respect of the Q-DASH and grip strength scores preoperatively and at 6 weeks and 3 and 6 months post-injection. No statistically significant difference was determined between the groups in respect of the VAS scores preoperatively and at 6 weeks and 6 months. No systemic or local complications were reported during the treatment. There was no statistically significant difference compared to the blinded injection technique, and the mean score differences between the groups are of no clinical relevance.

  11. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Krogh, Thøger Persson; Bartels, Else Marie; Ellingsen, Torkell; Stengaard-Pedersen, Kristian; Buchbinder, Rachelle; Fredberg, Ulrich; Bliddal, Henning; Christensen, Robin

    2013-06-01

    Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available. To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis. Systematic review and meta-analysis. Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs). Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (-0.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to -0.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to -0.71]) and platelet-rich plasma (-1.13 [-1.77 to -0.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to -0.82]) and hyaluronic acid (-5.58 [-6.35 to -4.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0

  12. Platelet rich plasma versus steroid on lateral epicondylitis: meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Mi, Bobin; Liu, Guohui; Zhou, Wu; Lv, Huijuan; Liu, Yi; Wu, Qipeng; Liu, Jing

    2017-05-01

    Lateral epicondylitis (LE) is a common tendinopathy for which an effective treatment is still unknown. The purpose of this meta-analysis was to compare the effectiveness of platelet rich plasma (PRP) vs steroid in reducing pain and improving function of the elbow in the treatment of LE. A systematic search of the literature was conducted to identify related articles published from January 1980 to September 2016 in Pubmed, Embase, the Cochrane Library and SpringerLink. All studies that compared PRP with steroid administration on LE were included. Main outcomes were collected and analyzed by the Review Manager 5.1. Eight randomized controlled trials (RCTs) that involved 511 patients met the criteria. This meta-analysis showed that there was no significant difference in pain relief in the short-term (2 to 4 weeks: SMD = 1.02, P = .03; 6 to 8 weeks: SMD = .73, P = .24) and the intermediate-term (12 weeks: SMD = -0.28, P = .35). Steroid exhibited a better efficacy of function in the short-term (2 to 4 weeks: SMD = .61, P < .001; 6 to 8 weeks: SMD = .53, P < .001). However, PRP was superior to steroid for pain relief in the long-term (half year: SMD = -1.6, P < .001; one year: SMD = -1.45, P < .001), and also for function improving in the intermediate-term (12 weeks: SMD = -0.53, P < .001) and the long-term (half year: SMD = -0.56, P < .001; one year: SMD = -0.7, P < .001). No serious adverse effects of treatment were observed in the two groups. Treatment of patients with LE by steroid could slightly relieve pain and significantly improve function of elbow in the short-term (2 to 4 weeks, 6 to 8 weeks). PRP appears to be more effective in relieving pain and improving function in the intermediate-term (12 weeks) and long-term (half year and one year). Considering the long-term effectiveness of PRP, we recommend PRP as the preferred option for LE.

  13. Ultrasonographic findings of healing of torn tendon in the patients with lateral epicondylitis after prolotherapy

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Song, In Sup; Lee, Jong Beom; Lee, Hea Yeon; Yoo, Seung Min; Yang, Sung Joon; Seo, Kyung Muk; Kim, Don Gyu

    2003-01-01

    The purpose of this study was to describe the sonographic findings of healing in torn common extensor tendon of elbow after prolotherapy and to evaluate the value of US in the course of management of lateral epicondylitis. 12 common extensor tendons in eleven patients were examined by sonography before and after prolotherapy. On initial US examination, 11 tendons showed a partial tear and one tendon showed a full thickness but incomplete width tear. All patients were managed with prolotherapy several times(2 to 6 times). The time interval between the initial US and follow up US examination after treatment was from 4.5 to 6.5 months(mean ; 5.8 months). The findings of healing were evaluated with respect to the change of echogenicity(anechoic focus, hypoechoic focus), presence or absence of fibrillar pattern in the tendon on gray scale US, and focus of hypervascularity on color Doppler image. We used the visual analogue scale(VAS) of pain to assess the response to the treatment. All patients showed symptom improvement as the points drop on VAS in a range between 1.5 and 6.5(mean ; 4.5). In one tendon, a few echogenic lines were seen within the initially anechoic lesion(pattern I). In three tendons, most of the anechoic lesion(tear) was filled with fibrillar echogenicity except for a small focus of anechogenicity(pattern II). In two tendons, initial anechoic lesion in common extensor tendon was changed to same sized hypoechoic lesion with diffuse fibrillar pattern within the initial anechoic lesion (pattern III). In 6 tendons, initial anechoic lesion became smaller with diffuse fibrillar pattern were seen(pattern IV). Color Doppler examination was performed in 11 tendons after therapy and six of 11 tendons showed hypervascularity. Most important finding of healing in torn tendon is reappearance of fibrillar pattern in initial anechoic lesion(tear). The follow up sonography of the common extensor tendon in the course of treatment can be useful to evaluate the effects

  14. Ultrasonographic findings of healing of torn tendon in the patients with lateral epicondylitis after prolotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Song, In Sup; Lee, Jong Beom; Lee, Hea Yeon; Yoo, Seung Min; Yang, Sung Joon; Seo, Kyung Muk; Kim, Don Gyu [Chungang University Hospital, Seoul (Korea, Republic of)

    2003-09-15

    The purpose of this study was to describe the sonographic findings of healing in torn common extensor tendon of elbow after prolotherapy and to evaluate the value of US in the course of management of lateral epicondylitis. 12 common extensor tendons in eleven patients were examined by sonography before and after prolotherapy. On initial US examination, 11 tendons showed a partial tear and one tendon showed a full thickness but incomplete width tear. All patients were managed with prolotherapy several times(2 to 6 times). The time interval between the initial US and follow up US examination after treatment was from 4.5 to 6.5 months(mean ; 5.8 months). The findings of healing were evaluated with respect to the change of echogenicity(anechoic focus, hypoechoic focus), presence or absence of fibrillar pattern in the tendon on gray scale US, and focus of hypervascularity on color Doppler image. We used the visual analogue scale(VAS) of pain to assess the response to the treatment. All patients showed symptom improvement as the points drop on VAS in a range between 1.5 and 6.5(mean ; 4.5). In one tendon, a few echogenic lines were seen within the initially anechoic lesion(pattern I). In three tendons, most of the anechoic lesion(tear) was filled with fibrillar echogenicity except for a small focus of anechogenicity(pattern II). In two tendons, initial anechoic lesion in common extensor tendon was changed to same sized hypoechoic lesion with diffuse fibrillar pattern within the initial anechoic lesion (pattern III). In 6 tendons, initial anechoic lesion became smaller with diffuse fibrillar pattern were seen(pattern IV). Color Doppler examination was performed in 11 tendons after therapy and six of 11 tendons showed hypervascularity. Most important finding of healing in torn tendon is reappearance of fibrillar pattern in initial anechoic lesion(tear). The follow up sonography of the common extensor tendon in the course of treatment can be useful to evaluate the effects

  15. Effects of corticosteroid on the expressions of neuropeptide and cytokine mRNA and on tenocyte viability in lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    Han Soo

    2012-10-01

    Full Text Available Abstract Background The purpose of this study was to determine the reaction mechanism of corticosteroid by analyzing the expression patterns of neuropeptides (substance P (SP, calcitonin gene related peptide (CGRP and of cytokines (interleukin (IL-1α, tumor growth factor (TGF-β after corticosteroid treatment in lateral epicondylitis. In addition, we also investigated whether corticosteroid influenced tenocyte viability. Methods The corticosteroid triamcinolone acetonide (TAA was applied to cultured tenocytes of lateral epicondylitis, and the changes in the mRNA expressions of neuropeptides and cytokines and tenocyte viabilities were analyzed at seven time points. Quantitative real-time polymerase chain reaction and an MTT assay were used. Results The expression of SP mRNA was maximally inhibited by TAA at 24 hours but recovered at 72 hours, and the expressions of CGRP mRNA and IL-1α mRNA were inhibited at 24 and 3 hours, respectively. The expression of TGF-β mRNA was not significant. Tenocyte viability was significantly reduced by TAA at 24 hours. Conclusions We postulate that the reaction mechanism predominantly responsible for symptomatic relief after a corticosteroid injection involves the inhibitions of neuropeptides and cytokines, such as, CGRP and IL-1α. However the tenocyte viability was compromised by a corticosteroid.

  16. MR imaging of epicondylitis

    International Nuclear Information System (INIS)

    Martin, C.E.; Schweitzer, M.E.

    1998-01-01

    Objective. To systematically evaluate the MR findings in patients with epicondylitis compared with asymptomatic volunteers. Design and patients. We imaged 43 elbows: 24 with epicondylitis (22 lateral, 2 medial) diagnosed by clinical examination, and 19 in 16 normal volunteers. MRI was performed at 1.5 T using axial T1-weighted, axial fat-saturated FSE, and coronal or sagittal Fast STIR sequences. Two independent observers evaluated the images for intratendon signal, tendon thickening, periosteal reaction, fluid in the radial head bursa, and anconeus edema. Results. All 24 patients with epicondylitis had increased signal on fat-saturated FSE and Fast STIR images. Twenty-two of these patients had increased intratendon T1 signal, and 19 had tendon thickening. No patient demonstrated fluid in the radial head bursa or periosteal reaction. Only two patients had subtle anconeus edema, while three patients unexpectedly had increased T2 signal within the involved epicondyle. One asymptomatic volunteer (high-performance athlete) had increased T1 and T2 signal with tendon thickening. An additional two asymptomatic volunteers had increased T1 signal only. Conclusion. MRI of epicondylitis demonstrates tendon thickening with increased T1 and T2 signal, but these findings may be seen in a small minority of asymptomatic individuals. Anconeus edema, previously demonstrated on MRI in epicondylitis, was only rarely found, and distension of the radial head bursa, surgically described, was not seen. Increased marrow T2 signal within the involved epicondyle is occasionally seen. (orig.)

  17. MR imaging of epicondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Martin, C.E.; Schweitzer, M.E. [Thomas Jefferson University Hospital, Philadelphia, PA (United States)

    1998-03-01

    Objective. To systematically evaluate the MR findings in patients with epicondylitis compared with asymptomatic volunteers. Design and patients. We imaged 43 elbows: 24 with epicondylitis (22 lateral, 2 medial) diagnosed by clinical examination, and 19 in 16 normal volunteers. MRI was performed at 1.5 T using axial T1-weighted, axial fat-saturated FSE, and coronal or sagittal Fast STIR sequences. Two independent observers evaluated the images for intratendon signal, tendon thickening, periosteal reaction, fluid in the radial head bursa, and anconeus edema. Results. All 24 patients with epicondylitis had increased signal on fat-saturated FSE and Fast STIR images. Twenty-two of these patients had increased intratendon T1 signal, and 19 had tendon thickening. No patient demonstrated fluid in the radial head bursa or periosteal reaction. Only two patients had subtle anconeus edema, while three patients unexpectedly had increased T2 signal within the involved epicondyle. One asymptomatic volunteer (high-performance athlete) had increased T1 and T2 signal with tendon thickening. An additional two asymptomatic volunteers had increased T1 signal only. Conclusion. MRI of epicondylitis demonstrates tendon thickening with increased T1 and T2 signal, but these findings may be seen in a small minority of asymptomatic individuals. Anconeus edema, previously demonstrated on MRI in epicondylitis, was only rarely found, and distension of the radial head bursa, surgically described, was not seen. Increased marrow T2 signal within the involved epicondyle is occasionally seen. (orig.) With 2 figs., 49 refs.

  18. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up.

    Science.gov (United States)

    Iwamoto, Wataru; Okuno, Yuji; Matsumura, Noboru; Kaneko, Takao; Ikegami, Hiroyasu

    2017-08-01

    Abnormal vessels and accompanying nerves are possible sources of pain with lateral epicondylitis. The purpose of this study was to describe the safety and efficacy of transcatheter arterial embolization (TAE) for lateral epicondylitis resistant to conservative treatment. This prospective study was conducted in 24 patients with lateral epicondylitis resistant to conservative treatments for more than 3 months, with a symptom duration longer than 6 months, and with moderate to severe pain who were treated with TAE between March 2013 and October 2014. Two patients were lost to follow-up, and the remaining 22 patients were followed up for 2 years after TAE. Abnormal vessels were identified in all of the patients. No major adverse events were observed. The Quick Disabilities of the Arm, Shoulder and Hand scores at baseline significantly decreased at 1, 3, 6, and 24 months after treatment (50.8 vs 23.4, 8.3, 5.3, and 2.7, respectively; all P lateral epicondylitis that fails to improve with conservative treatments. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis: an analysis of 3863 patients.

    Science.gov (United States)

    Degen, Ryan M; Cancienne, Jourdan M; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

    2017-04-01

    This study was conducted to identify the rate of failure of operative treatment of lateral epicondylitis, defined as progression to ipsilateral revision surgery, and associated patient-specific risk factors for failure. A national database was used to identify patients undergoing surgical treatment of lateral epicondylitis from 2005 to 2012. Patients undergoing concomitant procedures were excluded. Patients who then required subsequent ipsilateral extensor carpi radialis brevis débridement or release within 2 years were identified using similar methods. A multivariate binomial logistic regression analysis was used to evaluate patient-related risk factors for revision surgery. In addition, the number of preoperative injections (1, 2, or ≥3) in the ipsilateral elbow was identified and included in the regression analysis. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor. Of 3863 patients who underwent operative treatment of lateral epicondylitis, 58 (1.5%) required ipsilateral revision surgery. Risk factors for revision surgery included age lateral epicondylitis in the studied population is low (1.5%). Risk factors for revision surgery include younger age, male gender, morbid obesity, tobacco use, and inflammatory arthritis. The most significant risk factor for revision surgery is having ≥3 ipsilateral preoperative injections. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Autologous Conditioned Plasma Versus Placebo Injection Therapy in Lateral Epicondylitis of the Elbow: A Double Blind, Randomized Study.

    Science.gov (United States)

    Schöffl, Volker; Willauschus, Wolfgang; Sauer, Felix; Küpper, Thomas; Schöffl, Isabelle; Lutter, Christoph; Gelse, Kolja; Dickschas, Jörg

    2017-01-01

    Introduction  There are various therapeutic approaches to the treatment of lateral epicondylitis, a highly prevalent musculoskeletal disorder. Recently, injection therapy with autologous conditioned plasma (ACP) has shown promise as a new approach. Methods  Set up as a prospective, double-blind, randomized controlled clinical trial, this study involved 50 patients with lateral epicondylitis. Following external randomization, 25 patients received one round of injection therapy with ACP (platelet rich plasma, PRP), while the remaining 25 patients received a placebo of 0.9 % NaCl. All patients were re-evaluated with respect to lateral epicondylitis of the elbow at four-weeks and six-months post-injection. Results  Out of 50 patients, 36 qualified for reevaluation, 18 patients from the ACP therapy group and 18 from the placebo group. The initial Disability of the Arm, Shoulder and Hand (DASH) score for all reevaluated patients was 36.4 in the ACP group, and 41.0 in the placebo group; both groups exhibited decreased DASH scores at the four-week and six-month post-injection follow-up (6 months: ACP 30.1, placebo 25.8). The decrease of the DASH score after 4 weeks was greater and qualified as statistically significant in the placebo group (p = 0.041), compared to the DASH score decrease in the ACP treatment group, which was statistically non-significant. Additionally, the difference between the DASH scores of the treatment and placebo groups was statistically non-significant four weeks and six months after treatment. Discussion  The results of this study suggest a therapeutic effect in both the ACP and placebo groups, with no evidence for a therapeutically significant difference between ACP and placebo treatments. It is hypothesized that, in accordance with the study protocols, injection with a local anaesthetic prior to ACP therapy may have an influence on the therapeutic effect of ACP. Future studies have to confirm recent findings that demonstrated a

  1. Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system

    Energy Technology Data Exchange (ETDEWEB)

    Steinborn, M.; Heuck, A.; Bonel, H.; Reiser, M. [Department of Radiology, Ludwig Maximilians Univ., Muenchen (Germany); Jessel, C. [Department of Orthopedics, Ludwig Maximilians Univ., Muenchen (Germany)

    1999-09-01

    The purpose of this study was to evaluate MR imaging findings of the common extensor tendon in patients with lateral epicondylitis and asymptomatic volunteers studied on a 0.2-T dedicated system. In 23 patients (age range 29-58 years, mean age 47 years) with clinical symptoms of lateral epicondylitis MR imaging was performed using T1-, T2- and contrast-enhanced T1-weighted spin-echo sequences. In addition, the elbows of seven healthy volunteers (age range 22-29 years, mean age 25 years) and the symptom-free contralateral elbow of 11 of the 23 patients (age range 29-58 years, mean age 47 years) were studied as controls. Five patients were surgically treated after the MR examination and the results of histopathology were correlated with MR findings. Of the patients, 95.6 % showed intratendinous signal intensity changes on T1-weighted images on the symptomatic side. In 69.6 % signal alterations were observed on T2-weighted sequences and in 56.5 % an intratendinous contrast enhancement was present. Histopathology showed fibrovascular proliferation and fatty degeneration in patients with distinct signal intensity changes and contrast enhancement. Patients with only minor signal intensity changes on T1- and T2-weighted sequences and no contrast enhancement demonstrated fibrosclerotic degeneration and intratendinous cartilage formation in histopathology. The contralateral elbow showed signal intensity changes in 6 of 11 (54.5 %) cases on T1-weighted images and in 3 of 11 (27.3 %) on T2-weighted images. In the group of healthy volunteers minor signal intensity changes of the common extensor tendon could be seen in only 1 case. In patients with lateral epicondylitis of the elbow the type and extent of pathologic changes within the common extensor tendon can be evaluated using a dedicated low-field MR system. On the basis of MR imaging findings a more specified therapy planning among the variety of treatment modalities can be achieved. (orig.) With 3 figs., 5 tabs., 15 refs.

  2. Ultrasonographic Evaluation of Acupuncture Effect on Common Extensor Tendon Thickness in Patients with Lateral Epicondylitis: A Randomized Controlled Study.

    Science.gov (United States)

    Ural, Fatma Gülçin; Öztürk, Gökhan Tuna; Bölük, Hüma; Akkuş, Selami

    2017-10-01

    To explore the effect of acupuncture on common extensor tendon (CET) thickness in patients with lateral epicondylitis (LE). Additionally, to identify whether clinical and ultrasonographic changes showed any correlation. Forty-one patients were randomly assigned to acupuncture and control groups. Conventional treatment (rest, NSAİİ, bracing, exercise) methods for LE were applied to all patients. In addition to this, the acupuncture treatment was applied to the acupuncture group. The visual analog scale (VAS) for pain, the Duruoz Hand Index (DHI) for functioning of the affected limb, the pressure pain threshold, and CET thickness (via ultrasound imaging) were assessed before and end of the treatment in both groups. The VAS and DHI scores in both groups decreased. The pressure pain threshold and CET thickness only demonstrated improvement in the acupuncture group. These findings show that the CET thickness was reduced after 10 sessions of acupuncture treatment in LE patients.

  3. Ultrasonographic findings of Epicondylitis

    International Nuclear Information System (INIS)

    Kwak, Seo Hyun; Song, In Sup; Lee, Jong Beum; Lee, Hwa Yeon; Yoo, Seung Min; Yang, Seong Jun; Seo, Kyung Mook

    2002-01-01

    To evaluate the usefulness of ultrasonographic findings of the common extensor and flexor tendon in evaluation of patients with lateral and medial epicondylitis. Thirty eight elbows from twenty four patients (mean age=45.2 years) were included. Ultrasonographic examination was performed to evaluate lateral or medial epicondylitis. Epicondylitis was divided into five groups according to the severity of disease: 1) normal, 2) tendinopathy, 3) tendinopathy with a partial tear, partial tear and 4) complete tear. Change in the size of a tendon, bony change of the epicondylitis, presence or absence of calcification or echogenic foci in the common tendon and hypervascularity for each categories were also assessed. In addition, these lesions were divided into the superficial and deep according to the location of lesions. According to the severity, there were 15 cases of normal, 13 tendinopathies, 8 tendinopathies with a partial tear, 2 partial tears and 0 complete tear. Bony change was seen only in tendinopathy, tendinopathy with partial tear and partial tear. Calcification or echogenic foci were only observed in cases with tendinopathy and tendinopathy with partial tear. Hypervascularity was only seen in one case of tendinopathy. With thorough understanding of ultrasonographic findings of epicondylitis, ultrasonographic examination can be especially useful and effective in evaluating the severity and location of lesions.

  4. Ultrasonographic findings of Epicondylitis

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    Kwak, Seo Hyun; Song, In Sup; Lee, Jong Beum; Lee, Hwa Yeon; Yoo, Seung Min; Yang, Seong Jun [Yong San Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of); Seo, Kyung Mook [Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    2002-09-15

    To evaluate the usefulness of ultrasonographic findings of the common extensor and flexor tendon in evaluation of patients with lateral and medial epicondylitis. Thirty eight elbows from twenty four patients (mean age=45.2 years) were included. Ultrasonographic examination was performed to evaluate lateral or medial epicondylitis. Epicondylitis was divided into five groups according to the severity of disease: 1) normal, 2) tendinopathy, 3) tendinopathy with a partial tear, partial tear and 4) complete tear. Change in the size of a tendon, bony change of the epicondylitis, presence or absence of calcification or echogenic foci in the common tendon and hypervascularity for each categories were also assessed. In addition, these lesions were divided into the superficial and deep according to the location of lesions. According to the severity, there were 15 cases of normal, 13 tendinopathies, 8 tendinopathies with a partial tear, 2 partial tears and 0 complete tear. Bony change was seen only in tendinopathy, tendinopathy with partial tear and partial tear. Calcification or echogenic foci were only observed in cases with tendinopathy and tendinopathy with partial tear. Hypervascularity was only seen in one case of tendinopathy. With thorough understanding of ultrasonographic findings of epicondylitis, ultrasonographic examination can be especially useful and effective in evaluating the severity and location of lesions.

  5. MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor tendon an isolated lesion?

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    Liang Qi

    Full Text Available OBJECTIVE: To investigate whether an injury of the common extensor tendon (CET is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI. METHODS: Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1 the injury degree of CET; (2 associated injuries in the elbow joint. Spearman's rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. RESULTS: Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe. Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01 was found in injuries of CET and lateral ulnar collateral ligament (LUCL. CONCLUSION: Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL.

  6. MR Imaging of Patients with Lateral Epicondylitis of the Elbow: Is the Common Extensor Tendon an Isolated Lesion?

    Science.gov (United States)

    Li, Feng; Wang, Ren-Fa

    2013-01-01

    Objective To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at plateral ulnar collateral ligament (LUCL). Conclusion Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL. PMID:24244512

  7. Comparison of the effects of sodium hyaluronate-chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: a prospective randomized trial.

    Science.gov (United States)

    Tosun, Haci Bayram; Gumustas, Seyitali; Agir, Ismail; Uludag, Abuzer; Serbest, Sancar; Pepele, Demet; Ertem, Kadir

    2015-09-01

    Hyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA + CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis. In total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA + CS group, 25 patients received a single injection of a solution containing an HA + CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6 months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated. No serious adverse events were reported throughout the study. The mean pain and function scores for the HA + CS and triamcinolone groups had significantly improved at 3 months, but the mean function scores in the HA + CS group were statistically significantly better when compared to the triamcinolone group. At 6 months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA + CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA + CS group was much better when compared with the triamcinolone group, and the HA + CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6 months. This study supports the idea that for a single injection treatment of patients with

  8. A Comparison of Radiofrequency-Based Microtenotomy and Arthroscopic Release of the Extensor Carpi Radialis Brevis Tendon in Recalcitrant Lateral Epicondylitis: A Prospective Randomized Controlled Study.

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    Lee, Jae-Hoo; Park, In; Hyun, Hwan-Sub; Shin, Sang-Jin

    2018-01-20

    To compare the clinical effects of radiofrequency (RF)-based microtenotomy and arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in patients with recalcitrant lateral epicondylitis through a prospective randomized controlled study. A total of 46 patients were randomly assigned to receive arthroscopic release (group A, 24 patients) or RF-based microtenotomy (group B, 22 patients). The visual analog scale (VAS) score for pain, flexion-extension arc, operation time, Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Mayo Elbow Performance Score (MEPS), and grip power of groups A and B were compared during the recovery phases for up to 2 postoperative years. Both groups showed statistically significant functional improvement compared with their preoperative grip strength and DASH, VAS, and MEPS scores at 2 years after surgery (P lateral epicondylitis provided clinical outcomes comparable with those from arthroscopic release of ECRB tendon during the recovery phase. RF-based microtenotomy is considered as one of the surgical procedures for treating recalcitrant lateral epicondylitis, with the advantages of reliable elbow functional restoration and significantly shorter operation time. Level I, prospective randomized trial. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  9. Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis.

    Science.gov (United States)

    Taheri, Parisa; Emadi, Masoud; Poorghasemian, Jafar

    2017-01-01

    One of the most common reasons of elbow and forearm pain is lateral epicondylitis diagnosed based on clinical examination. The extracorporeal shock wave therapy is applied for less invasive treatments with different dosages. This study aimed to investigate the effects of high- and low-dose ESW in treating the lateral epicondylitis. This clinical trial was done in Al Zahra medical center on 40 patients who were selected randomly and divided into two groups. After VAS, the first group was treated by Duolith SD1 shock wave, energy of 0.25 mj/mm 2 , 1000 shocks; the second was treated by focus with the energy of 0.10 mj/mm 2 , 1000 shocks per session for 15 minutes with weekly intervals in three sessions. The patients were also treated with drugs (NSAIDs) and the visual analog scale (VAS) was reassessed 1 week after the last session and 12 weeks after finishing the treatment. The mean of pain intensity during study was decreased in the two groups but reduction of pain intensity in the low-dose groups was higher than the high-dose groups ( P = 0.001). Changes in other parameters including wrist extension test, middle finger extension test and PG was also similar. Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.

  10. Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis: Is There a Relationship Between Magnetic Resonance Imaging Abnormalities of the Common Extensor Tendon and the Patient's Clinical Symptom?

    Science.gov (United States)

    Qi, Liang; Zhang, Yu-Dong; Yu, Rong-Bin; Shi, Hai-Bin

    2016-02-01

    The aim of the study is to determine the inter-reliability and intra-observer reliability of magnetic resonance imaging (MRI) for lateral epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom.The study group comprised 96 consecutive patients (46 men and 50 women) with a clinical diagnosis of chronic lateral epicondylitis, which were examined on 3.0 T MR. An MRI scoring system was used to grade the degree of tendinopahty. Three independent musculoskeletal radiologists, who were blinded to the patients' clinical information, scored images separately. Clinical symptoms were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE).Of all the patients, total 96 elbows had MRI-assessed tendinopathy, including 38 (39.6%) with grade 1, 31 (32.3%) with grade 2, and 27 (28.1%) with grade 3. Inter-observer reliability and intra-observer agreement for MRI interpretation of the grades of tendinopathy was good, and a positive correlation between the grades of tendinopathy and PRTEE was determined.MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signal changes positively correlate with the patient's clinical symptom.

  11. Efficacy of a forearm band in addition to exercises compared with exercises alone for lateral epicondylitis: A multicenter, randomized, controlled trial.

    Science.gov (United States)

    Nishizuka, Takanobu; Iwatsuki, Katsuyuki; Kurimoto, Shigeru; Yamamoto, Michiro; Hirata, Hitoshi

    2017-03-01

    A forearm band is frequently used for lateral epicondylitis worldwide. However, evidence regarding its efficacy has been insufficient. The objective of this prospective, randomized, controlled trial was to analyze the effects of a forearm band for treatment of lateral epicondylitis at 1, 3, 6, and 12 months. Patients with lateral epicondylitis were randomly allocated into a band (n = 55) or non-band (n = 55) group. Patients in the band group were instructed to wear a forearm band for more than 6 h daily for at least 6 months. Patients in both groups were instructed to perform wrist extensor stretching exercises for 30 s, 3 times daily, for 6 months. Hand10, pain, and satisfaction scores, and proportions of positive physical examinations, including tenderness assessment, Thomsen test, and middle finger extension test, were evaluated at 1, 3, 6, and 12 months after enrollment. There were no significant differences between the band and non-band groups with regard to Hand10, pain, or satisfaction scores at 1, 3, 6, and 12 months. Likewise, there was no significant difference in proportions of positive physical examinations between groups at 1, 3, 6, and 12 months. The results of the current study suggest that a forearm band may have no more than a placebo effect, and do not support the use of a forearm band based on its effectiveness. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  12. A case study of 20 patients with lateral epicondylitis of the elbow by using hwachim (burning acupuncture therapy) and sweet bee venom pharmacopuncture.

    Science.gov (United States)

    Jung, Seho; Lee, Chamgeol; Yeo, Inho; Sung, Heejin; Roh, Jeongdu; Jo, Nayoung; Lee, Eunyong

    2014-12-01

    This study was performed to estimate the effectiveness of burning acupuncture therapy (Hwachim) and sweet bee venom pharmacopuncture (S-BV pharmacopuncture) in treating lateral epicondylitis of elbow. We selected 33 patients at first, but 13 patients were excluded due to unclear medical records. Finally, a total of 20 patients who had received treatment from January 2012 to December 2013 were included in this study; all 20 patients had undergone Hwachim for the treatment of lateral epicondylitis of elbow, and 19 of the 20 had been treated with S-BV pharmacopuncture (Korea Pharmacopuncture Institute, KPI) and transcutaneous electrical nerve stimulation (TENS) as an ancillary treatment method. The degrees of pain of the 20 patients were evaluated by using the visual analogue scale (VAS) score at their first and final visits. The Wilcoxon signed rank test and the Kruskal-Wallis test were used to compare the VAS scores statistically. The VAS score had decreased significantly from 10.00 ± 0.00 to 4.00 ± 2.47 (P = 0.000) by the end of the treatment. No significant changes were observed based on the number of treatments (P = 0.246), the age of the patients (P = 0.810), the duration of the illness (P = 0.705), and the location of the lesion (P = 0.076). This study suggests Hwachim and S-BV pharmacopuncture are very effective for treating lateral epicondylitis of the elbow.

  13. A Case Study of 20 Patients with Lateral Epicondylitis of the Elbow by Using Hwachim (Burning Acupuncture Therapy and Sweet Bee Venom Pharmacopuncture

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    Seho Jung

    2014-12-01

    Full Text Available Objectives: This study was performed to estimate the effectiveness of burning acupuncture therapy (Hwachim and sweet bee venom pharmacopuncture (S-BV pharmacopuncture in treating lateral epicondylitis of elbow. Methods: We selected 33 patients at first, but 13 patients were excluded due to unclear medical records. Finally, a total of 20 patients who had received treatment from January 2012 to December 2013 were included in this study; all 20 patients had undergone Hwachim for the treatment of lateral epicondylitis of elbow, and 19 of the 20 had been treated with S-BV pharmacopuncture (Korea Pharmacopuncture Institute, KPI and transcutaneous electrical nerve stimulation (TENS as an ancillary treatment method. The degrees of pain of the 20 patients were evaluated by using the visual analogue scale (VAS score at their first and final visits. The Wilcoxon signed rank test and the Kruskal-Wallis test were used to compare the VAS scores statistically. Results: The VAS score had decreased significantly from 10.00 ± 0.00 to 4.00 ± 2.47 (P = 0.000 by the end of the treatment. No significant changes were observed based on the number of treatments (P = 0.246, the age of the patients (P = 0.810, the duration of the illness (P = 0.705, and the location of the lesion (P = 0.076. Conclusion: This study suggests Hwachim and S-BV pharmacopuncture are very effective for treating lateral epicondylitis of the elbow.

  14. Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis

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    Parisa Taheri

    2017-01-01

    Full Text Available Background: One of the most common reasons of elbow and forearm pain is lateral epicondylitis diagnosed based on clinical examination. The extracorporeal shock wave therapy is applied for less invasive treatments with different dosages. This study aimed to investigate the effects of high- and low-dose ESW in treating the lateral epicondylitis. Materials and Methods: This clinical trial was done in Al Zahra medical center on 40 patients who were selected randomly and divided into two groups. After VAS, the first group was treated by Duolith SD1 shock wave, energy of 0.25 mj/mm2, 1000 shocks; the second was treated by focus with the energy of 0.10 mj/mm2, 1000 shocks per session for 15 minutes with weekly intervals in three sessions. The patients were also treated with drugs (NSAIDs and the visual analog scale (VAS was reassessed 1 week after the last session and 12 weeks after finishing the treatment. Results: The mean of pain intensity during study was decreased in the two groups but reduction of pain intensity in the low-dose groups was higher than the high-dose groups (P = 0.001. Changes in other parameters including wrist extension test, middle finger extension test and PG was also similar. Conclusion: Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.

  15. Radial Extracorporeal Shock Wave Therapy Is Not More Effective Than Placebo in the Management of Lateral Epicondylitis: A Double-Blind, Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    Capan, Nalan; Esmaeilzadeh, Sina; Oral, Aydan; Basoglu, Ceyhun; Karan, Ayse; Sindel, Dilsad

    2016-07-01

    The aim of this study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on pain, function, and grip strength in the treatment of patients with lateral epicondylitis unresponsive to previous treatments. A double-blind, randomized, placebo-controlled trial was conducted in outpatient clinics in a medical faculty hospital. Fifty-six patients with lateral epicondylitis were randomized to rESWT (n = 28) or sham rESWT (n = 28) groups. Both the patients and the outcome assessing investigator were blinded to group assignment. The rESWT was administered to the painful epicondyle at the elbow with a total of 2000 pulses of 10 Hz frequency at a 1.8 bar of air pressure at each session at three once weekly sessions. Sham rESWT was applied without the contact of the applicator at the same area. Study patients were assessed at baseline and at 1 and 3 mos after treatment using a visual analog scale for pain and Roles and Maudsley scale and Patient-Rated Tennis Elbow Evaluation for pain and function. Grip strength of the affected extremity was also measured using a hand dynamometer. Both rESWT and sham rESWT groups showed a significant improvement in all outcome measures at posttreatment follow-up points. Favorable absolute and percentage changes in assessments at 1- and 3-mo posttreatment did not show any significant difference between groups. The rESWT does not seem to be more effective either in reducing pain or improving function or grip strength in patients with lateral epicondylitis at least at 3 mos after treatment when compared with sham rESWT.

  16. Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis.

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    Artur Bachta

    Full Text Available To investigate the diagnostic performance and reliability of ultrasonography (US in detecting and grading common extensor tendon (CET tear in patients with chronic lateral epicondylitis (LE, using magnetic resonance imaging (MRI as the reference standard.The study comprised fifty-eight chronic LE patients. Each patient underwent US and MRI. CET status was classified as: high-grade tear (≥50% thickness, low-grade tear (<50% thickness, suspected tear (possible but not evident tear, no tear. Additionally, the following dichotomous scale was used: confirmed or unconfirmed CET tear. Relative US parameters (versus MRI for detecting CET tear included: sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV and accuracy. The agreement between US and MRI findings was measured using the weighted Cohen kappa coefficient (κ.US showed moderate agreement with MRI in detecting and grading CET tear (κ = 0.49. Sensitivity, specificity, and accuracy in CET tear detecting by US were 64.52%, 85.19%, and 72.73%, respectively. PPV and NPV of US were 83.33% and 67.65%, respectively. No patient with unconfirmed CET tear on US had high-grade CET tear on MRI.Ultrasonography is a valuable imaging modality that can be used as a screening tool to exclude high-grade CET tear in chronic LE patients. Once a tear is evident on US, MRI should be considered to assess precisely the extent of tendon injury.

  17. Avaliação dos resultados do tratamento artroscópico da epicondilite lateral Evaluation of the results of arthroscopic treatment of the lateral epicondylitis

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    Alberto Naoki Miyazaki

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados dos pacientes com epicondilite lateral tratados cirurgicamente pela técnica artroscópica. MÉTODOS: Vinte pacientes foram operados pela técnica artroscópica. A idade variou de 19 a 54 anos (média de 41 anos e oito meses, sendo 12 (60% pacientes do sexo feminino e oito (40%, do masculino. O seguimento mínimo foi de 12 meses e o máximo, de 48 meses, sendo a média de 20 meses. Todos os casos eram refratários ao tratamento conservador (repouso e fisioterapia, com tempo de tratamento clínico prévio variando entre seis e 136 meses. Para a avaliação dos resultados utilizamos os critérios da Associação Médica Americana (AMA, modificados por Bruce. RESULTADOS: Obtivemos 13 (65% resultados excelentes e sete (13% regulares, com apenas uma complicação (distrofia simpático-reflexa. Este foi o único caso que referiu não estar satisfeito. CONCLUSÃO: O tratamento cirúrgico pela técnica artroscópica da epicondilite lateral do cotovelo representa uma boa opção para 65% dos casos.OBJECTIVE: To evaluate the results in patients with lateral epicondylitis surgically treated by the arthroscopy technique. METHODS: Twenty patients were submitted to surgery by the arthroscopic technique. Age ranged from 19 to 54 years (average 41 years and eight months. Twelve (60% of the patients were female and eight (40% male. The minimum follow-up period was 12 months and the maximum period, 48 months, with an average of 20 months. All the cases were refractory to conservative treatment (rest and physiotherapy, with previous clinical treatment times varying ranging from six to 136 months. For the evaluation of the results, we used the criteria of the American Medical Association (AMA, modified by Bruce. RESULTS: We obtained 13 (65% excellent results and seven (13% regular results, with just one complication (reflex sympathetic dystrophy. This was the only patient who reported dissatisfaction. CONCLUSION: Surgical treatment

  18. Racquet string tension directly affects force experienced at the elbow: implications for the development of lateral epicondylitis in tennis players

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    Mohandhas, Badri R; Makaram, Navnit; Drew, Tim S; Wang, Weijie; Arnold, Graham P

    2016-01-01

    Background Lateral epicondylitis (LE) occurs in almost half of all tennis players. Racket-string tension is considered to be an important factor influencing the development of LE. No literature yet exists that substantiates how string-tension affects force transmission to the elbow, as implicated in LE development. We establish a quantitative relationship between string-tension and elbow loading, analyzing tennis strokes using rackets with varying string-tensions. Methods Twenty recreational tennis players simulated backhand tennis strokes using three rackets strung at tensions of 200 N, 222 N and 245 N. Accelerometers recorded accelerations at the elbow, wrist and racket handle. Average peak acceleration was determined to correlate string-tension with elbow loading. Results Statistically significant differences (p elbow at 200 N string-tension (acceleration of 5.58 m/s2) was compared with that at 222 N tension (acceleration of 6.83 m/s2) and 245 N tension (acceleration of 7.45 m/s2). The 200 N racket induced the least acceleration at the elbow. Conclusions Although parameters determining force transmission to the elbow during a tennis stroke are complex, the present study was able to control these parameters, isolating the effect of string-tension. Lower string-tensions transmit less force to the elbow in backhand strokes. Reducing string-tension should be considered favourably with respect to reducing the risk of developing LE. PMID:27583017

  19. Racquet string tension directly affects force experienced at the elbow: implications for the development of lateral epicondylitis in tennis players.

    Science.gov (United States)

    Mohandhas, Badri R; Makaram, Navnit; Drew, Tim S; Wang, Weijie; Arnold, Graham P; Abboud, Rami J

    2016-07-01

    Lateral epicondylitis (LE) occurs in almost half of all tennis players. Racket-string tension is considered to be an important factor influencing the development of LE. No literature yet exists that substantiates how string-tension affects force transmission to the elbow, as implicated in LE development. We establish a quantitative relationship between string-tension and elbow loading, analyzing tennis strokes using rackets with varying string-tensions. Twenty recreational tennis players simulated backhand tennis strokes using three rackets strung at tensions of 200 N, 222 N and 245 N. Accelerometers recorded accelerations at the elbow, wrist and racket handle. Average peak acceleration was determined to correlate string-tension with elbow loading. Statistically significant differences (p < 0.05) were observed when average peak acceleration at the elbow at 200 N string-tension (acceleration of 5.58 m/s(2)) was compared with that at 222 N tension (acceleration of 6.83 m/s(2)) and 245 N tension (acceleration of 7.45 m/s(2)). The 200 N racket induced the least acceleration at the elbow. Although parameters determining force transmission to the elbow during a tennis stroke are complex, the present study was able to control these parameters, isolating the effect of string-tension. Lower string-tensions transmit less force to the elbow in backhand strokes. Reducing string-tension should be considered favourably with respect to reducing the risk of developing LE.

  20. Is wrist splint more effective than forearm band for lateral epicondylitis?

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    Arturo Meissner; María Ignacia Vives; Javier Román; Arturo Meissner

    2017-01-01

    Resumen INTRODUCCIÓN La epicondilitis lateral es una causa común de dolor lateral de codo. Existen numerosos tratamientos que han reportado disminuir los síntomas, entre ellos el uso de órtesis. Las principales órtesis disponibles para este efecto son las bandas de antebrazo y las muñequeras. Actualmente no está claro cuál de ellos constituiría la mejor alternativa de tratamiento sintomático. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de...

  1. Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial

    Science.gov (United States)

    Espandar, Ramin; Heidari, Pedram; Rasouli, Mohammad Reza; Saadat, Soheil; Farzan, Mahmood; Rostami, Mohsen; Yazdanian, Shideh; Mortazavi, S.M. Javad

    2010-01-01

    Background When using botulinum toxin for the management of lateral epicondylitis, injection at a fixed distance from an anatomic landmark could result in inadequate paralysis of the intended muscle. We assessed the effectiveness of injection of botulinum toxin using precise anatomic measurement in individual patients. Methods In this randomized placebo-controlled trial, 48 patients with chronic refractory lateral epicondylitis were randomly assigned to receive a single injection of either botulinum toxin (60 units) or placebo (normal saline). The site of injection was chosen as a distance one-third the length of the forearm from the tip of the lateral epicondyle on the course of the posterior interosseus nerve. The primary outcome measure was intensity of pain at rest, measured with the use of a 100-mm visual analogue scale, at baseline and at 4, 8 and 16 weeks after injection. Results Compared with the placebo group, the group given botulinum toxin had significant reductions in pain at rest during follow-up (decrease at 4 weeks 14.1 mm, 95% confidence interval [CI] 5.8–22.3; at 8 weeks 11.5 mm, 95% CI 2.0–21.0; at 16 weeks 12.6 mm, 95% CI 7.7–17.8; p = 0.01). As for the secondary outcomes, the intensity of pain during maximum pinch decreased in the botulinum toxin group; there was no difference in pain during maximum grip or in grip strength between the two groups. All but one of the patients in the intervention group experienced weakness in the extension of the third and fourth fingers at week 4 that resolved by week 16. No serious adverse events were reported. Interpretation The use of precise anatomic measurement to guide injection of botulinum toxin significantly reduced pain at rest in patients with chronic refractory lateral epicondylitis. However, the transient extensor lag makes this method inappropriate for patients whose job requires finger extension. (ClinicalTrials.gov trial register no. NCT00497913.) PMID:20421357

  2. A COMPARATIVE STUDY TO FIND OUT IMMEDIATE EFFECTIVENESS OF MOVEMENT WITH MOBILIZATION VERSUS ELBOW ORTHOSIS ON PAIN AND GRIP STRENGTH IN LATERAL EPICONDYLITIS IN HOUSEWIVES

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    Trishna Kakati

    2015-12-01

    Full Text Available Background: There are various studies using Mulligan’s MWM with or without combining with electrotherapy modalities and proved the efficacy of the technique in immediately decreasing pain and improving grip strength in patients with lateral epicondylitis. Orthotic as a treatment is also proved to be beneficial in decreasing pain and improving grip strength. There is evidence that housewives are prone to develop lateral epicondylitis due to their routine household work. But there is lack of evidence which compare initial effects of MWM and orthosis in housewives bringing up better outcome measures. The purpose of this study is to compare the initial effectiveness of Mulligan’s MWM and elbow orthosis on pain and grip strength in housewives with lateral epicondylitis. The aim of the study is to evaluate the effectiveness of Mulligan’s MWM technique versus counterforce elbow orthosis in immediately reducing pain and improving grip strength in lateral epicondylitis in housewives. Methodos: All subjects underwent a pre-treatment examination to assess pain and pain free hand grip strength with the help of outcome measures. Subjects were randomly assigned into two groups, A and B respectively; having 25 subjects in each group. Group A was treated with one session of Mulligan’s MWM technique. Group B was treated with Counterforce elbow strap orthosis. Data was assessed pre-treatment and immediately after treatment. Visual Analogue Scale (VAS and hand grip on Hand Grip Dynamometer (HGD were used as outcome measures. Results: Independent t-test was performed to see the effectiveness between Mulligan’s MWM and elbow orthosis. For VAS, t = - 2.243 which is significant at 5% level of significance. It has been inferred that VAS decreases more when Mulligan’s MWM was applied. For HGD, t = 0.878 which is not significant implying that increase in HGD do not differ remarkably for the two treatments. Conclusion: It has been recorded from the study that

  3. Is wrist splint more effective than forearm band for lateral epicondylitis?

    Directory of Open Access Journals (Sweden)

    Arturo Meissner

    2017-12-01

    Full Text Available Resumen INTRODUCCIÓN La epicondilitis lateral es una causa común de dolor lateral de codo. Existen numerosos tratamientos que han reportado disminuir los síntomas, entre ellos el uso de órtesis. Las principales órtesis disponibles para este efecto son las bandas de antebrazo y las muñequeras. Actualmente no está claro cuál de ellos constituiría la mejor alternativa de tratamiento sintomático. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyen cuatro ensayos aleatorizados pertinentes a esta pregunta. Con esta evidencia, concluimos que podría no haber diferencia en la percepción de mejoría global ni en el umbral mecánico de dolor por presión entre el uso de banda de antebrazo y muñequera, y que no está claro si el uso de muñequera disminuye el dolor en comparación a la banda de antebrazo, porque la certeza de la evidencia es muy baja.

  4. The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

    Science.gov (United States)

    Ben-Nafa, Walid; Munro, Wendy

    2018-01-01

    Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of

  5. Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques.

    Science.gov (United States)

    Gaspar, Michael P; Motto, Michael A; Lewis, Sarah; Jacoby, Sidney M; Culp, Randall W; Lee Osterman, A; Kane, Patrick M

    2017-12-01

    Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Cohort study; Level of evidence, 3. A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P < .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P < .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group ( P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant

  6. Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

    Science.gov (United States)

    Gaspar, Michael P.; Motto, Michael A.; Lewis, Sarah; Jacoby, Sidney M.; Culp, Randall W.; Lee Osterman, A.; Kane, Patrick M.

    2017-01-01

    Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, –6.1; 95% CI, –6.8 to –5.5; P < .0001), QuickDASH (mean, –46; 95% CI, –52 to –40; P < .0001), and PRTEE (mean, –57; 95% CI, –64 to –50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection

  7. Comparison of Effectiveness of Supervised Exercise Program and Cyriax Physiotherapy in Patients with Tennis Elbow (Lateral Epicondylitis): A Randomized Clinical Trial

    Science.gov (United States)

    Viswas, Rajadurai; Ramachandran, Rejeeshkumar; Korde Anantkumar, Payal

    2012-01-01

    Objective. To compare the effectiveness of supervised exercise program and Cyriax physiotherapy in the treatment of tennis elbow (lateral epicondylitis). Design. Randomized clinical trial. Setting. Physiotherapy and rehabilitation centre. Subjects. This study was carried out with 20 patients, who had tennis elbow (lateral epicondylitis). Intervention. Group A (n = 10) had received supervised exercise program. Group B (n = 10) was treated with Cyriax physiotherapy. All patients received three treatment sessions per week for four weeks (12 treatment sessions). Outcome measures. Pain was evaluated using a visual analogue scale (VAS), and functional status was evaluated by completion of the Tennis Elbow Function Scale (TEFS) which were recorded at base line and at the end of fourth week. Results. Both the supervised exercise program and Cyriax physiotherapy were found to be significantly effective in reduction of pain and in the improvement of functional status. The supervised exercise programme resulted in greater improvement in comparison to those who received Cyriax physiotherapy. Conclusion. The results of this clinical trial demonstrate that the supervised exercise program may be the first treatment choice for therapist in managing tennis elbow. PMID:22629225

  8. Comparison of Effectiveness of Supervised Exercise Program and Cyriax Physiotherapy in Patients with Tennis Elbow (Lateral Epicondylitis: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Rajadurai Viswas

    2012-01-01

    Full Text Available Objective. To compare the effectiveness of supervised exercise program and Cyriax physiotherapy in the treatment of tennis elbow (lateral epicondylitis. Design. Randomized clinical trial. Setting. Physiotherapy and rehabilitation centre. Subjects. This study was carried out with 20 patients, who had tennis elbow (lateral epicondylitis. Intervention. Group A (=10 had received supervised exercise program. Group B (=10 was treated with Cyriax physiotherapy. All patients received three treatment sessions per week for four weeks (12 treatment sessions. Outcome measures. Pain was evaluated using a visual analogue scale (VAS, and functional status was evaluated by completion of the Tennis Elbow Function Scale (TEFS which were recorded at base line and at the end of fourth week. Results. Both the supervised exercise program and Cyriax physiotherapy were found to be significantly effective in reduction of pain and in the improvement of functional status. The supervised exercise programme resulted in greater improvement in comparison to those who received Cyriax physiotherapy. Conclusion. The results of this clinical trial demonstrate that the supervised exercise program may be the first treatment choice for therapist in managing tennis elbow.

  9. Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis.

    Science.gov (United States)

    Stasinopoulos, Dimitrios; Stasinopoulos, Ioannis

    2006-01-01

    To compare the effectiveness of Cyriax physiotherapy, a supervised exercise programme, and polarized polychromatic non-coherent light (Bioptron light) in the treatment of lateral epicondylitis. Controlled clinical trial. Rheumatology and rehabilitation centre. This study was carried out with 75 patients who had lateral epicondylitis. They were allocated to three groups by sequential allocation. Group A (n = 25) was treated with Cyriax physiotherapy. A supervised exercise programme was given to group B (n = 25). Group C (n = 25) received polarized polychromatic non-coherent light (Bioptron light). All patients received three treatments per week for four weeks. Pain was evaluated using a visual analogue scale and function using a visual analogue scale and pain-free grip strength at the end of the four-week course of treatment (week 4), one month (week 8), three months (week 16) and six months (week 28) after the end of treatment. The supervised exercise programme produced the largest effect in the reduction of pain and in the improvement of function at the end of the treatment (PBioptron light) may be suitable.

  10. Calcific periarthritis of the elbow presenting as acute tennis elbow.

    Science.gov (United States)

    Jawad, F; Jawad, A S M

    2014-01-01

    A 28-year-old woman presented with sudden acute lateral epicondylitis. There was no history of preceding trauma or repetitive use of the arm. Because of the acute onset and signs of acute inflammation, an X-ray was arranged. The X-ray showed a hyperdense calcified elongated globule distal to the lateral epicondyle. A diagnosis of calcific periarthritis (calcium apatite) of the elbow was made. Calcific periarthritis has rarely been reported as a cause of acute elbow pain.

  11. OCCUPATION AND EPICONDYLITIS: A POPULATION-BASED STUDY

    Science.gov (United States)

    Walker-Bone, Karen; Palmer, Keith T; Reading, Isabel C; Coggon, David; Cooper, Cyrus

    2012-01-01

    Objectives To explore the relationship between occupational exposures and lateral and medial epicondylitis and the effect of epicondylitis on sickness absence in a population sample of working aged adults. Methods This was a cross-sectional study of 9696 randomly selected adults aged 25-64 years involving a screening questionnaire and standardised physical examination. Age- and sex-specific prevalence rates of epicondylitis were estimated and associations with occupational risk factors explored. Results Among 6038 respondents, 636 (11%) reported elbow pain in the last week. 0.7% of those surveyed were diagnosed with lateral epicondylitis and 0.6% with medial epicondylitis. Lateral epicondylitis was associated with manual work (OR 4.0, 95% CI 1.9-8.4). In multivariate analyses, repetitive bending/straightening elbow > 1 hour day was independently associated with lateral (OR 2.5, 95% CI 1.2-5.5) and medial epicondylitis (OR 5.1, 95% CI 1.8-14.3). 5% of adults with epicondylitis took sickness absence because of their elbow symptoms in the past 12 months (median 29 days). Conclusions Repetitive exposure to bending/straightening the elbow was a significant risk factor for medial and lateral epicondylitis. Epicondylitis is associated with prolonged sickness absence in 5% of affected working-aged adults. PMID:22019808

  12. Ultrasonographic assessment of tendon thickness, Doppler activity and bony spurs of the elbow in patients with lateral epicondylitis and healthy subjects

    DEFF Research Database (Denmark)

    Krogh, T P; Fredberg, U; Christensen, Robin

    2013-01-01

    PURPOSE: Tennis elbow, also known as lateral epicondylitis (LE), is a common disorder often assessed by ultrasound. The aim of this study was to evaluate the ultrasonographic outcomes and methods used in LE research and clinical practice. MATERIALS AND METHODS: This study was designed as an intra......- and interobserver reliability and agreement study. Ultrasonographic examination of the common extensor tendon of the elbow was performed. The intraobserver study examined tendon thickness twice in 20 right elbows from 20 healthy individuals at an interval of 7 to 12 days. The interobserver study examined tendon...... thickness, color Doppler activity, and bony spurs in 18 right elbows in 9 healthy individuals and 9 patients with LE. Two trained rheumatologists performed the interobserver examinations with the same scanner on the same day. The main outcomes were intra- and interclass correlation (ICC) and agreement...

  13. Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis.

    Science.gov (United States)

    Trentini, R; Mangano, T; Repetto, I; Cerruti, P; Kuqi, E; Trompetto, C; Franchin, F

    2015-09-01

    Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature. In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated. A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %. Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.

  14. Comparative effectiveness of botulinum toxin versus non-surgical treatments for treating lateral epicondylitis: a systematic review and meta-analysis.

    Science.gov (United States)

    Lin, Yu-Ching; Wu, Wei-Ting; Hsu, Yu-Chun; Han, Der-Sheng; Chang, Ke-Vin

    2018-02-01

    To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis. Data sources including PubMed, Scopus, Embase and Airity Library from the earliest record to February 2017 were searched. Study design, patients' characteristics, dosage/brand of botulinum toxin, injection techniques, and measurements of pain and hand grip strength were retrieved. The standardized mean differences (SMDs) in pain relief and grip strength reduction were calculated at the following time points: 2-4, 8-12, and 16 weeks or more after injection. Six randomized controlled trials (321 participants) comparing botulinum toxin with placebo or corticosteroid injections were included. Compared with placebo, botulinum toxin injection significantly reduced pain at all three time points (SMD, -0.729, 95% confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95% CI, -0.740 to -0.152; SMD, -0.543, 95% CI, -0.978 to -0.107, respectively). Botulinum toxin was less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95% CI, 0.568-1.737) and both treatments appeared similar in efficacy after 8 weeks. Different injection sites and dosage/brand did not affect effectiveness. Botulinum toxin decreased grip strength 2-4 weeks after injection, and high equivalent dose could extend its paralytic effects to 8-12 weeks. When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.

  15. Effect of simultaneous stretching of the wrist and finger extensors for lateral epicondylitis: a gross anatomical study of the tendinous origins of the extensor carpi radialis brevis and extensor digitorum communis.

    Science.gov (United States)

    Shirato, Rikiya; Wada, Takuro; Aoki, Mitsuhiro; Iba, Kousuke; Kanaya, Kohei; Fujimiya, Mineko; Yamashita, Toshihiko

    2015-11-01

    Pulling the wrist into flexion with the elbow in extension and forearm in pronation has been used as the stretching technique of wrist extensors for lateral epicondylitis. Simultaneous stretching of the fingers in addition to the wrist flexion has also been applied. However, the mechanism of this simultaneous stretching has not been clarified. This study is designed to clarify the mechanism underlying this simultaneous stretching technique based on the anatomical features of the origins of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). Thirty-nine arms from formalin-embalmed Japanese human specimens were dissected. The features of the origins of the ECRB and EDC were macroscopically observed, and the locations of each origin on the lateral epicondyle were measured. The ECRB had a long and wide, purely tendinous origin which originated from the anterior slope of the lateral epicondyle. The tendinous origin of the index finger of the EDC (EDC-IF) arose from the posterior aspect of the ECRB tendinous origin, with a coexisting muscular portion observed at the level of the proximal forearm. The middle finger of the EDC (EDC-MF) had a short tendinous origin with an associated muscular portion and originated proximo-laterally to the origin of the ECRB on the lateral epicondyle. In addition, the muscular origin of the EDC-MF arose on the superficial and posterior aspect of the ECRB tendinous origin. In contrast, the ring and little fingers of the EDC originated from the tendinous septum of the extensor digiti minimi and extensor carpi ulnaris, and had no connection with the ECRB tendinous origin. On the basis of our anatomical findings, simultaneous stretching of the wrist extensors by wrist, index and middle fingers flexion could provide stretching force to both the tendinous origins of the ECRB and EDC through the EDC-IF and EDC-MF.

  16. The Effect of Dry Needling of the Trigger Points of Shoulder Muscles on Pain and Grip Strength in Patients with Lateral Epicondylitis: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Alireza Kheradmandi

    2015-09-01

    Full Text Available Background: Lateral epicondylitis, also known as tennis elbow, is the most common overuse syndrome of the elbow. The severity of pain may not be directly caused by tendinopathy of wrist extensors since trigger points of the shoulder muscles have a referral zone in the arm and elbow. Therefore the aim of this study was to evaluate the effect of dry needling of shoulder myofascial trigger points on wrist extensors muscles pain and function. Methods: Fourteen female patients with tennis elbow (aged 20 - 45 years old were recruited after primary evaluation by an orthopedist. They entered the study if they had pain in the lateral aspect of elbow of the dominant hand for more than 3 months along with the presence of myofascial trigger points in any muscles of supra spinatus, infra spinatus, sub scapularis or scalenes. Pain pressure threshold, maximal grip force and pain intensity of the hand extensors on lateral epicondyle of elbow were measured before and after treatment. Pain intensity was measured on a one to ten scale of visual analogue scale (VAS. A hand dynamometer used to measure the maximal grip force value of the affected hand in 0˚shoulder flexion/ abduction, 90˚ elbow extension and mid-poison of forearm in sitting position. A pressure algometer was applied on hand extensor muscles to define their trigger point sensitivity. For the control group, treatment regimens consisted of routine physical therapy of tennis elbow. This regime was accompanied by dry needling of mentioned muscles for the intervention group. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis. Results: Comparison of the results after intervention showed that the patients’ pain significantly decreased in both groups (P<0.001; but the patient’s PPT and grip force significantly increased solely in the intervention group (P<0.05. Mann Whitney test showed significant pain differences in both groups (P=0.001. The comparison of differences

  17. IMpact of Platelet Rich plasma OVer alternative therapies in patients with lateral Epicondylitis (IMPROVE): protocol for a multicenter randomized controlled study: a multicenter, randomized trial comparing autologous platelet-rich plasma, autologous whole blood, dry needle tendon fenestration, and physical therapy exercises alone on pain and quality of life in patients with lateral epicondylitis.

    Science.gov (United States)

    Chiavaras, Mary M; Jacobson, Jon A; Carlos, Ruth; Maida, Eugene; Bentley, Todd; Simunovic, Nicole; Swinton, Marilyn; Bhandari, Mohit

    2014-09-01

    Lateral epicondylitis, commonly known as tennis elbow, is the most common cause of lateral elbow pain and the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting. Many therapeutic options, including conservative, surgical, and minimally invasive procedures, have been advocated for the treatment of lateral epicondylitis. Although numerous small studies have been performed to assess the efficacy of various treatments, there are conflicting results with no clear consensus on the optimal treatment. In an economic environment with limited health care resources, it is paramount that optimal cost-effective therapies with favorable patient-important outcomes be identified. This is a protocol paper which outlines a multicenter, multidisciplinary, single-blinded, four-arm randomized controlled trial, comparing platelet-rich plasma (PRP), whole blood injection, dry needle tendon fenestration, and sham injection with physical therapy alone for the treatment of lateral epicondylitis. Patients are screened based on pre-established eligibility criteria and randomized to one of the four study groups using an Internet-based system. The patients are followed at 6-week, 12-week, 24-week, and 52-week time points to assess the primary and secondary outcomes of the study. The primary outcome is pain. Secondary outcomes include health-related quality of life and ultrasound appearance of the common extensor tendon. Two university centers (McMaster University and the University of Michigan) are currently recruiting patients. We have planned a sample size of 100 patients (25 patients per arm) to ensure over 80% power to detect a three-point difference in pain scores at 52 weeks of follow-up. This study has ethics approval from the McMaster University Research Ethics Board (REB# 12-146) and the University of Michigan Institutional Review Board (IRB# HUM00067750). Successful completion of this proposed study will significantly impact

  18. Supinated forearm is correlated with the onset of medial epicondylitis in professional slalom water-skiers.

    Science.gov (United States)

    Rosa, Donato; Di Donato, Sigismondo Luca; Balato, Giovanni; D'Addona, Alessio; Schonauer, Fabrizio

    2016-01-01

    prolonged and laborious activities involving wrists and forearms has been long associated with the onset of epicondylitis. Slalom water-skiing can be included in this category. The purpose of the study is to analyse the correlation between the pronated or supinated position of forearms during water-skiing practice and the presence respectively of lateral and medial epicondylitis. sixty-six pro and semi-pro slalom water-skiers were enrolled in the study. A questionnaire was submitted to each athlete. Diagnosis of lateral or medial epicondylitis was made through anamnesis and clinical exam by an expert orthopaedic surgeon. Chi-squared were performed for categorical variables, and Mann-Whitney U test for continuous ones. from 116 upper limbs examined, we observed 15 (12.9%) cases of lateral epicondylitis, 30 (25.9%) cases of medial epicondylitis, 10 (8.6%) were affected by both lateral and medial epicondylitis. Lateral and medial epicondylitis were associated (95% C.I.=2,489-26,355; P=epicondylitis (95% C.I.=1,529-9,542; P=0.003). slalom water-skiing can be considered a high-risk sport for epicondylitis. In slalom water-skiers there is a correlation between development of lateral and medial epicondylitis in the same upper limb. Supinated position of forearms is strongly associated with the diagnosis of medial epicondylitis.

  19. Ultrasonographic assessment of tendon thickness, Doppler activity and bony spurs of the elbow in patients with lateral epicondylitis and healthy subjects: a reliability and agreement study.

    Science.gov (United States)

    Krogh, T P; Fredberg, U; Christensen, R; Stengaard-Pedersen, K; Ellingsen, T

    2013-10-01

    Tennis elbow, also known as lateral epicondylitis (LE), is a common disorder often assessed by ultrasound. The aim of this study was to evaluate the ultrasonographic outcomes and methods used in LE research and clinical practice. This study was designed as an intra- and interobserver reliability and agreement study. Ultrasonographic examination of the common extensor tendon of the elbow was performed. The intraobserver study examined tendon thickness twice in 20 right elbows from 20 healthy individuals at an interval of 7 to 12 days. The interobserver study examined tendon thickness, color Doppler activity, and bony spurs in 18 right elbows in 9 healthy individuals and 9 patients with LE. Two trained rheumatologists performed the interobserver examinations with the same scanner on the same day. The main outcomes were intra- and interclass correlation (ICC) and agreement. In the intraobserver study, the ICC with regard to tendon thickness ranged from 0.76 to 0.81, depending on the measurement techniques used. The agreement ranged from 0.06 to 0.13 mm. In the interobserver study, the tendon thickness ICC ranged from 0.45 to 0.65 and the agreement ranged from -0.17 to 0.13 mm. The ICC for color Doppler activity was 0.93, with agreement in 14/18 (78 %) of the cases. A perfect reliability was demonstrated for bony spurs, with an ICC of 1 and exact agreement in 18/18 (100 %) of the cases. Good to excellent reliability was obtained for all measurements. The ultrasonographic techniques evaluated in this trial can be recommended for use in both research and clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

  20. A randomized clinical trial on comparison of corticosteroid injection with or without splinting versus saline injection with or without splinting in patients with lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Tahririan

    2014-01-01

    Full Text Available Background: Lateral epicondylitis is a common problem affecting 1-3% of the population. There has been much debate about the best treatment modality for this condition. There is, however, no conclusive evidence in support of any of the proposed treatment modalities. In this trial, we have studied the effect of corticosteroid injection (with or without splinting with normal saline injection (with or without splinting. Materials and Methods: In this double-blind, randomized clinical trial, individuals were randomly assigned to either of four treatment groups and received either 40 mg depomedrol injection alone, 40 mg depomedrol injection with splinting, normal saline injection alone, or normal saline injection with splinting. They were evaluated using the visual analog scale (VAS at weeks 2, 4 and 24 and with the Oxford elbow scale (OES at 24 weeks. Results: A total of 79 patients were participated in the study. The corticosteroid injection groups had better pain relief as measured by VAS at 2 and 4 weeks compared with the two saline injection groups. Mean VAS difference at week 0 versus week 2 was 4.5 ± 0.9 and 2.8 ± 0.6 in corticosteroid injection groups and saline injection groups respectively (P < 0.01 but at 24 weeks, there was only moderate benefit reported for the group which received steroid injection and splinting (P < 0.01 compared to the saline injection groups. The saline injection groups reported better improvement in OES scores (20.1 ± 3.7 at the end of the trial compared corticosteroid injection groups (16.1 ± 2.9 (P < 0.05. Conclusion: Our results indicate that despite the clear pain reduction benefit associated with steroid injection in short term, this benefit in comparison with normal saline injection fades by the 24 th week of follow-up.

  1. A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis.

    Science.gov (United States)

    Matache, Bogdan A; Berdusco, Randa; Momoli, Franco; Lapner, Peter L C; Pollock, J W

    2016-06-01

    Tennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. Most cases resolve within 2 years of symptom onset, but a subset of patients will develop persistent symptoms despite appropriate conservative management. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. This procedure involves the arthroscopic release of the extensor carpi radialis brevis tendon (ECRB) origin at the elbow. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. However, in order to justify its widespread use and growing popularity, a high level of evidence study is required. The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis. We will conduct a prospective single center, double-blind, randomized sham-controlled parallel arm trial evaluating the efficacy of arthroscopic tennis elbow release in adult patients with symptoms for at least 6 months. Patients will undergo intraoperative randomization after diagnostic arthroscopy of the elbow to receive either ECRB release (through the creation of a lateral portal) or a sham lateral portal and no ECRB release. The primary outcome will be the Mayo Elbow Performance Score (MEPS) at 1 year follow-up. Secondary outcomes will be the abbreviated Disability of the Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons elbow (ASES-e) score and grip strength at 3, 6, 12 and 24 months as well as return-to-work time, ability to return to full duty and adverse outcomes. Results of this study will provide empirical

  2. The use of polarized polychromatic non-coherent light as therapy for acute tennis elbow/lateral epicondylalgia: a pilot study.

    Science.gov (United States)

    Stasinopoulos, Dimitrios

    2005-02-01

    The aim of this study was to assess the efficacy of polarized, polychromatic, non-coherent, low energy light (Bioptron 2, Bioptron AG, Switzerland) in the treatment of acute tennis elbow. Tennis elbow, or lateral epicondylitis, is one of the most common lesions affecting the arm. A plethora of treatment regimes have been described for this condition, but no specific therapy has emerged as a gold standard. A pilot study was carried out with 25 patients who had acute tennis elbow. Bioptron 2 device was applied over lateral epicondyle three times per week for 4 weeks. Pain on VAS, function on VAS, and painfree grip strength were measured at the beginning (week 0) and at the end of the study (week 4). The pain on VAS was reduced at the end of treatment (t(24) = 3.84, p = 0.001). Function on VAS was increased at the end of treatment (t(24) = 4.23, p Bioptron 2 could reduce patients' symptoms with acute tennis elbow, future controlled studies are needed to establish the relative and absolute effectiveness of Bioptron 2.

  3. The effects of extracorporeal shock-wave therapy (ESWT versus Mulligan concept of manual therapy in treating lateral epicondylitis = Efektywność terapii zewnątrzustrojową falą uderzeniową versus terapia manualna w koncepcji Mulligana w leczeniu zapalenia nadkłykcia bocznego

    Directory of Open Access Journals (Sweden)

    Janusz Kocjan

    2016-07-01

    SUMMARY Extracorporeal shockwave therapy (ESWT is a conservative treatment in case of many musculoskeletal disorders, including lateral epicondylitis. The aim of the study was the assessment of the efficacy of the shockwave - compare to manual therapy treatment (Mulligan concept in a population of consecutive patients affected by tennis elbow. 26 patients who suffered from chronic persistent tennis elbow were randomly assigned to one of the two treatment groups. Group 1 (n=13, mean age=37,14±10,07 received an extracorporeal shock wave treatment (ESWT; 2,500 shocks, while Group 2 (n=13, mean age= was undergoing manual therapy in Mulligan concept. Visual Analogue Scale (VAS and Patient-Rated Tennis Elbow Evaluation (PRTEE were used. The results of the study presented here shows that ESWT and Mulligan therapy are an effective treatment of lateral epicondylitis. Both groups achieved improvement in all of analysed variables, but in case of Mulligan Concept statistical significant differences were found in 4 from 6 variables. It is concluded that ESWT and Mulligan therapy appears to be a useful non invasive treatment methods that reduces the symptoms of lateral epicondylitis.   Key words: ESWT, mulligan, tennis elbow, lateral epicondylitis.

  4. The Prevalence of Medial Epicondylitis Among Patients With C6 and C7 Radiculopathy

    Science.gov (United States)

    Lee, Aaron Taylor; Lee-Robinson, Ayse L.

    2010-01-01

    Background: Medial epicondylitis, or golfer’s/pitcher’s elbow, develops as a result of medial stress overload on the flexor muscles at the elbow and presents as pain at the medial epicondyle. Cervical radiculopathy has been associated with lateral epicondylitis, but few associations between the cervical spine and medial epicondylitis have been made. Researchers propose that there is an association, suggesting that the weakness and imbalance in the elbow flexor and extensor muscles from C6 and C7 radiculopathy allow for easy onset of medial epicondylitis. Hypothesis: Medial epicondylitis will present in over half the patients diagnosed with C6 and C7 radiculopathy. Methodology: A total of 102 patients initially presenting with upper extremity or neck symptoms were diagnosed with cervical radiculopathy. They were then examined for medial epicondylitis. Data were collected by referring to patient charts from February 2008 until June 2009. Results: Fifty-five patients were diagnosed with medial epicondylitis. Of these, 44 had C6 and C7 radiculopathy whereas 11 presented with just C6 radiculopathy. Conclusion: Medial epicondylitis presented with cervical radiculopathy in slightly more than half the patients. Weakening of the flexor carpi radialis and pronator teres and imbalance of the flexor and extensor muscles from the C6 and C7 radiculopathy allow for easy onset of medial epicondylitis. Patients with medial epicondylitis should be examined for C6 and C7 radiculopathy to ensure proper treatment. Physicians dealing with golfers, pitchers, or other patients with medial epicondylitis should be aware of the association between these 2 diagnoses to optimize care. PMID:23015956

  5. Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study

    Directory of Open Access Journals (Sweden)

    Bhargava Arti S

    2010-09-01

    Full Text Available Abstract Background Lateral epicondylitis is a common sports injury of the elbow caused due to altered muscle activation during repetitive wrist extension in many athletic and non-athletic endeavours. The amount of muscle activity and timing of contraction eventually is directly dependent upon joint position during the activity. The purpose of our study was to compare the grip strength in athletes with lateral epicondylalgia in two different wrist extension positions and compare them between involved and uninvolved sides of athletes and non-athletes. Methods An assessor-blinded case-control study of eight athletes and twenty-two non-athletes was done. The grip strength was measured using JAMAR® hand dynamometer in kilograms-force at 15 degrees (slightly extended and 35 degrees (moderately extended wrist extension positions (maintained by wrist splints on both involved and uninvolved sides of athletes and non-athletes with unilateral lateral epicondylitis of atleast 3 months duration. Their pain was to be elicited with local tenderness and two of three tests being positive- Cozen's, Mill's manoeuvre, resisted middle finger extension tests. For comparisons of grip strength, Wilcoxon signed rank test was used for within-group comparison (between 15 and 35 degrees wrist extension positions and Mann-Whitney U test was used for between-group (athletes vs. non-athletes comparisons at 95% confidence interval and were done using SPSS 11.5 for Windows. Results Statistically significant greater grip strength was found in 15 degrees (27.75 ± 4.2 kgms in athletes; 16.45 ± 4.2 kgms in non-athletes wrist extension than at 35 degrees (25.25 ± 3.53 kgm in athletes and 14.18 ± 3.53 kgm in non-athletes. The athletes had greater grip strength than non-athletes in each of test positions (11.3 kgm at 15 degrees and 11.07 kgm at 35 degrees measured. There was also a significant difference between involved and uninvolved sides' grip strength at both wrist

  6. Skuteczność kompleksowej fizjoterapii ambulatoryjnej u chorych z rozpoznaniem zapalenia nadkłykcia bocznego kości ramiennej = The efficiency of complex outpatient physiotherapy in patients diagnosed with lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    Klaudia Pasiud

    2016-08-01

    fizjoterapeutycznymi w przypadku zapalenia nadkłycia bocznego kości ramiennej były: laseroterapia (67,5%, krioterapia (60% oraz ultradźwięki (55%. Zaobserwowano istotną statystycznie różnicę (p<0,001 w poziomie dolegliwości bólowych przed (6,67 i po serii zabiegów (2,27 w skali NRS oraz w poziomie niesprawności kończyny górnej w skali DASH (przed 58,49, po serii zabiegów 23,90. W testach funkcjonalnych uzyskano poprawę u prawie 95% badanych. WNIOSKI. Kompleksowa fizjoterapia, obejmująca od 3 do 5 zabiegów, prowadzona w ramach fizjoterapii ambulatoryjnej, jest skuteczna u pacjentów z rozpoznaniem zapalenia nadkłykcia bocznego kości ramiennej.   SŁOWA KLUCZOWE: kompleksowa fizjoterapia, fizjoterapia ambulatoryjna, łokieć tenisisty.     SUMMARY INTRODUCTION. Lateral epicondylitis commonly known as 'tennis elbow' is one of the most often diagnosed problems in the neighbourhood of the elbow joint in patients aged 30 to 65. The disease is present among 1-3% of the population and its main cause is the overload of the forearm extensor muscles as a result of long-term dynamic work or static work of small load. The people who perform manual activities professionally are especially predisposed to the disease. PURPOSE. The purpose of the study carried out was the evaluation of the efficiency of complex physiotherapy in patients diagnosed with lateral epicondylitis. MATERIAL AND METHODS. The study was carried out in a group of 40 people (25 men and 15 women diagnosed with lateral epicondylitis who have experienced pain for 4 to 6 months. The average age of the study group was 44 years ± 10.22. In the study the method of diagnostic survey was applied based on the author's questionnaire and standardized questionnaire concerning the disability of the upper limb, DASH (Disability of the Arm, Shoulder and Hand. Pain level was assessed by means of NRS (Numerical Rating Scale. Moreover, there were three functional tests performed on the interviewees: Thomson's test, Cozen

  7. A novel method for assessing elbow pain resulting from epicondylitis

    Science.gov (United States)

    Polkinghorn, Bradley S.

    2002-01-01

    Abstract Objective To describe a novel orthopedic test (Polk's test) which can assist the clinician in differentiating between me- dial and lateral epicondylitis, 2 of the most common causes of elbow pain. This test has not been previously described in the literature. Clinical Features The testing procedure described in this paper is easy to learn, simple to perform and may provide the clinician with a quick and effective method of differentiating between lateral and medial epicondylitis. The test also helps to elucidate normal activities of daily living that the patient may unknowingly be performing on a repetitive basis that are hindering recovery. The results of this simple test allow the clinician to make immediate lifestyle recommendations to the patient that should improve and hasten the response to subsequent treatment. It may be used in conjunction with other orthopedic testing procedures, as it correlates well with other clinical tests for assessing epicondylitis. Conclusion The use of Polk's Test may help the clinician to diagnostically differentiate between lateral and medial epicondylitis, as well as supply information relative to choosing proper instructions for the patient to follow as part of their treatment program. Further research, performed in an academic setting, should prove helpful in more thoroughly evaluating the merits of this test. In the meantime, clinical experience over the years suggests that the practicing physician should find a great deal of clinical utility in utilizing this simple, yet effective, diagnostic procedure. PMID:19674572

  8. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study.

    Science.gov (United States)

    Alessio-Mazzola, Mattia; Repetto, Ilaria; Biti, Besmir; Trentini, Roberto; Formica, Matteo; Felli, Lamberto

    2018-01-01

    To compare the efficacy of two independent groups of patients treated with ultrasound (US)-guided extracorporeal shock wave (ESW) therapy and with US-guided injection of platelet-rich plasma (PRP) for chronic lateral epicondylitis (LE) with a minimum of 2-year follow-up. We retrospectively evaluated 63 patients treated for chronic LE (31 patients with autologous US-guided PRP injection and 32 patients with US-guided focal ESW therapy) from 2009 to 2014. All the patients were evaluated by means of Roles-Maudsley (RM) score, quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, visual analogic scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) to retrospectively assess the pain relief, level of activity, the self-reported function and subjective satisfaction at minimum of 2-year follow-up. Both US-guided autologous PRP injection and US-guided focal ESW administration proved effective in chronic LE with significant improvement in the QuickDASH, VAS, RM and PRTEE scores ( p 0.05). The mean time between treatment and symptom resolution was significantly shorter for the PRP treatment ( p = 0.0212); furthermore, the mean time to return to the normal activities was quicker for PRP group ( p = 0.0119). Both PRP injection and ESW therapy are feasible and safe options for the treatment of chronic LE with low risk of complications and with good long-term follow-up results. US-guided PRP injection has quick efficacy when compared with US-guided focal ESW therapy.

  9. Diagnostic guidlines for occupational epicondylitis

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    Patrycja Krawczyk-Szulc

    2015-07-01

    Full Text Available Making final decisions on the occupational etiology of musculoskeletal diseases is often difficult and problematic at every stage of the diagnostic procedure. Taking into account the need to facilitate decision-making about the causal relationship between the diagnosed disease entity and the working conditions guidelines for the recognition of work-related musculoskeletal diseases have been developed. This paper presents the guidelines for the diagnosis of occupational etiology of humeral epicondylitis, one of the most common occupational disease of the musculoskeletal system in Poland. The developed guidelines have been based on the literature data concerning occupational risk factors of humeral epicondylitis, workload classification, including repetitive movements, awkward postures, and force. Some criteria applied in ergonomic evaluation methods were also included. The presented diagnostic guidelines define approximate benchmarks for stating (after excluding non-occupational etiology that the identified humeral epicondylitis, is related to the way of working. Crucial work factors that should be analyzed include an operating time of movements overloading tendons connecting to the epicondyle, repetition and force used to perform occupational activities. The developed guidelines are aimed to facilitate occupational physicians diagnostic and certification procedures in case of humeral epicondylitis and determination whether there is a likelihood of its occupational etiology. Med Pr 2015;66(3:443–450

  10. Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors

    Science.gov (United States)

    Descatha, Alexis; Leclerc, Annette; Chastang, Jean-François; Roquelaure, Yves

    2003-01-01

    As medial epicondylitis has not been studied alone, we investigated its links between personal and occupational factors in repetitive work, and its course. 1757 workers were examined by an occupational health physician in 1993–94. 598 of them were re-examined three years later. Prevalence was between 4 and 5%, with annual incidence estimated at 1.5%. Forceful work was a risk factor for medial epicondylitis (OR 1.95 CI [1.15–3.32]), but not exposure to repetitive work (OR 1.11, CI [0.59–2.10]). Workers with medial epicondylitis had a significantly higher prevalence of other work-related upper-limb musculoskeletal disorders (WRMD). Risk factors differed for medial and lateral epicondylitis. The prognosis for medial epicondylitis in this population was good with a three-year recovery rate at 81%. Medial epicondylitis was clearly associated with forceful work and other upper-limb WRMD, and its prognosis was good. PMID:14506342

  11. Stroke Laterality Bias in the Management of Acute Ischemic Stroke.

    Science.gov (United States)

    McCluskey, Gavin; Wade, Carrie; McKee, Jacqueline; McCarron, Peter; McVerry, Ferghal; McCarron, Mark O

    2016-11-01

    Little is known of the impact of stroke laterality on the management process and outcome of patients with acute ischemic stroke (AIS). Consecutive patients admitted to a general hospital over 1 year with supratentorial AIS were eligible for inclusion in the study. Baseline characteristics and risk factors, delays in hospital admission, imaging, intrahospital transfer to an acute stoke unit, stroke severity and classification, length of hospital admission, as well as 10-year mortality were measured and compared among right and left hemisphere AIS patients. There were 141 patients (77 men, 64 women; median age 73 [interquartile range 63-79] years), There were 71 patients with left hemisphere AIS and 70 with right hemisphere AIS. Delays to hospital admission from stroke onset to neuroimaging were similar among right and left hemisphere AIS patients. Delay in transfer to an acute stroke unit (ASU) following hospital admission was on average 14 hours more for right hemisphere compared to left hemisphere AIS patients (P = .01). Laterality was not associated with any difference in 10-year survival. Patients with mild and nondominant AIS merit particular attention to minimize their intrahospital transfer time to an ASU. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Intra-Articular Entrapment of the Medial Epicondyle following a Traumatic Fracture Dislocation of the Elbow in an Adult

    Science.gov (United States)

    Hassan, Youssef G.; Joukhadar, Nabih I.

    2018-01-01

    Medial epicondyle entrapment after an acute fracture dislocation of the elbow is a common finding in the pediatric population, but a rare finding in adults. We present a case of an adult patient diagnosed with a traumatic fracture dislocation of the elbow joint with intra-articular entrapment of the medial epicondyle. After initial evaluation, closed reduction was done. Stability testing after reduction showed an unstable joint; thus, open reduction and internal fixation was decided. PMID:29666736

  13. [Four surgical tips in the treatment of epicondylitis].

    Science.gov (United States)

    Jiménez, I; Marcos-García, A; Muratore-Moreno, G; Medina, J

    2016-01-01

    Lateral epicondylitis is a common injury in the population. Most patients improve with conservative treatment, but in a small percentage surgery is necessary. The aim of this study is to analyse the clinical results obtained by a «4 surgical tips» technique. This is a retrospective study of 35 operated elbows, with a mean follow-up of 5.3 years. In all cases epicondylar denervation, removal of the angiofibroblastic degeneration core, epicondylectomy, and release of posterior interosseous nerve, was performed. Each patient was evaluated using the Broberg and Morrey Rating System (BMRS), Mayo Elbow Performance Score (MEPS), Visual Analogue Scale (VAS), DASH questionnaire, and a survey of subjective assessment. BMRS mean score was 97.2 points, with 95.71 points with the MEPS. The mean decrease in VAS was 8.12 points, and the mean score on the DASH was 1.68 points. The results were rated as excellent or very good by 94.3% of patients. There was one recurrence, which resolved with further surgery. Two neuropraxia of the posterior interosseous nerve occurred, which completely recovered in 10 weeks. Using the «4 surgical tips» technique, clinical resolution of symptoms in 97.1% was achieved at the first operation. Therefore, it appears to be an effective, reproducible technique with few complications, in the surgical treatment of lateral epicondylitis resistant to conservative treatment. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Repair of acute injuries of the lateral ligament complex of the ankle by suture anchors

    OpenAIRE

    Liu, Xiang-Fei; Fang, Yang; Cao, Zhong-Hua; Li, Guang-Feng; Yang, Guo-Qing

    2015-01-01

    Objective: The objective of this study was to investigate the clinical curative effect of stage I repair of acute injuries of the lateral ligament complex of the ankle by the application of suture anchors. Methods: We retrospectively analyzed 18 cases of III degree acute injuries of the lateral ligament complex of the ankle. Results: There were statistically significant differences in preoperative and last follow-up VAS pain scores and AOFAS ankle hind-foot function scores. The X-ray talus di...

  15. Comparative ultrasound study of acute lateral ankle ligament ...

    African Journals Online (AJOL)

    The return to competitive level of sport dates were also documented and compared. A single blind randomised control study comparing the JSFB rehabilitation programme with conventional ankle rehabilitation programmes was used. Ultrasound examinations were done on all first time lateral ankle ligament injuries 72 ...

  16. Intra-articular Entrapment of Medial Epicondyle Fracture Fragment in Elbow Joint Dislocation Causing Ulnar Neuropraxia: A Case Report

    Directory of Open Access Journals (Sweden)

    Syed J

    2017-03-01

    Full Text Available Traumatic elbow dislocations in children are rare but most of them are complex dislocations, and in such dislocations, medial humerus epicondyle fractureis the most common associated injury. Fracture incarceration in the elbow joint occurs in 5-18% of medial humerus epicondyle fractures but ulnar neuropraxia is very rare. Open reduction internal fixation is indicated in medial humerus epicondyle fracture with fracture incarceration, ulnar neuropraxia, marked instability or open fracture. Operative treatment options include fragment excision and sutures, closed or open reduction and Kirschner wire fixation, open reduction and suture fixation, open reduction and smooth pin fixation, and open reduction and screw fixation. However, ulnar nerve transposition is debatable as good outcome had been reported with and without nerve transposition. We report a case of a 13-year old boy, who presented with right elbow dislocation and intra-articular entrapment of medial humerus epicondyle fracture fragment, complicated with sensory ulnar neuropraxia, following a fall onto his right outstretched hand in a motor vehicle accident. The elbow joint was reduced using close manipulative reduction but the fracture fragment remained entrapped post-reduction. The patient then underwent open reduction and screw fixation of the medial humerus epicondyle fracture without ulnar nerve transposition. He had good functional outcome six weeks after surgical intervention, with complete recovery of ulnar neuropraxia six months later. Currently, he is doing well at school and is active with his sporting activity.

  17. Therapeutic vaccine for acute and chronic motor neuron diseases: implications for amyotrophic lateral sclerosis.

    Science.gov (United States)

    Angelov, D N; Waibel, S; Guntinas-Lichius, O; Lenzen, M; Neiss, W F; Tomov, T L; Yoles, E; Kipnis, J; Schori, H; Reuter, A; Ludolph, A; Schwartz, M

    2003-04-15

    Therapeutic vaccination with Copaxone (glatiramer acetate, Cop-1) protects motor neurons against acute and chronic degenerative conditions. In acute degeneration after facial nerve axotomy, the number of surviving motor neurons was almost two times higher in Cop-1-vaccinated mice than in nonvaccinated mice, or in mice injected with PBS emulsified in complete Freund's adjuvant (P amyotrophic lateral sclerosis, Cop-1 vaccination prolonged life span compared to untreated matched controls, from 211 +/- 7 days (n = 15) to 263 +/- 8 days (n = 14; P sclerosis. The protocol for non-autoimmune neurodegenerative diseases such as amyotrophic lateral sclerosis, remains to be established by future studies.

  18. The severity of acute bronchiolitis in infants was associated with quality of life nine months later.

    Science.gov (United States)

    Rolfsjord, Leif Bjarte; Skjerven, Håvard Ove; Carlsen, Kai-Håkon; Mowinckel, Petter; Bains, Karen Eline Stensby; Bakkeheim, Egil; Lødrup Carlsen, Karin C

    2016-07-01

    Acute bronchiolitis in infancy increases the risk of later asthma and reduced health-related quality of life (QoL). We aimed to see whether the severity of acute bronchiolitis in the first year of life was associated with QoL nine months later. The parents of 209 of 404 of children hospitalised for acute bronchiolitis in eight paediatric departments in south-east Norway at a mean four months of age (range 0-12 months) completed the Infant/Toddler Quality of Life Questionnaire sent by mail nine months after the acute illness. Disease severity was measured by length of stay and the need for supportive treatment. Interactions with gender, inclusion age, prematurity, maternal ethnicity and maternal education were examined. Reduced QoL in four domains was associated with increased length of stay and need for ventilatory support. Physical abilities and general health were associated with both severity markers, whereas bodily pain and discomfort and change in health were associated with length of stay. Ventilatory support was more negatively associated with QoL than atopic eczema and also associated with reduced parental emotions and parental time. The severity of acute bronchiolitis in infants was associated with reduced QoL nine months later. ©2016 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

  19. The Distal Humerus Axial View: Assessment of Displacement in Medial Epicondyle Fractures.

    Science.gov (United States)

    Souder, Christopher D; Farnsworth, Christine L; McNeil, Natalie P; Bomar, James D; Edmonds, Eric W

    2015-01-01

    The assessment and treatment of childhood medial epicondyle humerus fractures continues to be associated with significant debate. Several studies demonstrate that standard radiographic views are unable to accurately portray the true displacement. Without reliable ways to assess the amount of displacement, how can we debate treatment and outcomes? This study introduces a novel imaging technique for the evaluation of medial epicondyle fractures. An osteotomy of a cadaveric humerus was performed to simulate a medial epicondyle fracture. Plain radiographs were obtained with the fracture fragment displaced anteriorly in 2-mm increments between 0 and 18 mm. Anteroposterior (AP), internal oblique (IR), lateral (LAT), and distal humerus axial (AXIAL) views were performed. Axial images were obtained by positioning the central ray above the shoulder at 15 to 20 degrees from the long axis of the humerus, centered on the distal humerus. Displacement (mm) was measured by 7 orthopaedic surgeons on digital radiographs. At 10 mm displacement, AP views underestimated displacement by 5.5±0.6 mm and IR views underestimated by 3.8±2.1 mm. On LAT views, readers were not able to visualize fragments with displacement. Displacement ≥10 mm from LAT views was overestimated by 1 reader by up to 4.6 mm and underestimated by others by up to 18.0 mm. AXIAL images more closely estimated the true amount of displacement, with a mean 1.5±1.1 mm error in measurement for displacement and a mean 0.8±0.7 mm error for displacements of ≥10 mm. AXIAL measurements correlated strongly with the actual displacement (r=0.998, Pdisplacement of medial epicondyle humerus fractures. The newly described AXIAL projection more accurately and reliably demonstrated the true displacement while reducing the need for advanced imaging such as computed tomography. This simple view can be easily obtained at a clinic visit, enhancing the surgeon's ability to determine the true displacement.

  20. Repair of acute injuries of the lateral ligament complex of the ankle by suture anchors

    Science.gov (United States)

    Liu, Xiang-Fei; Fang, Yang; Cao, Zhong-Hua; Li, Guang-Feng; Yang, Guo-Qing

    2015-01-01

    Objective: The objective of this study was to investigate the clinical curative effect of stage I repair of acute injuries of the lateral ligament complex of the ankle by the application of suture anchors. Methods: We retrospectively analyzed 18 cases of III degree acute injuries of the lateral ligament complex of the ankle. Results: There were statistically significant differences in preoperative and last follow-up VAS pain scores and AOFAS ankle hind-foot function scores. The X-ray talus displacement values in the anterior drawer test and pressure anteroposterior X-ray talar tilt in the ankle talar tilt test also showed statistically significant differences. Complications occurred in 2 patients, incision surface infection in one, and postoperative lateral dorsal skin numbness in one. All these cases were cured after symptomatic treatment. At the last follow-up all patients’ ankle joint activity recovered to their preinjury function levels. Conclusion: The application of suture anchors for small incision stage I repair of the lateral collateral ligament of ankle joint degree III injury, can effectively restored the stability of ankle joint, and prevent the occurrence of chronic ankle instability complications. It is effective and feasible for the treatment of ankle joint lateral collateral ligament injuries. PMID:26885144

  1. MR imaging in chronic epicondylitis humeri radialis at 1.0 T: is Gd-DTPA administration useful?

    International Nuclear Information System (INIS)

    Herber, S.; Kalden, P.; Kreitner, K.-F.; Thelen, M.

    2001-01-01

    Purpose: Evaluation of the diagnostic value and confidence of contrast-enhanced MR imaging in patients with lateral epicondylitis in comparison to clinical diagnosis. Material and Methods: 42 consecutive patients with clinically proven chronic lateral epicondylitis and 10 elbow joints of healthy controls have been examined on a 1.0 T MR-unit. Criteria for inclusion in the prospective study were: persistant pain and a failed conservative therapy. The MR protocol included STIR sequence, a native, T 2 -weighted, fat-supressed TSE sequence, and a flash-2-D sequence. Also, fat-supressed, T 1 -weighted SE sequences before and after administration of Gd-DTPA contrast media have been recorded. Results: In 39/42 patients the STIR sequence showed an increased SI of the common extensor tendom. Increased MR signal of the lateral collateral ligament combined with a thickening and a partial rupture or a full thickness tear have been observed in 15/42 cases. A bone marrow edema at the lateral epicondylus was noticed in 6 of the studied patients and a joint effusion in 18/42 patients. After administration of contrast media we noticed an average increase of SI by about 150%. However, enhanced MR imaging did not provide additional information. Conclusion: In MR imaging of chronic epicondylitis administration of gadolinium-DTPA does not provide additional information. (orig.) [de

  2. THE METHOD OF SURGICAL TREATMENT OF HUMERAL EPICONDYLITIS

    Directory of Open Access Journals (Sweden)

    S. B. Korolev

    2011-01-01

    Full Text Available Method of treatment of epicondylitis of humeral bone is descripted. This metod is proposited to use if conservative therapy was not effective. Experience of use this method show excellent results.

  3. Effect of acute lateral hemisection of the spinal cord on spinal neurons of postural networks

    Science.gov (United States)

    Zelenin, P. V.; Lyalka, V. F.; Orlovsky, G. N.; Deliagina, T. G.

    2016-01-01

    In quadrupeds, acute lateral hemisection of the spinal cord (LHS) severely impairs postural functions, which recover over time. Postural limb reflexes (PLRs) represent a substantial component of postural corrections in intact animals. The aim of the present study was to characterize the effects of acute LHS on two populations of spinal neurons (F and E) mediating PLRs. For this purpose, in decerebrate rabbits, responses of individual neurons from L5 to stimulation causing PLRs were recorded before and during reversible LHS (caused by temporal cold block of signal transmission in lateral spinal pathways at L1), as well as after acute surgical (Sur) LHS at L1. Results obtained after Sur-LHS were compared to control data obtained in our previous study. We found that acute LHS caused disappearance of PLRs on the affected side. It also changed a proportion of different types of neurons on that side. A significant decrease and increase in the proportion of F- and non-modulated neurons, respectively, was found. LHS caused a significant decrease in most parameters of activity in F-neurons located in the ventral horn on the lesioned side and in E-neurons of the dorsal horn on both sides. These changes were caused by a significant decrease in the efficacy of posture-related sensory input from the ipsilateral limb to F-neurons, and from the contralateral limb to both F- and E-neurons. These distortions in operation of postural networks underlie the impairment of postural control after acute LHS, and represent a starting point for the subsequent recovery of postural functions. PMID:27702647

  4. Postural control strategies during single limb stance following acute lateral ankle sprain.

    Science.gov (United States)

    Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

    2014-06-01

    Single-limb stance is maintained via the integration of visual, vestibular and somatosensory afferents. Musculoskeletal injury challenges the somatosensory system to reweight distorted sensory afferents. This investigation supplements kinetic analysis of eyes-open and eyes-closed single-limb stance tasks with a kinematic profile of lower limb postural orientation in an acute lateral ankle sprain group to assess the adaptive capacity of the sensorimotor system to injury. Sixty-six participants with first-time acute lateral ankle sprain completed a 20-second eyes-open single-limb stance task on their injured and non-injured limbs (task 1). Twenty-three of these participants successfully completed the same 20-second single-limb stance task with their eyes closed (task 2). A non-injured control group of 19 participants completed task 1, with 16 completing task 2. 3-dimensional kinematics of the hip, knee and ankle joints, as well as associated fractal dimension of the center-of-pressure path were determined for each limb during these tasks. Between trial analyses revealed significant differences in stance limb kinematics and fractal dimension of the center-of-pressure path for task 2 only. The control group bilaterally assumed a position of greater hip flexion compared to injured participants on their side-matched "involved"(7.41 [6.1°] vs 1.44 [4.8]°; η(2)=.34) and "uninvolved" (9.59 [8.5°] vs 2.16 [5.6°]; η(2)=.31) limbs, with a greater fractal dimension of the center-of-pressure path (involved limb=1.39 [0.16°] vs 1.25 [0.14°]; uninvolved limb=1.37 [0.21°] vs 1.23 [0.14°]). Bilateral impairment in postural control strategies present following a first time acute lateral ankle sprain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial

    Directory of Open Access Journals (Sweden)

    Guilherme S Nunes

    2015-01-01

    Full Text Available Question: Does Kinesio Taping reduce swelling in athletes who have suffered an acute, lateral ankle sprain? Design: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment. Participants: Thirty-six athletes who participated regularly in one of seven different sports modalities and suffered an acute ankle sprain. Intervention: The experimental group received Kinesio Taping application for 3 days, which was designed to treat swelling. The control group received an inert Kinesio Taping application. Outcome measures: For the comparison between groups, the swelling was measured via volumetry, perimetry, relative volumetry and two analyses of the difference in volume and perimetry between ankles of each participant. Data were collected immediately after the 3 days of intervention and at follow-up, which was 15 days post intervention. Results: At 3 days after intervention, there were no differences between groups for swelling in volumetry (MD –2 ml, 95% CI –28 to 32; perimetry (MD 0.2 cm, 95% CI –0.6 to 1.0; relative volumetry (MD 0.0 cm, 95% CI –0.1 to 0.1; and the other analyses. At day 15 follow-up, there were no significant between-group differences in outcomes. Conclusion: The application of Kinesio Taping, with the aim of stimulating the lymphatic system, is ineffective in decreasing acute swelling after an ankle sprain in athletes. Trial registration: Brazilian Registry of Clinical Trials, RBR-32sctf. [Nunes GS, Vargas VZ, Wageck B, dos Santos Hauphental DP, da Luz CM, de Noronha M (2015 Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial. Journal of Physiotherapy 61: 28–33

  6. Motor-neuron pool excitability of the lower leg muscles after acute lateral ankle sprain.

    Science.gov (United States)

    Klykken, Lindsey W; Pietrosimone, Brian G; Kim, Kyung-Min; Ingersoll, Christopher D; Hertel, Jay

    2011-01-01

    Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Case-control study. Laboratory. Ten individuals with acute ankle sprains (6 females, 4 males; age= 19.2 ± 3.8 years, height= 169.4 ± 8.5 cm, mass= 66.3 ± 11.6 kg) and 10 healthy individuals(6 females,4 males; age= 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass= 66.3 ± 10.2 kg) participated. The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (H(max)) and maximal muscle response (M(max)) and was then normalized using the H(max):M(max) ratio. The soleus MNPE in the ankle-sprain group was higher in the injured limb (H(max):M(max) = 0.63; 95% confidence interval [Cl],0.46, 0.80) than the uninjured limb (H(max):M(max) = 0.47; 95%Cl, 0.08, 0.93)(t(6) = 3.62,P =.01).In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (H(max):M(max) =0.06; 95% Cl, 0.01, 0.10) than in the uninjured ankle (H(max):M(max) =0.22; 95%Cl, 0.09, 0.35),but this finding was not different (t(9) =-2.01, P =.07). No differences were detected between injured (0.22; 95% Cl, 0.14, 0.29) and uninjured (0.25; 95%Cl, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t(9) =-0.739, P =.48). We found no side-to-side differences in any muscle among the healthy group. Facilitated MNPE was present in the involved soleus muscle of patients with acute

  7. Magnetic resonance imaging findings in patients with medial epicondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Kijowski, Richard; Smet, Arthur A. De [University of Wisconsin Hospital, Department of Radiology, Madison (United States)

    2005-04-01

    To compare the MR imaging findings of 13 patients with clinically diagnosed medial epicondylitis with the MR imaging findings of 26 patients of similar age with no clinical evidence of medial epicondylitis. The study group consisted of 13 patients with clinically diagnosed medial epicondylitis. The control group consisted of 26 patients of similar age with no clinical evidence of medial epicondylitis. The medical records and MR imaging findings of these patients were retrospectively reviewed by two fellowship-trained musculoskeletal radiologists. Eleven of the 13 patients in the study group had thickening and increased signal intensity of the common flexor tendon on both T1-weighted and T2-weighted images. The remaining two patients in the study group had soft tissue edema around a normal-appearing common flexor tendon. Twenty-one of the 26 patients in the control group had a normal-appearing common flexor tendon on MR imaging. Three patients in the control group had a thickened common flexor tendon which was of intermediate signal intensity on T1-weighted images but of uniform low signal intensity on T2-weighted images. Two patients in the control group had a thickened common flexor tendon which was of intermediate signal intensity on both T1-weighted and T2-weighted images. None of the patients in the control group had soft tissue edema around the common flexor tendon. MR imaging findings of patients with clinically diagnosed medial epicondylitis included thickening and increased T1 and T2 signal intensity of the common flexor tendon and soft tissue edema around the common flexor tendon. The presence of intermediate to high T2 signal intensity or high T2 signal intensity within the common flexor tendon and the presence of paratendinous soft tissue edema were the most specific findings of medial epicondylitis on MR imaging. (orig.)

  8. Manual Correction of an Acute Lumbar Lateral Shift: Maintenance of Correction and Rehabilitation: A Case Report with Video

    OpenAIRE

    Laslett, Mark

    2009-01-01

    The acute onset lumbar lateral shift, otherwise known as a list or acute scoliosis, is a common clinical observation associated with low back pain. In general orthopaedics, the presence of a lateral shift is associated with a poor prognosis; however, a manual correction method devised by McKenzie is claimed to produce rapid reversal of the deformity and reduction in pain. This single-case report presents the details of the McKenzie Mechanical Diagnosis and Treatment (MDT) management of a majo...

  9. Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection

    DEFF Research Database (Denmark)

    Geirsson, Arnar; Ahlsson, Anders; Franco-Cereceda, Anders

    2018-01-01

    and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival. CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year...... A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications...

  10. MR findings in humeral epicondylitis: A systematic review

    International Nuclear Information System (INIS)

    Pasternack, I.; Vehmas, T.; Malmivaara, A.; Tuovinen, E.M.; Lohman, M.

    2001-01-01

    Purpose: To highlight the importance of meta-analysis in diagnostic imaging by presenting a systematic search of the literature on the accuracy of MR imaging in epicondylitis. Material and Methods: The literature was comprehensively reviewed to identify studies on MR findings in epicondylitis. Reviewers blind to the clinical diagnoses screened the data according to predetermined inclusion criteria. Data were collected and validity and relevance were assessed on structured forms. Results: Seven studies including 148 patients with epicondylitis were accepted for the analysis. Eleven asymptomatic contralateral elbows and 29 elbows of healthy volunteers served as controls. The volunteers were distinctly younger than the patients. The MR technique was divergent, and the observed pathological changes also varied. The most frequent alteration was a change in the common extensor tendon signal (90%, 95% confidence interval 84-94%); 14% of the healthy volunteers and 50% of the contralateral elbows displayed the similar alteration. Conclusion: Small sample size and methodological shortcomings in the original studies make the assessment of MR findings in epicondylitis questionable. There is a need for well-designed studies in which clinical features and occupational backgrounds as well as imaging parameters are carefully documented

  11. MR findings in humeral epicondylitis: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Pasternack, I.; Vehmas, T.; Malmivaara, A. [Finnish Inst. of Occupational Health, Helsinki (Finland); Tuovinen, E.M. [Medivire Occupational Health Services (Finland); Lohman, M. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology

    2001-09-01

    Purpose: To highlight the importance of meta-analysis in diagnostic imaging by presenting a systematic search of the literature on the accuracy of MR imaging in epicondylitis. Material and Methods: The literature was comprehensively reviewed to identify studies on MR findings in epicondylitis. Reviewers blind to the clinical diagnoses screened the data according to predetermined inclusion criteria. Data were collected and validity and relevance were assessed on structured forms. Results: Seven studies including 148 patients with epicondylitis were accepted for the analysis. Eleven asymptomatic contralateral elbows and 29 elbows of healthy volunteers served as controls. The volunteers were distinctly younger than the patients. The MR technique was divergent, and the observed pathological changes also varied. The most frequent alteration was a change in the common extensor tendon signal (90%, 95% confidence interval 84-94%); 14% of the healthy volunteers and 50% of the contralateral elbows displayed the similar alteration. Conclusion: Small sample size and methodological shortcomings in the original studies make the assessment of MR findings in epicondylitis questionable. There is a need for well-designed studies in which clinical features and occupational backgrounds as well as imaging parameters are carefully documented.

  12. Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners.

    Science.gov (United States)

    Ziai, Pejman; Benca, Emir; Wenzel, Florian; Schuh, Reinhard; Krall, Christoph; Auffahrt, Alexander; Hofstetter, Martin; Windhager, Reinhard; Buchhorn, Tomas

    2016-04-01

    A painful episode in the region of the peroneal tendons, within the retromalleolar groove, is a common precipitating event of an acute lateral ankle sprain. A forefoot striking pattern is suspected to cause peroneal tendinosis. The aim of this study is to analyse the role of peroneal tendinosis as a predisposing factor for ankle sprain trauma in runners. Fifty-eight runners who had experienced acute ankle sprain trauma, with pre-existing pain episodes for up to 4 weeks in the region of the peroneal tendons, were assessed clinically. Fractures were excluded by conventional radiography. An magnetic resonance imaging (MRI) scan had been performed within 14 days after the traumatic event and was subsequently evaluated by two experienced radiologists. MRI revealed peroneal tendinosis in 55 patients (95% of the total study population). Peroneus brevis (PB) tendinosis was found in 48 patients (87% of all patients with peroneal tendinosis), and peroneus longus (PL) tendinosis was observed in 42 cases (76%). Thirty-five patients (64%) had combined PB and PL tendinosis. A lesion of the anterior talofibular ligament was found to be the most common ligament injury associated with peroneal tendinosis (29 cases; 53%), followed by a lesion of the calcaneofibular ligament (16 cases; 29%) and a lesion of the posterior tibiofibular ligament (13 cases; 24%). The results of this study reflect the correlation between peroneal tendinosis and ankle sprain trauma. Injuries of one or more ligaments are associated with further complications. A period of rest or forbearance of sports as well as adequate treatment of the peroneal tendinosis is essential to prevent subsequent ankle injuries, especially in runners. Modification of the running technique would also be beneficial. IV.

  13. Comparative study of acute lateral skin damage during radio wave and laser exposure

    Directory of Open Access Journals (Sweden)

    Dubensky V.V.

    2017-09-01

    Full Text Available The purpose was to study the depth and nature of the zones of thermal damage to the skin under radio wave and laser skin dissection during experiment. Material and Methods. The model of acute thermal damage was full-liner skin wounds of 20 nonlinear rats that were divided into 2 groups and operated by different methods. In the 1st group, the incisions were made by the apparatus of radio wave surgery (Surgitron DF S5, in the 2nd group the animals were operated with a laser surgical apparatus. The magnitude and structure of the lateral thermal damage was evaluated when analyzing the biopsy material. Results. During the study of experimental wounds, the extent of carbonation in the first group (operated with Surgitron DF S5 was 11.56±3.056 urn, coagulation necrosis 116.5±26.78 urn, and the hyper-thermiazone 148.42±60.171 urn. In the group of animals operated with a laser apparatus, the carbonization zone was 22.58±6.62 urn, the coagulation necrosis zone was 331.1±79.08 urn, and the hyperthermia extent was 376.2±53.27 urn. Conclusion. A comparative study of lateral skin damage in radio wave and laser skin dissection revealed a deeper thermal change in the skin and an increase in the extent of thermally altered structures under laser action: the carbonization zone was larger than for radio waves by 11.02 urn, coagulation necrosis by 214.6 urn, and the hyperthermia zone by 227.78 urn.

  14. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults

    NARCIS (Netherlands)

    Kerkhoffs, G. M. M. J.; Handoll, H. H. G.; de Bie, R.; Rowe, B. H.; Struijs, P. A. A.

    2002-01-01

    BACKGROUND: Inversion injuries, primarily sprains, of the ankle are one of the most commonly treated injuries. The three main treatment modalities for acute lateral ankle ligament injuries are immobilisation with plaster cast or splint, 'functional treatment' comprising early mobilisation and the

  15. MR imaging in chronic epicondylitis humeri radialis at 1.0 T: is Gd-DTPA administration useful?; MRT bei chronischer Epicondylitis humeri radialis an einem 1,0 T-Geraet - Kontrastmittelgabe notwendig?

    Energy Technology Data Exchange (ETDEWEB)

    Herber, S.; Kalden, P.; Kreitner, K.-F.; Thelen, M. [Tuebingen Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Riedel, C.; Rompe, J.D. [Klinik und Poliklinik fuer Orthopaedie Johannes-Gutenberg-Univ. Mainz (Germany)

    2001-05-01

    Purpose: Evaluation of the diagnostic value and confidence of contrast-enhanced MR imaging in patients with lateral epicondylitis in comparison to clinical diagnosis. Material and Methods: 42 consecutive patients with clinically proven chronic lateral epicondylitis and 10 ellbow joints of healthy controls have been examined on a 1.0 T MR-unit. Criteria for inclusion in the prospective study were: persistant pain and a failed conservative therapy. The MR protocol included STIR sequence, a native, T{sub 2}-weighted, fat-supressed TSE sequence, and a flash-2-D sequence. Also, fat-supressed, T{sub 1}-weighted SE sequences before and after administration of Gd-DTPA contrast media have been recovded. Results: In 39/42 patients the STIR sequence showed an increased SI of the common extensor tendom. Increased MR signal of the lateral collateral ligament combined with a thickening and a partial rupture or a full thickness tear have been observed in 15/42 cases. A bone marrow edema at the lateral epicondylus was noticed in 6 of the studied patients and a joint effusion in 18/42 patients. After administration of contrast media we noticed an average increase of SI by about 150%. However, enhanced MR imaging did not provide additional information. Conclusion: In MR imaging of chronic epicondylitis administration of gadolinium-DTPA does not provide additional information. (orig.) [German] Zielsetzung: Evaluation der Wertigkeit der Gadolinium-DTPA-Gabe in der MR-Diagnostik der chronischen Epicondylitis humeri radialis im Vergleich zur klinischen Befunderhebung. Material und Methoden: 42 konsekutive Patienten mit einer klinisch diagnostizierten chronischen Epicondylitis humeri radialis sowie 10 Ellenbogengelenke bei 5 Probanden wurden bei 1,0 T prospektiv untersucht. Einschlusskriterium war eine persistierende Schmerzsymptomatik ueber mehr als ein halbes Jahr. Das MR-Protokoll beinhaltete neben einer STIR-Sequenz eine native T{sub 2}-gewichtete TSE-Sequenz mit Fettsupression sowie

  16. Electrocardiographic changes of acute lateral wall myocardial infarction: a reappraisal based on scintigraphic localization of the infarct

    International Nuclear Information System (INIS)

    Movahed, A.; Becker, L.C.

    1984-01-01

    To determine how often acute lateral myocardial infarcts may be electrocardiographically silent, a new approach was utilized in which subjects were selected by admission thallium scintigraphy. Thirty-one patients with their first infarction were identified with moderate to severe perfusion defects of the lateral and posterolateral walls, persistent over 7 days and associated with severe wall motion abnormalities. Patients with involvement of the anterior, septal or inferior regions were not included. In nine patients, the perfusion defect extended to the anterolateral wall: all developed ST elevation and Q waves in at least one of the lateral leads (I, aVL or V6) but none showed changes in the inferior leads (II, III or aVF). In the other 22 patients, the perfusion defect was limited to the lateral and posterolateral walls: only 12 showed ST elevations (inferior leads only in 7, lateral leads only in 2, both leads in 3) and only 9 developed Q waves (inferior in all). In 8 of these 22 patients, the infarct was silent in the sense that no ST segment elevation or Q waves were seen, although ST depressions or T wave inversions, or both, in all but one patient were compatible with subendocardial infarction. The results indicate that the standard electrocardiogram is insensitive to changes in the lateral and posterolateral regions. Additional diagnostic studies are needed for proper localization and sizing of acute myocardial infarcts

  17. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  18. Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases.

    Science.gov (United States)

    Dodds, Seth D; Flanagin, Brody A; Bohl, Daniel D; DeLuca, Peter A; Smith, Brian G

    2014-09-01

    To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle. We conducted a retrospective case review of 11 consecutive children and adolescents with an incarcerated medial epicondyle fracture after elbow dislocation. All patients underwent open reduction internal fixation using a similar technique. We characterized outcomes at final follow-up. Average follow-up was 14 months (range, 4-56 mo). All patients had clinical and radiographic signs of healing at final follow-up. There was no radiographic evidence of loss of reduction at intervals or at final follow-up. There were no cases of residual deformity or valgus instability. Average final arc of elbow motion was 4° to 140°. All patients had forearm rotation from 90° supination to 90° pronation. Average Mayo elbow score was 99.5. Four of 11 patients had ulnar nerve symptoms postoperatively and 1 required a second operation for ulnar nerve symptoms. In addition, 1 required a second operation for flexion contracture release with excision of heterotopic ossification. Three patients had ulnar nerve symptoms at final follow-up. Two of these had mild paresthesia only and 1 had both mild paresthesia and weakness. Our results suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation leads to satisfactory motion and function; however, the injury carries a high risk for complications, particularly ulnar neuropathy. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Inter-joint coordination strategies during unilateral stance following first-time, acute lateral ankle sprain: A brief report.

    Science.gov (United States)

    Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Delahunt, Eamonn

    2015-07-01

    This investigation combined measures of inter-joint coordination and stabilometry to evaluate eyes-open (condition 1) and eyes-closed (condition 2) static unilateral stance performance in a group of participants with an acute, first-time lateral ankle sprain injury in comparison to a control group. Sixty-six participants with an acute first-time lateral ankle sprain and 19 non-injured controls completed three 20-second unilateral stance task trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb 3-D kinematic data for similarity in the aim of establishing patterns of inter-joint coordination for these groups. Between-group analyses revealed significant differences in stance limb inter-joint coordination strategies for conditions 1 and 2. Injured participants displayed increases in ankle-hip linked coordination compared to controls in condition 1 (sagittal/frontal plane: 0.12 [0.09] vs 0.06 [0.04]; η(2)=.16) and condition 2 (sagittal/frontal plane: 0.18 [0.13] vs 0.08 [0.06]; η(2)=0.37). Participants with acute first-time lateral ankle sprain exhibit a hip-dominant coordination strategy for static unilateral stance compared to non-injured controls. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. [Design of a multicenter study for assessing the effectiveness of extracorporeal shockwave therapy in epicondylitis humeri radialis].

    Science.gov (United States)

    Haake, M; Jensen, K; Prinz, H; Willenberg, T

    2000-01-01

    Previously published studies concerning, extracorporeal shock-wave therapy (ESWT) in the treatment of lateral epicondylitis do not fulfil the biometric standards of modern clinical research. The objective of the trial is to show that ESWT is effective in the treatment of chronic LE. A prospective, randomized, placebo-controlled, single-blinded, multicenter trial with an independent blinded observer was designed. The effectiveness of ESWT is evaluated by comparison with a control group in which sham-ESWT is performed, both under local anaesthesia. Outcome is determined on the basis of the Roles/Maudsley-Score. Inclusion criteria are a history of at least 6 months of LE and failure of conventional treatment. The therapy includes 3 sessions of low energy ESWT with 2000 impulses (energy flux density 0.07-0.09 mJ/mm2). Sample size is 272 patients. Randomisation started in October 1998 and is planned over a period of two and a half years. Only a randomised clinical trial with adequate control of placebo effects and observer bias can provide the required evidence for the efficiency of ESWT in the treatment of lateral epicondylitis of the elbow.

  1. Como o ortopedista brasileiro trata entorse lateral aguda do tornozelo? How does the brazilian orthopedic surgeon treat acute lateral ankle sprain?

    Directory of Open Access Journals (Sweden)

    Paulo Santoro Belangero

    2010-01-01

    Full Text Available OBJETIVO: A entorse lateral aguda do tornozelo (ELAT é uma afecção frequente cujo tratamento ainda não se encontra totalmente estabelecido. O objetivo do estudo foi verificar a conduta do médico ortopedista brasileiro (incluindo residentes em relação ao diagnóstico, classificação, tratamento e complicações da entorse lateral aguda do tornozelo (ELAT. MÉTODOS: Um questionário de múltipla escolha foi elaborado com objetivo de abordar os principais aspectos do tratamento da ELAT. O questionário foi veiculado na página eletrônica oficial da Sociedade Brasileira de Ortopedia e Traumatologia, no período de 15 de junho a 1º de agosto de 2004. RESULTADOS: Foram incluídos para análise um total de 444 questionários. Os resultados demonstraram concordância da maioria dos entrevistados em relação aos seguintes aspectos: 90,8% utilizam alguma classificação para nortear o tratamento da entorse; 59% classificam a ELAT com segurança; 63,7% utilizam imobilização rígida nas lesões ligamentares completas; 60,6% utilizam medicação anti-inflamatória na ruptura ligamentar parcial; 75,9% relataram que a dor residual é a complicação mais frequente. Não houve consenso quanto ao método de imobilização da ELAT parcial visto que imobilização e tratamento funcional foram escolhidos com a mesma frequência (47%. Não houve diferenças significativas entre as respostas dos residentes e a dos ortopedistas (p = 0,81. CONCLUSÕES: Os ortopedistas e residentes em ortopedia do Brasil têm dificuldade em classificar a ELAT e não há consenso quanto à melhor opção para a ELAT parcial.OBJECTIVE: Acute lateral ankle sprain (ALAS is one of the most common injuries, the treatment of which has yet to be firmly established. The purpose of this study was to determine the Brazilian Orthopaedic Surgeon's behavior in relation to diagnosis, classification, treatment and complications of the Acute Lateral Ankle Sprain. METHODS: A multiple choice

  2. Lower extremity function during gait in participants with first time acute lateral ankle sprain compared to controls.

    Science.gov (United States)

    Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

    2015-02-01

    Laboratory analyses of chronic ankle instability populations during gait have elucidated a number of anomalous movement patterns. No current research exists analysing these movement patterns in a group in the acute phase of lateral ankle sprain (LAS) injury. It is possible that participants with an acute LAS display movement patterns continuous with their chronically impaired counterparts. Sixty eight participants with acute LAS and nineteen non-injured participants completed five gait trials. 3D lower extremity temporal kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). During period 1, the LAS group displayed increased knee flexion with increased net extensor pattern at the knee joint, increased ankle inversion with a greater inversion moment, and reduced ankle plantar flexion, compared to the non-injured control group. During period 2, the LAS group displayed decreased hip extension with a decrease in the flexor moment at the hip, and decreased ankle plantar flexion with a decrease in the net plantar flexion moment, compared to the non-injured control group. These results indicate that participants with acute LAS display coordination strategies which may play a role in the onset of chronicity or recovery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Neuronal apoptosis and neurofilament protein expression in the lateral geniculate body of cats following acute optic nerve injuries

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: The visual pathway have 6 parts, involving optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation and cortical striatum area. Corresponding changes may be found in these 6 parts following optic nerve injury. At present, studies mainly focus on optic nerve and retina, but studies on lateral geniculate body are few.OBJECTIVE: To prepare models of acute optic nerve injury for observing the changes of neurons in lateral geniculate body, expression of neurofilament protein at different time after injury and cell apoptosis under the optical microscope, and for investigating the changes of neurons in lateral geniculate body following acute optic nerve injury.DESIGN: Completely randomized grouping design, controlled animal experiment.SETTING: Department of Neurosurgery, General Hospital of Ji'nan Military Area Command of Chinese PLA.MATERIALS: Twenty-eight adult healthy cats of either gender and common grade, weighing from 2.0 to 3.5 kg, were provided by the Animal Experimental Center of Fudan University. The involved cats were divided into 2 groups according to table of random digit: normal control group (n =3) and model group (n =25). Injury 6 hours, 1, 3, 7 and 14 days five time points were set in model group for later observation, 5 cats at each time point. TUNEL kit (Bohringer-Mannheim company)and NF200& Mr 68 000 mouse monoclonal antibody (NeoMarkers Company) were used in this experiment.METHODS: This experiment was carried out in the Department of Neurosurgery, General Hospital of Ji'nan Military Area Command of Chinese PLA between June 2004 and June 2005. ① The cats of model group were developed into cat models of acute intracranial optic nerve injury as follows: The anesthetized cats were placed in lateral position. By imitating operation to human, pterion approach was used. An incision was made at the joint line between outer canthus and tragus, and deepened along cranial base until white optic nerve via optic nerve pore

  4. Kinematics of the lateral ligamentous constraints of the elbow joint

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Søjbjerg, Jens Ole; Dalstra, Michel

    1996-01-01

    preventer of elbow joint laxity. The LCLC was observed to be a complex structure of ligamentous fibers rather than discreet bands. The LCLC forms a ligamentous constraint between the lateral humeral epicondyle and the ulna, stabilizing the elbow joint and forming a base for radial head stability...

  5. Acute respiratory distress syndrome 40 years later: time to revisit its definition.

    Science.gov (United States)

    Phua, Jason; Stewart, Thomas E; Ferguson, Niall D

    2008-10-01

    Acute respiratory distress syndrome is a common disorder associated with significant mortality and morbidity. The aim of this article is to critically evaluate the definition of acute respiratory distress syndrome and examine the impact the definition has on clinical practice and research. Articles from a MEDLINE search (1950 to August 2007) using the Medical Subject Heading respiratory distress syndrome, adult, diagnosis, limited to the English language and human subjects, their relevant bibliographies, and personal collections, were reviewed. The definition of acute respiratory distress syndrome is important to researchers, clinicians, and administrators alike. It has evolved significantly over the last 40 years, culminating in the American-European Consensus Conference definition, which was published in 1994. Although the American-European Consensus Conference definition is widely used, it has some important limitations that may impact on the conduct of clinical research, on resource allocation, and ultimately on the bedside management of such patients. These limitations stem partially from the fact that as defined, acute respiratory distress syndrome is a heterogeneous entity and also involve the reliability and validity of the criteria used in the definition. This article critically evaluates the American-European Consensus Conference definition and its limitations. Importantly, it highlights how these limitations may contribute to clinical trials that have failed to detect a potential true treatment effect. Finally, recommendations are made that could be considered in future definition modifications with an emphasis on the significance of accurately identifying the target population in future trials and subsequently in clinical care. How acute respiratory distress syndrome is defined has a significant impact on the results of randomized, controlled trials and epidemiologic studies. Changes to the current American-European Consensus Conference definition are

  6. Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Moshe Y. Flugelman

    2016-01-01

    Full Text Available Acute occlusion of left main coronary artery is a catastrophic event. We describe two patients with acute occlusion of the left main coronary artery treated thirty years apart. The first patient was treated in 1982 and survived the event without revascularization but developed severe heart failure. His survival was so unusual that it merited a case report at that time. The second patient was treated at the end of 2015. Early revascularization resulted in myocardial reperfusion and near normal left ventricular function. These patients exemplify the progress in therapeutic cardiology over the last 30 years.

  7. Overweight or obese BMI is associated with earlier, but not later survival after common acute illnesses.

    Science.gov (United States)

    Prescott, Hallie C; Chang, Virginia W

    2018-02-06

    Obesity has been associated with improved short-term mortality following common acute illness, but its relationship with longer-term mortality is unknown. Observational study of U.S. Health and Retirement Study (HRS) participants with federal health insurance (fee-for-service Medicare) coverage, hospitalized with congestive heart failure (N = 4287), pneumonia (N = 4182), or acute myocardial infarction (N = 2001), 1996-2012. Using cox proportional hazards models, we examined the association between overweight or obese BMI (BMI ≥ 25.0 kg/m 2 ) and mortality to 5 years after hospital admission, adjusted for potential confounders measured at the same time as BMI, including age, race, sex, education, partnership status, income, wealth, and smoking status. Body mass index (BMI) was calculated from self-reported height and weight collected at the HRS survey prior to hospitalization (a median 1.1 year prior to hospitalization). The referent group was patients with a normal BMI (18.5 to BMI was associated with lower mortality at 1 year after hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction-with adjusted hazard ratios of 0.68 (95% CI 0.59-0.79), 0.74 (95% CI: 0.64-0.84), and 0.65 (95%CI: 0.53-0.80), respectively. Among participants who lived to one year, however, subsequent survival was similar between patients with normal versus overweight/obese BMI. In older Americans, overweight or obese BMI was associated with improved survival following hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction. This association, however, is limited to the shorter-term. Conditional on surviving to one year, we did not observe a survival advantage associated with excess weight.

  8. Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

    Science.gov (United States)

    Kemler, Ellen; Thijs, Karin M; Badenbroek, Ilse; van de Port, Ingrid G L; Hoes, Arno W; Backx, Frank J G

    2016-12-01

    Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. Retrospective cohort study. Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. Functional treatment of the initial ALALS. Acute lateral ankle ligamentous sprain recurrences and residual symptoms. A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

    Directory of Open Access Journals (Sweden)

    Tiren Davut

    2012-01-01

    Full Text Available Abstract Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%. Nine patients (32% developed impingement symptoms and in 7 patients (25% subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14% developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11% had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.

  10. Arthroscopic treatment for chronic lateral epicondylitis☆

    Science.gov (United States)

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

    2015-01-01

    Objective To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Methods Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. Results A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p  0.05). Conclusion Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure. PMID:26401498

  11. Single-leg drop landing movement strategies 6 months following first-time acute lateral ankle sprain injury.

    Science.gov (United States)

    Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

    2015-12-01

    No research exists predicating a link between acute ankle sprain injury-affiliated movement patterns and those of chronic ankle instability (CAI) populations. The aim of the current study was to perform a biomechanical analysis of participants, 6 months after they sustained a first-time acute lateral ankle sprain (LAS) injury to establish this link. Fifty-seven participants with a 6-month history of first-time LAS and 20 noninjured participants completed a single-leg drop landing task on both limbs. Three-dimensional kinematic (angular displacement) and sagittal plane kinetic (moment of force) data were acquired for the joints of the lower extremity, from 200 ms pre-initial contact (IC) to 200 ms post-IC. Individual joint stiffnesses and the peak magnitude of the vertical component of the ground reaction force (GRF) were also computed. LAS participants displayed increases in hip flexion and ankle inversion on their injured limb (P < 0.05); this coincided with a reduction in the net flexion-extension moment at the hip joint, with an increase in its stiffness (P < 0.05). There was no difference in the magnitude of the peak vertical GRF for either limb compared with controls. These results demonstrate that altered movement strategies persist in participants, 6 months following acute LAS, which may precipitate the onset of CAI. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Maternal deprivation affects the neuromuscular protein profile of the rat colon in response to an acute stressor later in life.

    Science.gov (United States)

    Lopes, Luísa V; Marvin-Guy, Laure F; Fuerholz, Andreas; Affolter, Michael; Ramadan, Ziad; Kussmann, Martin; Fay, Laurent B; Bergonzelli, Gabriela E

    2008-04-30

    Early life stress as neonatal maternal deprivation (MD) predisposes rats to alter gut functions in response to acute psychological stressors in adulthood, mimicking features of irritable bowel syndrome (IBS). We applied proteomics to investigate whether MD permanently changes the protein profile of the external colonic neuromuscular layer that may condition the molecular response to an acute stressor later in life. Male rat pups were separated 3 h/day from their mothers during the perinatal period and further submitted to water avoidance (WA) stress during adulthood. Proteins were extracted from the myenteric plexus-longitudinal muscle of control (C), WA and MD+WA rat colon, separated on 2D gels, and identified by mass spectrometry. MD amplified the WA-induced protein changes involved in muscle contractile function, suggesting that stress accumulation along life imbalances the muscle tone towards hypercontractility. Our results also propose a stress dependent regulation of gluconeogenesis. Secretogranin II - the secretoneurin precursor - was induced by MD. The presence of secretoneurin in myenteric ganglia may partially explain the stress-mediated modulation of gastrointestinal motility and/or mucosal inflammation previously described in MD rats. In conclusion, our findings suggest that neonatal stress alters the responses to acute stress in adulthood in intestinal smooth muscle and enteric neurons.

  13. Acute Effects of Lateral Thigh Foam Rolling on Arterial Tissue Perfusion Determined by Spectral Doppler and Power Doppler Ultrasound.

    Science.gov (United States)

    Hotfiel, Thilo; Swoboda, Bernd; Krinner, Sebastian; Grim, Casper; Engelhardt, Martin; Uder, Michael; Heiss, Rafael U

    2017-04-01

    Hotfiel, T, Swoboda, B, Krinner, S, Grim, C, Engelhardt, M, Uder, M, and Heiss, R. Acute effects of lateral thigh foam rolling on arterial tissue perfusion determined by spectral Doppler and power Doppler ultrasound. J Strength Cond Res 31(4): 893-900, 2017-Foam rolling has been developed as a popular intervention in training and rehabilitation. However, evidence on its effects on the cellular and physiological level is lacking. The aim of this study was to assess the effect of foam rolling on arterial blood flow of the lateral thigh. Twenty-one healthy participants (age, 25 ± 2 years; height, 177 ± 9 cm; body weight, 74 ± 9 kg) were recruited from the medical and sports faculty. Arterial tissue perfusion was determined by spectral Doppler and power Doppler ultrasound, represented as peak flow (Vmax), time average velocity maximum (TAMx), time average velocity mean (TAMn), and resistive index (RI), and with semiquantitative grading that was assessed by 4 blindfolded investigators. Measurement values were assessed under resting conditions and twice after foam rolling exercises of the lateral thigh (0 and 30 minutes after intervention). The trochanteric region, mid portion, and distal tibial insertion of the lateral thigh were representative for data analysis. Arterial blood flow of the lateral thigh increased significantly after foam rolling exercises compared with baseline (p ≤ 0.05). We detected a relative increase in Vmax of 73.6% (0 minutes) and 52.7% (30 minutes) (p power Doppler scores at all portions revealed increased average grading of 1.96 after intervention and 2.04 after 30 minutes compared with 0.75 at baseline. Our results may contribute to the understanding of local physiological reactions to self-myofascial release.

  14. Results of radiotherapy with different doses in epicondylitis humeri. Ergebnisse der Strahlentherapie der Epicondylitis humeri bei unterschiedlicher Dosierung

    Energy Technology Data Exchange (ETDEWEB)

    Kammerer, R.; Bollmann, G.; Schwenger, P.; Michael, G.; Koeppen, D. (Klinik fuer Radiologie, Medizinische Akademie Magdeburg (Germany))

    1990-01-01

    In a prospective analysis the effectiveness of roentgen irradiation with minimal doses (daily single dosis 0.3Gy up to a total dose of 1.5Gy) was investigated in 207 patients with an epicondylitis humeri. Compared with a group of 92 patients, who were irradiated with higher doses beeing in general use (weekly 2 x single dosis 1.0 Gy to a total dose of 4.0 Gy), the therapeutic results show no sihnificant differences. After termination of the first irradiation series an improvement of complaints was seen in half of the patients (48.8% or 50.0%). A further increase of the quota in success to 74.9% or 70.6% was found 6 weeks after termination or irradiation. By reason of radiotherapeutic results, mainly attained in chronic states of epicondylitis humeri after primary conservative therapy without success for months and partly surgical pretreatment, the radiotherapy should be used more frequently than till now, especially in consideration of its slight side-effects and injuries of patients. (orig.).

  15. Reliability of internal oblique elbow radiographs for measuring displacement of medial epicondyle humerus fractures: a cadaveric study.

    Science.gov (United States)

    Gottschalk, Hilton P; Bastrom, Tracey P; Edmonds, Eric W

    2013-01-01

    Standard elbow radiographs (AP and lateral views) are not accurate enough to measure true displacement of medial epicondyle fractures of the humerus. The amount of perceived displacement has been used to determine treatment options. This study assesses the utility of internal oblique radiographs for measurement of true displacement in these fractures. A medial epicondyle fracture was created in a cadaveric specimen. Displacement of the fragment (mm) was set at 5, 10, and 15 in line with the vector of the flexor pronator mass. The fragment was sutured temporarily in place. Radiographs were obtained at 0 (AP), 15, 30, 45, 60, 75, and 90 degrees (lateral) of internal rotation, with the elbow in set positions of flexion. This was done with and without radio-opaque markers placed on the fragment and fracture bed. The 45 and 60 degrees internal oblique radiographs were then presented to 5 separate reviewers (of different levels of training) to evaluate intraobserver and interobserver agreement. Change in elbow position did not affect the perceived displacement (P=0.82) with excellent intraobserver reliability (intraclass correlation coefficient range, 0.979 to 0.988) and interobserver agreement of 0.953. The intraclass correlation coefficient for intraobserver reliability on 45 degrees internal oblique films for all groups ranged from 0.985 to 0.998, with interobserver agreement of 0.953. For predicting displacement, the observers were 60% accurate in predicting the true displacement on the 45 degrees internal oblique films and only 35% accurate using the 60 degrees internal oblique view. Standardizing to a 45 degrees internal oblique radiograph of the elbow (regardless of elbow flexion) can augment the treating surgeon's ability to determine true displacement. At this degree of rotation, the measured number can be multiplied by 1.4 to better estimate displacement. The addition of a 45 degrees internal oblique radiograph in medial humeral epicondyle fractures has good

  16. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-Ying; Ding, Hong-Yu [Shandong University, Department of Ultrasonography, Qianfoshan Hospital, Jinan (China); Zheng, Lei; Sun, Bai-Sheng [Chinese People' s Armed Police Force, Department of Radiology, Shandong Provincial Corps Hospital, Jinan (China); Li, En-Miao [Jinan Third People' s Hospital, Department of Ultrasonography, Jinan (China); Shi, Hao [Shandong University, Department of Radiology, Qianfoshan Hospital, Jinan (China)

    2015-01-15

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. (orig.)

  17. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

    International Nuclear Information System (INIS)

    Zhang, Guang-Ying; Ding, Hong-Yu; Zheng, Lei; Sun, Bai-Sheng; Li, En-Miao; Shi, Hao

    2015-01-01

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. (orig.)

  18. Laboratory Measures of Postural Control During the Star Excursion Balance Test After Acute First-Time Lateral Ankle Sprain

    Science.gov (United States)

    Doherty, Cailbhe; Bleakley, Chris M.; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

    2015-01-01

    Context No researchers, to our knowledge, have investigated the immediate postinjury-movement strategies associated with acute first-time lateral ankle sprain (LAS) as quantified by center of pressure (COP) and kinematic analyses during performance of the Star Excursion Balance Test (SEBT). Objective To analyze the kinematic and COP patterns of a group with acute first-time LAS and a noninjured control group during performance of the SEBT. Design Case-control study. Setting University biomechanics laboratory. Patients or Other Participants A total of 81 participants with acute first-time LAS (53 men, 28 women; age = 23.22 ± 4.93 years, height = 1.73 ± 0.09 m, mass = 75.72 ± 13.86 kg) and 19 noninjured controls (15 men, 4 women; age = 22.53 ± 1.68 years, height = 1.74 ± 0.08 m, mass = 71.55 ± 11.31 kg). Intervention Participants performed the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the SEBT. Main Outcome Measure(s) We assessed 3-dimensional kinematics of the lower extremity joints and associated fractal dimension (FD) of the COP path during performance of the SEBT. Results The LAS group had decreased normalized reach distances in the ANT, PL, and PM directions when compared with the control group on their injured (ANT: 58.16% ± 6.86% versus 64.86% ± 5.99%; PL: 85.64% ± 10.62% versus 101.14% ± 8.39%; PM: 94.89% ± 9.26% versus 107.29 ± 6.02%) and noninjured (ANT: 60.98% ± 6.74% versus 64.76% ± 5.02%; PL: 88.95% ± 11.45% versus 102.36% ± 8.53%; PM: 97.13% ± 8.76% versus 106.62% ± 5.78%) limbs (P postural control, as evidenced by the bilateral reduction in angular displacement of the lower extremity joints and reduced reach distances and FD of the COP path on the injured limb during performance of the SEBT. PMID:25811845

  19. Fracture of an unossified humeral medial epicondyle: use of magnetic resonance imaging for diagnosis

    International Nuclear Information System (INIS)

    Tanabe, Katsuhisa; Miyamoto, Nao

    2016-01-01

    Fracture of the humeral medial epicondyle is a relatively common injury in children. Surgery is a good option for treatment, but correct diagnosis is important. Most fractures occur after the ossification of the medial epicondylar apophysis. If a fracture occurs before the ossification of the medial epicondyle, it is undetectable by radiographs. Here we report a case of an unossified medial epicondyle fracture of the humerus. A 9-year-old boy had persistent pain in the medial side of the right elbow after a fall. Despite his pain, he could move his injured elbow with a range from 60 to 90 . Radiographs and computed tomography showed neither fracture nor dislocation in the injured elbow, and soft tissue swelling was the only finding. Neither the trochlea nor the medial epicondyle was ossified. Magnetic resonance imaging showed that the medial epicondyle was separated from the medial metaphysis and displaced. This clear finding led us to surgical fixation. Under general anesthesia, valgus stress showed gross instability of the injured elbow. Two years after the operation, he had no complaints and could play sports with the same range of motion as the left elbow. It is important to keep in mind that medial epicondylar fractures may be hidden in a normal radiograph before the ossification of the medial epicondylar apophysis. (orig.)

  20. Fracture of an unossified humeral medial epicondyle: use of magnetic resonance imaging for diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, Katsuhisa; Miyamoto, Nao [Nishinomiya Municipal Central Hospital, Department of Orthopaedic Surgery, Nishinomiya (Japan)

    2016-10-15

    Fracture of the humeral medial epicondyle is a relatively common injury in children. Surgery is a good option for treatment, but correct diagnosis is important. Most fractures occur after the ossification of the medial epicondylar apophysis. If a fracture occurs before the ossification of the medial epicondyle, it is undetectable by radiographs. Here we report a case of an unossified medial epicondyle fracture of the humerus. A 9-year-old boy had persistent pain in the medial side of the right elbow after a fall. Despite his pain, he could move his injured elbow with a range from 60 to 90 . Radiographs and computed tomography showed neither fracture nor dislocation in the injured elbow, and soft tissue swelling was the only finding. Neither the trochlea nor the medial epicondyle was ossified. Magnetic resonance imaging showed that the medial epicondyle was separated from the medial metaphysis and displaced. This clear finding led us to surgical fixation. Under general anesthesia, valgus stress showed gross instability of the injured elbow. Two years after the operation, he had no complaints and could play sports with the same range of motion as the left elbow. It is important to keep in mind that medial epicondylar fractures may be hidden in a normal radiograph before the ossification of the medial epicondylar apophysis. (orig.)

  1. Extreme lateral approach in a case of acute-onset quadriplegia due to high cervical neurenteric cyst.

    Science.gov (United States)

    Abhishek, Agrawal; Anushree, Agrawal; Patir, Rana; Sehgal, A D

    2007-01-01

    Spinal neurenteric cysts are very rare intradural developmental lesions, predominantly localized anterior to the cervical cord and arising from misplaced endodermal cells in the 3rd week of embryonic life. An acute onset of symptoms can occur due to hemorrhage, but has not as yet been reported in relation to infection in the cyst. We report an 18-year-old male who presented with a rapid onset of respiratory distress and quadriplegia over a period of 6 h requiring intubation and ventilatory support. There was no respiratory effort with a dense sensory level from the neck. MRI of the cervical spine revealed an intradural extramedullary ventrally located cystic lesion at the C(2-3) level. There was no evidence of systemic infection elsewhere in the body. The lesion was radically excised using an extreme lateral approach as it provided excellent visualization of the cyst, thus permitting safe dissection without retraction of the cord. The cyst was tense and the contents turbid, thick, creamy and mucinous without any evidence of fresh or altered blood. Histopathological examination confirmed the cyst to be a neurenteric cyst. The cystic fluid, which was sent for culture, grew coagulase-negative Staphylococcus aureus. This is the first documented case of rapid neurological deterioration due to infection in a neurenteric cyst. In spite of an early effective surgical management, outcome was poor due to the rapid and profound neurological deficit. Copyright (c) 2007 S. Karger AG, Basel.

  2. The correlation between dysphagia and involvement of the ambiguous nucleus on MRI in acute-phase lateral medullary syndrome

    International Nuclear Information System (INIS)

    Kurono, Hiroko; Uesaka, Yoshikazu; Kunimoto, Masanari; Imafuku, Ichirou

    2006-01-01

    In this study, the clinical features and MRI findings of 21 patients admitted for acute lateral medullary syndrome, including 10 patients with dysphagia, were examined. According to Cytoarchitecture of the Human Brain Stem (Olszewski, J and Baxter, D), MRI-identified lesions were classified into four groups based on their location (upper, middle-upper, middle-lower, and lower parts of the medulla oblongata). We also examined whether each lesion involved the ambiguous nucleus (AN). We then studied the correlation between dysphagia and involvement of the AN. Ten patients had dysphagia, which improved very quickly in all but one. In the horizontal plane, lesions of all patients with dysphagia exhibited AN involvement, suggesting that dysphagia is strongly correlated with AN involvement. Among the 8 patients with lesions in the upper part of the medulla oblongata, the lesions of 7 patients included the AN, and 6 of those 7 patients had dysphagia. Among the 5 patients with lesions in the middle-upper part of the medulla oblongata, the lesions of two contained the AN, and one of those two patients had dysphagia. Among the 6 patients with lesions in the middle-lower part of the medulla oblongata, all lesions contained the AN, but only 3 of the patients exhibited dysphagia. In both patients who had lesions in the lower part of the medulla oblongata, the lesions did not include the AN and neither patient had dysphagia. Patients who had lesions involving the AN in the rostral part of the medulla oblongata were more likely to have dysphagia than the other patients. On the other hand, half of the patients with lesions involving the AN in the middle-lower part of the medulla oblongata did not have dysphagia. This might suggest that the caudal part of the AN has little involvement in the mechanisms of dysphagia. (author)

  3. Osteosynthesis of medial humeral epicondyle fractures in children. 8-year follow-up of 33 cases

    DEFF Research Database (Denmark)

    Duun, P S; Ravn, Pernille; Hansen, L B

    1994-01-01

    33 children with a mean age of 12 (7-15) years had open reduction and osteosynthesis for a displaced fracture of the medial humeral epicondyle. 8 (2-15) years after the operation a clinical and radiographic examination was performed. 22/33 had a prominent scar. No patients had symptoms from...

  4. Three-phase scintigraphy in epicondylitis of the lateral lower humerus

    Energy Technology Data Exchange (ETDEWEB)

    Koppers, B.; Riel, K.

    1982-08-01

    Ten patients with tennis elbow were examined by three-phase scintigraphy, using sup(99m)Tc-MDP. In agreement with the histological findings of H. Schneider (14), there was no uptake during the perfusion and soft tissue phase. In the phase, there was focal bone uptake in one patient only.

  5. Three-phase scintigraphy in epicondylitis of the lateral lower humerus

    International Nuclear Information System (INIS)

    Koppers, B.; Riel, K.; Technische Univ. Muenchen

    1982-01-01

    Ten patients with tennis elbow were examined by three-phase scintigraphy, using sup(99m)Tc-MDP. In agreement with the histological findings of H. Schneider (14), there was no uptake during the perfusion and soft tissue phase. In the phase, there was focal bone uptake in one patient only. (orig.) [de

  6. Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study

    DEFF Research Database (Denmark)

    Haahr, J. P.; Andersen, JH

    2003-01-01

    : Manual job tasks were associated with tennis elbow (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.9 to 5.1). The self reported physical risk factors "posture" and "forceful work" were related to tennis elbow. Among women, work involving performing repeated movements of the arms was related...... index was established based on posture, repetition, and force. The adjusted ORs for tennis elbow at low, medium, and high strain were 1.4 (CI 0.8 to 2.7), 2.0 (CI 1.1 to 3.7), and 4.4 (CI 2.3 to 8.7). Low social support at work, adjusted for physical strain, was a risk factor among women (OR 2.4, CI 1......, tennis elbow among women was associated with low social support at work. The results for precision demanding movements and for vibration were less consistent...

  7. TO COMPARE THE EFFECTIVENESS OF CRYOTHERAPY WITH EXERCISES VERSUS TAPING WITH EXERCISES IN TREATING ACUTE LATERAL ANKLE SPRAIN

    OpenAIRE

    Suresh; Ranganath; Sridhar; Rohit; Rajeev; Afrin

    2014-01-01

    BACKGROUND: Ankle sprain is a common form of sport injuries and it is a leading cause of pain and disability in common man and sportsman worldwide. Rate of this injury is 1 per 10, 000 persons in common man whereas lateral ligament injuries account for 15 to 25% of all sports injuries. Lateral ankle sprains are one of the most common injuries sustained in sports and exercise activities. It is one of the most common soft tissue injury encountered in clinical practice. Compl...

  8. A Clinical Study of Bee Venom Acupuncture Therapy on External Epicondylitis

    Directory of Open Access Journals (Sweden)

    Kyung-Tae Kim

    2006-06-01

    Full Text Available Objective : This study was to evaluate the effectiveness of Bee Venom acupuncture therapy on external epicondylitis. Methods : We divided chronic arthritis of ankle patient into 2 groups; one group combined bee venom acupuncture therapy and acupuncture therapy, another group was only acupuncture therapy. To estimate the effectiveness of treatment that applied for two groups, we used visual analog scale(VAS. We compared the VAS score of two groups statistically. Results : 1. As a result of evaluation by using visual analog scale(VAS, treatment score at final was marked more higher than score before treatment on each groups. 2. treatment at final, acupuncture and bee venom acupuncture therapy group had significant result on visual analog scale(VAS compared with acupuncture therapy group. Conclusion : Bee Venom acupuncture therapy can be used with acupuncture therapy for highly effective treatment for external epicondylitis.

  9. Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial.

    Science.gov (United States)

    Baumbach, Sebastian Felix; Fasser, Mariette; Polzer, Hans; Sieb, Michael; Regauer, Markus; Mutschler, Wolf; Schieker, Matthias; Blauth, Michael

    2013-01-14

    Ankle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV) is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains. 60 patients, aged 18-40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D. This is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various neuromuscular parameters, WBV is a promising treatment method for

  10. Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Baumbach Sebastian Felix

    2013-01-01

    Full Text Available Abstract Background Ankle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains. Methods/Design 60 patients, aged 18–40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D. Discussion This is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various

  11. Hydro-galvanic and rising - temperature bath therapy for chronic elbow epicondylitis: a comparative study

    Directory of Open Access Journals (Sweden)

    C. Mucha

    2004-02-01

    Full Text Available The efficacy of two different regimens of physiotherapy for epicondylitis was compared. A combination treatment with hydrogalvanic four-cell bath and arm bath with rising temperature, which had showed good effects in treatment of tennis elbow in an earlier observational study (Mucha 1987, was compared with the analgesic interference current treatment often recommended in the literature (Sadil and Sadil 1994, Noteboom et al 1994, Becker and Reuter 1982. For this study, 60 patients with epicondylitis that was resistant to conservative treatment were randomized into two groups for comparison. In group 1, interference currents were administered twice a day for six weeks and group 2 received combination treatment with the hydrogalvanic four-cell bath and rising- temperature arm bath once a day for six weeks. Criteria for inclusion, control and appraisal were laid down prospectively. Several parameters were used, recorded and statistically evaluated as outcome measures.  These were active joint range of movement of the elbow, grip strength, pain provocation with muscle contraction, palpation pain and pain with functional activities.  The results showed a significant superiority of combination treatment over therapy with interference current. It is therefore recommended that hydrogalvanic four-cell bath and arm bath with rising temperature should be carried out before considering surgical treatment for chronic epicondylitis.

  12. EFFECT OF ECCENTRIC EXERCISE PROGRAMME ON PAIN AND GRIP STRENGTH FOR SUBJECTS WITH MEDIAL EPICONDYLITIS

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    Mishra Prashant Akhilesh

    2014-04-01

    Full Text Available Background and Objective: Therapeutic eccentric exercise may provide both a structural and functional benefit during tendinopathy rehabilitation. The objective is to find the effect of eccentric exercises on improvement of pain and grip strength for subjects with Medial Epicondylitis. Method: Pre to post test experimental study design randomized thirty subjects with medial epicondylitis, 15 each into Group A and Group B. Group B subjects were treated with conventional therapy and Eccentric exercises. Group A subjects were treated with conventional therapy. Results: When means of post intervention were compared using Independent ‘t’ between groups there was no statistically significant difference in improvements obtained in VAS scores and grip strength. There was a statistically significant change in means of VAS score and Grip strength when means were analyzed by using Paired‘t’ test and Wilcoxon signed rank test within the groups with positive percentage of change. Conclusion: It is concluded that four weeks of Eccentric Exercise Programme combined with conventional therapy shown significant effect on improving pain and Grip strength, however the improvement obtained has no difference when compared with control conventional treatment for Subjects with Medial Epicondylitis.

  13. Acute Restraint Stress Alters Wheel-Running Behavior Immediately Following Stress and up to 20 Hours Later in House Mice.

    Science.gov (United States)

    Malisch, Jessica L; deWolski, Karen; Meek, Thomas H; Acosta, Wendy; Middleton, Kevin M; Crino, Ondi L; Garland, Theodore

    In vertebrates, acute stressors-although short in duration-can influence physiology and behavior over a longer time course, which might have important ramifications under natural conditions. In laboratory rats, for example, acute stress has been shown to increase anxiogenic behaviors for days after a stressor. In this study, we quantified voluntary wheel-running behavior for 22 h following a restraint stress and glucocorticoid levels 24 h postrestraint. We utilized mice from four replicate lines that have been selectively bred for high voluntary wheel-running activity (HR mice) for 60 generations and their nonselected control (C) lines to examine potential interactions between exercise propensity and sensitivity to stress. Following 6 d of wheel access on a 12L∶12D photo cycle (0700-1900 hours, as during the routine selective breeding protocol), 80 mice were physically restrained for 40 min, beginning at 1400 hours, while another 80 were left undisturbed. Relative to unrestrained mice, wheel running increased for both HR and C mice during the first hour postrestraint (P Wheel running was also examined at four distinct phases of the photoperiod. Running in the period of 1600-1840 hours was unaffected by restraint stress and did not differ statistically between HR and C mice. During the period of peak wheel running (1920-0140 hours), restrained mice tended to run fewer revolutions (-11%; two-tailed P = 0.0733), while HR mice ran 473% more than C (P = 0.0008), with no restraint × line type interaction. Wheel running declined for all mice in the latter part of the scotophase (0140-0600 hours), restraint had no statistical effect on wheel running, but HR again ran more than C (+467%; P = 0.0122). Finally, during the start of the photophase (0720-1200 hours), restraint increased running by an average of 53% (P = 0.0443) in both line types, but HR and C mice did not differ statistically. Mice from HR lines had statistically higher plasma corticosterone concentrations

  14. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    International Nuclear Information System (INIS)

    Zhang, Guang-ying; Ding, Hong-yu; Zheng, Lei; Ji, Bing-jun; Shi, Hao; Feng, Yan

    2017-01-01

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  15. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-ying; Ding, Hong-yu [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Ultrasonography, Jinan (China); Zheng, Lei; Ji, Bing-jun [Shandong Provincial Corps Hospital of Chinese People' s Armed Police Force, Department of Radiology, Jinan (China); Shi, Hao [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Radiology, Jinan (China); Feng, Yan [Affiliated Hospital of Binzhou Medical College, Department of Radiology, Binzhou (China)

    2017-03-15

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  16. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

    Directory of Open Access Journals (Sweden)

    Zimmermann Heinz

    2008-12-01

    Full Text Available Abstract Background In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. Methods This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17. After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER: Follow-up and final examination in the hospital's emergency unit. Group B (GP: Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Results Female and male patients were equally represented in both groups. The age of the patients ranged from 16 – 64 years, with a mean age of 34 years (ER and 35 years (GP. 98% (n = 98 of all patients were satisfied with their treatment, and 93% (n = 93 were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively. 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc. on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669. Conclusion Patients who first present at the ER with a lateral

  17. Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

    Science.gov (United States)

    Schwab, Patrik R; Benneker, Lorin M; Eggli, Stefan; Zimmermann, Heinz; Exadaktylos, Aristomenis K

    2008-12-23

    In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a

  18. Acute food deprivation enhances fear extinction but inhibits long-term depression in the lateral amygdala via ghrelin signaling.

    Science.gov (United States)

    Huang, Chiung-Chun; Chou, Dylan; Yeh, Che-Ming; Hsu, Kuei-Sen

    2016-02-01

    Fear memory-encoding thalamic input synapses to the lateral amygdala (T-LA) exhibit dynamic efficacy changes that are tightly correlated with fear memory strength. Previous studies have shown that auditory fear conditioning involves strengthening of synaptic strength, and conversely, fear extinction training leads to T-LA synaptic weakening and occlusion of long-term depression (LTD) induction. These findings suggest that the mechanisms governing LTD at T-LA synapses may determine the behavioral outcomes of extinction training. Here, we explored this hypothesis by implementing food deprivation (FD) stress in mice to determine its effects on fear extinction and LTD induction at T-LA synapses. We found that FD increased plasma acylated ghrelin levels and enhanced fear extinction and its retention. Augmentation of fear extinction by FD was blocked by pretreatment with growth hormone secretagogue receptor type-1a antagonist D-Lys(3)-GHRP-6, suggesting an involvement of ghrelin signaling. Confirming previous findings, two distinct forms of LTD coexist at thalamic inputs to LA pyramidal neurons that can be induced by low-frequency stimulation (LFS) or paired-pulse LFS (PP-LFS) paired with postsynaptic depolarization, respectively. Unexpectedly, we found that FD impaired the induction of PP-LFS- and group I metabotropic glutamate receptor agonist (S)-3,5-dihydroxyphenylglycine (DHPG)-induced LTD, but not LFS-induced LTD. Ghrelin mimicked the effects of FD to impair the induction of PP-LFS- and DHPG-induced LTD at T-LA synapses, which were blocked by co-application of D-Lys(3)-GHRP-6. The sensitivity of synaptic transmission to 1-naphthyl acetyl spermine was not altered by either FD or ghrelin treatment. These results highlight distinct features of fear extinction and LTD at T-LA synapses. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. [External stability of the elbow after surgical treatment of epicondylitis. Presentation of a case].

    Science.gov (United States)

    Llop-Corbacho, A; Romero-Ruiz, J; Denia-Alarcón, N

    2014-01-01

    Elbow instability is a difficult to diagnose condition in certain cases, and could lead to some problems that limit daily functioning, such as joint blocks, bumps, projections, muscle weakness, and persistent pain. A case is presented of a patient with a clinical picture of epicondylitis, with a previous history of a fall on the affected arm. As there was no improvement after performing conventional non-aggressive treatment, surgery was performed on the affected tendon. The outcome of this was persistent pain and clinical instability of the elbow that ended up requiring surgery to reconstruct the ligament over the external complex. In follow-up 6 months after the operation, the clinical instability had disappeared, but there was still external discomfort and a 30° extension deficit. When faced with a picture of epicondylitis with a previous injury that does not respond to conventional therapies, it is important to take into account the possibility of an underlying elbow instability, ruling this out with a correct physical examination and, where necessary, with the appropriate complementary tests. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  20. Surgical management of medial humeral epicondylitis, cubital synovial osteochondromatosis and humeroradial subluxation in a cat

    Directory of Open Access Journals (Sweden)

    Karen L Perry

    2017-02-01

    Full Text Available Case summary A 13-year-old domestic shorthair cat presented for evaluation of pain and difficulty ambulating. Orthopedic examination and CT facilitated a diagnosis of bilateral elbow synovial osteochondromatosis with medial humeral epicondylitis and concurrent osteoarthritis. Right humeroradial subluxation was evident on CT images, but no instability was evident preoperatively. Surgical treatment was elected, including external neurolysis of the ulnar nerve, removal of the areas of mineralization within the flexor carpi ulnaris muscle and medial arthrotomy to remove intra-articular mineralized bodies. Following closure, instability of the right elbow was noted with humeroradial subluxation necessitating placement of circumferential suture prostheses to provide satisfactory stability. Reassessment was performed 2, 6, 12, 24 and 40 weeks postoperatively and revealed maintenance of elbow stability and substantial improvement in mobility and comfort. Relevance and novel information While humeroradial subluxation has been reported in association with medial humeral epicondylitis on post-mortem examination, associated clinically significant instability has not been documented previously. Surgeons should be aware of the potential for this complication and check elbow stability following surgery. Despite this complication, a favorable medium-term outcome was achieved for this cat.

  1. Efficacy of tennis elbow (epicondylitis humeri radialis) treatment in CBR "Praxis".

    Science.gov (United States)

    Pecar, Dzemal; Avdić, Dijana

    2009-02-01

    Tennis elbow (Epicondylitis humeri radialis) is the most frequent reason that patients with elbow pain report to a physician. The exact cause of elbow pain is still unclear. However, it is certainly causally connected with connective intersection between forearm muscle and bone in the elbow region. In this paper, we analyzed patients that, over the period of 15 years, reported to "Praxis" clinic for elbow pain treatment (Epicondylitis humeri radialis). Of the total number of 228 patients, 126 were male, 101 female while one patient was younger than 14. Initial analysis established that average overall health condition grade was 2,87 at the onset of treatment. Following the treatment completion that grade was 4,48. Of the total number of 223 patients who were treated by combined method of manipulation and local corticosteroid instillation, eight patients received physical therapy as well. Thus, surgical treatment was not necessary in any patient. The patients' treatment included: 1. Application of manipulative methods in order to reestablish mobility in the "blocked" radio-humeral and the upper radio-ulnar joints. 2. Local instillation of corticosteroid depot in order to control inflammation (enthesitis) and thus, eliminate pain and establish physiological conditions for functioning of joint and local structures. Unlike conservative method which includes initial immobilization due to irritation and inflammation development prevention with concomitant analgesic and antirheumatic therapy, initial application of manipulation with reinstatement of joint mobility instead of immobilization with subsequent instillation of steroid preparations achieves functional restitution and fast reinstatement of full working ability, as a rule.

  2. Efficacy of tennis elbow (Epicondylitis humeri radialis treatment in CBR "PRAXIS".

    Directory of Open Access Journals (Sweden)

    Džemal Pecar

    2009-02-01

    Full Text Available Tennis elbow (Epicondylitis humeri radialis is the most frequent reason that patients with elbow pain report to a physician. The exact cause of elbow pain is still unclear. However, it is certainly causally connected with connective intersection between forearm muscle and bone in the elbow region.In this paper, we analyzed patients that, over the period of 15 years, reported to “Praxis” clinic for elbow pain treatment (Epicondylitis humeri radialis. Of the total number of 228 patients, 126 were male, 101 female while one patient was younger than 14. Initial analysis established that average overall health condition grade was 2,87 at the onset of treatment. Following the treatment completion that grade was 4,48.Of the total number of 223 patients who were treated by combined method of manipulation and local corticosteroid instillation, eight patients received physical therapy as well. Thus, surgical treatment was not necessary in any patient.The patients’ treatment included:Application of manipulative methods in order to reestablish mobility in the “blocked” radio-humeral and the upper radio-ulnar joints.Local instillation of corticosteroid depot in order to control inflammation (enthesitis and thus, eliminate pain and establish physiological conditions for functioning of joint and local structures. Unlike conservative method which includes initial immobilization due to irritation and inflammation development prevention with concomitant analgesic and antirheumatic therapy, initial application of manipulation with reinstatement of joint mobility instead of immobilization with subsequent instillation of steroid preparations achieves functional restitution and fast reinstatement of full working ability, as a rule.

  3. EFFICACY OF TENNIS ELBOW (EPICONDYLITIS HUMERI RADIALIS) TREATMENT IN CBR “PRAXIS”

    Science.gov (United States)

    Pecar, Džemal; Avdić, Dijana

    2009-01-01

    Tennis elbow (Epicondylitis humeri radialis) is the most frequent reason that patients with elbow pain report to a physician. The exact cause of elbow pain is still unclear. However, it is certainly causally connected with connective intersection between forearm muscle and bone in the elbow region. In this paper, we analyzed patients that, over the period of 15 years, reported to “Praxis” clinic for elbow pain treatment (Epicondylitis humeri radialis). Of the total number of 228 patients, 126 were male, 101 female while one patient was younger than 14. Initial analysis established that average overall health condition grade was 2,87 at the onset of treatment. Following the treatment completion that grade was 4,48. Of the total number of 223 patients who were treated by combined method of manipulation and local corticosteroid instillation, eight patients received physical therapy as well. Thus, surgical treatment was not necessary in any patient. The patients’ treatment included: Application of manipulative methods in order to reestablish mobility in the “blocked” radio-humeral and the upper radio-ulnar joints. Local instillation of corticosteroid depot in order to control inflammation (enthesitis) and thus, eliminate pain and establish physiological conditions for functioning of joint and local structures. Unlike conservative method which includes initial immobilization due to irritation and inflammation development prevention with concomitant analgesic and antirheumatic therapy, initial application of manipulation with reinstatement of joint mobility instead of immobilization with subsequent instillation of steroid preparations achieves functional restitution and fast reinstatement of full working ability, as a rule. PMID:19284391

  4. Simultaneous bilateral elbow dislocation with bilateral medial epicondyle fractures in a 13-year-old female gymnast with hyperlaxity

    Science.gov (United States)

    Bauer, Stefan; Dunne, Ben; Whitewood, Colin

    2012-01-01

    Bilateral simultaneous elbow dislocations are extremely rare and have only been described in 12 cases. In the paediatric population unilateral elbow dislocations are rare with 3–6% of all elbow injuries and there are only few studies describing this injury exclusively in children. There is only one case report of a paediatric patient who sustained a simultaneous bilateral elbow dislocation with medial epicondyle fractures. We present a second paediatric case of simultaneous bilateral elbow dislocation with associated displaced bilateral medial epicondyle fractures in a gymnast with joint hyperlaxity (3 of 5 Wynne-Davies criteria) treated with closed reduction and short-term immobilisation (3 weeks). The patient returned to full trampoline gymnastics between 4 and 5 months postinjury and made an uneventful recovery. PMID:23234820

  5. The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

    Directory of Open Access Journals (Sweden)

    Ben-Nafa Walid

    2018-01-01

    Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

  6. Initial Effect of Taping Technique on Wrist Extension and Grip Strength and Pain of Individuals with Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    Alireza Shamsoddini

    2010-04-01

    Full Text Available Objectives: Aim of this study is to investigate the initial effect of taping technique on wrist extension and grip strength and pain of Individuals with tennis elbow. Methods: fifteen patients (10 men and 5 women with 42.53 years on their dominant arm participated in this study. Outcome measures were wrist extension and grip strength and pain taken before and immediately after application of tape. The unaffected arm served as a control. Used of hand-held dynamometer and jammar dynamometer for evaluated of wrist extension and grip strength. Also, visual analog scale (VAS used for evaluated of pain Results: Among the variables, significant differences were found in wrist extension strength between effected and unaffected arm (P=0.006. Also, changes in grip strength shows statically significant improve in effect arm than unaffected arm (P=0.001. Changes in pain in impaired arm were positive. Discussion: Taping technique, as applied in this study demonstrated an impressive effect on wrist extension and grip strength and pain in individuals with tennis elbow. Therefore, it is recommended that this method may be useful in the management of this condition during exercise and functional rehabilitation.

  7. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both: a randomized clinical trial

    NARCIS (Netherlands)

    Struijs, P. A. A.; Kerkhoffs, G. M. M. J.; Assendelft, W. J. J.; van Dijk, C. N.

    2004-01-01

    BACKGROUND: The authors evaluated the effectiveness of brace-only treatment, physical therapy, and the combination of these for patients with tennis elbow. METHODS: Patients were randomized over 3 groups: brace-only treatment, physical therapy, and the combination of these. Main outcome measures

  8. Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia.

    Science.gov (United States)

    Fernández-Carnero, Josué; Fernández-de-Las-Peñas, César; de la Llave-Rincón, Ana Isabel; Ge, Hong-You; Arendt-Nielsen, Lars

    2007-05-01

    Referred pain and pain characteristics evoked from the extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum communis, and brachioradialis muscles was investigated in 20 patients with lateral epicondylalgia (LE) and 20-matched controls. Both groups were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The quality and location of the evoked referred pain, and the pressure pain threshold (PPT) at the lateral epicondyle on the right upper extremity (symptomatic side in patients, and dominant-side on controls) were recorded. Several lateral elbow pain parameters were also evaluated. Within the patient group, the elicited referred pain by manual exploration of 13 out of 20 (65%) extensor carpi radialis brevis muscles, 12/20 (70%) extensor carpi radialis longus muscles, 10/20 (50%) brachioradialis muscles, and 5/20 (25%) extensor digitorum communis muscles, shares similar pain patterns as their habitual lateral elbow and forearm pain. The mean number of muscles with TrPs for each patient was 2.9 [95% confidence interval (CI) 1,4] of which 2 (95% CI 1,3) were active, and 0.9 (95% CI 0,2) were latent TrPs. Control participants only had latent TrPs (mean: 0.4; 95% CI 0,2). TrP occurrence between the 2 groups was significantly different for active TrPs (P0.05). The referred pain pattern was larger in patients than in controls, with pain referral to the lateral epicondyle (proximally) and to the dorso-lateral aspect of the forearm in the patients, and confined to the dorso-lateral aspect of the forearm in the controls. Patients with LE showed a significant (Plateral epicondyle was negatively correlated with both the total number of TrPs (rs=-0.63; P=0.003) and the number of active TrPs (rs=-0.5; P=0.02): the greater the number of active TrPs, the lower the PPT at the lateral epicondyle. Our results suggest that in patients with LE, the evoked referred pain and its sensory characteristics shared similar patterns

  9. [Clinical observation on external humeral epicondylitis treated with back-rotation traction].

    Science.gov (United States)

    Fu, Rui-yang; Wang, Ya-ling; Gu, Zhong-zhong; Wang, Bao-hu; Zhu, Qi; Li, Ye; Wang, En-ping

    2009-02-01

    To evaluate the clinical effect of manipulation on external humeral epicondylitis, and to explore the functional mechanism and ideal treatment. Eighty-six patients who had been treated with acupuncture, obturation and needle-knife were divided into routine group and treatment group randomly. In routine group, there were 42 cases (male 13, female 29, means 40.8 years); and in treatment group there were 44 cases (male 16, female 28, means 41.2 years). There's no further treatment for the routine group after the therapy above, while the treatment group was added with back-rotation traction manipulation. Taking Verhaar therapy effect appraisal system of tennis-ball elbow to evaluate elbow function. After 7 days of therapy, the results were excellent in 13 cases, good in 16, fair in 4, poor in 9 in the routine group; and excellent in 38, good in 4 and fair in 2 in treatment group; and the effect in the treatment group were better than that of the routine group (P Making manipulation after routine acupuncture, local obturation and needle-knife has active meaning to remove trauma inflammation, prevent re-conglutination, promote recovery and prevent recurrence.

  10. Lateral Concepts

    DEFF Research Database (Denmark)

    Gad, Christopher; Bruun Jensen, casper

    2016-01-01

    This essay discusses the complex relation between the knowledges and practices of the researcher and his/her informants in terms of lateral concepts. The starting point is that it is not the prerogative of the (STS) scholar to conceptualize the world; all our “informants” do it too. This creates...... the possibility of enriching our own conceptual repertoires by letting them be inflected by the concepts of those we study. In a broad sense, the lateral means that there is a many-to-many relation between domains of knowledge and practice. However, each specific case of the lateral is necessarily immanent...... to a particular empirical setting and form of inquiry. In this sense lateral concepts are radically empirical since it locates concepts within the field. To clarify the meaning and stakes of lateral concepts, we first make a contrast between lateral anthropology and Latour’s notion of infra-reflexivity. We end...

  11. Prenatal Stress and Acute Stress Later in Life Impacts the Responses in Tests for Depressive-Like Behavior in a Sex-Specific Manner

    DEFF Research Database (Denmark)

    Sickmann, Helle Mark; Skoven, Christian; Arentzen, Tina S.

    in locomotor activity, depressive- and anxiety-like behavior as well as sleep architecture. Some animals were analyzed for CNS microstructural changes based on diffusion MRI. Subsets of PS and control rats were exposed to an acute stressor prior to the behavioral tests. Rearing/climbing activity in a familiar...

  12. Corticosteroïdinjecties, fysiotherapie of een afwachtend beleid voor patiënten met een epicondylitis lateralis? Een gerandomiseerd onderzoek in de eerste lijn.

    NARCIS (Netherlands)

    Smidt, N.; Windt, D. van der; Assendelft, P.; Devillé, W.; Bouter, L.

    2004-01-01

    Doel: Vergelijking van de effecten van corticosteroïdinjecties, fysiotherapie en een afwachtend beleid voor een epicondylitis lateralis. Methoden: Patiëntenselectie vond plaats in 65 deelnemende huisartsenpraktijken. De belangrijkste insluitcriteria waren: minimaal 6 weken pijn aan de laterale zijde

  13. Internal antecubital fold line: A new useful anatomical repair to identify the medial epicondyle and avoid iatrogenic ulnar nerve injury in patients with supracondylar fracture of the humerus Línea del pliegue antecubital interno: Un nuevo reparo anatómico útil para identificar la epitróclea y evitar lesiones iatrogénicas del nervio ulnar en pacientes con fractura supracondílea del humero

    Directory of Open Access Journals (Sweden)

    Luis José Cespedes

    2012-12-01

    Full Text Available Introduction: The supracondylar fracture of the distal humerus is the most common pediatric fracture around the elbow. The currently accepted techniques of fixation are two lateral parallel wires , crosswiring technique from the lateral side, two divergent wires laterally and two retrograde crossed wires. The retrograde crossed wires provide the best mechanical stability. Many children with this fracture have swelling around the elbow, making difficult the feeling of the anatomic landmarks for percutaneous pinning, increasing the risk of ulnar nerve injury. Objective: To evaluate the correspondence of the internal antecubital fold line with the internal epicondyle in patients with supracondylar fracture and the incidence of iatrogenic ulnar nerve injuries . Methods: We conducted a series of clinical cases. In the first group we included 56 children with supracondylar fracture Gartland type III, from August 2000 to September 2007, who underwent closed reduction and crossed retrograde nail fixation. In the second group we included 241 (481 elbows outpatients with no anatomic abnormality. We used the extension of antecubital fold line to find the internal epicondyle in both groups. Results: The prolongation of the antecubital fold line intersected the medial epicondyle in all participants of the first group. In 96.3% of the participants in the second group, the extension of antecubital fold line intersected the internal epicondyle. None patient had iatrogenic ulnar nerve injury. Conclusions: The use of the antecubital internal fold line may be useful to identify the internal epicondyle and thus avoid iatrogenic ulnar nerve injury. Salud UIS 2012; 44 (2: 9-14La fractura supracondílea del húmero distal es la más común alrededor del codo en niños. Las técnicas actualmente aceptadas de fijación son dos clavos laterales paralelos, dos clavos cruzados laterales, dos clavos laterales divergentes y dos clavos retrógrados cruzados. Los clavos retr

  14. Sheep laterality.

    Science.gov (United States)

    Anderson, Dean M; Murray, Leigh W

    2013-01-01

    Turning preferences among 309 white-faced ewes were individually evaluated in an enclosed, artificially lit T-maze, followed by each ewe choosing either a right or left return alley to return to peers. Data recorded included time in the start box, time in the T-maze, exit arm chosen to leave the T-maze, and return alley. Right and left arms of the T-maze were chosen 65.7% and 34.3% of the time, respectively, while right and left return alleys were chosen 32.4% and 67.6%, respectively. Exit arm and return alley were not independently chosen (p laterality was not related (α =.05) to time of day the test was administered, ewe's age or genetics, most recent liveweight, or most recent shorn fleece weight. The mean time spent in the start box (21 s) was not related to exit arm (p =.947) or return alley (p =.779). Mean time (15 s) spent in the T-maze was not related to exit arm (p =.086) or return alley (p =.952). More research will be required to understand sheep turning laterality and how it can impact working facilities and research equipment.

  15. The application of mechanical diagnosis and therapy in lateral epicondylalgia

    Science.gov (United States)

    Maccio, Joseph R.; Fink, Sarah; Yarznbowicz, Richard; May, Stephen

    2016-01-01

    Background lateral epicondylalgia (LE) is a musculoskeletal diagnosis that causes pain and dysfunction in the lateral aspect of the elbow. Mechanical diagnosis and therapy (MDT) is an orthopaedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movement. There has been no investigation of the association between MDT and patients diagnosed with LE. Case description this report presents three patients matching the currently accepted diagnostic criteria for LE, two with a diagnosis of lateral epicondylitis (tennis elbow) from a medical doctor. These patients were classified and treated by a diplomat of MDT and two third-year doctoral students of physical therapy using MDT. Outcomes short- and long-term (one year) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in 3–6 visits between 11–59 days. Patients demonstrated the ability to prevent and manage reoccurrence of symptoms independently without seeking further health care. Discussion this case series raises questions about whether or not the pathologies traditionally associated with the aetiology of LE are actually at fault. Moreover, it raises questions about the utility of special tests typically utilized to identify those structures. The series provides preliminary evidence that MDT may be capable of providing effective short- and long-term outcomes in the management of LE. Level of Evidence: 4 PMID:27559286

  16. Estudo anatômico do ligamento patelofemoral lateral em joelho de cadáveres Anatomical study of the lateral patellofemoral ligament in cadaver knees

    Directory of Open Access Journals (Sweden)

    Marcelo Schmidt Navarro

    2008-07-01

    fresh cadavers by means of anatomical dissections. The dissections were standardized and the data were noted down and forwarded to statistical analysis. RESULTS: The LPFL presented a mean 16.05 mm width (standard deviation of 2.48, 42.10 mm length (standard deviation of 8.84. The femoral insertion was found at the lateral femoral epicondyle and with a fan-like expansion of the fibers, predominantly in the posterior region proximal to the lateral epicondyle. In the patella, the insertion found was in the upper-lateral region (in the middle of the upper third of the coronal plan, also with expanded fibers, but less intensely so. In the sagittal plan, the ligament was located in the posterior half of the border of the patella. The LPFL was isolated in the second lateral retinacular layer, the deep transverse retinaculum. CONCLUSION: The LPFL is located in the deep transverse retinacular layer with the presence of a fan-like expansion of its fibers both in the femoral and in the patellar insertions. The insertion is more posterior and proximal at the femoral epicondyle and in the posterior half of the patellar border (sagittal plan and in the upper-lateral aspect.

  17. Tennis elbow

    Science.gov (United States)

    Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral; Tendonitis - elbow ... tennis or other racket sports, hence the name "tennis elbow." Backhand is the most common stroke to cause ...

  18. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review

    International Nuclear Information System (INIS)

    Dones, Valentin C III; Grimmer, Karen; Thoirs, Kerry; Suarez, Consuelo G; Luker, Julie

    2014-01-01

    Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler

  19. Anwendung der extrakorporalen Stoßwellentherapie bei kalzifizierender Periathropathia humeroscapularis, Fersensporn und Epicondylitis humeri - Erfahrungsbericht aus dem Wilhelminenspital

    Directory of Open Access Journals (Sweden)

    Feyertag J

    2004-01-01

    Full Text Available Die Stoßwellentherapie wird bei verschiedenen Indikationen, die unter konservativen Therapien schwer zu schwer zu behandeln sind, eingesetzt. Dazu zählen die kalzifizierenden Schultererkrankungen (Tendinitis calcarea, Epicondylitis humeri (EHR und die plantare Fasciitis mit/ohne plantarem Fersensporn (FSP. Berichtet werden die Ergebnisse von 147 Patienten (102 Frauen/45 Männer, mittleres Alter betrug 57,8 Jahre, die mittels einer einmaligen extrakorporalen Stoßwellentherapie (ESWT (Tend. calc. 82 %, FSP 11 % oder EHR 7 % mittels eines HMT-ReflecTron therapiert wurden. Verabreicht wurden im Mittel 1.800 Stoßwellen. Untersucht wurde die subjektive Verbesserung der Schmerzen anhand einer visuellen Analogskala vor und 6 Wochen nach der Therapie bei allen Patienten. Bei Patienten mit Tendinitis calcarea wurde auch eine Verbesserung der Funktion sowie Veränderungen der Kalzifizierungen untersucht. Bei allen Patienten konnte eine statistisch signifikante Verbesserung der Schmerzen sowie des Bewegungsumfanges beobachtet werden (p 0,0001. Röntgenaufnahmen ergaben eine partielle Verkleinerung der Kalkdepots bei ca. 80 % der Patienten. Aufgrund der geringen Zahl der Patienten fand sich für die EHR keine signifikante Verbesserung der Schmerzsymptomatik. Eine einmalige ESWT kann zu einer deutlichen Verbesserung der Schmerzsymptomatik und zu einer Verbesserung des Bewegungsumfanges führen. Bei 80 % der Patienten mit einer Tendinitis calcarea findet sich weiter eine partielle Verkleinerung der Kalkdepots 6 Wochen nach Therapie.

  20. Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE).

    Science.gov (United States)

    Arrigoni, Paolo; Cucchi, Davide; D'Ambrosi, Riccardo; Menon, Alessandra; Aliprandi, Alberto; Randelli, Pietro

    2017-07-01

    Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow. Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated. SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention. Retrospective case series, Level IV.

  1. Chronic Lateral Epicondylalgia Does Not Exhibit Mechanical Pain Modulation in Response to Noxious Conditioning Heat Stimulus.

    Science.gov (United States)

    Lim, Edwin Choon Wyn; Sterling, Michele; Vicenzino, Bill

    2017-10-01

    The impaired attenuation of pain by the application of a noxious conditioning stimulus at a segmentally distinct site, known as conditioned pain modulation (CPM), has been implicated in clinical pain states. Chronic lateral epicondylalgia (LE), which is characterized by lower pressure pain thresholds (PPTs) at sites remote to the affected elbow and spinal cord hyperexcitability, is a clinical pain state that might plausibly involve less efficacious CPM. This study aimed to determine whether LE exhibits a less efficacious CPM compared with that in pain-free controls. Results: Twenty participants with LE, aged 50.7 years (SD=7.05) and who had their condition for 10.2 months (range: 2 to 80 mo), were matched by age and sex to 22 pain-free participants. All participants indicated their PPT over the lateral epicondyle(s) before and during a conditioning noxious heat stimulus that was applied over the calf. A CPM score was calculated as the difference between the PPT before and during the heat pain-conditioning stimulus expressed as a percentage of PPT before the heat pain-conditioning stimulus. The condition (LE vs. control) by side (affected vs. unaffected) analysis of variance revealed a significant condition effect (P=0.001), but not side effect (P=0.192) or side-by-condition interaction effect (P=0.951). Follow-up tests for the effect of condition revealed a mean deficit in CPM of -24.5% (95% confidence interval, -38.0 to -11.0) in LE compared with that in pain-free participants. The results that suggest an impaired ability to modulate pain might be associated with the previously observed spinal cord hyperexcitability and the mechanical hyperalgesia that characterizes LE.

  2. The Halloween Lateral Canthotomy Model

    Directory of Open Access Journals (Sweden)

    Nur-Ain Nadir

    2017-04-01

    Full Text Available Audience: The Halloween Lateral Canthotomy Model” is designed to instruct Emergency Medicine residents PGY 1-4, as well as Emergency Medicine-bound students. Introduction: Although uncommon, retrobulbar hemorrhage associated with facial trauma is a potential cause of permanent vision loss due to orbital compartment syndrome. To prevent vision loss, treatment with lateral canthotomy is time-sensitive and to perform this procedure in an emergent setting requires properly trained practitioners. Objectives: The purpose of the model is to teach residents and students how to perform lateral canthotomy and to achieve competency in their skills. Method: Lateral canthotomy is an important skill to be proficient in for any Emergency Medicine Physician, as it is an uncommon, sight-saving procedure. It is indicated in scenarios of facial trauma that cause a retrobulbar hemorrhage. Patients are at risk for permanent vision loss due to acute orbital compartment syndrome if the procedure is not done expeditiously.1 A less likely cause of retrobulbar hemorrhage is spontaneous hemorrhage due to a bleeding disorder or anticoagulant use.2 The features of retrobulbar hemorrhage include acute loss of visual acuity, relative afferent pupillary defect, proptosis with resistance to retropulsion, increased intraocular pressure, and limited extra ocular movement.3 While the diagnosis is clinical, it can be confirmed by computed tomography (CT and measurement of intraocular pressure.2 When the diagnosis is established, lateral canthotomy and cantholysis should be performed emergently. Cantholysis is contraindicated when a globe rupture is suspected or with an orbital blowout fracture. Potential complications of this procedure include iatrogenic injury to the globe or lateral rectus muscle, damage to the elevator aponeurosis resulting in ptosis, injury to the lacrimal gland and lacrimal artery, bleeding and infection.3 This task trainer uses affordable materials to let

  3. Function Lateralization via Measuring Coherence Laterality

    Science.gov (United States)

    Wang, Ze; Mechanic-Hamilton, Dawn; Pluta, John; Glynn, Simon; Detre, John A.

    2009-01-01

    A data-driven approach for lateralization of brain function based on the spatial coherence difference of functional MRI (fMRI) data in homologous regions-of-interest (ROI) in each hemisphere is proposed. The utility of using coherence laterality (CL) to determine function laterality was assessed first by examining motor laterality using normal subjects’ data acquired both at rest and with a simple unilateral motor task and subsequently by examining mesial temporal lobe memory laterality in normal subjects and patients with temporal lobe epilepsy. The motor task was used to demonstrate that CL within motor ROI correctly lateralized functional stimulation. In patients with unilateral epilepsy studied during a scene-encoding task, CL in a hippocampus-parahippocampus-fusiform (HPF) ROI was concordant with lateralization based on task activation, and the CL index (CLI) significantly differentiated the right side group to the left side group. By contrast, normal controls showed a symmetric HPF CLI distribution. Additionally, similar memory laterality prediction results were still observed using CL in epilepsy patients with unilateral seizures after the memory encoding effect was removed from the data, suggesting the potential for lateralization of pathological brain function based on resting fMRI data. A better lateralization was further achieved via a combination of the proposed approach and the standard activation based approach, demonstrating that assessment of spatial coherence changes provides a complementary approach to quantifying task-correlated activity for lateralizing brain function. PMID:19345736

  4. Cross-cultural adaptation and determination of the reliability and validity of PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge, a questionnaire for patients with lateral epicondylalgia, in a Swedish population

    Directory of Open Access Journals (Sweden)

    Baigi Amir

    2008-06-01

    Full Text Available Abstract Background In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients' difficulties when they suffer from lateral epicondylitis/epicondylalgia. However, there is a Canadian questionnaire, in English, that could make the evaluation of a patient's pain and functional loss both quick and inexpensive. Therefore, the aim of this study was to translate and cross-culturally adapt the questionnaire "Patient-rated Tennis Elbow Evaluation" into Swedish (PRTEE-S; "Patientskattad Utvärdering av Tennisarmbåge", and to evaluate the reliability and validity of the test. Methods The Patient-rated Tennis Elbow Evaluation was cross-culturally adapted for the Swedish language according to well-established guidelines. Fifty-four patients with unilateral epicondylitis/epicondylalgia were assessed using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge, the Disabilities of Arm, Shoulder, and Hand questionnaire, and the Roles & Maudsley score to establish the validity and reliability of the PRTEE-S. Reliability was determined via calculation of the intra-class correlation coefficient (ICC the internal consistency was assessed by Cronbach's alpha, and validity was calculated using Spearman's correlation coefficient. Results The test-retest reliability, using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge intraclass correlation coefficient, was 0.95 and the internal consistency was 0.94. The PRTEE-S correlated well with the Disabilities of the Arm, Shoulder, and Hand questionnaire (r = 0.88 and the Roles & Maudsley score (r = 0.78. Conclusion The PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge represents a reliable and valid instrument to evaluate the subjective outcome in Swedish speaking patients with lateral epicondylitis/epicondylalgia, and can be used in both research and clinical settings.

  5. Lateral collateral ligament (image)

    Science.gov (United States)

    The lateral collateral ligament connects the end of the femur (thigh) to the top of the fibula (the thin bone that runs next to the shin bone). The lateral collateral ligament provides stability against varus stress. Varus stress ...

  6. It's time to change perspective! New diagnostic tools for lateral elbow pain.

    Science.gov (United States)

    Arrigoni, P; Cucchi, D; Menon, A; Randelli, P

    2017-12-01

    The presence of intra-articular findings that may complement the extra-articular pathology in lateral epicondilytis has been suggested, and a role for minor instability of the elbow as part of the causative process of this disease has been postulated. This study was designed to describe two new clinical tests, aimed at detecting intra-articular pathology in patients affected by recalcitrant lateral epicondylitis and investigate their diagnostic performance. Ten patients suffering of atraumatic lateral elbow pain unresponsive to conservative treatment were considered in this study. Two clinical tests were developed and administrated prior to arthroscopy: Supination and Antero-Lateral pain Test (SALT); Posterior Elbow Pain by Palpation-Extension of the Radiocapitellar joint (PEPPER). Sensitivity, specificity, predictive values and accuracy of SALT and PEPPER as diagnostic tests for seven intra-articular findings were calculated. In 90% of the patients, at least one test was positive. All patients with signs of lateral ligamentous patholaxity or intra-articular abnormal findings had a positive response to at least one of the two tests. SALT proved to have a high sensitivity but a low specificity and is accurate in detecting the presence of intra-articular abnormal findings, especially synovitis. PEPPER test was sensible, specific and accurate in the detection of radial head chondropathy. Two new diagnostic tests (SALT and PEPPER) were specifically designed to evoke pain from intra-articular structures. These tests could be a valid support in the diagnostic algorithm of recalcitrant lateral elbow pain. Positive findings may be indicative of a minor instability of the lateral elbow condition. Diagnostic study, development of diagnostic criteria on basis of consecutive patients, level II.

  7. Impact of acute cadmium exposure on the trunk lateral line neuromasts and consequences on the 'C-start' response behaviour of the sea bass (Dicentrarchus labrax L.; Teleostei, Moronidae)

    International Nuclear Information System (INIS)

    Faucher, Karine; Fichet, Denis; Miramand, Pierre; Lagardere, Jean Paul

    2006-01-01

    Behavioural responses of sea bass Dicentrarchus labrax were investigated after exposure to cadmium ions in laboratory-controlled conditions. The aim of this study was to discover whether environmental exposure to cadmium ions inactivates fish lateral line system neuromasts, and to determine the behavioural consequences of such a sensory blockage. For this, fish escape behaviour in response to an artificial water jet was recorded using a 25-frames s -1 analog video camera before and after cadmium exposure. Experimental set up was tested with fish whose lateral line system was artificially inactivated by antibiotics (gentamicin and streptomycin). Histological analyses with scanning electron microscopy showed antibiotic treatment destroyed lateral line system neuromasts. In addition, these fish did not respond to stimulations provoked by the water jet after antibiotic treatment. Fish escape behaviour was then recorded before and after cadmium exposure at two different concentrations. When fish were exposed to the first concentration of cadmium tested (0.5 μg l -1 , which represents the maximal cadmium concentration encountered in contaminated estuaries), no alteration in neuromast tissue was observed. In addition, before cadmium exposure, fish responded positively in 98.41 ± 4.95% of lateral line system stimulations (escape behaviour in response to the water jet). After cadmium exposure, no behavioural modification could be detected: the fish responded positively in 95.16 ± 9.79% of stimulations (χ 2 = 2.464, p = 0.116). In contrast, the high cadmium concentration used (5 μg l -1 , which represents 10 times the concentration occurring in highly polluted estuarine areas) involved severe neuromast tissue damage. Just after such cadmium exposure, fish showed only 41.67 ± 35.36% of positive responses to their lateral line system stimulations, while they responded positively in 95.93 ± 9.10% of stimulations under control conditions (χ 2 = 24.562, p 2 = 2.876, p = 0

  8. Medial epicondylitis - golfer's elbow

    Science.gov (United States)

    ... Golf Baseball and other throwing sports, such as football and javelin Racquet sports, such as tennis Weight ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  9. Does the lateral intercondylar ridge disappear in ACL deficient patients?

    NARCIS (Netherlands)

    van Eck, C.F.; Martins, C.A.Q.; Vyas, S.M.; Celentano, U.; van Dijk, C.N.; Fu, F.H.

    2010-01-01

    The aim of this study was to determine whether there is a difference in the presence of the lateral intercondylar ridge and the lateral bifurcate ridge between patients with sub-acute and chronic ACL injuries. We hypothesized that the ridges would be present less often with chronic ACL deficiency.

  10. 凉性经筋通贴膏治疗急性踝关节外侧副韧带Ⅰ、Ⅱ度损伤的临床观察%Clinical Observation of Lateral Collateral Ligament Injury of Ⅰ and ⅡDegree in Acute Ankle Sprain Treated with Liangxing Jingjintong Plaster

    Institute of Scientific and Technical Information of China (English)

    郭雪霞; 黄明喜; 沈钊雄

    2016-01-01

    Objective To observe the effects on lateral collateral ligament(LCL)injury of Ⅰ andⅡ degree in acute acute sprain treated with liangxing jingjintong plaster. Methods Ninety - two patients of LCL injury of Ⅰ and Ⅱ degree in acute acute sprain were randomized into a treatment group and a control group,46 cases in each one. In the treatment group,the external application of liangxing jingjintong plaster was used. In the control group,voltaren ointment was used in the local area. The clinical efficacy was observed in 14 days of treatment. Besides,Kofoed scale was used to score the ankle function. Results After treat-ment,the clinical efficacy and Kofoed score in the treatment group were better than those in the control group,indicating the significant differences(P < 0. 05). Conclusion Liangxing jingjintong plaster achieves the better efficacy on LCL injury of Ⅰ and Ⅱ degree in acute acute sprain and ankle function at the early re-covery stage. This therapy deserves to be promoted in clinical practice.%目的:观察凉性经筋通贴膏治疗急性踝关节外侧副韧带Ⅰ、Ⅱ度损伤的临床疗效。方法将92例确诊为急性踝关节外侧副韧带Ⅰ、Ⅱ度损伤的患者随机分为治疗组和对照组,每组46例。治疗组采用凉性经筋通贴膏外敷治疗;对照组采用扶他林软膏局部涂擦治疗。两组患者治疗14 d 后观察临床疗效,同时采用 Kofoed 踝关节活动度评分对踝关节功能进行评分。结果两组患者治疗后治疗组临床疗效及踝关节功能评分均优于对照组,两组比较差异有统计学意义( P <0.05)。结论凉性经筋通贴膏对早期恢复急性踝关节外侧副韧带Ⅰ、Ⅱ度损伤患者的踝关节功能有较好疗效,值得临床推广应用。

  11. Laterally loaded masonry

    DEFF Research Database (Denmark)

    Raun Gottfredsen, F.

    In this thesis results from experiments on mortar joints and masonry as well as methods of calculation of strength and deformation of laterally loaded masonry are presented. The strength and deformation capacity of mortar joints have been determined from experiments involving a constant compressive...... stress and increasing shear. The results show a transition to pure friction as the cohesion is gradually destroyed. An interface model of a mortar joint that can take into account this aspect has been developed. Laterally loaded masonry panels have also been tested and it is found to be characteristic...... that laterally loaded masonry exhibits a non-linear load-displacement behaviour with some ductility....

  12. Later zaaien kost opbrengst

    NARCIS (Netherlands)

    Alblas, J.

    2000-01-01

    Onderzoek naar de gevolgen van het uitstellen van het zaaitijdstip op de gewasproductie en op opbrengstderving, bijvoorbeeld doordat de grond later bewerkt kan worden door een hogere grondwaterstand als gevolg van peilverhoging

  13. LATERAL ANKLE INJURY

    OpenAIRE

    Pollard, Henry; Sim, Patrick; McHardy, Andrew

    2002-01-01

    Background: Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football. Objective: To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with ...

  14. Preventing Errors in Laterality

    OpenAIRE

    Landau, Elliot; Hirschorn, David; Koutras, Iakovos; Malek, Alexander; Demissie, Seleshie

    2014-01-01

    An error in laterality is the reporting of a finding that is present on the right side as on the left or vice versa. While different medical and surgical specialties have implemented protocols to help prevent such errors, very few studies have been published that describe these errors in radiology reports and ways to prevent them. We devised a system that allows the radiologist to view reports in a separate window, displayed in a simple font and with all terms of laterality highlighted in sep...

  15. Depression following acute coronary syndrome

    DEFF Research Database (Denmark)

    Joergensen, Terese Sara Hoej; Maartensson, Solvej; Ibfelt, Else Helene

    2016-01-01

    PURPOSE: Depression is common following acute coronary syndrome, and thus, it is important to provide knowledge to improve prevention and detection of depression in this patient group. The objectives of this study were to examine: (1) whether indicators of stressors and coping resources were risk...... factors for developing depression early and later after an acute coronary syndrome and (2) whether prior depression modified these associations. METHODS: The study was a register-based cohort study, which includes 87,118 patients with a first time diagnosis of acute coronary syndrome during the period...... 2001-2009 in Denmark. Cox regression models were used to analyse hazard ratios (HRs) for depression. RESULTS: 1.5 and 9.5 % develop early (≤30 days) and later (31 days-2 years) depression after the acute coronary syndrome. Among all patients with depression, 69.2 % had first onset depression, while 30...

  16. Lateral flow assays

    NARCIS (Netherlands)

    Posthuma-Trumpie, G.A.; Amerongen, van A.

    2012-01-01

    A simple version of immunochemical-based methods is the Lateral Flow Assay (LFA). It is a dry chemistry technique (reagents are included); the fluid from the sample runs through a porous membrane (often nitrocellulose) by capillary force. Typically the membrane is cut as a strip of 0.5*5 cm. In most

  17. Stamina in later life.

    Science.gov (United States)

    Colerick, E J

    1985-01-01

    Patterns of aging raise a number of important questions concerning the paths to successful adaptation. What gives some older individuals their staying power in the face of misfortune? What causes others to function less effectively when stressed, to resist change? Clearly, the margin of safety, the degree of elasticity and resilience varies across individuals in the later years. This study focuses on event histories and current behavior of 62 elderly men and women (Phase I) and reports by their confidants (N = 62; Phase II). A central proposition, that stamina in later life depends, in part, on the appraisal of previous events involving loss is investigated using a model that incorporates aspects of earlier life, cognitive appraisal and clinically judged dimensions of stamina in old age. Multivariate (particularly path analytic) techniques are used to test the links between variable foci. Results suggest that antecedents of stamina involve the interaction of social resources and cognitive orientations. Specifically, stamina in later life is contingent, for the most part, on a triumphant, positive outlook during periods of adversity. Elderly so oriented are also those with robust health histories and marked educational accomplishments. Conversely, persons who view situations involving loss as threatening, overwhelming and potentially defeating experience no such outcome; low levels of stamina mark their later years. Interestingly, quality childhood ties matter for stamina in old age only by increasing the likelihood of perceptions of a supportive environment during hard times. The findings corroborate the general pattern of research documenting the importance of cognitive orientations in adaptive processes.

  18. The lateral angle revisited

    DEFF Research Database (Denmark)

    Morgan, Jeannie; Lynnerup, Niels; Hoppa, R.D.

    2013-01-01

    measurements taken from computed tomography (CT) scans. Previous reports have observed that the lateral angle size in females is significantly larger than in males. The method was applied to an independent series of 77 postmortem CT scans (42 males, 35 females) to validate its accuracy and reliability...... method appears to be of minimal practical use in forensic anthropology and archeology....

  19. Laterally situated sinus pericranii

    International Nuclear Information System (INIS)

    Koshu, K.; Takahashi, S.

    1981-01-01

    Sinus pericranii has been reported to be situated usually along the midline. Two cases of laterally situated sinus pericranii are presented. Venous blood was obtained by puncturing the tumors directly. Injection of contrast medium into the tumors demonstrated a communication between the tumors and the intracranial venous sinuses through marked diploic veins. (orig.)

  20. Lateral restraint assembly for reactor core

    Science.gov (United States)

    Gorholt, Wilhelm; Luci, Raymond K.

    1986-01-01

    A restraint assembly for use in restraining lateral movement of a reactor core relative to a reactor vessel wherein a plurality of restraint assemblies are interposed between the reactor core and the reactor vessel in circumferentially spaced relation about the core. Each lateral restraint assembly includes a face plate urged against the outer periphery of the core by a plurality of compression springs which enable radial preloading of outer reflector blocks about the core and resist low-level lateral motion of the core. A fixed radial key member cooperates with each face plate in a manner enabling vertical movement of the face plate relative to the key member but restraining movement of the face plate transverse to the key member in a plane transverse to the center axis of the core. In this manner, the key members which have their axes transverse to or subtending acute angles with the direction of a high energy force tending to move the core laterally relative to the reactor vessel restrain such lateral movement.

  1. Clozapine Intoxication Mimicking Acute Stroke

    Directory of Open Access Journals (Sweden)

    Joshua D. Villarreal

    2018-04-01

    Full Text Available Clozapine is an atypical antipsychotic drug prescribed for treatment-resistant schizophrenia. The risk of adverse hematologic, cardiovascular, and neurologic effects has tempered its use, and reports of overdoses remain rare. We report a case of accidental acute clozapine intoxication in a clozapine-naïve patient, who presented with symptoms mimicking acute stroke and later developed status epilepticus. Clozapine intoxication is a rare presentation in the emergency department with potential for iatrogenic harm if not correctly identified.

  2. Diagnostic ultrasound imaging for lateral epicondylalgia: a case-control study.

    Science.gov (United States)

    Heales, Luke James; Broadhurst, Nathan; Mellor, Rebecca; Hodges, Paul William; Vicenzino, Bill

    2014-11-01

    Lateral epicondylalgia (LE) is clinically diagnosed as pain over the lateral elbow that is provoked by gripping. Usually, LE responds well to conservative intervention; however, those who fail such treatment require further evaluation, including musculoskeletal ultrasound. Previous studies of musculoskeletal ultrasound have methodological flaws, such as lack of assessor blinding and failure to control for participant age, sex, and arm dominance. The purpose of this study was to assess the diagnostic use of blinded ultrasound imaging in people with clinically diagnosed LE compared with that in a control group matched for age, sex, and arm dominance. Participants (30 with LE and 30 controls) underwent clinical examination as the criterion standard test. Unilateral LE was defined as pain over the lateral epicondyle, which was provoked by palpation, resisted wrist and finger extension, and gripping. Controls without symptoms were matched for age, sex, and arm dominance. Ultrasound investigations were performed by two sonographers using a standardized protocol. Grayscale images were assessed for signs of tendon pathology and rated on a four-point ordinal scale. Power Doppler was used to assess neovascularity and rated on a five-point ordinal scale. The combination of grayscale and power Doppler imaging revealed an overall sensitivity of 90% and specificity of 47%. The positive and negative likelihood ratios for combined grayscale and power Doppler imaging were 1.69 and 0.21, respectively. Although ultrasound imaging helps confirm the absence of LE, when findings are negative for tendinopathic changes, the high prevalence of tendinopathic changes in pain-free controls challenges the specificity of the measure. The validity of ultrasound imaging to confirm tendon pathology in clinically diagnosed LE requires further study with strong methodology.

  3. 手针联合中药外敷治疗急性踝关节外侧韧带扭伤效果探讨%Discussion Acupuncture Combined With Chinese Medicine Topical Treatment of Acute Lateral Ankle Ligament Sprain Effect

    Institute of Scientific and Technical Information of China (English)

    蔡洪新

    2015-01-01

    Objective To investigate the effect of acupuncture combined with Chinese medicine topical therapy of acute lateral ankle ligament sprain. Methods 96 cases of acute lateral ankle ligament sprain patients were randomly divided into study group and control group of 48 cases. Implement routine acupuncture treatment group, the study group using acupuncture and Chinese herbal medicine topical treatment. Compared two groups of treatment and pain, swelling disappeared. Results Study treatment group total effective rate was 95.83%, the control group was 81.25%(P<0.05), pain time of the study group (7.12±1.15) d, the control group (8.06±1.28) d (P<0.05), Study Group swelling disappeared time (3.15±1.21) d, the control group (4.07±1.32) d (P<0.05). Conclusion Acupuncture combined with TCM herbs can effectively improve the therapeutic effect of acute lateral ankle ligament sprain, promote remission of clinical symptoms.%目的:探讨手针联合中药外敷对急性踝关节外侧韧带扭伤的治疗效果。方法选取96例急性踝关节外侧韧带扭伤患者按随机数字表法分成研究组和对照组各48例。对照组实行常规针刺治疗,研究组采用手针联合中药外敷进行治疗。对比两组的治疗效果及疼痛、肿胀消失时间。结果研究组治疗的总有效率为95.83%,对照组为81.25%(P<0.05);研究组疼痛消失时间为(7.12±1.15)d,对照组为(8.06±1.28) d(P<0.05);研究组肿胀消失时间为(3.15±1.21)d,对照组为(4.07±1.32)d(P<0.05)。结论手针联合中药外敷可有效提高对急性踝关节外侧韧带扭伤的治疗效果,促进临床症状的缓解。

  4. Lateral type of intracerebral hemorrhage

    International Nuclear Information System (INIS)

    Yamagami, Tatsuhito; Gotoh, Yasunobu; Imataka, Kiyoharu; Niijima, Kyo; Handa, Hajime.

    1987-01-01

    The magnetic resonance imaging (MRI) of intracerebral hemorrhages (lateral type) was studied. The strength of the magnetic field was 0.2 Tesla. Four cases were studied with inversion recovery (IR) and saturation recovery (SR) images. The findings of the acute stage (within 1 week) were a central isointensity and a peripheral low intensity on the IR image. On the SR image we recognized a central isointensity and a peripheral high intensity holding a faintly high intensity area around the hematoma. The findings of the subacute stage (from 1 to 3 weeks) were characterized by a central isointensity and a peripheral high-intensity ring, with a low-intensity area outside the hematoma on the IR image. A widespread high-intensity area including the hematoma itself and the surrounding white matter was observed on the SR image. The findings of the chronic stage (over 3 weeks) were the disapperance of a high-intensity ring and a change to a low-intensity area on the IR image. The hematoma itself and surrounding white matter had a high intensity, which has decreased in size in comparison with that of the subacute stage. The hypointensity rim was found in the immediately adjacent part of the original hematoma on the SR image. The MRI of a small hematoma 70 days from the onset showed an almost normal brain structure. Some magnetic resonance findings of intracerebral hemorrhage were reviewed. (author)

  5. Acute appendicitis mistaken as acute rejection in renal transplant recipients.

    Directory of Open Access Journals (Sweden)

    Talwalkar N

    1994-01-01

    Full Text Available Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.

  6. Lateral Attitude Change.

    Science.gov (United States)

    Glaser, Tina; Dickel, Nina; Liersch, Benjamin; Rees, Jonas; Süssenbach, Philipp; Bohner, Gerd

    2015-08-01

    The authors propose a framework distinguishing two types of lateral attitude change (LAC): (a) generalization effects, where attitude change toward a focal object transfers to related objects, and (b) displacement effects, where only related attitudes change but the focal attitude does not change. They bring together examples of LAC from various domains of research, outline the conditions and underlying processes of each type of LAC, and develop a theoretical framework that enables researchers to study LAC more systematically in the future. Compared with established theories of attitude change, the LAC framework focuses on lateral instead of focal attitude change and encompasses both generalization and displacement. Novel predictions and designs for studying LAC are presented. © 2014 by the Society for Personality and Social Psychology, Inc.

  7. Organizations Utilize Lateral Relationships

    OpenAIRE

    Jacqueline C.

    2017-01-01

    The structures that subscribe to different organization play a major role and determine how information flows throughout an organization as well as the reporting structure within the organization. In some organization, decision making rely with the top management, and in other organizations, decision making responsibilities may be distributed within the organization. The latter part is what mainly constitutes a lateral structural arrangement where various departments work hand in hand in achi...

  8. Advantages of later motherhood.

    Science.gov (United States)

    Myrskylä, M; Barclay, K; Goisis, A

    2017-01-01

    In high-income countries childbearing has been increasingly postponed since the 1970s and it is crucial to understand the consequences of this demographic shift. The literature has tended to characterize later motherhood as a significant health threat for children and parents. We contribute to this debate by reviewing recent evidence suggesting that an older maternal age can also have positive effects. Literature linking the age at parenthood with the sociodemographic characteristics of the parents, with macrolevel interactions, and with subjective well-being. Comprehensive review of the existing literature. Recent studies show that there can also be advantages associated with later motherhood. First, whilst in past older mothers had low levels of education and large families, currently older mothers tend to have higher education and smaller families than their younger peers. Consequently, children born to older mothers in the past tended to have worse outcomes than children born to younger mothers, whilst the opposite is true in recent cohorts. Second, postponement of childbearing means that the child is born at a later date and in a later birth cohort, and may benefit from secular changes in the macroenvironment. Evidence shows that when the positive trends in the macroenvironment are strong they overweigh the negative effects of reproductive ageing. Third, existing studies show that happiness increases around and after childbirth among older mothers, whereas for younger mothers the effect does not exist or is short-lived. There are important sociodemographic pathways associated with postponement of childbearing which might compensate or even more than compensate for the biological disadvantages associated with reproductive ageing.

  9. [Local demyelination in amyotrophic lateral sclerosis].

    Science.gov (United States)

    Kvirkvelia, N; Shakarishvili, R

    2013-02-01

    It is well known that the demyelination of peripheral nerves can be diffuse or local. Pathogenesis of acute or chronic inflamentary demyelination polyneurophathy is based on diffuse demyelination. Local demyelination occured by conduction block with electoneuromyographic (ENMG) researches. It is the main characteristic of multifocal motor neuropathy (MMN). Generally it is considered, that conduction block is not usual for amyotrophic lateral sclerosis (ALS). More over, its existance excludes this diagnosis. The article discribes 3 cases of ALS with conduction block verified with ENMG researches. Article also deals with pathogenetic mechanisms of conduction block in ALS and MMN. In addition it observes the issues of differential diagnosis between ALS and MMW.

  10. Prolonged lateral steep position impairs respiratory mechanics during continuous lateral rotation therapy in respiratory failure.

    Science.gov (United States)

    Schellongowski, Peter; Losert, Heidrun; Locker, Gottfried J; Laczika, Klaus; Frass, Michael; Holzinger, Ulrike; Bojic, Andja; Staudinger, Thomas

    2007-04-01

    To establish whether prolonged lateral steep position during continuous rotation therapy leads to improvement on pulmonary gas exchange, respiratory mechanics and hemodynamics. Prospective observational study. Intensive care unit of a university hospital. Twelve consecutive patients suffering from acute lung injury or adult respiratory distress syndrome undergoing continuous rotation therapy. Blood gas analysis, static lung compliance, blood pressure, cardiac index and pulmonary shunt fraction were measured in supine as well as in left and right lateral steep position at 62 degrees during continuous rotation therapy (phase I). Rotation was then stopped for 30 min with the patients in supine position, left and right lateral steep position, and the same measurements were performed every 10 min (phase II). Phase I and II revealed no significant changes in PaO(2)/FiO(2) ratio, mean arterial blood pressure, pulmonary shunt fraction, or cardiac index. Significantly lower static compliance was observed in lateral steep position than in supine position (pposition than in left and right lateral steep position (ppositioning impairs the compliance of the respiratory system. Prolonged lateral steep position does not lead to benefits with respect to oxygenation or hemodynamics. Individual response to the different positions is unpredictable. The pauses in "extreme" positions should be as short as possible.

  11. Herpes zoster-induced acute urinary retention.

    Science.gov (United States)

    Addison, Ben; Harvey, Martyn

    2013-06-01

    Urinary retention is a common acute presentation for men in their later decades. Potential contributing pathologies are numerous. We report an unusual case of acute urinary retention requiring catheterisation secondary to sacral herpes zoster reactivation (S2-4) in an 88-year-old man with minimal preceding obstructive symptoms. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Laparoscopic Puestow: lateral pancreaticojejunostomy.

    Science.gov (United States)

    Biteman, Benjamin R; Harr, Jeffrey N; Brody, Fred

    2016-12-01

    Chronic pancreatitis is a painful inflammatory disease that leads to progressive and irreversible destruction of pancreatic parenchyma [1]. A lateral pancreaticojejunostomy, also known as the Puestow procedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures [4]. An open approach is used traditionally due to the complexity of the case, and there have only been a handful of laparoscopic case reports [2]. This video depicts a laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis. A 45-year-old gentleman with a 20-year history of chronic alcohol abuse presented with diffuse abdominal pain. His pain was worse postprandially and associated with loose stools. A computed tomography scan revealed multiple calcified deposits within the body and tail of the pancreas, and a dilated pancreatic duct measuring 1.4 cm with a proximal obstructing calcified stone. A 5-port foregut technique was used, and a 15-cm pancreatic ductotomy was performed with an ultrasonic scalpel. Calcified stones were cleared from the duct, and a roux-en-y pancreaticojejunostomy was performed using a hand-sewn technique. The patient had a relatively uncomplicated hospital course with return of bowel function on postoperative day 4. His patient-controlled analgesic device was discontinued on post operative day 3. He was ambulating, tolerating a regular diet and discharged home on postoperative day 5. At 12- and 26-month follow-up, he remains off narcotics, but still requires 1-2 tabs of pancreatic enzyme replacement per meal. Most importantly, he has not had any alcohol for over 2 years. The two primary goals in treating chronic pancreatitis include long-term pain relief and improvements in quality of life [3]. For patients with chronic pancreatitis and a dilated pancreatic duct, a laparoscopic lateral pancreaticojejunostomy may be an effective approach to decrease pain and improve quality of life.

  13. Modified puestow lateral pancreaticojejunostomy.

    Science.gov (United States)

    Ceppa, Eugene P; Pappas, Theodore N

    2009-05-01

    There are various surgical options for the treatment of pain associated with chronic pancreatitis. The modified Puestow lateral pancreaticojejunostomy has been proven to be effective in ameliorating symptoms and expediting return to normal lifestyle while maintaining a low rate of morbidity and mortality. However, the debate regarding which surgical treatment provides the best outcomes is controversial. The aims of this manuscript are to identify the patient population for which the Puestow benefits the most and discuss the pertinent technical aspects of the surgical procedure.

  14. 高频超声诊断急性踝内翻外侧副韧带损伤的临床价值%Effectiveness of Application of High-frequency Ultrasonography in Diagnosis of Acute Ankle Inversion Sprain Injury of Lateral Collateral Ligament

    Institute of Scientific and Technical Information of China (English)

    肖岚; 李素淑

    2016-01-01

    Objective To explore the effectiveness of application of thehigh-frequency ultrasonography in diagnosis of the acute ankle inversion sprain injury of the lateral collateral ligament.Methods Patients with clinical diagnosis of acute ankle inversion sprain were examined with the high frequency liner probe, and the appearances of lateral collateral ligament injury and avulsion fracture were emphatically observed. The ultrasonographic diagnosis of avulsion fracture was compared with X-Ray examination in all patients.Results Among 46 cases who were diagnosed of ATFL (Anterior taloifbular ligament) injuries with ultrasonography, 17 cases were Degree I injury, 20 cases were Degree II injury, 9 cases were Degree III injury, combined with 7 cases of CFL (Calcaneoifbular Ligament) contusion in Degree I injury and 5 cases in Degree II injury. Among 12 patients with ultrasound manifestations of tiny and avulsion fracture, 10 patients were positive and 2 were negative with X-Ray examination. Good consistency was seen between the results of ultrasound and X-Ray in diagnosis of fractures.Conclusion Thehigh-frequency ultrasonography demonstrates itself an imaging method with high-resolution and easy-to-operate features in evaluating soft tissue injuries and coexistent avulsion or tiny fractures for acute ankle sprain, which is worth wider clinical application.%目的:探讨高频超声诊断急性踝内翻外侧副韧带损伤的临床价值。方法对临床诊断为踝关节扭伤的患者,采用高频线阵探头探查其踝关节,重点观察外侧副韧带损伤情况及是否有撕脱性骨折。同时,对所有患者均行X线检查,将其中伴有撕脱性骨折的患者的超声诊断结果与X线检查结果进行比较。结果在46例经超声诊断为距腓前韧带损伤的患者中,17例为Ⅰ型损伤,20例为Ⅱ型损伤,9例为Ⅲ型损伤;合并跟腓韧带Ⅰ型损伤7例,Ⅱ型损伤5例;合并撕脱性或微小骨折12例,其中10

  15. Spontaneous lateral temporal encephalocele.

    Science.gov (United States)

    Tuncbilek, Gokhan; Calis, Mert; Akalan, Nejat

    2013-01-01

    A spontaneous encephalocele is one that develops either because of embryological maldevelopment or from a poorly understood postnatal process that permits brain herniation to occur. We here report a rare case of lateral temporal encephalocele extending to the infratemporal fossa under the zygomatic arch. At birth, the infant was noted to have a large cystic mass in the right side of the face. After being operated on initially in another center in the newborn period, the patient was referred to our clinic with a diagnosis of temporal encephalocele. He was 6 months old at the time of admission. Computerized tomography scan and magnetic resonance imaging studies revealed a 8 × 9 cm fluid-filled, multiloculated cystic mass at the right infratemporal fossa. No intracranial pathology or connection is seen. The patient was operated on to reduce the distortion effect of the growing mass. The histopathological examination of the sac revealed well-differentiated mature glial tissue stained with glial fibrillary acid protein. This rare clinical presentation of encephaloceles should be taken into consideration during the evaluation of the lateral facial masses in the infancy period, and possible intracranial connection should be ruled out before surgery to avoid complications.

  16. Acute nephritic syndrome

    Science.gov (United States)

    Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute ... Acute nephritic syndrome is often caused by an immune response triggered by an infection or other disease. Common causes in children ...

  17. Vitiligo Lateral Lower Lip

    Directory of Open Access Journals (Sweden)

    Sahoo Antaryami

    2002-01-01

    Full Text Available Vitiligo characteristically affecting the lateral lower lip (LLL is a common presentation in South Orissa. This type of lesion has rarely been described in literature. One hundred eighteen such cases were studied during the period from October 1999 to September, 2000. LLL vitiligo constituted 16.39% of all vitiligo patients. Both sexes were affected equally. The peak age of onset was in the 2nd decade, mean duration of illness 21.46 months. Fifty six patients had unilateral lesion (38 on the left and 18 on the right. Among the 62 patients having bilateral lesions, the onset was more frequent on the left (38 than either the right (8 or both sides together (16. All the patients were right handed. Association with local factors like infection, trauma, cheilitis, FDE etc were associated in 38.98% of cases, but systemic or autoimmune diseases were not associated. Positive family history was found in 22% of cases.

  18. Acute Hemolysis Caused by Incidental Trichlorfon Exposure

    Directory of Open Access Journals (Sweden)

    Ming-Ling Wu

    2009-04-01

    Full Text Available Trichlorfon (o-o-dimethyl-2,2,2-trichloro-hydroxyethylphosphate, an organophosphate, has a moderately potent anti-cholinesterase activity. Organophosphate poisoning is well known for its characteristic symptoms and signs, but acute hemolysis caused by trichlorfon is rarely reported. We present a patient who developed acute hemolysis and renal function impairment after percutaneous trichlorfon exposure. A 54-year-old man applied trichlorfon powder to his dog to kill its parasites. Half an hour later, the dog was suspected to die of cholinergic crisis and the patient felt abdominal cramping pain. Later, he developed severe nausea, vomiting, chills, high fever, and cold sweat. Laboratory work-up disclosed a picture of acute hemolysis, jaundice, renal function impairment and leukocytosis. However, there were no clinical features of acute cholinergic syndrome except gastrointestinal symptoms, and blood cholinesterase activities were also normal. He eventually had a full recovery. Trichlorfon should be added to the toxins known to cause acute hemolysis.

  19. Robotic lateral pancreaticojejunostomy (Puestow).

    Science.gov (United States)

    Meehan, John J; Sawin, Robert

    2011-06-01

    A lateral pancreaticojejunostomy (LPJ), also known as the Puestow procedure, is a complex procedure performed for chronic pancreatitis when the pancreatic duct is dilated and unable to drain properly. Traditionally, these procedures are performed with open surgery. A minimally invasive approach to the LPJ using rigid handheld nonarticulating instruments is tedious and rarely performed. In fact, there are no prior laparoscopic case reports for LPJ in children and only a small handful of cases in the adult literature. This lack of laparoscopic information may be an indication of the difficulty in performing this complex operation with nonarticulating laparoscopic instruments. The advantages of robotic surgery may help overcome these difficulties. We present the first robotic LPJ ever reported in a 14-year-old child with idiopathic chronic pancreatitis. This case demonstrates the utility of this advanced surgical technology and may lead to a new minimally invasive option for both adults and children with chronic pancreatitis requiring surgical intervention. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Lateral loadings on snubber assemblies

    International Nuclear Information System (INIS)

    Raphael, L.S.

    1981-01-01

    This paper examines the installation of snubber assemblies in power plants with respect to transverse or lateral loads as well as axial loads. Evaluation of the effects of low level, lateral loads was performed by analytical means. At higher loadings, the snubber assembly could no longer be treated as a column; therefore, the effects of lateral loadings was determined by test. The test consisted of applying both lateral and axial loads simultaneously. Results of both the analysis and the test showed that the application of lateral loads had a considerable effect on the snubber assemblies

  1. Computerized tomography in acute toxic encephalopathy

    International Nuclear Information System (INIS)

    Aoki, Nobuhiko; Kaneshi, Kunio; Mizuguchi, Masashi; Kurihara, Eiji.

    1983-01-01

    We experienced three cases of acute toxic encephalopathy, including a case of probable Reye syndrome, which had similar and unique CT findings in their acute stage; symmetrical low density area in the thalamus and the dentate nucleus, followed by changes in cerebellar hemispheres and around lateral ventricles. The CT findings, common to probable Reye syndrome and other acute toxic encephalopathy, may suggest the possibility of similar pathogenesis of brain damage in both disorders. The authors propose that present cases are a new subgroup in acute toxic encephalopathy, because of their similar and unique CT features. (author)

  2. Acute Pancreatitis and Pregnancy

    Science.gov (United States)

    ... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  3. Cosmetic Lateral Canthoplasty: Preserving the Lateral Canthal Angle

    Directory of Open Access Journals (Sweden)

    Yeon-Jun Kim

    2016-07-01

    Full Text Available Cosmetic lateral canthoplasty, in which the size of the eye is increased by extending the palpebral fissure and decreasing the degree of the eye slant, has become a prevalent procedure for East Asians. However, it is not uncommon for there to be complications or unfavorable results after the surgery. With this in mind, the authors have designed a surgical method to reduce complications in cosmetic lateral canthoplasty by preserving the lateral canthal angle. We discuss here the anatomy required for surgery, the surgical methods, and methods for reducing complications during cosmetic lateral canthoplasty.

  4. LATERAL SURVIVAL: AN OT ACCOUNT

    Directory of Open Access Journals (Sweden)

    Moira Yip

    2004-12-01

    Full Text Available When laterals are the targets of phonological processes, laterality may or may not survive. In a fixed feature geometry, [lateral] should be lost if its superordinate node is eliminated by either the spreading of a neighbouring node, or by coda neutralization. So if [lateral] is under Coronal (Blevins 1994, it should be lost under Place assimilation, and if [lateral] is under Sonorant Voicing (Rice & Avery 1991 it should be lost by rules that spread voicing. Yet in some languages lateral survives such spreading intact. Facts like these argue against a universal attachment of [lateral] under either Coronal or Sonorant Voicing, and in favour of an account in terms of markedness constraints on feature-co-occurrence (Padgett 2000. The core of an OT account is that IFIDENTLAT is ranked above whatever causes neutralization, such as SHARE-F or *CODAF. laterality will survive. If these rankings are reversed, we derive languages in which laterality is lost. The other significant factor is markedness. High-ranked feature co-occurrence constraints like *LATDORSAL can block spreading from affecting laterals at all.

  5. Amyotrophic lateral sclerosis

    Directory of Open Access Journals (Sweden)

    Leigh P Nigel

    2009-02-01

    Full Text Available Abstract Amyotrophic lateral sclerosis (ALS is a neurodegenerative disease characterised by progressive muscular paralysis reflecting degeneration of motor neurones in the primary motor cortex, corticospinal tracts, brainstem and spinal cord. Incidence (average 1.89 per 100,000/year and prevalence (average 5.2 per100,000 are relatively uniform in Western countries, although foci of higher frequency occur in the Western Pacific. The mean age of onset for sporadic ALS is about 60 years. Overall, there is a slight male prevalence (M:F ratio~1.5:1. Approximately two thirds of patients with typical ALS have a spinal form of the disease (limb onset and present with symptoms related to focal muscle weakness and wasting, where the symptoms may start either distally or proximally in the upper and lower limbs. Gradually, spasticity may develop in the weakened atrophic limbs, affecting manual dexterity and gait. Patients with bulbar onset ALS usually present with dysarthria and dysphagia for solid or liquids, and limbs symptoms can develop almost simultaneously with bulbar symptoms, and in the vast majority of cases will occur within 1–2 years. Paralysis is progressive and leads to death due to respiratory failure within 2–3 years for bulbar onset cases and 3–5 years for limb onset ALS cases. Most ALS cases are sporadic but 5–10% of cases are familial, and of these 20% have a mutation of the SOD1 gene and about 2–5% have mutations of the TARDBP (TDP-43 gene. Two percent of apparently sporadic patients have SOD1 mutations, and TARDBP mutations also occur in sporadic cases. The diagnosis is based on clinical history, examination, electromyography, and exclusion of 'ALS-mimics' (e.g. cervical spondylotic myelopathies, multifocal motor neuropathy, Kennedy's disease by appropriate investigations. The pathological hallmarks comprise loss of motor neurones with intraneuronal ubiquitin-immunoreactive inclusions in upper motor neurones and TDP-43

  6. Acute pancreatitis.

    Science.gov (United States)

    Talukdar, Rupjyoti; Vege, Santhi S

    2015-09-01

    To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis. Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis. A reliable clinical or laboratory marker or a scoring system to predict severity is lacking. The PYTHON trial has shown that oral feeding with on demand nasoenteric tube feeding after 72 h is as good as nasoenteric tube feeding within 24 h in preventing infections in predicted severe acute pancreatitis. Male sex, multiple organ failure, extent of pancreatic necrosis, and heterogeneous collection are factors associated with failure of percutaneous drainage of pancreatic collections. The newly proposed classification systems of acute pancreatitis need to be evaluated more critically. New biomarkers are needed for severity prediction. Further well designed studies are required to assess the type of enteral nutritional formulations for acute pancreatitis. The optimal minimally invasive method or combination to debride the necrotic collections is evolving. There is a great need for a drug to treat the disease early on to prevent morbidity and mortality.

  7. Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

    Science.gov (United States)

    Denegar, Craig R.; Miller, Sayers J., III

    2002-01-01

    Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

  8. Plasma cytokines in acute stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik

    2011-01-01

    GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...... months later plasma levels of interleukin 1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 10 (IL-10), soluble tumor necrosis factor receptor 1 (sTNF-R1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were...

  9. Lagrangian Studies of Lateral Mixing

    Science.gov (United States)

    2017-09-19

    Final Technical 3. DATES COVERED (From - To) 01/01/2009 – 12/31/2015 4. TITLE AND SUBTITLE Lagrangian Studies of Lateral Mixing 5a. CONTRACT NUMBER...public release; distribution is unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT The Lateral Mixing Experiment (LATMIX) focused on mixing and...anomalies. LATMIX2 targeted the wintertime Gulf Stream, where deep mixed layers, strong lateral density gradients (Gulf Stream north wall) and the

  10. Integrated vehicle's lateral safety: the LATERAL SAFE experience

    NARCIS (Netherlands)

    Amditis, A.; Floudas, N.; Kaiser-Dieckhoff, U.; Hackbarth, T.; Broek, S.P. van den; Miglietta, M.; Danielson, L.; Gemou, M.; Bekiaris, E.

    2008-01-01

    The applications developed and the evaluation results of the EU funded automotive safety PReVENT IP subproject LATERAL SAFE are described. The data synthesis algorithms that aim at achieving a reliable representation of the objects and their kinematics, in the lateral and rear fields of the host

  11. Integrated vehicle’s lateral safety: the LATERAL SAFE experience

    NARCIS (Netherlands)

    Amditis, A.; Floudas, N.; Kaiser-Dieckhoff, U.; Hackbarth, T.; Broek, S.P. van den; Miglietta, M.; Danielson, L.; Gemou, M.; Bekiaris, E.

    2008-01-01

    The applications developed and the evaluation results of the EU funded automotive safety PReVENT IP subproject LATERAL SAFE are described. The data synthesis algorithms that aim at achieving a reliable representation of the objects and their kinematics, in the lateral and rear fields of the host

  12. A Pascalian lateral drift sensor

    International Nuclear Information System (INIS)

    Jansen, H.

    2016-01-01

    A novel concept of a layer-wise produced semiconductor sensor for precise particle tracking is proposed herein. In contrast to common semiconductor sensors, local regions with increased doping concentration deep in the bulk termed charge guides increase the lateral drift of free charges on their way to the read-out electrode. This lateral drift enables charge sharing independent of the incident position of the traversing particle. With a regular grid of charge guides the lateral charge distribution resembles a normalised Pascal's triangle for particles that are stopped in depths lower than the depth of the first layer of the charge guides. For minimum ionising particles a sum of binomial distributions describes the lateral charge distribution. This concept decouples the achievable sensor resolution from the pitch size as the characteristic length is replaced by the lateral distance of the charge guides.

  13. A Pascalian lateral drift sensor

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, H., E-mail: hendrik.jansen@desy.de

    2016-09-21

    A novel concept of a layer-wise produced semiconductor sensor for precise particle tracking is proposed herein. In contrast to common semiconductor sensors, local regions with increased doping concentration deep in the bulk termed charge guides increase the lateral drift of free charges on their way to the read-out electrode. This lateral drift enables charge sharing independent of the incident position of the traversing particle. With a regular grid of charge guides the lateral charge distribution resembles a normalised Pascal's triangle for particles that are stopped in depths lower than the depth of the first layer of the charge guides. For minimum ionising particles a sum of binomial distributions describes the lateral charge distribution. This concept decouples the achievable sensor resolution from the pitch size as the characteristic length is replaced by the lateral distance of the charge guides.

  14. Diclofenac Patch for Treatment of Mild to Moderate Tendonitis or Bursitis

    Science.gov (United States)

    2008-08-05

    Rotator Cuff Tendonitis; Bicipital Tendonitis; Subdeltoid Bursitis of the Shoulder; Subacromial Bursitis of the Shoulder; Medial Epicondylitis of the Elbow; Lateral Epicondylitis of the Elbow; DeQuervain's Tenosynovitis of the Wrist

  15. Acute Pancreatitis

    DEFF Research Database (Denmark)

    Bertilsson, Sara; Håkansson, Anders; Kalaitzakis, Evangelos

    2017-01-01

    Aims: We aimed to evaluate the potential relation between the incidence of (alcoholic and non-alcoholic) acute pancreatitis (AP) and alcohol consumption in the general population, and whether the occurrence of AP shows any seasonal variation, particularly in relation to periods with expected...... consumption in the general population do not appear to be related to changes in the incidence of AP and there are no significant seasonal differences in the occurrence of AP in Sweden. Short summary: The incidence of acute pancreatitis (AP) is increasing, and alcohol is still recognized as one of the most...

  16. Acute external otitis as debut of acute myeloid leukemia - A case and review of the literature.

    Science.gov (United States)

    Slengerik-Hansen, Joachim; Ovesen, Therese

    2018-03-01

    Acute leukemia is a well known childhood cancer. The relation between leukemia and otological symptoms has long been established but is highly rare as a debut symptom of leukemia. External otitis is a common condition affecting many children, and most cases are successively treated with topical medicine. Here we present a child with acute external otitis later shown to be the debut symptom of acute myeloid leukemia, to our knowledge the first specific case described. We have reviewed the literature to find red flags for suspicion of severe disease in case of acute external otitis. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Lateralization of the Huggins pitch

    Science.gov (United States)

    Zhang, Peter Xinya; Hartmann, William M.

    2004-05-01

    The lateralization of the Huggins pitch (HP) was measured using a direct estimation method. The background noise was initially N0 or Nπ, and then the laterality of the entire stimulus was varied with a frequency-independent interaural delay, ranging from -1 to +1 ms. Two versions of the HP boundary region were used, stepped phase and linear phase. When presented in isolation, without the broadband background, the stepped boundary can be lateralized on its own but the linear boundary cannot. Nevertheless, the lateralizations of both forms of HP were found to be almost identical functions both of the interaural delay and of the boundary frequency over a two-octave range. In a third experiment, the same listeners lateralized sine tones in quiet as a function of interaural delay. Good agreement was found between lateralizations of the HP and of the corresponding sine tones. The lateralization judgments depended on the boundary frequency according to the expected hyperbolic law except when the frequency-independent delay was zero. For the latter case, the dependence on boundary frequency was much slower than hyperbolic. [Work supported by the NIDCD grant DC 00181.

  18. Lateral positioning for critically ill adult patients.

    Science.gov (United States)

    Hewitt, Nicky; Bucknall, Tracey; Faraone, Nardene M

    2016-05-12

    % confidence interval (CI) -67.33 to -31.18; P value patients. Research gaps include the effectiveness of lateral positioning compared with semi recumbent positioning for mechanically ventilated patients, lateral positioning compared with prone positioning for acute respiratory distress syndrome (ARDS) and less frequent changes in body position. We recommend that future research be undertaken to address whether the routine practice of repositioning patients on their side benefits all, some or few critically ill patients.

  19. Motor laterality as an indicator of speech laterality.

    Science.gov (United States)

    Flowers, Kenneth A; Hudson, John M

    2013-03-01

    The determination of speech laterality, especially where it is anomalous, is both a theoretical issue and a practical problem for brain surgery. Handedness is commonly thought to be related to speech representation, but exactly how is not clearly understood. This investigation analyzed handedness by preference rating and performance on a reliable task of motor laterality in 34 patients undergoing a Wada test, to see if they could provide an indicator of speech laterality. Hand usage preference ratings divided patients into left, right, and mixed in preference. Between-hand differences in movement time on a pegboard task determined motor laterality. Results were correlated (χ2) with speech representation as determined by a standard Wada test. It was found that patients whose between-hand difference in speed on the motor task was small or inconsistent were the ones whose Wada test speech representation was likely to be ambiguous or anomalous, whereas all those with a consistently large between-hand difference showed clear unilateral speech representation in the hemisphere controlling the better hand (χ2 = 10.45, df = 1, p laterality are related where they both involve a central control of motor output sequencing and that a measure of that aspect of the former will indicate the likely representation of the latter. A between-hand measure of motor laterality based on such a measure may indicate the possibility of anomalous speech representation. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  20. Acute Otitis Media in Children.

    Science.gov (United States)

    Leung, Alexander K C; Wong, Alex H C

    2017-01-01

    Acute otitis media is a common childhood infection. Prompt diagnosis and appropriate treatment are very important. To review in depth the epidemiology, pathophysiology, clinical manifestations, diagnosis, complications and particularly treatment of acute otitis media in children. A PubMed search was completed in Clinical Queries using the key term "acute otitis media". Patents were searched using the key term "acute otitis media" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. Acute otitis media affects over 80% of children before their third birthday and 30 to 45% of these children have suffered two or more episodes. Streptococcus pneumoniae, nontypable Haemophilus influenzae, and Moraxella catarrhalis are the most frequently isolated middle-ear pathogens. The diagnosis is based on acute onset of symptoms such as otalgia and fever, middle ear inflammation such as erythema of the tympanic membrane, and middle ear effusion. The choice of treatment method depends on the age of the child, laterality, and the severity of the disease. Recent patents related to the management of acute otitis media are also retrieved and discussed. Antimicrobial treatment is recommended for all children less than two years of age, as well as in children ≥ two years of age who have a temperature ≥ 39oC; are toxic looking; have otalgia > 48 hours; have bilateral otitis media or otorrhea; have craniofacial abnormalities; are immunocompromised; or have uncertain access to follow-up. Amoxicillin is the drug of choice. Observation without antibiotic is an option in immunocompetent children ≥ two years of age who have an acute uncomplicated otitis media and non-severe illness if appropriate follow-up can be arranged. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  1. Cerebral Laterality and Verbal Processes

    Science.gov (United States)

    Sherman, Jay L.; And Others

    1976-01-01

    Research suggests that we process information by way of two distinct and functionally separate coding systems. Their location, somewhat dependent on cerebral laterality, varies in right- and left-handed persons. Tests this dual coding model. (Editor/RK)

  2. Modeling multi-lateral wells

    Energy Technology Data Exchange (ETDEWEB)

    Su, H. J.; Fong, W. S. [Chevron Petroleum Technology Company (United States)

    1998-12-31

    A method for modeling multi-lateral wells by using a computational scheme embedded in a general-purpose, finite difference simulator was described. The calculation of wellbore pressure profile for each lateral included the frictional pressure drop along the wellbore and proper fluid mixing at lateral connection points. To obtain a good production profile the Beggs and Brill correlation, a homogenous flow model, and the model proposed by Ouyang et al, which includes an acceleration term and accounts for the lubrication effect due to radial influx, were implemented. Well performance prediction results were compared using the three models. The impact of different tubing sizes on the well performance and the prediction contribution from each lateral were also studied. Results of the study in the hypothetical example and under normal field operating conditions were reviewed. 7 refs., 10 tabs., 3 figs.

  3. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance

    International Nuclear Information System (INIS)

    Stensby, J.D.; Baker, Jonathan C.; Fox, Michael G.

    2016-01-01

    The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries. (orig.)

  4. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance

    Energy Technology Data Exchange (ETDEWEB)

    Stensby, J.D. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States); Mallinckrodt Institute of Radiology, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO (United States); Baker, Jonathan C. [Mallinckrodt Institute of Radiology, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO (United States); Fox, Michael G. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States)

    2016-02-15

    The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries. (orig.)

  5. [Brain lateralization and seizure semiology: ictal clinical lateralizing signs].

    Science.gov (United States)

    Horváth, Réka; Kalmár, Zsuzsanna; Fehér, Nóra; Fogarasi, András; Gyimesi, Csilla; Janszky, József

    2008-07-30

    Clinical lateralizing signs are the phenomena which can unequivocally refer to the hemispheric onset of epileptic seizures. They can improve the localization of epileptogenic zone during presurgical evaluation, moreover, their presence can predict a success of surgical treatment. Primary sensory phenomena such as visual aura in one half of the field of vision or unilateral ictal somatosensory sensation always appear on the contralateral to the focus. Periictal unilateral headache, although it is an infrequent symptom, is usually an ipsilateral sign. Primary motor phenomena like epileptic clonic, tonic movements, the version of head ubiquitously appear contralateral to the epileptogenic zone. Very useful lateralization sign is the ictal hand-dystonia which lateralizes to the contralateral hemisphere in nearly 100%. The last clonus of the secondarily generalized tonic-clonic seizure lateralizes to the ipsilateral hemisphere in 85%. The fast component of ictal nystagmus appears in nearly 100% on the contralateral side of the epileptic focus. Vegetative symptoms during seizures arising from temporal lobe such as spitting, nausea, vomiting, urinary urge are typical for seizures originating from non-dominant (right) hemisphere. Ictal pallor and cold shivers are dominant hemispheric lateralization signs. Postictal unilateral nose wiping refers to the ipsilateral hemispheric focus compared to the wiping hand. Ictal or postictal aphasia refers to seizure arising from dominant hemisphere. Intelligable speech during complex partial seizures appears in non-dominant seizures. Automatism with preserved consciousness refers to the seizures of non-dominant temporal lobe.

  6. Acute pulmonary parenchymal densities in the adult

    International Nuclear Information System (INIS)

    Murphy, C.H.; Murphy, M.R.

    1987-01-01

    The thrust of the radiographic interpretation is to correlate the often non-specific appearance of any parenchymal density with its time-table of development, rate of change, distribution, and the patient's clinical status. Although this chapter contains separate sections on each major cause of acute pulmonary opacification, the intent of the chapter overall is their differential diagnosis. Before beginning to deal with acute pulmonary densities, it is stressed that acute densities can only be differentiated from chronic ones by reviewing preoperative or pre-existing studies. Without the baseline comparison film or reliable presumption of prior normalcy, the acuteness of a parenchymal density may not be apparent until later examinations reveal change or resolution. Also, as discussed is baseline pathology that is altered by the portable technique can be terribly confusing when attempting to evaluate a single isolated film in an acute clinical situation

  7. Acute abdomen

    Directory of Open Access Journals (Sweden)

    Wig J

    1978-01-01

    Full Text Available 550 cases of acute abdomen have been analysed in detail includ-ing their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%. External hernia was responsible for 26% of cases of intestinal obstruction. Perforated peptic ulcer was the commonest cause of peritonitis in the present series (31.7% while incidence of biliary peritonitis was only 2.4%.. The clinical accuracy rate was 87%. The mortality in operated cases was high (10% while the over-all mortality rate was 7.5%.

  8. Acute Blindness.

    Science.gov (United States)

    Meekins, Jessica M

    2015-09-01

    Sudden loss of vision is an ophthalmic emergency with numerous possible causes. Abnormalities may occur at any point within the complex vision pathway, from retina to optic nerve to the visual center in the occipital lobe. This article reviews specific prechiasm (retina and optic nerve) and cerebral cortical diseases that lead to acute blindness. Information regarding specific etiologies, pathophysiology, diagnosis, treatment, and prognosis for vision is discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Lateral topological crystalline insulator heterostructure

    Science.gov (United States)

    Sun, Qilong; Dai, Ying; Niu, Chengwang; Ma, Yandong; Wei, Wei; Yu, Lin; Huang, Baibiao

    2017-06-01

    The emergence of lateral heterostructures fabricated by two-dimensional building blocks brings many exciting realms in material science and device physics. Enriching available nanomaterials for creating such heterostructures and enabling the underlying new physics is highly coveted for the integration of next-generation devices. Here, we report a breakthrough in lateral heterostructure based on the monolayer square transition-metal dichalcogenides MX2 (M  =  W, X  =  S/Se) modules. Our results reveal that the MX2 lateral heterostructure (1S-MX2 LHS) can possess excellent thermal and dynamical stability. Remarkably, the highly desired two-dimensional topological crystalline insulator phase is confirmed by the calculated mirror Chern number {{n}\\text{M}}=-1 . A nontrivial band gap of 65 meV is obtained with SOC, indicating the potential for room-temperature observation and applications. The topologically protected edge states emerge at the edges of two different nanoribbons between the bulk band gap, which is consistent with the mirror Chern number. In addition, a strain-induced topological phase transition in 1S-MX2 LHS is also revealed, endowing the potential utilities in electronics and spintronics. Our predictions not only introduce new member and vitality into the studies of lateral heterostructures, but also highlight the promise of lateral heterostructure as appealing topological crystalline insulator platforms with excellent stability for future devices.

  10. Vertical and lateral heterogeneous integration

    Science.gov (United States)

    Geske, Jon; Okuno, Yae L.; Bowers, John E.; Jayaraman, Vijay

    2001-09-01

    A technique for achieving large-scale monolithic integration of lattice-mismatched materials in the vertical direction and the lateral integration of dissimilar lattice-matched structures has been developed. The technique uses a single nonplanar direct-wafer-bond step to transform vertically integrated epitaxial structures into lateral epitaxial variation across the surface of a wafer. Nonplanar wafer bonding is demonstrated by integrating four different unstrained multi-quantum-well active regions lattice matched to InP on a GaAs wafer surface. Microscopy is used to verify the quality of the bonded interface, and photoluminescence is used to verify that the bonding process does not degrade the optical quality of the laterally integrated wells. The authors propose this technique as a means to achieve greater levels of wafer-scale integration in optical, electrical, and micromechanical devices.

  11. Audiometric asymmetry and tinnitus laterality.

    Science.gov (United States)

    Tsai, Betty S; Sweetow, Robert W; Cheung, Steven W

    2012-05-01

    To identify an optimal audiometric asymmetry index for predicting tinnitus laterality. Retrospective medical record review. Data from adult tinnitus patients (80 men and 44 women) were extracted for demographic, audiometric, tinnitus laterality, and related information. The main measures were sensitivity, specificity, positive predictive value (PPV), and receiver operating characteristic (ROC) curves. Three audiometric asymmetry indices were constructed using one, two, or three frequency elements to compute the average interaural threshold difference (aITD). Tinnitus laterality predictive performance of a particular index was assessed by increasing the cutoff or minimum magnitude of the aITD from 10 to 35 dB in 5-dB steps to determine its ROC curve. Single frequency index performance was inferior to the other two (P .05). Two adjoining frequency elements with aITD ≥ 15 dB performed optimally for predicting tinnitus laterality (sensitivity = 0.59, specificity = 0.71, and PPV = 0.76). Absolute and relative magnitudes of hearing loss in the poorer ear were uncorrelated with tinnitus distress. An optimal audiometric asymmetry index to predict tinnitus laterality is one whereby 15 dB is the minimum aITD of two adjoining frequencies, inclusive of the maximal ITD. Tinnitus laterality dependency on magnitude of interaural asymmetry may inform design and interpretation of neuroimaging studies. Monaural acoustic tinnitus therapy may be an initial consideration for asymmetric hearing loss meeting the criterion of aITD ≥ 15 dB. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  12. Computerized lateral-shear interferometer

    Science.gov (United States)

    Hasegan, Sorin A.; Jianu, Angela; Vlad, Valentin I.

    1998-07-01

    A lateral-shear interferometer, coupled with a computer for laser wavefront analysis, is described. A CCD camera is used to transfer the fringe images through a frame-grabber into a PC. 3D phase maps are obtained by fringe pattern processing using a new algorithm for direct spatial reconstruction of the optical phase. The program describes phase maps by Zernike polynomials yielding an analytical description of the wavefront aberration. A compact lateral-shear interferometer has been built using a laser diode as light source, a CCD camera and a rechargeable battery supply, which allows measurements in-situ, if necessary.

  13. An observational study of implicit motor imagery using laterality recognition of the hand after stroke.

    Science.gov (United States)

    Amesz, Sarah; Tessari, Alessia; Ottoboni, Giovanni; Marsden, Jon

    2016-01-01

    To explore the relationship between laterality recognition after stroke and impairments in attention, 3D object rotation and functional ability. Observational cross-sectional study. Acute care teaching hospital. Thirty-two acute and sub-acute people with stroke and 36 healthy, age-matched controls. Laterality recognition, attention and mental rotation of objects. Within the stroke group, the relationship between laterality recognition and functional ability, neglect, hemianopia and dyspraxia were further explored. People with stroke were significantly less accurate (69% vs 80%) and showed delayed reaction times (3.0 vs 1.9 seconds) when determining the laterality of a pictured hand. Deficits either in accuracy or reaction times were seen in 53% of people with stroke. The accuracy of laterality recognition was associated with reduced functional ability (R(2) = 0.21), less accurate mental rotation of objects (R(2) = 0.20) and dyspraxia (p = 0.03). Implicit motor imagery is affected in a significant number of patients after stroke with these deficits related to lesions to the motor networks as well as other deficits seen after stroke. This research provides new insights into how laterality recognition is related to a number of other deficits after stroke, including the mental rotation of 3D objects, attention and dyspraxia. Further research is required to determine if treatment programmes can improve deficits in laterality recognition and impact functional outcomes after stroke.

  14. Het effect van flurbiprofen bij acute enkeldistorsies

    NARCIS (Netherlands)

    de Nies, F.; Lagrand, W. K.; Patka, P.

    1989-01-01

    The efficacy of flurbiprofen was studied by means of a double-blind randomized clinical trial involving 50 patients with an acute lateral ankle distortion (grade I). It could not be demonstrated that the NSAID shortened the duration of convalescence after this injury. Neither the pain nor the

  15. Acute Appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Qvist, Niels

    2017-01-01

    and treatment of AA it is important that the classifications are consistent. Furthermore, in the clinical settings, incorrect classification might lead to over diagnosing and a prolonged antibiotic treatment. The aim of our study was to investigate the concordance between perioperative diagnosis made......BACKGROUND: The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency...

  16. Evaluation and Management of Elbow Tendinopathy

    Science.gov (United States)

    Taylor, Samuel A.; Hannafin, Jo A.

    2012-01-01

    Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury. PMID:23016111

  17. Laterally Loaded Nail-Plates

    DEFF Research Database (Denmark)

    Nielsen, Jacob; Rathkjen, Arne

    Load-displacement curves from about 200 short-term and laterally loaded nail-plate joints are analysed. The nail-plates are from Gang-Nail Systems, type GNA 20 S. The test specimens and the measuring systems are described. The tests are divided into 32 different series. The influence of the number...

  18. Laterality of basic auditory perception.

    Science.gov (United States)

    Sininger, Yvonne S; Bhatara, Anjali

    2012-01-01

    Laterality (left-right ear differences) of auditory processing was assessed using basic auditory skills: (1) gap detection, (2) frequency discrimination, and (3) intensity discrimination. Stimuli included tones (500, 1000, and 4000 Hz) and wide-band noise presented monaurally to each ear of typical adult listeners. The hypothesis tested was that processing of tonal stimuli would be enhanced by left ear (LE) stimulation and noise by right ear (RE) presentations. To investigate the limits of laterality by (1) spectral width, a narrow-band noise (NBN) of 450-Hz bandwidth was evaluated using intensity discrimination, and (2) stimulus duration, 200, 500, and 1000 ms duration tones were evaluated using frequency discrimination. A left ear advantage (LEA) was demonstrated with tonal stimuli in all experiments, but an expected REA for noise stimuli was not found. The NBN stimulus demonstrated no LEA and was characterised as a noise. No change in laterality was found with changes in stimulus durations. The LEA for tonal stimuli is felt to be due to more direct connections between the left ear and the right auditory cortex, which has been shown to be primary for spectral analysis and tonal processing. The lack of a REA for noise stimuli is unexplained. Sex differences in laterality for noise stimuli were noted but were not statistically significant. This study did establish a subtle but clear pattern of LEA for processing of tonal stimuli.

  19. Amyotrophic lateral sclerosis mimic syndromes.

    Science.gov (United States)

    Ghasemi, Majid

    2016-04-03

    Amyotrophic lateral sclerosis (ALS) misdiagnosis has many broad implications for the patient and the neurologist. Potentially curative treatments exist for certain ALS mimic syndromes, but delay in starting these therapies may have an unfavorable effect on outcome. Hence, it is important to exclude similar conditions. In this review, we discuss some of the important mimics of ALS.

  20. MRI of discoid lateral meniscus

    International Nuclear Information System (INIS)

    Araki, Yutaka; Ootani, Masatoshi; Furukawa, Tomoaki; Yamamoto, Tadatsuka; Tomoda, Kaname; Tsukaguchi, Isao; Mitomo, Masanori.

    1991-01-01

    We retrospectively reviewed the MR examinations of 10 patients (17 knees) with surgically documented discoid lateral meniscus of the knee joint. As MRI of the knee is being used more often, the criteria for diagnosis of this entity with MRI need to be established. We tried to define MRI criteria for the detection of discoid menisci by performing numerical measurements of MR images on a display screen. The transverse diameter of the midbody of a discoid lateral meniscus averaged 21.9 mm (normal control: 8.6 mm), and its proportion to the transverse width of the tibia averaged 29.4% (normal control: 12.0%). The measurable difference in height between the discoid and the medial meniscus was negligible. The number of sagittal sections on which the anterior and posterior horns connected varied from two to five in cases of discoid lateral meniscus, and from zero to two in normal controls. Among these parameters, the transverse diameter and its proportion of the transverse width of the tibia proved to be the most reliable. We concluded that a discoid meniscus is indicated if a transverse diameter of a lateral meniscus exceeds 15 mm (proportion to the tibia: 20%). (author)

  1. Misleading signs in acute vertigo.

    Science.gov (United States)

    Lance, Sean; Mossman, Stuart Scott

    2018-04-01

    The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral elbow tendinopathy for French-speaking patients.

    Science.gov (United States)

    Kaux, Jean-François; Delvaux, François; Schaus, Jean; Demoulin, Christophe; Locquet, Médéa; Buckinx, Fanny; Beaudart, Charlotte; Dardenne, Nadia; Van Beveren, Julien; Croisier, Jean-Louis; Forthomme, Bénédicte; Bruyère, Olivier

    Translation and validation of algo-functional questionnaire. The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire was specifically designed to measure pain and functional limitations in patients with lateral epicondylitis (tennis elbow). First developed in English, this questionnaire has since been translated into several languages. The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this translated version of the questionnaire (PRTEE-F). The PRTEE was translated and cross-culturally adapted into French according to international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants were asked twice to fill in the PRTEE-F, and once the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Short Form Health Survey (SF-36). Internal consistency (using Cronbach's alpha), test-retest reliability (using intraclass correlation coefficient (ICC), standard error of measurement and minimal detectable change), and convergent and divergent validity (using the Spearman's correlation coefficients respectively with the DASH and with some subscales of the SF-36) were assessed. The PRTEE was translated into French without any problems. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.86) and for each item (ICC 0.8-0.96) and a high internal consistency (Cronbach's alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (convergent validity) and, as expected, a low or moderate correlation with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect. The PRTEE questionnaire was successfully cross-culturally adapted into French. The PRTEE-F is reliable and valid for evaluating French-speaking patients with lateral elbow

  3. Acute lower extremity ischaemia

    African Journals Online (AJOL)

    Acute lower extremity ischaemia. Acute lower limb ischaemia is a surgical emergency. ... is ~1.5 cases per 10 000 persons per year. Acute ischaemia ... Table 2. Clinical features discriminating embolic from thrombotic ALEXI. Clinical features.

  4. Acute kidney failure

    Science.gov (United States)

    ... Renal failure - acute; ARF; Kidney injury - acute Images Kidney anatomy References Devarajan P. Biomarkers for assessment of renal function during acute kidney injury. In: Alpern RJ, Moe OW, Caplan M, ...

  5. Laterally Loaded Piles in Clay

    DEFF Research Database (Denmark)

    Christensen, Helle; Niewald, Gitte

    1992-01-01

    The ultimate lateral resistance of a pile element moved horizontally can be analyzed by the theory of plasticity. At a certain depth the movements around the pile are purely horizontal and upper bound solutions can be estimated theoretically under undrained circumstances. Model tests...... in the laboratory show ultimate resistances close to the estimated limits and p - y curves close to curves based on test results from full-scale piles. Rough and smooth piles with circular and square cross sections are investigated....

  6. Dysphagia caused by a lateral medullary infarction syndrome (Wallenberg's syndrome)

    Science.gov (United States)

    El Mekkaoui, Amine; Irhoudane, Hanane; Ibrahimi, Adil; El Yousfi, Mounia

    2012-01-01

    A 68-year-old man was referred to our hospital for a dysphagia evolving for 10 days. Clinical examination had found neurological signs as contralateral Horner's syndrome, ipsilateral palatal paresis, gait ataxia and hoarseness. Video-fluoroscopy showed a lack of passage of contrast medium to the distal esophagus. Esogastroduodenoscopy was normal. The cranial MRI had shown an acute ischemic stroke in the left lateral medullar region and the diagnosis of Wallenberg syndrome (WS) was established. WS remains an unknown cause of dysphagia in the clinical practice of the gastroenterologist. PMID:23077713

  7. Manual lateralization in macaques: handedness, target laterality and task complexity.

    Science.gov (United States)

    Regaiolli, Barbara; Spiezio, Caterina; Vallortigara, Giorgio

    2016-01-01

    Non-human primates represent models to understand the evolution of handedness in humans. Despite several researches have been investigating non-human primates handedness, few studies examined the relationship between target position, hand preference and task complexity. This study aimed at investigating macaque handedness in relation to target laterality and tastiness, as well as task complexity. Seven pig-tailed macaques (Macaca nemestrina) were involved in three different "two alternative choice" tests: one low-level task and two high-level tasks (HLTs). During the first and the third tests macaques could select a preferred food and a non-preferred food, whereas by modifying the design of the second test, macaques were presented with no-difference alternative per trial. Furthermore, a simple-reaching test was administered to assess hand preference in a social context. Macaques showed hand preference at individual level both in simple and complex tasks, but not in the simple-reaching test. Moreover, target position seemed to affect hand preference in retrieving an object in the low-level task, but not in the HLT. Additionally, individual hand preference seemed to be affected from the tastiness of the item to be retrieved. The results suggest that both target laterality and individual motivation might influence hand preference of macaques, especially in simple tasks.

  8. Diagnosis of laterality in the school environment

    OpenAIRE

    Šnajdrová, Veronika

    2011-01-01

    This bachelor thesis contains theoretical principals of expressions of the dominance of the brain hemispheres - laterality. It solves the development of laterality, its genotype and phenotype, levels, laterality types and species, refers to the educational consequences of the improper educational influence on genotype laterality and subsequent corrections. It also deals with the diagnosis of laterality, especially from a position of a teacher. The basic idea of this work is to support the nat...

  9. Acute Pancreatitis in acute viral hepatitis

    Directory of Open Access Journals (Sweden)

    S K.C.

    2011-03-01

    Full Text Available Introduction: The association of acute viral hepatitis and acute pancreatitis is well described. This study was conducted to find out the frequency of pancreatic involvement in acute viral hepatitis in the Nepalese population. Methods: Consecutive patients of acute viral hepatitis presenting with severe abdominal pain between January 2005 and April 2010 were studied. Patients with history of significant alcohol consumption and gall stones were excluded. Acute viral hepatitis was diagnosed by clinical examination, liver function test, ultrasound examination and confirmed by viral serology. Pancreatitis was diagnosed by clinical presentation, biochemistry, ultrasound examination and CT scan. Results: Severe abdominal pain was present in 38 of 382 serologically-confirmed acute viral hepatitis patients. Twenty five patients were diagnosed to have acute pancreatitis. The pancreatitis was mild in 14 and severe in 11 patients. The etiology of pancreatitis was hepatitis E virus in 18 and hepatitis A virus in 7 patients. Two patients died of complications secondary to shock. The remaining patients recovered from both pancreatitis and hepatitis on conservative treatment. Conclusions: Acute pancreatitis occurred in 6.5 % of patients with acute viral hepatitis. Cholelithiasis and gastric ulcers are the other causes of severe abdominal pain. The majority of the patients recover with conservative management. Keywords: acute viral hepatitis, acute pancreatitis, pain abdomen, hepatitis E, hepatitis A, endemic zone

  10. Clinical neurogenetics: amyotrophic lateral sclerosis.

    Science.gov (United States)

    Harms, Matthew B; Baloh, Robert H

    2013-11-01

    Our understanding of amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease, is expanding rapidly as its genetic causes are uncovered. The pace of new gene discovery over the last 5 years has accelerated, providing new insights into the pathogenesis of disease and highlighting biological pathways as targets for therapeutic development. This article reviews our current understanding of the heritability of ALS and provides an overview of each of the major ALS genes, highlighting their phenotypic characteristics and frequencies as a guide for clinicians evaluating patients with ALS. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Clinical Neurogenetics: Amyotrophic Lateral Sclerosis

    Science.gov (United States)

    Harms, Matthew B.; Baloh, Robert H.

    2013-01-01

    Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, about which our understanding is expanding rapidly as its genetic causes are uncovered. The pace of new gene discovery over the last 5 years has accelerated, providing new insights into the pathogenesis of disease and highlighting biological pathways for target for therapeutic development. This article reviews our current understanding of the heritability of ALS, provides an overview of each of the major ALS genes, highlighting their phenotypic characteristics and frequencies as a guide for clinicians evaluating patients with ALS. PMID:24176417

  12. Inconscious, brain lateralization and parapsychology

    Directory of Open Access Journals (Sweden)

    Alečković-Nikolić Mila S.

    2015-01-01

    Full Text Available In this paper, we have tried to show that it is impossible to study and understand the language of parapsychology without knowing the problem of 'conscious' and 'unconscious' process and issues of brain lateralization. We tried to clarify the different concepts of the notion of the unconscious and to classify all parapsychological phenomena that can be explored. But the real survey of human creativity and those of physical and cognitive abilities of the human mind which are not sufficiently explained today, can not be possible without the cooperation of psychological sciences, clinical psychology, psychopathology, biochemistry, linguistics and quantum physics.

  13. Acute abdomen

    International Nuclear Information System (INIS)

    Beger, H.G.; Kern, E.

    1987-01-01

    The book first presents the anatomy and physiology of the abdomen and continues with chapters discussing clinical and laboratory aspects and a suitable order of diagnostic examinations with reference to the acute processes, explaining the diagnostic tools: ultrasonography, radiography including angiography and CT, tapping techniques and endoscopy together with their basic principles, examination techniques, and diagnosis. One chapter presents a complete survey of the processes involving the entire abdomen - as e.g. peritonitis, ileus, abdominal trauma, intraperitoneal hemorrage. This chapter profoundly discusses the diagnostics and therapies including emergency measures and surgery. Problems requiring consultation among varous specialists, in internal medicine, gynecology, urology, or pediatrics, are discussed in great detail. Information for the anesthetist is given for cases of emergency. More than one third of the book is devoted to organ-specific information, dicussing the pathogenesis, diagnostics, and therapy of the oesophagus, stomach, large and small intestine, bile ducts, pankreas, liver, spleen, and the abdominal vessels and the abdominal wall. (orig.) With 153 figs., 90 tabs [de

  14. Hypothermia-Related Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Kyawzaw Lin

    2018-05-01

    Full Text Available Acute pancreatitis (AP is an inflammatory disease presenting from mild localized inflammation to severe infected necrotic pancreatic tissue. In the literature, there are a few cases of hypothermia-induced AP. However, the association between hypothermia and AP is still a myth. Generally, mortality from acute pancreatitis is nearly 3–6%. Here, we present a 40-year-old chronic alcoholic female who presented with acute pancreatitis induced by transient hypothermia. A 40-year-old chronic alcoholic female was hypothermic at 81°F on arrival which was improved to 91.7°F with warming blanket and then around 97°F in 8 h. Laboratory tests including complete blood count, lipid panel, and comprehensive metabolic panels were within the normal limit. Serum alcohol level was 0.01, amylase 498, lipase 1,200, ammonia 26, serum carboxyhemoglobin level 2.4, and β-HCG was negative. The entire sepsis workup was negative. During rewarming period, she had one episode of witnessed generalized tonic-clonic seizure. It was followed by transient hypotension. Fluid challenge was successful with 2 L of normal saline. Sonogram (abdomen showed fatty liver and trace ascites. CAT scan (abdomen and pelvis showed evidence of acute pancreatitis without necrosis, peripancreatic abscess, pancreatic mass, or radiopaque gallstones. The patient was managed medically and later discharged from the hospital on the 4th day as she tolerated a normal low-fat diet. In our patient, transient hypothermia from chronic alcohol abuse and her social circumstances might predispose to microcirculatory disturbance resulting in acute pancreatitis. Early and aggressive fluid resuscitation prevents complications.

  15. Acute otitis externa

    OpenAIRE

    Hui, Charles PS

    2013-01-01

    Acute otitis externa, also known as ‘swimmer’s ear’, is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  16. Craving creativity in later life

    DEFF Research Database (Denmark)

    Fristrup, Tine

    2013-01-01

    The societal norms of ageing and old age are changing in society today, due to demographic changes that favour a pedagogicalization of society, focusing on the management of human resources throughout the entire lifespan. The discourse on active ageing mot only reveals ‘better’ ways of ageing...... discourses on ‘active ageing’ are challenged by the focus of museums and archives on using heritage and participatory arts as an arena to performAGE in later life by craving creativity as a notion of age and opportunity....... but it also raises questions as to what constitutes a ‘good’ and ‘active’ life in all societies. The conflicting aspect of the discursive battlefield on active ageing constitutes a fight for authority: Who has the ‘right’ to define the meaning of being ‘active’ and how can ‘activity’ be identified? ‘Active...

  17. Relativism in Feyerabend's later writings.

    Science.gov (United States)

    Kusch, Martin

    2016-06-01

    This paper reconstructs, and distinguishes between, Feyerabend's different forms of relativism in his later writings. Science in a Free Society remains close to familiar forms of relativism, while, at the same time, developing an original but under-argued form of political relativism, and rejecting "conversion" models of cultural exchange. Farewell to Reason moves away from common renderings of relativism, and develops a range of different new forms. Central here are links between relativism, skepticism and infallibilism. In the last six years of his life, Feyerabend often criticizes a peculiar radical form of relativism that arguably no-one has ever proposed or defended. In the same context, Feyerabend sketches an "ontological" form of relativism. It combines "Kantian humility", metaphysical pluralism and constructivism. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Prenatal and pubertal testosterone affect brain lateralization

    NARCIS (Netherlands)

    Beking, T; Geuze, R H; van Faassen, M; Kema, I P; Kreukels, B P C; Groothuis, T G G

    After decades of research, the influence of prenatal testosterone on brain lateralization is still elusive, whereas the influence of pubertal testosterone on functional brain lateralization has not been investigated, although there is increasing evidence that testosterone affects the brain in

  19. Lateralization of visual learning in the honeybee

    OpenAIRE

    Letzkus, Pinar; Boeddeker, Norbert; Wood, Jeff T; Zhang, Shao-Wu; Srinivasan, Mandyam V

    2007-01-01

    Lateralization is a well-described phenomenon in humans and other vertebrates and there are interesting parallels across a variety of different vertebrate species. However, there are only a few studies of lateralization in invertebrates. In a recent report, we showed lateralization of olfactory learning in the honeybee (Apis mellifera). Here, we investigate lateralization of another sensory modality, vision. By training honeybees on a modified version of a visual proboscis extension reflex ta...

  20. Hemispheric Laterality in Music and Math

    Science.gov (United States)

    Szirony, Gary Michael; Burgin, John S.; Pearson, L. Carolyn

    2008-01-01

    Hemispheric laterality may be a useful concept in teaching, learning, training, and in understanding more about human development. To address this issue, a measure of hemispheric laterality was compared to musical and mathematical ability. The Human Information Processing Survey (HIPS) instrument, designed to measure hemispheric laterality, was…

  1. [Synchronous acute cholecystolithiasis and perforated acute appendicitis. Case report].

    Science.gov (United States)

    Padrón-Arredondo, Guillermo; de Atocha Rosado-Montero, Manuel

    2016-01-01

    Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate on. However, it is rarely described in its synchronous form. A 43 year-old woman attending the clinic for right upper quadrant pain of 11 days duration. The patient refers to intermittent radiating pain in the right side, with positive Murphy, tachycardia, and fever. The laboratory results showed white cells 16,200/mm(3), glucose 345 mg/dl, abnormal liver function tests. Acute cholecystitis was reported with ultrasound. A Masson-type incision was made, noting an enlarged pyogenic gallbladder with thickened walls, sub-hepatic abscess of approximately 300 ml, greenish-yellow colour, and foetid. An anterograde subtotal cholecystectomy is performed due to difficulty in identifying elements of Calot triangle due to the inflammatory process, opening it and extracting stones. The right iliac fossa is reviewed, finding a plastron and a sub-serous retrocaecal appendix perforated in its middle third with free fecalith and an abscess in the pelvic cavity. An anterograde appendectomy was performed and the patient progressed satisfactorily, later being discharged due to improvement. In this patient, with a history of recurrent episodes of gallbladder pain and disseminated acute abdominal pain without peritoneal irritation, clinical suspicion was exacerbated cholecystitis with probable empyema of the gallbladder. Open surgery approach for this patient allowed access to both the appendix and gallbladder in order to perform a complete exploration of the abdominal cavity. The synchronous presentation of cholecystolithiasis and complicated appendicitis has not been reported in the literature. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  2. Acute Korsakoff syndrome following mammillothalamic tract infarction.

    Science.gov (United States)

    Yoneoka, Yuichiro; Takeda, Norio; Inoue, Akira; Ibuchi, Yasuo; Kumagai, Takashi; Sugai, Tsutomu; Takeda, Ken-ichiro; Ueda, Kaoru

    2004-01-01

    There are limited case reports of structural lesions causing Korsakoff syndrome. This report describes acute Korsakoff syndrome following localized, bilateral infarction of the mammillothalamic tracts (MTTs). Axial T2-weighted imaging revealed the lesions at the lateral wall level of the third ventricle and diffusion-weighted imaging confirmed that the left lesion was new and the right old. Korsakoff syndrome persisted 6 months after the onset. This case suggests that bilateral MTT dysfunction can lead to Korsakoff syndrome.

  3. LATER RETIREMENT? PATTERNS, PREFERENCES, POLICIES

    Directory of Open Access Journals (Sweden)

    Martin Kohli

    2015-07-01

    Full Text Available Pension systems are a major part of the political economy of current societies – much beyond providing old-age income security. The well-known demographics of population aging as well as globalization today challenge their financial viability. Later retirement seems to be a good way to meet these challenges. However, it is not only unpopular but also inequitable in terms of differential longevity. The paper first discusses these problems, with a particular focus on the social stratification of mortality. It then analyzes the preferences towards retirement age at several levels:  in terms of attitudes towards public spending on pensions or towards the state’s responsibility in this matter, of support for pension policy alternatives, and of preferred individual age of retirement. Results show that large majorities across all age groups are in favour of more government spending on pensions. There is a substantial amount of ‘involuntary retirement’, meaning that people would have preferred to work longer than they actually did, as well as a somewhat lower amount of ‘involuntary work’, but the preferred ages are everywhere below 65, and in some countries still below 60. Finally, the paper examines the policies of raising the retirement age adopted during the last two decades. What has especially been lacking in these policies is a consideration of socially differentiated longevity.

  4. Acute respiratory distress syndrome

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000103.htm Acute respiratory distress syndrome To use the sharing features on this page, please enable JavaScript. Acute respiratory distress syndrome (ARDS) is a life-threatening lung ...

  5. AcuTable

    DEFF Research Database (Denmark)

    Dibbern, Simon; Rasmussen, Kasper Vestergaard; Ortiz-Arroyo, Daniel

    2017-01-01

    In this paper we describe AcuTable, a new tangible user interface. AcuTable is a shapeable surface that employs capacitive touch sensors. The goal of AcuTable was to enable the exploration of the capabilities of such haptic interface and its applications. We describe its design and implementation...

  6. Acute mastoiditis in children

    DEFF Research Database (Denmark)

    Anthonsen, Kristian; Høstmark, Karianne; Hansen, Søren

    2013-01-01

    Conservative treatment of acute otitis media may lead to more complications. This study evaluates changes in incidence, the clinical and microbiological findings, the complications and the outcome of acute mastoiditis in children in a country employing conservative guidelines in treating acute...

  7. The Later Wittgenstein and the Later Husserl on Language

    Directory of Open Access Journals (Sweden)

    Paul Ricoeur

    2014-07-01

    Full Text Available This article presents an edited version of lectures given by Paul Ricœur at Johns Hopkins University in April 1966. Ricœur offers a comparative analysis of Wittgenstein’s and Husserl’s late works, taking the problem of language as the common ground of investigation for these two central figures of phenomenology and analytic philosophy. Ricœur develops his study in two parts. The first part considers Husserl’s approach to language after the Logical Investigations and concentrates on Formal and Transcendental Logic; leaving a transcendental reflection on language behind it re-examines a phenomenological conception, according to which the sphere of logic is not separable from that of experience. The main focus of the second part is Wittgenstein’s later philosophy as it moved on from the conception of an isomorphic relation between language and the world, as set out in the picture theory in the Tractatus Logico-Philosophicus, to the more pragmatic notion of a language-game in the Philosophical Investigations. In order to get beyond the irrevocable differences between the two philosophies and the unresolved theoretical issues on both sides, Ricœur suggests turning to a semiological paradigm based on the Saussurean distinction between “language” and “speaking.” Keywords: Analytic Philosophy, Husserl, Phenomenology, Semiology, Wittgenstein.Résumé Cet article est une version éditée de conférences données par Paul Ricœur à la Johns Hopkins University en avril 1966. Ricœur propose une analyse comparée des dernières œuvres de Wittgenstein et Husserl, avec le problème du langage comme sol commun d’investigations pour ces deux figures centrales de la phénoménologie et la philosophie analytique. Cette analyse de Ricœur se joue à travers deux parties. La première partie revient sur l'approche du langage chez Husserl depuis Recherches logiques avec une attention particulière aux développements de Logique formelle et

  8. A Rare Complication of Acute Otitis Media: Otitic Hydrocephalus

    Directory of Open Access Journals (Sweden)

    Ahmet Mutlu

    2013-06-01

    Full Text Available Acute otitis media is very common disorder in childhood. In this article we present a 6-years old boy who applied with diplopia, dysfunction of lateral eye movements on left eye, nausea, at 10th day of acute otitis media treatment. After the radiological images case was described as an otitic hydrocephalus clinic. Patient underwent medical treatment, lomboperitoneal shunt operation and simple mastoidectomy. We wanted to share the evaluation and the management steps of this very rare complication of acute otitis media.

  9. CT recognition of lateral lumbar disk herniation

    International Nuclear Information System (INIS)

    Williams, A.L.; Haughton, V.M.; Daniels, D.L.; Thornton, R.S.

    1982-01-01

    Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

  10. Lateral step initiation behavior in older adults

    OpenAIRE

    Sparto, Patrick J; Jennings, J Richard; Furman, Joseph M; Redfern, Mark S

    2013-01-01

    Older adults have varied postural responses during induced and voluntary lateral stepping. The purpose of the research was to quantify the occurrence of different stepping strategies during lateral step initiation in older adults and to relate the stepping responses to retrospective history of falls. Seventy community-ambulating older adults (mean age 76 y, range 70–94 y) performed voluntary lateral steps as quickly as possible to the right or left in response to a visual cue, in a blocked de...

  11. Lateral displacement in small angle multiple scattering

    Energy Technology Data Exchange (ETDEWEB)

    Bichsel, H.; Hanson, K.M.; Schillaci, K.M. (Los Alamos National Lab., NM (USA))

    1982-07-01

    Values have been calculated for the average lateral displacement in small angle multiple scattering of protons with energies of several hundred MeV. The calculations incorporate the Moliere distribution which does not make the gaussian approximations of the distribution in projected angle and lateral deflections. Compared to other published data, such approximations can lead to errors in the lateral displacement of up to 10% in water.

  12. Inferior hilar window on lateral chest radiographs

    International Nuclear Information System (INIS)

    Park, C.K.; Webb, W.R.; Klein, J.S.

    1990-01-01

    This paper determines the accuracy of lateral chest radiography in the detection of masses in the inferior hilar window, a normally avascular hilar region anterior to the lower lobe bronchi. Fifty patients with normal thoracic CT scans and 25 with hilar masses/adenopathy were selected retrospectively. The 75 corresponding lateral chest radiographs were blindly evaluated for visibility of the anterior walls of the lower lobe bronchi and the presence and laterality of abnormal soft tissue (>1 cm) in the inferior hilar window. Only a 7 x 7-cm square of the lateral radiograph was viewed

  13. Laterality of radiographic osteoarthritis of the knee.

    Science.gov (United States)

    Komatsu, Daigo; Ikeuchi, Kazuma; Kojima, Toshihisa; Takegami, Yasuhiko; Amano, Takafumi; Tsuboi, Masaki; Ishiguro, Naoki; Hasegawa, Yukiharu

    2017-05-01

    There are few reports of the laterality in radiological knee osteoarthritis (ROA). This study aimed to evaluate laterality in terms of the minimum joint space width (mJSW) and osteophyte areas (OFs) in a cross-sectorial general population screen and elucidate the association between laterality and risk of osteoarthritis. We enrolled 330 participants (mean age 64.6 years) and examined the presence of ROA (Kellgren-Lawrence grade ≧ 2) laterality in terms of the mJSW and OF on the medial tibia using auto-measuring software. Moreover, we examined the association between laterality and leg dominance. The right and left medial mJSWs were 4.02 ± 0.98 mm and 4.05 ± 1.01 mm, respectively, showing no laterality; the laterals were also similar. The participants who had osteophytes ≥1 mm 2 in the right, left, and bilateral knees were 15, 37, and 57 respectively, with osteophytes being significantly more common in the left knee. The OF was significantly larger in the left knee. Conversely, the medial and lateral mJSWs and OF did not differ according to leg dominance. The prevalence of ROA was higher and the OF was more pronounced in the left knee. However, the mJSW showed no laterality. Additionally, the mJSW and OF showed no differences according to leg dominance.

  14. Vehicle lateral dynamics stabilization using active suspension

    Directory of Open Access Journals (Sweden)

    Drobný V.

    2008-12-01

    Full Text Available The paper deals with the investigation of active nonlinear suspension control in order to stabilize the lateral vehicle motion in similar way as systems like ESP do. The lateral stabilization of vehicle based on braking forces can be alternatively provided by the different setting of suspension forces. The basis of this control is the nonlinear property of the tyres. The vehicle has at least four wheels and it gives one or more redundant vertical forces that can be used for the different distribution of vertical suspension forces in such a way that resulting lateral and/or longitudinal forces create the required correction moment for lateral dynamic vehicle stabilization.

  15. Simplified analysis of laterally loaded pile groups

    Directory of Open Access Journals (Sweden)

    F.M. Abdrabbo

    2012-06-01

    Full Text Available The response of laterally loaded pile groups is a complicated soil–structure interaction problem. Although fairly reliable methods are developed to predicate the lateral behavior of single piles, the lateral response of pile groups has attracted less attention due to the required high cost and complication implication. This study presents a simplified method to analyze laterally loaded pile groups. The proposed method implements p-multiplier factors in combination with the horizontal modulus of subgrade reaction. Shadowing effects in closely spaced piles in a group were taken into consideration. It is proven that laterally loaded piles embedded in sand can be analyzed within the working load range assuming a linear relationship between lateral load and lateral displacement. The proposed method estimates the distribution of lateral loads among piles in a pile group and predicts the safe design lateral load of a pile group. The benefit of the proposed method is in its simplicity for the preliminary design stage with a little computational effort.

  16. Pedestrian-induced lateral forces on footbridges

    DEFF Research Database (Denmark)

    Ingolfsson, Einar Thor; Georgakis, Christos T.; Jönsson, Jeppe

    2012-01-01

    of the underlying pavement. An extensive experimental analysis has been carried out to determine the lateral forces generated by pedestrians when walking on a laterally moving treadmill. Two different conditions are investigated; initially the treadmill is fixed and then it is laterally driven in a sinusoidal...... motion at varying combinations of frequencies (0.33-1.07 Hz) and amplitudes (4.5-48 mm). The component of the pedestrian-induced force which is caused by the laterally moving surface is herewith quantified through equivalent velocity and acceleration proportional coefficients. It is shown that large...

  17. Pedestrian-induced lateral forces on footbridges

    DEFF Research Database (Denmark)

    Ingólfsson, Einar Thór; Georgakis, Christos T.; Jönsson, Jeppe

    2011-01-01

    of the underlying pavement. An extensive experimental analysis has been carried out to determine the lateral forces generated by pedestrians when walking on a laterally moving treadmill. Two different conditions are investigated; initially the treadmill is fixed and then it is laterally driven in a sinusoidal...... motion at varying combinations of frequencies (0.33-1.07 Hz) and amplitudes (4.5-48 mm). The component of the pedestrian-induced force which is caused by the laterally moving surface is herewith quantified through equivalent velocity and acceleration proportional coefficients. It is shown that large...

  18. Lateralization of visual learning in the honeybee.

    Science.gov (United States)

    Letzkus, Pinar; Boeddeker, Norbert; Wood, Jeff T; Zhang, Shao-Wu; Srinivasan, Mandyam V

    2008-02-23

    Lateralization is a well-described phenomenon in humans and other vertebrates and there are interesting parallels across a variety of different vertebrate species. However, there are only a few studies of lateralization in invertebrates. In a recent report, we showed lateralization of olfactory learning in the honeybee (Apis mellifera). Here, we investigate lateralization of another sensory modality, vision. By training honeybees on a modified version of a visual proboscis extension reflex task, we find that bees learn a colour stimulus better with their right eye.

  19. Valsartan-induced acute pancreatitis.

    Science.gov (United States)

    Can, Burak; Sali, Mursel; Batman, Adnan; Yilmaz, Hasan; Korkmaz, Ugur; Celebi, Altay; Senturk, Omer; Hulagu, Sadettin

    2014-01-01

    Gastrointestinal toxicity is uncommon among patients treated with angiotensin II receptor antagonists. A 58-year-old man presented with nausea, vomiting and constant pain in the epigastrium that radiated to the flanks. He received treatment with valsartan (160 mg daily) for hypertension. The clinical, biochemical and radiological findings were compatible with a diagnosis of acute pancreatitis. After the patient achieved a clinical and biochemical recovery, the valsartan therapy was started again. Six weeks later, he returned to the hospital with an attack of pancreatitis. Subsequently, he returned with repeated attacks of pancreatitis twice, and the valsartan was discontinued. Ten months after the treatment, the patient had no complaints. When severe abdominal symptoms occur for no apparent reason during treatment with valsartan, a diagnosis of pancreatitis should be considered.

  20. Vannevar Bush: Fifty Years Later

    Science.gov (United States)

    Lagowski, J. J.

    1995-12-01

    It is ironic that the 50th anniversary year of Vannevar Bush's Report to President Truman entitled "Science the Endless Frontier", which put into motion the eminently successful current system of education of scientists in this country occurs at a time when serious questions are being asked about the usefulness of that very system. Bush viewed his proposal to establish a national research foundation (later to be called the National Science Foundation) as a "social compact." Judgment of scientific merit would be delegated to expert peers in return for scientific progress, which would ultimately benefit the nation in terms of scientific needs--military security, economic productivity, and enhanced quality of life. Bush wanted the funding of basic research intertwined with training, and preferred to use universities for this purpose rather than industrial or national labs. Bush viewed college and university scientists as teachers and investigators. He believed university-based research would uniquely encourage and engage the next generation of scientists as no other institutional arrangement could. Bush did not trust industry's commitment to basic research, an instinct that proved prophetic. The academic reserve of scientists (PhD's in training and postdoctoral students) that existed before World War II, and upon which the United States could draw for its needs, which were primarily associated with defense efforts, was probably one of the defining factors in Bush's suggested strategy. Currently, that reserve of talent has gotten so large that it is the obvious throttle in the pipeline slowing the continued development of the university research enterprise. Since 1977, the rate at which we have trained new scientists exceeds an average of 4% annually. Since 1987, the "science work force"--PhD's--has grown at three times the rate of the general labor supply. Temporary positions for postdoctoral scientists have grown even faster (over 5% per year since 1989). To compound

  1. Herniographic appearance of the lateral inguinal fossa

    International Nuclear Information System (INIS)

    Ekberg, O.; Kesek, P.

    1987-01-01

    Herniography frequently reveals clinically undetected groin hernia. Thereby herniography contributes to the clinical work-up in patients with obscure groin pain. However, the distinction between clinically important and unimportant abnormalities within the lateral inguinal fossa can be difficult. This study was therefore designed in order to elucidate the herniographic appearance of the lateral inguinal fossa in patients with obscure groin pain. Herniographic findings were compared with laterality of the patients' symptoms. The lateral umbilical fold was visible in only 47% of the groins. A triangular shaped outpouching from the lateral inguinal fossa and a patent processus vaginalis were found with equal frequency on the left and right side. They were five times as frequent in men as in women. Their presence did not correlate with laterality of the patients' symptoms. Indirect hernias were almost twice as common on the symptomatic side as compared with the asymptomatic side. On the left side they were found twice as often in men as in women while there was no significant sex difference on the right side. Our results show that neither a patent processus vaginalis nor a triangular outpouching from the lateral inguinal fossa correlate with the laterality of the patients' symptoms while true indirect hernias do. (orig.)

  2. Diagnosing Dyslexia: The Screening of Auditory Laterality.

    Science.gov (United States)

    Johansen, Kjeld

    A study investigated whether a correlation exists between the degree and nature of left-brain laterality and specific reading and spelling difficulties. Subjects, 50 normal readers and 50 reading disabled persons native to the island of Bornholm, had their auditory laterality screened using pure-tone audiometry and dichotic listening. Results…

  3. Self-caring in later life

    DEFF Research Database (Denmark)

    Fristrup, Tine; Grut, Sara

    2015-01-01

    . The phenomenon of gerontopedagogicalisation is a process of becoming a juvenile and entrepreneurial self in later life, conceptualised as performAGE (Fristrup, 2012a). PerformAGE is an approach to understanding the different ways of performing age in later life which favours the performing of this juvenile...

  4. Lateral Pharyngeal Diverticulum presenting with Dysphagia ...

    African Journals Online (AJOL)

    Lateral pharyngeal diverticulum (Pharyngocele) is the protrusion of pharyngeal mucosa through the pharyngeal wall, usually through either of two weak areas in the pharyngeal wall as an acquired or congenital case. Lateral diverticula are very rare and not to be mistaken for the rather more frequent and abundantly ...

  5. [Latest advances in acute pancreatitis].

    Science.gov (United States)

    de-Madaria, Enrique

    2013-10-01

    The present article analyzes the main presentations on acute pancreatitis (AP) in Digestive Disease Week 2013. Perfusion computed tomography allows early diagnosis of pancreatic necrosis. Neutrophil gelatinase-associated lipocalin predicts the development of acute renal failure, severe AP and death. Factors associated with greater fluid sequestration in AP are alcoholic etiology, an elevated hematocrit, and the presence of criteria of systemic inflammatory response syndrome; fluid sequestration is associated with a worse outcome. True pseudocysts (fluid collections without necrosis for more than 4 weeks) are a highly infrequent complication in AP. Patients with necrotic collections have a poor prognosis, especially if associated with infection. A meta-analysis on fluid therapy suggests that early aggressive fluid administration is associated with higher mortality and more frequent respiratory complications. According to a meta-analysis, enteral nutrition initiated within 24 hours of admission improves the outcome of AP compared with later initiation of enteral nutrition. Pentoxifylline could be a promising alternative in AP; a double-blind randomized study showed that this drug reduced the length of hospital and intensive care unit stay, as well as the need for intensive care unit admission. The association of octreotide and celecoxib seems to reduce the frequency of organ damage compared with octreotide alone. Mild AP can be managed in the ambulatory setting through hospital-at-home units after a short, 24-hour admission. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  6. [Hepatic pseudotumor in acute fascioliasis].

    Science.gov (United States)

    Castillo Contreras, Ofelia Brisaida; Frisancho Velarde, Oscar

    2013-03-01

    We report a 61-year-old woman who was hospitalized because of abdominal pain in the right upper quadrant related to a liver tumor (ultrasound and tomographic findings). A collection of blood was obtained by a biopsy and there were no tumor cells. With the suspicion of acute fascioliasis (liver stage), due to severe eosinophilia and recent travel to endemic area of Fasciola hepatica, arc II and ELISA Fas 2 we carried out and were positive. Parasitological stool examinations were negative. During hospitalization a hepatic subcapsular hematoma presented as a complication and the patient developed fever because of cholangiolitic microabscesses in the left hepatic lobe. Percutaneous drainage was performed and positive cultures of secretions were obtained She received antibiotic coverage with vancomycin and imipenem. Treatment for Fasciola hepatica was initiated with nitaxozanida but it was discontinued due to oral intolerance. Later, she received a single dose of 250 mg triclabendazole with clinical and laboratory improvement. We presented this case because it is an unusual pseudotumoral presentation in acute hepatic fascioliasis. This parasitic disease is an emerging zoonosis in Perú.

  7. Associations between schizotypy and cerebral laterality.

    Science.gov (United States)

    Park, Haeme R P; Waldie, Karen E

    2017-03-01

    Atypical lateralization for language has been found in schizophrenia, suggesting that language and thought disorders on the schizophrenia spectrum may be due to left hemispheric dysfunction. However, research with those with non-clinical schizotypy has been inconsistent, with some studies finding reduced or reversed language laterality (particularly with positive schizotypal traits), and others finding typical left hemispheric specialization. The aim of the current study was to use both a behavioural (dual reading-finger tapping) task and an functional magnetic resonance imaging lexical decision task to investigate language laterality in a university sample of high- and low-schizotypal adults. Findings revealed no evidence for atypical lateralization in our sample for both overall schizotypy (measured by the Oxford-Liverpool Inventory of Feelings and Experiences) and positive schizotypy (measured by the Unusual Experiences subscale) groups. Our findings provide further evidence that non-clinical schizotypy is not associated with atypical language laterality.

  8. Lateral collateral ligament of the elbow joint

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Vaesel, M T; Søjbjerg, Jens Ole

    1996-01-01

    The structure and kinematics of the lateral collateral ligament of the elbow joint were investigated in 10 cadaveric specimens. The lateral collateral ligament was observed to be a distinct part of the lateral collateral ligament complex. It contains posterior fibers that pass through the annular....... Division of the posterolateral capsule caused no further laxity. Cutting the lateral collateral ligament induced a maximum laxity of 11.8 degrees at 110 degrees of flexion in forced varus and a maximum laxity of 20.6 degrees at 110 degrees of flexion in forced external rotation. The corresponding maximal...... posterior radial head translation was observed at 80 degrees to 100 degrees of flexion and was 5.7 mm in forced varus and 8.1 mm in forced external rotation. This study suggests the lateral collateral ligament to be an important stabilizer of the humeroulnar joint and the radial head in forced varus...

  9. Osteogenesis imperfecta and acute lymphoid leukemia: case report

    Directory of Open Access Journals (Sweden)

    Gabriel David Tarud

    2017-08-01

    Discussion: It is well described that genetic and chromosomal abnormalities increase the risk of leukemia, however the relationship between osteogenesis imperfecta and acute lymphoblastic leukemia is rare. In the world literature, there are few cases mentioning this association. It is important to continue observing the occurrence of later cases, which allow describing if there is a direct relationship between these two entities.

  10. Thrombolysis in acute myocardial infarction : factors determining its efficacy

    NARCIS (Netherlands)

    Brügemann, Johannes

    1994-01-01

    Insight in the mechanisms leading to acute myocardial infarction (MI) has resulted in the administration of exogenous plasminogen activator, later called thrombolytic therapy. This treatment was associated with a significant reduction in mortality and morbidity. However, success has not always been

  11. approach to and management of acute ankle ligamentous injuries

    African Journals Online (AJOL)

    Enrique

    Tibionavicular part. Medial (deltoid) ligament of ankle {. Table I. Differential diagnosis of acute ankle injury. ATFL sprain. CFL sprain. Syndesmosis sprain. Anterior process calcaneus fracture. Lateral process talus fracture. Fifth metatarsal base fracture. Subtalar injury. Peroneal tendon injury. Osteochondral injury of the talus.

  12. Acute Idiopathic Scrotal Edema

    Directory of Open Access Journals (Sweden)

    Micheál Breen

    2013-01-01

    Full Text Available We report a case of acute idiopathic scrotal edema (AISE in a 4-year-old boy who presented with acute scrotal pain and erythema. The clinical features, ultrasound appearance, and natural history of this rare diagnosis are reviewed. In this report, we highlight the importance of good ultrasound technique in differentiating the etiology of the acute scrotum and demonstrate the color Doppler “Fountain Sign” that is highly suggestive of AISE.

  13. Acute fibrinous and organising pneumonia.

    Science.gov (United States)

    Gonçalves, João Rocha; Marques, Ricardo; Serra, Paula; Cardoso, Leila

    2017-09-07

    Acute fibrinous and organising pneumonia (AFOP) is a rare histological pattern of interstitial lung disease. The authors describe a 60-year-old woman admitted to the hospital for sustained fever, presenting with an alveolar opacity on chest X-ray, with the presumed diagnosis of community-acquired pneumonia and the onset of antibiotics. Since serological results suggested that Legionella pneumophila was the infectious agent, she was discharged on levofloxacin. A week later, she was again admitted with fever. CT scan showed opacities with crescentic morphology and a central ground-glass area suggestive of cryptogenic organising pneumonia. Microbiological, serological and autoimmunity tests were negative. She underwent surgical lung biopsy that revealed inflammatory infiltrate, macrophage desquamation, fibroblasts proliferation and fibrin deposition in the alveolar spaces, consistent with AFOP. She started corticotherapy with good response. Disease relapsed after prednisolone discontinuation, 10 months later. Currently, the patient is on prednisolone 5 mg/day without clinical and radiological recurrence. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. The "LIFT" lesion: lateral inverted osteochondral fracture of the talus.

    Science.gov (United States)

    Dunlap, Bradley J; Ferkel, Richard D; Applegate, Gregory R

    2013-11-01

    The purpose of this study was to assess a series of lateral inverted osteochondral fractures of the talus. Over a 17-year period, 10 patients with an acute lateral inverted osteochondral fracture of the talus after an inversion injury to the ankle were identified. Diagnosis was made by physical examination, radiographs, magnetic resonance imaging, and/or computed tomography scan. Arthroscopy was initially performed on all patients. All patients had an inverted osteochondral fragment. In 8 of 10 patients the fragment was reattached in an open manner in conjunction with lateral ligament reefing. The fragment was excised in 2 patients. The mean age of the patients was 17.2 years. They were evaluated with the Single Assessment Numeric Evaluation, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, modified Weber score, Berndt and Harty score, and Short Form 36 version 2 score. Physical and radiographic examination was also performed. The mean time to follow-up was 112.3 months (9.3 years). The mean American Orthopaedic Foot and Ankle Society score improved from 18.9 preoperatively to 86.9 postoperatively (P ≤ .0001). The mean Single Assessment Numeric Evaluation and modified Weber scores were 81.6 and 81.5, respectively. On the Berndt and Harty scale, 6 patients had a good to excellent rating; 3, fair; and 1, poor. The mean Short Form 36 version 2 scores corresponded to national averages for healthy populations. Mean loss of motion for dorsiflexion and plantarflexion was 6.8° and 3.0°, respectively, when compared with the contralateral side. All patients showed some osteophyte formation on follow-up radiographs. An inverted osteochondral fracture of the lateral talus (lateral, inverted, fracture, talus [LIFT lesion]) can occur after a twisting injury to the ankle. Clinical suspicion should be high, especially in the younger athlete. This injury can be successfully managed with a combined arthroscopic and open approach. Level IV, therapeutic case

  15. Bucket foundations under lateral cyclic loading

    DEFF Research Database (Denmark)

    Foglia, Aligi

    failure envelopes. A jacked installation test is successfully compared with existing models. Tests of bucket foundations under lateral loading applied at different loading rates are analysed. As expected, the bearing capacity of bucket foundations under transient lateral loading increases dramatically...... documents on bearing capacity and installation of bucket foundations are reviewed and the results from the models found in literature are compared to the experimental results obtained in the current study. Monotonic tests of bucket foundations under lateral loading until failure are compared with existing...

  16. Lateral cervical puncture for cervical myelography

    International Nuclear Information System (INIS)

    Seol, Hae Young; Cha, Sang Hoon; Kim, Yoon Hwan; Suh, Won Hyuck

    1985-01-01

    Eleven cervical myelograms were performed by lateral cervical puncture using Metrizamide. So, following results were obtained: 1. Site of lateral cervical puncture; Posterior one third of bony cervical canal at C 1-2 level. 2. Advantages as compared with lumbar puncture for cervical myelograms; 1) Small amount of contrast media 2) Excellent image 3) Less position charge 4) Short time 5) Well visualization of superior margin of obstructive lesion in spinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2) Localized collection of contrast media

  17. Lateral cervical puncture for cervical myelography

    Energy Technology Data Exchange (ETDEWEB)

    Seol, Hae Young; Cha, Sang Hoon; Kim, Yoon Hwan; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

    1985-12-15

    Eleven cervical myelograms were performed by lateral cervical puncture using Metrizamide. So, following results were obtained: 1. Site of lateral cervical puncture; Posterior one third of bony cervical canal at C 1-2 level. 2. Advantages as compared with lumbar puncture for cervical myelograms; 1) Small amount of contrast media 2) Excellent image 3) Less position charge 4) Short time 5) Well visualization of superior margin of obstructive lesion in spinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2) Localized collection of contrast media.

  18. Laterality and Lateralization in Autism Spectrum Disorder, Using a Standardized Neuro-Psychomotor Assessment.

    Science.gov (United States)

    Paquet, A; Golse, B; Girard, M; Olliac, B; Vaivre-Douret, L

    2017-01-01

    A detailed assessment of laterality in children with Autism Spectrum Disorder (ASD) was realized, including handedness and other measures (muscle tone, manual performance, dominant eye), using a standardized battery for the developmental assessment of neuro-psychomotor functions. The results of the laterality tests relating to cerebral hemisphere organization (spontaneous gestural laterality and tonic laterality) were different in ASD children, and indicate that the cerebral organization could be disrupted. These assessments, added to the observations of usual laterality most often reported in the literature, provide better understanding of the developmental organization from the pathophysiological point of view in children with ASD.

  19. Comparing the effects of exercise program and low-level laser therapy with exercise program and polarized polychromatic non-coherent light (bioptron light) on the treatment of lateral elbow tendinopathy.

    Science.gov (United States)

    Stasinopoulos, Dimitrios; Stasinopoulos, Ioannis; Pantelis, Manias; Stasinopoulou, Kalliopi

    2009-06-01

    The use of low-level laser therapy (LLLT) and polarized polychromatic non-coherent light as supplements to an exercise program has been recommended for the management of lateral elbow tendinopathy (LET). To investigate whether an exercise program supplemented with LLLT is more successful than an exercise program supplemented with polarized polychromatic non-coherent light in treating LET. Patients with unilateral LET for at least 4 wk were sequentially allocated to receive either an exercise program with LLLT or an exercise program with polarized polychromatic non-coherent light. The exercise program consisted of eccentric and static stretching exercises of wrist extensors. In the LLLT group a 904-nm Ga-As laser was used in continuous mode, and the power density was 130 mW/cm(2), and the dose was 0.585 J/point. In the group receiving polarized polychromatic non-coherent light the Bioptron 2 was used to administer the dose perpendicularly to the lateral epicondyle at three points at an operating distance of 5-10 cm for 6 min at each position. The outcome measures were pain and function and were evaluated at baseline, at the end of the treatment (week 4), and 3 mo after the end of treatment (week 16). Fifty patients met the inclusion criteria. At the end of treatment there was a decline in pain and a rise in function in both groups compared with baseline (p 0.0005 on the independent t-test). The results suggest that the combination of an exercise program with LLLT or polarized polychromatic non-coherent light is an adequate treatment for patients with LET. Further research to establish the relative and absolute effectiveness of such a treatment approach is needed.

  20. Pediatric acute lung injury

    NARCIS (Netherlands)

    Dahlem, P.; van Aalderen, W. M. C.; Bos, A. P.

    2007-01-01

    Among ventilated children, the incidence of acute lung injury (ALI) was 9%; of that latter group 80% developed the acute respiratory distress syndrome (ARDS). The population-based prevalence of pediatric ARDS was 5.5 cases/100.000 inhabitants. Underlying diseases in children were septic shock (34%),

  1. Acute hamstringblessures bij sporters

    NARCIS (Netherlands)

    Reurink, Gustaaf; Tol, Johannes L.; de Vos, Robert-Jan

    2014-01-01

    Acute hamstring injuries are the most common injuries in participants in popular sports such as football and track and field athletics. The diagnosis is made if there is a history of acute-onset pain in the posterior thigh, and presence of the triad of pain on contraction, stretching and palpation.

  2. ACUTE COMPARTMENT SYNDROME

    African Journals Online (AJOL)

    muscle destruction, muscle fibrosis, contractures and permanent disability and at worst case scenario of amputation (3,4). As reported by Frink et al (3) on their study on acute compartment syndrome it can occur even when there is no fracture. Also general surgeons have reported acute compartment syndrome.

  3. [Acute kidney injury

    NARCIS (Netherlands)

    Hageman, D.; Kooman, J.P.; Lance, M.D.; van Heurn, L.W.; Snoeijs, M.G.

    2012-01-01

    - 'Acute kidney injury' is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease).- Acute kidney injury occurs as a result of the combination of reduced perfusion in the

  4. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  5. Septum formation of the lateral ventricles

    International Nuclear Information System (INIS)

    Celik, Hakan H.; Aldur, Mustafa M.; Tatar, I.; Tascioglu, A.B.

    2005-01-01

    In an MRI study examining anomalies of the septum pellucidum in 505 cases, we detected bilateral septum formation of the lateral ventricles in a 17-months-old-baby. In this study, we evaluate 505 (242 males and 263 females) patients referred to the Emaray Imaging Center, Ankara, Turkey with various prediagnoses. We specially selected all the cases from a non-psychotic population. We obtained MRI scans on a 1-Tesla imager (Picker International, Highland Heights, Ohio, USA), with slices of 5 and 6 mm thickness. In the axial and coronal sections, we observed septum formation laterally between the anterior horn and the ventricular body of the lateral ventricles. Radio opaque septum formations started from the caudate nucleus and stretched to the genu of the corpus callosum. There was a second septum formation between the posterior horn and the ventricular body of the right lateral ventricle. It started from the caudate nucleus and stretched to the cavum vergae. (author)

  6. Projectile Aerodynamic Jump Due to Lateral Impulsives

    National Research Council Canada - National Science Library

    Cooper, Gene

    2003-01-01

    .... The formulation shows for sufficiently long-range target interception; lateral impulse trajectory response for a guided projectile is independent of when the impulse is activated during the yaw cycle...

  7. -MoS2 Lateral Heterojunctions

    KAUST Repository

    Li, Ming-yang; Pu, Jiang; Huang, Jing-Kai; Miyauchi, Yuhei; Matsuda, Kazunari; Takenobu, Taishi; Li, Lain-Jong

    2018-01-01

    2D layered heterostructures have attracted intensive interests due to their unique optical, transport, and interfacial properties. The laterally stitched heterojunction based on dissimilar 2D transition metal dichalcogenides forms an intrinsic p

  8. Carrier illumination measurement of dopant lateral diffusion

    International Nuclear Information System (INIS)

    Budiarto, E.; Segovia, M.; Borden, P.; Felch, S.

    2005-01-01

    This paper describes the application of the carrier illumination technique to non-destructively measure the lateral diffusion of implanted dopants after annealing. Experiments to validate the feasibility of this method employed test structures with a constant line width of 300 nm and varying undoped spaces of 100-5000 nm. The test patterns were implanted with a p-type dopant and annealed in a 3 x 3 matrix. For each implant condition, the measured lateral diffusion was found to increase with annealing temperature, as expected. More interestingly, the lateral diffusion was not observed to relate to the vertical diffusion by a fixed proportionality factor, as is usually assumed. The ratio of lateral to vertical diffusion varies with annealing temperature, with a trend that depends on the implant condition

  9. Introduction to Single Piles under Lateral Loading

    DEFF Research Database (Denmark)

    Augustesen, Anders; Ibsen, Lars Bo

    .2). The description is based on results of laboratory tests, full-scale field tests as well as numerical investigations presented in literature. Second, general methods that attempt to model lateral pile response are discussed in section 1.4. Third, focus is paid to a widely used method for prediction of the response......The purpose of this chapter is to give a short introduction to single piles subjected to lateral loading. First, the observed behaviour of laterally loaded piles is described, i.e. the effects of loading conditions, installation procedure, pile type etc. on pile behaviour are presented (section 1...... of a lateral loaded pile, namely the Winkler approach in which the pile is modelled as an elastic beam on an elastic foundation (section 1.5). The soil response and thereby the elastic foundation is represented by springs with nonlinear behaviour (p-y curves). In section 1.6 different types and formulations...

  10. C-reactive protein and later preeclampsia

    DEFF Research Database (Denmark)

    Rebelo, Fernanda; Schlüssel, Michael M; Vaz, Juliana S

    2013-01-01

    This study aims to determine whether high C-reactive protein (CRP) concentration during pregnancy is associated with later preeclampsia and whether weight status (BMI) is a potential modifier of the relation between CRP and preeclampsia....

  11. Lateral power transistors in integrated circuits

    CERN Document Server

    Erlbacher, Tobias

    2014-01-01

    This book details and compares recent advancements in the development of novel lateral power transistors (LDMOS devices) for integrated circuits in power electronic applications. It includes the state-of-the-art concept of double-acting RESURF topologies.

  12. Pedestrian-induced lateral vibrations of footbridges

    DEFF Research Database (Denmark)

    Ingólfsson, Einar Thór

    by pedestrians during walking on a laterally moving treadmill. Two different conditions are investigated; initially the treadmill is fixed and then it is laterally driven in a sinusoidal motion at varying combinations of frequencies (0.33 – 1.07 Hz) and amplitudes (4.5 – 48mm). The experimental campaign involved...... is triggered. This disproportionate increase in the lateral vibration response is caused by a dynamic interaction between the pedestrian and the laterally moving structure, although the governing mechanism which generates the load is still disputed. In this thesis, a comprehensive literature review...... 71 test subjects who covered approximately 55 km of walking distributed on almost 5000 individual tests. An in-depth analysis of the movement of the pedestrians that participated in the experimental campaign reveal that synchronisation is not a pre-condition for the ix development of large amplitude...

  13. Brain and behavioural lateralization in invertebrates.

    OpenAIRE

    Elisa eFrasnelli

    2013-01-01

    Traditionally, only humans were thought to exhibit brain and behavioural asymmetries, but several studies have revealed that most vertebrates are also lateralized. Recently, evidence of left-right asymmetries in invertebrates has begun to emerge, suggesting that lateralization of the nervous system may be a feature of simpler brains as well as more complex ones. Here I present some examples in invertebrates of sensory and motor asymmetries, as well as asymmetries in the nervous system. I illu...

  14. Brain and behavioral lateralization in invertebrates

    OpenAIRE

    Frasnelli, Elisa

    2013-01-01

    Traditionally, only humans were thought to exhibit brain and behavioral asymmetries, but several studies have revealed that most vertebrates are also lateralized. Recently, evidence of left–right asymmetries in invertebrates has begun to emerge, suggesting that lateralization of the nervous system may be a feature of simpler brains as well as more complex ones. Here I present some examples in invertebrates of sensory and motor asymmetries, as well as asymmetries in the nervous system. I illus...

  15. Brain and behavioral lateralization in invertebrates.

    Science.gov (United States)

    Frasnelli, Elisa

    2013-12-11

    Traditionally, only humans were thought to exhibit brain and behavioral asymmetries, but several studies have revealed that most vertebrates are also lateralized. Recently, evidence of left-right asymmetries in invertebrates has begun to emerge, suggesting that lateralization of the nervous system may be a feature of simpler brains as well as more complex ones. Here I present some examples in invertebrates of sensory and motor asymmetries, as well as asymmetries in the nervous system. I illustrate two cases where an asymmetric brain is crucial for the development of some cognitive abilities. The first case is the nematode Caenorhabditis elegans, which has asymmetric odor sensory neurons and taste perception neurons. In this worm left/right asymmetries are responsible for the sensing of a substantial number of salt ions, and lateralized responses to salt allow the worm to discriminate between distinct salt ions. The second case is the fruit fly Drosophila melanogaster, where the presence of asymmetry in a particular structure of the brain is important in the formation or retrieval of long-term memory. Moreover, I distinguish two distinct patterns of lateralization that occur in both vertebrates and invertebrates: individual-level and population-level lateralization. Theoretical models on the evolution of lateralization suggest that the alignment of lateralization at the population level may have evolved as an evolutionary stable strategy in which individually asymmetrical organisms must coordinate their behavior with that of other asymmetrical organisms. This implies that lateralization at the population-level is more likely to have evolved in social rather than in solitary species. I evaluate this new hypothesis with a specific focus on insects showing different level of sociality. In particular, I present a series of studies on antennal asymmetries in honeybees and other related species of bees, showing how insects may be extremely useful to test the evolutionary

  16. The equine flexed lateral fetlock radiographic view

    International Nuclear Information System (INIS)

    Dyer, L.L.

    1993-01-01

    Recommendations for obtaining the flexed lateral radiographic view of the equine fetlock are provided. By tilting the X-ray tube in a 10-degrees dorsal direction, the angle of the flexed lateral fetlock joint is matched. While this view will not be effective on all horses, utilizing the flexed view aids in evaluating those horses that present an abnormal conformation when the fetlock joint is flexed

  17. Brain and behavioural lateralization in invertebrates.

    Directory of Open Access Journals (Sweden)

    Elisa eFrasnelli

    2013-12-01

    Full Text Available Traditionally, only humans were thought to exhibit brain and behavioural asymmetries, but several studies have revealed that most vertebrates are also lateralized. Recently, evidence of left-right asymmetries in invertebrates has begun to emerge, suggesting that lateralization of the nervous system may be a feature of simpler brains as well as more complex ones. Here I present some examples in invertebrates of sensory and motor asymmetries, as well as asymmetries in the nervous system. I illustrate two cases where an asymmetric brain is crucial for the development of some cognitive abilities. The first case is the nematode C. elegans, which has asymmetric odour sensory neurons and taste perception neurons. In this worm left/right asymmetries are responsible for the sensing of a substantial number of salt ions, and lateralized responses to salt allow the worm to discriminate between distinct salt ions. The second case is the fruit fly D. melanogaster, where the presence of asymmetry in a particular structure of the brain is important in the formation or retrieval of long-term memory. Moreover, I distinguish two distinct patterns of lateralization that occur in both vertebrates and invertebrates: individual-level and population-level lateralization. Theoretical models on the evolution of lateralization suggest that the alignment of lateralization at the population level may have evolved as an evolutionary stable strategy in which individually-asymmetrical organisms must coordinate their behaviour with that of other asymmetrical organisms. This implies that lateralization at the population-level is more likely to have evolved in social rather than in solitary species. I evaluate this new hypothesis with specific focus on insects showing different level of sociality. In particular, I present a series of studies on antennal asymmetries in honeybees and other related species of bees, showing how insects may be extremely useful to test evolutionary

  18. Analisis Tekuk Lateral Pipa Gas Bawah Laut

    Directory of Open Access Journals (Sweden)

    Fitrotul Laeli Hidayaturrohmah

    2016-08-01

    Full Text Available To prevent solidification on the pipeline, hydrocarbon is transferred in high temperature and high pressure. High presure and temperature lead to axial tension appearence along the pipeline. Interaction between soil and the surface of pipeline trigering frictional resistance which holding axial force on the pipeline and could cause the occurence of global buckling. According to DNV RP F110, global buckling may occur in several directions which one of them is in the lateral direction. Lateral buckling usually occurs only in the exposed pipe which occurs when the compressive force on the pipe imperfection released at one point so that the excess force in the slip zone turn into buckling. According to DNV RP F 110, there are three methods of analysis that can be used to perform the analysis of lateral buckling the pipe. Those are methods of Hobbs, Van GAF, and Spinazle. In this paper, lateral buckling analysis performed on a 7.67 km subsea gas pipeline by using Hobbs method which concluded that the pipeline has the potential to lateral buckling. Analysis by using software ABAQUS was also carried out to determine the location of the lateral buckling which is the location where overstressed occur.

  19. Possible evolutionary origins of cognitive brain lateralization.

    Science.gov (United States)

    Vallortigara, G; Rogers, L J; Bisazza, A

    1999-08-01

    Despite the substantial literature on the functional architecture of the asymmetries of the human brain, which has been accumulating for more than 130 years since Dax and Broca's early reports, the biological foundations of cerebral asymmetries are still poorly understood. Recent advances in comparative cognitive neurosciences have made available new animal models that have started to provide unexpected insights into the evolutionary origins and neuronal mechanisms of cerebral asymmetries. Animal model-systems, particularly those provided by the avian brain, highlight the interrelations of genetic, hormonal and environmental events to produce neural and behavioural asymmetries. Novel evidences showing that functional and structural lateralization of the brain is widespread among vertebrates (including fish, reptiles and amphibians) have accumulated rapidly. Perceptual asymmetries, in particular, seem to be ubiquitous in everyday behaviour of most species of animals with laterally placed eyes; in organisms with wider binocular overlap (e.g., amphibians), they appear to be retained for initial detection of stimuli in the extreme lateral fields. We speculate that adjustment of head position and eye movements may play a similar role in mammals with frontal vision as does the choice for right or left lateral visual fields in animals with laterally placed eyes. A first attempt to trace back the origins of brain asymmetry to early vertebrates is presented, based on the hypothesis that functional incompatibility between the logical demands associated with very basic cognitive functions is central to the phenomenon of cerebral lateralization.

  20. US findings in acute viral hepatitis

    Energy Technology Data Exchange (ETDEWEB)

    Corsi, M; Lorenzon, G; Mesaglio, S

    1988-01-01

    Reports on colecystic alterations during acute viral hepatitis are more and more frequent; the pathogenesis and clinical meaning of these alterations are still debated. Consensual periportal lymphnode enlargment has been not yet reported. The authors describe four cases of acute viral hepatites in whichUS showed alterations of colecystic walls and/or contents; in two cases enlarged periportal lymphnodes were demonstrated too. Later US exams showed a complete regression of both colecystic and lymphnodal lesions. Clinical findings and laboratory out-comes are evaluated; the connection of US results with hepatitis and its meaning are discussed. The causes of colecystic alterations are still questionable; they might be related to blood disorders or to an increased portal pressure, or else they might be considered as phlogistic lesions. The authors conclude that both colecystic and lymphnodal alterations have a phlogistic nature; moreover, they are not related to a particulary evolution of hepatitis. The importance of distinguishing colecystic alterations from different pathology is stressed.

  1. US findings in acute viral hepatitis

    International Nuclear Information System (INIS)

    Corsi, M.; Lorenzon, G.; Mesaglio, S.

    1988-01-01

    Reports on colecystic alterations during acute viral hepatitis are more and more frequent; the pathogenesis and clinical meaning of these alterations are still debated. Consensual periportal lymphnode enlargment has been not yet reported. The authors describe four cases of acute viral hepatites in whichUS showed alterations of colecystic walls and/or contents; in two cases enlarged periportal lymphnodes were demonstrated too. Later US exams showed a complete regression of both colecystic and lymphnodal lesions. Clinical findings and laboratory out-comes are evaluated; the connection of US results with hepatitis and its meaning are discussed. The causes of colecystic alterations are still questionable; they might be related to blood disorders or to an increased portal pressure, or else they might be considered as phlogistic lesions. The authors conclude that both colecystic and lymphnodal alterations have a phlogistic nature; moreover, they are not related to a particulary evolution of hepatitis. The importance of distinguishing colecystic alterations from different pathology is stressed

  2. Segmental sensory disturbance in brain stem infarctions of the lateral lower pons and lateral medulla

    International Nuclear Information System (INIS)

    Matsumoto, Sadayuki; Yamasaki, Masahiro; Maya, Kiyomi; Imai, Terukuni; Okuda, Bungo.

    1987-01-01

    We reported on seven cases of brainstem infarctions of the lateral lower pons and lateral medulla, the sensory deficit manifested over the trunk or the leg namely segmental sensory disturbances. All patients showed dissociated sensory disturbance of pain and temperature with retained deep sensations except two cases in which touch was also slightly impaired. The sensory distribution was classified into two types. The first ''crossed type'', ipsilatral face and contralateral trunk and leg below the level was involved in 4 cases, and the second ''unilateral type'' contralateral face and trunk above the level in 3 cases. Clinico-anatomical evaluation was executed by MRI. Lesions were detected in the lateral lower pons in two cases and in the lateral medulla in one case. The location of lesions by MRI revealed more lateral lesions showed ''crossed type'' of segmental sensory disturbance and more medial lesions ''unilateral type''. It was shown that the segmental sensory disturbance could be explained by the partial involvement of the lateral spinothalamic tract, which is arranged with the fibers from the sacral segments most lateral. We considered it very important to differentiate the segmental sensory disturbance by brainstem lesion in practical clinical diagnosis. We also emphasize the type of segmental sensory disturbance could be a localizing sign in the lateral brainstem as such, ''crossed type'' indicating the lesion of the lateral portion and ''unilateral type'' the medial portion of the lateral lower brainstem. (author)

  3. Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2013-07-01

    Full Text Available BackgroundBreast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.MethodsFrom September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.ResultsThe average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.ConclusionsPartial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

  4. Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

    Directory of Open Access Journals (Sweden)

    Ho Yong Park

    2013-07-01

    Full Text Available Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

  5. Acute renal failure from inhalation of mycotoxins.

    Science.gov (United States)

    Di Paolo, N; Guarnieri, A; Loi, F; Sacchi, G; Mangiarotti, A M; Di Paolo, M

    1993-01-01

    Mysterious deaths of archeologists after opening Egyptian tombs have been suspected to be secondary to inhalation of mycotoxin, however, the hypothesis has never been verified. Recently, we observed a case of acute renal failure (ARF) undeniably due to inhalation of ochratoxin of Aspergillus ochraceus. After spending 8 h in a granary which had been closed for several months, a farmer and his wife suffered temporary respiratory distress; 24 h later, the woman developed nonoliguric ARF and biopsy revealed tubulonecrosis which healed in 24 days. Toxic substances were not found, but a strain of A. ochraceus producing ochratoxin was isolated from the wheat.

  6. Acute myocardial infarction with a non-diagnostic electrocardiogram. Case presentation and overview

    Energy Technology Data Exchange (ETDEWEB)

    Przybojewski, J Z; Gilburt, S G.M. [Tygerberg Hospital, Stellenbosch (South Africa). Dept. of Internal Medicine

    1983-12-17

    The clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.

  7. Gait Biomechanics in Participants, Six Months after First-time Lateral Ankle Sprain.

    Science.gov (United States)

    Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

    2016-06-01

    No research currently exists predicating a link between the injury-affiliated sensorimotor deficits of acute ankle sprain and those of chronic ankle instability during gait. This analysis evaluates participants with a 6-month history of ankle sprain injury to affirm this link. 69 participants with a 6-month history of acute first-time lateral ankle sprain were divided into subgroups ('chronic ankle instability' and 'coper') based on their self-reported disability and compared to 20 non-injured participants during a gait task. Lower extremity kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). The 'chronic ankle instability' subgroup (who reported greater disability) displayed increased knee flexion during period 1. During period 2, this subgroup exhibited greater total displacement at their ankle joint and greater extensor dominance at their knee. That many of these features are present, both in individuals with acute ankle sprain and those with chronic ankle instability may advocate a link between acute deficits and long-term outcome. Clinicians must be aware that the sensorimotor deficits of ankle sprain may persevere beyond the acute stage of injury and be cognizant of the capacity for impairments to pervade proximally. © Georg Thieme Verlag KG Stuttgart · New York.

  8. [Acute anal pain].

    Science.gov (United States)

    Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

    2013-07-01

    Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically.

  9. Acute oncological emergencies.

    LENUS (Irish Health Repository)

    Gabriel, J

    2012-01-01

    The number of people receiving systemic anti-cancer treatment and presenting at emergency departments with treatment-related problems is rising. Nurses will be the first point of contact for most patients and need to be able to recognise oncological emergencies to initiate urgent assessment of patients and referral to the acute oncology team so that the most appropriate care can be delivered promptly. This article discusses the role of acute oncology services, and provides an overview of the most common acute oncological emergencies.

  10. Language Lateralization Shifts with Learning by Adults

    Science.gov (United States)

    Plante, Elena; Almryde, Kyle; Patterson, Dianne K.; Vance, Christopher J.; Asbjørnsen, Arve E.

    2014-01-01

    For the majority of the population, language is a left hemisphere lateralized function. During childhood, a pattern of increasing left lateralization for language has been described in brain imaging studies, suggesting this trait develops. This development could reflect change due to brain maturation or change due to skill acquisition, given that children acquire and refine language skills as they mature. We test the possibility that skill acquisition, independent of age-associated maturation can result in shifts in language lateralization in classic language cortex. We imaged adults exposed to unfamiliar language during three successive fMRI scans. Participants were then asked to identify specific words embedded in Norwegian sentences. Exposure to these sentences, relative to complex tones, resulted in consistent activation in the left and right superior temporal gyrus. Activation in this region became increasingly left lateralized with repeated exposure to the unfamiliar language. These results demonstrate that shifts in lateralization can be produced in the short-term within a learning context, independent of maturation. PMID:25285756

  11. Absence of lateral palpebral raphe in Caucasians

    Directory of Open Access Journals (Sweden)

    Lucy Goold

    2009-07-01

    Full Text Available Lucy Goold1, Hirohiko Kakizaki1,2,3, Raman Malhotra3, Dinesh Selva11South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Australia; 2Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 3Corneoplastic Unit and Eye Bank, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, United KingdomAbstract: Classical anatomical teaching reports the presence of the lateral palpebral raphe formed at the union in the preseptal and orbital parts of the orbicularis oculi muscle, or by the tendon adhering these to the underlying zygomatic bone. The lateral palpebral raphe has been shown to be absent in Asian cadavers. The current study uses both evidence from the anatomical dissection of five eyelids from three Caucasian cadavers, and histological assessment of the lateral canthus of 13 eyelids from seven Caucasian cadavers to illustrate the absence of the lateral palpebral raphe in Caucasian population.Keywords: lateral palpebral raphe, orbicularis oculi muscle, Caucasian, cadavers

  12. -MoS2 Lateral Heterojunctions

    KAUST Repository

    Li, Ming-yang

    2018-02-28

    2D layered heterostructures have attracted intensive interests due to their unique optical, transport, and interfacial properties. The laterally stitched heterojunction based on dissimilar 2D transition metal dichalcogenides forms an intrinsic p–n junction without the necessity of applying an external voltage. However, no scalable processes are reported to construct the devices with such lateral heterostructures. Here, a scalable strategy, two-step and location-selective chemical vapor deposition, is reported to synthesize self-aligned WSe2–MoS2 monolayer lateral heterojunction arrays and demonstrates their light-emitting devices. The proposed fabrication process enables the growth of high-quality interfaces and the first successful observation of electroluminescence at the WSe2–MoS2 lateral heterojunction. The electroluminescence study has confirmed the type-I alignment at the interface rather than commonly believed type-II alignment. This self-aligned growth process paves the way for constructing various 2D lateral heterostructures in a scalable manner, practically important for integrated 2D circuit applications.

  13. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Directory of Open Access Journals (Sweden)

    Olfa Kassar

    2015-01-01

    Full Text Available Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patient and conservative treatment was attempted in the other patient. None treatment measures were effective and two patients died. Acute acalculous cholecystitis is a serious complication in neutropenic patients. Earlier diagnosis could have expedited the management of these patients.

  14. Basics of acute stroke treatment

    International Nuclear Information System (INIS)

    Haass, A.

    2005-01-01

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O 2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [de

  15. Laterality, spatial abilities, and accident proneness.

    Science.gov (United States)

    Voyer, Susan D; Voyer, Daniel

    2015-01-01

    Although handedness as a measure of cerebral specialization has been linked to accident proneness, more direct measures of laterality are rarely considered. The present study aimed to fill that gap in the existing research. In addition, individual difference factors in accident proneness were further examined with the inclusion of mental rotation and navigation abilities measures. One hundred and forty participants were asked to complete the Mental Rotations Test, the Santa Barbara Sense of Direction scale, the Greyscales task, the Fused Dichotic Word Test, the Waterloo Handedness Questionnaire, and a grip strength task before answering questions related to number of accidents in five areas. Results indicated that handedness scores, absolute visual laterality score, absolute response time on the auditory laterality index, and navigation ability were significant predictors of the total number of accidents. Results are discussed with respect to cerebral hemispheric specialization and risk-taking attitudes and behavior.

  16. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

    Full Text Available Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  17. Recovery of Dysphagia in lateral medullary stroke.

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  18. Lateral human-structure interaction on footbridges

    DEFF Research Database (Denmark)

    Ingólfsson, Einar Thór; Georgakis, Christos; Ricciardelli, Francesco

    2010-01-01

    generated by pedestrians during walking on an instrumented moving treadmill. The treadmill was driven sinusoidally in a lateral motion at various vibration frequencies and amplitudes. Visual observations made during the experiments and testimonies from the walkers, as well as subsequent analysis of video...... recordings, suggested that synchronisation is not as pronounced as generally believed. To confirm this, further analyses were undertaken on the walking patterns of 10 test subjects that were instrumented with waist-mounted tri-axial accelerometers. In this paper, the results from these tests are presented....... The tests reveal that synchronisation is not a pre-condition for the development of large amplitude lateral vibrations on footbridges, as walking frequencies and phase angles remain largely unaffected by lateral motion at most frequencies and amplitudes. Instead, large amplitude vibrations are the result...

  19. Recovery of Dysphagia in Lateral Medullary Stroke

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function. PMID:25045555

  20. Acute Liver Failure

    Science.gov (United States)

    ... can cause acute liver failure. It is an industrial chemical found in refrigerants and solvents for waxes, varnishes ... measures when spraying insecticides, fungicides, paint and other toxic chemicals. Follow product instructions carefully. Watch what gets on ...

  1. Acute Coronary Syndrome

    Science.gov (United States)

    ... heart cells are dying. An electrocardiogram (ECG or EKG) can diagnose an acute coronary syndrome by measuring ... Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  2. Acute postirradiation nephropathy

    International Nuclear Information System (INIS)

    Trojanowski, Z.

    1982-01-01

    The pathogenesis, morphological and clinical signs of acute postirradiation nephropathy are described with particular attention paid to the relationship between the clinical signs of renal involvement and the dose of radiation. (author)

  3. Acute Intermittent Porphyria (AIP)

    Science.gov (United States)

    ... the Healthcare Professionals area of our site. PBS Documentary AIP Diagnosis Stories **Diagnostic Testing for the Acute ... be administered only by physicians experienced in the management of porphyrias in a hospital setting. Panhematin is ...

  4. Acute nutritional axonal neuropathy.

    Science.gov (United States)

    Hamel, Johanna; Logigian, Eric L

    2018-01-01

    This study describes clinical, laboratory, and electrodiagnostic features of a severe acute axonal polyneuropathy common to patients with acute nutritional deficiency in the setting of alcoholism, bariatric surgery (BS), or anorexia. Retrospective analysis of clinical, electrodiagnostic, and laboratory data of patients with acute axonal neuropathy. Thirteen patients were identified with a severe, painful, sensory or sensorimotor axonal polyneuropathy that developed over 2-12 weeks with sensory ataxia, areflexia, variable muscle weakness, poor nutritional status, and weight loss, often with prolonged vomiting and normal cerebrospinal fluid protein. Vitamin B6 was low in half and thiamine was low in all patients when obtained before supplementation. Patients improved with weight gain and vitamin supplementation, with motor greater than sensory recovery. We suggest that acute or subacute axonal neuropathy in patients with weight loss or vomiting associated with alcohol abuse, BS, or dietary deficiency is one syndrome, caused by micronutrient deficiencies. Muscle Nerve 57: 33-39, 2018. © 2017 Wiley Periodicals, Inc.

  5. Acute Pancreatitis in Children

    Science.gov (United States)

    ... a feeding tube or an IV to prevent malnutrition and improve healing. Does my child have to ... Acute Pancreatitis in Children Chronic Pancreatitis in Children Childhood Inherited Disorders Pancreatic Cancer Pancreatic Cancer Risks and ...

  6. Acute incidents during anaesthesia

    African Journals Online (AJOL)

    management of acute incidents and the prevention of ... High or total (complete) spinal blocks in obstetric .... Pain and opioid analgesics lead to delayed ... Step up postoperative care and use ... recognise suprasternal and supraclavicular.

  7. Acute interstitial pneumonia

    International Nuclear Information System (INIS)

    Cuervo M, Francisco; Carrillo Bayona, Jorge; Ojeda, Paulina

    2004-01-01

    The paper refers to a 71 year-old patient, to who is diagnosed acute interstitial pneumonia; with square of 20 days of evolution of cough dry emetizant, fever, general uneasiness, migraine, progressive dyspnoea and lost of weight

  8. Acute generalised exanthematous pustulosis

    Directory of Open Access Journals (Sweden)

    Criton S

    2001-01-01

    Full Text Available Acute generalised exanthernatous pustulosis (AGEP is a condition characterised by sudden onset of non-follicular aseptic pustules all over the body. It is distinct from pustular psoriasis with characteristic morphology, histopathology and evolution.

  9. Acute generalised exanthematous pustulosis.

    Science.gov (United States)

    Criton, S; Sofia, B

    2001-01-01

    Acute generalised exanthernatous pustulosis (AGEP) is a condition characterised by sudden onset of non-follicular aseptic pustules all over the body. It is distinct from pustular psoriasis with characteristic morphology, histopathology and evolution.

  10. Acute coronary syndrome

    Science.gov (United States)

    ... Have plenty of fruits, veggies, whole grains, and lean meats. Try to limit foods high in cholesterol ... et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary ...

  11. Acute mountain sickness

    Science.gov (United States)

    ... GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Acute mountain sickness URL of this page: //medlineplus.gov/ency/article/ ...

  12. Lateral step initiation behavior in older adults.

    Science.gov (United States)

    Sparto, Patrick J; Jennings, J Richard; Furman, Joseph M; Redfern, Mark S

    2014-02-01

    Older adults have varied postural responses during induced and voluntary lateral stepping. The purpose of the research was to quantify the occurrence of different stepping strategies during lateral step initiation in older adults and to relate the stepping responses to retrospective history of falls. Seventy community-ambulating older adults (mean age 76 y, range 70-94 y) performed voluntary lateral steps as quickly as possible to the right or left in response to a visual cue, in a blocked design. Vertical ground reaction forces were measured using a forceplate, and the number and latency of postural adjustments were quantified. Subjects were assigned to groups based on their stepping strategy. The frequency of trials with one or two postural adjustments was compared with data from 20 younger adults (mean age 38 y, range 21-58 y). Logistic regression was used to relate presence of a fall in the previous year with the number and latency of postural adjustments. In comparison with younger adults, who almost always demonstrated one postural adjustment when stepping laterally, older adults constituted a continuous distribution in the percentage of step trials made with one postural adjustment (from 0% to 100% of trials). Latencies of the initial postural adjustment and foot liftoff varied depending on the number of postural adjustments made. A history of falls was associated a larger percentage of two postural adjustments, and a longer latency of foot liftoff. In conclusion, the number and latency of postural adjustments made during voluntary lateral stepping provides additional evidence that lateral control of posture may be a critical indicator of aging. Copyright © 2013 Elsevier B.V. All rights reserved.

  13. Reversible transinsular herniation of the lateral ventricle

    Energy Technology Data Exchange (ETDEWEB)

    Holodny, Andrei I. [UMDNJ-New Jersey Medical School, Department of Radiology, Newark, NJ (United States); Memorial Sloan Kettering Cancer Center, The Department of Radiology, New York, NY (United States); Gor, Devang M.; Thaver, Hussain; Millian, Brian R. [UMDNJ-New Jersey Medical School, Department of Radiology, Newark, NJ (United States)

    2004-11-01

    We present a 7-year-old boy, with a history of neonatal intraventricular hemorrhage, leading to hydrocephalus with multiple shunt revisions. The current presentation of shunt failure and resultant hydrocephalus was complicated by herniation of the trigone of the lateral ventricle into the posterior fossa. Despite the dramatic radiological appearance, this herniation of the lateral ventricle was not accompanied by any additional clinical signs or symptoms other than those usually attributed to hydrocephalus. Following successful shunt revision, the patient returned to his baseline clinically with the trigone reverting back to its normal position. We also present a second companion case. (orig.)

  14. Later Wittgenstein and the Philosophy of Religion

    DEFF Research Database (Denmark)

    Hansen, Stig Børsen

    2010-01-01

    This article sets out by distinguishing Wittgenstein’s own views in the philosophy of religion from a school of thought in the philosophy of religion that relies on later Wittgenstein’s philosophy of language. After a survey of distinguishing features of Wittgenstein’s later philosophy, the third...... section explores Wittgenstein’s treatment of Frazer’s account of magic among primitive peoples. The following section offers an account of Wittgensteinian philosophy of religion, including the use of the notions of a language game and superstition. I conclude by criticizing a very influential argument...

  15. Acute liver failure

    DEFF Research Database (Denmark)

    Larsen, Fin Stolze; Bjerring, Peter Nissen

    2011-01-01

    Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these.......Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these....

  16. [Acute agitation conditions].

    Science.gov (United States)

    Mavrogiorgou, P; Juckel, G

    2015-09-01

    Acute agitation psychiatric emergencies as frequently occur in psychiatric as well as in non-psychiatric settings, such as general hospitals, specialized clinics, emergency services and private practices. Psychiatric emergencies can be life-threatening and necessitate immediate treatment. This article presents the core symptomatology, differential diagnoses and treatment options of acute agitation emergencies. Case control studies and reliable data regarding prevalence and treatment of acute agitation in psychiatric and general hospitals or private practices are sparse. Existing evidence suggests that optimization of diagnosis and therapy of psychiatric emergencies, such as acute agitation is warranted. Treatment of acute agitation, psychological distress and other psychiatric emergencies are highly demanding regarding psychiatric expertise and concerning the personality and behavior of the therapist. The basis of therapy comprises the ability to form a stable and trustworthy relationship with the patient as well as to patiently calm down agitated patients. Unambiguous and rapid decision-making that takes effective pharmacological treatment options into account usually leads to swift amelioration of the acute symptomatology.

  17. An Acute Lateral Ankle Sprain Significantly Decreases Physical Activity across the Lifespan

    Directory of Open Access Journals (Sweden)

    Tricia Hubbard-Turner, Erik A. Wikstrom, Sophie Guderian, Michael J. Turner

    2015-09-01

    Full Text Available We do not know the impact an ankle sprain has on physical activity levels across the lifespan. With the negative consequences of physical inactivity well established, understanding the effect of an ankle sprain on this outcome is critical. The objective of this study was to measure physical activity across the lifespan after a single ankle sprain in an animal model. Thirty male mice (CBA/J were randomly placed into one of three groups: the transected calcaneofibular ligament (CFL group, the transected anterior talofibular ligament (ATFL/CFL group, and a SHAM group. Three days after surgery, all of the mice were individually housed in a cage containing a solid surface running wheel. Physical activity levels were recorded and averaged every week across the mouse’s lifespan. The SHAM mice ran significantly more distance each day compared to the remaining two running groups (post hoc p = 0.011. Daily duration was different between the three running groups (p = 0.048. The SHAM mice ran significantly more minutes each day compared to the remaining two running groups (post hoc p=0.046 while the ATFL/CFL mice ran significantly less minutes each day (post hoc p = 0.028 compared to both the SHAM and CFL only group. The SHAM mice ran at a faster daily speed versus the remaining two groups of mice (post hoc p = 0.019 and the ATFL/CFL mice ran significantly slower each day compared to the SHAM and CFL group (post hoc p = 0.005. The results of this study indicate that a single ankle sprain significantly decreases physical activity across the lifespan in mice. This decrease in physical activity can potentially lead to the development of numerous chronic diseases. An ankle sprain thus has the potential to lead to significant long term health risks if not treated appropriately.

  18. Differential intrathecal inflammatory markers in acute optic neuritis and later conversion to multiple sclerosis

    DEFF Research Database (Denmark)

    Olesen, Mads Nikolaj; Soelberg, Kerstin; Nilsson, Anna Christine

    Background: Optic neuritis (ON) is often an early inflammatory, demyelinating event of multiple sclerosis (MS). We proffer that cytokine and chemokine profiles may (a) differ between patients with MS-related ON and those with non-MS-related ON and (b) predict conversion to MS in patients presenting......-up compared to those who had not. These findings are of potential relevance to our understanding of the pathogenesis of MS and may predict conversion of ON to MS....

  19. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  20. MELAS syndrome presenting as an acute surgical abdomen.

    Science.gov (United States)

    Dindyal, S; Mistry, K; Angamuthu, N; Smith, G; Hilton, D; Arumugam, P; Mathew, J

    2014-01-01

    MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. The diagnosis was later confirmed with histological and genetic studies. This case highlights the difficulties in diagnosing MELAS because of its unpredictable presentation and clinical course. We therefore recommend a high index of suspicion in cases of an acute surgical abdomen with additional neurological features or raised lactate.