Bobby Chhabra, UVA Professor, describes his technique for open lateral epicondylitis surgery. Epicondylitis humeri radialis – acute and chronic (tennis elbow) Epicondylitis support band with lateral and medial nopped friction pad and wrist bandage. In einer prospektiven Studie wurden 85 Patienten mit einer chronischen therapieresistenten Epicondylitis humeri radialis (EHR) mit extrakorporaler.
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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.
Epicondylitis humeri radialis – acute and chronic (tennis elbow) – Sporlastic
However, it is certainly causally connected with connective intersection between forearm muscle and bone in the elbow region. Of the total number of patients, were male, female while one patient was younger than 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, Of the total number of 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.
Tennisarm (Epicondylitis humeri radialis)
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.
Tennis elbow Epicondylitis humeri radialis is a painful syndrome caused by inflammational, nonspecific changes in forearm and hand muscles connection at lateral epicondyle of humerus and radio-humeral joint and its capsule. Epicondylitis humeri radialis is an enthesitis at the point where muscle extensor connects to the lateral epicondyle of humerus.
Microtrauma to the tendons connection sites result in minor damages and ruptures in tendons fibers that may develop into necrotic changes and cause deposition of calcium salts. Similar changes may result from metabolic disturbance or rheumatism, although rarely.
The most frequently affected individuals are those who utilize forearm musculature to the maximum capacity: The second category includes sportsmen: Lateral epicondylitis reveals itself in the form of pain in the outer part of elbow joint, at the place of the attachment of tendons of hand and fingers extensors, which occurs during work or sports activity.
Pain may appear either suddenly or gradually, sometimes spreading along outer side of forearm. In addition, the affected individual describes hand muscles fatigue, which may disable performing everyday activities such as: It is 7 to 10 times more frequent in radial than in medial humeral epicondyle.
It is frequent in middle-aged persons, equally frequent in men and women and generally affects dominant hand. Its names are due to higher frequency of these overexertion syndromes in certain sports. Other than in sportsmen, it is a professional ailment in typists, bricklayers, truck drivers, dentists and surgeons, that is in individuals with frequent contractions of extensors and supinators lateral epicondylitis or flexors and pronators medial epicondylitis.
The main symptom includes epicondyal pain of various intensities. Pain is accompanied with the loss in hand power. Clinical examination resorts to tests based on the contraction of particular muscle group with resistance, which results in pain, in particular to palpation in epicondyal region. Just like in other overexertion syndromes, treatment may include whole range of procedures, from conservative to surgical treatment.
Conservative treatment should be adjusted to the intensity of inflammation and pain and include control of further activities. Successful treatment depends on the reduction of irritating movement, resting of certain muscle group, adequate cryo-therapy, isotonic and stretching exercises. Should the response to therapy be inadequate corticosteroid injection may be administered. Following the surgical treatment subel-bow immobilization implemented for one week.
Thereafter, the treatment continues with physical therapy. In our group of patients, the positive test result was characteristic of entesopathy of extensor carpi radialis brevis muscle, which is inserted in radial epicondyl.
When the test is negative pain is considered to be of spondy- logenic, arthrogenic or neurogenic nature. Test is significant radkalis the selection of therapeutical approach and establishment of indications for surgical intervention 1. In the course of surgery, an unknown submuscular ly-poma was found to cause supinatory syndrome with fingers extensors paresis. In the cases of pain therapy resistance, in particular in conservative therapy of tennis elbow, non-traumatic supinator syndrome should be considered as diagnostic possibility 2.
Following the exact verification of tennis elbow and unsuccessful intensive conservative treatment, application of Hohmann procedure that involves incision to the tendon of proximal extensor is clearly advantageous from patho-physiological point of view. This epicpndylitis procedure may safely be performed endoscopically 3. Following ineffective conservative treatment, 55 patients with tennis elbow 29 female and 16 maleof average age 41,1 years 21 to 61were surgically treated.
In 47 patients surgery involved tendon caput communae extensorum while m. This study concurs with general opinion that surgical epicondy,itis be indicated only in patients who received unsuccessful conservative treatment 4.
In a study that involved 85 patients with epicondyltiis epicon-dylitis humeri that resisted long-term therapy, extracorporeal shock wave therapy ESWT was applied.
All the patients received physical therapy, local injections and other conservative procedures over six months period. Complications in the form of small hematoma were encountered in only four patients. Following average monitoring period of 3,7 months, it was possible to evaluate 78 patients using Rolles and Maudsley Sore. In a group of 25 patients, retrospective analysis following the unsuccessful conservative therapy indicated neurophysiological examination whereby the syndrome of nervus radialis compression was established.
Surgical treatment by Wilhelm and Wachsmuth method was indicated 6. In 14 patients with epicondylitis who were resistant to conservative therapy and received surgical treatment by Wilhelm procedure, significant reduction in symptoms was observed following observation period of 7,5 years on average years. Therefore, this surgical procedure was recommended 7. In untrained persons, frequently practiced recreational sports activity may result in epicondylitis humeri radialis.
In these cases, it is necessary to establish clear differential diagnosis in order to distinguish various pain syndromes that are frequently described as elbow pain. Thus, elbow pain is defined as syndrome ligamentum anullarae radii that frequently appears as post-traumatic pain of synovial origin.
[Differential diagnosis of epicondylitis humeri radialis].
Osteoarthritis and rheumatoid arthritis raddialis also be linked to the pain of post-traumatic origin. This group also includes patients with elbow pain caused by frequently unrecognized changes in cervical region of spine.
Tennis elbow symptoms may be a consequence of radial nerve irritation which imitates supinator syndrome. Younger patients may suffer from osteonecrosis or epifiseolysis 8. The analysis raxialis performed in order to establish frequency of the conditions that belong into RSI group, the total requirement for CBR rehabilitation and to evaluate the effects of local instillation of corticosteroid depot on epicondylitis humeri radialis tennis elbow treatment.
Within the group with RSI syndrome we evaluated treatment efficacy in patients with diagnosis epicondylitis humeri dadialis. A scale was determined for the grading of clinical condition prior and after the treatment Table 1.
Elbow pain is the main symptom that is related to numerous microlocations within the joint itself, not only to the lateral epicondyl humeri for which it is named.
Because of anular ligament and radius capitulum elbow performs rotational gumeri along longitudinal joint axis in addition to flexion and extension. In our method, manipulation has a major role. Simultaneously, joint decompression and relaxation in the conjoint musculature are achieved which result in pain relief. Following the manipulative therapy, additional instillation of corticosteroids reduces inflammation and contributes to overall physiological reintegration of function of this complex joint.
It has strong anti-inflammatory and secondary analgesic activity. It is applied locally, in the epicondyl area, and in part, intra-articularly in the area of radio-humeral joint. According to literature data as well as experience, the drug effect and pain relief are expected within 6 to 12 hours following the drug administration. Full effect is expected after 24 hours.
Epicondylitos, function normalization and pain relief occur simultaneously. Thus, evaluation of treatment success may be performed during the first control follow-up. Also, each case may be individually and competently epicodnylitis. All the treatment procedures, pre-and post-treatment assessment as well as the results of any additional procedures are entered into adequate database and stored for subsequent professional and academic analysis 9.
The data will be presented in Tables and Humerii. These two parameters, gender breakdown and pronounced pain in pre-treatment initial assessment epiccondylitis us to explore every aspect of this ailment. Following the evaluation and final assessment of functional condition, the analysis shows high level of success and fast recovery.
Practically, the total cost includes: There is no loss of working hours in the employed patients. Expressed in value points it amounts to 80 points 1 point is a relative value defined in Federal health humefi normative which is 15 times less than when applying standard protocols.
Epicondylltis the case of this ailment standard protocol proscribes the following steps:. Following the examination by family doctor and orthopedic specialist days immobilization cast is usually applied along with analgesic drugs and sick leave. Three weeks of treatment and sick leave – total points.
This calculation does not include contribution in working epicojdylitis at the place of work. The value of this variable is not adequately assessed and cannot be applied epicondylittis our conditions.
In the USA this loss amounts to more than twice the individual wage. Because of anular ligament and radius capitulum, elbow performs rotational movements along longitudinal joint axis in addition to flexion and extension. In our method, a major role belongs to manipulation as epicondyltis to immobilization, which is major step in classic clinical method. Our results suggest that the application of this method completely diminishes the need for surgical intervention. Also, the functional ability of elbow is, in majority of patients, fully restored.
National Center for Biotechnology InformationU. Bosn J Basic Med Sci. Author information Copyright and License information Disclaimer. Abstract Tennis elbow Epicondylitis humeri radialis is the most frequent reason that patients with elbow pain report to a physician.
Epicondylitis humeri radialis, manipulation, drug therapy.
Open in a separate window. A diagnostic sign in so-called epicondylitis humeri radialis. Z Orthop Ihre Grenzgeb. Schmidt R, Swoboda B.
Decompensation of a supinator syndrome in submuscular lipoma.