Prospective Evaluation of the Effectiveness of a Home-Based Program of Isometric Strengthening Exercises: 12-Month Follow-up

BACKGROUND: The aim of this prospective randomized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis (LE) of the distal humerus. We hypothesized that 1) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2) functional improvements after exercise would be time-dependent. METHODS: Patients were assigned to one of two groups: 1) an immediate physical therapy group (group I), or 2) a delayed physical therapy group (group D). Group I patients (n = 16) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program. Group D patients (n = 15) learned and did the exercises after being on medications for 4 weeks. RESULTS: Outcomes at the 1-month clinic visit indicated that pain (measured using a visual analogue scale [VAS]) had been significantly reduced in group I compared to group D (p < 0.01). However, significant differences between groups were not found at 3-, 6-, and 12-month follow-up for either VAS scores or Mayo elbow performance scores. For modified Nirschl/Pettrone scores, a significant difference between groups was found only at the 1-month follow-up visit. By then, the number of participants who returned to all activities with no pain or occasional mild pain was six (37%) in Group I and two (13%) in Group D (p = 0.031). At the final follow-up visit, 88% of all participants performed physical activities without pain. CONCLUSIONS: Isometric strengthening exercises done early in the course of LE (within 4 weeks) provides a clinically significant improvement.

Elbow Dislocation Combined with Coronoid Process and Radial Head Fracture

PURPOSE: To evaluate the clinical outcome for terrible triad injury of the elbow joint. MATERIAL AND METHODS: We reviewed consecutive 10 cases retrospectively among 12 terrible triad injuries, which had been followed up for a minimum 1 year. The average age at the time of injury was 45 years (range, 32~72). All cases were dislocated posteriorly. The 3 cases had fracture of olecranon. Combined medial and lateral approach was performed in 3 cases, medial and lateral approach after extensile posterior approach in 4 cases, transolecranon approach using existed olecranon fracture in 2 cases, and transolecranon approach in 1 case were done. RESULTS: The average Mayo elbow performance score was 87, with 5 excellent, 4 good, and 1 poor results. Results by Riseborough and Radin's rating criteria include 9 good and 1 fair. The 8 cases were stable. But 2 cases were classified with moderate and severe instability; these cases had been performed by radial head allograft and excision respectively. CONCLUSION: A stable, functional elbow can be restored in terrible triad injury by early active rehabilitation after anatomic reduction and firm internal fixation.

Treatment of Pain Around the Shoulder Joint

Shoulder pain is a common and important musculo-skeletal problem. Compromised shoulder movement due to pain, stiffness, or weakness can cause a substantial disability and affect a person's ability to carry out daily activities (eating, dressing, and personal hygiene) and work. The self-reported prevalence of shoulder pain is estimated to be between 16% and 26%; it is the third most common cause of musculoskeletal consultation in primary care, and approximately 1% of adults consult a general practitioner with new shoulder pain annually in the United Kingdom. The diagnosis and treatment of the shoulder should be specified in each disease entity. Self help advices, including relative rest and attention to occupational, sporting, or other physical factors, should be offered as well as analgesics. The evidence from common intervention such as steroids and physiotherapy is relatively limited. Physiotherapy and steroid have a marginal short-term effect on pain. Surgery should be considered when conservative measures fail.