Tratamiento artroscópico de la epicondilitis lateral crónica. Resultados a corto plazo de tres casos / Arthroscopic treatment of chronic lateral epicondylitis. Short-term results of 3 cases

Resumen: Objetivo: Mostrar el resultado a corto plazo de la liberación artroscópica en pacientes que presentan epicondilitis crónica lateral. Material y métodos: Se realiza liberación artroscópica de tres pacientes con epicondilitis lateral. Seguimiento de seis meses. Se utiliza la escala de Clínica Mayo para valoración de resultados. Se lleva a cabo revisión y discusión de la literatura. Resultados: Dos pacientes del género femenino y uno del género masculino dedicados a las actividades cotidianas, no deportistas. El dolor fue el síntoma capital que afectó el puntaje de la escala de valoración. Estos puntajes mejoraron luego de la cirugía. Se logró retorno precoz a sus actividades cotidianas. No se reportaron complicaciones neurológicas. Discusión: El tratamiento artroscópico resultó una alternativa segura y eficaz para el tratamiento de la epicondilitis lateral en estos tres pacientes, el cual permite realizar simultáneamente exploración articular con fines diagnósticos y tratar patologías asociadas. Se requieren series más amplias y estudios comparativos a fin de establecer protocolos definitivos en nuestra casuística.

Abstract: Objective: To assess the outcome of arthroscopic release in three patients with chronical lateral epicondylitis. Material and methods: Arthroscopic release in three patients with lateral epicondylitis is performed. Mayo Clinic scale for evaluation of results is used. A review and discussion of the literature is made. Results: Three patients, two female and one male, the common activities was principal labors, not athletes. Patients had significant pain. It was the principal symptom that affect the score of the rating scale. These scores improved after surgery. It was achieved early return to normal daily activities. No neurological complications were reported. Discussion: Arthroscopic treatment was an alternative safe and effective for treating chronical lateral epicondilitis in this three cases. It allows simultaneous joint exploration for diagnostic purposes and to treat associated pathologies. Broader Series and studies are necessary in order to establish definitive protocols in our cases.

Evaluation of patients submitted to the arthroscopic treatment of the lateral epicondylitis refractory to the conservative treatment / Avaliação de pacientes submetidos ao tratamento artroscópico da epicondilite lateral refratária ao tratamento conservador

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. .

Objetivo: Avaliar os resultados do tratamento artroscópico da epicondilite lateral. Métodos: Foram avaliados 14 pacientes (15 cotovelos) submetidos ao tratamento artroscópico da epicondilite lateral refratária ao tratamento conservador, o qual foi feito por um período mínimo de 18 meses. Além da coleta de dados demográficos, os pacientes foram avaliados segundo a classificação artroscópica de Baker et al., o questionário Disabilities of the Arm, Shoulder, and Hand (DASH) e o Mayo Elbow Performance Score (MEPS). As idades dos pacientes variaram entre 23 e 56 anos (média de 46) e foram oito do sexo masculino e seis do feminino. Dos 15 cotovelos, 12 eram do membro dominante e um paciente tinha lesão bilateral. O seguimento após a cirurgia foi de no mínimo 24 meses e no máximo 72 meses (média de 41). Resultados: Foram constatadas, segundo a classificação artroscópica de Baker et al., dois pacientes com lesão do tipo I, nove com lesão do tipo II e três com lesão do tipo III. Encontramos as seguintes complicações: um paciente com alteração da sensibilidade na região do portal lateral, um com déficit de dez graus na extensão, um com plica sinovial e um com sinovite em compartimento lateral. Nossa pontuação no questionário DASH foi de no mínimo 32 pontos e no máximo 120 pontos (média de 57) e a escala de MEPS apresentou pontuação mínima de 60 pontos e máxima de 100 pontos (média de 90 pontos). Conclusão: O tratamento artroscópico da epicondilite lateral, além de seguro, apresenta resultados satisfatórios. .

El ultrasonido en el estudio del síndrome de codo doloroso: [revisión] / Ultrasound in the study of elbow pain syndrome: [review]

La ultrasonografía es una herramienta útil para la evaluación de las anormalidades del codo, especialmente aquellas relacionadas con artropatías inflamatorias, mecánicas y degenerativas, al deporte, con actividades repetitivas o con entesitis. Es una herramienta dinámica que permite evaluar tanto estructuras extraarticulares como los ligamentos, tendones, músculos, bursas, entesis, nervios y vasos, así como las estructuras intraarticulares como los recesos articulares, cartílagos y superficies óseas articuladas. El objetivo de esta revision es brindar una actualizacion del uso de este método de imagen en las patologías más frecuentes que afectan el codo.

Ultrasonography is a useful tool for evaluation of abnormalities of the elbow, especially those related to inflammatory arthritis, mechanical and degenerative diseases, sports with repetitive activities or enthesitis. It is a dynamic tool that provides an evaluation of extra-articular structures such as ligaments, tendons, muscles, bursas, enthesis, nerves and vessels, as well as intra-articular structures such as joint recess, cartilage and bone surfaces articulated. The aim of this review is to provide an update on the use of this method of image in the most common diseases that affect the elbow.

Mini-open Muscle Resection Procedure under Local Anesthesia for Lateral and Medial Epicondylitis

BACKGROUND: This study examined the clinical results of surgical treatment using a mini-open muscle resection procedure under local anesthesia for intractable lateral or medial epicondylitis. METHODS: Forty two elbows (41 patients) were treated surgically for lateral or medial epicondylitis. The indication for surgery was refractory pain after six months of conservative treatment, or a history of more than three local injections of steroid, or severe functional impairment in the occupational activities. The treatment results were assessed in terms of the pain using the visual analogue scale (VAS), Roles & Maudsley score, and Nirschl & Pettrone grade. RESULTS: The preoperative VAS scores of pain were an average of 5.36 at rest, 6.44 at daily activities, and 8.2 at sports or occupational activities. After surgery, the VAS scores improved significantly (p < 0.01): 0.3 at rest, 1.46 at daily activities, and 2.21 at sports or occupational activities. The preoperative Roles & Maudsley score was acceptable in 6 cases, and poor in 36 cases, which was changed to excellent in 23 cases, good in 16 cases, acceptable in 3 cases after surgery. According to the grading system by Nirschl & Pettrone, 23 cases were excellent, 18 cases were good, and the remaining 1 case was fair. Overall, 41 cases (97.6%) achieved satisfactory results. Postoperative complications were encountered in three cases. Subcutaneous seroma due to the leakage of joint fluid in two patients was managed by additional surgery and suction drainage, and resulted in a satisfactory outcome. One patient complained of continuous pain on occupational activity, but her pain at rest was improved greatly. CONCLUSIONS: The mini-open muscle resection procedure under local anesthesia appears to be one of effective methods for intractable lateral or medial epicondylitis.