Subject(s)
Debridement , Rotator Cuff Injuries , Rotator Cuff/surgery , Shoulder Impingement Syndrome/surgery , Acromion/surgery , Activities of Daily Living , Adult , Arthroscopy , Humans , Joint Instability/etiology , Rupture , Shoulder Impingement Syndrome/physiopathology , Shoulder Impingement Syndrome/rehabilitation , Shoulder Joint/physiopathology , Treatment OutcomeABSTRACT
We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery. At revision surgery, findings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the pathologic tissue usually present in the extensor carpi radialis brevis tendon should be resected. Release operations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.
Subject(s)
Arthroplasty/methods , Salvage Therapy/methods , Tennis Elbow/surgery , Adult , Aged , Cicatrix/surgery , Debridement , Female , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Tendons/surgery , Tennis Elbow/rehabilitation , Treatment OutcomeABSTRACT
Adult patients in a family medicine clinic were surveyed to identify variables related to situational anxiety in a relatively unthreatening medical setting. Anxiety scores ranged from extremely calm to extremely anxious, with the average near the midpoint. Scores on other variables were reliably related to degree of reported anxiety. Multiple regression and discriminant analyses revealed the following to be the strongest predictors of higher anxiety: a passive orientation toward the visit; uncertainty about the state of one's health; expectations of physical discomfort, embarrassment, and invasion of privacy; a shorter time waiting; and few previous exposures to the clinic, physician, and procedure. Results are discussed in terms of implications for practice and for future research.
