ABSTRACT
A modified lateral approach for release of posttraumatic flexion contracture of the elbow is described. The approach is a modification of the procedure described by Nirschl for resection and repair of lateral elbow tendinosis (tennis elbow). The modified approach allows visualization of the entire anterior elbow joint without disturbing the common extensor origin or the collateral ligaments. If necessary, a second, posterior triceps-splitting incision is used to access the olecranon fossa. Twelve consecutive patients were treated from 1988 to 1992. Mean flexion/deformity, which measured 41 degrees before operation, measured 8 degrees immediately after operation. The mean flexion/extension arc measured 70 degrees before operation and improved to 117 degrees after operation. With an average follow-up of 36.5 months, mean flexion contracture was 11 degrees and the mean flexion/extension arc of motion was 114 degrees. In no case was a medial approach or transhumeral perforation required. All patients were treated after operation with the elbow splinted in extension for 3 days, after which they were started on an aggressive physical therapy regimen. There were no wound complications, no neurovascular injuries, and no formations of heterotopic bone.
Subject(s)
Elbow Joint/surgery , Orthopedic Procedures/methods , Adolescent , Adult , Contracture/etiology , Contracture/surgery , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Postoperative Care , Elbow InjuriesABSTRACT
The purpose of this study was to investigate the effect of age, dominance, joint position, and lidocaine injection on proprioception of the normal shoulder. Position sense and the detection of passive shoulder motion were investigated in 40 young (20 to 30 years) and old (50 to 70 years) subjects. An additional 20 young subjects were tested before and after a glenohumeral (n = 10) or a subacromial (n = 10) lidocaine injection was performed. A significant decline occurred in proprioception between the young and old age groups. No difference was observed between dominant and nondominant sides. Position sense was consistently less accurate in the maximum range of motion tested when compared with the lesser ranges tested for flexion and abduction. No differences were identified in the ability to detect motion in flexion, abduction, and external rotation in the younger group, whereas in the older group a difference was observed in flexion. No learning effect was detected for any test trial. No significant changes occurred in proprioceptive ability after either glenohumeral or subacromial lidocaine injection was performed.
Subject(s)
Lidocaine/administration & dosage , Proprioception/drug effects , Proprioception/physiology , Shoulder Joint/physiology , Adult , Age Factors , Aged , Humans , Injections, Intra-Articular , Male , Middle Aged , Range of Motion, Articular/drug effects , Reference Values , Shoulder Joint/drug effectsABSTRACT
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 OutcomeSubject(s)
Managed Care Programs , Mythology , Orthopedics , Forecasting , Greece , Health Maintenance Organizations , Hippocratic Oath , Medicaid , Medicare , United StatesABSTRACT
Acute elbow injuries are often collision related; chronic elbow injuries typically stem from overuse and valgus stress. What seems a purely traumatic injury, though, may actually represent an acute-on-chronic process, so a detailed history and physical exam are essential in pinpointing the injury process and making a specific diagnosis. Important details in the history are the quality, intensity, and onset of pain and the location of symptoms and their effect on function. The exam should include visual inspection, palpation, range of motion, and key tests such as applying valgus stress. Treatment can often be conservative, with emphasis on strength-building rehabilitation.
ABSTRACT
Tennis elbow involves damage to the forearm muscles and tendons. Rehabilitation from this painful condition usually includes rest, icing, stretching exercises, improving tennis technique, and using an elbow strap called a counterforce brace. But perhaps the most important part of rehabilitation is strengthening exercises, which both promote recovery and help keep tennis elbow from returning. Two types of exercise will help you regain strength: exercises with weights and exercises without.
