The Nirschl procedure versus arthroscopic extensor carpi radialis brevis débridement for lateral epicondylitis.

BACKGROUND: The Nirschl technique and arthroscopic débridement are common surgical procedures for chronic lateral elbow tendinopathy. The purpose of this study was to compare outcomes following the use of these techniques to treat chronic lateral elbow tendinopathy. METHODS: We retrospectively reviewed 59 elbows of 55 patients who did not improve after conservative treatment. Twenty-nine elbows of 26 patients were treated with the Nirschl procedure (Nirschl group), and 30 elbows of 29 patients were treated with arthroscopic débridement (arthroscopy group). Outcomes were assessed subjectively with the quick Disabilities of the Arm, Shoulder and Hand questionnaire and the visual analog scale (VAS) for pain in 3 domains (overall pain, pain at rest, and pain during hard work) and objectively with pain-free grip strength. RESULTS: The Nirschl and arthroscopy groups showed significant improvements in subjective and objective outcomes at a mean of 28.5 months and 31 months, respectively (P <.05). No significant between-group differences were found in postoperative outcomes, including quick Disabilities of the Arm, Shoulder and Hand questionnaire scores; pain-free grip strength; and VAS scores for overall pain and pain at rest (P > .05). However, a small but significant difference was found in the postoperative VAS score for pain during hard work (1.6 ± 1.3 for Nirschl group vs 2.2 ± 2.0 for arthroscopy group, P = .042). CONCLUSIONS: Both techniques are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy. Although the Nirschl technique provides slightly superior pain relief during hard work, the effect size is very small and the difference does not appear to be clinically important.

Surgical Anatomy of the Longus Colli Muscle and Uncinate Process in the Cervical Spine.

PURPOSE: There have been a few previous reports regarding the distances between the medial borders of the longus colli to expose the disc space. However, to our knowledge, there are no reports concerning longus colli dissection to expose the uncinate processes. This study was undertaken to assess the surgical relationship between the longus colli muscle and the uncinate process in the cervical spine. MATERIALS AND METHODS: This study included 120 Korean patients randomly selected from 333 who had cervical spine MRIs and CTs from January 2003 to October 2013. They consisted of 60 males and 60 females. Each group was subdivided into six groups by age from 20 to 70 years or more. We measured three parameters on MRIs from C3 to T1: left and right longus colli distance and inter-longus colli distance. We also measured three parameters on CT: left and right uncinate distance and inter-uncinate distance. RESULTS: The longus colli distances, uncinate distances, and inter-uncinate distances increased from C3 to T1. The inter-longus colli distances increased from C3 to C7. There was no difference in longus colli distances and uncinate distances between males and females. There was no difference in the six parameters for the different age groups. CONCLUSION: Although approximate guidelines, we recommend the longus colli be dissected approximately 5 mm at C3-5, 6 mm at C5-6, 7 mm at C6-7, and 8 mm at C7-T1 to expose the uncinate process to its lateral edge.

Physiological relaxation induced by horticultural activity: transplanting work using flowering plants.

BACKGROUND: Despite increasing attention and a growing volume of research data, little physiological evidence is available on the benefits of horticultural activity and the different effects on individuals. Therefore, the aim of the present study was to investigate the physiological effects of horticultural activity and to examine how differences in personality alter these effects. RESULTS: The effects of transplanting real flowers (horticultural activity) and handling artificial flowers (control activity) on human physiological activity were compared. On the first day, eight participants engaged in horticultural activity and another eight in the control activity. On the second day, participants switched roles. Participants' physiological conditions during each activity were assessed by measuring the heart rate and heart rate variability (HRV). Psychological responses, which were measured using a semantic differential rating scale, showed that the horticultural activity promoted comfortable, soothed, and natural feelings, compared to the control activity. Analysis of physiological responses using two-way repeated measures analysis of variance (ANOVA) revealed that sympathetic nervous activity significantly decreased in the late time period (11 to 15 minutes) of horticultural activity only in the type A group. CONCLUSIONS: This study supports the fact that the horticultural activity can enhance psychological and physiological relaxation effects, although these physiological effects can differ among individuals with different personalities.