Percutaneous tennis elbow release under local anaesthesia.

INTRODUCTION: When the non-operative treatment of tennis elbow fails to improve the symptoms a surgical procedure can be performed. Many different techniques are available. The percutaneous release of the common extensor origin was first presented by Loose at a meeting in 1962. Despite the simplicity of the operation and its effectiveness in relieving pain with minimal scarring this procedure is still not widely accepted. This study presents the long-term results of percutaneous tennis elbow release in patients when conservative measures including local steroid injections have failed to relieve the symptoms. PATIENTS AND METHODS: Percutaneous release of the extensor origin was performed in 24 consecutive patients (seven male and seventeen female), providing 30 elbows for this study. The age of the patients ranged from 26 to 71 years with mean age of 55 years. The technique involved a day case procedure in the operating theatre using local anaesthesia without the need for a tourniquet. The lateral elbow was infiltrated with 5mls 1% lignocaine and 5mls 0.5% bupivicaine with 1:200,000 adrenaline. All operations were performed by the senior author. The patients were assessed post operatively by using DASH (disabilities of arm, shoulder and hand) score and Oxford elbow scores. The mean follow up period was 36 months (1-71months). RESULTS: Twenty one patients returned the DASH and Oxford elbow questionnaires. Four patients were lost in the follow up. The post operative outcome was good to excellent in most patients. Eighty seven percent of patients had complete pain relief. The mean post-op DASH score was 8.47 (range 0 to 42.9) and the mean Oxford elbow score was 42.8 (range 16 to 48). There were no complications reported. All the patients returned to their normal jobs, hobbies such as gardening, horse riding and playing musical instruments. CONCLUSION: In our experience Percutaneous release of the epicondylar muscles for humeral epicondylitis has a high rate of success, is relatively simple to perform, is done as a day case procedure and has been without complications. Percutaneous release is a viable treatment option after failed conservative management of tennis elbow.

[Ultrasound bone densitometry in children and adolescents; Italian refence curves with multi-site device (Omnisense)]. / Densitometria ossea a ultrasuoni in età pediatrica: creazione di un database in una popolazione italiana con densitometro multi-sede Omnisense (Sunlight Technologies).

The values of bone density represent one of the best parameters for the prediction of the risk of fracture in the adult. Since the peak of bone mass depends over that on genetic factors also on modifiable environmental factors, the evaluation of the state of bone health in paediatric populations has assumed great importance; the ultrasound techniques seem to represent a potential alternative to DXA and QTC. Using Omnisense device (Omnisense, Sunlight Ultrasound Technologies) we have evaluated the bone strength in a champion of 652 children and teen-agers aged 6-18 (328 females, 324 males). The measurements have been made at the distal third of the radius and midshaft tibia. The purpose has been to record the values of SOS in a healthy paediatric population, building a normal database and to find a correlation between the SOS values and anthropometric data, dietary factors and physical activity. The comparison with an analogous study conducted by other Authors prompted us to conclude that in the paediatric population the construction of proper curves of reference, with which to compare the data of the patients, is essential to avoid errors in the evaluation of bone density, in agreement with how much already underlined in literature. Besides a correct interpretation of the data obtained with ultrasounds systems asks for a change of the thresholds values established by the OMS for the diagnosis of osteopenia/osteoporosis with the DXA. As already happened for the adult population in children also it will be therefore necessary to compare a great number of pathological subjects with the normal database, establishing so the new values of Z-Score and giving a clinical meaning to the effected measurements.

[Association among postural and skull-cervico-mandibular disorders in childhood and adolescence. Analysis of 428 subjects]. / Associazione tra disordini posturali e cranio-cervico-mandibolari in età evolutiva. Analisi di un campione di 428 soggetti.

The aim of the study is to appraise the prevalence of the mild defects of the spine or paramorphysm in a normal paediatric population, without orthopaedic pathology, and to verify the possible association with the dysfunctions of the dental apparatus. The recovery of a real association among these pathologies could furnish a sprout for a correct therapeutic approach. In the study 428 subjects (211 females and 217 males), aged 9 to 14 years, have been analyzed. The data have been recorded on special schedules, orthopaedic and orthodontic, containing the number of progressive order and the initials of name and last name, in the respect of the privacy of the subjects. From the study a 2.8% scoliosis incidence has emerged, an incidence of scoliotic attitudes 9.5% and an incidence of 83% normality deviations. As deviations by the normality have been classified the isolated skeletal asymmetries, agreements as varying functional not yet pathological, for instance scapular or flank asymmetry, mild genu varum or valgum, femoral anteversion. A statistically significant relationship among that disorders of posture and malocclusion (P < 0.005) and ogival palate (P < 0.002) has been found. Despite these correlations, it is very difficult to explain this association from the point of view of etiopathogenesis. For this we hold to have to continue the study, to give a meaning to such correlations and to find an appropriate therapy.