Early Results of Kinesio Taping and Steroid Injections in Elbow Lateral Epicondylitis: A Randomized, Controlled Study.

Background and objectives: This study prospectively compares early results of Kinesio tape (KT) as an alternative method for the treatment of lateral epicondylitis with those of corticosteroid injection and the rest-and-medication group (RMG). Materials and methods: Among the fifty patients (53 elbows), KT was applied to 20 patients (21 elbows), and corticosteroid injection (CSI) was applied to 15 patients (17 elbows). Fifteen patients were included in the RMG. Patients in the RMG were informed about their condition, and necessary warnings were given. No oral or topical treatments were recommended. If needed, paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed. Patients were classified according to the Nirschl scores and evaluated with visual analog scale (VAS); Quick Disability of Arm, Shoulder and Hand (QDASH); and the Turkish version of the Patient Related Elbow Evaluation (PREE-T). Results: Improvements in all scores were statistically significant in all groups at the end of the second week. At the end of the fourth week, there was also a statistically significant improvement in all three groups, but these improvements were not as high as they were in the first 2 weeks. There was a slight deterioration in the functional scores in the RMG and CSI groups, while the improvement in the KT group continued. In the KT group, the average QDASH score was 18.1 (4.5-35), the VAS score was 2 (1-3), the VAS score in resisted wrist extension was 4 (2-5) and the Nirschl score was 2 (1-3) at the fourth week. The KT group had significant superiority in these parameters over the RMG (p = 0.035, p = 0.035, p = 0.029, p = 0.035, respectively). However, there was no significant difference between the KT, the RMG and the CSI groups at the fourth week. Conclusions: CSI, KT and rest-and-medication treatments were all effective in terms of pain reduction and functional scores at the end of week 2, and the only treatment that continued to be effective in the final week was KT.

A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty.

OBJECTIVE: The aim of this study was to compare the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty. METHODS: Thirty patients (28 female, 2 male; mean age: 69.37±5.11 years, range: 61 to 80 years) undergoing total knee arthroplasty between May 2011 and September 2011 were randomly divided into 2 groups. All patients received spinal anesthesia with bupivacaine. Postoperative analgesia of 72 ml 0.9% NaCl + 48 ml bupivacaine (1 ml = 5 mg, total 120 ml) was administered throughout 24 hours to Group 1 (n=15) by epidural catheter and to Group 2 (n=15) by ON-Q infiltration pump. Groups were compared based on the Bromage scores and visual analog scale (VAS), blood pressure, postoperative analgesia requirement and side effects. RESULTS: Demographic data were similar in both groups. Rates of additional analgesia requirement at the postoperative 60th minute and 2nd hour were significantly higher in Group 2 than Group 1 (p<0.05). Rates of nausea-vomiting at the postoperative 60th minute and 2nd hour were significantly higher in Group 1 than Group 2 (p<0.05 and p<0.01, respectively). Bromage scores at 60 minutes and 2 hours was significantly higher in Group 1 than in Group 2 (p<0.01). Mean VAS scores at 60 minutes and 2 hours were significantly higher in Group 2 than Group 1 (p<0.05). While a statistically significant difference was found between systolic arterial pressure measurements at 60 minutes (p<0.05), there was no significant difference in diastolic arterial pressure and peak heart rate. CONCLUSION: Although the analgesic effect of local infiltration is provided later than by epidural analgesia, the same level of pain control can be achieved with initial additional analgesia. Local infiltration is superior to epidural analgesia in respect of few side effects and early mobilization.

Treatment of isolated diaphyseal fractures of the radius with an intramedullary nail in adults.

BACKGROUND: The goal of the radius diaphysis fractures in surgical treatment is restoration of bone length, rotation correction and to secure fixation that allows early mobilization. The purpose of this study is evaluating the results of intramedullary (IM) radius nail for the treatment of isolated adult diaphyseal fractures of the radius. MATERIALS AND METHODS: We retrospectively reviewed adults with isolated fractures of the radius, who were treated with closed or mini open reduction with a IM radius nail between May 2008 and November 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture, or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores. RESULTS: Twenty-three enrolled patients (mean age 34 years; 17 men) had 23 isolated radius fractures. Mean time to fracture union was 12 weeks (range 10-13 weeks) for radius fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Follow-up ranged from 12 to 42 months. Grace and Eversmann ratings of 21 patients were excellent or good, and 2 patients were medium. Mean DASH score was 4.2 points (range 0-13.3). CONCLUSIONS: Our experience indicates that this new IM radius nail may be considered as an alternative to plate osteosynthesis for fractures of the radius diaphysis in adults. IM nailing of radius fractures provides reliable bony union and excellent postoperative clinical results in adults.