Physical therapy intervention versus corticosteroid injection for lateral elbow tendinopathy. Does slow and steady win the race? - A systematic review.

Background: Lateral elbow tendinopathy is one of the most common chronic and degenerative diseases which significantly affects quality of life and the activities of daily living of a person. The following is a systematic review reporting a comparison between physical therapy intervention and corticosteroid injection for the treatment of lateral elbow tendinopathy. Method: PubMed, Web of Science, and Embase were searched using headings related to treatment options for Lateral elbow tendinopathy. The following keywords were used: lateral epicondylitis, physical therapy, and corticosteroid injection. Result: We descriptively analyzed and reviewed a total of 12 studies including a total of 1253 patients for lateral elbow tendinopathy. The physical therapy intervention included interventions like electrotherapy, manual therapy, and exercise. The studies included had an overall low to unknown risk of bias. Conclusion: Our review suggests corticosteroid injection provides beneficial short-term effects and physical therapy interventions provide intermediate to long-term effects, less additional treatment and low recurrence rate in patients with lateral elbow tendinopathy. Although high-quality randomized control trials are required in order to have a better understanding of both intervention types.

A Novel Wall Touch-Single Limb Stance Exercise for Dynamic Activation o f Gluteus Maximus - A Cross Sectional Study.

Objective: Gluteus maximus (GM) dysfunction is associated with spinal/lower extremity musculoskeletal conditions. Studies on weightbearing GM exercises that can be used earlier in rehabilitation is limited. Utilizing GM isometric contraction and load transmission to thoracolumbar fascia during trunk straightening under unilateral stance, we for the first time describe Wall Touch Single Limb Stance (WT-SLS) exercise. Specific exercise prescription may be rationalised using knowledge of how upper and lower fibres of GM (UGM, LGM) respond during novel WT-SLS. Methodology: Surface EMG signals from UGM and LGM were compared among WT-SLS, Step up (SU) and Unilateral wall squat (UWS) in healthy subjects (N = 24). Raw data was normalized and expressed as percentage of maximum voluntary isometric contraction (%MVIC). Relative easiness in performing the exercises was scored using Borg's CR10 scale. Statistical significance was defined as p < 0.05. Results: WT-SLS had the highest %MVIC for both UGM and LGM (p < 0.0001), suggesting maximum activation of GM in healthy adults by our novel exercise. WT-SLS generated more motor unit action potentials, and had significantly greater activity for UGM than LGM (p = 0.0429). Remaining exercises had no differential activation of UGM and LGM. WT-SLS was perceived as only 'slight' exertion. Conclusions: WT-SLS depicted the greatest muscle activation, suggesting possible better clinical and functional outcomes considering GM activation and strengthening. UGM was preferentially activated during WT-SLS, but not during SU and UWS. Therefore, targeting GM with our novel exercise may improve gluteal weakness and dysfunction in lumbar radiculopathy, knee ligament injuries; as preventive measure for injury; or for postural correction.

Management of ipsilateral trifocal fracture of the radius-a case report.

Introduction: Diaphyseal forearm fractures are commonly seen in clinical practice. However, segmental forearm fractures are relatively rare. We hereby present a case of surgical management of trifocal fracture of radius (mid-shaft of radius, distal end of radius and neck of radius fracture) with ipsilateral shaft ulna fracture. Case report: A middle aged patient with ulnar shaft fracture and trifocal radius fracture was managed surgically with open reduction and internal fixation of all four fractures. The ulna was addressed first, to achieve alignment, followed by distal radius and shaft radius fixation through the same incision. A separate incision was used to address radial neck fracture. Conclusion: A trifocal radius fracture with ulna shaft fracture has been rarely reported in the literature. Prompt surgical management of the complex fracture led to rapid and satisfactory recovery and good functional outcome for our patient.

Antegrade vs retrograde intramedullary nailing in humerus shaft fractures: A systematic review and meta-analysis.

Introduction: Plate osteosynthesis, external fixators and intramedullary nails are the commonly used devices for fixation of humerus shaft fractures. Humerus nails are gradually coming into popular use. Both antegrade and retrograde nails are used for this, however no evidence clearly states the benefits of one over the other. Thus, the purpose of this study was to evaluate the available evidence comparing the complications and outcomes of antegrade versus retrograde nails. Patients and methods: We followed the Preferred Reporting Items for Meta-analyses Statement (PRISMA) guidelines. All studies in any language comparing the use of antegrade and retrograde nailing for humerus fractures, with a minimum follow up of 12 months were included. The primary outcome measures were complications and time to union. Results: Seven studies including 384 patients (200 antegrade, 184 retrograde) were analyzed. A significantly lower complication rate was observed with retrograde nails (OR 1.77, p = 0.04, 95% CI 1.02,3.06; p = 0.04). Antegrade nails were associated with shorter operative time (MD -13.69, p > 0.00001). There was no significant difference in time to union and intra-operative blood loss between the two techniques. Conclusion: Retrograde nails have a significantly lower complication rate. However, the surgeon's experience with these devices and the location of the fracture are the primary considerations when choosing either implant. Loe: Level IV.