Lateral epicondylitis: Current concepts.

BACKGROUND: Lateral epicondylitis, more commonly referred to as 'tennis elbow', is a common condition seen in general practice. It effects approximately 4-7 per 1000 individuals. Despite this, the aetiology and pathophysiology remain poorly understood. Often presenting as lateral elbow pain, the differential diagnosis includes entrapment syndromes, cervical radiculopathy, osseous pathology and inflammatory conditions. Though in 90% of cases the condition is self-limiting, persistent symptoms can be difficult to manage. OBJECTIVE: In this article, a review of recent English-language journal articles explores current concepts related to lateral epicondylitis and examines the evidence behind the recommendation for the use of non-operative and operative treatment modalities. DISCUSSION: Lateral epicondylitis is an enthesopathy associated with the origin of the extensor carpi radialis brevis (ECRB) muscle. A clinical history and examination is usually sufficient to make a diagnosis. Maudsley's and Cozen's clinical tests have a high sensitivity in diagnosing lateral epicondylitis. The available evidence supports the use of non-operative treatment modalities in managing this condition. When comparing the different operative treatments described, there appears to be no significant advantage of intervention over the natural history of lateral epicondylitis.

Basal thumb arthritis: Treatment strategies for managing pain.

BACKGROUND: The carpometacarpal joint of the thumb is one of the joints most commonly affected by arthritis. The dominant hand is involved in 60-65% of cases, with a higher prevalence among women. The condition results in significant disability of the hand, which affects activities of daily living. Management is dependent on both the clinical stage of the disease and patient expectations and demands. OBJECTIVE: The aim of this article is to review the current non-operative and operative modalities in managing pain symptoms, and explore evidence for the use of these modalities. DISCUSSION: Basal thumb arthritis is a very common condition encountered by the general practitioner. Treatment must focus on functional expectations and demands of the patient, and individualised treatment plans need to be tailored to the patient. Hand therapy in addition to patient education and use of an orthosis has been shown to be very effective in management of the early stages of basal thumb arthritis. With more advanced disease, surgical modalities provide better symptomatic control.

Water conservation in surgery: a comparison of two surgical scrub techniques demonstrating the amount of water saved using a 'taps on/taps off' technique.

OBJECTIVE: Australia finds itself in the grip of its worst drought on record. The surgical profession has a responsibility to conserve water where possible. We tried to show how much water we saved through the simple measure of turning taps off while not in use during the surgical scrub. DESIGN: We conducted a prospective analysis of two different scrub techniques at the Gold Coast Hospital in Queensland, Australia. Ten participants completed two 5-min scrubs using standard 'elbow on' taps. In the first, they left the taps running throughout the scrub; in the second, they turned the taps on and off so that water ran only when rinsing the hands. Water was collected and the amount of time the hands spent under running water was recorded. MAIN OUTCOME MEASURE: Amount of water used during the surgical scrub. RESULTS: A mean of 15.5 L was used during the 'taps on' scrub, with participants spending a mean of 47 s rinsing the hands. During the 'taps on/off' scrub, participants used a mean of 4.5 L, spending 40 s rinsing the hands. This represents a water saving of 11 L or 71% for each scrub (P < 0.001). There was a difference of 7 s in time rinsing the hands (P = 0.16). CONCLUSION: A taps on/off technique is a simple and effective way of conserving large amounts of water during the surgical scrub. The technique should be adopted as standard practice.