Long-term follow-up of platelet-rich plasma injections for refractory lateral epicondylitis.

BACKGROUND: Lateral epicondylitis (LE)1 affects between 1 and 3% of the population. Recently, platelet-rich plasma (PRP)2 has gained popularity. AIM: Assess the long-term outcomes of PRP for patients with refractory LE. METHODS: We assessed 31 patients who had failed conservative management using the Oxford Elbow Score (OES).3. RESULTS: Mean follow-up: 5.2 years (range 4.2-6.1 years).87.1% exhibited minimum clinically important difference (MCID)4 in pain scores between pre-op and long-term. 90.3% displayed MCID in function and psycho-social domains.Two patients had a repeat injection and six underwent open release. DISCUSSION: PRP is successful in treating refractory LE in most patients and avoiding surgery.

Heterotopic ossification following anterior shoulder dislocation.

Heterotopic ossification (HO) is the abnormal growth of extraskeletal bone. Joint involvement may result in chronic stiffness and pain causing considerable functional impairment and the inability to perform the activities of daily living. HO affecting the shoulder joint is rare and little is known about its clinical course or treatment. Here, we describe the first reported case of glenohumeral HO following anterior dislocation. This occurred in a 70-year-old man following a fall onto outstretched hand. Due to persistent stiffness and pain at 8 months from initial injury, he underwent plain radiographs and MRI scans that confirmed rotator cuff tear and HO. He was managed conservatively with physiotherapy and non-steroidal anti-inflammatory drugs. At 1-year follow-up, the patient maintains a good functional outcome.

Fragility fractures in the upper limb: proximal and distal humerus.

The incidence of fragility fractures of the humerus is increasing worldwide. Although clinicians are aware of fractures of hips and wrists, fractures of the shoulder and elbow do not receive much attention. A considerable proportion of the elderly population (estimated at 10-24%) is dependent on walking aids. A well-functioning and pain-free shoulder and elbow is essential for use of these aids. The impact of loss of mobility in the elderly is well known, hence the overall impact of these fractures on the individual can be considerable. This article increases the awareness of these fractures among non-orthopaedic colleagues and provides a brief outline of their management. In the elderly population using walking aids, the shoulder and elbow are effectively weight-bearing joints. Fractures of the shoulder or elbow in the elderly require extra attention to maintain their mobility during this period by physiotherapy to the lower limbs and chest. In patients who mobilize using a frame, the use of a stick on the opposite side of the injury may have to be considered while recovery is in progress.