Effects of a manual therapy technique in experimental lateral epicondylalgia.

In patients with lateral epicondylalgia, mobilization-with-movement (MWM) is used as an intervention aimed at achieving analgesia and enhancing grip force, although the mechanisms underlying these effects are unclear. The present study investigated the acute sensory and motor effects of an MWM intervention in healthy controls with experimentally induced lateral epicondylalgia. Twenty-four subjects were randomly allocated to either a MWM or a placebo group (n=12). In both groups, to generate the model of lateral epicondylalgia, delayed onset muscle soreness (DOMS) was provoked in one arm 24h prior (Day 0) to hypertonic saline-induced pain in the extensor carpi radialis brevis muscle (Day 1). Either a MWM or placebo intervention was applied during the saline-induced pain period. Saline-induced pain intensity (visual analogue scale: VAS), pain distribution and pain quality were assessed quantitatively. Pressure pain thresholds (PPTs) were recorded at the common extensor origin and the extensor carpi radialis brevis muscle. Maximal measures of grip and wrist extension force were recorded. In both groups (pooled data), DOMS was efficiently induced as demonstrated by a significant decrease in pre-exercise to pre-injection PPT at the common extensor origin (-45+/-19%) and at the extensor carpi radialis brevis (-61+/-23%; P<0.05), and a significant decrease in maximal grip force (-25+/-6%) and maximal wrist extension force (-40+/-12%; P<0.001). Moreover, both groups experienced a significant increase in muscle soreness (3.9+/-0.2; P<0.0001) at Day 1 compared to pre-exercise. During saline-induced pain and in response to intervention, there were no significant between-group differences in VAS profiles, pain distributions, induced deep tissue hyperalgesia or force attenuation. These data suggest that the lateral glide-MWM does not activate mechanisms associated with analgesia or force augmentation in subjects with experimentally induced features simulating lateral epicondylalgia.

[Features of occupational fluorosis course]. / Osobennosti techeniia professional'nogo fliuoroza.

Analysis of X-ray signs in 397 patients suffering from fluorosis revealed degenerative and dystrophic lumbar disorders in 94%, calcified anterior longitudinal ligament in 65%, various changes (epicondylosis, periarthrosis and arthrosis deformans) in 91%. Locomotory disorders appeared systemic, multiple and symmetrical.

Epicondylitis after treatment with fluoroquinolone antibiotics.

We report two cases of epicondylitis of the elbow occurring after treatment with fluoroquinolone antibiotics. Both patients had intense pain which appeared very shortly after the first dose of the drug and was not relieved by conservative treatment. Ultrasonography revealed extensive inflammatory lesions with pseudonecrotic areas. MRI confirmed the lesions and also showed a subclinical abnormality of the adjoining tendons. The persistent nature of the pain was the indication for surgical release of the extensor mechanism. After operation pain disappeared completely and the patients were able to return to their normal activities. Lesions of the tendo Achillis are a well-known side-effect of treatment with fluoroquinolone. Our two cases show that such lesions may occur elsewhere. They also indicate the need for caution when prescribing these antibiotics to patients at risk of tendon lesions, such as top-level sportsmen or patients on dialysis or steroid treatment.

[Epicondylitis induced by fluoroquinolones in athletes. Apropos of 2 cases]. / Epicondylites induites par les fluoroquinolones chez le sportif. A propos de 2 cas.

Epicondylitis occurred in two leisure athletes who were taking fluoroquinolones. No similar cases have been reported in the literature. In both cases, pain occurred early after initiating drug therapy. Pain was intense and was not controlled by usual care. Echography demonstrated major inflammatory lesions with pseudo-necrosis. Magnetic resonance imaging confirmed the lesions and gave evidence of infraclinical lesions of the adjacent tendons. Surgical disinsertion of the epicondyles with biopsy was indicated due to the persistent pain. Histological examination revealed unspecific lesions of hyalin degeneration and a few giant cells in one case. Pain disappeared after surgery and the patients were able to return to their work, but neither was able to continue his sports activity. Lesions of the Achilles tendon have been observed in patients taking fluoroquinolone and the two cases reported here confirm the possibility of other localizations. Care must therefore be taken when prescribing these antibiotics in patients at risk (dialysis patients, those on corticosteroids, high-performance athletes).