Aims and objectives
Lateral elbow tendinopathy,
also referred to as tennis elbow has been described extensively in medical literature. It affects the common extensor tendon,
most commonly occurring within the extensor carpi radialis brevis.
Although it may have a self-limiting course,
the relative morbidity in the economically active population has resulted in a variety of non-conservative therapies.
Invasive treatments such as surgery,
injection with steroids and platelet-rich plasma have been used in the management of refractory cases.
There is no histological evidence of acute inflammatory cells within the...
Methods and materials
With the approval of institutional review board,
this prospective study involved patients who had failed non-operative medical management for tennis elbow.
A diagnostic ultrasound was performed as baseline before the procedure.
The primary outcome measures were Disabilities of the Arm,
Shoulder and Hand (DASH) score and Visual analogue scale (VAS) score which were administered with ultrasound examination performed at the follow-up interval of 3 months,
6 months and 36 months after procedure.
The diagnostic ultrasound was performed by a musculoskeletal radiologist using high frequency transducer....
Results
There were 20 patients (13 females and 7 Males) with a median age of 45.5 years (range 33 – 65 years).
The mean duration of failed conservative therapy was 12.5 months (range 4 – 48 months).
The latter included prior steroid injection and acupuncture.
One patient had previously undergone surgical treatment.
At the 36 month follow up,
19 of the 20 subjects were contactable.
The mean VAS score recorded at baseline was 5.4 (range 1 – 8). This showed reduction to 2.0 (range 0 –...
Conclusion
The variability in tendon thickness measurement depending on site of measurement has been reported(3).
In this study,
to maintain consistency all measurements were obtained over the thickest portion of the tendon at its humeral aspect.
A recent study(4) has opined that there is no correlation between tendon thickness and neovascularity with regards to pain severity or functional disability.
The use of colour doppler to demonstrate reduction in blood flow in patients who have undergone therapy reported in another study(5) is similar to our findings.
This...
Personal information
P Chandra Mohan,
Department of Diagnostic Radiology,
Singapore General Hospital (SGH),
Singapore.
(
[email protected])
Joyce SB Koh,
Department of Orthopaedic Surgery,
SGH,
Singapore.
Bernard F.
Morrey,
Department of Orthopaedic Surgery,
Mayo Clinic and Mayo School of Medicine,
Rochester,
Minnesota,
USA.
Brian PH Lee,Orthopaedics Associates,
Mount Elizabeth Hospital,
Singapore.
Howe Tet Sen,
Department of Orthopaedic Surgery,
SGH,
Singapore.
Png Meng Ai,
Department of Diagnostic Radiology,SGH,
Singapore.
References
Nirschl RP,
Pettrone FA.
Tennis elbow: the surgical treatment of lateral epicondylitis.
J Bone Joint Surg Am.
1979;61:832-839
Koh JSB,
Mohan PC,Howe TS,
Lee BP,
Chia SL,Yang Z,Morrey BF.Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: early clinical experience with a novel device for minimally invasive percutaneous microresection.
Am J Sports Med.
2013 Mar;41(3):636-644.
Ustuner E,
Toprak U,
Baskan B,
Oztuna D.
Sonographic examination of the common extensor tendon of the forearm at three different locations in the normal asymptomatic population.
Surg Radiol Anat.2013...