Saturday, August 27, 2011
Posted by wintjc at 9:43 AM
Wednesday, August 17, 2011
Tennis Elbow: treatment (Lateral Epicondylitis)treatment
taken and modified from the American Academy of Orthopedic Surgery (AAOS) website
for additional information taken from ASSH website to see our office website click here
|DescriptionTennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (epicondyle) on the outside (lateral side) of the elbow. The tendons involved are responsible for anchoring the muscles that extend or lift the wrist and hand (see Figure 1).|
Tennis elbow happens mostly in patients between the ages of 30 years to 50 years. It can occur in any age group. Tennis elbow can affect as many as half of athletes in racquet sports. However, most patients with tennis elbow are not active in racquet sports. Most of the time, there is not a specific traumatic injury before symptoms start. Many individuals with tennis elbow are involved in work or recreational activities that require repetitive and vigorous use of the forearm muscles (see Table 1). Some patients develop tennis elbow without any specific recognizable activity leading to symptoms.
Patients often complain of severe, burning pain on the outside part of the elbow. In most cases, the pain starts in a mild and slow fashion. It gradually worsens over weeks or months. The pain can be made worse by pressing on the outside part of the elbow or by gripping or lifting objects. Lifting even very light objects (such as a small book or a cup of coffee) can lead to significant discomfort. In more severe cases, pain can occur with simple motion of the elbow joint. Pain can radiate to the forearm.
To diagnose tennis elbow, tell the doctor your complete medical history. He or she will perform a physical examination.
In many cases when there are fairly severe symptoms a simultaneous-three pronged approach, (1) use of anti-inflammatories, (2) orthotic bracing and (3)injection at the same time work more efficaciously and can save time in treatment and offers a more rapid resolution of symptoms. Sometimes, when conditions are right a more slow sequential treatment is offered. This takes longer but may be more suitable for those with minimal symptoms
In most cases, nonoperative treatment should be tried before surgery. Pain relief is the main goal in the first phase of treatment. The doctor may tell you to stop any activities that cause symptoms. You may need to apply ice to the outside part of the elbow. You may need to take acetaminophen or an anti-inflammatory medication for pain relief.
Orthotics can help diminish symptoms of tennis elbow. The doctor may want you to use counterforce braces and wrist splints. These can reduce symptoms by resting the muscles and tendons (see Figure 2).
Surgery is considered only in patients who have incapacitating* pain that does not get better after non-operative treatment.
*The difficult question to answer is: What is incapacitating pain? Very often what affects one person may not be significant for another. This is especially true for those engaged in athletics or jobs that require very specific motions or activities. Thus the indications for surgery are relative in most and absolute in few.
The surgical procedure involves removing diseased tendon tissue and reattaching normal tendon tissue to bone (see Figure 4). The procedure is an outpatient surgery; you do not need to stay in the hospital overnight. It can be performed under regional or general anesthesia.
*Note: steps E and F are not often needed except in cases where large *tears exist.
So far, no significant benefits have been found to using an arthroscopic method over the traditional open incision.
After surgery, the elbow is placed in a small brace and the patient is sent home. About one week later, the sutures and splint are removed. Then exercises are started to stretch the elbow and restore range of motion. Light, gradual strengthening exercises are started two months after surgery. The doctor will tell you when you can return to athletic activity. This is usually approximately four months to six months after surgery. Tennis elbow surgery is considered successful in approximately 90 percent of patients.
Persistent pain can be from associated arthritis in the elbow, nerve compression, muscular fatigue or residual bone pain. While most patients return to full activity after tennis elbow surgery, many still relate that there is aching pain that persists at times. Overall, however, most are satisfied and have a significant improvement and much less pain than prior to surgery
Author Information (Please note that although the original document has been modified we wish to grant the original author from the AAOS credit.)
Posted by wintjc at 9:37 AM
Friday, August 12, 2011
The dorsal wrist ganglion is most often confused with the carpal boss, so named by the French physician Foille. The carpal boss is an osteoarthritic spur that develops at the base of the second and/or third carpometacarpal joints. (figure 1) A firm, bony, nonmobile, tender mass is visible and palpable at the base of the carpometacarpal joints, especially when the wrist is volar flexed.
Radiologically, the mass is best visualized with the hand in 30 to 40 degrees supination and
20 to 30 degrees ulnar deviation ("carpal boss view")( figure 3).
The boss is more common in women (2:1), in the right hand (2:1), and between the third and fourth decades. The mass may be asymptomatic, but the patient may complain of considerable pain and aching. A small ganglion is associated with the carpal boss in 30 percent of cases, adding to its confusion with the more common dorsal wrist ganglion.
Injection to the ganglion or to the cmc joint may be used to reduce pain and irritation. This may be combined with splinting and anti inflammatory medication and avoidance of trauma to the back of the hand\
If symptoms persist at times surgery may be offered. (figure 2) Surgery may involve the removal of the prominent bone, the excision of an associated ganglion or cyst and at times involves tenosynovectomy or tenolysis of adjacent affected tendons. What occurs during surgery may depend upon the preoperative findings as well as the surgical intra operative findings
The most common complication is the persistence of a mass because of excision of the ganglion alone or inadequate excision of the osteophytes. Pain will persist unless all abnormal abutting surfaces have been excised. Dorsal wrist ganglions can present over the carpometacarpal joints and must be distinguished from the carpal boss with its own associated ganglion. Avoidance of injury to branches of the radial and ulnar sensory nerves is again stressed.
Posted by wintjc at 11:16 AM