Lateral epicondylitis:New trends and challenges in treatment

Lateral epicondylitis(LE)is a chronic aseptic inflammatory condition caused by repetitive microtrauma and excessive overload of the extensor carpi radialis brevis muscle.This is the most common cause of musculoskeletal pain syndrome in the elbow,inducing significant pain and limitation of the function of the upper limb.It affects approximately 1-3%of the population and is frequently seen in racquet sports and sports associated with functional overload of the elbow,such as tennis,squash,gymnastics,acrobatics,fitness,and weight lifting.Typewriters,artists,musicians,electricians,mechanics,and other professions requiring frequent repetitive movements in the elbow and wrists are also affected.LE is a leading causation for absence from work and lower sport results in athletes.The treatment includes a variety of conservative measures,but if those fail,surgery is indicated.This review summarizes the knowledge about this disease,focusing on risk factors,expected course,prognosis,and conservative and surgical treatment approaches.

PROGRESSION ON TREATMENT OF HUMERAL EPICONDYLITIS WITH ACUPUNCTURE AND MOXIBUSTION

In recent years, the measures on treatment of humeral epicondylitis with acupuncture and moxibustion were increased daily and a certain progression had been achieved. It had been synthesized in the paper various therapies of acupuncture and moxibustion in treatment of the disease, named filiform needling technique, special needling, warm needling and comprehensive therapy, as well as therapeutic evaluations and mechanisms. Additionally, the problems and shortcomings existed at present had been proposed in the paper.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE OF CHONGYANG ACUPOINT PLUS MOXIBUSTION FOR TREATMENT OF 30 CASES OF EXTERNAL HUMERAL EPICONDYLITIS

In the present paper, the authors summarize their results of 30 cases of external humeral epicondylitis treated with thermal acupuncture of Chongyang (ST 42) and Ashi points. After 3-15 sessions of treatment, of the 30 cases, 24 (80%) were cured, and the rest 6 (20%) responded with apparent improvement in their symptoms.

TREATMENT OF 62 CASES OF EXTERNAL HUMERAL EPICONDYLITIS WITH STILETTO NEEDLE

External humeral epicondylitis, also known as brachioradial bursitis, popularly called “tennis elbow” refers to the acute or chronic myofascitis, the injury of the common extensor tendon of the humeral epicondyle. The authors have recently treated 62 cases of the disease by means of stiletto needle, the therapeutic effect of the treatment is so satisfactory, following is the report of the treatment.

Treatment of Chronic Lateral Epicondylitis: Platelet Rich Plasma versus Extra-Corporeal Shock Wave Therapy

Background: Several treatment options have been proposed to treat lateral epicondylitis. Both Platelet rich plasma (PRP) and Extra-corporeal Shock Wave Therapy (ESWT) are new treatment modalities for tendinopathy. Patients and Methods: Thirty seven patients suffering from chronic lateral epicondylitis (tennis elbow) for at least six months were treated in this study. The patients were divided into two treatment groups, the first group including 20 patients treated by ESWT and the second group including 17 patients treated by local injection of platelet-rich plasma. The results were evaluated using the visual analogue scale and the DASH score. Results: In the first group (treated by ESWT), the average follow-up period was 21.55 months. The average VAS improved from 8.2 to 1.95 and the average DASH score improved from 72.25 to 51.7. Moreover, 11 cases were satisfied (55%), 3 cases (15%) were satisfied with reservation and 6 cases (30%) were not satisfied. In the second group (treated by PRP), the average follow-up period was 18.47 months. The average VAS improved from 8.52 to 1.47, the DASH score improved from 72 to 48.23. Concerning patient satisfaction, 13 cases were satisfied (83.33%), 3 cases (10.52%) were satisfied with reservation and 1 case (5.55%) was not satisfied. Conclusion: Platelet rich plasma was proved to achieve superior results when compared to ESWT as regards pain relief, improvement of elbow function and patient satisfaction at follow-up.

Seventy-two cases of external humeral epicondylitis treated by wrist-ankle acupuncture

Objective To observe the clinical effects of wrist-ankle acupuncture on external humeral epicondylitis. Methods Seventy-two cases diagnosed as external humeral epicondylitis were brought into the study. Horizontal needling was used at upper area 3, upper area 4 and upper area 5 near wrists with long filiform needles. The frequency was once a day, and a course included 10 times. Results 27 cases got cured, 36 cases were marked effective, 5 cases were effective and 4 cases were failed after 1 course to 5 courses of treatment. The total effective rate was 94.5%. Conclusion Wrist-ankle acupuncture is a simple and effective therapy on external humeral epicondylitis.

Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion,as tendon attachmentlocalized avulsions and stress fracture equivalents

Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions,it seems inappropriate to attribute it to stresses related to a person’s normal activities.Conversely,sudden or unconditioned repetitive stresses appears the more likely culprit.Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy.Clinical evaluation by palpation and mani-pulation may be as effective as application of radiologic techniques.Recognition of the mechanical nature of the disease,including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.

Clinical observation on 30 cases of external humeral epicondylitis treated with electroacupuncture at Zhouling and Ashi points combined with blood-letting cupping

Objective:To observe the clinical effect of electroacupuncture(EA)at Zhouling(Extra)and Ashi points in combination with blood-letting cupping for the treatment of external humeral epicondylitis(EHE).Methods:Thirty EHE patients were treated with EA at Zhouling(Extra)and Ashi points in combination with blood-letting cupping,once every 2 days,twice a week,4 times as one course of treatment,and2 successive courses of treatment were given.Before treatment,after 1 course of treatment,and after 2 courses of treatment,the visual analogue scale(VAS)score and Mayo elbow performance score(MEPS)were adopted to evaluate the curative effect.Results:Before treatment,the VAS score of patients was 7.81±1.39.After 1 course of treatment and after 2 courses of treatment,it was 4.77±1.56 and 2.95±1.23 respectively,lowered than before treatment,and the difference was statistically significant(both P<0.01).Before treatment,the Mayo score of patients was 32.17±19.31.After 1 course of treatment and after 2 courses of treatment,it was 47.39±19.85 and85.21±20.47 respectively,increased than before treatment,and the difference was statistically significant(both P<0.01).Of the 30 patients,5 were cured,accounting for 16.67%;14 cases obviously effective,accounting for 46.67%;8 cases effective,accounting for 26.67%;3 cases ineffective,accounting for 10.00%,and the total effective rate was 90.00%.Conclusion:EA at Zhouling(Extra)and Ashi points and blood-letting cupping used in combination are remarkably effective in the treatment of EHE,being worthy for popularization.

Lateral Epicondylitis Successfully Treated with Fire Needle Therapy:A Case Report

Lateral epicondylitis （LE） is a common musculoskeletal problem. The incidence is estimated to be 0.4%-0.7% per year in general practice, and between 1% and 3% per year in the adult general populationJ2） LE results from repetitive micro-trauma by overuse of the wrist extensor musculature, which ultimately leads to failure of the common extensor tendon,

Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study

BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.

Mechanical solution for a mechanical problem:Tennis elbow

Lateral epicondylitis is a relatively common clinical prob lem, easily recognized on palpation of the lateral protu berance on the elbow. Despite the "itis" suffix, it is no an inflammatory process. Therapeutic approaches with topical non-steroidal anti-inflammatory drugs, cortico steroids and anesthetics have limited benefit, as would be expected if inflammation is not involved. Other ap proaches have included provision of healing cytokine from blood products or stem cells, based on the recog nition that this repetitive effort-derived disorder repre sents injury. Noting calcification/ossification of tendon attachments to the lateral epicondyle(enthesitis), dry needling, radiofrequency, shock wave treatments and surgical approaches have also been pursued. Physi ologic approaches, including manipulation, therapeuti ultrasound, phonophoresis, iontophoresis, acupuncture and exposure of the area to low level laser light, ha also had limited success. This contrasts with the benefi of a simple mechanical intervention, reducing the stres on the attachment area. This is based on displacemen of the stress by use of a thin(3/4-1 inch) band applied just distal to the epicondyle. Thin bands are required as thick bands(e.g., 2-3 inch wide) simply reduce mus cle strength, without significantly reducing stress. Thi approach appears to be associated with a failure rateless than 1%, assuming the afflicted individual modifies the activity that repeatedly stresses the epicondylar attachments.

Lateral elbow tendinopathy: Evidence of physiotherapy management

Lateral elbow tendinopathy(LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.

Can extracorporeal shock-wave therapy be used for the management of lateral elbow tendinopathy?

Lateral elbow tendinopathy(LET) is one of the two most common tendinopathies of the upper limb. The most effective treatment in the management of LET is the exercise program. Clinicians combine exercise program with other physiotherapy, electrotherapeutic and no, techniques. Extracorporeal shock wave therapy(ESWT) is one of the most common recommended electrotherapeutic modalities for the management of LET. Further research is needed to find out the optimal treatment protocol of ESWT in the management of

Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus:Report of three cases and review of the literature

BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage.Open reduction and internal fixation(ORIF)has become the preferred treatment because it provides anatomical reduction,stable internal fixation,and early motion,but the optimal surgical approach remains controversial.CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach,in which lateral epicondyle osteotomy was performed based on the extended lateral approach.We named the novel surgical approach the lateral epicondyle osteotomy approach.All patients underwent surgical treatment and were discharged successfully.All patients had excellent functional results according to the Mayo elbow performance score.The average range of motion was 118°in flexion/extension and 172°in pronation/supination.Only case 2 had a complication,which was implant prolapse.CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.

MEDIAL EPICONDYLE FRACTURE OF THE HUMERUS WITH ULNAR NERVE PALSY OF AN 11-MONTH-OLD INFANT:CASE REPORT

To our knowledge,there is no report concerning medial epicondyle fracture of the humerus for infants,the clinical course and treatment outcome of an 11 -month-old boy with such fracture with ulnar nerve palsy was described in this article.Ulnar nerve detection and scar tissue release were performed.The bony fragment was anatomically reduced and fixed with an anchor.The above-elbow wellpadded anterior plastic splint was used postoperatively for 4 weeks.After removing the splint,the motion of hand had no obvious improvement accompanied with claw hand deformity,and nerve transplantation was suggested to the patient’s parent.We would like to remind clinicians of encountering the clinical manifestations to be vigilant for any possibilities.