The Experts below are selected from a list of 2667 Experts worldwide ranked by ideXlab platform

Felix H Savoie - One of the best experts on this subject based on the ideXlab platform.

  • lateral and medial Epicondylitis
    2015
    Co-Authors: Patrick M Obrien, Felix H Savoie
    Abstract:

    Epicondylitis of the elbow is a commonly encountered condition in people with elbow pain, with lateral Epicondylitis involved more often than medial Epicondylitis. Clinically, patients present with an insidious onset of pain about either the lateral or medial epicondyle, worsened with resisted wrist extension in the former and resisted wrist flexion in the latter. Concurrent conditions, however, may be present and must be evaluated for, especially when investigating medial elbow pain. While both conditions remain clinical diagnoses, MRI can provide valuable information, particularly in assessing the adjacent tissue for any concomitant pathology. Numerous conservative treatment options have been described and are usually effective. These include periods of rest, physical therapy, anti-inflammatory medication, injections (including corticosteroid and platelet-rich plasma), and trials of bracing. However, in recalcitrant cases, surgical intervention may be required. While traditionally performed with an open surgical debridement of the diseased tissue, arthroscopic treatment of Epicondylitis has become more common. Additionally, arthroscopic treatment has been shown to provide equivalent, if not superior, clinical improvement with the potential for a quicker return to work and sporting activities.

  • arthroscopic tennis elbow release
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Felix H Savoie, Wade Vansice, Michael J Obrien
    Abstract:

    Lateral Epicondylitis, originally referred to as "tennis elbow," affects between 1% and 3% of the population and is usually noted in patients aged between 35 and 50 years old. Although it was first thought lateral Epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon in any of these associated structures. Most cases of lateral Epicondylitis respond to appropriate nonoperative treatment protocols. Nonoperative management includes medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices. When these are unsuccessful, however, surgical measures may be performed with a high rate of success. Satisfactory results of the arthroscopic surgical procedures have been documented, with reported improvement rates of 91% to 97.7%. The recent advances in arthroscopic repair and plication of these lesions, along with the recognition of the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide results superior to other measures.

  • tendinosis of the extensor carpi radialis brevis an evaluation of three methods of operative treatment
    Journal of Shoulder and Elbow Surgery, 2006
    Co-Authors: Joshua S Szabo, Felix H Savoie, Larry D Field, Randall J Ramsey, Chad D Hosemann
    Abstract:

    Many procedures have been described for treating lateral Epicondylitis with good success. The purpose of this report is to compare 3 operative methods for treatment of recalcitrant lateral Epicondylitis—open, arthroscopic, and percutaneous. All patients with lateral Epicondylitis who were operated on over a 7-year period were retrospectively reviewed. A minimum of 3 months of conservative care before surgery had failed in these patients, and they had a minimum of 2 years of follow-up. Concomitant pathology, complications, and necessary further care were noted. The outcomes were evaluated preoperatively and postoperatively with the Andrews-Carson score and visual analog scale scores for pain at rest, worst pain, and pain with activity. We included 109 patients in the study: 24 percutaneous, 44 arthroscopic, and 41 open procedures. The mean duration of conservative care was 13.2 months, including 2.5 conservative measures and 1.35 cortisone injections. The mean follow-up was 47.8 months. The preoperative Andrews-Carson score was 160.3. The postoperative Andrews-Carson score was 195. There was a statistically significant difference between preoperative and postoperative Andrews-Carson scores for each of the groups. There were no significant differences among the populations regarding age, gender, dominance, conservative measures used, cortisone injections, recurrences, complications, failures, visual analog scale scores, and preoperative and postoperative Andrews-Carson scores. In addition, no difference in outcome scores was noted when intraarticular and concomitant pathology was addressed in comparison to the population in which tendinosis alone was addressed. Open, arthroscopic, and percutaneous treatments of lateral Epicondylitis offer 3 highly effective ways for the clinician to address this common clinical problem.

Larry D Field - One of the best experts on this subject based on the ideXlab platform.

  • lateral and medial Epicondylitis in the athlete
    Operative Techniques in Sports Medicine, 2017
    Co-Authors: Kyle E Fleck, Eric D Field, Larry D Field
    Abstract:

    Lateral and medial Epicondylitis are common pathologic conditions and can be debilitating problems for athletes. Lateral Epicondylitis occurs much more commonly than medial Epicondylitis but both can create significant and persistent symptoms that limit performance. Nonoperative management is the mainstay of treatment for both conditions with more invasive treatments, including surgical intervention, reserved for recalcitrant cases. Both pathological entities can be operatively managed by using either percutaneous, formal open, or arthroscopic surgical techniques.

  • arthroscopic lateral Epicondylitis release using the bayonet technique
    Arthroscopy techniques, 2014
    Co-Authors: Eric C Stiefel, Larry D Field
    Abstract:

    Most patients diagnosed with lateral Epicondylitis respond well to conservative management. For patients who do not respond to nonoperative modalities, surgical treatment represents a viable option for long-term symptomatic relief. The arthroscopic surgical technique described in this article has been consistently used by the senior author for the treatment of recalcitrant lateral Epicondylitis for more than 5 years (198 patients) without the occurrence of any major complications and appears to be a safe, reliable, and efficacious surgical intervention for the management of lateral Epicondylitis.

  • tendinosis of the extensor carpi radialis brevis an evaluation of three methods of operative treatment
    Journal of Shoulder and Elbow Surgery, 2006
    Co-Authors: Joshua S Szabo, Felix H Savoie, Larry D Field, Randall J Ramsey, Chad D Hosemann
    Abstract:

    Many procedures have been described for treating lateral Epicondylitis with good success. The purpose of this report is to compare 3 operative methods for treatment of recalcitrant lateral Epicondylitis—open, arthroscopic, and percutaneous. All patients with lateral Epicondylitis who were operated on over a 7-year period were retrospectively reviewed. A minimum of 3 months of conservative care before surgery had failed in these patients, and they had a minimum of 2 years of follow-up. Concomitant pathology, complications, and necessary further care were noted. The outcomes were evaluated preoperatively and postoperatively with the Andrews-Carson score and visual analog scale scores for pain at rest, worst pain, and pain with activity. We included 109 patients in the study: 24 percutaneous, 44 arthroscopic, and 41 open procedures. The mean duration of conservative care was 13.2 months, including 2.5 conservative measures and 1.35 cortisone injections. The mean follow-up was 47.8 months. The preoperative Andrews-Carson score was 160.3. The postoperative Andrews-Carson score was 195. There was a statistically significant difference between preoperative and postoperative Andrews-Carson scores for each of the groups. There were no significant differences among the populations regarding age, gender, dominance, conservative measures used, cortisone injections, recurrences, complications, failures, visual analog scale scores, and preoperative and postoperative Andrews-Carson scores. In addition, no difference in outcome scores was noted when intraarticular and concomitant pathology was addressed in comparison to the population in which tendinosis alone was addressed. Open, arthroscopic, and percutaneous treatments of lateral Epicondylitis offer 3 highly effective ways for the clinician to address this common clinical problem.

Ren-fa Wang - One of the best experts on this subject based on the ideXlab platform.

  • mr imaging of patients with lateral Epicondylitis of the elbow is the common extensor tendon an isolated lesion
    PLOS ONE, 2013
    Co-Authors: Liang Qi, Feng Li, Ren-fa Wang
    Abstract:

    Objective To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. Results Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe). Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01) was found in injuries of CET and lateral ulnar collateral ligament (LUCL). Conclusion Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral Epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL.

  • mr imaging of patients with lateral Epicondylitis of the elbow is the common extensor tendon an isolated lesion
    PLOS ONE, 2013
    Co-Authors: Zhengfeng Zhu, Ren-fa Wang
    Abstract:

    Objective To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. Results Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe). Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01) was found in injuries of CET and lateral ulnar collateral ligament (LUCL). Conclusion Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral Epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL.

Alexis Descatha - One of the best experts on this subject based on the ideXlab platform.

  • Do Symptoms And Physical Examination Findings Predict Elbow Pain And Functional Outcomes In A Working Population
    Journal of occupational and environmental medicine, 2014
    Co-Authors: Alexis Descatha, Ann Marie Dale, Lisa Jaegers, Bradley A. Evanoff
    Abstract:

    To the Editor, Epicondylitis (medial and lateral) is one of the most common disorders among active workers,1,2 prompting recommendations for surveillance 3,4 or post-offer pre-placement examinations.5 However, little is known about the value of symptoms and physical examination findings for Epicondylitis in predicting future elbow pain, Epicondylitis, and job impairment. In a large cohort of newly employed workers, we measured symptoms and physical examination findings of Epicondylitis at the time of initial employment and examined the predictive value of these findings for elbow pain, Epicondylitis, and work impairment three years later. We recruited 1107 newly employed workers in several industries in St. Louis, USA between July 2004 and October 2006. 6,7 Subjects completed a symptom questionnaire (elbow and forearm symptoms occurring more than 3 times or lasting more than one week in the last year) and received a physical examination (PE) at baseline. The PE was considered positive if the subject reported pain or discomfort in either arm when the examiner palpated the medial or lateral epicondyles, muscle insertions, and surrounding musculature, or if the subject reported any pain or discomfort in the elbow when the examiner applied resistance against extension or flexion at the wrist (resistance was applied mid-dorsally to the subject's hand with the elbow in 90° of flexion). Examiners were trained in the use of a structured PE protocol. Subjects’ baseline status was classified in four categories: 1) subjects with no elbow symptoms and negative (normal) PE; 2) subjects without elbow symptoms, but with a positive (abnormal) PE; 3) subjects with elbow symptoms and negative PE; and 4) subjects meeting our Epicondylitis case definition of elbow symptoms and positive PE occurring in the same arm. We conducted follow-up questionnaires and performed PE 3 years after baseline measures using similar protocols. At follow-up we defined “severe” elbow pain as elbow pain within the past 30 days with a rating of 5 or higher on a scale of 0 (no discomfort) to 10 (worst discomfort imaginable). Job impairment was assessed using a composite outcome 6 that included any worker who reported a limitation attributed to elbow symptoms in any one of the following areas: 1) limited ability to work, 2) decreased productivity, 3) lost time from work, 4) placed on job restrictions, and 5) change in job or employer because of symptoms. Analysis compared baseline subject categorization to three outcomes at follow-up: Epicondylitis, severe elbow pain, and job impairment. Comparisons used non-ordinal multinomial logistic regression models (for outcomes with more than 2 categories) and simple logistic regression models for the outcomes of job impairment and severe elbow pain. We also examined the predictive value of baseline subject categorization for elbow pain, Epicondylitis, and work impairment three years later. The study group included 1107 newly hired workers, 65.1% male, with a mean age of 30.3 years (SD 10.3). Symptom questionnaires and repeated physical examination data were available on 742 subjects. Median follow-up was 34 months, with a range of 26 months to 71 months. There were no differences in baseline classification of elbow outcomes between subjects lost to follow-up and those who were followed. The evolution of symptoms and PE findings by category are summarized in Table 1. Of the subjects with Epicondylitis at follow-up, 59.6% (n=34) had no elbow symptoms and positive elbow PE at baseline. The natural history of symptoms was also complex. Across all outcomes, subjects with both elbow symptoms and PE findings (Epicondylitis) had the strongest association with future pain (OR severe pain =7.2[2.8-21.4]), PE findings (OR Epicondylitis=10.3[3.4-31.5]), and job impairment (OR job impairment =7.2[2.4-21.3]). Although PE findings in subjects without pain were associated with future Epicondylitis (and with future PE findings), PE alone was not associated with job impairment, whereas pain alone was associated with all outcomes. Positive predictive value of different combinations of symptoms and PE was low for all categories (less than 30%, Table 1). In this relatively healthy worker cohort, negative predictive values were high for all combinations of symptoms and PE. Table 1 Evolution of symptoms and PE findings, and predictive values, according to baseline categories. This study of elbow pain in newly hired workers found that elbow pain and physical findings suggestive of Epicondylitis predicted future pain and job impairment, though the predictive value of symptoms and physical findings was low. Limitations of the study include the follow-up intervals, which may have been too widely spaced to detect all cases of elbow pain or Epicondylitis. This information is useful for designing surveillance programs for Epicondylitis.

  • self reported physical exposure association with medial and lateral Epicondylitis incidence in a large longitudinal study
    Occupational and Environmental Medicine, 2013
    Co-Authors: Alexis Descatha, Ann Marie Dale, Lisa Jaegers, Eleonore Herquelot, Bradley A. Evanoff
    Abstract:

    Introduction Although previous studies have related occupational exposure and Epicondylitis, the evidence is moderate and mostly based on cross-sectional studies. Suspected physical exposures were tested over a 3-year period in a large longitudinal cohort study of workers in the USA. Method In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables. Results Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral Epicondylitis (6.9%), with 34 cases of lateral Epicondylitis (4.9%), 30 cases of medial Epicondylitis (4.3%) and 16 workers who had both. After adjusting for age, lack of social support and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral Epicondylitis (ORs 2.8 (1.2 to 6.2) and 3.6 (1.2 to 11.0) in men and women, respectively). Conclusions Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial Epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved.

  • Work-related risk factors for lateral Epicondylitis and other cause of elbow pain in the working population.
    American Journal of Industrial Medicine, 2013
    Co-Authors: Eleonore Herquelot, Julie Bodin, Yves Roquelaure, Annette Leclerc, Marcel Goldberg, Marie Zins, Alexis Descatha
    Abstract:

    BACKGROUND: This study was designed to assess the relationship between work-related combined physical and psychosocial factors and elbow disorders (lateral Epicondylitis and non-specific disorders without lateral Epicondylitis) in the working population. METHODS: A total of 3,710 workers (58% men) in a French region in 2002-2005 participated in physical examinations by occupational health physicians and assessed their personal factors and work exposure by self-administered questionnaire. Statistical associations between elbow disorders and risks factors were analyzed using multinomial logistic regression. RESULTS: A total of 389 (10.5%) workers had elbow pain without lateral Epicondylitis and 90 (2.4%) workers had lateral Epicondylitis. Age, body mass index (>25), and low social support (only for men) were significant risks factors. Hard perceived physical exertion combined with elbow flexion/extension (>2 hr/day) and wrist bending (>2 hr/day) was a strong significant risk factor for elbow pain and Epicondylitis: among men, adjusted Odds Ratio (ORa) = 2.6 (1.9-3.7) and ORa = 5.6 (2.8-11.3), respectively; among women, ORa = 1.4 (0.9-2.2) and ORa = 2.9 (1.3-6.5). CONCLUSIONS: This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral Epicondylitis. Certain observed differences in associations with lateral Epicondylitis and elbow pain only indicate the need for additional longitudinal studies on different stages of elbow disorders and known risk factors. Am. J. Ind. Med. 56:400-409, 2013. © 2012 Wiley Periodicals, Inc.

  • medial Epicondylitis in occupational settings prevalence incidence and associated risk factors
    Journal of Occupational and Environmental Medicine, 2003
    Co-Authors: Alexis Descatha, Jean-françois Chastang, Annette Leclerc, Yves Roquelaure
    Abstract:

    Because medial Epicondylitis has not been studied alone, we investigated its links between personal and occupational factors in repetitive work and its course. A total of 1757 workers were examined by an occupational health physician in 1993-1994. Five hundred ninety-eight of them were reexamined 3 years later. Prevalence was between 4% and 5%, with an annual incidence estimate at 1.5%. Forceful work was a risk factor (odds ratio [OR], 1.95; confidence interval [CI] = 1.15-3.32), but not exposure to repetitive work (OR, 1.11; CI = 0.59-2.10). Workers with medial Epicondylitis had a significantly higher prevalence of other work-related upper-limb musculoskeletal disorders (WRMD). Risk factors differed for medial and lateral Epicondylitis. The prognosis for medial Epicondylitis in this population was good with a 3-year recovery rate at 81%. Medial Epicondylitis was clearly associated with forceful work and other upper-limb WRMD, and its prognosis was good.

  • Les épicondylites médiales en milieu de travail : évolution et prévention.
    Archives des Maladies Professionnelles et de Medecine du Travail, 2003
    Co-Authors: Alexis Descatha, Jean-françois Chastang, Annette Leclerc, Yves Roquelaure
    Abstract:

    Purpose of the study: We studied the evolution of medial Epicondylitis, the association with other work related musculoskeletal disorders, and the consequences for prevention. Methods: In 1993-1994 and again in 1996-1997, 598 workers exposed to repetitive job were examined by 18 occupational health physicians and completed a self-administered questionnaire. The study was performed in order to consider all upper-limb occupational disorders; we focused here on the evolution and prevention of medial Epicondylitis. Results: Prevalence was 5.2 percent in this population. Annual incidence was estimated at 1.5 percent. Medial Epicondylitis had a good medical (recovering rate 81 % CI [63%;92%]) and professional prognosis. There was a claim for occupational disease compensation for four percent of medial Epicondylitis. Forceful job was associated with prevalence, but was not found as a risk factor for incidence. Other upper-limb occupational disorders, especially shoulder tendinitis, carpal tunnel syndrome, lateral Epicondylitis, and ulnar nerve syndrome at elbow were associated with incidence of medial Epicondylitis (Relative Risk = 2.5 ;CI[1.01;6.00]), suggesting that this disorder is secondary to other work-related disorders. Conclusions: Medial Epicondylitis had a good prognosis in our study. The disorder could be detected easily by the occupational physicians, especially in the population at high risk. In our study, workers recovered without changing their working conditions

Margareta Nordin - One of the best experts on this subject based on the ideXlab platform.

  • Are passive physical modalities effective for the management of common soft tissue injuries of the elbow? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
    The Clinical Journal of Pain, 2017
    Co-Authors: Sarah Dion, Jessica J Wong, Sharanya Varatharajan, Pierre Cote, Deborah Sutton, Kristi Randhawa, Danielle Southerst, Paula Stern, Margareta Nordin
    Abstract:

    OBJECTIVE: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS: We screened 6618 articles; 21 were eligible for critical appraisal and nine (reporting on eight RCTs) had a low risk of bias. All RCTs with a low risk of bias focused on lateral Epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral Epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral Epicondylitis of variable duration; and (2) shockwave therapy or low level laser therapy for persistent lateral Epicondylitis. DISCUSSION: Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral Epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low level laser therapy for the treatment of lateral Epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries. Language: en