Many procedures have been described for the operative treatment of
Purpose: It is known from previous studies that reduced grip strength is associated with
Many procedures have been described for the operative treatment of
This study describes percutaneous method of
1.
Aim: Description of and Prospective analysis of long-term outcomes of arthroscopic
Objectives. Local corticosteroid infiltration is a common practice of treatment
for
The efficacy of extracorporeal shock-wave therapy for
Introduction: Different surgical options are available for the treatment of
Introduction:
Summary Statement. Applying appropriate upper limb regional-specific and joint-specific tools along with suitable psychologic tools provides an effective assessment of supportive, interventional, and treatment strategies in TE. Background.
We propose a grading system for contrast free MRI images of
The aim of this study was to evaluate the analgesic effect of extracorporeal shock wave lithotripsy (ESWL) in patients with refractory
Failure of conservative treatment for
Objective: The main objective of our study was to compare the outcome and complications between open and percutaneous
We undertook a prospective, randomised study to compare the analgesic effect of injection of steroid and of extracorporeal shock-wave therapy (ESWT) for the treatment of
We conducted a prospective, randomised, controlled trial of 45 patients (47 elbows), with
Aims of the Study: To compare the outcome of percutaneous release and formal open release for
Aim: To assess the outcome of open release of the common extensor origin in the management of
The aim of this study was to review the effectiveness of percutaneous release of the common extensor origin for
We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in
Aims: Primary aim of this study was to evaluate the inßuence of simultaneous local anesthesia on the clinical outcome after repetitive low-energy extracorpreal shock wave therapy (ESWT) for chronic
We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of
We have reviewed 185 articles published since 1966 to assess the scientific evidence for methods of treatment for
Introduction and Aims: To compare the outcome of percutaneous release and fonnal open release for
We conducted a prospective randomised controlled trial. 45 patients (total of 47 elbows) underwent either a formal open release or a percutaneous tenotomy (24 open, 23 percutaneous). All patients had pre-operative assessment by the DASH (Disability of the Arm, Shoulder and Hand) scoring system. The surgery was performed by 1 surgeon (BN Muddu). Both groups were followed up for a minimum of 12 months and re-assessed using the DASH scores, time for return to work and patient satisfaction. Statistical analysis using Mann-Whitney and repeated measures ANOVA were performed. The groups were similar in respect of demographic and pre-test variables. Statistical analyses using Mann-Whitney showed significant differences for patient satisfaction (p=0.012), time to return to work (p=0.0001), improvements in DASH Score (p=0.002) and improvement in sporting activities (p=0.046). There was a trend to improvement in work related activity. Repeated measures ANOVA comparing the pre-operative data for each group were also significant for standardized DASH scores (p=0.0082) and sporting activities (p=0.043). Our study has shown that there is a significant difference in outcome in the two patient groups. Those patients undergoing a percutaneous release returned to work on average 3 weeks earlier and their symptoms as shown from their DASH scores improved significantly more than those undergoing an open procedure. The percutaneous procedure is a quicker, simpler procedure to perform than an open procedure. Our study has shown that patients have significantly better outcome measures after a percutaneous procedure.
The August 2023 Shoulder & Elbow Roundup360 looks at: Motor control or strengthening exercises for rotator cuff-related shoulder pain? A multi-arm randomized controlled trial; Does the choice of antibiotic prophylaxis influence reoperation rate in primary shoulder arthroplasty?; Common shoulder injuries in sport: grading the evidence; The use of medial support screw was associated with axillary nerve injury after plate fixation of proximal humeral fracture using a minimally invasive deltoid-splitting approach; MRI predicts outcomes of conservative treatment in patients with
The June 2024 Shoulder & Elbow Roundup. 360. looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; acid for rotator cuff repair: a systematic review and meta-analysis of randomized controlled trials; Metal or ceramic humeral head total shoulder arthroplasty: an analysis of data from the National Joint Registry; Platelet-rich plasma has better results for long-term functional improvement and pain relief for
The August 2013 Shoulder &
Elbow Roundup. 360 . looks at: the sternoclavicular joint revisited; surgical simulators: more than just a fancy idea?; arthroscopic
Introduction.
Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as
Musculoskeletal disorders have been recognised as common occupational risks for all orthopaedic surgeons. The nature of tasks performed by hip surgeons often requires both forceful and repetitive manoeuvres, potentially putting them at higher risk of musculoskeletal injuries compared to other orthopaedic sub-specialities. This study aimed to investigate the prevalence of musculoskeletal conditions among hip surgeons and evaluate the association between their workplace and lifestyle factors and musculoskeletal health. An online questionnaire consisting of 22 questions was distributed to UK-based consultant hip surgeons via email and social media platforms. This survey was completed by 105 hip surgeons. The mean age of the respondents was 49 years (range 35–69), with an average of 12 years (range 1–33) in service. 94% were full-time and 6% worked part-time. 49% worked at a district general hospital, 49% at a tertiary centre and 4% at a private institution. 80% were on the on-call rota and 69% had additional trauma commitments. 91% reported having one or more, 50% with three or more and 13% with five or more musculoskeletal conditions. 64% attributed their musculoskeletal condition to their profession. The most common musculoskeletal conditions were base of thumb arthritis (22%), subacromial impingement (20%), degenerative lumbar spine (18%) and medial or
Purpose: It is known from the literature that gripping, which is commonly used in various work-related, sport-related, and daily activities, activates both wrist extensors and flexors. Pain aggravation occurs during grip due to over-exertion of the extensor muscle group in
Several surgical techniques have been described of resistant
Introduction and Aims: Several surgical techniques have been described for the treatment of resistant
OBJECTIVE: The purpose of this study is to examine the effect of a single percutaneous injection of platelet-rich-plasma compared to an injection of corticosteroids in patients with chronic
Autologous injection of platelet rich plasma (PRP) stimulates healing process in degenerated tendons. The purpose of this study is to compare the functional outcome of
The aim of this study was to document the findings and the pathology of
Platelet Rich Plasma (PRP) has shown to be a general stimulation for repair and 1 year results showed promising success percentages. To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic
The February 2015 Shoulder &
Elbow Roundup. 360 . looks at: Proximal Humerus fractures a comprehensive review, Predicting complications in shoulder ORIF, The Coronoid Revisited, Remplissage and bankart repair for Hill-Sach’s lesions, Diabetes and elbow arthroplasty, Salvage surgery for failed bankart repair, Sternoclavicular Joint Reconstruction, Steroids effective in the short-term for
The October 2014 Shoulder &
Elbow Roundup. 360 . looks at: PRP is not effective in
The April 2013 Shoulder &
Elbow Roundup. 360 . looks at: biceps, pressure and instability; chronic acromio-clavicular joint instability; depression and shoulder pain; shoulder replacement and transfusion; cuff integrity and function; iatropathic plexus injury; the accuracy of acromio-clavicular joint injection; and tennis as a risk factor for
This study presents the clinical outcome of Boyd-McLeod procedure for
This is a retrospective review and analysis of cases of
Following the recognition of platelet rich plasma (PRP) as an interventional procedure by NICE, patients who had failed standard conservative treatment for chronic elbow tendinitis and referred for surgery were recruited prospectively into a PRP injection study. 52 patients at Torbay Hospital, Devon, UK received PRP injections in 18 months and 37 had a minimum of 6 months follow up. The outcomes in these patients are summarised. There were 16 males and 21 females. 30 had
The best surgical treatment of
Aims.
Goodfellow &
Bullough (1968) first described the pattern of articular cartilage wear in the elbow. More recent post mortem studies have shown that advanced degenerative changes can develop in the radio-capitellar (lateral) compartment of elbow joints of elderly subjects in which the humero-ulnar (medial) compartment remains remarkably well preserved. The significance of this post-mortem findings,in an elderly population, with unknown elbow symptom logy, who died from diverse causes, is unknown. There has been no clinically based,in vivo,study of this subject. Our study would support these observations, but indicates that symptomatic degenerative change occurs at a much earlier age than had previously been thought. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with elbow pain resistant to conservative treatments (age range 21–80 years: mean age 51 years). We documented established degenerative changes involving articular cartilage in 68 patients (59%). In this group we found that in 60 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with normal appearances of the articular cartilage of the medial compartment. The findings presented in this work are in full agreement with previous work on the articular wear and biomechanics of the elbow joint. Previous studies which have been on cadaveric specimens, with findings of uncertain symptomatic relevance. To our knowledge, this finding has not previously been demonstrated in a symptomatic, young population. Unicompartmental lateral degeneration of the elbow is therefore a real clinical entity rather than a interesting post mortem finding. As such, it demands consideration in terms of investigation, diagnosis and treatment. It is likely that in the past, many patients have been misdiagnosed as having chronic
Purpose: The purpose of this study was to clinically evaluate the efficiency of extracorporal shockwave therapy for enthesopathies. Materials, Methods and Results: 26 patients with mean age of 51 (range: 18–73) which suffered from enthesopathies in different regions were included in this study. Prior to treatment pain and function were assessed subjectively by using a visual analog scale ranging from 1 (maximum pain/minimum function) to 10 (no pain, full function). The follow-up period was 6–18 months with an average follow-up period of 13 months. All patients were treated with ESWT. One to three treatment sessions were provided to each patient with an interval of one week between the sessions. After all sessions were finished, pain and function were reassessed in the same method that was used before the beginning of the treatment. The overall mean pain value was 1.96 before the treatment and 5.92 after the treatment. 8 patients (30.7%) reported no pain at all after the treatment and in 6 patients (23%) a significant improvement in pain was achieved. 7 patients (19%) reported of only slight relief of pain and 4 patients (15.4%) reported no change in pain level. Only in one patient (3.9%) worsening of the pain was observed. The overall mean function capacity was 5.76 before the treatment and 8.65 after the treatment. 11 patients (42%) returned to full functional capacity and in 7 patients (27%) a significant improvement in functional capacity was observed. In 8 patients (30.7%) no change in the functional capacity was noticed. Good results of improvement in pain severity and functional capacity were observed in cases of plantar fasciitis and
Introduction: Radial Tunnel Syndrome is characterised by pain over the anterolateral proximal forearm. It is thought to result from compression of the posterior interosseous nerve, and is estimated to be present in 5% of
Introduction A procedure of selective musculo-tendinous lengthenings is presented as treatment for chronic lateral elbow pain. The rationale for surgery is to decrease tensile force at the lateral epicondyle and simultaneously reduce posterior interosseous nerve compression in the radial tunnel. This study presents biomechanical and clinical data on this surgical technique. Methods In a human cadaver study, force transducer measurements were made in the common extensor tendon, and after sequential tensioning of the muscles arising from the lateral epicondyle. In a separate cadaver study, a balloon catheter measured pressure in the radial tunnel after sequential musculo-tendinous lengthening of the forearm extensor muscles. A preliminary clinical study was performed on 12 subjects (13 elbows). All had failed extensive conservative treatment and subsequently underwent combined musculo-tendinous lengthening of ECRB, EDC, and superficial head of supinator (SHS). In the clinical series, 75% of subjects were involved in Work Cover claims. Clinical outcomes in this small series were reviewed. Results ECRB and EDC tensioning produced the largest force transducer measurements in the common extensor tendon at the lateral epicondyle. SHS increased force transducer measurements moderately, suggesting this muscle may also contribute to the clinical syndrome of
Introduction. Orthopaedic trauma surgery is characterised by repetitive, forceful tasks that are physically demanding, thus theoretically increasing the risk of musculoskeletal injuries in these surgeons. The aim of this study is to assess prevalence, characteristics and impact of musculoskeletal disorders among orthopaedic trauma surgeons. Methods. A modified version of the physical discomfort survey was sent to surgeon members of the Orthopaedics Trauma Association (OTA) via e-mail. For data analysis, one-way ANOVA and Fisher Exact test were performed to compare the variables where appropriate. P values<0.05 were considered statistically significant. Results. A total of 86 surgeons completed the survey during the period of data collection. Of the respondents 84.9% were males and more than half were aged between 30–45 years old. The majority of musculoskeletal complaints and disorders were low back pain (29.3%), wrist or forearm tendinitis (18.0%), elbow
The December 2022 Shoulder & Elbow Roundup360 looks at: Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears; Resistance training combined with corticosteroid injections or tendon needling in patients with lateral elbow tendinopathy; Two-year functional outcomes of completely displaced midshaft clavicle fractures in adolescents; Patients who undergo rotator cuff repair can safely return to driving at two weeks postoperatively; Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures; Treatment of acute distal biceps tendon ruptures; Rotator cuff tendinopathy: disability associated with depression rather than pathology severity; Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae.
Lateral Epicondylitis is a common condition caused by angiofibroblastic hyperplasia of the tendinous insertion. Its treatment is varied and includes rest, physiotherapy, corticosteroid injection and surgical release. Of late, the role of Platelet Rich Plasma (PRP) injections have been explored, with positive results. We prospectively assessed the outcomes of
To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. The OCD lesion was created on the trochlear groove of left articular cartilage of femur per rat (40 rats in total). The experimental groups were Sham, OCD, and ESWT (0.25 mJ/mm2, 800 impulses, 4 Hz). The animals were euthanized at 2, 4, 8, and 12 weeks post-treatment, and histopathological analysis, micro-CT scanning, and immunohistochemical staining were performed for the specimens.Aims
Methods
1. Resistant cases of
Background. Since its first description, the pathology, natural history and treatment of
Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including
The cause of elbow tendinosis is most likely a combination of mechanical overloading and abnormal microvascular responses. Numerous methods of treatment have been advocated. In this study, we evaluated the use of platelet-rich plasma (PRP) as a treatment for resistant epicondylitis. The rationale for using platelets is that they participate predominantly in the early inflammation phases and degranulation. They constitute a reservoir of critical growth factors and cytokines which when placed directly into the damaged tissue, may govern and regulate the tissue healing process. We looked at 25 patients (19 with lateral and 6 with medial) who failed to improve after physiotherapy, cortisone injections and application of epicondylar clasps and assessed the efficacy of platelet-rich plasma injections using Gravitational platelet separation system (GPS). The cohort of patients included over a period of three years had physiotherapy, stretches, epicondylar clasp and an average of 2.9steroid injections (1–6) before having a PRP injection. The mean patient age was 43 years ranging between 24 and 54. There were 11 men and 14 women. The study included 19 patients with
Fifteen patients with identical symptoms of pain and tenderness at the tip of the greater trochanter are reviewed. Diagnosis by the referring doctor was usually osteoarthritis of the hip or sciatica, but localised tenderness and pain on resisted abduction were the only clinical signs. Radiographs were usually normal. Most cases were relieved by one or more local steroid injections. This disorder has much in common with
We studied the origin of extensor carpi radialis brevis using 40 fresh frozen human cadaver specimens. Ten were stained with haematoxylin and eosin and trichrome which showed the collagenous structure of the extensor tendons at their origin. Gross anatomical observation showed that there was no definitive separation between brevis and communis at the osseotendinous junction. The histological findings confirmed the lack of separation between the two tendons. The extensor tendons were in close proximity to the joint capsule but trichrome staining showed no interdigitation of the tendon with the capsule. The validity of ascribing the pain of
During the last four years the author has used extracorporeal shock wave therapy (ESWT) to treat tendonoses, including 82 cases of
Problem: Surgical technique and short term results of ligament reconstruction with trizeps tendon graft in posterolateral rotational instability of the elbow. Methods: From 2003 to 2006 posterolateral ligament reconstruction with a single strand trizeps tendon graft was performed in 38 patients with posterolateral instability of the elbow, mainly associated with refractory
The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O’Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary.Aims
Methods
Purpose: The aim our study was to establish the existence of a symptomatic humero-radial synovial plica causing lateral elbow pain and the resection of which has improved pain and restored elbow function. Materials &
Methods: Our study included 117 consecutive elbow arthroscopies performed by two surgeons for a period of 18 months from January 2002 to July 2003. All patients were treated non operatively before undergoing arthroscopy. Conservative treatment included rest, activity modification, physiotherapy including ultrasound bracing, NSAIDS and corticoste-riod injection. Results: Radial head plica were found in 21(18%) out of 117 elbow arthroscopies and were resected using a soft tissue resector. There were 16 men and 5 women in the study group,all of whom were young and active: mean age 38 years (range 24 to 56 years). All patients were scored pre op and post op using the Mayo clinic performance index for the elbow. Of the 21 patients 17(81%) had a post op score 90 or more(excellent) and 5(19%) had a score 75-89(good). Conclusion: The synovial fold of the humero-radial joint is documented and considered as a meniscus between the two articulation(Duparc f etal 2002). They can also present present as symptoms suggesting intra articular loose bodies(Clarke R.P etal 1998). In the case of resistant
Between 1994 and 2006, 58 patients underwent decompression of radial tunnel. The senior author using an anterior approach performed all procedures. 43 patients were available for follow-up evaluation at an average of 47.3 months (12–156 months). The average age of patients was 49.7 years (35 – 72 years) and the mean duration of their symptoms was 18 months (6 – 56 months). There were 12 patients (13 extremities) over 5 years follow-up. All had a trial of conservative treatment with steroid injections, physiotherapy and ultrasound therapy. All except 2 had nerve conduction studies which were inconclusive. The results were evaluated using Mayo elbow scores and DASH scores. Mayo scores improved from a mean of 62.37 pre-op to 87.13 post-op (p<
0.05) and DASH scores improved from 67.58 pre-op to 40.12 post-op (p<
0.04). 35 patients (81.3%) were satisfied with the surgery while 8 patients were not (4 patients had other pathologies). There were few complications – neuropathic pain-1, neuropraxia – 1 and residual pain – 2. Six patients who had simultaneous release of lateral epicondylar muscles and radial tunnel did extremely well and were satisfied. Hence there is a role for simultaneous decompression of
Goodfellow &
Bullough (1968) first described the pattern of articular cartilage wear in the elbow. More recent post mortem studies have shown that advanced degenerative changes can develop in the radio-capitellar (lateral) compartment of elbow joints of elderly subjects in which the humeroulnar (medial) compartment remains remarkably well preserved. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with elbow pain resistant to conservative treatments (age range 21–80 years: mean age 51 years). We documented established degenerative changes involving articular cartilage in 68 patients (59%). In this group we found that in 60 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with normal appearances of the articular cartilage of the medial compartment. The post mortem studies carried out on mainly elderly subjects demonstrated that the degree of degenerative change in the elbow is age dependant and involves predominantly the lateral compartment of the joint. Our study would support these observations, but indicates that symptomatic degenerative change occurs at a much earlier age than had previously been thought. We consider that lateral compartment degenerative change is a distinct clinical entity. It begins in relatively young patients in whom the x ray appearance may be normal or near normal and is often diagnosed as
The NHS Plan (2000) identified the need for change in the way patients are asked to give consent for surgery to make the process more explicit. A new NHS operation consent form was introduced in April 2002 following the Bristol enquiry into deaths associated with Cardiac Surgery. Methods: We have addressed the obtaining of consent for surgery as an evidence-based exercise. The published literature has been reviewed and we have attempted to accurately quantify the success rates for surgery, complication rates and poor outcomes in order to identify what the likely benefits and risks are for our common operations –. Shoulder – Arthroscopic Sub-Acromial Decompression, Anterior stabilisation, Rotator Cuff repair, excision lateral end of clavicle and Shoulder Arthroplasty. Elbow –
The aim of the study is to assess the humero radial plica which could be a factor in causing lateral elbow pain. The cause of lateral elbow pain has been an enigma for the orthopaedic surgeons over the years. The synovial fold of the humeroradial joint has been well documented and considered as a meniscus between the articulation. They can also present as symptoms suggesting intra articular loose bodies causing pain in these patients. Our study included 117 consecutive elbow arthroscopies performed by two surgeons for a period of 18 months. All patients were initially treated non-operatively as a ‘tennis elbow’ before undergoing arthroscopy. Conservative treatment included rest, activity modification, physiotherapy including ultrasound bracing, nsaids and local corticosteroid injection. All patients were assessed using the Mayo clinic performance index for elbows both pre and post operatively. Radial head plica was found in 21(18%) out of 117 elbow arthroscopies and was resected using a soft tissue resector. There were 16 (76%) men and 5(24%) women in this affected group and all of whom were young and active with a mean age 38 years. Of the 21 patients 16(76%) had a post operative score of 90 or more (excellent) and 5(24%) had a score 75–89(good). This study addresses the fact that cause of lateral elbow pain can be due to various pathologies in the elbow and in the cases of ‘resistant
Extracorporal shock wave therapy (ESWT) seems to be a promising new tool for the treatment of chronic pain due to tendinopathies such as
Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients. Material and Methods: 28 patients from Ealing Hospital and West Middlesex Hospital were referred to The Lithotripsy unit at Charing Cross Hospital for Shock wave therapy. Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist. The cases included:. 4 Humeral fractures: 1 Case in HIV +ve 19 years old. 5 Femoral non-union: 1 case bilateral in Osteogenesis imperfecta. 4 Tibial non-union: 1 Recurent Fracture in 65 years old man. 2 Osteochondritis of the Talus. 2 Osteochondritis of the knee. 4 Scaphoid fractures: 1 case had been fixed and grafted. Medial Epicondyle fracture non union. 5. th. Metacarpal Fracture. Trochanteric Bursitis.
We conducted a study to identify factors that are prognostic
of the outcome of extracorporeal shockwave therapy (ESWT) for calcific
tendinitis of the shoulder. Since 1998, patients with symptomatic calcific tendinitis of
the rotator cuff have been treated with ESWT using an electrohydraulic
mode shockwave device. One year after ESWT, patients were grouped
according to the level of resorption of calcification.Aims
Patients and Methods
The December 2013 Shoulder &
Elbow Roundup360 looks at: Platelet-rich plasma; Arthroscopic treatment of sternoclavicular joint osteoarthritis; Synchronous arthrolysis and cuff repair; Arthroscopic arthrolysis; Regional blockade in the beach chair; Recurrent instability; Avoiding iatrogenic nerve injury in elbow arthroscopy; and Complex reconstruction of total elbow revisions
Modern athletes are constantly susceptible to performance-threatening injury as they push their bodies to greater limits and endure higher physical stresses. Loss of performance and training time can adversely and permanently affect a sportsperson’s career. Now more than ever with advancing medical technology the answer may lie in biologic therapy. We have been using peripheral blood stem cells (PBSC) clinically and have been able to demonstrate that stem cells differentiate into target cells to enable regenerative repair. The potential of this technique as a regenerative agent can be seen in three broad applications: 1) articular cartilage, 2) bone and 3) soft tissue. This article highlights the successful cases, among many, in all three of these applications.
Our purpose was to determine the quality of current randomised
controlled trials (RCTs) in hand surgery using standardised metrics. Based on five-year mean impact factors, we selected the six journals
that routinely publish studies of upper extremity surgery. Using
a journal-specific search query, 62 RCTs met our inclusion criteria.
Then three blinded reviewers used the Jadad and revised Coleman Methodology
Score (RCMS) to assess the quality of the manuscripts.Aims
Materials and Methods
We present a review of claims made to the NHS
Litigation Authority (NHSLA) by patients with conditions affecting the
shoulder and elbow, and identify areas of dissatisfaction and potential
improvement. Between 1995 and 2012, the NHSLA recorded 811 claims
related to the shoulder and elbow, 581 of which were settled. This
comprised 364 shoulder (64%), and 217 elbow (36%) claims. A total
of £18.2 million was paid out in settled claims. Overall diagnosis,
mismanagement and intra-operative nerve injury were the most common
reasons for litigation. The highest cost paid out resulted from
claims dealing with incorrect, missed or delayed diagnosis, with
just under £6 million paid out overall. Fractures and dislocations
around the shoulder and elbow were common injuries in this category.
All 11 claims following wrong-site surgery that were settled led
to successful payouts. This study highlights the diagnoses and procedures that need
to be treated with particular vigilance. Having an awareness of
the areas that lead to litigation in shoulder and elbow surgery
will help to reduce inadvertent risks to patients and prevent dissatisfaction
and possible litigation. Cite this article:
The aim of this study was to compare the pain caused by the application
of a tourniquet after exsanguination of the upper limb with that
occurring after simple elevation. We used 26 healthy volunteers (52 arms), each of whom acted as
their own matched control. The primary outcome measure was the total pain experienced by
each volunteer while the tourniquet was inflated for 20 minutes.
This was calculated as the area under the pain curve for each individual
subject. Secondary outcomes were pain at each time point; the total
pain experienced during the recovery phase; the ability to tolerate the
tourniquet and the time for full recovery after deflation of the
tourniquet. Aims
Patients and Methods
The April 2015 Foot &
Ankle Roundup360 looks at: Plantar pressures linked to radiographs; Strength training for ankle instability?; Is weight loss good for your feet?; Diabetes and foot surgery complications; Tantalum for failed ankle arthroplasty?; Steroids, costs and Morton’s neuroma; Ankle arthritis and subtalar joint
Drug therapy forms an integral part of the management
of many orthopaedic conditions. However, many medicines can produce
serious adverse reactions if prescribed inappropriately, either
alone or in combination with other drugs. Often these hazards are
not appreciated. In response to this, the European Union recently
issued legislation regarding safety measures which member states
must adopt to minimise the risk of errors of medication. In March 2014 the Medicines and Healthcare products Regulatory
Agency and NHS England released a Patient Safety Alert initiative
focussed on errors of medication. There have been similar initiatives
in the United States under the auspices of The National Coordinating
Council for Medication Error and The Joint Commission on the Accreditation
of Healthcare Organizations. These initiatives have highlighted
the importance of informing and educating clinicians. Here, we discuss common drug interactions and contra-indications
in orthopaedic practice. This is germane to safe and effective clinical
care. Cite this article:
To investigate the appropriate dose and interval for the administration
of triamcinolone acetonide (TA) in treating tendinopathy to avoid
adverse effects such as tendon degeneration and rupture. Human rotator cuff-derived cells were cultured using three media:
regular medium (control), regular medium with 0.1 mg/mL of TA (low
TA group), and with 1.0 mg/mL of TA (high TA group). The cell morphology,
apoptosis, and viability were assessed at designated time points.Objectives
Methods
We describe the intermediate results of lateral ligamentous repair or reconstruction for posterolateral rotatory instability of the elbow. Between 1986 and 1999, we performed 12 direct repairs and 33 ligament reconstructions with a tendon autograft. One patient was lost to follow-up and 44 were retrospectively studied at a mean of six years (2 to 15). Surgery restored stability in all except five patients. In two the elbow became stable after a second procedure. The mean post-operative Mayo elbow performance score was 85 points (60 to 100). The result was classified as excellent in 19, good in 13, fair in seven and poor in five patients. Thirty-eight patients (86%) were subjectively satisfied with the outcome of the operation. Better results were obtained in patients with a post-traumatic aetiology (p = 0.03), those with subjective symptoms of instability at presentation (p = 0.006) and those who had an augmented reconstruction using a tendon graft (p = 0.04). Reconstruction using a tendon graft seems to provide better results than ligament repair and the results do not seem to deteriorate with time. The outcome of this procedure is less predictable in patients with no subjective instability.
The aim of this study was to determine the effect
of radial extracorporeal shock-wave therapy (rESWT) on patients with
chronic tendinitis of the rotator cuff. This was a randomised controlled
trial in which 82 patients (mean age 47 years (24 to 67)) with chronic
tendinitis diagnosed clinically were randomly allocated to a treatment
group who received low-dose rESWT (three sessions at an interval
10 to 14 days, 2000 pulses, 0.11 mJ/mm2, 8 Hz) or to
a placebo group, with a follow-up of six months. The patients and
the treating orthopaedic surgeon, who were both blinded to the treatment,
evaluated the results. A total of 44 patients were allocated to
the rESWT group and 38 patients to the placebo group. A visual analogue
scale (VAS) score for pain, a Constant–Murley (CMS) score and a simple
shoulder test (SST) score significantly improved in both groups
at three and six months compared with baseline (all p ≤ 0.012).
The mean VAS was similar in both groups at three (p = 0.43) and
six months (p = 0.262). Also, the mean CMS and SST scores were similar
in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or
improve function in patients chronic rotator cuff tendinitis compared
with placebo treatment. Cite this article:
Posterolateral rotatory instability is the most common type of symptomatic chronic instability of the elbow. In this condition the forearm complex rotates externally in relation to the humerus, causing posterior subluxation or dislocation of the radial head. The lateral ligament complex, radial head and coronoid process are important constraints to posterolateral rotatory instability, and their disruption is involved in the pathogenesis of this condition. The diagnosis relies on a high index of clinical suspicion, active and passive apprehension tests, and examination under anaesthesia. Surgical treatment has given consistently successful results. Open reconstruction of the lateral ligaments with a tendon graft has been the procedure of choice, with arthroscopic techniques emerging as a potential alternative.