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 tennis elbows’ we recommend that the existence of a radial head synovial plica should be considered and if present treatment should be directed at this. Our study demonstrates that by resecting the synovial plical fold, pain will be relieved and these patients regained elbow function. Since this was noted in the young active age group this could reduce the morbidity and the time for rehabilitation required especially for those involved in active sports. A similar series has not been cited in English literature

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 tennis elbow the existence of a radial head synovial plica should be considered. Our study concludes that by resecting the synovial plical fold will relieve the pain and restore the elbow motion

Purpose: The purpose of this study is to evaluate the arthroscopic findings in patients who presented with persistent lateral elbow pain despite conventional conservative measures, with special regard to diagnosis specific results. The controversy regarding the etiopathogenesis, whether intraarticular, extraarticular or both continues to exist. Method: This is a retrospective review of 280 arthroscopies of elbow in 262 patients over a period of 6 years with a minimum follow-up of 6 months. All of them are therapeutic procedures involving ECRB release, excision of plica, synovectomy or debridement of the joint. The functional outcome was assessed and recorded independently by two experienced upper limb physiotherapists using the Mayo elbow performance score. Results: Dominant hand was involved in 68% of the cases. The average age was 54 years. Isolated pathology such as common extensor inflammation was identified in 138 (49%), synovial plica in 24 (8%) and degenerative changes confined to lateral compartment with normal appearance of articular cartilage of medial compartment is noted in 31 (11%). In the rest mixed pathology with various combinations were identified. Conclusion: Good to excellent results were seen in those with isolated common extensor inflammation and poor outcomes were noted in 20 (7%) of patients and the common intraoperative finding seen was degenerative changes of radiocapitellar joint. This was found to be statistically significant

The Cochrane Collaboration has produced three new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner. These are relevant to a wide range of musculoskeletal specialists, and include reviews in lateral elbow pain, osteoarthritis of the big toe joint, and cervical spine injury in paediatric trauma patients

Tennis elbow (lateral epicondylitis or lateral elbow tendinopathy) is a self-limiting condition in most patients. Surgery is often offered to patients who fail to improve with conservative treatment. However, there is no evidence to support the superiority of surgery over continued nonoperative care or no treatment. New evidence also suggests that the prognosis of tennis elbow is not influenced by the duration of symptoms, and that there is a 50% probability of recovery every three to four months. This finding challenges the belief that failed nonoperative care is an indication for surgery. In this annotation, we discuss the clinical and research implications of the benign clinical course of tennis elbow.

Cite this article: Bone Joint J 2023;105-B(2):109–111.

The aim of this study was to document the findings and the pathology of tennis elbow during arthroscopy in patients who had failed conservative treatment for lateral elbow pain with a presumptive diagnosis of lateral epicondylitis (tennis elbow). Materials and Methods: We carried out a prospective study of a consecutive series of 397 patients who underwent elbow arthroscopy for lateral elbow pain previously diagnosed as lateral epicondylitis. All the patients had a period of atleast six months of various conservative treatment modalitiesin the nature of NSAIDS, bracing physiotherapy and ultrasound. The arthroscopy procedures were performed by one of two surgeons using identical standard techniques and the findings were carefully documented. Results: There were 238 men and 159 women in the study group: mean age 51 years (range 21 to 80 years). Synovitis was present in 173(44%), degenerative changes in 232 (58%), common extensor origin inflammation in 173(44%), radial head plica in 121(30%), loose bodies in 85(21%), ostephyte formation in 45(11%) and intra-articular adhesions in 26(6%). Of the 232 patients who had degenerative changes 186(80%) had articular cartilage changes in the lateral compartment(radial head & capitellum), partial thickness loss in n=94(51%) and full thickness cartilage loss in n=92(49%). Conclusion: The clinical diagnosis of lateral epicondylitis is applied to patients who have a variety of pathologies involving the tissues of the lateral compartment of the elbow. In addition to inflammation and degenerative tears of common extensor origin other pathologies such as synovitis, radial head plica, loose bodies and degenerative osteoarthritis should be considered. This diagnosis of tennis elbow is often applied to patients with degenerative changes(osteoarthritis) involving the lateral compartment. Advanced degenerative changes involving the articular cartilage of the lateral compartment can be present in patients with little or no abnormality visible on x-ray. We conclude that arthroscopy is a definitive diagnostic tool to evaluate the various pathologies giving rise to lateral elbow pain and also helps in planning and initiating the appropriate treatment plan directed against specific and accurate conditions causing lateral elbow pain(lateral epicondylitis)

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 lateral epicondylitis. ECRL and ECU tensioning lead to non significant increases in force transducer measurements. Radial tunnel pressure dropped substantially (77%) after musculo-tendinous lengthening of SHS. Lengthening of other forearm extensors had little effect on measured radial tunnel pressure. All subjects recorded improvement in visual analogue pain scores, with post-operative scores between zero and two. Grip strength was preserved or improved. By the criteria of Roles and Maudsley, nine elbows were excellent, two good, one fair and one poor. Overall 11 of the 12 subjects reported they would have the procedure again. Conclusions This study demonstrates a biomechanical basis for SHS in the aetiology of lateral epicondylitis and radial tunnel syndrome, and supports a combined musculo-tendinous lengthening of ECRB, EDC, and SHS in the treatment of chronic lateral elbow pain. Satisfactory clinical results are reported in this group of patients including those involved in Work Cover claims

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. Tennis elbow (TE) is a painful pathologic condition with its origin in the common wrist extensor muscles at the lateral epicondyle. As the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting, with an annual incidence of 4 to 7 cases per 1000 patients in general practice (with a peak at 35 to 54 yrs of age), TE has considerable socioeconomic costs. As pain relief and improvement in functional performance are the 2 common aims of all treatment strategies, the importance of using appropriate tools for the assessment of pain and functional disability in TE is evident. In view of the high prevalence of TE, uncertainties about its treatment, and its substantial socioeconomic consequences, using more specific, patient-centred assessment tools is essential for providing more useful information on the level of pain and functional disability in TE. The Study aimed to: 1) compare pain and functional disability in tennis elbow (TE) patients with healthy controls; and 2) evaluate the relationship between the 2 major psychologic factors (anxiety and depression) and TE. Methods. Sixteen consecutive TE patients were recruited at an upper limb clinic: inclusion criteria were lateral epicondyle tenderness, pain with resisted wrist and middle finger extension and at least 3 months localised lateral elbow pain. Sixteen healthy controls with no upper limb problem were recruited from students and staff. Participants were given 4 questionnaires, together with instructions for completion: Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, Patient-Rated Wrist Evaluation Questionnaire, and Hospital Anxiety and Depression Scale. The independent t test was used to compare the total and subscale scores between the groups. Results. Significantly higher scores were found in TE for pain and function subscales and also total score for Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, and Patient-Rated Wrist Evaluation Questionnaire. For Hospital Anxiety and Depression Scale, both anxiety and depression subscales (P<0.001) and the total score (P<0.01) were significantly higher in TE. According to the anxiety and depression subscales, 55% and 36% of patients, respectively, were classified as probable cases (score >11). Discussion. TE patients showed markedly increased pain and functional disability. Significantly elevated levels of depression and anxiety pointed out the importance of psychologic assessment in TE patients. In the development of supportive and treatment strategies, we suggest the combination of “upper limb” and “psychologic” assessment tools

Aim: To determine the effectiveness of arthroscopic surgery, without excision of the radial head, in elbows with end stage arthritis of the radiocapitellar joint. Methods: Twenty-three elbows with bone-on-bone degeneration of the radio-capitellar joint, but with only minor degeneration of the humeroulnar joint, had arthroscopic surgery, with synovectomy, removal of loose bodies and excision of impinging tissues and bone. The average age was 51 years (range: 16 years to 59 years). Evaluation was by a questionnaire and the follow-up was after a minimum of one year. Results: The average follow up was 41 months (range 12 months to 83 months). Twenty-one of 22 patients reported improvements. Six patients were pain free, 12 had mild residual pain and six had significant, continuing pain. Only three patients reported residual lateral elbow pain. The average visual analogue pain score was 3.4. According to the Mayo elbow function score, there were eight excellent, seven good, six fair, and three poor outcomes. Conclusions: Satisfactory improvements in symptoms and function were obtained in arthritic elbows with arthroscopic surgery, even in the presence of severe radiocapitellar arthritis

Lateral epicondylitis, or ’tennis elbow’, is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments.

Cite this article: Bone Joint J 2013;95-B:1158–64.

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.