Primary bony tumours of the elbow account for approximately 1% of all osseous tumours. The delayed diagnosis is commonly reported in the literature as a result of lack of clinician familiarity. We present the largest series of primary bone tumours of the elbow in the English literature. We sought to identify characteristics specific to primary elbow tumours and compare these to the current literature. We discuss cases of misdiagnosis and reasons for any delay in diagnosis. The authors also recommend a collaborative protocol for the diagnosis and management of these rare tumours. A prospectively collected national database of all bone tumours is maintained by an independent clerk. The registry and case notes were retrospectively reviewed from January 1954 until June 2013. Eighty cases of primary osseous elbow tumours were studied. Tumours were classified as benign or malignant and then graded according to the Enneking spectrum. There were no benign latent cases in this series. All cases in this series required surgical intervention. These cases presented with persistent rest pain, with or without swelling. The distal humerus was responsible for the majority and most aggressive of cases. The multidisciplinary approach at a specialist centre is integral to management. Misdiagnosis was evident in 12.5 % of all cases. Malignant tumours carried a 5-year mortality of 61%. Benign tumours exhibited a 19% recurrence rate and in particular, giant cell tumour was very aggressive. The evolution in treatment modalities has clearly benefited patients. Clinicians should be aware that elbow tumours can be initially misdiagnosed as soft tissue injuries or cysts. The suspicion of a tumour should be raised in the patient with unremitting, unexplained non-mechanical bony elbow pain. We suggest an investigatory and treatment protocol to avoid a delay to diagnosis. With high rates of local recurrence, we recommend regular postoperative reviews.
With an ageing population and increasing pressures on all orthopaedic services, it is vital that we are able to develop efficient and acceptable means to streamline the patient journey. Our department uses telephone review appointments for selected patients to reduce the need for additional visits to the outpatient clinic. The aim of this study was to assess the efficacy of this approach, and to determine whether it was acceptable to patients. We identified all patients who had received a first-time telephone review appointment within a four month period. Using a short structured telephone questionnaire they were asked about their experiences of the process, whether they had subsequently required a clinic visit, and whether they would have preferred to be seen in person in the clinic. 50 of the 55 (91%) patients were successfully contacted, and all gave consent to participate. Reasons for follow-up included post-operative discectomy and lumbar decompression, post-nerve root injection, and MRI results. All patients (100%) were satisfied with the telephone consultation. Only 8 (16%) would have preferred a clinic appointment with 5 of these subsequently visiting the clinic. 32 (64%) of the patients did not require a further clinic appointment for the same problem. 32 (64%) of patients stated that they were very satisfied with the overall follow-up process with the remaining 18 (36%) being satisfied. Our study has shown that using telephone review follow-up for selected patients is effective at reducing the number of clinic visits, and is acceptable to patients.
Post-operative pain is well recognised in patients undergoing shoulder surgery. With the recent advances in arthroscopic shoulder surgery over the last decade, a larger number of cases are being performed in day surgery units. These procedures are generally performed under general anaesthetic with either an interscalene or suprascapular nerve block or local anaesthetic infiltration. The aim of our prospective audit was to investigate the adequacy of analgesia provided for patients, undergoing day case arthroscopic shoulder procedures in a rural district general hospital, to ensure best medical care and to tailor certain procedures to appropriate analgesic pathways in the future. Fifty consecutive patients, who underwent day case arthroscopic shoulder surgery, were contacted by telephone one week post surgery, to assess their post-operative pain scores and analgesic requirements. Patients who received a nerve block were found to have a significantly longer duration of pain relief (p < 0.001). These patients also had significantly less pain performing their usual activities of daily living in the immediate post-operative period (p = 0.05), compared to patients who only had local anaesthetic infiltration. There was no trend found between the type of procedure and post-operative pain scores. Our audit has confirmed that nerve blocks provide longer pain relief, but has also highlighted the need to take into consideration pre-operative pain and pain perception to enable analgesia to be tailored.
