The efficacy of extracorporeal shock-wave therapy for
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
We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in
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 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
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 outcome of surgery in patients with medial epicondylitis of the elbow is less favourable in those with co-existent symptoms from the ulnar nerve. We wanted to know whether we could successfully treat such patients by using musculofascial lengthening of the flexor-pronator origin with simultaneous deep transposition of the ulnar nerve. We retrospectively reviewed 19 patients who were treated in this way. Seven had grade I and 12 had grade IIa ulnar neuropathy. At a mean follow-up of 38 months (24 to 48), the mean visual analogue scale pain scores improved from 3.7 to 0.3 at rest, from 6.6 to 2.1 with activities of daily living, and from 7.9 to 2.3 at work or sports, and the mean disabilities of the arm, shoulder and hand scores improved from 42.2 to 23.5. These results suggest that this technique can be effective in treating patients with medial epicondylitis and coexistent ulnar nerve symptoms.
The lateral ligament complex is the primary constraint to posterolateral rotatory laxity of the elbow, and if it is disrupted during surgery, posterolateral instability may ensue. The Wrightington approach to the head of the radius involves osteotomising the ulnar insertion of this ligament, rather than incising through it as in the classic posterolateral (Kocher) approach. In this biomechanical study of 17 human cadaver elbows, we demonstrate that the surgical approach to the head can influence posterolateral laxity, with the Wrightington approach producing less posterolateral rotatory laxity than the posterolateral approach.