Lee Van Rensburg May 2011. Lateral Epicondylitis Arthroscopy Arthroplasty.
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Transcript of Lee Van Rensburg May 2011. Lateral Epicondylitis Arthroscopy Arthroplasty.
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Lee Van RensburgMay 2011
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Lateral Epicondylitis Arthroscopy Arthroplasty
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Lateral sided elbow painLateral sided elbow pain Radial tunnel syndrome (PIN)Radial tunnel syndrome (PIN) Cervical radiculopathyCervical radiculopathy Osteochondral radiocapitellar lesionOsteochondral radiocapitellar lesion Posterolateral elbow plicaPosterolateral elbow plica Posterolateral elbow instabilityPosterolateral elbow instability
PathologyPathology Degenerative – NOT “itis”Degenerative – NOT “itis” Tendinosis ECRBTendinosis ECRB
Volume 16, Number 1, January 2008
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J Bone Joint Surg Am. 2005;87:187-202
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Treatment Non operative
Activity modification Physiotherapy Counterforce bracing Injection – What? ECSW ??????
Operative
Volume 16, Number 1, January 2008
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Physiotherapy Stretches Ecentric strengthening
How do ecentric exercises workRheumatology (2008) 47 (10): 1444-1445
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Injections Local anaesthetic and steroid Hyaluronic acid Botox Blood Platelet rich plasma Mesenchymal Stem cells
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Injections Local anaesthetic and steroid
BMJ; 2006;333:939
Bisset L, Beller E, Jull G, et al: Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial.
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Injections Local anaesthetic and steroid
Lindenhovius A, Henket M, Gilligan BP, Lozano-Calderon S, Jupiter JB, Ring D.
Injection of dexamethasone versus placebo for lateral
elbow pain: a prospective, double-blind, randomized clinical trial.
J Hand Surg Am. 2008 Jul-Aug;33(6):909-19.
CONCLUSIONS:
Corticosteroid injection did not affect the apparently self-limited course of lateral elbow pain.
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Injections Local anaesthetic and steroid
Hyaluronic acidBotox
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Injections Local anaesthetic and steroid Hyaluronic acid Botox Blood
American Journal of Physical Medicine & Rehabilitation; Volume 89(8), August 2010, pp 660-667
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Injections Local anaesthetic and steroid Hyaluronic acid Botox Blood Platelet rich plasma - PRP
Am J Sports Med 2010 38: 255
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Platelets VEGF – Vascular endothelial growth factor PDGF – Platelet derived growth factor FGF – Fibroblast growth factor TGF B – Transforming growth factor EGF – Epithelial growth factor
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Injections Local anaesthetic and steroid Hyaluronic acid Botox Blood Platelet rich plasma - PRP Mesenchymal Stem cells
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ECSWL
J Rheumatol. 2008;35:2038-46.
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Percutaneous Open Arthroscopic
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What I say/ do – No magic bullet – Non operative 6 months Physiotherapy
5 – 10 minutes won’t do
Use counter force brace Reassure – Hurts no long term harm Injection
Veering away from steroids Try PRP (£)
Percutaneous release ( x - ray/ MRI - a scope) www.cambridgeelbow.co.uk
Patient information
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Diagnostic Removal of loose bodies Radial head excision Debridement osteophytes OK procedure Capsular release
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VOLUME 83-A · NUMBER 1 · JANUARY 2001
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VOLUME 83-A · NUMBER 1 · JANUARY 2001
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VOLUME 83-A · NUMBER 1 · JANUARY 2001
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Arthroscopy video
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Linked Fixed hinge (no varus/ valgus play) Sloppy hinge
Unlinked
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Sloppy hinge implants restore a better arc of movement
Higher proportion of good and excellent results
May have a lower rate of radiographic loosening
Revision rates of sloppy hinge and unlinked devices were comparable at five years
Little et al. J Bone Joint Surg; Br.2005; 87-B: 437-444
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Overall 30% Infection 5% Wound healing 10% Triceps detachment 3% Ulna nerve palsy 5% (permanent) Disassembly (linked) 1-6% Dislocation (unlinked) 5%, instability 14% Loosening 9%
Little et al. J Bone Joint Surg; Br.2005; 87-B: 437-444
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11% revision rate Improved ROM 35° 82% good to excellent results
Little et al. J Bone Joint Surg; Br.2005; 87-B: 437-444
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10 Total elbows per year 30 Shoulder arthroplasties per year About 2 hips per day ADH USA Medicare 2003
6,700 shoulder joints 106,887 hip replacements 199,195 total knee replacements
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Little et al. J Bone Joint Surg; Br.2005; 87-B: 437-444
30°30°13%13%
5 yrs5 yrs
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Revision ROM improvement
Good/ Excellent
Overall 13% 26° 78%
RA 10% 26° 83%
PTA 10% 49° 81%
Acute #
*
3% NA 99%
* 3yr F/U small numbers reported
Little et al. J Bone Joint Surg; Br.2005; 87-B: 437-444