Current concepts in examination and treatment of elbow tendon injury.

Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to optimally design treatment programs for rehabilitation and prevention.

Evidence Acquisitions: The PubMed database was searched in January 2012 for English-language articles pertaining to elbow tendon injury.

Nirschl surgical technique for concomitant lateral and medial elbow tendinosis: a retrospective review of 53 elbows with a mean follow-up of 11.7 years.

Background: Combined lateral elbow tendinosis (tennis elbow) and medial elbow tendinosis (golfer's elbow) can be a disabling condition that, if unresponsive to nonoperative treatments, may be effectively treated surgically. The authors are not aware of any study that reports the outcome of a combined operation for lateral and medial elbow tendinosis (country club elbow) performed in the same operative setting.

Hypothesis: Combined surgical treatment of country club elbow in the same operative setting has similar outcomes to those seen in the literature for single operative procedures.

Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis.

Background: Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques.

Hypothesis: Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up.

Study Design: Case series; Level of evidence, 4.

Arthroscopic rotator cuff debridement without decompression for the treatment of tendinosis.

Purpose: The treatment of rotator cuff injury in the absence of a full-thickness tear has traditionally consisted of acromioplasty. However, this disorder may also be treated by arthroscopic rotator cuff debridement without acromioplasty. Our previous study of 79 shoulders so treated reported 87% good or excellent results at an average 53-month follow-up.

Tennis elbow tendinosis (epicondylitis).

Tennis elbow tendinosis (epicondylitis) is most commonly caused by tendon overuse and failed tendon healing. The pathoanatomy of overuse tendinopathy is noninflammatory "angiofibroblastic tendinosis." The specific areas of elbow abnormality include the extensor carpi radialis brevis-extensor digitorum communis complex laterally, the pronator teres, flexor carpi radialis medially, and triceps posteriorly.

Elbow tendinopathy: tennis elbow.

The pathoanatomy of overuse tendinopathy is noninflammatory angiofibroblastic tendinosis. The areas of elbow abnormality are specific, including the ECRB-EDC complex laterally, the pronator teres, flexor carpi radialis medially, and triceps posteriorly. The goals of nonoperative treatment are to revitalize the unhealthy pain-producing tendinosis tissue.

Internal impingement in the etiology of rotator cuff tendinosis revisited.

Purpose: The theory of internal impingement holds that, in overhead athletes, repeated contact between the undersurface of the rotator cuff and the posterosuperior glenoid rim leads to articular-sided partial-thickness rotator cuff tears and superior labral lesions. However, we have noted this same constellation of lesions in our general patient population. These recreational athletic patients do not routinely assume the position of extreme abduction and external rotation, and thus are unlikely to experience significant internal impingement forces.

Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. A randomized, double-blinded, placebo-controlled study.

Background: A better treatment modality is needed to control the pain of medial or lateral epicondylitis (tennis elbow).

Hypothesis: Dermal iontophoretic administration of dexamethasone sodium phosphate will be significantly more effective in controlling pain than a placebo in patients with medial or lateral elbow epicondylitis.

Study Design: Randomized, double-blinded, placebo-controlled study.

Arthroscopic debridement for the treatment of osteoarthritis of the knee: 2- and 5-year results.

Purpose: The purpose of this study was to evaluate the effect that arthroscopic debridement in osteoarthritic knees has on patient satisfaction and function.

Type Of Study: Cohort observational study.

Methods: Thirty-six patients (mean age, 64.

Evaluation of overuse elbow injuries.

The evaluation of elbow pain can be challenging because of the complexity of the joint and its central location in the upper extremity. Diagnosing the injury correctly requires an understanding of the anatomy of the elbow, which includes three articulations, two ligament complexes, four muscle groups and three major nerves. The history should be directed at pinpointing the location of symptoms and the activities that cause the patient's pain.

A modified lateral approach for release of posttraumatic elbow flexion contracture.

A modified lateral approach for release of posttraumatic flexion contracture of the elbow is described. The approach is a modification of the procedure described by Nirschl for resection and repair of lateral elbow tendinosis (tennis elbow). The modified approach allows visualization of the entire anterior elbow joint without disturbing the common extensor origin or the collateral ligaments.

Salvage surgery for lateral tennis elbow.

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery.

Arthroscopic transglenoid suture capsulolabral repair. Five-year followup.

The preliminary results of our arthroscopic transglenoid suture capsulolabral repair demonstrated a failure rate of only 10%, with no postoperative dislocations. The purpose of this study was to reevaluate a patient population with a 5-year minimum followup similar to the one previously reported with a 2-year followup. We performed a retrospective analysis of 38 shoulders in 37 consecutive patients who underwent arthroscopic transglenoid suture capsulolabral repair between January 1989 and June 1990.

Managing overuse injuries: a systematic approach.

Cumulative, repetitive microtrauma can cause tissue damage that leads to overuse injuries, which constitute a large share of sports-related disorders. The authors explain their five-step approach to treating overuse injuries: establishing a pathoanatomic diagnosis, controlling inflammation, promoting healing, increasing fitness, and controlling tissue abuse. The case of a 28-year-old male runner with heel pain demonstrates their management of overuse injuries.

Tennis elbow. Current concepts of treatment and rehabilitation.

Tennis elbow occurs as a result of repetitive microtrauma to the musculotendinous unit causing inflammatory and degenerative tissue damage. A good understanding of the aetiology and pathoanatomy will aid the clinician in preventing and recognising this condition. Early recognition with a quality rehabilitative programme, and the judicious use of surgical intervention usually results in full recovery and excellent functional outcomes.