Regenerative Orthopedics Enabled by Cross-Cutting Technologies
Kohlstadt Ingrid, Cintron Kenneth in Metabolic Therapies in Orthopedics, Second Edition, 2018
PRP has been utilized in the treatment of lateral epicondylitis (LE) with significant beneficial results [18, 4]. In a randomized control trial (RCT), the authors were trying to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic LE with a 2-year follow-up. One hundred patients with chronic lateral epicondylitis were randomly assigned to a L-PRP injection or the corticosteroid injection using a peppering technique with no activating agents into the common extensor tendon. The study showed statically significant reduced pain (VAS scores) and increased functionality (DASH) in the group treated with L-PRP and no serious complications after a 2-year follow-up.
Test Paper 6
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
The ossification centres occur in order of appearance according to the commonly recited mnemonic CRITOE – capitellum, radial, internal (medial epicondyle), trochlear, olecranon and external (lateral epicondyle). Although the associated age groups are commonly stated as 1, 3, 5, 7, 9 and 11 years of age, respectively, there is actually some variability, particularly as the final ossification centres appear. As such, the lateral epicondyle ossification centre may not appear until age 13. Medial epicondyle avulsion injuries are far more common than lateral epicondyle avulsion injuries. The common extensor tendon inserts onto the lateral epicondyle and the common flexor tendons insert onto the medial epicondyle.
Musculoskeletal system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
The common extensor tendon origin appears as a beak-shaped hyperechoic structure located between the subcutaneous tissue and the lateral ulnar collateral ligament (Fig. 3.15b). The common flexor tendon inserts in the medial epicondyle and appears shorter than the common extensor tendon (Fig. 3.15c). Both tendons have a normal fibrilar pattern. Due to this pattern, it is sometimes difficult to differentiate the lateral ulnar collateral ligament and the extensor tendon.
Prevalence of lateral epicondylosis in veteran manual wheelchair users participating in adaptive sports
Published in The Journal of Spinal Cord Medicine, 2022
Andrea K. Cyr, Berdale S. Colorado, Michael J. Uihlein, Kristin L. Garlanger, Sergey S. Tarima, Kenneth Lee
LE remains a clinical diagnosis, however, ultrasound evaluation of the elbow may reveal calcifications, tears, bony irregularity of the lateral epicondyle and thickening and heterogenicity of the common extensor tendon, all findings suggestive of LE.7,8 Although LE is a clinical diagnosis, ultrasound is being used to confirm this with physical exam findings. For example, a common extensor tendon thickness of 4.2 mm or greater correlates well with LE.9 Previous interobserver studies examining tendon thickness, color doppler activity and bony spurs found good to excellent reliability for all measurements.8,10 Ultrasound findings of hypoechogenicity of the extensor tendon complex and bony changes indicate increased stress of the common extensor tendon at the lateral epicondyle as seen with LE.11 A previous study in the able-bodied population found that the common extensor tendon of the dominant elbow in asymptomatic, able-bodied individuals was thicker as compared to the nondominant elbow in males as compared to females but with no age correlation.12
Ultrasonographic comparison of the lateral epicondyle in wheelchair-user (and able-bodied) tennis players: A pilot study
Published in The Journal of Spinal Cord Medicine, 2021
Vivian Roy, Leah Lee, Michael Uihlein, Ishan Roy, Kenneth Lee
Lateral epicondylosis (LE), previously termed epicondylitis, is a common injury in tennis players and the general population.1 This condition is characterized by degenerative changes in the common extensor tendon due to microtears and scarring from overuse.1 The most commonly affected tendon is that of the extensor carpi radialis brevis (ECRB); however, other extensors such as extensor carpi radialis longus (ECRL) and extensor digitorum communis (EDC) may also be affected.1 The diagnosis is clinical and is often identified as tenderness over the ECRB tendon, 1–2 cm distal and anterior to the lateral epicondyle.1 LE may develop with any prolonged repetitive motion at the wrist, and tennis playing is a known risk factor. According to an epidemiological study of 150 nonprofessional male tennis players, the weekly number of playing hours is the best predictor for LE.2 In this study, the average “pain-free” tennis player spent 5.5 h per week of play time; the average “tennis elbow sufferer” spent 8 h per week.2 In addition, there is evidence that recreational tennis players are more at risk compared to professional players, along with players who use a one-handed backhand as opposed to a two-handed backhand.1,3 Treatment includes rest, occupational therapy (stretching and eccentric strengthening exercises), corticosteroid or platelet-rich plasma injections, and, rarely, surgical intervention such as repair or removal of scar tissue.
An evidence-based evaluation of mobile health apps for the management of individuals with lateral elbow tendinopathy using a systematic review framework
Published in Physical Therapy Reviews, 2021
Luke J. Heales, Samantha Randall, Bill Vicenzino, Brooke K. Coombes, Steven Obst
Consistent with current evidence, a majority of the apps state that LET is an overuse injury of the common extensor tendon. Two apps recommended activity modification [18,24], while four apps suggested complete rest [18,20–22]. While activity modification is consistent with current clinical practice [30], it is also recommended that complete rest/immobilisation should be avoided to minimise muscular atrophy and deconditioning [39]. Although pain may diminish during complete rest it is likely to return following activity, as rest does not address the primary impairment of decreased tendon load tolerance. The majority of apps suggested that individuals with elbow pain contact their health professional for an accurate diagnosis, prior to using the app, whereas one app suggested that MRI is urgently required to confirm a diagnosis of LET [18]. According to Level I evidence, there is limited usefulness of MRI in diagnosing LET [40]; however, this evidence is two decades old and more recent observational studies have suggested that ultrasound imaging can be a useful screening tool for LET [41]. Furthermore, observational studies have suggested that diagnostic imaging should be reserved for recalcitrant cases of LET that are not responsive to treatment [42,43]. Three apps also provided instruction to perform the Chair test to aid in the self-diagnosis of LET [20–22]. The Chair test is a relatively less common clinical test originating in the 1970s [44]. Although the Chair test is provocative in an individual with LET, observational studies investigating the diagnostic utility of provocation tests in LET have failed to include the Chair test [45]. Finally, two apps highlighted the use of tennis coaching to limit the progression of LET [18,24]. Although clinical opinion has suggested that tennis coaching could limit the progression/development of LET [33], this statement lacks scientific evidence.
Related Knowledge Centers
- Extensor Carpi Ulnaris Muscle
- Extensor Digitorum Muscle
- Inflammation
- Lateral Epicondyle of The Humerus
- Tendon
- Forearm
- Humerus
- Lateral Epicondyle of The Humerus
- Extensor Carpi Radialis Brevis Muscle
- Extensor Digiti Minimi Muscle
- Repetitive Strain Injury