Gold Coast

蛋糕毛巾 無尾熊 郵局正妹 Wade 泳裝 

US-guided Tenotomy I: Lateral Humeral Epicondylopathy
" Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed. "
top images from: http://www.wehelpwhathurts.homestead.com/ecrl_perc_tenotomy_edit_finalb_op_800x373.jpg
Sonographically Guided Percutaneous Needle Tenotomy for Treatment of Common Extensor Tendinosis in the Elbow
J Ultrasound Med 25:1281-1289 http://www.jultrasoundmed.org/cgi/content/abstract/25/10/1281
John M. McShane, MD, Levon N. Nazarian, MD and Marc I. Harwood, MD
McShane Sports Medicine, Villanova, Pennsylvania USA (J.M.M.); and Department of Radiology (L.N.N.) and Department of Family and Community Medicine, Division of Sports Medicine (M.I.H.), Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA.
Objective. Chronic tendinosis of the common extensor tendon of the lateral elbow can be a difficult problem to treat. We report our experience with sonographically guided percutaneous needle tenotomy to relieve pain and improve function in patients with this condition. Methods. We performed sonographically guided percutaneous needle tenotomy on 58 consecutive patients who had persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the common extensor tendon, and the tip of the needle was used to repeatedly fenestrate the tendinotic tissue. Calcifications, if present, were mechanically fragmented, and the adjacent bony surface of the apex and face of the epicondyle were abraded. Finally, the fenestrated tendon was infiltrated with a solution containing corticosteroid mixed with bupivacaine. After the procedure, patients were instructed to perform passive stretches and to undergo physical therapy. During a subsequent telephone interview, patients answered questions about their experience, their functioning level, and their perceptions of procedure outcome. Results. Fifty-five (95%) of 58 patients were contacted by telephone and agreed to participate in the study. Thirty-five (63.6%) of 55 respondents reported excellent outcomes, 16.4% good, 7.3% fair, and 12.7% poor. The average follow-up time from the date of the procedure to the date of the interview was 28 months (range, 17–44 months). No adverse events were reported; 85.5% stated that they would refer a friend or close relative for the procedure. Conclusions. Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed.
Selected Readings:
Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow. BMJ. 2006 Nov 4;333(7575):939 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17012266&itool=iconpmc&query_hl=3&itool=pubmed_docsum