1/26. Low power laser therapy and analgesic action. OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery. ( info) |
2/26. "Little league elbow"--acute traction apophysitis in an adolescent badminton player. A case of an acute traction apophysitis, "little league elbow", in an adolescent badminton player is presented. After a period of intense badminton activity, the patient developed typical signs of inflammation related to his elbow. X-ray showed soft tissue calcifications and ultrasound showed intra-articular swelling and a possible apophysitis related to the elbow. After a period of immobilization followed by low activity he could return to normal sports activity. ( info) |
3/26. Novel use of laser Doppler imaging for investigating epicondylitis. OBJECTIVE: This investigation evaluated a novel form of tissue perfusion measurement, laser Doppler imaging (LDI), in a case of lateral epicondylitis to establish if it might have applications in assessing soft tissue lesions. LDI was used in conjunction with ultrasonography to provide information about tissue oedema as well as the power Doppler signal as an alternative method of assessing blood flow. methods: A laser Doppler imager with a near-infrared (NIR) laser source was used to improve tissue penetration and yield measurements of perfusion (flux) from structures under the skin. skin temperature over the lateral epicondylar region was also measured. ultrasonography was used in both grey-scale and power Doppler modes. LDI, temperature measurements and ultrasonographic data were obtained before treatment and serially after local injection of methylprednisolone. RESULTS: Before treatment there was increased perfusion and skin temperature and the presence of a power Doppler sign associated with the right lateral epicondyle as well as oedema at the extensor origin. None of these was present at the asymptomatic contralateral epicondylar region. Twenty-four hours after methylprednisolone administration, both perfusion and skin temperature had increased, and they declined over the subsequent 48 h. Although skin temperature had declined to normal (referenced to the contralateral epicondyle) by the third day after injection, it took until the eleventh day after injection for perfusion to normalize. CONCLUSIONS: LDI using an NIR laser source appears to be an effective non-invasive method for the examination of inflammatory responses in soft tissue, with greater sensitivity than thermally based methods. In addition, LDI was found to correlate with power Doppler ultrasonography. ( info) |
4/26. Conservative chiropractic care of lateral epicondylitis. OBJECTIVE: To discuss the management of a patient with lateral epicondylitis refractory to previous medical and conservative interventions. CLINICAL FEATURES: A 45-year-old woman had difficulty in supinating her left elbow because of pain from activities at work. Standard tests demonstrated and reproduced pain at the lateral epicondyle with resisted extension of the wrist and fingers. INTERVENTION AND OUTCOME: Specific joint manipulation for relief of lateral epicondylitis was performed. immobilization of the elbow joint after manipulation was accomplished by means of a sugar tong plaster splint. Follow-up joint manipulation with a progressive rehabilitation program was effective in providing relief of symptoms. CONCLUSION: Resolution of pain and limited elbow motion was demonstrated after Mills' manipulation. ( info) |
5/26. Lateral epicondylitis in a hospital phlebotomist--an ergonomic solution. This report outlines a case of lateral epicondylitis in a hospital phlebotomist thought to be due to the forceful gripping, and repetitive twisting, involved in breaking the seals on green vacutainer needles. An ergonomic solution in the form of a device to aid breaking of the vacutainer seals is presented. The importance of seeking ergonomic solutions with manufacturers is highlighted. ( info) |
6/26. Heterotopic ossification after lateral epicondylectomy. Lateral epicondylitis is a common affliction that can be treated nonsurgically. However, surgical treatment is rarely indicated, and results are usually effective in more than 90% of patients. Although complications have been described, ours is the first report of heterotopic ossification after an uncomplicated lateral epicondylectomy. ( info) |
| Osteoid osteoma is an uncommon bony neoplasm which rarely occurs in the elbow region. We present a case in a sixteen year old male whose symptoms were suggestive of lateral epicondylitis, or tennis elbow, and he had been treated as such for a period of eighteen months. CT scan and isotope bone scan showed typical features of osteoid osteoma and his symptoms resolved rapidly following excision of the lesion. tennis elbow is rare in the adolescent age group, and other diagnoses should be excluded in cases where the clinical findings are suggestive of this condition. ( info) |
8/26. Electrodiagnostic medicine. Electrodiagnostic testing examines the physiologic integrity of the peripheral nervous system. However, such testing should represent only one part of an electrodiagnostic consultation in which the entire clinical context, including the history, physical examination, laboratory studies, and electrodiagnostic testing, is considered as a whole. Although each electrodiagnostic laboratory establishes its own normal values for nerve conduction studies and needle EMG, these values should not be used in isolation. The electrodiagnostic consultation can help narrow an otherwise broad differential diagnosis, confirm a suspected diagnosis, or help define a confusing clinical picture. ( info) |
9/26. Computerised infrared thermography and isotopic bone scanning in tennis elbow. Thirty five cases of tennis elbow (17 unilateral, nine bilateral) were studied with infrared thermography and isotopic bone scanning. A hot focus was visualised in 16 of 17 cases of unilateral tennis elbow (94%) and in all nine cases of bilateral tennis elbow (100%) on infrared thermography, and abnormal increased epicondylar activity seen in 12 of 17 (71%) and eight of 18 (44%) cases respectively with isotopic bone scanning. Unilateral visual cooling (somatosympathetic responses) occurred in seven of 13 cases of unilateral tennis elbow (54%) with infrared thermography, and reduced perfusion in seven of 12 (58%) of similar cases with blood pool isotopic bone scanning. Computerised temperature assessments showed statistically significant side to side temperature differences when 17 active tennis elbows were compared with the opposite normal elbows for spot temperatures, proximal and distal forearm gradients. Similar temperature assessments in 18 bilateral tennis elbows compared with 17 normal elbows showed significant temperature differences for elbow spot temperatures and distal forearm gradients, but not for proximal gradients. ( info) |
10/26. Fifty cases of external humeral epicondylitis treated by moxibustion and point-injection. OBJECTIVE: To observe the therapeutic effects of moxibustion and point-injection on external humeral epicondylitis. METHOD: The disease is treated with the combined method of moxibustion and point-injection of the Compound Dan Shen Injectio and Ye Mu Gua Injectio RESULTS: 30 of the total 50 cases were cured, 18 cases were improved, and 2 cases were with no effect. The total effective rate was 96%. CONCLUSION: The combined method of moxibustion and point-injection is a cure indicated for external humeral epicondylitis. ( info) |