Treatment Options for Tennis Elbow - An Umbrella Review.

INTRODUCTION: The main goal of the present umbrella review was to provide the most up-to- date and evidence-based results regarding the various treatment options for tennis elbow (TE), which hopefully will significantly decrease the confusions existing in the literature. Furthermore, our study differs from past analytical studies because, as to the best of the authors' knowledge, is the first to provide independent (not in comparison to other treatment) statistical results regarding the effectiveness of each TE treatment. MATERIALS AND METHODS: Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO were searched. The overall search process was conducted in 3 stages. RESULTS: A total of 40 studies met the inclusion criteria and were included in this study. Out of those 40 meta-analyses, a total of 160 primary studies were screened in order to extract the data and perform a statistical analysis. CONCLUSION: The present umbrella review underlines the efficiency of injection therapies, especially autologous blood, and platelet-rich plasma, while simultaneously proving the ineffectiveness of acupuncture and shock wave therapy as treatments for TE. Furthermore, the value of other known conservative treatment modalities, such as physical therapy, has been demonstrated.

The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years.

Introduction: A review of the literature from the last 10 years quite clearly shows that immobilization of the wrist in the splint (orthosis) is the most effective, initial method of conservative treatment of carpal tunnel syndrome (CTS). The particular advantages of the described method of treatment are: availability, low cost, good patient tolerance, simplicity and minimal incidence of complications.The aim of this study was to try to define the criteria of proceeding with the selection of the type of orthosis and the duration of its use depending on the clinical condition and the patient's expectations. Methods: The PubMed electronic database was searched for appropriately selected studies published between 2012 and 2022. The search strategy used was based on the following keywords: carpal tunnel syndrome, immobilization, orthosis, conservative treatment. The authors also searched the cited literature on relevant research and review papers on potentially relevant topics related to conservative treatment of the CTS. Conclusions: Immobilization in an orthosis gives therapeutic effects in all patients, regardless of the stage of the carpal tunnel syndrome.Most often the orthosis is only used at night for several weeks. During the exacerbation of symptoms, it can also be used during the day during activities that increase symptoms.In practice, it is recommended to wear a splint that immobilizes the wrist in a neutral position or slightly extended at 0-15 degrees (most often 0-5 degrees).A splint immobilizing the wrist and the 2-5 metacarpophalangeal joints are recommended for patients with positive Berger test results.There are no statistically significant differences in the treatment results between individual and traditional orthoses.No statistically significant differences were observed in the treatment effects between rigid and soft orthoses.

Comparative Assessment of Functional Outcomes of Surgical Treatment in Patients with Distal Radial Fractures.

BACKGROUND: Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kir-schner wires, open reduction and fixation with a non-locking or locking plate or with an external device. The aim of this paper was to try to answer the following question: are there differences in functional treatment outcomes in patients after surgery with the use of Kirschner wires vs LCP plate fixation? MATERIAL AND METHODS: The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires (50 patients) and by open reduction and LCP locking plate fixation (50 patients). The study assessed the following parameters: global grip strength, pain severity in a VAS scale, range of motion, functional status of the wrist based on the Fernandez classification, quality of life according to the QuickDASH score, and the frequency of complications. These parameters were assessed at 6 and 12 months after surgery. RESULTS: An assessment of the treatment outcomes at 6 and 12 months after surgery showed statistically significant differences between the treatment methods in the following parameters: pain severity, global grip strength and range of motion in the sagittal plane. A comparison of the functional status of the wrist at 6 and 12 months between the groups showed considerably worse results in the Kirschner wire fixation group. The frequency of postoperative complications at 12 months was 6% in the Kirschner wire fixation group and 2% in the LCP plate fixation group. CONCLUSIONS: 1. Treatment outcomes were better in patients with distal radial fractures managed with LCP plate fixation. 2. The use of LCP plate fixation predisposes pa-tients to better ranges of mobility in the sagittal plane in the radiocarpal joint. 3.The values of global grip strength were higher in the group treated with LCP plate fixation. 4. Patients treated with LCP plates have better limb function and quality of life and lower pain intensity after treatment completion. 5. The number of complications was higher in pa-tients treated with Kirschner wire fixation.

[Outcomes of surgical treatment of proximal humerus fractures in elderly people]. / Wyniki operacyjnego leczenia zlaman nasady blizszej kosci ramiennej u osób w podeszlym wieku.

The aim of the study is analysis of outcomes of surgical treatment in a group of 32 patients with fractures of the proximal humerus treated surgically in the orthopaedic and traumatic ward of St. Lucas Hospital in Tarnów during the years 2006-2009. Results were estimated by Constant-Murley criteria. Among the surgical methods the best results were observed in cases of healing with percutaneus Kirschners wires fixed appropriately with the closed method of two- and three-part fractures of the neck of the humerus. The worst results were observed in four-part humerus fractures when open surgical procedure were used irrespective of the kind of applied implant. In case of these fractures of proximal humerus, satisfactory results were obtained by using hemi-arthroplasty.

Ulnar and Median Nerve Abnormalities in Carpal Tunnel Syndrome.

BACKGROUND: Nerve compression underlying carpal tunnel syndrome (CTS) results in an increase in the threshold of superficial sensation in the area supplied by the median nerve, which is a mixed nerve dominated by sensory fibres. The distribution of sensory symptoms is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment at wrist level is still unclear. Patho-logical processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra-median spread of sensory symptoms in CTS patients. MATERIAL AND METHODS: The study involved 88 patients (104 hands), with 70 women (83 hands) and 18 men (21 hands) aged between 25 and 77 years. 50 age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. The diagnosis of carpal tunnel syndrome was made according to the criteria of the American Academy of Neurology 1993 guidelines. Based on the results of an ENG trace evaluating the degree of conduction disturbances in the median nerve, the patients were classified to one of three severity subgroups. The threshold of sensory excitability to pulsed current was determined in a test with single 100 ms rectangular pulses. CONCLUSIONS: 1. The threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly lon-ger in patients with CTS than in controls. 2. Surgical treatment decreases the threshold of sensation in the fingers innervated by the median nerve. 3. Surgical treatment does not decrease the threshold of sensation in the fingers innervated by the ul-nar nerve. 4. The preoperative and postoperative threshold of sensation in the fingers innervated by the median and ulnar nerve is significantly longer in patients with severe carpal tunnel than in mild and moderate cases.

Comparison of Radiographic Outcomes of Surgical Treatment in Patients with Distal Radial Fractures.

BACKGROUND: Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kirschner wires, open reduction, and fixation with a non-locking or locking plate or with an external device. Choosing a surgical method that produces "better" outcomes may help select the most efficient treatment method. MATERIAL AND METHODS: The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires and by open reduction and LCP locking plate fixation. Radiographic assessment was based on images obtained before the surgery, immediately after fracture reduction, and at 6 weeks, 6 months, and 12 months after the procedure. RESULTS: A comparison of the volar tilt angle in patients after fixation with Kirschner wires and LCP plates did not show any statistically significant differences before the surgery or at 6 weeks. A difference in the outcomes was found at 6 and 12 months and it turned out to be highly statistically significant. A comparison of the inclination angle and radial height in patients after Kirschner wire and LCP plate fixation showed statistically significant differences at 6 weeks, 6 months, and 12 months. A comparison of the radiographic outcomes using the Sarmiento classification in patients after Kirschner wire and LCP plate fixation revealed statistically significant differences at all follow-up time points. CONCLUSIONS: 1. The radiographic parameters were superior in patients treated by open reduction and LCP plate fixation. 2. The difference was seen with regard to all the parameters studied.

Results of surgical treatment of carpal tunnel syndrome.

BACKGROUND: The method of carpal tunnel syndrome (CTS) treatment depends on the severity of the symptoms. It is generally accepted that patients with mild and moderate CTS may be referred for conservative treatment while surgical treatment is recommended in patients with severe symptoms. The conclusions drawn on the basis of our study results should facilitate predicting treatment outcomes in patients with various degrees of disturbance in median nerve conduction and the severity of accompanying symptoms. They should also help in making the decision to operate or institute conservative treatment. The aim of this study was to assess sensory impairment as well as treatment efficacy in carpal tunnel syndrome depending on the degree of symptom severity and conduction disturbances. MATERIAL AND METHODS: Surgical procedures were performed by several neurosurgeons from the same department using the same surgical method. The program of early postoperative rehabilitation was implemented and monitored by one person, the first author of this paper. The study had a prospective design. Treatment efficacy was evaluated by assessing changes in sensory excitability threshold by pulsed current, time to onset of paraesthesia in challenge tests, and scores in two subjective symptom severity scales: the Symptom Severity Scale and Functional Status Scale (Hand). The study participants were divided into several subgroups which differed in terms of carpal tunnel syndrome severity: the degree of symptom severity and the severity of conduction disturbances. RESULTS: A statistically significant difference was confirmed in the final threshold of sensation in the pulps of fingers I-III. It was found in the patients with mild and severe as well as moderate and severe conduction disturbances. A statistically significant difference in the degree of postoperative improvement measured with the SSS and FSS was confirmed between the groups with mild and severe conduction disturbances. After treatment completion, the lowest symptom severity (measured with SSS and FSS) was found in the patients who had reported mild symptoms before the surgery (difference among the groups was statistically significant). The difference in the degree of improvement after treatment between the groups was statistically significant. The largest improvement was confirmed in the patients with severe baseline symptoms and included the SSS and FSS scores as well as the time to onset of paraesthesia in challenge tests. CONCLUSIONS: 1. Surgical treatment and early postoperative rehabilitation reduce subjective symptom severity, improve functional status of the hand, decrease superficial sensory disturbances on the pulps of fingers I-III and decrease median nerve responses to challenge tests. 2. The lower the severity of baseline conduction disturbances, the better the sensory function of the hand after treatment. 3. The improvement in subjective symptom severity and functional status is most marked in the patients with severe baseline conduction disturbances in the median nerve. 4. The best clinical condition after treatment (symptom severity, functional status) was found in the patients with mild CTS.