No todo dolor de codo es epicondilitis / Not every elbow pain is epicondylitis

Pain located in the lateral aspect of the elbow is a common cause of consultation in the trauma consultation. The most common cause is "lateral epicondylitis," however there are several differential diagnoses that may require different management. There is a case of radial tunnel syndrome secondary to extrinsic compression, with an emphasis on its diagnosis and surgical technique.

Differential Diagnosis Using Two Electrophysiological Testing Methods for Radial Tunnel Syndrome / 昆明医科大学学报

Objective To compare the traditional electrophysiological testing with modified methods for differential diagnosis of Radial Tunnel Syndrome (RTS).Methods A total of 87 selected patients were initially diagnosed as Lateral Epicondylitis (LE) or Tennis Elbow (TE) by doctors from the Outpatient Department of Orthopedics and Rehabilitation.Medical history was asked.Patients received physical examination and examinations for the sensory nerve action potential (SNAP) of superficial radial nerve,the compound muscle action potential (CMAP) of radial nerve and needle electromyography (EMG) to record the muscle Motor Unit Action Potentials (MUAPs).Then,the modified methods for CMAP of radial nerve were conducted on the forearm in the neutral,pronation and supination positions.Three values of CMAP latency were compared.RTS was diagnosed when the difference value ≥0.3 ms.The x 2 test was used to compare the positive detectable rates of the two methods for the RTS diagnosis.Results Thirteen out of 87 patients were diagnosed as RTS,among which three had interosseous nerve lesion and one had superficial radial nerve lesion.The traditional EMG failed to diagnose the remaining 9 RTS cases.These patients were finally diagnosed due to their latency difference of radial nerve CMAP ≥0.3ms when their forearms were examined in three positions.Conclusion The modified electrophysiology method shows a higher positive rate for the diagnosis of RTS.(P＜0.05).

Morphology of Brachialis Muscle: Variations and Clinical Significance.

Background: Though rare but variations of brachialis muscle insertion have been reported. Material and Methods: The study was conducted on 115 upper limbs over a period of 4 years. The dissection of arm and forearm was done carefully to preserve all minute details ,observing the morphology of insertion pattern and nerve supply. Observation: Out of 115 specimens, 2 specimens showed insertion of brachialis into bicipital aponeuroses. Accessory slips were seen in 4 specimens which are mixed with main fibers at insertion point. Rarest of all was insertion of an accessory brachialis muscle on radial tuberosity in 2 specimens. The muscle originated from lateral border of shaft of humerus and shared a few fibers with main Brachialis muscle. The muscle was inserted into radius just below the radial tuberosity. Conclusion: The identification of an inter-nervous plane may allow for improvement in the current anterior and anterolateral surgical approaches to the humerus. This could be one of a possible etiology of Radial tunnel syndrome.

Radial Tunnel Syndrome: Case Report

Radial tunnel syndrome is a rare disorder and it's symptoms sometimes so closely overlap those lateral epicondylitis, causing difficulties to differentiate. A 39-year-old man was presented who had a 2.5-year history of right elbow and forearm pain which was unseccesfully treated as 'tennis elbow'. Clinically, severe tender point over the forearm was relieved after a local anesthetic injection. Axial STIR(short tau inversion recovery) image showed high signal intensity at the origin of the extensor carpi radialis brevis, which was so minimal that it was not comparable to clinical symptoms. But radial nerve was revealed normal. So we decided that the symptoms were caused not by lateral epicondylitis but rather by radial tunnel sybdrome and an operation was performed. In the operative field, the most proximal part of the superficial head of the supinator muscle was tendinous and formed a fibrous arch, which was resected. After the operation, the right arm pain was relieved. This is a case diagnosed as lateral epicondylitis which showed no improvement under conservative treatment, but improved after a local anesthetic injection on the tender point. When a case with no correlations between lateral epicondylitis degree in MRI and clinical symptoms, one should take the possibility of radial tunnel syndrome into consideration.