Evaluation of Sleep Position for Possible Nightly Aggravation and Delay of Healing in Tennis Elbow.

Tennis elbow symptoms are reportedly most severe in the morning, which prompted a search for a pathological process while asleep. A "pathological sleep position" was hypothesized that repetitively aggravates an elbow lesion if the arm is overhead and pressure is on the lateral elbow. This hypothesis was tested by using a restraint to keep the arm down while asleep. METHODS: This study was a retrospective review. All patients were advised to use a restraint to keep the arm down at night. The presence of the restraint in the morning was correlated with the subjective report. The control group consisted of the noncompliant patients. RESULTS: Compliance and subjective improvement was documented in 33 of 39 patients (85%). Subjective improvement was reported by 66% of the compliant patients after 1 month. Pain continued after the first 3 months only in 6 of 39 noncompliant patients (15%). DISCUSSION: In this pilot study, patients who kept the arm down at night improved, whereas patients who were noncompliant continued to be symptomatic. Sleep position should be considered as a possible aggravating factor that delays healing of an acute injury and results in chronic pain. If validated, keeping the arm down at night can be recommended for tennis elbow.

Shoulder impingement presenting as neck pain.

BACKGROUND: Chronic neck pain can be a difficult problem to evaluate and treat, as it can have several different causes. We studied a series of patients with neck pain near the superomedial aspect of the scapula that was referred pain from inflammation of the shoulder secondary to chronic impingement. We postulate that some patients with specific clinical findings and neck pain can benefit from treatment of shoulder impingement. METHODS: We conducted a retrospective review of the charts of thirty-four patients with neck pain who met three criteria for the diagnosis of shoulder impingement syndrome: (1) a positive impingement sign with pain referred to the neck, (2) radiographic abnormalities, and (3) relief of neck pain after injection of lidocaine and cortisone into the subacromial space. Subjective pain scores were determined before and after the injection. RESULTS: Thirty of the thirty-four patients obtained immediate relief of the neck pain following injection into the subacromial space, and the remaining four had substantial pain relief when they were evaluated three weeks following the injection. Avoidance of the shoulder impingement position (forward elevation of the arm above 90 degrees ) subsequently minimized recurrences. CONCLUSIONS: In selected patients, chronic neck pain may be caused by shoulder impingement, which can be easily diagnosed with standard techniques. The difficulty in making this diagnosis is that the patient presents with neck pain rather than with the typical shoulder pain. The differential diagnosis of chronic lower neck pain should include shoulder impingement syndrome, which can be identified by classic physical and radiographic signs and can be treated with injection into the subacromial space and avoidance of the shoulder impingement position.