Jeffrey A. Housner

Sonographically Guided Percutaneous Needle Tenotomy for the Treatment of Chronic Tendinosis

Objective. Initial reports have shown percutaneous sonographically guided needle tenotomy without corticosteroid injection to be effective for the treatment of tennis elbow. The purpose of this study was to determine the effectiveness of this procedure with various tendons throughout the body. Methods. Fourteen tendons in 13 patients were identified as having a greater than 6‐month history of clinical presentation consistent with tendinopathy that had failed treatment with physical therapy. All patients were treated with sonographically guided percutaneous tenotomy using a 22‐gauge needle and a local anesthetic. A visual analog scale (VAS) pain score measurement was obtained before the procedure and at 4‐ and 12‐week follow‐up appointments. All complications were recorded. Results. The 14 tendons in this study included patellar (5), Achilles (4), proximal gluteus medius (1), proximal iliotibial tract (1), proximal hamstring (1), common extensor elbow (1), and proximal rectus femoris (1). The composite VAS score was significantly lower at both 4 weeks (mean ± SEM, 2.4 ± 0.7) and 12 weeks (2.2 ± 0.7) compared with the baseline (5.8 ± 0.6; P < .001). No complications or morbidity occurred. Conclusions. Sonographically guided percutaneous tenotomy of tendinosis was effective in improving patient symptoms without complications. Further investigation with additional patients and comparisons to alternative treatments is needed to validate these preliminary results.

Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases

Objective:To report the retrospective results of ultrasound-guided needle fenestration for the treatment of recalcitrant patellar tendinopathy. Design:Retrospective follow-up study. Setting:University outpatient sports medicine clinic. Patients:Forty-seven patellar tendons in 32 patients (26 men and 6 women; mean age, 26 years) with recalcitrant patellar tendinopathy. Diagnosis made via history, physical examination, and sonographic examination. Intervention:Ultrasound-guided needle fenestration after failure of conservative management. Main Outcome Measures:Pre-treatment and 4-week clinical follow-up determination of functional activity score. Phone follow-up determination of best achievable level of activity and satisfaction score of the procedure. Results:Average time to follow-up was 45 months. Seventy-two percent of patients reported excellent or good results when questioned regarding return to activity. Twenty-eight percent of patients were unable to return to their desired activity level. Six patients subsequently underwent surgical treatment. One athlete underwent surgery to repair a patellar tendon rupture that occurred 6 weeks after the procedure. Eighty-one percent of patients reported excellent or good satisfaction scores. Conclusions:Ultrasound-guided needle fenestration warrants further investigation for the treatment of recalcitrant patellar tendinopathy.

Management of clavicle fractures.

Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. The history and physical examination remain the primary means of diagnosing this injury. Plain radiographs are helpful to confirm the diagnosis and to provide information regarding fracture classification, prognosis, and treatment options. The emphasis of this article is on the management of these injuries. Historically, only unstable distal clavicle fractures were treated operatively. However, recent well-conducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and non-union, compared with non-operative treatment. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. Multiple factors should be considered when counseling an athlete on the appropriate time to return to sports participation after a clavicle fracture.

Clavicle fractures: individualizing treatment for fracture type.

Clavicle fractures are common injuries in both children and adults. In most cases, the diagnosis can be made readily from the patients history and physical examination. X-rays are helpful to confirm the diagnosis, to assess the severity of the fracture, and to follow interval healing. Most fractures are treated nonoperatively, and surgical intervention is typically reserved for unstable distal clavicle fractures. Nonoperative options involve either a sling-and-swathe or figure-of-eight splint. Return-to-play decisions should be individualized based on the age of the patient, location and severity of the fracture, degree of clinical and radiographic healing, and the sport in which the athlete will be participating.

Anabolic-androgenic steroids and testosterone precursors: Ergogenic aids and sport

This article reviews the recent literature on the use of anabolic-androgenic steroids (AAS) for performance enhancement. Recent studies utilizing supraphysiologic doses of testosterone have demonstrated increases in strength and improvements in body composition, despite earlier assertions by the medical community that steroids were ineffective as ergogenic aids. Although data that support the theory of conversion of prohormones, such as androstenediol, to testosterone in the body is available, support for testosterone precursors alone as ergogenic aids is lacking. Drug testing laboratories are utilizing new techniques that analyze carbon-13 levels of urinary steroids to detect exogenously administered steroids as well as the use of urine-manipulating agents. Investigations that seek to refute athletes’ various claims for positive drug tests are ongoing. The recent discovery, characterization, and development of a urine test for tetrahydrogestrinone, a designer steroid, has brought the issue of performance enhancement once again into the public spotlight. Increasing attention is also being paid to the long-term effects of AAS abuse, as more authors characterize the changes to hematologic, hepatic, lipid, and hormone profiles as a result of years of steroid use. Although the understanding of AAS and testosterone precursors as performance-enhancing drugs continues to advance, there are likely to be more revelations as scientific investigations continue.

Steps to take for clavicle fractures.

The bones that reach from the middle of your chest to the shoulders form the struts that make up the front of the shoulder. They can be broken when they are overstressed.