Robert P. Nirschl

Conservative Treatment of Tennis Elbow.

In briel: Classic tennis elbow is the result of a pathological entity the authors call fibroangiomatous hyperplasia. Their conservative treatment program has resulted in a high success rate, and includes the following steps: (1) relieving inflammation and pain with rest, ice, anti-inflammatory medications, and occasionally cortisone injections; (2) promoting the healing process with high-voltage galvanic stimulation; (3) exercises for strength, endurance, and flexibility in the arm and forearm; and (4) reducing the overload forces that caused the original injury by using a counterforce brace and modifying the players technique and equipment. Surgery may be required as a last resort in patients with chronic symptoms.

Internal impingement in the etiology of rotator cuff tendinosis revisited

PURPOSEnThe theory of internal impingement holds that, in overhead athletes, repeated contact between the undersurface of the rotator cuff and the posterosuperior glenoid rim leads to articular-sided partial-thickness rotator cuff tears and superior labral lesions. However, we have noted this same constellation of lesions in our general patient population. These recreational athletic patients do not routinely assume the position of extreme abduction and external rotation, and thus are unlikely to experience significant internal impingement forces. The goal of this study was to document the prevalence of superior labral lesions in patients being treated for partial-thickness undersurface rotator cuff tears.nnnTYPE OF STUDYnRetrospective case series.nnnMETHODSnWe retrospectively reviewed the records of 75 shoulders arthroscopically treated for partial-thickness articular-sided rotator cuff tears. With the exception of one professional tennis player, no patients were playing sports at a professional or major college level. No professional or collegiate throwing athletes were included. The prevalence of these lesions and their association with recreational athletics was noted.nnnRESULTSnWe found that 55 of 75 (73.3%) shoulders with articular-sided partial-thickness rotator cuff tears also had superior labral lesions. A statistically significant increased prevalence of superior labral lesions in the dominant shoulder was seen (P =.03). In addition, our patients who engaged in overhand throwing had significantly fewer superior labral lesions in the dominant shoulders than did nonthrowers (P =.017).nnnCONCLUSIONSnThe kissing lesions of undersurface rotator cuff tears and posterosuperior labral damage may be explained by mechanisms other than internal impingement.

Five-step treatment for overuse injuries

In brief Overuse injuries can be particularly challenging to manage. An athletes premature return to athletic activity often results in recurrent and recalcitrant injury. A five-step management plan that includes establishing a pathoanatomic diagnosis, controlling inflammation, promoting healing, increasing fitness, and controlling abusive activity offers athletes optimal opportunity to return successfully to athletic performance.

Assessment and treatment guidelines for elbow injuries.

Acute elbow injuries are often collision related; chronic elbow injuries typically stem from overuse and valgus stress. What seems a purely traumatic injury, though, may actually represent an acute-on-chronic process, so a detailed history and physical exam are essential in pinpointing the injury process and making a specific diagnosis. Important details in the history are the quality, intensity, and onset of pain and the location of symptoms and their effect on function. The exam should include visual inspection, palpation, range of motion, and key tests such as applying valgus stress. Treatment can often be conservative, with emphasis on strength-building rehabilitation.