Shalom Stahl

The Efficacy of an Injection of Steroids for Medial Epicondylitis. A Prospective Study of Sixty Elbows

We report the details of a prospective, randomized, double-blind study that was undertaken to analyze the short-term and long-term effects of the local injection of methylprednisolone to treat medial epicondylitis. Fifty-eight patients (sixty elbows) were assigned to receive a single injection of 1 per cent lidocaine with either forty milligrams of methylprednisolone (experimental group) or saline solution (control group); both groups were also managed with physical therapy and the use of non-steroidal anti-inflammatory drugs. The two groups were not significantly different with regard to the age and gender of the patients, the duration of the symptoms, the degree of pain before the injection, or the number of dominant upper limbs involved. Six weeks after the injection, the experimental group had significantly less pain than the control group (p < 0.03), as determined with a modification of the grading system of Nirschl and Pettrone. However, the groups did not differ with regard to pain at three months and at one year. The intensity of pain, as measured on a visual-analog scale, did not differ between the two groups six weeks and one year after the injection. We believe that the improvement observed in both groups primarily reflects the natural history of the disorder, and we conclude that the local injection of steroids provides only short-term benefits in the treatment of medial epicondylitis.

Axillary block complicated by hematoma and radial nerve injury.

BACKGROUND AND OBJECTIVES Hematoma is typically cited as one mechanism of nerve injury following axillary block. However, documented cases of this are lacking. METHODS A healthy 38-year-old man was scheduled for surgical removal of a tumor of the hand. A transarterial axillary block was performed with a 22-gauge short-bevel needle using 40 mL of a mixture of equal volumes of 1.5% lidocaine and 0.5% bupivacaine containing 1:200,000 epinephrine. No paresthesias were reported. Postoperative, the patient developed a large axillary hematoma accompanied by paresthesias and radial nerve weakness. RESULTS With conservative management, nerve recovery was complete in 6 months. CONCLUSIONS Hematoma complicating axillary block may result in nerve dysfunction.

Neuroma of the superficial branch of the radial nerve after intravenous cannulation.

I n spite of the rich sensory innervation of the upper extremity and the vast number of peripheral vein cannulations that are performed, there are very few reported cases of nerve injury from such cannulation. This suggests not only an extremely low incidence of the complication, but also that perhaps the problem is not recognized and diagnosed. We report here a case of a neuroma of a superficial branch of the radial nerve after intravenous cannulation and describe both its presentation and treatment. Neuromas or neuritis of the superficial sensory branch of the radial nerve have been reported after surgical release of DeQuervain syndrome (l-3), in association with Wartenberg’s syndrome (4-6), and after wounding at the distal third of the forearm (6). However, there is only one previous report of injury to the radial nerve after peripheral venous cannulation (7). In that case, the patient went untreated and was left with a complete work disability. This additional case report emphasizes the importance of considering this diagnosis of a very real, painful, and progressively disabling entity. It also illustrates various management options for treating this rare complication and the potential for complete recovery.

Anterior interosseous nerve palsy associated with Galeazzi fracture.

&NA; Galeazzi fracture is more common in adults than in children. Associated neurologic deficits are rare and easily missed at the first clinical examination. The authors describe a case of anterior interosseous nerve palsy after closed Galeazzi fracture. Conservative treatment resulted in complete return of normal nerve function, suggesting that this is a neurapraxia type of injury.

The 'upside-down' radial head: a diagnostic challenge.

The author describes a rare, traumatic dislocation of the radial head in an 8 year old girl. Only four similar cases were found in the literature. The danger of misdiagnosis and the life-long disability can be avoided by careful examination of the post-reduction radiograph.

SIMULTANEOUS SCAPHOID AND GALEAZZI FRACTURES

Among wrist injuries, scaphoid fractures are second only in number to fractures of the distal radius, while Galeazzi fractures are relatively infrequent. It is rare for the two fractures to occur concomitantly. We report such a case in a 65-year-old woman.