Subtle elbow instability associated with lateral epicondylitis
Abstract Background In lateral epicondylitis, even in the absence of apparent instability, subtle instability can be found under anesthesia. We wanted to ascertain the following: (1) how many elbows surgically treated with lateral epicondylitis showed subtle instability during examination under anes...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-018-2069-8 |
| _version_ | 1819264832553091072 |
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| author | Sang Ho Kwak Seung-Jun Lee Hee Seok Jeong Min Uk Do Kuen Tak Suh |
| author_facet | Sang Ho Kwak Seung-Jun Lee Hee Seok Jeong Min Uk Do Kuen Tak Suh |
| author_sort | Sang Ho Kwak |
| collection | DOAJ |
| description | Abstract Background In lateral epicondylitis, even in the absence of apparent instability, subtle instability can be found under anesthesia. We wanted to ascertain the following: (1) how many elbows surgically treated with lateral epicondylitis showed subtle instability during examination under anesthesia (EUA), (2) how effective magnetic resonance imaging (MRI) was in predicting subtle instability, and (3) if any difference existed in preoperative clinical data between elbows with and without subtle instability during EUA. Methods One hundred and twenty-two elbows (117 patients) diagnosed with intractable lateral epicondylitis underwent surgical treatment. No elbow showed apparent instability with conventional physical examination. Under general anesthesia, the elbows were examined for subtle instability via fluoroscopy and divided into unstable and stable groups. Potential prognostic factors and functional scores were assessed retrospectively. The MRIs were reviewed again by two radiologists. Results Seventeen elbows (unstable group, 13.9%) had subtle instability in EUA, while 105 elbows (stable group, 86.1%) did not. Lateral collateral ligament (LCL) complex injury was noted in the MRIs of 28 elbows. Fifteen elbows showed subtle instability among 28 elbows with abnormal MRI (positive predictive value, 53.6%), while 81 elbows did not show subtle instability among 82 elbows with normal MRI (negative predictive value, 98.7%). The preoperative visual analog scale score was higher in the unstable group than in the stable group (p < 0.001), and a history of multiple corticosteroid injections (≥3) was related to subtle instability in EUA (p = 0.042). Other factors showed no significant differences between both groups. Conclusions Subtle instability resulting from LCL complex injury was noted in elbows with lateral epicondylitis. This could be visualized with fluoroscopic EUA, and preoperative MRI could be used to exclude subtle instability. Surgeons should consider checking for subtle instability, especially when patients have a history of multiple corticosteroid injections (≥3) or severe pain and MRI indicates instability. |
| first_indexed | 2024-12-23T20:35:45Z |
| format | Article |
| id | doaj.art-05007ce8fd4547eead076537f750523f |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-23T20:35:45Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-05007ce8fd4547eead076537f750523f2022-12-21T17:32:04ZengBMCBMC Musculoskeletal Disorders1471-24742018-05-011911710.1186/s12891-018-2069-8Subtle elbow instability associated with lateral epicondylitisSang Ho Kwak0Seung-Jun Lee1Hee Seok Jeong2Min Uk Do3Kuen Tak Suh4Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of MedicineDepartment of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of MedicineAbstract Background In lateral epicondylitis, even in the absence of apparent instability, subtle instability can be found under anesthesia. We wanted to ascertain the following: (1) how many elbows surgically treated with lateral epicondylitis showed subtle instability during examination under anesthesia (EUA), (2) how effective magnetic resonance imaging (MRI) was in predicting subtle instability, and (3) if any difference existed in preoperative clinical data between elbows with and without subtle instability during EUA. Methods One hundred and twenty-two elbows (117 patients) diagnosed with intractable lateral epicondylitis underwent surgical treatment. No elbow showed apparent instability with conventional physical examination. Under general anesthesia, the elbows were examined for subtle instability via fluoroscopy and divided into unstable and stable groups. Potential prognostic factors and functional scores were assessed retrospectively. The MRIs were reviewed again by two radiologists. Results Seventeen elbows (unstable group, 13.9%) had subtle instability in EUA, while 105 elbows (stable group, 86.1%) did not. Lateral collateral ligament (LCL) complex injury was noted in the MRIs of 28 elbows. Fifteen elbows showed subtle instability among 28 elbows with abnormal MRI (positive predictive value, 53.6%), while 81 elbows did not show subtle instability among 82 elbows with normal MRI (negative predictive value, 98.7%). The preoperative visual analog scale score was higher in the unstable group than in the stable group (p < 0.001), and a history of multiple corticosteroid injections (≥3) was related to subtle instability in EUA (p = 0.042). Other factors showed no significant differences between both groups. Conclusions Subtle instability resulting from LCL complex injury was noted in elbows with lateral epicondylitis. This could be visualized with fluoroscopic EUA, and preoperative MRI could be used to exclude subtle instability. Surgeons should consider checking for subtle instability, especially when patients have a history of multiple corticosteroid injections (≥3) or severe pain and MRI indicates instability.http://link.springer.com/article/10.1186/s12891-018-2069-8LateralEpicondylitisTendinosisLigamentInstabilityElbow |
| spellingShingle | Sang Ho Kwak Seung-Jun Lee Hee Seok Jeong Min Uk Do Kuen Tak Suh Subtle elbow instability associated with lateral epicondylitis BMC Musculoskeletal Disorders Lateral Epicondylitis Tendinosis Ligament Instability Elbow |
| title | Subtle elbow instability associated with lateral epicondylitis |
| title_full | Subtle elbow instability associated with lateral epicondylitis |
| title_fullStr | Subtle elbow instability associated with lateral epicondylitis |
| title_full_unstemmed | Subtle elbow instability associated with lateral epicondylitis |
| title_short | Subtle elbow instability associated with lateral epicondylitis |
| title_sort | subtle elbow instability associated with lateral epicondylitis |
| topic | Lateral Epicondylitis Tendinosis Ligament Instability Elbow |
| url | http://link.springer.com/article/10.1186/s12891-018-2069-8 |
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