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Patient-reported outcome of surgical treatment of nerve entrapments in the proximal forearm
Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2011 (English)In: Advances in orthopedics, ISSN 2090-3472, Vol. 2011, 727689- p.Article in journal (Refereed) Published
Abstract [en]

The outcome of decompression for long-standing symptoms of nerve entrapments in the proximal forearm was investigated in a retrospective study of 205 patients using a self-assessment questionnaire, 45 months after the operation. The questionnaire consisted of visual analogue scale recordings of pre- and postoperative pain during rest and activity, questions about remaining symptoms and appreciation of the result and the Disabilities of Arm, Shoulder and Hand form (DASH). Altogether, 59% of the patients were satisfied, 58% considered themselves improved, and 3% as being entirely relieved of all symptoms. Pain decreased significantly (P = 0.001). There was a significant correlation between preoperative duration and patient perceived post-operative pain. Preoperative pain was a chief complaint, and pain reduction appears to be the principal gain of the operation. Although the majority of the patients benefited from the operation, a substantial proportion was not satisfied. There is apparently room for improvement of the diagnostic and surgical methods applied in this study.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2011. Vol. 2011, 727689- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-72717DOI: 10.4061/2011/727689PubMedID: 21991420OAI: oai:DiVA.org:liu-72717DiVA: diva2:461767
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2014-09-25Bibliographically approved
In thesis
1. Treatment of Epicondylalgia and Nerve Entrapments around the Elbow
Open this publication in new window or tab >>Treatment of Epicondylalgia and Nerve Entrapments around the Elbow
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Disorders causing pain in the elbow region is a common problem and is one of the most frequent forms of work-related health problems. These conditions are thus of major importance from the public health point of view, as well as from that of the suffering individual. Both sensory and motor function may be impaired, particularly in cases where a nerve is involved, resulting in severely impaired hand function.

“Tennis elbow” (lateral epicondylalgia) has been found to be the second most frequently diagnosed musculoskeletal disorder of the upper extremity in the primary health-care setting. “Golfer’s elbow” (medial epicondylalgia) is not that commonly encountered. It has been stated that tennis or golfer’s elbow syndromes are self-limiting. Even so, clinical experience has shown that there are a few cases where symptoms have a painful and long-lasting course, resistant to many forms of therapy. The outcomes of frequently adopted management regimes for treatment of epicondylalgia or nerve entrapments around the elbow were examined in the following five studies:

I: A randomised, prospective study of 38 patients with tennis elbow (lateral epicondylalgia). Groups were assigned to eccentric exercises or stretching. Eccentric exercise gave somewhat better results.In a second part of the study, a 4-year follow-up of 127 patients who used eccentric exercises for tennis elbow was performed. Patients showed decreased pain and increased grip-strength after 3 months treatment. At the time of publication this study was the first to examine eccentric exercises for this condition.

II: A retrospective analysis of long-term results from 51 patients treated with surgical release of the common extensor origin because of “chronic tennis elbow”. Eighty-seven per cent of the patients rated themselves as completely recovered or improved.

III: A randomised, prospective study of 70 patients with ulnar neuropathy in the forearm (cubital tunnel syndrome). Groups assigned the commonly recommended elbow brace at night or nerve gliding exercises were compared with a control group (information only). The majority of patients improved considerably, both subjectively and objectively, after a 3 months period, regardless of group. The study thus showed the effectiveness of information and expectance, and that orthosis or nerve gliding exercises added nothing further to the result.

IV: A retrospective study of 205 patients treated with surgery for suspected nerve entrapment in the forearm. Followup, almost 4 years later, demonstrated a subjective improvement in two of three patients, but only 3% experienced complete relief of all symptoms.

V: A prospective long-term study on 20 patients with golfer’s elbow (medial epicondylalgia) treated with eccentric exercises over 3 months. The results showed decreased pain and increased gripstrength. This is the first study published on the management of this disorder with eccentric exercises.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 93 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1262
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72719 (URN)978-91-7393-065-9 (ISBN)
Public defence
2012-01-28, Ekensalen, Campus US, Linköpings universitet, Linköping, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2011-12-16Bibliographically approved

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Nylander, GöranAdolfsson, Lars

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Plastic Surgery, Hand Surgery and BurnsFaculty of Health SciencesDepartment of Hand and Plastic SurgeryOrthopaedics and Sports MedicineDepartment of Orthopaedics in Linköping
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