Department of Orthopaedic Surgery & Tulane Institute of Sports Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
J Shoulder Elbow Surg. 2012 Dec;21(12):1651-5. doi: 10.1016/j.jse.2012.04.008. Epub 2012 Jun 26.
Lateral elbow pain has multiple etiologies; most common is lateral epicondylitis. Radio-capitellar arthritis, posterolateral rotatory instability (PLRI), plica and radial tunnel syndromes may produce similar pain. The purpose of this study is to report on a rare subset of patients who had an acute injury during treatment for chronic lateral epicondylitis, exacerbating symptoms and lessening function. Indications for surgery were a failure of another round of nonoperative management and diagnosis of a new injury to the lateral ligaments in addition to the lateral epicondylitis. Surgical intervention revealed the acute injury to the radial ulno-humeral ligament (RUHL) complex, superimposed on chronic lateral epicondylitis, which we believe caused worsening of symptoms. Surgical repair of both lesions provided satisfactory results.
Seven patients (range, 29-46 years; mean, 40.7) being treated for chronic lateral epicondylitis each sustained an acute elbow injury resulting in PLRI. Study data, including Andrews-Carson Elbow Score (ACES) and Mayo Elbow Performance Score (MEPS), were collected in the initial evaluation and at regular postoperative intervals, with a follow-up period of 12-24 months. Indications for surgery were pain, functional impairment, and failure of other treatments. All surgeries were performed on an outpatient basis under general anesthesia in the prone position.
All patients showed arthroscopic evidence of chronic lateral epicondylitis and acute RUHL injury. All showed significant improvement in total ACES and MEPS after repair of both lesions, full range of motion, and objective improvement in strength and function, with no adverse effects or complications.
Patients with chronic lateral epicondylitis who sustain an acute injury may damage the RUHL complex. Early recognition of this additional injury may allow surgical repair of both injuries with satisfactory results.
肘外侧疼痛有多种病因；最常见的是外侧上髁炎。桡骨头-肱骨小头关节炎、后外侧旋转不稳定（PLRI）、滑膜皱襞和桡侧腕管综合征可能产生类似的疼痛。本研究的目的是报告一组罕见的患者，他们在慢性外侧上髁炎的治疗过程中发生急性损伤，使症状加重，功能降低。手术指征为另一轮非手术治疗失败，以及除外侧上髁炎外，外侧韧带的新损伤。手术干预显示急性桡尺骨肱桡韧带（RUHL）复合体损伤，叠加在慢性外侧上髁炎上，我们认为这导致了症状恶化。对这两种病变的手术修复均提供了满意的结果。
7 名患者（年龄范围 29-46 岁；平均年龄 40.7 岁）正在接受慢性外侧上髁炎的治疗，他们每人都发生了导致 PLRI 的急性肘部损伤。在初始评估和定期术后间隔收集包括 Andrews-Carson 肘部评分（ACES）和 Mayo 肘部功能评分（MEPS）在内的研究数据，随访时间为 12-24 个月。手术指征为疼痛、功能障碍和其他治疗失败。所有手术均在全身麻醉下于俯卧位进行门诊手术。
所有患者均显示慢性外侧上髁炎和急性 RUHL 损伤的关节镜证据。所有患者在修复两种病变后，ACES 总分和 MEPS 均显著改善，活动范围完全，力量和功能客观改善，无不良反应或并发症。
患有慢性外侧上髁炎的患者发生急性损伤可能会损伤 RUHL 复合体。早期识别这种额外的损伤可能允许对两种损伤进行手术修复，获得满意的结果。
