Fifty cases in 48 patients of intractable medial tennis elbow tendinosis (medial humeral epicondylitis) were treated surgically from 1985 to 1990 with identification and excision of the injured tendon, while retaining and closing the resection defect. All patients had symptoms that were aggravated by repetitive upper extremity activities and had failed to improve with nonoperative therapy. At surgery, the flexor carpi radialis-pronator teres interval was involved in 28 cases. Histologic examination revealed angiofibroblastic tendinosis and fibrillary degeneration of collagen. Postoperative followup averaged 37 months. An analog scale was used to analyze pain intensity, and pain occurrence was evaluated by a pain phase scale. All patients reported partial or complete pain relief postoperatively (improvement in their pain phase and pain intensity scales). Preoperatively, 14 patients had pain at rest; all 14 had relief of this pain postoperatively. Ten patients did not return to their sporting or occupational activities. Objective dynamometer strength testing revealed a significant improvement postoperatively in all patients; no major complications were seen in this series. A large percentage of patients who fail conservative treatment for medial humeral epicondylitis (tendinosis) can obtain pain relief and return to activities with the described operative technique.
Gymnastics has undergone a tremendous increase in popularity largely due to exposure during the Olympics. The injury rate in gymnastics is exceeded only by football, wrestling, and softball. A prospective analysis of club level gymnastic injuries over one season (1982-83) was conducted. Complete responses from 15 clubs (2,558 participants) were obtained. Parameters of clubs followed were: skill level, student, instructor ratio, safety equipment, and conditioning and warm-up exercises. Data obtained from each participant were: injuries sustained, event in which injury occurred, setting of injury, type of injury, and duration of disability. Results were 62 injuries among 542 competitive and 2,016 noncompetitive level athletes (5.3 per 100 competitors and 0.7 per 100 beginners). Of the 62 injuries, 51 were acute and 11 chronic. Twenty-one injuries occurred during floor exercises, 13 on beam, 9 on vault, 6 on uneven parallel bars, and 2 on springboard. Acute injuries included 21 sprains, 16 fractures, 6 contusions, 4 dislocations, and 4 muscle strains. A significant finding was the increased frequency of acute injury seen at dismount. Also there was a positive correlation between duration of frequency of practice (fatigue) and injury rate. We would define a high risk gymnast as one who is performing at an advanced competitive level, performing floor or beam exercises, and practicing more than 20 hours per week.
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