he efficacy of extracorporeal shock-wave therapy for tennis elbow was investigated using a single fractionated dosage in a randomised, double-blind study. Outcomes were assessed using the Disabilities of Arm, Shoulder and Hand questionnaire, measurements of grip strength, levels of pain, analgesic usage and the rate of progression to surgery. Informed consent was obtained before patients were randomised to either the treatment or placebo group. In the final assessment, 74 patients (31 men and 43 women) with a mean age of 43.4 years (35 to 71), were included.None of the outcome measures showed a statistically significant difference between the treatment and control groups (p > 0.05). All patients improved significantly over time, regardless of treatment. Our study showed no evidence that extracorporeal shock-wave therapy for tennis elbow is better than placebo. Tennis elbow (lateral epicondylitis) is a condition whose aetiology is poorly understood. The principal symptom is pain located at the lateral epicondyle of the humerus and the common extensor origin just distal to it. The pain quite commonly radiates distally over the extensor surface of the forearm and tends to worsen with activities which require action of the extensor muscles. The onset of symptoms is usually abrupt after an unaccustomed activity, but it may T also be gradual. It usually follows a protracted course, with the degree of pain increasing and decreasing. The principal methods of treatment include splinting, physiotherapy, ultrasound and functional bracing, as with a tennis elbow clasp. If these measures fail, injection of corticosteroids into the common extensor origin is usually given. Surgery is reserved for persistent cases. The commonly used term 'lateral epicondylitis' implies inflammation, but it has not been possible to demonstrate inflammation in pathological specimens, either in the acute or chronic form, because most patients had previously received local injections. Although extracorporeal shock wave therapy (ESWT) has been used extensively for a variety of orthopaedic conditions, the mechanism of its effect on bone and soft tissues remains controversial. Its effect on tennis elbow and on other orthopaedic conditions is unproven because of the lack of randomised, double-blind studies with adequate power. We have attempted to address this deficiency in this study. Patients and MethodsWe recruited 158 patients (70 men and 88 women) into the study all of whom had received extensive conservative treatment and were awaiting surgery. They were sent information about the planned study by post and 141 (63 men and 78 women) who responded were invited to an initial screening clinic. The senior author (LCB) examined each patient to apply the inclusion and exclusion criteria (Table I). He excluded 55 patients (28 men and 27 women), either because it was not possible to make a firm diagnosis of tennis elbow, or because they had a criterion for exclusion. An in-depth discussion of the design of the study and the proposed form of treatment was ...

Deterioration of hand function is a predictable outcome of HPI injury. This information should be shared with the patient at the outset so as to avoid subsequent disappointment.

The paper summarises current knowledge on ganglia of the wrist including the views of patients and doctors. The efficacy of available treatment options are discussed. Summary points are derived from the available knowledge with a referral protocol from primary care.

Twenty patients (14 males, six females) were assessed at an average of 32 months (ten to 156 months) after ray amputation using the disability shoulder, arm, hand (DASH) questionnaire, physical examination and functional testing. There were 14 border (eight index, six little) and six central ray (five middle, one ring) amputations. Our results showed on average 27% less grip and 22% three-point pinch strength in the operated hands. Peak power output was 22% and average work output 14% less on the operated side than the contralateral hand. The DASH function score was 29.2 (range 3.3-74.2). Nine patients returned to their previous occupation, two had to change jobs and two did not return to work. Six patients were not working, one was of school age. The ensuing disability remained within limits reflected by our measurements and the acceptance of the patients.

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