Background: Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management. Purpose: To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery. Study Design: Cohort study; Level of evidence, 3. Methods: To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity. Results: The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively ( P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores. Conclusion: In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.

Background:Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective.Purpose:To evaluate the clinical outcomes of a double-row repair for ME.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system.Results:The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively (P < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively (P = .67).Conclusion:A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.

A three-year-old neutered male Domestic Medium Hair cat was referred for evaluation of a right hindlimb monoparesis of one month duration following a femoral head ostectomy (FHO) performed elsewhere. Examination of the limb revealed muscle atrophy and decreased sensory perception over the sciatic nerve distribution with conscious proprioception and postural reaction deficits. The tentative diagnosis was sciatic neurapraxia. Radiographs taken prior to the FHO revealed a chronic nonunion right femoral neck fracture. The FHO was performed to remove the remnant of the femoral head and neck remaining in the acetabulum. Surgery was performed to explore the sciatic nerve and to revise the FHO into a total hip replacement. Sciatic nerve entrapment was present. Tethering sutures and extensive perineural adhesions were released to restore nerve gliding. Postoperatively, activity was limited for six weeks; normal activity resumed at eight weeks. Rehabilitation treatments were provided to maximise the patient's excellent recovery.

Case: A 69-year-old woman with chronic upper extremity lymphedema secondary to bilateral mastectomy and axillary lymph node dissection for breast cancer 10 years before presented to the clinic with a massive rotator cuff tear. Her shoulder pain and dysfunction persisted despite nonoperative treatment. She underwent left shoulder arthroscopic rotator cuff repair (RCR) and biceps tenotomy. Arm, forearm, and wrist circumference measurements were obtained, preoperatively, immediately postoperatively, and 1-week and 2-weeks postoperatively. No permanent increase in extremity circumference measurements was observed. Conclusion: This case suggests that it is possible to perform an arthroscopic RCR in a patient with chronic upper extremity lymphedema without creating further morbidity.

Background: Systematic evaluation of patients with the post-COVID-19 infections using standardized symptom assessment tools and laboratory testing in the context of clinical care has not been reported previously. Methods: This is a cohort of individuals referred to post-COVID-19 recovery clinics in British Columbia from July 9, 2020 to March 10, 2022. The purpose of the clinics was to systematically assess patients for 3-month post-COVID-19 infections, using validated symptom assessment tools for shortness of breath, fatigue, neuro-psychiatric symptoms, and organ dysfunction as measured by laboratory tests. Patients were referred according to specified criteria, including hospitalization or persistence of symptoms. For our analysis, we included the patients who were referred and evaluated at 3-month post-COVID-19 infection with persistent symptoms. The period chosen corresponds to waves 1–4 in British Columbia.Results: In total, 892 patients were included (median [IQR] age, 53 [42,63] years, with 54.0% females, 39.7% white ethnicity, and 62.0% hospitalized). Shortness of breath (85.9%), fatigue (75.7%), weakness (56.1%), memory problem (47.3%), and myalgia (45.6%) were the most common symptoms reported. Phenotypes of different patients and wave of infection were found associated with different long COVID-19 clinical manifestations after controlling for vaccination status and the underlying comorbidities. Conclusions: Using validated symptom assessment tools, we describe the variability, severity, and frequency of symptoms in this cohort with long COVID-19. Further studies are required to assess the heterogeneity of the long COVID-19 manifestations using standardized assessments to better target therapeutic treatments. RésuméContexte: L’évaluation systématique des patients après une infection par le SRAS-CoV-2à l’aide d’outils normalisés d’évaluation des symptômes et d’examens de laboratoire dans le contexte des soins cliniques n’a jamais été mise en évidence auparavant. Méthodologie: Il s’agit d’une cohorte de personnes orientées vers des cliniques de rétablissement de la COVID-19 en Colombie-Britannique entre le 9  juillet  2020 et le 10  mars  2022. Ces cliniques visent à évaluer systématiquement les patients trois mois après avoir contracté la COVID-19, à l’aide d’outils d’évaluation des symptômes validés pour l’essoufflement, la fatigue, les symptômes neuropsychiatriques et le dysfonctionnement organique mesurés par des examens de laboratoire.L’orientation des patients vers ces cliniques a été effectuée selon des critères prédéfinis, y compris l’hospitalisation ou la persistance des symptômes. Aux fins de notre analyse, nous avons retenu les patients qui ont été orientés et évalués trois mois après avoir contracté la COVID-19 et qui présentaient des symptômes persistants. La période choisie correspond aux vagues 1 à 4 de COVID-19 en Colombie-Britannique. Résultats: Au total, 892 patients ont fait partie de l’analyse (âge médian de 53 ans,écart interquartile [EIQ] de 42 à 63; 54,0% sont des femmes; 39,7% sont de race blanche; 62,0% ont été hospitalisés). L’essoufflement (85,9%), la fatigue (75,7%), la faiblesse (56,1%), les troubles de la mémoire (47,3%) et la myalgie (45,6%) sont les symptômes mentionnés le plus souvent. On constate que les différents phénotypes des patients et la vague au cours de laquelle est survenue l’infection sont associés à des symptômes différents de la COVID-19 longue après la prise en compte du statut vaccinal et des affections comorbides sous-jacentes. Conclusions: À l’aide d’outils validés d’évaluation des symptômes, nous décrivons la variabilité, la gr-avité et la fréquence des symptômes chez cette cohorte de patients atteints de la COVID-19 longue. D’autres études sont nécessaires pour évaluer l’hétérogénéité des symptômes de la COVID-19 longue au moyen d’évaluations normalisées afin de mieux cibler les traitements curatifs.