Introduction

Acetabular labral pathology is now recognized as a more common injury than previously thought. With cost constraints of MRI and invasiveness of MRI arthrogram, physical examination remains essential for diagnosis. Most tests for labral pathology are currently done in the supine position. We have developed the “twist test,” which is done with the patient standing and can evaluate the patient in functional, weight bearing position. The purpose of this study is to describe the twist test and compare its reliability to MRI arthrogram.

Introduction

Superior Labral Anterior Posterior Tears are being treated surgically in increasing numbers. Stiffness is the most common complication. We reviewed 115 cases of SLAP repairs to try and identify preoperative risk factors if any for stiffness.

Introduction and Aims: This randomised, double-blind, placebo-controlled study evaluated the safety and effectiveness of dermal iontophoretic administration of Dexamethasone Sodium Phosphate 0.4% Injection, USP versus placebo in patients with medial and lateral elbow epicondylitis.

Method: 199 patients with elbow epicondylitis received 40 mA-min of either active or placebo treatment on six occasions. Treatments were spaced one to three days apart and were completed within 15 days. Efficacy variables included patient and investigator global evaluation of improvement, patient and investigator pain evaluation, patient evaluation of symptoms, investigator disease severity assessment and investigator evaluation of tenderness. Baseline scores were compared with scores two days and one month after the sixth treatment.

Results: Dexamethasone produced a 23 mm improvement in patient visual analog scale ratings compared with 14 mm for placebo (p=0.012) at two days and 24 mm compared with 19 mm (p=0.249) at one month. More dexamethasone patients than placebo patients had a score of moderate or better on the investigator global improvement score (52% vs 33%, p=0.013) at two days. This was not significant at one month (54% vs 49%, p=0.650). Investigator pain scores and tenderness scores favoured dexamethasone over placebo (p=0.019 and p< 0.001, respectively) at two days. Patients completing six treatments in ≤10 days appeared to show better efficacy than patients completing treatments over a longer period of time.

Conclusion: Iontophoresis treatment was well tolerated by the majority of the patients and was effective in reducing symptoms of epicondylitis at short-term follow-up.

Introduction and Aims: The purpose of this study was to report our results of surgical resection of plantar fasciosis without a full release using a small transverse plantar incision.

Method: All patients who had a surgical resection for plantar fasciosis at our institution from July 1992 to November 2000 were identified. All surgeries were performed by the senior author (R.P.N.). A small transverse plantar incision was utilised. The focus of the operative technique was identification and resection of only the pathologic fasciosis tissue. A full release of normal plantar fascia was not performed, and the associated calcaneal traction spur was addressed only if easily accessible with the fasciosis resection. Patients were then contacted and asked to fill out a scoring sheet developed at our institution that relates to pain, function, and patient satisfaction after plantar fasciosis resection. This was compared to a scoring sheet that rated the same parameters just prior to surgery. A Wilcoxan signed ranks test was used to compare the results. The incidence of patient and physician noted wound complications were also recorded.

Results: Twelve patients had 15 plantar fasciosis resection operations between July 1992 and November 2000. Of these 12, three were lost to follow-up. The remaining nine patients, four men and five women, had 12 operations (three were bilateral). The ages of the patients at time of surgery ranged from 34 to 72 years. Time of follow-up ranged from two to 10 years (average 6.25 years). There were six left and six right feet for comparison. The pain rating of patients improved from a median of five to 25 (p=0.011). The functional score improved from a median of 3.75 to 25 (p=0.007). The satisfaction of the patients improved from a median of zero to 15 (p=0.007). Patients reported no complaints of wound dehiscence, chronic pain or paresthesias from their plantar incision.

Conclusions: Plantar fasciosis can be effectively treated with acceptable long-term results with a mini-transverse plantar incision that resects only pathologic fasciosis tissue. A full release of the plantar fascia or resection of the calcaneal traction spur is unnecessary for surgical success.