|Posted: Mon Jul 07, 2003 1:59 pm GMT +0000 Post subject: Nirschl Procedure
|Hey Doc...been a while!
I'll get to the point. I landed on the left lebow when going over backwards on a ride more than 6 months ago. It hit a rock on the outside pointy end of the elbow. very soon, I started having tendonitis symptoms and now I couldn't pick up the Sunday paper with that arm if I wanted to. Weird thing is, i can still ride. It HAS however continued to get worse and some of the pain has moved top the other inside bone, but not to the extent of the original injury area. 2 xrays...no fractues or chips that can be seen. injected 2 seperate times with the cortisteroids they use now. Saw some improvement but right back to major pain. Ibuprofen 800 for anti-inflamatory hasn't taken it away. Even the vicoprofen for my back and neck doesn't ALWAY completely get rid of the pain in the arm.
I have surgery scheduled for the 16th to do a Nirschl Procedure. My question to you is what all does that entail and what is the success rate, time of recovery, etc.? I was laid off from work the other day and I have to do it this month or wait until some other time when I regain insurance.
What is your recommendations?
Thanks in advance and hope you and family are doing good!
|The Bike Doc
Joined: 08 May 2003
Location: Corpus Christi and Warda, Texas
|Posted: Mon Jul 07, 2003 5:01 pm GMT +0000 Post subject: Nirschl Procedure
I did a PubMed search http://www.ncbi.nlm.nih.gov./PubMed/ using the search terms of Nirschl AND Procedure and I got this reference from the British Journal of Sports Medicine: http://bjsm.bmjjournals.com/cgi/content/full/35/3/200
The abstract follows:
Br J Sports Med. 2001 Jun;35(3):200-1.
Nirschl tennis elbow release with or without drilling.
Orthopaedic Unit, West Wales Hospital, Camarthen, Wales, UK. firstname.lastname@example.org
Nirschl release appears to be a very successful technique for surgically suitable cases of tennis elbow. However, although the drilling or decortication aspect of the procedure was thought to be of benefit to the immediate outcome, this has not actually been confirmed. This randomised double blind comparative prospective trial shows that drilling confers no benefit and actually causes more pain, stiffness, and wound bleeding than not drilling.
Randomized Controlled Trial
Another two abstracts follow for your review:
J Shoulder Elbow Surg. 1999 Sep-Oct;8(5):476-80.
A modified lateral approach for release of posttraumatic elbow flexion contracture.
Kraushaar BS, Nirschl RP, Cox W.
Nirschl Orthopaedic Sportsmedicine Clinic/Arlington Hospital Sportsmedicine Fellowship Program, VA, USA.
A modified lateral approach for release of posttraumatic flexion contracture of the elbow is described. The approach is a modification of the procedure described by Nirschl for resection and repair of lateral elbow tendinosis (tennis elbow). The modified approach allows visualization of the entire anterior elbow joint without disturbing the common extensor origin or the collateral ligaments. If necessary, a second, posterior triceps-splitting incision is used to access the olecranon fossa. Twelve consecutive patients were treated from 1988 to 1992. Mean flexion/deformity, which measured 41 degrees before operation, measured 8 degrees immediately after operation. The mean flexion/extension arc measured 70 degrees before operation and improved to 117 degrees after operation. With an average follow-up of 36.5 months, mean flexion contracture was 11 degrees and the mean flexion/extension arc of motion was 114 degrees. In no case was a medial approach or transhumeral perforation required. All patients were treated after operation with the elbow splinted in extension for 3 days, after which they were started on an aggressive physical therapy regimen. There were no wound complications, no neurovascular injuries, and no formations of heterotopic bone.
Am J Sports Med. 1997 Nov-Dec;25(6):746-50.
Salvage surgery for lateral tennis elbow.
Organ SW, Nirschl RP, Kraushaar BS, Guidi EJ.
Nirschl Orthopaedic Sportsmedicine Clinic, Arlington, Virginia, USA.
We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery. At revision surgery, findings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the pathologic tissue usually present in the extensor carpi radialis brevis tendon should be resected. Release operations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.
If you live near a major medical center, you may be able to get a copy of this article for more detailed review.
Take time to read the article available at the link as well as the abstracts of the other articles I have provided. It will help answer some of your questions and give some further questions you should discuss with your surgeon before deciding whether or not to procede with the surgery. If still you have concerns, you may wish to get a second opinion before you procede with the surgery. From my review of these abstracts and article there seems to be benefit for the Nirschl surgical release without drilling for tennis elbow like tendonitis and associated joint complications.
Paul K. Nolan, MD
AKA: The Bike Doc