Orthopedic surgery / by Sir Robert Jones and Robert W. Lovett.

  • Robert Jones
Date:
1929
Catalogue details

Licence: Public Domain Mark

Credit: Orthopedic surgery / by Sir Robert Jones and Robert W. Lovett. Source: Wellcome Collection.

    85/832 (page 65)
    usual physiotherapeutic measures. One of the most effective forms of con¬ servative treatment is the application of a small felt pad with a hole in the centre to accomodate the epicondyle, combined with modified use of the joint. In certain cases manipulation under anaesthesia often brings about a dramatic cure. Examination shows little more than a definite area of tenderness with perhaps a feeling of increased elasticity and the X-ray examination is negative. Motions are free, and when passively carried out generally painless; but if a fist is made and the wrist palmar flexed, there is pain at the site of the lesion. A study of the anatomy shows that there is often a small bursa beneath the conjoined tendon over the radiohumeral joint. In the cases reported by \6XvcoX\% VeacKA ixtetvsoY caw ycAAqXxs ca^OcxxVm. tcAw.— ycx. eAexisoT -cav^x NiWarVg 'ax.\\evo'f wYtxans W\. <«Ww<30Y MXTX ■ COXXXXXXXXXUS X\V<XVvf.Ot^».=> w.aAaxxsw caxxjx. 'coAxcvW \c'r\9\x«, 'Ctx.Vro.c.Vxxo---- Y oA\&Y\‘5 Fig. 51.—Muscular anatomy, showing location of radiohumeral bursa through split in conjoined tendon of extensor muscles (R. B. Osgood). Osgood relief follows the removal of this bursa, and it seems fair to assume that in most cases the essential pathology is due to an inflammatory reaction in the connective tissue plane, located beneath the conjoined tendon of the extensor muscles between this tendon and the tip of the epicondyle, the origin of the supinator radii brevis and the radiohumeral joint. It is of course pos¬ sible that this so-called “epicondylitis” may be due to lesions of more than one structure, but where a definite bursa exists, the operative removal of the latter seems to be the best treatment. An oblique incision is made, extending from the condyle downward in line with the radius, well over the radial head. Dis¬ section is carried down through the fascia in this line and the fibres of the conjoined tendon split. The diseased tissues are removed and the wound closed (Figs. 51-52). A similar result may be sometimes obtained after the insertion of a hot cautery needle into the painful scar.