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PubMed2000

Evaluation of the donor site morbidity after lateral arm flap with skin paddle extending over the elbow joint.

The free lateral arm flap may be extended to include the skin over the lateral aspect of the elbow and the forearm. However, extending the flap beyond the lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the lateral aspect of the elbow joint. Seventeen consecutive lateral arm flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the forearm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by flap harvesting (P = 0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contralateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm(2)(range 20-75 cm(2)) was found on the posterolateral surface of the forearm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the lateral arm flap over the lateral condyle.

Adolescent↗

PubMed2003

Angle-specific impairment of elbow flexors strength after isometric exercise at long muscle length.

In this study, we examined the long-term reductions in maximal isometric force (MIF) caused by a protocol of repeated maximal isometric contractions at long muscle length. Furthermore, we wished to ascertain whether the reductions in MIF are dependent on muscle length--that is, are the reductions in MIF more pronounced when the muscle contracts at a short length. The MIF of the elbow flexors of seven young male volunteers was measured at five different elbow angles between 50 degrees and 160 degrees. On a separate day, the participants performed 50 maximal voluntary isometric muscle contractions with the elbow flexors at a lengthened position; that is, with the shoulder hyperextended at 45 degrees and the elbow joint fixed at 140 degrees. Following this exercise, the MIF at the five elbow angles, range of motion, muscle soreness and plasma creatine kinase activity were measured at 24 h intervals for 4 days. On day 1, the decline in MIF was higher at the more acute elbow angles of 50 degrees (42 +/- 8%) and 70 degrees (39 +/- 8%; both P<0.01) than at 90 degrees (26 +/- 4%) and 140 degrees (16 +/- 3%; both P<0.01). No significant reduction in MIF was evident at an elbow angle of 160 degrees. Maximal isometric force at an elbow angle of 140 degrees was fully restored on day 3, whereas at an angle of 50 degrees it remained depressed for the 4 day observation period. Restoration of MIF was a function of the elbow angle, with force recovery being less at the smaller angles. The range of motion was decreased by 14 +/- 2 degrees on day 1 (P<0.01) and did not return to baseline values by day 4. Muscle soreness ratings remained significantly elevated for the 4 day period. Serum creatine kinase peaked on day 1 (522 +/- 129 IU, P<0.01) and decreased thereafter. We conclude that the disproportionate decrease in MIF at the small elbow angles and the length-specific recovery in MIF after repeated maximal isometric contractions at long muscle length may be explained by the presence of overstretched sarcomeres that increased in series compliance of the muscle, therefore causing a rightward shift of the force-length relationship.

Adult↗

PubMedDate not supplied

Sensitivity and specificity of radiographic detection of canine elbow incongruence in an in vitro model.

Canine elbow incongruence is believed to be the consequence of underdevelopment of the radius. The purpose of this study is to determine the sensitivity and specificity of radiography to detect elbow incongruence in an in vitro model and to assess the optimal elbow angle and radiographic beam position. Five normal cadaveric canine left forelimbs were used. A four-pin, type 1 external fixator with a linear motor side bar was fixed to the cranial part of the radius of each limb and a 1 cm segment of bone was removed from the mid-diaphysis to allow radial shortening. Each elbow was subjected to the same protocol. They were radiographed at two different angles (90 degrees and 135 degrees) of flexion, with 10 different radiographic beam positions (centered on the humeral condyle, 3 cm cranial, 3 cm caudal, 3 cm distal, 3 cm proximal, 3 cm cranio-proximal, 3 cm cranio-distal, 3 cm caudo-proximal, 3 cm caudo-distal and on the shoulder joint) and at four different level of radial shortening (0, 1, 2 and 3 mm). In addition, a radiographic view centered on the elbows flexed at 135 degrees was made after simulating weight bearing. The acquired digital images were independently evaluated by three evaluators unaware of the elbows status. The elbows were judged normal, incongruent or borderline based on specific criteria. The sensitivity for detection of elbow incongruence at and beyond 2 mm was excellent at 90 degrees (median = 100% for all views) and good at 135 degrees (median = 80%) of flexion with no difference between examiners. The sensitivity at 1 mm of incongruence was unchanged at 135 degrees but was reduced at 90 degrees of flexion (median = 60%) with a significant difference between the evaluators. The specificity was significantly different between the evaluators and ranged from 70% to 90% at 90 degrees of flexion and from 50% to 80% at 135 degrees. The lowest specificities at 90 degrees were obtained with the proximal displacements of the X-ray beam. Simulating weight bearing significantly decreased the sensitivity at 1 mm (from 80% to 50%) and 3 mm (from 100% to 80%) of incongruence and slightly increased the specificity (from 55% to 65%). Radiography is a sensitive and specific test to detect moderate-to-severe radio-ulnar incongruence (2 mm and over) if the elbow is flexed at a 90 degrees angle regardless of the radiographic beam position. Finally, canine elbow incongruence appeared reduced after an in vitro weight-bearing simulation.

Animals↗

PubMed2002

Deformities of the elbow in achondroplasia.

Lack of full extension of the elbow is a common abnormality in patients with achondroplasia. We studied 23 patients (41 elbows) clinically and radiologically. Extension of the elbow was assessed clinically and the angle of posterior bowing of the distal humerus was measured from lateral radiographs. There was limited extension of the elbow in 28 (68.3%) and the mean loss of extension was 13.1 degrees. Posterior bowing of the humerus was seen in all elbows with a mean angle of 17.0 degrees. There was a positive correlation between these two measurements. Posterior bowing greater than 20 degrees caused a loss of full elbow extension. Posterior dislocation of the radial head was seen in nine elbows (22.0%). The mean loss of extension of the elbows was 28.7 degrees which was significantly greater than that of these elbows in which the head was not dislocated (8.7 degrees), although posterior bowing was not significantly different between these two groups (19.3 degrees and 16.3 degrees). Posterior bowing of the distal humerus is a principal cause of loss of extension of the elbow. Posterior dislocation of the radial head causes further limitation of movement in the more severely affected joints.

Achondroplasia↗

PubMedDate not supplied

Restoration of elbow extension via functional electrical stimulation in individuals with tetraplegia.

Functional electrical stimulation of the triceps is a method of restoring elbow extension to individuals with paralyzed triceps. Eleven arms of individuals with cervical-level spinal cord injuries (SCIs) received a triceps electrode as an addition to a hand-grasp neuroprosthesis. Stimulation was controlled either as part of a preprogrammed pattern or via a switch or an accelerometer that was connected to the neuroprosthesis external controller. The outcome measures were (1) elbow extension moments at different elbow positions, (2) performance in controllable workspace experiments, and (3) comparison to an alternative method of providing elbow extension in these individuals--a posterior deltoid (PD) to triceps tendon transfer. Stimulated elbow extension moments in 11 arms ranged from 0.8 to 13.3 N.m. The stimulated elbow extension moments varied with elbow angle in a manner consistent with the length-tension properties of the triceps. Triceps stimulation provided a significantly stronger elbow extension moment than the PD to triceps tendon transfer. The elbow extension moment generated by the tendon transfer and triceps electrode being activated together was always greater than either method used separately. Stimulation of the long head of the triceps should be avoided in persons with weak shoulder abduction, since the long head adducts the shoulder and limits shoulder function in these cases. Statistically, elbow extension neuroprostheses significantly increased the ability to successfully reach and move an object and significantly decreased the time required to acquire an object while reaching.

Analysis of Variance↗

PubMed1998

Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability.

Current elbow-scoring systems are based on the observer-derived assessment of a variety of clinical and functional criteria, which are scored separately and then aggregated. The aggregate score then is assigned a categorical ranking that ranges from excellent to poor. The developers of different elbow-scoring systems have chosen different outcome criteria, assigned different weights to each criterion, and accorded different ranges of values to each categorical ranking. Five different elbow-scoring systems (the Mayo elbow-performance index and the systems of Broberg and Morrey, Ewald et al., The Hospital for Special Surgery, and Pritchard) were used to evaluate the same group of patients. The validity of the scoring systems was determined with use of visual-analog scales for the assessment of pain and function, patient and physician-derived ratings of the severity of impairment of the elbow, and two functional questionnaires completed by the patient (the Disabilities of the Arm, Shoulder and Hand questionnaire and the Modified American Shoulder and Elbow Surgeons patient self-evaluation form). The study sample consisted of sixty-nine patients who had sought treatment at one of two tertiary referral clinics because of problems related to the elbow. Pearson product-moment correlation coefficients were used to compare the raw aggregate scores, and kappa statistics were used to determine the level of agreement among the categorical rankings (excellent, good, fair, and poor). Examination of the five scoring systems revealed a remarkable lack of concordance with regard to the aspects of elbow function that were assessed. Good correlation was observed when the systems were compared on the basis of raw scores (Pearson product-moment correlation coefficients, 0.79 to 0.90), but only slight-to-moderate correlation was noted when the systems were compared on the basis of categorical rankings (quadratic weighted kappa coefficients, 0.18 to 0.49). Validity testing showed the system of Ewald et al. and the Mayo elbow-performance index to be the most discriminating, the system of Pritchard to be the least discriminating, and the system of The Hospital for Special Surgery and the system of Broberg and Morrey to be intermediate. The scores determined with the elbow-scoring systems demonstrated only moderate correlation with the score for function on the visual analog scale (Pearson product-moment correlation coefficients, 0.44 to 0.66), whereas those derived from the functional questionnaires completed by the patient demonstrated moderate-to-good correlation with the score for function (Pearson product-moment correlation coefficients, 0.72 and 0.80).

Adolescent↗

PubMed1998

Total elbow arthroplasty in patients who have juvenile rheumatoid arthritis.

Patients who have juvenile rheumatoid arthritis often are seen at a very young age because of severe stiffness and pain in several joints. While total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft tissues and the extremely small bones and intramedullary cavities in these patients. As there is little information in the literature regarding this procedure, we attempted to learn about the long-term results by evaluating nineteen patients (twenty-four elbows) with juvenile rheumatoid arthritis who had been managed with total elbow arthroplasty. At an average of 7.4 years (range, two to fourteen years) after the operation, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 points (range, 55 to 100 points). Twenty-two (96 per cent) of the twenty-three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average arc of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperative arc of flexion began at 35 degrees, with additional flexion to 125 degrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average arc of 73 degrees after the operation, and evaluation of the twenty ipsilateral wrists that were not limited by disease revealed that pronation and supination had been maintained. The average functional score improved from 9 points (range, 0 to 25 points) preoperatively to 23 points (range, 15 to 25 points) postoperatively (p < 0.001). The function of eighteen elbows (78 per cent) did not adversely affect the ability to perform activities of daily living. There were thirteen complications, including one perioperative death, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a fracture of the olecranon, subluxation of the prosthesis, stiffness of the elbow, and problems with wound-healing, led to an additional operative procedure but did not adversely affect the long-term outcome after appropriate diagnosis and treatment. Late complications (aseptic loosening, instability, and worn bushings) led to three poor results. None of the eighteen semiconstrained prostheses had radiographic evidence of loosening at the most recent follow-up evaluation. Of the twenty-three elbows that had been followed for at least two years, twelve (52 per cent) had an excellent result, eight (35 per cent) had a good result, and three (13 per cent) had a poor result.

Activities of Daily Living↗

PubMed2004

Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis.

BACKGROUND: Total elbow arthroplasty is a well-established treatment for the painful elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total elbow prosthesis. METHODS: Between June 1982 and December 2000, 204 primary total elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. RESULTS: Six of the 204 elbows had pain at rest at the time of the latest follow-up. Ten patients (ten elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four elbows had revision of the total elbow prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the prosthesis (one). One prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. CONCLUSIONS: Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗

PubMed2005

Intrinsic constraint of unlinked total elbow replacements--the ulnotrochlear joint.

BACKGROUND: Many unlinked total elbow replacement designs with radically differing articular geometries exist, suggesting that there is no consensus regarding an optimal design. A feature inherent to the articular design is the intrinsic constraint afforded to the joint by the implant. Our aim was to compare the intrinsic constraints of unlinked implants with that of the normal ulnotrochlear joint. METHODS: We tested twelve cadaveric ulnotrochlear joints with a custom-made multiple-axis materials testing machine. With compressive loads ranging from 10 to 100 N, the joints were moved in either valgus or varus directions at 90 degrees of flexion. The ulnotrochlear components from a single example of five medium-sized unlinked elbow replacements (Ewald, Kudo, Pritchard ERS, Sorbie-Questor, and Souter-Strathclyde) were also tested. The recorded measurements included the torques and forces, angular displacement, and axial displacement of the humerus relative to the ulna. RESULTS: In general, the peak torque and the constraint ratio significantly increased with increasing compressive load for the implants as well as for the normal elbow. In valgus displacement, the Souter-Strathclyde implant had the highest and the Sorbie-Questor had the smallest peak torque and the Souter-Strathclyde had the highest and the Ewald had the smallest constraint ratio. In varus displacement, the Kudo had the highest and the Ewald had the smallest peak torque and constraint ratio. CONCLUSIONS: The constraint ratio is a characteristic that is useful for describing elbow joint behavior and for comparing the behavior of implants with that of the human elbow. Of the unlinked implants tested, the Souter-Strathclyde and Kudo prostheses most closely approximated the behavior of the human elbow joint. Implants that resemble the human elbow in appearance do not replicate normal behavior consistently, whereas other implants that do not resemble the human elbow closely do not deviate markedly from human behavior. Thus, much basic information about elbow form and function is needed to improve the performance of total elbow prostheses.

Aged↗

PubMed2005

Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. Surgical technique.

Arthritis, Rheumatoid↗

PubMed2000

[Sequential nerve conduction studies in a patient with ulnar neuropathy at the elbow treated by night athletic supporter].

Ulnar nerve can be stretched with the elbow flexed position. To avoid elbow flexed position in patients with ulnar neuropathy at the elbow we used an athletic elbow supporter. We herein demonstrate a 31-year-old man with right ulnar neuropathy at the elbow whose neuropathy was resolved by using this supporter only at night. He had complained of weakness and paraesthesia in the ulnar side of his right hand. Nerve conduction studies of right ulnar nerve revealed decrease in the amplitude of compound nerve action potentials and a severe motor nerve conduction block with apparent conduction delay around the ulnar groove. A diagnosis of ulnar neuropathy at the elbow was done and we recommended him to wear an athletic elbow supporter at night. Paraesthesia of his right hand improved in a few days after starting this therapy. Three months later paraesthesia was resolved. One year later grip power of his right hand increased to 35 kg from 20 kg, and the conduction block at the elbow completely disappeared. Compound nerve action potentials, recorded at the segment of wrist to above elbow and wrist to finger, were improved equally. These observations suggest that the conduction block at the elbow entrapment site and the distal axonal degeneration gradually recovered together.

Elbow↗

PubMed2000

[Clinical study on chitosan for prevention of elbow adhesion].

OBJECTIVE: To study the clinical effect of chitosan on prevention of elbow adhesion after elbow arthrolysis. METHODS: Twenty six patients with elbow ankylosis were performed elbow arthrolysis, which divided into two groups, in chitosan group, 12 patients were injected 2% chitosan into the elbow joint cavity, and no chitosan used in the other 14 patients as control group. The average range of extension and flexion of elbow joint was detected to evaluate the clinical results. RESULTS: All patients were followed up 8 to 51 months, averaged 24 months. In the chitosan group, the average range of extension and flexion of elbow joint was restored to 92.9 degrees +/- 20.9 degrees, with an average increase of 55.0 degrees +/- 15.9 degrees compared with preoperation. In the control group, the average range of extension and flexion of elbow joint was restored to 75.4 degrees +/- 17.5 degrees, with an average increase of 38.2 degrees +/- 11.9 degrees. The outcome showed significant difference between the chitosan group and the control group (P < 0.01). CONCLUSION: Chitosan can prevent or reduce elbow adhesion after elbow arthrolysis.

Adolescent↗

PubMed2002

Can elbow extension be used as a test of clinically significant injury?

BACKGROUND: The objective of this study was to evaluate whether a simple test of full elbow extension was a reliable indicator of bone/joint injury at the elbow joint. METHODS: In this prospective study, patients with acute elbow injuries were asked to fully extend the injured elbow. Radiologists blinded to the results of the extension test interpreted the radiographs. RESULTS: Of 114 patients with acute elbow injury entered into the study, 110 underwent adiographic evaluation. Inability to extend the elbow was found in 37 of 38 patients with bone injury. Only 1 of 54 patients who were able to fully extend the elbow was found to have bone/joint injury. The sensitivity and specificity of the elbow-extension test for identification of bone/joint injury was 97% and 69%, respectively. CONCLUSIONS: The elbow-extension test can be used as a sensitive clinical screening test for patients with acute elbow injuries.

Adolescent↗

PubMed2002

[Kudo non-constrained elbow prosthesis for inflammatory and hemophilic joint disease: analysis in 30 cases].

PURPOSE OF THE STUDY: We analyzed retrospectively 30 Kudo non-constrained elbow prostheses to determine: 1) functional outcome and mobility, 2) frequency of loosening and any complications. MATERIAL AND METHODS: From 1992 to 1998, 30 Kudo total elbow arthroplasties were performed in 29 patients, mean age 55 years. Mean follow-up was 36 months. These patients had severe joint disease: rheumatoid arthritis for 24, psoriatic arthritis for 2, and hemophilic arthritis for 3. The 29 patients experienced severe pain before surgery. RESULTS: At review, 21 elbows were pain free and the 9 others had only occasional pain. Among these 9 elbows, 3 exhibited a rupture of the humeral implant; one had already been revised but remained painful. One patient had a stiff painful elbow after reflex dystrophy and five others had pain but no other complication. Twenty-six patients were satisfied or very satisfied. Three patients were unsatisfied because of the humeral implant fracture. Mean mobility at last follow-up was: 128 degrees flexion, -35 degrees extension, 72 degrees pronation, and 74 degrees supination. Mean gain in flexion-extension was 15 degrees and mean gain in pronosupination was 3 degrees. Pronosupination was greater than 100 degrees except for two patients. There was one immediate post-operative dislocation with failure of prolonged orthopedic treatment after reduction; this patient underwent revision reconstruction with repair of the ulnar collateral ligaments (plasty of the medial collateral ligament with a synthetic ligament). Painful movement of the radial stump was observed with one Kudo prosthesis and required resection to achieve cure. In all, there were 3 fractures of the Kudo I prosthesis at the junction of the trochlea and the humeral stem. Among these patients, one underwent revision due to persistent pain, and two others with currently acceptable symptoms are awaiting revision. At last follow-up, we had: 1 ulnar loosening associated with cortical thinning facing the end of the ulnar implant that had migrated and showed a circular lucent line measuring > 1 mm and progressing; 9 unique ulnar lucent lines measuring<1 mm without progression at the proximal part of the implant (6 at the bone-cement interface and 3 at the bone-implant interface); 3 humeral radiolucent lines (<1 mm without progression) on the distal part of the Kudo II humeral stems corresponding to a zone without surfacing. We also observed 13 cases of incomplete ossification between the humerus and ulna and among these 13, 7 elbows had amplitudes of less than 100 degrees. DISCUSSION AND CONCLUSION: Elbow arthroplasty can restore a painless joint and maintain or improve elbow motion. The procedure is indicated when the joint disease impair daily life activities. Final mobility basically depends on the preoperative mobility. The bone stock remains the greatest problem with these resurfaced prostheses. The GUEPAR elbow prosthesis would appear to be more adapted due to the reconstruction of the trochlea. Resection of the radial head is a source of instability for elbow prostheses and should lead to the design of three-compartment prostheses.

Activities of Daily Living↗

PubMed2002

[Restoration of elbow joint flexion using pectoral muscle transfer in patients with arthrogryposis multiplex congenita. Part I: surgical method, rehabilitation and clinical results].

PURPOSE OF THE STUDY: In patients with type I arthrogryposis multiplex congenita, elbows are fixed in extension. The m. biceps brachii and m. brachialis are usually atrophic. The main objective of arm treatment is to restore flexion in the elbow that would enable the patient to reach the mouth with the hand as well as maintain active extension of the arm for hygienic purposes. This can be achieved by several techniques of muscle transfer. Of these, we selected and modified the method of Clark based on transfer of distal parts of the greater pectoral muscle. The aim of this study was to develop the surgical procedure in detail, to design the course of rehabilitation and to evaluate the outcomes of treatment. MATERIAL AND METHODS: The procedure for optimal transfer of three fifths of the m. pectoralis major was based on an anatomical study. In addition, a unified course of rehabilitation was developed. Between 1996 and 1999, this approach was applied to nine upper limbs in five patients (age range, 4.3 to 9 years). All the patients were evaluated in terms of their clinical state according to selected subjective and objective criteria. RESULTS: The outcomes of transfer of the m. pectoralis major were evaluated as very good and good in six cases. Active movement of the elbow was in the range of 15 degrees to 95 degrees; useful movement ranged from 40 degrees to 70 degrees. The strength of elbow flexion rated 4 or 4+. In three cases, although muscle transfer restricted active elbow extension it did not prevent the upper limb from being used for hygienic purposes. In the remaining three cases, the method failed to restore the patient's ability of reaching the mouth. The analysis of unsuccessful results showed that these were always related to a very limited pre-operative passive flexion of the elbow, restricted movement of the shoulder joint and a failure in distal fixation of the muscle transposed. DISCUSSION: Our results show that transfer of the distal three fifths of the m. pectoralis major, performed by a modified method of Clark, was an effective approach because the working capacity of this muscle was comparable with those of the m. biceps brachii and m. brachialis. Bilateral transfer enabled the patients to reach the mouth with both hands and to use the remaining elbow extension for hygienic purposes. The best function was achieved when active movement of the shoulder had permitted raising the arm above the horizontal and passive elbow flexion had been 90 degrees. Our results are comparable with those reported in the literature. The critical phase of this transfer involved fixation of the m. pectoralis major to the forearm. CONCLUSIONS: The surgical procedure for transfer of the m. pectoralis major and subsequent rehabilitation in patients with type I arthrogryposis are described in detail. Good results are achieved in patients who, pre-operatively, had passive movement of the elbow joint and active movement of the shoulder joint. The method is not suitable for patients with a markedly limited pre-operative movement of both the elbow and the shoulder in whom an alternative surgical treatment should be used.

Arthrogryposis↗

PubMed2005

[The anatomic basis and the clinical treatment of the elbow joint stiffness after electric injury].

OBJECTIVE: To explore the optimal method for the treatment of the elbow joint stiffness accompanied with neural injury after electrical injury. METHODS: Thirty adult cadaver elbows were fixed and dissected to observe the attachments of the ligaments and the muscles around the joint, and its relationship with the major nerves. Ten patients with electric burns with stiffness of the elbow joint were treated by means of loosening the anterior and posterior fascicles of radial and ulnar collateral ligaments, at the same time down shifting the insertion of flexor muscles, replacing the ulnar nerve anteriorly, in order to reconstruct flexor and extension functions of the elbow. The effect was evaluated with biomechanics criteria. RESULTS: Through anatomical study, it was revealed that contracture of the posterior fascicles of the radial and ulnar collateral ligaments and triceps brachii muscle would result in stiffness of the elbow joint, and contracture due to disuse of the two anterior fascicles of the radial and ulnar collateral ligaments and M.biceps brachii would produce flexion deformity of the elbow joint. Postoperatively, the functions of the elbow joints of all the 10 patients recovered satisfactorily. Follow-up from 1 to 3 years showed no change in the range of flexion and extension movements of the elbows, and on the contrary, mobility of the elbow joints was improved. CONCLUSION: Loosening of the anterior and posterior fascicles of the two collateral ligaments and replacement of insertions of biceps and triceps are pivotal in the treatment of stiffness of the elbow joint. Meanwhile lowering the origins of forearm flexor muscles on epicondylus and replacing anteriorly the ulnar nerve can further improve the flexion, function of the joint and relieve compression of the nerve.

Adult↗

PubMed2006

Neuropathic arthropathy of the elbow: a report of two cases.

BACKGROUND: Neuropathic arthropathy (charcot joint) of the elbow is a rare condition. It is among the least frequently reported charcot pathology of the joint. The clinical symptoms are characterized by a painless and unstable joint. Infection in the neuropathic joint is rare. Only a limited number of cases have been reported in the literature. The authors present two cases of neuropathic arthropathy of the elbow. One of them was diagnosed as Septic neuropathic arthropathy. MATERIAL AND METHOD: Two patients with neuropathic arthropathy of the elbow (an infected and a noninfected case) were treated at our department. Both patients were over 60 years old. The underlying conditions associated with the arthropathy included combined median and ulnar neuropathy in the infected case and idiopathic in the non-infected case. Both of the patients had a history of specific trauma at the affected elbows. The radiographs of the elbows revealed dislocation, fracture fragmentation and some bony sclerosis. The management in the non-infected case aimed to maintain the function of the elbow with a short period of immobilization and physical therapy. For the infected case, the patient was treated successfully with systemic antibiotic, surgical debridement and a period of immobilization with an external fixator RESULTS: The patients were followed-up for approximately 9 months for the non-infected and 2 years for the infected case. Both of them had painless and functional range of motion of the elbows in the most recent follow-up examination. For the infected case, the surgical incision healed well and there was no recurrent discharge from that affected elbow. CONCLUSION: In the first case, with neuropathic arthropathy of the elbow, the investigations were made to find the underlying disease. The second case with septic neuropathic joint, systemic antibiotic, surgical debridement and appropriate immobilization were needed. With gross instability and marked distortion of the joint, the elbow of both patients functioned remarkably well.

Aged↗

PubMed1990

Total elbow arthroplasty with a non-constrained surface-replacement prosthesis in patients who have rheumatoid arthritis. A long-term follow-up study.

Thirty-seven elbows in thirty-six patients who had rheumatoid arthritis had a total elbow arthroplasty with insertion of a non-constrained surface-replacement prosthesis. The patients were followed for an average of nine years and six months, the longest follow-up being seventeen years. A good result was seen in twenty-nine elbows; a fair result, in one; and a poor result, in seven. The reasons for the poor results were gross posterior displacement of the humeral component in five elbows, persistent subluxation with pain in one, and recurrent ankylosis in one. Of the five elbows that had gross posterior displacement, four had a revision operation with a new humeral component, and a satisfactory result was eventually achieved. Radiographic examination revealed various degrees of proximal subsidence of the humeral component in 70 per cent of the elbows. However, in most of the elbows the subsidence was not progressive and was compatible with a good clinical result. In contrast, the rate of loosening of the ulnar component was low; loosening was seen in only 5 per cent of the elbows. Seventeen elbows were followed for ten years or more, and comparison of the clinical results in the intermediate period with those at the most recent review revealed that the results improved with time. Because of the number of elbows in which subsidence of the humeral component developed, we now use a humeral component with an intramedullary stem, and were no longer recommend the use of our Type-1 and Type-2 prostheses.

Adult↗