[Unusual injury of the elbow joint].
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Elbow Joint↗
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Sports-related injuries of the elbow: an approach to MRI interpretation.
MRI is a valuable tool for evaluating the athlete with elbow pain, particularly in those with nonlocalizable pain. MRI also is helpful in sorting out the cause of pain in athletes who may have acute trauma superimposed on tendinopathy or other chronic injuries from repetitive microtrauma. Even in athletes in whom the cause of pain confidently can be diagnosed clinically, MRI can document the injury severity, which can be helpful for estimating recovery time or in preoperative planning. By contributing to an accurate early diagnosis, MRI also can help minimize the time that athletes are away from their sports. The authors describe their approach to the MRI interpretation of elbow injuries in athletes, including osteochondral lesions, epicondylitis, and tears of the medial collateral ligament.
Arthrography↗
Injuries around the elbow joint.
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Arm Injuries↗
Biceps and triceps injuries of the elbow.
In this article, the common biceps and triceps injuries about the elbow are reviewed. The relevant anatomy, presenting signs, symptoms, and treatment of these injuries are discussed.
Female↗
Magnetic resonance imaging of sports injuries of the elbow.
Many abnormalities seen in the elbow result from trauma, often from sports such as baseball and tennis. Elbow problems are frequently related to the medial tension-lateral compression phenomenon, where repeated valgus stress produces flexor-pronator strain, ulnar collateral ligament sprain, ulnar traction spurring, and ulnar neuropathy. Lateral compression causes osteochondral lesions of the capitellum and radial head, degenerative arthritis, and loose bodies. Other elbow abnormalities seen on magnetic resonance imaging include radial collateral ligament injuries, biceps and triceps tendon injuries, other nerve entrapment syndromes, loose bodies, osseous and soft-tissue trauma, arthritis, and masses, including bursae.
Athletic Injuries↗
Injuries of the medial epicondylar ossification center of the humerus.
The complex nature of the ossification centers makes elbow injuries in a child or adolescent difficult to evaluate. The medial epicondylar ossification center is involved in a significant proportion. Injuries vary from simple avulsions to wide displacement with entrapment in the elbow. When entrapment occurs, it may be mistaken for the trochlear ossification center and the true nature of the injury overlooked. Radiographic findings are presented. The anteroposterior view was found to be diagnostic in minimal or marked avulsions of the medial epicondyle because of the characteristic inferior displacement. The anteroposterior view may not always be diagnostic in cases of entrapment of the medial epicondyle; the lateral view is usually diagnostic. In elbow dislocation, the presence and position of the medial epicondyle must be ascertained. Comparison and oblique views are often of value.
Adolescent↗
Clinical biomechanics of the elbow in tennis: implications for evaluation and diagnosis.
Elbow injuries constitute a sizeable percentage of tennis injuries. Biomechanical analysis of the forces, loads, and motions on the elbow in tennis, and the constraint systems operating the control the forces, can lead to an understanding of the pathophysiology of these injuries. A biomechanically based evaluation framework can be used to document all of the clinical symptoms, anatomic alterations, and biomechanical alterations that are associated with the pathological problem.
Athletic Injuries↗
A new look at the sequential development of elbow-ossification centers in children.
The pattern and sequence of ossification of the six secondary ossification centers around the elbow in the child were mainly derived from studies done >30 years ago. This series reexamined the sequence and pattern based on a cross-sectional study of the elbow radiographs of 1,577 Chinese children with elbow injuries; age range, from newborn to 17 years. The ratio of girls to boys was 1:2. Each child had a radiograph of the normal and the injured elbow giving a total of 3,154 radiographs. A percentile chart of ossification was constructed for each of the ossification centers in both sexes for easy reference. No differences in the timing and ossification pattern were found between the right and left elbow or between the normal and injured elbow in this study. The sequence of ossification in both boys and girls was found to be the same (i.e., the capitulum first, followed by the radial head, medial epicondyle, olecranon, trochlea, and last, the lateral epicondyle). The ages at which 50% of the girls were found to have positive radiologic ossification for each of these centers were ages 1, 5, 5, 9, 9, and 10 years, respectively. In boys, with the exception of the capitulum, an average delay of 2 years was found in each of the ossification centers, although the sequence remained similar.
Adolescent↗
Complex fracture of the radial neck in a child: an unusual case.
A rare elbow fracture pattern involving the radial neck, olecranon, and medial epicondyle is described in a pediatric patient. Medial and lateral fixation was necessary to control the three planes of instability. Commonly, radial neck fractures with an associated elbow injury (olecranon or medial epicondyle) are stable with lateral fixation alone.
Bone Wires↗
Confidence of graduating family practice residents in their management of musculoskeletal conditions.
A study was undertaken to determine the confidence of graduating family practice residents in the management of musculoskeletal conditions and to determine the level of exposure of graduating family practice residents to fracture care. A 2-page questionnaire consisting of 50 items was sent to 680 graduating family practice residents at 100 randomly selected residency training programs throughout the United States. Family practice residents were questioned about their fracture care experience, including the number of fractures diagnosed, the number of fractures reduced, the number of fractures treated to healing, and the number of casts and splints applied. Residents were also asked about their training experience on an orthopedic surgery service. Residents were asked to rate their confidence on a scale of 1 (least confident) to 10 (most confident) in the physical examination, radiographic evaluation, diagnosis, and treatment of a variety of musculoskeletal conditions, including physical examination of the knee, lower back, ankle, wrist, cervical spine, shoulder, hand, and foot; radiographic evaluation of the lumbosacral spine, traumatic cervical spine, hand injuries, adult shoulder trauma, osteomyelitis, and pediatric elbow injuries; diagnosis of carpal tunnel syndrome, herniated lumbar disc, knee instability, rotator cuff tear, and shoulder instability; and treatment of ankle sprain, tennis elbow, olecranon bursitis, distal radius fracture (Colles), bimalleolar ankle fracture, hip avascular necrosis, knee dislocation, and pediatric elbow fracture. These results were compared with graduating family practice residents' confidence in the physical examination, radiographic evaluation, diagnosis, and treatment of a variety of nonmusculoskeletal conditions. Completed questionnaires were returned by 351 graduating family practice residents. The overall fracture care experience of graduating family practice residents was minimal. Seventy-nine percent of graduating residents had reduced 5 or fewer fractures during their entire residency training program. Experience with cast and splint application was also relatively limited. Graduating family practice residents reported an average of 5.1 weeks (range, 0-10 wk) of training experience on an orthopedic surgery service during their residency. Graduating family practice residents were significantly more confident in the physical examination, radiographic evaluation, diagnosis, and treatment of nonmusculoskeletal conditions than in those of musculoskeletal conditions (P = .0001). Family practice residents who had rotated on an orthopedic service for 8 weeks or more during their training reported significantly higher confidence for all 4 skills-physical examination (P = .003), radiographic evaluation (P = .003), diagnosis (P = .007), and treatment (P = .009). In conclusion, family practice residents show relatively low confidence in the management of musculoskeletal conditions and receive minimal exposure to all aspects of fracture care. Confidence can be improved with greater exposure to the musculoskeletal sciences--such as a rotation of 8 weeks or more on an orthopedic surgery service.
Adult↗
High-resolution MR imaging of the elbow using a microscopy surface coil and a clinical 1.5 T MR machine: preliminary results.
OBJECTIVE: To obtain high-resolution MR images of the elbow using a microscopy surface coil with a 1.5 T clinical machine and to evaluate the feasibility of its use for elbow injuries. DESIGN AND PATIENTS: Five asymptomatic normal volunteers and 13 patients with elbow pain were prospectively studied with MR imaging using a microscopy surface coil 47 mm in diameter. High-resolution MR images using a microscopy coil were obtained with fast spin echo (FSE) proton density-weighted sequence, gradient recalled echo (GRE) T2*-weighted sequence, and short tau inversion recovery (STIR) sequence, with a 1-2 mm slice thickness, a 50-70 mm field of view, an imaging matrix of 140-224 x 512 using zero fill interpolation, and 2-6 excitations. RESULTS: High-resolution MR images of normal volunteers using a microscopy coil clearly showed each structure of the medial and lateral collateral ligaments on GRE T2*-weighted images and FSE proton-density weighted images. Partial medial collateral ligament injury, a small avulsion of the medial epicondyle, and osteochondritis dissecans were well demonstrated on high-resolution MR images. CONCLUSION: High-resolution MR imaging of the elbow using a microscopy surface coil with a 1.5 T clinical machine is a promising method for accurately characterizing the normal anatomy of the elbow and depicting its lesions in detail.
Adolescent↗
Treatment of fractures of the humeral capitellum using herbert screws.
Isolated fractures of the capitellum are rare injuries and account for 1% of all elbow injuries. The purpose of this study is to evaluate the clinical outcomes of 11 Type I capitellum fractures treated by open reduction and internal fixation using at least two standard Herbert screws between 1998 and 2003. The average age of the patients was 27.5 years. The mean follow-up time was 23.4 months. The final postoperative assessment was made at the 12th month. The results were evaluated according to the Mayo Elbow Performance Index. We obtained excellent result in eight patients and good result in three patients. We recommend open reduction and fixation with Herbert screws inserted from the posterior surface of the lateral epicondyle and early mobilization in Type I fractures of the capitellum.
Adolescent↗
Current therapy in the management of heterotopic ossification of the elbow: a review with case studies.
Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.
Adult↗
Longitudinal study of elbow and shoulder pain in youth baseball pitchers.
PURPOSE: Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions. METHODS: A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables. RESULTS: The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season. CONCLUSION: Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.
Alabama↗
MR imaging of tendon abnormalities of the elbow.
Tendon injuries about the elbow are among the most commonly encountered pathology in this articulation. These injuries are often the result of chronic repetitive microtrauma but can be seen in the setting of acute trauma. This article focuses on the imaging diagnosis of tendon pathology in the elbow and the associated findings that can be seen with tendon injury. A detailed understanding of common pathology and patterns of injury can facilitate the ease and accuracy of imaging diagnosis.
Humans↗
Complex elbow instability.
Complex elbow instability consists of dislocation of the ulnohumeral joint with a concomitant fracture of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoid process, or distal humerus. Recurrent instability is not often associated with simple dislocation, but an improperly managed complex dislocation may be a prelude to chronic, recurrent elbow instability. Complex instability is significantly more demanding to manage than simple instability. Radial head, coronoid, and olecranon fracture associated with dislocation each must be assessed and often require surgery. Long-term outcome with surgical management of complex elbow injuries is unknown. A few published series examine combinations of different injury patterns managed with various methods. Recently, however, several well-designed prospective outcome studies have evaluated management of several different individual fracture-dislocation patterns with a unified treatment algorithm. Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability.
Collateral Ligaments↗
[An analysis of overstrain injuries in rock climbing].
Between spring and autumn 1990 a study was performed with the goal of recording and classifying overstrain injuries due to rock-climbing and to define their causes. Of the 332 climbers participating in the study, 114 (34.4%) had suffered from at least one overstrain injury. The degree of climbing skill proved to be the main risk factor; with increasing climbing skills of the observed persons the percentage of injuries increased very substantially. The degree of climbing skill also was the only significant difference between injured and non-injured persons--injured persons had a climbing skill which was 1.3 degrees (UIAA) higher. Warming up was unable to prevent most overstrain injuries. A total of 237 injuries were described. 34.6% of these were long-term defects such as foot deformations and nail dystrophies of the toes. 65.4% were overstrain injuries; 90.3% of these cases concerned the upper part of the body and the upper extremities including the thoracic girdle, areas which are particularly strained in climbs of high degrees of difficulty. The areas affected were almost exclusively tendons, joint capsules and ligaments. By far the most frequent injury of the upper extremity was the proximal interphalangeal joint injury, followed by injuries to the proximal phalanx, the flexor tendons of the forearm and the distal interphalangeal joint. With regard to training injuries, finger injuries occurred most frequently in addition to elbow injuries. 51% of the overstrain injuries were severe, with healing times of months to years. Only 30% of the injured persons consulted a physician.
Athletic Injuries↗
Valgus Extension Injuries of the Elbow in the Throwing Athlete.
Valgus extension injuries of the elbow are common among throwing athletes. There is a wide spectrum of these injuries, ranging from early soft-tissue inflammatory changes to attenuation and incompetence of the ulnar collateral ligament, as well as bone changes, including chondromalacia, osteochondritis, and osteophyte formation. Early treatment should be directed toward decreasing pain and inflammation, followed by global strengthening and conditioning of the elbow with special emphasis on plyometric strengthening of the flexor-pronator musculature. In patients who remain symptomatic after an initial course of nonoperative treatment, arthroscopy of the elbow can address many of the later changes, including chondromalacia, osteochondritis, and osteophyte formation. Reconstruction of the ulnar collateral ligament should be reserved for those patients who wish to remain active at a highly competitive level and for whom rehabilitation and less invasive procedures have failed. Appropriate rehabilitation remains the cornerstone of successful treatment of these patients, facilitating their return to competitive play.
Journal Article↗