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At least 307 records · Page 17Linked to original sources
PubMed2001

Elbow load during pushup at various forearm rotations.

OBJECTIVE: Elbow joint loading was evaluated during pushup exercises at various forearm rotations. DESIGN: Subjects were asked to perform pushup in various forearm rotations: neutral, 90 degrees internal rotation, and 90 degrees external rotation. BACKGROUND: Training with pushup exercise is good for the muscles and joints of the upper extremities. However, excessive shear forces on the elbow might lead to injuries to either normal trainees or to handicapped people, especially for those who rely on elbow prosthesis. METHODS: The kinematics and kinetics of the elbow joint were investigated under various forearm rotations. RESULTS: The loading biomechanics of the elbow joint differed with various forearm rotations. It was noted that greater posterior and varus forces of the elbow are encountered with internal rotation of the hand position and, consequently, full forearm pronation. CONCLUSIONS: Pushup with hands in internally rotated position should be prevented so as to avoid excessive shear forces or moments. RELEVANCE: Knowledge of elbow kinematics and kinetics may be helpful in preventing injuries by reducing the elbow shear force with changes of forearm rotation.

Adult↗
PubMed2003

Prospective evaluation of biceps to triceps and deltoid to triceps for elbow extension in tetraplegia.

PURPOSE: The purpose of this study was to evaluate and compare the deltoid to triceps and biceps to triceps transfers for restoration of elbow extension in young persons with tetraplegia. METHODS: This was a prospective randomized study. Sixteen arms of 9 subjects between 8 and 20 years of age with cervical-level spinal cord injuries were assigned randomly to undergo either a deltoid to triceps transfer or a biceps to triceps transfer. All arms were followed-up prospectively for at least 2 years after surgery. RESULTS: Elbow extension was restored in 8 arms via the deltoid and in 8 arms via the biceps transfers. At the 24-month follow-up evaluation 7 of the 8 biceps transfers produced antigravity strength (grade 3 or better); in contrast only one arm with the deltoid transfer was able to extend against gravity. There was a considerable but subclinical loss (no subject appreciated any functional deficit) of elbow flexion torque after both transfers. Three months after surgery the deltoid group showed a 51% loss of elbow flexion torque and the biceps group showed a 52% loss of elbow flexion torque. By 24 months after surgery both groups improved but still showed a loss of flexion torque (deltoid 32%, biceps 47%). After gaining elbow extension the subjects in both groups rated the performance of most activities of daily living (ADL) and all self-selected activities as better, as measured on the Modified University of Minnesota Tendon Transfer Functional Improvement Questionnaire and the Canadian Occupational Performance Measure, respectively. Likewise all subjects were more satisfied with performance of their goals after undergoing elbow extension reconstruction. CONCLUSIONS: This study showed the benefits of restoring elbow extension in persons with tetraplegia and provided support for the biceps transfer as an alternative to the deltoid to triceps transfer in individuals with good brachialis and supinator strength.

Activities of Daily Living↗
PubMed1985

Arthroscopy of the elbow.

A technique of diagnostic and surgical arthroscopy of the elbow is presented, and the normal intraarticular anatomy as viewed from the anterolateral, anteromedial, and posterolateral portals is described. A preliminary study of 12 patients who underwent surgical arthroscopy of the elbow demonstrated that removal of loose bodies produced the best objective and subjective results. Less satisfactory results were obtained when procedures such as capitellum and radial head chondroplasties were performed. Using a preoperative and postoperative point accumulation rating system for four objective and four subjective criteria, the following results were noted. Before surgery 50% of the patients objectively rated their elbows as satisfactory (excellent or good), whereas postoperative ratings increased to 83%. Subjectively, 17% rated their elbows as satisfactory before surgery, improving to 58% satisfactory ratings postoperatively. The only complication was a transient median nerve palsy caused by the extracapsular extravasation of a local anesthetic. From this preliminary study, it was concluded that attention to detail is essential in performing a safe, reproducible arthroscopic examination of the elbow, that arthroscopy of the elbow is an effective diagnostic procedure, and that operative elbow arthroscopy is effective in the treatment of certain elbow disorders.

Adolescent↗
PubMedDate not supplied

Acute elbow injuries in the National Football League.

We performed a retrospective review to evaluate acute medial collateral ligament injuries of the elbow in professional football players from 1991 to 1996 (5 seasons). There were 5 acute medial collateral ligament injuries in 4 players (1 player with bilateral involvement). All injuries occurred with the hand planted on the playing surface while a valgus or hyperextension force was applied to the elbow. There were 2 centers, both involved with long-snapping situations, 1 running back, and 1 quarterback. All elbows had valgus instability on physical examination. Despite this instability, all players were able to function without operative reconstruction of the medial collateral ligament. No evidence of valgus instability was seen at the time of follow-up (average, 3.4 years). Next, we reviewed all acute elbow injuries in the National Football League from the same 5-season period. Ninety-one acute elbow injuries were reviewed. Overall, there were 70 (76.9%) elbow sprains, 16 (17.6%) dislocation/subluxation patterns, 4 (4.4%) fractures, and 1 (1.1%) miscellaneous injury. Review of the acute elbow sprains revealed 39 (55.7%) hyperextension injuries, 14 (20%) medial collateral ligament injuries, 2 (2.9%) lateral collateral ligament sprains, and 15 (21.4%) nonspecific sprains. The epidemiology of the 14 medial collateral ligament injuries was studied in more detail. The 2 most common mechanisms of injury were blocking at the line of scrimmage (50%) and the application of a valgus force with the hand planted on the playing surface (29%). There were 8 linemen, 4 receivers, 1 running back, and 1 quarterback. All injuries were managed with nonoperative treatment. The average time lost was 0.64 games (range, 0 to 4). We report 19 acute medial collateral ligament injuries of the elbow in elite football players, 2 of whom are considered overhead throwing athletes, who were able to function at a competitive level without surgical repair or reconstruction, in contrast to baseball players, in whom the mechanics and demands may differ.

Adult↗
PubMedDate not supplied

Surgical reconstruction for posterolateral rotatory instability of the elbow.

We reviewed the results of 10 patients (10 elbows) who underwent surgical reconstruction for clinically symptomatic posterolateral rotatory instability of the elbow. The symptoms resulted from previous dislocation or a hyperextension or varus stress injury of the elbow. Two elbows had underlying preexisting varus deformity. Surgical reconstruction was performed with a tendon graft in 6 elbows and reattachment of the lateral ulnar collateral ligament to the humerus in 4. Postoperatively, no patient had residual instability or a positive pivot shift test in the elbow. Results were graded as excellent or good in 8 and fair in 2. All patients with excellent results had surgical reconstruction with a tendon graft. Subjective assessment revealed that all 10 patients were satisfied with the outcome of the surgery. Accurate recognition of posterolateral rotatory instability of the elbow is important for appropriate management. Surgical ligament reconstruction or repair is the most favorable treatment option for restoration of normal elbow function. The choice of reconstruction with a tendon graft appeared to produce better results than the reattachment of the injured ligament by itself in achieving an excellent outcome.

Adult↗
PubMed2001

V-Y slide of the common extensor origin for lateral elbow tendonopathy.

Twenty-two patients (23 limbs) with chronic lateral elbow tendonopathy were examined retrospectively after surgical management. Thirteen men and 9 women with an average age of 43 years (range, 32-54 years) had a mean follow-up time of 41.2 months (range, 9-97 months). All patients underwent at least 6 months of nonsurgical treatment without favorable response. V-Y slide of the common extensor origin was done for all patients. Sixteen patients (17 elbows) were examined after surgery and 6 were interviewed by telephone. None of the patients had major complications or permanent loss of elbow motion. A pain rating scale of 1 to 10 (10 being the worst) showed a difference from a rating of 9.0 (range, 7-10) before surgery to 1.4 (range, 0-4) after surgery. Grip strength increased from 57 lb (range, 5-125 lb) to 99 lb (range, 60-135 lb). Five patients (23%) reported some degree of cold intolerance. Twenty-one patients (95%) returned to their preoperative occupation with 1 patient not returning to work because of elbow pain caused by heavy and repetitive elbow stress especially from vibrating tools. Twenty-one patients (95%) reported no limitations in daily activities; 1 patient reported difficulty with opening jars. Seven people (32%) reported limitations in high-demand recreational activities. All patients were rated as poor before surgery and excellent or good after surgery by a grading scale. All patients were satisfied with the outcome of surgery. After surgical treatment for lateral elbow tendonopathy, pain relief and restoration of elbow function can be achieved. V-Y slide of the extensor origin has low morbidity, does not violate the joint space or lateral stabilizing ligaments of the elbow, allows adequate release, and has a high rate of satisfaction.

Activities of Daily Living↗
PubMedDate not supplied

Single-strand ligament reconstruction of the medial collateral ligament restores valgus elbow stability.

The purpose of this study was to determine the contribution of the central portion of the anterior bundle of the medial collateral ligament (MCL) to elbow stability and to evaluate the effectiveness of a single-strand MCL reconstruction in restoring elbow stability. Testing of 11 fresh-frozen upper extremities was first performed on the intact elbow and then with the capsule, flexor-pronator muscle group, posterior bundle, anterior or posterior band, and central band cut sequentially. Next, a single-strand reconstruction of the MCL was performed. The elbow was moved passively through a full arc of flexion in both varus and valgus gravity-loaded positions. Ulnar movement with respect to the humerus was analyzed by means of an electromagnetic tracking system. Maximum varus-valgus laxity throughout the arc of supinated flexion and pronated flexion was 6.6 degree plus minus 2.4 degree and 7.4 degree plus minus 2.0 degree, respectively, for the intact specimen, 34.2 degree plus minus 5.6 degree and 37.7 degree plus minus 11.8 degree for the specimen with all of the medial valgus elbow stabilizers cut, and 9.0 degree plus minus 2.5 degree and 10.5 degree plus minus 2.7 degree for the reconstructed specimen. Maximum varus-valgus laxity was not significantly different among any of the sectioning sequences until the central band was cut (P <.0001). There was no significant difference in maximum varus-valgus laxity between the intact and reconstructed elbows (P <.05). Our results demonstrate that the central band is an important valgus stabilizer of the elbow and that a simplified single-strand reconstruction is able to restore stability to the MCL-deficient elbow.

Aged↗
PubMed1985

Elbow moment and forces at the hands during swing-through axillary crutch gait.

We investigated swing-through axillary crutch gait (nonweight bearing on the left lower extremity) to determine the effects of gait speed, crutch length, and handle position on the forces exerted at the hands and on the moments exerted about the elbow joints. Ten healthy subjects, skilled in swing-through crutch gait, walked at three speeds using fitted crutches, at a fixed speed with four different crutch lengths, and at a fixed speed with four different handle positions. We collected ground reaction forces that exerted simultaneously on the right crutch and motion data with a force plate and three high-speed movie cameras. A biomechanical model was developed to calculate the forces exerted at the right hand and the moments exerted about the right elbow joint. Changing gait speed from slow to the normal gait of the subject showed statistically significant effects (p less than .05) on the forces at the hand. When we changed crutch heights for the subjects, we found no significant effects on the forces at the subjects' hands. Changing handle position significantly affected the moment at the elbow. Increasing the elbow-flexion angle above 30 degrees by raising the crutch handle 1 to 2 in resulted in a 100 percent increase in elbow-extension moment. We found a correlation of .82 between actual average elbow-flexion angle and elbow-extension moment. Changing gait speed or crutch length did not affect elbow moment.

Adult↗
PubMedDate not supplied

Changes in head and neck position have a greater effect on elbow joint position sense in people with whiplash-associated disorders.

BACKGROUND: It has been shown that perception of elbow joint position is affected by changes in head and neck position. Further, people with whiplash-associated disorders (WAD) present with deficits in upper limb coordination and movement. OBJECTIVES: This study is aimed to determine whether the effect of changes in head position on elbow joint position error (JPE) is more pronounced in people with WAD, and to determine whether this is related to the participant's pain and anxiety levels. METHODS: Nine people with chronic and disabling WAD and 11 healthy people participated in this experiment. The ability to reproduce a position at the elbow joint was assessed after changes in the position of the head and neck to 30 degrees , and with the head in the midline. Pain was monitored in WAD participants. RESULTS: Absolute elbow JPE with the head in neutral was not different between WAD and control participants (P=0.5). Changes in the head and neck position increased absolute elbow JPE in the WAD group (P<0.05), but did not affect elbow JPE in the control group (P=0.4). There was a connection between pain during testing and the effect of changes in head position on elbow JPE (P<0.05). DISCUSSION: Elbow JPE is affected by movement of the head and neck, with smaller angles of neck rotation in people with WAD than in healthy individuals. This observation may explain deficits in upper limb coordination in people with WAD, which may be due to the presence of pain or reduced range of motion in this population.

Adult↗
PubMed2005

Elbow arthroplasty using a convertible implant.

Total elbow arthroplasty remains the most definitive functional procedure for patients with end-stage painful arthritis of the elbow. Complication rates have historically been quite high, and early revision was not uncommon. A greater understanding of elbow anatomy and kinematics has led to advances in prosthetic design and surgical technique. The success of modern elbow arthroplasty for low-demand patients with rheumatoid arthritis has approached that of hip and knee arthroplasty. Mechanical failures have been noted to increase as a complication of both longevity and the use of elbow arthroplasty in a younger, higher-demand patient population. As the indications for total elbow arthroplasty widen to include more complex situations, it becomes more important to precisely recreate the flexion-extension axis of the elbow to optimally balance muscle forces and ligaments in an effort to improve implant durability. Advances in implant modularity and instrumentation can make determination and recreation of the flexion-extension axis more reliable and reproducible. An anatomic convertible implant allows the surgeon great versatility in choosing to perform hemiarthroplasty or unlinked or linked total elbow arthroplasty with assurance that later revision can be performed without the compulsory removal of well-fixed components. Conversion from an unlinked to a linked constraint, and visa versa, can be performed at any time. If late conversion is required, it can be performed in a minimally invasive fashion.

Arthritis↗
PubMed2006

Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients.

BACKGROUND: Distal humerus fractures in elderly patients are difficult to treat as these fractures are often complicated by varying degrees of comminution intra-articular involvement and osteoporosis. We retrospectively reviewed the results of primary total elbow arthroplasty in the treatment of distal humerus fractures in seven patients followed for a minimum of 1 year. METHODS: Between July 2000 and June 2002, seven patients with distal humerus fractures were treated electively with total elbow arthroplasty using the semiconstrained Coonrad-Moorey elbow replacement prostheses. The Mayo Elbow Performance Score was used to assess the outcomes. RESULTS: The mean age of our patients was 72.9 years. The mean duration of postoperative hospitalization stay was 7.6 days. The average length of follow up was 24.9 months. Six of these patients had no pain, and one patient had mild pain. The mean arc of flexion was 88.6 degrees. Six elbows had excellent results, while 1 elbow had good result. The mean Mayo score was 94.3 points. One elbow developed blisters postoperatively but resolved with dressings and antibiotics. CONCLUSIONS: Our review suggests that total elbow arthroplasty can give good to excellent short term results when used in the treatment of distal humerus fractures in elderly Asian patients.

Aged↗
PubMed2004

Compass elbow hinge: short-term results in five adolescents.

The Compass Elbow Hinge (Smith and Nephew, Memphis, Tennessee, USA) was developed in the late 1990s as a mean of treating elbow contractures, utilizing Ilizarov's principles of distraction histeogenesis and a circular frame external fixator. Subsequent reports were published on its use for treating elbow ankylosis and instability in adults. Since 1999 five paediatric patients (aged from 12 to 15 years) have been treated by this device in our institute. The indications were post-traumatic elbow stiffness in four patients and elbow ankylosis following septic arthritis in one patient. Application of the elbow hinge was accompanied by open soft tissue contracture release, both anteriorly and posteriorly. Elbow mobilization and physiotherapy were commenced immediately postoperatively. The hinge was removed after 6-8 weeks. Follow-up ranged from 5 to 36 months. Complications were limited to simple pin track infection in three patients, and transient ulnar neuropraxia in one. The Compass Elbow Hinge (Smith & Nephew) application was successful in improving the arc of motion in three patients out of five.

Adolescent↗
PubMed2001

Reciprocal EMG control of elbow extension by FES.

Elbow extension is critical in performing activities of daily living. Individuals with a C5-C6 spinal cord injury have paralyzed elbow extensors, yet retain weak to strong voluntary control of elbow flexion. Previous studies have shown that functional electrical stimulation (FES) of the triceps provides sufficient elbow extension strength and control to greatly improve function. With triceps stimulation applied at a constant level, elbow angle is controlled naturally by voluntary flexion opposing the stimulated extension-referred to as voluntary antagonist control. We have investigated an alternative reciprocal control scheme employing biceps electromyogram (EMG) to modulate triceps stimulation. With reciprocal control, increasing biceps EMG proportionally reduces triceps stimulation. A personal computer (PC)-based lab system was designed to test the feasibility of reciprocal control. Reciprocal control increased the range of elbow moments, was stable during maintained elbow angle or isometric moment, and used less stimulation. Reciprocal control of triceps stimulation using biceps EMG is an effective method for restoring elbow extension to C5-C6 spinal cord injury patients, and could be extended to other situations where a voluntarily controlled muscle can be opposed by stimulating an antagonist.

Activities of Daily Living↗
PubMed1998

The effect of strength training on 'handball goalie's elbow'--a prospective uncontrolled clinical trial.

'Handball goalie's elbow' is defined as pain due to repetitive forced hyperextension of the elbow. Strength training has been suggested for prevention and rehabilitation of this injury. The present study examines the effect of a strength-training programme after 24 months in a prospective uncontrolled clinical trial in goalkeepers with 'handball goalie's elbow'. Concentric and eccentric elbow exercise loads at approximately 80% of one repetition maximum (1-RM) were carried out 8 to 10 times 3 times a day, 3 days a week. Muscle strength was measured for flexion and extension of the elbow and wrist, and pro- and supination of the forearm. Sixteen amateur goalkeepers (10 men and 6 women) with 25 (12 right and 13 left) injured elbows (16 male and 9 female) were evaluated. Their mean age was 21.0 (range 16-35) years and their elbow pain had at the time of inclusion lasted for 28.9 (range 3-54) months. The players were tested at inclusion and after 24 months. The strength tests showed improvement in all the tested motions. The subjective status of the goalkeepers was excellent in 9, good in 9, and fair in 7. The study indicates that specific strength training may be effective in rehabilitation of 'handball goalie's elbow'.

Adolescent↗
PubMed1998

Muscular resistance to varus and valgus loads at the elbow.

Although the contributions of passive structures to stability of the elbow have been well documented, the role of active muscular resistance of varus and valgus loads at the elbow remains unclear. We hypothesized that muscles: (1) can produce substantial varus and valgus moments about the elbow, and (2) are activated in response to sustained varus and valgus loading of the elbow. To test the first hypothesis, we developed a detailed musculoskeletal model to estimate the varus and valgus moment-generating capacity of the muscles about the elbow. To test the second hypothesis, we measured EMGs from 11 muscles in four subjects during a series of isometric tasks that included flexion, extension, varus, and valgus moments about the elbow. The EMG recordings were used as inputs to the elbow model to estimate the contributions of individual muscles to flexion-extension and varus-valgus moments. Analysis of the model revealed that nearly all of the muscles that cross the elbow are capable of producing varus or valgus moments; the capacity of the muscles to produce varus moment (34 Nm) and valgus moment (35 Nm) is roughly half of the maximum flexion moment (70 Nm). Analysis of the measured EMGs showed that the anconeus was the most significant contributor to valgus moments and the pronator teres was the largest contributor to varus moments. Although our results show that muscles were activated in response to static varus and valgus loads, their activations were modest and were not sufficient to balance the applied load.

Adult↗
PubMed2006

Influence of shoulder abduction and lateral trunk tilt on peak elbow varus torque for college baseball pitchers during simulated pitching.

Elbow varus torque is a primary factor in the risk of elbow injury during pitching. To examine the effects of shoulder abduction and lateral trunk tilt angles on elbow varus torque, we conducted simulation and regression analyses on 33 college baseball pitchers. Motion data were used for computer simulations in which two angles-shoulder abduction and lateral trunk tilt-were systematically altered. Forty-two simulated motions were generated for each pitcher, and the peak elbow varus torque for each simulated motion was calculated. A two-way analysis of variance was performed to analyze the effects of shoulder abduction and trunk tilt on elbow varus torque. Regression analyses of a simple regression model, second-order regression model, and multiple regression model were also performed. Although regression analyses did not show any significant relationship, computer simulation indicated that the peak elbow varus torque was affected by both angles, and the interaction of those angles was also significant. As trunk tilt to the contralateral side increased, the shoulder abduction angle producing the minimum peak elbow varus torque decreased. It is suggested that shoulder abduction and lateral trunk tilt may be only two of several determinants of peak elbow varus torque.

Abdomen↗
PubMed2004

Mapping from motor cortex to biceps and triceps altered by elbow angle.

This experiment used cortical microstimulation to probe the mapping from primary motor cortex to the biceps and triceps muscles of the arm in monkeys. The mapping appeared to change depending on the angle at which the elbow was fixed. For sites in the dorsal part of the arm and hand representation, the effects of stimulation were consistent with initiating a movement of the elbow to an extended angle. Stimulation evoked more triceps activity than biceps activity, and this difference was largest when the elbow was fixed in a flexed angle. For sites in the ventral part of the arm and hand representation, stimulation had the opposite effect, consistent with initiating a movement of the elbow to a flexed angle. For these sites, stimulation evoked more biceps activity than triceps activity, and the difference was largest when the elbow was fixed in an extended angle. For sites located in intermediate positions, stimulation evoked an intermediate effect consistent with initiating a movement of the elbow to a middle, partially flexed angle. For these sites, when the elbow was fixed at a flexed angle, the evoked activity was largest in the triceps, and when the elbow was fixed at an extended angle, the evoked activity was largest in the biceps. These effects were obtained with 400-ms-long trains of biphasic pulses presented at 200 Hz and 30 microA. They were also obtained by averaging the effects of individual, 30-microA pulses presented at 15 Hz. How this stimulation-evoked topography relates to the normal function of motor cortex is not yet clear. One hypothesis is that these results reflect a cortical map of desired joint angle.

Animals↗
PubMed2005

The "moving valgus stress test" for medial collateral ligament tears of the elbow.

BACKGROUND: The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. HYPOTHESIS: The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. RESULTS: The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. CONCLUSIONS: The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

Adolescent↗