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PubMed2005

Elbow range of motion in professional baseball pitchers.

BACKGROUND: Physicians involved with the care of baseball players have noted elbow range of motion changes in pitchers. Objective data regarding the extent of these changes have rarely been documented. HYPOTHESIS: Dominant and nondominant elbow range of motion differences are common in baseball pitchers, and these differences are related to player age, amount and length of time professionally pitched, and history of surgical procedures on the dominant extremity. STUDY DESIGN: Cross-sectional study; Level of evidence, 4. METHODS: Thirty-three professional pitchers were evaluated for elbow range of motion during spring training preseason physical examination. Dominant and nondominant elbow range of motion including flexion, extension, supination, and pronation were measured with a goniometer. Range of motion measures from the dominant and nondominant sides were compared. Baseball records were reviewed for arm dominance, age, years of professional pitching, professional innings pitched, and history of elbow surgery. These factors were evaluated for their possible association with range of motion for each side and the difference between sides. RESULTS: Statistically significant differences between dominant and nondominant sides were noted for elbow extension (dominant decreased 7.9 degrees +/- 7.4 degrees, P < .0001), flexion (dominant decreased 5.5 degrees +/- 7.8 degrees, P = .0003), and total flexion-extension arc (dominant decreased 13.3 degrees +/- 13.7 degrees, P < .0001). No significant difference between sides was found for the supination or pronation measures. No correlation was noted for age, pitching history, surgery, or arm dominance and the motion differences. CONCLUSION: Professional pitchers demonstrate elbow flexion and extension differences between dominant and nondominant elbows. No correlation was found between motion differences and age, pitching history, surgery, or arm dominance.

Adult↗
PubMed2004

Tennis elbow--outcome following the Garden procedure: a retrospective study.

PURPOSE: From 1993 to 1999, 17 patients (18 elbows) underwent the Garden procedure for clinically diagnosed tennis elbow. Non-operative treatment was ineffective for these patients. METHODS: The study group consisted of 10 men and 7 women, with a mean age of 49.6 years. Follow-up duration ranged from 18 months to 6 years, with a mean of 37 months. Patients' pain, activity level, and hand grip strength were evaluated postoperatively. RESULTS: 14 (77.8%) elbows had an excellent or good result, 2 elbows had a fair result, and another 2 elbows had a poor result and required revision surgery. Most patients had immediate relief of elbow pain, returned to work early, and did not notice any weakness of hand grip strength or radial wrist extension. There were no significant complications. CONCLUSION: The Garden procedure produced good results for tennis elbow with minimal morbidity in an unselected group of patients. This retrospective study supports the view that the underlying lesion in tennis elbow is in the origin of extensor carpi radialis brevis.

Adult↗
PubMed2002

Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players.

BACKGROUND: The prevalence of medial elbow instability is high in athletes who throw, such as baseball players. The aim of this study was to assess the medial aspect of the elbow with ultrasonography to detect changes in baseball players. METHODS: Ultrasonography of the medial aspect of the elbow was performed, while gravity stress was applied with the elbow in 90 degrees of flexion, on thirty college baseball players (twelve pitchers and eighteen fielders) to assess medial joint laxity and deformity of the ulnar collateral ligament. The dominant (throwing) extremity was compared with the contralateral extremity. Clinical data were correlated with ultrasonographic findings. RESULTS: The medial joint space was significantly wider on the throwing side than it was on the contralateral side (2.7 mm and 1.6 mm, respectively; p < 0.01), and the proximal part of the ulna was shifted significantly laterally on the throwing side (p < 0.01). Angular deformity of the ulnar collateral ligament was found in five subjects, and it was significantly associated with lateral shift of the proximal part of the ulna (p < 0.01). Medial elbow pain was associated with widening of the medial joint space (p < 0.05) and with the presence of angulation of the ulnar collateral ligament (p < 0.01). CONCLUSIONS: Medial elbow laxity and elbow valgus on the throwing side of baseball players were increased compared with those in nonplayers. Angular deformity of the ulnar collateral ligament suggests that the ligament bends over the distal-medial edge of the trochlea. Ultrasonography can provide useful information about the condition of the ulnar collateral ligament and about medial elbow laxity in athletes who throw.

Adolescent↗
PubMed2003

Operative release of complete ankylosis of the elbow due to heterotopic bone in patients without severe injury of the central nervous system.

BACKGROUND: Although uncommon, complete ankylosis of the elbow secondary to heterotopic ossification results in severe disability. The results of surgical management remain unclear. METHODS: A single surgeon used a consistent operative technique to treat complete osseous ankylosis of the elbow in eleven limbs in seven patients after severe burns and in nine elbows in eight patients after trauma. The elbows in the burn cohort were more often ankylosed in extension (average, 47 degrees of flexion) compared with those in the trauma cohort (66 degrees of flexion), and they had more skin problems (three elbows required a free microvascular muscle transfer for coverage) and associated problems of the shoulder, wrist, and hand. RESULTS: Four patients in the burn cohort and three patients in the trauma cohort failed to regain at least 80 degrees of ulnohumeral motion. After a repeat release in three burn patients and three trauma patients, and at an average follow-up of forty months, the average arc of ulnohumeral motion was 81 degrees in the burn cohort and 94 degrees in the trauma cohort. Six of the eleven limbs in the burn cohort and five of the nine in the trauma cohort had a good result. The average score according to the American Shoulder and Elbow Surgeons elbow assessment form was 72 points for the burn cohort and 76 points for the trauma cohort. CONCLUSIONS: Osseous ankylosis of the elbow is a severely disabling problem, and attempts to regain mobility are both worthwhile and safe. The results are comparable when the ankylosis is caused by burns or trauma despite the greater complexity of osseous ankylosis in the burned arm. Patients and surgeons should be aware of the small risk of recurrent heterotopic ossification and the moderate risk of pain or recurrent contracture after operative release.

Adult↗
PubMed2004

Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow.

BACKGROUND: The purpose of this study was to evaluate the role of the radial head and the coronoid process as posterolateral rotatory stabilizers of the elbow and to determine the stabilizing effect of radial head replacement and coronoid reconstruction. METHODS: The posterolateral rotatory displacement of the ulna was measured after application of a valgus and supinating torque (1). in seven intact elbows, (2). after radial head excision, (3). after sequential resection of the coronoid process, (4). after subsequent insertion of each of two different types of metal radial head prostheses (a rigid implant and a bipolar implant with a floating cup), and (5). after subsequent reconstruction of the coronoid with each of two different techniques in the same cadaveric elbow. RESULTS: The posterolateral rotatory laxity averaged 5.4 degrees in the intact elbows. The surgical approach used in this study insignificantly increased the mean laxity to 9 degrees. Excision of the radial head in an elbow with intact collateral ligaments caused a mean posterolateral rotatory laxity of 18.6 degrees (p < 0.0001). Additional removal of 30% of the height of the coronoid fully destabilized the elbows, always resulting in ulnohumeral dislocation despite intact ligaments. Implantation of a rigid radial head prosthesis stabilized the elbows. However, a mean laxity of 16.9 degrees persisted after insertion of a floating prosthesis (p < 0.0001). The elbows with a defect of 50% or 70% of the coronoid, loss of the radial head, and intact ligaments could not be stabilized by radial head replacement alone, but additional coronoid reconstruction restored stability. CONCLUSIONS: The results of this study suggest that the coronoid and the radial head contribute significantly to posterolateral rotatory stability.

Arthroplasty, Replacement↗
PubMed2004

Proximal ulnar reconstruction with strut allograft in revision total elbow arthroplasty.

BACKGROUND: The growing frequency of joint arthroplasty has led to increasing numbers of patients requiring revision surgery. In the treatment of a failed total elbow arthroplasty not associated with infection, one of the main issues is poor or absent proximal ulnar bone stock due to osteolysis. We report our experience with the use of strut allograft reconstruction of the proximal part of the ulna as an adjunct to revision total elbow arthroplasty with a noncustom implant. Our aim was to better define the indications, outcomes, and complications of this technique in a population of patients with a failed total elbow arthroplasty. METHODS: We reviewed the cases of patients with aseptic failure of a total elbow replacement and proximal ulnar bone deficiency who were treated with allograft bone struts. The patients had had an average of 2.5 (range, one to four) prior open osseous operations addressing the elbow joint. In addition to revision of the prosthetic components, the deficient bone stock was treated with allograft strut grafts in one of four ways: (1) discrete cortical defects were contained, (2) periprosthetic fractures were splinted, (3) deficient triceps attachments were reconstructed, and (4) expanded segments were augmented with struts and filled with impaction graft. Twenty-one patients (twenty-two elbows) were followed for an average of four years (range, two to eleven years). RESULTS: The mean Mayo Elbow Performance Score improved from 34 points preoperatively to 79 points at the time of the latest follow-up. The scores for pain, stability, and activities of daily living improved most; there was little change in motion. Complications, consisting of four soft-tissue and four osseous problems, occurred in eight patients. Three patients had incorporation of 26% to 50% of the graft; five, 51% to 75%; and fourteen, 76% to 100%. CONCLUSIONS: Most deficiencies of proximal ulnar bone stock and fractures complicating revision total elbow surgery can be treated with allograft strut grafting. Although the complication rate is high, this technique is suitable for discrete cortical lesions, periprosthetic fractures, and an expanded proximal part of the ulna, which also requires augmentation with impaction grafting. The technique has been unreliable, however, in restoring deficient olecranon bone stock.

Arthroplasty, Replacement↗
PubMed2004

Dynamic contributions of the flexor-pronator mass to elbow valgus stability.

BACKGROUND: Previous studies have indicated that the demands placed on the medial ulnar collateral ligament of the elbow when it is subjected to valgus torque during throwing exceed its failure strength, which suggests the necessary dynamic contribution of muscle forces. We hypothesized that the flexor-pronator mass assists the medial ulnar collateral ligament in stabilizing the elbow against valgus torque. METHODS: Six cadaveric elbows were tested at 30 degrees and 90 degrees of flexion with no other constraints to motion. A full medial ulnar collateral ligament tear was simulated in each elbow. Muscle forces were simulated on the basis of the centroids and physiological cross-sectional areas of individual muscles. The biceps, brachialis, and triceps were simulated during flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum superficialis and flexor carpi ulnaris, and pronator teres-loading conditions. Kinematic data were obtained at each flexion angle with use of a three-dimensional digitizer. RESULTS: Release of the medial ulnar collateral ligament caused a significant increase in valgus instability of 5.9 degrees +/- 2.4 degrees at 30 degrees of elbow flexion and of 4.8 degrees +/- 2.0 degrees at 90 degrees of elbow flexion (p < 0.05). The differences in valgus angulation between each muscle-simulation condition and the medial ulnar collateral ligament-intact condition were significantly different from each other (p < 0.05), except for the difference between the flexor carpi ulnaris contraction condition and the flexor digitorum superficialis-flexor carpi ulnaris co-contraction condition. This co-contraction provided the most correction of the valgus angle in comparison with the intact condition at both 30 degrees and 90 degrees of elbow flexion (1.1 degrees +/- 1.8 degrees and 0.38 degrees +/- 2.3 degrees , respectively). Simulation of the flexor carpi ulnaris alone provided the greatest reduction of the valgus angle among all individual flexor-pronator mass muscles tested (p < 0.05), whereas simulation of the pronator teres alone provided the least reduction of the valgus angle (p < 0.05). CONCLUSIONS: The flexor-pronator mass dynamically stabilizes the elbow against valgus torque. The flexor carpi ulnaris is the primary stabilizer, and the flexor digitorum superficialis is a secondary stabilizer. The pronator teres provides the least dynamic stability.

Adult↗
PubMed2006

Mechanical distraction for the treatment of posttraumatic stiffness of the elbow in children and adolescents.

BACKGROUND: Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. METHODS: Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100 degrees. Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. RESULTS: The mean preoperative arc of total elbow motion was 37 degrees. The mean pronation was 46 degrees, and the mean supination was 56 degrees. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a functional arc of motion of 100 degrees. The mean arc of flexion-extension was 108 degrees (range, 75 degrees to 130 degrees). The mean range of pronation was 73 degrees (range, 20 degrees to 90 degrees), and the mean range of supination was 75 degrees (range, 10 degrees to 90 degrees). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. CONCLUSIONS: Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents.

Adolescent↗
PubMed2006

Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial.

BACKGROUND: Closed fractures of the distal third of the forearm are the most common fractures of childhood, but the method of immobilization after closed reduction is controversial. This study was undertaken to determine whether below-the-elbow casts are as effective as above-the-elbow casts in immobilizing these types of fractures and to identify patient and treatment considerations that are related to loss of reduction. METHODS: We designed a blinded, randomized, controlled trial. The criteria for reduction and remanipulation were set a priori. The primary outcome measure was fracture immobilization as reflected by reangulation in the cast and by the need for remanipulation. Exploratory analysis with use of stepwise logistic regression analysis was undertaken to search for factors predictive of loss of reduction. RESULTS: A total of 102 children were enrolled in the study and were allocated to two groups: the above-the-elbow cast group (fifty-six children) and the below-the-elbow cast group (forty-six children). The mean age was 8.6 years, and sixty-one patients were boys. The groups did not differ with respect to the initial fracture angulation, postreduction angulation, reangulation during cast immobilization, and angulation of the fracture at the time of cast removal. In the above-the-elbow cast group, twenty-three (42%) of fifty-five children with adequate radiographs met the criteria for remanipulation compared with fourteen (31%) of forty-five children with adequate radiographs in the below-the-elbow cast group (p = 0.27); only four of these thirty-seven children actually underwent remanipulation. Children with fractures of both the radius and ulna (p = 0.01) and those with residual angulation after reduction (p = 0.0001) were at the highest risk of meeting the criteria for remanipulation. The rates of complications related to the cast did not differ between the groups. CONCLUSIONS: Below-the-elbow casts perform as well as above-the-elbow casts in maintaining reduction of fractures in the distal third of the forearm in children, and the complication rates are similar. Factors that are associated with a higher risk of loss of reduction include combined radial and ulnar fractures and residual angulation of the fracture after the initial reduction.

Casts, Surgical↗
PubMed2001

Changes in surface EMG and acoustic myogram parameters during static fatiguing contractions until exhaustion: influence of elbow joint angles.

The purpose of this study was to evaluate muscle fatigue using electromyogram (EMG) and acoustic myogram (AMG) signals of the shoulder and arm muscles during sustained holding tasks, with the elbow at different angles and at different levels of maximum voluntary contraction (MVC). The EMG and AMG of four muscles, including the upper trapezius (TP), anterior deltoid (DL), biceps brachii (BB), and brachioradialis (BR), were recorded during experiments using 10 healthy young males. The experiments were conducted under 9 pairs of conditions: 3 elbow angles (120 degrees, 90 degrees, and 60 degrees) and *3 levels of %MVC (20%, 40%, and 60%). Subjects were instructed to hold a weight equal to the designated %MVC at designated joint angles and asked to maintain that condition for as long as possible until exhaustion. Joint angles were also recorded by the electrogoniometers. The analysis of variance revealed that there was no significant effect of elbow angle on the mean MVC or on the endurance time. Elbow angle showed a significant effect on mean power frequency (MPF) of EMG in DL, BB, and BR, and a significant effect on root mean square (RMS) of EMG in four muscles. In BB and BR, MPF of EMG at 120 degrees was found to be significantly lower than 90 degrees and 60 degrees, respectively. There was a significant main effect of elbow angle on MPF of AMG for TP at 20% MVC; for DL at 20% and 40% MVC; for BB at 40% and 60% MVC; and for BR at the three levels of %MVC. The results showed that the range MPF of AMG for DL, BB, and BR was between 32 to 46 Hz, whereas that for TP was from 49 to 83 Hz. There was a significant effect of elbow angle on RMS of AMG in all four muscles in all experiments. At 20% MVC, a progressive increase in RMS of AMG was observed with time. In contrast, at 40% and 60% MVC, RMS showed very different behavior; specifically, it was found that RMS of AMG at 20% MVC significantly increased with increase of elbow angle. We conclude that RMS of AMG has a good and clear correlation with elbow angle at a low level of contraction.

Adult↗
PubMed1993

The functional anatomy of the elbow complex.

The functional anatomy of the elbow joint complex is unique in orientation and configuration. Three bones, the ulna, radius, and humerus, articulate to form four articulations: the humeroulnar, humeroradial, superior radioulnar, and inferior radioulnar joints. This unique osseous structure provides the elbow excellent static stabilization, which is enhanced by the ulnar collateral ligament, the lateral collateral ligament, and the elbow joint capsule. Twenty-three muscles are directly associated with the elbow joint and can be classified into four main groups: the elbow flexors and extensors and the flexor-pronator and extensor-supinator groups. These muscles provide dynamic stabilization to the elbow and enable the hand to perform skilled, precise motions. The purpose of this review article is to provide the clinician with an understanding of the unique anatomy at the elbow joint and to enhance the clinician's knowledge of the biomechanics, clinical examination, and rehabilitation of the elbow complex.

Elbow Joint↗
PubMed2003

Isokinetic profile of elbow flexion and extension strength in elite junior tennis players.

STUDY DESIGN: Descriptive study. OBJECTIVES: To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players. BACKGROUND: The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extremity musculature of elite players. No previous study has addressed elbow flexion and extension strength. METHODS AND MATERIALS: Thirty-eight elite junior tennis players were bilaterally tested for concentric elbow flexion and extension muscle performance on a Cybex 6000 isokinetic dynamometer at 90 degrees/s, 210 degrees/s, and 300 degrees/s. Repeated-measures ANOVAs were used to test for differences between extremities, muscle groups, and speed. RESULTS: Significantly greater (P<0.002) dominant-arm elbow extension peak torque values were measured at 90 degrees/s, 210 degrees/s, and 300 degrees/s for males. Significantly greater (P<0.002) dominant-arm single-repetition work values were also measured at 90 degrees/s and 210 degrees/s for males. No significant difference was measured between extremities in elbow flexion muscular performance in males and for elbow flexion or extension peak torque and single-repetition work values in females. No significant difference between extremities was measured in elbow flexion/extension strength ratios in females and significant differences between extremities in this ratio were only present at 210 degrees/s in males (P<0.002). CONCLUSION: These data indicate muscular adaptations around the dominant elbow in male elite junior tennis players but not females. These data have ramifications for clinicians rehabilitating upper extremity injuries in patients from this population.

Adaptation, Physiological↗
PubMed1999

Metallic radial head arthroplasty improves valgus stability of the elbow.

The stabilizing influence of radial head arthroplasty was studied in eight medial collateral ligament deficient anatomic specimen elbows. An elbow testing apparatus, which used computer controlled pneumatic actuators to apply tendon loading, was used to simulate active elbow flexion. The motion pathways of the elbow were measured using an electromagnetic tracking device, with the forearm in supination and pronation. As a measure of stability, the maximum varus to valgus laxity over the range of elbow flexion was determined from the difference between varus and valgus gravity loaded motion pathways. After transection of the medial collateral ligament, the radial head was excised and replaced with either a silicone or one of three metallic radial head prostheses. Medial collateral ligament transection caused a significant increase in the maximum varus to valgus laxity to 18.0 degrees +/- 3.2 degrees. After radial head excision, this laxity increased to 35.6 degrees +/- 10.3 degrees. The silicone implant conferred no increase in elbow stability, with a maximum varus to valgus laxity of 32.5 degrees +/- 15.5 degrees. All three metallic implants improved the valgus stability of the medial collateral ligament deficient elbow, providing stability similar to the intact radial head. The use of silicone arthroplasty to replace the radial head in the medial collateral ligament deficient elbow must be questioned. Metallic radial head arthroplasty provides improved valgus stability, approaching that of an intact radial head.

Aged↗
PubMed2000

[Does simple posterior dislocation of the elbow necessitate strict immobilization?].

OBJECTIVE: To research for the ideal treatment of isolated posterior dislocation with the elbow after reduction. METHODS: 36 patients of isolated posterior dislocation of the elbow after closed reduction (male 26, female 10; left 14, right 22; dominant extremity 21, undominant extremity 15; average age 22) were examined by varus and valgus stress test and push-draw test. Satisfactory stability from 30 degrees to 130 degrees flexion of the elbow was found in all patients. For the 30 patients below 35 years old, long-arm posterior splint was applied to immobilize the elbow joint at 90 degrees flexion and pronation for one week. For 6 patients over 35 years old, we only immobilized the elbow joint for 3 to 5 days with a neck-wrist sling. Prompt active motion begin after the swelling and pain reduced slightly, but the last 30 extension was not allowed for the first 1 to 2 weeks. Forceful passive motion and stretching of the elbow joint were avoided in all patients. RESULTS: The average follow-up time was 9 months (3 - 15 months). Range of motion and muscle power were regained within 3 - 4 months. 32 patients rehabilitated completely and 4 of the 6 patients decreased extension for 5 degrees - 10 degrees. No unstable symptoms and signs or recurrent dislocation were found. No ectopic calcification or post-traumatic arthritic changes were found on X-ray follow-up. CONCLUSIONS: The ulna-humeral joint is one of the most highly constrained joints in the body with intrinsic stability. Bony structure is stable enough to allow for capsular and ligamental structure healing, even during active motion. For isolated posterior dislocation of the elbow joint, short-term immobilization and early functional exercise are desirable. Elbow instability and recurrent dislocation are rare and do not necessitate long-term strict immobilization.

Adolescent↗
PubMed2003

The assessment and management of the stiff elbow.

Posttraumatic loss of elbow motion can cause substantial disability, limiting the ability to put one's hand in the volume of a sphere in space. Although a number of conditions can lead to loss of motion, a greater understanding of the functional anatomy of the elbow has led to advances in surgical management. Elbow stiffness has been classified in a number of ways, but the consistent feature is capsular contracture. Treatment of the stiff elbow begins with clinical evaluation of elbow stiffness and identification of indications for surgical intervention. Techniques of open and arthroscopic elbow contracture release are evolving. Assessment and management of elbow contracture associated with heterotopic ossification, and treatment of distal humerus nonunion should be done early to restore elbow motion.

Arthroscopy↗
PubMed2004

[Measurement of the carrying angle of the elbow in 2,000 children at ages six and fourteen years].

OBJECTIVES: It is important to know the carrying angles of both elbows in the evaluation of deformities which may be seen after treatment of distal humerus fractures. This study was performed to determine the basal values of the carrying angle in specific age groups. METHODS: The carrying angles of both elbows were measured with the use of a goniometry in 2000 students of randomly selected primary schools in Sivas and its nearby districts. Measurements were performed in those who completed the ages of six (500 girls, 500 boys) and 14 (500 girls, 500 boys) years, with the elbow in full extension and forearm in supination. The mean carrying angles of dominant and non-dominant elbows were analyzed in eight groups. RESULTS: The mean angles measured from dominant arms were significantly greater than those of the contralateral side in both sexes and age groups (p<0.05). The mean angles of both elbows were greater in girls than those of the corresponding elbows in boys at six years of age, while vice versa was the case at 14 years of age; however, these differences did not reach significance (p>0.05). Finally, both boys and girls at 14 years of age had significantly greater angles in dominant and non-dominant elbows compared to corresponding sex and elbow side in six-year groups (p<0.001). CONCLUSION: Our results are consistent with the literature data showing that the carrying angle increases with age and that it is always greater on the dominant side.

Adolescent↗
PubMed2006

Validity and reliability of measurements of elbow flexion strength obtained from older adults using elastic bands.

PURPOSE: This study determined the validity and reliability of measurements of elbow flexion strength obtained from older adults using elastic bands. METHODS: Forty-eight community-dwelling older adults with documented functional limitations completed 3 assessments of elbow flexion strength: a 30-second test using elastic bands to generate resistance, a similar test using dumbbells, and a test using an isokinetic dynamometer. One week later, subjects repeated the 30-second elbow flexion test using elastic bands. RESULTS: The 30-second elbow flexion test using elastic bands was significantly correlated with both the 30-second elbow flexion test using dumbbells (r = 0.62, P < 0.01 ) and the maximum isokinetic torque of the elbow flexors (r = 0.46, P < 0.01 ). The 30-second elbow flexion test using elastic bands demonstrated a high degree of test-retest reliability (intraclass correlation coefficient = 0.89, P < 0.01 ). CONCLUSION: The validity and reliability elbow flexion strength measured with elastic bands supports its use among functionally limited elders.

Aged↗
PubMed2006

Clinical and radiological presentation of tuberculosis of the elbow.

The diagnosis of tuberculosis of the elbow is often missed in the early stages, so that irreversible osteoarticular destruction may occur. The authors describe their experience with 48 elbows in 47 patients. Most patients were in the first three decades of life. All patients presented with pain, swelling and loss of motion. Sixteen elbows had discharging sinuses. Eight elbows had a palpable supratrochlear lymph node. Six were completely ankylosed in flexion, at an angle of 73.3 degrees on average; the other elbows had a mean range of motion from 31.3 degrees to 105.2 degrees. Plain radiographs showed periosteal reaction in 6 elbows without discharging sinus and thus free of superinfection, and para-articular round to oval lytic lesions in 29. According to the radiological classification of Martini, 6 elbows were in stage 1, 13 in stage 2, 20 in stage 3 and 9 in stage 4. All the patients were treated conservatively with antituberculous drugs for a minimum period of 9 months. Twenty-seven elbows were available for follow-up, with a minimum follow-up period of 9 months. The functional results were related to the radiological stage at presentation, not to the duration of symptoms or to the initial loss of range of motion.

Adolescent↗