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Acute elbow trauma in children: spectrum of injury revealed by MR imaging not apparent on radiographs.

OBJECTIVE: The objective of this study is to evaluate the frequency and significance of unrecognized bone or soft-tissue injury in pediatric patients with elbow trauma assessed with radiographs alone. SUBJECTS AND METHODS: Fifty children (32 boys and 18 girls; mean age, 7.3 years; age range, 2-12 years) with acute elbow trauma were examined with radiography and MR imaging. Radiographs were categorized into those showing normal findings, an effusion, an equivocal fracture, or an unequivocal fracture. MR examinations were assessed for an effusion, fracture, transphyseal fracture extension, physeal injury, bone bruising, and ligament or muscle injury. Average clinical follow-up was 1.6 years (range, 6-28 months) after injury. RESULTS: Radiographs showed normal findings in seven children (14%), an effusion only in 17 children (34%), and an unequivocal or equivocal fracture in 26 children (52%). MR imaging showed an effusion in 48 children (96%); unequivocal fracture in 37 children (74%), including transphyseal fracture in seven children (14%) and other physeal injury in three children (6%); bone bruising in 45 children (90%); ligament injury in six children (14%); and muscle injury in 19 children (38%). A less severe spectrum of injury occurred in children with normal findings on radiographs than in those with an effusion or fracture seen on radiography. Follow-up radiographs did not help in the detection of radiographically occult fractures. MR findings had no appreciable effect on patient treatment and no value in predicting duration of convalescence or clinical outcome at an average of 1.6 years after injury. CONCLUSION: In children with elbow trauma, MR imaging reveals a broad spectrum of bone and soft-tissue injury beyond that recognizable radiographically. However, the additional information afforded by MR imaging has little bearing on treatment or clinical outcome.

Acute Disease↗

Return to sport following elbow surgery.

Although less common than injuries to the knee or shoulder, elbow injuries can be a substantial challenge to sports medicine providers. Many elbow problems respond to routine nonoperative measures including periods of activity modification and physical therapy, but others may ultimately require surgery. Following surgery, appropriate attention to rehabilitation is important to achieve optimal function. This article addresses some of the more common sports-related operative elbow pathology, basic principals of surgery (with an emphasis on techniques only where it may impact rehabilitation or return-to-sport decisions), and return-to-play decisions (including typical "targeted" time frames). The emphasis is on an understanding of sport-specific functional demands and the difficult assessment of reinjury risk following surgery.

Athletic Injuries↗

[Operative treatment of ruptures of distal tendon of biceps muscle with a minimally invasive technique using suture anchors--clinical results].

AIM: Ruptures of the distal tendon of the biceps muscle should be treated operatively. A minimally invasive technique and the use of suture anchors may decrease the intraoperative risks. But can satisfactory clinical results be achieved? METHOD: We present the results of a clinical study. Between 1999 and 2005 nine patients were operated for distal biceps tendon avulsion. A minimally invasive operating technique using a suture anchor was established and the technique is described. Rantanen and Orava's score was used to compare clinical and radiological findings. RESULTS: Clinical follow-up was performed at 6 months after operation. In six patients excellent results according to Rantanen and Orava were achieved. No loss of strength was noticed in 6 of 9 cases. Range of motion was unlimited in six patients. In two cases we found heterotopic ossifications. CONCLUSION: On the basis of our results we suggest that minimally invasive surgery using a suture anchor should be performed more often. The technique described leads to results that are comparable to those found in the literature.

Accidents, Occupational↗

Splinting programme for patients with burnt hand.

Splintage is commonly used in conjunction with pressure therapy to tackle the contracted scars, make it supple and thus minimise dysfunction. A static or dynamic splint can provide valuable therapy that goes beyond any treatment session. The patient's active participation in the splint programme can facilitate early recovery. A good splinting design and wearing regime often depends on the therapist's understanding and integration of visco-elastic properties in soft tissues, maturation process of hypertrophic scars and mechanical principles in splinting. Different types of splints serve different functions at different stages of rehabilitation. A suitable and efficient application of splints can minimise most of the corrective surgical intervention and alleviate psychological trauma. This article attempts to highlight the clinical rationale and special considerations when applying different splintage on burns patients with upper limbs involvement.

Axilla↗

Nerve injuries in the throwing elbow.

The unique anatomy of the elbow combined with the angular velocity and stresses placed across this hinge joint while throwing can cause a large number of pathologic changes associated with nerves. Although the ulnar nerve is the most commonly injured, neuropathies are also seen with the branches of the median and radial nerves. These neuropathies are typically responsive to rest, activity modification, ice, splinting, and anti-inflammatories. A graduated return to throwing is then needed before returning to play. When conservative measures fail, surgical decompression is warranted, but results have been less than perfect.

Athletic Injuries↗

The use of MRI scanning for investigating soft-tissue abnormalities in the elbow.

It is well known that the elbow is one of the most difficult joints to be examined in MR, because of its position in relation to the body during the examination. Moreover, there is relatively little information about the elbow, even less in its soft tissues abnormalities, in the literature in comparison to other joints. This article describes the spectrum of MR findings soft tissues abnormalities of the elbow, giving an analysis of injuries to the elbow ranging from inflammation to rupture to masses, and the role of MR in post-surgical follow-up. It is demonstrated that MR provides an excellent alternative to other imaging techniques that would be of interest to orthopedic surgeons. The value of MRI to accurately determine the nature and extent of the pathologic changes in ligaments, tendons and muscles structures of the elbow joint is presented in the following discussion.

Elbow Joint↗

[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↗

Elbow, forearm, wrist, and hand injuries among sport rock climbers.

OBJECTIVES: Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. DATA SOURCES: The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. STUDY SELECTION: Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. DATA EXTRACTION: Data were extracted directly from the sourced articles. DATA SYNTHESIS: The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. CONCLUSION: Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport.

Arm Injuries↗

Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus.

Traumatic root avulsion brachial plexus injuries in 216 patients were treated with spinal accessory-musculocutaneous neurotization to restore elbow flexion. The average postoperative follow-up period was 6 years, with a minimum of 2 years for all patients. The percentage of satisfactory biceps recovery (MRC III or better) was 72.5%. The average interval between the operation and MRC III motor recovery was 17 months. The percentage of poor results increased from 25.5% to 62.5% in patients who underwent operation later than 9 months after injury. This method of neurotization produces a result comparable with, if not better than, the results of other types of neurotization in restoration of elbow flexion.

Accessory Nerve↗

Letters: Tennis elbow.

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Athletic Injuries↗