Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Elbow Injuries”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 559 records · Page 31Linked to original sources

Nerve injury in revision total elbow arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Revision total elbow arthroplasty (TEA) is technically demanding and carries a substantial risk of postoperative neurological complications because of scarring, altered anatomy, implant removal, and repeated humeral and ulnar exposure. The incidence, nerve distribution, and recovery profile of nerve injury after revision TEA remain incompletely defined. This study aimed to systematically review the literature to define the incidence, recovery profile, and risk factors for nerve injury after revision TEA. METHODS: A systematic review of the literature was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Thirteen retrospective case series were included, comprising 282 revision TEAs in 271 patients. Random-effects meta-analysis of proportions was undertaken where the data permitted. The primary outcome was postoperative nerve injury following revision TEA. Secondary outcomes included nerve type, recovery, secondary nerve-related procedures, infection, triceps insufficiency, metallosis, periprosthetic fracture, and re-revision. RESULTS: The pooled incidence of postoperative nerve injury was 22.3% (95% confidence interval [CI] 16.3 to 29.6; I2 = 34.6%). The crude incidence was 60 of 282 revisions (21.3%, 95% CI 16.6 to 26.5). The ulnar nerve was involved in 66.7% of all nerve injuries, the radial nerve in 31.7%, and the median nerve in 1.7%. No significant difference in pooled nerve-injury incidence was identified between studies published before 2010 and those published from 2010 onwards (22.9% vs. 21.4%, P = .837). Recovery reporting was heterogeneous; among injuries with numerically extractable outcomes, 85.4% improved partially or completely (95% CI 72.2 to 93.9). Secondary nerve-related procedures were reported in 7 studies. Pooled complication estimates were 10.2% for infection, 13.6% for triceps insufficiency, 25.5% for metallosis, 15.9% for periprosthetic fracture, and 14.0% for re-revision. CONCLUSIONS: Postoperative nerve injury is a common and clinically important complication of revision TEA, affecting approximately 1 in 5 cases. The ulnar nerve is most frequently involved, although radial nerve injury accounts for a substantial proportion of cases. Many neuropathies improve during follow-up, but persistent deficits and the need for secondary nerve-related procedures are not uncommon. Future studies should adopt standardized neurological definitions and reporting to improve comparability and guide preventive surgical strategies.

Humans↗

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

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

Adolescent↗

Median nerve entrapment after dislocation of the elbow in children. A report of 2 cases and review of literature.

Median nerve injury after elbow dislocation is uncommon. Reported are 2 cases of median nerve paralysis caused by entrapment within the elbow joint. For both patients, the diagnosis was made several months after the injury at surgical exploration. This complication occurs almost exclusively in the skeletally immature. A median nerve deficit after reduction of an elbow dislocation in children, especially when associated with a medial epicondylar fracture, should be an indication for surgical exploration and release of the entrapped nerve.

Child↗

Untreated intra-articular entrapment of the medial humeral epicondyle.

Six children with entrapment of the medial epicondyle in the elbow after closed reduction of a posterior dislocation were seen an average of 14 weeks after injury. The elbows were painful and the average range of flexion was 22 degrees. Two children had ulnar nerve involvement which recovered after operation. The epicondyle was removed from the joint and either reattached to the humerus or excised, and the muscles reattached. Two children had anterior transposition of the ulnar nerve, one for pre-operative hyperaesthesia, and the other to relieve tension on the nerve. At follow-up, at an average of 15 months after operation, flexion had increased fivefold, none of the children had pain and all were leading normal lives.

Adolescent↗

Fractures of the coronoid process of the ulna.

The coronoid process is critical to elbow stability and is vulnerable during injury. Traumatic elbow injures are relatively uncommon, so it is important for surgeons to be mindful of the importance of specialized treatment of the coronoid for optimal elbow function. Optimal coronoid fracture fixation is determined by fracture morphology, which can usually be predicted based on the overall pattern of injury. There is evidence that improved understanding of coronoid fractures and their management is improving the results of treatment.

Biomechanical Phenomena↗

Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint.

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.

Journal Article↗

Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury).

From 1985 to 1990, 167 patients were treated for impaired elbow flexion caused by brachial plexus injury. Surgical procedures were divided into two categories: nerve reconstruction (128 patients) and muscle or tendon transfers (39 patients). Surgery in the nerve reconstruction group included direct suturing, nerve grafting of portions of the brachial plexus responsible for elbow flexion, or nerve transfer (intercostal, phrenic, or spinal accessory nerve) to the musculocutaneous nerve. The second category included tendon or muscle transfer or a functioning free muscle transplantation for biceps replacement. Results were assessed by the Medical Research Council grading system and weight-lifting evaluation. Functional results revealed that nerve reconstruction was superior to muscle tendon transfers, direct suturing was superior to nerve grafting, short nerve grafts (< 10 cm) were superior to long nerve grafts (> 10 cm), infraclavicular plexus injuries did better than supraclavicular injuries, vascularized ulnar nerve grafts (if indicated) were superior to conventional long nerve grafts, ruptured plexus injuries recovered better than root avulsions. Intercostal nerve transfer to the musculocutaneous nerve has satisfactory results. In the muscle tendon transfer group, Steindler flexorplasty resulted in upgrading muscle strength from level one to level two. Functioning free muscle transplantation had results similar to the latissimus dorsi transfer.

Adolescent↗

Arthroscopy of the elbow. Diagnostic and therapeutic benefits and hazards.

We analyzed the results of seventy-one arthroscopies of the elbow in seventy patients who had been followed for an average of thirty-four months, in order to evaluate the risks and benefits of the procedure. Thirty-four arthroscopies were done for diagnostic purposes, fifteen were done for treatment, and twenty-two were done for both diagnosis and treatment. Overall, fifty-one (73 per cent) of the seventy patients benefited in some way. There were diagnostic benefits in thirty-six (64 per cent) of the fifty-six elbows in which diagnosis was an indication for the procedure, and there were therapeutic benefits in thirty (70 per cent) of the forty-three elbows in which treatment was intended or was performed although not planned. The procedure was of benefit in only eighteen (75 per cent) of the twenty-four elbows that had loose bodies, but it was successful in all elbows in which the loose bodies were not secondary to some other condition, including arthrosis. The procedure was also successful in all four elbows in which the loose bodies had been due to osteochondritis dissecans. In twelve (80 per cent) of the fifteen patients who had débridement (removal of flaps or loose fragments of articular cartilage) and in one of the two in whom a synovectomy had been performed, the treatment was successful. Seven (10 per cent) of the seventy patients had complications, none of which were major. Three patients (4 per cent) had a transient radial-nerve palsy after intra-articular injection of local anesthetic; four others had persistent drainage and negative cultures, but the drainage resolved with antibiotic therapy. In one of the four patients, a permanent flexion contracture of 15 degrees developed, and 10 degrees of flexion was lost.

Adult↗

Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. A prospective randomized study.

Thirty consecutive patients who had dislocation of the elbow without concomitant fracture and who were sixteen years old or more were examined under general anesthesia for stability of the joint at an average of four days after the injury. All of the elbows showed medial and sixteen showed both medial and lateral instability. The patients were then randomly assigned to undergo either non-surgical or surgical treatment of the ligamentous injuries. All of the surgically treated elbows showed complete rupture or avulsion of both the medial and lateral collateral ligaments, and in about half of these patients the muscle origins were found to be torn from the humeral epicondyles. At follow-up, both groups showed generally good results; the differences were not statistically significant. There was no evidence that the results of surgical repair of the ligaments were any better than those of non-surgical treatment.

Adolescent↗

Arthroscopy of the elbow.

As our understanding of the anatomy and function of the elbow joint continues to grow and technology continues to advance, our ability to correct disorders of the elbow with arthroscopic techniques will expand. Today, we are at the brink of major advances in the arthroscopic evaluation and treatment of elbow ailments. Many open surgical procedures currently being performed will undoubtedly be adapted for an arthroscopic approach, as we are already seeing in the treatment of radiocapitellar arthrosis, tennis elbow, arthrofibrosis, and ulnohumeral arthroplasty. Elbow procedures, such as ligamentous tightening, fracture treatment with bioabsorbable devices, and biologic joint replacement will be commonly performed in the future with the aid of the arthroscope. Although elbow arthroscopy is technically demanding, it is a highly effective surgical technique in treating many intra-articular disorders with minimal morbidity. Most of the complications associated with elbow arthroscopy can be avoided by adhering to strict and proper surgical technique. Successful elbow arthroscopy requires a thorough understanding of local gross and arthroscopic anatomy. To maintain proper orientation at all times, the skin should be properly marked before starting the procedure. The joint should be kept distended during initiation of portals to move the neurovascular structures away from the arthroscopic instruments. Nonvented cannulas with blunt trocars should be used to allow for safe passage of instruments and to avoid multiple capsular punctures. Finally, the elbow should remain flexed to 90 deg during most of the procedure, thus keeping the neurovascular structures in the antecubital fossa relaxed. If these techniques are followed, the surgical morbidity should remain low, and surgeon and patient will find elbow arthroscopy tremendously effective.

Arthroplasty↗