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PubMedDate not supplied

A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons.

The American Shoulder and Elbow Surgeons have adopted a standardized form for assessment of the elbow. This form was developed by the Research Committee of the American Shoulder and Elbow Surgeons and subsequently adopted by the membership. The patient self-evaluation section contains visual analog scales for pain and a series of questions relating to function of the extremity. The responses to the questions are scored on a 4-point ordinal scale. The physician assessment section has 4 parts: motion, stability, strength, and physical findings. It is hoped that adoption of this method of data collection will stimulate multicenter studies and improve communication between professionals who assess and treat patients with elbow disorders.

Activities of Daily Living↗
PubMed2006

MDCT of the elbow in pediatric patients with posttraumatic elbow effusions.

OBJECTIVE: The purpose of this study was to determine the performance characteristics of MDCT in the detection of fractures in children with posttraumatic elbow effusions and to assess the effect of MDCT findings on clinical management. SUBJECTS AND METHODS: Unenhanced MDCT of the elbow was prospectively performed without sedation on 31 children 20 months to 16 years old who had posttraumatic elbow effusions. Two blinded reviewers independently and in consensus characterized all MDCT scans as positive or negative for the presence of fracture. Level of interobserver agreement was determined with the kappa statistic. Sensitivity, specificity, positive predictive value, and negative predictive value of MDCT for fracture detection were determined for the consensus MDCT interpretations with follow-up radiographs as the reference standard. Patients were treated with casts and instructed to return in 2-3 weeks for clinical and radiographic follow-up unless a change in management was indicated on the basis of MDCT findings. The frequency of alteration of management was determined. RESULTS: Both reviewers detected fractures in 15 (48%) of the patients individually and in 16 (52%) of the patients by consensus. Interobserver agreement for fracture detection with MDCT was excellent (kappa = 0.85). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in the detection of fractures were 92%, 79%, 79%, and 92%, respectively. Four (13%) of the children had changes in management based on the MDCT findings. CONCLUSION: MDCT is a sensitive means of evaluating for radiographically occult fractures in children with posttraumatic elbow effusions. It has a high negative predictive value and a high level of interobserver agreement. MDCT findings may lead to alteration of treatment of children with nondisplaced lateral condylar and radial head fractures.

Adolescent↗
PubMedDate not supplied

Fractured rheumatoid elbow: treatment with Souter elbow arthroplasty--a clinical and radiologic midterm follow-up study.

We report the results in 26 patients who had 32 preoperative fractures treated with Souter elbow arthroplasty. All were rheumatoid patients with a mean disease duration of 29.7 years (range, 10 to 43). Six of the fractures were of the olecranon and 26 of the distal humerus. The time interval between fracture and arthroplasty was 9 months (mean; range, 0 to 48). Fragments were not excised, and osteosynthesis was performed. The follow-up was 2.6 years (mean; range, 0.5 to 8), when 20 of the fractures had united and 12 had not. K-wire fixation, either alone or in combination with cerclage or PDS suture, and bone grafting led to satisfactory results. Union was verified in 14 of 17 cases treated with this technique. There were no severe early complications. Six patients had late complications. In 3 cases, loosening of the humeral component was observed radiologically. One patient had a hematogenous deep infection 4 years after the operation, and 2 patients had avulsion rupture of the triceps tendon. Fracture in the badly destroyed elbow can be more reasonably treated with an arthroplasty than with an attempt of osteosynthesis before arthroplasty. If excision of the fragments is avoided, original, or near original, anatomy of the elbow joint can be better restored and acceptable outcome obtained with elbow arthroplasty.

Adult↗
PubMed2005

Limited influence of prosthetic position on aseptic loosening of elbow replacements: 125 elbows followed for an average period of 5.6 years.

BACKGROUND: Aseptic loosening of elbow replacements, seen in long-term follow-up, remains a problem. In this study, we attempted to determine the influence of cementing technique, prosthetic position, different component sizes, use of a bone plug, and intraoperative fractures on the development and progression of radiolucent lines and aseptic loosening. METHODS: We studied standard radiographs of 125 primary Souter-Strathclyde total elbow prostheses using the Wrightington method. Additionally, 104 preoperative radiographs were available for analysis. We used a Markow statistical model to detect relationships between all factors described above. RESULTS: After a mean follow-up time of 5.5 (2-19) years, 21 (17%) prostheses had loosened radiographically (10-year survival: 65%). When the humeral component was tilted more medially or more anteriorly, we found development of radiolucent lines at the medial condyle and at the posterior side of the humeral component. However, the progression of these lines was not influenced by these positions. No other prognostic factors for radiolucent lines or aseptic loosening were found. INTERPRETATION: Despite the small number of elbows studied, the weak influence of prosthetic position on aseptic loosening gives more ground for a multifactorial cause for aseptic loosening of the Souter-Strathclyde total elbow prosthesis.

Adult↗
PubMed2005

Hinged elbow external fixation for severe elbow contracture.

BACKGROUND: When it was first introduced, it was hoped that hinged external fixation with a built-in gear mechanism for applying passive motion and static progressive stretch by turning a dial would improve the arc of ulnohumeral motion, by gradually stretching contracted muscles, after open release of a severe elbow contracture. METHODS: Forty-two patients were evaluated at an average of thirty-nine months after operative release of a severe posttraumatic elbow contracture (defined as < or =40 degrees of motion). Twenty-three patients had been treated, during the early part of the study, with a hinged external fixator that incorporated a worm gear to apply static progressive stretch postoperatively. These patients were compared with nineteen patients who had been treated without hinged external fixation during the later part of the study, when the hinge was used less frequently. The operative techniques did not otherwise change during the study period. Demographic and injury characteristics as well as associated problems were comparable between the two groups. RESULTS: The average gain in the range of motion after the index procedure was 89 degrees in the patients treated with a hinge and 78 degrees in those treated without a hinge, an insignificant difference with the numbers available (p = 0.175). Complications associated with use of the hinge included five pin-track infections, one case of pin-track osteomyelitis, one ulnar fracture through a pin site, two broken Schanz screws, and two cases of irritation of the ulnar nerve. CONCLUSIONS: Open release of a severe elbow contracture results in a substantial gain in motion, with or without hinged elbow fixation. The slightly greater improvement in motion provided by the hinge does not justify the associated increase in risk, expense, and complications.

Adolescent↗
PubMed2003

Total elbow replacement for distal humerus fractures and traumatic deformity: results and complications of semiconstrained implants and design rationale for the Discovery Elbow System.

Recent advances in elbow replacement design have further extended its usefulness as an expedient reconstructive method for restoring elbow function following trauma. This is particularly true in elderly patients, for whom treatment is complicated by the frequent presence of osteoporosis, severe comminution with small condylar fracture fragments, and diminished bone-healing capacity. This article addresses the role of elbow replacement for fracture, traumatic deformity, post-traumatic arthritis, and instability. Indications, techniques, and results are presented. Complications of semiconstrained implants are presented, and the design rationale for, and examples of, the latest-generation Discovery Elbow System (Biomet Orthopedics, Warsaw, Indiana) are discussed.

Aged↗
PubMed1979

Functional anatomy of the elbow joint and three-dimensional quantitative motion analysis of the elbow joint.

This work consists of two parts. Part One is a three-dimensional study of the passive motion of the elbow joint and revealed that the elbow joint was not a true hinge joint. Part Two is a three-dimensional quantitative motion analysis which was undertaken to compare shoulder and trunk motion in normal subjects with those with contracted elbows. This analysis revealed that shoulder rotation, shoulder abduction, trunk flexion and trunk rotation compensates for a contracted elbow.

Elbow Joint↗
PubMed2004

[Semiconstrained total elbow arthroplasty for severe post traumatic ankylosis of the elbow: a case-report].

Post traumatic stiffness in young subjects has been long considered a bad indication for total elbow arthroplasty. We present the case of a 48 year old woman with an elbow fracture, operated in childhood who developed progressive painful stiffness. After treatment with a cemented semi constrained Coonrad-Morrey total arthroplasty, we have obtained a good result at over 4 years follow-up. The gain of ROM is 40 degrees, the analogue scale for pain is 2.5/10 and the Mayo Clinic Performance Index for the Elbow is 80/100. The subjective impression is excellent and there were no complications.

Age Factors↗
PubMedDate not supplied

Imaging of the elbow: a review of imaging findings in acute and chronic traumatic disorders of the elbow.

Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.

Acute Disease↗
PubMed1996

Radial epicondylalgia (tennis elbow): measurement of range of motion of the wrist and the elbow.

The aim of the present investigation was to determine the range of motion (ROM) features of the elbow and wrist joints in patients with radial epicondylalgia (tennis elbow), since there have been contradictory statements in previous reports and apparently no accurate study has been published to establish these typical ROM values. The precision of the measuring technique and the active and passive ROMs of these joints were first evaluated in an intratester reliability study in 16 healthy individuals, 12 men and four women with a mean age of 46 years (range = 26-67). The clinical study consisted of 123 patients with unilateral symptoms, 75 men and 48 women with a mean age of 43 years (19-63) and a mean symptom duration of 11 months (0.5-72). All measurements were performed using a simple plastic goniometer. The precision of the measuring procedure, expressed as the standard deviation of the random error of the mean, was 1-6 degrees depending on the actual ROM measured. In patients with unilateral radial epicondylalgia, almost all measured ROMs of the elbow and wrist were found to be limited in the affected arm. This could give a rationale to use stretching in the treatment of radial epicondylalgia.

Adult↗
PubMed1993

Total elbow arthroplasty: salvage of unsuccessful previous elbow operations.

Six consecutive patients with a stiff, painful, nonfunctional elbow were reconstructed utilizing a semicontrained total elbow prosthetic replacement. All patients had multiple previous surgical procedures with unsuccessful results. The average preoperative flexion (80 degrees) and extension (-60 degrees) improved to 130 degrees to -10 degrees respectively. All patients were able to regain satisfactory use of the elbow without pain.

Adult↗
PubMed1980

The synergy of elbow extensor muscles during dynamic work in man. I. Elbow extension.

This study concerns the synergy of the elbow extensor muscles during voluntary elbow extension performed at various velocities against different intertia and in a horizontal plane. The quantity of excitation (Q) of the three heads of the triceps brachii muscle increases linearly with the external work (W). On the contrary, the anconeus Q increases rapidly for low values of W while for higher values it increases very slowly but linearly with the W. These results imply a proportionality between Q and W of the different muscles except in the case of anconeus for low values of W. Furthermore, it is shown that the position of the shoulder does not influence the relative contribution of the different muscles to W but leads to an adjustment of the activity of the long head. The different extensor muscles do not come into play simultaneously. The chronology of the muscular activities depends on velocity and inertia. The importance of anconeus activity for slow movements is pointed out, and it is suggested that there exists a specific control of the motoneurons of the different elbow extensor muscles. The limits of the concept of muscle equivalent are also discussed.

Adolescent↗
PubMed2000

Management of the floating elbow injury in children. Simultaneous ipsilateral fractures of the elbow and forearm.

Simultaneous ipsilateral fracture of the elbow and forearm--floating elbow--is an uncommon injury. During a 7-year period we prospectively followed 12 children who presented with completely displaced supracondylar fractures of the humerus associated with a forearm fracture of the same limb. All patients underwent emergency operative reduction and percutaneous K-wire stabilisation. At a minimum of 18 months, all patients were assessed clinically and radiologically and the results evaluated according to a conventional scoring system. Ten patients had good or excellent outcomes, and there were two fair results. The incidence of open fractures and nerve injury and the need to perform an open reduction were higher than those recorded for isolated supracondylar fractures. The floating elbow is an indicator of a high energy injury and requires aggressive operative management.

Age Factors↗
PubMed2006

Radiographic changes at the elbow in primary osteoarthritis: a comparison with normal aging of the elbow joint.

A retrospective case-control study was undertaken to evaluate the pathologic radiographic changes that occur in primary osteoarthritis of the elbow. The radiographs of 50 patients with primary osteoarthritis of the elbow were compared with an age- and sex-matched control group to distinguish those features specific to elbow osteoarthritis from those occurring as a result of normal aging. We assessed 100 radiographs (50 anteroposterior and 50 lateral views) in both the study and control groups for 10 radiographic features. In the osteoarthritic group, osteophytes of the olecranon (96%), coronoid process (90%), radial head (86%), and coronoid and radial fossae (64%) were the most frequent findings. Joint space narrowing occurred predominantly at the radiocapitellar joint (58%) and was more common than at the ulnotrochlear joint (16%). Thickening of the olecranon fossa membrane was noted in 68%. In the age- and sex-matched control group, coronoid osteophytes occurred in 36% of cases, but the other features were rarely observed.

Adult↗
PubMed2002

A motion of forearm supination with maintenance of elbow flexion produced by electrical stimulation to two elbow flexors in humans.

Motions of the forearm induced by electrical stimulation to two elbow flexors (brachioradialis: BR, biceps brachii: BB) were examined in five healthy human subjects. Stainless steel wire electrodes were implanted percutaneously into each motor point of the muscles. The muscles were stimulated separately with a computer-controlled multi-channel stimulator. The motions were taken with a digital video system. Angular changes of the motions in elbow flexion/extension and forearm pronation/supination were measured. Electromyograms (EMG) of BR, BB, and the triceps brachii (TB) were recorded. Electrical stimulation to BR induced a motion of flexion and that to BB motions of flexion and supination. The stimulation to BR with an adequate intensity provided holding of flexion with the prone forearm in all the subjects. In this situation, additional stimulation to BB resulted in motions of flexion and supination. However, the additional stimulation accompanied with a decrease of the stimulation intensity for BR provided a motion of supination with maintenance of the flexion in all the subjects. Since during the stimulation BR, BB, and TB showed no voluntary contraction in EMG, it is suggested that modulation of contraction between BR and BB by the stimulation can produce force in supination with keeping constant force in flexion to support the weight below the elbow.

Adult↗
PubMed2000

Fitting of electronic elbow on an elbow disarticulated patient by means of a new surgical technique.

Rehabilitation of trans-humeral amputees represents a challenge. One of the difficulties to overcome is prosthetic suspension. In the case of elbow disarticulation the presence of humeral condyles permits better suspension, but there is no room for elbow joints, particularly electronic ones, and the only available mechanisms are provided by external hinges. The purpose of this report is to present a case of a primarily elbow disarticulated patient, with indication for surgical revision due to bad skin coverage, neuroma and the wish to improve prosthetic fitting. The surgical plan outlined was to produce a shortening of the humerus, by means of an osteotomy just above the humeral condyles, preserving them for prosthetic suspension. This bone reduction was carried out with complementary shaping of bone segments with an indentation to enhance fixation. The operation was completed with neuroma resection, myodesis and removal of the skin grafted area. Preservation of the humeral condyles actually produced effective suspension. For final fitting a Utah Arm II was used, with wrist rotator, and interchangeable hand and Greifer for terminal devices. Good initial results and at nine months follow-up suggest this procedure should be considered in other elective situations.

Accidents, Traffic↗
PubMed1996

Determining consistency of elbow joint threshold angle in elbow flexor muscles with spastic hypertonia.

BACKGROUND AND PURPOSE: Threshold angle, the point in passive range of motion where a muscle response or torque change is elicited, may be a potentially valid measure of hypertonus. Because the relationship of initial muscle length to threshold angle has not been addressed previously, this preliminary study examined whether starting elbow joint position and speed of stretch to elbow flexor muscles affect threshold angle. SUBJECTS: Five subjects with stroke-induced hypertonia of the elbow flexor muscles participated. METHODS: Two starting angles and two designated stretch speeds were applied randomly by a torque motor at each of three testing sessions. RESULTS: Starting angle, subject, and session affected threshold angle. A 90-degree starting angle at a stretch speed of approximately 1.0 radian/s produced the most consistent threshold angles between sessions within subjects, and threshold angle was relatively consistent for some subjects, irrespective of speed. CONCLUSION AND DISCUSSION: If future research indicates that these data can be generalized, the use of threshold angle as a consistent measure of hypertonia will require comparison within individuals, use of a consistent starting angle, and a movement condition of a 90-degree starting angle and an approximate movement speed of 1.0 radian/s across sessions.

Adult↗
PubMed1998

Electromyographic study of the elbow flexors and extensors in a motion of forearm pronation/supination while maintaining elbow flexion in humans.

Activities of the elbow flexors (biceps brachii, BB; brachialis, B; brachioradialis, BR) and extensors (triceps brachii, TB) in a motion of forearm pronation/supination with maintenance of elbow flexion (PS-movement) in nine healthy human subjects were studied by electromyography (EMG). The subject performed the PS-movement slowly or quickly with or without a load extending the elbow. In the slow PS-movement, an increase and decrease of EMG activities during supination and pronation, respectively, were seen in BB and the reverse was in B. A clear increment of EMG activities in BB accompanied with a reduction of EMG activities in B and/or BR, and the reverse were often observed. The contraction level and gain with the forearm supine were higher and larger than those with the forearm prone, respectively, in BB and the reverse was in B and BR. In a series of the quick PS-movement, alternating increases of EMG activities between BB and the other flexors (B and BR) were seen. Since TB showed no EMG activities throughout the experiment, it is suggested that reciprocal contractions between BB and the other flexors, which produce a complementary force in flexion direction, enable motions of pronation/supination with maintenance of flexion. Contraction properties of the flexors were discussed.

Adult↗