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At least 163 records · Page 9Linked to original sources
PubMed2002

Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow: long-term outcome and complications.

BACKGROUND: Primary degenerative arthritis of the elbow is an uncommon disorder that recently has been more clearly recognized. The purpose of this study was to analyze the long-term results and complications of ulnohumeral arthroplasty as treatment of primary osteoarthritis of the elbow and to document any tendency for recurrence of the arthritis after the procedure. METHODS: The results of ulnohumeral arthroplasties performed at our institution, between 1986 and 1996, in forty-six elbows (forty-five patients) with primary osteoarthritis were reviewed at an average of eighty months (range, twenty-four to 164 months) after the operation. There were forty-four men and one woman with a mean age of forty-eight years. All patients complained of pain with terminal elbow extension. The pain was associated with locking in fourteen elbows and with ulnar nerve symptoms in twelve. The surgical procedure involved fenestration of the olecranon fossa and excision of olecranon and coronoid osteophytes in all patients, with removal of loose bodies in thirty-six elbows. A capsular release was performed in nineteen elbows, and an ulnar nerve transposition or neurolysis was done in eight. Preoperative and follow-up assessment included evaluation of elbow pain and range of motion with the Mayo Elbow Performance Score. RESULTS: The mean arc of flexion-extension improved from 79 degrees (range, 10 degrees to 135 degrees) preoperatively to 101 degrees (range, 45 degrees to 135 degrees) at the time of follow-up (p < 0.05). At the last follow-up examination, thirty-five elbows (76%) were not painful or were only mildly painful and eleven were moderately or severely painful. According to the Mayo Elbow Performance Score, the result was excellent for twenty-six elbows, good for eight, fair for four, and poor for eight. Thirteen of the forty-five patients reported some degree of ulnar nerve symptoms postoperatively, and six of them required another operation to decompress or translocate the nerve. Two other patients underwent additional surgery because of persistent symptoms. CONCLUSIONS: The data from this study show that ulnohumeral arthroplasty can yield satisfactory long-term pain relief and an increase in the range of motion. Patients with severe preoperative limitation of elbow extension of >60 degrees and flexion of <100 degrees and those who undergo manipulation under anesthesia in the early postoperative period to increase motion are at risk for the development of ulnar nerve dysfunction postoperatively. One should consider prophylactic ulnar nerve decompression or mobilization under these circumstances.

Adult↗
PubMed2004

The effect of radial head excision and arthroplasty on elbow kinematics and stability.

BACKGROUND: Radial head fractures are common injuries. Comminuted radial head fractures often are treated with radial head excision with or without radial head arthroplasty. The purpose of the present study was to determine the effect of radial head excision and arthroplasty on the kinematics and stability of elbows with intact and disrupted ligaments. We hypothesized that elbow kinematics and stability would be (1) altered after radial head excision in elbows with intact and disrupted ligaments, (2) restored after radial head arthroplasty in elbows with intact ligaments, and (3) partially restored after radial head arthroplasty in elbows with disrupted ligaments. METHODS: Eight cadaveric upper extremities were studied in an in vitro elbow simulator that employed computer-controlled actuators to govern tendon-loading. Testing was performed in stable, medial collateral ligament-deficient, and lateral collateral ligament-deficient elbows with the radial head intact, with the radial head excised, and after radial head arthroplasty. Valgus angulation and rotational kinematics were determined during passive and simulated active motion with the arm dependent. Maximum varus-valgus laxity was measured with the arm in a gravity-loaded position. RESULTS: In specimens with intact ligaments, elbow kinematics were altered and varus-valgus laxity was increased after radial head excision and both were corrected after radial head arthroplasty. In specimens with disrupted ligaments, elbow kinematics were altered after radial head excision and were similar to those observed in specimens with a native radial head after radial head arthroplasty. Varus-valgus laxity was increased after ligament disruption and was further increased after radial head excision. Varus-valgus laxity was corrected after radial head arthroplasty and ligament repair; however, it was not corrected after radial head arthroplasty without ligament repair. CONCLUSIONS: Radial head excision causes altered elbow kinematics and increased laxity. The kinematics and laxity of stable elbows after radial head arthroplasty are similar to those of elbows with a native radial head. However, radial head arthroplasty alone may be insufficient for the treatment of complex fractures that are associated with damage to the collateral ligaments as arthroplasty alone does not restore stability to elbows with ligament injuries.

Aged↗
PubMed1992

Use of comparison radiographs in the diagnosis of traumatic injuries of the elbow.

STUDY OBJECTIVE: To determine whether comparison radiographic views of the uninjured elbow result in increased diagnostic accuracy in elbow trauma. DESIGN: Physicians were provided with a short clinical summary and asked to interpret radiographs of the injured elbow or of both the injured and the uninjured elbow in a randomized fashion. SETTING: The radiology department in a university hospital. METHODS: Fifty sets of radiographs from 25 children with elbow injuries were reviewed by two residents, two emergency physicians, and one pediatric radiologist using a standard classification of injuries. For each child, there were two sets of radiographs: one of the injured elbow and one of both the injured and the uninjured elbow. Descriptive statistics were used to report the results. kappa statistics were used to determine interobserver and intraobserver agreement. Missed diagnoses were divided into those that were clinically relevant and those that were not. RESULTS: The overall percentage of correct diagnoses (one versus two elbow radiographs) were as follows: residents, 69% versus 70%; emergency physicians, 62% versus 67%; and pediatric radiologist, 74% versus 72% (P greater than .05). kappa scores for interobserver variability and intrarater agreement were in the moderate range (.383 to .805; kappa, .08). Clinically relevant diagnoses were missed by trainees and emergency physicians regardless of whether radiographs of just the injured elbow or both the injured and the uninjured elbow were interpreted. Incorrect radiograph interpretations were due to false-positives in 17 of 23 cases. CONCLUSION: Comparison radiographs of the uninjured elbow did not improve diagnostic accuracy in elbow trauma in the pediatric emergency department.

Adolescent↗
PubMed2002

The influence of elbow position on the range of motion of the wrist following transfer of the brachioradialis to the extensor carpi radialis brevis tendon.

BACKGROUND: In patients who have an injury of the cervical spinal cord, the brachioradialis tendon may be transferred to the extensor carpi radialis brevis tendon to restore voluntary wrist extension. We hypothesized that the active range of motion of the wrist depends on the position of the elbow after this transfer because the brachioradialis changes length substantially during elbow flexion, which implies the maximum force that the muscle can produce varies with elbow position. The objectives of this study were to determine whether the position of the elbow influences the range of motion of the wrist following transfer of the brachioradialis to the extensor carpi radialis brevis tendon and to evaluate the effect of surgical tensioning. METHODS: The range of motion of eight wrists was assessed after brachioradialis transfer. Two positions of the elbow were tested, the passive limit of elbow extension and 120 degrees of flexion. The range of motion of the wrist was also simulated with use of a biomechanical model. Using the model, we compared the active range of motion of the wrist, with the elbow at 0 degrees and 120 degrees of flexion, following three different approaches to surgical tensioning. The simulations were also repeated to evaluate how muscle strength influences outcomes. RESULTS: Wrist extension decreased and passive flexion increased when the elbow was flexed. Maximum wrist extension was significantly correlated with passive flexion in all subjects (r = 0.95 and p < 0.001 when the elbow was extended and r = 0.82 and p < 0.03 when the elbow was flexed). The biomechanical model suggested that tensioning the tendon transfer so that the fibers of the brachioradialis do not become excessively short when the elbow is flexed may improve outcomes. The simulations also revealed that it is more difficult to maintain a consistent wrist position with the elbow in different postures when a weaker muscle is transferred. CONCLUSIONS: The model suggests that altering the surgical tension could improve wrist extension when the elbow is flexed. However, the ultimate result is sensitive to the strength of the brachioradialis.

Humans↗
PubMed2004

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↗
PubMedDate not supplied

Functional outcome comparison of semiconstrained and unconstrained total elbow arthroplasties.

Twenty-six patients, each of whom had undergone either a semiconstrained (linked) or an unconstrained (unlinked) total elbow arthroplasty, were examined specifically to evaluate the restoration of function with respect to activities of daily living. The functional outcomes of these 2 groups were then compared to identify any significant differences. All of the unlinked/unconstrained prostheses were Ewald total elbow arthroplasties; the linked/semiconstrained prostheses, all of which were performed by a single surgeon, were Mayo-Coonrad prostheses. Follow-up radiographs, taken to rule out loosening or failure of the prosthesis as a cause for functional deficits, were available for review for 25 elbows. There were 14 elbows in 13 patients who had semiconstrained prostheses and 12 elbows in 10 patients who had unconstrained total prostheses. Average age at the time of elbow replacement surgery was 62.8 years (range, 47-75 years) for the semiconstrained group and 63.1 years (range, 54-74 years) for the unconstrained group. The semiconstrained group consisted of 8 female and 6 male elbows; the unconstrained group consisted of 10 female and 2 male elbows. Follow-up averaged 35.5 months (range, 24-73 months) in the semiconstrained group and 73 months (range, 27-110 months) in the unconstrained group. Twenty-two operations were performed for rheumatoid arthritis, 3 for posttraumatic humeral nonunion, and 1 for posttraumatic degenerative arthritis. Two elbows required revision, one (in the semiconstrained group) for aseptic loosening and the other (in the unconstrained group) for metal synovitis and pain from a chronically dislocated prosthesis; both of these elbows were considered failures and excluded from the functional comparison. No significant differences in functional performance were found, and no elbows demonstrated progressive radiolucencies suggestive of loosening. With the exception of 1 patient (in addition to the patients who had revisions) with a dislocated unconstrained prosthesis, all patients were satisfied with the procedure. It appears that when it is properly performed, total elbow arthroplasty with either type of prosthesis yields satisfactory functional results.

Activities of Daily Living↗
PubMed2002

Acupuncture for lateral elbow pain.

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. Acupuncture has long been used to treat lateral elbow pain in China and in Western countries practitioners and consumers are increasingly exploring acupuncture as a first line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral elbow pain. OBJECTIVES: To determine the effectiveness of acupuncture in the treatment of adults with lateral elbow pain with respect to pain reduction, improvement in function, grip strength and adverse effects. SEARCH STRATEGY: We searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group's specialist trial database from 1966 to June 2001. Identified keywords and authors were searched in an effort to retrieve as many trials as possible. SELECTION CRITERIA: Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral elbow pain (tennis elbow). Outcomes of interest were pain, function, disability, quality of life, strength, participant satisfaction with treatment and adverse effect. DATA COLLECTION AND ANALYSIS: For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analysed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity. MAIN RESULTS: Four small randomized controlled trials were included but due to flaws in study designs (particularly small populations, uncertain allocation concealment and substantial loss to follow up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomised controlled trial found that needle acupuncture results in relief of pain for significantly longer than placebo (WMD = 18.8 hours, 95%CI 10.1 to 27.5) and is more likely to result in a 50% or greater reduction in pain after 1 treatment (RR 0.33, 95%CI 0.16 to 0.69) (Molsberger 1994). A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01 to 0.64) (Haker 1990a). No significant differences were found in the longer term (after 3 or 12 months). A randomized controlled trial of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit (Haker 1990b). A fourth included trial published in Chinese demonstrated no difference between Vitamin B12 injection plus acupuncture, and Vitamin B12 injection alone (Wang 1997). REVIEWER'S CONCLUSIONS: There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain. This review has demonstrated needle acupuncture to be of short term benefit with respect to pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilising appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis elbow.

Acupuncture Therapy↗
PubMed1998

Static torque-angle relation of human elbow joint estimated with artificial neural network technique.

Static relations between elbow joint angle and torque at constant muscle activity in normal volunteers were investigated with the aid of an artificial neural network technique. A subject sat on a chair and moved his upper- and forearm in a horizontal plane at the height of his shoulder. The subject was instructed to maintain the elbow joint at a pre-determined angle. The wrist was then pulled to extend the elbow joint by the gravitational force of a weight hanging from a pulley. Integrated electromyograms (IEMGs), elbow and shoulder joint angles and elbow joint torque were measured. Then the relation among IEMGs, joint angles and torque was modeled with the aid of the artificial neural network, where IEMGs and joint angles were the inputs and torque was the output. After back propagation learning, we presented various combinations of IEMGs, shoulder and elbow joint angles to the model and estimated the elbow joint torque to obtain the torque-angle relation for constant muscle activation. The elbow joint torque increased and then decreased with extension of the elbow joint. This suggests that if the forearm is displaced from an equilibrium point, the torque angle relation would not act like a simple spring. In a view of the musculoskeletal structure of the elbow joint, the relation between the elbow joint angle and the moment arm of the elbow flexor muscles seems to have a dominant effect on the torque-angle relation.

Adult↗
PubMed2001

The effect of forearm rotation on laxity and stability of the elbow.

OBJECTIVE: The purpose of this study was to quantify the relationship between forearm rotation and valgus/varus laxity of the elbow joint over the range of elbow flexion. BACKGROUND: There is little known about the influence of forearm rotation on the laxity and stability of the elbow joint. The general opinion exists that forearm rotation does not significantly influence the laxity and stability of the elbow joint. METHODS: Nine fresh-frozen cadaver elbows were used. Passive elbow flexion with the forearm in neutral rotation and in 40 degrees and 80 degrees of pronation and supination was performed under valgus/varus loads: (1) in intact elbows; (2) after a lateral surgical approach (lateral epicondylar osteotomy of the distal humerus); (3) after release of the anterior bundle of the medial collateral ligament; and (4) after release of the anterior bundle of the medial collateral ligament plus radial head resection. Valgus/varus elbow laxity was quantified using an electromagnetic tracking device. RESULTS: There was a statistically significant effect (P < 0.05) of forearm rotation on valgus/varus laxity throughout the range of flexion. The laxity was always greater in pronation than in supination, regardless of the surgical approach or the integrity of the anterior bundle of the medial collateral ligament or radial head. CONCLUSIONS: Valgus/varus laxity of the elbow is forearm rotation-dependent. The potential role of this effect should be considered and controlled for in the design of studies examining laxity and stability of the elbow joint. RELEVANCE: The observation that forearm pronation increases valgus/varus laxity, particularly in medial collateral ligament deficient elbows, implies a possible additional factor in throwing kinematics that might put professional baseball pitchers at risk of medial collateral ligament injury due to chronic valgus overload. Our data indicate that forearm rotation should be considered during the clinical examination of elbow instability.

Aged↗
PubMed2005

Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers.

BACKGROUND: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition. PURPOSE: To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3-24.5 months). At a mean follow-up of 33.8 months (range, 24-65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score. RESULTS: Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3-9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery. CONCLUSION: Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play.

Adolescent↗
PubMed2004

Allograft-prosthesis composite for revision of catastrophic failure of total elbow arthroplasty.

BACKGROUND: Revision of a failed total elbow arthroplasty is a challenging procedure, often associated with bone deficiency. The purpose of this investigation was to review our experience with a composite allograft-implant reconstruction for patients with a failed total elbow arthroplasty. METHODS: Thirteen patients (thirteen elbows) in whom a total elbow arthroplasty had failed, primarily as a result of loosening of the humeral or ulnar component, were operated on with use of an allograft-prosthesis composite; the composite was placed on the humeral side in four of these patients and on the ulnar side in nine. The delay between the last total elbow arthroplasty and the allograft-prosthesis-composite procedure averaged eight years. RESULTS: At an average of forty-two months after the revision, the Mayo Elbow Performance Score was excellent for four elbows, good for three, fair for one, and poor for five. Nine of the thirteen patients had no or only slight pain in the elbow. The mean arc of flexion was 97 degrees, with an average of 28 degrees (range, 0 degrees to 60 degrees ) of extension to 125 degrees (range, 100 degrees to 140 degrees ) of flexion. There were seven complications affecting seven elbows, and five of the seven required a revision procedure. Deep infection developed in four elbows, and the allograft-prosthesis composite had to be removed from three. Two nonunions occurred at the allograft-humeral junction. CONCLUSIONS: An allograft-prosthesis composite can be a valuable option in selected patients with a failed total elbow arthroplasty with massive bone loss. The union and implant survival rates are high. Deep infection remains the main complication. Hence, we recommend the pursuit of other revision options, such as strut graft reconstruction, whenever possible before resorting to the use of an allograft-prosthesis composite in the surgical treatment of a failed total elbow arthroplasty with massive bone loss.

Adult↗
PubMedDate not supplied

Total elbow replacement with the GSB III prosthesis.

Fourteen consecutive elbows have been treated for rheumatoid arthritis (9 elbows) and for post-traumatic osteoarthrosis (5 elbows) by total elbow replacement with the GSB III implant. The elbows were reviewed retrospectively after a mean follow-up of 6 years (2 to 9 years). Ten of 14 elbows had a functioning GSB III implant at follow-up; 7 of them were rated satisfactory and 3 unsatisfactory with the Mayo elbow performance score. In 5 of these 10 cases, the patients had significant pain relief with no or only mild pain at follow-up, whereas 5 had moderate to severe pain. With a functioning implant the range of motion averaged 140 degrees of flexion, 19 degrees of lack of extension, 65 degrees of pronation, and 84 degrees of supination. Six (43%) elbows had major complications requiring 1 to 8 additional operations. Aseptic loosening requiring revision occurred in 4 (29%) elbows. Two of them were treated by a resection arthroplasty, and 2 were revised with another hinged semiconstrained device. Three further elbows had radiolucent lines involving more than 50% of the cement-bone interface of either the humeral or the ulnar component. However, in 8 elbows the cementing technique was considered marginal or inadequate. Poor cementing (marginal or inadequate) was associated with loosening (P = .008). The GSB III total elbow prosthesis can restore function and reduce pain. The rate of aseptic loosening in this series was higher than previously reported. Based on this observation, we conclude that the GSB III implant seems to be sensitive to the insertion technique and does not tolerate suboptimal cementing.

Aged↗
PubMed1999

The posterior fat pad sign in association with occult fracture of the elbow in children.

BACKGROUND: An elevated posterior fat pad visible on a lateral radiograph of a child's elbow following trauma is generally considered to be suggestive of an intracapsular fracture about the elbow. However, in previous studies, the prevalence of fracture in elbows with an elevated posterior fat pad and no other radiographic evidence of fracture has ranged from only 6 percent (two of thirty-one) to 29 percent (nine of thirty-one). We are not aware of any prospective studies, limited to children, on the value of an elevated posterior fat pad as an indicator of an occult fracture about the elbow. While it is common practice to manage children who have radiographic evidence of an elevated posterior fat pad as if they have a fracture, scientific evidence for this approach is lacking. METHODS: Forty-five consecutive children who had an average age of four and a half years, a history of trauma to the elbow, and an elevated posterior fat pad without other radiographic evidence of a fracture were enrolled in the study. At an average of three weeks after the injury, anteroposterior, lateral, and two oblique radiographs were made and evaluated for evidence of fracture-healing. If there was evidence of new-bone formation on any of these four radiographs, it was considered to indicate a fracture of the elbow. RESULTS: Thirty-four (76 percent) of the forty-five patients had evidence of a fracture. Eighteen (53 percent) of the thirty-four had a supracondylar fracture of the humerus; nine (26 percent), a fracture of the proximal part of the ulna; four (12 percent), a fracture of the lateral condyle; and three (9 percent), a fracture of the radial neck. CONCLUSIONS: This prospective study demonstrated that the posterior fat pad sign was predictive of an occult fracture of the elbow following trauma in thirty-four (76 percent) of forty-five children who had no other evidence of fracture on anteroposterior, lateral, and oblique radiographs after the injury. This finding is in contrast to those of previous studies, in which the highest prevalence of fracture in elbows with an elevated posterior fat pad and no other radiographic evidence of fracture was 29 percent (nine of thirty-one elbows). Our results support the practice of managing children who have a history of trauma to the elbow, an elevated posterior fat pad, and no other radiographic evidence of fracture as if they have a nondisplaced fracture about the elbow.

Child, Preschool↗
PubMed2000

Rehabilitation of the medial collateral ligament-deficient elbow: an in vitro biomechanical study.

The purpose of this study was to determine the relative contribution of muscle activity and the effect of forearm position on the stability of the medial collateral ligament (MCL)-deficient elbow. Simulated active and passive elbow flexion with the forearm in both supination and pronation was performed using a custom elbow testing apparatus. Testing was first performed on intact specimens, then on MCL-deficient specimens. Elbow instability was quantified using an electromagnetic tracking device by measuring internal-external rotation and varus-valgus laxity of the ulna relative to the humerus. Compared with the intact elbow, transection of the MCL, with the arm in a vertical orientation, caused a significant increase in internal-external rotation during passive elbow flexion with the forearm in pronation, but forearm supination reduced this instability. Overall, following MCL transection the elbow was more stable with the forearm in supination than pronation during passive flexion. In the pronated forearm position simulated active flexion also reduced the instability detected during passive flexion, with the arm in a varus and valgus gravity-loaded orientation. The maximum varus-valgus laxity was significantly increased with MCL transection regardless of forearm position during passive flexion. We concluded that active mobilization of the elbow with the arm in vertical orientation during rehabilitation is safe in the setting of an MCL-deficient elbow with the forearm in a fully supinated and pronated position. Splinting and passive mobilization of the MCL-deficient elbow with the forearm in supination should minimize instability and valgus elbow stresses should be avoided throughout the rehabilitation period.

Aged↗
PubMed2002

Surgery for lateral elbow pain.

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the lateral elbow and forearm and lack of strength and function of the elbow and wrist. Surgery is sometimes recommended in treating chronic cases of lateral elbow pain where other less invasive interventions have failed. Various operations have been described based upon the surgeon's concept of the pathological entity. The most described surgical procedures involve release of the extensor carpi radialis brevis (ECRB) from the lateral epicondyle region based upon the premise that there is pathology in the attachment of ECRB to the lateral epicondyle. No systematic review has previously been published assessing the effect of surgical interventions for lateral elbow pain. OBJECTIVES: To determine the effectiveness of surgical interventions in the treatment of adults with lateral elbow pain. SEARCH STRATEGY: Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trials Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were researched in an effort to identify as many trials as possible. Searches were conducted up to October 2001. SELECTION CRITERIA: Two independent reviewers assessed all identified studies against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were to be included in the review provided they were studying the effects of a surgical intervention and included a control as treatment for adults with lateral elbow pain. The control intervention could comprise no treatment or another intervention including an alternate surgical intervention. Outcomes of interest included pain, function, disability and quality of life, strength and adverse effects. DATA COLLECTION AND ANALYSIS: The planned collection and analysis of data is described. MAIN RESULTS: Our search did not identify any controlled trials investigating the effect of surgery on lateral elbow pain. REVIEWER'S CONCLUSIONS: At this time there are no published controlled trials of surgery for lateral elbow pain. Without a control group, it is not possible to draw any conclusions about the value of this modality of treatment.

Adult↗
PubMed2001

Functional anatomy of the medial ligamentous complex of the elbow. Its role in anterior posterior instability.

The question remains unanswered regarding the role of repair of medial ligament injuries associated with subluxation of the elbow and non-reconstructable radial head fracture and whether or not this will decrease the risk of chronic instability and cubitus valgus. The goal of this study was to define the role of the medial ligamentous complex of the elbow in elbow instability and to describe the anatomy of the complex in 35 fresh-frozen cadaver elbows. We documented medial ligamentous complex anatomy and compared our results to those in the literature. 25 elbows were dissected in order to describe the different bundles of the medial ligament complex and to precise the positions of the elbow that placed each in tension; section of the different ligamentous bundles was done to study the role of each in elbow stability. 10 other elbows were dissected and used for the ligamentous section studies which were performed subcutaneously. We found two bundles at the level of the anterior portion and termed them superficial and deep. Section of the anterior bundle lead to posterior subluxation of the elbow at 30-100 degrees flexion in both supination and pronation. Posterior subluxation was obtained after an anterior capsulotomy; medial epicondylectomy did not compromise the stability of the elbow after a complete section of the insertion of the deep fibers of the anterior bundle. Elements thus required for stability of the elbow are integrity of the articular surface of the humerus and the ulna, and the anterior bundle of the medial ligamentous complex.

Adult↗
PubMed2005

Effect of elbow position on canine flexor digitorum profundus tendon tension.

Tendon injury in the finger remains a clinical challenge to hand surgeons. A canine model is commonly used to study biological effects of tendon injuries and their treatment. There is an important anatomical difference between human and canine anatomy that may be overlooked, however, namely that most of the flexor digitorum profundus (FDP) muscle in dogs takes its origin from the medial epicondyle of the humerus, whereas in humans this muscle arises purely from the forearm. Therefore, elbow position can affect the tension of this muscle in dogs, while having no effect in humans. The purpose of this study was to measure the effect of elbow position on tendon tension in the canine digit in vitro. Elbow position had a significant effect on tendon tension. Digit motion with the elbow fully flexed resulted in significantly higher tendon tension compared to digit motion with the elbow flexed 90 degrees or fully extended, regardless of digit or wrist position (p<0.05). The tension with the elbow flexed 90 degrees was also significantly higher than with the elbow fully extended (p<0.05). The maximum tendon tension with the elbow fully flexed was more than eight times larger than that of the fully extended elbow (p<0.05). We conclude that, in the canine model, elbow position is an important parameter that affects the passive tension applied to the flexor digitorum profundus, and, by implication, to any repair of that tendon. Dog flexor tendon rehabilitation protocols should therefore specify elbow position, in addition to wrist and digit position.

Animals↗
PubMed1993

Intraarticular capacity and compliance of stiff and normal elbows.

The capacity, compliance, and position of minimum intraarticular pressure were measured in eight stiff and 10 normal elbows of 11 patients before corrective surgery for posttraumatic elbow joint contracture. Capsular compliance was determined from the slope of the pressure/volume relationships. The capacity of the normal elbow joint capsule was 14 +/- 2, whereas that of the stiff elbow was 6 +/- 3 ml. The capsular compliance of the stiff elbow was only 15% of normal, confirming that the capsule is structurally altered and not just contracted. Adequate capsular distension of the stiff elbow might therefore not be possible, increasing the potential for neurovascular injury with use of the anterior portals in elbow arthroscopy. The position of minimum intraarticular pressure and maximum compliance ("resting position"), of the normal elbow was 70 degrees. If the elbow is left immobilized in this position for an extended period of time, the risk of posttraumatic elbow joint capsule contracture might increase. This agrees with our finding that the stiff elbows had a preoperative arc of motion of 70-120 degrees and a significantly diminished capsular capacity relative to normal.

Adolescent↗