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At least 19 recordsLinked to original sources
PubMedDate not supplied

The kinematic elbow axis as a parameter to evaluate total elbow replacement: A cadaver study of the iBP elbow system.

Malpositioning of prosthetic implants leads to biomechanical changes, often resulting in deteriorating functional outcome. This emphasizes the relevance of evaluating the surgical process of inserting the prostheses. This study tested to what extent the iBP elbow prosthesis and its alignment tools enabled a surgeon to reconstruct normal joint kinematics. It demonstrates the use of the kinematic elbow axis as an evaluation tool. An electromagnetic tracking device registered controlled passive elbow flexion of 10 embalmed upper extremities. The position and direction of the preoperative and postoperative kinematic elbow axes were established with the use of helical axes and compared. The postoperative position of the elbow axis differed from the preoperative axis because of limitations of the alignment tools. Suggestions for adjustment of the alignment tools are made. The direction of the imposed resection plane was correct; therefore, the direction of the postoperative elbow axis corresponded with the direction of the preoperative axis.

Arthroplasty, Replacement↗
PubMed2000

Semiconstrained total elbow arthroplasty for ankylosed and stiff elbows.

BACKGROUND: Total elbow arthroplasty can be a valuable option for the treatment of ankylosed or very stiff elbows. METHODS: A semiconstrained total elbow arthroplasty was performed in thirteen patients (fourteen elbows) with a preoperative range of elbow motion of 30 degrees or less. Nine elbows were fused or ankylosed preoperatively. The mean age at the time of the surgery was fifty years (range, twenty-four to seventy-nine years). The etiology of the stiffness was trauma for eleven elbows, juvenile rheumatoid arthritis for two, and rheumatoid arthritis for one. RESULTS: After a mean duration of follow-up of sixty-three months, the result was excellent for four elbows, good for four, fair for one, and poor for five, according to the Mayo elbow performance score. The mean arc of flexion improved from 7 degrees (range, 0 to 30 degrees) preoperatively to 67 degrees (range, 10 to 115 degrees) after the surgery. The most important factor that influenced the final result was the presence of ectopic bone surrounding the elbow joint. There were seven complications. Infection developed in five elbows. Three elbows had a superficial infection, which did not compromise the final result in two and which was treated with a myocutaneous flap in one with skin necrosis, with an excellent result. Deep infection developed in two other elbows. Both had an unsatisfactory result, one after implant removal and one after several debridements and retention of the prosthesis. Two patients sustained a fracture because of a loose component, and the prosthesis was revised. Four patients who lost motion within the first month following the surgery had a manipulation under anesthesia. CONCLUSIONS: Semiconstrained total elbow arthroplasty is a useful option for patients with an ankylosed or a very stiff elbow and results in a considerable improvement of motion. Because of the nature of the underlying pathology, complications, including reoperation, are frequent, but the risk can be lessened by careful preoperative planning and surgical technique. Replacement is the preferred option in patients who are more than sixty years of age, but it is also a good choice in younger patients if there is no other viable option.

Adult↗
PubMed1994

[The collateral ligaments of the elbow joint: their functional anatomy with special reference to the pathology and treatment of post-traumatic stiff elbow].

Factors which cause stiff elbow were investigated both experimentally and clinically. Since a thickened and shortened medial collateral ligament is often seen in stiff elbow, then changes in the length of the medial collateral ligament (MCL) and in the length of the lateral collateral ligament (LCL) were investigated in cadaver elbow specimens, and correlated with the observed range of motion. The MCL was divided into five bundles, and the LCL into three bundles. The length changes during flexion and extension of the elbow joint were measured, and the length change pattern was found to be different from bundle to bundle. The lengths of the LCL and the anterior oblique ligament (AOL) of the MCL changed little during elbow flexion. On the other hand, the length of the posterior oblique ligament (POL) of the MCL considerably increased when the elbow joint was flexed. The more posterior the bundle was, the larger the change in length that was observed. Because the origin of the POL is far distant from the axis of motion, it was suspected that a shortening in the POL was one of the most important pathologic changes in stiff elbow. The results of the biomechanic study were applied to a subsequent clinical study. Scar formation or ectopic ossification on the medial and/or posterior parts of the elbow joint was observed in 38 of 43 cases at surgery. These pathologic regions were resected, including the scarred POL. The intra-operative findings revealed that the major restraints in stiff elbow were the medial and/or posterior parts of the elbow. The importance of the shortened POL in the clinical pathology of stiff elbow was clearly demonstrated.

Adolescent↗
PubMed1992

Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a cause of elbow pain? A controlled study.

Elbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, chi 2 = 5.32, P less than 0.025, n = 85, olds ratio (OR) 3.30 (95% CI 1.16-9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, chi 2 = 4.51, P less than 0.05, n = 84, OR = 3.20 (95% CI 1.06-9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent in cases with elbow hyperostosis compared to controls (21% versus 13%, chi 2 = 0.75, NS, OR = 1.84 (95% CI 0.46-7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

Aged↗
PubMed1999

Instability of the elbow treated with semiconstrained total elbow arthroplasty.

The results of nineteen semiconstrained modified Coonrad-Morrey total elbow arthroplasties performed in nineteen patients to treat instability were evaluated at an average of seventy-two months (range, twenty-five to 128 months) postoperatively. Preoperatively, all patients had either a flail elbow or gross instability of the elbow that prevented useful function of the extremity. The instability of sixteen elbows was the result of a traumatic injury or of the treatment of such an injury. The most recent result was satisfactory for sixteen elbows and unsatisfactory for three. The average overall Mayo elbow performance score increased from 44 points preoperatively to 86 points postoperatively. At the most recent follow-up examination, no elbow was unstable. The average arc of flexion was from 25 degrees (range, 0 to 60 degrees) to 128 degrees (range, 30 to 142 degrees), which represented a 58-degree increase from the preoperative average arc. Sixteen patients had little or no pain after the arthroplasty. There were four complications in four patients. Three complications (loosening of the humeral component in one patient and a fracture of the ulnar component in two) occurred postoperatively; all three were treated with a revision procedure. The other complication (a fracture of the olecranon) occurred intraoperatively and was treated with tension-band fixation; the most recent outcome was not affected. Radiographically, one patient had complete (type-V) radiolucency about the humeral component. None of the nine patients for whom true anteroposterior radiographs were available had evidence of wear of the bushings. The bone graft behind the anterior flange of the humeral prosthesis was mature in fourteen elbows, incomplete in two, and resorbed in two. One patient was excluded from this analysis because radiographs were not available. Instability of the elbow resulting in the inability to use the extremity is a challenging clinical situation. However, in patients who are more than sixty years old and in selected patients who are less than sixty years old but who have extensive loss of bone as a result of severe injury, have had multiple operations, or have rheumatoid arthritis, total elbow arthroplasty with a linked, semiconstrained prosthesis reestablishes a mobile, stable joint without premature loosening or failure of the components. In our experience, the use of customized implants, maintenance of the muscular attachments to the epicondyles, and reconstruction of the epicondyles to the implant were unnecessary.

Arthroplasty, Replacement↗
PubMedDate not supplied

The effect of elbow position on the radial pulse measured by Doppler ultrasonography after surgical treatment of supracondylar elbow fractures in children.

We performed a prospective study of 20 patients with displaced extension supracondylar humerus fractures and evaluated the effect of elbow flexion, forearm supination, and forearm pronation on blood flow to the injured arm after closed reduction and Kirschner wire fixation. Ten patients had a Gartland type II fracture and 10 patients had a Gartland type III fracture. After closed reduction and percutaneous pinning, the radial pulse was examined with Doppler ultrasonography starting with the elbow in extension. The elbow was slowly flexed, and the angle of elbow flexion at which the radial pulse disappeared was determined. This angle of elbow flexion was measured with the forearm in both supination and pronation. Gartland type III fractures demonstrated less elbow flexion prior to radial pulse ablation compared to Gartland type II fractures when the forearm was placed in supination (p = 0.001) and in pronation (p = 0.005). Supination allowed > or = 5 degrees of elbow flexion prior to radial pulse ablation in six Gartland type II and four Gartland type III fractures. We concluded that after closed reduction and percutaneous Kirschner wire fixation of displaced extension supracondylar fractures, vascular safety is enhanced by extending the elbow and supinating the forearm. The ideal position of elbow immobilization depends on the amount of swelling and the presence of a radial pulse.

Child↗
PubMed2002

Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow.

BACKGROUND: Medial elbow ganglia have been reported in association with cubital tunnel syndrome. This lesion is thought to occur rarely and has not been emphasized in the literature. The purposes of the present study are to report our experience with this lesion in order to elucidate its prevalence as well as its clinical and radiographic features, to describe our operative findings, and to present the results of surgical treatment. METHODS: Four hundred and eighty-seven elbows in 472 patients were treated for cubital tunnel syndrome between 1980 and 1999. We performed a retrospective study of the thirty-eight patients who had a medial ganglion. All of the ganglia were excised, and the ulnar nerve was translocated subcutaneously. Thirty-two patients were followed for a mean of thirty-seven months. RESULTS: Medial elbow ganglion was the third most common causative factor associated with cubital tunnel syndrome, with an overall prevalence of 8%. Resting pain in the medial aspect of the elbow was reported by twenty-five of the thirty-eight patients, and a sudden onset of numbness in the ring and little fingers or of medial elbow pain without prior symptoms was reported by twenty-nine patients. The symptoms lasted two months or less in thirty-one patients. All ganglia originated from the medial aspect of the ulnohumeral joint, and radiographs of that joint showed degenerative changes in thirty-seven patients. At the time of follow-up, all measurements of sensory and motor function of the ulnar nerve had improved and no recurrence of nerve palsy was found. CONCLUSIONS: Although uncommon, medial elbow ganglia have a strong association with osteoarthritis of the elbow and can cause a relatively acute onset of cubital tunnel syndrome. A patient with cubital tunnel syndrome associated with elbow osteoarthritis who complains of medial elbow pain or severe numbness within two months after the onset of the syndrome should be strongly suspected of having a ganglion. Most ganglia are occult, and ultrasonography and magnetic resonance imaging can assist in the preoperative diagnosis. Careful excision of the ganglion performed concurrently with subcutaneous anterior transposition of the ulnar nerve can produce satisfactory results.

Adult↗
PubMedDate not supplied

Electromyographic activity in stiff and normal elbows during elbow flexion and extension.

This prospective, controlled pilot study investigated electromyographic activity in elbow muscles during active elbow flexion and extension and during prolonged elbow extension with and without resistance. Biceps brachii, brachialis, brachioradialis, and triceps activity was measured in 10 subjects with elbow motion deficits after injury and in 10 controls. Surface electromyography was recorded during active elbow flexion, extension, and passively positioned elbow extension with and without 3 lb on the distal forearm. All muscles of the stiff elbow group had greater activity compared with controls during active elbow flexion and extension. Biceps brachii of the stiff group showed antagonist activity equivalent to agonist. For all other flexors in both groups, agonist activity was greater than antagonist. During prolonged extension, biceps brachii, unweighted, showed greater activity in the stiff group than in controls. Both groups showed greater flexor activity when weighted. Across time, activity was sustained or increased in all muscles in both groups.

Adult↗
PubMed1995

Comparison of the flexed and extended elbow positions in localizing ulnar neuropathy at the elbow.

Electrophysiologic localization of ulnar neuropathy at the elbow often depends on demonstration of segmental slowing. Based on normative data obtained from 50 control subjects, we compared the utility of flexed and extended elbow positions in demonstrating focal slowing at the elbow as compared to the forearm segment in patients with ulnar neuropathy. We studied 35 patients with ulnar neuropathy with definite electrophysiologic localization to the elbow segment defined by conduction block across the elbow segment or by focal slowing demonstrated either in the flexed or extended position. Applying cutoff values from the control group, all 35 patients demonstrated focal slowing at the elbow in the flexed position, whereas only 5 of 35 (14%) patients did so in the extended position. We conclude that the flexed elbow position is more sensitive than the extended position in localizing ulnar neuropathy at the elbow and should be the preferred method when performing ulnar motor conduction studies.

Adult↗
PubMed1995

Loose-hinge total elbow arthroplasty. An experimental study of the effects of implant alignment on three-dimensional elbow kinematics.

A previous study suggested that the kinematics of a loose-hinge total elbow arthroplasty (TEA) are those of a truly semiconstrained joint. This study addresses the effects of malposition of the implant. The three-dimensional elbow kinematics during simulated active motion were studied in six cadaver specimens using an electromagnetic tracking device. In addition to simulated active elbow flexion, flexion arcs were obtained under an elbow varus or valgus moment, to calculate the structural varus-valgus laxities. The results after four different Coondrad-Morrey TEA positions of implantation were compared with those of the intact elbow. The flexion-extension amplitudes were not significantly decreased after TEA implantation, except with external rotation of the ulnar component, which resulted in a loss of extension. In the intact elbow and after TEA implantation in any position, the mean varus-valgus deviations throughout elbow flexion were in a narrower range than the structural limits imposed by the ligaments (intact elbow) or the TEA hinge design. With internal malrotation of the humeral component over 10 degrees, however, the valgus structural limit was reached and, conversely, the varus limit with external rotation over 10 degrees. The clinical improvement observed with the semiconstrained TEA is derived from the benefits of the less constrained articulation. The proximodistal changes of TEA implantation have no consequence on the kinematic pattern. Rotational malpositioning of either humeral or ulnar component should be avoided, the first because it changes the kinematic pattern toward the structural limits of the implant and, therefore, may lead to excessive stresses at the bone-cement-implant interfaces and to early loosening, and the latter because it causes loss of extension.

Biomechanical Phenomena↗
PubMed2003

[Total elbow arthroplasty. Indications, operative technique and results after implantation of an Acclaim elbow prosthesis].

Total elbow arthroplasty has become a reliable treatment option for patients with rheumatoid arthritis as well as primary or posttraumatic arthrosis. The aim of this study is to present the indications, operative technique and results for the implantation of an Acclaim elbow prosthesis. Case reports are given to demonstrate the indications for prosthesis implantation. Furthermore, the follow-up results are reported for 65 patients after implantation of an Acclaim prosthesis. Pre- and postoperative pain were evaluated using the visual analogue scale. The pain level decreased from 8.0 to 2.3 postoperatively. After implantation of an elbow prosthesis, there was a significant improvement in the range of motion. The mean flexion increased from 103 degrees preoperatively to 140 degrees postoperatively. An increase of 10 degrees was found for both supination and pronation. Complications included temporary ulnary nerve irritation in seven patients, intraoperative fractures in four cases and postoperative elbow dislocation in one case. In conclusion, total elbow arthroplasty results in a reduction of pain and an improvement in elbow movement. However, selection of the right patient is important. Patients are advised not to lift heavy objects or to perform hard physical work. If patients' compliance can not be ensured preoperatively, no total elbow arthroplasty should be performed.

Aged↗
PubMed1998

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm.

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulnar nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.

Aged↗
PubMed1997

Elbow allograft for reconstruction of the elbow with massive bone loss. Long term results.

Transplantation of total elbow allografts has been used as a salvage procedure in an attempt to provide patients with functional, painless range of motion of the elbow. This procedure is appropriate for patients with massive bone loss after trauma, tumor resection, or revision elbow arthroplasty. During the past 20 years, 23 patients have undergone elbow allograft reconstruction with variable results and a high complication rate. Ten of 14 patients with elbow allografts observed for an average of 7.5 years report satisfactory results. Allograft removal was required in six patients: for infection (two), instability (three), and nonunion and resorption (one). Three patients with instability have since undergone successful total elbow arthroplasty. Two patients have been observed less than 1 year and another patient died during the study period. Complications occurred in 16 of 23 patients. This operation is not recommended for routine use and is viewed as a salvage procedure. The use of allografts in elbow reconstruction does not preclude subsequent reconstruction with another allograft or fusion. In patients with deficient bone stock, the allograft reestablishes bone mass to permit an arthrodesis or reconstructive arthroplasty.

Adult↗
PubMedDate not supplied

A modified posterior approach to the elbow for total elbow replacement.

Fifty-nine consecutive primary total elbow replacements were performed with the modified posterior approach. The approach differs from other described approaches. The fascia and periosteum over the subcutaneous border of the ulna are preserved, and dissection is carried out on either side of the ulna. This enables a more secure repair of the posteromedial and posterolateral muscle compartments. The ulnar nerve is mobilized to prevent any injury. The distal humerus and proximal ulna can be fully exposed by this approach, giving wide access so necessary for accurate positioning of the prosthesis. The overall complication rate in 59 total elbow replacements was 33.9% including 4 (6.7%) ulnar nerve palsy, 4 (6.7%) wound infections, 2 (3.3%) delayed healing, 4 (11.8%) diminished range of motion in the affected elbow, 2 (3.3%) instability (1 had dislocated elbow and 1 had subluxation), and 1 (1.7%) triceps dehiscence requiring exploration and repair. All the patients could perform active resisted extension of the elbow, indicating continuity of the triceps. The senior author (SCG) has been using this approach for the Roper-Tuke unconstrained total elbow replacement for the last 15 years, and it has been associated with a lower incidence of complications. This approach has not been described before and is recommended for total elbow replacement.

Arthroplasty, Replacement↗
PubMed1996

High prevalence of elbow problems among goalkeepers in European team handball -- 'handball goalie's elbow'.

The aim of this study was to describe elbow problems among goalkeepers in team handball. A questionnaire was sent to the coaches of 449 senior and 32 junior teams in Norway in 1992. Of these, 304 coaches responded (63%) and their teams were included in the study. A total of 329 out of 729 goalkeepers (45+/-1.8%) and 166 out of 4120 court players (4.0+/-0.3%) were reported by their coaches to have current or previous symptoms from one or both elbows when playing handball. In response to a second questionnaire sent to all the goalkeepers (729; response rate 81%), 41+/-2.0% reported current elbow problems and an additional 34+/-2.0% reported previous problems. During a 2-year observation period from 1992 to 1994, 8.6+/-1.8% of the goalkeepers with previously healthy elbows experienced elbow problems. The typical complaint was recurrent pain and disability episodes, each with an acute onset, but with varying duration. The mechanism of injury for the goalkeepers appears to be repeated hyperextension traumas. We conclude that elbow pain and disability is a significant problem for a large number of goalkeepers in team handball. These problems may be described as a syndrome called 'handball goalie's elbow'.

Adolescent↗
PubMed2001

Valgus deformity and proximal subluxation of the rheumatoid elbow: a radiographic 15 year follow up study of 148 elbows.

OBJECTIVE: To evaluate the nature of positional changes of humeroulnar (HU) and humeroradial (HR) joints in a cohort of 74 patients with seropositive and erosive rheumatoid arthritis (RA) followed up prospectively. METHODS: At the 15 year follow up standard anteroposterior and lateral radiographs of 148 elbow joints were evaluated. The mediolateral HU angle of the elbow was measured from anteroposterior radiographs. The proximal subluxation of the HU joint was measured from lateral radiographs as the distance between the posterior aspect of the olecranon process and the posterior surface of the humerus. The anteroposterior subluxation of the HR joint was measured from lateral radiographs as the relation of the midpoint of head of the radius to the midpoint of the capitellum of the humerus. Destruction of the elbow joints was assessed with the Larsen method on a scale of 0 to 5 and compared with the measurements. RESULTS: Mean HU angle in 148 elbows of patients with RA was 11.5 degrees (SD 6.1), range -21 degrees (varus) to 34 degrees (valgus); 9.9 degrees (SD 4.3) in men and 12.0 degrees (SD 6.4) in women. The mean HU angle, 14.4 degrees (SD 6.0) of the affected joints (Larsen grades 2-4), showed more valgus than the mean 9.8 degrees (SD 2.5) of the non-affected (Larsen grades 0 to 1) joints; totally destroyed and unstable Larsen 5 joints were excluded. Mean HU and HR subluxations, 2.0 mm (SD 3.8) and 0.8 mm, of the affected joints (Larsen 2-5) were greater than the means, -1.1 mm (SD 1.5) and -0.4 mm (SD 0.9), of the non-affected joints. Both the HU proximal subluxation and the HR anterior subluxation correlated, r(s)=0.64 (95% CI 0.53 to 0.73 ) and r(s)=0.48 (95% CI 0.34 to 0.60), with the destruction of the elbow joint. CONCLUSIONS: The elbow seems to turn into valgus during rheumatoid destruction and excision of the radial head may speed up this process. However, totally unstable Larsen grade 5 joints may also have varus deformity owing to mutilating bone destruction. The ulna subluxates proximally in relation to the humerus, whereas the radius moves slightly anteriorly as a consequence of elbow involvement.

Adolescent↗
PubMed1997

Collateral ligaments of the elbow: conventional MR imaging and MR arthrography with coronal oblique plane and elbow flexion.

PURPOSE: To determine the best plane and position of the elbow for optimal visualization of normal and abnormal collateral ligaments with conventional magnetic resonance (MR) imaging and MR arthrography, to determine the normal appearance of the collateral ligaments at MR arthrography and to assess use of MR arthrography in evaluation of collateral ligamentous lesions. MATERIALS AND METHODS: Nine cadaveric elbow specimens were imaged with and without intraarticular administration of gadolinium-containing solution in several planes that were identified as potentially useful in a pilot study in two specimens. MR imaging findings were compared with anatomic findings. RESULTS: Normal and abnormal ligaments were best depicted in a 20 degrees posterior oblique coronal plane in relation to the humeral shaft with the elbows extended and a coronal plane aligned with the humeral shaft with the elbows slightly flexed (20 degrees-30 degrees of flexion). Gadolinium enhancement improved the delineation of normal and abnormal ligaments on T1-weighted images in each case. CONCLUSION: The posterior oblique coronal plane with the elbows extended or the coronal plane aligned with the humeral shaft with the elbows slightly flexed allows accurate assessment of the collateral ligaments. Gadolinium-enhanced MR arthrography of the elbow seems to be a promising technique.

Aged↗