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At least 19 recordsLinked to original sources
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↗
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↗
PubMed1992

Elbow tendinosis/tennis elbow.

The histology of pathologic tennis elbow tissue reveals noninflammatory tissue, thus the term angio-fibroblastic tendinosis. The goal of nonsurgical treatment is a revascularization and collagen repair of this pathologic tissue by rehabilitative exercise. In the event of rehabilitation failure, surgical correction by removal of this pathologic tissue is the surgical technique of choice.

Diagnosis, Differential↗
PubMedDate not supplied

[Long-term results of epicondylitis humeri ulnaris ("golfer's elbow") after treatment analogous to Hohmann's incision of epicondylitis humeri radialis ("tennis elbow")].

With an average follow-up of 6.1 years the results of Hohmann's operation in treatment of humeri ulnaris epicondylitis in 23 cases are presented. For evaluation a numerical rating system with subjective and objective criteria was designed. The results were excellent in 43.5%, good in 26.1% and fair in 17.5% by subjective and excellent in 47.9%, good in 26.1% and fair in 13% by objective evaluation. Three cases had a poor result. The study reviews causes, clinical tests, conservative treatment and our operative method.

Adult↗
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↗
PubMedDate not supplied

Semiconstrained total elbow arthroplasty.

Diminution of elbow function may be both embarrassing and severely disabling, especially in patients with multiple arthritic joints. Over the past century, multiple techniques of soft tissue reconstruction of the elbow have been advocated. In general, they do not compare well with total elbow arthroplasty. Arthrolysis has often resulted in little improvement of elbow motion and interposition arthroplasty to instability. Synovectomy may however offer satisfactory relief of disability for the rheumatoid elbow provided that initially there is little evidence of joint destruction. The major problem with rigidly linked total elbow arthroplasty has been a high incidence of prosthetic loosening. Biomechanical analysis has shown that high moments tend to disrupt the osseousmethacrylate junction in the humoral medulary canal. Development of a semi-constrained total elbow prosthesis transfers the developed stress to the collateral soft tissues and reduces prosthetic loosening to approximately 3 per cent. This is about one-tenth of the incidence of loosening of the hinge type arthroplasty. This reduction in prosthetic loosening has been coupled with excellent gains in flexion and estension. However, improvement in forearm rotation has not been predictable, especially in elbows exhibiting preoperative fusion or fibrous ankylosis. Though the semi-counstrained total elbow has only been generally available for 3 years, a review of these results justifies its continued use for elbow reconstruction.

Arthritis, Rheumatoid↗
PubMed1992

Computerised infrared thermography and isotopic bone scanning in tennis elbow.

Thirty five cases of tennis elbow (17 unilateral, nine bilateral) were studied with infrared thermography and isotopic bone scanning. A hot focus was visualised in 16 of 17 cases of unilateral tennis elbow (94%) and in all nine cases of bilateral tennis elbow (100%) on infrared thermography, and abnormal increased epicondylar activity seen in 12 of 17 (71%) and eight of 18 (44%) cases respectively with isotopic bone scanning. Unilateral visual cooling (somatosympathetic responses) occurred in seven of 13 cases of unilateral tennis elbow (54%) with infrared thermography, and reduced perfusion in seven of 12 (58%) of similar cases with blood pool isotopic bone scanning. Computerised temperature assessments showed statistically significant side to side temperature differences when 17 active tennis elbows were compared with the opposite normal elbows for spot temperatures, proximal and distal forearm gradients. Similar temperature assessments in 18 bilateral tennis elbows compared with 17 normal elbows showed significant temperature differences for elbow spot temperatures and distal forearm gradients, but not for proximal gradients.

Adult↗
PubMed1978

The radiological diagnosis of posttraumatic effusion of the elbow joint and its clinical significance: the 'displaced fat pad' sign.

Alterations occur in the radiological appearance of the soft tissues after injury to the elbow joint. These are due to displacement of the intra-articular fat pads by capsular distension when an effusion is present. A prospective study of 89 consecutive elbow injuries was undertaken in an attempt to assess the usefulness and reliability of these changes in the diagnosis of minor elbow injuries and the assessment of their clinical progress. In 61 elbows (69 per cent) there was no radiological evidence of an effusion and no evidence of bony injury. All quickly returned to normal. In 28 elbows (31 per cent) radiological evidence of an effusion was present. Twenty-three (80 per cent) of these were also found to have a fracture in, or adjacent to the elbow joint. In 9 elbows the fracture could not be seen on the initial radiographs. Because of the presence of an effusion, repeat radiographs were taken and a fracture discovered. The presence of an effusion was associated with an increase in the time required for full recovery.

Adipose Tissue↗
PubMed1979

The determination of bone age in the elbow as compared to the hand. A study in 390 children.

In a prospective study, bone age (BA) from both hand and elbow was assessed in 390 children, aged 6-15 years, in order to determine: (a) whether or not BA assessment from the hand and from the elbow give comparable results, and (b) whether the accuracy of predicting skeletal age from the hand may be improved by the additional BA determination in the elbow. BA assessment in the hand was performed according to the method of Greulich and Pyle while the standards of Schinz and Baensch were used for the elbow. Statistical analysis of data was carried out according to age groups as well as according to groups of clinical diagnoses. With only one exception in the group of so-called "healthy individuals", there was no difference between "hand age" and "elbow age". Thus, except in a very small group of subjects, both methods of BA assessment were found to be equivalent in predicting skeletal age in children between 6-15 years. Equivocal results were obtained regarding the question of whether the accuracy of BA assessment in the hand may be improved by the simultaneous BA determination from the elbow. Until further studies on larger statistical material provide more conclusive information in this matter, we feel that the combined determination of BA in the hand and elbow is not warranted for clinical purposes.

Adolescent↗
PubMed1976

Electrodiagnosis of ulnar nerve lesions at the elbow.

To determine electrical criteria which might be helpful in the diagnosis of ulnar nerve entrapment at the elbow, clinical and electrodiagnostic features in 78 patients with suspected ulnar nerve entrapment at the elbow are described and compared to the results of sensory and motor conduction in the ulnar nerve in a control group of normal persons. These criteria include (1) absent or abnormal evoked sensory nerve action potential in the little finger, (2) motor conduction velocity of less than 45.0 meters/sec in across elbow segment of the ulnar nerve with elbow flexed at 35 degrees, and (3) abnormal electromyographic findings including the presence of increased insertional activity or signs of denervation in the first dorsal interosseous, abductor digiti minimi, and/or flexor carpi ulnaris muscles. Electromyographic abnormality was seen in 77.5% of patients with ulnar motor conduction velocity of less than 45.0 meters/sec across the elbow. The first dorsal interosseous was the most commonly affected muscle. A study of certain important anatomic and histologic factors, such as the arrangement and relative concentration of the motor and sensory fibers at certain key points inthe course of the ulnar nerve trunk, is necessary to understand the correlation between the clinicopathologic and electrodiagnostic features in patients with ulnar nerve entrapment at the elbow.

Adult↗
PubMedDate not supplied

A survey of postoperative elbow immobilization approaches.

A survey of 200 North American burn units was designed to gather data about elbow immobilization positions and methods. Respondents were asked to identify the position of elbow and forearm immobilization after grafting to the upper extremity, the rationale for this, the location of the burn for the immobilization position chosen, who was responsible for immobilizing the patient's elbow after surgery, what type of material was used, and on what day range of motion to the elbow was resumed. Results indicated that elbow immobilization positions varied from full extension to more than 20 degrees of flexion, although full extension and slight flexion were used most, as was the forearm midposition. The rationale for immobilization that was most frequently given was prevention of contractures. Occupational therapists were most likely to be involved in or responsible for elbow immobilization, and thermoplastic materials were used most often. The day that range of motion was resumed also varied but was most frequently postoperative day 5.

Arm Injuries↗
PubMed1992

Elbow arthroscopy.

Elbow arthroscopy has made rapid advances in recent years. The improvement in the arthroscopic technique, as well as the development of technically advanced equipment, has made elbow arthroscopy very attractive to orthopaedic surgeons. It is important to realize that elbow arthroscopy is a modality that should be respected. This demanding procedure requires keen awareness of the elbow's anatomy and the technical arthroscopic approach to the elbow joint. With this careful approach in mind, the orthopaedist will find that elbow arthroscopy can be a valuable tool.

Arthroscopy↗
PubMed1992

Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow.

Fifty-four patients in whom a total of fifty-eight semiconstrained modified Coonrad elbow implants had been inserted for rheumatoid arthritis were followed for a mean of 3.8 years (range, two to eight years). At the latest follow-up, there was little or no pain in fifty-three elbows (91 per cent). The arc of motion was from an average point in flexion of 20 degrees to an average point in flexion of 129 degrees, representing an average increase of 12 degrees of extension and 11 degrees of flexion. The average arc of pronation was 78 degrees, an increase of 14 degrees, and the average arc of supination was 77 degrees, an increase of 18 degrees. An additional ten patients who had had insertion of ten modified Coonrad implants during the same period were followed for less than two years but were included in the assessment of complications. Fifteen (22 per cent) of the sixty-eight elbows had a complication: four, infection; eight, acute or delayed condylar or ulnar fracture; and one each, ulnar neuritis, avulsion of the triceps, and fracture of the implant. Radiographic evaluation was performed for fifty-four of the fifty-eight elbows; the other four were excluded from this evaluation because of infection. A satisfactory radiographic appearance of the cement--its extent and the absence of skip areas--was noted for all of the ulnar components and for fifty-one (94 per cent) of the humeral components. No patient had radiographic evidence of a loose implant. A reoperation was performed in six elbows (10 per cent of the fifty-eight; 9 per cent of the sixty-eight): four were done for infection; one, for insufficiency of the triceps; and one, for a fractured ulnar component. Of the fifty-eight elbows, forty (69 per cent) had an excellent result; thirteen (22 per cent), a good result; four (7 per cent), a fair result; and one, a poor result.

Arthritis, Rheumatoid↗
PubMed1977

Total replacement of the elbow joint.

Total replacement of the elbow joint has been performed on 86 elbows at the Mayo Clinic, all but 15 in patients with rheumatoid arthritis. The Mayo design, which replaces both radiohumeral and humeroulnar joints, was used in 41 elbows, almost all in rheumatoid patients, with 71% good results. The Coonrad hinge with polyethylene bushings was used in 34 elbows; it was successful in 64% of rheumatoid patients, but failed in 46% of posttraumatic patients with bone loss. Previous designs have failed because of humeral loosening. Total elbow replacement is a technique still to be perfected in medical centers before general release.

Arthritis, Rheumatoid↗