Active Elbow Research Articles

Unusual anterior radial head dislocation associated with transposed biceps tendon: A case report

ASE REPORT A 12-year-old girl fell from a ladder, landed on the round, and twisted her right forearm with her right elbow xtended. Her right elbow was swollen and painful, but here were no signs of neurologic or vascular injury. Withut delay, she went to the hospital. Radiographs of the lbow taken immediately after the injury showed an anteior radial head dislocation and fracture in the medial picondyle of the humerus (Figure 1). Radiographs of the orearm were not taken. The patient underwent operation nder general anesthesia on the same day of the injury. eduction of the radial head, by use of an image intensifier, as performed via a lateral approach with a small splitting f the common extensors. The reduced radial head was nstable. However, exposure of the radiocapitellar joint as not done, and transcapitellar Kirschner wire fixation as performed to stabilize the reduced radial head (Figure ). The medial epicondyle fracture was treated by open eduction–internal fixation by use of a single pin and suplemental steel wire via a medial approach (Figure 2). ostoperatively, an above-elbow cast immobilization was pplied. Six weeks after the operation, the cast and trancapitellar Kirschner wire were removed at the same time, nd active elbow movements were then begun. However, adiographs of the elbow 7 weeks postoperatively showed n anterior radial head dislocation. At 9 weeks 6 days after the initial operation, the patient as referred to our department for further examination and reatment. On initial examination, the radial head was alpable with tenderness in the antecubital fossa. Flexion/ xtension of the elbow was 90°/ 50°, and pronation/

Options and Results in Nerve Reconstruction of Elbow Flexion in Patients with Post-Traumatic Brachial Plexus Injury

If active elbow flexion must be reconstructed in brachial plexus lesions, the option of nerve reconstruction should always be considered first. Depending on the etiology, there are several possibilities for re-neurotization of the musculocutaneous nerve, such as intraplexual reconstruction from the C6 root, or extraplexual reconstruction from the accessory nerve, phrenic nerve, intercostal nerves, ulnar nerve, pectoral nerve, and contralateral C7 root.

Differential Controls Over Tactile Detection in Humans by Motor Commands and Peripheral Reafference

The purpose of this study was to determine the extent to which motor commands and peripheral reafference differentially control the detection of near-threshold, tactile stimuli. Detection of weak electrical stimuli applied to the index finger (D2) was evaluated with two bias-free measures of sensory detection, the index of detectability (d') and the proportion of stimuli detected. Stimuli were presented at different delays prior to and during two motor tasks, D2 abduction, and elbow extension; both tasks were tested in two modes, active and passive. For both active tasks, the peak decrease in tactile suppression occurred at the onset of electromyographic activity. The time course for the suppression of detection during active and passive D2 abduction was identical, and preceded the onset of movement (respectively, -35 and -47 ms). These results suggest that movement reafference alone, acting through a mechanism of backward masking, could explain the modulation seen with D2 movement. In contrast, tactile suppression was significantly earlier for active elbow movements (-59 ms) as compared with passive (-21 ms), an observation consistent with both the motor command and peripheral reafference contributing to the suppression of detection of stimuli applied to D2 during movements about a proximal joint. A role for the motor command in tactile gating during distal movements cannot be discounted, however, because differences in the strength and distribution of the peripheral reafference may also have contributed to the proximo-distal differences in the timing of the suppression.

Botulinum toxin type-A and plaster cast treatment in children with upper brachial plexus palsy

Electrical stimulation, physical therapy and occupational therapy remain the main treatment for children with upper brachial plexus palsy (UBPP), when surgery has been excluded. A pilot study was undertaken to investigate whether botulinum toxin type A (BoNT-A) and plaster casting, as adjunct to the physical therapy, decreased muscle contracture and improved the position and function of the impaired arm. Twenty-two children (mean age 5.6 +/- 3.4 years) with mild UBPP who previously underwent serial cast treatment, unsuccessfully, were enrolled. Neurological impairment and functional status were quantified using Medical Research Council (MRC) and Mallet scales and the Nine-Hole Peg Test (NHPT). Elbow extension was measured using a goniometer. Biceps brachii, brachialis, pronator teres and pectoralis major muscles were injected with 22 units kg(-1) BoNT-A (Dysport, Ipsen). After injection, the treated arm was fixed with a plaster cast and progressively lengthened over 14 days. The cast was maintained for 30 days. Assessments of elbow extension, MRC, Mallet Scale and NHPT were made at baseline, 3, 6 and 12 months. After BoNT-A injection, children had significant improvement of active elbow extension (15.5 degrees +/- 17.1 at 12 months after injection, compared with 42.0 degrees +/- 10.4 at baseline; p < 0.001). NPHT scores improved significantly over the 12 months (51.1 +/- 21.8 seconds compared with 56.7 +/- 19.3 seconds at baseline, p < 0.01). MRC and Mallet scale scores of the paretic muscles were unchanged. The children showed a reduction in muscular contracture and improvements of the arm position and elbow extension. The data support the use of BoNT-A and plaster casting as an adjunct to physical therapy, in the treatment of children with mild UBPP.

Effect of bilateral reaching on affected arm motor control in stroke – with and without loading on unaffected arm

Purpose. To investigate the effect of bilateral reaching, with/without inertial loading on the unaffected arm, on hemiparetic arm motor control in stroke.Methods. Twenty unilateral stroke patients were recruited. A three-dimensional optical motion capture system was used to measure the movement trajectory of the hemiparetic arm while performing three tasks: affected limb reaching forward; two-limb reaching forward; and two-limb reaching forward with inertia loading of 25% upper limb weight on the unaffected limb, respectively. Kinematical parameters were utilized to quantify the reaching performance of the affected arm.Results. No matter whether loading was applied on the unaffected arm or not, the bilateral reaching task did not significantly facilitate smoother and faster movement. Furthermore, during bilateral reaching task with/without loading on the unaffected arm, stroke patients showed slower movement, lower maximal movement velocity, feedback control dominant and discontinuous movements in the affected arm than the same task with unilateral reaching. Subjects showed the greatest active upper extremity range of motion in proximal joints during the bilateral reaching task without unaffected arm loading. The amount of trunk movement also increased during bilateral reaching either with or without loading on the unaffected arm. Patients with moderate upper extremity motor impairment performed more discontinuous movements and less active elbow range of motion during bilateral reaching tasks; however, those with mild upper extremity motor impairment performed smoother movements and demonstrated greater active elbow range of motion during bilateral reaching tasks.Conclusions. Bilateral reaching tasks with/without loading on the unaffected arm could be considered as adding challenges during motor control training. Training with bilateral arm movements may be considered as a treatment strategy, and can be incorporated in stroke rehabilitation to facilitate greater arm active movement and improve motor control performance in the affected arm.

Effectiveness of Prophylactic Hyperextension Elbow Braces on Limiting Active and Passive Elbow Extension Prephysiological and Postphysiological Loading

Experimental 3-factor design with repeated measures on all factors. The purpose of this study was to determine the effectiveness of 3 prophylactic hyperextension elbow braces on limiting active and passive elbow extension before and after exercise. Prophylactic hyperextension elbow braces are used to protect the joint against excessive extension, but their effectiveness for this purpose has not been determined. Twenty Division I intercollegiate football players (mean +/- SD age, 20.2 +/- 1.3 years; mean +/- SD height, 184.4 +/- 9.9 cm, mean +/- SD mass, 102.9 +/- 22.0 kg) completed all phases of the study. The Breg Functional Elbow Brace, PRO 470 Kendall Elbow Brace, and DonJoy Elbow Guard were tested both actively and passively before and after an isokinetic exercise session on a Biodex Multi-Joint Testing and Exercise Dynamometer. For all tests, the braces were set at a 30 degrees flexion limit angle. The exercise session consisted of 1 set of reciprocal elbow extension and flexion at an angular velocity of 360 degrees/s, totaling 1627 J of work. None of the braces limited elbow extension to the 30 degrees flexion limit. However, all of the braces were successful in preventing the elbow from reaching the vulnerable position of hyperextension. The Breg Functional Elbow Brace was the most effective for limiting elbow extension near its set angle, followed by the DonJoy Elbow Guard, and the PRO 470 Kendall Elbow Brace across all test conditions. The braces' effectiveness to limit motion is enhanced when limits are set higher than the desired angle of the protected motion.

Effectiveness of Prophylactic Hyperextension Elbow Braces on Limiting Active and Passive Elbow Extension Prephysiological and Postphysiological Loading

Effectiveness of Prophylactic Hyperextension Elbow Braces on Limiting Active and Passive Elbow Extension Prephysiological and Postphysiological Loading

Predictors of Persistent Elbow Tendonitis Among Auto Assembly Workers

Lateral and medial epicondylitis associated with work activity is a common upper extremity musculoskeletal disorder with a prevalence of 4-30% depending upon the work setting and diagnostic criteria. The influence of treatment, ergonomic factors, medical history, psychosocial variables, and aging on the improvement of symptoms has not been well defined. This was a prospective cohort study of a cohort of 45 workers with active elbow tendonitis for an average of 13 months. Complete resolution of symptoms was the defined outcome measure. The predictive factors for persistent elbow tendonitis included older age (OR = 1.1, 95% CI: 0.99, 1.33), higher hand repetition level for their job(s) (OR = 2.5, 95% CI: 1.00, 6.25), more deviation from a neutral wrist position during the work activity (OR = 2.0, 95% CI: 0.80, 5.56), and lower perceived decision authority on the job (OR = 0.9, 95% CI: 0.79, 0.98). Other ergonomic, psychosocial, and electrophysiologic measures were not predictive. The models had relatively high sensitivity and specificity. Treatment effects could not be evaluated due to incomplete data available. Older workers with jobs requiring more repetition and awkward wrist postures, and less decision authority were less likely to have resolution of their elbow tendonitis. Workers at highest risk for persistent elbow tendonitis should be placed at jobs with lower repetition levels and that use more neutral wrist postures. Effective interventions must address both the ergonomic and psychosocial risk factors in a multifaceted approach to this problem.

Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy

Botulinum toxin type A was recently introduced for treatment of biceps-triceps muscle cocontraction, which compromises elbow function in children with obstetrical brachial plexopathy. This is our preliminary experience with this new approach. Eight children were treated with 2-3 U/kg of botulinum toxin injected in the triceps (4 patients) and biceps (4 patients) muscle, divided in 2 or 3 sites. All patients submitted to triceps injections showed a long-lasting improvement of active elbow flexion and none required new injections, after a follow-up of 3 to 18 months. Three of the patients submitted to biceps injections showed some improvement of elbow extension, but none developed anti-gravitational strength for elbow extension and the effect lasted only three to five months. One patient showed no response to triceps injections. Our data suggest that botulinum toxin can be useful in some children that have persistent disability secondary to obstetrical brachial plexopathy.

Functional Outcome After Operative Treatment of Eight Type III Coronoid Process Fractures

There have been few reports about surgical outcomes of coronoid process fractures. Eight cases of clinical results of type III coronoid process fractures were reviewed. Eight patients with coronoid type III fracture were retrospectively reviewed. All were men with an average age of 33 years. There were three isolated fractures, two elbow dislocations, two radial head and neck fractures, and one medial collateral ligament rupture. An open reduction and internal fixation through an anterior approach with cannulated screws was used. The patients were followed up for a mean of 31 months (range, 24-60 months). Average active elbow joint motion at the most recent follow-up was 105 degrees. The average Mayo Elbow Performance Score was 76.9 (range, 50-95). Of the results, there was one excellent, four good, two fair, and one poor. Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated injuries to the elbow and fracture comminution were considered as important prognostic factors.

Elbow Flexion Reconstruction by Steindler Flexorplasty in Obstetric Brachial Plexus Palsy

The results of Steindler flexorplasty in nine patients with obstetric brachial plexus palsy are reported. There were 5 girls and 4 boys with a mean age of 6 (range 2-13) years. Selection criteria for the procedure included strong (at least M4) grip strength and wrist and elbow extension, as well as the presence of the "Steindler effect". Pre-operatively, elbow flexion was rated as M0 or M1 in three patients and M2 in the remaining six patients. Intra-operatively, the detached common flexor origin was advanced 5 to 7 cm and fixation was done to the anterior humerus either with direct suture to the periosteum (in younger children) or suturing into a drill hole in the humerus (in older children). Postoperatively, the elbow was immobilized in flexion and supination for 6 weeks. At a mean follow-up of 5 years, the results in eight patients were good with mean active elbow flexion against resistance of 110 degrees and a mean elbow flexion contracture of 35 degrees. The result in the remaining patient was poor (unsuccessful transfer). It is concluded that the results of the Steindler flexorplasty in obstetric brachial plexus palsy patients are good and reliable, provided patient selection is careful.

Shoulder Support for Children with Subluxation: A Case Study

ABSTRACT Children with brachial plexus injury from birth may present with varying degrees of muscle imbalance, as well as a subluxation of the glenohumeral joint. Shoulder subluxation occurs when the muscles of the shoulder girdle are weak or flaccid. The deltoid and the rotator cuff musculatures are unable to position the humerus appropriately to the glenoid fossa, and there is concurrent stretching of the glenohumeral joint capsule, ligaments, and nonactive muscles. Treatment for reducing the subluxation and positioning the arm typically has involved use of an appropriate sling or humeral cuff support. There are commercially available slings for children but no child-size shoulder support. The purpose of this case study was to design a custom-fitted shoulder support for children that reduces subluxation and maintains alignment through extended periods of the day. A validated radiographic method was used to quantify the subluxation before application of the shoulder support, immediately after applying the shoulder support, and after 3 hours of wear. A motion tracking system objectively quantified active shoulder and elbow movements in the presence and absence of the shoulder support. This case study suggests that the custom-designed child support significantly reduced the subluxation, maintained alignment through extended periods of the day, and maintained the active range in elbow flexion.

A Biomechanical Analysis of Two Biceps Tenodesis Fixation Techniques

To assess and compare the biomechanical properties and load-to-failure of 2 biceps tenodesis fixation techniques, interference screw fixation and double suture anchor fixation. Biomechanical study. Eleven fresh-frozen human cadaveric specimens were used in this study. A biceps tenodesis was performed using 1 of 2 techniques, interference screw fixation or double suture anchor fixation. A 7-mm interference screw was used in 5 cadaveric trials. A double suture anchor technique was performed in 6 cadaveric specimens. The tenodesis construct in each specimen was loaded to failure using a Servohydraulic materials test system (MTS Model 858; Bionix, MTS Corp, Minneapolis, MN). Each specimen was loaded at 5 mm/second with a preload of 5 N with the vector of pull distally in line with the long axis of the humerus. Each specimen was then loaded until failure of the repair occurred. Statistical analysis of the interference screw group compared with the suture anchor group was performed using a Student t test. The mode of failure of the interference screw group was variable, but the suture anchor group consistently failed at the anchor or anchor eyelet. The average pullout strength of the suture anchor group was 135.5 +/- 37.8 N whereas the failure load in the interference group was 233.5 +/- 55.5 N. The interference group had a significantly greater resistance to pullout than the suture anchor group (P = .007). Based on these results, a biceps tenodesis using an interference screw will provide greater fixation strength than a biceps tenodesis performed with a double suture anchor technique. The surgeon treating biceps tenodesis may wish to choose a fixation technique with higher initial strength (interference screw instead of double suture anchor) to lessen the chance of early failure, particularly if the patient begins early active elbow flexion.

Early Mobilization Using Dynamic Splinting with Acute Triceps Tendon Avulsion: A Case Report

Avulsion of the triceps tendon is rare, and no previous report of a completed dynamic splinting rehabilitation plan was found in the literature. A case of a military member and power weightlifter who sustained a triceps tendon avulsion and repair is presented with a six-month follow-up. The rehabilitation program included early active elbow flexion and passive extension using a dynamic elbow splint. The Disabilities of the Arm, Shoulder and Hand (DASH) 1–3 questionnaire was used to monitor the patient's use of his right dominant arm while in the dynamic splint. The DASH scores indicated that he experienced improved use of his affected arm during the splinting period. The end result was a good return of function within 13 weeks and full resumption of work and bodybuilding activities in six months, three months earlier than others reported in the literature who were immobilized after surgery. 4,5

Static magnetic fields neither prevent nor diminish symptoms and signs of delayed onset muscle soreness

Reeser JC, Smith DT, Fischer V, Berg R, Liu K, Untiedt C, Kubista M. Static magnetic fields neither prevent nor diminish symptoms and signs of delayed onset muscle soreness. ObjectiveTo determine whether application of a commercially available static magnetic field would alter the signs and/or symptoms of delayed onset muscle soreness (DOMS) produced by exhaustive eccentric exercise. DesignA double-blinded, randomized, and placebo-controlled study, with subjects serving as their own controls. SettingAn outpatient physical therapy and performance center. ParticipantsTwenty-three healthy volunteers (18 women; mean age, 30y; range, 18–40y; 5 men; mean age, 29y; range, 19–39y). InterventionAfter exhaustive eccentric exercise of both the right and left elbow flexor muscle groups, subjects received daily treatment with either a 350G magnet or a placebo device for 5 consecutive days. Main outcome measuresOutcome variables, including anthropometric measurements, perceived discomfort, and muscle force production, were compared using linear mixed models. ResultsArm circumference, relaxed elbow flexion angle, and pain increased, whereas active elbow flexion angle and maximal isometric torque decreased transiently before returning to near baseline. No significant difference in outcome variables existed between the treated and control arms. Participants reported less pain in both treated and control arms after each session, suggesting a placebo effect. ConclusionsStatic magnetic fields were no more effective than placebo in preventing DOMS.

Arthroscopic Release of the Long Head of the Biceps Tendon

Background Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. Hypothesis In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. Study Design Case series; Level of evidence, 4. Methods Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. Results The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P <. 05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. Conclusion Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. Clinical Relevance Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.

Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia

Bryden AM, Kilgore KL, Lind BB, Yu DT. Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia. Arch Phys Med Rehabil 2004; 85:1880-5. Objective To determine whether the existence of elbow flexion contractures in persons with C5 or C6 tetraplegia is related to a lack of residual voluntary triceps function and triceps denervation (ie, lower motoneuron damage). Design A retrospective study of impairment data from 74 arms to identify the incidence of elbow flexion contractures and the contributing factors toward this deformity. Setting Five spinal cord injury (SCI) rehabilitation centers in the United States, 1 in England, and 1 in Australia. Participants Forty-three subjects with motor complete C5 or C6 traumatic SCI. Interventions Not applicable. Main outcome measures Active and passive elbow extension, triceps voluntary muscle strength, and triceps response to electric stimulation. Results Subjects with weak voluntary triceps had significantly fewer and less severe elbow flexion contractures than those with paralyzed triceps ( P=.024). Subjects with completely denervated triceps (ie, no response to electric stimulation) had significantly more elbow flexion contractures than subjects with even a weak response to electric stimulation ( P=.003). Overall, 51% of the arms could not be passively extended to zero. Forty-six percent of the arms classified as C5 lacked full passive elbow extension, compared with 63% of the arms classified as C6 ( P=.302). Conclusions A relationship has been found between elbow flexion contractures and lack of residual voluntary triceps and triceps denervation in subjects with C5 or C6 tetraplegia. There should be a greater awareness of the elbow flexion contractures that may develop as a result of this relationship. A better understanding of this deformity and its characteristics can lead to more effective clinical treatment and prevention strategies.

Glenohumeral arthrodesis in upper and total brachial plexus palsy

We have compared the functional outcome after glenohumeral fusion for the sequelae of trauma to the brachial plexus between two groups of adult patients reviewed after a mean interval of 70 months. Group A (11 patients) had upper palsy with a functional hand and group B (16 patients) total palsy with a flail hand. All 27 patients had recovered active elbow flexion against resistance before shoulder fusion. Both groups showed increased functional capabilities after glenohumeral arthrodesis and a flail hand did not influence the post-operative active range of movement. The strength of pectoralis major is a significant prognostic factor in terms of ultimate excursion of the hand and of shoulder strength. Glenohumeral arthrodesis improves function in patients who have recovered active elbow flexion after brachial plexus palsy even when the hand remains paralysed.

Efficacy of Compressive Sleeve use for Reducing DOMS Symptoms Following Eccentric Loading of the Arm

2008 Heavy eccentric exercise induces muscle damage and is implicated in causing delayed onset of muscle soreness. DOMS may be associated with loss of function and anthropometric alterations. PURPOSE: To determine if a compressive sleeve worn after a bout of eccentric arm exercise would lessen the symptoms of exercise-induced muscle damage. Methods: Twelve non-strength trained males and females were matched for sex and arm strength, then assigned to one of two groups: non-treatment (NT, n = 5) or experimental (required wearing a compressive sleeve post-exercise for the ensuing 96 hours) (SL, n = 7). Subjects performed five sets of ten repetitions of the eccentric phase of the biceps curl at 120% of their concentric one-repetition max (1-RM). Measurements of active soreness (AS), arm circumference, relaxed elbow extension (REE), active elbow flexion (AEF), and peak isokinetic torque (concentric) (PIT), were collected prior to eccentric exercise and immediately, 24, 48, 72 and 96 hours after the exercise bout. Data were analyzed using ANOVA. Results: AS showed a significant effect for time (p<0.001) and a trend (p = 0.062) for a group effect. REE showed a significant effect for time (p = 0.007), but no significant difference between the groups was observed. AEF showed a significant effect for time (p = 0.043) and a trend (p = 0.054) for an interaction; no group effect was present. Despite a 35.9% decrease in PIT post-exercise, no time (p = 0.053), interaction or group effects were present. No effects were present for arm circumference measures. Conclusion: Based on the results of this study, it appears that compressive sleeve therapy tended to exacerbate subjective perceived soreness, but did not appear to have affected objective measures in the days following heavy eccentric loading of the arm.

The Steindler flexorplasty for the arthrogrypotic elbow

Purpose The arthrogrypotic elbow often lacks active flexion. If active elbow flexion can be provided by muscle transfer, patient independence increases and the patient can function in a less conspicuous manner by avoiding adaptive mechanisms. The purpose of this article is to review the outcome of patients with arthrogryposis treated with the Steindler flexorplasty to obtain active elbow flexion. Methods Seventeen elbows in 10 patients with an average age of 7 years were treated surgically with the Steindler flexorplasty procedure. Before surgery none of the patients was able to flex actively the elbow against gravity. All of the patients had at least 70° of passive elbow flexion. Upper-extremity active and passive range of motion, strength of flexion, functional outcome, and patient satisfaction were assessed at an average of 5 years after surgery (range, 2–9 years). Results After surgery all patients obtained active elbow flexion against gravity averaging 85° (range, 30°–120°); patients were able to lift an average of 1 kg through their entire arc of elbow flexion. At last follow-up evaluation patients lost an average of 27° of elbow extension. Patients lost forearm rotation but did not lose wrist or finger range of motion. Subjectively, 9 of the 10 patients were satisfied with the outcome of the surgery and would recommend the surgery to others. Conclusions The Steindler flexorplasty provides improved elbow flexion strength and patient function and should be considered for children with arthrogryposis.