Elbow Diseases Research Articles

Proximal radioulnar joint, but not posterolateral, instability in patients with symptomatic minor instability of the lateral elbow

IntroductionThe elbow joint is stabilized laterally by a complex of bony and ligamentous structures, such as the lateral ulnar collateral ligament (LUCL) and radial lateral collateral ligament (RLCL). Pathogenesis of many elbow conditions like SMILE (Symptomatic Minor Instability of the Lateral Elbow) is based on ligamentous incompetency. The aim of this study is to measure ligament elongation in SMILE patients and determine the correlation with the development of this pathological condition. Materials and MethodsTwenty-eight patients were included in this study: half of them were operated for suspected SMILE while the others were affected by other elbow diseases. All the patients underwent elbow arthroscopy. During this procedure, four parameters were analyzed: Annular Drive Through (ADT), Ulnar-humeral Stressed Distance (UHSD) at 45° and 30° of flexion, and Loose Collar Sign (LCS). A dedicated arthroscopic mini-spreader introduced through an arthroscopic portal was used to do measurements. Results and DiscussionA statistically significative difference was found for LCS (p value 0,0003) and ADT (p value 0,000002). UHSD at 30° and 45° elbow flexion was slightly higher in SMILE patients, but not significantly. Progressive stretching of the RLCL and annular ligament may lead to their elongation, allowing a pathological antero-posterior shifting of the radial head and a lower congruence between the inner surface of the annular ligament and the radial head cartilage, resulting in proximal radio-ulnar instability. ConclusionsRLCL and annular ligament are elongated in SMILE patients compared to controls, causing instability of the proximal radio-ulnar joint (PRUJ) and confirming that ligament incompetency is involved in SMILE condition.

FREQUENCY OF LATERAL EPICONDYLITIS AMONG TANDOOR WORKERS

Tennis elbow, also referred to as lateral epicondylitis and medial epicondylitis, are injuries caused by overuse that hurts and makes the elbow uncomfortable on the outside and inside of the elbow, respectively. They can harm the muscles and tendons around the joint at the elbow and are frequently linked to repetitive actions. Research has been done better to understand the connection between workplace conditions and elbow diseases. Objective: The study aimed to determine the frequency of lateral epicondylitis among tandoor workers and formulate suggestions for reducing their occupational risks. Materials and Methods: This cross-sectional study was based on a probability convenient sampling technique due to time constraints, resulting in a sample size of 106 individuals who met the inclusion and exclusion criteria. An updated version of the "Patient-Rated Elbow Evaluation" (PREE) questionnaire was administered through a paper-based form with multiple-choice answers. Results: Around 37.7% had work experience exceeding three years, while 44.3% worked for 3-5 hours. The mild pain reported during repeated movements was 41.5% with worst pain of 0.9%. The most prevalent experience of pain at its least was mild pain (40.6%) and worst pain experienced by 0.9%. Positive Cozen and Mills tests were found in 40.6% and 34.9% of cases, respectively. Conclusion: The following research shows that lateral epicondylitis is present among tandoor workers working for more than 3-5 hours.

Safe Arthroscopic Approaches for Epicodilitis: Topographic-Anatomical Study

Background. Arthroscopic methods of diagnosis and treatment of elbow diseases have not yet become widespread due to the small volume of the joint, the close location to neurovascular bundles and the manipulation difficulty.
 The aim of the study was to determine the safe zones for the minimally invasive approaches to the elbow in patients with lateral and medial epicondylitis.
 Methods. A complex anatomical and clinical study was performed. The anatomical part was carried out on 30 non-fixed anatomical preparations of the upper limb. The features of the tendon-muscular and neurovascular structures surrounding the elbow were studied, depending on the angle of elbow flexion at three different levels: level I 5 cm above the articular gap, level II the articular gap, level III the neck of the radius. In the clinical part of the study, the these structures were studied by MRI in 30 patients.
 Results. The brachial artery at the level I is located from the bone at a distance 28.6 (28.4-28.7) mm at the elbow flexion to 90. The radial nerve at level II is located at a distance of 15.8 (15.6-16.0) mm from the nominal medial epicondylar line (NMEL). From the NMEL the median nerve is located at a distance of 17.5 (16.6-18.1) mm, the brachial artery 22.4 (20.5-22.8) mm. The anterior bundle of the medial collateral ligament has the following average width throughout: the proximal part 6.21.4 mm; the middle part 6.51.5 mm; the distal part 9.31.4 mm. The average area of the medial collateral ligament attachment to the medial condyle of the humerus was 45.59.3 mm2 and has a rounded shape. The average length of the radial collateral ligament was 20.51.9 mm; width 5.20.8 mm, the average area of its attachment to the humerus was 13.61.4 mm2. The average area of the extensor carpi radialis brevis on the lateral condyle of the humerus was 53.13.7 mm2. The average distance from the entrance of the deep branch of the radial nerve into the supinator canal to the articular gap 28 (25.5-29.6) mm.
 Conclusion. The results of the study make it possible to choose the safe arthroscopic approaches to the elbow with minimal risk of damage to neurovascular structures in the treatment of patients with lateral and medial epicondylitis.

Radiographic and computed tomographic evaluation of supinator sesamoid bones in dogs

BackgroundThe present study evaluated the frequency of supinator sesamoid bones (SSB) on radiography and computed tomography (CT). Interobserver agreement was evaluated in the detection of the SSBs in both methods. A correlation between the existence of SSBs and elbow diseases (ED) was assessed. For these purposes, radiographs, and CT scans of 100 dogs were scored by 3 observers.ResultsThe SSB was identified as a round to oval-shaped opacity and measured 0.5–6.56 mm × 0.5–6.2 mm. SSBs were reported in an average of 8,33% of dogs on radiographs and 26% of dogs on CT; a bilateral sesamoid bone was present in 43,52% and 76,92% of these dogs, respectively. Seventy-two percent of the SSBs was identified on CT were not detected on radiographs. The Kappa test showed a substantial agreement (κ = 0.691) and a perfect agreement (κ = 1) between the observers in the detection of SSBs on radiography and on CT scans respectively. Additionally, a weak positive correlation was detected between ED and the existence of SSBs.ConclusionA supinator sesamoid bone can be detected occasionally in the evaluation of the canine elbow joints by routine radiography. CT is superior to radiography for assessing SSBs with a higher interobserver agreement. The correlation of the existence of the SSBs and ED, needs further evaluations to prove a probable pathophysiological connection.

Approval status and characteristics of work-related musculoskeletal disorders among Korean workers in 2020.

This study aimed to investigate the characteristics of work-related musculoskeletal disorders (WRMSDs) in occupational disease claims and identify patterns of WRMSDs for each body part by industry and occupation. This study analyzed the raw data of occupational disease claims for musculoskeletal disorders deliberated by the Occupational Disease Decision Committee of the Korea Workers' Compensation & Welfare Service in 2020. The data was classified into 6 body parts with the highest numbers of occupational disease cases by using the complete enumeration data on principal diagnoses and 4 types of subdiagnoses in the raw data. The characteristics and approval rates of WRMSDs by body part, industry and occupation were examined and summarized. A total of 13,015 occupational disease cases for WRMSDs were classified, and lumbar spinal (back) diseases accounted for the largest proportion of claimed diseases, followed by shoulder, elbow, wrist, knee, and neck diseases in a descending order. The occupations with the highest and second highest numbers of occupational disease cases by body part were found to be automobile assemblers and production-related elementary workers for the neck, school meal service workers and cooks for the back, construction frame mold carpenters and school meal service workers for the shoulder, elementary workers in mining and food service workers for the elbow, food service workers and automobile parts assemblers for the wrist, and ship welders and school meal service workers for the knee. This study examined the characteristics and approval status of WRMSDs by body part and occupation. Based on the study results, management strategies for the prevention of WRMSDs should be established regarding occupations with a high risk of WRMSDs for each body part.

Neoplastic Elbow Diseases and Mimickers.

Tumors around the elbow are infrequent, and delayed diagnosis is a common theme because of the low incidence and lack of familiarity. However, just like any other site, the radiologic work-up of musculoskeletal tumors around the elbow remains the same, with plain films the first investigation in a patient with a suspected bone tumor and ultrasound the first modality to evaluate a soft tissue lump. The management of both bone and soft tissue tumors around the elbow is unique because of a large number of important structures in an anatomically confined space and little normal tissue to spare without severely compromising the joint's function. Many benign nonneoplastic entities can mimic bone and soft tissue tumors on imaging. It is important to keep the characteristic imaging appearance in mind while formulating a differential diagnosis to avoid an unnecessary additional work-up. This article reviews the most common benign and malignant bone and soft tissue tumors around the elbow, mimickers, imaging features, and current therapeutic concepts.

Preclinical Models of Elbow Injury and Pathology.

The human elbow is a complex joint that is essential for activities of daily living requiring the upper extremities; however, this complexity generates significant challenges when considering its response to injury and management of treatment. The current understanding of elbow injury and pathologies lags behind that of other joints and musculoskeletal tissues. Most research on the elbow joint is mainly focused on the late-stage disease states when irreversible damage has occurred. Consequentially, the specific contribution and relative time course of different elbow tissues in disease progression, as well as optimized approaches for treating such conditions, remains largely unknown. Given the challenge of studying elbow pathologies in humans, preclinical models can serve as ideal alternatives. However, a limited number of preclinical models exist to investigate elbow injury and pathology. This review highlights significant clinical elbow diseases and the preclinical models currently available to recapitulate these diseases, while also providing recommendations for the development of future preclinical models. Overall, this review will serve as a guide for preclinical models studying injuries and pathologies of the elbow, with the long-term goal of developing novel intervention strategies to improve the treatment of elbow diseases in human patients.

Indications, Results and Complications of Elbow Arthroscopy Treatment in Eighteen Patients

Background: Elbow arthroscopy is increasingly applied to diagnose and treat elbow pathologies. Although evidence about its efficacy is rising, it is still not sufficient to prove it as the preferred technique for the treatment of elbow diseases. Methods: Since this method is very new and only a few studies have been carried out on this technique, the current researchers decided to undertake a study at an academic referral hospital to determine the functional outcome of this method. Data were provided using review of records, applying questionnaires before and after operation, and at final visit (one-year postop). Results: In this analytical case-series study, eighteen patients, who underwent elbow arthroscopy with mean age of 36.11 ± 6.14 years were enrolled during year 2013 to 2015. Between 32 indications of elbow arthroscopy, most indications were arthrolysis (12 cases) and removal of osteophyte and debridement in elbow arthritis (9 cases). Based on the Visual Analogue Scale (VAS), the mean scores of elbow pain intensity were 5.22 ± 1.7 before the surgery and 2.94 ± 1.73 at final follow up. Also, mean scores provided by Quick Dash questionnaire were 41.2 ± 16.5 before the surgery and 20.8 ± 12.9 at one-year postop visit (P < 0.001). In patients’ follow-up, no complications, such as infection and nervous damage of compartment syndrome, were seen. Conclusions: Although arthroscopic treatment of elbow lesions may possess few complications, it has favorable functional outcome, and it is a reliable method in the hands of expert orthopedists. Attaining favorable results may require paying attention to contraindications, technical considerations, careful patient selection, and proper general care of the patient.

Results of cementless total elbow arthroplasty using the Discovery elbow system at a mean follow-up of 61.8 months

The available literature on the use of a cementless total elbow arthroplasty (TEA) design and its results are limited. This clinical study reports the outcome of the cementless Discovery elbow system. Patients were operated on by a single surgeon between 2007 and 2014. Nineteen patients (20 elbows) were available for review, 2 women (1 bilateral TEA) and 17 men. The age of the patients ranged from 27 to 75 years (mean, 48 years). The mean follow-up was 61.8 months (range, 12-156 months). Patients were assessed for range of motion, pain, and satisfaction level. Outcome scores included the Mayo Elbow Performance Score, the Liverpool Elbow Score, and the 12-Item Short Form Health Survey (version 1). Radiographs were reviewed to evaluate for loosening. The mean Mayo Elbow Performance Score was 77.25, and the mean Liverpool Elbow Score was 6.76. The mean flexion range was 123°, and the mean extension lag was 35°. The mean pronation was 59°, and the mean supination was 58°. On radiologic evaluation, there were no signs of loosening; however, in 2 cases, nonprogressive radiolucent lines were observed. No signs of infection were detected at final follow-up, and no elbows were revised. More than 90% of patients were satisfied with the overall outcome. The cementless TEA seems to be a reliable option for treatment of varying elbow diseases. Long-term results are needed to assess the survivorship of this design.

Bi-Oblique Dynamic Proximal Ulnar Osteotomy: Surgical Technique and Clinical Outcome in 86 Dogs.

To describe the technique of bi-oblique dynamic proximal ulnar osteotomy (BODPUO) and report the clinical outcome in a series of dog with medial compartment disease and other developmental elbow diseases. Retrospective case series. Dogs (n=86; 120 elbows) treated for elbow disease with BODPUO. Medical records and diagnostic images were reviewed. Type and frequency of complications and treatment required were recorded. Force plate data were reported in dogs for which data had been recorded preoperatively and at follow-up. Mean (standard deviation) final follow-up was 23.4 (35.6) weeks. There were minor complications in 15 elbows (12%, 14 dogs). There were no major complications. The caudo-cranial and latero-medial mean osteotomy angles were 55° (7°) and 48° (10°), respectively. The most caudo-proximal point of the osteotomy was located at a mean of 39% (5%) of the total ulnar length from the olecranon. Sixty of 68 elbows (88%) were considered healed by 4 months postoperative based on radiographs. Subjective lameness scores were significantly decreased by final follow-up for all dogs. For dogs treated with BODPUO alone for medial compartment disease, peak vertical force was significantly higher at 6 months postoperative. Dogs with medial compartment disease undergoing BODPUO showed clinical improvement in the 6 month follow-up. No complications required surgical intervention.

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Purpose. To optimize the results of treating the elbow severe injuries and their consequences, as well as the elbow diseases in young patients, to evaluate the immediate and mid-term results of the elbow arthroplasty in young patients. Materials and Methods. We have analyzed the results of 52 surgeries of primary total arthroplasty of the elbow in patients at the age below 40 years. We used the implants by Endoservice (Russia) and those Coonrad-Morrey by Zimmer (USA). The main indications for the elbow arthroplasty in young age developed. The technique of surgery and postoperative rehabilitation described. We evaluated the results according to ASES system (Richards R.R. et al., 1994). Results. The results of treatment analyzed within 1-10 years after surgery. Good and excellent results obtained in 78.8% of all treated patients; satisfactory ones registered in 15.4% of all treated patients. Unsatisfactory results of arthroplasty occurred in 5.8% of the total number of operated patients. Conclusion. The elbow arthroplasty in young patients is a high-tech surgical intervention which is a traditionally used alternative, and in some cases it is the method of choice for treatment of some severe injuries and diseases of the elbow. It should be performed in the extreme and severe cases when the limit of other familiar techniques reached.

Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition – comparative study

ObjectiveTo compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded. MethodsNinety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. ResultsAccording to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. ConclusionBoth techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

Neuropatia compressiva cubital no cotovelo: neurólise in situ versus transposição anterior–Estudo comparativo

ObjectiveTo compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non‐compressive neuropathy were excluded. MethodsNinety‐seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. ResultsAccording to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. ConclusionBoth techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

Accuracy of Patient Recall of Hand and Elbow Disability on the QuickDASH Questionnaire Over a Two-Year Period

Patient self-reporting questionnaires such as the QuickDASH, a shortened version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, are critical to current orthopaedic outcomes research. The use of these questionnaires could introduce recall bias in retrospective, case-control, and cross-sectional studies if no preoperative data has been collected prior to study inception. The purpose of this study was to quantify recall accuracy on the QuickDASH questionnaire as a function of the duration of the recall interval. This cross-sectional study enrolled 140 patients with nontraumatic hand and elbow diseases. Patients were stratified into groups of thirty-five based on the time since their initial office visit (three months, six months, twelve months, or twenty-four months). All patients had completed the QuickDASH as part of a standard intake form at the time of the initial office visit (actual baseline score). Patients were contacted by phone and asked to recall their upper extremity disability from the time of the initial office visit with use of the QuickDASH questionnaire. Patients also completed the QuickDASH to rate their current disability. Actual and recalled QuickDASH scores for each group were statistically compared. Kruskal-Wallis analysis was used to determine any differences in recall accuracy between the groups. Pearson correlation coefficients quantified relations between recall accuracy and patient age and current function (absolute QuickDASH scores). Mean differences between recalled QuickDASH scores and actual scores were all less than the QuickDASH minimal clinically important difference (MCID) of 13 points at different time points: three months (-7.1, p < 0.01), six months (0.8, p = 0.79), twelve months (-2.3, p = 0.43), and twenty-four months (-2.8, p = 0.26). There were no significant differences in recall accuracy across the four groups (p = 0.77). Recalled QuickDASH scores were highly correlated with actual baseline values (rp ≥ 0.74). Recall accuracy was neither correlated with patient age nor current QuickDASH scores (rp ≤ 0.04). Patients with a nontraumatic hand or elbow diagnosis are able to recall prior level of function accurately for up to two years with the QuickDASH questionnaire. Although data collected prospectively remain optimal, our data suggest that research conducted with use of recalled QuickDASH scores produces reliable assessment of disability from common upper extremity diagnoses with acceptable recall bias.

Dysplastic elbow diseases in dogs

Dysplastic elbow diseases in dogs

전완부 총 신근 건 기시부의 석회화 건염 - 2예 보고 -

Purpose: We report here on two cases of calcific tendinitis at the origin of the common extensor tendons of the forearm. Materials and Methods: A 42 year-old female complained of left elbow pain and flexion contracture. After obtaining the simple radiographs and MRI, surgical excision of the calcific deposits was done under the diagnosis of calcific tendinitis. A 25 year-old female complained of right elbow pain and a limited range of motion. Simple radiographs showed a calcific deposit just distal to the lateral epicondyle, and then she was managed with extracorporeal shock wave therapy. Results: The pain disappeared completely and both patients regained a full range of motion after treatments. Conclusion: Calcific tendinitis at the origin of the common extensor tendons of the forearm should be included in the differential diagnosis of the lateral elbow diseases that cause pain and a limited range of motion.

Efficacy and safety of "Five-Sequential-Portal Method" in elbow arthroscopy

Objective To evaluate the efficacy and safety of Five-Sequential-Portal Method which was designed by us in arthroscopy for elbow diseases. Methods From April 2004 to May 2007, 53 patients were treated for elbow diseases with an arthroscopic procedure in our hospital. The final diagnoses included 24 cases of elbow contracture, 15 elbow fracture, 7 loose body, 2 subluxation of capitulum radii, 8 tuberculous arthritis, 4 rheumatoid arthritis, 5 myositis ossificans, 3 pigmented villonodular synovitis and 1 synovial chondromatosis. We used self-designed Five-Sequential-Portal Method to establish the portals of elbow arthroscopy. The arthroscopy was inserted into the soft spot to make the first portal. The second portal was established anterolaterally under the arthroscopy in the first portal. The third portal was established an-teromedially through the second portal, passing the coronoid process, to make the incision of skin by the in-side-out technique. The forth and the fifth portals were established posterolaterally and postcromcdially on both sides of the triceps tendon. The joint was explored in sequence and an etiotropic procedure was taken. After surgery, rehabilitation exercises were performed under algesia controller. The Mayo elbow-performance indexes before and after surgery were compared. Results In this group, 46 patients were followed up for 6 to 34 (average, 11.65) months. The preoperative Mayo elbow-performance indexes ranged from 45 to 85 (average, 66.8±11.5) points. Fourteen cases were rated as good, 21 fair, and 11 poor. The postoperative Mayo el-bow-performance indexes ranged from 55 to 100 (average, 84.5±10.5) points. Sixteen cases were rated as excellent, 21 good, 8 fair, and 1 poor. Two patients had transient nerve palsy, involving one ulnar nerve and one deep branch of the radial nerve, but recovered in 3 months. Condusions Our Five-Sequential-Portal Method can ensure satisfactory exposure and clear view in elbow arthroseopy. The portals are safe, leading to low incidence of postoperative complications. It is recommendable in clinic. Key words: Elbow joint; Arthroscopy; Joint diseases

The effects of topical tropicamide and systemic medetomidine, followed by atipamezole reversal, on pupil size and intraocular pressure in normal dogs.

Twenty normal Golden Retrievers being screeened for eye, hip and elbow diseases were given tropicamide topically and medetomidine systemically. Medetomidine effects were later reversed with systemic atipamezole. Pupil size and intraocular pressure changes were determined. Pupil size increased significantly following tropicamide administration and continued to increase slightly but significantly after medetomidine injection. It was unclear whether the slight increase in pupil size following medetomidine administration was due to continued effect of tropicamide or due to the medetomidine itself. Atipamezole did not influence pupil size. Intraocular pressure (IOP) was not affected by these drugs. Ophthalmic screening examination for inherited disease following tropicamide administration is equally feasible prior to sedation with medetomidine and after reversal with atipamezole, but not during the period of sedation.