Elbow Pain Research Articles

Predictive value of magnetic resonance imaging in outcomes of nonsurgical treatment of lateral epicondylitis.

BackgroundThe diagnosis of lateral epicondylitis is typically made on the basis of clinical history and examination. However, magnetic resonance imaging (MRI) is often used to supplement evaluation of the patient with a painful elbow and can identify extensor carpi radialis brevis (ECRB) tendon tears. The objective of this study was to determine if ECRB tear size on MRI could be used as a prognostic indicator for patients with recalcitrant lateral epicondylitis and partial ECRB tears.MethodsForty-one patients with recalcitrant lateral epicondylitis and a partial ECRB tear on MRI were identified (22 men and 19 women; age: 49 ± 8 years; height: 165 ± 36 mm; weight: 73 ± 18 kg). Patients were divided into two groups based on whether they underwent surgery or not. Nonsurgical treatment was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire, and surgery was considered a failure of nonsurgical treatment. Nonsurgical treatment was variable and included a mixture of physical therapy, rest, injection therapy, and splinting.ResultsOf the 41 patients, 5 patients opted for immediate surgery and 36 patients were treated nonsurgically. Of those 36 patients, 11 patients had symptom relief, 19 patients had subsequent surgery, and 6 patients chose not to have surgery despite continued symptoms. Tear size on MRI did not differ significantly between the patients who had symptom relief with nonsurgical treatment and the other patients (7.7 ± 4.3 mm vs. 9.7 ± 2.5 mm, P = .07).DiscussionOnly 11 of 41 patients (27%) with recalcitrant lateral epicondylitis and ECRB tear had symptom relief with nonsurgical treatment. However, ECRB tendon defect size on MRI did not predict success or failure of nonsurgical treatment.

High-definition magnetic resonance images on medial elbow injuries in preadolescent Little Leaguers

BackgroundThe incidence of throwing-related elbow injuries is still rising. The study aimed to enhance the pathology of acute medial elbow injuries among young Little Leaguers by examining the medial elbows of symptomatic 9–10 years old Little Leaguers using High-Definition Magnetic Resonance Images (HDMRI), which uses a small-diameter surface coil on the target area, leading to greater image resolution. MethodWe identified Little Leaguers aged 9–10 years old. To minimize the detection of the chronic adaptative changes, players who experienced the medial elbow pain previously and whose HDMRI had not been taken within 4 weeks from the onset of medial elbow pain were excluded. This study considered 21 players, and the mean age was 9.4 ± 0.5 years. ResultThe fragmentation of the medial epicondyle apophysis via HDMRI was found in 15 elbows (71.4%), while the avulsion was seen in three cases. The signal hyperintensity at the medial epicondyle apophysis was observed in 2 cases. Our data showed abnormal changes to the medial epicondyle apophysis and surrounding structures, such as the ulnar collateral ligament (UCL), flexor-pronator tendons or the coronoid process of the ulna. We detected 11 abnormalities on X-ray imaging, while 20 subjects showed some abnormal findings via HDMRI. DiscussionThe current study showed that initial medial elbow injury in Little Leaguers without a history of previous elbow injury could be attributed to multi-structure injury. Over 90% of subjects were injured in the perichondrium, while 71.4% demonstrated a fragmentation of the secondary ossification center, and 14.3% experienced an avulsion of the medial epicondyle apophysis. Because the injuries were not limited to bony structures, HDMRI may be beneficial for the appropriate evaluation of medial elbow pain. The pathology of initial medial elbow injuries in young baseball players may be due to acute trauma instead of repetitive microtrauma.

Medical Checkup for College Baseball Players—Relationship between Physical Function and Shoulder or Elbow Pain—

Medical Checkup for College Baseball Players—Relationship between Physical Function and Shoulder or Elbow Pain—

Evaluating the relationship between smartphone addiction/overuse and musculoskeletal pain among medical students at Taif University

Background: Smartphone use has recently increased, and smartphones do the most common daily tasks. Therefore, a lot of time spent on these devices can be associated with a bad posture that can lead to musculoskeletal pain. Thus, in this study, we aim to raise awareness and assess the relationship between smartphone addiction/overuse and musculoskeletal pain among Taif University, Kingdom of Saudi Arabia, medical students. Methods: A descriptive cross-sectional study was conducted at Taif University. The Problematic Use of Mobile Phones (PUMP) scale was used to estimate the level of smartphone addiction; meanwhile, Nordic Musculoskeletal Scale was used to assess musculoskeletal pain. Mann-Whitney and Kruskal-Wallis tests were used to associate PUMP scores with demographic factors and Nordic Musculoskeletal Questionnaire items. Results: The study included 285 participants, of which 67.4% were males. The average PUMP score among participants was 62.3. Neck pain was reported by 61.1% of participants, upper and lower back pains were reported by 37.5% and 47.7%, respectively, and 41.4% reported shoulder pain. PUMP score was significantly associated with age (p = 0.000), as the highest PUMP score was reported among the eldest age group (25 years or older), followed by the youngest (19 to 20 years). PUMP score was also significantly associated with neck pain (p = 0.000), right shoulder pain (p = 0.004), right elbow pain (p = 0.030), right wrist pain (p = 0.012), upper and lower back pain (p = 0.000, p = 0.000, respectively). Conclusion: The study found an association between problematic phone usage and discomfort in the neck, upper back, and lower back. The research also found that those with higher PUMP scores had more significant discomfort on their right elbow and wrist than on their left.

Sleep in Adolescent Baseball Players—Correlation of Sleep with Shoulder and Elbow Pain and Pitching Performance—

Sleep in Adolescent Baseball Players—Correlation of Sleep with Shoulder and Elbow Pain and Pitching Performance—

The Relationship between Elbow Pain, Standing Up and Sitting On One Leg, Throwing Plane in Junior High School Baseball Players

The Relationship between Elbow Pain, Standing Up and Sitting On One Leg, Throwing Plane in Junior High School Baseball Players

Massive Tophaceous Gout at Right Elbow Region in 55 Years Old Male

Gouty arthritis is one of the most common inflammatory joint diseases, characterized by monosodium urate crystals in or around the joints that comes from purine metabolism. Risk factors of gout are age, excessive intake of purine, alcohol, obesity, lack of physical activity, hypertension and heart disease, certain drugs, and impaired kidney function. This case presented a 55-year-old male patient with lumps and pain in the right elbow. Uric acid laboratory test results with a level of 9.20 mg/dL. Surgical excision could be the only solution to solve minimally decreased range of motion and aesthetic problems. Metabolic problems should be considered a priority with the patients who have unilateral joints problems.

Landmark Guided Lower Interscalene Block as a Rescue Approach in a Case of Elusive Supraclavicular Block for Elbow Surgery

Dear Editor, Our case was an 18 yrs/m, weighing 54 kg without co morbidities presented with pain in right elbow and was posted for screw fixation of fracture capitulum. His routine blood work and airway examination were normal to undergo the surgery under supraclavicular block (SCB). On arrival, patient’s PR was 84/min, BP- 118/72 mm Hg, SpO2- 98% on room air. For right sided SCB, patient was placed supine, head turned to left side with shoulder depressed and needle was inserted lateral to subclavian artery pulsation just above the clavicle, posterolaterally. There was inadvertent puncture of subclavian artery each time, despite using standard techniques. Hence we decided to abandon standard SCB and proceed with lower interscalene block (LISB).Using modified Winnie’s approach interscalene groove was palpated and needle was inserted 2-3 cm below the classical interscalene block (ISB) site. Paresthesia was attained over whole upper limb and then Inj. Lignocaine + Adrenaline (2%) 10 ml along with inj. Bupivacaine 0.5% 10 ml was injected after repeated negative aspirations. A satisfactory sensory and motor blockade was obtained after 15 minutes of injection. Throughout the procedure, patient was continuously monitored and surgery was completed within 1.5h without any adverse event. The patient was shifted to ward. The block weaned off in 6 hrs and his vitals were stable throughout his course of stay in the hospital. Traditionally, the subclavian artery is an important relation of the brachial plexus for landmark guided SCB. However, anatomical variation may be present in as much as 50% of the population. [1] T1 nerve root supplies skin both above and below the elbow. Some authors have suggested a combined ISB + axillary block to get profound anaesthesia for elbow surgery. [2,3] Axillary nerve block was not contemplated in our case as optimal arm positioning was precluded due to severe pain at elbow. The advantages of LISB over SCB and ISB or ISB + axillary block are that it significantly reduces the risk of pneumothorax , inadvertent arterial puncture, ulnar sparing (as lower trunks of brachial plexus are more superficial in LISB) and avoids multiple injections. LISB also provides adequate anaesthesia and analgesia to whole upper limb which could be due to the relative proximity of the inferior trunks to the other components of brachial plexus as they become tightly bundled between the clavicle and first rib at this level.[2] Performing an LISB is easier due to its accessibility and shallow location of the brachial plexus, which may be favourable to those who disfavour or may not be comfortable with the supraclavicular approach. [4] Our case exemplifies that in those centres where ultrasound machine is unavailable and access to the brachial plexus for SCB by landmark technique remains elusive despite troubleshooting, lower interscalene block can be safely used to provide similar quality and extent of surgical anaesthesia.

Influence of Tendon Neuroplastic Training in Grip Strength of Patient with Lateral Elbow Tendinopathy – A Case Report

This case report is about a 38-year-old female IT worker experiencing elbow pain for six months in the lateral aspect of her right elbow 3-4 centimetres distal to the lateral epicondyle of humerus. Patient underwent a four week supervised Tendon Neuroplastic Training TNT program and static stretching exercises for extensor muscle group of wrist joint and isometric training for wrist extensors in both 90 degree elbow flexion and 0 degree elbow extension positions to improve functional integrity. In addition rotator cuff muscles and scapular muscles were strengthened and supinator muscle strengthening exercises were performed. Outcome measures were recorded evaluated at week 0 baseline at week-4 last day of the treatment and at week-12 2 month after the end of treatment. Function and pain were measured in this study where pain-free grip strength was measured with handheld dynamometer to evaluate function and pain was measured by using a visual analogue scale VAS and finally both pain and function were measured by using Patient-Rated Tennis Elbow Evaluation PRTEE. After therapeutic interventions at week-4 the grip strength was 24.3 kg pain score on VAS was 1 and PRTEE questionnaire score was 8. At week-12 pain score on VAS was 0 PRTEE questionnaire score was 5 and grip strength was 31 kgs. There was a marked increase in grip strength with increment of 20.18 kg from baseline marked reduction in pain score VAS with 8 points and marked reduction in PRTEE questionnaire score with 66 points at 12th week follow-up. Based on this case study it can be concluded that TNT exercises can improve grip strength and result in pain reduction in the patients with lateral elbow tendinopathy with multi model exercise approach. Future studies need to be done with high quality trails and long-term follow-up.

Restriction of Active Range of Motion of Little Finger Flexion on the Baseball Players with the History of Elbow Pain －2nd Report－

Restriction of Active Range of Motion of Little Finger Flexion on the Baseball Players with the History of Elbow Pain －2nd Report－

Sequential presentation of CPPD in shoulder and elbow: A case report

Calcific tendinitis is a self-limiting condition characterized by the deposition of calcium crystals into the tendons, most commonly affecting the Shoulder joint. Calcium hydroxyapatite crystals are often seen, but calcium pyrophosphate dehydrate (CPPD) is a rare variant of crystal deposition in tendons. Calcific deposits at triceps insertion are not a common presentation of calcific tendinitis. A 35-year male patient presented with acute onset elbow pain and swelling with CPPD crystal deposition and calcific tendinitis of the triceps tendon. The patient had a previous history of calcific tendinitis of the shoulder, which was treated with arthroscopy. The patient underwent ultrasound-guided needling for calcific tendinitis of triceps and lavage, followed by physiotherapy. He had excellent results with full return to functions on follow-up.

Distal Triceps Tendon Injury

Background: Triceps tendon ruptures typically result from a forceful elbow eccentric contraction. The goal of a distal triceps tendon repair is to reattach the torn tendon back to the olecranon. Surgery is indicated for patients with complete rupture of the triceps tendon or symptomatic partial tears with failed conservative management. The complication rate occurs in 22% of patients postoperatively; however, only 0% to 4% of patients suffer a re-rupture of the tendon. Indications: We present a case of a highly active 38-year-old right-hand dominant man with acute onset of left posterior elbow pain following 1-handed pushup resulting in a complete distal triceps avulsion with 1.5 cm retraction. Technique: The distal triceps avulsion was repaired in a double row fashion using 2 double-loaded all-suture anchors in the medial row and anchor in the lateral row through a posterior approach. Results: Full anatomic footprint coverage was able to be achieved intraoperatively, and gentle range of motion from 0 to 90 degrees of flexion did not result in gap formation. Discussion/Conclusion: Successful outcomes with full anatomic footprint coverage of the distal triceps tendon can be achieved through a double row repair configuration.

Occupational-Related Upper and Lower Extremity Musculoskeletal Pain Among Working Population of Ethiopia: Systematic Review and Meta-Analysis.

Background:Currently, work-related musculoskeletal disorders are a significant public health concern and are a leading cause of disability-adjusted life years and reduced quality of life worldwide. In developing countries, including Ethiopia, as a result of poor occupational health and safety practices and underreporting of the problems, work-related musculoskeletal disorders have been increased, remaining less prioritized, and there is no adequate evidence on the prevalence of musculoskeletal disorders. Thus, the current study aimed to determine and provide the overall prevalence of occupational-related upper and lower extremity musculoskeletal pain among the working population of Ethiopia.MethodsThe current study considered full-text articles conducted in Ethiopia, written in English, and published from 2017 to 2020. Ten electronic databases: PubMed/MEDLINE, Web of Science, SCOPUS, Google Scholar, MedNar, Embase, CINAHL, Cochrane Library, African Index Medicus, and African Journals Online database were used to search the articles using a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings, and main keywords. The quality assessment of the articles was performed using the Joanna Briggs Institute Critical Appraisal tools to determine the relevance of the article to the current study.Results:Of the 1377 articles identified from the included electronic databases, 12 studies were included in the systematic review and meta-analysis. The study found that the pooled prevalence of occupational-related elbow pain, wrist/hand pain, knee/leg pain, foot/ankle pain, and hip/thigh pain in the previous one year was 19.7% (95% CI: 12.3, 30.1), 24.2% (95% CI: 17.4, 32.7), 25.0% (95% CI: 18.5, 32.8), 20.2% (95% CI: 12.8, 30.4), and 15.5% (95% CI: 9.9, 23.4), respectively. Based on a subgroup analysis, the last year’s pooled prevalence of occupational-related elbow, wrist/hand, knee/leg, foot/ankle, and hip/thigh pain was increased to 33.7% [95% CI: 31.9, 35.5], 29.7% [95% CI: 28.2, 31.2], 31.5% [95% CI: 29.9, 33.2], 30.6% [95% CI: 29.0, 32.4], and 27.3% [95% CI: 25.5, 29.2], respectively.Conclusion:Occupational-related musculoskeletal disorders continue to have a potential impact on workers’ health and productivity. The current study found that the overall pooled prevalence of occupational-related upper and lower extremity musculoskeletal disorders in the last year ranged from 15.5 to 33.7%. Implementing occupational health and safety measures play an important role in preventing work-related musculoskeletal disorders and other occupational hazards.

Arthroscopic lateral collateral ligament imbrication for treatment of atraumatic posterolateral rotatory instability.

Among the causative lesions of lateral elbow pain, atraumatic posterolateral rotatory instability (PLRI) is a rare condition, but it produces pain and disability to the elbow. It still lacks published specific treatment literature. According to the development of arthroscopy, the arthroscopic lateral collateral ligament (LCL) imbrication can possibly be an alternative minimal invasive procedure that can eradicate the atraumatic PLRI. Hypothesis/Purpose: To report clinical results of arthroscopic LCL imbrication for the treatment on atraumatic PLRI elbow. Methods: Thirty-three patients with chronic atraumatic lateral elbow pain were presented to our institution between July 2015 and December 2021. Eight patients were diagnosed with atraumatic PLRI and underwent arthroscopic LCL imbrication. Comparison between the pre- and post-operative scores were recorded, which were The Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score, Mayo Elbow Performance Index (MEPI) and Visual Analog Scale for pain (VAS). Results: Mean follow-up was 16months (9-24months). Comparing between pre-operation and post-operation, all of eight patients had significant improved Quick-DASH score (mean 55.62 vs 7.62, p = .004), MEPI (mean 50.00 vs 96.87, p = .000) and VAS for pain (mean 8.14 vs 1.28, p = .000). Conclusion: Atraumatic PLRI is a concerning lesion in patients with lateral elbow pain. Arthroscopic LCL imbrication can be simultaneously performed with other lateral elbow pain causations, such as tennis elbow and pathological plica, and provide painless, stable, and functional elbow. Case Series (Level of evidence: 4).

Antropometry Analysisi Of Stove Cooking Tofu Production On the Employee’s Safety And Convenience

Ergonomics approach to vehicle design is emphasized on researching the limited capabilities of humans, both physically and mentally psychologically and their interactions in an integral human-machine system. Then systematically the ergonomics approach will then utilize this information for design purposes, so as to create a product system or work environment that is more suitable for humans. Objectives of the Research; Knowing the anthropometry of workers and the furnace knows the process of boiling tofu; determine the suitability of the anthropometry of workers with the tofu boiling process furnace; knowing the level of complaints felt by workers during the tofu boiling process. This study uses quantitative methods, with a descriptive analysis approach to the dimensions of the tofu boiling stove on the anthropometry of the workers' bodies. The instruments used in this research are literature study, observation and interviews. The variable used is the anthropometric data of workers in the manufacture of tofu. The dimensions measured include; hand width, the distance from the fingertips to the left to the right, the height of the hand grip from a vertical hand position up from standing upright, the distance from the hand grip to the back, the length of the hand, and the width of the palm. The body dimensions measured in the study are as follows: body height in standing position, shoulder height, elbow height, shoulder height in sitting position, elbow height in sitting position, shoulder width, hip width, body height in sitting position. The results of this study indicate that the measurement of the dimensions of the body of the community in the city of Mataram obtained varying results. The results of the measurement of body height when standing ranged from 131 to 153 cm and for the average body height of all people measured was 151 cm. Interviews on average workers complained of pain in the left elbow and right elbow and pain in the upper arm. left, right upper arm, right wrist and left wrist. By using the NBM questionnaire which is described in 27 points, the method of collecting data directly to workers by means of direct interviews on the spot is used

Ultrasound-Guided Injection Therapy for Elbow, Wrist, and Hand Pain

Ultrasound-Guided Injection Therapy for Elbow, Wrist, and Hand Pain

Posterior (Boyd) approach to terrible triad injuries.

BackgroundA ‘terrible triad injury of the elbow’ (TTIE) refers to an injury pattern involving posterior dislocation of the ulnohumeral joint, fracture of the radial head, and fracture of the coronoid process of the ulna. It is a complex injury to the elbow joint and can result in long-term elbow instability, pain, stiffness, and arthritis. In specific cases, it may be treated conservatively, but in most circumstances, surgical stabilization is advised.The ‘drop sign’ is an objective static radiographically measured ulnohumeral distance of ≥4 mm seen intraoperatively and postoperatively. Although controversial, it may portend postoperative instability and arthritis. The senior author repairs these injuries in a standardized fashion through a modified Boyd rather than a lateral approach. Our aim was to assess the number of cases demonstrating an intraoperative drop sign after surgical treatment of a TTIE with this approach.MethodsWe retrospectively analyzed 22 consecutive patients with 23 acute TTIEs. These injuries were treated by a single surgeon using a modified Boyd (posterior) approach to the elbow. Intraoperative image intensifier x-rays were analyzed by the two authors to assess for a ‘drop sign’.ResultsNone of the 23 cases had ‘drop signs’ on intraoperative imaging after stabilization. No patient has redislocated, underwent reoperation, or had symptoms of instability at follow-up.ConclusionNone of our patient cohort had an intraoperative ‘drop sign’ after standardized stabilization for a TTIE injury using a modified Boyd approach.

Avulsion of the Common Extensor Tendon and Radial Collateral Ligament Tear

A 59-year-old left hand dominant female was evaluated by a physical therapist. The patient had an 8-year history of chronic intermittent left elbow pain with a recent exacerbation occurring after moving furniture.

Prevalence and Exposure to Ergonomic Risk Factors among Crop Farmers in Nigeria

This study examined the prevalence and exposure to ergonomic risks factors among crop farmers in selected states in Nigeria. We used cross-sectional data to provide this evidence. Data were collected with the aid of a standardized questionnaire administered to farmers. A total of 480 smallholder cassava farmers selected across 24 farming communities in Kogi and Kwara states, Nigeria, were engaged in the study. Descriptive statistics and binary regression were used for analysis. About 96% of the respondents reported shoulder pain, 85% reported lower back pain, 82% reported upper back pain, 64% reported neck pain, and 53% reported elbow pain during farming operations. We found that the age of farmers (OR = 2.01) and daily duration of daily chemical spray (OR = 1.17) were risk factors, while previous training on the safe use and application of farm chemicals was found to be a protective factor (α = 0.05). The study identified affordability of farm safety measures and poor access to relevant safety information as top constraints to farmers’ adoption of safe farm practices. We concluded there is a high prevalence of ergonomic risks during cassava operations among respondents. A crop-specific co-designed ergonomic intervention targeted at Nigerian farmers to reduce exposure to ergonomic risks is recommended.

Stand-up test could be a helpful adjunct for screening elbow disorders in Little League baseball players

BackgroundThe purpose of this study is to justify the result of the modified Stand–Up test (MSUT) in Little League baseball players and to clarify the association with sports related disorders in the elbow. MethodsA total of 245 (240 boys and 5 girls) Little League baseball players aged 9 to 12 underwent physical examination, elbow ultrasonography and questionnaires during a routine medical checkup. In addition, the MSUT, based on the Japanese Orthopaedic Association (JOA)'s original Stand–Up test to evaluate the risk of Locomotive syndrome, was performed. ResultsSeventeen osteochondritis dissecans (OCD) of capitellum and 4 medial epicondylar fragmentation (MEF) cases were diagnosed with ultrasonography in 242 players. Based on the MSUT, five boys could not stand up from 40 cm platform with the single leg stance, two of whom complained of current elbow pain, three of whom diagnosed with a positive finding with ultrasonography. Odds ratio (95% confidence limits) of risk factors for failing to the 40 cm-MSUT with the single leg stance were: incidence of current elbow pain 5.7 (0.9–35.5); OCD (Grade 1b and 2) 8.2 (0.8–83); and MEF 19.5 (1.7–230). ConclusionTwo percent of Little League baseball players were unable to stand up from a 40 cm high platform/stool with the single leg stance by the MSUT and it was associated with an increase in MEF or OCD diagnosis by ultrasonography and presence of elbow pain. These results suggest that players who failed to the 40 cm-MSUT with the single leg stance are at risk of elbow disorders. Also, these results are consistent with previous research on throwing injuries that have associated poor control in the legs or trunk with pain and injury involving the upper extremities. MSUT, a relatively simple procedure, may be a helpful adjunct for screening to estimate readiness for resuming general physical activity in Little League baseball players.