High-grade Partial Tears Research Articles

Rotator cuff crepitus: could Codman really feel a cuff tear?

The objective of this study was to assess the accuracy of palpating crepitus to diagnose rotator cuff tears. Seventy consecutive consenting patients who presented with shoulder pain and no previous imaging or surgery on the affected shoulder were prospectively enrolled during a 10-month period. A standardized patient history and examination, including the crepitus test, were recorded in addition to obtaining standard radiographs. Additional imaging after initial evaluation was performed with magnetic resonance imaging and interpreted by a musculoskeletal radiologist blinded to the examination findings. Statistical analysis was used to determine sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the crepitus test in the clinical diagnosis of a rotator cuff tear. Sixty-three patients had histories, examinations, and imaging studies available for analysis. The crepitus test had a sensitivity of 67%, specificity of 80%, PPV of 91%, and NPV of 43% for all types of rotator cuff tears. The sensitivity and specificity for full-thickness or high-grade partial tears was 82% and 73%, respectively; the PPV and NPV were 77% and 79%. Increasing age improved accuracy as the presence of crepitus in patients older than 55 years had a sensitivity of 76%, specificity of 100%, PPV of 100%, and NPV of 38%. The crepitus test has a favorable sensitivity, specificity, PPV, and NPV to assess the integrity of the rotator cuff and may be a useful examination in the clinical diagnosis of a rotator cuff tear.

Magnetic Resonance Imaging Findings in Acute Elbow Dislocation: Insight Into Mechanism

To identify with magnetic resonance imaging the location and severity of ligamentous injury after acute elbow dislocations. Based on observations that many elbow dislocations arise from an initial acute valgus load, we hypothesized that all patients would have a high-grade medial injury but not all would demonstrate injury of the lateral ligaments. The medial collateral ligament was subdivided into anterior bands of the anterior bundle of the medial collateral ligament (MCL) and posterior bands of the anterior bundle of the MCL, whereas the lateral collateral ligament was divided into the lateral ulnar collateral ligament and the radial collateral ligament. Distinction on magnetic resonance imaging was made between normal morphology and low-grade partial tear (< 50% of the ligament fibers), high-grade partial tear (≥ 50%), and full-thickness disruption. The site of disruption was also characterized. Acute magnetic resonance imaging studies for 16 patients were included. No low-grade tears or intact evaluations of either the anterior or posterior bands of the anterior bundle of the MCL were observed; most demonstrated complete tears. The lateral ulnar collateral ligament most frequently showed complete disruption but was occasionally intact. The radial collateral ligament infrequently showed full disruption. Complete tears involving either the anterior or posterior portions of the anterior band of the MCL were significantly more common than complete tears involving the ligaments on the lateral side. After elbow dislocation, complete ligamentous tears were more common on the medial versus the lateral side. Whereas the lateral ligaments were occasionally preserved, this was never observed on the medial side. These data suggest a sequence of failure starting on the medial side with subsequent variable energy dissipation laterally. Diagnostic IV.

Elbow Injury- Pull Ups

HISTORY: A 59-year-old right hand dominate male presented to our orthopedic clinic with complaints of pain on the medial side of his left elbow. He had no previous problems with this elbow until two weeks before his office visit. On that day he was doing a pull up on a standard pull up bar with his hands supinated when he felt a pop with immediate onset of pain in his medial, left elbow. The pain was severe enough that he had to stop working out. He continued to have medial elbow pain with any axial load to his forearm. He had no parasthesias. He was in good health with no systemic illnesses. PHYSICAL EXAMINATION: Upon physical exam he was in no acute distress. When comparing both upper extremities, there was no atrophy, deformity, ecchymosis or swelling of his upper extremity. He had some tenderness over the medial epicondyle. He was also tender 1.5cm distal to his medial epicondyle in the flexor mass, but this tenderness was proximal to the sublime tubercle of the ulna. The patient's elbow motion was 10 to 140 degrees. His medial collateral ligament was intact with no pain to valgus stress testing with the elbow in full extension, 30 degrees and 90 degrees of flexion. He was neurologically intact for all sensory and motor peripheral nerves in both upper extremities. He had full strength to resisted wrist flexion and this testing did not provoke his pain. He had a negative Tinel's at the elbow. DIFFERENTIAL DIAGNOSIS Medial Epicondylitis Tear of the Flexor Mass Ulnar Collateral Ligament Strain Fracture of the medial epicondyle Subluxation of ulnar nerve TESTS AND RESULTSPlain radiographs of the elbow including anterior-posterior and lateral view No abnormalities, medial epicondyle intact Magnetic Resonance Imaging High-grade partial tear of the common flexor attachment at the medial epicondyle with mild myotendenious strain of the pronator teres. The ulnar collateral ligament was intact. FINAL/WORKING DIAGNOSIS: Partial avulsion of the flexor-pronator mass, strain of the pronator teres TREATMENT AND OUTCOMESAllowed full range of motion of elbow but was restricted form weight lifting until follow up at six weeks. Allowed to increase weights to forearm at 6 weeks; advised to not do pull-ups Followed periodically in office until resolution of symptoms and return to sports at 6 months