Lateral Epicondyle Of Humerus Research Articles

Evaluation of enthesitis in patients with juvenile idiopathic arthritis by power color and spectral Doppler ultrasonography.

Ultrasonography in patients with juvenile idiopathic arthritis (JIA) could potentially be useful for evaluation of enthesitis. The aim of this study was to evaluate enthesitis in patients with JIA quantitatively by power color and spectral Doppler ultrasonography by determining color fraction (CF) and resistive index (RI). A cross-sectional single-center study was performed in 15 (61 entheseal sites) patients with JIA with clinical enthesitis. A total of 9 age and sex matched healthy controls (53 entheseal sites) were also examined and compared. Entheseal sites (quadriceps tendon, patellar tendon, tendo-Achilles, medial and lateral epicondyles of humerus) were examined on USG B mode for tendon thickening, hypo- and hyper-echogenicity, enthesophytes, and cortical erosions/irregularities by power Doppler ultrasound for the presence of Doppler signal and by power color Doppler and spectral Doppler ultrasonography to derive CF and RI respectively. The mean thickness of entheseal site in patients and controls were 3.55±0.82 mm and 2.8±0.37 mm, respectively (p<0.001). The power Doppler signal was present in 93.4% of patients (p<0.001). The pooled data of all entheseal sites revealed a significantly higher CF in patients (0.08±0.03) than in controls (0.006±0.008) (p<0.001). The mean RI in patients (0.61±0.09) was significantly lower than that in controls (0.92±0.12) (p<0.001). The cut-off of RI (0.7) and CF (0.029) determined by receiver operating curve analysis revealed a diagnostic accuracy of 94.7% and 96.5%, respectively. Evaluation of enthesitis by determining CF and RI via power color Doppler and spectral Doppler is possible in JIA patients.

Prediction of the location of radial nerve in arm to avoid iatrogenic injury: Cadaveric study in Indian population

Background: The radial nerve arises from posterior cord of brachial plexus and descends distally to spiral groove, our aim is to study upper and lower margins of groove with respect of bony landmark like posterolateral aspect of Acromian process, medial and lateral epicondyle of humerus, which helps to identify radial nerve during humerus fracture fixation surgery and hence will reduce iatrogenic radial nerve injury.Methods: Twenty formalin preserved cadaveric upper limbs obtained from anatomy department of Government medial collage, Surat. Dissection done, Radial nerve isolated from low triangular space to lateral inter muscular septum and various measurements done for each specimen.Result: Without sex or age differentiation the results of this study are: The mean humeral length was 30.6 ± 1.86 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.3±1.48 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.49±1.46 cm. The mean length of radial nerve groove/spiral groove was 4.29±1.28 cm.Conclusion: Radial nerve is at the risk of injury with fracture & fixation in two areas. First along the spiral groove & second along the lateral aspect of humerus in distal third from proximal to lateral epicondyle to level of proximal aspect of metaphyseal flare. Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and zone of danger of humerus provide more safety during surgical interference of humerus. To do this, radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.

Lateral Epicondylitis: A Common Cause of Elbow Pain in Primary Care

Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.

Efficacy of local corticosteroid Vs Sod. hyaluronate injection in the management of tennis elbow: A prospective randomized comparative study

Background: Lateral elbow pain being the most common cause of medical consultation for non- traumatic elbow disorders and defined as a chronic degenerative condition of extensor tendons (of wrist) involving their attachment to the lateral humeral epicondyle. In our study, we aim to compare the efficacy of local Corticosteroid Vs. Sod. Hyaluronate injection in the management of Tennis Elbow. Material and Methods: A prospective randomized comparative study of 60 patients has been done, with complain of pain on lateral aspect of the elbow, which increased on pressure applied on lateral epicondyle of humerus. Positive results of Cozen’s test and Mill’s test were included in study. Two groups were made through alternate randomization, In Group I (n=30) single injection of 1 ml of Methylprednisolone Acetate (20 mg) mixed with 2 ml of 2% Lidocaine Hydrochloride was injected and In Group II (n= 30) single injection of 2 ml of Sodium Hyaluronate (20 mg) mixed with 2 ml of 2% Lidocaine Hydrochloride was injected. Criteria for evaluation of results are pain (+/-), tenderness (+/-), Cozen’s test (+/-), Mill’s test (+/-) and then reporting it as poor, good, and excellent results. Results: Results were evaluated at the end of 4 weeks. In Group I, 56.66% patient (n=17) had excellent, 36.66% patient (n=11) had good and 6.66% patient (n=2) had poor results respectively. Whereas, in Group II, 33.33% patient (n=10) showed excellent, 43.33% patient (n=13) showed good and 23.33% patient (n=7) had poor outcome. Discussion and Conclusion: As per our study, Corticosteroid injections are effective in reducing pain in the acute condition. Despite of many researches, there are no articles that favours single best treatment of tennis elbow, especially for effective long-term (≥52 weeks) outcomes.

Effect of Functional Task Exercises on Hand Function and Grip Strength in Patients with Lateral epicondylitis

Background: Tennis Elbow is the most common overuse syndrome in the elbow. It is a tendinopathy injury involving the extensor muscles of the forearm. The lateral epicondylitis is characterized by pain and tenderness at the lateral epicondyle of the humerus as there is non-specific inflammation at the origin of the extensor muscles of forearm. As there is pain and inflammation, the grip strength in decreased and hand function is affected. But there are few research done on intervention regarding same. Hence a comparative study was carried on 60 patient, 30 subjects were grouped in Group A which were given functional task exercises and Group B was given Conventional therapy. The stastical analysis showed that out of 30 subjects, mean age of group A patients was 25±6.23 and mean age of group B patients was 27.2±4.8. Grip strength in between Group A (63.5± 14.2) and Group B (60.4± 12.9) with p value 0.04, Patient rated tennis elbow evaluation scale in between Group A (44.1± 6.8) and Group B (43.8±10.6) with p value 0.002 and Michigan hand outcome measures in between Group A (62.5±14.4) and Group B (54.3±14.7) with p value 0.0005. Hence the study concluded that there is significant effect of Functional Task Exercises on Grip strength and Hand function in lateral epicondylitis.

Myofascial Release Technique with Virtual Reality Biofeedback in Lateral Epicondylitis – A Case Report

Background &amp; Aim: Lateral Epicondylitis (LE) also known as Tennis Elbow is a lesion due to chronic overuse injury of wrist extensors which causes damage to the wrist extensor tendons at their origin i.e. lateral epicondyle of the humerus. Thus, the aim of this case report is to report about the efficacy of virtual reality through EMG biofeedback and myofascial release technique in the case of lateral epicondylitis. Methodology: This study reports the efficacy virtual reality through EMG biofeedback and myofascial release technique along with pulsed ultrasound therapy in 37 year old male non-diabetic patient diagnosed with chronic lateral epicondylitis. The main intervention in this case involved virtual reality through EMG biofeedback and myofascial release technique (MFR) along with pulsed ultrasound therapy for 4 weeks. The treatment goal was to reduce inflammation, pain and restore wrist extensor muscle strength to avoid recurrence. The treatment outcome for pain was measured by 11 point Numerical Pain Rating scale, hand grip strength by hand dynamometer &amp; functional score by Patient Rated Tennis Elbow Evaluation. All the outcome measures were taken and analysed at baseline and after end of treatment. Conclusion: Combination of virtual reality through EMG biofeedback and myofascial release technique along with pulsed ultrasound therapy had promising result in rehabilitation of lateral epicondylitis and thus allowing return to work and play as quickly as possible.

Prevalence of Scapulothoracic Joint Dysfunction in Patients with Lateral Epicondylitis

Background: Lateral epicondylitis is a cumulative trauma disorder or repetitive motion disorder which is characterized by pain in the lateral epicondyle of humerus. This condition is mainly seen in individuals those who have repeated use of elbow like housewives, cooks, heavy load lifter, tennis player, painters, plumbers, carpenters, auto workers and in even butchers. As human body work as a unit. It is a kinetic chain if there is problem elsewhere in a body then nearby structures may also get affected. The patients those who have lateral epicondylitis are either avoid the movements of affected hand or do trick movements due to which proximal muscles undergo into weakness and it will leads to scapulothoracic joint dysfunction. This study was conducted to find out scapulothoracic joint dysfunction in patients with lateral epicondylitis. Objective: To find out prevalence of scapulothoracic joint dysfunction in patients with lateral epicondylitis. Method: An observational study was carried out using a cross sectional study design. The study was conducted in the city of Karad, Maharashtra. Study was conducted using a sample size of 21 patients with lateral epicondylitis (n= 4pq/L2 ) for a period of 6 months. The inclusion criteria was 30-50 years of age group and both male and female were included who were having lateral epicondylitis and exclusion criteria was the subjects with upper quadrent musculoskeletal problems and any thoracic surgery within past 6 months and subjects who have any spinal deformity like scoliosis. Result: The results showed that there was significant dysfunction in scapulothoracic joint in patients with lateral epicondylitis by using DASH questionnaire, scapular retraction test and scapular load test. Conclusion: On the basis of the result of the study, it was concluded that there is significant dysfunction in the scapulothoracic joint in patient with lateral epicondylitis.

Variation in the morphology of the extensor pollicis longus and extensor digitorum muscles: A case report

This case report aims to highlight the variation in the morphology of the extensor pollicis longus (EPL) and the extensor digitorum (ED) muscles. EPL originates from the posterolateral surface of the ulna, and the ED originates from the lateral epicondyle of the humerus. Both of these muscles are innervated by the radial nerve. EPL’s primary function serves to extend the pollex, while the ED serves to aid in the extension of the metacarpal phalangeal, proximal interphalangeal, and distal interphalangeal joints of digits 2 through 5. During routine anatomical dissections of 48 upper limbs from 24 cadavers (n=24) at Oakland University William Beaumont School of Medicine, one adult female (75‐years‐old) was observed to have an EPL with an accessory tendon attaching on the 2nd metacarpal‐phalangeal joint and an accessory tendon of the ED inserting on the distal phalanx of the pollex unilaterally on the left side. The EPL is known to be one of the most anatomically consistent structures with its tendon, only inserting into the pollex (Kim, Lee, &amp; Baek). This variation of the EPL was described as extensor pollicis et indicis accessorius, which was found in 1.2% of the cadavers (n=431) in Yoashida’s study. Although there are a few isolated patient cases describing the similar ED variation, such as in Hanrahan et al., very few results have been found regarding the prevalence of the accessory ED muscle belly in the general population. It is likely that the ED tendon inserting into the pollex weakly assists with the extension function. Additional variations of the extensor indicis muscle providing an accessory tendon to the 3rd digit and extensor digiti minimi muscle providing an accessory tendon to the 4th digit were noticed bilaterally on the same cadaver. The knowledge of these variations will be vital in proper surgical planning for tendon transfers, grafts, and transplantations.

The Efficacy of Eccentric Training Versus Concentric Training Along With Therapeutic Ultrasound Therapy for Pain and Functioning in Subjects with Lateral Epicondylitis

Background: Lateral Epicondylitis is a disabling musculoskeletal condition leading to pain and/or tenderness around the elbow. A common presentation may show pain and tenderness over the lateral epicondyle of the humerus , the radial head , the fascia , between the origins of extensor muscles as well as radiating into the forearm. Materials &amp; Methodology: Patients with Lateral Epicondylitis (n=20) were included in this study and patients with fracture of upper limb , radiculopathies , undergoing steroid therapy , rheumatoid arthritis were excluded from the study. A comparative study was done where two groups were made , Group A (n=10) received Eccentric exercise along with Ultrasound Therapy and Group B (n=10) received Concentric exercise along with Ultrasound Therapy. Treatment was given for 3 times a week for 3 weeks. Pain was assessed using Numerical Pain Rating Scale and functional disability was assessed using Patient Rated Tennis Elbow Evaluation. Results: Group A showed significant decrease in pain and functioning as compared to Group B. Mean pre NPRS of eccentric subjects was 6.70 which was significantly higher than mean post NPRS 6.30 (p&lt;0.001). Mean pre NPRS of concentric subjects was 6.30 which was significantly higher than mean post NPRS 2.60 (p&lt;0.001). Mean pre PRTEE of eccentric subjects was 53.90 which was significantly higher than mean post PRTEE 12.85 (p&lt;0.001). Mean pre PRTEE of concentric subjects was 55.45 which was significantly higher than mean post PRTEE 23.50 (p&lt;0.001) Conclusion: The study concluded that Eccentric exercise along with Ultrasound Therapy is more effective than Concentric exercise along with Ultrasound Therapy.

Extensor Carpi Radialis brevis: Review of Anatomy and Clinical Significance to Orthopedics

The extensor carpi radialis brevis (ECRB) muscle is an integral extensor and abductor of the wrist. It originates from the lateral epicondyle of the humerus, laying deep to the extensor carpi radialis longus and extensor digitorum communis, and superficial to the supinator. Insertion occurs at the base of the third metacarpal. The radial nerve or a derivative supplies innervation. Its significance in orthopedics is highlighted by its involvement in multiple surgical approaches, such as the Thompson and Kaplan approaches for exposure of the radius, as well as its association with several routinely observed pathologies. Many of the associated syndromes, such as lateral epicondylitis, arise from repetitive gripping motions or overuse and are frequently seen in the orthopedic clinic. This review seeks to provide a comprehensive summary of the relevance of the ECRB to the orthopedic setting to broaden knowledge of its anatomy and increase recognition and proper management of associated pathologies.

Ultrasound-guided percutaneous neuromodulation in chronic lateral elbow pain

Abstract Background Lateral epicondylalgia (LE), also known as tennis elbow, refers to a painful condition around the lateral epicondyle of the humerus and the common extensor tendon, which worsens with dorsiflexion and/or wrist supination against resistance. The aim of this study was to evaluate the effect of ultrasound-guided percutaneous neuromodulation (PNM) applied to the radial nerve in relation to pain, functionality, electrophysiological excitation and the morphology of the nerve in patients with chronic lateral epicondylalgia. Material and Methods A randomized clinical trial was performed. In total, 28 patients (15 women, 13 men) with chronic unilateral LE were randomly divided into two groups: a control group (CG = 12) who did not receive any treatment and an experimental group (PNM = 16) who received a weekly session during three weeks of ultrasound-guided PNM on the affected radial nerve. Concretely, the therapy consisted of the application of an asymmetric biphasic current on the symptomatic side, with a frequency of 10 Hz, a phase duration of 250 microseconds, and sufficient current intensity to observe a contraction in the forearm during 1.5 minutes. The variables analyzed were: pain, measured via the visual analog scale (VAS); functionality, measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE); the morphology of the nerve with the calculation of the cross-sectional area (CSA) and the electrophysiological excitability with the intensity-time curve (accommodation coefficient) of the radial nerve studied Results There were no differences between the two groups in the initial assessment regarding pain, functionality and nerve morphology (all comparisons obtained a p &gt; 0.05). However, at the end of the study, the groups were significantly different. After treatment, there were significant differences in all variables: for the VAS (p &lt; 0.001) with a large effect size (d &gt; 0.8); for all values of the PRTEE (p &lt; 0.001) the effect size was median (d &gt; 0.5) and for the CSA (p = 0.001) the effect size was large (d &gt; 0.8). Only the PNM group displayed significant increases in their values compared to the initial assessment, with a large effect size for all variables (d &gt; 0.8). Regarding the accommodation coefficient, 75% of patients (12/16) displayed hypoexcitability of the nerve in the PNM group and 64% of patients (8/12) in the CG at the beginning of the study. After treatment, only the PNM group showed significant improvements in the pattern of excitability of the radial nerve, reaching normal nerve function in all subjects (p &lt; 0.001). Conclusion Ultrasound-guided PNM leads to a decrease in pain and CSA of the radial nerve; furthermore, it produces an increased functionality of the elbow and normalization of the electrophysiological excitability of the affected radial nerve. Ultrasound-guided PNM appears to be an appropriate tool for the treatment of patients with chronic LE.

The impact on anatomical landmark identification after an ultrasound-guided palpation intervention: a pilot study

BackgroundTo determine whether a discrepancy exists in identifying three musculoskeletal landmarks (medial meniscus, lateral malleolus and lateral epicondyle of the humerus) and whether ultrasound-guided (US-guided) palpation intervention can reduce that discrepancy and improve localization for chiropractic interns.MethodsSixteen chiropractic interns were asked to identify three subcutaneous anatomical landmarks before/ after the intervention and at a 3-day follow-up. The intervention was a three-minute US-guided demonstration of the landmarks after the intern’s initial localization. The primary outcome measure was the change in distance between the intern’s landmark identification. Non-normal data were analyzed with the Friedman’s and Wilcoxon signed rank tests. Discrepancy between examiner-determined landmarks and intern-identified landmarks at the initial time point was assessed with a 1-sample Wilcoxon signed rank test.ResultsAll locations demonstrated an initial discrepancy between examiner-determined landmarks and intern-identified landmarks at the initial time point. Overall, a statistically significant difference was noted in the identification of the medial meniscus (p = 0.012) and lateral malleolus (p = 0.001), but not at the lateral epicondyle (p = 0.086). For the before and immediately after comparison, a significant improvement was found with the medial meniscus (p = 0.005) and lateral malleolus (p = 0.002). The 3-day post-intervention comparison found an improvement only for the lateral malleolus (p = 0.008).ConclusionThis pilot study demonstrated palpatory discrepancy at identifying all three landmarks. Our data suggests that US-guided palpation intervention seems to improve an intern’s ability to palpate two landmarks (medial meniscus and lateral malleolus) post-intervention.

Strength-Duration Curves of Radial Nerve in Patients With Lateral Elbow Pain.

Lateral epicondylalgia (LE) refers to a painful condition at or around the lateral epicondyle of the humerus. LE is one of the most common injuries of the elbow; however, the cause of the pathology is not clear. Patients often experience symptoms consistent with a radial nerve injury; however, data on the involvement of the radial nerve are needed. To analyze the relationship between electrophysiologic excitability and morphology of the radial nerve in patients with unilateral chronic LE. Cross-sectional study. Department of Physiotherapy, University of Seville. A total of 56 elbows (28 right, 28 left) in 28 patients (12 females, 16 males; age 49 [7.37]y) were recruited by convenience sampling. Strength-duration curves (chronaxia and accommodation index) and cross-sectional area (CSA) of the radial nerve were made in all participants. All parameters were compared between both limbs. Also, pain with palpation in the lateral epicondyle and functional pain of involved extremities was assessed using visual analog scale and the Patient-Rated Tennis Elbow Evaluation, respectively. Symptomatic limb showed higher CSA values of the radial nerve when compared with the asymptomatic limb (P < .001). On the symptomatic limb, duration of symptoms was positively correlated with CSA values. Chronaxia values were all normal and similar between both limbs (P = .35). Regarding accommodation index, 14 (54%) patients showed accommodation indices that suggested pathological radial nerve on the right limb, 4 (14%) on the left limb, 5 (18%) on both limbs, and 4 (14%) had none of the affected nerves. Eight-six percent of patients showed accommodation indices that suggested pathological radial nerve, independently of symptomatic limb. In these cases, affected nerves had higher CSA than the unaffected nerve (P = .01). On the affected nerves, duration of symptoms was positively correlated with accommodation indices. These findings suggest that patients with unilateral chronic LE show a decreased excitability in any radial nerve, independently of the symptomatic limb, and that pathological nerves have higher CSA than the nonpathological nerves.

Ultrasound-Guided Interventions in Lateral Epicondylitis.

Lateral epicondylitis is a painful condition related to the myotendinous origin of the extensor muscles at the lateral epicondyle of the humerus. Primary treatment typically involves the use of rest, non-steroidal anti-inflammatory drugs (NSAIDs), and physiotherapy. However, in refractory cases where conventional therapy is ineffective, ultrasound-guided injection therapies have become a growing form of treatment. These include needle tenotomy, autologous whole blood injection (AWB), platelet-rich plasma (PRP) injection and steroid injection. The consensus regarding the efficacy of individual approaches of ultrasound-guided treatment is unclear in the literature, and is explored further in this review.When evaluating these injection therapies individually, there are multiple case series describing the efficacy of each intervention in refractory lateral epicondylitis. A systematic review of needle tenotomy demonstrates an improvement in pain symptoms for patients with this condition, but all studies were poorly designed with no placebo or control group. Additionally, for PRP therapy, a systematic review performed in 2013 demonstrated a statistically significant improvement in pain and functionality for refractory lateral epicondylitis. However, these studies were similarly associated with a high risk of bias. Autologous whole blood injection has been evaluated through well-designed studies to show statistically significant reductions in pain with this intervention. But very few studies in total have been completed using AWB for lateral epicondylitis, and therefore no clear conclusions can be drawn at this time. Finally, corticosteroid use overall is unsupported in the evidence both in the short and long term, especially given that this condition is not an inflammatory pathology.

Reverse vascularized bone graft of the lateral distal humerus for non-union of the radial neck fracture: anatomical study and case report

A few treatment options for radial neck non-union have been reported, including radial head excision, radial head replacement, and internal fixation with a bone graft. We describe a new treatment for radial neck non-union using a reverse vascularized bone graft of the lateral distal humerus. In the anatomical study, the posterior radial collateral artery (PRCA) was dissected in eight fresh-frozen cadaver arms. The number of branches from the PRCA to the humerus was determined, and the distances from these branches to the lateral epicondyle of the humerus were measured. We then used this information to create a reverse vascularizedhumeral bone graft, which was used to treat non-union of a radial neck fracture in a 73-year-old female. There were two to four PRCA branches (mean: 3.3) entering the bone. The distance from the branches to the lateral epicondyle of the humerus ranged from 2.5 to 10.8 cm. The mean distances from the most proximal and distal PRCA branches to the lateral epicondyle of the humerus were 7.6 cm and 3.4 cm, respectively. The case of non-union of a radial neck fracture was successfully treated with a reverse vascularized humeral bone graft. There were no major complications, and radiographs showed bony union at 8 weeks postoperatively. This procedure may become a new option for the treatment of non-union of fractures of the radial head and neck, as it enables preservation of the radial head, which is an important structure in the elbow and proximal radioulnar joints.

Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

BackgroundThe use of bone graft for the radial head fractures has been previously described and occasionally used by other authors.This is the first paper, to my knowledge, dealing with the relevant issue about the importance that the use of an autologous bone graft can have on the radial head fractures.MethodsFrom July 2010 to July 2014, 20 consecutive patients who underwent open reduction and internal fixation for a closed Mason type II radial head fracture were retrospectively reviewed. Patients with Mason type I, III, simple type II, and comminuted type II fractures treated without bone grafting were excluded. A clinical examination and radiographic evaluation were performed. The overall functional result was evaluated using the Mayo Elbow Performance Score (MEPS). The Broberg and Morrey classification was used to evaluate traumatic arthritis.ResultsThe average follow-up duration was 31 months (range, 24–50 months). Bone union of the radial head fracture was achieved in all patients at an average of 13.5 weeks (range, 12–17 weeks). Postoperative radiographs showed no cases of postsurgical ligamentous instability, necrosis of the radial head, or internal fixation failure. The mean range of motion of the affected elbow was 128° ± 8.4° in flexion, 14.5° ± 11.1° in extension, 68.7° ± 14.1° in pronation, and 65.2° ± 18.2° in supination. The mean MEPS was 92 ± 7.9 points (range, 80–100); the outcome was excellent (90–100 points) in 13 patients and good (75–89 points) in 7 patients. The MEPS tended to be higher in patients with an isolated fracture (p = 0.016). Based on the Broberg and Morrey classification for radiographic assessment of post-traumatic arthritis, 15 elbows had no evidence of degenerative changes (grade 0), and 5 elbows had grade 1 changes.ConclusionAlthough radial head fractures may not be amenable to internal fixation, our findings suggest that open reduction and internal fixation with an autogenous bone graft from the lateral epicondyle of the humerus provides satisfactory elbow function in patients with comminuted Mason type II radial head fractures.

Partial avulsion of the ulnaris lateralis and enthesiopathy of the lateral epicondyle of the humerus in a thoroughbred race horse

BackgroundThere is relatively little literature on elbow disease in the horse. The only published reports on soft tissue conditions describe collateral ligament and biceps brachii injuries.Case presentationA three-year old Thoroughbred gelding presented with a history of acute onset right forelimb lameness of less than one week duration, one month after commencing training in a National Hunt racing yard. Physical examination and peri-neural anaesthesia failed to localise the lesion. Lameness was localised to the distal humerus by nuclear scintigraphy and intra-articular anaesthesia. A partial avulsion of the tendinous origin of the ulnaris lateralis and enthesiopathy of the lateral humeral epicondyle was diagnosed on ultrasonography. Ultrasonographic findings were loss of longitudinal fibre pattern, a discrete hypo-echoic region within the ulnaris lateralis tendon of origin, and remodelling of the lateral epicondyle of the right humerus at the site of the origin of the ulnaris lateralis. No abnormalities were identified on radiography. The lameness did not resolve with rest, but was successfully treated with extra corporal shockwave therapy (ECSWT) and intra-lesional corticosteroid injections.ConclusionThis is the first report of partial avulsion of the ulnaris lateralis and enthesiopathy of the lateral humeral epicondyle in the horse. In contrast to other reported soft tissue conditions of the elbow, this horse had a successful return to work. This case highlights the value of ultrasonography in assessing peri-articular soft tissues, and the importance of pain relief as treatment in some soft tissue injuries.

Prospective comparative study of local steroid and autologous blood injection in the treatment of lateral epicondylitis

Background: Tennis elbow (Lateral epicondylitis) frequently encountered myotendinosis affecting around 3 -5 % of population. It’s an ECRB insertion overuse injury at the lateral epicondyle of humerus affecting dominant arm. Non-operative treatment is successful in 80% of patients with tennis elbow. Recent research papers indicate autologous blood injection at the insertion of ECRB proved to be effective in decreasing pain in intermediate and long-term period Methods: This was a randomized control study done in Rajarajeshwari medical college and hospital, Bengaluru to compare the effectiveness of steroid and autologous blood local injection in terms of controlling pain and disability in short term. Total no. of 40 patients, divided in to 2 groups. One group injected at the site of lateral epicondyle with steroid (methyl prednisolone acetate-40mg) and another group with autologous blood (2ml of venous blood). Patients were followed up at 1st, 4th, and 12th week, pain and disability assessed with visual analogue scale (VAS) and Nirschl staging. Results: At 1st week corticosteroid injection group (Group I) recorded a statistically significant decrease in pain (VAS Score) compared to autologous blood injection group. At 4th week both group patients had decrease in pain and disability but statistically not significant when compared to each other. At 12th week review, autologous blood injection group (Group II) recorded statistically significant decrease in pain (P-0.0146) and disability (P-0.0001) compared to corticosteroid injection group. Conclusion: Since autologous blood injection at the lateral epicondyle on OPD basis showed significant improvement in pain and disability, we recommend using same for the treatment of tennis elbow.

An unusual elbow muscle in the red howler monkey: does it deserve invention of a new name musculus contrahens cubiti?

During dissection of a juvenile specimen of howler monkey (Alouatta seniculus), we discovered a supernumerary muscle. This muscle originates from the lateral epicondyle of the humerus, distal to the m. brahioradialis and beneath the m. extensor carpi radialis longus, and runs deeply to insert on the proximal part of the radius adjacent to the m. supinator.To determine homology of the unusual muscle, we compared it with the known abnormal extra muscles in the group of preaxial forearm extensors in humans and other primates, as well as other mammals. The only similar muscle is the so-called m. brachioradialis accessorius, which is very rarely found in humans medial to the n. radialis r. superficialis. Both in howlers and humans, its unique topological interrelations with the n. radialis suggest that this muscle is fundamentally different from all surrounding forearm extensors including the proper m. brachioradialis. At the same time, its innervation by the n. radialis confirms that it is a true extensor, contrary to the reptilian m. tractor radii.The general problem of identifying homology of anomalies and novelties is considered. As the enigmatic muscle departs from rules of myological architecture of the tetrapod forelimb, we failed to establish its general homology and, instead, suggest naming it as m. contrahens cubiti. This means that the muscle acts as the elbow flexor although it intimately belongs to extensors.

Spinal manipulation does not affect pressure pain thresholds in the absence of neuromodulators: a randomized controlled trial

Background: Measurement of pressure pain threshold (PPT) is a way to determine one of the many potential treatment effects of spinal manipulative therapy.Objective: To determine how multiple spinal manipulations administered in a single-session affected PPTs at local and distal sites in asymptomatic individuals.Methods: Participants were randomly assigned into one of three groups: Group one (n = 18) received a lumbar manipulation followed by a cervical manipulation. Group two (n = 17) received a cervical manipulation followed by a lumbar manipulation. The control group (n = 19) received two bouts of five minutes of rest. At baseline and after each intervention or rest period, each participant’s PPTs were obtained using a handheld algometer. The PPTs were tested bilaterally over the lateral epicondyles of the humerus and over the mid-bellies of the upper trapezius, lumbar paraspinal, and the tibialis anterior muscles. This study was registered with ClinicalTrials.gov, and its Identifier is NCT02828501.Results: Repeated-measures ANOVAs and Kruskal–Wallis tests showed no significant within- or between-group differences in PPT. Within-group effect sizes in the changes of PPT ranged from −.48 at the left paraspinal muscles to .24 at the left lateral humeral epicondyle. Statistical power to detect significant differences at α of 0.05 was calculated to be 0.94.Conclusions: This study suggests that in young adults who do not have current or recent symptoms of spinal pain, multiple within-session treatments of cervical and lumbar spinal manipulation fail to influence PPTs. Changes in PPT that are observed in symptomatic individuals are likely to be primarily influenced by pain-related neuromodulators rather than by an isolated, mechanical effect of spinal manipulation.