Patient-Rated Elbow Evaluation Research Articles

How effective is proprioception exercise on pain, grip force, dexterity and proprioception of elbow joint in patients with tennis elbow? A randomized controlled trial

BackgroundPatients with tennis elbow (TE) disorder suffer from proprioception deficits alongside other symptoms, which usually is neglected to be targeted in different physiotherapy protocols. This study aimed to investigate the effects of proprioception exercises on treatment outcomes. MethodsIn this RCT, 14 males and 30 females TE volunteered patients were randomly divided into two intervention (IG) and control (CG) groups, in which CG received routine physiotherapy, while IG underwent further proprioception exercises for 18 sessions within six weeks. Pain, function, grip force, dexterity, and proprioception of elbow joint were evaluated using Patient-Rated Elbow Evaluation (PREE) questionnaire, handheld dynamometer, Purdue Pegboard, and isokinetic dynamometer, respectively. ResultsA significant within group improvement was observed in terms of pain (IG: 49.93%, CG: 42.75%), function (IG: 61.9%, CG: 48.95%), grip force (IG: 22.1% CG: 16.9%), dexterity (IG: 18.96% CG: 11.82%), active joint position error (IG: 32.99, CG: 7.33 %), and the threshold to detection of passive motion (TTDPM) for both groups (IG: 24.35, CG: 24.86%) in both groups after treatment as compared to before treatment (p < .0001), with no statistically significant differences between the groups for these variables except for active joint position error, which showed a significant reduction in the IG (p < .02). ConclusionIt could be concluded that proprioception exercises has a limited added value on routine physiotherapy it terms of pain, function, grip force, and dexterity. However, adding proprioception exercises found to be beneficial for improving variables determining joint position sense.

Distal biceps tendon repair: outcome and complications with single incision anchor fixation.

The purpose of this study is to evaluate the functional outcome and quality of life in distal biceps tendon repair with single incision technique and anchor fixation method. A retrospective cohort study was made of patients with complete distal biceps tendon rupture. The chosen repair method was single incision technique with anchor fixation. The outcome was assessed with functional testing of the elbow with strength and ROM. Additionally Mayo elbow performance index, Oxford elbow score, Disability arm hand shoulder questionnaire and patient rated elbow evaluation scores were used to evaluate quality of life. Of the 28 patients, the average strength in flexion and supination was decreased with 91% and 89% of the strength compared to the non-injured arm. ROM was preserved in flexion, extension, supination and pronation. The mean scores for quality of life evaluation were MEPS = 96 ± 7.8, OES = 46.8 ± 1.9, DASH = 1.0 ± 1.9 and PREE = 2.0 ± 3.6. LABCN injury was the most common temporary complication with 30% followed by pain with 23%. Two patients were identified with HO and 1 patient was identified with median nerve injury. There were no cases of radioulnar synostosis and PIN injury. Overall strength in flexion and supination were slightly decreased with preserved ROM. Patients reported nearly perfect quality of life as demonstrated with the scores. The complications rate was high with mainly minor complications. Distal biceps tendon repair with single incision technique and anchor fixation overall leads to a very satisfying outcome.

Distal biceps tendon repair using a double intracortical button anatomic footprint repair technique

Distal biceps tendon repair is usually performed via a double-incision or single-incision bicortical drilling technique. However, these techniques are associated with specific complications and usually do not allow for anatomic footprint restoration. It was the aim of this study to report the clinical results of a double intracortical button anatomic footprint repair technique for distal biceps tendon tears. We hypothesized that this technique would result in supination strength comparable to the uninjured side with a low rerupture rate and minimal bony or neurologic complications. This was a retrospective, single-surgeon cohort study of a consecutive series of 22 patients with a mean (standard deviation) age of 50.7 (9.4) years and at least 1-year follow-up after distal biceps tendon repair. At final follow-up, complications, range of motion (ROM), the Patient-rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS) for pain, patient satisfaction, and supination strength in neutral as well as 60° of supination were analyzed. Radiographic evaluation was performed on a computed tomography scan. One patient (4.5%) experienced slight paresthesia in the area of the lateral antebrachial cutaneous nerve. Heterotopic ossification was seen in 1 patient (4.5%). All patients recovered full ROM except for 1 who had 10° of loss of flexion and extension. Median PREE score was 4.6 (0-39.6), median MEP was 100 (70-100), and median DASH score was 1.4 (0-16.7). All but 1 patient were very satisfied with the outcome. The affected arm had a mean of 98% (±13%) of neutral supination strength (P=.633) and 94% (±12%) of supination strength in 60° (P=.054) compared with the contralateral, unaffected side. There were 4 cases (18.2%) of cortical thinning due to at least 1 button and 1 case of button pullout (4.5%). The double intracortical button anatomic footprint repair technique seems to provide reliable restoration of supination strength and excellent patient satisfaction while minimizing complications, particularly nerve damage and heterotopic ossification.

Bridge plating is an effective adjunct treatment for complex elbow instability

Managing persistent elbow instability and chronic dislocations presents challenges despite traditional treatments. Supplementary methods like immobilization and various fixations, though common, can carry high complication rates. This study assesses the efficacy of bridge plating in treating complex elbow instability through a retrospective review of patients. Data on characteristics, treatment duration, range of motion, complications, and evaluation scores were analyzed, providing insights into outcomes complications associated with bridge plating. Eleven patients were reviewed at a mean follow-up of 80±68 weeks postoperatively. The mean age was 53±14 years and there were 5 females and 6 males. The mean body mass index was 38. Bridge plating was used for a spectrum of complex elbow injuries. The mean time from injury to bridge plating in acute cases was 29±19 days and 344±381 days in chronic cases. The mean duration of bridge plating was 121±72 days. At the time of plate removal, mean intraoperative elbow motion was extension 58°±12°, flexion 107°±14°, supination 66°±23° and pronation 60°±26°. At the latest follow-up visit, mean elbow motion was extension 37°±22°, flexion 127°±17°, supination 72°±15°, and pronation 63°±18°. There were 6 complications (55%): heterotopic ossification, ulnar neuropathy, wound failure over the plate in a thin patient, an ulnar shaft periprosthetic fracture due to a seizure-induced fall, and persistent elbow subluxation despite bridge plate fixation. Finally, 1 patient sustained a fracture of a 3.5-mm locking bridge plate. One patient required a contracture release for persistent stiffness. Four of these complications can be directly attributed to the use of the bridge plate (36%). At final follow-up, the mean patient-rated elbow evaluation score was 34, with 0 indicating no pain and disability. The mean Single Assessment Numeric Evaluation score was 66% for the 8 patients who had this available, with 100% being the best possible attainable score. Bridge plating effectively maintains joint reduction in selected complex elbow instability cases. However, patients with bridge plates often require a second surgery for removal and experience high rates of general complications because of the complexity of their condition.

Midterm follow-up of the Nexel total elbow arthroplasty

IntroductionAseptic loosening is one of the most common complications of total elbow arthroplasty (TEA). Modern implants, such as the Nexel, have been designed in an attempt to decrease loosening. The present study aims to report implant survivorship, radiographic assessment of loosening and lucency, and patient-reported outcome measures (PROMs) in patients treated with the Nexel TEA at mid-term follow-up. MethodsConsecutive series of adult patients underwent TEA using the Nexel by a single surgeon via standardized technique. Patients with minimum 3 year follow-up with radiographic and PROM data were included. Survivorship was defined by the absence of revision. Loosening was assessed via Wrightington method by three independent fellowship-trained shoulder and elbow surgeons. Lucency was analyzed across individual radiographic zones on orthogonal radiographs. PROMs included the Quick Dash (QDASH), Patient Rated Elbow Evaluation (PREE), and EuroQoL (EQ5D). Results38 consecutive patients (22 female, 16 male) with mean age of 67 underwent TEA via triceps-sparing isolated medial window approach. Mean follow-up was 5.5 years (range 3-9). Primary diagnoses were: 19 osteoarthritis (OA), 9 rheumatoid arthritis (RA), 9 post-traumatic arthritis (PA), 1 conversion of elbow arthrodesis. Overall survivorship was 97.4%, with one patient undergoing revision for infection. Loosening was found in 5.3% of elbows, averaged across three observers. Lucency was most pronounced at the level of the humeral condyles. PROMs demonstrated significant and clinically meaningful improvements in 76%, 92%, and 73% of patients for QDASH, PREE, and EQ5D, respectively. No significant correlations were found between patient age, gender, loosening, lucency, and PROMs. ConclusionAt mid-term follow-up, the Nexel TEA demonstrated excellent overall survivorship and low rate of implant loosening. The single failure requiring revision for infection was conversion of a prior elbow arthrodesis. PROMs overall exhibited marked and consistent improvement from preop to final postop follow-up. Although promising, these results should be interpreted with some caution as long term data regarding this prosthesis are still lacking.

Alteration of Interhemispheric Inhibition in Patients With Lateral Epicondylalgia

Patients with lateral epicondylalgia (LE) show alterations in the primary motor cortex (M1) contralateral to the affected side. Cortical alterations have been investigated by measuring intracortical facilitation/inhibition; however, their association with pain remains controversial. Furthermore, no studies have investigated changes in interhemispheric inhibition (IHI). IHI can be assessed using the ipsilateral silent period (iSP) known as the temporary inhibition of electromyographic activity evoked by transcranial magnetic stimulation in the ipsilateral M1 of the contracting muscle. To better understand the relationship between cortical alterations and pain in LE, this observational study investigated the relationship between iSP and pain in LE. Twenty-seven healthy volunteers and 21 patients with LE were recruited. The duration of iSP in the extensor carpi radialis brevis was measured. The IHI asymmetry ratio was calculated to determine the IHI balance. Pain and disability were scored using the Japanese version of the patient-rated elbow evaluation. We observed increased inhibitory input from the ipsilateral M1 on the affected side to the contralateral M1 in LE. Additionally, the IHI balance correlated with pain severity. Hence, regulating imbalanced IHI can potentially decrease lateral elbow pain in LE. PerspectivePatients with lateral epicondylalgia (LE) experience persistent pain and cortical alterations. However, there is no established relationship between cortical alterations and pain. This study demonstrated that the interhemispheric inhibition (IHI) balance is correlated with pain. Regulating imbalanced IHI can potentially decrease lateral elbow pain in patients with LE.

Indomethacin for heterotopic ossification prophylaxis following surgical treatment of elbow trauma: a randomized controlled trial

Heterotopic ossification is a frequent complication following surgical treatment of elbow trauma. The use of indomethacin to prevent heterotopic ossification is reported in the literature; however, its effectiveness is controversial. The purpose of this randomized, double-blind, placebo-controlled study was to determine whether indomethacin is effective in reducing the incidence and severity of heterotopic ossification after surgical management of elbow trauma. Between February 2013 and April 2018, 164 eligible patients were randomized to receive postoperative indomethacin or placebo medication. The primary outcome was the incidence of heterotopic ossification on elbow radiographs at 1-year follow-up. Secondary outcomes included the Patient Rated Elbow Evaluation score, Mayo Elbow Performance Index score, and Disabilities of the Arm, Shoulder and Hand score. Range of motion, complications, and nonunion rates were also obtained. At 1-year follow-up, there was no significant difference in the incidence of heterotopic ossification between the indomethacin group (49%) and the control group (55%) (relative risk, 0.89; P=.52). There were no significant differences in postoperative Patient Rated Elbow Evaluation, Mayo Elbow Performance Index, and Disabilities of the Arm, Shoulder and Hand scores or range of motion (P=.16). The complication rate was 17% in both the treatment and control groups (P>.99). There were no nonunions in either group. This Level I study demonstrated that indomethacin prophylaxis against heterotopic ossification in the setting of surgically treated elbow trauma was not significantly different from placebo.

Lateral ulnar collateral ligament (LUCL) Reconstruction using an Autologous Triceps Tendon Graft for Subclinical Posterolateral Rotatory Instability in Recalcitrant Lateral Epicondylitis.

To evaluate mid-term outcome of LUCL repair with triceps autograft in patients with PLRI under recalcitrant lateral epicondylitis. In total 25 elbows (23 patients) with recalcitrant epicondylitis longer than 12 months were included into this retrospective study. All patients underwent arthroscopic instability examination. In 18 elbows (16 patients, mean age 47.4 years, range 25-60) PLRI was verified, and a LUCL repair using an autologous triceps tendon graft was performed. Clinical outcome was evaluated before and at least three years after surgery using the American Shoulder and Elbow Surgeons Score (ASES), Liverpool Elbow Score (LES), Mayo Elbow Performance Index (MEPI), Patient-Rated Elbow Evaluation score (PREE), Subjective Elbow Value (SEV), quick Disabilities of the Arm, Shoulder and Hand score (qDASH), and the visual analog scale (VAS) for pain. Postoperative satisfaction with the procedure and complications were recorded. Seventeen patients were available at a mean follow-up of 66.4 months (range 48-81). Patient satisfaction postoperatively was reported in 15 elbows as excellent (90-100%) and 2 as moderate with 93.1% overall. All scores of the three female and 12 male patients significantly increased from pre- to the postoperative follow-up (ASES: 28.3±10.7 to 54.6±12.1, p<0.001; MEPI: 49.2±8.3 to 90.5±15.4, p<0.001; PREE: 66.1±14.9 to 11.3±23.5, p<0.001; qDASH: 63.2±21.1 to 11.5±22.6, p<0.001; VAS: 8.75±1.0 to 1.5±2.0, p<0.001) All patients suffered from high extension pain preoperatively, which was reported to be relived after surgery. No reinstability nor major complication occurred. The repair and augmentation of the LUCL with a triceps tendon autograft reached significant improvements; hence, it seems to be a good treatment option for posterolateral elbow rotatory instability with promising mid-term results under a low rate of reinstability.

Japanese version of the Patient-rated elbow evaluation score correlates with physician-rated Japanese orthopaedic association-Japan elbow society elbow function score

BackgroundThe association between Patient-Rated Elbow Evaluation: Japanese version (PREE-J) and Japanese Orthopaedic Association-Japan Elbow Society Elbow Function score (JOA-JES score) is unclear. This study evaluated the association between PREE-J and JOA-JES scores. MethodsThe patients with elbow disorders were divided into two groups: Group A (conservative treatment, n = 97) and Group B (surgical treatment, n = 156). The patients were also divided into four disease subgroups according to the JOA-JES classification (rheumatoid arthritis, trauma, sports, and epicondylitis groups), and the association between PREE-J and JOA-JES scores in each disease category was examined. In group B, associations between PREE-J and JOA-JES scores were examined pre-and postoperatively. ResultsIn group A, there were significant associations between PREE-J and JOA-JES scores. In group B, a strong association between preoperative PREE-J and JOA-JES scores was observed in all disease categories. There was also a significant association between postoperative PREE-J and JOA-JES scores. Additionally, group B showed significant postoperative improvements in PREE-J and JOA-JES scores. ConclusionsThe PREE-J score correlates well with the JOA-JES score and reflects treatment response before and after treatment.

Short-Term Patient Outcomes after Placement of an Internal Joint Stabilizer for Terrible Triad Injuries: A Multicenter Study

The purpose of this study was to assess the functional and patient-reported outcomes after the use of the internal joint stabilizer (IJS) for unstable terrible triad injuries. Specifically, we sought to determine our complication rate and the impact of complications on patient outcomes. We identified all patients who had an IJS placed as a supplemental fixation for a terrible triad injury at two urban, level 1 academic medical centers. We reviewed these patients' charts for demographic information, complication profiles, postoperative range of motion (ROM), and pain-level data. We also collected the QuickDASH and Patient-Rated Elbow Evaluation (PREE) scores. Descriptive statistics were reported. Final visit data were compared between patients who returned to the OR for a complication and those who did not. From 2018 to 2020, 29 patients had an IJS placed for a terrible triad injury. The median final follow-up was 6.3 months after surgery (IQR: 6.2 months). There were 38 complications in 19 patients (65.5%) that required 12 patients to return to the OR (41.3%) for procedures beyond simple IJS removal. There were no significant differences in the ROM between patients who returned to the OR for a complication and those who did not. QuickDASH and PREE scores were greater (indicating more disability) in patients who had a complication that required a secondary surgical procedure. Patients who receive an IJS incur a high rate of complications. When patients sustain complications that require secondary surgeries, their ultimate functional outcome scores worsen. Therapeutic IV.

Primary repair of acute versus chronic ruptures of the distal biceps tendon. Comparison of functional results in a case-control study

BackgroundIn the event of a rupture of the distal tendon of the biceps brachii, most authors recommend early reinsertion to recover optimal elbow function. However, these ruptures are not always diagnosed or promptly referred to surgeons, thus creating a delay in treatment. Studies reporting functional results in cases of chronic repair (greater than 21 days) of the distal biceps brachii tendon show an increased rate of complications. HypothesisPrimary repairs of chronic ruptures (treatment delayed for more than 21 days) and acute ruptures of the distal biceps give the same functional results and the same rate of complications. Material and methodsWe conducted a retrospective study between January 2017 and December 2021 comparing chronic primary repair of the distal biceps at the elbow (experimental group, comprising 75 patients) and acute (control group, comprising 135 patients) by endobutton. We analyzed the time between trauma and surgery, and assessed short- and long-term functional recovery by measuring residual pain (VAS), a collection of the following functional scores: Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Patient-Rated Elbow Evaluation (PREE), as well as a measure of strength (as a percentage of the healthy side). We evaluated the rate of complications and radiographically analyzed the rate of heterotopic ossification. ResultsThe mean time between trauma and surgery was 73±66 days (experimental group) versus 11.2±5 days (control group). In the short-term (4.79±2.09 months), there was no significant difference in the MEPS, Q-DASH and PREE functional scores between the two groups (p=0.354, p=0.412 and p=0.958, respectively). In the long-term (28.9±17.9 months), the functional evolution remained similar. The recovery of strength in flexion and supination was 89.19±13.43% and 77.48±16.68%, respectively, and similar in the two cohorts (p=0.476 and p=0.395). There was no difference in the rate of complications; however, the rate of heterotopic ossification was higher in the control group (p=0.006). DiscussionThe functional results and the recovery of strength did not change according to the time until surgery. Although the overall complication rate was similar, repairs of the biceps in less than 21 days led to more heterotopic ossification. Level of evidenceIII; retrospective case-control study.

NON-DRUG NON-INVASIVE TREATMENT IN THE MANAGEMENT OF TENNIS ELBOW

Introduction: Tennis elbow is a common disorder of upper extremity. Majority of the patients can be treated conservatively. It is the major cause of disability and time off work, after low back pain. The disease impacts upon activities of daily living ultimately leading to a loss of functional independence and quality of life. Purpose: The main purpose of this study was to assess the results of nondrug non-invasive treatment in the management of tennis elbow. This study was conducted in the department Methods: of Orthopaedics from December 2010 to December 2015. One hundred ten outpatients of tennis elbow with a mean age of 45 years were studied. They were managed with non-invasive treatment and were followed for twelve months. At twelve months follow-up visits, the intensity Results: of tennis elbow pain and disability were assessed by using Quick dash scoring system and Patient-rated elbow evaluation system. Physician global evaluations up to the age of 40 years at twelve months were excellent. At 40 to 60 years of age, it was good to excellent. Over the age of 60 years, it was good. The patient global evaluation was found very good up to the age of 40 years at twelve months follow up, good to very good between 40 to 60 years and over the age of 60 years it was good. Nondrug non-invasive interve Conclusions: ntions can reduce pain and improve function in tennis elbow.

Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years

Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes. The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2-7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared. Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class. In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries. Prognostic IV.

Is a primary distal biceps tendon repair a matter of time? Comparison of functional outcome in a retrospective case-control study

Acute tendon ruptures are not always promptly recognized or referred appropriately, creating a delayed patients presentation to the surgeon. Previous reports have noted an increased complication rate of patients with a delay to surgery, however, there is a paucity of literature reporting functional outcomes of chronic/delayed distal biceps repair. With our clinical experience, we noticed that a chronic distal biceps tendon rupture can safely be directly repaired to the radial tuberosity. We hypothesized that delayed primary distal biceps tendon repair (> 21 days from injury) has similar functional outcomes and complication rate, compared to acute repair. A retrospective case-control study was used to compare the delayed (study) and acute (control) primary distal biceps tendon repair, performed between January 2017 and December 2021. Strength measurements were noted as a percentage of the unaffected contralateral side. Functional outcomes were recorded using the Visual Analog Scale, the Mayo Elbow Performance Score, the short version of the Disabilities of the Arm, Shoulder and Hand score and the Patient-Rated Elbow Evaluation. All questionaries, including Satisfaction, were completed at the final follow-up. All clinical records were evaluated for any adverse events. We selected 210 out of 217 patients. The study and control cohort consisted of 75 and 135 patients respectively. Time to surgery was 73 ± 66.05 days versus 11.27 ± 5.14 days respectively. At short term (4.79 ± 2.09 months), the functional outcome in terms of Mayo Elbow Performance Score, the short version of the Disabilities of the Arm, Shoulder and Hand score and the Patient-Rated Elbow Evaluation were statistically not significant different ( P = 0.354, P = 0.412 and P = 0.958, respectively). The mean flexion and supination strength were respectively 89.19 ± 13.43% and 77.48 ± 16.68%, similar for both cohorts ( P = 0.476 and P = 0.395, respectively). Significantly higher incidence of asymptomatic heterotopic ossification in the control cohort ( P = 0.006), however not difference in overall complication rate ( P = 0.072). At long term (28.9 ± 17.9 months), the functional outcomes remain similar. This study demonstrates that delayed primary distal biceps repair is reliable and overall safe Functional outcomes and strength did not changed with a delayed repair. There was a higher incidence of heterotopic ossification in acute distal biceps repair. The overall complication rate was similar, no matter what time to surgery.

The patient-rated elbow evaluation was successfully translated into the Arabic language

•The patient-rated elbow evaluation (PREE) was successfully translated into the Arabic language using published guidelines •An expert committee has reconciled some terminologies in the newly adapted Arabic version of the patient-rated elbow evaluation (PREE-AR) •The PREE-AR is valid and reliable to use in Arabic-speaking subjects with elbow pain. •The PREE-AR has comparable psychometric properties to the other versions. •The PREE is recommend it to be used with Arabic-speaking patients with elbow pathologies both in clinical and research settings.

Ultrasound-Guided Tenotomy Via a Hydrosurgery Resection Device Improves Symptoms of Chronic Elbow Tendinopathy: A Multi-Center Prospective Study

Objectives To test the hypothesis that ultrasound-guided, minimally invasive tenotomy using the TenJet™ resection device might provide symptomatic pain relief and functional recovery to patients with chronic tennis or golfer’s elbow. Methods This multi-center, prospective, single-arm study enrolled patients who experienced pain symptoms persisting &gt;3 months, failed conservative care, demonstrated ultrasound or magnetic resonance imaging findings consistent with the diagnosis of tendinosis, and had opted for ultrasound-guided treatment using the TenJet resection device. Post-procedure follow-ups occurred at 2 and 6 weeks and 3, 6, and 12 months. Outcome measures included a patient-rated elbow evaluation (PREE) questionnaire for pain and function, visual analog scale (VAS) for pain, procedure complications, and adverse events. Results A total of 29 patients (32 elbows) were enrolled in the study. Significant improvements in mean PREE total scores and mean VAS scores were observed at all follow-up time points (both p &lt; 0.05). There were no device malfunctions or procedure-related complications. Two patients (6.9%) proceeded to have open debridement, one after the 2-week follow-up visit and the other after the 3-month follow-up visit. Conclusion Ultrasound-guided tenotomy and debridement using the TenJet resection device provided patients with significant pain relief and functional recovery. Additional studies may be necessary to further validate the clinical outcomes observed in this study.

Japanese version of Patient-Rated Elbow Evaluation is a useful outcome measure that potentially reflects hand function in patients with rheumatoid arthritis who underwent total elbow arthroplasty.

We examined the relationship between the Japanese version of Patient-Rated Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA). This study involved 46 elbows of 40 RA patients. We collected clinical data 1 year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures preoperatively and postoperatively. Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength [B = -0.09; 95% confidence interval (95% CI) -0.17 to -0.01, p = 0.03] and preoperative Hand20 (B = 0.31, 95% CI 0.03-0.58, p = 0.03) were significant factors that might influence the postoperative PREE-J. The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture.

For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Métaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.

The Unsalvageable Radial Head in Patients Aged 30 Years and Younger

Concern exists regarding the use of radial head arthroplasty (RHA) in younger patients. This study assessed clinical, functional, and radiographic outcomes of RHA in patients aged 30 years and younger. A retrospective review identified 26 elbows that underwent a smooth stem modular RHA in patients aged 30 years and younger at a median follow-up of 3.3 years clinically and 2.9 years radiographically. The mean age was 24 ± 5 years. Indications were acute trauma in 13 patients and chronic pathologies in the remaining 13, and these 2groups were evaluated separately. Patients underwent clinical, functional, and radiographic evaluation. Average arc of motion was 137° ± 16° in the cohort with acute trauma and 120° ± 24° in the cohort with chronic pathologies. Mean Patient-Rated Elbow Evaluation scores were 23 ± 18 (acute) and 31 ± 19 (chronic). Mean Quick Disabilities of the Arm, Shoulder, and Hand scores were 18 ± 15 (acute) and 23 ± 20 (chronic). Average Mayo Elbow Performance Index scores were 90 ± 9 (acute) and 80 ± 13 (chronic). Severe capitellar erosion was present in 1 patient (4%) in the cohort with chronic pathologies. Radiographic stem lucency was seen in all cases with 10 of these (38%) graded as severe. Moderate-to-severe ulnohumeral arthritis developed in 4 patients (15%), 3 of whom were in the chronic reconstruction group. Two patients (8%) required reoperation, 1 for persistent instability and 1 for stiffness, both in the cohort with chronic pathologies. For acute trauma and challenging chronic conditions involving the radial head in patients aged 30 years and younger, a smooth stem modular RHA is an option. Although reoperation rates based on this series are low, osteoarthritis is common when used for posttraumatic conditions and severe radiographic stem lucency was seen in greater than one-third of patients. These concerning features warrant close follow-up, and further long-term outcomes are needed. Therapeutic IV.

The ultrasonographic assessment of the morphologic changes in the ulnar nerve at the cubital tunnel in Japanese volunteers: relationship between dynamic ulnar nerve instability and clinical symptoms.

BackgroundWe investigated the differences in the prevalence of ulnar nerve instability (UNI) by hand dominance and evaluated the relationship between UNI and morphologic changes in the ulnar nerve and the clinical findings and upper limb function.MethodsThis study examined 153 healthy participants (n = 306 elbows; 44 men, 112 women; mean age 65.4 years) who underwent ultrasonography to assess the ulnar nerve cross-sectional area (UNCSA) at three points of the bilateral cubital tunnel at 30° of elbow flexion. Participants were divided into three groups based on the ultrasonography findings of UNI: no instability (type N), subluxation (type S), and dislocation (type D). For the dominant and nondominant sides, we assessed the relationship between the UNCSA and clinical factors, including the age, gender, height, weight, body mass index, fat mass, grip strength, key pinch strength, UNCSA, and Patient-Rated Elbow Evaluation score.ResultsWe identified 75 cases without instability in both elbows and 78 cases with some instability. The prevalence of UNI was 51%. No significant difference was found between hand dominance and the prevalence of UNI. The UNCSA at 1 cm proximal to the medial epicondyle on the bilateral sides in type S was the most increased among three types.ConclusionUNI was identified in almost half of the participants, with no marked difference found in the hand dominance. The UNCSA at 1 cm proximal to the medial epicondyle was significantly increased the most in type S. UNI does not appear to be associated with elbow symptoms in the general population.