Radiohumeral Joint Research Articles

A study of the posterior interosseous nerve (PIN) and the radial tunnel in 30 Thai cadavers

Sixty fresh cadaver upper extremities were dissected for a study of the course of the posterior interosseous nerve (PIN) in the radial tunnel, an area that varies but begins in the furrow between the brachioradialis and brachialis in the distal arm and ends at the distal edge of the supinator muscle in the proximal forearm. The radial nerve pierces the lateral intermuscular septum 13 cm above the elbow joint line. At 1.3 cm above the joint line the nerve divides into its posterior interosseous and superficial radial branches. The extensor carpi radialis brevis muscle received nerve supply from the superficial radial nerve, radial nerve, and PIN in 43%, 55%, and 2%, respectively. The PIN passed through the radial tunnel anterior to the radiohumeral joint and then coursed laterally and posteriorly beneath the arcade of Frohse, which is the proximal edge of the superficial layer of the supinator muscle. The arcade was tendinous in 57% of the cadavers and membranous in 43%. The distal edge of the supinator was tendinous in 65% of the specimens and membranous in 35%. The purpose of this article was to measure the various lengths of the PIN and to study possible compression sites at normal variations along the course of the PIN in the radial tunnel. No cases showed evidence of PIN compression in the radial tunnel.

Radio-ulnar dissociation. A review of twenty cases.

The results of treatment were reviewed for twenty patients who had sustained concomitant injuries of the lateral compartment of the radiohumeral joint and the ipsilateral distal radio-ulnar joint. The ages of the patients ranged from eight to seventy-four years (average, thirty-five years) and the duration of follow-up ranged from four months to twenty-seven years (average, 113 months). In fifteen patients, the injury of the wrist was diagnosed after a mean delay of seven years and eleven months (range, one month to twenty-six years). In all fifteen, the radial head injury was treated by excision, either initially or after some delay. After excision of the radial head, all fifteen patients complained of severe pain at the distal radio-ulnar joint. The results, on the basis of elbow and wrist scores of fair or better without complications, were satisfactory in only three patients. In the remaining five patients, in whom the injuries of both the elbow and the wrist had been identified at the initial evaluation, the radial head was either preserved or replaced. The results, on the basis of elbow and wrist scores of fair or better, were graded as satisfactory in four of these patients. Our data show that any injury to the lateral side of the elbow should prompt a careful evaluation of the ipsilateral distal radio-ulnar joint for associated instability.

TREATMENT OF THE MISSED MONTEGGIA FRACTURE IN THE CHILD

Eight children with missed Monteggia fracture-dislocations are described. Seven had reconstructive surgery which included resection of scar tissue from the radiohumeral joint, proximal ulnar osteotomy, reduction of the radial head and reconstruction of the annular ligament. One had excision of the radial head. Excellent results were obtained in patients under ten years of age, up to four years after the initial injury.

Monteggia injuries in athletes. Causes, classification, results

Monteggia-fractures are serious combination injuries to the forearm. Sport injuries are being increasingly observed; the reason for this, besides the general expansion of mass sports, is the increasing burden of high-performance sports. Monteggia fractures can occur during a fall on an outstretched arm, for example in motor or bicycle sport injuries, but also when falling from gymnastic equipment. Generally, it is easy to diagnose the monteggia injury. Considerable secondary damage could occur from the frequent failure to notice the involved radiohumeral joint. It should be demanded that in case of an uluar fracture the adjoining joints should be x-rayed on two planes in order not to overlook the possibility of a chisel fracture. The different forms of this combination injury, its classification and the results of our own medical bulletins are presented.

Treatment of the missed Monteggia fracture in the child.

Eight children with missed Monteggia fracture-dislocations are described. Seven had reconstructive surgery which included resection of scar tissue from the radiohumeral joint, proximal ulnar osteotomy, reduction of the radial head and reconstruction of the annular ligament. One had excision of the radial head. Excellent results were obtained in patients under ten years of age, up to four years after the initial injury.

Posterolateral rotatory instability of the elbow.

Posterolateral rotatory instability (PLRI) of the elbow is recurrent elbow instability caused by injury to the radial ulnohumeral ligament or lateral ulnar collateral ligament. Deficiencies of the radial ulnohumeral ligament and laxity of the lateral capsule allow the proximal radioulnar joint to rotate and the radial head to subluxate posteriorly when stressed. Whether isolated or in conjunction with other injuries, PLRI represents the initial stage in the pathology of the unstable elbow. The diagnosis of PLRI can be difficult because the provocative tests are challenging to perform. Diagnostic arthroscopy is an excellent tool to demonstrate this instability. Treatment options include bracing for acute injuries, and primary repair or reconstruction for chronic injuries. Although arthroscopic plication and repair have been as effective as open techniques, the clinician should be prepared for open reconstruction if needed.

Divergent Pediatric Elbow Dislocation

A six-year-old boy with divergent elbow dislocation is reported, emphasizing the rarity of this condition. A literature review revealed only three roentgenographically documented divergent elbow dislocations in the pediatric age group. Reduction is usually accomplished with ease; however, a full range of elbow motion and forearm rotation must be obtained to ensure complete reduction of the radiohumeral joint.

Force transmission through the radial head.

A technique has been developed to study the transmission of axial force across the radiohumeral joint during simulated active motion of the elbow. Variations in the line of action and in the amount of muscle load, as well as in rotation of the forearm during flexion and extension of the elbow, were assessed. Consistent patterns of force transmission were demonstrated in the three specimens that were studied. The greatest force transmission occurred between zero and 30 degrees of flexion, and it consistently decreased with increased flexion. Force transmission was consistently greater in magnitude when the forearm was in pronation than when it was in supination. The varus-valgus pivot point with the elbow extended was established to closely approximate the line of action of the brachial muscle, which crosses near the center of the lateral portion of the trochlea.

乳児尺骨骨髄炎による広範な欠損に対する法の一例

A 3 years and 5 months old child, who had lost distal shaft of the ulna after osteomyelits at the age of 6 months, had deformity of the left forearm and dislocation of the radio-humeral joint. She was treated by production of a one-bone forearm. The functional results were good.

上腕骨小頭離断性骨軟骨炎に対するとう骨短縮術の検討

Four cases of osteochondritis dissecans of the humeral capitellum which were treated surgically are reviewed. All cases were males and involved the dominant side. The age at surgery ranged from 14 to 16 years. Follow-up period ranged from 8 months to 3 years, 1 month. All cases belonged to children's baseball teams. Two of them continue to play even now. In addition to curettage or drilling etc, shortening of the radius was performed in all cases. All had good results. There was no instability after surgery. It seemed that shortening of the radius decreased the pressure in the radio-humeral joint.

Total replacement of the elbow joint.

Total replacement of the elbow joint has been performed on 86 elbows at the Mayo Clinic, all but 15 in patients with rheumatoid arthritis. The Mayo design, which replaces both radiohumeral and humeroulnar joints, was used in 41 elbows, almost all in rheumatoid patients, with 71% good results. The Coonrad hinge with polyethylene bushings was used in 34 elbows; it was successful in 64% of rheumatoid patients, but failed in 46% of posttraumatic patients with bone loss. Previous designs have failed because of humeral loosening. Total elbow replacement is a technique still to be perfected in medical centers before general release.

Fibrillation of head of radius as one cause of tennis elbow.

Twenty-five patients with resistant tennis elbow were treated by exploration of the radio-humeral joint. Twenty cases showed abnormalities of the cartilage of the head of the radius. Division of the orbicular ligament and excision of the abnormal cartilage gave good results in 19 to 20 cases seen recently. We believe fibrillation of the head of the radius is an important cause of tennis elbow, and the arguments to support this theory are enumerated.

THE PATTERN OF AGEING OF THE ARTICULAR CARTILAGE OF THE ELBOW JOINT

1. The age changes in the articular cartilage of the elbow joint are presented from a study of twenty-eight necropsy subjects aged eighteen to eighty-eight years. During early adult life those areas of cartilage which do not usually articulate with opposed cartilage always show some degree of chondromalacia. 2. Evidence is presented that the almost inevitable degeneration of the radio-humeral joint in old age is related to the combination of rotation and hinge movements that occur at that joint. This is in marked contrast with the relative immunity of the humero-ulnar articulation which has hinge movement only.

GREENSTICK FRACTURE OF THE UPPER END OF THE ULNA WITH DISLOCATION OF THE RADIO-HUMERAL JOINT OR DISPLACEMENT OF THE SUPERIOR RADIAL EPIPHYSIS

1. Five cases of greenstick fracture of the upper end of the ulna with dislocation of the radio-humeral joint are described. 2. Although the direction of angulation of the fracture and the corresponding displacement of the upper end of the radius may be lateral, medial or anterior, it is suggested that all five cases form a group in which the mechanism of injury is essentially the same. This mechanism is considered to be a fall on the outstretched hand with the forearm held in supination. 3. The complications of the injury are described.

LATERAL DISLOCATION OF THE RADIO-HUMERAL JOINT WITH GREENSTICK FRACTURE OF THE UPPER END OF THE ULNA

1. Two cases of lateral dislocation of the radio-humeral joint with greenstick fracture of the upper end of the ulna are described. 2. One case was complicated by a radial nerve lesion. 3. Treatment was by reduction under general anaesthesia and resting the elbow in a collar and cuff sling. Full recovery was present in six weeks.

ACUTE DEPOSITION OF CALCIUM NEAR THE ELBOW

1. Three cases of localised deposition of calcium salts deep to the origin of the common extensors of the forearm with acute symptoms clinically indistinguishable from "tennis elbow" are described. 2. Reports of nine similar cases have been found in the literature. 3. It is suggested that "tennis elbow" is caused by a lesion, probably an adventitial bursa, in the tissue space between the tendon of origin of the forearm extensors and the capsule of the radio-humeral joint; and that it is the sudden precipitation of calcium phosphate at this site which causes the lesion here described. 4. Acute calcification near the elbow joint is compared with the similar calcification which may occur in the insertion of the supraspinatus tendon. 5. Operative treatment is advised.

A modified approach in surgery for tuberculosis of the elbow in the adult

1. 1. An improvement in technic is presented for arthrodesis of the tuberculous elbow in the adult. 2. 2. In the face of notoriously poor statistical results, this operation has been completely successful in the three cases described. Although three cases do not constitute a series, I have reason to believe that similar good results will be obtained in future cases. 3. 3. It appears that there may be no need to attack the radiohumeral joint at the time of the operation. The sinuses may disappear spontaneously, as they did in both the above cases, if the ulnohumeral joint becomes fused. 4. 4. It is of interest to note that the patients desired an attitude of slight extension in the elbow, as the best functional position most suitable to them in their occupations. 5. 5. In view of the excellent results obtained by following the described technic, the writer wishes to recommend this operation to others.