Heritabilities and genetic trends for elbow score as recorded by the New Zealand Veterinary Association Elbow Dysplasia Scheme (1992-2013) in four breeds of dog.

PubMed

Soo, M; Lopez-Villalobos, N; Worth, A J

2018-05-01

To estimate the heritability of the New Zealand Veterinary Association (NZVA) elbow phenotype, obtain estimated breeding values (EBV) for the worst-elbow score and estimate the genetic trends for this trait in four populous breeds of dogs, using the records from the NZVA Canine Elbow Dysplasia Scheme database (1992-2013). Overall, 4,070 elbow records from a pedigree of 11,311 dogs were available for animals scored between 1992 and 2013. The worst elbow score between the left and right elbows was identified for each dog and used for EBV analysis. Estimates of heritability and EBV for the elbow score of dogs from German Shepherd dog, Labrador Retriever, Golden Retriever and Rottweiler breeds were obtained using restricted maximum likelihood procedures with a within-breed linear animal model. The model included the fixed effects of sex and birth year, with age at scoring as a covariable, and the random effect of animal. Genetic trends for the worst-elbow score were calculated as the regression coefficient of the EBV, weighted by reliabilities, on year of birth. The estimates of heritability for worst-elbow score were 0.25 (SE 0.06) in German Shepherd dogs, 0.46 (SE 0.06) in Labrador Retrievers, 0.18 (SE 0.07) in Golden Retrievers and 0.29 (SE 0.11) in Rottweilers. The genetic trend for German Shepherd dogs was -0.0082 (SE 0.0015), for Labrador Retrievers was -0.0016 (SE 0.0016), for Golden Retrievers was -0.0033 (SE 0.0010) and for Rottweilers was -0.0070 (SE 0.0023) units per annum, which were different from zero (p<0.01) in all breeds except Labrador Retrievers. A small but favourable response to selection was achieved by three of the four breeds in the study period; during which selection for elbow traits has been largely voluntary. While the magnitude of genetic change in terms of elbow units per annum may appear small, it must be remembered that elbow scoring grades only range from 0-3. Greater improvement may be possible if compulsory screening was a requirement for pedigree breeding stock, and if greater selection pressure were applied on the basis on an individual's EBV, rather than the worst-elbow score alone. The maintenance of an open registry, with transparency of EBV information made available to all breeders, may enhance selection intensity opportunities and potentially assist with the process and progress of breeding selection.

Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial.

PubMed

Viveen, Jetske; Doornberg, Job N; Kodde, Izaak F; Goossens, Pjotr; Koenraadt, Koen L M; The, Bertram; Eygendaal, Denise

2017-11-22

The elbow is prone to stiffness after trauma. To regain functional elbow motion several conservative- and surgical treatment options are available. Conservative treatment includes physical therapy, intra-articular injections with corticosteroids and a static progressive or dynamic splinting program. If conservative treatment fails, an operative release of the posttraumatic stiff elbow is often performed. The best Evidence-Based rehabilitation protocol for patients after an operative release is unknown to date and differs per surgeon, hospital and country. Options include early- or delayed motion supervised by a physical therapist, immediate continuous passive motion (CPM), (night) splinting and a static progressive or dynamic splinting program. The SET-Study (Stiff Elbow Trial) is a single-centre, prospective, randomized controlled trial. The primary objective of this study is to compare the active Range of Motion (ROM) (flexion arc and rotational arc) twelve months after surgery between three groups. The first group will receive in-hospital CPM in combination with early motion Physical Therapy (PT) supervised by a physical therapist, the second group will receive only in-hospital early motion PT supervised by a physical therapist and the third group will receive outpatient supervised PT from postoperative day seven till ten. Secondary outcome measures will be Patient Reported Outcome Measures (PROMs) including the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), the quick Disabilities of Arm, Shoulder and Hand (qDASH) score, Visual Analogue pain Scale in rest and activity (VAS), Pain Catastrophizing Scale (PCS), the Short Form (SF)-36, the Centre for Epidemiological Studies Depression Scale Revised (CESD-R) and the Work Rehabilitation Questionnaire (WORQ) for the upper limb. A successful completion of this trial will provide evidence on the best rehabilitation protocol in order to (re)gain optimal motion after surgical release of the stiff elbow. The trial is registered at the Dutch Trial Register: NTR6067 , 31-8-2016.

Functional Results in Arthroscopic Treatment in Patients with Chronic Lateral Elbow Pain.

PubMed

Phorkhar, Termphong; Chanlalit, Cholawish

2015-11-01

Modern surgery as elbow arthroscopic surgery is an accepted operation due to benefit in precise intra-articular lesion detection and minimally invasive surgery. To report the functional results when using arthroscopic surgery to treat chronic lateral elbow pain. The data was collected from 25 patients with chronic lateral elbow pain that failed in non-operative treatment and treated with elbow arthroscopic surgery. Five patients were excluded from this study due to diagnosed as instability that needed the ligament reconstruction. The etiology of pain were grouped in to tennis elbow (4 pts), plica (9 pts), tennis elbow combined with plica (4 pts) and cartilage lesion (3 pts). Thai quick DASH questionnaire was used to evaluate the functional results by comparing pre and post operation score and calculated statistic results with paired t-test by level of significance p < 0.05. The mean follow-up after surgery was 22 months by mean disability module pre and post-operative score is 68 and 18 respectively. In the occupation module was 74 and 25 respectively and in sports module was 81 and 17 respectively. All modules, scores was significant improved with p-value = 0.000, 0.000 and 0.004 respectively. The disability mean score in pre and post-operative along the diagnosis, tennis elbow mean score was 74 and 33, in plica lesion mean score was 65 and 11, combined lesions mean score was 60 and 18 and cartilage lesion mean score was 60 and 20. Approaching chronic lateral elbow pain with arthroscopy can maintain the signficant improvement of functional result in midterm follow-up.

A 5-22-year follow-up study of stemmed alumina ceramic total elbow arthroplasties with cement fixation for patients with rheumatoid arthritis.

PubMed

Nishida, Keiichiro; Hashizume, Kenzo; Nasu, Yoshihisa; Kishimoto, Makoto; Ozaki, Toshifumi; Inoue, Hajime

2014-01-01

We determined mid to long-term results of total elbow arthroplasty (TEA) by use of unlinked elbow prostheses with solid alumina ceramic trochleae, and ceramic ulnar stems (stemmed Kyocera type I; SKC-I) for patients with rheumatoid arthritis. Fifty-four elbows of 39 patients were available for detailed clinical and radiographic review after a follow-up period of at least 5 years. The mean follow-up period was 12.6 years (range 5-22 years). Clinical condition before and after surgery was assessed by use of a modified version of the Mayo Elbow Performance Score (MEPS; 0-100 points) and a Japan Orthopaedic Association Elbow score (JOA score; 0-100 points). The radiographs were reviewed and loosening was defined as a progressive radiolucent line >1 mm wide that was completely circumferential around the prosthesis. Clinical records of post-operative events affecting the elbows were used for survival analysis of the prostheses using the Kaplan-Meier method. The average modified MEPS and JOA scores improved significantly from 39.7 ± 14.3 to 44.7 ± 9.4, respectively, pre-operatively, to 89.7 ± 15.4 and 83.1 ± 12.8, respectively, post-operatively (P < 0.0001). The functional assessment score also improved from 4.9 ± 2.8 to 8.5 ± 3.3 points (P < 0.0001). With loosening or implant revision defined as end points, the likelihood of survival of the prosthesis for up to 20 years was 92.6% (95% confidence interval (CI), 85.6-100.0) or 86.3 % (95 % CI 75.0-97.6), respectively. Satisfactory clinical results were obtained after TEA using SKC-I prostheses, which provided excellent pain relief and functional range of motion. The results of our study reveal the high reliability over a long period of the cemented SKC-I prosthesis with an alumina ceramic component.

Early results of Latitude primary total elbow replacement with a minimum follow-up of 2 years.

PubMed

Mehta, Saurabh S; Watts, Adam C; Talwalkar, Sumedh C; Birch, Ann; Nuttall, David; Trail, Ian A

2017-10-01

The aim of this study was to present outcomes of primary Latitude total elbow replacement (TER) with a minimum follow-up of 2 years. A retrospective cohort study was undertaken with prospective outcome data collection for the latest outcome. Included were 63 consecutive primary Latitude TERs in 58 patients performed during a period of 5 years at a specialist orthopedic hospital. The mean age of the patients was 62 years (33-85 years). Five primary TERs (4 patients) were lost to follow-up. The primary diagnosis was rheumatoid arthritis in 49, osteoarthritis in 8, and trauma in 6 elbows. The mean flexion-extension arc was 75° preoperatively and 97° postoperatively. Mean postoperative Elbex pain score was 19/100, and function score was 37/100. Mean postoperative scores were 42/100 for the Quick Disabilities of the Arm, Shoulder, and Hand and 38/50 for the elbow-specific American Shoulder and Elbow Surgeons assessment. Four patients died of unrelated causes, and 8 of 63 underwent further surgical intervention, including explantation and conversion from unlinked to linked implant. On radiographic review of 41 surviving TERs, aseptic radiologic loosening was observed of the humeral component in 4 elbows and of the ulnar component in 9. Seven elbows had no radial component, and of the remaining 34 elbows, 16 (47%) had signs of loosening of the radial implant. Complications included 1 heterotopic ossification, 1 olecranon fracture, and 3 further procedures for ulnar nerve entrapment. The results indicate that the early outcome of Latitude TER is comparable to that of other prostheses. There is concern about early radiologic loosening of the radial component. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Haptic Recreation of Elbow Spasticity

PubMed Central

Kim, Jonghyun; Damiano, Diane L.

2013-01-01

The aim of this paper is to develop a haptic device capable of presenting standardized recreation of elbow spasticity. Using the haptic device, clinicians will be able to repeatedly practice the assessment of spasticity without requiring patient involvement, and these practice opportunities will help improve accuracy and reliability of the assessment itself. Haptic elbow spasticity simulator (HESS) was designed and prototyped according to mechanical requirements to recreate the feel of elbow spasticity. Based on the data collected from subjects with elbow spasticity, a mathematical model representing elbow spasticity is proposed. As an attempt to differentiate the feel of each score in Modified Ashworth Scale (MAS), parameters of the model were obtained respectively for three different MAS scores 1, 1+, and 2. The implemented haptic recreation was evaluated by experienced clinicians who were asked to give MAS scores by manipulating the haptic device. The clinicians who participated in the study were blinded to each other’s scores and to the given models. They distinguished the three models and the MAS scores given to the recreated models matched 100% with the original MAS scores from the patients. PMID:22275660

Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.

PubMed

Abed, Yasser; Nour, Khaled; Kandil, Yasser Roshdy; El-Negery, Abed

2018-02-01

Long standing nonunion of the lateral humeral condyle (LHC) usually results in elbow pain and instability with progressive cubitus valgus and tardy ulnar neuritis. Surgical treatment of long standing nonunion is still a controversial issue due to the reported complications, such as stiffness, loss of elbow motion, and avascular necrosis of the LHC fragment. In this study, we reported the outcomes of treatment of cubitus valgus deformity in long standing nonunion of the LHC in children treated with combined triple management (fixation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modified para-triceptal approach. We evaluated ten patients with cubitus valgus deformity more than 20 degrees after neglected nonunion of the lateral humeral condyle more than 24 months. Only childern with post-operative follow up more than 24 months were included in this study. All patients were evaluated clinically, radio logically, and by pre- and post-operative functional evaluation using Mayo elbow performance score. For evaluation of ulnar nerve affection, the Akahori's system was used. There were six females and four males with the average age of 7.7 years at operation. The left elbow was affected in six patients and the right elbow was affected in four patients. The average time between fracture of the LHC and operation was 40.3 months with average post-operative follow up of 44.3 months. The average carrying angle of the healthy side was 5.5 degrees and pre-operative carrying angle of the affected side was 33.5 degrees. The average post-operative carrying angle of the affected side was 6.1 degrees. The improvement of the carrying angle at the last follow up was found statistically significant (p < 0.05). All six patients that had pre-operative various degrees of ulnar nerve affection had completely improved at last follow up. The osteotomy site united in an average time of 43 days, whereas the LHC nonunion site united in an average time of 77.2 days. The osteotomy site united in significantly less time than the LHC non-union site (p < 0.05). The correlation between time since injury and time of union of LHC non-union site was significant (p < 0.05). Post-operative elbow range of motion was not changed in five patients, slightly decreased in four patients, and increased in one patient. Three patients had an average 6.7 degrees (range; 5-10) loss of the last degrees of flexion. One patient developed extension lag of 10 degrees. The mean elbow range of motion (ROM) pre-operatively was 139 ± 4.6 degrees while the mean post-operative ROM was 138 ± 5.3 degrees. The difference was found to be statistically insignificant (p > 0.05). The mean pre-operative Mayo elbow performance score was poor 55 ± 9.7, four patients had fair score, and six had poor score. The mean post-operative Mayo elbow performance score was excellent 92.5 ± 10, six patients had excellent score, and four had good score. The improvement of the Mayo score at the last follow up was found to be statistically significant (p < 0.05). No intra-operative complications were recorded during any of the procedures and no patient developed a wound or pin track infection post-operatively. At the last follow up, none of the patients had developed avascular necrosis of the LHC. Preservation of the blood supply of the nonunited fragment is the key to successful management. This combined technique successfully addresses different aspects of the problem simultaneously and provides a durable solution without deterioration of the results over time. The para-triceptal approach provided excellent exposure of both sides of the elbow with minimal disruption of the triceps muscle.

Preseason Perceived Physical Capability and Previous Injury.

PubMed

Sciascia, Aaron; Haegele, Lauren E; Lucas, Jean; Uhl, Timothy L

2015-09-01

Patient opinion about the ability to perform athletic maneuvers is important after injury; however, prospective assessment of self-perceived physical capability for athletes before the beginning of a season is lacking. To perform a descriptive analysis of knee, shoulder, and elbow self-perceived measures of physical capability specific to athletics and to compare the measures between athletes with and without a history of injury. Cross-sectional study. Preparticipation physical examinations. A total of 738 collegiate athletes (486 men, 251 women; age = 19 ± 1 years) were administered questionnaires after receiving medical clearance to participate in their sports. Of those athletes, 350 reported a history of injury. Athletes self-reported a history of knee, shoulder, or elbow injury. Perceived physical capability of the 3 joints was evaluated using the Knee Injury and Osteoarthritis Outcome Score Sport and Recreation Function and Knee-Related Quality of Life subscales and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score. We conducted nonparametric analysis to determine if scores differed between athletes with and without a history of injury. Median values for the Knee Injury and Osteoarthritis Outcome Score Sports and Recreation Function and Knee-Related Quality of Life subscales and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score for all athletes were 100. Median values for perceived physical capability of athletes with a history of injury were 3 to 12 points lower for each questionnaire before the start of the season (P < .001). Our study provided descriptive values for individual perceived knee, shoulder, and elbow physical capability of collegiate athletes participating in 19 sports. Athletes who did not report previous injuries perceived their physical capabilities to be nearly perfect, which could set the goal for these athletes to return to participation after injury. Athletes reporting previous injuries perceived less physical capability before the competitive season. Self-assessment of joint-specific capability may supplement preseason physical examinations, identifying particular athletes needing further monitoring or care during a season.

Does immediate elbow mobilization after distal biceps tendon repair carry the risk of wound breakdown, failure of repair, or patient dissatisfaction?

PubMed

Smith, James R A; Amirfeyz, Rouin

2016-05-01

Rehabilitation protocols after distal biceps repair are highly variable, with many surgeons favoring at least 2 weeks of immobilization. Is this conservative approach necessary to protect the repair? This was a consecutive series of 22 distal biceps tendon repairs in which a cortical button system was used. Patients were encouraged to mobilize their elbow actively from the day of surgery. Physiotherapy commenced at 3 weeks, with strengthening exercises when full range of movement (ROM) was achieved. The primary outcome measured was the clinical integrity of the repaired tendon. Secondary outcomes comprised wound or nerve complication, elbow ROM, and patient-reported outcome measures (the 11-item version of the Disabilities of Arm, Shoulder and Hand, Mayo Elbow Performance Index, and Oxford Elbow Score). All patients were male, and the dominant arm was repaired in 60%. Mean age was 40.6 years (range, 27-62 years), and mean time to surgery was 17 days (range, 5-99 days). Mean follow-up was 16.6 months (range, 3.8-29 months). All tendons were clinically intact at time of review. No wound breakdown occurred. Mean extension was -6° (range, -10° to 10°), and flexion was 144° (range, 135°-150°). All patients achieved full pronosupination. ROM was equivalent to the uninjured arm (P = .7). The mean 11-item version of the Disabilities of Arm, Shoulder and Hand score was 2.7 (range, 0-15.9), the Mayo Elbow Performance Index was 97.8 (range, 70-100), and the Oxford Elbow Score was 46.9 (range, 43-48) at the latest follow-up. One-third of patients experienced a transient sensory neurapraxia. Immediate mobilization after biceps tendon repair with a cortical button is possible, and in this series was not associated with failure of the repair, wound breakdown, or patient dissatisfaction. However, this series emphasizes the high incidence of nerve complication that can be associated with the single transverse incision technique. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Clinic research on the treatment for humeral shaft fracture with minimal invasive plate osteosynthesis: a retrospective study of 128 cases.

PubMed

Chen, H; Hu, X; Yang, G; Xiang, M

2017-04-01

Minimal invasive plate osteosynthesis (MIPO) is one of the most important techniques in the treatment for humeral shaft fractures. This study was performed to evaluate the efficacy of MIPO technique for the treatment for humeral shaft fractures. We retrospectively evaluated 128 cases with humeral shaft fractures that were treated with MIPO technique from March 2005 to August 2008. All the patients were followed up by routine radiological imaging and clinical examinations. Constant-Murley score and HSS elbow joint score were used to evaluate the treatment outcome. The average duration of the surgery was 60 min (range 40-95 min) without blood transfusion. All fractures healed without infection. All cases recovered carrying angle except four cases with 10°-15° cubitus varus. After the average follow-up of 23 (13-38) months, satisfactory function was achieved according to Constant-Murley score and HSS elbow joint score. Constant-Murley score was 80 on average (range 68-91). According to HSS elbow joint score, there were 123 cases of excellent clinical outcome and five cases of effective outcome. It seems to be a safe and effective method for managing humeral shaft fractures with MIPO technique.

RELATIONSHIP OF PRESEASON MOVEMENT SCREENS WITH OVERUSE SYMPTOMS IN COLLEGIATE BASEBALL PLAYERS

PubMed Central

Clifton, Daniel R.; Onate, James A.; Ramsey, Vincent K.; Cromartie, Fred

2017-01-01

Background: The shoulder mobility screen of the Functional Movement Screen™ (FMS™) and the upper extremity patterns of the Selective Functional Movement Assessment (SFMA) assess global, multi-joint movement capabilities in the upper-extremities. Identifying which assessment can most accurately determine if baseball players are at an increased risk of experiencing overuse symptoms in the shoulder or elbow throughout a competitive season may reduce throwing-related injuries requiring medical attention. Purpose: The purpose of this study was to determine if preseason FMS™ or SFMA scores were related to overuse severity scores in the shoulder or elbow during the preseason and competitive season. Study design: Cohort study. Methods: Sixty healthy, male, Division III collegiate baseball players (mean age = 20.1 ± 2.0 years) underwent preseason testing using the FMS™ shoulder mobility screen, and SFMA upper extremity patterns. Their scores were dichotomized into good and bad movement scores, and were compared to weekly questionnaires registering overuse symptoms and pain severity in the shoulder or elbow during the season. Results: Poor FMS™ performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason independent of grade and position (adjusted odds ratio [OR] = 5.14, p = 0.03). Poor SFMA performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason (adjusted OR = 6.10, p = 0.03) and during the competitive season (adjusted OR = 17.07, p = 0.03) independent of grade and position. Conclusion: FMS™ shoulder mobility and SFMA upper extremity pattern performance were related to the likelihood of experiencing overuse symptoms during a baseball season. Participants with poor FMSTM performances may be more likely to experience at least one overuse symptom in their shoulder or elbow during the preseason. Additionally, individuals with poor SFMA performances may be more likely to report overuse symptoms during the preseason or competitive season. Level of evidence: Level 3 PMID:29158957

Cross-cultural adaptation and validation of the Italian version of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score.

PubMed

Merolla, Giovanni; Corona, Katia; Zanoli, Gustavo; Cerciello, Simone; Giannotti, Stefano; Porcellini, Giuseppe

2017-12-01

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a reliable and sensitive tool to measure the performance of overhead athletes. The purpose of this study was to carry out a cross-cultural adaptation and validation of the KJOC questionnaire in Italian and to assess its reliability, validity, and responsiveness. Ninety professional athletes with a painful shoulder were included in this study and were assigned to the "injury group" (n = 32) or the "overuse group" (n = 58); 65 were managed conservatively and 25 were treated by arthroscopic surgery. To assess the reliability of the KJOC score, patients were asked to fill in the questionnaire at baseline and after 2 weeks. To test the construct validity, KJOC scores were compared to those obtained with the Italian version of the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, and with the DASH sports/performing arts module. To test KJOC score responsiveness, the follow-up KJOC scores of the participants treated conservatively were compared to those of the patients treated by arthroscopic surgery. Statistical analysis demonstrated that the KJOC questionnaire is reliable in terms of the single items and the overall score (ICC 0.95-0.99); that it has high construct validity (r s  = -0.697; p < 0.01); and that it is responsive to clinical differences in shoulder function (p < 0.0001). The Italian version of the KJOC Shoulder and Elbow score performed in a similar way to the English version and demonstrated good validity, reliability, and responsiveness after conservative and surgical treatment. II.

The Unilateral Below Elbow Test: a function test for children with unilateral congenital below elbow deficiency.

PubMed

Bagley, Anita M; Molitor, Fred; Wagner, Lisa V; Tomhave, Wendy; James, Michelle A

2006-07-01

The Unilateral Below Elbow Test (UBET) was developed to evaluate function in bimanual activities for both the prosthesis wearer and non-wearer. Nine tasks were chosen for each of four age-specific categories defined by development stages of hand function (2-4y, 5-7y, 8-10y, and 11-21y). Two scales, Completion of Task and Method of Use, were designed to rate performance. To measure reliability, four occupational therapists scored samples of videotaped UBET performances. For Completion of Task, an interval scale, agreement in scoring was measured with interclass correlation coefficients (ICC; n=9; five females, four males). For Method of Use, a nominal scale, chance-adjusted association was calculated with Cohen's kappa coefficients (interobserver n=198; 111 females, 87 males; intraobserver n=93; 56 females, 37 males). For Completion of Task, the average ICC was 0.87 for the prosthesis-on condition, and 0.85 for the prosthesis-off condition. ICCs exceeded 0.80 for eight out of nine tasks for the two older age groups, but for only five out of nine tasks in the younger age groups. Higher inter- and intraobserver kappa coefficients for Method of Use resulted when scoring children with their prostheses on versus off. The oldest age group had lower kappa values than the other three groups. The UBET is recommended for the functional evaluation of Completion of Task in children with unilateral congenital below elbow deficiency with and without their prostheses. Method of Use scoring can evaluate individuals for directed therapy interventions or prosthetic training.

Monitoring Hip and Elbow Dysplasia achieved modest genetic improvement of 74 dog breeds over 40 years in USA.

PubMed

Hou, Yali; Wang, Yachun; Lu, Xuemei; Zhang, Xu; Zhao, Qian; Todhunter, Rory J; Zhang, Zhiwu

2013-01-01

Hip (HD) and Elbow Dysplasia (ED) are two common complex developmental disorders of dogs. In order to decrease their prevalence and severity, the Orthopedic Foundation for Animals (OFA) has a voluntary registry of canine hip and elbow conformation certified by boarded radiologists. However, the voluntarily reports have been severely biased against exposing dogs with problems, especially at beginning period. Fluctuated by additional influential factors such as age, the published raw scores barely showed trends of improvement. In this study, we used multiple-trait mixed model to simultaneously adjust these factors and incorporate pedigree to derive Estimated Breeding Values (EBV). A total of 1,264,422 dogs from 74 breeds were evaluated for EBVs from 760,455 hip scores and 135,409 elbow scores. These EBVs have substantially recovered the reporting bias and the other influences. Clear and steady trends of genetic improvement were observed over the 40 years since 1970. The total genetic improvements were 16.4% and 1.1% of the phenotypic standard deviation for HD and ED, respectively. The incidences of dysplasia were 0.83% and 2.08%, and the heritabilities were estimated as 0.22 and 0.17 for hip and elbow scores, respectively. The genetic correlation between them was 0.12. We conclude that EBV is more effective than reporting raw phenotype. The weak genetic correlation suggested that selection based on hip scores would also slightly improve elbow scores but it is necessary to allocate effort toward improvement of elbow scores alone.

Monitoring Hip and Elbow Dysplasia Achieved Modest Genetic Improvement of 74 Dog Breeds over 40 Years in USA

PubMed Central

Zhang, Xu; Zhao, Qian; Todhunter, Rory J.; Zhang, Zhiwu

2013-01-01

Hip (HD) and Elbow Dysplasia (ED) are two common complex developmental disorders of dogs. In order to decrease their prevalence and severity, the Orthopedic Foundation for Animals (OFA) has a voluntary registry of canine hip and elbow conformation certified by boarded radiologists. However, the voluntarily reports have been severely biased against exposing dogs with problems, especially at beginning period. Fluctuated by additional influential factors such as age, the published raw scores barely showed trends of improvement. In this study, we used multiple-trait mixed model to simultaneously adjust these factors and incorporate pedigree to derive Estimated Breeding Values (EBV). A total of 1,264,422 dogs from 74 breeds were evaluated for EBVs from 760,455 hip scores and 135,409 elbow scores. These EBVs have substantially recovered the reporting bias and the other influences. Clear and steady trends of genetic improvement were observed over the 40 years since 1970. The total genetic improvements were 16.4% and 1.1% of the phenotypic standard deviation for HD and ED, respectively. The incidences of dysplasia were 0.83% and 2.08%, and the heritabilities were estimated as 0.22 and 0.17 for hip and elbow scores, respectively. The genetic correlation between them was 0.12. We conclude that EBV is more effective than reporting raw phenotype. The weak genetic correlation suggested that selection based on hip scores would also slightly improve elbow scores but it is necessary to allocate effort toward improvement of elbow scores alone. PMID:24124555

Elbow-specific clinical rating systems: extent of established validity, reliability, and responsiveness.

PubMed

The, Bertram; Reininga, Inge H F; El Moumni, Mostafa; Eygendaal, Denise

2013-10-01

The modern standard of evaluating treatment results includes the use of rating systems. Elbow-specific rating systems are frequently used in studies aiming at elbow-specific pathology. However, proper validation studies seem to be relatively sparse. In addition, these scoring systems might not always be used for appropriate populations of interest. Both of these issues might give rise to invalid conclusions being reported in the literature. Our aim was to investigate the extent to which the available elbow-specific outcome measurement tools have been validated and the quality of the validation itself. We also aimed to provide characteristics of the populations used for validation of these scales to enable clinicians to use them appropriately. A literature search identified 17 studies of 12 different elbow-specific scoring systems. These were assessed for validity, reliability, and responsiveness characteristics. The quality of these assessments was rated according to the Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist criteria, a standardized and validated tool developed specifically for this purpose. Currently, the only elbow-specific rating system that is validated using high-quality methodology is the Oxford Elbow Score, a patient-administered outcome measure tool that has been validated on heterogeneous study populations. Other rating systems still have to be proven in the future to be as good as the Oxford Elbow Score for clinical or research purposes. Additional validation studies are needed. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Fresh osteochondral allograft transplantation for osteochondritis dissecans of the capitellum in baseball players.

PubMed

Mirzayan, Raffy; Lim, Michael J

2016-11-01

Osteochondritis dissecans (OCD) of the capitellum is a rare yet debilitating injury seen in young athletes. This is the first report in the literature describing fresh osteochondral allograft transplantation (FOCAT) to treat OCD of the capitellum. Nine male baseball players (mean age, 15.3; range, 14-18 years), with OCD of the capitellum were treated with FOCAT. There were 6 pitchers and 3 position players. A ligament-sparing, mini-open approach was used. A fresh femoral hemicondyle was used as a donor source. Of the 9 patients, 7 required 1 plug and 2 required 2 plugs. The average plug diameter was 11 mm (range, 8-18 mm). Five plugs were press fit, and 4 required additional fixation. Clinical outcomes were evaluated at a mean follow-up of 48.4 months (range, 11-90 months). Preoperative and postoperative outcome scores were calculated using the paired t test. The Mayo Elbow Performance score improved from an average 57.8 to 98.9 (P < .01). The Oxford Elbow Score improved from 22.4 to 44.8 (P < .01). The Disabilities of the Arm, Shoulder and Hand score improved from 35.2 to 5.4 (P < .01). The visual analog scale score improved from 7.8 to 0.5 (P < .01). The Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score improved from 32.6 to 82.5 (P < .01). All patients returned to throwing and were still active in their sport or played at least 2 years of baseball before leaving the sport unrelated to the elbow. FOCAT for OCD of the capitellum in properly selected cases is a viable treatment with significant functional improvement and pain reduction in throwers. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Ultrasound-guided, minimally invasive, percutaneous needle puncture treatment for tennis elbow.

PubMed

Zhu, Jiaan; Hu, Bing; Xing, Chunyan; Li, Jia

2008-10-01

This report evaluates the efficacy of percutaneous needle puncture under sonographic guidance in treating lateral epicondylitis (tennis-elbow). Ultrasound-guided percutaneous needle puncture was performed on 76 patients who presented with persistent elbow pain. Under a local anesthetic and sonographic guidance, a needle was advanced into the calcification foci and the calcifications were mechanically fragmented. This was followed by a local injection of 25 mg prednisone acetate and 1% lidocaine. If no calcification was found then multiple punctures were performed followed by local injection of 25 mg prednisone acetate and 1% lidocaine. A visual analog scale (VAS) was used to evaluate the degree of pain pre-and posttreatment at 1 week to 24 weeks. Elbow function improvement and degree of self-satisfaction were also evaluated. Of the 76 patients, 55% were rated with excellent treatment outcome, 32% good, 11% average, and 3% poor. From 3 weeks posttreatment, VAS scores were significantly reduced compared with the pretreatment score (P<0.05) and continued to gradually decline up to 24 weeks posttreatment. Sonography demonstrated that the calcified lesions disappeared completely in 13% of the patients, were reduced in 61% of the patients, and did not change in 26% of the patients. Color Doppler flow signal used to assess hemodynamic changes showed a significant improvement after treatment in most patients. Ultrasound-guided percutaneous needle puncture is an effective and minimally invasive treatment for tennis elbow. Sonography can be used to accurately identify the puncture location and monitor changes.

Quantifying selective elbow movements during an exergame in children with neurological disorders: a pilot study.

PubMed

van Hedel, Hubertus J A; Häfliger, Nadine; Gerber, Corinna N

2016-10-21

It is difficult to distinguish between restorative and compensatory mechanisms underlying (pediatric) neurorehabilitation, as objective measures assessing selective voluntary motor control (SVMC) are scarce. We aimed to quantify SVMC of elbow movements in children with brain lesions. Children played an airplane game with the glove-based YouGrabber system. Participants were instructed to steer an airplane on a screen through a cloud-free path by correctly applying bilateral elbow flexion and extension movements. Game performance measures were (i) % time on the correct path and (ii) similarity between the ideal flight path and the actually flown path. SVMC was quantified by calculating a correlation coefficient between the derivative of the ideal path and elbow movements. A therapist scored whether the child had used compensatory movements. Thirty-three children with brain lesions (11 girls; 12.6 ± 3.6 years) participated. Clinical motor and cognitive scores correlated moderately with SVMC (0.50-0.74). Receiver Operating Characteristics analyses showed that SVMC could differentiate well and better than clinical and game performance measures between compensatory and physiological movements. We conclude that a simple measure assessed while playing a game appears promising in quantifying SVMC. We propose how to improve the methodology, and how this approach can be easily extended to other joints.

70° frontal visualization of lateral compartment of the elbow allows extensor carpi radialis brevis tendon release with preservation of the radial lateral collateral ligament.

PubMed

Arrigoni, Paolo; Fossati, Chiara; Zottarelli, Leonardo; Brady, Paul C; Cabitza, Paolo; Randelli, Pietro

2014-01-01

To determine whether the radial component of the lateral collateral ligament (R-LCL) and extensor carpi radialis brevis (ECRB) are consistently visible, using a 70° arthroscope, as parallel structures in the extra-articular space of the elbow, and to evaluate the clinical outcomes of these techniques in a series of patients. An arthroscopic ECRB tendon release was performed between 2008 and 2010. Eighteen patients were retrospectively evaluated at a minimum of 24 months' follow-up. The surgeon performed the ECRB release while protecting the R-LCL and viewing the structures extra-articularly with a 70° arthroscope through the anteromedial portal. Patients underwent surgery if they presented with localized tenderness and pain not responding to conservative treatment for 12 months and had magnetic resonance imaging scans indicating tendinopathy or degeneration. Arthritis, posterolateral rotatory instability, trauma, and previous surgeries were exclusion criteria. Intraoperative videos were reviewed and a clinical examination was performed by an independent reviewer at 24 months postoperatively. Patients were also evaluated with the Mayo Elbow Performance Score; Andrews-Carson score; and shortened Disabilities of the Arm, Shoulder and Hand questionnaire. Direct varus stress was applied in extension and flexion (40°), and the posterolateral pivot-shift and chair tests were performed. Visualization with the 70° arthroscope through the anteromedial portal was successful in all of the cases (100%). Visualization of the residual ECRB tendon stump, as well as the posterior common extensor tendon, was also achieved 94% of the time. The final mean Mayo Elbow Performance Score and Andrews-Carson score were 82.5 (range, 60 to 100) and 185.3 (range, 125 to 200), respectively. The mean postoperative score on the shortened Disabilities of the Arm, Shoulder and Hand questionnaire was 20.14 (range, 5 to 57.5). Clinical tests showed stability in all the cases. The 70° arthroscope allows visualization of the ECRB insertion and R-LCL frontally and in parallel. A surgical plane could be created between the structures. The clinical outcome was good or excellent in 78% of the cases. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma.

PubMed

Podesta, Luga; Crow, Scott A; Volkmer, Dustin; Bert, Timothy; Yocum, Lewis A

2013-07-01

Studies have demonstrated the potential of platelet-rich plasma (PRP) to heal damaged tissue. To date, there are no published reports of clinical outcomes of partial ulnar collateral ligament (UCL) tears of the elbow treated with PRP. Platelet-rich plasma will promote the healing of partial UCL tears and allow a return to play. Case series; Level of evidence, 4. Thirty-four athletes with a partial-thickness UCL tear confirmed on magnetic resonance imaging were prospectively followed. All patients had failed at least 2 months of nonoperative treatment and an attempt to return to play. Baseline questionnaires, including the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) and Disabilities of the Arm, Shoulder and Hand (DASH) measures, were completed by each patient before injection. Baseline ultrasound measurement of the humeral-ulnar joint space was assessed with 10 lb of valgus stress on the elbow. Each patient received a single type 1A PRP injection at the UCL under ultrasound guidance. The same treating physician at a single institution performed all injections with the same PRP preparation used. Patients completed a course of guided physical therapy and were allowed to return to play based on their symptoms and physical examination findings. Outcome scores, including KJOC and DASH scores, were collected after return to play and were compared with baseline scores. Ultrasound measurements were collected at final follow-up and compared with preinjection values. At an average follow-up of 70 weeks (range, 11-117 weeks), 30 of 34 athletes (88%) had returned to the same level of play without any complaints. The average time to return to play was 12 weeks (range, 10-15 weeks). The average KJOC score improved from 46 to 93 (P < .0001). The average DASH score improved from 21 to 1 (P < .0001). The sports module of the DASH questionnaire improved from 69 to 3 (P < .0001). Medial elbow joint space opening with valgus stress decreased from 28 to 20 mm at final follow-up (P < .0001). The difference in medial elbow joint space opening (stressed vs nonstressed) decreased from 7 to 2.5 mm at final follow-up (P < .0001). One player had persistent UCL insufficiency and underwent ligament reconstruction at 31 weeks after injection. The results of this study indicate that PRP is an effective option to successfully treat partial UCL tears of the elbow in athletes.

Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation.

PubMed

Gautam, V K; Verma, Saurabh; Batra, Sahil; Bhatnagar, Nidhi; Arora, Sumit

2015-04-01

To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms, which involved 46.7% of the CS patients. At 6 months, the number of patients positive for various ulrasonographic findings generally decreased. However, in the CS group, the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12, and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11. PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.

Psychometric properties of the Mayo Elbow Performance Score.

PubMed

Celik, Derya

2015-06-01

To translate and culturally adapt the Mayo Elbow Performance Score (MEPS), a widely used instrument for evaluating disability associated with elbow injuries, into Turkish (MEPS-T) and to determine psychometric properties of the translated version. The MEPS was translated into Turkish using published methodological guidelines. The measurement properties of the MEPS-T (construct validity and floor and ceiling effects) were tested in 91 patients with elbow pathology. The reproducibility of the MEPS-T was tested in 59 patients over 7-14 days. The responsiveness of the MEPS-T was tested in a subgroup of 46 patients diagnosed with lateral epicondylitis and who received conservative treatment for 6 weeks. The interclass correlation coefficient (ICC) was used to estimate the test-retest reliability. The construct validity was analyzed with the disabilities of the arm, shoulder and hand (DASH), Visual Analog Scale (VAS) and the Short Form 36 (SF-36). Effect size (ES) was used to assess the responsiveness. The distribution of floor and ceiling effects was determined. The MEPS-T showed very good test-retest reliability (ICC 0.89). The correlation coefficients between the MEPS-T and DASH and VAS were -0.61 and -0.53, respectively (p < 0.001). The highest correlations were between the MEPS-T and the mental component summary (r = 0.47, p = 0.001) and role emotional (r = 0.45, p = 0.001). The MEPS-T ES, 0.50, was moderate (95% CI 0.33-0.62). We observed no ceiling or floor effects. The MEPS-T represents a valid, reliable and moderately responsive instrument for evaluating patients with elbow disease.

Outcomes and radiographic findings of anatomic press-fit radial head arthroplasty.

PubMed

Levy, Jonathan C; Formaini, Nathan T; Kurowicki, Jennifer

2016-05-01

Radial head arthroplasty (RHA) is a popular method of treatment for complex fractures of the radial head. The purpose of this study was to investigate patient outcomes and radiographic findings associated with a single anatomic monopolar press-fit radial head system commonly used for the treatment of radial head fractures. A retrospective review of prospectively collected data was performed for a consecutive series of patients treated with a press-fit anatomically designed RHA between November 2007 and April 2014. The most recent radiographs were evaluated for loosening, stress shielding, and instability. Postoperative motion and outcomes were reported at most recent follow-up. At an average follow-up of 30 months, 6 of the 15 patients (40%) demonstrated radiographic loosening. Six of the 9 patients (67%) without loosening demonstrated stress shielding (average, 6 mm). Functional outcome scores included a mean American Shoulder and Elbow Surgeons score of 70, Mayo Elbow Performance Score of 85, visual analog scale score for pain of 2, visual analog scale score for function of 7, and Single Assessment Numeric Evaluation score of 75. Average flexion-extension arc was 14° to 138°, and average pronation-supination was 75° to 74°. All 6 of the patients with radiographic loosening had undergone RHA with an associated ligamentous injury repair. Satisfaction among patients was high as no patient reported an unsatisfactory outcome. The use of an anatomic, press-fit monopolar RHA in the management of acute complex radial head fractures has yielded excellent clinical outcomes despite high rates of radiographic loosening and stress shielding. Press-fit RHA in the setting of ligamentous injury warrants further investigation because of a high rate of implant loosening observed. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Internet resources for Tommy John injuries: what are patients reading?

PubMed

Johnson, Christine C; Garcia, Grant H; Liu, Joseph N; Stepan, Jeffrey G; Patel, Ronak M; Dines, Joshua S

2016-12-01

The quality of medical information on the Internet has come under scrutiny. This study investigates the quality, accuracy, and readability of online information regarding ulnar collateral ligament (UCL) injuries. Three search terms ("elbow ulnar collateral ligament injury," "tommy john injury," and "pitcher's elbow") were entered into 3 Internet search engines. Three independent reviewers evaluated the content and accuracy of the information with a set of predetermined scoring criteria. Website quality was further assessed by the Journal of the American Medical Association benchmark criteria and Health on the Net Foundation certification. Website readability was ascertained with the Flesch-Kincaid score. We evaluated 113 unique websites. The average quality for all websites was 8.88 ± 6.8 (maximum, 32 points). Website quality and accuracy were lower with use of the search term "pitcher's elbow" as compared with "elbow ulnar collateral ligament injury" or "tommy john injury" (P ≤ .001). Sites certified by the Health on the Net Foundation had higher quality scores than non-certified sites (P = .034). The mean reading grade level was 10.7. Reading level was significantly correlated with website accuracy and quality (P ≤ .001) and physician authorship (P = .012). Forty-three websites (38.1%) described surgical reconstruction; of these, 16 (37.2%) mentioned improved pitching performance postoperatively. Online information on UCL injuries is often inaccurate and written at an inappropriate reading level. Information quality depends on the search term used, website authorship, and commercial bias. Clinicians must be aware of factors influencing website quality in order to direct patients to appropriate resources. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Arm-eye coordination test to objectively quantify motor performance and muscles activation in persons after stroke undergoing robot-aided rehabilitation training: a pilot study.

PubMed

Song, Rong; Tong, Kai-Yu; Hu, Xiaoling; Li, Le; Sun, Rui

2013-09-01

This study designed an arm-eye coordination test to investigate the effectiveness of the robot-aided rehabilitation for persons after stroke. Six chronic poststroke subjects were recruited to attend a 20-session robot-aided rehabilitation training of elbow joint. Before and after the training program, subjects were asked to perform voluntary movements of elbow flection and extension by following sinusoidal trajectories at different velocities with visual feedback on their joint positions. The elbow angle and the electromyographic signal of biceps and triceps as well as clinical scores were evaluated together with the parameters. Performance was objectively quantified by root mean square error (RMSE), root mean square jerk (RMSJ), range of motion (ROM), and co-contraction index (CI). After 20 sessions, RMSE and ROM improved significantly in both the affected and the unaffected side based on two-way ANOVA (P < 0.05). There was significant lower RMSJ in the affected side at higher velocities (P < 0.05). There was significant negative correlation between average RMSE with different tracking velocities and Fugl-Meyer shoulder-elbow score (P < 0.05). There was also significant negative correlation between average RMSE and average ROM (P < 0.05), and moderate nonsignificant negative correlation with RMSJ, and CI. The characterization of velocity-dependent deficiencies, monitoring of training-induced improvement, and the correlation between quantitative parameters and clinical scales could enable the exploration of effects of different types of treatment and design progress-based training method to accelerate the processes of recovery.

Outcome of Surgical Fixation of Lateral Column Distal Humerus Fractures.

PubMed

Von Keudell, Arvind; Kachooei, Amir R; Moradi, Ali; Jupiter, Jesse B

2016-05-01

The purpose of this study was to report the long-term outcome and complications of surgically fixated lateral unicondylar distal humerus fractures. Retrospective Review. Two level 1 Trauma Centers, Massachusetts General Hospital and Brigham and Women's Hospital. Between 2002 and 2014, 24 patients treated with open reduction and internal fixation for lateral unicondylar distal humerus fractures (OTA/AO type B1 fractures) were retrospectively reviewed. Open reduction and internal fixation. Union rates, early complications, functional outcome, and the range of elbow motion were evaluated. Disabilities of the arm, shoulder, and hand, Mayo elbow Performance Index, satisfaction, pain scale, and American Shoulder and Elbow Surgeons. The mean age of patients was 46 ± 23 years at the time of surgery. The average final flexion/extension arc of motion was 108°. Reoperations were performed in 9 of 24 elbows after an average 21 ± 31 months. Twenty of the 24 patients were available for the clinical follow-up at an average of 70 months (range: 16-144 months). Disabilities of the arm, shoulder, and hand averaged at 10.8 ± 11.7 points, satisfaction at 9.5 ± 1.2, American Shoulder and Elbow Surgeons score at 88.5 ± 13.3 points at final follow-up. Based on the functional classification proposed by Jupiter, 16 demonstrated good to excellent results, 2 fair and 2 poor result. Outcome of open reduction and internal fixation of isolated lateral column distal humerus fractures can result in high union rates with acceptable outcome scores and high patient satisfaction despite a high reoperation rate. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Performance and return to sport in elite baseball players and recreational athletes following repair of the latissimus dorsi and teres major.

PubMed

Erickson, Brandon J; Chalmers, Peter N; Waterman, Brian R; Griffin, Justin W; Romeo, Anthony A

2017-11-01

Tears of the latissimus dorsi (LD) and teres major (TM) are rare but disabling injuries in the overhead athlete. All patients who underwent an LD and/or TM repair between January 1, 2010, and June 6, 2016, with more than 12 months' follow-up were included. Demographic information and postoperative range of motion were recorded. Patients were contacted via phone and answered questions to provide the following: Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow outcome score, American Shoulder and Elbow Surgeons (ASES) shoulder score, and visual analog scale (VAS) score. Performance data for professional athletes were recorded preoperatively and postoperatively and compared by paired t tests. Eleven male patients aged 29.9 ± 12.4 years were included; 86% were right hand dominant, 86% underwent surgery on the dominant side, and 73% were pitchers (7 professional and 1 collegiate). The mean time from injury to repair was 389 ± 789 days; 36% of repairs were performed within 6 weeks of injury. At final follow-up, the VAS score was 0.7 ± 1.9, the ASES score was 100 ± 0, and the KJOC score was 93 ± 5. Professional (major and minor league) pitchers had a mean total time participating in professional baseball of 6.6 ± 3.9 years, with 3.9 ± 2.3 years before surgery and 2.7 ± 1.8 years after surgery. Among professional pitchers, the VAS pain score was 0.0 ± 0.0, the ASES score was 100 ± 0, and the KJOC score was 89 ± 2. All professional pitchers returned to the same level of play. No significant differences existed between any preoperative and postoperative performance metrics for pitchers (P > .05). Repair of LD and TM tears in both professional and recreational athletes produces reliable functional recovery with minimal pain and the ability to return to preoperative athletic activity, even among elite throwing athletes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Shoulder functional performance status of Minor League professional baseball pitchers.

PubMed

Fronek, Jan; Yang, Jingzhen Ginger; Osbahr, Daryl C; Pollack, Keshia M; ElAttrache, Neal S; Noonan, Thomas J; Conte, Stan A; Mandelbaum, Bert R; Yocum, Lewis A

2015-01-01

The Overhead Shoulder and Elbow Score (Kerlan-Jobe Orthopaedic Clinic [KJOC] score) among healthy or uninjured professional baseball pitchers is lacking. We hypothesized that shoulder function and performance status measured by the KJOC score among active Minor League professional baseball pitchers were high at pre-participation and that the pitchers who had not been previously treated for a shoulder injury and were playing without arm trouble had significantly higher KJOC scores than their counterparts. In this cross-sectional survey, data on pre-participation KJOC scores, along with other study measures, were collected from a cohort of Minor League professional baseball pitchers. Generalized estimating equations with a Poisson distribution were used for analysis. A total of 366 Minor League professional pitchers were included, with a mean KJOC score of 92.8 points (SD, 12.1 points), suggesting that participating pitchers' shoulder function and performance were high. Participating pitchers who had not received treatment for a shoulder injury had significantly higher KJOC scores than those who had received treatment, either surgical or nonsurgical (β = 0.0238, P = .0495). In addition, pitchers who were not currently injured, were playing without arm trouble, or had not missed games in the past 12 months because of a shoulder injury also had statistically significantly higher KJOC scores than their counterparts. This study provides an empirical profile of the KJOC score for a large sample of active Minor League professional baseball pitchers and identifies risk factors associated with decreased KJOC scores. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Arthroscopic Fragment Resection for Capitellar Osteochondritis Dissecans in Adolescent Athletes: 5- to 12-Year Follow-up

PubMed Central

Ueda, Yusuke; Sugaya, Hiroyuki; Takahashi, Norimasa; Matsuki, Keisuke; Tokai, Morihito; Onishi, Kazutomo; Hoshika, Shota; Hamada, Hiroshige

2017-01-01

Background: Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes has often been seen in baseball players and gymnasts. The choice of surgical procedure for unstable lesions in skeletally immature athletes remains controversial. Purpose: To investigate functional outcomes and radiographic changes in the midterm to long-term postoperative period after arthroscopic (AS) resection for small to large capitellar OCD lesions in skeletally immature athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 elbows in 38 patients (33 boys, 5 girls; mean age, 14 years [range, 13-15 years]) with skeletally immature elbows underwent AS resection for capitellar OCD. Patients were observed for at least 5 years (mean, 8 years [range, 5-12 years]). Elbows with a lesion width that did not exceed one-half of the radial head diameter were assigned to group 1 (n = 17 elbows), and larger lesions were assigned to group 2 (n = 21 elbows). Functional scores, patient satisfaction, range of motion (ROM), and osteoarthritis (OA) grades were evaluated between the groups. Results: All patients returned to sports activity. Functional scores at the final follow-up were not significantly different between the groups. Patient satisfaction scores were significantly higher in group 1 than in group 2. There was significant improvement in flexion ROM at the final follow-up compared with preoperative values in group 1 (P = .017), and there was a significant between-group difference (group 1: 141°; group 2: 133°; P = .002). Extension ROM showed significant improvement in both groups (group 1: from –8° to 3°; group 2: from –17° to –1°; P < .001 for both). Group 1 tended to have better extension than group 2, but the difference was not significant. There were no elbows with severe OA in either group, but the OA grade progressed in 5 elbows (29%) in group 1 and 9 elbows (43%) in group 2, and this rate of OA progression was statistically significant between groups (P = .005). Conclusion: Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with small lesions. Although overall outcomes were acceptable in elbows with larger lesions, flexion ROM and patient satisfaction scores were significantly inferior to those in elbows with smaller lesions. PMID:29276715

Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain.

PubMed

Rajeev, Aysha; Pooley, Joesph

2015-04-01

To review the outcome of 121 patients who underwent arthroscopic resection of a humeroradial synovial plica for persistent lateral elbow pain. 92 men and 29 women aged 24 to 56 (mean, 38) years with chronic lateral elbow pain underwent arthroscopic resection of a humeroradial synovial plica using a motorised soft tissue shaver, followed by intensive physiotherapy. The modified elbow score and range of motion were assessed, as were wound healing, infection, soft tissue swelling or effusion, tenderness, ligamentous instability, and motor strength. No patient had any ligamentous instability. 80 patients were pain-free at 3 months; only 3 patients were taking pain medication at 6 months. All patients had full pronation and supination; the mean range of motion was 3º to 135º of flexion. The mean modified elbow score at 12 months was 93.2 (range, 72-100). The percentages of patients with excellent, good, fair, and poor score were 70%, 17%, 8%, and 5% at 3 months, 74%, 20%, 3%, and 3% at 6 months, and 76%, 18%, 3%, and 3% at 12 months, respectively. A humeroradial synovial plica is one of the causes of chronic lateral elbow pain. Arthroscopic resection of the synovial plica followed by intensive physiotherapy achieved good outcome.

Functional outcomes of "floating elbow" injuries in adult patients.

PubMed

Yokoyama, K; Itoman, M; Kobayashi, A; Shindo, M; Futami, T

1998-05-01

To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment. Retrospective clinical review. Level I trauma center in Kanagawa, Japan. Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995. All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25. All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated. Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture. Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.

Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis.

PubMed

Hechtman, Keith S; Uribe, John W; Botto-vanDemden, Angie; Kiebzak, Gary M

2011-01-01

Thirty patients (31 elbows) with epicondylitis unresponsive to nonsurgical treatment (including steroid injection) for >6 months received a single treatment of platelet-rich plasma injected with a peppering technique. Patients were followed using a 5-subcategory visual analog scale (VAS) for pain (0, no pain; 10, worst possible pain), modified American Shoulder and Elbow Surgeons assessment survey, and VAS for patient satisfaction (0, not at all satisfied; 10, very satisfied). Successful treatment was defined as a 25% decrease in worst pain at follow-up with no intervention after 1 year. Two patients (2 elbows) elected for surgery 1 month postinjection. Of the remaining 29 elbows followed, 28 had a 25% reduction in worst pain at ≥1 follow-up visits, for an overall success rate of 90% (28 of 31 elbows). Mean scores for worst pain at baseline, 3 months, and last follow-up (patients with at least 6 months of follow-up; 25±14 months) were 7.2±1.6 (n=30 elbows), 4.0±2.2 (n=23), and 1.1±1.7 (n=26), respectively (P<.01 or less comparing follow-up scores to baseline using each patient as his or her own control). Patient satisfaction scores improved from 5.1±2.5 at 1 month to 9.1±1.9 at last follow-up (P<.01). Only 1 patient reported no improvement after 6 months. Results suggest that a single platelet-rich plasma injection can improve pain and function scores, thus avoiding surgery. Copyright 2011, SLACK Incorporated.

Risk factors for decreased range of motion and poor outcomes in open periarticular elbow fractures.

PubMed

Dickens, Jonathan F; Wilson, Kevin W; Tintle, Scott M; Heckert, Reed; Gordon, Wade T; D'Alleyrand, Jean-Claude G; Potter, Benjamin K

2015-04-01

The purpose of this study was to identify risk factors present at the time of injury that predict poor functional outcomes and heterotopic ossification (HO) in open periarticular elbow fractures. We performed a retrospective review of 136 combat-related open elbow fractures from 2003 to 2010. Patient demographics, injury characteristics, treatment variables, and complications were recorded. Functional outcomes were analyzed to determine range of motion (ROM) and Mayo Elbow Performance Score (MEPS). Secondary outcome measures included the development of HO, return to duty, and revision operation. At a median 2.7 years from injury the median MEPS was 67.8 (range 30-100) with an average ulnohumeral arc motion of 89°. Bipolar fractures, with periarticular fractures on both sides of the elbow and at least one side containing intra-articular extension, were independently associated with decreased ulnohumeral motion (p=0.02) and decreased MEPS (p<0.004). Additional independent risk factors for decreased ROM included more severe osseous comminution (p=0.001), and increased time to definitive fixation (p=0.03) and HO (p=0.02). More severe soft tissue injury (Gustilo and Anderson fracture type, p=0.02), peripheral nerve injury (p=0.04), and HO (p=0.03) were independently associated with decreased MEPS. HO developed in 65% (89/136) of extremities and was associated with more severe Orthopaedic Trauma Association (OTA) fracture type (p=0.01) and escalating Gustilo and Anderson fracture classification (p=0.049). In the largest series of open elbow fractures, we identified risk factors that portend a poor clinical outcome and decreased ROM. Bipolar elbow fractures, which have not previously been associated with worse results, are particularly prone to decreased ROM and worse outcomes. Prognostic level IV. Published by Elsevier Ltd.

Long term changes of the throwing arm of former elite javelin throwers.

PubMed

Schmitt, H; Hansmann, H J; Brocai, D R; Loew, M

2001-05-01

The aim of this study was to determine long term changes in shoulder and elbow joints of former elite javelin throwers. Twenty-one elite javelin throwers were examined at an average of 19 years after the end of their high performance phase. Mean age at examination was 50 years. Functional assessment of both shoulders was determined by the Constant-score. The shoulder of the throwing arm was examined by magnetic resonance imaging. Both elbow joints were examined clinically and radiographically. Five athletes complained about transient shoulder pain in their throwing arm affecting activities of daily living, fourteen athletes had a deficit of internal rotation of at least ten degrees. Constant-scores of throwing arms were six points lower than those of non-throwing arms (P < 0.05). Complete ruptures and partial tears of the rotator cuff were frequent. Three athletes complained about transient elbow pain in their throwing arm affecting activities of daily living; ten athletes had a deficit of extension of more than five degrees. All dominant elbows had advanced arthrotic alterations (osteophytes, sclerosis) compared to the non-dominant side. Athletes who trained with weights of more than 3 kg had a significantly higher risk of degenerative changes than athletes who did not (P < 0.01). We therefore recommend to avoid throwing training with weights of more than 3 kg.

Handgrip strength deficits best explain limitations in performing bimanual activities after stroke.

PubMed

Basílio, Marluce Lopes; de Faria-Fortini, Iza; Polese, Janaine Cunha; Scianni, Aline A; Faria, Christina Dcm; Teixeira-Salmela, Luci Fuscaldi

2016-04-01

[Purpose] To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles and the performance in bimanual activities and to determine which muscular group would best explain the performance in bimanual activities of chronic stroke individuals. [Subjects and Methods] Strength measures of handgrip, wrist extensor, elbow flexor/extensor, and shoulder flexor muscles of 107 subjects were obtained and expressed as RSD. The performance in bimanual activities was assessed by the ABILHAND questionnaire. [Results] The correlations between the RSD of handgrip and wrist extensor muscles with the ABILHAND scores were negative and moderate, whereas those with the elbow flexor/extensor and shoulder flexor muscles were negative and low. Regression analysis showed that the RSD of handgrip and wrist extensor muscles explained 38% of the variance in the ABILHAND scores. Handgrip RSD alone explained 33% of the variance. [Conclusion] The RSD of the upper limb muscles were negatively associated with the performance in bimanual activities and the RSD of handgrip muscles were the most relevant variable. It is possible that stroke subjects would benefit from interventions aiming at improving handgrip strength, when the goal is to increase the performance in bimanual activities.

Effectiveness of extracorporeal shockwave therapy in three major tendon diseases.

PubMed

Carulli, Christian; Tonelli, Filippo; Innocenti, Matteo; Gambardella, Bonaventura; Muncibì, Francesco; Innocenti, Massimo

2016-03-01

Extracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies. A group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epicondylitis of the elbow (80 subjects). Each patient had 3 applications with a monthly interval, and was followed up at 1, 6, and 12 months after treatment. Results were evaluated by the numeric rating scale (NRS) in all cases, the Constant Murley Score for the assessment of the shoulder function, the American Orthopaedic Foot and Ankle Society Score for subjects affected by chronic Achilles tendinopathy, and the Oxford Elbow Score for those affected by a lateral epicondylitis of the elbow. One year after treatment, the results were considered satisfactory with an almost complete resolution of symptoms. There were statistically significant results at the 12-month follow-ups regarding the mean NRS score (from 6.25 to 0.2), the Constant Murley Score (from 66.7 to 79.4), the Oxford Elbow Score (from 28 to 46), and the AOFAS (from 71 to 86). Extracorporeal shockwave therapy may be considered a safe, economic, and effective treatment for several chronic musculoskeletal disorders, allowing satisfactory pain relief and improvement of function ability. Level IV.

Comparative analyses of genetic trends and prospects for selection against hip and elbow dysplasia in 15 UK dog breeds

PubMed Central

2013-01-01

Background Hip dysplasia remains one of the most serious hereditary diseases occurring in dogs despite long-standing evaluation schemes designed to aid selection for healthy joints. Many researchers have recommended the use of estimated breeding values (EBV) to improve the rate of genetic progress from selection against hip and elbow dysplasia (another common developmental orthopaedic disorder), but few have empirically quantified the benefits of their use. This study aimed to both determine recent genetic trends in hip and elbow dysplasia, and evaluate the potential improvements in response to selection that publication of EBV for such diseases would provide, across a wide range of pure-bred dog breeds. Results The genetic trend with respect to hip and elbow condition due to phenotypic selection had improved in all breeds, except the Siberian Husky. However, derived selection intensities are extremely weak, equivalent to excluding less than a maximum of 18% of the highest risk animals from breeding. EBV for hip and elbow score were predicted to be on average between 1.16 and 1.34 times more accurate than selection on individual or both parental phenotypes. Additionally, compared to the proportion of juvenile animals with both parental phenotypes, the proportion with EBV of a greater accuracy than selection on such phenotypes increased by up to 3-fold for hip score and up to 13-fold for elbow score. Conclusions EBV are shown to be both more accurate and abundant than phenotype, providing more reliable information on the genetic risk of disease for a greater proportion of the population. Because the accuracy of selection is directly related to genetic progress, use of EBV can be expected to benefit selection for the improvement of canine health and welfare. Public availability of EBV for hip score for the fifteen breeds included in this study will provide information on the genetic risk of disease in nearly a third of all dogs annually registered by the UK Kennel Club, with in excess of a quarter having an EBV for elbow score as well. PMID:23452300

Comparative analyses of genetic trends and prospects for selection against hip and elbow dysplasia in 15 UK dog breeds.

PubMed

Lewis, Thomas W; Blott, Sarah C; Woolliams, John A

2013-03-02

Hip dysplasia remains one of the most serious hereditary diseases occurring in dogs despite long-standing evaluation schemes designed to aid selection for healthy joints. Many researchers have recommended the use of estimated breeding values (EBV) to improve the rate of genetic progress from selection against hip and elbow dysplasia (another common developmental orthopaedic disorder), but few have empirically quantified the benefits of their use. This study aimed to both determine recent genetic trends in hip and elbow dysplasia, and evaluate the potential improvements in response to selection that publication of EBV for such diseases would provide, across a wide range of pure-bred dog breeds. The genetic trend with respect to hip and elbow condition due to phenotypic selection had improved in all breeds, except the Siberian Husky. However, derived selection intensities are extremely weak, equivalent to excluding less than a maximum of 18% of the highest risk animals from breeding. EBV for hip and elbow score were predicted to be on average between 1.16 and 1.34 times more accurate than selection on individual or both parental phenotypes. Additionally, compared to the proportion of juvenile animals with both parental phenotypes, the proportion with EBV of a greater accuracy than selection on such phenotypes increased by up to 3-fold for hip score and up to 13-fold for elbow score. EBV are shown to be both more accurate and abundant than phenotype, providing more reliable information on the genetic risk of disease for a greater proportion of the population. Because the accuracy of selection is directly related to genetic progress, use of EBV can be expected to benefit selection for the improvement of canine health and welfare. Public availability of EBV for hip score for the fifteen breeds included in this study will provide information on the genetic risk of disease in nearly a third of all dogs annually registered by the UK Kennel Club, with in excess of a quarter having an EBV for elbow score as well.

Arthroscopically assisted elbow interposition arthroplasty without hinged external fixation: surgical technique and patient outcomes.

PubMed

Chauhan, Aakash; Palmer, Bradley A; Baratz, Mark E

2015-06-01

Total elbow arthroplasty is successful in older, lower demand patients but not in the younger, more active individual with severe elbow arthritis. Interposition arthroplasty is an alternative for younger patients who hope to minimize the degree to which arm use is restricted. Interposition arthroplasty traditionally involves release of all ligaments and capsule. As a result, the postoperative care included the use of a hinged external fixator of the elbow to apply distraction and to permit motion during the early phases of healing. We describe a novel surgical technique without a hinged external fixator that allows secure fixation of the interposition graft through arthroscopic assistance and maintains the integrity of the medial collateral ligament with only a takedown and repair of the lateral collateral ligament complex. A retrospective chart review was performed to analyze 4 patients with an average age of 57 years who underwent surgery between 2007 and 2011. The patients were also contacted to assess elbow-specific American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder, and Hand scores. The average follow-up was 3.6 years (range, 2.5-6 years), and 1 patient was converted to a total elbow arthroplasty after 2.5 years because of persistent pain. The remaining 3 patients have done well with regard to pain control, stability, and functional use of the operative extremity. There were no postoperative complications. On the basis of our small series of patients, an arthroscopically assisted elbow interposition arthroplasty without hinged external fixation can provide satisfactory medium-term outcomes as a salvage procedure for a difficult condition with limited options. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Tennis elbow: associated psychological factors.

PubMed

Aben, Aurelie; De Wilde, Lieven; Hollevoet, Nadine; Henriquez, Carlos; Vandeweerdt, Marc; Ponnet, Koen; Van Tongel, Alexander

2018-03-01

The etiology of tennis elbow is multifactorial. Overuse of the wrist extensors along with anatomic factors, such as flexibility problems, aging, and poor blood circulation, may play a role. This study investigated whether patients with tennis elbow have a different psychological profile compared with healthy controls. Patients with clinical signs of tennis elbow, consulting at the Ghent University Hospital between September 2015 and January 2017, were offered a paper-and-pencil questionnaire about Big Five personality traits, perfectionism, anxiety, depression, work satisfaction, and working conditions. Healthy controls in the same risk group were offered the same questionnaires. We recruited 69 patients (35 men, 34 women) and 100 controls (44 men, 56 women). Tennis elbow patients scored significantly lower on the personality traits extraversion and agreeableness. Men, in particular, scored significantly higher on perfectionism and were more likely to develop an anxiety disorder or a depression. Concerning work, patients indicated a significantly higher workload (especially men) and a significantly lower autonomy (especially women). Female patients also indicated less contact with colleagues. However, work satisfaction was relatively high in both groups. The results suggest that there is a relationship between complaints related to tennis elbow and psychological characteristics. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Open arthrolysis and prosthetic replacement of the radial head for elbow stiffness associated with rotation limitation.

PubMed

Liu, Shen; Liu, Jun-jian; Li, Xu-jun; Ruan, Hong-jiang; Fan, Cun-yi

2013-02-01

Limited forearm rotation is a frequent combined disorder in elbow stiffness. If the radial head cannot be saved during open arthrolysis, prosthetic replacement might be considered because it enhances stability and allows early motion. In this study we retrospectively analyzed the outcome of 8 patients (7 men, 1 woman) who underwent open arthrolysis and simultaneous prosthetic replacement after resection of the radial head to restore elbow range of motion and forearm rotation. Patients were a mean age of 31.7 years (range, 22-40 years). Postoperatively, the mean (range) active range of motion improved from 29.4° (0°-70°) to 113.1° (80°-135°), mean (range) supination increased from 38.8° (0°-80°) to 77.5° (50°-90°), and mean (range) pronation improved from 18.8° (0°-80°) to 68.8° (50°-80°). The Mayo Elbow Performance Score improved from a mean (range) of 57.5 (50-70) to 92.5 (85-100) points. No elbow valgus instability was detected over a mean duration of 26 months of follow-up. The implant was considered stable in all patients. Open arthrolysis and prosthetic replacement of the radial head are effective in treating elbow stiffness with associated rotation limitation after resection of the radial head. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Primary repair of retracted distal biceps tendon ruptures in extreme flexion.

PubMed

Morrey, Mark E; Abdel, Matthew P; Sanchez-Sotelo, Joaquin; Morrey, Bernard F

2014-05-01

Distal biceps tendon ruptures may have tendinous retraction, making primary repair difficult and calling into question the need for graft reconstruction. The decision for when to primarily fix or augment high-flexion repairs has not been addressed. We hypothesized high-flexion repairs would have good outcomes without graft augmentation. The purpose of this study was to examine allograft use and outcomes of distal biceps tendon ruptures requiring repair in greater than 60° of flexion. This was a retrospective case-control study 188 distal biceps tendon repairs; of these, 19 chronic and 4 acute cases were identified with repairs of >60° of flexion using a 2-incision technique. Graft need, complications, and Mayo Elbow Performance Score to assess function, were examined with a record review. Patients were surveyed regarding return to work and subjective satisfaction. A control group matched for surgeon, chronicity, and age, but without a high-flexion repair, was compared with cases by using the Student paired t test. Graft augmentation was used in 1 patient with poor tendon quality. The Mayo Elbow Performance Score was 100 for all 23 patients, with extension/flexion range of motion from 3° to 138°. All were subjectively "very satisfied/satisfied," with full work return, yet 3 reported mild fatigability. There were 4 complications: 3 transient lateral antebrachial cutaneous neurapraxias and 1 rerupture at the myotendinous junction after retrauma. Differences between cases and controls were not statistically significant. Contracted distal biceps tendons may be reliably reattached to their anatomic insertion with up to 90° of elbow flexion. This lessens the need for reconstruction in such circumstances. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Intermanual Transfer Effects in Below-Elbow Myoelectric Prosthesis Users.

PubMed

de Boer, Errit; Romkema, Sietske; Cutti, Andrea G; Brouwers, Michael A; Bongers, Raoul M; van der Sluis, Corry K

2016-11-01

To determine intermanual transfer effects in patients with a below-elbow amputation using a myoelectric prosthesis and to establish whether laterality affects these effects. Case-control. A standardized setting in a rehabilitation clinic. A convenience sample (N=44) of experienced myoelectric prosthesis users (n=22) and matched controls (n=22). Controls were matched on sex, age (±5y), and hand dominance. Both the experienced group and the control group performed several tasks using a prosthesis simulator attached to their nonaffected arm. Movement time, force control, Box and Block test (BBT) scores, and duration of hand opening. Movement times of myoelectric prosthesis users were shorter, and these users had significantly higher BBT scores and shorter hand opening durations than those of controls. No intermanual transfer effects on force control and no laterality effects were found. Intermanual transfer effects were present in experienced myoelectric prosthesis users with a below-elbow amputation, independent of laterality. These findings support the clinical relevance of intermanual transfer training, which may facilitate persons with an upper limb amputation to start training directly after the amputation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Medialized repair for retracted rotator cuff tears.

PubMed

Kim, Young-Kyu; Jung, Kyu-Hak; Won, Jun-Sung; Cho, Seung-Hyun

2017-08-01

The purpose of this study was to evaluate the functional outcomes of medialized rotator cuff repair and the continuity of repaired tendon in chronic retracted rotator cuff tears. Thirty-five consecutive patients were selected from 153 cases that underwent arthroscopic rotator cuff repair for more than medium-sized posterosuperior rotator cuff tears between July 2009 and July 2012 performed with the medialized repair. All cases were available for at least 2 years of postoperative follow-up. The visual analog scale of pain, muscle strength, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and University of California-Los Angeles score were evaluated. At the final follow-up, all clinical outcomes were significantly improved. The visual analog scale score for pain improved from 6 ± 1 preoperatively to 2 ± 1 postoperatively. The range of motion increased from preoperatively to postoperatively: active forward elevation, from 134° ± 49° to 150° ± 16°; active external rotation at the side, from 47° ± 15° to 55° ± 10°; and active internal rotation, from L3 to L1. The shoulder score also improved: Constant score, from 53.5 ± 16.7 to 79 ± 10; American Shoulder and Elbow Surgeons score, from 51 ± 15 to 82 ± 8; and University of California-Los Angeles score, from 14 ± 4 to 28 ± 4. The retear cases at the final follow-up were 6 (17%). Medialized repair may be useful in cases in which anatomic bone-to-tendon repair would be difficult because of the excessive tension of the repaired tendon and a torn tendon that does not reach the anatomic insertion. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reliability of sonographic assessment of tendinopathy in tennis elbow.

PubMed

Poltawski, Leon; Ali, Syed; Jayaram, Vijay; Watson, Tim

2012-01-01

To assess the reliability and compute the minimum detectable change using sonographic scales to quantify the extent of pathology and hyperaemia in the common extensor tendon in people with tennis elbow. The lateral elbows of 19 people with tennis elbow were assessed sonographically twice, 1-2 weeks apart. Greyscale and power Doppler images were recorded for subsequent rating of abnormalities. Tendon thickening, hypoechogenicity, fibrillar disruption and calcification were each rated on four-point scales, and scores were summed to provide an overall rating of structural abnormality; hyperaemia was scored on a five point scale. Inter-rater reliability was established using the intraclass correlation coefficient (ICC) to compare scores assigned independently to the same set of images by a radiologist and a physiotherapist with training in musculoskeletal imaging. Test-retest reliability was assessed by comparing scores assigned by the physiotherapist to images recorded at the two sessions. The minimum detectable change (MDC) was calculated from the test-retest reliability data. ICC values for inter-rater reliability ranged from 0.35 (95% CI: 0.05, 0.60) for fibrillar disruption to 0.77 (0.55, 0.88) for overall greyscale score, and 0.89 (0.79, 0.95) for hyperaemia. Test-retest reliability ranged from 0.70 (0.48, 0.84) for tendon thickening to 0.82 (0.66, 0.90) for overall greyscale score and 0.86 (0.73, 0.93) for calcification. The MDC for the greyscale total score was 2.0/12 and for the hyperaemia score was 1.1/5. The sonographic scoring system used in this study may be used reliably to quantify tendon abnormalities and change over time. A relatively inexperienced imager can conduct the assessment and use the rating scales reliably.

Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach

PubMed Central

Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

2014-01-01

AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey’s modified double-incision approach. METHODS: We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient’s satisfaction, elbow and forearm motion, grip strength and complications occurrence. RESULTS: At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. CONCLUSION: This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate. PMID:25133147

Treatment strategy and long-term functional outcome of traumatic elbow dislocation in childhood: a single centre study.

PubMed

Nussberger, G; Schädelin, S; Mayr, J; Studer, D; Zimmermann, P

2018-04-01

Traumatic elbow dislocation (TED) is the most common injury of large joints in children. There is an ongoing debate on the optimal treatment for TED. We aimed to assess the functional outcome after operative and nonoperative treatment of TED. We analysed the medical records of patients with TED treated at the University Children's Hospital, Basel, between March 2006 and June 2015. Functional outcome was assessed using the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) Sport and Music Module score. These scores were compared between nonoperatively and operatively treated patients. A total of 37 patients (mean age 10.2 years, 5.2 to 15.3) were included. Of these, 21 (56.8%) children had undergone nonoperative treatment, with 16 (43.2%) patients having had operative treatment. After a mean follow-up of 5.6 years (1.2 to 5.9), MEPS and QuickDASH Sport and Music Module scores in the nonoperative group and operative group were similar: MEPS: 97.1 points (SD 4.6) versus 97.2 points (SD 2.6); 95% confidence interval (CI)-2.56 to 2.03); p = 0.53; QuickDASH Sport and Music Module score: 3.9 points (SD 6.1) versus 3.1 points (SD 4.6); 95% CI 2.60 to 4.17; p = 0.94. We noted no significant differences regarding the long-term functional outcome between the subgroup of children treated operatively versus those treated nonoperatively for TED with accompanying fractures of the medial epicondyle and medial condyle. Functional outcome after TED was excellent, independent of the treatment strategy. If clear indications for surgery are absent, a nonoperative approach for TED should be considered. Level III - therapeutic, retrospective, comparative study.

Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement.

PubMed

Heise, Carlos O; Siqueira, Mario G; Martins, Roberto S; Foroni, Luciano H; Sterman-Neto, Hugo

2017-09-01

Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach. We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0-7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. We considered elbow flexion scores of 6 or 7 as good results. The mean elbow flexion score and the proportion of good results were better using distal nerve transfers than supraclavicular grafting at 12 months (p < 0.01), but not at 24 months. Two patients with failed supraclavicular nerve grafting at 12 months showed good elbow flexion recovery after ulnar nerve transfers. Distal nerve transfers provided faster elbow flexion recovery than supraclavicular nerve grafting, but there was no significant difference in the outcome after 24 months of surgery. Patients with failed supraclavicular grafting operated early can still benefit from late distal nerve transfers. Supraclavicular nerve grafting should remain as the first line surgical treatment for children with neonatal brachial plexus palsy.

Rehabilitation of neglected Monteggia fracture: Dislocations in children.

PubMed

Yıldırım, Azad; Nas, Kemal

2017-11-06

There are limited studies related to the rehabilitation of neglected Monteggia fracture-dislocations. This study reports the results of the rehabilitation of neglected Monteggia fractures and dislocations and the best treatment options available. Thirteen children were rehabilitated between 2009 and 2012. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, time delay from symptom onset to fracture, Bado classification, Mayo Elbow Performance Index (MEPI) which includes pain, range of motion and daily life comfort, surgeries, length of hospitalization, location and pattern of fracture, length of follow-up and complications. The study group included thirteen children and adolescents; eleven males and two females with a mean age of 8.5 (range 2-15) years. According to the Bado classification, 11 patients had type 1, one had type 3 and one had type 4 fracture-dislocations. For Mayo Elbow Performance Index (MEPI) scales, patients that were less than ten years old had greater mean scores. Two patients had superficial infection, one had subluxation, one had osteoarthritis, one had delayed bone union and two had rigidity at the elbow. The goals of elbow rehabilitation following Neglected Monteggia cases include restoring function by restoring motion and muscle performance; influencing scar remodeling and preventing joint contracture; and restoring or maintaining joint stability. Patients aged younger than 10 years and intervals of less than one-year, between trauma and diagnosis, as well as early and effective rehabilitation were found as important parameters regarding favorable outcomes.

Open arthrolysis for elbow stiffness increases carrying angle but has no impact on functional recovery.

PubMed

Fan, Dapeng; Wang, Wei; Hildebrand, Kevin A; Fan, Cun-Yi

2016-09-09

With the exception of normal anatomic changes in the medial collateral ligament and radial head, other factors related to carrying angle changes have not been systematically studied. We reviewed patients who underwent open arthrolysis of the elbow, and evaluated if open arthrolysis could change carrying angle. We then identified factors associated with carrying angle changes. Fifty patients with a minimum of 24 months of follow-up after open arthrolysis were evaluated retrospectively. Preoperative and postoperative carrying angles were compared. The carrying angles of 36 elbows in 36 patients were unchanged after surgery (Group A), while the carrying angles of 14 elbows in 14 patients increased postoperatively (Group B). In Group A, mean postoperative extension and flexion were 7° (range 0-24°) and 125° (range 10-135°) respectively, while mean postoperative pronation and supination were 60° (range 50-80°) and 65° (range 30-85°), respectively. In Group B, mean postoperative extension and flexion were 25° (range 0-40°) and 128° (range 60-138°), while mean postoperative pronation and supination were 65° (range 45-85°) and 60° (range 45-75°), respectively. No significant difference in range of motion and Mayo Elbow Performance Score was observed between the two groups. During open arthrolysis, humeral trochlea debridement and techniques for improving forearm rotation could increase carrying angle. However, this had no impact on elbow functional recovery.

Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy.

PubMed

Arad, Ehud; Stephens, Derek; Curtis, Christine G; Clarke, Howard M

2013-06-01

Residual muscle imbalance is a common problem affecting obstetrical brachial plexus palsy patients. The goal of this study was to examine the efficacy of botulinum toxin type A (Botox) in improving this muscle imbalance. The authors retrospectively reviewed obstetrical brachial plexus palsy patients treated with Botox for muscle imbalance as an isolated procedure. Outcomes were the change in Active Movement Scale scores from pre-Botox scores to scores at 1 month after Botox and 1 year after Botox. Twenty-seven patients were included, 19 treated for shoulder imbalance and eight treated for elbow imbalance. Active Movement Scale scores (mean±SD) for shoulder external rotation improved from 0.6±1.0 before Botox to 2.6±2.14 (p<0.01) at 1 month after Botox, and declined to 1.3±1.2 (p<0.01) at 1 year after Botox. Scores for elbow flexion were 3.3±2.1 before Botox, unchanged at 4.4±1.8 (p=0.07) 1 month after Botox, and improved to 5.8±0.5 (p<0.01) at 1 year after Botox. Scores for elbow supination were 2.9±1.7 before Botox and 3.4±1.5 (p=0.2) at 1 month after Botox, and improved to 3.9±2.0 (p<0.01) at 1 year after Botox. Botox for shoulder movement imbalance produces improvement in external rotation that is not sufficiently sustained over time to be of clinical benefit. However, Botox for elbow movement imbalance produces a sustained and clinically useful improvement. Therapeutic, IV.

Biceps tenodesis is a viable option for salvage of failed SLAP repair.

PubMed

Werner, Brian C; Pehlivan, Hakan C; Hart, Joseph M; Lyons, Matthew L; Gilmore, C Jan; Garrett, Cara B; Carson, Eric W; Diduch, David R; Miller, Mark D; Brockmeier, Stephen F

2014-08-01

Outcomes of arthroscopic superior labral anterior-posterior (SLAP) repairs have been well reported with generally favorable outcomes. Unfortunately, a percentage of patients remain dissatisfied or suffer further injury after SLAP repair and may seek additional treatment. The purpose of this study was to evaluate the surgical outcomes of biceps tenodesis for failed SLAP repairs. A retrospective review of all patients undergoing biceps tenodesis was completed. Inclusion criteria were previous SLAP repair and subsequent revision biceps tenodesis. Exclusion criteria were additional shoulder procedures including rotator cuff repair, instability procedures, and preoperative frozen shoulder. Objective outcomes were postoperative assessments with Constant score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 36-Item Health Survey. Physical examination was conducted to determine postoperative range of motion and strength compared with the nonoperative shoulder. A cohort of 24 patients was identified, and of these, 17 patients (71%) completed the study at 2 years' follow-up. The average postoperative Constant score was 84.4; American Shoulder and Elbow Surgeons score, 75.5; Single Assessment Numeric Evaluation score, 73.1%; Simple Shoulder Test score, 9.2; and Veterans RAND 36-Item Health Survey score, 76.1. Postoperative range of motion of the operative shoulder returned to near that of the asymptomatic nonoperative shoulder. Workers' compensation status led to inferior results. Options for patients with a failed prior SLAP repair are limited. As a salvage operation for failed SLAP repair, biceps tenodesis serves the majority of patients well, with favorable outcomes by validated measures and excellent shoulder range of motion and elbow strength at 2 years' follow-up. Workers' compensation status may predispose patients to poorer outcomes. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Heterogeneity in health status and the influence of patient characteristics across patients seeking musculoskeletal orthopaedic care - a cross-sectional study.

PubMed

Perruccio, Anthony V; Gandhi, Rajiv; Rampersaud, Y Raja

2013-03-07

Health status is an important predictor of patient outcomes. Consequently, identifying patient predictors of health status is essential. In musculoskeletal orthopaedic care, the majority of work examining the association between patient characteristics and health status has been undertaken among hip/knee cohorts. We investigate these associations comparing findings across four musculoskeletal cohorts (hip/knee; foot/ankle; neck/back; elbow/shoulder). Patients seeking elective musculoskeletal orthopaedic care were recruited prior to consultation. Questionnaires captured health domain status (bodily pain, physical functioning, and mental and general health) and covariates: demographics; socioeconomic characteristics; and comorbidity. Scores were compared across cohorts. Two path regression analyses were undertaken. First, domain scores were simultaneously examined as dependent variables in the overall sample. Subsequently, the model was assessed stratified by cohort. 1,948 patients: 454 neck/back, 767 hip/knee, 378 shoulder/elbow, 349 foot/ankle. From stratified analyses, significant variability in covariate effects was observed. Worse bodily pain scores were associated with increasing age and female sex among hip/knee, low income among foot/ankle, and overweight/obese for foot/ankle and hip/knee. Worse mental health scores were associated with low income across cohorts except elbow/shoulder, low education within neck/back, and compared to Whites, Blacks had significantly worse scores among foot/ankle, better scores among hip/knee. Worse general health scores were observed for Asians among hip/knee, Blacks among foot/ankle, and South-Asians among elbow/shoulder and neck/back. The substantial heterogeneity across musculoskeletal cohorts suggests that patient- and cohort-specific approaches to patient counsel and care may be more effective for achieving optimal health and outcomes.

Neck osteotomy for malunion of neglected radial neck fractures in children: a report of 2 cases.

PubMed

Ceroni, Dimitri; Campos, José; Dahl-Farhoumand, Agnes; Holveck, Jérôme; Kaelin, André

2010-01-01

Radial neck fractures are a common injury in children as a result of a fall on an extended and supinated outstretched hand. We present 2 cases of osteotomy of the neck of the radius performed in 2 children with neglected radial neck fractures. Preoperatively, both patients complained of pain and severely reduced mobility of the elbow. Surgery was performed at 6 weeks and 3 months, respectively, after the initial injury and the 2 children were reviewed at 6 and 16 months follow-up. Osteotomies healed within the usual time and no avascular necrosis of the radial head, proximal radioulnar synostosis, or myositis ossificans were observed. The Mayo Elbow Performance Index Score improved significantly after the operation with the 2 patients rated as excellent. In this small series, we present a novel technique of proximal osteotomy of the radius to correct this deformity in children. Case series, level IV evidence.

The effects of below-elbow immobilization on driving performance.

PubMed

Jones, Evan M; Barrow, Aaron E; Skordas, Nic J; Green, David P; Cho, Mickey S

2017-02-01

There is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance. 20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1-10 analogue scoring). The greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n=6; p=0.02) and left arm spica casts (n=5; p=0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2±1.9; p<0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2.5±1.6; p>0.05). There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization. Drivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity. Copyright © 2016. Published by Elsevier Ltd.

Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review.

PubMed

Saridakis, Paul; Jones, Grant

2010-03-01

Arthroscopic rotator cuff repair is a common procedure that is gaining wide acceptance among orthopaedic surgeons because it is less invasive than open repair techniques. However, there is little consensus on whether to employ single-row or double-row fixation. The purpose of the present study was to systematically review the English-language literature to see if there is a difference between single-row and double-row fixation techniques in terms of clinical outcomes and radiographic healing. PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE were reviewed with the terms "arthroscopic rotator cuff," "single row repair," and "double row repair." The inclusion criteria were a level of evidence of III (or better), an in vivo human clinical study on arthroscopic rotator cuff repair, and direct comparison of single-row and double-row fixation. Excluded were technique reports, review articles, biomechanical studies, and studies with no direct comparison of arthroscopic rotator cuff repair techniques. On the basis of these criteria, ten articles were found, and a review of the full-text articles identified six articles for final review. Data regarding demographic characteristics, rotator cuff pathology, surgical techniques, biases, sample sizes, postoperative rehabilitation regimens, American Shoulder and Elbow Surgeons scores, University of California at Los Angeles scores, Constant scores, and the prevalence of recurrent defects noted on radiographic studies were extracted. Confidence intervals were then calculated for the American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Constant scores. Quality appraisal was performed by the two authors to identify biases. There was no significant difference between the single-row and double-row groups within each study in terms of postoperative clinical outcomes. However, one study divided each of the groups into patients with small-to-medium tears (< 3 cm in length) and those with large-to-massive tears (> or = 3 cm in length), and the authors noted that patients with large to massive tears who had double-row fixation performed better in terms of the American Shoulder and Elbow Surgeons scores and Constant scores in comparison with those who had single-row fixation. Two studies demonstrated a significant difference in terms of structural healing of the rotator cuff tendons after surgery, with the double-row method having superior results. There was an overlap in the confidence intervals between the single-row and double-row groups for all of the studies and the American Shoulder and Elbow Surgeons, Constant, and University of California at Los Angeles scoring systems utilized in the studies, indicating that there was no difference in these scores between single-row and double-row fixation. Potential biases included selection, performance, detection, and attrition biases; each study had at least one bias. Two studies had potentially inadequate power to detect differences between the two techniques. There appears to be a benefit of structural healing when an arthroscopic rotator cuff repair is performed with double-row fixation as opposed to single-row fixation. However, there is little evidence to support any functional differences between the two techniques, except, possibly, for patients with large or massive rotator cuff tears (> or = 3 cm). A risk-reward analysis of a patient's age, functional demands, and other quality-of-life issues should be considered before deciding which surgical method to employ. Double-row fixation may result in improved structural healing at the site of rotator cuff repair in some patients, depending on the size of the tear.

Total elbow arthroplasty for the treatment of distal humeral fractures.

PubMed

Gallucci, G L; Larrondo Calderón, W; Boretto, J G; Castellaro Lantermo, J A; Terán, J; de Carli, P

2016-01-01

To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. This retrospective study was performed in two surgical centres. A total of 23patients were included, with a mean age of 79years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. Level of Evidence IV. Copyright © 2016 SECOT. Published by Elsevier Espana. All rights reserved.

Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

PubMed Central

Tercier, Stéphane; Bregou-Bourgeois, Aline; Zambelli, Pierre-Yves

2013-01-01

The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months) postoperatively. The clinical results were compared using the Mayo Elbow Performance Score (MEPS). Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children. PMID:24228016

Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex.

PubMed

Babaqi, AbdulRahman A; Kotb, Mohammed M; Said, Hatem G; AbdelHamid, Mohamed M; ElKady, Hesham A; ElAssal, Maher A

2014-06-01

There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores. In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria. After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P < 0.05). Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex.

Arthroscopic rotator cuff repair in the weight-bearing shoulder.

PubMed

Kerr, Jacek; Borbas, Paul; Meyer, Dominik C; Gerber, Christian; Buitrago Téllez, Carlos; Wieser, Karl

2015-12-01

In wheelchair-dependent individuals, pain often develops because of rotator cuff tendon failure and/or osteoarthritis of the glenohumeral joint. The purposes of this study were to investigate (1) specific rotator cuff tear patterns, (2) structural healing, and (3) clinical outcomes after arthroscopic rotator cuff repair in a cohort of wheelchair-dependent patients. Forty-six shoulders with a mean follow-up of 46 months (range, 24-82 months; SD, 13 months) from a consecutive series of 61 shoulders in 56 patients (46 men and 10 women) undergoing arthroscopic rotator cuff repair were available for analysis. Clinical outcome analysis was performed using the Constant-Murley score, the Subjective Shoulder Value, and the American Shoulder and Elbow Surgeons score. The integrity of the repair was analyzed by ultrasound. Of the shoulders, 87% had supraspinatus involvement, 70% had subscapularis involvement, and 57% had an anterosuperior lesion involving both the supraspinatus and subscapularis. Despite an overall structural failure rate of 33%, the patients showed improvements in the Constant-Murley score from 50 points (range, 22-86 points; SD, 16 points) preoperatively to 80 points (range, 40-98 points; SD, 12 points) postoperatively and in the American Shoulder and Elbow Surgeons score from 56 points (range, 20-92 points; SD, 20 points) preoperatively to 92 points (range, 53-100 points; SD, 10 points) postoperatively, with a mean postoperative Subjective Shoulder Value of 84% (range, 25%-100%; SD, 17%). Failure of the rotator cuff in weight-bearing shoulders occurs primarily anterosuperiorly. Arthroscopic rotator cuff repair leads to a structural failure rate of 33% but satisfactory functional results with high patient satisfaction at midterm follow-up. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Prevalence and co-occurrence of hip dysplasia and elbow dysplasia in Dutch pure-bred dogs.

PubMed

Lavrijsen, I C M; Heuven, H C M; Meij, B P; Theyse, L F H; Nap, R C; Leegwater, P A J; Hazewinkel, H A W

2014-05-01

Hip as well as elbow dysplasia (HD, ED) are developmental disorders leading to malformation of their respective joints. For a long time both disorders have been scored and targeted for improvement using selective breeding in several Dutch dog populations. In this paper all scores for both HD and ED, given to pure bred dogs in the Netherlands from 2002 to 2010, were analyzed. Heritabilities and correlations between HD and ED were calculated for the 4 most frequently scored breeds. Heritabilities ranged from 0.0 to 0.37 for HD related traits (FCI-score, osteoarthritis, congruity, shape and laxity (Norberg angle); FCI: Fédération Cynologique Internationale) and from 0.0 to 0.39 for ED related traits (IEWG score, osteoarthritis, sclerosis and indentation; IEWG: International Elbow Working Group). HD related traits showed high genetic and residual correlations among each other but were only to a minor extent correlated with ED related traits, which also showed high correlations among each other. Genetic correlations were higher than residual correlations. Phenotypic and genetic trends since 2001 for the four most scored breeds were slightly positive but decreasing over time, indicating that selection over the past decade has not been effective. Copyright © 2014. Published by Elsevier B.V.

A haptic-robotic platform for upper-limb reaching stroke therapy: Preliminary design and evaluation results

PubMed Central

Lam, Paul; Hebert, Debbie; Boger, Jennifer; Lacheray, Hervé; Gardner, Don; Apkarian, Jacob; Mihailidis, Alex

2008-01-01

Background It has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1) an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2) an unobtrusive upper body postural sensing system; and 3) a vibratory elbow stimulation device to encourage muscle movement. Methods A multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data. Results Seven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good) out of 4.0 (good). The postural sensors detected 93 of 96 (97%) therapist-simulated abnormal postures and correctly ignored 90 of 96 (94%) of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral) for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device. Conclusion All eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as the prototype was considered to be generally well designed and capable of delivering reaching task therapy. The next stage of this project is to proceed to clinical trials with stroke patients. PMID:18498641

[Case-control study on comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow].

PubMed

Lin, Guang-Mao; Liu, Liang-Le; Ye, Li-Jie; Li, Qi; Liu, Mei-Fen

2014-11-01

To study therapeutic effects of comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow. From December 2008 to December 2013,32 patients with elbow triad were randomly divided into two groups: therapy group and control group. There were 17 patients in control group including 12 males and 5 females with a mean age of (41.0 ± 7.1) years old. The patients in control group were received the past procedure therapy. There were 15 patients in therapy group, including 10 males and 5 females with a mean age of (41.3 ± 7.6) years old. The patients in therapy group were received comprehensive traditional Chinese medicine therapy, including passive exercise training at early stage (0 to 2 weeks after operation), transition from passive to active exercise training at middle stage (3 to 4 weeks after operation), and active exercise training at late stage (5 to 12 weeks after operation). Other treatment methods, such as orally taking or externally use of Chinese herbal medicine, manipulation and physiotherapy, were used at all stages. The Mayo Elbow Performance Score, patient satisfaction and complications were evaluated and analyzed. All the patients were followed up, and the mean duration was 7.5 months. There were no complications such as internal fixation loosing, obvious displacement fracture and heterotopic ossification occurred. The Mayo score and patient satisfaction in therapy group were higher than those in control group (t = 12.78, P = 0.00; χ2 = 8.719, P = 0.003). Seven patients needed reoperation in control group, compared with 1 patient in therapy group (χ2 = 4.626, P = 0.032). The comprehensive traditional Chinese medicine therapy is effective to prevent postoperative stiffness after operation for terrible triad of the elbow by using different methods at different stages, which is worthy of spread and application.

Immediate Biomechanical Implications of Transfer Component Skills Training on Independent Wheelchair Transfers.

PubMed

Tsai, Chung-Ying; Boninger, Michael L; Hastings, Jennifer; Cooper, Rory A; Rice, Laura; Koontz, Alicia M

2016-10-01

To evaluate the immediate effects of transfer training based on the Transfer Assessment Instrument (TAI) on the upper limb biomechanics during transfers. Pre-post intervention. Biomechanics laboratory. Full-time manual wheelchair users (N=24) performed 5 transfers to a level height bench, while their natural transfer skills were scored using the TAI, and their biomechanical data were recorded. Participants with 2 or more component skill deficits were invited to return to receive personalized transfer training. TAI part 1 summary scores and biomechanical variables calculated at the shoulder, elbow, and wrist joints were compared before and immediately after transfer training. Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual wheelchair users came back for the revisit. Their TAI part 1 summary scores improved from 6.31±.98 to 9.92±.25. They had significantly smaller elbow range of motion, shoulder resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing side during transfers after training (P<.05). On the leading side, shoulder maximum internal rotation and elevation angles, and shoulder resultant moments and rates of rise of shoulder resultant force and moment decreased after training (P<.04). The TAI-based training showed short-term beneficial biomechanical effects on wheelchair users' upper limbs, such as better shoulder positioning and lower joint loadings. If the skills are practiced longer-term, they may help protect the upper limbs from developing pain and injuries. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Clinical and Radiographic Outcomes of Unipolar and Bipolar Radial Head Prosthesis in Patients with Radial Head Fracture: A Systemic Review and Meta-Analysis.

PubMed

Chen, Hongwei; Wang, Ziyang; Shang, Yongjun

2018-06-01

To compare clinical outcomes of unipolar and bipolar radial head prosthesis in the treatment of patients with radial head fracture. Medline, Cochrane, EMBASE, Google Scholar databases were searched until April 18, 2016 using the following search terms: radial head fracture, elbow fracture, radial head arthroplasty, implants, prosthesis, unipolar, bipolar, cemented, and press-fit. Randomized controlled trials, retrospective, and cohort studies were included. The Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, radiologic assessment, ROM, and grip strength following elbow replacement were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head arthroplasty, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prosthesis were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups, with both groups have comparable risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values <0.001 for both unipolar and bipolar prosthesis). However, bipolar radial head prosthesis was associated with an increased chance of heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis was not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039). Unipolar and bipolar radial head prostheses were similar with respect to clinical outcomes. Additional comparative studies are necessary to further compare different radial head prostheses used to treat radial head fracture.

Nonoperative treatment of distal biceps brachii musculotendinous partial rupture: a report of two cases.

PubMed

López-Zabala, I; Fernández-Valencia, J A

2013-01-01

Musculotendinous ruptures of the distal biceps brachii are extremely rare injuries whose clinical presentation is similar to distal biceps avulsion. We describe two cases of patients who suffered a distal biceps brachii musculotendinous partial rupture. The first patient was playing soccer as goalkeeper and experienced sudden pain while throwing the ball overhead with his left arm. The second patient experienced sudden pain while weightlifting with his right arm. The mechanism of injury was the same in the two cases, as both involved glenohumeral elevation with elbow extension and forearm supination. Neither of these two patients underwent surgical repair or rehabilitation, and both had perfect scores of 100 on the Mayo Clinic Performance Index for the Elbow at one-year followup.

Validity and cross-cultural adaptation of the persian version of the oxford elbow score.

PubMed

Ebrahimzadeh, Mohammad H; Kachooei, Amir Reza; Vahedi, Ehsan; Moradi, Ali; Mashayekhi, Zeinab; Hallaj-Moghaddam, Mohammad; Azami, Mehran; Birjandinejad, Ali

2014-01-01

Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.

Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon

PubMed Central

The, Bertram; Brutty, Mike; Wang, Allan; Campbell, Peter T.; Halliday, Michael J. C.; Ackland, Timothy R.

2014-01-01

Introduction: The objective of this study is to evaluate the biomechanical function of the upper arm after arthroscopic long head of biceps (LHB) tenotomy at long-term follow-up. Materials and Methods: Twenty-five male subjects ranging from 30 to 63 years old were evaluated at a mean follow-up of 7.0 years after tenotomy. Bilateral isokinetic testing was performed to obtain peak torque values, as well as total work done throughout the full range of elbow flexion and supination. Results: Magnetic resonance imaging scans revealed nine unrecognized LHB ruptures in the contralateral arm, leaving 16 subjects to complete the testing protocol. The mean quickDASH score was 8.1 (standard error [SE] 2.5). The mean oxford elbow score was 97.9 (SE 1.6). The tenotomy arm recorded a decrease in peak flexion torque of 7.0% (confidence interval [CI] 1.2-12.8), and a decrease in the peak supination torque of 9.1% (CI 1.8-16.4) relative to the contralateral arm. The total work carried out through the full range of joint motion was reduced in elbow flexion by 5.1% (CI −1.3-11.4) and in forearm supination by 5.7% (CI-2.4-13.9). Discussion: Maximum strength in elbow flexion and forearm supination is significantly reduced compared with the contralateral arm. However, this impairment is partially compensated for by relatively greater strength sustained through the latter stages of joint motion. This results in comparable total work measurements between the tenotomised and contralateral side, potentially accounting for ongoing high levels of patient satisfaction and clinical function in the long term after LHB tenotomy. Level of Evidence IV: Case series without comparison group. PMID:25258498

Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon.

PubMed

The, Bertram; Brutty, Mike; Wang, Allan; Campbell, Peter T; Halliday, Michael J C; Ackland, Timothy R

2014-07-01

The objective of this study is to evaluate the biomechanical function of the upper arm after arthroscopic long head of biceps (LHB) tenotomy at long-term follow-up. Twenty-five male subjects ranging from 30 to 63 years old were evaluated at a mean follow-up of 7.0 years after tenotomy. Bilateral isokinetic testing was performed to obtain peak torque values, as well as total work done throughout the full range of elbow flexion and supination. Magnetic resonance imaging scans revealed nine unrecognized LHB ruptures in the contralateral arm, leaving 16 subjects to complete the testing protocol. The mean quickDASH score was 8.1 (standard error [SE] 2.5). The mean oxford elbow score was 97.9 (SE 1.6). The tenotomy arm recorded a decrease in peak flexion torque of 7.0% (confidence interval [CI] 1.2-12.8), and a decrease in the peak supination torque of 9.1% (CI 1.8-16.4) relative to the contralateral arm. The total work carried out through the full range of joint motion was reduced in elbow flexion by 5.1% (CI -1.3-11.4) and in forearm supination by 5.7% (CI-2.4-13.9). Maximum strength in elbow flexion and forearm supination is significantly reduced compared with the contralateral arm. However, this impairment is partially compensated for by relatively greater strength sustained through the latter stages of joint motion. This results in comparable total work measurements between the tenotomised and contralateral side, potentially accounting for ongoing high levels of patient satisfaction and clinical function in the long term after LHB tenotomy. Case series without comparison group.

Effects of electromyography-driven robot-aided hand training with neuromuscular electrical stimulation on hand control performance after chronic stroke.

PubMed

Rong, Wei; Tong, Kai Yu; Hu, Xiao Ling; Ho, Sze Kit

2015-03-01

An electromyography-driven robot system integrated with neuromuscular electrical stimulation (NMES) was developed to investigate its effectiveness on post-stroke rehabilitation. The performance of this system in assisting finger flexion/extension with different assistance combinations was evaluated in five stroke subjects. Then, a pilot study with 20-sessions training was conducted to evaluate the training's effectiveness. The results showed that combined assistance from the NMES-robot could improve finger movement accuracy, encourage muscle activation of the finger muscles and suppress excessive muscular activities in the elbow joint. When assistances from both NMES and the robot were 50% of their maximum assistances, finger-tracking performance had the best results, with the lowest root mean square error, greater range of motion, higher voluntary muscle activations of the finger joints and lower muscle co-contraction in the finger and elbow joints. Upper limb function improved after the 20-session training, indicated by the increased clinical scores of Fugl-Meyer Assessment, Action Research Arm Test and Wolf Motor Function Test. Muscle co-contraction was reduced in the finger and elbow joints reflected by the Modified Ashworth Scale. The findings demonstrated that an electromyography-driven NMES-robot used for chronic stroke improved hand function and tracking performance. Further research is warranted to validate the method on a larger scale. Implications for Rehabilitation The hand robotics and neuromuscular electrical stimulation (NMES) techniques are still separate systems in current post-stroke hand rehabilitation. This is the first study to investigate the combined effects of the NMES and robot on hand rehabilitation. The finger tracking performance was improved with the combined assistance from the EMG-driven NMES-robot hand system. The assistance from the robot could improve the finger movement accuracy and the assistance from the NMES could reduce the muscle co-contraction on finger and elbow joints. The upper limb functions were improved on chronic stroke patients after the pilot study of 20-session hand training with the combined assistance from the EMG-driven NMES-robot. The muscle spasticity on finger and elbow joints was reduced after the training.

Patients recall worse preoperative pain after shoulder arthroplasty than originally reported: a study of recall accuracy using the American Shoulder and Elbow Surgeons score.

PubMed

Lowe, Jeremiah T; Li, Xinning; Fasulo, Sydney M; Testa, Edward J; Jawa, Andrew

2017-03-01

Patient-reported outcome measures (PROMs) are valuable tools for quantifying outcomes of orthopedic surgery. However, when baseline scores are not obtained, there is considerable controversy about whether PROMs can be administered retrospectively for patients to recall their preoperative state. We investigated the accuracy of patient recall after total shoulder arthroplasty (TSA) using the American Shoulder and Elbow Surgeons (ASES) assessment score. Recalled ASES scores were collected postoperatively at 6 weeks, 3 months, 6 months, and 12 months from 169 patients who previously completed baseline scores before TSA. The ASES total score was divided into its two subcomponents: functional ability and visual analog scale (VAS) for pain. We compared preoperative and recalled scores for each subcomponent and the total ASES score. Recalled ASES function scores were comparable to corresponding preoperative scores across all time points (analysis of variance, P = .21), but recalled VAS pain was significantly higher at all time points beyond 6 weeks after surgery (P = .0001 at 3 months; P = .005 at 6 months; and P = .001 at 12 months). As a result, the ASES total score was only comparable at 6 weeks after surgery (P = .39) and differed at all time points thereafter. Patients are able to recall preoperative function with considerable accuracy for up to 12 months after TSA. However, beyond 6 weeks postoperatively, patients recall having worse pain than they originally reported, and recalled ASES total scores are unreliable as a result. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE).

PubMed

Arrigoni, Paolo; Cucchi, Davide; D'Ambrosi, Riccardo; Menon, Alessandra; Aliprandi, Alberto; Randelli, Pietro

2017-07-01

Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow. Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated. SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excellent subjective results. Post-operative median quickDASH was 9.1 [0-25] points and OES 42 [34-48]. Median post-operative flexion was 145°, and extension was 0°. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up. R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention. Retrospective case series, Level IV.

Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture

PubMed Central

Schmale, Gregory A.; Mazor, Suzan; Mercer, Laina D.; Bompadre, Viviana

2014-01-01

Background: The goal of the study was to evaluate the efficacy of physical therapy in restoring function and mobility after a pediatric supracondylar humeral fracture. Methods: The study included sixty-one patients from five to twelve years of age with a supracondylar humeral fracture that was treated with casting or with closed reduction and pinning followed by casting. Patients were randomized to receive either no further treatment (no-PT group) or six sessions of a standardized hospital-based physical therapy program (PT group). The ASK-p (Activities Scale for Kids-performance version) and self-assessments of activity were used to assess function at one, nine, fifteen, and twenty-seven weeks after injury. Motion was measured at nine and fifteen weeks after injury by a blinded therapist. Anxiety was measured at one and nine weeks after injury with a self-assessment. Differences in ASK-p scores and anxiety level were analyzed with use of multivariate generalized estimating equations. Results: ASK-p scores were significantly better in the no-PT group at nine and fifteen weeks after injury (p = 0.02 and 0.01, respectively) but the difference at twenty-seven weeks was not significant. There were no differences between groups with respect to performance of activities of daily living or time to return to sports. Anxiety at nine weeks was associated with worse ASK-p scores at nine and fifteen weeks in the PT group and with better ASK-p scores in the no-PT group at these time points (p = 0.01 and 0.02, respectively). There were no differences between the groups with respect to elbow motion in the injured arm at any time. Severity of injury had no impact on function or elbow motion in either the PT or the no-PT group. Conclusions: Children undergoing closed treatment of a supracondylar humeral fracture that was limited to approximately three weeks of cast immobilization received no benefit involving either return of function or elbow motion from a short course of physical therapy. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. PMID:24897743

Three dimensional printing technology and materials for treatment of elbow fractures.

PubMed

Yang, Long; Grottkau, Brian; He, Zhixu; Ye, Chuan

2017-11-01

3D printing is a rapid prototyping technology that uses a 3D digital model to physically build an object. The aim of this study was to evaluate the peri-operative effect of 3D printing in treating complex elbow fractures and its role in physician-patient communication and determine which material is best for surgical model printing. Forty patients with elbow fractures were randomly divided into a 3D printing-assisted surgery group (n = 20) and a conventional surgery group (n = 20). Surgery duration, intra-operative blood loss, anatomic reduction rate, incidence of complications and elbow function score were compared between the two groups. The printing parameters, the advantages and the disadvantages of PLA and ABS were also compared. The independent-samples t-test was used to compare the data between groups. A questionnaire was designed for orthopaedic surgeons to evaluate the verisimilitude, the appearance of being true or real, and effectiveness of the 3D printing fracture model. Another questionnaire was designed to evaluate physician-patient communication effectiveness. The 3D group showed shorter surgical duration, lower blood loss and higher elbow function score, compared with the conventional group. PLA is an environmentally friendly material, whereas ABS produce an odour in the printing process. Curling edges occurred easily in the printing process with ABS and were observed in four of ten ABS models but in only one PLA model. The overall scores given by the surgeons about the verisimilitude and effectiveness of the 3D model were relatively high. Patient satisfaction scores for the 3D model were higher than those for the 2D imaging data during physician-patient discussions. 3D-printed models can accurately depict the anatomic characteristics of fracture sites, help surgeons determine a surgical plan and represent an effective tool for physician-patient communication. PLA is more suitable for desktop fused deposition printing in surgical modeling applications.

Randomised, prospective, non-blinded pilot study comparing the effect of intramuscular steroid injections and intralesional steroid injections in the management of tennis elbow

PubMed Central

Tahir, Hasan; Biro, Izolda; Donnelly, Simon; Greenwood, Mandy

2016-01-01

Background Tennis elbow is an overuse injury affecting people performing repetitive forearm movements. It is a soft tissue disorder that causes significant disability and pain. The aim of the study was to establish that an intramuscular steroid injection is effective in the short-term pain relief and functional improvement of tennis elbow. The severity of pain at the injection site was monitored to determine whether the intramuscular injection is better tolerated than the intralesional injection. Methods and results 19 patients, who had no treatment for tennis elbow in the preceding 3 months, were recruited from Whipps Cross University Hospital, London, and were randomised to receive either 80 mg of intramuscular Depo-Medrone or 40 mg of intralesional Depo-Medrone injection. Blinding proved difficult as the injection sites differed and placebo arms were not included in the study. A Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire and a 10-point Likert scale were used to assess primary outcome. Six weeks after the treatment, there was a reduction in pain, improvement in function and total PRTEE scores in both intramuscular and intralesional groups (p=0.008) using a 95% CI for mean treatment difference of −26 to +16 points. A statistically significant result (p=0.001) in favour of intramuscular causing less pain at the injection site was noted. Conclusion Non-inferiority of intramuscular to intralesional injections was not confirmed; however, the intramuscular injection proved to be effective in reducing tennis elbow-related symptoms and was found less painful at the site of injection at the time of administration. Trial registration number EUDRACT Number: 2010-022131-11. REC Number: 10/H0718/76 (NRES, Central London REC 1). PMID:28879024

Screw fixation versus arthroplasty versus plate fixation for 3-part radial head fractures.

PubMed

Wu, P H; Shen, L; Chee, Y H

2016-04-01

To compare the outcome following headless compression screw fixation versus radial head arthroplasty versus plate fixation for 3-part Mason types III or IV radial head fracture. Records of 25 men and 16 women aged 21 to 80 (mean, 43.3) years who underwent fixation using 2 to 3 2-mm cannulated headless compression screws (n=16), radial head arthroplasty (n=13), or fixation with a 2-mm Synthes plate (n=12) for 3-part Mason types III or IV radial head and neck fracture were reviewed. Treatment option was decided by the surgeon based on the presence of associated injury, neurovascular deficit, and the Mason classification. Bone union, callus formation, and complications (such as heterotopic ossification, malunion, and nonunion) were assessed by an independent registrar or consultant using radiographs. The Mayo Elbow Performance Score and range of motion were assessed by an independent physiotherapist. The median age of the 3 groups were comparable. Associated injuries were most common in patients with arthroplasty, followed by screw fixation and plate fixation (61.5% vs. 50% vs. 33%, p=0.54). The median time to bone union was shorter after screw fixation than plate fixation (55 vs. 86 days, p=0.05). No patient with screw fixation had nonunion, but 4 patients with plate fixation had nonunion. The 3 groups were comparable in terms of the mean Mayo Elbow Performance Score (p=0.56) and the mean range of motion (p=0.45). The complication rate was highest after plate fixation, followed by screw fixation and arthroplasty (50% vs. 18.8% vs. 15.4%, p=0.048). Excluding 20 patients with associated injuries (8 in screw fixation, 8 in arthroplasty, and 4 in plate fixation), the 3 groups were comparable in terms of the median time to bone union (p=0.109), mean Mayo Elbow Performance Score (p=0.260), mean range of motion (p=0.162), and complication rate (p=0.096). Headless compression screw fixation is a viable option for 3-part radial head fracture. It achieves earlier bone union with fewer complications.

Latissimus dorsi transfer for irreparable subscapularis tendon tears.

PubMed

Mun, Sang Won; Kim, Ji Young; Yi, Seung Hoon; Baek, Chang Hee

2018-06-01

There are several tendon transfers for reconstruction of irreparable subscapularis tears. The latissimus dorsi (LD) could be used because its direction and function are similar to those of the subscapularis. We performed LD transfers for irreparable subscapularis tears and evaluated clinical outcomes. The study enrolled 24 consecutive patients who underwent LD transfers. Clinical and functional outcomes were evaluated using the Constant score, American Shoulder and Elbow Surgeons score, pain visual analog scale, and range of shoulder motion preoperatively and at last follow-up. The lift-off and belly-press tests were performed to assess subscapularis integrity and function. Magnetic resonance imaging was performed preoperatively and 1 year postoperatively to evaluate tendon integrity. Mean Constant, American Shoulder and Elbow Surgeons, and pain scores improved from 46 ± 6 to 69 ± 5 (P < .001), from 40 ± 3 to 70 ± 5 (P < .001), and from 6 ± 1 to 2 ± 1 (P = .006), respectively. The mean range of motion for forward elevation and internal rotation increased from 135° ± 17° to 166° ± 15° (P = .016) and from L5 to L1 (P = .010), respectively. Improvement in the range of motion for external rotation was not significant (51° ± 7° to 68° ± 7°; P = .062). At final follow-up, the belly-press test results were negative for 18 of 24 patients, and the lift-off test results were negative for 16 of 20 patients. No complications related to tendon transfer, including axillary and radial nerve injuries, were found. No retearing of the transferred LD was observed. LD transfer resulted in pain relief and restoration of shoulder range of motion and function. LD transfer could be considered an effective and safe salvage treatment for irreparable subscapularis tears. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Does arthroscopic rotator cuff repair improve patients' activity levels?

PubMed

Baumgarten, Keith M; Chang, Peter S; Dannenbring, Tasha M; Foley, Elaine K

2018-06-04

Rotator cuff repair decreases pain, improves range of motion, and increases strength. Whether these improvements translate to an improvement in a patient's activity level postoperatively remains unknown. The Shoulder Activity Level is a valid and reliable outcomes survey that can be used to measure a patient's shoulder-specific activity level. Currently, there are no studies that examine the effect of rotator cuff repair on shoulder activity level. Preoperative patient-determined outcomes scores collected prospectively on patients undergoing rotator cuff repair were compared with postoperative scores at a minimum of 2 years. These scores included the Shoulder Activity Level, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, and simple shoulder test. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. Included were 281 shoulders from 273 patients with a mean follow-up of 3.7 years. The postoperative median Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), Single Assessment Numeric Evaluation (30 vs. 95), and simple shoulder test (4 vs. 11) scores were statistically significantly improved compared with preoperative scores (P < .0001). The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11; P < .0001). Patients reported a statistically significant deterioration of their Shoulder Activity Level score after rotator cuff repair compared with their preoperative scores, although disease-specific and joint-specific quality of life scores all had statistically significantly improvement. This study suggests that patients generally have (1) significant improvements in their quality of life and (2) small deteriorations in activity level after arthroscopic rotator cuff repair. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Tennis Elbow Diagnosis Using Equivalent Uniform Voltage to Fit the Logistic and the Probit Diseased Probability Models

PubMed Central

Lin, Wei-Chun; Lin, Shu-Yuan; Wu, Li-Fu; Guo, Shih-Sian; Huang, Hsiang-Jui; Chao, Pei-Ju

2015-01-01

To develop the logistic and the probit models to analyse electromyographic (EMG) equivalent uniform voltage- (EUV-) response for the tenderness of tennis elbow. In total, 78 hands from 39 subjects were enrolled. In this study, surface EMG (sEMG) signal is obtained by an innovative device with electrodes over forearm region. The analytical endpoint was defined as Visual Analog Score (VAS) 3+ tenderness of tennis elbow. The logistic and the probit diseased probability (DP) models were established for the VAS score and EMG absolute voltage-time histograms (AVTH). TV50 is the threshold equivalent uniform voltage predicting a 50% risk of disease. Twenty-one out of 78 samples (27%) developed VAS 3+ tenderness of tennis elbow reported by the subject and confirmed by the physician. The fitted DP parameters were TV50 = 153.0 mV (CI: 136.3–169.7 mV), γ 50 = 0.84 (CI: 0.78–0.90) and TV50 = 155.6 mV (CI: 138.9–172.4 mV), m = 0.54 (CI: 0.49–0.59) for logistic and probit models, respectively. When the EUV ≥ 153 mV, the DP of the patient is greater than 50% and vice versa. The logistic and the probit models are valuable tools to predict the DP of VAS 3+ tenderness of tennis elbow. PMID:26380281

Effect of window length on performance of the elbow-joint angle prediction based on electromyography

NASA Astrophysics Data System (ADS)

Triwiyanto; Wahyunggoro, Oyas; Adi Nugroho, Hanung; Herianto

2017-05-01

The high performance of the elbow joint angle prediction is essential on the development of the devices based on electromyography (EMG) control. The performance of the prediction depends on the feature of extraction parameters such as window length. In this paper, we evaluated the effect of the window length on the performance of the elbow-joint angle prediction. The prediction algorithm consists of zero-crossing feature extraction and second order of Butterworth low pass filter. The feature was used to extract the EMG signal by varying window length. The EMG signal was collected from the biceps muscle while the elbow was moved in the flexion and extension motion. The subject performed the elbow motion by holding a 1-kg load and moved the elbow in different periods (12 seconds, 8 seconds and 6 seconds). The results indicated that the window length affected the performance of the prediction. The 250 window lengths yielded the best performance of the prediction algorithm of (mean±SD) root mean square error = 5.68%±1.53% and Person’s correlation = 0.99±0.0059.

Design and application of nickel-titanium olecranon memory connector in treatment of olecranon fractures: a prospective randomized controlled trial.

PubMed

Chen, Xiao; Liu, Peng; Zhu, Xiaofei; Cao, Liehu; Zhang, Chuncai; Su, Jiacan

2013-06-01

We carried out this study to test the efficacy of the olecranon memory connector (OMC) in olecranon fractures. We designed a prospective randomised controlled trial involving 40 cases of olecranon fractures. From May 2004 to December 2009, 40 patients with olecranon fractures were randomly assigned into two groups. Twenty patients were treated with OMC, while another 20 patients were fixed with locking plates in our hospital. The DASH score, MEP score, range of motion and radiographs were used to evaluate the postoperative elbow function and complications. For MEP score, OMC was better than the locking plate; for DASH score, complication rate, and range of elbow motion, the two methods presented no significant difference. The study showed that OMC could be an effective alternative to treat olecranon fractures.

Coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures.

PubMed

Cho, Chul-Hyun; Jung, Jae-Hoon; Kim, Beom-Soo

2017-05-01

The purpose of this study was to evaluate the radiologic and clinical outcomes of coracoclavicular (CC) stabilization using a suture button device for Neer type IIB lateral clavicle fractures. Eighteen consecutive patients with Neer type IIB fractures were treated with CC stabilization using a TightRope device (Arthrex, Naples, FL, USA). The mean follow-up period was 46.6 months (range, 24-75 months). Radiologic outcomes were assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale pain score; University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; and subjective shoulder value. Intraoperative and postoperative complications were also evaluated. Of the 18 cases, 17 (94.4%) showed complete bony union. The mean final visual analog scale pain score was 1.1; University of California, Los Angeles score, 31.3; American Shoulder and Elbow Surgeons score, 88.6; and subjective shoulder value, 88.5%. Four complications were observed: (1) intraoperative coracoid process fracture, (2) nonunion, (3) delayed union, and (4) shoulder stiffness. The case with a coracoid process fracture during coracoid tunnel generation was converted to the K-wire tension band technique. CC stabilization using a suture button device for Neer type IIB lateral clavicle fractures yielded satisfactory radiologic and clinical outcomes. The major advantage of this technique is that implant removal is not required. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Measurement of ulnar subtrochlear sclerosis using a percentage scale in labrador retrievers with minimal radiographic signs of periarticular osteophytosis.

PubMed

Smith, Thomas J; Fitzpatrick, Noel; Evans, Richard B; Pead, Mathew J

2009-02-01

To report the development of a measurement method for quantifying ulnar subtrochlear sclerosis (STS) in Labrador Retrievers. Prospective blinded study. Radiographs of Labrador Retrievers elbows (n=30) with minimal radiographic signs of periarticular osteophytosis. Measurement of STS as a % of the distance between 2 standardized radiographic landmarks (%STS) was developed. Mediolateral radiographic projections of flexed elbows were collected from 2 cohorts termed diseased (n=15; confirmed disease of the medial coronoid process) and control (n=15; free from clinically evident disease). Five observers blindly assessed each radiograph for radiographic technique, elbow positioning, periarticular osteophytosis, and STS, which, if present, was measured and assigned a %STS score. Intraobserver and interobserver variations in measuring STS and the ability to differentiate study cohorts were assessed using receiver operator curve (ROC) characteristics. A P-value of <.05 was considered significant. Median %STS for diseased elbows was 47% (range, 0-74%) and 0% (range, 0-62%) for control elbows. Correlations were not significantly different between each observer's assessments of %STS, with a median Spearman's P-value of .75 (range, .67-.86). All observers differentiated the 2 cohorts with "fair-good" accuracy, with a median ROC value of 0.81 (range, 0.75-0.88). Measurement of %STS in Labrador Retrievers was repeatable for each observer and repeatable between observers. A method for measuring STS allows comparison of Labrador Retrievers of different sizes, is easy to perform, and could be used to investigate the clinical significance of STS in this breed.

Comparative Readability of Shoulder and Elbow Patient Education Materials within Orthopaedic Websites.

PubMed

Beutel, Bryan G; Danna, Natalie R; Melamed, Eitan; Capo, John T

2015-12-01

There is growing concern that the readability of online orthopaedic patient education materials are too difficult for the general public to fully understand. It is recommended that this information be at the sixth grade reading level or lower. This study compared the readability of shoulder and elbow education articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites. Seventy-six patient education articles from the AAOS and ASSH concerning shoulder and elbow disorders were evaluated. Each article was assessed for the number of years since its last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. Only one article was at or below the sixth grade reading level. The AAOS and ASSH articles had the following respective scores: a mean Flesch Reading Ease score of 54.3 and 51.8, Flesch-Kincaid grade level of 9.4 and 10.3, SMOG grade of 8.5 and 9.4, and New Dale-Chall grade of 10.4 and 11.0. Articles from the AAOS were longer (p < 0.001), had a lower percentage of passive sentences (p < 0.001), and were more recently updated (p = 0.02) than their ASSH counterparts. Higher percentages of passive sentences were found to correlate with more difficult readability. Patient education materials regarding the shoulder and elbow on the AAOS and ASSH websites have readability scores above the recommended reading level. These may be too challenging for the majority of patients to read and consequently serve as a barrier to proper patient education. Reducing the percentage of passive sentences may serve as a novel target for improving readability.

Infraclavicular versus axillary nerve catheters: A retrospective comparison of early catheter failure rate.

PubMed

Quast, Michaela B; Sviggum, Hans P; Hanson, Andrew C; Stoike, David E; Martin, David P; Niesen, Adam D

2018-05-01

Continuous brachial plexus catheters are often used to decrease pain following elbow surgery. This investigation aimed to assess the rate of early failure of infraclavicular (IC) and axillary (AX) nerve catheters following elbow surgery. Retrospective study. Postoperative recovery unit and inpatient hospital floor. 328 patients who received IC or AX nerve catheters and underwent elbow surgery were identified by retrospective query of our institution's database. Data collected included unplanned catheter dislodgement, catheter replacement rate, postoperative pain scores, and opioid administration on postoperative day 1. Catheter failure was defined as unplanned dislodging within 24 h of placement or requirement for catheter replacement and evaluated using a covariate adjusted model. 119 IC catheters and 209 AX catheters were evaluated. There were 8 (6.7%) failed IC catheters versus 13 (6.2%) failed AX catheters. After adjusting for age, BMI, and gender there was no difference in catheter failure rate between IC and AX nerve catheters (p = 0.449). These results suggest that IC and AX nerve catheters do not differ in the rate of early catheter failure, despite differences in anatomic location and catheter placement techniques. Both techniques provided effective postoperative analgesia with median pain scores < 3/10 for patients following elbow surgery. Reasons other than rate of early catheter failure should dictate which approach is performed. Copyright © 2018. Published by Elsevier Inc.

Treatment of Ulnar Collateral Ligament Tears of the Elbow: Is Repair a Viable Option?

PubMed

Erickson, Brandon J; Bach, Bernard R; Verma, Nikhil N; Bush-Joseph, Charles A; Romeo, Anthony A

2017-01-01

Ulnar collateral ligament (UCL) tears have become common, and UCL reconstruction (UCLR) is currently the preferred surgical treatment method for treating UCL tears. The purpose of this study was to review the literature surrounding UCL repair and determine the viability of new repair techniques for treatment of UCL tears. We hypothesized that UCL repair techniques will provide comparable results to UCLR for treatment of UCL tears. Systematic review and meta-analysis; Level of evidence, 4. A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Biomechanical and clinical outcome investigations reporting on UCL repair with levels of evidence 1 through 4 were eligible for inclusion. Descriptive statistics were calculated for each study and parameter/variable analyzed. Of the 46 studies eligible, 4 studies (3 clinical and 1 biomechanical) were included. There were 92 patients (n = 92 elbows; 61 males [62.3%]; mean age, 21.9 ± 4.7 years) included in the clinical studies, with a mean follow-up of 49 ± 14.4 months. Eighty-six percent of repairs performed were on the dominant elbow, and 38% were in college athletes. Most UCL repairs (66.3%) were performed via suture anchors. After UCL repair, 87.0% of patients were able to return to sport. Overall, 94.9% of patients scored excellent/good on the Andrews-Carson score. Patients who were able to return to sport after UCL repair did so within 6 months after surgery. Biomechanically, when UCL repair was compared with the modified Jobe technique, the repair group showed significantly less gap formation than the reconstruction group. In patients for whom repair is properly indicated, UCL repair provides similar return-to-sport rates and clinical outcomes with shorter return-to-sport timing after repair compared with UCL reconstruction. Future outcome studies evaluating UCL repair with internal bracing are necessary before recommending this technique.

Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures.

PubMed

Hughes, Meghan; Dua, Karan; O'Hara, Nathan N; Brighton, Brian K; Ganley, Theodore J; Hennrikus, William L; Herman, Martin J; Hyman, Joshua E; Lawrence, J Todd; Mehlman, Charles T; Noonan, Kenneth J; Otsuka, Norman Y; Schwend, Richard M; Shrader, M Wade; Smith, Brian G; Sponseller, Paul D; Abzug, Joshua M

2017-10-18

Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes. Level V.

Clavicle hook plate fixation for distal-third clavicle fracture (Neer type II): comparison of clinical and radiologic outcomes between Neer types IIA and IIB.

PubMed

Lee, Wonyong; Choi, Chong-Hyuk; Choi, Yun-Rak; Lim, Kyung-Han; Chun, Yong-Min

2017-07-01

The purpose of this study was to investigate clinical and radiologic outcomes of clavicle hook plate fixation for distal-third clavicle fracture (Neer type II) and to compare the clinical and radiologic outcomes and complications between Neer type IIA and type IIB. We retrospectively reviewed 35 patients who underwent open reduction and internal fixation with AO hook locking compression plate (LCP) for distal clavicle fracture, including 13 patients with Neer type IIA and 22 patients with type IIB. Visual analog scale pain score, shoulder scores (subjective shoulder value, University of California-Los Angeles shoulder score, American Shoulder and Elbow Surgeons score), and active range of motion were evaluated to determine clinical outcome. Coracoclavicular distance was measured, and that of the injured side at last follow-up was compared with that of the uninjured side to evaluate radiologic outcomes. AO hook LCP fixation for distal-third clavicle fracture (Neer type II) produced satisfactory radiologic outcomes, including high union rates (100%) and coracoclavicular distance maintenance, as well as satisfactory clinical outcomes, including visual analog scale score for pain, shoulder scores (subjective shoulder value, University of California-Los Angeles shoulder score, American Shoulder and Elbow Surgeons score), and active range of motion. There were no significant differences between Neer type IIA and type IIB. With regard to complications, 22.9% of patients experienced shoulder stiffness and 17.1% had subacromial erosion; however, there were no significant differences between the 2 groups. The AO hook LCP is a suitable choice for Neer type IIA and type IIB distal-third clavicle fracture fixation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Ultrasound-Guided Elbow Procedures.

PubMed

Sussman, Walter I; Williams, Christopher J; Mautner, Ken

2016-08-01

High-resolution ultrasonography can help clinicians visualize key anatomic structures of the elbow and guide periarticular and intra-articular injections. Historically, most procedures done around the elbow have been done using landmark guidance, and few studies have reported the accuracy of ultrasonography-guided injections in the elbow region. This article reviews common musculoskeletal disorders about the elbow that can be evaluated with ultrasonography, reviews the literature on ultrasonography-guided injections of the elbow region, and describes the senior author's preferred approach for the most commonly performed elbow region injections. Copyright © 2016 Elsevier Inc. All rights reserved.

Biologic resurfacing arthroplasty with acellular human dermal allograft and platelet-rich plasma (PRP) in young patients with glenohumeral arthritis-average of 60 months of at mid-term follow-up.

PubMed

Lo, Eddie Y; Flanagin, Brody A; Burkhead, Wayne Z

2016-07-01

The treatment of young patients with glenohumeral arthritis has been challenging. Alternative treatment options include activity modification, arthroscopic débridement, and arthroplasty. Addressing the glenoid during arthroplasty in this population of patients continues to be a significant challenge. In this study, we evaluated the midterm outcomes of hemiarthroplasty with biologic resurfacing of the glenoid with human dermal matrix allograft. Between 2004 and 2011, 55 patients underwent hemiarthroplasty and biologic resurfacing of the glenoid with human dermal matrix allograft. The average age was 50 ± 9 years. Subjective evaluation was performed with the Western Ontario Osteoarthritis of the Shoulder Index, American Shoulder and Elbow Surgeons score, visual analog scale, and Single Assessment Numeric Evaluation. Patients returned to the clinic for clinical examination and radiographic evaluation. The average follow-up was 60 months. The average postoperative American Shoulder and Elbow Surgeons score was 76 ± 22, and the Western Ontario Osteoarthritis of the Shoulder Index score was 76% ± 22%. The visual analog scale score was 2.4 ± 2.6. The average preoperative Single Assessment Numeric Evaluation score was 33% ± 22%, which significantly improved to 72% ± 22% postoperatively. Eighty-one percent of the patients were satisfied (10/47) or highly satisfied (28/47) with their result. With radiographic evaluation, the average joint space was 1 ± 1 mm preoperatively and 2 ± 1 mm postoperatively. A total of 5 cases (9.1%) were revised to anatomic total shoulder arthroplasty with implantation of a glenoid component. Hemiarthroplasty with biologic resurfacing of the glenoid using human dermal matrix allograft can lead to successful midterm outcomes with satisfactory complication and revision rates. Both patient satisfaction and clinical outcome remain high regardless of radiographic outcome. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability.

PubMed

Kniesel, Bettina; Huth, Jochen; Bauer, Gerhard; Mauch, Frieder

2014-12-01

In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy. We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction. Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation. Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate. Level III.

Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow.

PubMed

Schnetzke, Marc; Schüler, Svenja; Keil, Holger; Aytac, Sara; Studier-Fischer, Stefan; Grützner, Paul-Alfred; Guehring, Thorsten

2016-07-26

The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient's own range of motion (ROM) of the wrist and the elbow. In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers' compensation cases). Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers' compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire. The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM. Diagnostic study, Level II.

[Validation of the German version of the Oxford Elbow Score : A cross-sectional study].

PubMed

Marquardt, J; Schöttker-Königer, T; Schäfer, A

2016-08-01

Elbow complaints are complex problems leading to severe consequences for affected people and the healthcare system. The German version of the Oxford Elbow Score (OES) is the first German-speaking instrument that specifically measures elbow complaints from the patient's perspective and changes of their health status. The aim of this study is the validation of the German version of the OES. In this context the internal consistency and the construct validity were investigated. 59 patients with elbow complaints completed the German version of the OES, the DASH and the SF-36 in a cross-sectional study. The internal consistency was calculated with Cronbach's alpha coefficients. Spearman's correlation coefficients were used to confirm construct validity. Cronbach's alpha for pain, function and psychological subscales was 0.88, 0.81 and 0.90, respectively. The whole questionnaire presents a Cronbach's alpha value of 0.93. Convergent construct validity was confirmed with correlation coefficients containing values of -0.84, -0.77 and -0.82 compared to DASH and values ranging from 0.41 to 0.80 compared with the physical domains of the SF-36. The divergent construct validity presented values ranging from 0.07 to 0.20 with the SF-36 domains of "general health perception" and "mental health". The German OES is an internal consistent instrument with good convergent and divergent construct validity. Other aspects of the validity, the reliability and the responsiveness should be confirmed through further studies.

Rehabilitation of the elbow extension with motor imagery in a patient with quadriplegia after tendon transfer.

PubMed

Grangeon, Murielle; Guillot, Aymeric; Sancho, Pierre-Olivier; Picot, Marion; Revol, Patrice; Rode, Gilles; Collet, Christian

2010-07-01

To test the effect of a postsurgical motor imagery program in the rehabilitation of a patient with quadriplegia. Crossover design with kinematic analysis. Rehabilitation Hospital of Lyon. Study approved by the local Human Research Ethics Committee. C6-level injured patient (American Spinal Injury Association Impairment Scale grade A) with no voluntary elbow extension (triceps brachialis score 1). The surgical procedure was to transfer the distal insertion of the biceps brachii onto the triceps tendon of both arms. The postsurgical intervention on the left arm included 10 sessions of physical rehabilitation followed by 10 motor imagery sessions of 30 minutes each. The patient underwent 5 sessions a week during 2 consecutive weeks. The motor imagery content included mental representations based on elbow extension involved in goal-directed movements. The rehabilitation period of the right arm was reversed, with motor imagery performed first, followed by physical therapy. The kinematics of upper-limb movements was recorded (movement time and variability) before and after each type of rehabilitation period. A long-term retention test was performed 1 month later. Motor imagery training enhanced motor recovery by reducing hand trajectory variability-that is, improving smoothness. Motor performance then remained stable over 1 month. Motor imagery improved motor recovery when associated with physical therapy, with motor performance remaining stable over the 1-month period. We concluded that motor imagery should be successfully associated with classic rehabilitation procedure after tendon transfer. Physical sessions may thus be shortened if too stressful or painful. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Functional outcomes after bilateral arthroscopic rotator cuff repair.

PubMed

Aleem, Alexander W; Syed, Usman Ali M; Wascher, Jocelyn; Zoga, Adam C; Close, Koby; Abboud, Joseph A; Cohen, Steven B

2016-10-01

Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Clinico-radiological Outcome Analysis of Parallel Plating with Perpendicular Plating in Distal Humeral Intra-articular Fractures: Prospective Randomised Study

PubMed Central

Shekhawat, Vishal; Banshiwal, Ramesh Chandra; Verma, Rajender Kumar

2017-01-01

Introduction The distal humeral fractures are common fractures of upper limb and are difficult to treat. These fractures, if left untreated or inadequately treated, leads to poor outcomes. Management of distal humeral fractures are pertained to many controversies and one among them is position of plates. Aim To compare the clinical and radiological outcomes in patients with intra-articular distal humerus fractures, treated using parallel and perpendicular double plating methods. Materials and Methods A total of 38 patients with distal humerus fractures, 20 in perpendicular plating group (group A) and 18 in parallel plating group (group B), were included in this prospective randomised study. At each follow up patients were evaluated clinically and radiologically for union and the outcomes were measured in terms of Mayo Elbow Performance Score (MEPS) consisting of pain intensity, range of motion, stability and function. MEP score greater than 90 is considered as excellent; Score 75 to 89 is good; Score 60 to 74 is fair and Score less than 60 is poor. Results In our study, 15 patients (75%) in group A, and 13 patients (72.22%) in group B achieved excellent results. Two patients (10%) in group A and 4 patients (22.22%) in group B attained good results. Complications developed in 2 patients in each groups. No significant differences were found between the clinical outcomes of the two plating methods. Conclusion Neither of the plating techniques are superior to the other, as inferred from the insignificant differences in bony union, elbow function and complications between the two plating techniques. PMID:28384948

Clinico-radiological Outcome Analysis of Parallel Plating with Perpendicular Plating in Distal Humeral Intra-articular Fractures: Prospective Randomised Study.

PubMed

Govindasamy, Ramachandran; Shekhawat, Vishal; Banshiwal, Ramesh Chandra; Verma, Rajender Kumar

2017-02-01

The distal humeral fractures are common fractures of upper limb and are difficult to treat. These fractures, if left untreated or inadequately treated, leads to poor outcomes. Management of distal humeral fractures are pertained to many controversies and one among them is position of plates. To compare the clinical and radiological outcomes in patients with intra-articular distal humerus fractures, treated using parallel and perpendicular double plating methods. A total of 38 patients with distal humerus fractures, 20 in perpendicular plating group (group A) and 18 in parallel plating group (group B), were included in this prospective randomised study. At each follow up patients were evaluated clinically and radiologically for union and the outcomes were measured in terms of Mayo Elbow Performance Score (MEPS) consisting of pain intensity, range of motion, stability and function. MEP score greater than 90 is considered as excellent; Score 75 to 89 is good; Score 60 to 74 is fair and Score less than 60 is poor. In our study, 15 patients (75%) in group A, and 13 patients (72.22%) in group B achieved excellent results. Two patients (10%) in group A and 4 patients (22.22%) in group B attained good results. Complications developed in 2 patients in each groups. No significant differences were found between the clinical outcomes of the two plating methods. Neither of the plating techniques are superior to the other, as inferred from the insignificant differences in bony union, elbow function and complications between the two plating techniques.

Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction.

PubMed

Neuman, Brian J; Boisvert, C Brittany; Reiter, Brian; Lawson, Kevin; Ciccotti, Michael G; Cohen, Steven B

2011-09-01

The majority of the literature on surgical outcomes of superior labral anterior posterior (SLAP) repairs has focused on short-term follow-up of 1 to 2 years, not allowing adequate time for full rehabilitation and return to maximum level of competition for all types of athletes. Also, previous studies have concentrated on using questionnaires that primarily evaluate patients' activities of daily living, which do not focus on sport-specific performance. To determine the midterm results of type II SLAP repairs in overhead athletes, focusing primarily on athletic performance as well as activities of daily living. Case series; Level of evidence, 4. A retrospective review of 30 overhead athletes, who underwent an arthroscopic superior labral repair for a symptomatic type II SLAP tear between 2002 and 2007, was performed. Our study population included 22 male and 8 female patients with a mean age at the time of surgery of 24 years. Twenty-one patients participated in baseball or softball, and the remainder of patients were involved in javelin throwing or tennis. The average follow-up was 3.5 years. The outcome of treatment was evaluated using the American Shoulder and Elbow Society (ASES) scoring system, assessing activities of daily living, and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) score, assessing sport-specific performance. In addition, the length of time to return to sport and the degree of successful performance were evaluated. Repairs resulted in ASES scores comparable with those from prior published studies (average ASES score, 87.9). The KJOC score averaged 73.6. The athletes' perception was that they returned to approximately 84.1% of their preinjury level of function with a mean time to return to play of 11.7 months. There was a significant drop in the ASES to KJOC score for the baseball/softball players (87.9 ± 14.94 and 72 ± 19.24, respectively; P = .006). Patients reported an overall satisfaction rate of 93.3% with the procedure, with the majority being very satisfied. Arthroscopic SLAP repairs show excellent results and a high rate of overall satisfaction; however, the outcomes are less reliable in throwers. The KJOC score provides a more stringent assessment of overhead athletes' function after SLAP repair than the ASES score. Our findings also indicate that SLAP repairs lead to improved shoulder function during routine daily activities but that consistent return to elite throwing sports may still remain somewhat problematic.

Physical risk factors identification based on body sensor network combined to videotaping.

PubMed

Vignais, Nicolas; Bernard, Fabien; Touvenot, Gérard; Sagot, Jean-Claude

2017-11-01

The aim of this study was to perform an ergonomic analysis of a material handling task by combining a subtask video analysis and a RULA computation, implemented continuously through a motion capture system combining inertial sensors and electrogoniometers. Five workers participated to the experiment. Seven inertial measurement units, placed on the worker's upper body (pelvis, thorax, head, arms, forearms), were implemented through a biomechanical model of the upper body to continuously provide trunk, neck, shoulder and elbow joint angles. Wrist joint angles were derived from electrogoniometers synchronized with the inertial measurement system. Worker's activity was simultaneously recorded using video. During post-processing, joint angles were used as inputs to a computationally implemented ergonomic evaluation based on the RULA method. Consequently a RULA score was calculated at each time step to characterize the risk of exposure of the upper body (right and left sides). Local risk scores were also computed to identify the anatomical origin of the exposure. Moreover, the video-recorded work activity was time-studied in order to classify and quantify all subtasks involved into the task. Results showed that mean RULA scores were at high risk for all participants (6 and 6.2 for right and left sides respectively). A temporal analysis demonstrated that workers spent most part of the work time at a RULA score of 7 (right: 49.19 ± 35.27%; left: 55.5 ± 29.69%). Mean local scores revealed that most exposed joints during the task were elbows, lower arms, wrists and hands. Elbows and lower arms were indeed at a high level of risk during the total time of a work cycle (100% for right and left sides). Wrist and hands were also exposed to a risky level for much of the period of work (right: 82.13 ± 7.46%; left: 77.85 ± 12.46%). Concerning the subtask analysis, subtasks called 'snow thrower', 'opening the vacuum sealer', 'cleaning' and 'storing' have been identified as the most awkward for right and left sides given mean RULA scores and percentages of time spent at risky levels. Results analysis permitted to suggest ergonomic recommendations for the redesign of the workstation. Contributions of the proposed innovative system dedicated to physical ergonomic assessment are further discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hybrid external fixation in high-energy elbow fractures: a modular system with a promising future.

PubMed

Lerner, A; Stahl, S; Stein, H

2000-12-01

Severe, high-energy, periarticular elbow injuries producing a "floating joint" are a major surgical challenge. Their reconstruction and rehabilitation are not well documented. Therefore, the following reports our experience with treating such injuries caused by war wounds. Seven adults with compound open peri- and intra-articular elbow fractures were treated in hybrid ring tubular fixation frames. After debridement, bone stabilization, and neurovascular reconstructions, early controlled daily movements were started in the affected joint. These seven patients had together seven humeral, five radial, and six ulnar fractures. All fractures united at a median time of 180 days. No deep infection developed. The functional end results assessed by the Khalfayan functional score were excellent in two, good in one, and fair in four of these severely mangled upper extremities. None was amputated. The Mangled Extremity Severity Score has been shown to be unable to provide a reliable assessment for severe high-energy limb injuries surgically managed with the modular hybrid thin wire tubular external fixation system. This hybrid system is a very useful addition to the surgical armamentarium of orthopedic trauma surgeons. It both allows complex surgical reconstructions and reduces the incidence of deep infections in these heavily contaminated injuries. The hybrid circular (thin wire) external fixation system is very modular and may provide secure skeletal stabilization even in cases of severely comminuted juxta-articular fractures on both sides of the elbow joint (floating elbow) with severe damage to soft tissues. This fixation system allows individual fixation of forearm bone fractures, thus allowing the preservation of pronation-supination movements.

Elbow joint fatigue and bench-press training.

PubMed

Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2014-01-01

Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Controlled laboratory study. Motion research laboratory. A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Participants performed bench-press training until fatigued. Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.

Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial.

PubMed

Pandey, Vivek; Bandi, Atul; Madi, Sandesh; Agarwal, Lipisha; Acharya, Kiran K V; Maddukuri, Satish; Sambhaji, Charudutt; Willems, W Jaap

2016-08-01

Platelet-rich plasma (PRP) has the potential to improve tendon-bone healing. The evidence is still controversial as to whether PRP application after repair of medium-sized to large cuff tears leads to superior structural and clinical outcome, especially after single-row repair. In a randomized study, 102 patients (PRP group, 52 patients; control group, 50 patients) with medium-sized and large degenerative posterosuperior tears were included for arthroscopic repair with a minimum follow-up of 2 years. Patients were evaluated with clinical scores (visual analog scale score, Constant-Murley score, University of California-Los Angeles score, and American Shoulder and Elbow Surgeons score) and ultrasound to assess retear and vascularity pattern of the cuff. Visual analog scale scores were significantly lower in the PRP group than in controls at 1 month, 3 months, and 6 months but not later. Constant-Murley scores were significantly better in the PRP group compared with controls at 12 and 24 months, whereas University of California-Los Angeles scores were significantly higher in the PRP group at 6 and 12 months (P < .05). The American Shoulder and Elbow Surgeons score in both groups was comparable at all the times. At 24 months, retear in the PRP group (n = 2; 3.8%) was significantly lower than in the control group (n = 10; 20%; P = .01). The retear difference was significant only for large tears (PRP:control group, 1:6; P = .03). Doppler ultrasound examination showed significant vascularity in the PRP group repair site at 3 months postoperatively (P < .05) and in peribursal tissue until 12 months. Application of moderately concentrated PRP improves clinical and structural outcome in large cuff tears. PRP also enhances vascularity around the repair site in the early phase. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A clinical and ultrasonographic study of risk factors for elbow injury in young baseball players.

PubMed

Tajika, T; Kobayashi, T; Yamamoto, A; Kaneko, T; Shitara, H; Shimoyama, D; Iizuka, Y; Okamura, K; Yonemoto, Y; Warita, T; Ohsawa, T; Nakajima, I; Iizuka, H; Takagishi, K

2016-04-01

To determine the risk factors for elbow injury and its association with glenohumeral internal rotation deficit among young baseball players. 229 baseball players aged 9 to 14 (mean, 11) years completed a self-administered questionnaire with items related to years of playing baseball, hours of training per weekday, days of training per week, and past and present experience of elbow pain. Two orthopaedic surgeons measured the range of motion of both shoulders and elbows. Another 2 orthopaedic surgeons performed ultrasonography to detect any elbow abnormality such as fragmentation of the medial epicondylar apophysis and osteochondritis dissecans of the capitellum. Using univariate and multivariable analyses, participants with or without elbow abnormality were compared to determine the risk factors for elbow abnormality. Elbow abnormality was detected in 100 of the participants and comprised osteochondritis dissecans of the capitellum (n=18) and fragmentation of the medial epicondylar apophysis (n=82). Elbow abnormality was associated with being a pitcher, past and present experience of elbow pain, loss of elbow extension, and the side-to-side internal rotation difference. The 100 participants with elbow abnormality were stratified into symptomatic (n=57) or asymptomatic (n=43) of elbow pain. Those with elbow abnormality and elbow pain was associated with being a pitcher. Being a pitcher was a risk factor for both elbow abnormality and elbow pain. Nonetheless, 43% of baseball players with elbow abnormality were asymptomatic. The use of ultrasonography was effective in detecting elbow abnormality and enabling early treatment.

Analysis of elbow muscle strength parameters in Brazilian jiu-jitsu practitioners.

PubMed

Follmer, Bruno; Dellagrana, Rodolfo André; de Lima, Luis Antonio Pereira; Herzog, Walter; Diefenthaeler, Fernando

2017-12-01

Upper-body dynamic and isometric maximum strength are essential components for success in Brazilian jiu-jitsu (BJJ). This study was aimed at analysing strength parameters in the elbow flexor and extensor muscles of BJJ practitioners. Participants (n = 28) performed maximum isometric contractions of elbow flexors and extensors to determine peak torque (PT), rate of force development (RFD), and the torque-angle (T-A) relationship at elbow angles of 45°, 60°, 75°, 90°, 105°, and 120°. Additionally, concentric and eccentric PTs were measured at 1.04 rad·s -1 . Student t-test and ANOVA were performed using α = 0.05. Elbow flexors were stronger isometrically (P < 0.001, ES = 1.23) but weaker concentrically (P < 0.05, ES = 0.54) than extensor muscles, possibly because of the extensive grip disputes and pushing of opponents in BJJ. The T-A relationship had an inverted "U"-shape. Torque differences across elbow angles were moderate (ES = 0.62) for the extensor and large (ES = 0.92) for the flexor muscles. Isometric torque was greatest for elbow angles of 105° and 75° and smallest for 45° and 120° for extensor and flexor muscles, respectively. Elbow flexors had a greater RFD than extensors, regardless of elbow angle. The present study provides comprehensive results for elbow muscle strength in BJJ practitioners.

Primary versus revision arthroscopic reconstruction with remplissage for shoulder instability with moderate bone loss.

PubMed

McCabe, Michael P; Weinberg, Douglas; Field, Larry D; O'Brien, Michael J; Hobgood, E Rhett; Savoie, Felix H

2014-04-01

This study aims to evaluate our outcomes of arthroscopic remplissage in this setting. A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score. Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001). In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. All rights reserved.

Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment.

PubMed

Lawrence, J Todd R; Patel, Neeraj M; Macknin, Jonathan; Flynn, John M; Cameron, Danielle; Wolfgruber, Hayley C; Ganley, Theodore J

2013-05-01

The optimal treatment of medial epicondyle fractures in pediatric athletes remains unclear. To evaluate the outcomes of operative and nonoperative management of medial epicondyle fractures in young athletes. Case series; Level of evidence, 4. The records of all children with fractures of the medial epicondyle over a 5-year period, with a minimum 2 years of follow-up at a pediatric tertiary referral center, were reviewed. Patients with intra-articular entrapment of the fracture fragment or ulnar nerve entrapment were excluded. Treatment decisions were made primarily based on injury mechanism and elbow laxity or instability. Patients were contacted and asked to complete a modified Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Complete data with 2-year follow-up were available for 20 athletes: 6 treated nonoperatively and 14 treated operatively. At the latest follow-up, both groups achieved excellent DASH scores. Half of each cohort required physical therapy, and 6 of 14 patients who received operative treatment reported numbness. All patients were either very or completely satisfied with their treatment. Fourteen patients were overhead athletes (8 treated operatively, 6 nonoperatively). Excellent DASH scores were achieved in both groups, and all overhead athletes were able to return to their sport at the next appropriate level. Seven patients were baseball pitchers and sustained a fracture while throwing (4 treated operatively, 3 nonoperatively). None felt their performance was limited after treatment, and excellent DASH scores were achieved in both groups. These data demonstrate that nonoperative treatment can be successful in young athletes with low-energy medial epicondyle avulsions, a stable elbow, and minimal fracture displacement. Surgical management can be successful in athletes who sustain more significant trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement after a fracture of the medial epicondyle.

Pain, functional disability, and psychologic status in tennis elbow.

PubMed

Alizadehkhaiyat, Omid; Fisher, Anthony C; Kemp, Graham J; Frostick, Simon P

2007-01-01

First to compare pain and functional disability in tennis elbow (TE) patients with healthy controls. Second, to evaluate the relationship between the 2 major psychologic factors (anxiety and depression) and TE. Sixteen TE patients were recruited from 46 consecutive attendees at an upper limb clinic: inclusion criteria were lateral epicondyle tenderness, pain with resisted wrist and middle finger extension and at least 3 months localized lateral elbow pain. Sixteen healthy controls with no upper limb problem were recruited from students and staff. Participants were given 4 questionnaires, together with instructions for completion: Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, Patient-Rated Wrist Evaluation Questionnaire, and Hospital Anxiety and Depression Scale. The independent t test was used to compare the total and subscale scores between the groups. Significantly higher scores were found in TE for pain and function subscales and also total score for Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, and Patient-Rated Wrist Evaluation Questionnaire. For Hospital Anxiety and Depression Scale, both anxiety and depression subscales (P<0.001) and the total score (P<0.01) were significantly higher in TE. According to the anxiety and depression subscales, 55% and 36% of patients, respectively, were classified as probable cases (score >11). TE patients showed markedly increased pain and functional disability. Significantly elevated levels of depression and anxiety pointed out the importance of psychologic assessment in TE patients. In the development of supportive and treatment strategies, we suggest the combination of "upper limb" and "psychologic" assessment tools.

[Efficacies of arthroscopic debridement and olecranon fossa plasty in the treatment of osteoarthritis and posterior elbow impingement].

PubMed

Liu, Yu-jie; Wang, Jun-liang; Li, Hai-feng; Qi, Wei; Wang, Ning

2012-07-17

To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint. Between 1999 and 2008, a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement. There were 15 males and 6 females. And there were 16 right and 15 left cases. They included volleyball players (n = 7), tennis players (n = 7), golf enthusiasts (n = 4) and fencers (n = 3). The average duration of onset-operation was 3.5 years (range: 2.5 - 8). Arthroscopic exploration revealed synovial hyperplasia hypertrophy, cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa. Debridement and plasty were performed. Loose bodies were removed from elbow joint in 6 patients. Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area. Dynamic observation showed no posterior elbow impingement. Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up. The average follow-up period was 25.3 months (range: 18 - 42). All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale. The outcomes were excellent (n = 12), good (n = 7) and fair (n = 2). Postoperative patients elbow swelling and pain relieve, sports and life function returns to normal, elbow flexion and rotating mobility obviously improved. With the elbow radiological films to measure the range of motion, the average range of motion was 90.5° preoperatively and improved to 130° postoperatively. There was significant improvement in all cases. Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities. Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

[Case-control study on local injection of autoallergic platelet rich plasma or whole blood for the treatment of tennis elbow].

PubMed

Zhao, Li-Lai; Tong, Pei-Jian; Xiao, Lu-Wei; Zhu, Qiu-Liang; Xu, Bin; Yan, Mao-Hua

2014-11-01

To compare therapeutic effects of local injection with autoallergic platelet rich plasma (PRP) or autoallergic whole blood (AWB) for the treatment of chronic tennis elbow. From January 2011 to January 2014, 40 patients with chronic tennis elbow were divided into 2 groups, 20 cases in each group: PRP group and AWB group. There were 20 patients in PRP group treated with local injection of autoallergic platelet rich plasma, including 5 males and 15 females, with an average age of (47.50 ± 9.86) years old; and the average course of disease was (4.67 ± 3.27) months. Among the 20 patients in AWB group treated with local injection of autoallergic whole blood, 3 patients were male and 17 patients were female, with an average age of (46.50 ± 9.96) years old;and the average course of disease was (4.53 ± 2.27) months. The elbow joint was fixed with elastic stockings after injection. All the patients were guided to do strengthening and extension exercises during the follow-up period. Visual analog scale (VAS), Mayo scores for elbow and pressure pain threshold (PPT) were used to evaluate clinical effects after injection immediately and 4,8 weeks after treatment. Results:All the patients were followed up,there were no infections and swelling occurred. The VAS, Mayo and PPT scores of patients in PRP group were improved from pre-therapy 7.22 ± 1.32, 56.71 ± 10.90 and 17.47 ± 4.62 to 2.73 ± 1.00, 91.59 ± 6.95 and 21.35 ± 4.80 respectively 8 weeks after treatment. The VAS, Mayo and PPT scores of patients in AWB group were improved from pre-therapy 7.16 ±1.27, 54.72 ± 8.36 and 17.06 ± 4.83 to 3.81 ± 1.36, 82.06 ± 7.89 and 20.12 ± 4.97 respectively 8 weeks after treatment. All the pain and functional variables including VAS, PPT, and Mayo scores were improved significantly in both groups 4 weeks after injection. On the 4th week after injection, there was no statistically significant difference in PPT between two groups; while the VAS and Mayo score of AWB group were lower than those of PRP group. On the 8th week after injection, the VAS of AWB group was higher than that of PRP group; but the Mayo and PPT scores of AWB group were lower than those of PRP group. PRP and AWB injections are both effective to treat chronic lateral epicondylitis. Compared with AWB injection, PRP injection may be more effective in releasing pain and improving function for a longer time.

ANALYSIS OF THE PATTERN AND MECHANISM OF ELBOW INJURIES RELATED TO ARMBAR-TYPE ARMLOCKS IN JIU-JITSU FIGHTERS.

PubMed

Almeida, Thiago Bernardo Carvalho DE; Dobashi, Eiffel Tsuyoshi; Nishimi, Alexandre Yukio; Almeida, Eduardo Bernardo DE; Pascarelli, Luciano; Rodrigues, Luciano Miller Reis

2017-01-01

The objective of this study was to analyze elbow injuries and their probable mechanism in Jiu-Jitsu fighters resulting from the armbar-type armlock. We evaluated 5 high-performance Jiu-Jitsu fighters from the Gracie Elite gym who were injured during a tournament. All were healthy males with a mean age of 28.8 years. The right arm was involved in three patients (60%). The athletes were followed for approximately 4.6 months, and pain was present in all cases. Clinical examination of the elbow was performed immediately after the injury and when magnetic resonance imaging (MRI) was performed. The radiography showed no changes. Clinical examination detected specific tender points on the medial and anterior topography of the elbows, but no ligamentous instability of the elbow was seen during dynamic testing. The main MRI findings were injury to the common flexor tendon and the ulnar collateral ligament, bone contusion of the distal humerus and olecranon, and joint effusion. The main pattern of injury indicated by the MRI in the athletes was injury to the medial elbow complex. The primary mechanism that determined the injury was most likely elbow hyperextension applied with the forearm in neutral position of forearm. Level of Evidence IV, Case Series.

ANALYSIS OF THE PATTERN AND MECHANISM OF ELBOW INJURIES RELATED TO ARMBAR-TYPE ARMLOCKS IN JIU-JITSU FIGHTERS

PubMed Central

ALMEIDA, THIAGO BERNARDO CARVALHO DE; DOBASHI, EIFFEL TSUYOSHI; NISHIMI, ALEXANDRE YUKIO; ALMEIDA, EDUARDO BERNARDO DE; PASCARELLI, LUCIANO; RODRIGUES, LUCIANO MILLER REIS

2017-01-01

ABSTRACT Objective: The objective of this study was to analyze elbow injuries and their probable mechanism in Jiu-Jitsu fighters resulting from the armbar-type armlock. Methods: We evaluated 5 high-performance Jiu-Jitsu fighters from the Gracie Elite gym who were injured during a tournament. All were healthy males with a mean age of 28.8 years. The right arm was involved in three patients (60%). The athletes were followed for approximately 4.6 months, and pain was present in all cases. Clinical examination of the elbow was performed immediately after the injury and when magnetic resonance imaging (MRI) was performed. The radiography showed no changes. Clinical examination detected specific tender points on the medial and anterior topography of the elbows, but no ligamentous instability of the elbow was seen during dynamic testing. Results: The main MRI findings were injury to the common flexor tendon and the ulnar collateral ligament, bone contusion of the distal humerus and olecranon, and joint effusion. Conclusion: The main pattern of injury indicated by the MRI in the athletes was injury to the medial elbow complex. The primary mechanism that determined the injury was most likely elbow hyperextension applied with the forearm in neutral position of forearm. Level of Evidence IV, Case Series. PMID:29081707

Phenotypic hip and elbow dysplasia trends in Rottweilers and Labrador retrievers in South Africa (2007-2015): Are we making progress?

PubMed

Kirberger, Robert M

2017-11-22

Canine hip and elbow dysplasia are major orthopaedic problems prevalent the world over, and South Africa is no exception. Hip and elbow dysplasia phenotypic status is certified by a number of different radiographic schemes in the world. South Africa uses the Fédération Cynologique Internationale system to certify hips, and the International Elbow Working Group scheme to certify elbows. One way of reducing these often crippling conditions is by selective breeding using only dogs with no or marginal dysplastic joints. In South Africa, only seven breeds, including the Rottweiler, have breeding restrictions for hip dysplasia. There are no such restrictions for elbow dysplasia. This study assessed the prevalence of hip and elbow dysplasia over a 9-year-period in the Rottweiler and the Labrador retriever in South Africa as evaluated by official national scrutineers. Records from 1148 Rottweilers and 909 Labrador retrievers were obtained and were graded as normal or dysplastic, and numerical values were also evaluated. Data were compared between the two breeds, males and females as well as over time and were compared with similar data of the Orthopaedic Foundation for Animals in the United States. The prevalence values for hip dysplasia in Rottweilers and Labrador retrievers were 22% and 31%, respectively, whereas for elbow dysplasia the values were 39% and 19%, respectively. In Labrador retrievers, this incidence was much higher than in the American population. Rottweiler hip and elbow dysplasia numerical scores significantly improved over time, whereas in Labrador retrievers, only hip dysplasia showed a minor but significant improvement. This study proved that prescribing minimum breeding requirements, as in the Rottweiler in this study, significantly improved the breeding stock, suggesting that minimum hip and elbow breeding requirements should be initiated for all breeds at risk of these often crippling conditions.

Chronic elbow dislocation: a rare complication of tennis elbow surgery. Successful treatment by open reduction and external fixator.

PubMed

Degreef, I; De Smet, L

2007-06-01

A case is presented of chronic dislocation of the elbow after tennis elbow surgery combined with posterior interosseous nerve (PIN) release. An open reduction with repair of the collateral ligaments was performed. Postoperative rehabilitation involved the use of an articulated external fixator and there was a successful outcome. Possible causes of the dislocation are discussed.

Effect of Humeral Component Version on Outcomes in Reverse Shoulder Arthroplasty.

PubMed

Aleem, Alexander W; Feeley, Brian T; Austin, Luke S; Ma, C Benjamin; Krupp, Ryan J; Ramsey, Matthew L; Getz, Charles L

2017-05-01

Although reverse shoulder arthroplasty provides excellent clinical results in appropriately selected patients, loss of external and internal rotation may occur. Component selection, design, and placement affect postoperative results. Recent studies considered the effect of humeral component version on functional results. The current study investigated whether humeral stem retroversion affects the outcomes of reverse shoulder arthroplasty with a retrospective review of a multisurgeon, industry-sponsored, prospectively gathered database of a single reverse shoulder arthroplasty implant. All patients had at least 2-year follow-up. Clinical outcomes, including American Shoulder and Elbow Surgeons score, visual analog scale pain score, Short Form-12 Mental and Physical Component scores, range of motion, and internal rotation function, were compared between patients with humeral retroversion of 10° or less (group A) and those with humeral retroversion of 20° or greater (group B). Radiographic outcomes were compared. The analysis included 64 patients (group A, 29 patients; group B, 35 patients). No clinical or statistically significant difference was found in American Shoulder and Elbow Surgeons scores. Both groups showed statistical and clinical improvement vs preoperative scores, with group A averaging 77.8 and group B averaging 79.2 at final follow-up. No differences were found between groups in range of motion or ability to perform tasks that require shoulder internal rotation. Patients can expect good clinical improvement after reverse shoulder arthroplasty. No difference was found in clinical or radiologic outcomes based on humeral component retroversion. Despite the theoretical increase in external rotation when the humeral component is placed closer to native retroversion, the results did not show this effect. [Orthopedics. 2017; 40(3):179-186.]. Copyright 2017, SLACK Incorporated.

Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures.

PubMed

Phadnis, Joideep; Flannery, Olivia; Watts, Adam C

2016-06-01

Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature. Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively. The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications. Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Outcomes of arthroscopic revision rotator cuff repair with acellular human dermal matrix allograft augmentation.

PubMed

Hohn, Eric A; Gillette, Blake P; Burns, Joseph P

2018-05-01

The purpose was to assess the minimum 2-year patient-reported outcomes and failure rate of patients who underwent revision arthroscopic rotator cuff repair augmented with acellular human dermal matrix (AHDM) allograft for repairable retears. From 2008-2014, patients who underwent revision rotator cuff repair augmented with AHDM with greater than 2 years' follow-up by a single surgeon were retrospectively reviewed. Data regarding surgical history, demographic characteristics, and medical comorbidities were collected. Outcome data included American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, as well as rotator cuff healing on magnetic resonance imaging or ultrasound. Retears and subsequent surgical procedures were characterized. A total of 28 patients met our inclusion criteria, and 23 (82%) were available for follow-up at 2 years. The mean age was 60.1 ± 9.3 years (range, 43-79 years), with a mean follow-up period of 48 ± 23 months. All patients had at least 1 prior rotator cuff repair. Of the 23 patients, 13 (56%) underwent postoperative imaging, and 4 of these 13 (31%) had a retear. A reoperation was performed in 3 of 23 patients (13%). Among the 6 patients with both preoperative and postoperative outcome scores, we saw improvement in the ASES score from 56 to 85 (P = .03) and in the SANE score from 42 to 76 (P = .03). The full cohort's mean postoperative ASES and SANE scores were 77 and 69, respectively. AHDM allograft augmentation is a safe and effective treatment method for patients with full-thickness rotator cuff retears. Further research is needed with larger studies to confirm these findings from our small cohort of patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children.

PubMed

Datta, Tanmay; Chatterjee, Nd; Pal, Ananda Kisor; Das, Sunil Kumar

2014-06-01

Neglected Monteggia fracture dislocation in the paediatric age group constitutes significant disability in respect to pain, stiffness, deformity, neurological compromise and restriction of activities of daily living. A longitudinal prospective study was done on 21 children with old Monteggia fracture-dislocation which included 18 cases of Bado type I and 3 cases of Bado type III at the department of orthopaedics, IPGME&R,SSKM hospital, Kolkata, India between 2007 and 2012. All were treated by modified Hirayama corrective osteotomy of ulna with wedge bone grafting along with restoration of its length and reconstruction of annular ligament using Bell Tawse method and fixation of radial head with transcapitellar Kirschner wire. Average follow up period was 5.5 years. Results were evaluated on the basis of 100 point Mayo Elbow Performance Index, radiology and questionnaire. The mean postoperative increase in Mayo Elbow Performance Index score was 30 with average increase in the range of movement by 30o. In three cases, there was subluxation of radial head and in addition one had transient palsy of posterior interosseous nerve. Three cases showed distortion of the radial head which were insignificant functionally. Results of improvement in mean MEPI were analysed by chi-square test and was significant at 0 .01 level of significance. Study showed good results with modified Hirayama osteotomy with annular ligament reconstruction using Bell Tawse procedure which is a more biological option for restoration of elbow biomechanics.

Elbow Joint Fatigue and Bench-Press Training

PubMed Central

Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2014-01-01

Context: Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. Objective: To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Design: Controlled laboratory study. Setting: Motion research laboratory. Patients or Other Participants: A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Intervention(s): Participants performed bench-press training until fatigued. Main Outcome Measure(s): Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. Results: We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. Conclusions: The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions. PMID:24533529

Outcomes After Shoulder and Elbow Injury in Baseball Players: Are We Reporting What Matters?

PubMed

Makhni, Eric C; Saltzman, Bryan M; Meyer, Maximilian A; Moutzouros, Vasilios; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

2017-02-01

Return to play, as well as time to return to play, are the most important metrics considered by athletes when attempting to make treatment decisions after injury. However, the consistency of reporting of these metrics in the scientific literature is unknown. To investigate patterns of outcomes reporting in the medical literature of shoulder and elbow injuries in active baseball players. Systematic review. A systematic review of literature published within the past 10 years was performed to identify all recent clinical studies focusing on shoulder and elbow injuries in baseball players across all levels. Review articles, case reports, and laboratory/biomechanical studies were all excluded. A total of 49 studies were included for review. The majority of studies were either level 3 or level 4 evidence (96%). In total, 71% of studies reported on rates of return to preinjury level of play, whereas 31% of studies reported on time to return to preinjury level of play. Only 47% of studies reported on both rate and time of return to preinjury level of play. A minority of studies (8%) reported patient satisfaction rates. Finally, 27 different subjective and patient-reported outcomes were reported, and none of these appeared in more than 14% of all studies. Time to return to preinjury level of play is inadequately reported in studies of shoulder and elbow injury in baseball players. Similarly, satisfaction rates and scores are underreported. Finally, the significant variability of subjective and patient-reported outcomes utilized may undermine the ability of clinicians to accurately compare results from different studies.

Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device.

PubMed

Proctor, Christopher S

2014-10-01

Rotator cuff repair is a procedure with varying outcomes, and there has been subsequent interest in devices that reinforce the repair and enhance structural and functional outcomes. The objective of this study was to determine these outcomes for arthroscopic repair of large and massive rotator cuff tears augmented with a synthetic absorbable mesh designed specifically for reinforcement of tendon repair by imaging and clinical assessments. Consecutive arthroscopic repairs were performed on 18 patients with large to massive rotator cuff tears by use of a poly-l-lactic acid synthetic patch as a reinforcement device and fixation with 4 sutures. Patients were assessed preoperatively and at 6 months, 12 months, and a mean of 42 months after surgery by the American Shoulder and Elbow Surgeons (ASES) shoulder score to evaluate clinical performance and at 12 months by ultrasound to assess structural repair. Ultrasound showed that 15 of 18 patients had intact rotator cuff repair at 12 months; at 42 months, an additional patient had a failed repair. Patients showed improvement in the ASES shoulder score from 25 preoperatively to 71 at 12 months and 70 at 42 months after surgery. Patients with intact rotator cuff (n = 14) at 42 months had an ASES shoulder score of 82. The poly-l-lactic acid bioabsorbable patch designed specifically to reinforce the surgical repair of tendons supported successful repair of large to massive rotator cuff tears in 83% of patients at 12 months after surgery and 78% of patients at 42 months after surgery, with substantial functional improvement. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effect of a commercially available fish-based dog food enriched with nutraceuticals on hip and elbow dysplasia in growing Labrador retrievers.

PubMed

Manfredi, Sabrina; Di Ianni, Francesco; Di Girolamo, Nicola; Canello, Sergio; Gnudi, Giacomo; Guidetti, Gianandrea; Miduri, Francesca; Fabbi, Martina; Daga, Eleonora; Parmigiani, Enrico; Centenaro, Sara; Volta, Antonella

2018-04-01

The aim of this study was to evaluate the prevalence of hip and elbow dysplasia in a group of growing Labrador retrievers fed a fish-based diet enriched with nutraceuticals with chondroprotective properties. The puppies ranged from 3 to 12 mo of age and were divided into 2 groups, each fed a different diet. The control diet consisted of a high quality, chicken-based dog food, while the test diet was a fish-based dog food, enriched with nutraceuticals. Hip and elbow joints were radiographed and scored at 6 and 12 mo of age. Overall, 42 dogs completed the study. At 12 mo of age, no differences were found between the groups in the prevalence of hip and elbow dysplasia, although dogs fed the fish-based food enriched with nutraceuticals had a less severe grade of osteoarthritis at 12 mo. It was concluded that the fish-based diet with nutraceuticals did have beneficial effects on the development of severe osteoarthritis.

Relationship between diffusion tensor fractional anisotropy and long-term motor outcome in patients with hemiparesis after middle cerebral artery infarction.

PubMed

Koyama, Tetsuo; Marumoto, Kohei; Miyake, Hiroji; Domen, Kazuhisa

2014-10-01

Magnetic resonance diffusion tensor fractional anisotropy (DTI-FA) is often used to characterize neural damage after stroke. Here we assessed the relationship between DTI-FA and long-term motor outcome in patients after middle cerebral artery (MCA) infarction. Fractional anisotropy (FA) maps were generated from diffusion tensor brain images obtained from 16 patients 14-18 days postinfarction, and tract-based spatial statistics (TBSS) analysis was applied. Regions of interest were set within the right and left corticospinal tracts, and mean FA values were extracted from individual TBSS data. Hemiparesis motor outcome was evaluated according to Brunnstrom stage (BRS: 1-6, severe-normal) for separate shoulder/elbow/forearm, hand, and lower extremity functions, as well as the motor component score of the Functional Independence Measure (FIM-motor: 13-91, null-full) 5-7 months after onset. Ratios between FA values in the affected and unaffected hemispheres (rFA) were assessed by BRS and FIM-motor scores. rFA values were .636-.984 (median, .883) and BRS scores were 1-6 (median, 3) for shoulder/elbow/forearm, 2-6 (median, 3) for hand, and 3-6 (median, 5) for the lower extremities. FIM-motor scores were 51-90 (median, 75). Analysis revealed significant relationships between rFA and BRS data (correlation coefficient: .687 for shoulder/elbow/forearm, .579 for hand, and .623 for lower extremities) but no significance relationship between rFA and FIM-motor scores. The results suggest that DTI-FA is applicable for predicting the long-term outcome of extremity functions after MCA infarction. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Medial Elbow Joint Space Increases With Valgus Stress and Decreases When Cued to Perform A Maximal Grip Contraction.

PubMed

Pexa, Brett S; Ryan, Eric D; Myers, Joseph B

2018-04-01

Previous research indicates that the amount of valgus torque placed on the elbow joint during overhead throwing is higher than the medial ulnar collateral ligament (UCL) can tolerate. Wrist and finger flexor muscle activity is hypothesized to make up for this difference, and in vitro studies that simulated activity of upper extremity musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, support this hypothesis. To assess the medial elbow joint space at rest, under valgus stress, and under valgus stress with finger and forearm flexor contraction by use of ultrasonography in vivo. Controlled laboratory study. Participants were 22 healthy males with no history of elbow dislocation or UCL injury (age, 21.25 ± 1.58 years; height, 1.80 ± 0.08 m; weight, 79.43 ± 18.50 kg). Medial elbow joint space was measured by use of ultrasonography during 3 separate conditions: at rest (unloaded), under valgus load (loaded), and with a maximal grip contraction under a valgus load (loaded-contracted) in both limbs. Participants lay supine with their arm abducted 90° and elbow flexed 30° with the forearm in full supination. A handgrip dynamometer was placed in the participants' hand to grip against during the contracted condition. Images were reduced in ImageJ to assess medial elbow joint space. A 2-way (condition × limb) repeated-measures analysis of variance and Cohen's d effect sizes were used to assess changes in medial elbow joint space. Post hoc testing was performed with a Bonferroni adjustment to assess changes within limb and condition. The medial elbow joint space was significantly larger in the loaded condition (4.91 ± 1.16 mm) compared with the unloaded condition (4.26 ± 1.23 mm, P < .001, d = 0.712) and the loaded-contracted condition (3.88 ± 0.94 mm, P < .001, d = 1.149). No significant change was found between the unloaded and loaded-contracted conditions ( P = .137). Medial elbow joint space increases under a valgus load and then decreases when a maximal grip contraction is performed. This indicates that wrist and finger flexor muscle contraction may assist in limiting medial elbow joint space, a result similar to findings of previous research in vitro. Muscle activation of the upper extremity limits the medial elbow joint space, suggesting that injury prevention programs for throwing athletes should incorporate exercises for the elbow, wrist, and hand to limit excessive medial elbow joint space gapping during activities that create high valgus load.

Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial.

PubMed

Wu, Ching-Yi; Huang, Pai-Chuan; Chen, Yu-Ting; Lin, Keh-Chung; Yang, Hsiu-Wen

2013-06-01

To compare the effects of mirror therapy (MT) versus control treatment (CT) on movement performance, motor control, sensory recovery, and performance of activities of daily living in people with chronic stroke. Single-blinded, randomized controlled trial. Four hospitals. Outpatients with chronic stroke (N=33) with mild to moderate motor impairment. The MT group (n=16) received upper extremity training involving repetitive bimanual, symmetrical movement practice, in which the individual moves the affected limb while watching the reflective illusion of the unaffected limb's movements from a mirror. The CT group received task-oriented upper extremity training. The intensity for both groups was 1.5 hours/day, 5 days/week, for 4 weeks. The Fugl-Meyer Assessment; kinematic variables, including reaction time, normalized movement time, normalized total displacement, joint recruitment, and maximum shoulder-elbow cross-correlation; the Revised Nottingham Sensory Assessment; the Motor Activity Log; and the ABILHAND questionnaire. The MT group performed better in the overall (P=.01) and distal part (P=.04) Fugl-Meyer Assessment scores and demonstrated shorter reaction time (P=.04), shorter normalized total displacement (P=.04), and greater maximum shoulder-elbow cross-correlation (P=.03). The Revised Nottingham Sensory Assessment temperature scores improved significantly more in the MT group than in the CT group. No significant differences on the Motor Activity Log and the ABILHAND questionnaire were found immediately after MT or at follow-up. The application of MT after stroke might result in beneficial effects on movement performance, motor control, and temperature sense, but may not translate into daily functions in the population with chronic stroke. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Obesity-related differences in neural correlates of force control.

PubMed

Mehta, Ranjana K; Shortz, Ashley E

2014-01-01

Greater body segment mass due to obesity has shown to impair gross and fine motor functions and reduce balance control. While recent studies suggest that obesity may be linked with altered brain functions involved in fine motor tasks, this association is not well investigated. The purpose of this study was to examine the neural correlates of motor performance in non-obese and obese adults during force control of two upper extremity muscles. Nine non-obese and eight obese young adults performed intermittent handgrip and elbow flexion exertions at 30% of their respective muscle strengths for 4 min. Functional near infrared spectroscopy was employed to measure neural activity in the prefrontal cortex bilaterally, joint steadiness was computed using force fluctuations, and ratings of perceived exertions (RPEs) were obtained to assess perceived effort. Obesity was associated with higher force fluctuations and lower prefrontal cortex activation during handgrip exertions, while RPE scores remained similar across both groups. No obesity-related differences in neural activity, force fluctuation, or RPE scores were observed during elbow flexion exertions. The study is one of the first to examine obesity-related differences on prefrontal cortex activation during force control of the upper extremity musculature. The study findings indicate that the neural correlates of motor activity in the obese may be muscle-specific. Future work is warranted to extend the investigation to monitoring multiple motor-function related cortical regions and examining obesity differences with different task parameters (e.g., longer duration, increased precision demands, larger muscles, etc.).

Delayed repair of distal biceps tendon ruptures is successful: a case-control study.

PubMed

Haverstock, John; Grewal, Ruby; King, Graham J W; Athwal, George S

2017-06-01

The literature has shown an increased complication rate with a delay to surgical repair of acute distal biceps tendon ruptures; however, little has been documented regarding the outcome of delayed repairs. This case-control study compared a study cohort of delayed (>21 days) distal biceps tendon repairs with a control cohort repaired acutely (<21 days). Sixteen delayed repair cases were reviewed and matched with acute controls (1:3) based on repair technique, age, and workers' compensation status. The delayed cohort was reviewed and completed isometric strength testing and the Disabilities of the Arm, Shoulder and Hand questionnaire; Patient-Rated Elbow Evaluation; and American Shoulder and Elbow Surgeons elbow questionnaire. The time to surgery averaged 37 ± 12 days in the delayed cohort versus 10 ± 6 days in the acute cohort. Complications occurred in 63% of patients in the delayed cohort versus 29% in the acute cohort (P = .04); however, 90% of the delayed cohort's complications consisted of transient paresthesias. Follow-up scores on the Patient-Rated Elbow Evaluation, Disabilities of the Arm, Shoulder and Hand questionnaire, and American Shoulder and Elbow Surgeons elbow questionnaire were not statistically different between cohorts (P > .37, P > .22, and P > .46, respectively). Despite a high rate of initial complications, patients treated with distal biceps tendon repair after a delay (>21 days) can expect similar functional outcomes to those treated acutely. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A quantitative evaluation of the high elbow technique in front crawl.

PubMed

Suito, Hiroshi; Nunome, Hiroyuki; Ikegami, Yasuo

2017-07-01

Many coaches often instruct swimmers to keep the elbow in a high position (high elbow position) during early phase of the underwater stroke motion (pull phase) in front crawl, however, the high elbow position has never been quantitatively evaluated. The aims of this study were (1) to quantitatively evaluate the "high elbow" position, (2) to clarify the relationship between the high elbow position and required upper limb configuration and (3) to examine the efficacy of high elbow position on the resultant swimming velocity. Sixteen highly skilled and 6 novice male swimmers performed 25 m front crawl with maximal effort and their 3-dimensional arm stroke motion was captured at 60 Hz. An attempt was made to develop a new index to evaluate the high elbow position (I he : high elbow index) using 3-dimensional coordinates of the shoulder, elbow and wrist joints. I he of skilled swimmers moderately correlated with the average shoulder internal rotation angle (r = -0.652, P < 0.01) and swimming velocity (r = -0.683, P < 0.01) during the pull phase. These results indicate that I he is a useful index for evaluating high elbow arm stroke technique during the pull phase in front crawl.

Failure after reverse total shoulder arthroplasty: what is the success of component revision?

PubMed

Black, Eric M; Roberts, Susanne M; Siegel, Elana; Yannopoulos, Paul; Higgins, Laurence D; Warner, Jon J P

2015-12-01

Complication rates remain high after reverse total shoulder arthroplasty (RTSA). Salvage options after implant failure have not been well defined. This study examines the role of reimplantation and revision RTSA after failed RTSA, reporting outcomes and complications of this salvage technique. Sixteen patients underwent component revision and reimplantation after a prior failed RTSA from 2004 to 2011. Indications included baseplate failure (7 patients, 43.8%), instability (6 patients, 37.5%), infection (2 patients, 12.5%), and humeral loosening (1 patient, 6.3%). The average age of the patient during revision surgery was 68.6 years. Outcomes information at follow-up was recorded, including visual analog scale score for pain, subjective shoulder value, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test score, and these were compared with pre-revision values. Repeated surgeries and complications were noted. Average time to follow-up from revision was 58.9 months (minimum, 2 years; range, 24-103 months). The average postoperative visual analog scale score for pain was 1.7/10 (7.5/10 preoperatively; P < .0001), and the subjective shoulder value was 62% (17% preoperatively; P < .0001). The average postoperative American Shoulder and Elbow Surgeons score was 66.7, and the Simple Shoulder Test score was 52.6. Fourteen patients (88%) noted that they felt "better" postoperatively than before their original RTSA and would go through the procedure again if given the option. Nine patients suffered major complications (56%), and 6 of these ultimately underwent further procedures (38% of cohort). Salvage options after failure of RTSA remain limited. Component revision and reimplantation can effectively relieve pain and improve function compared with baseline values, and patient satisfaction levels are moderately high. However, complication rates and reoperation rates are significant. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Minimum 2-year outcomes and return to sport following resection arthroplasty for the treatment of sternoclavicular osteoarthritis.

PubMed

Katthagen, J Christoph; Tahal, Dimitri S; Menge, Travis J; Horan, Marilee P; Millett, Peter J

2017-02-01

The aim of this study was to assess the effect of open resection arthroplasty for osteoarthritis of the sternoclavicular (SC) joint on pain levels, functional outcomes, and return to sport. Patients from a single surgeon's practice who underwent open resection arthroplasty (maximum 10-mm resection) for SC osteoarthritis or prearthritic changes between November 2006 and November 2013 were retrospectively reviewed. This was an outcomes study with prospectively collected data. Preoperative and postoperative American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder, and Hand score, Single Assessment Numeric Evaluation score, several pain scores, and level of sport intensity were assessed. Seventeen SC joints in 16 patients (9 female, 7 male) met inclusion criteria. Mean age at time of surgery way 41.1 years (range, 12-66 years). One patient refused participation in the study. Three SC joint resections (17.7%) required SC joint revision surgery. Minimum 2-year outcomes data were available for 11 of the remaining 13 SC joints (84.6%). The mean time to follow-up was 3.3 years (range, 2.0-8.8 years). Pain at its worst (P = .026), pain at competition (P = .041), the Quick Disabilities of the Arm, Shoulder, and Hand score (P = .034), and the ability to sleep on the affected shoulder (P = .038) showed significant improvement postoperatively. The average postoperative American Shoulder and Elbow Surgeons score was 83.3. The level of sports participation (P = .042) as well as strength and endurance when participating in sport (P = .039) significantly increased postoperatively. Resection arthroplasty of the medial end of the clavicle in patients with osteoarthritis of the SC joint without instability results in pain reduction, functional improvement, and a high rate of return to sport at midterm follow-up. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports.

PubMed

Akuthota, Venu; Chou, Larry H; Drake, David F; Nadler, Scott F; Toledo, Santiago D

2004-03-01

This self-directed learning module discusses classic topics and highlights new advances in this area. This article discusses upper-limb sports injuries as part of a section of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on shoulder and elbow pain in the athlete. To discuss shoulder and elbow overuse injuries in sports.

The "moving valgus stress test" for medial collateral ligament tears of the elbow.

PubMed

O'Driscoll, Shawn W M; Lawton, Richard L; Smith, Adam M

2005-02-01

The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. Cohort study (diagnosis); Level of evidence, 2. Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

Isokinetic profile of elbow flexion and extension strength in elite junior tennis players.

PubMed

Ellenbecker, Todd S; Roetert, E Paul

2003-02-01

Descriptive study. To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players. The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extremity musculature of elite players. No previous study has addressed elbow flexion and extension strength. Thirty-eight elite junior tennis players were bilaterally tested for concentric elbow flexion and extension muscle performance on a Cybex 6000 isokinetic dynamometer at 90 degrees/s, 210 degrees/s, and 300 degrees/s. Repeated-measures ANOVAs were used to test for differences between extremities, muscle groups, and speed. Significantly greater (P<0.002) dominant-arm elbow extension peak torque values were measured at 90 degrees/s, 210 degrees/s, and 300 degrees/s for males. Significantly greater (P<0.002) dominant-arm single-repetition work values were also measured at 90 degrees/s and 210 degrees/s for males. No significant difference was measured between extremities in elbow flexion muscular performance in males and for elbow flexion or extension peak torque and single-repetition work values in females. No significant difference between extremities was measured in elbow flexion/extension strength ratios in females and significant differences between extremities in this ratio were only present at 210 degrees/s in males (P<0.002). These data indicate muscular adaptations around the dominant elbow in male elite junior tennis players but not females. These data have ramifications for clinicians rehabilitating upper extremity injuries in patients from this population.

Kinematics of pointing movements made in a virtual versus a physical 3-dimensional environment in healthy and stroke subjects.

PubMed

Knaut, Luiz A; Subramanian, Sandeep K; McFadyen, Bradford J; Bourbonnais, Daniel; Levin, Mindy F

2009-05-01

To compare kinematics of 3-dimensional pointing movements performed in a virtual environment (VE) displayed through a head-mounted display with those made in a physical environment. Observational study of movement in poststroke and healthy subjects. Motion analysis laboratory. Adults (n=15; 4 women; 59+/-15.4y) with chronic poststroke hemiparesis were recruited. Participants had moderate upper-limb impairment with Chedoke-McMaster Arm Scores ranging from 3 to 6 out of 7. Twelve healthy subjects (6 women; 53.3+/-17.1y) were recruited from the community. Not applicable. Arm and trunk kinematics were recorded in similar virtual and physical environments with an Optotrak System (6 markers; 100Hz; 5s). Subjects pointed as quickly and as accurately as possible to 6 targets (12 trials/target in a randomized sequence) placed in arm workspace areas requiring different arm movement patterns and levels of difficulty. Movements were analyzed in terms of performance outcome measures (endpoint precision, trajectory, peak velocity) and arm and trunk movement patterns (elbow and shoulder ranges of motion, elbow/shoulder coordination, trunk displacement, rotation). For healthy subjects, precision and trajectory straightness were higher in VE when pointing to contralateral targets, and movements were slower for all targets in VE. Stroke participants made less accurate and more curved movements in VE and used less trunk displacement. Elbow/shoulder coordination differed when pointing to the lower ipsilateral target. There were no group-by-environment interactions. Movements in both environments were sufficiently similar to consider VE a valid environment for clinical interventions and motor control studies.

Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement.

PubMed

Hartzler, Robert U; Steen, Brandon M; Hussey, Michael M; Cusick, Michael C; Cottrell, Benjamin J; Clark, Rachel E; Frankle, Mark A

2015-11-01

Some patients unexpectedly have poor functional improvement after reverse shoulder arthroplasty (RSA) for massive rotator cuff tear without glenohumeral arthritis. Our aim was to identify risk factors for this outcome. We also assessed the value of RSA for cases with poor functional improvement vs. The study was a retrospective case-control analysis for primary RSA performed for massive rotator cuff tear without glenohumeral arthritis with minimum 2-year follow-up. Cases were defined as Simple Shoulder Test (SST) score improvement of ≤1, whereas controls improved SST score ≥2. Risk factors were chosen on the basis of previous association with poor outcomes after shoulder arthroplasty. Latissimus dorsi tendon transfer results were analyzed as a subgroup. Value was defined as improvement in American Shoulder and Elbow Surgeons (ASES) score per $10,000 hospital cost. In a multivariate binomial logistic regression analysis, neurologic dysfunction (P = .006), age <60 years (P = .02), and high preoperative SST score (P = .03) were independently associated with poor functional improvement. Latissimus dorsi tendon transfer patients significantly improved in active external rotation (-0.3° to 38.7°; P < .01). The value of RSA (ΔASES/$10,000 cost) for cases was 0.8 compared with 17.5 for controls (P < .0001). Young age, high preoperative function, and neurologic dysfunction were associated with poor functional improvement. Surgeons should consider these associations in counseling and selection of patients. Concurrent latissimus dorsi transfer was successful in restoring active external rotation in a subgroup of patients. The critical economic importance of improved patient selection is emphasized by the very low value of the procedure in the case group. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Revision ulnar collateral ligament reconstruction using a suspension button fixation technique.

PubMed

Lee, Gregory H; Limpisvasti, Orr; Park, Maxwell C; McGarry, Michelle H; Yocum, Lewis A; Lee, Thay Q

2010-03-01

Revision ulnar collateral ligament reconstruction remains a challenging problem. The objective of this study was to biomechanically evaluate an ulnar collateral ligament reconstruction technique using a suspension button fixation technique that can be used even in the case of ulnar cortical bone loss. An ulnar suspension fixation technique for ulnar collateral ligament reconstruction can restore elbow kinematics and demonstrate failure strength comparable to that of currently available techniques. Controlled laboratory study. Nine pairs of cadaveric elbows were dissected free of soft tissue and potted. After simulating ulnar cortical bone loss, ulnar collateral ligament reconstruction was performed in 1 elbow of each pair using palmaris longus autograft and a 30-mm RetroButton suspended from the far (lateralmost) ulnar cortex. A docking technique was used for humeral fixation of the graft. Elbow valgus angle was quantified using a Microscribe 3DLX digitizer at multiple elbow flexion angles. Valgus angle was measured with the ulnar collateral ligament intact, transected, and reconstructed. In addition, load-to-failure testing was performed in 1 elbow of each pair. Release of the ulnar collateral ligament caused a significant increase in valgus angle at each flexion angle tested (P < .002). Reconstructed elbows demonstrated no significant differences in valgus angle from the intact elbow at all flexion angles tested. Load-to-failure tests showed that reconstructed elbows had an ultimate torque (10.3 + or - 5.7 N x m) significantly less than intact elbows (26.4 + or - 10.6 N x m) (P = .001). Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. Load-to-failure testing demonstrated comparable fixation strength to several historic controls of primary reconstruction techniques despite the simulated ulnar cortical bone loss. Ulnar collateral ligament reconstruction using a suspension button fixation technique can be considered in the case of ulnar cortical bone loss in a primary or revision setting.

Corrective osteotomy for cubitus varus in middle-aged patients.

PubMed

Lim, Tae Kang; Koh, Kyoung Hwan; Lee, Do Kyung; Park, Min Jong

2011-09-01

We reviewed the results of corrective osteotomy for cubitus varus in middle-aged patients to investigate whether it is recommended in this age group. We studied 20 consecutive patients who underwent 3-dimensional corrective osteotomy at an average age of 47.9 years (range, 41-55 years). The osteotomy was fixed with single plating in 8 patients and with double plating in 12. The average follow-up was 23 months (range, 18-109 months). The average humerus-elbow-wrist angle improved from 21.4° (range, 15°-35°) varus to 8.7° (range, -4°-20°) valgus. Osseous union was radiographically demonstrated in all patients at an average of 17.5 weeks (range, 8-36 weeks). Delayed union of longer than 12 weeks was observed in 15 patients (75%). The average time to union in the single-plating group was 21.0 weeks compared with 15.1 weeks in the double-plating group (P = .012). Failure of fixation occurred in 2 patients who had single plating. The preoperative and postoperative arc of motion was similar. According to Oppenheim criteria, results were excellent in 10, good in 8, and poor in 2. The average final Mayo Elbow Performance Score was 90.3 points (range, 70-100 points). Cubitus varus in middle-aged patients can be treated by a closing wedge osteotomy and fixation with double plating. This provides satisfactory deformity correction, maintenance of the elbow motion, and good functional outcome, although healing of the osteotomy tends to be delayed. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases.

PubMed

Dodds, Seth D; Flanagin, Brody A; Bohl, Daniel D; DeLuca, Peter A; Smith, Brian G

2014-09-01

To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle. We conducted a retrospective case review of 11 consecutive children and adolescents with an incarcerated medial epicondyle fracture after elbow dislocation. All patients underwent open reduction internal fixation using a similar technique. We characterized outcomes at final follow-up. Average follow-up was 14 months (range, 4-56 mo). All patients had clinical and radiographic signs of healing at final follow-up. There was no radiographic evidence of loss of reduction at intervals or at final follow-up. There were no cases of residual deformity or valgus instability. Average final arc of elbow motion was 4° to 140°. All patients had forearm rotation from 90° supination to 90° pronation. Average Mayo elbow score was 99.5. Four of 11 patients had ulnar nerve symptoms postoperatively and 1 required a second operation for ulnar nerve symptoms. In addition, 1 required a second operation for flexion contracture release with excision of heterotopic ossification. Three patients had ulnar nerve symptoms at final follow-up. Two of these had mild paresthesia only and 1 had both mild paresthesia and weakness. Our results suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation leads to satisfactory motion and function; however, the injury carries a high risk for complications, particularly ulnar neuropathy. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Does Flooring Substrate Impact Kennel and Dog Cleanliness in Commercial Breeding Facilities?

PubMed Central

Stella, Judith; Hurt, Moriah; Bauer, Amy; Croney, Candace

2018-01-01

Simple Summary It is important to understand how the flooring substrate used in dog housing impacts dog health and well-being. Aspects to consider include paw, elbow, and hock health, the cleanliness of the dog, and the ability of the floors to be cleaned easily and thoroughly. This pilot study assessed the health and cleanliness of 118 dogs housed on three different types of flooring commonly found in commercial breeding kennels. No serious paw, elbow, or hock problems were identified. Thirty-one percent or fewer kennels at each facility were found to have fecal contamination after routine cleaning and the majority of dogs were clean. These findings indicate that a well-managed kennel can maintain clean, healthy dogs on different types of flooring substrates. Abstract Evaluation of kennel flooring surfaces is needed to understand their impacts on dog health and well-being. This pilot study aimed to characterize aspects of physical health, kennel cleanliness, and dog body cleanliness on flooring types common in US breeding kennels. Subjects were 118 adult dogs housed on diamond-coated expanded metal (DCEM), polypropylene (POLY), or concrete (CON) flooring at five commercial breeding facilities in Indiana, U.S. Body condition, paw, elbow, and hock health scores were recorded. Each indoor kennel and dog was visually assessed for cleanliness. Kennels were swabbed immediately after cleaning with electrostatic dry cloths and cultured for Escherichia coli. Descriptive statistics were used for analysis. Mean body condition score (BCS), kennel and dog cleanliness scores were all near ideal (3, 1.15, and 1.04, respectively). Thirty-one percent or fewer kennels at each facility were culture-positive for E. coli after cleaning. No serious paw, elbow, or hock problems were identified. Overall, the findings indicate that with appropriate management and regular access to additional surfaces, dog foot health, cleanliness, and kennel cleanliness can be maintained on the flooring types investigated. PMID:29690514

Effect of single dose radiation therapy on weight-bearing lameness in dogs with elbow osteoarthritis.

PubMed

Kapatkin, Amy S; Nordquist, Barbro; Garcia, Tanya C; Griffin, Maureen A; Theon, Alain; Kim, Sun; Hayashi, Kei

2016-07-19

To determine if a single low dose of radiation therapy in dogs with osteoarthritis of the elbow joint was associated with a detectable improvement in their lameness and pain as documented by force platform gait analysis. In this cohort longitudinal observational study, five Labrador Retrievers with lameness due to elbow osteoarthritis that was unresponsive to medical treatment were removed from all non-steroidal anti-inflammatory and analgesic medications. A single treatment of radiation therapy delivering 10 Gray was performed on the affected elbow joint(s). Force platform gait analysis was used to assess the ground reaction forces of a limb affected with elbow osteoarthritis both before and after radiation therapy. Significant differences occurred in the weight-bearing on an affected limb with elbow osteoarthritis after radiation therapy at weeks six and 14. Change due to treatment was particularly apparent in dogs with unilateral elbow osteoarthritis. Administering a single low dose of radiation therapy may have a short-term benefit in dogs with elbow osteoarthritis, which is similar to the evidence supporting the use of radiation therapy in horses with orthopaedic disease.

Effects of equal-volume resistance training with different training frequencies in muscle size and strength in trained men

PubMed Central

Fisher, James; Steele, James; Campos, Mario H.; Silva, Marcelo H.; Paoli, Antonio; Giessing, Jurgen; Bottaro, Martim

2018-01-01

Background The objective of the present study was to compare the effects of equal-volume resistance training (RT) performed with different training frequencies on muscle size and strength in trained young men. Methods Sixteen men with at least one year of RT experience were divided into two groups, G1 and G2, that trained each muscle group once and twice a week, respectively, for 10 weeks. Elbow flexor muscle thickness (MT) was measured using a B-Mode ultrasound and concentric peak torque of elbow extensors and flexors were assessed by an isokinetic dynamometer. Results ANOVA did not reveal group by time interactions for any variable, indicating no difference between groups for the changes in MT or PT of elbow flexors and extensors. Notwithstanding, MT of elbow flexors increased significantly (3.1%, P < 0.05) only in G1. PT of elbow flexors and extensors did not increase significantly for any group. Discussion The present study suggest that there were no differences in the results promoted by equal-volume resistance training performed once or twice a week on upper body muscle strength in trained men. Only the group performing one session per week significantly increased the MT of their elbow flexors. However, with either once or twice a week training, adaptations appear largely minimal in previously trained males.

Effects of equal-volume resistance training with different training frequencies in muscle size and strength in trained men.

PubMed

Gentil, Paulo; Fisher, James; Steele, James; Campos, Mario H; Silva, Marcelo H; Paoli, Antonio; Giessing, Jurgen; Bottaro, Martim

2018-01-01

The objective of the present study was to compare the effects of equal-volume resistance training (RT) performed with different training frequencies on muscle size and strength in trained young men. Sixteen men with at least one year of RT experience were divided into two groups, G1 and G2, that trained each muscle group once and twice a week, respectively, for 10 weeks. Elbow flexor muscle thickness (MT) was measured using a B-Mode ultrasound and concentric peak torque of elbow extensors and flexors were assessed by an isokinetic dynamometer. ANOVA did not reveal group by time interactions for any variable, indicating no difference between groups for the changes in MT or PT of elbow flexors and extensors. Notwithstanding, MT of elbow flexors increased significantly (3.1%, P  < 0.05) only in G1. PT of elbow flexors and extensors did not increase significantly for any group. The present study suggest that there were no differences in the results promoted by equal-volume resistance training performed once or twice a week on upper body muscle strength in trained men. Only the group performing one session per week significantly increased the MT of their elbow flexors. However, with either once or twice a week training, adaptations appear largely minimal in previously trained males.

Synergic co-activation of muscles in elbow flexion via fractional Brownian motion.

PubMed

Chang, Shyang; Hsyu, Ming-Chun; Cheng, Hsiu-Yao; Hsieh, Sheng-Hwu

2008-12-31

In reflex and volitional actions, co-activations of agonist and antagonist muscles are believed to be present. Recent studies indicate that such co-activations can be either synergic or dyssynergic. The aim of this paper is to investigate if the co-activations of biceps brachii, brachialis, and triceps brachii during volitional elbow flexion are in the synergic or dyssynergic state. In this study, two groups with each containing six healthy male volunteers participated. Each person of the first group performed 30 trials of volitional elbow flexion while each of the second group performed 30 trials of passive elbow flexion as control experiments. Based on the model of fractional Brownian motion, the intensity and frequency information of the surface electromyograms (EMGs) could be extracted simultaneously. No statistically significant changes were found in the control group. As to the other group, results indicated that the surface EMGs of all five muscle groups were temporally synchronized in frequencies with persistent intensities during each elbow flexion. In addition, the mean values of fractal dimensions for rest and volitional flexion states revealed significant differences with P < 0.01. The obtained positive results suggest that these muscle groups work together synergically to facilitate elbow flexion during the co-activations.

Treatment of elbow osteomyelitis with an interposition arthroplasty using a rectus abdominis free flap.

PubMed

Jaiswal, Rohit; Busse, Brittany; Allen, Robert; Sahar, David

2015-05-01

Osteomyelitis of the elbow may be a complex clinical problem. Treatment goals include the eradication of infection and preservation of maximal joint function. Bony debridement may be necessary in addition to elbow joint arthroplasty. The use of synthetic material or allograft as the arthroplasty material may be contraindicated in the setting of infection. The use of free muscle transfer as an arthroplasty medium has not been well described. A 22-year-old paraplegic man developed recurrent osteomyelitis of the right elbow, necessitating extensive bony debridement by the orthopedic surgery team. Reconstruction arthroplasty was performed using a free rectus abdominis muscle flap as the arthroplasty material to serve as a source of biologically active, well-vascularized arthroplasty medium in the presence of ongoing infection. A successful free muscle flap arthroplasty was performed. External fixation and physical therapy were implemented postoperatively. The patient had resolution of osteomyelitis and excellent functional use of the elbow for activities of daily living and wheelchair motion. Elbow arthroplasty in the setting of active infection may be accomplished by means of free tissue muscle transfer. Elimination of infection and acceptable joint function may be possible with this form of reconstruction.

Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation.

PubMed

Triantafyllopoulos, Ioannis K; Lampropoulou-Adamidou, Kalliopi; Schizas, Nikitas P; Karadimas, Eleftherios V

2017-12-01

Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. In all cases, the postoperative scores were significantly improved (P < .005 in all comparisons with the preoperative scores), and all patients returned to their preinjury high level of activity 6 months postoperatively. Radiographs at 1 month and 6 months revealed the maintenance of reduction. There were no complications. According to the results of our series of patients, demanding cases of acute AC joint dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Dynamic Analysis of the Abnormal Isometric Strength Movement Pattern between Shoulder and Elbow Joint in Patients with Hemiplegia.

PubMed

Liu, Yali; Hong, Yuezhen; Ji, Linhong

2018-01-01

Patients with hemiplegia usually have weak muscle selectivity and usually perform strength at a secondary joint (secondary strength) during performing a strength at one joint (primary strength). The abnormal strength pattern between shoulder and elbow joint has been analyzed by the maximum value while the performing process with strength changing from 0 to maximum then to 0 was a dynamic process. The objective of this study was to develop a method to dynamically analyze the strength changing process. Ten patients were asked to perform four group asks (maximum and 50% maximum voluntary strength in shoulder abduction, shoulder adduction, elbow flexion, and elbow extension). Strength and activities from seven muscles were measured. The changes of secondary strength had significant correlation with those of primary strength in all tasks ( R > 0.76, p < 0.01). The antagonistic muscles were moderately influenced by the primary strength ( R > 0.4, p < 0.01). Deltoid muscles, biceps brachii, triceps brachii, and brachioradialis had significant influences on the abnormal strength pattern (all p < 0.01). The dynamic method was proved to be efficient to analyze the different influences of muscles on the abnormal strength pattern. The muscles, deltoid muscles, biceps brachii, triceps brachii, and brachioradialis, much influenced the stereotyped movement pattern between shoulder and elbow joint.

Dynamic Analysis of the Abnormal Isometric Strength Movement Pattern between Shoulder and Elbow Joint in Patients with Hemiplegia

PubMed Central

2018-01-01

Patients with hemiplegia usually have weak muscle selectivity and usually perform strength at a secondary joint (secondary strength) during performing a strength at one joint (primary strength). The abnormal strength pattern between shoulder and elbow joint has been analyzed by the maximum value while the performing process with strength changing from 0 to maximum then to 0 was a dynamic process. The objective of this study was to develop a method to dynamically analyze the strength changing process. Ten patients were asked to perform four group asks (maximum and 50% maximum voluntary strength in shoulder abduction, shoulder adduction, elbow flexion, and elbow extension). Strength and activities from seven muscles were measured. The changes of secondary strength had significant correlation with those of primary strength in all tasks (R > 0.76, p < 0.01). The antagonistic muscles were moderately influenced by the primary strength (R > 0.4, p < 0.01). Deltoid muscles, biceps brachii, triceps brachii, and brachioradialis had significant influences on the abnormal strength pattern (all p < 0.01). The dynamic method was proved to be efficient to analyze the different influences of muscles on the abnormal strength pattern. The muscles, deltoid muscles, biceps brachii, triceps brachii, and brachioradialis, much influenced the stereotyped movement pattern between shoulder and elbow joint. PMID:29610654

Biomechanical comparison of graft fixation at 30° and 90° of elbow flexion for ulnar collateral ligament reconstruction by the docking technique.

PubMed

Cohen, Steven B; Woods, Daniel P; Siegler, Sorin; Dodson, Christopher C; Namani, Ramya; Ciccotti, Michael G

2015-02-01

Ulnar collateral ligament (UCL) injuries have been successfully treated by the docking reconstruction. Although fixation of the graft has been suggested at 30° of elbow flexion, no quantitative biomechanical data exist to provide guidelines for the optimal elbow flexion angle for graft fixation. Testing was conducted on 10 matched pairs of cadaver elbows with use of a loading system and optoelectric tracking device. After biomechanical data on the native UCL were obtained, reconstruction by the docking technique was performed with use of palmaris longus autograft with one elbow fixated at 30° and the contralateral elbow at 90° of elbow flexion. Biomechanical testing was undertaken on these specimens. The load to failure of the native UCL (mean, 20.1 N-m) was significantly higher (P = .004) than that of the reconstructed UCL (mean, 4.6 N-m). There was no statistically significant difference in load to failure of the UCL reconstructions fixated at 30° of elbow flexion (average, 4.86 N-m) compared with those at 90° (average, 4.35 N-m). Elbows reconstructed at 30° and 90° of elbow flexion produced similar kinematic coupling and valgus laxity characteristics compared with each other and with the intact UCL. Although not statistically significant, the reconstructions fixated at 30° more closely resembled the biomechanical characteristics of the intact elbow than did reconstructions fixated at 90°. No statistically significant difference was found in comparing the docking technique of UCL reconstruction with graft fixation at 30° vs. 90° of elbow flexion. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Computational Fluid Dynamic simulations of pipe elbow flow.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Homicz, Gregory Francis

2004-08-01

One problem facing today's nuclear power industry is flow-accelerated corrosion and erosion in pipe elbows. The Korean Atomic Energy Research Institute (KAERI) is performing experiments in their Flow-Accelerated Corrosion (FAC) test loop to better characterize these phenomena, and develop advanced sensor technologies for the condition monitoring of critical elbows on a continuous basis. In parallel with these experiments, Sandia National Laboratories is performing Computational Fluid Dynamic (CFD) simulations of the flow in one elbow of the FAC test loop. The simulations are being performed using the FLUENT commercial software developed and marketed by Fluent, Inc. The model geometry and meshmore » were created using the GAMBIT software, also from Fluent, Inc. This report documents the results of the simulations that have been made to date; baseline results employing the RNG k-e turbulence model are presented. The predicted value for the diametrical pressure coefficient is in reasonably good agreement with published correlations. Plots of the velocities, pressure field, wall shear stress, and turbulent kinetic energy adjacent to the wall are shown within the elbow section. Somewhat to our surprise, these indicate that the maximum values of both wall shear stress and turbulent kinetic energy occur near the elbow entrance, on the inner radius of the bend. Additional simulations were performed for the same conditions, but with the RNG k-e model replaced by either the standard k-{var_epsilon}, or the realizable k-{var_epsilon} turbulence model. The predictions using the standard k-{var_epsilon} model are quite similar to those obtained in the baseline simulation. However, with the realizable k-{var_epsilon} model, more significant differences are evident. The maximums in both wall shear stress and turbulent kinetic energy now appear on the outer radius, near the elbow exit, and are {approx}11% and 14% greater, respectively, than those predicted in the baseline calculation; secondary maxima in both quantities still occur near the elbow entrance on the inner radius. Which set of results better reflects reality must await experimental corroboration. Additional calculations demonstrate that whether or not FLUENT's radial equilibrium pressure distribution option is used in the PRESSURE OUTLET boundary condition has no significant impact on the flowfield near the elbow. Simulations performed with and without the chemical sensor and associated support bracket that were present in the experiments demonstrate that the latter have a negligible influence on the flow in the vicinity of the elbow. The fact that the maxima in wall shear stress and turbulent kinetic energy occur on the inner radius is therefore not an artifact of having introduced the sensor into the flow.« less

Treatment of massive and recurrent rotator cuff tears augmented with a poly-l-lactide graft, a preliminary study.

PubMed

Lenart, Brett A; Martens, Kelly A; Kearns, Kenneth A; Gillespie, Robert J; Zoga, Adam C; Williams, Gerald R

2015-06-01

The incidence of failed rotator cuff repairs remains high, especially in the setting of massive tears or revision repairs. The purpose of this study was to evaluate patient outcomes and repair integrity after augmentation with the repair patch, a poly-l-lactide synthetic polymer. Sixteen consecutive patients with massive or recurrent rotator cuff tears underwent open repair with synthetic poly-l-lactide patch augmentation. Two patients required the patch to bridge defects, and 1 patient retore after a motor vehicle accident and had revision surgery at another institution. The 13 remaining patients were retrospectively evaluated from 1.2 to 1.7 years (average, 1.5 years) after surgery by PENN, American Shoulder and Elbow Surgeons, and Single Assessment Numeric Evaluation scores. Magnetic resonance imaging was used to examine the integrity of the repair at a minimum of 1 year of follow-up. The mean age was 57.3 years (42-68 years). Five patients (38%) had an intact rotator cuff at the time of follow-up. The remaining patients (62%) had full-thickness tears. PENN scores significantly improved from a preoperative score of 50.9 to 77.6 (P < .005). American Shoulder and Elbow Surgeons scores significantly improved from 32.8 to 74.2 (P = .0001). Single Assessment Numeric Evaluation scores at latest follow-up were 76.2. Poly-l-lactide repair patch augmentation of massive and recurrent large to massive rotator cuff tears demonstrates significant improvement in shoulder outcome measures for this difficult population, despite a retear rate of 62%. Further investigation with larger, prospective long-term studies is needed to determine whether this technique provides a true benefit compared with traditional, nonaugmented repair. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Occupational therapy and Colles' fractures.

PubMed

Christensen, O M; Kunov, A; Hansen, F F; Christiansen, T C; Krasheninnikoff, M

2001-01-01

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary.

Electromyographic activity after latissimus dorsi transfer: testing of coactivation as a simple tool to assess latissimus dorsi motor learning.

PubMed

Plath, Johannes E; Seiberl, Wolfgang; Beitzel, Knut; Minzlaff, Philipp; Schwirtz, Ansgar; Imhoff, Andreas B; Buchmann, Stefan

2014-08-01

The purpose of this study was to investigate coactivation (CoA) testing as a clinical tool to monitor motor learning after latissimus dorsi tendon transfer. We evaluated 20 patients clinically with the American Shoulder and Elbow Surgeons (ASES) and University of California-Los Angeles (UCLA) outcomes scores, visual analog scale, active external rotation (aER), and isometric strength testing in abduction and external rotation. Measurements of aER were performed while the latissimus dorsi was activated in its new function of external rotation with concomitant activation (coactivation) of its native functions (adduction and extension). Bilateral surface electromyographic (EMG) activity was recorded during aER measurements and the strength testing procedure (EMG activity ratio: with/without CoA). Patients were divided into two groups (excellent/good vs fair/poor) according to the results of the ASES and UCLA scores. The mean follow-up was 57.8 ± 25.2 months. Subdivided by clinical scores, the superior outcome group lost aER with CoA, whereas the inferior outcome group gained aER (UCLA score: -2.2° ± 7.4° vs +4.3° ± 4.1°; P = .031). Patients with inferior outcomes in the ASES score showed higher latissimus dorsi EMG activity ratios (P = .027), suggesting an inadequate motor learning process. Isometric strength testing revealed that the latissimus dorsi transfer had significantly greater activity compared with the contralateral side (external rotation, P = .008; abduction, P = .006) but did not have comparable strength (external rotation, P = .017; abduction, P = .009). Patients with inferior clinical results were more likely to be dependent on CoA to gain external rotation. Therefore, CoA testing may be used as a tool to evaluate the status of postoperative motor learning after latissimus dorsi transfer. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Accuracy of visual estimates of joint angle and angular velocity using criterion movements.

PubMed

Morrison, Craig S; Knudson, Duane; Clayburn, Colby; Haywood, Philip

2005-06-01

A descriptive study to document undergraduate physical education majors' (22.8 +/- 2.4 yr. old) estimates of sagittal plane elbow angle and angular velocity of elbow flexion visually was performed. 42 subjects rated videotape replays of 30 movements organized into three speeds of movement and two criterion elbow angles. Video images of the movements were analyzed with Peak Motus to measure actual values of elbow angles and peak angular velocity. Of the subjects 85.7% had speed ratings significantly correlated with true peak elbow angular velocity in all three angular velocity conditions. Few (16.7%) subjects' ratings of elbow angle correlated significantly with actual angles. Analysis of the subjects with good ratings showed the accuracy of visual ratings was significantly related to speed, with decreasing accuracy for slower speeds of movement. The use of criterion movements did not improve the small percentage of novice observers who could accurately estimate body angles during movement.

FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES

PubMed Central

Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

2016-01-01

Objectives To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. Background/Purpose While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. Methods A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. Results At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque (p = 0.47) or total work (p = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue (p = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F(1,22)=5.67, p = 0.03. Conclusion The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Study design Retrospective case series Level of Evidence Level 4 PMID:27904798

FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES.

PubMed

Redmond, Christine L; Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

2016-12-01

To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque ( p  = 0.47) or total work ( p  = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue ( p  = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F (1,22)=5.67, p  = 0.03. The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Retrospective case series. Level 4.

Effect of Anconeus Muscle Blocking on Elbow Kinematics: Electromyographic, Inertial Sensors and Finite Element Study.

PubMed

Miguel-Andres, Israel; Alonso-Rasgado, Teresa; Walmsley, Alan; Watts, Adam C

2017-03-01

The specific contribution of the anconeus muscle to elbow function is still uncertain. This study aimed to investigate the effect on elbow kinematics and kinetics of blocking anconeus using lidocaine. Ten healthy volunteers performed experimental trials involving flexion-extension and supination-pronation movements in horizontal and sagittal planes. Inertial sensors and surface electromyography were used to record elbow kinematics and kinetics and electrical activity from the anconeus, biceps and triceps brachii before and after blocking anconeus. Moreover, a finite element model of the elbow was created to further investigate the contribution of anconeus to elbow kinematics. The electrical activity results from the trials before blocking clearly indicated that activity of anconeus was increased during extension, suggesting that it behaves as an extensor. However, blocking anconeus had no effect on the elbow kinematics and kinetics, including the angular velocity, net torque and power of the joint. The electrical activity of the biceps and triceps brachii did not alter significantly following anconeus blocking. These results suggest that anconeus is a weak extensor, and the relative small contribution of anconeus to extension before blocking was compensated by triceps brachii. The finite element results indicated that anconeus does not contribute significantly to elbow kinematics.

Linking of total elbow prosthesis during surgery; a biomechanical analysis.

PubMed

De Vos, Maarten J; Wagener, Marc L; Hendriks, Jan C M; Eygendaal, Denise; Verdonschot, Nico

2013-09-01

Presently, 2 types of elbow prostheses are used: unlinked and linked. The Latitude total elbow prosthesis allows the surgeon to decide during the implantation whether the prosthesis is placed unlinked or linked, and whether the native radial head is retained, resected, or replaced. The purpose of this study is to assess and to compare the varus and valgus laxity of the unlinked and linked version of the latitude total elbow prosthesis with: (1) the native radial head preserved, (2) the native radial head excised, and (3) the native radial head replaced by a radial head component. Biomechanical testing was performed on 14 fresh-frozen upper limb specimens. Linking the prosthesis predominantly influences the valgus laxity of the elbow. Linking the Latitude total elbow prosthesis results in increased valgus stability. In the linked version of the total elbow prosthesis, the radial head only plays a small part in both valgus and varus stability. An unlinked situation is not advised in absence of a native radial head or in case of inability to replace the radial head. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Phase-dependence of elbow muscle coactivation in front crawl swimming.

PubMed

Lauer, Jessy; Figueiredo, Pedro; Vilas-Boas, João Paulo; Fernandes, Ricardo J; Rouard, Annie Hélène

2013-08-01

Propulsion in swimming is achieved by complex sculling movements with elbow quasi-fixed on the antero-posterior axis to transmit forces from the hand and the forearm to the body. The purpose of this study was to investigate how elbow muscle coactivation was influenced by the front crawl stroke phases. Ten international level male swimmers performed a 200-m front crawl race-pace bout. Sagittal views were digitized frame by frame to determine the stroke phases (aquatic elbow flexion and extension, aerial elbow flexion and extension). Surface electromyograms (EMG) of the right biceps brachii and triceps brachii were recorded and processed using the integrated EMG to calculate a coactivation index (CI) for each phase. A significant effect of the phases on the CI was revealed with highest levels of coactivation during the aquatic elbow flexion and the aerial elbow extension. Swimmers stabilize the elbow joint to overcome drag during the aquatic phase, and act as a brake at the end of the recovery to replace the arm for the next stroke. The CI can provide insight into the magnitude of mechanical constraints supported by a given joint, in particular during a complex movement. Copyright © 2013 Elsevier Ltd. All rights reserved.

Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study.

PubMed

Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Aune, Kyle T; Porterfield, Ron A; Harker, Paul; Evans, Timothy J; Andrews, James R

2014-09-01

Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Cohort study; Level of evidence, 2. For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was assessed with the subject supine and the scapula stabilized per methods previously established. Elbow injuries and days missed because of elbow injuries were assessed and recorded by the medical staff of the team. Throwing and nonthrowing shoulder measurements were compared by using Student t tests; 1-tailed Fisher exact tests were performed to identify significant associations between shoulder motion and elbow injury. Nominal logistic regression was performed to determine the odds of elbow injury. Significant differences were noted during side-to-side comparisons within subjects. There were 49 elbow injuries and 8 surgeries in 38 players, accounting for a total of 2551 days missed. Neither glenohumeral internal rotation deficit nor external rotation insufficiency was correlated with elbow injuries. Pitchers with deficits of >5° in total rotation in their throwing shoulders had a 2.6 times greater risk for injury. Pitchers with deficit of ≥5° in flexion of the throwing shoulder had a 2.8 times greater risk for injury. Bilateral differences in shoulder total rotation and flexion had a significant effect on the risk for elbow injuries in pitchers. Clinicians need to be aware of these findings and plan preventive programs that address these issues in hopes of reducing elbow injuries. © 2014 The Author(s).

Does Flooring Substrate Impact Kennel and Dog Cleanliness in Commercial Breeding Facilities?

PubMed

Stella, Judith; Hurt, Moriah; Bauer, Amy; Gomes, Paulo; Ruple, Audrey; Beck, Alan; Croney, Candace

2018-04-21

Evaluation of kennel flooring surfaces is needed to understand their impacts on dog health and well-being. This pilot study aimed to characterize aspects of physical health, kennel cleanliness, and dog body cleanliness on flooring types common in US breeding kennels. Subjects were 118 adult dogs housed on diamond-coated expanded metal (DCEM), polypropylene (POLY), or concrete (CON) flooring at five commercial breeding facilities in Indiana, U.S. Body condition, paw, elbow, and hock health scores were recorded. Each indoor kennel and dog was visually assessed for cleanliness. Kennels were swabbed immediately after cleaning with electrostatic dry cloths and cultured for Escherichia coli . Descriptive statistics were used for analysis. Mean body condition score (BCS), kennel and dog cleanliness scores were all near ideal (3, 1.15, and 1.04, respectively). Thirty-one percent or fewer kennels at each facility were culture-positive for E. coli after cleaning. No serious paw, elbow, or hock problems were identified. Overall, the findings indicate that with appropriate management and regular access to additional surfaces, dog foot health, cleanliness, and kennel cleanliness can be maintained on the flooring types investigated.

Glenoid bone grafting in primary reverse total shoulder arthroplasty.

PubMed

Ernstbrunner, Lukas; Werthel, Jean-David; Wagner, Eric; Hatta, Taku; Sperling, John W; Cofield, Robert H

2017-08-01

Severe glenoid bone loss remains a challenge in patients requiring shoulder arthroplasty and may necessitate glenoid bone grafting. The purpose of this study was to determine results, complications, and rates of failure of glenoid bone grafting in primary reverse shoulder arthroplasty. Forty-one shoulders that underwent primary reverse arthroplasty between 2006 and 2013 with a minimum follow-up of 2 years (mean, 2.8 years; range, 2-6 years) were reviewed. Thirty-four (83%) received corticocancellous grafts and 7 (17%) structural grafts. Active range of motion and pain levels were significantly improved (P < .001), with mean American Shoulder and Elbow Surgeons score of 77, Simple Shoulder Test score of 9, and patient satisfaction of 93% at the most recent follow-up. Preoperative severe glenoid erosion and increasing body mass index were significantly associated with worse American Shoulder and Elbow Surgeons scores (P = .04). On radiographic evaluation, 7 patients (18%) had grade 1 or grade 2 glenoid lucency. Glenoid bone graft incorporation was observed in 31 patients (78%). Twelve patients (30%) suffered from grade 1 or grade 2 scapular notching. All of the patients with structural grafts showed graft incorporation and no signs of glenoid lucency. Although glenoid lucency, glenoid graft resorption, and scapular notching were present at short-term to midterm follow-up, none of the patients needed revision surgery. Primary reverse shoulder arthroplasty with glenoid reconstruction using bone graft relieved pain and restored shoulder function and stability. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

PubMed

Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

2014-10-01

Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up.

PubMed

Ballesteros-Betancourt, J R; Fernández-Valencia, J A; García-Tarriño, R; Domingo-Trepat, A; Sastre-Solsona, S; Combalia-Aleu, A; Llusá-Pérez, M

Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with screws, with or without heads. The lateral Kocher approach is the most common approach for open reduction. We believe that the limited anterior approach of the elbow, could be a valid technique for treating these fractures, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process. A description is presented of the surgical technique, as well as of 2cases with a Bryan-Morrey type 1 fracture (Dubberley type 1A). Two different final quality of life evaluation questionnaires were completed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D), and the patient part of the Liverpool Elbow Score (PAQ-LES) questionnaire. The 2patients showed favourable clinical progress at 36 and 24 months, respectively, with an extension/flexion movement arc of -5°/145° and -10°/145°, as well as a pronosupination of 85°/80° and 90°/90°. The 2patients showed radiological consolidation with no signs of osteonecrosis. The EQ-5D score was 0.857 and 0.910 (range: 0.36-1), and a PAQ-SLE of 35 and 35 (range: 17-36), respectively. We believe that the limited anterior approach of the elbow is a technical option to consider for the open surgical treatment of a capitellum fracture, although further studies are needed to demonstrate its superiority and clinical safety compared to the classical lateral Kocher approach. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Assessing the therapeutic effect of 625-nm light-emitting diodes

NASA Astrophysics Data System (ADS)

Mao, Zongzhen; Xu, Guodong; Yang, Yi

2014-09-01

To evaluate the effects of red Light-Emitting Diodes on elbow extensor and flexor strength and the recovery of exercise induced fatigue, the torque values from the isokinetic dynamometer as well as biochemistry parameters were used as outcome measures. A randomized double-blind placebo-controlled crossover trial was performed with twenty male young tennis athletes. Active LED therapy (LEDT, with wavelength 625nm, 10 minutes total irradiation time, irradiated area amount to 30cm2, and 900J of total energy irradiated) or an identical placebo was delivered under double-blinded conditions to the left elbow just before exercise. The isokinetic muscle strength was measured immediately after irradiation. The blood lactate levels were sampled pre-exercise and post-exercise. The peak torque values of elbow extensor strength were significantly different between two groups. As in elbow flexor strength, the difference of peak torque was not significant. The blood lactate concentration of LEDT group post-exercise was significantly lower than those of placebo group. The results indicate that 625nm LED therapy is effective in preventing muscle fatigue as it can significantly reduce peak torque value of elbow extensors and blood lactate concentration. It has no effect on the strength of left elbow flexor or backhand performance in tennis.

Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial.

PubMed

Palacio, Evandro Pereira; Schiavetti, Rafael Ramos; Kanematsu, Maiara; Ikeda, Tiago Moreno; Mizobuchi, Roberto Ryuiti; Galbiatti, José Antônio

2016-01-01

To evaluate the effects of platelet-rich plasma (PRP) infiltration in patients with lateral epicondylitis of the elbow, through analysis of the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaires. Sixty patients with lateral epicondylitis of the elbow were prospectively randomized and evaluated after receiving infiltration of three milliliters of PRP, or 0.5% neocaine, or dexamethasone. For the scoring process, the patients were asked to fill out the DASH and PRTEE questionnaires on three occasions: on the day of infiltration and 90 and 180 days afterwards. Around 81.7% of the patients who underwent the treatment presented some improvement of the symptoms. The statistical tests showed that there was evidence that the cure rate was unrelated to the substance applied (p = 0.62). There was also intersection between the confidence intervals of each group, thus demonstrating that the proportions of patients whose symptoms improved were similar in all the groups. At a significance level of 5%, there was no evidence that one treatment was more effective than another, when assessed using the DASH and PRTEE questionnaires.

Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) scores with legacy patient-reported outcome scores in patients undergoing rotator cuff repair.

PubMed

Patterson, Brendan M; Orvets, Nathan D; Aleem, Alexander W; Keener, Jay D; Calfee, Ryan P; Nixon, Devon C; Chamberlain, Aaron M

2018-06-01

The Patient-Reported Outcomes Measurement Information System (PROMIS) is being used to assess outcomes in many patient populations despite limited validation. The purpose of this study was to investigate the relationship between American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores and PROMIS Physical Function (PF) and Upper Extremity (UE) function scores collected preoperatively in patients undergoing rotator cuff repair. This cross-sectional study analyzed 164 consecutive patients undergoing arthroscopic rotator cuff repair. Study inclusion required preoperative completion of the ASES and SST evaluations, as well as the PROMIS PF, UE, and Pain Interference computerized adaptive tests. Descriptive statistics were produced, and Pearson correlation coefficients were calculated between each of the outcome measures. Average PROMIS UE scores indicated greater impairment than PROMIS PF scores (34 vs 44). Three percent of patients reached the PROMIS UE ceiling score of 56. PROMIS PF scores demonstrated a weak correlation with ASES scores (r = 0.43, P < .001) and a moderate correlation with SST scores (r = 0.51, P < .001). PROMIS UE scores demonstrated a moderate correlation with both ASES scores (r = 0.59, P < .001) and SST scores (r = 0.62, P < .001). PROMIS Pain Interference scores demonstrated weak negative correlations with both ASES scores (r = -0.43, P < .001) and SST scores (r = -0.41, P < .001). Patients answered fewer questions on average using the PROMIS PF and UE instruments as compared with the ASES and SST instruments. PROMIS UE scores indicate greater impairment and demonstrate a stronger correlation with the legacy shoulder scores than PROMIS PF scores in patients with symptomatic rotator cuff tears. PROMIS computerized adaptive tests allow for more efficient patient-reported outcome data collection compared with traditional outcome scores. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Endoscopic repair of tears of the superficial layer of the distal triceps tendon.

PubMed

Heikenfeld, Roderich; Listringhaus, Rico; Godolias, Georgios

2014-07-01

The purpose of this study was to evaluate the results after endoscopic repair of partial superficial layer triceps tendon tears. Fourteen patients treated surgically between July 2005 and December 2012 were studied prospectively for 12 months. Indication for surgery was a partial detachment of the triceps tendon from the olecranon that was proved by magnetic resonance imaging (MRI) in all cases. Ten of these patients had chronic olecranon bursitis. All patients were treated with endoscopic surgery including bursectomy and repair of the distal triceps tendon with double-loaded suture anchors. Clinical examination of the patients as well as functional and subjective scores (Mayo Elbow Performance Index [MEPI], Disabilities of the Arm, Shoulder and Hand Score [Quick DASH]) were obtained preoperatively and postoperatively at 6 and 12 months. An isokinetic strength measurement and MRI were performed preoperatively and 12 months after surgery. All 14 patients were completely evaluated. The MEPI and Quick DASH Score improved significantly after the repair at all postoperative examinations. The MEPI gained 29 points, up to 96 points at last follow-up (P < .05), and the Quick DASH Score went down 15.6 points after 12 months to 4.5 points (P < .05). Maximum extension power improved 55.8%, up to 94.7% at last follow-up compared with the contralateral side. Using MRI, we found one reruptured partial tear of the triceps tendon that did not require revision surgery. Although triceps tendon ruptures are generally uncommon, partial superficial tears might be more common than previously described. Once the diagnosis is made, endoscopic repair is a method leading to good clinical results with improved function of the affected elbow. Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. Strength recovers to nearly that of the contralateral side, and serious complications appear to be infrequent. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A musculoskeletal model of the elbow joint complex

NASA Technical Reports Server (NTRS)

Gonzalez, Roger V.; Barr, Ronald E.; Abraham, Lawrence D.

1993-01-01

This paper describes a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. Musculotendon parameters and the skeletal geometry were determined for the musculoskeletal model in the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing both isometric and ballistic elbow joint complex movements. In general, the model predicted kinematic and muscle excitation patterns similar to what was experimentally measured.

IMPACT OF GRAVITY LOADING ON POST-STROKE REACHING AND ITS RELATIONSHIP TO WEAKNESS

PubMed Central

Beer, Randall F.; Ellis, Michael D.; Holubar, Bradley G.; Dewald, Julius P.A.

2010-01-01

The ability to extend the elbow following stroke depends on the magnitude and direction of torques acting at the shoulder. The mechanisms underlying this link remain unclear. The purpose of this study was to evaluate whether the effects of shoulder loading on elbow function were related to weakness or its distribution in the paretic limb. Ten subjects with longstanding hemiparesis performed movements with the arm either passively supported against gravity by an air bearing, or by activation of shoulder muscles. Isometric maximum voluntary torques at the elbow and shoulder were measured using a load cell. The speed and range of elbow extension movements were negatively impacted by actively supporting the paretic limb against gravity. However, the effects of gravity loading were not related to proximal weakness or abnormalities in the elbow flexor–extensor strength balance. The findings support the existence of abnormal descending motor commands that constrain the ability of stroke survivors to generate elbow extension torque in combination with abduction torque at the shoulder. PMID:17486581

Impact of gravity loading on post-stroke reaching and its relationship to weakness.

PubMed

Beer, Randall F; Ellis, Michael D; Holubar, Bradley G; Dewald, Julius P A

2007-08-01

The ability to extend the elbow following stroke depends on the magnitude and direction of torques acting at the shoulder. The mechanisms underlying this link remain unclear. The purpose of this study was to evaluate whether the effects of shoulder loading on elbow function were related to weakness or its distribution in the paretic limb. Ten subjects with longstanding hemiparesis performed movements with the arm either passively supported against gravity by an air bearing, or by activation of shoulder muscles. Isometric maximum voluntary torques at the elbow and shoulder were measured using a load cell. The speed and range of elbow extension movements were negatively impacted by actively supporting the paretic limb against gravity. However, the effects of gravity loading were not related to proximal weakness or abnormalities in the elbow flexor-extensor strength balance. The findings support the existence of abnormal descending motor commands that constrain the ability of stroke survivors to generate elbow extension torque in combination with abduction torque at the shoulder.

sEMG feature evaluation for identification of elbow angle resolution in graded arm movement.

PubMed

Castro, Maria Claudia F; Colombini, Esther L; Aquino, Plinio T; Arjunan, Sridhar P; Kumar, Dinesh K

2014-11-25

Automatic and accurate identification of elbow angle from surface electromyogram (sEMG) is essential for myoelectric controlled upper limb exoskeleton systems. This requires appropriate selection of sEMG features, and identifying the limitations of such a system.This study has demonstrated that it is possible to identify three discrete positions of the elbow; full extension, right angle, and mid-way point, with window size of only 200 milliseconds. It was seen that while most features were suitable for this purpose, Power Spectral Density Averages (PSD-Av) performed best. The system correctly classified the sEMG against the elbow angle for 100% cases when only two discrete positions (full extension and elbow at right angle) were considered, while correct classification was 89% when there were three discrete positions. However, sEMG was unable to accurately determine the elbow position when five discrete angles were considered. It was also observed that there was no difference for extension or flexion phases.

Depression and Anxiety in Traumatic Brachial Plexus Injury Patients Are Associated With Reduced Motor Outcome After Surgical Intervention for Restoration of Elbow Flexion.

PubMed

Wilson, Thomas J; Chang, Kate W C; Yang, Lynda J-S

2016-06-01

Depression has been associated with poor outcomes in neurosurgical patients, including increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding an association of psychiatric diagnoses with outcomes after brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. To analyze patients undergoing brachial plexus reconstruction to assess the relationship of depression/anxiety with functional outcome. Data were collected retrospectively on all patients who underwent brachial plexus reconstruction to restore elbow flexion between 2005 and 2013. Elbow flexion, graded via the Medical Research Council scale, was assessed at latest follow-up. Multiple variables, including the presence of Axis I psychiatric diagnoses, were assessed for their association with the dichotomous outcome of Medical Research Council scale score ≥3 (antigravity) vs <3 elbow flexion. Standard statistical methods were used. Thirty-seven patients met inclusion criteria. The median postsurgical follow-up time was 21 months. Operations included neurolysis (n = 3), nerve graft repair (n = 6), and nerve transfer (n = 28). Depression was present in 10 of 37 patients (27%). Of variables tested, only depression was associated with poor elbow flexion outcome (odds ratio: 6.038; P = .04). Preoperative depression is common after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery after reconstruction. Our data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction. MRC, Medical Research CouncilTBI, traumatic brain injury.

Reliability testing of the Larsen and Sharp classifications for rheumatoid arthritis of the elbow.

PubMed

Jew, Nicholas B; Hollins, Anthony M; Mauck, Benjamin M; Smith, Richard A; Azar, Frederick M; Miller, Robert H; Throckmorton, Thomas W

2017-01-01

Two popular systems for classifying rheumatoid arthritis affecting the elbow are the Larsen and Sharp schemes. To our knowledge, no study has investigated the reliability of these 2 systems. We compared the intraobserver and interobserver agreement of the 2 systems to determine whether one is more reliable than the other. The radiographs of 45 patients diagnosed with rheumatoid arthritis affecting the elbow were evaluated. Anteroposterior and lateral radiographs were deidentified and distributed to 6 evaluators (4 fellowship-trained upper extremity surgeons and 2 orthopedic trainees). Each evaluator graded all 45 radiographs according to the Larsen and Sharp scoring methods on 2 occasions, at least 2 weeks apart. Overall intraobserver reliability was 0.93 (95% confidence interval [CI], 0.90-0.95) for the Larsen system and 0.92 (95% CI, 0.86-0.96) for the Sharp classification, both indicating substantial agreement. Overall interobserver reliability was 0.70 (95% CI, 0.60-0.80) for the Larsen classification and 0.68 (95% CI, 0.54-0.81) for the Sharp system, both indicating good agreement. There were no significant differences in the intraobserver or interobserver reliability of the systems overall and no significant differences in reliability between attending surgeons and trainees for either classification system. The Larsen and Sharp systems both show substantial intraobserver reliability and good interobserver agreement for the radiographic classification of rheumatoid arthritis affecting the elbow. Differences in training level did not result in substantial variances in reliability for either system. We conclude that both systems can be reliably used to evaluate rheumatoid arthritis of the elbow by observers of varying training levels. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The role of arthroscopy in chronic elbow instability.

PubMed

Goodwin, David; Dynin, Maria; Macdonnell, J Ryan; Kessler, Michael W

2013-12-01

Elbow arthroscopy has had an emerging role in the management of many disorders of the elbow. In patients with chronic elbow instability, several arthroscopic techniques have been described in the diagnosis and management of posterolateral rotatory instability and valgus instability. We performed a systematic review investigating the role of arthroscopy in posterolateral rotatory instability and valgus instability in the elbow using the PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, and the Cochrane Database of Systematic Reviews, consisting of articles from peer-reviewed journals published in the English language after January 1, 1991. Search criteria initially identified 249 articles. Twenty-five articles met criteria for inclusion. This included 17 review articles, 4 cadaveric studies, 3 retrospective studies, and 1 prospective study. Two of the retrospective studies compared arthroscopic and open techniques. Articles included in this systematic review concluded that arthroscopy is an accurate adjunct to physical examination and imaging in the diagnosis of chronic elbow instability and affords an exceptional view of the joint with the ability to address intra-articular pathologic conditions. Arthroscopic surgical techniques have shown equivalent clinical outcomes in a comparison of arthroscopic and open techniques. Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability. Patients treated arthroscopically benefit from additional diagnostic techniques, improved visualization of the elbow joint, the ability to address coexisting intra-articular pathologic conditions, and minimal soft tissue injury with no clinical consequences in outcomes. With such significant advantages, the use of elbow arthroscopy is likely to expand in the management of chronic elbow instability. Level IV, systematic review. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Reduced muscle fiber force production and disrupted myofibril architecture in patients with chronic rotator cuff tears.

PubMed

Mendias, Christopher L; Roche, Stuart M; Harning, Julie A; Davis, Max E; Lynch, Evan B; Sibilsky Enselman, Elizabeth R; Jacobson, Jon A; Claflin, Dennis R; Calve, Sarah; Bedi, Asheesh

2015-01-01

A persistent atrophy of muscle fibers and an accumulation of fat, collectively referred to as fatty degeneration, commonly occur in patients with chronic rotator cuff tears. The etiology of fatty degeneration and function of the residual rotator cuff musculature have not been well characterized in humans. We hypothesized that muscles from patients with chronic rotator cuff tears have reduced muscle fiber force production, disordered myofibrils, and an accumulation of fat vacuoles. The contractility of muscle fibers from biopsy specimens of supraspinatus muscles of 13 patients with chronic full-thickness posterosuperior rotator cuff tears was measured and compared with data from healthy vastus lateralis muscle fibers. Correlations between muscle fiber contractility, American Shoulder and Elbow Surgeons (ASES) scores, and tear size were analyzed. Histology and electron microscopy were also performed. Torn supraspinatus muscles had a 30% reduction in maximum isometric force production and a 29% reduction in normalized force compared with controls. Normalized supraspinatus fiber force positively correlated with ASES score and negatively correlated with tear size. Disordered sarcomeres were noted, along with an accumulation of lipid-laden macrophages in the extracellular matrix surrounding supraspinatus muscle fibers. Patients with chronic supraspinatus tears have significant reductions in muscle fiber force production. Force production also correlates with ASES scores and tear size. The structural and functional muscle dysfunction of the residual muscle fibers is independent of the additional area taken up by fibrotic tissue. This work may help establish future therapies to restore muscle function after the repair of chronically torn rotator cuff muscles. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears?

PubMed

Bae, Kyu Hwan; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Jong Yun; Joo, Min Su; Kim, Dong Moon

2016-09-01

We aimed to identify the clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears of all sizes with a modified tension band suture technique. Among 63 patients who underwent arthroscopic rotator cuff repair for a full-thickness rotator cuff tear with the modified tension band suture technique at a single hospital between July 2011 and March 2013, 47 were enrolled in this study. The mean follow-up period was 29 months. Visual analog scale scores, range of motion, American Shoulder and Elbow Surgeons scores, Constant scores, and Shoulder Strength Index were measured preoperatively and at the final follow-up. For radiologic evaluation, we conducted magnetic resonance imaging 6 months postoperatively and ultrasonography at the final follow-up. We allocated the small and medium tears to group A and the large and massive tears to group B and then compared clinical outcomes and repair integrity. Postoperative clinical outcomes at the final follow-up showed significant improvements compared with those seen during preoperative evaluations (P < .001). However, group B showed worse clinical results than group A. Evaluation with magnetic resonance imaging performed 6 months postoperatively and ultrasonography taken at the final follow-up revealed that group B showed a significantly higher retear rate than did group A (69% vs. 6%, respectively; P < .001). Arthroscopic repair with the modified tension band suture technique for rotator cuff tears was a more suitable method for small to medium tears than for large to massive tears. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The challenge of Monteggia-like lesions of the elbow: mid-term results of 46 cases.

PubMed

Jungbluth, P; Tanner, S; Schneppendahl, J; Grassmann, J-P; Wild, M; Hakimi, M; Windolf, J; Laun, R

2018-02-01

The aim of this retrospective multicentre study was to evaluate mid-term results of the operative treatment of Monteggia-like lesions and to determine the prognostic factors that influence the clinical and radiological outcome. A total of 46 patients (27 women and 19 men), with a mean age of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion were followed up clinically and radiologically after surgical treatment. The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score (MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder and Hand (DASH) score were used for evaluation at a mean of 65 months (27 to 111) postoperatively. All ulnar fractures were stabilized using a proximally contoured or precontoured locking compression plate. Mason type I fractures of the radial head were treated conservatively, type II fractures were treated with reconstruction, and type III fractures with arthroplasty. All Morrey type II and III fractures of the coronoid process was stabilized using lag screws. Good results were found for the MMWS, with a mean of 88.4 (40 to 100). There were 29 excellent results (63%), nine good (20%), seven satisfactory (15%), and one poor (2%). Excellent results were obtained for the MEPS, with a mean of 90.7 (70 to 100): 31 excellent results (68%), 13 good (28%), and two fair (4%). Good results were also found for the functional rating index of Broberg and Morrey, with a mean score of 86.6 (57 to 100). There were 16 excellent results (35%), 22 good (48%), six fair (13%), and two poor (4%). The mean DASH score was 15.1 (0 to 55.8). Two patients had delayed wound healing; four patients had nonunion requiring bone grafting. One patient had asymptomatic loosening of the radial head prosthesis. Monteggia-like lesions are rare. With correct identification, classification, and understanding using CT scans followed by appropriate surgical treatment that addresses all components of the injury, good to excellent mid-term results can be achieved. Cite this article: Bone Joint J 2018;100-B:212-18. ©2018 The British Editorial Society of Bone & Joint Surgery.

Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty.

PubMed

Ranalletta, Maximiliano; Rossi, Luciano A; Atala, Nicolas A; Bertona, Agustin; Maignon, Gastón D; Bongiovanni, Santiago L

2017-07-01

To evaluate functional outcomes and complications in a consecutive group of patients with partial bursal rotator cuff tears (PBRCTs) treated with insitu repair without acromioplasty. Seventy-four patients who had undergone an arthroscopic single row in situ repair for bursal-sided rotator cuff tears were evaluated. Clinical assessment consisted of glenohumeral range of motion measurement, the American Shoulder and Elbow Surgeons score, and the University of California at Los Angeles score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. Mean age was 55.2 years (±6.3) with a minimum of 2-year follow-up. After arthroscopic repair, all active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons scores improved from 42.5 to 86.1; the University of California at Los Angeles scores improved from 15.8 to 31.4, and the visual analog scale scores improved from 6.6 to 0.7 (P < .0001). Only 3 patients developed a postoperative adhesive capsulitis that responded to physical therapy. In the midterm follow-up (42 months), arthroscopic in situ repair of PBRCTs without acromioplasty is a reliable procedure that produces significant functional improvements and pain relief. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Treatment for Ulnar Neuritis Around the Elbow in Adolescent Baseball Players: Factors Associated With Poor Outcome.

PubMed

Maruyama, Masahiro; Satake, Hiroshi; Takahara, Masatoshi; Harada, Mikio; Uno, Tomohiro; Mura, Nariyuki; Takagi, Michiaki

2017-03-01

Ulnar neuritis around the elbow is one of the injuries seen in throwing athletes. Outcomes of nonsurgical treatment and factors associated with failure outcomes have not been reported. To investigate the outcomes of treatments for ulnar neuritis in adolescent baseball players. Case series; Level of evidence, 4. We assessed 40 male baseball players with a mean age of 15.0 years (range, 13-17 years) who presented with ulnar neuritis. There were 19 pitchers and 21 fielders whose throwing side was affected. All patients had elbow pain, and 13 patients had hand numbness on the ulnar side. The mean Kerlan-Jobe Orthopaedic Clinic (KJOC) overhead athlete shoulder and elbow score was 52.5 at the first follow-up visit (n = 36 patients). Thirteen patients were identified with ulnar nerve subluxation, and 23 patients had concomitant elbow ulnar collateral ligament (UCL) injury. All patients underwent nonsurgical treatment, which included rehabilitation exercises and prohibition of throwing. If the nonsurgical treatment failed, we recommended surgical treatment. We investigated the outcomes of the nonsurgical and surgical treatments. Return to sports was evaluated, combined with factors associated with return to sports in nonsurgical treatment by univariate and multivariate statistical analysis. The mean follow-up period was 23.6 months (range, 6-39 months). After nonsurgical treatment, 24 patients (60%) returned to the previous competition level after a mean of 2.4 months. Two patients returned to a recreational level. One patient gave up playing baseball at 2 months. The remaining 13 patients underwent surgery and returned to sports after a mean of 2.0 months postoperatively, and 12 had no limitation of sports activities. Multivariate logistical regression analysis demonstrated that hand numbness, ulnar nerve subluxation, and UCL injury were associated with failure of nonsurgical treatment ( P < .05). In addition, KJOC score of <45 at the first follow-up tended to be associated with poor outcomes of nonsurgical treatment ( P = .06). Hand numbness on the ulnar side, ulnar nerve subluxation, and UCL injury are strong predictors of poor outcomes after nonsurgical treatment for ulnar neuritis, and surgery provides excellent results.

Subject-specific computer simulation model for determining elbow loading in one-handed tennis backhand groundstrokes.

PubMed

King, Mark A; Glynn, Jonathan A; Mitchell, Sean R

2011-11-01

A subject-specific angle-driven computer model of a tennis player, combined with a forward dynamics, equipment-specific computer model of tennis ball-racket impacts, was developed to determine the effect of ball-racket impacts on loading at the elbow for one-handed backhand groundstrokes. Matching subject-specific computer simulations of a typical topspin/slice one-handed backhand groundstroke performed by an elite tennis player were done with root mean square differences between performance and matching simulations of < 0.5 degrees over a 50 ms period starting from ball impact. Simulation results suggest that for similar ball-racket impact conditions, the difference in elbow loading for a topspin and slice one-handed backhand groundstroke is relatively small. In this study, the relatively small differences in elbow loading may be due to comparable angle-time histories at the wrist and elbow joints with the major kinematic differences occurring at the shoulder. Using a subject-specific angle-driven computer model combined with a forward dynamics, equipment-specific computer model of tennis ball-racket impacts allows peak internal loading, net impulse, and shock due to ball-racket impact to be calculated which would not otherwise be possible without impractical invasive techniques. This study provides a basis for further investigation of the factors that may increase elbow loading during tennis strokes.

Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Sustainability and Sonographic Progression at 3 Years.

PubMed

Seng, Chusheng; Mohan, P Chandra; Koh, Suang Bee Joyce; Howe, Tet Sen; Lim, Yee Gen; Lee, Brian P; Morrey, Bernard F

2016-02-01

A previously published study found positive outcomes for a novel technique for ultrasound-guided percutaneous ultrasonic tenotomy, showing good tolerability, safety, and early efficacy within an office setting. In this follow-up study, all 20 members of the original cohort were contacted after 3 years to explore the sustainability of symptomatic relief, functional improvement, and sonographic soft tissue response for percutaneous ultrasonic tenotomy. Case series; Level of evidence, 4. All 20 subjects of the clinical trial that was performed from June to November 2011 were further assessed at 36 months after the procedure in terms of visual analog scale for pain, Disabilities of the Arm, Shoulder and Hand (DASH)-Compulsory/Work scores, need for adjunct procedures, and overall satisfaction. Importantly, all 20 were reassessed with ultrasound imaging at 36 months, and evidence of the common extensor tendon response was assessed in terms of tendon hypervascularity, tendon thickness, and the progress of the hypoechoic scar tissue. A 100% clinical follow-up was achieved, inclusive of ultrasonographic assessment. None of the subjects required further treatment procedures, and 100% expressed satisfaction. Previous improvements in visual analog scale (current median ± SD, 0 ± 0.9; range, 0-3) and DASH-Work scores (current median, 0 ± 0) were sustained with conformity to a linear pattern on polynomial measures. There was further reduction in DASH-Compulsory scores to a median of 0 ± 0.644 (range, 0-2) with a significant decrease on repeated measures (P = .008). Tendon hypervascularity was resolved in 94% of patients, and 100% had reduction in tendon thickness. Overall reduction in the hypoechoic scar tissue was observed in all subjects, with a 90% response achieved by 6 months. Between 6 and 36 months, further reduction in the scar was observed in around 60% of patients, with 20% of patients having complete resolution of the hypoechoic scar. Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. It is one of the few procedures to demonstrate positive sonographic evidence of tissue-healing response and is an attractive alternative to surgical intervention for definitive treatment of recalcitrant elbow tendinopathy. © 2015 The Author(s).

Partial rotator cuff repair and biceps tenotomy for the treatment of patients with massive cuff tears and retained overhead elevation: midterm outcomes with a minimum 5 years of follow-up.

PubMed

Cuff, Derek J; Pupello, Derek R; Santoni, Brandon G

2016-11-01

A subset of patients with massive irreparable rotator cuff tears present with retained overhead elevation and pain as their primary complaint. Our aim was to evaluate the outcomes of partial arthroscopic rotator cuff repair with biceps tenotomy and to report the failure rate of this procedure for patients with >5 years of follow-up. Thirty-four patients underwent partial rotator cuff repair and biceps tenotomy for treatment of a massive rotator cuff tear. Patients had preoperative active forward elevation >120° and no radiographic evidence of glenohumeral arthritis. Patients were followed up clinically and radiographically, and 28 patients had a minimum of 5 years of follow-up. Failure was defined as an American Shoulder and Elbow Surgeons score of <70, loss of active elevation >90°, or revision to reverse shoulder arthroplasty during the study period. Patients demonstrated improvements in average preoperative to postoperative American Shoulder and Elbow Surgeons scores (46.6 to 79.3 [P < .001]) and Simple Shoulder Test scores (5.7 to 9.1 [P < .001]) along with decrease in visual analog scale for pain scores (6.9 to 1.9 [P < .001]). No significant change in forward elevation (168° to 154° [P = .07]), external rotation (38° to 39° [P = 1.0]), or internal rotation (84% to 80% [P = 1.0]) was identified; 36% of patients had progression of the Hamada stage. The failure rate was 29%; 75% of patients were satisfied with their index procedure. Partial rotator cuff repair and biceps tenotomy for patients with massive irreparable rotator cuff tears with retained overhead elevation and pain as the primary complaint produced reasonable outcomes at midterm follow-up of at least 5 years. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes.

PubMed

Provencher, Matthew T; Frank, Rachel M; Golijanin, Petar; Gross, Daniel; Cole, Brian J; Verma, Nikhil N; Romeo, Anthony A

2017-05-01

To assess the clinical and radiographic outcomes of patients with recurrent anterior shoulder instability treated with fresh distal tibia allograft (DTA) glenoid reconstruction. Consecutive patients with a minimum 15% anterior glenoid bone loss associated with recurrent anterior instability who underwent stabilization with DTA glenoid reconstruction were retrospectively reviewed. Patients were evaluated with the American Shoulder and Elbow Society score, Western Ontario shoulder instability index, and single numerical assessment evaluation score at a minimum 2 years after surgery. All patients also underwent postoperative imaging evaluation with computed tomography where graft incorporation and allograft angle were measured. Statistical analysis was performed with paired t-tests, with P < .05 considered significant. A total of 27 patients (100% male) with an average age of 31 ± 5 years and an average follow-up of 45 months (range, 30-66) were included. There were significant improvements in preoperative to postoperative American Shoulder and Elbow Society score (63-91, P < .01), Western Ontario shoulder instability index (46% to 11% of normal, P < .01), and single numerical assessment evaluation score (50-90.5, P < .01) outcomes. Analysis of computed tomography data at an average 1.4 years postoperatively (available for 25 patients) showed an allograft healing rate of 89% (range, 80% to 100%), average allograft angle of 14.9° (range, 6.6° to 29.3°), and average allograft lysis of 3% (range, 0% to 25%). Grafts with lesser allograft angles (<15°) were better opposed to the anterior glenoid, showing superior healing and graft incorporation. There were no cases of recurrent instability. At an average follow-up of 45 months, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption. Optimal allograft placement resulted in superior bony incorporation with the native glenoid. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Biceps muscle fatty infiltration and atrophy. A midterm review after arthroscopic tenotomy of the long head of the biceps.

PubMed

The, Bertram; Brutty, Mike; Wang, Allan; Wambeek, Nicholas D K; Campbell, Peter; Halliday, Michael J C; Ackland, Timothy R

2015-03-01

Pathology of the long head of the biceps (LHB) tendon is commonly treated by tenotomy. High levels of clinical function and patient satisfaction are reported in the short-term. The purpose of this study was to investigate the midterm effects of tenotomy on biceps fatty infiltration and atrophy in active working-age male patients. Twenty-five men (mean age, 57 years) were evaluated at a mean follow-up of 6.7 years after tenotomy. Bilateral magnetic resonance imaging (MRI) was performed, and fatty infiltration of the biceps was assessed relative to the ipsilateral triceps. Seventeen participants had an intact contralateral LHB tendon. To assess atrophy, anterior muscle compartment volume was measured by serial cross-sectional area measurements on MRI. The tenotomized side was then compared to the healthy side in these 17 participants. Clinical scores were obtained using the QuickDASH and Oxford Elbow Score, and the occurrence of a Popeye sign and residual pain were recorded. Good clinical function was maintained at a mean follow-up time of 6.7 years (range, 4 to 10 years) (QuickDASH score of 7.1; standard error [SE], 1.8) and Oxford Elbow Score of 97.9 [SE 1.2]). Eleven of the 25 participants had a Popeye deformity. Four participants showed signs of fatty infiltration, and all were minor (grade 1). The mean decrease in total volume of the anterior musculature was 3.6%. In participants without a Popeye deformity, it was 3.3%, whereas it was 4.1% in participants with a Popeye sign (P = .8). In the midterm, LHB tenotomy in active men of working age does not result in fatty degeneration or substantial atrophy in the anterior musculature of the arm. Clinical function remains good. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Open inferior capsular shift for multidirectional shoulder instability in adolescents with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome.

PubMed

Vavken, Patrick; Tepolt, Frances A; Kocher, Mininder S

2016-06-01

The objective of this study was to assess the outcome of open inferior capsular shift for multidirectional shoulder instability in patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome. Data were obtained for 18 open inferior capsular shift surgeries in 15 adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome with a mean follow-up of 7.5 years. End points were subjective clinical outcome (pain, stability, satisfaction, return to sport), objective clinical outcome (recurrence, complications), and functional outcome scores (American Shoulder and Elbow Surgeons, 11-item version of the Disabilities of Arm, Shoulder and Hand). Thirteen patients (87%) reported improved pain and stability and were satisfied with the procedure. Nine patients (64%) were able to return to sports. One patient (7%) was dissatisfied with continuous pain and recurrent instability and considered a surgical failure. Seven patients (47%) reported no further episodes of instability. The mean American Shoulder and Elbow Surgeons score at a mean of 7.5 years of follow-up was 88 ± 10 points, and the mean score for the 11-item version of the Disabilities of Arm, Shoulder and Hand was 14 ± 14 points. The management of multidirectional shoulder instability in adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome is challenging. Open inferior capsular shift results in improvement in subjective and objective shoulder function and stability in adolescent patients with ligamentous hyperlaxity or Ehlers-Danlos who have failed nonoperative treatment. We found no effect of the recalled number of prior dislocations, laterality, and type of hyperlaxity on subjective and objective clinical outcomes. Level IV; Case Series; Treatment Study. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study.

PubMed

Luginbühl, Rolf; Brunner, Florian; Schneeberger, Alberto G

2008-01-01

The objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used.

Quantitative assessment of four men using above-elbow prosthetic control.

PubMed

Popat, R A; Krebs, D E; Mansfield, J; Russell, D; Clancy, E; Gill-Body, K M; Hogan, N

1993-07-01

We studied the relationship between kinematically unconstrained activities of daily living (ADL) tasks and a kinematically constrained task in above-elbow (AE) amputee subjects using myoelectrically controlled prostheses. Four men, 24 to 49 years old, with unilateral AE amputation wore a prosthesis interfaced to a programmable controller to emulate two different elbow control schemes, conventional velocity and a new "natural" controller. Subjects were timed during three ADL tasks--cutting meat, donning socks, and rolling dough--with both controllers. The prosthesis emulator was then connected to a crank device with a handle, and the subjects turned the crank from bottom to top positions in a vertical plane using each controller. Synergistic shoulder-elbow joint coordination required for crank turning was quantified as the maximum slope of the change in elbow torque versus the change in crank-angle. Performance between the two controllers differed significantly for the crank test but not for ADL tasks. One subject did not complete all crank turning tests. Positive canonical correlation of 0.77 was found between time and crank domain measures. We conclude that biomechanical assessments should be integrated with time-based clinical tests to comprehensively evaluate performance of AE amputee subjects with a myoelectric device.

Elbow Injuries in Professional Baseball: Epidemiological Findings From the Major League Baseball Injury Surveillance System.

PubMed

Ciccotti, Michael G; Pollack, Keisha M; Ciccotti, Michael C; D'Angelo, John; Ahmad, Christopher S; Altchek, David; Andrews, James; Curriero, Frank C

2017-08-01

Elbow injuries cause significant disability for the throwing athlete. Scant data are available on the distribution and characteristics of these injuries in elite baseball players. No study exists that focuses solely on the epidemiological characteristics of elbow injuries in professional baseball players using a comprehensive injury surveillance system. Professional baseball players have a high occurrence of elbow injuries influenced by factors including length of time playing, time period within the annual baseball season, and specific position played. Descriptive epidemiological study. Data on elbow injuries occurring during the 2011-2014 seasons were collected from Major League Baseball's Health Injury and Tracking System, a comprehensive injury surveillance system. Each specific type of elbow injury was evaluated with respect to overall injury rate, years as a professional player, mechanism of injury, treatment, average time lost, and return to play. During the study period, 3185 elbow injuries (n = 430 Major League; n = 2755 Minor League) occurred. The mean number of days missed and percentage requiring surgery were similar between Major and Minor League players. Overall, 20.0% (650/3185) of the injuries required surgical treatment. Pitchers were the most likely to incur an elbow injury (40.0% of injured athletes were pitchers), were the most likely to require surgery (34.2% of injured pitchers required surgery), and had the greatest mean number of days missed when treated nonsurgically (33.2 days). Medial injuries composed 42.1% (1342/3185) of all elbow injuries. Of all elbow surgeries performed during the study period, the highest percentage involved ligaments (372/650; 57.2%). Elbow injuries are a considerable source of disability in professional baseball players. Pitchers are most likely to incur these injuries, are most likely to require surgery, and have the highest mean number of days missed when treated nonsurgically. The most common injuries involve the medial elbow, with ligament injuries most often requiring surgery. This study represents the only investigation to date using a comprehensive injury surveillance system to examine elbow injuries in professional baseball players. It provides a basis for injury prevention and treatment recommendations, establishes the most thorough framework for determining elbow injury risk, and focuses continued research on elbow injury prevention in the elite baseball player.

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint.

PubMed

Vedrine, Bertrand

2017-04-01

Transarticular external skeletal fixation usually involves rigid bars that result in a stable but stiff joint. This study describes the technique and the outcome of an elastic transarticular external fixator (ETEF) applied to the elbow joint. Four cases of elbow luxation with collateral ligament injuries were managed with closed reduction and application of an ETEF to maintain the reduction. A triceps tendon avulsion was surgically managed before applying an ETEF. The clinical outcome was considered excellent in 2 cats, good in 2 dogs (1 elbow luxation and the avulsion of the triceps tendon), and poor in 1 dog presented for elbow luxation and a permanent neurological defect. The procedure was rapid, easy to perform, and inexpensive. All animals except the one with a neurological defect had an early return to weight bearing. This method maintains extension of the joint while permitting its motion thereby promoting rehabilitation.

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint

PubMed Central

Vedrine, Bertrand

2017-01-01

Transarticular external skeletal fixation usually involves rigid bars that result in a stable but stiff joint. This study describes the technique and the outcome of an elastic transarticular external fixator (ETEF) applied to the elbow joint. Four cases of elbow luxation with collateral ligament injuries were managed with closed reduction and application of an ETEF to maintain the reduction. A triceps tendon avulsion was surgically managed before applying an ETEF. The clinical outcome was considered excellent in 2 cats, good in 2 dogs (1 elbow luxation and the avulsion of the triceps tendon), and poor in 1 dog presented for elbow luxation and a permanent neurological defect. The procedure was rapid, easy to perform, and inexpensive. All animals except the one with a neurological defect had an early return to weight bearing. This method maintains extension of the joint while permitting its motion thereby promoting rehabilitation. PMID:28373726

Isometric torque-angle relationship and movement-related activity of human elbow flexors: implications for the equilibrium-point hypothesis.

PubMed

Hasan, Z; Enoka, R M

1985-01-01

Since the moment arms for the elbow-flexor muscles are longest at intermediate positions of the elbow and shorter at the extremes of the range of motion, it was expected that the elbow torque would also show a peak at an intermediate angle provided the activity of the flexor muscles remained constant. We measured the isometric elbow torque at different elbow angles while the subject attempted to keep constant the electromyographic activity (EMG) of the brachioradialis muscle. The torque-angle relationship thus obtained exhibited a peak, as expected, but the shape of the relationship varied widely among subjects. This was due in part to differences in the variation of the biceps brachii EMG with elbow angle among the different subjects. The implications of these observations for the equilibrium-point hypothesis of movement were investigated as follows. The subject performed elbow movements in the presence of an external torque (which tended to extend the elbow joint) provided by a weight-and-pulley arrangement. We found in the case of flexion movements that invariably there was a transient increase in flexor EMG, as would seem necessary for initiating the movement. However, the steady-state EMG after the movement could be greater or less than the pre-movement EMG. Specifically, the least flexor EMG was required for equilibrium in the intermediate range of elbow angles, compared to the extremes of the range of motion. The EMG-angle relationship, however, varied with the muscle and the subject. The observation that the directions of change in the transient and the steady-state EMG are independent of each other militates against the generality of the equilibrium-point hypothesis. However, a form of the hypothesis which includes the effects of the stretch reflex is not contradicted by this observation.

Assessment of medial elbow laxity by gravity stress radiography: comparison of valgus stress radiography with gravity and a Telos stress device.

PubMed

Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Nemoto, Tadanobu; Koseki, Kazuhiko; Kato, Yoshihiro

2014-04-01

Valgus instability was reported to be higher with the elbow in 60° of flexion, rather than in 30° of flexion, although there are no studies using valgus stress radiography by gravity (gravity radiography) with the elbow in 60° of flexion. Fifty-seven patients with medial elbow pain participated. For both elbows, valgus stress radiography by use of a Telos device (Telos radiography) and gravity radiography, with the elbow in 60° of flexion, were performed for the assessment of medial elbow laxity. In both radiographs, the medial elbow joint space (MJS) on the affected side was compared with that on the opposite side, and the increase in the MJS on the affected side was assessed. For the Telos radiographs, the mean MJS was 4.7 mm on the affected side and 4.0 mm on the opposite side, with the mean increase in the MJS on the affected side being 0.7 mm. For the gravity radiographs, the mean MJS was 5.0 mm on the affected side and 4.2 mm on the opposite side, with the mean increase in the MJS on the affected side being 0.8 mm. There were significant correlations between the Telos and gravity radiographs in the MJS on the affected side, the MJS on the opposite side, and the increase in the MJS on the affected side (respectively, P < .0001). There was also a high level of intraobserver and interobserver reliability for the assessment of the gravity radiographs. Gravity radiography is useful for assessment of medial elbow laxity, similar to Telos radiography. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Age Differences in Dynamic Fatigability and Variability of Arm and Leg Muscles: Associations with Physical Function

PubMed Central

Senefeld, Jonathon; Yoon, Tejin; Hunter, Sandra K.

2016-01-01

Introduction It is not known whether the age-related increase in fatigability of fast dynamic contractions in lower limb muscles also occurs in upper limb muscles. We compared age-related fatigability and variability of maximal-effort repeated dynamic contractions in the knee extensor and elbow flexor muscles; and determined associations between fatigability, variability of velocity between contractions and functional performance. Methods 35 young (16 males; 21.0±2.6 years) and 32 old (18 males; 71.3±6.2 years) adults performed a dynamic fatiguing task involving 90 maximal-effort, fast, concentric, isotonic contractions (1 contraction/3 s) with a load equivalent to 20% maximal voluntary isometric contraction (MVIC) torque with the elbow flexor and knee extensor muscles on separate days. Old adults also performed tests of balance and walking endurance. Results Old adults had greater fatigue-related reductions in peak velocity compared with young adults for both the elbow flexor and knee extensor muscles (P<0.05) with no sex differences (P>0.05). Old adults had greater variability of peak velocity during the knee extensor, but not during the elbow flexor fatiguing task. The age difference in fatigability was greater for the knee extensor muscles (35.9%) compared with elbow flexor muscles (9.7%, P<0.05). Less fatigability of the knee extensor muscles was associated with greater walking endurance (r=−0.34, P=0.048) and balance (r=−0.41, P=0.014) among old adults. Conclusions An age-related increase in fatigability of a dynamic fatiguing task was greater for the knee extensor compared with the elbow flexor muscles in males and females, and greater fatigability was associated with lesser walking endurance and balance. PMID:27989926

Heterotopic ossification resection after open periarticular combat-related elbow fractures.

PubMed

Wilson, Kevin W; Dickens, Jonathan F; Heckert, Reed; Tintle, Scott M; Keeling, John J; Andersen, Romney C; Potter, Benjamin K

2013-01-01

A retrospective review was performed to evaluate the outcomes and complications following heterotopic ossification (HO) resection and lysis of adhesion procedures for posttraumatic contracture, after combat-related open elbow fractures. From 2004 to 2011, HO resection was performed on 30 blast-injured elbows at a mean 10 months after injury. Injuries included 8 (27%) Gustilo-Anderson type II fractures, 8 (27%) type III-A, 10 (33%) III-B, and 4 (13%) III-C. Mean preoperative flexion-extension range of motion (ROM) was 36.4°, compared with mean postoperative ROM of 83.6°. Mean gain of motion was 47.2°. Traumatic brain injury, need for flap, and nerve injury did not appear to have a significant effect on preoperative or postoperative ROM. Complications included one fracture, six recurrent contractures, and one nerve injury. The results and complications of HO resection for elbow contracture following high-energy, open injuries from blast trauma are generally comparable to those reported for HO resection following lower energy, closed injuries.

Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up.

PubMed

Osbahr, Daryl C; Cain, E Lyle; Raines, B Todd; Fortenbaugh, Dave; Dugas, Jeffrey R; Andrews, James R

2014-06-01

Ulnar collateral ligament reconstruction (UCLR) has afforded baseball players with excellent results; however, previous studies have described only short-term outcomes. To evaluate long-term outcomes after UCLR in baseball players. Case series; Level of evidence, 4. All UCLRs performed on competitive baseball players with a minimum 10-year follow-up were identified. Surgical data were collected prospectively and patients were surveyed by telephone follow-up, during which scoring systems were used to assess baseball career and post-baseball career outcomes. Of 313 patients, 256 (82%) were contacted at an average of 12.6 years; 83% of these baseball players (90% pitchers) were able to return to the same or higher level of competition in less than 1 year, but results varied according to preoperative level of play. Baseball career longevity was 3.6 years in general and 2.9 years at the same or higher level of play, but major and minor league players returned for longer than did collegiate and high school players after surgery (P < .001). Baseball retirement typically occurred for reasons other than elbow problems (86%). Many players had shoulder problems (34%) or surgery (25%) during their baseball career, and these occurrences most often resulted in retirement attributable to shoulder problems (P < .001). For post-baseball career outcomes, 92% of patients were able to throw without pain, and 98% were still able to participate in throwing at least on a recreational level. The 10-year minimum follow-up scores (mean ± standard deviation) for the Disabilities of the Arm, Shoulder and Hand (DASH), DASH work module, and DASH sports module were 0.80 ± 4.43, 1.10 ± 6.90, and 2.88 ± 11.91, respectively. Overall, 93% of patients were satisfied, with few reports of persistent elbow pain (3%) or limitation of function (5%). Long-term follow-up of UCLRs in baseball players indicates that most patients were satisfied, with few reports of persistent elbow pain or limitation of function. During their baseball career, most of these athletes were able to return to the same or higher level of competition in less than 1 year, with acceptable career longevity and retirement typically for reasons other than the elbow. According to a standardized disability and outcome scale, patients also had excellent results after UCLR during daily, work, and sporting activities. © 2014 The Author(s).

Ulnar Rotation Osteotomy for Congenital Radial Head Dislocation.

PubMed

Liu, Ruiyu; Miao, Wusheng; Mu, Mingchao; Wu, Ge; Qu, Jining; Wu, Yongtao

2015-09-01

To evaluate an ulnar rotation osteotomy for congenital anterior dislocation of the radial head. Nine patients (5 boys and 4 girls aged 6 to 13 years) with congenital anterior dislocation of the radial head were treated with ulnar rotation osteotomy. Magnetic resonance imaging of the elbow showed the proximal radioulnar joint on the anterior-lateral side of the ulna rather than on the lateral side in patients with congenital anterior dislocation of the radial head. On the basis of this finding, we performed an osteotomy on the ulna and laterally rotated the proximal radioulnar joint achieving radial head reduction and restoring the anatomical relationship between the radial head and the capitellum. Clinical and radiographical evaluation of the elbow was performed before surgery and at postoperative follow-up. All patients were followed for 13 to 45 months after surgery. Elbow radiography showed that the radiocapitellar joint was reduced in all patients at the last follow-up visit and that the carrying angle was decreased relative to that in the preoperative condition. Elbow stability and the range of elbow flexion motion were improved at the last follow-up. We did not observe ulnar osteotomy site nonunion or elbow osteoarthritis in these patients. Furthermore, radial head dislocation did not recur. At early follow-up, ulnar rotation osteotomy was a safe and effective method for the treatment of congenital anterior dislocation of the radial head. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The posterior transtriceps approach for elbow arthrography: a forgotten technique?

PubMed

Lohman, M; Borrero, C; Casagranda, B; Rafiee, B; Towers, J

2009-05-01

To evaluate the technical feasibility of performing elbow MR arthrography via a posterior approach through the triceps. The images of 19 patients with elbow MR arthrography via a posterior transtriceps approach were retrospectively studied. The injections were performed by four musculoskeletal radiologists, using fluoroscopic guidance and a 22- or 25-gauge needle. The fluoroscopic and subsequent MR images were reviewed by two musculoskeletal radiologists and evaluated for adequacy of joint capsular distention, degree and location of contrast leakage, and presence of gas bubbles. The injection was diagnostic in all 19 patients, with a sufficient amount of contrast agent seen in the elbow joint. No significant contrast leakage occurred in 12 patients who received injections of 8 cc or less of contrast agent, but moderate contrast leakage occurred in 6/7 patients who received injections of greater than 8 cc. Contrast leakage generally occurred within the triceps myotendinous junction. No gas bubbles were identified in the injected joints. Patients often present for MR arthrography of the elbow with medial or lateral elbow pain. Contrast leakage during a radiocapitellar approach may complicate evaluation of the lateral collateral ligament or the common extensor tendon origin. Transtriceps MR arthrography offers an alternative to the more commonly used radiocapitellar approach. With injected volumes not exceeding 8 cc, the risk of significant contrast leakage is small. An advantage of the transtriceps injection is that contrast leakage through the posterior needle tract does not interfere with evaluation of the lateral structures.

Can We Achieve Intuitive Prosthetic Elbow Control Based on Healthy Upper Limb Motor Strategies?

PubMed Central

Merad, Manelle; de Montalivet, Étienne; Touillet, Amélie; Martinet, Noël; Roby-Brami, Agnès; Jarrassé, Nathanaël

2018-01-01

Most transhumeral amputees report that their prosthetic device lacks functionality, citing the control strategy as a major limitation. Indeed, they are required to control several degrees of freedom with muscle groups primarily used for elbow actuation. As a result, most of them choose to have a one-degree-of-freedom myoelectric hand for grasping objects, a myoelectric wrist for pronation/supination, and a body-powered elbow. Unlike healthy upper limb movements, the prosthetic elbow joint angle, adjusted prior to the motion, is not involved in the overall upper limb movements, causing the rest of the body to compensate for the lack of mobility of the prosthesis. A promising solution to improve upper limb prosthesis control exploits the residual limb mobility: like in healthy movements, shoulder and prosthetic elbow motions are coupled using inter-joint coordination models. The present study aims to test this approach. A transhumeral amputated individual used a prosthesis with a residual limb motion-driven elbow to point at targets. The prosthetic elbow motion was derived from IMU-based shoulder measurements and a generic model of inter-joint coordinations built from healthy individuals data. For comparison, the participant also performed the task while the prosthetic elbow was implemented with his own myoelectric control strategy. The results show that although the transhumeral amputated participant achieved the pointing task with a better precision when the elbow was myoelectrically-controlled, he had to develop large compensatory trunk movements. Automatic elbow control reduced trunk displacements, and enabled a more natural body behavior with synchronous shoulder and elbow motions. However, due to socket impairments, the residual limb amplitudes were not as large as those of healthy shoulder movements. Therefore, this work also investigates if a control strategy whereby prosthetic joints are automatized according to healthy individuals' coordination models can lead to an intuitive and natural prosthetic control. PMID:29456499

Serial casting for elbow flexion contractures in neonatal brachial plexus palsy.

PubMed

Duijnisveld, B J; Steenbeek, D; Nelissen, R G H H

2016-09-02

The objective of this study was to evaluate the effectiveness of serial casting of elbow flexion contractures in neonatal brachial plexus palsy. A prospective consecutive cohort study was performed with a median follow-up of 5 years. Forty-one patients with elbow flexion contractures ≥ 30° were treated with serial casting until the contracture was ≤ 10°, for a maximum of 8 weeks. Range of motion, number of recurrences and patient satisfaction were recorded and analyzed using Wilcoxon signed-rank and Cox regression tests. Passive extension increased from a median of -40° (IQR -50 to -30) to -15° (IQR -10 to -20, p < 0.001). Twenty patients showed 37 recurrences. The baseline severity of passive elbow extension had a hazard ratio of 0.93 (95% CI 0.89 to 0.96, p < 0.001) for first recurrence. Median patient satisfaction was moderate. Four patients showed loss of flexion mobility and in two patients serial casting had to be prematurely replaced by night splinting due to complaints. Serial casting improved elbow flexion contractures, although recurrences were frequent. The severity of elbow flexion contracture is a predictor of recurrence. We recommend more research on muscle degeneration and determinants involved in elbow flexion contractures to improve treatment strategies and prevent side-effects.

Time-dependent changes after latissimus dorsi transfer: tenodesis or tendon transfer?

PubMed

Erşen, Ali; Ozben, Hakan; Demirhan, Mehmet; Atalar, Ata Can; Kapıcıoğlu, Mehmet

2014-12-01

Transfer of the latissimus dorsi tendon to the posterosuperior part of the rotator cuff is an option in active patients with massive rotator cuff tears to restore shoulder elevation and external rotation. However, it is unknown whether this treatment prevents progression of cuff tear arthropathy. The purpose of this study was to determine whether the observed improvement in shoulder function in the early postoperative period with latissimus dorsi tendon transfer for irreparable rotator cuff tears will be permanent or will deteriorate in the midterm period (at 1-5 years after surgery). During a 6-year period, we performed 11 latissimus dorsi tendon transfers in 11 patients for patients with massive, irreparable, chronic tears of the posterosuperior part of the rotator cuff (defined as > 5 cm supraspinatus and infraspinatus tendon tears with Goutallier Grade 3 to 4 fatty infiltration on MRI), for patients who were younger than 65 years of age, and had high functional demands and intact subscapularis function. No patients were lost to followup; minimum followup was 12 months (median, 33 months; range, 12-62 months). The mean patient age was 55 years (median, 53 years; range, 47-65 years). Shoulder forward elevation, external rotation, and Constant-Murley and American Shoulder and Elbow Surgeons scores were assessed. Pain was assessed by a 0- to 10-point visual analog scale. Acromiohumeral distance and cuff tear arthropathy (staged according to the Hamada classification) were evaluated on radiographs. Shoulder forward elevation, external rotation, Constant-Murley scores, and American Shoulder and Elbow Surgeons scores improved at 6 months. However, although shoulder motion values and Constant-Murley scores remained unchanged between the 6-month and latest evaluations, American Shoulder and Elbow Surgeons scores decreased in this period (median, 71; range, 33-88 versus median, 68; range, 33-85; p = 0.009). Visual analog scale scores improved between the preoperative and 6-month evaluations but then worsened (representing worse pain) between the 6-month and latest evaluations (median, 2; range, 0-5 versus median, 2; range, 1-6; p = 0.034), but scores at latest followup were still lower than preoperative values (median, 7; range, 4-8; p = 0.003). Although acromiohumeral distance values were increased at 6 months (median, 8 mm; range, 6-10 mm; p = 0.023), the values at latest followup (median, 8 mm; range, 5-10 mm) were no different from the preoperative ones (mean, 7 mm; range, 6-9 mm; p > 0.05). According to Hamada classification, all patients were Grade 1 both pre- and postoperatively, except one who was Grade 3 at latest followup. The latissimus dorsi tendon transfer may improve shoulder function in irreparable massive rotator cuff tears. However, because the tenodesis effect loses its strength with time, progression of the arthropathy should be expected over time. Nevertheless, latissimus dorsi tendon transfer may help to delay the need for reverse shoulder arthroplasty for these patients. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Randomized prospective study of olecranon fracture fixation: cable pin system versus tension band wiring.

PubMed

Liu, Q-H; Fu, Z-G; Zhou, J-L; Lu, T; Liu, T; Shan, L; Liu, Y; Bai, L

2012-01-01

This prospective, randomized study compared the effectiveness of the cable pin system (CPS) versus tension band wiring (TBW) for olecranon fracture fixation. Patients with acute transverse or slight oblique olecranon fractures were randomly divided into two groups: one fixed by CPS and the other by TBW. Clinical outcome data were collected and analysed following a mean duration of 21 months. The mean ± SD fracture healing time was significantly shorter in the CPS group (n = 30; 9.73 ± 2.02 weeks) compared with the TBW group (n = 32; 11.13 ± 2.21 weeks). One patient in the CPS group and seven patients in the TBW group experienced postoperative complications; this difference was statistically significant. The mean ± SD Mayo Elbow Performance Score in the CPS group was significantly higher (88.67 ± 6.42) than that in the TBW group (80.78 ± 11.99). Logistic regression analysis showed an association between fixation method and fracture healing time, complications and elbow function. Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW.

Prompt Referral in the Nonoperative Treatment of Obstetrical Brachial Plexus Injuries

PubMed Central

Aubin-Lemay, Camille; Kvann, Julie Chakriya; Retrouvey, Helene; Aldekhayel, Salah; Zadeh, Teanoosh

2017-01-01

Background: Prompt physical and occupational therapy is crucial in managing nonsurgical candidates with obstetrical brachial plexus injuries (OBPI). The objective of our study was to identify newborns suffering from nonoperative OBPI in need of a “fast-track” evaluation by a multidisciplinary team. Methods: This is a retrospective review of patients with OBPI from June 1995 to June 2015. All nonsurgical candidates (Narakas class 1) were included in the study. The Gilbert score and the Medical Research Council grading system were used to measure shoulder and elbow function, respectively. The relationship between shoulder and elbow functional outcomes and time delay to consultation was studied using analysis of variance and Welch’s tests. Various subgroups were studied based on OBPI risk factors: maternal diabetes, birth weight >4 kg, use of forceps, asphyxia, multiple comorbidities, and Apgar score at 1 and 5 minutes. Results: A total of 168 patients were included in this study. Mean follow-up time was 313.8 weeks (minimum: 52; maximum: 1072; SD: 228.1). A total of 19 patients had an Apgar scores <7 at 5 minutes. Time delay between birth and the first consult to our clinic had an impact on shoulder outcome in the subgroup of newborns with Apgar scores <7 at 5 minutes. Conclusions: The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population. PMID:29632767

A review of epidemiology of paediatric elbow injuries in sports.

PubMed

Magra, Merzesh; Caine, Dennis; Maffulli, Nicola

2007-01-01

The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many opportunities for prospective studies and other research projects among young athletes in various sports. Current studies will serve as a baseline for future research to assess the success of specific interventions in reducing the incidence of elbow injury in the paediatric athlete. Further epidemiological studies in various sports will help expand our knowledge and prevent potential disability and deformity in the paediatric elbow.

Neurophysiological localisation of ulnar neuropathy at the elbow: Validation of diagnostic criteria developed by a taskforce of the Danish Society of clinical neurophysiology.

PubMed

Pugdahl, K; Beniczky, S; Wanscher, B; Johnsen, B; Qerama, E; Ballegaard, M; Benedek, K; Juhl, A; Ööpik, M; Selmar, P; Sønderborg, J; Terney, D; Fuglsang-Frederiksen, A

2017-11-01

This study validates consensus criteria for localisation of ulnar neuropathy at elbow (UNE) developed by a taskforce of the Danish Society of Clinical Neurophysiology and compares them to the existing criteria from the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). The Danish criteria are based on combinations of conduction slowing in the segments of the elbow and forearm expressed in Z-scores, and difference between the segments in m/s. Examining fibres to several muscles and sensory fibres can increase the certainty of the localisation. Diagnostic accuracy for UNE was evaluated on 181 neurophysiological studies of the ulnar nerve from 171 peer-reviewed patients from a mixed patient-group. The diagnostic reference standard was the consensus diagnosis based on all available clinical, laboratory, and electrodiagnostic information reached by a group of experienced Danish neurophysiologists. The Danish criteria had high specificity (98.4%) and positive predictive value (PPV) (95.2%) and fair sensitivity (76.9%). Compared to the AANEM criteria, the Danish criteria had higher specificity (p<0.001) and lower sensitivity (p=0.02). The Danish consensus criteria for UNE are very specific and have high PPV. The Danish criteria for UNE are reliable and well suited for use in different centres as they are based on Z-scores. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Cross-cultural adaptation of Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score: Reliability and validity in Turkish-speaking overhead athletes.

PubMed

Turgut, Elif; Tunay, Volga Bayrakci

2018-03-09

Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes. The forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES). Participants were assigned to one of the following subgroups: asymptomatic (playing without pain) or symptomatic (playing with pain, or not playing due to pain). Internal consistency, reliability, construct validity, discriminant validity, and content validity of the KJOC-SES-Tr were tested. The test-retest reliability of the KJOC-SES-Tr was excellent with an interclass coefficient of 0.93. There was a strong correlation between the KJOC-SES-Tr and the DASH and the ASES, indicating that the construct validity was good for all participants. Results of the KJOC-SES-Tr significantly differed between different subgroups and categories of athletes. The floor and ceiling effects were acceptable for symptomatic athletes. The KJOC-SES-Tr was shown to be valid, reliable tool to monitor the return to sports following injuries in athletes. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

The Relationship Between Pitching Mechanics and Injury: A Review of Current Concepts

PubMed Central

Chalmers, Peter N.; Wimmer, Markus A.; Verma, Nikhil N.; Cole, Brian J.; Romeo, Anthony A.; Cvetanovich, Gregory L.; Pearl, Michael L.; Chalmers, Peter N.; Wimmer, Markus A.; Verma, Nikhil N.; Cole, Brian J.; Romeo, Anthony A.; Cvetanovich, Gregory L.; Pearl, Michael L.

2017-01-01

Context: The overhand pitch is one of the fastest known human motions and places enormous forces and torques on the upper extremity. Shoulder and elbow pain and injury are common in high-level pitchers. A large body of research has been conducted to understand the pitching motion. Evidence Acquisition: A comprehensive review of the literature was performed to gain a full understanding of all currently available biomechanical and clinical evidence surrounding pitching motion analysis. These motion analysis studies use video motion analysis, electromyography, electromagnetic sensors, and markered motion analysis. This review includes studies performed between 1983 and 2016. Study Design: Clinical review. Level of Evidence: Level 5. Results: The pitching motion is a kinetic chain, in which the force generated by the large muscles of the lower extremity and trunk during the wind-up and stride phases are transferred to the ball through the shoulder and elbow during the cocking and acceleration phases. Numerous kinematic factors have been identified that increase shoulder and elbow torques, which are linked to increased risk for injury. Conclusion: Altered knee flexion at ball release, early trunk rotation, loss of shoulder rotational range of motion, increased elbow flexion at ball release, high pitch velocity, and increased pitcher fatigue may increase shoulder and elbow torques and risk for injury. PMID:28107113

Musculoskeletal loading during the round-off in female gymnastics: the effect of hand position.

PubMed

Farana, Roman; Jandacka, Daniel; Uchytil, Jaroslav; Zahradnik, David; Irwin, Gareth

2014-06-01

Chronic elbow injuries from tumbling in female gymnastics present a serious problem for performers. This research examined how the biomechanical characteristics of impact loading and elbow kinematics and kinetics change as a function of technique selection. Seven international-level female gymnasts performed 10 trials of the round-off from a hurdle step to flic-flac with 'parallel' and 'T-shape' hand positions. Synchronized kinematic (3D-automated motion analysis system; 247 Hz) and kinetic (two force plates; 1,235 Hz) data were collected for each trial. Wilcoxon non-parametric test and effect-size statistics determined differences between the hand positions examined in this study. Significant differences (p < 0.05) and large effect sizes (ES > 0.8) were observed for peak vertical ground reaction force (GRF), anterior-posterior GRF, resultant GRF, loading rates of these forces and elbow joint angles, and internal moments of force in sagittal, transverse, and frontal planes. In conclusion, the T-shape hand position reduces vertical, anterior-posterior, and resultant contact forces and has a decreased loading rate indicating a safer technique for the round-off. Significant differences observed in joint elbow moments highlighted that the T-shape position may prevent overloading of the joint complex and consequently reduce the potential for elbow injury.

Failure Behavior of Elbows with Local Wall Thinning

NASA Astrophysics Data System (ADS)

Lee, Sung-Ho; Lee, Jeong-Keun; Park, Jai-Hak

Wall thinning defect due to corrosion is one of major aging phenomena in carbon steel pipes in most plant industries, and it results in reducing load carrying capacity of the piping components. A failure test system was set up for real scale elbows containing various simulated wall thinning defects, and monotonic in-plane bending tests were performed under internal pressure to find out the failure behavior of them. The failure behavior of wall-thinned elbows was characterized by the circumferential angle of thinned region and the loading conditions to the piping system.

Assessment of tennis elbow using the Marcy Wedge-Pro.

PubMed Central

Smith, R W; Mani, R; Cawley, M I; Englisch, W; Eckenberger, P

1993-01-01

The Marcy Wedge-Pro (MWP), a device used in training by tennis players, was employed in the assessment of tennis elbow. The MWP was used to measure the ability of patients to perform wrist extension exercises, since pain resulting from this specific activity is a prominent symptom of the condition. The MWP results were compared with clinical measures and found to identify accurately patients who responded to treatment (P < 0.05). This study illustrates the potential of the MWP to assess tennis elbow quantitatively. Images Figure 1 PMID:8130959

The Relationship of Throwing Arm Mechanics and Elbow Varus Torque: Within-Subject Variation for Professional Baseball Pitchers Across 82,000 Throws.

PubMed

Camp, Christopher L; Tubbs, Travis G; Fleisig, Glenn S; Dines, Joshua S; Dines, David M; Altchek, David W; Dowling, Brittany

2017-11-01

Likely due to the high level of strain exerted across the elbow during the throwing motion, elbow injuries are on the rise in baseball. To identify at-risk athletes and guide postinjury return-to-throw programs, a better understanding of the variables that influence elbow varus torque is desired. To describe the within-subject relationship between elbow varus torque and arm slot and arm rotation in professional baseball pitchers. Descriptive laboratory study. A total of 81 professional pitchers performed 82,000 throws while wearing a motusBASEBALL sensor and sleeve. These throws represented a combination of throw types, such as warm-up/catch, structured long-toss, bullpen throwing from a mound, and live game activity. Variables recorded for each throw included arm slot (angle of the forearm relative to the ground at ball release), arm speed (maximal rotational velocity of the forearm), arm rotation (maximal external rotation of the throwing arm relative to the ground), and elbow varus torque. Linear mixed-effects models and likelihood ratio tests were used to estimate the relationship between elbow varus torque and arm slot, arm speed, and arm rotation within individual pitchers. All 3 metrics-arm slot (χ 2 = 428, P < .001), arm speed (χ 2 = 57,683, P < .001), and arm rotation (χ 2 = 1392, P < .001)-were found to have a significant relationship with elbow varus torque. Within individual athletes, a 1-N.m increase in elbow varus torque was associated with a 13° decrease in arm slot, a 116 deg/s increase in arm speed, and an 8° increase in arm rotation. Elbow varus torque increased significantly as pitchers increased their arm rotation during the arm cocking phase, increased the rotational velocity of their arm during the arm acceleration phase of throwing, and decreased arm slot at ball release. Thus, shoulder flexibility, arm speed, and elbow varus torque (and likely injury risk) are interrelated and should be considered collectively when treating pitchers. It is well established that elbow varus torque is related to ulnar collateral ligament injuries in overhead throwers. This study describes the relationship of arm slot, arm speed, and arm rotation to elbow varus torque in an attempt to identify modifiable risk factors for injury.

Improved CHESS imaging with the use of rice pads: Investigation in the neck, shoulder, and elbow.

PubMed

Moriya, Susumu; Miki, Yukio; Yokobayashi, Tsuneo; Yamamoto, Akira; Kanagaki, Mitsunori; Komori, Yoshiaki; Fujimoto, Koji; Ishikawa, Mitsunori

2010-06-01

To investigate the feasibility of rice pads for improving nonuniform fat suppression in magnetic resonance imaging (MRI) of the neck, shoulder, and elbow using the chemical shift selective (CHESS) technique. CHESS imaging of the neck, shoulder, and elbow was performed on 10 healthy volunteers with and without the use of rice pads. Images were visually assessed by one radiologist and one radiologic technologist using a four-point scale. Results were compared using Wilcoxon's signed rank sum test. Images with and without rice pads were rated 3.9 and 1.5 for the neck (P = 0.002), 3.85 and 2.5 for the shoulder (P = 0.002), and 3.4 and 2.45 for the elbow (P = 0.004). Fat-suppressed images obtained using the CHESS technique were significantly improved by rice pads for the neck, shoulder, and elbow, indicating that image deterioration with CHESS caused by magnetic field nonuniformity can be improved by rice pads in all body areas.

Electrically Stimulated Antagonist Muscle Contraction Increased Muscle Mass and Bone Mineral Density of One Astronaut - Initial Verification on the International Space Station.

PubMed

Shiba, Naoto; Matsuse, Hiroo; Takano, Yoshio; Yoshimitsu, Kazuhiro; Omoto, Masayuki; Hashida, Ryuki; Tagawa, Yoshihiko; Inada, Tomohisa; Yamada, Shin; Ohshima, Hiroshi

2015-01-01

Musculoskeletal atrophy is one of the major problems of extended periods of exposure to weightlessness such as on the International Space Station (ISS). We developed the Hybrid Training System (HTS) to maintain an astronaut's musculoskeletal system using an electrically stimulated antagonist to resist the volitional contraction of the agonist instead of gravity. The present study assessed the system's orbital operation capability and utility, as well as its preventative effect on an astronaut's musculoskeletal atrophy. HTS was attached to the non-dominant arm of an astronaut staying on the ISS, and his dominant arm without HTS was established as the control (CTR). 10 sets of 10 reciprocal elbow curls were one training session, and 12 total sessions of training (3 times per week for 4 weeks) were performed. Pre and post flight ground based evaluations were performed by Biodex (muscle performance), MRI (muscle volume), and DXA (BMD, lean [muscle] mass, fat mass). Pre and post training inflight evaluations were performed by a hand held dynamometer (muscle force) and a measuring tape (upper arm circumference). The experiment was completed on schedule, and HTS functioned well without problems. Isokinetic elbow extension torque (Nm) changed -19.4% in HTS, and -21.7% in CTR. Isokinetic elbow flexion torque changed -23.7% in HTS, and there was no change in CTR. Total Work (Joule) of elbow extension changed -8.3% in HTS, and +0.3% in CTR. For elbow flexion it changed -23.3% in HTS and -32.6% in CTR. Average Power (Watts) of elbow extension changed +22.1% in HTS and -8.0% in CTR. For elbow flexion it changed -6.5% in HTS and -4.8% in CTR. Triceps muscle volume according to MRI changed +11.7% and that of biceps was +2.1% using HTS, however -0.1% and -0.4% respectively for CTR. BMD changed +4.6% in the HTS arm and -1.2% for CTR. Lean (muscle) mass of the arm changed only +10.6% in HTS. Fat mass changed -12.6% in HTS and -6.4% in CTR. These results showed the orbital operation capability and utility, and the preventive effect of HTS for an astronaut's musculoskeletal atrophy. The initial flight data together with the ground data obtained so far will be utilized in the future planning of human space exploration.

Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral elbow tendinopathy for French-speaking patients.

PubMed

Kaux, Jean-François; Delvaux, François; Schaus, Jean; Demoulin, Christophe; Locquet, Médéa; Buckinx, Fanny; Beaudart, Charlotte; Dardenne, Nadia; Van Beveren, Julien; Croisier, Jean-Louis; Forthomme, Bénédicte; Bruyère, Olivier

Translation and validation of algo-functional questionnaire. The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire was specifically designed to measure pain and functional limitations in patients with lateral epicondylitis (tennis elbow). First developed in English, this questionnaire has since been translated into several languages. The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this translated version of the questionnaire (PRTEE-F). The PRTEE was translated and cross-culturally adapted into French according to international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants were asked twice to fill in the PRTEE-F, and once the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Short Form Health Survey (SF-36). Internal consistency (using Cronbach's alpha), test-retest reliability (using intraclass correlation coefficient (ICC), standard error of measurement and minimal detectable change), and convergent and divergent validity (using the Spearman's correlation coefficients respectively with the DASH and with some subscales of the SF-36) were assessed. The PRTEE was translated into French without any problems. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.86) and for each item (ICC 0.8-0.96) and a high internal consistency (Cronbach's alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (convergent validity) and, as expected, a low or moderate correlation with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect. The PRTEE questionnaire was successfully cross-culturally adapted into French. The PRTEE-F is reliable and valid for evaluating French-speaking patients with lateral elbow tendinopathy. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Development and evaluation of a musculoskeletal model of the elbow joint complex

NASA Technical Reports Server (NTRS)

Gonzalez, Roger V.; Hutchins, E. L.; Barr, Ronald E.; Abraham, Lawrence D.

1993-01-01

This paper describes the development and evaluation of a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. The length, velocity, and moment arm for each of the eight musculotendon actuators were based on skeletal anatomy and position. Musculotendon parameters were determined for each actuator and verified by comparing analytical torque-angle curves with experimental joint torque data. The parameters and skeletal geometry were also utilized in the musculoskeletal model for the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by parameterized optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing ballistic elbow joint complex movements.

Outcomes of coronoid-first repair in terrible triad injuries of the elbow.

PubMed

Zhang, Junren; Tan, Mark; Kwek, Ernest Beng Kee

2017-09-01

Clinical outcomes of terrible triad injuries (TTIs) of the elbow are historically poor. To date, it is still debatable whether the coronoid needs to be fixed and if so, how and in which sequence. Between 2010 and 2013, 13 patients were treated surgically for acute TTIs of the elbow at a Tertiary Level 1 Trauma Centre by a single surgeon, using a standardized protocol, which included coronoid-brachialis complex fixation via pull-through trans-osseous sutures, radial head fixation or prosthetic replacement and a repair of the lateral ulnar collateral ligament. Repair of the medial collateral ligament (MCL) was done if valgus-stress test demonstrated persistent instability. Patients were then followed-up with clinical and radiological evaluation by the senior author until fracture union and elbow range of motion reached a plateau. Outcomes measured were range of motion, DASH scores and MEPS, as well as surgical complications. Intraoperative stability was achieved in all 13 cases, MCL repair was required in 3 cases and application of external fixation was not required in any case. Patients were followed-up for an average length of 27.7 months and the minimum follow-up period was 12 months. The average age of patients was 46.4 years (range 35-79 years old) at the time of trauma. This included eight Regan-Morrey Type I and five Regan-Morrey Type II coronoid fractures, with ten Mason Type I/II and three Mason Type III radial head fractures. The average arc of ulno-humeral motion was 105.0° (range 80°-135°). The average flexion contracture was 15.0° (range 0°-40°). The average supination-pronation arc was 114.9° (range 0°-180°). The average MEPS was 85 of 100 (range 45-100) and the average DASH score was 21.2 of 100 (range 1.7-61.2). A single case of radio-ulnar synostosis, heterotropic ossification and two cases of recurrent elbow instability were noted. The coronoid-first surgical approach, using a suture-lasso fixation method, has technical benefits for us and showed good clinical success in our series. This is important with postero-medial rotatory instability being common in our series of TTIs. We emphasize not to miss a TTI in an apparently isolated low Mason class radial head fracture.

A comparison of manual and quantitative elbow strength testing.

PubMed

Shahgholi, Leili; Bengtson, Keith A; Bishop, Allen T; Shin, Alexander Y; Spinner, Robert J; Basford, Jeffrey R; Kaufman, Kenton R

2012-10-01

The aim of this study was to compare the clinical ratings of elbow strength obtained by skilled clinicians with objective strength measurement obtained through quantitative testing. A retrospective comparison of subject clinical records with quantitative strength testing results in a motion analysis laboratory was conducted. A total of 110 individuals between the ages of 8 and 65 yrs with traumatic brachial plexus injuries were identified. Patients underwent manual muscle strength testing as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent) and quantitative elbow flexion and extension strength measurements. A total of 92 subjects had elbow flexion testing. Half of the subjects clinically assessed as having normal (5/5) elbow flexion strength on manual muscle testing exhibited less than 42% of their age-expected strength on quantitative testing. Eighty-four subjects had elbow extension strength testing. Similarly, half of those displaying normal elbow extension strength on manual muscle testing were found to have less than 62% of their age-expected values on quantitative testing. Significant differences between manual muscle testing and quantitative findings were not detected for the lesser (0-4) strength grades. Manual muscle testing, even when performed by experienced clinicians, may be more misleading than expected for subjects graded as having normal (5/5) strength. Manual muscle testing estimates for the lesser strength grades (1-4/5) seem reasonably accurate.

Efficacy of betamethasone valerate medicated plaster on painful chronic elbow tendinopathy: a double-blind, randomized, placebo-controlled trial

PubMed Central

Frizziero, Antonio; Causero, Araldo; Bernasconi, Stefano; Papalia, Rocco; Longo, Mario; Sessa, Vincenzo; Sadile, Francesco; Greco, Pasquale; Tarantino, Umberto; Masiero, Stefano; Rovati, Stefano; Frangione, Valeria

2016-01-01

Summary Objective to investigate the efficacy and safety of a medicated plaster containing betamethasone valerate (BMV) 2.25 mg in patients with chronic elbow tendinopathy. Methods randomized, double-blind, placebo-controlled study with assignment 2:2:1:1 to BMV medicated plaster applied daily for 12 hours, daily for 24 hours or matched placebo. 62 patients aged ≥18 years with chronic lateral elbow tendinopathy were randomized. The primary efficacy variable was pain reduction (VAS) at day 28. Secondary objectives included summed pain intensity differences (SPID), overall treatment efficacy and tolerability. Results mean reduction in VAS pain score at day 28 was greater in both BMV medicated plaster groups, −39.35±27.69 mm for BMV12-h and −36.91±32.50 mm for BMV24-h, than with placebo, −20.20±27.32 mm. Considering the adjusted mean decreases, there was a statistically significant difference between BMV12-h and placebo (p=0.0110). Global pain relief (SPID) and overall treatment efficacy were significantly better with BMV. BMV and placebo plasters had similar local tolerability and there were few treatment-related adverse events. Conclusions BMV plaster was significantly more effective than placebo at reducing pain in patients with chronic elbow tendinopathies. The BMV plaster was safe and well tolerated. PMID:27331041

A hybrid system for upper limb movement restoration in quadriplegics.

PubMed

Varoto, Renato; Barbarini, Elisa Signoreto; Cliquet, Alberto

2008-09-01

Generally, quadriplegic individuals have difficulties performing object manipulation. Toward satisfactory manipulation, reach and grasp movements must be performed with voluntary control, and for that, grasp force feedback is essential. A hybrid system aiming at partial upper limb sensory-motor restoration for quadriplegics was built. Such device is composed of an elbow dynamic orthosis that provides elbow flexion/extension (range was approximately from 20 degrees to 120 degrees , and average angular speed was approximately 15 degrees /s) with forearm support, a wrist static orthosis and neuromuscular electrical stimulation for grasping generation, and a glove with force sensors that allows grasping force feedback. The glove presents two user interface modes: visual by light emitting diodes or audio emitted by buzzer. Voice control of the entire system (elbow dynamic orthosis and electrical stimulator) is performed by the patient. The movements provided by the hybrid system, combined with the scapular and shoulder movements performed by the patient, can aid quadriplegic individuals in tasks that involve reach and grasp movements.

[External stability of the elbow after surgical treatment of epicondylitis. Presentation of a case].

PubMed

Llop-Corbacho, A; Romero-Ruiz, J; Denia-Alarcón, N

2014-01-01

Elbow instability is a difficult to diagnose condition in certain cases, and could lead to some problems that limit daily functioning, such as joint blocks, bumps, projections, muscle weakness, and persistent pain. A case is presented of a patient with a clinical picture of epicondylitis, with a previous history of a fall on the affected arm. As there was no improvement after performing conventional non-aggressive treatment, surgery was performed on the affected tendon. The outcome of this was persistent pain and clinical instability of the elbow that ended up requiring surgery to reconstruct the ligament over the external complex. In follow-up 6 months after the operation, the clinical instability had disappeared, but there was still external discomfort and a 30° extension deficit. When faced with a picture of epicondylitis with a previous injury that does not respond to conventional therapies, it is important to take into account the possibility of an underlying elbow instability, ruling this out with a correct physical examination and, where necessary, with the appropriate complementary tests. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study.

PubMed

Gilot, Gregory J; Alvarez-Pinzon, Andres M; Barcksdale, Leticia; Westerdahl, David; Krill, Michael; Peck, Evan

2015-08-01

To compare the results of arthroscopic repair of large to massive rotator cuff tears (RCTs) with or without augmentation using an extracellular matrix (ECM) graft and to present ECM graft augmentation as a valuable surgical alternative used for biomechanical reinforcement in any RCT repair. We performed a prospective, blinded, single-center, comparative study of patients who underwent arthroscopic repair of a large to massive RCT with or without augmentation with ECM graft. The primary outcome was assessed by the presence or absence of a retear of the previously repaired rotator cuff, as noted on ultrasound examination. The secondary outcomes were patient satisfaction evaluated preoperatively and postoperatively using the 12-item Short Form Health Survey, the American Shoulder and Elbow Surgeons shoulder outcome score, a visual analog scale score, the Western Ontario Rotator Cuff index, and a shoulder activity level survey. We enrolled 35 patients in the study: 20 in the ECM-augmented rotator cuff repair group and 15 in the control group. The follow-up period ranged from 22 to 26 months, with a mean of 24.9 months. There was a significant difference between the groups in terms of the incidence of retears: 26% (4 retears) in the control group and 10% (2 retears) in the ECM graft group (P = .0483). The mean pain level decreased from 6.9 to 4.1 in the control group and from 6.8 to 0.9 in the ECM graft group (P = .024). The American Shoulder and Elbow Surgeons score improved from 62.1 to 72.6 points in the control group and from 63.8 to 88.9 points (P = .02) in the treatment group. The mean Short Form 12 scores improved in the 2 groups, with a statistically significant difference favoring graft augmentation (P = .031), and correspondingly, the Western Ontario Rotator Cuff index scores improved in both arms, favoring the treatment group (P = .0412). The use of ECM for augmentation of arthroscopic repairs of large to massive RCTs reduces the incidence of retears, improves patient outcome scores, and is a viable option during complicated cases in which a significant failure rate is anticipated. Level III, prospective, blinded, nonrandomized, comparative study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts.

PubMed

Hegmann, Kurt T; Thiese, Matthew S; Kapellusch, Jay; Merryweather, Andrew; Bao, Stephen; Silverstein, Barbara; Wood, Eric M; Kendall, Richard; Foster, James; Drury, David L; Garg, Arun

2017-05-30

The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. These data suggest a potentially modifiable disease mechanism for LE.

Wearable Inertial Sensors Allow for Quantitative Assessment of Shoulder and Elbow Kinematics in a Cadaveric Knee Arthroscopy Model.

PubMed

Rose, Michael; Curtze, Carolin; O'Sullivan, Joseph; El-Gohary, Mahmoud; Crawford, Dennis; Friess, Darin; Brady, Jacqueline M

2017-12-01

To develop a model using wearable inertial sensors to assess the performance of orthopaedic residents while performing a diagnostic knee arthroscopy. Fourteen subjects performed a diagnostic arthroscopy on a cadaveric right knee. Participants were divided into novices (5 postgraduate year 3 residents), intermediates (5 postgraduate year 4 residents), and experts (4 faculty) based on experience. Arm movement data were collected by inertial measurement units (Opal sensors) by securing 2 sensors to each upper extremity (dorsal forearm and lateral arm) and 2 sensors to the trunk (sternum and lumbar spine). Kinematics of the elbow and shoulder joints were calculated from the inertial data by biomechanical modeling based on a sequence of links connected by joints. Range of motion required to complete the procedure was calculated for each group. Histograms were used to compare the distribution of joint positions for an expert, intermediate, and novice. For both the right and left upper extremities, skill level corresponded well with shoulder abduction-adduction and elbow prono-supination. Novices required on average 17.2° more motion in the right shoulder abduction-adduction plane than experts to complete the diagnostic arthroscopy (P = .03). For right elbow prono-supination (probe hand), novices required on average 23.7° more motion than experts to complete the procedure (P = .03). Histogram data showed novices had markedly more variability in shoulder abduction-adduction and elbow prono-supination compared with the other groups. Our data show wearable inertial sensors can measure joint kinematics during diagnostic knee arthroscopy. Range-of-motion data in the shoulder and elbow correlated inversely with arthroscopic experience. Motion pattern-based analysis shows promise as a metric of resident skill acquisition and development in arthroscopy. Wearable inertial sensors show promise as metrics of arthroscopic skill acquisition among residents. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder

PubMed Central

Garg, Anant Kumar; Ayan, Saankritya; Keshari, Vikas; Kundu, Debi; Mukhopadhyay, Kiran Kumar; Acharyya, Biplab

2011-01-01

Background: More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to subscapularis and reattaches to its anatomical location. We conducted a study on evaluation of long-term effect of modified Boytchev procedure and to compare our results with other studies published in literature. Materials and Methods: Since June 2002, modified Boytchev procedure was performed on 48 patients, who presented with recurrent anterior dislocation. 45 were men and 3 were women and were in the age group of 18-40 years (mean 27.83±4.95 years). Forty patients were affected on the dominant side and rest on the non-dominant side. The mean number of dislocations in these patients was 18.22±12.08. The mean followup period was 58.13±19.06 months (range 18-96 months). The patients were evaluated by visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Results: All the patients regained almost preoperative range of forward flexion at the last followup. In the preoperative period the mean external rotation deficit at 0° and at 90° of abduction was 13.22°±5.16° and 18.06°±6.50°, respectively. At the last followup, the mean external rotation deficit at 0° and at 90° of abduction was 8.06°±2.47° and 8.95°±2.07°, respectively. This improvement in external rotation deficit was statistically significant (P<.05). Preoperative scores were compared with the most recent followup scores for all variables with use of a paired t test. All patients had significant improvement in visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Four of the patients developed superficial infection which got resolved after treating with antibiotics, and two of the patients developed transient musculocutaneous nerve paresis. There was no radiological evidence of loosening and migration of coracoid screw or any glenohumeral arthritis on subsequent followup of skiagrams in any of our patients. Conclusion: Modified Boytchev procedure is an efficacious and technically simple procedure to treat recurrent anterior dislocation of shoulder. PMID:21772627

Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery.

PubMed

Somford, Matthijs Paul; Nieuwe Weme, Rebecca A; van Dijk, Cornelis Niek; IJpma, Frank Fa; Eygendaal, Denise

2016-10-01

Eponymous terms are used frequently in daily patient care and scientific literature. They remind us of our predecessors in surgery. It is debatable whether eponymous terms are reliable in case of information transfer. The aim of our study was to investigate whether the original meaning of eponymous terms in shoulder and elbow surgery has been preserved in its use in contemporary literature. To evaluate whether eponymous terms were used correctly, we analysed the use of frequently encountered eponymous terms from January to December 2014. By means of a PubMed search, articles with eponymous terms were identified and analysed for the way an eponymous term was used, and we compared it with the original description. The original description was traced back to the index publication. The use of the eponymous term was scored as similar, divergent or undefined. In the search for eponymous terms, we included those eponymous terms that were used more than 10 times in the English, German and Dutch literature of 2014. 6 eponymous terms were eligible for analysis: Bankart lesion, Bristow-Latarjet procedure, Essex-Lopresti injury of the forearm, Galeazzi fracture, Hill-Sachs lesion and Monteggia fracture. We analysed 96 articles with the listed eponymous terms, of which 27 (28%) were scored divergent, 32 (33%) undefined and 37 (39%) similar. Bristow-Latarjet scored lowest, with 0% descriptions similar to the original, meaning that all articles had an undefined or divergent eponym, and Essex-Lopresti scored highest with 82% similarity. Eponymous terms in shoulder and elbow trauma and surgery are used inadequately and inconsistently. The use of eponymous terms probably cannot be avoided, but since the majority of eponymous terms are not used properly and understanding of its meaning and content varies from surgeon to surgeon, we should be keen on explaining the meaning of eponymous terms when using them. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial

PubMed Central

Stegink-Jansen, Caroline W.

2015-01-01

Introduction. Patients with chronic lateral elbow (LE) tendinopathy, commonly known as tennis elbow, often experience prolonged symptoms and frequent relapses. Astym treatment, evidenced in animal studies to promote the healing and regeneration of soft tissues, is hypothesized to improve outcomes in LE tendinopathy patients. This study had two objectives: (1) to compare the efficacy of Astym treatment to an evidence-based eccentric exercise program (EE) for patients with chronic LE tendinopathy, and (2) to quantify outcomes of subjects non-responsive to EE who were subsequently treated with Astym treatment. Study Design. Prospective, two group, parallel, randomized controlled trial completed at a large orthopedic center in Indiana. Inclusion criteria: age range of 18–65 years old, with clinical indications of LE tendinopathy greater than 12 weeks, with no recent corticosteriod injection or disease altering comorbidities. Methods. Subjects with chronic LE tendinopathy (107 subjects with 113 affected elbows) were randomly assigned using computer-generated random number tables to 4 weeks of Astym treatment (57 elbows) or EE treatment (56 elbows). Data collected at baseline, 4, 8, 12 weeks, 6 and 12 months. Primary outcome measure: DASH; secondary outcome measures: pain with activity, maximum grip strength and function. The treating physicians and the rater were blinded; subjects and treating clinicians could not be blinded due to the nature of the treatments. Results. Resolution response rates were 78.3% for the Astym group and 40.9% for the EE group. Astym subjects showed greater gains in DASH scores (p = 0.047) and in maximum grip strength (p = 0.008) than EE subjects. Astym therapy also resolved 20/21 (95.7%) of the EE non-responders, who showed improvements in DASH scores (p < 0.005), pain with activity (p = 0.002), and function (p = 0.004) following Astym treatment. Gains continued at 6 and 12 months. No adverse effects were reported. Conclusion. This study suggests Astym therapy is an effective treatment option for patients with LE tendinopathy, as an initial treatment, and after an eccentric exercise program has failed. Registration/Funding. Ball Memorial Hospital provided limited funding. Trial registration was not required by FDAAA 801. Known about the Subject. Under the new paradigm of degenerative tendinopathy, eccentric exercise (EE) is emerging as a first line conservative treatment for LE tendinopathy. EE and Astym treatment are among the few treatment options aiming to improve the degenerative pathophysiology of the tendon. In this trial, Astym therapy, which has shown success in the treatment of tendinopathy, is compared to EE, which has also shown success in the treatment of tendinopathy. Clinical Relevance. There is a need for more effective, conservative treatment options. Based on the current efficacy study, Astym therapy appears to be a promising, non-invasive treatment option. PMID:26038722

Shoulder strength value differences between genders and age groups.

PubMed

Balcells-Diaz, Eudald; Daunis-I-Estadella, Pepus

2018-03-01

The strength of a normal shoulder differs according to gender and decreases with age. Therefore, the Constant score, which is a shoulder function measurement tool that allocates 25% of the final score to strength, differs from the absolute values but likely reflects a normal shoulder. To compare group results, a normalized Constant score is needed, and the first step to achieving normalization involves statistically establishing the gender differences and age-related decline. In this investigation, we sought to verify the gender difference and age-related decline in strength. We obtained a randomized representative sample of the general population in a small to medium-sized Spanish city. We then invited this population to participate in our study, and we measured their shoulder strength. We performed a statistical analysis with a power of 80% and a P value < .05. We observed a statistically significant difference between the genders and a statistically significant decline with age. To the best of our knowledge, this is the first investigation to study a representative sample of the general population from which conclusions can be drawn regarding Constant score normalization. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effects of a single whole body cryotherapy (-110°C) bout on neuromuscular performance of the elbow flexors during isokinetic exercise.

PubMed

Ferreira-Junior, J B; Vieira, C A; Soares, S R S; Guedes, R; Rocha Junior, V A; Simoes, H G; Brown, L E; Bottaro, M

2014-12-01

It has been demonstrated that body cooling may decrease neuromuscular performance. However, the effect of a single session of whole body cryotherapy (-110°C) on neuromuscular performance has not been well documented. Thus, the aim of this study was to evaluate the effects of a single exposure of WBC on elbow flexor neuromuscular performance. Thirteen physically active, healthy young men (age=27.9±4.2 years, mass=79.4±9.7 kg, height=176.7±5.2 cm) were randomly exposed to 2 different experimental conditions separated by a minimum of 72 h: 1) whole body cryotherapy- 3 min at -110°C; 2) control- 3 min at 21°C. All subjects were tested for maximal isokinetic elbow flexion at 60°.s(-1) 30 min before and 10 min after each condition. There were no significant differences in peak torque, average power, total work or muscle activity between conditions. Peak torque was lower at post-test compared to pre-test in both conditions (F=6.58, p=0.025). However, there were no differences between pre-test and post-test for any other variables. These results indicate that strength specialists, athletic trainers and physical therapists might utilize whole body cryotherapy before training or rehabilitation without compromising neuromuscular performance of the elbow flexors. © Georg Thieme Verlag KG Stuttgart · New York.

Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report.

PubMed

Bhatt, Jiten B; Glaser, Randal; Chavez, Andre; Yung, Emmanuel

2013-11-01

Case report. Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established. The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period. Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner. The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia. Therapy, level 4.

Quantification of shoulder and elbow passive moments in the sagittal plane as a function of adjacent angle fixations.

PubMed

Kodek, Timotej; Munih, Marko

2003-01-01

The goal of this study was an assessment of the shoulder and elbow joint passive moments in the sagittal plane for six healthy individuals. Either the shoulder or elbow joints were moved at a constant speed, very slowly throughout a large portion of their range by means of an industrial robot. During the whole process the arm was held fully passively, while the end point force data and the shoulder, elbow and wrist angle data were collected. The presented method unequivocally reveals a large passive moment adjacent angle dependency in the central angular range, where most everyday actions are performed. It is expected to prove useful in the future work when examining subjects with neuromuscular disorders. Their passive moments may show a fully different pattern than the ones obtained in this study.

Incidence of elbow injuries in adolescent baseball players: screening by a low field magnetic resonance imaging system specialized for small joints.

PubMed

Okamoto, Yoshikazu; Maehara, Kiyoshi; Kanahori, Tetsuya; Hiyama, Takashi; Kawamura, Takashi; Minami, Manabu

2016-04-01

The aim of this preliminary study was to examine the capability of screening for elbow injuries induced by baseball using a low field small joint MRI system. Sixty-two players in the 4th-6th elementary school grades, with ages ranging from 9 to 12 years, participated in this study. Screening for elbow injuries was performed using a low-magnetic-field (0.2-T) magnetic resonance imaging (MRI) system designed for examinations of small joints of the extremities. Gradient-echo coronal, sagittal, and short-tau inversion recovery (STIR) coronal images of the dominant arm used for pitching were obtained to identify medial collateral ligament (MCL) injuries with or without avulsion fracture and osteochondritis dissecans. All 62 examinations were performed successfully, with 26 players (41.9 %) showing positive findings, all being confined to the MCL. No child showed bone damage. All criteria in the MRI evaluation of injuries showed high agreement rates and kappa values between two radiologists. Screening for early detection of elbow injuries in junior Japanese baseball players can be successfully performed using a low-field MRI system specialized for small joints. The percentage of MCL injury without avulsion fracture was unexpectedly high (41.9 %).

Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis.

PubMed

Cai, You-zhi; Zhang, Chi; Lin, Xiang-jin

2015-12-01

The use of platelet-rich plasma (PRP) is an innovative clinical therapy, especially in arthroscopic rotator cuff repair. The purpose of this study was to compare the clinical improvement and tendon-to-bone healing with and without PRP therapy in arthroscopic rotator cuff repair. A systematic search was done in the major medical databases to evaluate the studies using PRP therapy (PRP+) or with no PRP (PRP-) for the treatment of patients with rotator cuff tears. We reviewed clinical scores such as the Constant score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles (UCLA) Shoulder Rating Scale, the Simple Shoulder Test, and the failure-to-heal rate by magnetic resonance imaging between PRP+ and PRP- groups. Five studies included in this review were used for a meta-analysis based on data availability. There were no statistically significant differences between PRP+ and PRP- groups for overall outcome scores (P > .05). However, the PRP+ group exhibited better healing rates postoperatively than the PRP- group (P = .03) in small/moderate full-thickness tears. The use of PRP therapy in full-thickness rotator cuff repairs showed no statistically significant difference compared with no PRP therapy in clinical outcome scores, but the failure-to-heal rate was significantly decreased when PRP was used for treatment of small-to-moderately sized tears. PRP therapy may improve tendon-to-bone healing in patients with small or moderate rotator cuff tears. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

[EFFECTIVENESS OF SHARP TEETH HOOK PLATE FOR TREATMENT OF OLECRANON FRACTURES].

PubMed

Yin, Qudong; Gu, Sanjun; Liu, Jun; Wu, Yongwei; Lu, Yao; Ma, Yunhong; Sheng, Youyin

2016-09-08

To investigate the effectiveness of sharp teeth hook plate by cutting for the treatment of olecranon fractures by comparison with Kirschner wire tension belt and locking plate. Between January 2011 and April 2015, 32 cases of olecranon fractures were treated. Fracture was fixed with sharp teeth hook plate by cutting in 12 cases (trial group) and with Kirschner wire tension belt or locking plate in 20 cases (control group). There was no significant difference in gender, age, side and type of fracture, and time from injury to operation between 2 groups ( P >0.05). The healing time of fractures and complications were recorded. At 1 year after operation, the subjective function results were evaluated according to Disability of Arm, Shoulder, and Hand (DASH) score, and objective function results by Mayo Elbow Score (MEPS); visual analogue scale (VAS) was used for elbow joint pain, and range of motion of flexion and extension of elbow joint was measured. All incisions healed by first intention, with no vascular and nerve injuries. All patients were followed up 12-36 months with an average of 18 months. All fractures healed, and there was no significant difference in the healing time between 2 groups ( P >0.05). Loosening of Kirschner wire occurred in 2 cases of control group, but no loosening of internal fixation was observed in trial group after operation. There was no significant difference in the incidence of complications between 2 groups ( P >0.05). The DASH, MEPS, VAS score, and range of motion of flexion in trial group were superior to those in control group, showing significant differences ( P <0.05) at 1 year after operation. There was no significant difference in range of motion of extension between 2 groups ( P >0.05). Sharp teeth hook plate for treatment of olecranon fractures overcomes the shortcomings that Kirschner wire tension is easy to slide and locking plate has a compression effect on triceps tendon, so it has good effectiveness.

Rupture of the distal biceps brachii tendon: conservative treatment versus anatomic reinsertion--clinical and radiological evaluation after 2 years.

PubMed

Chillemi, Claudio; Marinelli, Mario; De Cupis, Vincenzo

2007-10-01

Distal biceps tendon rupture is a relatively rare injury. It commonly occurs in the dominant extremity of middle-aged men during an excessive eccentric tension as the arm is forced from a flexed position, while it is rarely observed during sport activities. Many techniques, including non-operative and surgical option, have been described for the treatment of a ruptured distal biceps tendon, but there is still considerable controversy about the management of choice. Nine patients affected with traumatic distal tendon ruptures of the biceps brachii were followed-up for a minimum of 24 months. Five patients underwent surgery (two-incision technique) and four patients were treated conservatively. Tendon readaptation to its origin was done by a suture metal anchor. Outcome was evaluated based on the physical examination, radiographic analysis and the SECEC elbow score. The SECEC elbow score results show that every single item result is in favour of surgical treatment. On measurements of motion, we found a slight flexion-extension deficit in two patients, but reduced supination in six patients and reduced pronation in four. Two patients had postoperative dysfunction of the deep branch of the radial nerve. Radiographic examination showed heterotopic bone formation on the radial tuberosity around the presumed insertion of the reattached tendon in 2 of 5 patients and ectopic ossification more proximally in the area of the biceps muscle Our findings confirm the view that anatomic repair of distal biceps tendon rupture provides consistently good results and early anatomic reconstruction can restore strength and endurance for the elbow.

Elbow Angle during a Simulated Task Requiring Fine Psychomotor Control.

ERIC Educational Resources Information Center

Colangelo, Gary A.; And Others

1991-01-01

This study examined elbow angle during a fine motor task (threading a needle), in the context of positions used in preclinical training exercises and assumed by practitioners performing dental procedures. The 101 subjects tended to choose an obtuse angle (mean of 125 degrees) and to vary this angle only slightly in repeated trials. (DB)

Factors affecting healing rates after arthroscopic double-row rotator cuff repair.

PubMed

Tashjian, Robert Z; Hollins, Anthony M; Kim, Hyun-Min; Teefey, Sharlene A; Middleton, William D; Steger-May, Karen; Galatz, Leesa M; Yamaguchi, Ken

2010-12-01

Double-row arthroscopic rotator cuff repairs were developed to improve initial biomechanical strength of repairs to improve healing rates. Despite biomechanical improvements, failure of healing remains a clinical problem. To evaluate the anatomical results after double-row arthroscopic rotator cuff repair with ultrasound to determine postoperative repair integrity and the effect of various factors on tendon healing. Case series; Level of evidence, 4. Forty-eight patients (49 shoulders) who had a complete arthroscopic rotator cuff repair (double-row technique) were evaluated with ultrasound at a minimum of 6 months after surgery. Outcome was evaluated at a minimum of 1-year follow-up with standardized history and physical examination, visual analog scale for pain, active forward elevation, and preoperative and postoperative shoulder scores according to the system of the American Shoulder and Elbow Surgeons and the Simple Shoulder Test. Quantitative strength was measured postoperatively. Ultrasound and physical examinations were performed at a minimum of 6 months after surgery (mean, 16 months; range, 6 to 36 months) and outcome questionnaire evaluations at a minimum of 12 months after surgery (mean, 29 months; range, 12 to 55 months). Of 49 repairs, 25 (51%) were healed. Healing rates were 67% in single-tendon tears (16 of 24 shoulders) and 36% in multitendon tears (9 of 25 shoulders). Older age and longer duration of follow-up were correlated with poorer tendon healing (P < .03). Visual analog scale for pain, active forward elevation, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores all had significant improvement from baseline after repair (P < .0001). Increased age and longer duration of follow-up were associated with lower healing rates after double-row rotator cuff repair. The biological limitation at the repair site, as reflected by the effects of age on healing, appears to be the most important factor influencing tendon healing, even after maximizing repair biomechanical strength with a double-row construct.

Active elbow flexion is possible in C4 quadriplegia using hybrid assistive limb (HAL®) technology: A case study.

PubMed

Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Ikumi, Akira; Abe, Tetsuya; Marushima, Aiki; Ueno, Tomoyuki; Endo, Ayumu; Kawamoto, Hiroaki; Saotome, Kousaku; Matsushita, Akira; Matsumura, Akira; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

2017-07-01

Patients with complete quadriplegia after high cervical spinal cord injury are fully dependent with activities of daily living. Assistive technology can improve their quality of life. We examined the use of a hybrid assistive limb for single joints (HAL-SJ) in a 19-year-old man with complete C4 quadriplegia due to chronic spinal cord injury to restore function of active elbow flexion. This is the first report on the use of the HAL-SJ in a patient with spinal cord injury. The HAL-SJ intervention for each elbow was administered in 10 sessions. Clinical assessment using surface EMG was conducted to evaluate muscle activity of the trapezius, biceps brachii, infraspinatus, and triceps brachii muscle before, and during the 2nd, 3rd, 6th, and 9th interventions. Surface electromyography (EMG) before intervention showed no contraction in the upper arms, but in the bilateral trapezius. The HAL-SJ used motion intention from the right trapezius for activation. After the 6th and 7th session, respectively, biceps EMG showed that voluntary contraction and right elbow flexion could be performed by motion intention from the right biceps. After the 10th session, voluntary bicep contraction was possible. HAL-SJ treatment on the left elbow was performed using the same protocol with a similar outcome. After completing treatment on both upper extremities, both biceps contracted voluntarily, and he could operate a standard wheelchair for a short distance independently. HAL-SJ intervention is feasible and effective in restoring elbow flexor function in a patient with C4 chronic spinal cord injury and complete quadriplegia.

[Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension].

PubMed

Özcan Kahraman, Buse; Özsoy, İsmail; Acar, Serap; Özpelit, Ebru; Akdeniz, Bahri; Sevinç, Can; Savcı, Sema

2017-07-01

Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH. Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer. There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05). Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

Manual handling methods evaluation based on oxygen consumption

NASA Astrophysics Data System (ADS)

Nurmianto, E.; Ciptomulyono, U.; Suparno; Kromodihardjo, S.; Setijono, H.; Arief, N. A.

2018-04-01

Mining industry has become one of the largest industries in Indonesia, now competing in billions dollar market, with numbers people employed. Deliveries of a Return Rolls (RR) involve the use of a hand truck and, in many cases, a shoulder/elbow-mode of carriage. Workers usually prefer to the Gendong (carrying on the small of the back or the hip, supported by the waist and arm) mode or Manggul (carrying on some stuff shoulder) mode, because they feel safer by carrying RR on the shoulder/elbow. In this study, the physiological workload involved in shoulder/elbow-mode carrying was investigated, especially focusing on the effects of load weight and inclination. To measure heart rate and oxygen uptake while carrying on the shoulder/elbow, a laboratory experiment was conducted and safety guidelines for such tasks were proposed, based on the experimental results. Four healthy male subjects performed shoulder/elbow-mode carrying, weight between 20 and 24 kg: (1) on inclination of 10o, (2) 20o and (3) 30o. The results showed that inclination involved an increased physiological burden, and that a load of 24 kg entailed a significantly higher physiological cost than carrying a load of 20 kg. Although shoulder/elbow-mode carrying has some advantages, the worker should be advised to carry a load of less than 20 kg, to avoid a high physiological load. During shoulder/elbow-mode carrying, it is also recommended that a person prepare more training in order to have muscular strength.

Pipe crawler development for duct elbow removal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zollinger, W.T.; Treanor, R.C.

1992-01-01

This paper describes the development of equipment for removing an elbow in a 36 inch diameter ventilation line by cutting from the inside. Radiation levels, high air flow and physical constraints preclude any manual rework of the ventilation system. A remotely operated pipe crawler was developed. Testing has been performed in a full-scale mockup which models the ventilation duct configuration with the exception of radiation levels. The results gathered from the testing are discussed, and illustrate the strengths and weaknesses of the crawler and plasma arc torch system. To date, the equipment has successfully completed the tasks of maneuvering throughmore » the duct geometry, performing the two required cuts, and backing out of the duct mockup. The elbow successfully fell away from the main duct, showing that the line would be clear of obstructions.« less

Pipe crawler development for duct elbow removal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zollinger, W.T.; Treanor, R.C.

1992-11-01

This paper describes the development of equipment for removing an elbow in a 36 inch diameter ventilation line by cutting from the inside. Radiation levels, high air flow and physical constraints preclude any manual rework of the ventilation system. A remotely operated pipe crawler was developed. Testing has been performed in a full-scale mockup which models the ventilation duct configuration with the exception of radiation levels. The results gathered from the testing are discussed, and illustrate the strengths and weaknesses of the crawler and plasma arc torch system. To date, the equipment has successfully completed the tasks of maneuvering throughmore » the duct geometry, performing the two required cuts, and backing out of the duct mockup. The elbow successfully fell away from the main duct, showing that the line would be clear of obstructions.« less

Electrically Stimulated Antagonist Muscle Contraction Increased Muscle Mass and Bone Mineral Density of One Astronaut - Initial Verification on the International Space Station

PubMed Central

Takano, Yoshio; Yoshimitsu, Kazuhiro; Omoto, Masayuki; Hashida, Ryuki; Tagawa, Yoshihiko; Inada, Tomohisa; Yamada, Shin; Ohshima, Hiroshi

2015-01-01

Background Musculoskeletal atrophy is one of the major problems of extended periods of exposure to weightlessness such as on the International Space Station (ISS). We developed the Hybrid Training System (HTS) to maintain an astronaut’s musculoskeletal system using an electrically stimulated antagonist to resist the volitional contraction of the agonist instead of gravity. The present study assessed the system’s orbital operation capability and utility, as well as its preventative effect on an astronaut’s musculoskeletal atrophy. Methods HTS was attached to the non-dominant arm of an astronaut staying on the ISS, and his dominant arm without HTS was established as the control (CTR). 10 sets of 10 reciprocal elbow curls were one training session, and 12 total sessions of training (3 times per week for 4 weeks) were performed. Pre and post flight ground based evaluations were performed by Biodex (muscle performance), MRI (muscle volume), and DXA (BMD, lean [muscle] mass, fat mass). Pre and post training inflight evaluations were performed by a hand held dynamometer (muscle force) and a measuring tape (upper arm circumference). Results The experiment was completed on schedule, and HTS functioned well without problems. Isokinetic elbow extension torque (Nm) changed -19.4% in HTS, and -21.7% in CTR. Isokinetic elbow flexion torque changed -23.7% in HTS, and there was no change in CTR. Total Work (Joule) of elbow extension changed -8.3% in HTS, and +0.3% in CTR. For elbow flexion it changed -23.3% in HTS and -32.6% in CTR. Average Power (Watts) of elbow extension changed +22.1% in HTS and -8.0% in CTR. For elbow flexion it changed -6.5% in HTS and -4.8% in CTR. Triceps muscle volume according to MRI changed +11.7% and that of biceps was +2.1% using HTS, however -0.1% and -0.4% respectively for CTR. BMD changed +4.6% in the HTS arm and -1.2% for CTR. Lean (muscle) mass of the arm changed only +10.6% in HTS. Fat mass changed -12.6% in HTS and -6.4% in CTR. Conclusions These results showed the orbital operation capability and utility, and the preventive effect of HTS for an astronaut’s musculoskeletal atrophy. The initial flight data together with the ground data obtained so far will be utilized in the future planning of human space exploration. PMID:26296204

Triceps tendon tear in a middle-aged weightlifter.

PubMed

Molloy, Joseph M; Aberle, Curtis J; Escobar, Eduardo

2013-11-01

The patient was a 47-year-old man who was evaluated by a physical therapist for a chief complaint of posterior right elbow pain. The patient routinely participated in weightlifting activities and reported a sudden onset of triceps weakness and posterior elbow pain while performing clap push-ups 3 days prior. A physician assistant ordered radiographs, which were initially interpreted as normal, and routine magnetic resonance imaging for the right elbow. Following examination by a physical therapist, due to concern for a triceps tendon tear, the previously ordered magnetic resonance imaging was expedited, which revealed a partial triceps tendon tear with partial tendon retraction medially.

Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury Than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball.

PubMed

Camp, Christopher L; Zajac, John M; Pearson, David B; Sinatro, Alec M; Spiker, Andrea M; Werner, Brian C; Altchek, David W; Coleman, Struan H; Dines, Joshua S

2017-09-01

The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2) describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury. Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. All noncontact shoulder and elbow injuries were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified. A total of 53 shoulder (n = 25) and elbow (n = 28) injuries occurred during 132 pitcher seasons (n = 81 pitchers). The most significant categorical risk factor associated with increased elbow injury rates was the presence of a shoulder flexion deficit >5° (odds ratio [OR] 2.83; P = .042). For continuous variables, the risk of elbow injury increased by 7% for each degree of increased shoulder ER deficit (OR 1.07; P = .030) and 9% for each degree of decreased shoulder flexion (OR 1.09; P = .017). None of the measures significantly correlated with shoulder injuries. Preseason shoulder ER and flexion deficits are independent risk factors for the development of elbow injuries during the upcoming season. Although prior work has supported the importance of reducing glenohumeral internal rotation deficits in pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of subsequent elbow injury. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effects of a Short-Duration Stretching Drill After Pitching on Elbow and Shoulder Range of Motion in Professional Baseball Pitchers.

PubMed

Escamilla, Rafael F; Yamashiro, Kyle; Mikla, Tony; Collins, Jeff; Lieppman, Keith; Andrews, James R

2017-03-01

A glenohumeral internal rotation (IR) deficit or a total rotational motion (IR plus external rotation [ER]) deficit in the throwing shoulder compared with the nonthrowing shoulder has been shown to increase the risk of shoulder and elbow injuries. After a pitching session, both IR and total rotational motion deficits have been shown to occur naturally for an extended period of time in asymptomatic pitchers, but it is unclear how to best control these deficits between pitching sessions. Purpose/Hypothesis: The purpose of this study was to determine whether performing a short-duration stretching/calisthenics drill after pitching will result in an increase in IR, ER, total rotational motion, and elbow extension in professional baseball pitchers. It was hypothesized that these shoulder and elbow passive range of motion (PROM) measurements would all decrease after pitching but would subsequently return to prepitching values after the short-duration stretching/calisthenics drill. Controlled laboratory study. A convenience sample of 20 male professional baseball pitchers served as study participants. The following sequence of activities was performed for all participants: (1) a 5- to 10-minute dynamic warm-up consisting of running and light throwing, (2) elbow extension and IR and ER PROM measurements taken before pitching, (3) 40 full-effort pitches off the pitching mound, (4) 8 minutes of rest, (5) elbow extension and IR and ER PROM measurements taken after pitching, (6) a short-duration stretching/calisthenics drill (two-out drill), and (7) elbow extension and IR and ER PROM measurements taken after the two-out drill. A 1-way repeated-measures analysis of variance ( P < .05) was employed to assess differences in elbow extension, IR, ER, and total rotational motion in the 3 measurement conditions (prepitching, postpitching, and postdrill). To assess intrarater and interrater reliability, intraclass correlation coefficients (ICCs) were calculated, and the measurement error was calculated using the standard error of measurement (SEM). Significant differences were observed among the 3 conditions for ER ( P = .002), IR ( P = .027), and total rotational motion ( P < .001), but there was no significant difference in elbow extension ( P = .117). Bonferroni post hoc analyses revealed (1) significantly greater ER during prepitching and postdrill versus the postpitching condition (94° ± 7° [prepitching] and 94° ± 8° [postdrill] vs 88° ± 8°; P = .010 and .005, respectively), (2) significantly greater IR during prepitching and postdrill versus the postpitching condition (36° ± 10° [prepitching] and 35° ± 9° [postdrill] vs 30° ± 10°; P = .034 and .043, respectively), and (3) significantly greater total rotational motion during prepitching and postdrill versus the postpitching condition (129° ± 13° [prepitching] and 129° ± 13° [postdrill] vs 119° ± 13°; P = .034 and .004, respectively). There were no significant differences in ER, IR, or total rotational motion between the prepitching and postdrill conditions ( P > .999 for all). The intrarater reliability (ICC 3,1 ) was 0.91 for ER (SEM, 1.3°) and 0.90 for IR (SEM, 1.9°), and the interrater reliability (ICC 2,1 ) was 0.81 for ER (SEM, 3.3°) and 0.77 for IR (SEM, 4.3°). After a 40-pitch bullpen session, IR and ER PROM as well as total rotational motion were significantly lower than prepitching values; however, these deficits were restored back to their prepitching levels after the players performed the two-out drill, which may increase pitching performance and decrease the risk of shoulder and elbow injuries. More research is needed to test these hypotheses and assess the clinical efficacy of the two-out drill. The findings from the current study will assist clinicians better understand the positive effects of performing a short duration stretching/calisthenics drill on shoulder internal and external rotation range of motion between innings while pitching during a baseball game.

Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players.

PubMed

Jack, Robert A; Burn, Matthew B; Sochacki, Kyle R; McCulloch, Patrick C; Lintner, David M; Harris, Joshua D

2018-06-01

The anterior bundle of the medial ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow and is often injured among overhead throwing athletes. Despite prevention strategies, injuries to the elbow UCL are on the rise. To determine (1) the return-to-sport (RTS) rate of Major League Baseball (MLB) position players after elbow medial UCL reconstruction, (2) postoperative career length and games per season, (3) pre- and postoperative performance, (4) postoperative performance versus matched control players, and (5) whether position players changed positions after UCL reconstruction. Cohort study; Level of evidence, 3. MLB players who underwent elbow UCL reconstruction were identified (cases). Demographic and performance data were collected for each player. Matched controls were identified. RTS in MLB was defined as playing in at least 1 MLB game after UCL reconstruction. Comparisons between case and control groups and pre- and postoperative time points were made via paired samples Student t tests. Thirty-three players (34 surgical procedures) were identified with a mean ± SD age of 30.2 ± 4.2 years and a mean experience in the MLB of 6.3 ± 3.9 years at the time of surgery. Twenty-eight players (84.8%) were able to RTS in MLB at a mean 336.9 ± 121.8 days. However, players ≥30 years old demonstrated a significantly lower RTS rate (53.3%) than players <30 years old (89.4%; P < .05). Catchers had a significantly shorter postoperative career length (2.8 ± 1.8 years) versus matched controls (6.1 ± 1.9 years; P < .05). Outfielders had a significantly lower wins above replacement postoperatively (0.8 ± 0.7) versus preoperatively (1.5 ± 1.1; P < .05). There were no performance differences between cases and matched controls. Twelve players (48%) returned to a different position postoperatively. The RTS rate for MLB position players after elbow UCL reconstruction is similar to that of pitchers. Catchers had a significantly shorter career length than that of matched controls. Outfielders performed worse postoperatively versus preoperatively. There is a high rate of position change after Tommy John surgery for infielders and outfielders.

Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis.

PubMed

Budsberg, Steven C; Torres, Bryan T; Kleine, Stephanie A; Sandberg, Gabriella S; Berjeski, Amanda K

2018-02-15

OBJECTIVE To investigate the effectiveness of tramadol for treatment of osteoarthritis in dogs. DESIGN Randomized, blinded, placebo-controlled crossover study. ANIMALS 40 dogs with clinical osteoarthritis of the elbow or stifle joint. PROCEDURES Dogs orally received 3 times/d (morning, midday, and night) for a 10-day period each of 3 identically appearing treatments (placebo; carprofen at 2.2 mg/kg [1 mg/lb], q 12 h [morning and night], with placebo at midday; or tramadol hydrochloride at 5 mg/kg [2.3 mg/lb], q 8 h) in random order, with treatment sessions separated by a minimum 7-day washout period. Vertical ground reaction forces (vertical impulse [VI] and peak vertical force [PVF]) were measured and Canine Brief Pain Inventory (CBPI) scores assigned prior to (baseline) and at the end of each treatment period. Repeated-measures ANOVA was performed to compare VI and PVF data among and within treatments, and the χ 2 test was used to compare proportions of dogs with a CBPI-defined positive response to treatment. RESULTS 35 dogs completed the study. No significant changes from baseline in VI and PVF were identified for placebo and tramadol treatments; however, these values increased significantly with carprofen treatment. Changes from baseline in VI and PVF values were significantly greater with carprofen versus placebo or tramadol treatment. A significant improvement from baseline in CBPI scores was identified with carprofen treatment but not placebo or tramadol treatment. CONCLUSIONS AND CLINICAL RELEVANCE 10 days of treatment with tramadol as administered (5 mg/kg, PO, q 8 h) provided no clinical benefit for dogs with osteoarthritis of the elbow or stifle joint.

A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures.

PubMed

Akman, Yunus Emre; Sukur, Erhan; Circi, Esra; Ozyalvac, Osman Nuri; Ozyer, Fatih; Ozturkmen, Yusuf

2017-03-01

The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. Level III, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder?

PubMed

Bonnevialle, Nicolas; Bayle, Xavier; Faruch, Marie; Wargny, Matthieu; Gomez-Brouchet, Anne; Mansat, Pierre

2015-08-01

The aim of the study was to evaluate the relationship between bone microvascularization of the footprint and tendon integrity after rotator cuff repair of the shoulder. Forty-eight patients (mean age, 59 years; ±7.9) with a chronic rotator cuff tear underwent a tendon repair with a single-row technique and were studied prospectively. A core obtained from the footprint during the procedure allowed determination of the bone's microvascularization with an immunohistochemistry technique using anti-CD34 antibodies. Clinical evaluation was performed at a minimum of 12-month follow-up, and rotator cuff integrity was assessed with ultrasound according to Sugaya's classification. At a mean follow-up of 13 months, the Constant score improved from 40 to 75 points; American Shoulder and Elbow Surgeons score, from 59 to 89 points; and subjective shoulder value, from 38% to 83% (P < .001). Ultrasound identified 18 patients with Sugaya type I healing, 27 patients with type II, and 3 patients with type IV. No patients showed Sugaya type III or V repairs. The rate of microvascularization of the footprint was 15.6%, 13.9%, and 4.2% for type I, II, and IV tendon integrity, respectively (I vs. II, P = .22; II vs. IV, P = .02; I vs. IV, P = .0022). Patients with a history of corticosteroid injection had a lower rate of microvascularization than the others (10.3% vs. 16.2%; P = .03). Even if overall satisfactory clinical outcomes are achieved after a rotator cuff repair, bone microvascularization of the footprint plays a role in rotator cuff healing. A lower rate of microvessels decreases the tendon integrity and healing potential after repair. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The correlation between proprioception and handwriting legibility in children

PubMed Central

Hong, So Young; Jung, Nam-Hae; Kim, Kyeong Mi

2016-01-01

[Purpose] This study investigated the association between proprioception, including joint position sense and kinetic sense, and handwriting legibility in healthy children. [Subjects and Methods] Assessment of joint position sense, kinetic sense, and handwriting legibility was conducted for 19 healthy children. Joint position sense was assessed by asking the children to flex their right elbow between 30° to 110° while blindfolded. The range of elbow movement was analyzed with Compact Measuring System 10 for 3D motion Analysis. Kinetic sense was assessed using the Sensory Integration and Praxis Test. The children were directed to write 30 words from the Korean alphabet, and the legibility of their handwriting was scored for form, alignment, space, size, and shape. To analyze the data, descriptive statistics and Spearman correlation analysis were conducted using IBM SPSS Statistics 20.0. [Results] There was significant negative correlation between handwriting legibility and Kinetic sense. A significant correlation between handwriting legibility and Joint position sense was not found. [Conclusion] This study showed that a higher Kinetic sense was associated with better legibility of handwriting. Further work is needed to determine the association of handwriting legibility and speed with Joint position sense of the elbow, wrist, and fingers. PMID:27821948

[A case control study of perpendicular or parallel double plate for the treatment of young and middle-aged patients with type C fractures of distal humerus].

PubMed

Yu, Ye-Feng; Dai, Jia-Ping; Sheng, Jian-Ming; Zhou, Xiao

2017-06-25

To compare clinical outcomes of perpendicular or parallel double plate in treating type C fractures of distal humerus in adults. From March 2009 and March 2013, 40 adult patients with type C distal humerus fractures were treated. The patients were divided into two groups according to fixed form. In perpendicular group(group A), there were 13 males and 9 females with a mean age of (37.56±9.24) years old(ranged 18 to 56);while in parallel plating group(group B), including 11 males and 7 females, with a mean age of (41.35±9.03) year old(ranged 20 to 53). All fractures were fresh and closed without blood vessels or nerve damaged. Incision length, operating time, blood loss, hospital stay, preoperative and postoperative radiological change, range of activity of elbow joint, Mayo score, flexor and extensor elbow strength, and postoperative complications were observed and compared. All incisions were healed well. One patient occurred myositis ossificans between two groups. Two patients in group A and 1 patient in group B occurred elbow joint stiffness. All fractures were obtained bone union. Group A were followed up from 20 to 36 months with an average of (25.2±7.1) months, while group B were followed up from 18 to 35 months with an average of(24.3±6.0) months. There were significant differences in blood loss and operative time, while there was no obvious meaning in incision length, hospital stay, muscle strength, fracture healing time, range of activity of elbow joint. Mayo score of group A was 82.27±10.43, 6 cases obtained excellent results, 12 good, 3 moderate and 1 poor;in group B was 81.94±12.02, 5 cases obtained excellent results, 9 good, 3 moderate and 1 poor;and there were no statistical significance between two groups. There was no significant differences in clinical effects between perpendicular and parallel double plate for adult patients with type C distal humerus fractures, while the operation should choose according to facture and proficiency of operator.

Noninvasive monopolar capacitive-coupled radiofrequency for the treatment of pain associated with lateral elbow tendinopathies: 1-year follow-up.

PubMed

Weber, Tobias; Kabelka, Bernd

2012-03-01

To evaluate noninvasive monopolar capacitive-coupled radiofrequency (mcRF) for the treatment of pain associated with lateral elbow tendinopathies. Prospective, single-center, single-arm, 1-year follow-up. Private sports medicine practice. Thirty-nine consecutive patients with diagnosis of lateral elbow tendinopathy (including 3 bilateral cases, for a total of 42 elbows) participated in the study. All patients had been unsuccessfully treated with a variety of nonoperative therapies (eg, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and braces) for at least 3 months before they were enrolled in the study. Patients were treated with mcRF technology in the office without local anesthetic or any particular preparation. Anatomic landmarks and careful determination of the most tender point defined the area treated; rapid and precise mcRF pulses were delivered covering the area in a staggered fashion; and 10 additional pulses were delivered directly to the point of maximum tenderness (total of 100 pulses). Patients returned to activities of daily living without restriction and were instructed to avoid nonsteroidal anti-inflammatory drugs and/or ice over the treated area. Physical therapy or other treatment modalities were disallowed. The presence of pain before enrollment ranged from 15 weeks to 2 years (average, 32 weeks). Visual analog scores at rest, with regular activity, and with triggering events were gathered at 3, 6, and 12 months. The Nirschl Tennis Elbow Questionnaire and patient satisfaction also were used to evaluate study outcomes. Follow-up average was 423 days (range, 330-487 days). On the basis of the study's multifactorial success criteria, 81% of participants had successful outcomes. Furthermore, 89% of the patients who completed the study were completely or moderately satisfied with the outcome. Outcomes of this study suggest that noninvasive mcRF may have a role in the treatment of pain associated with lateral elbow tendinopathies. The noninvasive nature of the procedure and the safety and efficacy suggested by this study may offer significant advantages over current treatment alternatives. Further research in the form of a randomized clinical trial is recommended. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Functional Consequence of Distal Brachioradialis Tendon Release: A Biomechanical Study

PubMed Central

Tirrell, Timothy F.; Franko, Orrin I.; Bhola, Siddharth; Hentzen, Eric R.; Abrams, Reid A.; Lieber, Richard L.

2013-01-01

Purpose Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, this common procedure has the potential to decrease elbow flexion strength. To determine the potential morbidity associated with brachioradialis release, we measured the change in elbow torque as a function of incremental release of the brachioradialis insertion footprint. Methods In 5 upper extremity cadaveric specimens, the brachioradialis tendon was systematically released from the radius, and the resultant effect on brachioradialis elbow flexion torque was measured. Release distance was defined as the distance between the release point and the tip of the radial styloid. Results Brachioradialis elbow flexion torque dropped to 95%, 90% and 86% of its original value at release distances of 27mm, 46mm, and 52mm, respectively. Importantly, brachioradialis torque remained above 80% of its original value at release distances up to 7 centimeters. Conclusions Our data demonstrate that release of the brachioradialis tendon from its insertion has minor effects on its ability to transmit force to the distal radius. Clinical Relevance These data may imply that release of the distal brachioradialis tendon during distal radius open reduction internal fixation can be performed without meaningful functional consequences to elbow flexion torque. Even at large release distances, overall elbow flexion torque loss after brachioradialis release would be expected to be less than 5% due to the much larger contributions of the biceps and brachialis. Use of the brachioradialis as a tendon transfer donor should not be limited by concerns of elbow flexion loss, and the tendon could be considered as an autograft donor. PMID:23528425

Three-dimensional analysis of elbow soft tissue footprints and anatomy.

PubMed

Capo, John T; Collins, Christopher; Beutel, Bryan G; Danna, Natalie R; Manigrasso, Michaele; Uko, Linda A; Chen, Linda Y

2014-11-01

Tendinous and ligamentous injuries commonly occur in the elbow. This study characterized the location, surface areas, and origin and insertional footprints of major elbow capsuloligamentous and tendinous structures in relation to bony landmarks with the use of a precision 3-dimensional modeling system. Nine unpaired cadaveric elbow specimens were dissected and mounted on a custom jig. Mapping of the medial collateral ligament (MCL), lateral ulnar collateral ligament (LUCL), triceps, biceps, brachialis, and capsular reflections was then performed with 3-dimensional digitizing technology. The location, surface areas, and footprints of the soft tissues were calculated. The MCL had a mean origin (humeral) footprint of 216 mm(2), insertional footprint of 154 mm(2), and surface area of 421 mm(2). The LUCL had a mean origin footprint of 136 mm(2), an insertional footprint of 142 mm(2), and a surface area of 532 mm(2). Of the tendons, the triceps maintained the largest insertional footprint, followed by the brachialis and the biceps (P < .001-.03). The MCL, LUCL, and biceps footprint locations were consistent, with little variability. The surface areas of the anterior (1251 mm(2)) and posterior (1147 mm(2)) capsular reflections were similar (P = .82), and the anterior capsule extended farther proximally. Restoring the normal anatomy of key elbow capsuloligamentous and tendinous structures is crucial for effective reconstruction after bony or soft tissue trauma. This study provides the upper extremity surgeon with information that may aid in restoring elbow biomechanics and preserving range of motion in these patients. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The first 100 elbow arthroscopies of one surgeon: analysis of complications.

PubMed

Marti, Darius; Spross, Christian; Jost, Bernhard

2013-04-01

Elbow arthroscopy is technically challenging and prone to complications especially due to the close relation of nerves and vessels. Complication rates up to 20% are reported, depending on indication and how complications are defined. This study analyzes the complications of the first 100 elbow arthroscopies done by 1 fellowship- and cadaver-trained surgeon. From September 2004 to April 2009, 100 consecutive elbow arthroscopies were performed, and thus consequently standardized, by 1 surgeon in 1 institution. The clinical data of all patients were retrospectively analyzed for indication-specific complications. Complications were divided into minor (transient) and major (persistent or infection). Included were 65 male and 35 female patients (mean age, 41 years; range, 12-70 years) with a minimum follow-up of 12 months (clinical or telephone). The following indications were documented (several per patient were possible): osteoarthritis in 29, stiffness in 27, loose bodies in 27, tennis elbow in 24, traumatic sequelae in 19, and others in 24. No major complications occurred, but 6 minor complications occurred in 5 patients (5%), comprising 2 hematoma, 2 transient nerve lesions, 1 wound-healing problem, and 1 complex regional pain syndrome. No revision surgery was necessary. Complications were not significantly associated with the indication for operation or the surgeon's learning curve. This study shows an acceptable complication rate of the first 100 elbow arthroscopies from a single surgeon. A profound clinical education, including cadaver training as well as standardization of patient position, portals, and surgery, help to achieve this. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Reliability and precision of stress sonography of the ulnar collateral ligament.

PubMed

Bica, David; Armen, Joseph; Kulas, Anthony S; Youngs, Kevin; Womack, Zachary

2015-03-01

Musculoskeletal sonography has emerged as an additional diagnostic tool that can be used to assess medial elbow pain and laxity in overhead throwers. It provides a dynamic, rapid, and noninvasive modality in the evaluation of ligamentous structural integrity. Many studies have demonstrated the utility of dynamic sonography for medial elbow and ulnar collateral ligament (UCL) integrity. However, evaluating the reliabilityand precision of these measurements is critical if sonography is ultimately used as a clinical diagnostic tool. The purpose of this study was to evaluate the reliability and precision of stress sonography applied to the medial elbow. We conducted a cross-sectional study during the 2011 baseball off-season. Eighteen National Collegiate Athletic Association Division I pitchers were enrolled, and 36 elbows were studied. Using sonography, the medial elbow was assessed, and measurements of the UCL length and ulnohumeral joint gapping were performed twice under two conditions (unloaded and loaded) and bilaterally. Intraclass correlation coefficients (0.72-0.94) and standard errors of measurements (0.3-0.9 mm) for UCL length and ulnohumeral joint gapping were good to excellent. Mean differences between unloaded and loaded conditions for the dominant arms were 1.3 mm (gapping; P < .001) and 1.4 mm (UCL length; P < .001). Medial elbow stress sonography is a reliable and precise method for detecting changes in ulnohumeral joint gapping and UCL lengthening. Ultimately, this method may provide clinicians valuable information regarding the medial elbow's response to valgus loading and may help guide treatment options. © 2015 by the American Institute of Ultrasound in Medicine.

The Effects of Elbow Bracing on Medial Elbow Joint Space Gapping Associated With Repetitive Throwing in High School Baseball Players

PubMed Central

Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Takei, Keiichi; Yamamoto, Mitsuru

2017-01-01

Background: Throwing athletes risk medial elbow injury from extreme valgus stress generated across the medial elbow during throwing. Braces have been developed to protect the elbow joint; however, no previous study has investigated the effects of elbow bracing on medial elbow joint space gapping associated with repetitive throwing. Hypothesis/Purpose: The purpose of this study was to investigate the effects of elbow bracing on medial elbow joint space gapping during repetitive throwing. Our hypothesis was that an elbow brace may reduce mechanical stress on the elbow by reducing medial elbow joint space gapping. Study Design: Controlled laboratory study. Methods: Twenty-five high school baseball players participated in this study. Each subject pitched 100 times under 2 conditions: control (without elbow brace) and elbow brace. The ulnohumeral joint space was measured ultrasonically before pitching and after every block of 20 pitches. Measurement of the ulnohumeral joint space was carried out using ultrasound with the forearm hanging by the side. Two-way repeated-measures analysis of variance and post hoc tests were used to compare ulnohumeral joint space with repeated pitching and between the elbow brace and control conditions. Results: In the control condition, ulnohumeral joint space after 60 pitches was significantly greater than that before pitching (P < .01). In contrast, in the elbow brace condition, ulnohumeral joint space was not significantly different after repeated pitching. When comparing these 2 conditions, ulnohumeral joint space in the control condition was significantly greater than that in the elbow brace condition after 60 pitches (P < .01). Conclusion: An elbow brace has the effect of preventing medial elbow joint space gapping with repeated throwing when determined ultrasonically by measuring the ulnohumeral joint space under gravity load. Clinical Relevance: An elbow brace worn during baseball pitching practice may help reduce mechanical stress on the elbow by reducing medial elbow joint space gapping. PMID:28451622

The Effects of Elbow Bracing on Medial Elbow Joint Space Gapping Associated With Repetitive Throwing in High School Baseball Players.

PubMed

Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Takei, Keiichi; Yamamoto, Mitsuru

2017-04-01

Throwing athletes risk medial elbow injury from extreme valgus stress generated across the medial elbow during throwing. Braces have been developed to protect the elbow joint; however, no previous study has investigated the effects of elbow bracing on medial elbow joint space gapping associated with repetitive throwing. The purpose of this study was to investigate the effects of elbow bracing on medial elbow joint space gapping during repetitive throwing. Our hypothesis was that an elbow brace may reduce mechanical stress on the elbow by reducing medial elbow joint space gapping. Controlled laboratory study. Twenty-five high school baseball players participated in this study. Each subject pitched 100 times under 2 conditions: control (without elbow brace) and elbow brace. The ulnohumeral joint space was measured ultrasonically before pitching and after every block of 20 pitches. Measurement of the ulnohumeral joint space was carried out using ultrasound with the forearm hanging by the side. Two-way repeated-measures analysis of variance and post hoc tests were used to compare ulnohumeral joint space with repeated pitching and between the elbow brace and control conditions. In the control condition, ulnohumeral joint space after 60 pitches was significantly greater than that before pitching ( P < .01). In contrast, in the elbow brace condition, ulnohumeral joint space was not significantly different after repeated pitching. When comparing these 2 conditions, ulnohumeral joint space in the control condition was significantly greater than that in the elbow brace condition after 60 pitches ( P < .01). An elbow brace has the effect of preventing medial elbow joint space gapping with repeated throwing when determined ultrasonically by measuring the ulnohumeral joint space under gravity load. An elbow brace worn during baseball pitching practice may help reduce mechanical stress on the elbow by reducing medial elbow joint space gapping.

Structural Brain Damage and Upper Limb Kinematics in Children with Unilateral Cerebral Palsy.

PubMed

Mailleux, Lisa; Simon-Martinez, Cristina; Klingels, Katrijn; Jaspers, Ellen; Desloovere, Kaat; Demaerel, Philippe; Fiori, Simona; Guzzetta, Andrea; Ortibus, Els; Feys, Hilde

2017-01-01

Background: In children with unilateral cerebral palsy (uCP) virtually nothing is known on the relation between structural brain damage and upper limb (UL) kinematics quantified with three-dimensional movement analysis (3DMA). This explorative study aimed to (1) investigate differences in UL kinematics between children with different lesion timings, i.e., periventricular white matter (PWM) vs. cortical and deep gray matter (CDGM) lesions and (2) to explore the relation between UL kinematics and lesion location and extent within each lesion timing group. Methods: Forty-eight children (age 10.4 ± 2.7 year; 29 boys; 21 right-sided; 33 PWM; 15 CDGM) underwent an UL 3DMA during a reach-to-grasp task. Spatiotemporal parameters [movement duration, (timing of) maximum velocity, trajectory straightness], the Arm Profile Score (APS) and Arm Variable Scores (AVS) were extracted. The APS and AVS refer to the total amount of movement pathology and movement deviations of the wrist, elbow, shoulder, scapula and trunk respectively. Brain lesion location and extent were scored based on FLAIR-images using a semi-quantitative MRI-scale. Results: Children with CDGM lesions showed more aberrant spatiotemporal parameters ( p < 0.03) and more movement pathology (APS, p = 0.003) compared to the PWM group, mostly characterized by increased wrist flexion ( p = 0.01). In the CDGM group, moderate to high correlations were found between lesion location and extent and duration, timing of maximum velocity and trajectory straightness ( r = 0.53-0.90). Lesion location and extent were further moderately correlated with distal UL movement pathology (wrist flexion/extension, elbow pronation/supination, elbow flexion/extension; r = 0.50-0.65) and with the APS ( r = 0.51-0.63). In the PWM group, only a few and low correlations were observed, mostly between damage to the PLIC and higher AVS of elbow flexion/extension, shoulder elevation and trunk rotation ( r = 0.35-0.42). Regression analysis revealed damage to the temporal lobe with lesion timing as interactor (27%, p = 0.002) and the posterior limb of the internal capsule (PLIC) (7%, p = 0.04) as the strongest predictors, explaining 34% of the variance in APS. Conclusion: UL kinematic deviations are more influenced by lesion location and extent in children with later (CDGM) versus earlier lesions (PWM), except for proximal movement pathology. Damage to the PLIC is a significant predictor for UL movement pathology irrespective of lesion timing.

MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor tendon an isolated lesion?

PubMed

Qi, Liang; Zhu, Zheng-Feng; Li, Feng; Wang, Ren-Fa

2013-01-01

To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman's rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe). Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01) was found in injuries of CET and lateral ulnar collateral ligament (LUCL). Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL.

Revision of failed hemiarthroplasty for painful glenoid arthrosis to anatomic total shoulder arthroplasty.

PubMed

Sheth, Mihir M; Sholder, Daniel; Abboud, Joseph; Lazarus, Mark D; Ramsey, Matthew L; Williams, Gerald R; Namdari, Surena

2018-05-10

The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiarthroplasty is a common cause of reoperation, and conversion to anatomic total shoulder arthroplasty is one option. We identified patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period in a single tertiary-care health system. Presurgical and operative data were analyzed for 28 patients who met the inclusion and exclusion criteria. Patients were contacted at a minimum of 2 years' follow-up after revision surgery for functional outcome scores, reoperations, and implant survival. The 2- and 5-year implant survival rates were 93% and 86%, respectively. Functional outcomes were obtained from 21 patients with surviving implants. The mean American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Single Assessment Numerical Evaluation score were 78 ± 20, 2.3 ± 2.6, and 71 ± 24, respectively. The mean Short Form 12 mental and physical scores were 49 ± 10 and 43 ± 9, respectively. Of the patients, 17 (81%) were either satisfied or very satisfied with their outcome. Complications were seen in 10 patients (36%), and 6 patients (21%) required reoperation. Anatomic total shoulder arthroplasty following hemiarthroplasty can achieve successful outcomes and implant survival rates. Given our poor understanding of reverse shoulder arthroplasty longevity, this procedure should remain an option for patients with glenoid arthrosis and an intact rotator cuff. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Arthroscopic Bankart repair and subscapularis augmentation: an alternative technique treating anterior shoulder instability with bone loss.

PubMed

Maiotti, Marco; Russo, Raffaele; Zanini, Antonio; Schröter, Steffen; Massoni, Carlo; Bianchedi, Diana

2016-06-01

This study presents the preliminary results of a new arthroscopic technique consisting of the association of 2 procedures, capsulolabral repair and subscapularis augmentation tenodesis, in the treatment of traumatic anterior shoulder instability with both glenoid bone loss and a Hill-Sachs lesion. Eighty-nine patients engaged in sports were enrolled in this retrospective case-series study with 2 to 5 years' follow-up. All patients underwent a computed tomography scan to assess the percentage of glenoid bone loss by the Pico method. A prior stabilization procedure had failed in 20 patients, who were then segregated into a different group. Visual analog scale (VAS), Rowe, and American Shoulder and Elbow Surgeons (ASES) scores were used to assess the results. Only 3 of 89 patients had a post-traumatic redislocation. The mean length of follow-up was 31.5 months (range, 25-60 months). The VAS, Rowe, and ASES scores showed significant improvements: The VAS score decreased from a mean of 3.1 to 0.5 (P = .0157), the Rowe score increased from 58.9 to 94.1 (P = .0215), and the ASES score increased from 68.5 to 95.5 (P = .0197). The mean deficit of external rotation was 6° with the arm at the side of the trunk, and the mean deficit was 3° with the arm in 90° of abduction. The described procedure is a reproducible and effective technique used to restore joint stability in patients engaged in sports who have incurred anterior recurrent shoulder dislocation associated with glenoid bone loss (<25%) and a Hill-Sachs lesion. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow) polymer...

21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow) polymer...

21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow) polymer...

21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow) polymer...

21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow) polymer...

[Effectiveness comparison of suspension fixation plus hinged external fixator and double plate internal fixation in treatment of type C humeral intercondylar fractures].

PubMed

Zhang, Jian; Lin, Xu; Zhong, Zeli; Wu, Chao; Tan, Lun

2017-07-01

To compare the effectiveness of suspension fixation plus hinged external fixator with double plate internal fixation in the treatment of type C humeral intercondylar fractures. Between January 2014 and April 2016, 30 patients with type C (Association for the Study of Internal Fixation, AO/ASIF) humeral intercondylar fractures were treated. Kirschner wire suspension fixation plus hinged external fixator was used in 14 cases (group A), and double plate internal fixation in 16 cases (group B). There was no significant difference in gender, age, injury cause, disease duration, injury side, and type of fracture between 2 groups ( P >0.05). There was no significant difference in operation time and hospitalization stay between 2 groups ( P >0.05). But the intraoperative blood loss in group A was significantly less than that in group B ( P <0.05); the visual analogue scale (VAS) score at 1 day and 3 days after operation in group A were significantly less than those in group B ( P <0.05). Primary healing of incision was obtained in all patients of 2 groups, and no surgery-related complications occurred. The patients were followed up 6-24 months (mean, 12.3 months) in group A and 6-24 months (mean, 12.8 months) in group B. The self-evaluation satisfaction rate was 85.7% (12/14) in group A and was 81.2% (13/16) in group B at 3 months after operation, showing no significant difference ( χ 2 =0.055, P =0.990). Based on the improved Gassebaum elbow performance score at 6 months after operation, excellent and good rate of the elbow function was 78.6% (excellent in 5 cases, good in 6 cases, fair in 2 cases, and poor in 1 case) in group A and was 81.2% (excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case) in group B, showing no significant difference between 2 groups ( χ 2 =0.056, P =0.990). Heterotopic ossification occurred at 3 months after operation in 1 case of each group respectively. The X-ray films showed bony union in all cases; no loosening or breakage of screw was observed. The bone union time showed no significant difference between 2 groups ( t =-0.028, P =0.978). The time of internal fixation removal, the intraoperative blood loss, and VAS score at 1 day and 3 days after operation in group A were significant better than those in group B ( P <0.05). The suspension fixation plus hinged external fixator and double plate internal fixation for the treatment of type C humeral intercondylar fractures have ideal outcome in elbow function. But the suspension fixation plus hinged external fixator is better than double plate internal fixation in intraoperative blood loss, postoperative VAS score, and time of internal fixation removal.

A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke.

PubMed

Rong, Wei; Li, Waiming; Pang, Mankit; Hu, Junyan; Wei, Xijun; Yang, Bibo; Wai, Honwah; Zheng, Xiaoxiang; Hu, Xiaoling

2017-04-26

It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training. In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers. ClinicalTrials.gov. NCT02117089 ; date of registration: April 10, 2014.

The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management.

PubMed

George, Daniel M; McKay, Bartholomew P; Jaarsma, Ruurd L

2015-05-01

Conservative management for uncomplicated displaced clavicle fractures is common practice. Delay of surgical fixation may result in less favorable outcomes. A retrospective cohort study was conducted of 60 patients with a closed mid-third clavicle fracture that did not meet current operative or nonoperative guidelines; 20 primary (plate fixation <6 weeks), 20 delayed (plate fixation >6 weeks), and 20 matched conservative patients were included. Each patient completed 2 questionnaires, the Disabilities of the Arm, Shoulder, and Hand and the American Shoulder and Elbow Surgeons, as well as visual analog scales for pain, cosmetic satisfaction, and overall satisfaction. In addition, 10 patients from each group underwent clinical review of scapular rotation by the lateral scapular slide test, clinical impingement, range of motion assessment, and radiologic review of clavicle union and length. The American Shoulder and Elbow Surgeons patient self-reported questionnaire demonstrated a median score of 5.5 for the delayed group, 2 for the primary group, and 1 for the conservative group (P = .032). The median Disabilities of the Arm, Shoulder, and Hand score was 7.92 for the delayed group, 3.32 for the primary group, and 1.67 for the conservative group (P = .212). Six patients in the delayed group had scapular malrotation compared with 2 in the primary group and none in the conservative group (P = .008). Flexion and external rotation in 90° abduction were decreased in the conservative group (P = .049 and .041, respectively). We support the conservative management of uncomplicated displaced clavicle fractures but recognize that a lower threshold for early surgery should be considered where optimal shoulder function is required. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis.

PubMed

Yoo, Sang Ho; Cha, Jang Gyu; Lee, Bo Ra

2018-01-01

To determine the clinical efficacy of sonographically-guided percutaneous bone drilling of the lateral epicondyle (LE) for the treatment of patients with LE. We included 24 patients with LE who reported pain in this study. All patients underwent sonographically-guided percutaneous bone drilling of the lateral epicondyle. Follow-up sonography and physical examinations were performed 1, 3 and 6 months after the procedure. The outcome measures included sonographic findings, visual analogue scale (VAS) score, maximum voluntary grip strength (MVGS) and patient-related tennis elbow evaluation (PRTEE) score. None of the patients had immediate complications during the procedure. The area of the extensor carpi radialis brevis (ECRB) tears decreased significantly at 1 month and declined gradually over the remaining 5 months of the study (p < 0.001). The mean pain VAS score was significantly lower at 6 months than preoperatively (respectively; p < 0.001). The mean MVGS increased significantly between pretreatment and 6 months post-treatment (p < 0.001), whereas the PRTEE score decreased significantly during the same period (p < 0.001). Sonographically-guided percutaneous drilling is a quick and safe treatment option for LE that can be performed in an outpatient setting. • Percutaneous drilling of the lateral condyle is effective for the treatment of LE. • The area of ECRB tears can be measured by US-guided saline injection. • US-guided percutaneous drilling is a quick and safe treatment option for LE.

Arthroscopic sternoclavicular joint resection arthroplasty: a technical note and illustrated case report.

PubMed

Warth, Ryan J; Lee, Jared T; Campbell, Kevin J; Millett, Peter J

2014-02-01

Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.

Outcomes for a large metaphyseal volume hemiarthroplasty in complex fractures of the proximal humerus.

PubMed

White, Jonathan J E; Soothill, John R; Morgan, Marie; Clark, David I; Espag, Marius P; Tambe, Amol A

2017-03-01

A large metaphyseal volume shoulder hemiarthroplasty has been in use within our department since 2008; however, no clinical outcome data are available for this prosthesis apart from the designer surgeon series. During a 5-year period, data were collected for 40 patients (30 women, 10 men) treated consecutively with the Zimmer Anatomical Shoulder Fracture hemiarthroplasty system (Zimmer, Warsaw, IN, USA). The final analysis included 26 patients. The median age was 79 years (range, 58-91 years), and the median follow-up was 3.7 years (range, 2.0-5.8 years). The median Constant Score was 34 points (range, 16-70 points), and the median Oxford Shoulder Score was 27 points (range, 5-46 points). The greater tuberosity healed satisfactorily in 12 patients. Resorption of the greater tuberosity was seen radiologically in 18 patients. The presence of resorption had no significant effect on the Constant Score (P = .264) or the Oxford Shoulder Score (P = .469). Three patients (12%) required revision. This is the first report from a nondesigner center for outcomes for this prosthesis to date. The results demonstrate reduced functional performance compared with the designer series. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Is digital photography an accurate and precise method for measuring range of motion of the shoulder and elbow?

PubMed

Russo, Russell R; Burn, Matthew B; Ismaily, Sabir K; Gerrie, Brayden J; Han, Shuyang; Alexander, Jerry; Lenherr, Christopher; Noble, Philip C; Harris, Joshua D; McCulloch, Patrick C

2018-03-01

Accurate measurements of shoulder and elbow motion are required for the management of musculoskeletal pathology. The purpose of this investigation was to compare three techniques for measuring motion. The authors hypothesized that digital photography would be equivalent in accuracy and show higher precision compared to the other two techniques. Using infrared motion capture analysis as the reference standard, shoulder flexion/abduction/internal rotation/external rotation and elbow flexion/extension were measured using visual estimation, goniometry, and digital photography on 10 fresh frozen cadavers. These measurements were performed by three physical therapists and three orthopaedic surgeons. Accuracy was defined by the difference from the reference standard (motion capture analysis), while precision was defined by the proportion of measurements within the authors' definition of clinical significance (10° for all motions except for elbow extension where 5° was used). Analysis of variance (ANOVA), t-tests, and chi-squared tests were used. Although statistically significant differences were found in measurement accuracy between the three techniques, none of these differences met the authors' definition of clinical significance. Precision of the measurements was significantly higher for both digital photography (shoulder abduction [93% vs. 74%, p < 0.001], shoulder internal rotation [97% vs. 83%, p = 0.001], and elbow flexion [93% vs. 65%, p < 0.001]) and goniometry (shoulder abduction [92% vs. 74%, p < 0.001] and shoulder internal rotation [94% vs. 83%, p = 0.008]) than visual estimation. Digital photography was more precise than goniometry for measurements of elbow flexion only [93% vs. 76%, p < 0.001]. There was no clinically significant difference in measurement accuracy between the three techniques for shoulder and elbow motion. Digital photography showed higher measurement precision compared to visual estimation for shoulder abduction, shoulder internal rotation, and elbow flexion. However, digital photography was only more precise than goniometry for measurements of elbow flexion. Overall digital photography shows equivalent accuracy to visual estimation and goniometry, but with higher precision than visual estimation. Copyright © 2017. Published by Elsevier B.V.

Hemophilic Chronic Synovitis: Therapy of Hemarthrosis using Endovascular Embolization of Knee and Elbow Arteries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Galli, E., E-mail: emgalli1@yahoo.com.ar; Baques, A.; Moretti, N.

2013-08-01

PurposeCongenital hemophilia is a hereditary bleeding disorder that affects 1 in 5,000 males and is characterized by repetitive musculoskeletal bleeding episodes. Selective embolization of the knee and elbow arteries can prevent bleeding episodes. To evaluate the long-term efficacy of these procedures, we assessed the outcomes of 30 procedures performed in our center.MethodsWe performed 30 procedures in 27 hemophilic patients, including 23 knee, and 7 elbow procedures. To evaluate the efficacy of selective embolization of knee and elbow arteries in people with hemophilia, we analyzed the number of bleeding episodes during 12 months before the procedure compared with the amount ofmore » episodes that occurred 3, 6, and 12 months after embolization.ResultsTwenty-nine of 30 procedures were classified as successful. The median of 1.25 episodes per month (range 0-3) observed before the procedure was reduced to 0 (range 0-1.67; p < 0.001) at 3 months, 0.17 (range 0-1.67; p < 0.001) at 6 months, and 0.33 (range 0-1.67; p = 0.024) at 12 months. Three patients remained free of bleeding events for more than 6 months. Additionally, after the procedure there was a significant reduction in factor FVIII usage that sustained up to 12 months after the procedures. No serious adverse events were observed.ConclusionsSelective angiographic embolization of knee and elbow arteries is a feasible procedure that can prevent repetitive bleedings, which would translate in better joint outcomes for these patients.« less

Elbow joint angle and elbow movement velocity estimation using NARX-multiple layer perceptron neural network model with surface EMG time domain parameters.

PubMed

Raj, Retheep; Sivanandan, K S

2017-01-01

Estimation of elbow dynamics has been the object of numerous investigations. In this work a solution is proposed for estimating elbow movement velocity and elbow joint angle from Surface Electromyography (SEMG) signals. Here the Surface Electromyography signals are acquired from the biceps brachii muscle of human hand. Two time-domain parameters, Integrated EMG (IEMG) and Zero Crossing (ZC), are extracted from the Surface Electromyography signal. The relationship between the time domain parameters, IEMG and ZC with elbow angular displacement and elbow angular velocity during extension and flexion of the elbow are studied. A multiple input-multiple output model is derived for identifying the kinematics of elbow. A Nonlinear Auto Regressive with eXogenous inputs (NARX) structure based multiple layer perceptron neural network (MLPNN) model is proposed for the estimation of elbow joint angle and elbow angular velocity. The proposed NARX MLPNN model is trained using Levenberg-marquardt based algorithm. The proposed model is estimating the elbow joint angle and elbow movement angular velocity with appreciable accuracy. The model is validated using regression coefficient value (R). The average regression coefficient value (R) obtained for elbow angular displacement prediction is 0.9641 and for the elbow anglular velocity prediction is 0.9347. The Nonlinear Auto Regressive with eXogenous inputs (NARX) structure based multiple layer perceptron neural networks (MLPNN) model can be used for the estimation of angular displacement and movement angular velocity of the elbow with good accuracy.

Quantitative assessment of upper extremities motor function in multiple sclerosis.

PubMed

Daunoraviciene, Kristina; Ziziene, Jurgita; Griskevicius, Julius; Pauk, Jolanta; Ovcinikova, Agne; Kizlaitiene, Rasa; Kaubrys, Gintaras

2018-05-18

Upper extremity (UE) motor function deficits are commonly noted in multiple sclerosis (MS) patients and assessing it is challenging because of the lack of consensus regarding its definition. Instrumented biomechanical analysis of upper extremity movements can quantify coordination with different spatiotemporal measures and facilitate disability rating in MS patients. To identify objective quantitative parameters for more accurate evaluation of UE disability and relate it to existing clinical scores. Thirty-four MS patients and 24 healthy controls (CG) performed a finger-to-nose test as fast as possible and, in addition, clinical evaluation kinematic parameters of UE were measured by using inertial sensors. Generally, a higher disability score was associated with an increase of several temporal parameters, like slower task performance. The time taken to touch their nose was longer when the task was fulfilled with eyes closed. Time to peak angular velocity significantly changed in MS patients (EDSS > 5.0). The inter-joint coordination significantly decreases in MS patients (EDSS 3.0-5.5). Spatial parameters indicated that maximal ROM changes were in elbow flexion. Our findings have revealed that spatiotemporal parameters are related to the UE motor function and MS disability level. Moreover, they facilitate clinical rating by supporting clinical decisions with quantitative data.

Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome.

PubMed

Ochi, Kensuke; Horiuchi, Yukio; Tanabe, Aya; Morita, Kozo; Takeda, Kentaro; Ninomiya, Ken

2011-05-01

To compare the shoulder internal rotation test-a new, provocative test-with the elbow flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the elbow flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° flexion at the shoulder, with 90° elbow flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the elbow flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t-test with a confidence level of 95%. The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second elbow flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the elbow flexion test of the same duration and seemed specific to CubTS. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Intrarater reliability of goniometry and hand-held dynamometry for shoulder and elbow examinations in female team handball athletes and asymptomatic volunteers.

PubMed

Fieseler, Georg; Molitor, Thomas; Irlenbusch, Lars; Delank, Karl-Stefan; Laudner, Kevin G; Hermassi, Souhail; Schwesig, Rene

2015-12-01

To evaluate the intrarater reliability for examining active range of motion (ROM) and isometric strength of the shoulder and elbow among asymptomatic female team handball athletes and a control group using a manual goniometer and hand-held dynamometry (HHD). 22 female team handball athletes (age: 21.0 ± 3.7 years) and 25 volunteers (13 female, 12 male, age: 21.9 ± 1.24 years) participated to determine bilateral ROM for shoulder rotation and elbow flexion/extension, as well as isometric shoulder rotation and elbow flexion/extension strength. Subjects were assessed on two separate test sessions with 7 days between sessions. Relative (intraclass correlation coefficients (ICC) and standard error of measurement (SEM) reliability were calculated. Reliability for ROM and strength were good to excellent for both shoulders and groups (athletes: ICC = 0.94-0.97, SEM 1.07°-4.76 N, controls: ICC = 0.96-1.00, SEM = 0.00 N-4.48 N). Elbow measurements for both groups also showed good-to-excellent reliability (athletes: ICC = 0.79-0.97, SEM = 0.98°-5.94 N, controls: ICC = 0.87-1.00, SEM = 0.00 N-5.43 N). It is important to be able to reliably reproduce active ROM and isometric strength evaluations. Using a standardized testing position, goniometry and HHD are reliable instruments in the assessment of shoulder and elbow joint performance testing. We showed good-to-excellent reproducible results for male and female control subjects and female handball athletes, although the single parameters in ROM and strength were different for each group and between the shoulders and elbows.

Muscle torque and its relation to technique, tactics, sports level and age group in judo contestants.

PubMed

Lech, Grzegorz; Chwała, Wiesław; Ambroży, Tadeusz; Sterkowicz, Stanisław

2015-03-29

The aim of this study was to perform a comparative analysis of maximal muscle torques at individual stages of development of athletes and to determine the relationship between muscle torques, fighting methods and the level of sports performance. The activity of 25 judo contestants during judo combats and the effectiveness of actions were evaluated. Maximum muscle torques in flexors/extensors of the body trunk, shoulder, elbow, hip and knee joints were measured. The level of significance was set at p≤0.05; for multiple comparisons the Mann-Whitney U test, p≤0.016, was used. Intergroup differences in relative torques in five muscle groups studied (elbow extensors, shoulder flexors, knee flexors, knee extensors, hip flexors) were not significant. In cadets, relative maximum muscle torques in hip extensors correlated with the activity index (Spearman's r=0.756). In juniors, maximum relative torques in elbow flexors and knee flexors correlated with the activity index (r=0.73 and r=0.76, respectively). The effectiveness of actions correlated with relative maximum torque in elbow extensors (r=0.67). In seniors, the relative maximum muscle torque in shoulder flexors correlated with the activity index during the second part of the combat (r=0.821).

Muscle Torque and its Relation to Technique, Tactics, Sports Level and Age Group in Judo Contestants

PubMed Central

Lech, Grzegorz; Chwała, Wiesław; Ambroży, Tadeusz; Sterkowicz, Stanisław

2015-01-01

The aim of this study was to perform a comparative analysis of maximal muscle torques at individual stages of development of athletes and to determine the relationship between muscle torques, fighting methods and the level of sports performance. The activity of 25 judo contestants during judo combats and the effectiveness of actions were evaluated. Maximum muscle torques in flexors/extensors of the body trunk, shoulder, elbow, hip and knee joints were measured. The level of significance was set at p≤0.05; for multiple comparisons the Mann-Whitney U test, p≤0.016, was used. Intergroup differences in relative torques in five muscle groups studied (elbow extensors, shoulder flexors, knee flexors, knee extensors, hip flexors) were not significant. In cadets, relative maximum muscle torques in hip extensors correlated with the activity index (Spearman’s r=0.756). In juniors, maximum relative torques in elbow flexors and knee flexors correlated with the activity index (r=0.73 and r=0.76, respectively). The effectiveness of actions correlated with relative maximum torque in elbow extensors (r=0.67). In seniors, the relative maximum muscle torque in shoulder flexors correlated with the activity index during the second part of the combat (r=0.821). PMID:25964820

Good isometric and isokinetic power restoration after distal biceps tendon repair with anchors.

PubMed

Suda, Arnold J; Prajitno, Julia; Grützner, Paul A; Tinelli, Marco

2017-07-01

Distal biceps brachii tendon rupture can lead to 30-40% power loss of elbow flexion and up to 50% of forearm supination. Re-fixation of the distal biceps brachii tendon is recommended to warrant an adequate quality of the patient's life. This study reports the isometric and isokinetic results after anchor re-fixation 2.5 years after surgery. Between 2007 and 2010, 69 patients with distal biceps brachii tendon tear underwent a suture anchor reattachment. During the follow-up examination, a questionnaire and DASH score were filled in, the circumferences of the arm were measured, range of motion was collected, and different trials were conducted at the BTE Primus RS™ (Baltimore Therapeutic Equipment) on both arms. 49 patients (71%) were reinvestigated with a follow-up of 32 months (11-58 months). A significant difference was found in the ability of elbow flexion between the affected arm and the opposite side as well as in pronation and supination. In elbow flexion and extension as well as in pronation and supination of the forearm, the strength was significantly diminished. 32 months after surgical re-fixation of the distal biceps brachii tendon rupture, strength in all exercises is marginally reduced in comparison to the opposite arm. Re-fixation of the distal biceps brachii tendon is an adequate method to return the range of motion and the strength in the elbow joint to an almost normal level and that gives rise to a high level of patient satisfaction. Level III, case-control study.

Evaluation of the reliability and validity of the Persian version of Patient-Rated Elbow Evaluation questionnaire.

PubMed

Farazdaghi, Mohammad Reza; Mansoori, Ali; Vosoughi, Omid; Kordi Yoosefinejad, Amin

2017-05-01

Elbow joint pathologies are highly prevalent in Persian-speaking countries. A reliable low-cost method like an appropriate questionnaire is mandatory for the early diagnosis of elbow joint disorders. Among designed questionnaires, Patient-Rated Elbow Evaluation (PREE) is an accepted commonly used scale evaluating pain and dysfunction of the patients. The aims of the study were to cross-culturally adapt and also to identify the psychometric properties of the Persian PREE. The original version of the PREE was translated and cross-culturally adapted to Persian according to the guidelines by Beaton et al. Seventy-three patients and thirty-nine healthy people were enrolled in the study. Test-retest reliability and internal consistency were evaluated using ICC, Cronbach's alpha, and item-total correlation, respectively. Construct validity was investigated using Disability of Arm, Shoulder, and Hand (DASH) questionnaire and physical component scale of SF-36 (PCS). To determine a cutoff point for discriminating patients from non-patients, receiver operating characteristic curve was plotted. The Persian PREE displayed high internal consistency (Cronbach's alpha = 0.91) and had acceptable ICC values in the subscales and total score (ICC > 0.90). A positive moderate correlation with DASH (r = 0.66, P < 0.001) and a negative moderate correlation with PCS of SF-36 (r = -0.44, P < 0.001) were observed. The cutoff point equal to 13.16 was determined for Persian PREE. The Persian PREE exhibited promising validity and reliability. The findings supported its applicability in clinical situations that were consistent with the original version.

Soft neurological signs in childhood by measurement of arm movements using acceleration and angular velocity sensors.

PubMed

Kaneko, Miki; Yamashita, Yushiro; Inomoto, Osamu; Iramina, Keiji

2015-10-12

Soft neurological signs (SNS) are evident in the motor performance of children and disappear as the child grows up. Therefore SNS are used as criteria for evaluating age-appropriate development of neurological function. The aim of this study was to quantify SNS during arm movement in childhood. In this study, we focused on pronation and supination, which are arm movements included in the SNS examination. Two hundred and twenty-three typically developing children aged 4-12 years (107 boys, 116 girls) and 18 adults aged 21-26 years (16 males, two females) participated in the experiment. To quantify SNS during pronation and supination, we calculated several evaluation index scores: bimanual symmetry, compliance, postural stability, motor speed and mirror movement. These index scores were evaluated using data obtained from sensors attached to the participants' hands and elbows. Each score increased as age increased. Results obtained using our system showed developmental changes that were consistent with criteria for SNS. We were able to successfully quantify SNS during pronation and supination. These results indicate that it may be possible to use our system as quantitative criteria for evaluating development of neurological function.

A Removable Long-arm Soft Cast to Treat Nondisplaced Pediatric Elbow Fractures: A Randomized, Controlled Trial.

PubMed

Silva, Mauricio; Sadlik, Gal; Avoian, Tigran; Ebramzadeh, Edward

2018-04-01

The ideal type of immobilization for nondisplaced pediatric elbow fractures has not been established. We hypothesized that the use of a long-arm cylinder made of soft cast material will result in similar outcomes to those obtained with a traditional long-arm hard cast. We randomly assigned 100 consecutive children who presented with a closed, nondisplaced, type I supracondylar humeral fracture or an occult, closed, acute elbow injury, to 1 of 2 groups: group A (n=50) received a long-arm, traditional fiberglass (hard) cast. Group B (n=50) received a long-arm, soft fiberglass cast. After 4 weeks, the cast was removed in group A by a member of our staff using a cast saw, and in group B by one of the patient's parents by rolling back the soft fiberglass material. We compared the amount of fracture displacement and/or angulation, recovery of range of motion, elbow pain, and patient satisfaction. There were no instances of unplanned removal of the cast by the patient or parent. No evidence of fracture displacement or angulation was seen in either group. The final carrying angle of the affected elbow was nearly identical of that of the normal, contralateral elbow in both groups (P=0.64). At the latest follow-up appointment, elbows in groups A and B had a similar mean arc of motion (156 vs. 154 degrees; P=0.45), and had achieved identical relative arc of motion of 99.6% and 99.5% of that of the normal, contralateral side, respectively (P=0.94). Main pain scores were low and comparable over the study period. All patients in both groups reported the highest rate of satisfaction at the eighth week of follow-up. The results indicate that children with nondisplaced supracondylar humeral fractures can be successfully managed with the use of a removable long-arm soft cast, maintaining fracture alignment and resulting in comparable rates of range of motion, pain, and patient satisfaction. The use of a removable immobilization that can reliably maintain fracture alignment and result in similar outcomes, while minimizing the risk of noncompliance, could be advantageous. Although we elected to remove the soft cast during a scheduled follow-up, it appears that such immobilization could be removed easily and safely at home, potentially resulting in a lower number of patient visits, decreased health care costs, and higher patient/parent satisfaction. Level I.

Lateral epicondylitis of the elbow.

PubMed

Tosti, Rick; Jennings, John; Sewards, J Milo

2013-04-01

Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Repetitive occupational or athletic activities involving wrist extension and supination are thought to be causative. The typical symptoms include lateral elbow pain, pain with wrist extension, and weakened grip strength. The diagnosis is made clinically through history and physical examination; however, a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies. Most patients improve with nonoperative measures, such as activity modification, physical therapy, and injections. A small percentage of patients will require surgical release of the extensor carpi radialis brevis tendon. Common methods of release may be performed via percutaneous, arthroscopic, or open approaches. Copyright © 2013 Elsevier Inc. All rights reserved.

“In vitro” Implantation Technique Based on 3D Printed Prosthetic Prototypes

NASA Astrophysics Data System (ADS)

Tarnita, D.; Boborelu, C.; Geonea, I.; Malciu, R.; Grigorie, L.; Tarnita, D. N.

2018-06-01

In this paper, Rapid Prototyping ZCorp 310 system, based on high-performance composite powder and on resin-high strength infiltration system and three-dimensional printing as a manufacturing method are used to obtain physical prototypes of orthopaedic implants and prototypes of complex functional prosthetic systems directly from the 3D CAD data. These prototypes are useful for in vitro experimental tests and measurements to optimize and obtain final physical prototypes. Using a new elbow prosthesis model prototype obtained by 3D printing, the surgical technique of implantation is established. Surgical implantation was performed on male corpse elbow joint.

Normative reference values for strength and flexibility of 1,000 children and adults.

PubMed

McKay, Marnee J; Baldwin, Jennifer N; Ferreira, Paulo; Simic, Milena; Vanicek, Natalie; Burns, Joshua

2017-01-03

To establish reference values for isometric strength of 12 muscle groups and flexibility of 13 joint movements in 1,000 children and adults and investigate the influence of demographic and anthropometric factors. A standardized reliable protocol of hand-held and fixed dynamometry for isometric strength of ankle, knee, hip, elbow, and shoulder musculature as well as goniometry for flexibility of the ankle, knee, hip, elbow, shoulder, and cervical spine was performed in an observational study investigating 1,000 healthy male and female participants aged 3-101 years. Correlation and multiple regression analyses were performed to identify factors independently associated with strength and flexibility of children, adolescents, adults, and older adults. Normative reference values of 25 strength and flexibility measures were generated. Strong linear correlations between age and strength were identified in the first 2 decades of life. Muscle strength significantly decreased with age in older adults. Regression modeling identified increasing height as the most significant predictor of strength in children, higher body mass in adolescents, and male sex in adults and older adults. Joint flexibility gradually decreased with age, with little sex difference. Waist circumference was a significant predictor of variability in joint flexibility in adolescents, adults, and older adults. Reference values and associated age- and sex-stratified z scores generated from this study can be used to determine the presence and extent of impairments associated with neuromuscular and other neurologic disorders, monitor disease progression over time in natural history studies, and evaluate the effect of new treatments in clinical trials. © 2016 American Academy of Neurology.

Elbow arthroscopy: indications, techniques, outcomes, and complications.

PubMed

Adams, Julie E; King, Graham J W; Steinmann, Scott P; Cohen, Mark S

2015-01-01

Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. To achieve favorable outcomes after elbow arthroscopy, the surgeon should be aware of contraindications, technical considerations, anatomic principles, and the need for proper patient positioning and portal selection. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.

What factors are predictors of emotional health in patients with full-thickness rotator cuff tears?

PubMed

Barlow, Jonathan D; Bishop, Julie Y; Dunn, Warren R; Kuhn, John E

2016-11-01

The importance of emotional and psychological factors in treatment of patients with rotator cuff disease has been recently emphasized. Our goal was to establish factors most predictive of poor emotional health in patients with full-thickness rotator cuff tears (FTRCTs). In 2007, we began to prospectively collect data on patients with symptomatic, atraumatic FTRCTs. All patients completed a questionnaire collecting data on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcomes (12-Item Short Form Health Survey, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff Index [WORC], Single Assessment Numeric Evaluation score, Shoulder Activity Scale). Physicians recorded physical examination and imaging data. To evaluate the predictors of lower WORC emotion scores, a linear multiple regression model was fit. Baseline data for 452 patients were used for analysis. In patients with symptomatic FTRCTs, the factors most predictive of worse WORC emotion scores were higher levels of pain (interquartile range odds ratio, -18.9; 95% confidence interval, -20.2 to -11.6; P < .0001) and lower Single Assessment Numeric Evaluation scores (rating of percentage normal that patients perceive their shoulder to be; interquartile range odds ratio, 6.2; 95% confidence interval, 2.5-9.95; P = .0012). Higher education (P = .006) and unemployment status (P = .0025) were associated with higher WORC emotion scores. Education level, employment status, pain levels, and patient perception of percentage of shoulder normalcy were most predictive of emotional health in patients with FTRCTs. Structural data, such astendon tear size, were not. Those with poor emotional health may perceive their shoulder to be worse than others and experience more pain. This may allow us to better optimize patient outcomes with nonoperative and operative treatment of rotator cuff tears. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Results of revision anterior shoulder stabilization surgery in adolescent athletes.

PubMed

Blackman, Andrew J; Krych, Aaron J; Kuzma, Scott A; Chow, Roxanne M; Camp, Christopher; Dahm, Diane L

2014-11-01

The purpose of this study was to determine failure rates, functional outcomes, and risk factors for failure after revision anterior shoulder stabilization surgery in high-risk adolescent athletes. Adolescent athletes who underwent primary anterior shoulder stabilization were reviewed. Patients undergoing subsequent revision stabilization surgery were identified and analyzed. Failure rates after revision surgery were assessed by Kaplan-Meier analysis. Failure was defined as recurrent instability requiring reoperation. Functional outcomes included the Marx activity score; American Shoulder and Elbow Surgeons score; and University of California, Los Angeles score. The characteristics of patients who required reoperation for recurrent instability after revision surgery were compared with those of patients who required only a single revision to identify potential risk factors for failure. Of 90 patients who underwent primary anterior stabilization surgery, 15 (17%) had failure and underwent revision surgery (mean age, 16.6 years; age range, 14 to 18 years). The mean follow-up period was 5.5 years (range, 2 to 12 years). Of the 15 revision patients, 5 (33%) had recurrent dislocations and required repeat revision stabilization surgery at a mean of 50 months (range, 22 to 102 months) after initial revision. No risk factors for failure were identified. The Kaplan-Meier reoperation-free estimates were 86% (95% confidence interval, 67% to 100%) at 24 months and 78% (95% confidence interval, 56% to 100%) at 48 months after revision surgery. The mean final Marx activity score was 14.8 (range, 5 to 20); American Shoulder and Elbow Surgeons score, 82.1 (range, 33 to 100); and University of California, Los Angeles score, 30.8 (range, 16 to 35). At 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. We were unable to convincingly identify specific risk factors for failure of revision surgery. Level IV, retrospective therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: An intra- and interrater reliability and validity study

PubMed Central

Baschung Pfister, Pierrette; Sterkele, Iris; Maurer, Britta; de Bie, Rob A.; Knols, Ruud H.

2018-01-01

Manual muscle testing (MMT) and hand-held dynamometry (HHD) are commonly used in people with inflammatory myopathy (IM), but their clinimetric properties have not yet been sufficiently studied. To evaluate the reliability and validity of MMT and HHD, maximum isometric strength was measured in eight muscle groups across three measurement events. To evaluate reliability of HHD, intra-class correlation coefficients (ICC), the standard error of measurements (SEM) and smallest detectable changes (SDC) were calculated. To measure reliability of MMT linear Cohen`s Kappa was computed for single muscle groups and ICC for total score. Additionally, correlations between MMT8 and HHD were evaluated with Spearman Correlation Coefficients. Fifty people with myositis (56±14 years, 76% female) were included in the study. Intra-and interrater reliability of HHD yielded excellent ICCs (0.75–0.97) for all muscle groups, except for interrater reliability of ankle extension (0.61). The corresponding SEMs% ranged from 8 to 28% and the SDCs% from 23 to 65%. MMT8 total score revealed excellent intra-and interrater reliability (ICC>0.9). Intrarater reliability of single muscle groups was substantial for shoulder and hip abduction, elbow and neck flexion, and hip extension (0.64–0.69); moderate for wrist (0.53) and knee extension (0.49) and fair for ankle extension (0.35). Interrater reliability was moderate for neck flexion (0.54) and hip abduction (0.44); fair for shoulder abduction, elbow flexion, wrist and ankle extension (0.20–0.33); and slight for knee extension (0.08). Correlations between the two tests were low for wrist, knee, ankle, and hip extension; moderate for elbow flexion, neck flexion and hip abduction; and good for shoulder abduction. In conclusion, the MMT8 total score is a reliable assessment to consider general muscle weakness in people with myositis but not for single muscle groups. In contrast, our results confirm that HHD can be recommended to evaluate strength of single muscle groups. PMID:29596450

Effects of different magnitudes of whole-body vibration on arm muscular performance.

PubMed

Marín, Pedro J; Herrero, Azael J; Sáinz, Nuria; Rhea, Matthew R; García-López, David

2010-09-01

The purpose of this study was to analyze the effects of different vibration magnitudes via feet on the number of repetitions performed, mean velocity, and perceived exertion during a set of elbow-extension exercise to failure (70% 1 repetition maximum [1RM] load). Twenty recreationally active students (14 men and 6 women) performed, in 3 different days, 1 elbow-extension set applying randomly 1 of the 3 experimental conditions: high magnitude (HM; 50 Hz and 2.51 mmp-p; 98.55 mxs-2), low magnitude (LM; 30 Hz and 1.15 mmp-p; 20.44 m.s-2) or control (Control, without vibration stimulus). Results indicate that the vibration via feet provides superimposed stimuli for elbow-extensor performance, enhancing the total number of repetitions performed in the HM and LM conditions, which was significantly higher (p

Relationship between Joint Position Sense, Force Sense, and Muscle Strength and the Impact of Gymnastic Training on Proprioception

PubMed Central

Kochanowicz, Andrzej

2018-01-01

The aims of this study were (1) to assess the relationship between joint position (JPS) and force sense (FS) and muscle strength (MS) and (2) to evaluate the impact of long-term gymnastic training on particular proprioception aspects and their correlations. 17 elite adult gymnasts and 24 untrained, matched controls performed an active reproduction (AR) and passive reproduction (PR) task and a force reproduction (FR) task at the elbow joint. Intergroup differences and the relationship between JPS, FS, and MS were evaluated. While there was no difference in AR or PR between groups, absolute error in the control group was higher during the PR task (7.15 ± 2.72°) than during the AR task (3.1 ± 1.93°). Mean relative error in the control group was 61% higher in the elbow extensors than in the elbow flexors during 50% FR, while the gymnast group had similar results in both reciprocal muscles. There was no linear correlation between JPS and FS in either group; however, FR was negatively correlated with antagonist MS. In conclusion, this study found no evidence for a relationship between the accuracy of FS and JPS at the elbow joint. Long-term gymnastic training improves the JPS and FS of the elbow extensors. PMID:29670901

Assessment and prediction of inter-joint upper limb movement correlations based on kinematic analysis and statistical regression

NASA Astrophysics Data System (ADS)

Toth-Tascau, Mirela; Balanean, Flavia; Krepelka, Mircea

2013-10-01

Musculoskeletal impairment of the upper limb can cause difficulties in performing basic daily activities. Three dimensional motion analyses can provide valuable data of arm movement in order to precisely determine arm movement and inter-joint coordination. The purpose of this study was to develop a method to evaluate the degree of impairment based on the influence of shoulder movements in the amplitude of elbow flexion and extension based on the assumption that a lack of motion of the elbow joint will be compensated by an increased shoulder activity. In order to develop and validate a statistical model, one healthy young volunteer has been involved in the study. The activity of choice simulated blowing the nose, starting from a slight flexion of the elbow and raising the hand until the middle finger touches the tip of the nose and return to the start position. Inter-joint coordination between the elbow and shoulder movements showed significant correlation. Statistical regression was used to fit an equation model describing the influence of shoulder movements on the elbow mobility. The study provides a brief description of the kinematic analysis protocol and statistical models that may be useful in describing the relation between inter-joint movements of daily activities.

Simultaneous and Continuous Estimation of Shoulder and Elbow Kinematics from Surface EMG Signals

PubMed Central

Zhang, Qin; Liu, Runfeng; Chen, Wenbin; Xiong, Caihua

2017-01-01

In this paper, we present a simultaneous and continuous kinematics estimation method for multiple DoFs across shoulder and elbow joint. Although simultaneous and continuous kinematics estimation from surface electromyography (EMG) is a feasible way to achieve natural and intuitive human-machine interaction, few works investigated multi-DoF estimation across the significant joints of upper limb, shoulder and elbow joints. This paper evaluates the feasibility to estimate 4-DoF kinematics at shoulder and elbow during coordinated arm movements. Considering the potential applications of this method in exoskeleton, prosthetics and other arm rehabilitation techniques, the estimation performance is presented with different muscle activity decomposition and learning strategies. Principle component analysis (PCA) and independent component analysis (ICA) are respectively employed for EMG mode decomposition with artificial neural network (ANN) for learning the electromechanical association. Four joint angles across shoulder and elbow are simultaneously and continuously estimated from EMG in four coordinated arm movements. By using ICA (PCA) and single ANN, the average estimation accuracy 91.12% (90.23%) is obtained in 70-s intra-cross validation and 87.00% (86.30%) is obtained in 2-min inter-cross validation. This result suggests it is feasible and effective to use ICA (PCA) with single ANN for multi-joint kinematics estimation in variant application conditions. PMID:28611573

The Effects of Racket Inertia Tensor on Elbow Loadings and Racket Behavior for Central and Eccentric Impacts

PubMed Central

Nesbit, Steven M.; Elzinga, Michael; Herchenroder, Catherine; Serrano, Monika

2006-01-01

This paper discusses the inertia tensors of tennis rackets and their influence on the elbow swing torques in a forehand motion, the loadings transmitted to the elbow from central and eccentric impacts, and the racket acceleration responses from central and eccentric impacts. Inertia tensors of various rackets with similar mass and mass center location were determined by an inertia pendulum and were found to vary considerably in all three orthogonal directions. Tennis swing mechanics and impact analyses were performed using a computer model comprised of a full-body model of a human, a parametric model of the racket, and an impact function. The swing mechanics analysis of a forehand motion determined that inertia values had a moderate linear effect on the pronation-supination elbow torques required to twist the racket, and a minor effect on the flexion-extension and valgus-varus torques. The impact analysis found that mass center inertia values had a considerable effect on the transmitted torques for both longitudinal and latitudinal eccentric impacts and significantly affected all elbow torque components. Racket acceleration responses to central and eccentric impacts were measured experimentally and found to be notably sensitive to impact location and mass center inertia values. Key Points Tennis biomechanics. Racket inertia tensor. Impact analysis. Full-body computer model. PMID:24260004

Functional outcomes after shoulder resection: the patient's perspective.

PubMed

Stevens, Nicole M; Kim, H Mike; Armstrong, April D

2015-09-01

Resection arthroplasty is a salvage procedure used for the treatment of deep-seated infections after total shoulder arthroplasty, hemiarthroplasty, and reverse total shoulder arthroplasty. Previous studies have reported a 50% to 66% rate of pain relief after resection arthroplasty but with significant functional limitations. Our study aimed to qualify the perspective of the patients on their limitations and satisfaction with resection arthroplasty. A retrospective record review of resection arthroplasties performed between September 2003 and December 2012 yielded 14 patients, and 7 completed the survey. The patients completed surveys with the focus on the "patient perspective." Functional scores, including American Shoulder and Elbow Surgeons, Simple Shoulder Test, Disabilities of the Arm, Shoulder, and Hand (DASH), DASH work, and DASH sports, were determined. Pain reduction and functional outcomes were similar to past reports of resection arthroplasty. Five of the 7 patients (71%) reported satisfaction with their resection arthroplasty, and 6 of the 7 patients (86%) would undergo the procedure again if given the choice. Five of the 7 patients (71%) were able to most of activities of daily living. Patients in our study were generally satisfied with their resection arthroplasty. Resection arthroplasty is a reasonable option for treatment of deep-seated periprosthetic infections or for patients with multiple previous failed procedures for total shoulder arthroplasty, hemiarthroplasty. and reverse shoulder arthroplasty. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Martial arts: time needed for training.

PubMed

Burke, David T; Protopapas, Marina; Bonato, Paolo; Burke, John T; Landrum, Rpbert F

2011-03-01

To measure the time needed to teach a series of martial arts techniques to proficiency. Fifteen volunteer subjects without any prior martial arts or self-defense experience were recruited. A panel of martial arts experts selected 21 different techniques including defensive stances, arm blocks, elbow strikes, palm strikes, thumbs to eyes, instep kicks and a carotid neck restraint. The critical elements of each technique were identified by the panel and incorporated into a teaching protocol, and then into a scoring system. Two black belt martial arts instructors directed a total of forty-five 45-minute training sessions. Videotaped proficiency testing was performed weekly. The videotapes were reviewed by the investigators to determine the proficiency levels of each subject for each technique. The techniques were rated by the average number of training sessions needed for an individual to develop proficiency in that technique. The mean number of sessions necessary to train individuals to proficiency ranged from 27 to 38.3. Using this system, the most difficult techniques seemed to be elbow strikes to the rear, striking with thumbs to the eyes and arm blocking. In this study 29 hours of training was necessary to train novice students to be proficient in 21 offensive and defensive martial arts techniques. To our knowledge, this is the first study that attempts to measure the learning curves involved when teaching martial arts techniques.

Martial Arts: Time Needed for Training

PubMed Central

Burke, David T.; Protopapas, Marina; Bonato, Paolo; Burke, John T.; Landrum, Rpbert F.

2011-01-01

Purpose To measure the time needed to teach a series of martial arts techniques to proficiency. Methods Fifteen volunteer subjects without any prior martial arts or self-defense experience were recruited. A panel of martial arts experts selected 21 different techniques including defensive stances, arm blocks, elbow strikes, palm strikes, thumbs to eyes, instep kicks and a carotid neck restraint. The critical elements of each technique were identified by the panel and incorporated into a teaching protocol, and then into a scoring system. Two black belt martial arts instructors directed a total of forty-five 45-minute training sessions. Videotaped proficiency testing was performed weekly. The videotapes were reviewed by the investigators to determine the proficiency levels of each subject for each technique. Results The techniques were rated by the average number of training sessions needed for an individual to develop proficiency in that technique. The mean number of sessions necessary to train individuals to proficiency ranged from 27 to 38.3. Using this system, the most difficult techniques seemed to be elbow strikes to the rear, striking with thumbs to the eyes and arm blocking. Conclusions In this study 29 hours of training was necessary to train novice students to be proficient in 21 offensive and defensive martial arts techniques. To our knowledge, this is the first study that attempts to measure the learning curves involved when teaching martial arts techniques. PMID:22375215

Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears.

PubMed

Kim, Yang-Soo; Lee, Hyo-Jin; Bae, Sung-Ho; Jin, Hyonki; Song, Hyun Seok

2015-11-01

To compare the clinical outcomes of arthroscopic in situ repair with the tear completion repair technique for partial-thickness rotator cuff tears (PT-RCTs). We prospectively enrolled 100 cases with articular-sided and bursal-sided PT-RCTs exceeding 50% of tendon thickness and allocated them randomly. An in situ repair was performed in group 1 (n = 50). Completion of the remaining cuff tissue and repair were performed in group 2 (n = 50). The medial row was knotted as transosseous repair (suture-bridge technique) in all cases. American Shoulder Elbow Society (ASES) score, Constant shoulder (CS) score, Simple shoulder (SS) score, and Korean shoulder (KS) score, and visual analog scale (VAS) for pain and range of motion were assessed at 3, 6, and 12 months and at the last visit. Repaired tendon integrity was determined at 6 to 12 months by magnetic resonance imaging. Eight cases were lost to follow-up. Ultimately, 92 cases were analyzed. The average follow-up was 19.1 months (range, 12 to 42 months). Significant improvements in the VAS for pain and functional outcomes were observed in both groups postoperatively (P = .001 for VAS; P < .001 for ASES score; P < .001 for CS score; P = .001 for SS score; P<.001 for KS score). No significant difference in the clinical results was observed at any time between the groups. No difference of retear rate on articular-sided PT-RCT was observed between the groups (P = .34). Retears on the bursal-sided PT-RCT were more frequent in group 2 (P = .02). Arthroscopic repair of PT-RCT exceeding 50% of the thickness provided functional improvements and pain relief regardless of the repair technique. The retear rate for bursal-sided PT-RCT was higher in group 2, although the retear rate for the articular-sided PT-RCT was not different. Level II, prospective comparative study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Experimental measurement of flexion-extension movement in normal and corpse prosthetic elbow joint.

PubMed

TarniŢă, Daniela; TarniŢă, DănuŢ Nicolae

2016-01-01

This paper presents a comparative experimental study of flexion-extension movement in healthy elbow and in the prosthetic elbow joint fixed on an original experimental bench. Measurements were carried out in order to validate the functional morphology and a new elbow prosthesis type ball head. The three-dimensional (3D) model and the physical prototype of our experimental bench used to test elbow endoprosthesis at flexion-extension and pronation-supination movements is presented. The measurements were carried out on a group of nine healthy subjects and on the prosthetic corpse elbow, the experimental data being obtained for flexion-extension movement cycles. Experimental data for the two different flexion-extension tests for the nine subjects and for the corpse prosthetic elbow were acquired using SimiMotion video system. Experimental data were processed statistically. The corresponding graphs were obtained for all subjects in the experimental group, and for corpse prosthetic elbow for both flexion-extension tests. The statistical analysis has proved that the flexion angles of healthy elbows were significantly close to the values measured at the prosthetic elbow fixed on the experimental bench. The studied elbow prosthesis manages to re-establish the mobility for the elbow joint as close to the normal one.

Arthroscopic repair of circumferential lesions of the glenoid labrum: surgical technique.

PubMed

Tokish, John M; McBratney, Colleen M; Solomon, Daniel J; Leclere, Lance; Dewing, Christopher B; Provencher, Matthew T

2010-09-01

Symptomatic pan-labral or circumferential (360°) tears of the glenohumeral labrum are an uncommon injury. The purpose of the present study was to report the results of surgical treatment of circumferential lesions of the glenoid labrum with use of validated outcome instruments. From July 2003 to May 2006, forty-one shoulders in thirty-nine patients (thirty-four men and five women) with a mean age of 25.1 years were prospectively enrolled in a multicenter study and were managed for a circumferential (360°) lesion of the glenoid labrum. All patients had a primary diagnosis of pain and recurrent shoulder instability, and all underwent arthroscopic repair of the circumferential labral tear with a mean of 7.1 suture anchors. The outcomes for thirty-nine of the forty-one shoulders were assessed after a mean duration of follow-up of 31.8 months on the basis of the rating of pain and instability on a scale of 0 to 10, a physical examination, and three outcome instruments (the Single Assessment Numeric Evaluation score, the modified American Shoulder and Elbow Surgeons score, and the Short Form-12 score). Significant improvement was noted in terms of the mean pain score (from 4.3 to 1.1), the mean instability score (from 7.3 to 0.2), the mean modified American Shoulder and Elbow Surgeons score (from 55.5 to 89.6), the mean Short Form-12 score (from 75.7 to 90.0), and the mean Single Assessment Numeric Evaluation score (from 36.7 to 88.5). Six shoulders required revision surgery because of recurrent instability (two), recalcitrant biceps tendinitis (two), or postoperative tightness (two). All patients returned to their preinjury activity level. Pan-labral or circumferential lesions are an uncommon yet extensive injury of the glenohumeral joint that may result in recurrent instability and pain. The present study demonstrates that arthroscopic capsulolabral repair with suture anchor fixation can restore the stability of the glenohumeral joint and can provide a reliable improvement in subjective and objective outcome measures.

Risk factors for shoulder and elbow pain in youth baseball players.

PubMed

Matsuura, Tetsuya; Iwame, Toshiyuki; Suzue, Naoto; Arisawa, Kokichi; Sairyo, Koichi

2017-05-01

This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain. In total, 900 youth baseball players (aged 7-11 years) were enrolled in a 1-year prospective follow-up study. One year later, the players were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models. Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with pitcher position, catcher position, longer training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with age, pitcher position, catcher position, longer training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain. History of elbow pain, pitcher position, catcher position, and longer training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Age was associated with elbow pain but not shoulder pain.

Effects of pretension on work and power output of the muscle-tendon complex in dynamic elbow flexion.

PubMed

Wakayama, Akinobu; Nagano, Akinori; Hay, Dean; Fukashiro, Senshi

2005-06-01

The purpose of the present study was to investigate the effects of pretension on work and power output of the muscle-tendon complex during dynamic elbow flexion under several submaximal and maximal conditions. The subjects were 10 healthy female students. Randomized trials from 0% to 100% maximal voluntary contraction (MVC) pretension (PT) at 60 degrees elbow flexion were conducted. After about 3 s of static PT, subjects maximally flexed the elbow joint to 90 degrees using a quick release method. The weight was individually selected for each subject to provide an optimal load for the development of maximal power. A Hill-type model was utilized to analyze the performance of the elbow muscle-tendon complex (MTC). PT 0, 30, 60 and 90% MVC data were used for comparison, and all data were expressed as the mean and standard deviation. Multiple paired comparisons between the value of PT 0% MVC and that of the other PT levels were performed post-hoc using Dunnett's method. The work of the series elastic component (SEC) increased gradually with the PT level because elastic energy was stored in the PT phase. However, the work of the contractile component (CC) decreased gradually with an increase in PT level. Moreover, the work of the MTC also decreased, closely related to the CC work decrement. The phenomenon of CC work decrement was caused by force depression and was not related to either the force-length or force-velocity relationships of the CC. EMG activity (agonist and antagonist) showed no significant differences. Muscle geometry changes or intracellular chemical shifts may have occurred in the PT phase.

Ultrasonographic assessment of tendon thickness, Doppler activity and bony spurs of the elbow in patients with lateral epicondylitis and healthy subjects: a reliability and agreement study.

PubMed

Krogh, T P; Fredberg, U; Christensen, R; Stengaard-Pedersen, K; Ellingsen, T

2013-10-01

Tennis elbow, also known as lateral epicondylitis (LE), is a common disorder often assessed by ultrasound. The aim of this study was to evaluate the ultrasonographic outcomes and methods used in LE research and clinical practice. This study was designed as an intra- and interobserver reliability and agreement study. Ultrasonographic examination of the common extensor tendon of the elbow was performed. The intraobserver study examined tendon thickness twice in 20 right elbows from 20 healthy individuals at an interval of 7 to 12 days. The interobserver study examined tendon thickness, color Doppler activity, and bony spurs in 18 right elbows in 9 healthy individuals and 9 patients with LE. Two trained rheumatologists performed the interobserver examinations with the same scanner on the same day. The main outcomes were intra- and interclass correlation (ICC) and agreement. In the intraobserver study, the ICC with regard to tendon thickness ranged from 0.76 to 0.81, depending on the measurement techniques used. The agreement ranged from 0.06 to 0.13 mm. In the interobserver study, the tendon thickness ICC ranged from 0.45 to 0.65 and the agreement ranged from -0.17 to 0.13 mm. The ICC for color Doppler activity was 0.93, with agreement in 14/18 (78 %) of the cases. A perfect reliability was demonstrated for bony spurs, with an ICC of 1 and exact agreement in 18/18 (100 %) of the cases. Good to excellent reliability was obtained for all measurements. The ultrasonographic techniques evaluated in this trial can be recommended for use in both research and clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

Benign painful elbow syndrome. First results of a single center prospective randomized radiotherapy dose optimization trial.

PubMed

Ott, O J; Hertel, S; Gaipl, U S; Frey, B; Schmidt, M; Fietkau, R

2012-10-01

The goal of the present study was to evaluate the efficacy of two different dose-fractionation schedules for radiotherapy (RT) of patients with painful elbow syndrome. Between February 2006 and February 2010, 199 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received RT in orthovoltage technique. One RT course consisted of 6 single fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, right after, and 6 weeks after RT by a visual analogue scale (VAS) and a comprehensive pain score (CPS). The overall response rate for all patients was 80% direct after and 91% 6 weeks after RT. The mean VAS values before, after and 6 weeks after treatment for the 0.5 and 1.0 Gy groups were 59.6 ± 20.2 and 55.7 ± 18.0 (p = 0.463), 32.1 ± 24.5 and 34.4 ± 22.5 (p = 0.256), and 27.0 ± 27.7 and 23.5 ± 21.6 (p = 0.818). The mean CPS before, after, and 6 weeks after treatment was 8.7 ± 2.9 and 8.1 ± 3.1 (p = 0.207), 4.5 ± 3.2 and 5.0 ± 3.4 (p = 0.507), 3.9 ± 3.6 and 2.8 ± 2.8 (p = 0.186), respectively. No statistically significant differences between the two single dose trial arms for early (p = 0.103) and delayed response (p = 0.246) were found. RT is an effective treatment option for the management of benign painful elbow syndrome. For radiation protection reasons the dose for a RT series is recommended not to exceed 3.0 Gy.

Posterolateral Rotatory Apprehension Test in Tennis Elbow.

PubMed

Chanlalit, Cholawish; Phorkhar, Termphong

2015-11-01

Tennis elbow is a syndrome that commonly diagnosed in patient who comes with lateral elbow pain. Instability pain in tennis elbow patient was observed and reported in many previous literatures. Posterolateral rotatory apprehension test was proposed for diagnosis of posterolateral rotatory instability of elbow. However, no review literatures that studied about posterolateral rotatory apprehensions test in tennis elbow. To find out the relationship between posterolateral rotatory apprehension test and tennis elbow. There were 44 patients that were recruited in this study. We examined the posterolateral rotatory apprehension test in tennis elbow patients. The examination was done in our outpatient clinic from March 2012 to April 2012. The data was collected to find out the ratio of negative test in tennis elbow patient. The results from the posterolateral rotatory apprehension test were negative in 43 patients. The ratio of the negative test result was 98%. A result from posterolateral rotatory apprehension test should be negative in general tennis elbow patients. If this test is used in a tennis elbow patients who are suspected with hidden instability and the result is positive, further evaluation is strongly suggested.

Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.

PubMed

Barber, F Alan; Hrnack, Scott A; Snyder, Stephen J; Hapa, Onur

2011-08-01

To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging (MRI) and clinical outcome of arthroscopic rotator cuff repair. A comparative series of patients undergoing arthroscopic rotator cuff repair was studied. Two matched groups of patients (20 each) were included: rotator cuff repairs without PRPFM augmentation (group 1) and rotator cuff repairs augmented with 2 sutured platelet-rich plasma (PRP) constructs (group 2). A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon. Postoperative rehabilitation was held constant. Postoperative MRI scans were used to evaluate rotator cuff healing. Outcome measures included American Shoulder and Elbow Surgeons, Rowe, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Constant scores. We followed up 40 patients (2 matched groups with 20 patients each) with a mean age of 57 years (range, 44 to 69 years) for a mean of 31 months (range, 24 to 44 months). Postoperative MRI studies showed persistent full-thickness tendon defects in 60% of controls (12 of 20) and 30% of PRPFM-augmented repairs (6 of 20) (P = .03). Of the control group tears measuring less than 3 cm in anteroposterior length, 50% (7 of 14) healed fully, whereas 86% of the PRPFM group tears measuring less than 3 cm in anteroposterior length (12 of 14) healed fully (P < .05). There was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons (94.7 and 95.7, respectively; P = .35), Single Assessment Numeric Evaluation (93.7 and 94.5, respectively; P = .37), Simple Shoulder Test (11.4 and 11.3, respectively; P = .41), and Constant (84.7 and 88.1, respectively; P = .19) scores. The Rowe scores (84.8 and 94.9, respectively; P = .03) were statistically different. The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair resulted in lower retear rates identified on MRI than repairs without the constructs. Other than the Rowe scores, there was no postoperative clinical difference by use of standard outcome measures. Level III, case-control study. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome.

PubMed

Ochi, Kensuke; Horiuchi, Yukio; Tanabe, Aya; Waseda, Makoto; Kaneko, Yasuhito; Koyanagi, Takahiro

2012-06-01

Shoulder internal rotation enhances symptom provocation attributed to cubital tunnel syndrome. We present a modified elbow flexion test--the shoulder internal rotation elbow flexion test--for diagnosing cubital tunnel syndrome. Fifty-five ulnar nerves in cubital tunnel syndrome patients and 123 ulnar nerves in controls were examined with 5 seconds each of elbow flexion, shoulder internal rotation, and shoulder internal rotation elbow flexion tests before and after treatment (surgery in 18; conservative in others). For the shoulder internal rotation elbow flexion test position, 90° abduction, maximum internal rotation, and 10° flexion of the shoulder were combined with the elbow flexion test position. The test was considered positive if any symptom for cubital tunnel syndrome developed <5 seconds. Influence of the shoulder internal rotation elbow flexion test was evaluated by nerve conduction studies in 10 cubital tunnel syndrome nerves and 7 control nerves. The sensitivities/specificities of the 5-second elbow flexion, shoulder internal rotation, and shoulder internal rotation elbow flexion tests were 25%/100%, 58%/100%, and 87%/98%, respectively. Sensitivity differences between the shoulder internal rotation elbow flexion test and the other two tests were significant. Shoulder internal rotation elbow flexion test results and cubital tunnel syndrome symptoms were significantly correlated. Influence of the shoulder internal rotation elbow flexion test on the ulnar nerve was seen in 8 of 10 cubital tunnel syndrome nerves but not in controls. The 5-second shoulder internal rotation elbow flexion test is specific, easy and quick provocative test for diagnosing cubital tunnel syndrome. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Elbow arthroscopy: indications, techniques, outcomes, and complications.

PubMed

Adams, Julie E; King, Graham J W; Steinmann, Scott P; Cohen, Mark S

2014-12-01

Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. Contraindications, technical considerations, and favorable outcomes following treatment with elbow arthroscopy require careful patient evaluation, a thorough understanding of anatomic principles, and proper patient positioning and portal selection to guide preoperative planning and overall patient care. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Pectoralis major tendon transfer for the treatment of scapular winging due to long thoracic nerve palsy.

PubMed

Streit, Jonathan J; Lenarz, Christopher J; Shishani, Yousef; McCrum, Christopher; Wanner, J P; Nowinski, R J; Warner, Jon J P; Gobezie, Reuben

2012-05-01

Painful scapular winging due to chronic long thoracic nerve (LTN) palsy is a relatively rare disorder that can be difficult to treat. Pectoralis major tendon (PMT) transfer has been shown to be effective in relieving pain, improving cosmesis, and restoring function. However, the available body of literature consists of few, small-cohort studies, and more outcomes data are needed. Outcomes of 26 consecutive patients with electromyelogram-confirmed LTN palsy who underwent direct (n = 4) or indirect transfer (n = 22) of the PMT for dynamic stabilization of the scapula were reviewed. All patients were followed up clinically for an average of 21.8 months (range, 3-62 months) with evaluations of active forward flexion, active external rotation, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and observation of scapular winging. Preoperative to postoperative results included increases in the mean active forward flexion from 112° to 149° (P < .001) an in mean active external rotation from 53.8° to 62.8° (P = .045), an improvement in the mean ASES score from 28 to 67.0 (P < .001), and an improvement in the mean VAS pain score from 7.7 to 3.0 (P < .001). Recurrent scapular winging occurred in 5 patients. There was no difference in outcome by length of follow-up. PMT transfer is an effective treatment for painful scapular winging resulting from LTN palsy. This is the largest reported series of consecutive patients treated with PMT transfer for the correction of scapular winging. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up.

PubMed

Iwamoto, Wataru; Okuno, Yuji; Matsumura, Noboru; Kaneko, Takao; Ikegami, Hiroyasu

2017-08-01

Abnormal vessels and accompanying nerves are possible sources of pain with lateral epicondylitis. The purpose of this study was to describe the safety and efficacy of transcatheter arterial embolization (TAE) for lateral epicondylitis resistant to conservative treatment. This prospective study was conducted in 24 patients with lateral epicondylitis resistant to conservative treatments for more than 3 months, with a symptom duration longer than 6 months, and with moderate to severe pain who were treated with TAE between March 2013 and October 2014. Two patients were lost to follow-up, and the remaining 22 patients were followed up for 2 years after TAE. Abnormal vessels were identified in all of the patients. No major adverse events were observed. The Quick Disabilities of the Arm, Shoulder and Hand scores at baseline significantly decreased at 1, 3, 6, and 24 months after treatment (50.8 vs 23.4, 8.3, 5.3, and 2.7, respectively; all P < .001). There was a statistically significant (P < .001) change from baseline to the last observed value in all of the clinical parameters, including visual analog scale pain score, Patient-Rated Tennis Elbow Evaluation score, and pain-free grip strength. Magnetic resonance images obtained 2 years after TAE showed an improvement in tendinosis and tear scores compared with baseline, and no patients showed bone marrow necrosis, obvious cartilage loss, or muscle atrophy. TAE could be one possible treatment option for patients with lateral epicondylitis that fails to improve with conservative treatments. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Clinical Outcomes and Complications during the Learning Curve for Reverse Total Shoulder Arthroplasty: An Analysis of the First 40 Cases

PubMed Central

Song, Kwang-Soon; Koo, Tae-Won

2017-01-01

Background The purpose of this study was to investigate the results and complications during the learning curve of reverse total shoulder arthroplasty (RTSA) for rotator cuff deficiency. Methods We retrospectively reviewed the first 40 cases of RTSA performed by a single surgeon. The mean age of patients was 72.7 years (range, 63 to 81 years) and mean follow-up period was 26.7 months (range, 9 to 57 months). Clinical outcomes were evaluated using a visual analog scale (VAS) for pain, the University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, subjective shoulder value (SSV), and active range of motion (ROM). Intraoperative and postoperative complications were also evaluated. Results The average VAS pain score, UCLA score, ASES score, and SSV improved from 6.9%, 12.8%, 29.0%, and 29.0% before surgery to 1.6%, 27.0%, 73.3%, and 71.5% after surgery, respectively (p < 0.001). The mean forward flexion, abduction, and external rotation improved from 68.0°, 56.9°, and 28.0° before surgery to 131.0°, 112.3°, and 38.8° after surgery, respectively (p < 0.001, p < 0.001, and p = 0.021). However, the mean internal rotation did not improve after surgery (p = 0.889). Scapular notching was observed in 33 patients (51.5%). Eight shoulders (20%) had complications, including 2 major (1 deep infection and 1 glenoid fixation failure) and 6 minor complications (3 brachial plexus injuries, 2 acromial fractures, and 1 intraoperative periprosthetic fracture). Conclusions The first 40 cases of RTSA performed by a single surgeon during the learning curve period showed satisfactory short-term follow-up results with an acceptable complication rate. PMID:28567225

The Pedicled Latissimus Dorsi Flap Provides Effective Coverage for Large and Complex Soft Tissue Injuries Around the Elbow.

PubMed

Hacquebord, Jacques H; Hanel, Douglas P; Friedrich, Jeffrey B

2017-08-01

The pedicled latissimus flap has been shown to provide effective coverage of wounds around the elbow with an average size of 100 to 147 cm 2 but with complication rates of 20% to 57%. We believe the pedicled latissimus dorsi flap is an effective and safe technique that provides reliable and durable coverage of considerably larger soft tissue defects around the elbow and proximal forearm. A retrospective review was performed including all patients from Harborview Medical Center between 1998 and 2012 who underwent coverage with pedicled latissimus dorsi flap for defects around the elbow. Demographic information, injury mechanism, soft tissue defect size, complications (minor vs major), and time to surgery were collected. The size of the soft tissue defect, complications, and successful soft tissue coverage were the primary outcome measures. A total of 18 patients were identified with variable mechanisms of injury. Average defect size around the elbow was 422 cm 2 . Three patients had partial necrosis of the distal most aspect of the flap, which was treated conservatively. One patient required a secondary fasciocutaneous flap, and another required conversion to a free latissimus flap secondary to venous congestion. Two were lost to follow-up after discharge from the hospital. In all, 88% (14 of 16) of the patients had documented (>3-month follow-up) successful soft tissue coverage with single-stage pedicled latissimus dorsi flap. The pedicled latissimus dorsi flap is a reliable option for large and complex soft tissue injuries around the elbow significantly larger than previous reports. However, coverage of the proximal forearm remains challenging.

Elbow replacement

MedlinePlus

... arthroplasty Patient Instructions Elbow replacement - discharge Surgical wound care - open Images Elbow prosthesis References Cohen MS, Chen NC. Total elbow arthroplasty. In: Wolfe SW, Hotchkiss RN, Pederson ...

The use of shoulder scoring systems and outcome measures in the UK

PubMed Central

Lamb, J; Rambani, R; Venkateswaran, B

2014-01-01

Introduction In future, outcomes following shoulder surgery may be subject to public survey. Many outcome measures exist but we do not know whether there is a consensus between shoulder surgeons in the UK. The aim of this study was to survey the preferred outcome measures used by National Health Service (NHS) shoulder surgeons operating in the UK. Methods A total of 350 shoulder surgeons working in NHS hospitals were asked to complete a short written questionnaire regarding their use of scoring systems and outcome measures. Questionnaires were sent and responses were received by post. Results Overall, 217 responses were received (62%). Of the respondents, 171 (79%) use an outcome measure in their shoulder practice while 46 (21%) do not. There were 118 surgeons (69%) who use more than one outcome measure. The Oxford shoulder score was most commonly used by 150 surgeons (69%), followed by the Constant score with 106 (49%), the Oxford shoulder instability score with 82 (38%), and the Disabilities of the Arm, Shoulder and Hand score with 54 (25%). The less commonly used outcome measures were the SF-36® and SF-12® health questionnaires with 19 (9%), the University of California at Los Angeles activity score with 8 (4%), the American Shoulder and Elbow Surgeons shoulder assessment form with 8 (4%) and the EQ-5D™ with 10 (3%). Conclusions Validated outcome measures should be adopted by all practising surgeons in all specialties. This will allow better assessment of treatments in addition to assessment of surgical performance in a transparent way. PMID:25350180

The use of shoulder scoring systems and outcome measures in the UK.

PubMed

Varghese, M; Lamb, J; Rambani, R; Venkateswaran, B

2014-11-01

In future, outcomes following shoulder surgery may be subject to public survey. Many outcome measures exist but we do not know whether there is a consensus between shoulder surgeons in the UK. The aim of this study was to survey the preferred outcome measures used by National Health Service (NHS) shoulder surgeons operating in the UK. A total of 350 shoulder surgeons working in NHS hospitals were asked to complete a short written questionnaire regarding their use of scoring systems and outcome measures. Questionnaires were sent and responses were received by post. Overall, 217 responses were received (62%). Of the respondents, 171 (79%) use an outcome measure in their shoulder practice while 46 (21%) do not. There were 118 surgeons (69%) who use more than one outcome measure. The Oxford shoulder score was most commonly used by 150 surgeons (69%), followed by the Constant score with 106 (49%), the Oxford shoulder instability score with 82 (38%), and the Disabilities of the Arm, Shoulder and Hand score with 54 (25%). The less commonly used outcome measures were the SF-36® and SF-12® health questionnaires with 19 (9%), the University of California at Los Angeles activity score with 8 (4%), the American Shoulder and Elbow Surgeons shoulder assessment form with 8 (4%) and the EQ-5D™ with 10 (3%). Conclusions Validated outcome measures should be adopted by all practising surgeons in all specialties. This will allow better assessment of treatments in addition to assessment of surgical performance in a transparent way.

Influence of smartphone use styles on typing performance and biomechanical exposure.

PubMed

Ko, Ping-Hsin; Hwang, Yaw-Huei; Liang, Huey-Wen

2016-06-01

Twenty-seven subjects completed 2-min typing tasks using four typing styles: right-hand holding/typing (S-thumb) and two-hand typing at three heights (B-low, B-mid and B-high). The styles had significant effects on typing performance, neck and elbow flexion and muscle activities of the right trapezius and several muscles of the right upper limb (p < 0.0001 by repeated-measure analysis of variance). The subjects typed the fewest words (error-adjusted characters per minute: 78) with the S-thumb style. S-thumb style resulted in similar flexion angles of the neck, elbow and wrist, but significantly increased muscle activities in all tested muscles compared with the B-mid style. Holding the phone high or low reduced the flexion angles of the neck and right elbow compared with the B-mid style, but the former styles increased the muscle activity of the right trapezius. Right-hand holding/typing was not a preferable posture due to high muscle activities and slow typing speed. Practitioner Summary: Right-hand holding/typing was not favoured, due to increased muscle activities and slower typing speed. Holding the phone high or low reduced the flexion angles of the neck and right elbow, but the former styles increased the muscle activity of the right trapezius compared with holding the phone at chest level.

[APPLICATION OF COMPRESSION MINI-SCREWS IN TREATMENT OF PATIENTS WITH INJURY OF ELBOW JOINT BONES].

PubMed

Neverov, V A; Egorov, K S

2015-01-01

A case report presents the experience of application of compression pileateless mini-screws (Gerbert's screws) in treatment of intra-articular fractures, which formed the elbow joint (44 cases). There were performed 32 operations concerning fracture of head of radius, 10 operations on the occasion of fractures of distal section of the humerus and 2 operations on the coronoid process. Long-term treatment results were followed-up in 31 patients during more than 6 months. On basis of analysis of treatment results the authors made a conclusion that the application of mini-screws in case of bone fractures, which formed the elbow joint, allowed realization of stable osteosynthesis after anatomic reposition of articular surfaces, obtaining good anatomical and functional result and shortened the terms of patient's treatment.

Ulnar nerve entrapment in a French horn player.

PubMed

Hoppmann, R A

1997-10-01

Nerve entrapment syndromes are frequent among musicians. Because of the demands on the musculoskeletal system and the great agility needed to per-form, musicians often present with vague complaints early in the course of entrapment, which makes the diagnosis a challenge for the clinician. Presented here is such a case of ulnar nerve entrapment at the left elbow of a French horn player. This case points out some of the difficulties in establishing a diagnosis of nerve entrapment in musicians. It also supports the theory that prolonged elbow flexion and repetitive finger movement contribute to the development of ulnar entrapment at the elbow. Although surgery is not required for most of the musculoskeletal problems of musicians, release of an entrapped nerve refractory to conservative therapy may be career-saving for the musician.

Upper limb kinetic analysis of three sitting pivot wheelchair transfer techniques.

PubMed

Koontz, Alicia M; Kankipati, Padmaja; Lin, Yen-Sheng; Cooper, Rory A; Boninger, Michael L

2011-11-01

The objective of this study was to investigate differences in shoulder, elbow and hand kinetics while performing three different SPTs that varied in terms of hand and trunk positioning. Fourteen unimpaired individuals (8 male and 6 female) performed three variations of sitting pivot transfers in a random order from a wheelchair to a level tub bench. Two transfers involved a forward flexed trunk (head-hips technique) and the third with the trunk remaining upright. The two transfers involving a head hips technique were performed with two different leading hand initial positions. Motion analysis equipment recorded upper body movements and force sensors recorded hand reaction forces. Shoulder and elbow joint and hand kinetics were computed for the lift phase of the transfer. Transferring using either of the head hips techniques compared to the trunk upright style of transferring resulted in reduced superior forces at the shoulder (P<0.002), elbow (P<0.004) and hand (P<0.013). There was a significant increase in the medial forces in the leading elbow (P=0.049) for both head hip transfers and the trailing hand for the head hip technique with the arm further away from the body (P<0.028). The head hip techniques resulted in higher shoulder external rotation, flexion and extension moments compared to the trunk upright technique (P<0.021). Varying the hand placement and trunk positioning during transfers changes the load distribution across all upper limb joints. The results of this study may be useful for determining a technique that helps preserve upper limb function overtime. Published by Elsevier Ltd.

Immediate costs of mini-open versus arthroscopic rotator cuff repair in an Asian population.

PubMed

Hui, Yik Jing; Teo, Alex Quok An; Sharma, Siddharth; Tan, Bryan Hsi Ming; Kumar, V Prem

2017-01-01

While there has been increasing interest in minimally invasive surgery, the expenses incurred by patients undergoing this form of surgery have not been comprehensively studied. The authors compared the costs borne by patients undergoing arthroscopic rotator cuff repair with the standard mini-open repair at a tertiary hospital in an Asian population. This was a retrospective cohort study. The authors studied the inpatient hospital bills of patients following rotator cuff tear repair between January 2010 and October 2014 via the hospital electronic medical records system. 148 patients had arthroscopic repair and 78 had mini-open repair. The cost of implants, consumables, and the total cost of hospitalization were analyzed. Operative times and length of stay for both procedures were also studied. Constant scores and American Shoulder Elbow Scores (ASES) were recorded preoperatively and at 1 year postoperatively. Three fellowship-trained surgeons performed arthroscopic repairs and one performed the mini-open repair. The cost of implants and consumables was significantly higher with arthroscopic repair. The duration of surgery was also significantly longer with that technique. There was no difference in length of stay between the two techniques. There was also no difference in Constant scores or ASES scores, both preoperatively and at 1 year postoperatively. The immediate costs of mini-open repair of rotator cuff tears are significantly less than that of arthroscopic repair. Most of the difference arises from the cost of implants and consumables. Equivalent functional outcomes from both techniques suggest that mini-open repair may be more cost-effective.

Restoration of Elbow Flexion in Patients With Complete Traumatic and Obstetric Brachial Plexus Injury After Functional Free Gracilis Muscle Transfer: Our Experience and Management.

PubMed

Nath, Rahul K; Boutros, Sean G; Somasundaram, Chandra

2017-01-01

Background: Functional free gracilis muscle transfer is an operative procedure for elbow reconstruction in patients with complete brachial plexus nerve and avulsion injuries and in delayed or prolonged nerve denervation, as well as in patients with inadequate upper extremity function after primary nerve reconstruction. Methods: We retrospectively reviewed our patient records and identified 24 patients with complete brachial plexus nerve injury (13 obstetric, 11 males and 2 females; 11 traumatic, 9 males and 2 females) whose affected arm and shoulder were totally paralyzed and their voluntary elbow flexion or the biceps function was poor preoperatively (mean M0-1/5 in MRC grade). These patients had undergone the functional free gracilis muscle transfer procedure at our clinic since 2005. Results: Ninety-two percent of all patients showed recovery and improvement. Successful free gracilis muscle transfer is defined as antigravity biceps muscle strength of M3-4/5 and higher, which was observed in 16 (8 obstetric and 8 traumatic) of our 24 patients (67%) in this study at least 1 year after functional free gracilis muscle transfer. This is statistically significant ( P < .000001) in comparison with their mean preoperative score (M0-1/5). There was no improvement in motor level of the biceps muscle (M0/5) in 2 patients (1 from each group). The donor site of these 24 patients showed no deficit in motor and sensory functions. Conclusions: Taken together, a significant number (92%) of patients in both obstetric and traumatic brachial plexus injury groups had recovery and improvement and most of these patients (64%) achieved antigravity and elbow flexion at least 1 year after free gracilis muscle transfer at our clinic.

Restoration of Elbow Flexion in Patients With Complete Traumatic and Obstetric Brachial Plexus Injury After Functional Free Gracilis Muscle Transfer: Our Experience and Management

PubMed Central

Boutros, Sean G.; Somasundaram, Chandra

2017-01-01

Background: Functional free gracilis muscle transfer is an operative procedure for elbow reconstruction in patients with complete brachial plexus nerve and avulsion injuries and in delayed or prolonged nerve denervation, as well as in patients with inadequate upper extremity function after primary nerve reconstruction. Methods: We retrospectively reviewed our patient records and identified 24 patients with complete brachial plexus nerve injury (13 obstetric, 11 males and 2 females; 11 traumatic, 9 males and 2 females) whose affected arm and shoulder were totally paralyzed and their voluntary elbow flexion or the biceps function was poor preoperatively (mean M0-1/5 in MRC grade). These patients had undergone the functional free gracilis muscle transfer procedure at our clinic since 2005. Results: Ninety-two percent of all patients showed recovery and improvement. Successful free gracilis muscle transfer is defined as antigravity biceps muscle strength of M3-4/5 and higher, which was observed in 16 (8 obstetric and 8 traumatic) of our 24 patients (67%) in this study at least 1 year after functional free gracilis muscle transfer. This is statistically significant (P < .000001) in comparison with their mean preoperative score (M0-1/5). There was no improvement in motor level of the biceps muscle (M0/5) in 2 patients (1 from each group). The donor site of these 24 patients showed no deficit in motor and sensory functions. Conclusions: Taken together, a significant number (92%) of patients in both obstetric and traumatic brachial plexus injury groups had recovery and improvement and most of these patients (64%) achieved antigravity and elbow flexion at least 1 year after free gracilis muscle transfer at our clinic. PMID:29213347

Influence of body mass index on the outcome of brachial plexus surgery: are there any differences between elbow and shoulder results?

PubMed

Socolovsky, Mariano; Martins, Roberto S; Di Masi, Gilda; Bonilla, Gonzalo; Siqueira, Mario G

2014-12-01

Body mass index (BMI) has recently been identified as a predictor of outcomes following reconstructive surgery of shoulder palsies. In this study, we sought to determine if the same holds true for the reconstruction of elbow flexion. Forty patients who had undergone partial ulnar-to-biceps nerve transfer (Oberlin's procedure) for shoulder palsy were assessed and compared against 18 previously reported patients who had undergone reconstruction for elbow palsies. The British Medical Research Council (BMRC) scale and an index dividing shoulder abduction strength in the affected arm by healthy arm were recorded. All patients had undergone surgery within 12 months of injury and had ≥ 12 months of follow-up. M4 or M3 biceps strength was obtained in 90 % of patients. Final strength on the affected side averaged 5.8 kg, versus 20.2 kg on the normal side, for a mean recovery index score of 0.30. In this sample of 40 patients, BMI did not predict percentage strength or BMRC grade recovery. Neither did age, number of roots involved, the affected side, nor time to surgery. Comparing patients with elbow versus shoulder reconstruction, there were no differences, except that patients undergoing Oberlin's procedure had a statistically longer duration of time between injury and surgical repair (7.4 vs 5.1 months, p < 0.006). Our data suggest that proximal muscle re-innervation is functionally more dependent upon BMI than distal re-innervation, likely because proximal muscles must support the weight of the entire extremity, while more distal muscles do not. BMI should be taken into consideration when planning surgery.

Bennett lesions in baseball players detected by magnetic resonance imaging: assessment of association factors.

PubMed

Park, Jin-Young; Noh, Young-Min; Chung, Seok-Won; Moon, Sung-Gyn; Ha, Dae-Ho; Lee, Ki-Sun; Chung, Seok Won

2016-05-01

The purpose of this study was to evaluate the characteristics of Bennett lesions in baseball players compared with those without a Bennett lesion and to identify other possible factors associated with Bennett lesions on magnetic resonance imaging (MRI). We investigated 388 male baseball players with a career >1 year. Demographic factors and a routine physical examination, including glenohumeral internal rotation difference, scapular dyskinesis, and various pathologic changes, were reviewed on MRI to identify relative factors for Bennett lesions. Of the 388 patients evaluated, 125 (32.2%) were diagnosed with Bennett lesions of the shoulder. No significant differences were observed between the groups in demographic factors, physical examination results, visual analog scale score, American Shoulder and Elbow Surgeons score, or prevalence of concomitant diseases. However, players with Bennett lesions had played baseball longer than those without the lesions (P < .001). An association was found between Bennett lesions and the length of time that a patient with a Bennett lesion had played baseball. The prevalence of pathologic lesions detected on MRI and the physical examination results were not different between players with and without Bennett lesions. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Prevalence of posterior elbow problems in Japanese high school baseball players.

PubMed

Kida, Yoshikazu; Morihara, Toru; Furukawa, Ryuhei; Sukenari, Tsuyoshi; Kotoura, Yoshihiro; Yoshioka, Naoki; Hojo, Tatsuya; Oda, Ryo; Arai, Yuji; Sawada, Koshiro; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2016-09-01

Various posterior elbow problems cause posterior elbow pain among baseball players. We aimed to determine the prevalence and diagnoses associated with posterior elbow problems and post-treatment recovery time for returning to sports in Japanese high school baseball players when treated in the off-season. A total of 576 Japanese high school baseball players who participated in baseball skill training camp during the off-season were enrolled in the study. The elbow of each player's throwing arm was assessed by use of a questionnaire and physical examination. Players with abnormal results were advised to visit the hospital. Players who visited the hospital were initially treated conservatively and underwent surgery if necessary. Retrospectively, players with positive physical examination results associated with posterior elbow pain, defined as olecranon tenderness and/or a positive elbow extension impingement test, were selected. Information about their position, elbow pain, physical examination results, diagnosis, treatment, and recovery time before returning to playing sports was assessed. Olecranon tenderness and/or positive elbow extension impingement test results were found in 76 players (13.2%). Of these, 33 agreed to visit the hospital for further diagnostic imaging and 25 players (75.8%) were diagnosed with posteromedial elbow impingement. By the next spring, 87.9% of players returned to sport, and 100% of players returned to sport before the next summer. The average recovery period was 77 ± 47 days. Physical examinations related to posterior elbow injuries were positive in 13.2% of high school baseball players. The most common diagnosis for posterior elbow pain was posteromedial elbow impingement. All players returned to competitive sports activity levels within 77 ± 47 days. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The Posterior Bundle's Effect on Posteromedial Elbow Instability After a Transverse Coronoid Fracture: A Biomechanical Study.

PubMed

Shukla, Dave R; Golan, Elan; Weiser, Mitch C; Nasser, Philip; Choueka, Jack; Hausman, Michael

2018-04-01

There has been increased interest in the role of the posterior bundle of the medial collateral ligament (pMUCL) in the elbow, particularly its effects on posteromedial rotatory stability. The ligament's effect in the context of an unfixable coronoid fracture has not been the focus of any study. The purposes of this biomechanical study were to evaluate the stabilizing effect of the pMUCL with a transverse coronoid fracture and to assess the effect of graft reconstruction of the ligament. We simulated a varus and internal rotatory subluxation in 7 cadaveric elbows at 30°, 60°, and 90° elbow flexion. The amount of ulnar rotation and medial ulnohumeral joint gapping were assessed in the intact elbow after we created a transverse coronoid injury, after we divided the pMUCL, and finally, after we performed a graft reconstruction of the pMUCL. At all angles tested, some stability was lost after cutting the pMUCL once the coronoid had been injured, because mean proximal ulnohumeral joint gapping increased afterward by 2.1, 2.2, and 1.3 mm at 90°, 60°, and 30°, respectively. Ulnar internal rotation significantly increased after pMUCL transection at 90°. At 60° and 30° elbow flexion, ulnar rotation increased after resection of the coronoid but not after pMUCL resection. An uninjured pMUCL stabilizes against varus internal rotatory instability in the setting of a transverse coronoid fracture at higher flexion angles. Further research is needed to optimize graft reconstruction of the pMUCL. The pMUCL is an important secondary stabilizer against posteromedial instability in the coronoid-deficient elbow. In the setting of an unfixable coronoid fracture, the surgeon should examine for posteromedial instability and consider addressing the pMUCL surgically. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Factors That Increase the Risk of Infection After Elbow Arthroscopy: Analysis of Patient Demographics, Medical Comorbidities, and Steroid Injections in 2,704 Medicare Patients.

PubMed

Camp, Christopher L; Cancienne, Jourdan M; Degen, Ryan M; Dines, Joshua S; Altchek, David W; Werner, Brian C

2017-06-01

To use a national database to determine (1) the incidence of joint infection after elbow arthroscopy, (2) identify independent patient-related risk factors for infection, and (3) determine the influence of concomitant intra-articular corticosteroid injection on infection risk. The 100% Medicare Standard Analytic Files were queried to identify patients who underwent elbow arthroscopy from 2005 to 2012. Postoperative elbow infections occurring within 6 months of surgery were identified using both International Classification of Diseases, 9th Revision codes for postoperative infection and Current Procedural Terminology codes for the surgical treatment of a postoperative infection. Patients were excluded if their initial arthroscopic procedure was performed for infection. A multivariate binomial logistic regression analysis was then used to evaluate patient-related risk factors for postoperative infection. Of the 2,704 elbow arthroscopy cases identified, 42 (1.55%) developed a postoperative infection. The annual incidence of infections did not increase significantly over the course of the study (P = .374). A number of patient demographics and medical comorbidities significantly increased the risk of infection. The most notable factors included age ≥ 65 years (odds ratio [OR] 2.38, P = .006), body mass index > 40 (OR 1.97, P = .024), tobacco usage (OR 1.80, P = .046), alcohol usage (OR 4.01, P < .001), diabetes mellitus (OR 2.10, P = .015), inflammatory arthritis (OR 2.81, P < .001), hypercoagulable disorder (OR 2.51, P = .015), and intra-articular corticosteroid injection at the time of arthroscopy (OR 2.79, P = .006). The annual number of elbow arthroscopies performed in the United States has increased steadily; however, the postoperative infection rate remained consistently low at 1.55%. There are a number of patient-specific risk factors that increase this risk with OR ranging from 1.97 to 4.01. Similarly, patients who receive an intra-articular corticosteroid injection at the time of surgery are nearly 3 times (OR 2.79) more likely to develop a postoperative infection. LEVEL OF EVIDENCE: Level III, case-control study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Full Range of Motion Induces Greater Muscle Damage Than Partial Range of Motion in Elbow Flexion Exercise With Free Weights.

PubMed

Baroni, Bruno M; Pompermayer, Marcelo G; Cini, Anelize; Peruzzolo, Amanda S; Radaelli, Régis; Brusco, Clarissa M; Pinto, Ronei S

2017-08-01

Baroni, BM, Pompermayer, MG, Cini, A, Peruzzolo, AS, Radaelli, R, Brusco, CM, and Pinto, RS. Full range of motion induces greater muscle damage than partial range of motion in elbow flexion exercise with free weights. J Strength Cond Res 31(8): 2223-2230, 2017-Load and range of motion (ROM) applied in resistance training (RT) affect the muscle damage magnitude and the recovery time-course. Because exercises performed with partial ROM allow a higher load compared with those with full ROM, this study investigated the acute effect of a traditional RT exercise using full ROM or partial ROM on muscle damage markers. Fourteen healthy men performed 4 sets of 10 concentric-eccentric repetitions of unilateral elbow flexion on the Scott bench. Arms were randomly assigned to partial-ROM (50-100°) and full-ROM (0-130°) conditions, and load was determined as 80% of 1 repetition maximum (1RM) in the full- and partial-ROM tests. Muscle damage markers were assessed preexercise, immediately, and 24, 48, and 72 hours after exercise. Primary outcomes were peak torque, muscle soreness during palpation and elbow extension, arm circumference, and joint ROM. The load lifted in the partial-ROM condition (1RM = 19.1 ± 3.0 kg) was 40 ± 18% higher compared with the full-ROM condition (1RM = 13.7 ± 2.2 kg). Seventy-two hours after exercise, the full-ROM condition led to significant higher soreness sensation during elbow extension (1.3-4.1 cm vs. 1.0-1.9 cm) and smaller ROM values (97.5-106.1° vs. 103.6-115.7°). Peak torque, soreness from palpation, and arm circumference were statistically similar between conditions, although mean values in all time points of these outcomes have suggested more expressive muscle damage for the full-ROM condition. In conclusion, elbow flexion exercise with full ROM seems to induce greater muscle damage than partial-ROM exercises, even though higher absolute load was achieved with partial ROM.

21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an elbow...

Point-of-Care Ultrasound: Sonographic Posterior Fat Pad Sign: A Case Report and Brief Literature Review.

PubMed

Okumura, Yoshito; Maldonado, Nestor; Lennon, Kyle; McCarty, Bryan; Underwood, Philipp; Nelson, Mathew

2017-07-01

Diagnosis of elbow fracture can sometimes be difficult with plain radiography due to overlapping bones, growth plates, and maturing bones in the pediatric population. The radiographic posterior fat pad (PFP) sign is one of the frequently referenced indirect signs of an occult elbow fracture. This sign can be falsely negative if the sign is subtle, and can be falsely positive when the position of the elbow is not flexed at 90 degrees. We discuss a case in which sonographic PFP sign helped to diagnose an elbow fracture. A 57-year-old female presented to the emergency department (ED) after a fall on an outstretched hand. The point-of-care ultrasound (POCUS) was completed identifying an elevated PFP and an anechoic joint fluid collection with innumerous floating hyperechogenic spicules visualized in the olecranon fossa. Diagnosis of a radial head fracture was later confirmed by plain radiograph. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The increase in use and availability of POCUS in the ED makes this a very practical application. Our ability to rapidly perform the ultrasound of the elbow may allow us a more rapid diagnosis of pathology, as well as provide a way to further triage our patients. With time, it may even allow us to avoid routine use of plain radiography. Copyright © 2017 Elsevier Inc. All rights reserved.

Stress Indices and Flexibility Factors for 90-Degree Piping Elbows with Straight Pipe Extensions.

DTIC Science & Technology

1982-02-01

Laboratory, Oak Ridge, Tennessee (March 1972). 5. The M.W. Kellogg Company , Design of Piping Systems, Second Edition, John Wiley and Sons, Inc., New York (1964...FLEXIBILITY FACTORS FOR 90-DEGREE PIPING ELBOWS WITH STRAIGHT PIPE EXTENSIONS 6. PERFORMING OrG. REPORT NUMBER = 7. AUTHOR(e S . CONTRACT OR GRANT NUMBER(e...UNCLASSIFIED S /N 0102-LF-014-6601 SECURITY CLAUIFICAION OF THII PAGE (Sie. Det Shtee.E) SECURITY CLASSIFICATION OF THIS PACE (When Does Sat* .*) (Block 20

Design and characterization of a powered elbow prosthesis.

PubMed

Bennett, Daniel A; Mitchell, Jason; Goldfarb, Michael

2015-01-01

This paper describes the design of a powered elbow prosthesis, which incorporates a belt and cable drive transmission with a brushless DC motor to achieve an output torque of approximately 18.4 Nm, a backdrive torque of 1.5 Nm, and a speed of up to 360 deg/s while remaining within the anthropomorphic envelope with regard to mass and size. The measured torque and speed of the prosthesis is commensurate with nominal capability of the natural limb (for purposes of performing activities of daily living).

Kinetic chain contributions to elbow function and dysfunction in sports.

PubMed

Ben Kibler, W; Sciascia, Aaron

2004-10-01

The elbow functions in throwing and other athletic activities as a link in the kinetic chain of force development, regulation, and transfer. Efficient function, with maximal performance and minimal injury risk, requires optimum activation of all the link in the kinetic chain. Injury is often associated with alterations in force production or regulation capabilities in links that may be distant to the site of injury. Evaluation of injured athletes should include screening examinations for these areas, and treatment and conditioning should also include these areas.

Heterotopic ossification of the elbow after closed reduction and retrograde intramedullary nailing for radial neck fracture treated by anconeus interposition.

PubMed

Sreenivas, T; Menon, Jagdish; Nataraj, A R

2013-12-01

Heterotopic ossification around the elbow can lead to considerable functional disability. We describe a case of a 42-year-old man who developed heterotopic ossification of his elbow after closed reduction of the elbow dislocation and radial neck fracture and retrograde intramedullary nailing for radial neck fracture. During the follow-up after initial surgery, movements of the elbow were gradually deteriorated and diagnosed as heterotopic ossification of the elbow. Implant removal, radial head excision along with heterotopic mass, and also interposition of the anconeus muscle resulted in improvement of his elbow mobility. At 18 months of follow-up, patient had elbow flexion arc of 15°-110°, 70° of supination, and 50° of pronation without recurrence of heterotopic ossification. The uniqueness of this case lies in the treatment of heterotopic ossification of the elbow to prevent its recurrence, which was developed after retrograde intramedullary nailing for radial neck fracture following closed reduction.

Elbow pain

MedlinePlus

Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

It's time to change perspective! New diagnostic tools for lateral elbow pain.

PubMed

Arrigoni, P; Cucchi, D; Menon, A; Randelli, P

2017-12-01

The presence of intra-articular findings that may complement the extra-articular pathology in lateral epicondilytis has been suggested, and a role for minor instability of the elbow as part of the causative process of this disease has been postulated. This study was designed to describe two new clinical tests, aimed at detecting intra-articular pathology in patients affected by recalcitrant lateral epicondylitis and investigate their diagnostic performance. Ten patients suffering of atraumatic lateral elbow pain unresponsive to conservative treatment were considered in this study. Two clinical tests were developed and administrated prior to arthroscopy: Supination and Antero-Lateral pain Test (SALT); Posterior Elbow Pain by Palpation-Extension of the Radiocapitellar joint (PEPPER). Sensitivity, specificity, predictive values and accuracy of SALT and PEPPER as diagnostic tests for seven intra-articular findings were calculated. In 90% of the patients, at least one test was positive. All patients with signs of lateral ligamentous patholaxity or intra-articular abnormal findings had a positive response to at least one of the two tests. SALT proved to have a high sensitivity but a low specificity and is accurate in detecting the presence of intra-articular abnormal findings, especially synovitis. PEPPER test was sensible, specific and accurate in the detection of radial head chondropathy. Two new diagnostic tests (SALT and PEPPER) were specifically designed to evoke pain from intra-articular structures. These tests could be a valid support in the diagnostic algorithm of recalcitrant lateral elbow pain. Positive findings may be indicative of a minor instability of the lateral elbow condition. Diagnostic study, development of diagnostic criteria on basis of consecutive patients, level II.

Long term results in refractory tennis elbow using autologous blood.

PubMed

Gani, Naseem Ul; Khan, Hayat Ahmad; Kamal, Younis; Farooq, Munir; Jeelani, Hina; Shah, Adil Bashir

2014-10-27

Tennis elbow (TE) is one of the commonest myotendinosis. Different treatment options are available and autologous blood injection has emerged as the one of the acceptable modalities of treatment. Long term studies over a larger group of patients are however lacking. The purpose of this study was to evaluate these patients on longer durations. One-hundred and twenty patients of TE, who failed to respond to conventional treatment including local steroid injections were taken up for this prospective study over the period from year 2005 to 2011 and were followed up for the minimum of 3 years (range 3-9 years). Two mL of autologous blood was taken from the ipsilateral limb and injected into the lateral epicondyle. The effectiveness of the procedure was assessed by Pain Rating Sscale and Nirschl Staging, which was monitored before the procedure, at first week, monthly for first three months, at 6 months and then 3 monthly for first year, six monthly for next 2 years and then yearly. Statistical analysis was done and a P value of <0.05 was taken as significant. The patients (76 females and 44 males) were evaluated after procedure. The mean age group was 40.67±8.21. The mean follow up was 5.7±1.72 (range 3 to 9 years). The mean pain score and Nirschl stage before the procedure was 3.3±0.9 and 6.2±0.82 respectively. At final follow up the pain score and Nirschl were 1.1±0.9 and 1.5±0.91 respectively. Autologous blood injection was found to be one of the modalities for treatment of TE. Being cheap, available and easy method of treatment, it should be considered as a treatment modality before opting for the surgery. Universal guidelines for the management of tennis elbow should be made as there is lot of controversy regarding the treatment.

Outcome assessment of hemiparesis due to intracerebral hemorrhage using diffusion tensor fractional anisotropy.

PubMed

Koyama, Tetsuo; Marumoto, Kohei; Uchiyama, Yuki; Miyake, Hiroji; Domen, Kazuhisa

2015-04-01

This study aimed to evaluate the prognostic efficacy of magnetic resonance diffusion tensor fractional anisotropy (FA) for patients with hemiparesis due to intracerebral hemorrhage. Diffusion tensor FA brain images were acquired 14-21 days after putaminal and/or thalamic hemorrhage. The ratio of FA values within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated for each patient (n = 40) and assessed for correlation with Brunnstrom stage (BRS, 1-6), motor component of the functional independence measure (FIM-motor, 13-91), and the total length of stay (LOS) until discharge from rehabilitation (P < .05). Ordinal logistic regression analyses were conducted to determine the relationships between rFA and specific outcomes as measured by BRS range (poor, BRS 1 or 2; moderate, BRS 3 or 4; and good, BRS 5 or 6; P < .05). The rFA values were .571-1.043 (median, .856) and BRS scores were 1-6 (median, 4) for shoulder/elbow/forearm, 1-6 (median, 4) for hand, and 2-6 (median, 4) for lower extremities. FIM-motor scores were 58-86 (median, 78) and LOS ranged from 42 to 225 days (median, 175.5 days). Correlation coefficients were statistically significant between rFA and shoulder/elbow/forearm BRS (.696), hand BRS (.779), lower extremity BRS (.631), FIM-motor (.442), and LOS (-.598). Logistic model fit was moderate for shoulder/elbow/forearm BRS (R(2) = .221) and lower extremity BRS (R(2) = .277), but was much higher for hand BRS (R(2) = .441). Diffusion tensor FA values are predictive of clinical outcome from hemiparesis due to putaminal and/or thalamic hemorrhage, particularly hand function recovery. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

78 FR 59808 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-30

... ODPs, in addition to their complex nature and the need for a special format make publication in the...-Lapeer, RNAV (GPS) RWY 36, Orig Elbow Lake, MN, Elbow Lake Muni--Pride of the Prairie, RNAV (GPS) RWY 14, Orig Elbow Lake, MN, Elbow Lake Muni--Pride of the Prairie, RNAV (GPS) RWY 32, Orig Elbow Lake, MN...

General and disease-specific use of outcomes scores for the shoulder: a survey of AOSSM, AANA, and ISAKOS members.

PubMed

Provencher, Matthew T; Frank, Rachel M; Scuderi, Matthew G; Solomon, Daniel J; Ghodadra, Neil S; Bach, Bernard R; McCarty, Eric; Romeo, Anthony A

2014-09-01

To report on the knowledge and use of both general and disease-specific shoulder outcomes scores among orthopedic surgeons. A 22-question Internet survey was administered to members of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North American, and the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine via voluntary e-mail participation. Questions targeted demographic information, preferred surgical management of shoulder conditions, and the preferred use of shoulder outcomes instruments in clinical practice. Excluding defunct and duplicate e-mails among membership societies, a total of 3892 unique e-mails were sent, from which 1129 surveys were returned and were fully completed (29%). The largest number of respondents were in private practice (52%); 21% were in academia; and 26% were in a mix of settings. As for location, 74% practiced in the United States, 10% in Europe, 8% in Mexico/South America, and 6% in Asia. A total of 31% total respondents used scores all or most of the time, and 30% used scores at least some of the time. Respondents felt that the 3 most commonly utilized shoulder scores were the American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) score, and the Constant score. The majority of respondents (76%) performed all-arthroscopic instability repairs. The ASES and Western Ontario Shoulder Instability Index (WOSI) scores were the most preferred measures to monitor instability patients, whether or not the scores were actually implemented in their practice. Most perform between 10 and 25 superior labrum anterior-posterior repairs per year and preferred the ASES, UCLA, and Constant scores for these repairs; rotator cuff repair preferred outcomes instruments were similar. When asked to choose 1 score for all shoulder conditions, the ASES was the clear favorite. This study reports the knowledge and utilization of shoulder scores for both general and disease-specific conditions. Most respondents preferred the ASES score for most shoulder conditions; however, other scores, such as the WOSI, the Constant, and the Short-Form (SF)-36/12, were popular. This information offers insight into the current and future use of shoulder outcomes both for general and disease-specific use.

Impingement of Droplets in 60 Deg Elbows with Potential Flow

NASA Technical Reports Server (NTRS)

Hacker, Paul T.; Saper, Paul G.; Kadow, Charles F.

1956-01-01

Trajectories were determined for water droplets or other aerosol particles in air flowing through 600 elbows especially designed for two-dimensional potential motion. The elbows were established by selecting as walls of each elbow two streamlines of a flow field produced by a complex potential function that establishes a two-dimensional flow around. a 600 bend. An unlimited number of elbows with slightly different shapes can be established by selecting different pairs of streamlines as walls. Some of these have a pocket on the outside wall. The elbows produced by the complex potential function are suitable for use in aircraft air-inlet ducts and have the following characteristics: (1) The resultant velocity at any point inside the elbow is always greater than zero but never exceeds the velocity at the entrance. (2) The air flow field at the entrance and exit is almost uniform and rectilinear. (3) The elbows are symmetrical with respect to the bisector of the angle of bend. These elbows should have lower pressure losses than bends of constant cross-sectional area. The droplet impingement data derived from the trajectories are presented along with equations so that collection efficiency, area, rate, and distribution of droplet impingement can be determined for any elbow defined by any pair of streamlines within a portion of the flow field established by the complex potential function. Coordinates for some typical streamlines of the flow field and velocity components for several points along these streamlines are presented in tabular form. A comparison of the 600 elbow with previous calculations for a comparable 90 elbow indicated that the impingement characteristics of the two elbows were very similar.

Development and feasibility study of a sensory-enhanced robot-aided motor training in stroke rehabilitation.

PubMed

Liu, W; Mukherjee, M; Tsaur, Y; Kim, S H; Liu, H; Natarajan, P; Agah, A

2009-01-01

Functional impairment of the upper limb is a major challenge faced by many stroke survivors. The present study aimed at developing a novel sensory-enhanced robot-aided motor training program and testing its feasibility in stroke rehabilitation. A specially designed robot handle was developed as an attachment to the Inmotion2 robotic system. This handle provided sensory stimulation through pins connected to small servo motors inside the handle. Vibration of the pins was activated during motor training once pressure on the handle reached a certain threshold indicating an active motion of the study subject. Nine chronic stroke survivors were randomly assigned to either a sensory-enhanced robot-aided motor training group (SERMT) or robot-aided motor training only group (RMT). All participants underwent a 6-week motor training program, performing target reaching movements with the specialized handle with or without vibration stimulation during training. Motor Status (MS) scores were measured for functional outcome prior to and after training. The results showed significant improvement in the total MS scores after training in both experimental groups. However, MS sub-scores for the shoulder/elbow and the wrist/hand increased significantly only in the SERMT group (p<0.05). Future studies are required to confirm these preliminary findings.

Physical examination of the athlete's elbow.

PubMed

Hsu, Stephanie H; Moen, Todd C; Levine, William N; Ahmad, Christopher S

2012-03-01

Elbow injury is encountered less frequently than are other joint conditions. The bony architecture, muscle, ligament, and nerve anatomy are complex, and the forces leading to injury in the athlete's elbow are unique. Appreciating the pathomechanics leading to injury and a detailed knowledge of elbow anatomy are the foundation for conducting a directed history and physical examination that achieves an accurate diagnosis. Recent advances in physical examination have improved our ability to accurately diagnose and treat athletic elbow disorders. This article reviews general and focused physical examination maneuvers of the elbow in a systematic anatomic fashion.

An Epidemiological Comparison of Elbow Injuries Among United States High School Baseball and Softball Players, 2005-2006 Through 2014-2015.

PubMed

Pytiak, Andrew V; Kraeutler, Matthew J; Currie, Dustin W; McCarty, Eric C; Comstock, R Dawn

Pitching is a common mechanism of injury in baseball, with known risk factors for elbow injuries among adolescent pitchers. Elbow injury rates and mechanisms will differ between high school baseball and softball players. Descriptive epidemiology study. Level 3. Baseball- and softball-related injury data from the 2005-2006 through 2014-2015 academic years were collected from the High School Reporting Information Online (RIO) Internet-based data collection tool. Athlete-exposure (AE) and injury data were collected by certified athletic trainers. Rate ratios (RRs) were calculated comparing injury rates in the 2 populations. Injury proportion ratios (IPRs) comparing elbow injuries in pitchers and nonpitchers were calculated as the proportion of all elbow injuries in pitchers divided by the proportion of all elbow injuries in nonpitchers. A total of 214 elbow injuries in male baseball players occurred over 2,327,774 AEs, for an overall elbow injury rate of 0.92 per 10,000 AEs. A total of 75 elbow injuries were reported in female softball players over 1,731,644 AEs, for an overall rate of 0.43 per 10,000 AEs. The rate of elbow injury was significantly higher for baseball than softball (RR, 2.12; 95% CI, 1.64-2.77). A significantly greater proportion of elbow injuries in baseball were pitching-related compared with those from softball, with 50.2% occurring while pitching in baseball versus 11.0% in softball (IPR, 4.58; 95% CI, 2.35-8.93). If all injuries occurring during pitching were removed from both sports, the difference in elbow injury rate for baseball and softball would no longer be significant (RR, 1.19; 95% CI, 0.88-1.62). The rate of elbow injuries is significantly higher in baseball than softball. This is attributable to differences in rates of pitching-related injuries between these 2 groups. These results demonstrate that overhand pitching increases risk of elbow injury in high school athletes.

Quantitative evaluation of toothbrush and arm-joint motion during tooth brushing.

PubMed

Inada, Emi; Saitoh, Issei; Yu, Yong; Tomiyama, Daisuke; Murakami, Daisuke; Takemoto, Yoshihiko; Morizono, Ken; Iwasaki, Tomonori; Iwase, Yoko; Yamasaki, Youichi

2015-07-01

It is very difficult for dental professionals to objectively assess tooth brushing skill of patients, because an obvious index to assess the brushing motion of patients has not been established. The purpose of this study was to quantitatively evaluate toothbrush and arm-joint motion during tooth brushing. Tooth brushing motion, performed by dental hygienists for 15 s, was captured using a motion-capture system that continuously calculates the three-dimensional coordinates of object's motion relative to the floor. The dental hygienists performed the tooth brushing on the buccal and palatal sides of their right and left upper molars. The frequencies and power spectra of toothbrush motion and joint angles of the shoulder, elbow, and wrist were calculated and analyzed statistically. The frequency of toothbrush motion was higher on the left side (both buccal and palatal areas) than on the right side. There were no significant differences among joint angle frequencies within each brushing area. The inter- and intra-individual variations of the power spectrum of the elbow flexion angle when brushing were smaller than for any of the other angles. This study quantitatively confirmed that dental hygienists have individual distinctive rhythms during tooth brushing. All arm joints moved synchronously during brushing, and tooth brushing motion was controlled by coordinated movement of the joints. The elbow generated an individual's frequency through a stabilizing movement. The shoulder and wrist control the hand motion, and the elbow generates the cyclic rhythm during tooth brushing.

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty

PubMed Central

Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

2015-01-01

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

Risk of nerve injury during arthroscopy portal placement in the elbow joint: A cadaveric study

PubMed Central

Chaware, Prashant N; Santoshi, John A; Pakhare, Abhijit P; Rathinam, Bertha A D

2016-01-01

Background: Elbow arthroscopy has become a routine procedure now. However, placing portals is fraught with dangers of injuring the neurovascular structures around elbow. There are not enough data documenting the same amongst the Indians. We aimed to determine the relative distances of nerves around the elbow to the arthroscopy portals and risk of injury in different positions of the elbow. Materials and Methods: Six standard elbow arthroscopy portals were established in 12 cadaveric upper limbs after joint distension. Then using standard dissection techniques all the nerves around the elbow were exposed, and their distances from relevant portals were measured using digital vernier caliper in 90° elbow flexion and 0° extension. Descriptive statistical analysis was used for describing distance of the nerves from relevant portal. Wilcoxon-signed rank test and Friedman's test were used for comparison. Results: There was no major nerve injury at all the portals studied in both positions of the elbow. The total incidence of cutaneous nerve injury was 8.3% (12/144); medial cutaneous nerve of forearm 10/48 and posterior cutaneous nerve of forearm 2/24. No significant changes were observed in the distance of a nerve to an individual portal at 90° flexion or 0° extension position of the elbow. Conclusion: This study demonstrates the risk of injury to different nerves at the standard portals of elbow arthroscopy. In practice, the actual incidence of nerve injury may still be lower. We conclude that elbow arthroscopy is a safe procedure when all precautions as described are duly followed. PMID:26952128

Elbow arthroscopy.

PubMed

Dodson, Christopher C; Nho, Shane J; Williams, Riley J; Altchek, David W

2008-10-01

Arthroscopy of the elbow was originally considered to be an unsafe procedure because of the small size of the elbow joint capsule and its proximity to several crucial neurovascular structures. Over the past decade, however, the procedure has become safer and more effective. These improvements can be attributed to a better understanding of elbow anatomy and of the disorders about the elbow as well as to advances in arthroscopic equipment and surgical technique. The most common indications for elbow arthroscopy include removal of loose bodies, synovectomy, débridement and/or excision of osteophytes, capsular release, and the assessment and treatment of osteochondritis dissecans. More recent advances have expanded the indications of elbow arthroscopy to include fracture management (eg, radial head fractures) and the treatment of lateral epicondylitis.

Quantitative Evaluation of Head and Neck Cancer Treatment-Related Dysphagia in the Development of a Personalized Treatment Deintensification Paradigm.

PubMed

Quon, Harry; Hui, Xuan; Cheng, Zhi; Robertson, Scott; Peng, Luke; Bowers, Michael; Moore, Joseph; Choflet, Amanda; Thompson, Alex; Muse, Mariah; Kiess, Ana; Page, Brandi; Fakhry, Carole; Gourin, Christine; O'Hare, Jolyne; Graham, Peter; Szczesniak, Michal; Maclean, Julia; Cook, Ian; McNutt, Todd

2017-12-01

To test the hypothesis that quantifying swallow function with multiple patient-reported outcome (PRO) instruments is an important strategy to yield insights in the development of personalized deintensified therapies seeking to reduce the risk of head and neck cancer (HNC) treatment-related dysphagia (HNCTD). Irradiated HNC subjects seen in follow-up care (April 2015 to December 2015) who prospectively completed the Sydney Swallow Questionnaire (SSQ) and the MD Anderson Dysphagia Inventory (MDADI) concurrently on the web interface to our Oncospace database were evaluated. A correlation matrix quantified the relationship between the SSQ and MDADI. Machine-learning unsupervised cluster analysis using the elbow criterion and CLUSPLOT analysis to establish its validity was performed. We identified 89 subjects. The MDADI and SSQ scores were moderately but significantly correlated (correlation coefficient -0.69). K-means cluster analysis demonstrated that 3 unique statistical cohorts (elbow criterion) could be identified with CLUSPLOT analysis, confirming that 100% of variances were accounted for. Correlation coefficients between the individual items in the SSQ and the MDADI demonstrated weak to moderate negative correlation, except for SSQ17 (quality of life question). Pilot analysis demonstrates that the MDADI and SSQ are complementary. Three unique clusters of patients can be defined, suggesting that a unique dysphagia signature for HNCTD may be definable. Longitudinal studies relying on only a single PRO, such as MDADI, may be inadequate for classifying HNCTD. Copyright © 2017 Elsevier Inc. All rights reserved.

[Nutritional evaluation and physical functional ability in scleroderma patients].

PubMed

Azevedo, Valderilio Feijó; Müller, Carolina de Souza; Rinaldi, Luciane; Bredt, Murilo Cézar; Giovanni, Karizianni; Pereira, Marcela Abou Chami; Volaco, Fernanda Copabianco

2009-01-01

Systemic Sclerosis (SSc) is an inflammatory disease that decreases functional capacity through muscular atrophy, skin sclerosis and loss of joint function. Scleroderma patients suffer from movement's restriction. In addition, the disease affects the nutritional status, compromising the quality of life in varying degrees. The gastrointestinal involvement appears to be the main responsible for the nutritional impairment. To evaluate the physical and nutritional status of patients with SSc. We conducted a cross-sectional and descriptive study in 20 patients with SSc. All patients were evaluated in Physioteraphy Clinic of the Catholic University of Paraná, from July 2003 to April 2004. The evaluation was performed by Bioimpedance Body (BIA), the questionnaires Nutritional Risk Assessment (Determine), Mini Nutritional Assessment of Aging and Health Assessment Questionnaire (HAQ) and Visual Analogue Scale (VAS) for pain. The work muscle ability was assessed by measuring the peak torque of flexor and extensor muscles of the elbow in the isokinetic dynamometer Cybex Norm model 7000. We have calculated the mean and standard deviation for each variable analyzed, in addition to the percentage of peak torque deficit. The values of the VAS ranged from zero to 97.8 mm (mean: 48.9 +/- 32.9 mm). The HAQ scores ranged from zero to 2.75 (average: 0.95 +/- 0.8). The average BMI was 22.4 +/- 3.9 kg / m2. The average deficit of mass was: 1.3 +/- 2.1 kg. Ten patients had high nutritional risk. 1 patient was malnourished and 15 were at high risk for malnutrition. The average peak torque to the muscle groups of elbows was 19.2 +/- 5 N / m to the flexor and 21.9 +/-6.6 N/m for the extensors, with an average deficit of 17% and 13% for the both groups. We found that SSc patients were in poor nutritional status and had decreased functional and physical capacity by the weakening of the muscles of the elbow demonstrated by the isokinetic evaluation. We concluded that our SSc patients were at high risk for malnutrition and this may indicate that scleroderma patients need a better nutritional orientation. We do consider that SSc patients also must be included in physical activity programs in order to achieve better physical performance.

Conventional En Masse Repair Versus Separate Double-Layer Double-Row Repair for the Treatment of Delaminated Rotator Cuff Tears.

PubMed

Kim, Yang-Soo; Lee, Hyo-Jin; Jin, Hong-Ki; Kim, Sung-Eun; Lee, Jin-Woo

2016-05-01

The rotator cuff tendon is known to exert a shear force between the superficial and deep layers. Owing to this characteristic, separate repair of delaminated rotator cuff tears has been introduced for the restoration of the physiological biomechanics of the rotator cuff. However, whether conventional en masse repair or separate repair is superior is controversial in terms of outcomes. To compare clinical outcomes between conventional en masse repair and separate double-layer double-row repair for the treatment of delaminated rotator cuff tears. Randomized controlled study; Level of evidence, 2. Between August 2007 and March 2014, a total of 82 patients who underwent arthroscopic rotator cuff repair of a delaminated tear were enrolled and randomized into 2 groups. In group 1 (n = 48), arthroscopic conventional en masse repair was performed. In group 2 (n = 34), separate double-layer double-row repair was performed. The American Shoulder and Elbow Surgeons score, Constant score, Simple Shoulder Test score, and visual analog scale (VAS) score for pain and range of motion (ROM) were assessed before surgery; at 3, 6, and 12 months after surgery; and at the last follow-up visit. Magnetic resonance imaging (MRI) was performed at 12 months postoperatively to examine the retear rate and pattern. There was no significant difference between groups in the preoperative demographic data, including patient age, sex, symptom duration, tear size, and functional scores (P > .05). The mean follow-up period was 25.9 ± 1.2 months. Significant improvements in functional and pain scores were observed in both groups at the last follow-up visit. However, no significant differences in functional scores and ROM were found between the 2 groups at each time point, except that group 2 had significantly lower VAS pain scores (P < .05) at 3, 6, and 12 months postoperatively. Eight (17%) of 48 patients in group 1 and 6 (18%) of 34 patients in group 2 showed retears on MRI at 12-month follow-up (P > .05). Both conventional en masse repair and separate double-layer double-row repair were effective in improving clinical outcomes in the treatment of delaminated rotator cuff tears. Lower pain scores were seen in patients who underwent separate double-layer double-row repair. © 2016 The Author(s).

Golf hand prosthesis performance of transradial amputees.

PubMed

Carey, Stephanie L; Wernke, Matthew M; Lura, Derek J; Kahle, Jason T; Dubey, Rajiv V; Highsmith, M Jason

2015-06-01

Typical upper limb prostheses may limit sports participation; therefore, specialized terminal devices are often needed. The purpose of this study was to evaluate the ability of transradial amputees to play golf using a specialized terminal device. Club head speed, X-factor, and elbow motion of two individuals with transradial amputations using an Eagle Golf terminal device were compared to a non-amputee during a golf swing. Measurements were collected pre/post training with various stances and grips. Both prosthesis users preferred a right-handed stance initially; however, after training, one preferred a left-handed stance. The amputees had slower club head speeds and a lower X-factor compared to the non-amputee golfer, but increased their individual elbow motion on the prosthetic side after training. Amputees enjoyed using the device, and it may provide kinematic benefits indicated by the increase in elbow flexion on the prosthetic side. The transradial amputees were able to swing a golf club with sufficient repetition, form, and velocity to play golf recreationally. Increased elbow flexion on the prosthetic side suggests a potential benefit from using the Eagle Golf terminal device. Participating in recreational sports can increase amputees' health and quality of life. © The International Society for Prosthetics and Orthotics 2014.

Upper limb joint kinetic analysis during tennis serve: Assessment of competitive level on efficiency and injury risks.

PubMed

Martin, C; Bideau, B; Ropars, M; Delamarche, P; Kulpa, R

2014-08-01

The aim of this work was to compare the joint kinetics and stroke production efficiency for the shoulder, elbow, and wrist during the serve between professionals and advanced tennis players and to discuss their potential relationship with given overuse injuries. Eleven professional and seven advanced tennis players were studied with an optoelectronic motion analysis system while performing serves. Normalized peak kinetic values of the shoulder, elbow, and wrist joints were calculated using inverse dynamics. To measure serve efficiency, all normalized peak kinetic values were divided by ball velocity. t-tests were used to determine significant differences between the resultant joint kinetics and efficiency values in both groups (advanced vs professional). Shoulder inferior force, shoulder anterior force, shoulder horizontal abduction torque, and elbow medial force were significantly higher in advanced players. Professional players were more efficient than advanced players, as they maximize ball velocity with lower joint kinetics. Since advanced players are subjected to higher joint kinetics, the results suggest that they appeared more susceptible to high risk of shoulder and elbow injuries than professionals, especially during the cocking and deceleration phases of the serve. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment.

PubMed

Balke, Maurice; Bielefeld, Rebecca; Schmidt, Carolin; Dedy, Nicolas; Liem, Dennis

2012-03-01

Calcifying tendinitis is a common and painful disorder of the shoulder characterized by the presence of calcific deposits in the tendons of the rotator cuff. When nonoperative treatment over a prolonged period of time fails, surgical treatment should be considered. Midterm success rates are inconsistent, and the role of subacromial decompression is still unclear. Our hypotheses were that the rate of supraspinatus tears after arthroscopic treatment of calcifying tendinitis is comparable with that in the contralateral uninvolved shoulder and that subacromial decompression does not have beneficial effects compared with calcium removal alone. Case series; Level of evidence, 4. In 70 shoulders of 62 patients with a mean age of 54 years, arthroscopic removal of calcium deposits of the supraspinatus tendon was performed. In 44 shoulders, additional subacromial decompression was performed. After a mean follow-up of 6 years (range, 2-13 years), patients were clinically investigated, and function was statistically evaluated using Constant and American Shoulder and Elbow Surgeons (ASES) scores. Affected and contralateral shoulders were examined by ultrasound in 48 shoulders, and rotator cuff tears were documented. The mean Constant scores of the operated shoulders were significantly lower than those of the healthy shoulders (P < .001). The ASES scores significantly (P < .001) increased after surgery but were still lower than the ASES scores of the healthy shoulders (P < .001). Concerning the additional subacromial decompression, there were no significant differences in the overall ASES and Constant scores; the subitem "pain" was significantly better in the subacromial decompression group (P = .048). Ultrasound examination at last follow-up (48 shoulders) showed a partial supraspinatus tendon tear in 11 operated and 3 contralateral shoulders. Although the good clinical results after arthroscopic treatment of calcifying tendinitis of the shoulder persist midterm, the affected shoulders present significantly lower clinical scores than healthy shoulders. The rate of partial supraspinatus tendon tears seems to be higher after calcium removal. Additional subacromial decompression seems to reduce postoperative pain.

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up.

PubMed

Abrams, Geoffrey D; Gupta, Anil K; Hussey, Kristen E; Tetteh, Elizabeth S; Karas, Vasili; Bach, Bernard R; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

2014-06-01

Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated. To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty. Randomized controlled trial; Level of evidence, 2. Patients undergoing arthroscopic repair of full-thickness rotator cuff tears were randomized into acromioplasty or nonacromioplasty groups. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California-Los Angeles (UCLA) score, and Short Form-12 (SF-12) health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Intraoperative data including tear size, repair configuration, and concomitant procedures were recorded. Follow-up examination was performed at regular intervals up to 2 years. Preoperative imaging was reviewed to classify the acromial morphologic type, acromial angle, and lateral acromial angulation. A total of 114 patients were initially enrolled in the study, and 95 (83%; 43 nonacromioplasty, 52 acromioplasty) were available for a minimum 2-year follow-up. There were no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles. Within groups, there was a significant (P < .001) improvement in all functional outcome scores from preoperatively to all follow-up time points, including 2 years, for the nonacromioplasty and acromioplasty groups (ASES score: 55.1-91.5, 48.8-89.0; Constant score: 48.3-75.0, 51.9-78.7, respectively). There were no significant differences in functional outcomes between nonacromioplasty and acromioplasty groups or between subjects with different acromial features at any time point. The results of this study demonstrate no difference in clinical outcomes after rotator cuff repair with or without acromioplasty at 2 years postoperatively. © 2014 The Author(s).

Isolated Subscapularis Repair in Irreparable Posterosuperior Massive Rotator Cuff Tears Involving the Subscapularis Tendon.

PubMed

Kim, Sung-Jae; Choi, Yun-Rak; Jung, Min; Lee, Won-Yong; Chun, Yong-Min

2017-05-01

No previous study has examined whether isolated subscapularis tendon repair in irreparable posterosuperior massive rotator tears involving the subscapularis tendon in relatively young patients without arthritis can yield satisfactory outcomes. We hypothesized that this procedure would produce favorable outcomes in patients who might otherwise be candidates for reverse arthroplasty. Case series; Level of evidence, 4. This retrospective study included 24 patients in their 50s and 60s, without shoulder arthritis, who underwent arthroscopic isolated subscapularis repair for an irreparable massive rotator cuff tear involving the subscapularis tendon. Preoperative and postoperative visual analog scale (VAS) pain scores, subjective shoulder values (SSVs), University of California at Los Angeles (UCLA) shoulder scores, American Shoulder and Elbow Surgeons (ASES) scores, subscapularis strength (modified bell-press test; maximum of 5), and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity of the repaired subscapularis. At a mean 34.8 months (range, 24-49 months) of follow-up, VAS pain scores (improved from 7.1 to 2.5), SSVs (33.3 to 75.2), ASES scores (35.9 to 76.0), UCLA shoulder scores (11.6 to 24.8), subscapularis strength, and ROM were significantly improved compared with preoperative measurements ( P < .001). Subscapularis muscle strength improved from 3.7 to 4.2 ( P < .001). For active ROM, forward flexion and internal rotation improved significantly ( P < .001); however, external rotation exhibited no significant improvement. Follow-up MRA was performed in 22 patients (92%) and showed retear of the repaired subscapularis in 6 (27% of the 22). Isolated repair of the subscapularis tendon in irreparable massive rotator cuff tears involving the subscapularis tendon yielded satisfactory short-term outcomes and structural integrity in patients in their 50s and 60s without arthritis. If patients with irreparable massive rotator cuff tears involving the subscapularis tendon are relatively young or have minimal concomitant arthritis, this repair can be worthwhile.

Factors Related to Increased Ulnar Collateral Ligament Thickness on Stress Sonography of the Elbow in Asymptomatic Youth and Adolescent Baseball Pitchers.

PubMed

Atanda, Alfred; Averill, Lauren W; Wallace, Maegen; Niiler, Tim A; Nazarian, Levon N; Ciccotti, Michael G

2016-12-01

Stress ultrasound (SUS) of the elbow has demonstrated changes in the anterior band of the ulnar collateral ligament (UCL) in professional and high school-aged pitchers. However, there have been no large reports correlating pitching history data with SUS changes in youth and adolescent baseball pitchers. Changes of the UCL on SUS will correlate with pitching volume in youth and adolescent baseball pitchers. Cross-sectional study; Level of evidence, 3. SUS of the elbow was performed in both elbows of 102 youth and adolescent baseball pitchers. UCL thickness and the width of the ulnohumeral joint, at rest and with 150 N of valgus stress, were measured using a standardized, instrumented device. Demographic data, arm measurements, and a pitching history questionnaire were recorded as well. The pitchers were separated into 2 groups based on age: group 1 (12-14 years) and group 2 (15-18 years). SUS findings of the dominant elbows were compared between the 2 groups. Correlation analysis and linear regression were used to identify relationships between SUS findings and pitching history data. In all pitchers, the mean UCL thickness was 4.40 mm in the dominant elbow and 4.11 mm in the nondominant elbow (P =.03). There was no significant difference between elbows in any joint space characteristics. A comparison of group 1 versus group 2 demonstrated significant differences in UCL thickness (4.13 vs 4.96 mm; P < .001), resting joint space width (6.56 vs 4.04 mm; P < .001), and stressed joint space width (7.68 vs 4.07 mm; P < .001). There was no difference in the change in joint space width between the 2 groups (1.11 vs 0.76 mm; P = .05). The UCL was significantly thicker in pitchers who threw more than 67 pitches per appearance (4.69 vs 4.14 mm), who pitched more than 5 innings per appearance (4.76 vs 4.11 mm), and who had more than 5.5 years of pitching experience (4.71 vs 4.07 mm; P < .001). Linear regression demonstrated that age, weight, and pitches per appearance (R 2 = 0.114, 0.370, and 0.326, respectively) significantly correlated with UCL thickness. These findings suggest that UCL thickness increases as pitchers get older and heavier and as they increase their pitch volumes. © 2016 The Author(s).

Maximal Voluntary Activation of the Elbow Flexors Is under Predicted by Transcranial Magnetic Stimulation Compared to Motor Point Stimulation Prior to and Following Muscle Fatigue

PubMed Central

Cadigan, Edward W. J.; Collins, Brandon W.; Philpott, Devin T. G.; Kippenhuck, Garreth; Brenton, Mitchell; Button, Duane C.

2017-01-01

Transcranial magnetic (TMS) and motor point stimulation have been used to determine voluntary activation (VA). However, very few studies have directly compared the two stimulation techniques for assessing VA of the elbow flexors. The purpose of this study was to compare TMS and motor point stimulation for assessing VA in non-fatigued and fatigued elbow flexors. Participants performed a fatigue protocol that included twelve, 15 s isometric elbow flexor contractions. Participants completed a set of isometric elbow flexion contractions at 100, 75, 50, and 25% of maximum voluntary contraction (MVC) prior to and following fatigue contractions 3, 6, 9, and 12 and 5 and 10 min post-fatigue. Force and EMG of the bicep and triceps brachii were measured for each contraction. Force responses to TMS and motor point stimulation and EMG responses to TMS (motor evoked potentials, MEPs) and Erb's point stimulation (maximal M-waves, Mmax) were also recorded. VA was estimated using the equation: VA% = (1−SITforce/PTforce) × 100. The resting twitch was measured directly for motor point stimulation and estimated for both motor point stimulation and TMS by extrapolation of the linear regression between the superimposed twitch force and voluntary force. MVC force, potentiated twitch force and VA significantly (p < 0.05) decreased throughout the elbow flexor fatigue protocol and partially recovered 10 min post fatigue. VA was significantly (p < 0.05) underestimated when using TMS compared to motor point stimulation in non-fatigued and fatigued elbow flexors. Motor point stimulation compared to TMS superimposed twitch forces were significantly (p < 0.05) higher at 50% MVC but similar at 75 and 100% MVC. The linear relationship between TMS superimposed twitch force and voluntary force significantly (p < 0.05) decreased with fatigue. There was no change in triceps/biceps electromyography, biceps/triceps MEP amplitudes, or bicep MEP amplitudes throughout the fatigue protocol at 100% MVC. In conclusion, motor point stimulation as opposed to TMS led to a higher estimation of VA in non-fatigued and fatigued elbow flexors. The decreased linear relationship between TMS superimposed twitch force and voluntary force led to an underestimation of the estimated resting twitch force and thus, a reduced VA. PMID:28979211

Maximal Voluntary Activation of the Elbow Flexors Is under Predicted by Transcranial Magnetic Stimulation Compared to Motor Point Stimulation Prior to and Following Muscle Fatigue.

PubMed

Cadigan, Edward W J; Collins, Brandon W; Philpott, Devin T G; Kippenhuck, Garreth; Brenton, Mitchell; Button, Duane C

2017-01-01

Transcranial magnetic (TMS) and motor point stimulation have been used to determine voluntary activation (VA). However, very few studies have directly compared the two stimulation techniques for assessing VA of the elbow flexors. The purpose of this study was to compare TMS and motor point stimulation for assessing VA in non-fatigued and fatigued elbow flexors. Participants performed a fatigue protocol that included twelve, 15 s isometric elbow flexor contractions. Participants completed a set of isometric elbow flexion contractions at 100, 75, 50, and 25% of maximum voluntary contraction (MVC) prior to and following fatigue contractions 3, 6, 9, and 12 and 5 and 10 min post-fatigue. Force and EMG of the bicep and triceps brachii were measured for each contraction. Force responses to TMS and motor point stimulation and EMG responses to TMS (motor evoked potentials, MEPs) and Erb's point stimulation (maximal M-waves, M max ) were also recorded. VA was estimated using the equation: VA% = (1- SITforce / PTforce ) × 100. The resting twitch was measured directly for motor point stimulation and estimated for both motor point stimulation and TMS by extrapolation of the linear regression between the superimposed twitch force and voluntary force. MVC force, potentiated twitch force and VA significantly ( p < 0.05) decreased throughout the elbow flexor fatigue protocol and partially recovered 10 min post fatigue. VA was significantly ( p < 0.05) underestimated when using TMS compared to motor point stimulation in non-fatigued and fatigued elbow flexors. Motor point stimulation compared to TMS superimposed twitch forces were significantly ( p < 0.05) higher at 50% MVC but similar at 75 and 100% MVC. The linear relationship between TMS superimposed twitch force and voluntary force significantly ( p < 0.05) decreased with fatigue. There was no change in triceps/biceps electromyography, biceps/triceps MEP amplitudes, or bicep MEP amplitudes throughout the fatigue protocol at 100% MVC. In conclusion, motor point stimulation as opposed to TMS led to a higher estimation of VA in non-fatigued and fatigued elbow flexors. The decreased linear relationship between TMS superimposed twitch force and voluntary force led to an underestimation of the estimated resting twitch force and thus, a reduced VA.

Epidemiology of shoulder and elbow pain in youth baseball players.

PubMed

Matsuura, Tetsuya; Suzue, Naoto; Iwame, Toshiyuki; Arisawa, Kokichi; Fukuta, Shoji; Sairyo, Koichi

2016-01-01

There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. The purpose of this study was to investigate risk factors for shoulder and elbow pain in child and adolescent baseball players. A total of 1563 players aged 7 to 12 years participated in this investigation. Subjects were asked whether they had experienced episodes of shoulder or elbow pain. We investigated the following risk factors for shoulder and elbow pain: age, position, years of baseball experience, and training hours per week. Data from the groups with and without shoulder and elbow pain were analyzed using multivariate logistic regression models. Among the 1563 participants, 15.9% and 29.2% reported episodes of shoulder and elbow pain, respectively. Multivariate analysis showed that shoulder pain was associated with age 10, 11, and 12 years, and that elbow pain was associated with age 10, 11, and 12 years, playing catcher, and >2 years of baseball experience. Training hours per week were not associated with either shoulder or elbow pain. In over 1000 baseball players aged 7 to 12 years, 15.9% reported episodes of shoulder pain, while 29.2% reported elbow pain in the throwing arm. The associated risk factors were different for each type of pain. Shoulder pain was associated with increased age while elbow pain was associated with increased age, increased years of baseball experience, and playing catcher.

Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

PubMed Central

2012-01-01

The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT) scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation. When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes. PMID:23241173

On the Efficacy of Isolating Shoulder and Elbow Movements with a Soft, Portable, and Wearable Robotic Device

NASA Technical Reports Server (NTRS)

Kadivar, Zahra; Beck, Christopher E.; Rovekamp, Roger N.; O'Malley, Marcia K.; Joyce, Charles A.

2016-01-01

Treatment intensity has a profound effect on motor recovery following neurological injury. The use of robotics has potential to automate these labor-intensive therapy procedures that are typically performed by physical therapists. Further, the use of wearable robotics offers an aspect of portability that may allow for rehabilitation outside the clinic. The authors have developed a soft, portable, lightweight upper extremity wearable robotic device to provide motor rehabilitation of patients with affected upper limbs due to traumatic brain injury (TBI). A key feature of the device demonstrated in this paper is the isolation of shoulder and elbow movements necessary for effective rehabilitation interventions. Herein is presented a feasibility study with one subject and demonstration of the device's ability to provide safe, comfortable, and controlled upper extremity movements. Moreover, it is shown that by decoupling shoulder and elbow motions, desired isolated joint actuation can be achieved.

Prevalence and inheritance of and selection for elbow arthrosis in Bernese mountain dogs and Rottweilers in Sweden and benefit: cost analysis of a screening and control program.

PubMed

Swenson, L; Audell, L; Hedhammar, A

1997-01-15

To determine the prevalence and charges over time in the prevalence of elbow arthrosis in Bernese Mountain Dogs and Rottweilers, to ascertain whether prevalence or severity of elbow arthrosis was associated with sex of the dogs, age at the time of elbow joint examination, or ancestral background, to determine the effects of selective breeding, and to conduct an economic evaluation of the elbow arthrosis program operated by the Swedish Kennel Club. Analysis of radiographic evaluations of elbow joint conformity. 4,515 dogs from 2 breeds registered by the Swedish Kennel Club. All radiographs were scrutinized by a single radiologist (LA), and elbow joint conformation was classified as normal or arthrotic, with the degree of arthrosis classified as 1, 2, or 3. Decreasing prevalence of elbow arthrosis corresponding to selection of breeding stock and high heritabilities was found. Sex differences were documented in both breeds, but with contradictory directions. This was interpreted as breed differences in the distribution of genes related to elbow arthrosis. Economic analyses showed that costs of screening and registration of elbow joints was less than the value of dogs estimated to have been saved from moderate and severe elbow arthrosis in both breeds. Documented effects of age suggest that all dogs should be screened at the same age, rather than screening a few dogs at an older, more revealing age. In screening and control programs based on an open registry with access to family records, decreasing prevalence of elbow arthrosis can be expected, and related to selection of breeding stock.

The Youth Throwing Score: Validating Injury Assessment in Young Baseball Players.

PubMed

Ahmad, Christopher S; Padaki, Ajay S; Noticewala, Manish S; Makhni, Eric C; Popkin, Charles A

2017-02-01

Epidemic levels of shoulder and elbow injuries have been reported recently in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. Purpose/Hypothesis: The purpose of this study was to validate an upper extremity assessment tool specifically designed for young baseball players. We hypothesized that this tool will be both reliable and valid. Cohort study (diagnosis); Level of evidence, 2. The Youth Throwing Score (YTS) was constructed by an interdisciplinary team of providers and coaches as a tool to assess upper extremity injury in youth and adolescent baseball players (age range, 10-18 years). The psychometric properties of the test were then determined. A total of 223 players completed the final survey. The players' mean age was 14.3 ± 2.7 years. Pilot analysis showed that none of the 14 questions received a mean athlete importance rating less than 3 of 5, and the final survey read at a Flesch-Kincaid level of 4.1, which is appropriate for patients aged 9 years and older. The players self-assigned their injury status, resulting in a mean instrument score of 59.7 ± 8.4 for the 148 players "playing without pain," 42.0 ± 11.5 for the 60 players "playing with pain," and 40.4 ± 10.5 for the 15 players "not playing due to pain." Players playing without pain scored significantly higher than those playing with pain and those not playing due to pain ( P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument sports/physical functioning module, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, respectively. Injured players scored a mean of 9.4 points higher after treatment ( P < .001), and players who improved in their self-assigned pain categorization scored 16.5 points higher ( P < .001). The YTS is the first valid and reliable instrument for assessing young baseball players' upper extremity health.

Quantifying the Degree of Movement Dissimilarity between Two Distinct Action Scenarios: An Exploratory Approach with Procrustes Analysis.

PubMed

Passos, Pedro; Campos, Tania; Diniz, Ana

2017-01-01

Game consoles allow subjects to perform movements which are visually similar to the movements performed in 'real' world scenarios. Beyond entertainment, virtual reality devices are being used in several domains: sports performance; motor rehabilitation; training of risk professions. This article presents the Procrustes method to measure the degree of dissimilarity between movements performed in 'real' and 'virtual' scenarios. For this purpose, the 501 darts game and a video darts game played on a console were used. The participants' arm throwing movements were video recorded and digitized. The matrices of x and y coordinates of the movements of the wrist, elbow, and shoulder in both performance scenarios were subjected to the Procrustes method. The wrist displays the most extreme dissimilarity values (higher than elbow and shoulder). Results also revealed smaller dissimilarity values for movements performed under the same conditions (e.g., real-real) and larger dissimilarity values between movements performed in different scenarios.

Quantifying the Degree of Movement Dissimilarity between Two Distinct Action Scenarios: An Exploratory Approach with Procrustes Analysis

PubMed Central

Passos, Pedro; Campos, Tania; Diniz, Ana

2017-01-01

Game consoles allow subjects to perform movements which are visually similar to the movements performed in ‘real’ world scenarios. Beyond entertainment, virtual reality devices are being used in several domains: sports performance; motor rehabilitation; training of risk professions. This article presents the Procrustes method to measure the degree of dissimilarity between movements performed in ‘real’ and ‘virtual’ scenarios. For this purpose, the 501 darts game and a video darts game played on a console were used. The participants’ arm throwing movements were video recorded and digitized. The matrices of x and y coordinates of the movements of the wrist, elbow, and shoulder in both performance scenarios were subjected to the Procrustes method. The wrist displays the most extreme dissimilarity values (higher than elbow and shoulder). Results also revealed smaller dissimilarity values for movements performed under the same conditions (e.g., real–real) and larger dissimilarity values between movements performed in different scenarios. PMID:28503159

Evaluation of common elbow pathologies: a focus on physical examination.

PubMed

Laratta, Joseph; Caldwell, Jon-Michael; Lombardi, Joseph; Levine, William; Ahmad, Christopher

2017-05-01

Elbow tendinopathy accounts for the majority of elbow pathology in patients presenting to upper extremity and sports medicine surgeons. With increased participation in overhead sports in an aging population, the incidence of elbow injuries has risen. A comprehensive knowledge of elbow anatomy and biomechanical function of the elbow complex is prerequisite in the assessment of patients with elbow injuries; however, a thorough understanding of alternative and confounding pathologies is essential for accurate diagnosis. Because tendinopathy, tendonitis, and tendon tears have an anatomic basis for their pathology, a targeted history and meticulous physical examination often yields an accurate clinical diagnosis. The importance of physical examination and provocative examination maneuvers must be stressed in a technologically advanced era where clinical diagnosis is too commonly attained solely by advanced imaging modalities. A revived dedication to the physical examination may enhance our ability to correctly diagnose various pathologies about the elbow. Early and accurate clinical diagnosis is the first step in the proper initiation of treatment modalities and improvement in overall patient outcome.

Articular Contact Area and Pressure in Posteromedial Rotatory Instability of the Elbow.

PubMed

Bellato, Enrico; Fitzsimmons, James S; Kim, Youngbok; Bachman, Daniel R; Berglund, Lawrence J; Hooke, Alexander W; O'Driscoll, Shawn W

2018-03-21

Joint incongruity in posteromedial rotatory instability (PMRI) has been theorized to determine early articular degenerative changes. Our hypothesis was that the articular contact area and contact pressure differ significantly between an intact elbow and an elbow affected by PMRI. Seven cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and allow passive elbow flexion (0° to 90°). The mean contact area and contact pressure data were collected and processed using the Tekscan sensor and software. After testing the intact specimen (intact elbow), a PMRI injury was simulated (PMRI elbow) and the specimen was tested again. The PMRI elbows were characterized by initial joint subluxation and significantly elevated articular contact pressure. Both worsened, corresponding with a reduction in contact area, as the elbow was flexed from 0° until the joint subluxation and incongruity spontaneously reduced (at a mean [and standard error] of 60° ± 5° of flexion), at which point the mean contact pressure decreased from 870 ± 50 kPa (pre-reduction) to 440 ± 40 kPa (post-reduction) (p < 0.001) and the mean contact area increased from 80 ± 8 mm to 150 ± 58 mm (p < 0.001). This reduction of the subluxation was also followed by a shift of the contact area from the coronoid fracture edge toward the lower portion of the coronoid. At the flexion angle at which the PMRI elbows reduced, both the contact area and the contact pressure of the intact elbows differed significantly from those of the PMRI elbows, both before and after the elbow reduction (p < 0.001). The reduction in contact area and increased contact pressures due to joint subluxation and incongruity could explain the progressive arthritis seen in some elbows affected by PMRI. This biomechanical study suggests that the early degenerative changes associated with PMRI reported in the literature could be subsequent to joint incongruity and an increase in contact pressure between the coronoid fracture surface and the trochlea.

Multiple forearm robotic elbow configuration

DOEpatents

Fisher, John J.

1990-01-01

A dual forearmed robotic elbow configuration comprises a main arm having a double elbow from which two coplanar forearms depend, two actuators carried in the double elbow for moving the forearms, and separate, independent end effectors, operated by a cable carried from the main arm through the elbow, is attached to the distal end of each forearm. Coiling the cables around the actuators prevents bending or kinking when the forearms are rotated 360 degrees. The end effectors can have similar or different capabilities. Actuator cannisters within the dual elbow are modular for rapid replacement or maintenance. Coarse and fine resolver transducers within the actuators provide accurate position referencing information.

Pressure loss in elbow pipes of unplasticized polyvinyl chloride.

PubMed

Iwasaki, T; Ojima, J

1996-01-01

In the ductwork of local exhaust systems, 90 degrees elbow pipes (JIS K 6739) are commonly used to alter the direction of airflow; thus, are important components of polyvinyl chloride (PVC) ducts. Pressure loss in 90 degrees PVC elbow pipes was investigated by measuring static pressure, and the characteristics of airflow was determined. First, a linear decrease in static pressure was observed at points of the downstream side beyond a distance of 10 times the diameter (10d) from the flanged round opening of the smooth VU ducts (JIS K6741). The linear decrease was also observed at points of the downstream side located at distances of greater than 30d from the elbow pipe. Coefficients of loss in the PVC elbow pipes were found to be constant for the Reynolds numbers ranging from 3.38 x 10(4) to 5.96 x 10(5) for all diameters examined, and a chart of pressure loss was constructed with these coefficients. The coefficients of loss in PVC elbow pipes were not equivalent to those of metal stamped elbows for any R/d. However, the differences in the coefficients between the metal stamped elbow and the PVC elbow were smaller with larger R/d values.

Pulled elbow in children.

PubMed

Yamanaka, Syunsuke; Goldman, Ran D

2018-06-01

Question Our practice is seeing children with relatively minor injuries to their elbows, with a history of "swinging" them when their hands are being held to cross the road. Nothing is usually found on a physical examination. I know that this is likely a "pulled elbow." Can we manage this in the clinic setting rather than sending the family to the emergency department? What would be the best course of action in the clinic setting? Answer Pulled elbow, also called nursemaid's elbow , is a radial head subluxation caused by axial traction or a sudden pull of the extended pronated arm, and it is a very common phenomenon. The practice of swinging children while holding their hands should be abandoned. In the case of pulled elbow, the child usually avoids moving the affected arm, holding it close to his or her body, without considerable pain, and no obvious swelling or deformity can be seen. While a fracture should be excluded, pulled elbow can usually be identified based on this presentation. The reduction procedure can easily be done in the office setting, with an 80% success rate and no complications. The hyperpronation maneuver (holding the elbow at 90° and then firmly pronating the wrist) to reduce pulled elbow has been found to be better than a supination-flexion maneuver (holding the elbow at 90° with one hand, supinating and flexing the elbow rapidly with the other) and should be exercised first. When 2 trials of reduction are unsuccessful, the child's arm should be splinted and the family should be sent for further evaluation. Copyright© the College of Family Physicians of Canada.

The Prevalence, Rate of Progression, and Treatment of Elbow Flexion Contracture in Children with Brachial Plexus Birth Palsy

PubMed Central

Sheffler, Lindsey C.; Lattanza, Lisa; Hagar, Yolanda; Bagley, Anita; James, Michelle A.

2012-01-01

Background: Elbow flexion contracture is a well-known complication of brachial plexus birth palsy that adversely affects upper-extremity function. The prevalence, risk factors, and rate of progression of elbow flexion contracture associated with brachial plexus birth palsy have not been established, and the effectiveness of nonoperative treatment involving nighttime splinting or serial casting has not been well studied. Methods: The medical records of 319 patients with brachial plexus birth palsy who had been seen at our institution between 1992 and 2009 were retrospectively reviewed to identify patients with an elbow flexion contracture (≥10°). The chi-square test for trend and the Kaplan-Meier estimator were used to evaluate risk factors for contracture, including age, sex, and the extent of brachial plexus involvement. Longitudinal models were used to estimate the rate of contracture progression and the effectiveness of nonoperative treatment. Results: An elbow flexion contracture was present in 48% (152) of the patients with brachial plexus birth palsy. The median age of onset was 5.1 years (range, 0.25 to 14.8 years). The contracture was ≥30° in 36% (fifty-four) of these 152 patients and was accompanied by a documented radial head dislocation in 6% (nine). The prevalence of contracture increased with increasing age (p < 0.001) but was not significantly associated with sex or with the extent of brachial plexus involvement. The magnitude of the contracture increased by 4.4% per year before treatment (p < 0.01). The magnitude of the contracture decreased by 31% when casting was performed (p < 0.01) but thereafter increased again at the same rate of 4.4% per year. The magnitude of the contracture did not improve when splinting was performed but the rate of increase thereafter decreased to <0.1% per year (p = 0.04). Conclusions: The prevalence of elbow flexion contracture in children with brachial plexus birth palsy may be greater than clinicians perceive. The prevalence increased with patient age but was not significantly affected by sex or by the extent of brachial plexus involvement. Serial casting may initially improve severe contractures, whereas nighttime splinting may prevent further progression of milder contractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:22398733

Giant geode at the olecranon in the rheumatoid elbow--two case reports.

PubMed

Nakagawa, Natsuko; Abe, Shuji; Saegusa, Yasuhiro; Kimura, Hiroshi; Imura, Shigeaki; Nishibayashi, Yasuro; Yoshiya, Sinichi

2004-08-01

A single giant geode at the olecranon in a patient with rheumatoid arthritis (RA) is relatively rare, and may cause diagnostic difficulties or cause a spontaneous pathological fracture owing to weakness of the cortical bone associated with osteoporosis. We report two cases of patients presenting with single giant geodes at the olecranon. In one case we performed an open reduction and internal fixation with bone grafting for a pathological fracture due to the geode. In the other case we performed curettage of the geode with bone grafting to prevent a pathological fracture, and a synovectomy of the elbow. We suggest that the presence of a giant geode at the olecranon may necessitate surgical intervention to prevent the occurrence of a spontaneous pathological fracture.

Distal biceps brachii tendon repair: a systematic review of patient outcome determination using modified Coleman methodology score criteria.

PubMed

Nyland, John; Causey, Brandon; Wera, Jeff; Krupp, Ryan; Tate, David; Gupta, Amit

2017-07-01

This systematic literature review evaluated the methodological research design quality of studies that evaluated patient outcomes following distal biceps brachii tendon repair and developed evidence-based recommendations for future patient clinical outcomes research. Following the preferred reporting items for systematic reviews and meta-analyses criteria, and using "biceps brachii", "tendon", "repair" and "outcome assessment" search terms, the CINAHL, Academic Search Premier and MEDLINE databases were searched from January 1960-October 2015. The modified Coleman methodology score (MCMS) served as the primary outcome measure. Descriptive statistical analysis was performed for composite and component MCMS and for patient outcome assessment methodology use frequency. A total of 93 studies were evaluated. Overall MCMS was low (57.1 ± 14). Only 12 (12.9 %) had prospective cohort or randomized controlled trial designs. There was a moderate relationship between publication year and MCMS (r = 0.53, P < 0.0001). Although 61 studies (65.6 %) had adequate surgical descriptions, only 3 (3.2 %) had well-described rehabilitation. Of 2253 subjects, only 39 (1.7 %) were women. Studies published after 2008 had higher MCMS scores than studies published earlier (61.3 ± 10 versus 52.9 ± 16, P = 0.003). Although overall research study methodological scores improved on average since 2008, generally low MCMS scores, retrospective designs, lack of eccentric elbow flexor or supinator strength testing, and poorly described surgical and rehabilitation descriptions remain commonplace. These findings decrease clinical study validity and generalizability. III.

Clinical Outcomes of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment.

PubMed

Okuno, Yuji; Iwamoto, Wataru; Matsumura, Noboru; Oguro, Sota; Yasumoto, Taku; Kaneko, Takao; Ikegami, Hiroyasu

2017-02-01

To evaluate clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis resistant to conservative treatments. This study comprised 25 patients (18 women and 7 men; mean age, 53.8 y; range, 39-68 y) with adhesive capsulitis resistant to conservative treatments. TAE was performed, and adverse events (AEs), pain visual analog scale (VAS) score changes, range of motion (ROM), and American Shoulder and Elbow Surgeons (ASES) scores were assessed. Abnormal vessels were identified in all patients. No major AEs were associated with TAE. One patient was lost to follow-up. The remaining 24 patients were available for final follow-up (mean, 36.1 months; range, 30-44 months). Of the 24 patients, 16 (67%) experienced quick improvement of nighttime pain (ie, VAS scores decreased > 50% from baseline) within 1 week, and 21 (87%) improved within 1 month. In terms of mean overall pain (ie, pain at its worst), VAS scores significantly decreased at 1, 3, and 6 months after treatment (82 mm before treatment vs 52, 19, and 8 mm after treatment; P < .001). ASES scores significantly improved at 1, 3, and 6 months after treatment (16.1 before treatment vs 41.4, 69.1, and 83.5 after treatment; P < .001). No symptom recurrence or late-onset AEs were observed. Shoulder ROM and function further improved during midterm follow-up. TAE is a possible treatment option for patients with adhesive capsulitis that has failed to improve with conservative treatments. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Modular one-to-many clutchable actuator for a soft elbow exosuit.

PubMed

Canesi, M; Xiloyannis, M; Ajoudani, A; Biechi, A; Masia, L

2017-07-01

Exoskeletons have been developed for a wide range of applications, from the military to the medical field, with the aim of augmenting human performance or compensating for neuromuscular deficiencies. However, to empower the high number of degrees of freedom of the human body, they often employ a high number of motors, increasing the size, weight and power consumption of the system. We hereby present an actuation strategy to empower our elbow exosuit that adopts a single motor to drive multiple, independently actuated, degrees of freedom. This paradigm, known as One-to-many, is achieved using a modular design where each module comprises a clutchable mechanism that allows to convert a single directional motion from the prime mover to a selectable bidirectional output. Moreover, the mechanism has a locking feature that enables the wearer of the exoskeleton to hold a static load with a minimal power consumption. We present a simple controller for the clutchable unit based on a finite-state machine model, and evaluate its performance for varying input velocities. The system is shown to have a bandwidth of 1.5 Hz, sufficient for daily elbow movements, whilst retaining a compact design.

A primer for physical examination of the elbow.

PubMed

Zouzias, Ioannis C; Byram, Ian R; Shillingford, Jamal N; Levine, William N

2012-02-01

The elbow is a complex joint consisting of 3 separate but important articulations: the ulnohumeral, radiohumeral, and proximal radioulnar joints. The elbow assists in positioning the hand in space through 2 important motions, flexion-extension and pronation-supination. Although the elbow is not a weightbearing joint, it is subjected to significant loads, especially in overhead and throwing athletes. An accurate knowledge of the anatomy and physiology of the elbow joint is critical for conducting a focused physical examination and arriving at an accurate diagnosis. The goal of this article is to review general and focused physical examination of the elbow in a systematic manner based on medial, lateral, anterior, and posterior aspects.

Medial elbow pain

PubMed Central

Barco, Raul; Antuña, Samuel A.

2017-01-01

Medial elbow pain is uncommon when compared with lateral elbow pain. Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain. Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain. Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders. Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event. This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies. Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006 PMID:28932488

Submaximal delayed-onset muscle soreness: correlations between MR imaging findings and clinical measures

NASA Technical Reports Server (NTRS)

Evans, G. F.; Haller, R. G.; Wyrick, P. S.; Parkey, R. W.; Fleckenstein, J. L.; Blomqvist, C. G. (Principal Investigator)

1998-01-01

PURPOSE: To assess correlations between muscle edema on magnetic resonance (MR) images and clinical indexes of muscle injury in delayed-onset muscle soreness (DOMS) produced by submaximal exercise protocols. MATERIALS AND METHODS: Sixteen subjects performed 36 elbow flexions ("biceps curls") at one of two submaximal workloads that emphasized eccentric contractions. Changes in MR imaging findings, plasma levels of creatine kinase, and pain scores were correlated. RESULTS: Both exercise protocols produced DOMS in all subjects. The best correlation was between change in creatine kinase level and volume of muscle edema on MR images, regardless of the workload. Correlations tended to be better with the easier exercise protocol. CONCLUSION: Whereas many previous studies of DOMS focused on intense exercise protocols to ensure positive results, the present investigation showed that submaximal workloads are adequate to produce DOMS and that correlations between conventionally measured indexes of injury may be enhanced at lighter exercise intensities.

Large Critical Shoulder Angle Has Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair.

PubMed

Li, Hong; Chen, Yuzhou; Chen, Jiwu; Hua, Yinghui; Chen, Shiyi

2018-05-01

The critical shoulder angle (CSA) is the angle created between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion. A few studies recently investigated the relation between CSA and functional outcomes after rotator cuff repair. However, there is a lack of research investigating the effect of CSA on postoperative tendon integrity after rotator cuff repair. To assess the effects of the CSA on postoperative tendon integrity after rotator cuff repair. Cohort study; Level of evidence, 3. All patients who underwent rotator cuff repair for full-thickness supraspinatus tears by 1 senior surgeon between January 2010 and January 2014 were included in this study. All patients had standardized anteroposterior shoulder radiographs the day before surgery. CSA and acromial index (AI) were measured. AI was derived by measuring the distance from the glenoid plane to the lateral border of the acromion and dividing it by the distance from the glenoid plane to the lateral aspect of the humeral head. Functional scores-including American Shoulder and Elbow Surgeons shoulder evaluation form, modified University of California at Los Angeles score, Constant-Murley score, and visual analog scale for pain-were used to evaluate shoulder function at a minimum follow-up of 2 years. Meanwhile, magnetic resonance imaging examinations were performed to evaluate rotator cuff integrity according to the Sugaya method and the signal/noise quotient (SNQ) of the rotator cuff tendon. A total of 90 patients were included in this study: 42 patients with a single-row repair and 48 with a double-row repair. There was a significant positive correlation between CSA or AI and tendon SNQ. On the basis of CSA, the patients were divided into 2 groups: large CSA (>38°) and control (CSA ≤38°). At final follow-up, the large CSA group and the control CSA group demonstrated no significant differences in American Shoulder and Elbow Surgeons, University of California at Los Angeles, Constant, and visual analog scale scores. Postoperative magnetic resonance imaging revealed that the large CSA group had 9 cases of retear, with a significantly higher retear rate than the control group (15% vs 0%, P = .03). Furthermore, the tendon SNQ of the large CSA group was significantly greater than that of the control group. CSA did not appear to influence postoperative functional outcomes, while those in the large CSA group had poor tendon integrity after rotator cuff repair. These findings indicate that a large CSA is associated with an increased risk of rotator cuff tendon retear after repair.

Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures.

PubMed

Dwyer, Tim; Henry, Patrick D G; Cholvisudhi, Phantila; Chan, Vincent W S; Theodoropoulos, John S; Brull, Richard

2015-01-01

Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.

21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Elbow joint metal/polymer semi-constrained cemented prosthesis. 888.3160 Section 888.3160 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal...

21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3180...

21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3180...

21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3180...

21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3180...

21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3180...

The effectiveness of wrist guards for reducing wrist and elbow accelerations resulting from simulated forward falls.

PubMed

Burkhart, Timothy A; Andrews, David M

2010-08-01

The effectiveness of wrist guards and modifying elbow posture for reducing impact-induced accelerations at the wrist and elbow, for the purpose of decreasing upper extremity injury risk during forward fall arrest, has not yet been documented in living people. A seated human pendulum was used to simulate the impact conditions consistent with landing on outstretched arms during a forward fall. Accelerometers measured the wrist and elbow response characteristics of 28 subjects following impacts with and without a wrist guard, and with elbows straight or slightly bent. Overall, the wrist guard was very effective, with significant reductions in peak accelerations at the elbow in the axial and off-axis directions, and in the off-axis direction at the wrist by almost 50%. The effect of elbow posture as an intervention strategy was mixed; a change in magnitude and direction of the acceleration response was documented at the elbow, while there was little effect at the wrist. Unique evidence was presented in support of wrist guard use in activities like in-line skating where impacts to the hands are common. The elbow response clearly shows that more proximal anatomical structures also need to be monitored when assessing the effectiveness of injury prevention strategies.

Long-latency reflexes of elbow and shoulder muscles suggest reciprocal excitation of flexors, reciprocal excitation of extensors, and reciprocal inhibition between flexors and extensors

PubMed Central

Meriggi, Jenna; Parikh, Nidhi; Saad, Kenneth

2016-01-01

Postural corrections of the upper limb are required in tasks ranging from handling an umbrella in the changing wind to securing a wriggling baby. One complication in this process is the mechanical interaction between the different segments of the arm where torque applied at one joint induces motion at multiple joints. Previous studies have shown the long-latency reflexes of shoulder muscles (50–100 ms after a limb perturbation) account for these mechanical interactions by integrating information about motion of both the shoulder and elbow. It is less clear whether long-latency reflexes of elbow muscles exhibit a similar capability and what is the relation between the responses of shoulder and elbow muscles. The present study utilized joint-based loads tailored to the subjects' arm dynamics to induce well-controlled displacements of their shoulder and elbow. Our results demonstrate that the long-latency reflexes of shoulder and elbow muscles integrate motion from both joints: the shoulder and elbow flexors respond to extension at both joints, whereas the shoulder and elbow extensors respond to flexion at both joints. This general pattern accounts for the inherent flexion-extension coupling of the two joints arising from the arm's intersegmental dynamics and is consistent with spindle-based reciprocal excitation of shoulder and elbow flexors, reciprocal excitation of shoulder and elbow extensors, and across-joint inhibition between the flexors and extensors. PMID:26864766

Reverse shoulder arthroplasty in patients with os acromiale.

PubMed

Aibinder, William R; Schoch, Bradley S; Cofield, Robert H; Sperling, John W; Sánchez-Sotelo, Joaquin

2017-09-01

Os acromiale has been reported in up to 15% of the general population. Reverse total shoulder arthroplasty (RTSA) increases deltoid tension, which could potentially lead to excessive stress on a pre-existent os acromiale. The purpose of this study was to determine the outcome and complications of primary RTSA in patients with radiographic evidence of an os acromiale. Between 2005 and 2013, 25 shoulders underwent primary RTSA with an associated os acromiale, which was classified preacromion (3), mesoacromion (20), and meta-acromion (2). All patients were observed for a minimum of 2 years or until reoperation. Mean follow-up time was 30.8 (range, 1-81.4) months. Outcomes included pain scores, range of motion, patient satisfaction, American Shoulder and Elbow Surgeons scores, and radiographic outcomes. RTSA led to an improvement in pain scores in 24 of 25 shoulders. Mean elevation, external rotation, and internal rotation were improved at final follow-up (124°, 46°, and L4, respectively). Three patients required reoperation, including revision surgery for dislocation (2) and excision of a painful os acromiale (1). Postoperative tilting of the os acromiale was noted in 7 shoulders (28%). There was no statistically significant difference in any outcome measures between shoulders with and shoulders without postoperative tilt of the os acromiale. The outcome of RTSA does not seem to be negatively affected by the presence of an os acromiale. Pain around an os acromiale after RTSA is rare. Inferior tilting is observed in approximately one-third of the shoulders after RTSA and does not seem to change the overall outcome. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis.

PubMed

Strauss, Eric J; Verma, Nikhil N; Salata, Michael J; McGill, Kevin C; Klifto, Christopher; Nicholson, Gregory P; Cole, Brian J; Romeo, Anthony A

2014-03-01

The current study evaluated the outcomes of biologic resurfacing of the glenoid using a lateral meniscus allograft or human acellular dermal tissue matrix at intermediate-term follow-up. Forty-five patients (mean age, 42.2 years) underwent biologic resurfacing of the glenoid, and 41 were available for follow-up at a mean of 2.8 years. Lateral meniscal allograft resurfacing was used in 31 patients and human acellular dermal tissue matrix interposition in 10. Postoperative range of motion and clinical outcomes were assessed at the final follow-up. The overall clinical failure rate was 51.2%. The lateral meniscal allograft cohort had a failure rate of 45.2%, with a mean time to failure of 3.4 years. Human acellular dermal tissue matrix interposition had a failure rate of 70.0%, with a mean time to failure of 2.2 years. Overall, significant improvements were seen compared with baseline with respect to the visual analog pain score (3.0 vs. 6.3), American Shoulder and Elbow Surgeons score (62.0 vs. 36.8), and Simple Shoulder Test score (7.0 vs. 4.0). Significant improvements were seen for forward elevation (106° to 138°) and external rotation (31° to 51°). Despite significant improvements compared with baseline values, biologic resurfacing of the glenoid resulted in a high rate of clinical failure at intermediate follow-up. Our results suggest that biologic resurfacing of the glenoid may have a minimal and as yet undefined role in the management of glenohumeral arthritis in the young active patient over more traditional methods of hemiarthroplasty or total shoulder arthroplasty. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results.

PubMed

Capanna, Rodolfo; Totti, Francesca; Van der Geest, Ingrid C M; Müller, Daniel A

2015-08-01

Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft. The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred. Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Elbow reconstruction with a pedicled thoracodorsal artery perforator flap after excision of an upper-extremity giant hairy nevus.

PubMed

Oksüz, Sinan; Ulkür, Ersin; Tuncer, Serhan; Sever, Celalettin; Karagöz, Hüseyin

2013-04-01

The complexity of managing large soft-tissue defects at the elbow region by conventional techniques arises from the difficulty of providing sufficient tissue with adequate elasticity and durability. Reconstruction options that allow early mobilisation and avoid the risk of functional loss should be considered to achieve defect closure at the elbow region. A 21-year-old man presented with a congenital giant hairy nevus on his left upper extremity. The nevus was excised and the resulting raw surface after the excision was covered with a split-thickness skin graft except for the elbow region. The elbow was covered in one stage with an ipsilateral 24 cm long pedicled thoracodorsal artery perforator (TDAP) flap. The follow-up examination 3 years after total reconstruction demonstrated durable elbow support provided by the TDAP flap. The patient revealed no complaint considering pain or sensitivity even when exposed to mechanical stress. Split-thickness skin grafting of the large superficial defects is almost always possible; however, impairment of the function on joint areas due to gradual contraction and skin graft propensity to ulcers under mechanical stresses can be devastating. The elbow is a weight-bearing area of the body. Elbow defects require durable and thin soft-tissue coverage and the tissue cover must possess excellent elastic properties to re-establish elbow mobility. The TDAP flap is an ideal choice for elbow soft-tissue defects. The longest pedicle length reported for the TDAP flap is 23 cm. In our case, the pedicle length was 24 cm and it was possible to transfer this flap to the elbow on its pedicle. A pedicled TDAP skin flap so as to provide elbow coverage in one stage is a useful choice to retain in one's armamentarium. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Design of a Soft Robotic Elbow Sleeve with Passive and Intent-Controlled Actuation

PubMed Central

Koh, Tze Hui; Cheng, Nicholas; Yap, Hong Kai; Yeow, Chen-Hua

2017-01-01

The provision of continuous passive, and intent-based assisted movements for neuromuscular training can be incorporated into a robotic elbow sleeve. The objective of this study is to propose the design and test the functionality of a soft robotic elbow sleeve in assisting flexion and extension of the elbow, both passively and using intent-based motion reinforcement. First, the elbow sleeve was developed, using elastomeric and fabric-based pneumatic actuators, which are soft and lightweight, in order to address issues of non-portability and poor alignment with joints that conventional robotic rehabilitation devices are faced with. Second, the control system was developed to allow for: (i) continuous passive actuation, in which the actuators will be activated in cycles, alternating between flexion and extension; and (ii) an intent-based actuation, in which user intent is detected by surface electromyography (sEMG) sensors attached to the biceps and triceps, and passed through a logic sequence to allow for flexion or extension of the elbow. Using this setup, the elbow sleeve was tested on six healthy subjects to assess the functionality of the device, in terms of the range of motion afforded by the device while in the continuous passive actuation. The results showed that the elbow sleeve is capable of achieving approximately 50% of the full range of motion of the elbow joint among all subjects. Next, further experiments were conducted to test the efficacy of the intent-based actuation on these healthy subjects. The results showed that all subjects were capable of achieving electromyography (EMG) control of the elbow sleeve. These preliminary results show that the elbow sleeve is capable of carrying out continuous passive and intent-based assisted movements. Further investigation of the clinical implementation of the elbow sleeve for the neuromuscular training of neurologically-impaired persons, such as stroke survivors, is needed. PMID:29118693

Physical Risk Factors for a Medial Elbow Injury in Junior Baseball Players: A Prospective Cohort Study of 353 Players.

PubMed

Sakata, Jun; Nakamura, Emi; Suzukawa, Makoto; Akaike, Atsushi; Shimizu, Kuniaki

2017-01-01

The physical risk factors for a medial elbow injury in junior baseball players are unknown. To identify the risk factors for an initial medial elbow injury in junior baseball players. Case-control study; Level of evidence, 3. Junior baseball players (aged 6-12 years) without a history of elbow pain underwent a clinical assessment, ultrasonography, and physical function measurements before the baseball season started. Bilateral passive range of motion (ROM) of elbow extension and flexion, external rotation (ER) and internal rotation (IR) of the shoulder, and ER and IR of the hip were measured. IR and ER strength of the shoulder and scapular muscles were measured on both sides. The thoracic kyphosis angle was measured with participants in a relaxed standing position. Before these examinations, every participant completed a questionnaire regarding his or her age, sex, total years of baseball played, position in baseball, number of balls thrown, and episodes of pain during throwing. After the initial test session, each participant was followed up for 12 months to assess for the occurrence of a new injury. Multiple regression analysis was used to identify the risk factors for a medial elbow injury. Seventy-eight players (22.1%) sustained a medial elbow injury. Age ≥9 years (odds ratio [OR], 2.708; 95% CI, 1.224-5.990), pitcher position (OR, 2.620; 95% CI, 1.389-4.941), >100 throws per day (OR, 1.936; 95% CI, 1.072-3.497), thoracic kyphosis angle ≥30° (OR, 2.501; 95% CI, 1.381-4.531), and elbow extension deficit ≥5° (OR, 1.973; 95% CI, 1.022-3.809) were significantly associated with a medial elbow injury. The incidence of an initial medial elbow injury was 22.1%. Age, number of throws per day, thoracic kyphosis angle, and elbow extension deficit are newly discovered risk factors related to physical function. Improvement of the posture and early detection of a silent elbow extension deficit may prevent a medial elbow injury.

Revisiting the anatomy and biomechanics of the anconeus muscle and its role in elbow stability.

PubMed

Pereira, Barry P

2013-07-01

Recent studies have designated the anconeus muscle as an option for use as a pedicled flap for covering soft tissue defects about the elbow, with reported minimal risk of morbidity. This has raised the question as to the importance of the anconeus muscle and as to whether this is truly an accessory muscle that can be sacrificed, or whether the anconeus muscle significantly contributes to elbow and forearm stability? This study revisits the anatomy and biomechanics of the anconeus muscle and aims to investigate the neuromuscular compartments of the anconeus muscle and to determine the changes in the muscle length, fibre length and moment arm over a range of elbow flexion angles for each compartment. An anatomical study on 8 human cadavers (51-77 years of age) was done and a 2-dimensional kinematic elbow model developed to determine changes in the muscle length and moment arm of the muscle related to changes in elbow flexion angles. The muscle was modelled with two possible lines of action, one along the posterior and another on the anterior edge of the muscle as they had different muscle fibre lengths (posterior: average of 32 mm, anterior: average of 20 mm). The anterior edge also had an aponeurosis which was 70% of its length. From 0 to 120° elbow flexion, the length of the posterior and anterior edges increased with a maximum change recorded at 90° elbow flexion (31.7±1.0 mm and 65.3±1.4 mm, respectively). The moment arm is 14-mm at 0° flexion, but between the posterior and anterior edges it decreases at different rates with increasing elbow flexion angle. Beyond 80°, the anterior edge behaves as an elbow flexor, while the posterior edge remains an elbow extensor. The study demonstrates that the anconeus muscle has two neuromuscular compartments each with distinct intramuscular innervations and muscle fibre lengths. The posterior and deep aspect of the muscle functions as an elbow extensor decreasing in influence with increasing elbow flexion angle. The anterior superficial aspect which is adjacent and parallel to the lateral collateral ligaments, would most likely work in unison to provide constraint to the posterolateral stability of the elbow. Copyright © 2012. Published by Elsevier GmbH.

Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint.

PubMed

Duma, Stefan M; Hansen, Gail A; Kennedy, Eric A; Rath, Amber L; McNally, Craig; Kemper, Andrew R; Smith, Eric P; Brolinson, P Gunnar; Stitzel, Joel D; Davis, Martin B; Bass, Cameron R; Brozoski, Frederick T; McEntire, B Joseph; Alem, Nabih M; Crowley, John S

2004-11-01

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.

Does Increased Body Mass Index Influence Outcomes After Rotator Cuff Repair?

PubMed

Kessler, Katie E; Robbins, Christopher B; Bedi, Asheesh; Carpenter, James E; Gagnier, Joel J; Miller, Bruce S

2018-03-01

To investigate the influence of pre-existing obesity (body mass index [BMI] ≥ 30) on outcomes after rotator cuff repair surgery. We collected data on adult patients who underwent surgical repair for symptomatic full-thickness rotator cuff tears confirmed by imaging between 2012 and 2015. The required follow-up was 3 years. At baseline and 6, 12, 24, and 36 months, the American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff index, and visual analog scale pain scores were collected. Complications were assessed by a chart review. Obesity was defined as BMI ≥ 30. Chi-square analysis and Student's t-test examined differences between categorical and continuous variables at baseline. Generalized estimating equations examined the effects of fixed factors on outcome variables longitudinally from baseline to 36 months. Thirty-nine percent of 213 subjects were obese (mean BMI = 29.2; range, 16-48; standard deviation, 5.8). There were no statistically significant differences between obese and nonobese subjects in other baseline characteristics. When controlling for covariates, obese subjects reported no differences in Western Ontario Rotator Cuff, American Shoulder and Elbow Surgeons, or visual analog scale pain scores when compared with nonobese subjects at baseline and over 3 years from surgery. Although obese patients were more likely to have inpatient surgery, there was no difference in the incidence of postoperative complications. Contrary to our hypothesis, obese participants who underwent rotator cuff repair reported no difference in functional outcome or pain scores compared with nonobese participants over 3 years. In addition, obesity was not associated with postoperative complications in this study. However, as we hypothesized, obese participants were more likely than nonobese participants to have repair in the inpatient setting. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Prospective evaluation of postoperative compliance and outcomes after rotator cuff repair in patients with and without workers' compensation claims.

PubMed

Cuff, Derek J; Pupello, Derek R

2012-12-01

This study prospectively evaluated compliance and outcomes after rotator cuff repair in patients with and without Workers' Compensation claims. From December 2007 to January 2010, 42 consecutive patients with Workers' Compensation claims (Work Comp group), and 50 consecutive patients without a Workers' Compensation claim (non-Work Comp group) underwent arthroscopic rotator cuff repair and were enrolled in this study. Compliance with a postoperative protocol of shoulder immobilization and physical therapy was documented. Patients were monitored clinically for a minimum of 12 months. Noncompliance with protocol was documented in 22 of 42 patients (52%) in the Work Comp group compared with 2 of 50 (4%) in the non-Work Comp group (P < .001). The Work Comp group had less improvement in preoperative to postoperative outcome scores for the American Shoulder and Elbow Surgeons (ASES) score (40.4 to 60.1), Simple Shoulder Test (SST) score (3.9 to 6.0) and visual analog scale (VAS) for pain (7.0 to 3.5) compared with the non-Work Comp group (ASES, 41.7 to 89.2; SST, 4.3 to 10.7; VAS, 6.2 to 0.35; P < .0001). The compliant Work Comp patients had more favorable results in final outcome scores (ASES, 73.1; SST, 7.9; VAS, 1.5) than noncompliant Work Comp patients (ASES, 48.4; SST, 4.3; VAS, 5.3; P < .0001). Patients with Workers' Compensation claims demonstrated a high rate of postoperative noncompliance (52%) compared with patients without Workers' Compensation claims (4%) after rotator cuff repair. Those Workers' Compensation patients who had no evidence of noncompliance had significant improvements and more favorable outcomes than the noncompliant Workers' Compensation patients. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results.

PubMed

Kelly, Anne M; Drakos, Mark C; Fealy, Stephen; Taylor, Samuel A; O'Brien, Stephen J

2005-02-01

Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. Case series; Level of evidence, 4. Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.

Contributions of Altered Stretch Reflex Coordination to Arm Impairments Following Stroke

PubMed Central

Ravichandran, Vengateswaran J.; Krutky, Matthew A.; Perreault, Eric J.

2010-01-01

Patterns of stereotyped muscle coactivation, clinically referred to as synergies, emerge following stroke and impair arm function. Although researchers have focused on cortical contributions, there is growing evidence that altered stretch reflex pathways may also contribute to impairment. However, most previous reflex studies have focused on passive, single-joint movements without regard to their coordination during volitional actions. The purpose of this study was to examine the effects of stroke on coordinated activity of stretch reflexes elicited in multiple arm muscles following multijoint perturbations. We hypothesized that cortical injury results in increased stretch reflexes of muscles characteristic of the abnormal flexor synergy during active arm conditions. To test this hypothesis, we used a robot to apply position perturbations to impaired arms of 10 stroke survivors and dominant arms of 8 healthy age-matched controls. Corresponding reflexes were assessed during volitional contractions simulating different levels of gravitational support, as well as during voluntary flexion and extension of the elbow and shoulder. Reflexes were quantified by average rectified surface electromyogram, recorded from eight muscles spanning the elbow and shoulder. Reflex coordination was quantified using an independent components analysis. We found stretch reflexes elicited in the stroke group were significantly less sensitive to changes in background muscle activation compared with those in the control group (P < 0.05). We also observed significantly increased reflex coupling between elbow flexor and shoulder abductor–extensor muscles in stroke subjects relative to that in control subjects. This increased coupling was present only during volitional tasks that required elbow flexion (P < 0.001), shoulder extension (P < 0.01), and gravity opposition (P < 0.01), but not during the “no load” condition. During volitional contractions, reflex amplitudes scaled with the level of impairment, as assessed by Fugl-Meyer scores (r2 = 0.63; P < 0.05). We conclude that altered reflex coordination is indicative of motor impairment level and may contribute to impaired arm function following stroke. PMID:20962072

Rasch analysis of the Patient Rated Elbow Evaluation questionnaire.

PubMed

Vincent, Joshua I; MacDermid, Joy C; King, Graham J W; Grewal, Ruby

2015-06-20

The Patient Rated Elbow Evaluation (PREE) was developed as an elbow joint specific measure of pain and disability and validated with classical psychometric methods. More recently, Rasch analysis has contributed new methods for analyzing the clinical measurement properties of self-report outcome measures. The objective of the study was to determine aspects of validity of the PREE using the Rasch model to assess the overall fit of the PREE data, the response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality and person separation index (PSI). A convenience sample of 236 patients (Age range 21-79 years; M: F- 97:139) with elbow disorders were recruited from the Roth│McFarlane Hand and Upper Limb Centre, London, Ontario, Canada. The baseline scores of the PREE were used. Rasch analysis was conducted using RUMM 2030 software on the 3 sub scales of the PREE separately. The 3 sub scales showed misfit initially with disordered thresholds on17 out of 20 items), uniform DIF was observed for two items ("Carrying a 10lbs object" from specific activities subscale for age group; and "household work" from the usual activities subscale for gender); multidimensionality and local dependency. The Pain subscale satisfied Rasch expectations when item 2 "Pain - At rest" was split for age group, while the usual activities subscale readily stood up to Rasch requirements when the item 2 "household work" was split for gender. The specific activities subscale demonstrated fit to the Rasch model when sub test analysis accounted for local dependency. All three subscales of the PREE were well targeted and had high reliability (PSI >0.80). The three subscales of the PREE appear to be robust when tested against the Rasch model when subject to a few alterations. The value of changing the 0-10 format is questionable given its widespread use; further Rasch-based analysis of whether these findings are stable in other samples is warranted.

Cost analysis and outcomes of simple elbow dislocations

PubMed Central

Panteli, Michalis; Pountos, Ippokratis; Kanakaris, Nikolaos K; Tosounidis, Theodoros H; Giannoudis, Peter V

2015-01-01

AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations. METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level I trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation (LOI), patients were divided in three groups (Group I, < 2 wk; Group II, 2-3 wk; and Group III, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100° (from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed. RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d (median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d (median 57 d; range 10-351 d). Group III (prolonged immobilisation) had a statistically significant worse outcome in comparison to Group I and II (P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups I and II (P = 0.30). No statistically significant difference in the direct medical costs between the groups was identified. CONCLUSION: The length of elbow immobilization doesn’t influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome. PMID:26301180

Kinematic Analysis of Four Plyometric Push-Up Variations

PubMed Central

MOORE, LAURA H.; TANKOVICH, MICHAEL J.; RIEMANN, BRYAN L.; DAVIES, GEORGE J.

2012-01-01

Plyometric research in the upper extremity is limited, with the effects of open-chain plyometric exercises being studied most. Kinematic and ground reaction force data concerning closed-chain upper extremity plyometrics has yet to be examined. Twenty-one recreationally active male subjects performed four variations of plyometric push-ups in a counterbalanced order. These included box drop push-ups from 3.8 cm, 7.6 cm, 11.4 cm heights, and clap push-ups. Kinematics of the trunk, dominant extremity and both hands were collected to examine peak flight, elbow flexion at ground contact, elbow displacement, and hand separation. Additionally peak vertical ground reaction force was measured under the dominant extremity. The 11.4 cm and clap push-ups had significantly higher peak flight than the other variations (P<.001). At ground contact, the elbow was in significantly greater flexion for the 3.8 cm and clap push-up compared to the other variations (P<.001). The clap push-up had significantly more elbow displacement than the other variations (P<.001) while hand separation was not significantly different between variations (P=.129). Peak vertical ground reaction force was significantly greater for the clap push-ups than for all other variations (P< .001). Despite similar flight heights between the 11.4 cm and clap push-ups, the greater peak vertical ground reaction force and elbow displacement of the clap push-ups indicates the clap push-up is the most intense of the variations examined. Understanding the kinematic variables involved will aid in the creation of a closed chain upper-extremity plyometric progression. PMID:27182390

Quantitative magnetic resonance imaging analysis of the cross-sectional areas of the anconeus epitrochlearis muscle, cubital tunnel, and ulnar nerve with the elbow in extension in patients with and without ulnar neuropathy.

PubMed

Eng, Hing Y; Gunio, Drew A; Benitez, Carlos L

2018-05-10

The purpose of this study was to assess the cross-sectional area of the anconeus epitrochlearis muscle (AEM), cubital tunnel, and ulnar nerve with the elbow in extension in patients with and without ulnar neuropathy. We performed a retrospective, level IV review of elbow magnetic resonance imaging (MRI) studies. Elbow MRI studies of 32 patients with an AEM (26 men and 6 women, aged 18-60 years), 32 randomly selected patients without an AEM (aged 16-71 years), and 32 patients with clinical ulnar neuritis (22 men and 10 women, aged 24-76 years) were reviewed. We evaluated the ulnar nerve cross-sectional area proximal to, within, and distal to the cubital tunnel; AEM cross-sectional area; and cubital tunnel cross-sectional area. We found no significant difference in the nerve caliber between patients with and without an AEM. No correlation was found between the AEM cross-sectional area and ulnar nerve cross-sectional area within the cubital tunnel (r = 0.14). The mean cubital tunnel cross-sectional area was larger in patients with an AEM. Only 4 of the 32 patients with an AEM had findings of ulnar neuritis on MRI. Of the 32 patients with a clinical diagnosis of ulnar neuritis, only 2 had an AEM. With the elbow in extension, the presence or cross-sectional area of an AEM does not correlate with the area of the ulnar nerve or cubital tunnel. Only a small number of individuals with MRI evidence of an AEM had clinical evidence of ulnar neuropathy. Likewise, MRI evidence of an AEM was found in only a small number of individuals with clinical evidence of ulnar neuropathy. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

MRI and arthroscopy correlations of the elbow: a case-based approach.

PubMed

Abrams, Geoffrey D; Stoller, David W; Safran, Marc R

2012-01-01

The number of elbow arthroscopies and indications for the procedure have increased significantly since the advent of modern elbow arthroscopy in the 1980s. In addition to the patient history, physical examination, and plain radiography, MRI is an important tool for the clinician in diagnosing several pathologies within and around the elbow. Understanding the pathophysiology and clinical presentation and being familiar with the MRI characteristics of a variety of elbow conditions will assist the physician in making an accurate diagnosis and help guide appropriate treatment.

Elbow injuries at the London 2012 Summer Olympic Games: demographics and pictorial imaging review.

PubMed

Bethapudi, Sarath; Robinson, Philip; Engebretsen, Lars; Budgett, Richard; Vanhegan, Ivor S; O'Connor, Philip

2013-09-01

Elbow injuries in Olympic sports and their imaging findings have not been described previously. The main objective of this article is to analyze the demographic data on imaging of elbow injuries at the London 2012 Summer Olympic Games and to review the spectrum of imaging findings. Elbow injuries were seen in a wide variety of sports. Judo and weight-lifting contributed nearly half of all injuries, with only a surprisingly small number of injuries seen in throwing athletes. Knowledge of elbow anatomy coupled with awareness of types of elbow injuries and their prevalence in various sports will contribute toward improving diagnostic accuracy, handling of workload, and overall provision of services at similar major international sporting events in the future.

Ultrasonographic Differentiation of Lateral Elbow Pain

PubMed Central

Obuchowicz, R.; Bonczar, M.

2016-01-01

Lateral elbow pain is often attributed to degenerative or posttraumatic impairment of the common extensor tendon. Ultrasonography assesses the soft tissue structures of the lateral elbow, allowing the differentiation between various underlying processes, including angiofibroblastic degeneration, hyaline degeneration, and inflammation, and exclusion of other possible causes of pain such as posterior interosseous and lateral antebrachial nerve compression. Furthermore, the real-time imaging nature of ultrasonography enables the detection of impingement of the lateral synovial fold, degenerative changes in the elbow recess, and elbow posterolateral instability during dynamic maneuvers. Ultrasonography is widely accessible and well tolerated by patients, making it a perfect method for establishing an initial diagnosis and monitoring the healing process. This review describes the possible causes of lateral elbow pain and their ultrasonographic differentiation. PMID:27689169

Effects of strength training, detraining and retraining in muscle strength, hypertrophy and functional tasks in older female adults.

PubMed

Correa, Cleiton S; Cunha, Giovani; Marques, Nise; Oliveira-Reischak, Ãlvaro; Pinto, Ronei

2016-07-01

Previous studies presented different results regarding the maintenance time of muscular adaptations after strength training and the ability to resume the gains on muscular performance after resumption of the training programme. This study aimed to verify the effect of strength training on knee extensors and elbow flexor muscle strength, rectus femoris muscle volume and functional performance in older female adults after 12 weeks of strength training, 1 year of detraining and followed by 12 weeks of retraining. Twelve sedentary older women performed 12 weeks of strength training, 1 year of detraining and 12 weeks of retraining. The strength training was performed twice a week, and the assessment was made four times: at the baseline, after the strength training, after the detraining and after the retraining. The knee extensor and elbow flexor strength, rectus femoris muscle volume and functional task were assessed. Strength of knee extensor and elbow flexor muscles, rectus femoris muscle volume and 30-s sit-to-stand increased from baseline to post-training (respectively, 40%, 70%, 38% and 46%), decreased after detraining (respectively, -36%, -64%, -35% and -43%) and increased again these parameters after retraining (35%, 68%, 36% and 42%). Strength training induces gains on strength and hypertrophy, also increased the performance on functional tasks after the strength training. The stoppage of the strength caused strength loss and reduction of functional performance. The resumption of the strength training promoted the same gains of muscular performance in older female adults. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Musculoskeletal Model-Guided, Customizable Selection of Shoulder and Elbow Muscles for a C5 SCI Neuroprosthesis

PubMed Central

Hincapie, Juan Gabriel; Blana, Dimitra; Chadwick, Edward K.; Kirsch, Robert F.

2010-01-01

Individuals with C5/C6 spinal cord injury (SCI) have a number of paralyzed muscles in their upper extremities that can be electrically activated in a coordinated manner to restore function. The selection of a practical subset of paralyzed muscles for stimulation depends on the specific condition of the individual, the functions targeted for restoration, and surgical considerations. This paper presents a musculoskeletal model-based approach for optimizing the muscle set used for functional electrical stimulation (FES) of the shoulder and elbow in this population. Experimentally recorded kinematics from able-bodied subjects served as inputs to a musculoskeletal model of the shoulder and elbow, which was modified to reflect the reduced muscle force capacities of an individual with C5 SCI but also the potential of using FES to activate paralyzed muscles. A large number of inverse dynamic simulations mimicking typical activities of daily living were performed that included 1) muscles with retained voluntary control and 2) many different combinations of stimulated paralyzed muscles. These results indicate that a muscle set consisting of the serratus anterior, infraspinatus and triceps would enable the greatest range of relevant movements. This set will become the initial target in a C5 SCI neuroprosthesis to restore shoulder and elbow function. PMID:18586604

Sex comparisons of non-local muscle fatigue in human elbow flexors and knee extensors

PubMed Central

Ye, Xin; Beck, Travis W.; Wages, Nathan P.; Carr, Joshua C.

2018-01-01

Objectives: To examine non-local muscle fatigue (NLMF) in both contralateral homologous and non-related heterogonous muscles for both sexes. Methods: Ten men and nine women participated in this study. After the familiarization visit, subjects completed four separate randomly sequenced experimental visits, during which the fatiguing interventions (six sets of 30-second maximal isometric contractions) were performed on either their right elbow flexors or knee extensors. Before (Pre-) and after (Post-) the fatiguing interventions, the isometric strength and the corresponding surface electromyographic (EMG) amplitude were measured for the non-exercised left elbow flexors or knee extensors. Results: For the non-exercised elbow flexors, the isometric strength decreased for both sexes (sex combined mean±SE: Pre vs. Post=339.67±18.02 N vs. 314.41±16.37 N; p<0.001). For the non-exercised knee extensors, there is a time ´ sex interaction (p=0.025), showing a decreased isometric knee extension strength for men (Pre vs. Post =845.02±66.26 N vs. 817.39±67.64 N; p=0.019), but not for women. Conclusions: The presence of NMLF can be affected by factors such as sex and muscle being tested. Women are less likely to demonstrate NLMF in lower body muscle groups. PMID:29504584

Elbow joint variability for different hand positions of the round off in gymnastics.

PubMed

Farana, Roman; Irwin, Gareth; Jandacka, Daniel; Uchytil, Jaroslav; Mullineaux, David R

2015-02-01

The aim of the present study was to conduct within-gymnast analyses of biological movement variability in impact forces, elbow joint kinematics and kinetics of expert gymnasts in the execution of the round-off with different hand positions. Six international level female gymnasts performed 10 trials of the round-off from a hurdle step to a back-handspring using two hand potions: parallel and T-shape. Two force plates were used to determine ground reaction forces. Eight infrared cameras were employed to collect the kinematic data automatically. Within gymnast variability was calculated using biological coefficient of variation (BCV) discretely for ground reaction force, kinematic and kinetic measures. Variability of the continuous data was quantified using coefficient of multiple correlations (CMC). Group BCV and CMC were calculated and T-test with effect size statistics determined differences between the variability of the two techniques examined in this study. The major observation was a higher level of biological variability in the elbow joint abduction angle and adduction moment of force in the T-shaped hand position. This finding may lead to a reduced repetitive abduction stress and thus protect the elbow joint from overload. Knowledge of the differences in biological variability can inform clinicians and practitioners with effective skill selection. Copyright © 2014 Elsevier B.V. All rights reserved.

Comparison of joint space and end point space robotic training modalities for rehabilitation of interjoint coordination in individuals with moderate to severe impairment from chronic stroke.

PubMed

Brokaw, Elizabeth B; Holley, Rahsaan J; Lum, Peter S

2013-09-01

We have developed a novel robotic modality called Time Independent Functional Training (TIFT) that provides focused retraining of interjoint coordination after stroke. TIFT was implemented on the ARMin III exoskeleton and provides joint space walls that resist movement patterns that are inconsistent with the targeted interjoint coordination pattern. In a single test session, ten moderate to severely impaired individuals with chronic stroke practiced synchronous shoulder abduction and elbow extension in TIFT and also in a comparison mode commonly used in robotic therapy called end point tunnel training (EPTT). In EPTT, error is limited by forces applied to the hand that are normal to the targeted end point trajectory. The completion percentage of the movements was comparable between modes, but the coordination patterns used by subjects differed between modes. In TIFT, subjects performed the targeted pattern of synchronous shoulder abduction and elbow extension, while in EPTT, movements were completed with compensatory strategies that incorporated the flexor synergy (shoulder abduction with elbow flexion) or the extensor synergy (shoulder adduction with elbow extension). There were immediate effects on free movements, with TIFT resulting in larger improvements in interjoint coordination than EPTT. TIFT's ability to elicit normal coordination patterns merits further investigation into the effects of longer duration training.

[Pulley for strengthening a muscle replacement operation across two joints in brachial plexus lesion: description of the surgical technique].

PubMed

Berger, A; Schaller, E; Becker, M H

1994-01-01

The reconstruction of lost muscle functions in cases of brachial plexus lesion is possible even in those cases where primary nerve reconstruction was not performed or unsuccessful. If there are only few motor nerves available, we prefer free latissimus dorsi transplantation or pedicled latissimus dorsi transposition for replacement of biceps and finger flexors. The combination of elbow flexion and finger flexion becomes possible when the transposed motor is passed around a suitable pulley in the elbow region like the flexor carpi ulnaris or carpi radialis.

Estimation of elbow flexion force during isometric muscle contraction from mechanomyography and electromyography.

PubMed

Youn, Wonkeun; Kim, Jung

2010-11-01

Mechanomyography (MMG) is the muscle surface oscillations that are generated by the dimensional change of the contracting muscle fibers. Because MMG reflects the number of recruited motor units and their firing rates, just as electromyography (EMG) is influenced by these two factors, it can be used to estimate the force exerted by skeletal muscles. The aim of this study was to demonstrate the feasibility of MMG for estimating the elbow flexion force at the wrist under an isometric contraction by using an artificial neural network in comparison with EMG. We performed experiments with five subjects, and the force at the wrist and the MMG from the contributing muscles were recorded. It was found that MMG could be utilized to accurately estimate the isometric elbow flexion force based on the values of the normalized root mean square error (NRMSE = 0.131 ± 0.018) and the cross-correlation coefficient (CORR = 0.892 ± 0.033). Although MMG can be influenced by the physical milieu/morphology of the muscle and EMG performed better than MMG, these experimental results suggest that MMG has the potential to estimate muscle forces. These experimental results also demonstrated that MMG in combination with EMG resulted in better performance estimation in comparison with EMG or MMG alone, indicating that a combination of MMG and EMG signals could be used to provide complimentary information on muscle contraction.

Proprioceptive coordination of movement sequences: role of velocity and position information.

PubMed

Cordo, P; Carlton, L; Bevan, L; Carlton, M; Kerr, G K

1994-05-01

1. Recent studies have shown that the CNS uses proprioceptive information to coordinate multijoint movement sequences; proprioceptive input related to the kinematics of one joint rotation in a movement sequence can be used to trigger a subsequent joint rotation. In this paper we adopt a broad definition of "proprioception," which includes all somatosensory information related to joint posture and kinematics. This paper addresses how the CNS uses proprioceptive information related to the velocity and position of joints to coordinate multijoint movement sequences. 2. Normal human subjects sat at an experimental apparatus and performed a movement sequence with the right arm without visual feedback. The apparatus passively rotated the right elbow horizontally in the extension direction with either a constant velocity trajectory or an unpredictable velocity trajectory. The subjects' task was to open briskly the right hand when the elbow passed through a prescribed target position, similar to backhand throwing in the horizontal plane. The randomization of elbow velocities and the absence of visual information was used to discourage subjects from using any information other than proprioceptive input to perform the task. 3. Our results indicate that the CNS is able to extract the necessary kinematic information from proprioceptive input to trigger the hand opening at the correct elbow position. We estimated the minimal sensory conduction and processing delay to be 150 ms, and on the basis of this estimate, we predicted the expected performance with different degrees of reduced proprioceptive information. These predictions were compared with the subjects' actual performances, revealing that the CNS was using proprioceptive input related to joint velocity in this motor task. To determine whether position information was also being used, we examined the subjects' performances with unpredictable velocity trajectories. The results from experiments with unpredictable velocity trajectories indicate that the CNS extracts proprioceptive information related to both the velocity and the angular position of the joint to trigger the hand movement in this movement sequence. 4. To determine the generality of proprioceptive triggering in movement sequences, we estimated the minimal movement duration with which proprioceptive information can be used as well as the amount of learning required to use proprioceptive input to perform the task. The temporal limits for proprioceptive processing in this movement task were established by determining the minimal movement time during which the task could be performed.(ABSTRACT TRUNCATED AT 400 WORDS)

Phase-II Clinical Validation of a Powered Exoskeleton for the Treatment of Elbow Spasticity

PubMed Central

Crea, Simona; Cempini, Marco; Mazzoleni, Stefano; Carrozza, Maria Chiara; Posteraro, Federico; Vitiello, Nicola

2017-01-01

Introduction: Spasticity is a typical motor disorder in patients affected by stroke. Typically post-stroke rehabilitation consists of repetition of mobilization exercises on impaired limbs, aimed to reduce muscle hypertonia and mitigate spastic reflexes. It is currently strongly debated if the treatment's effectiveness improves with the timeliness of its adoption; in particular, starting intensive rehabilitation as close as possible to the stroke event may counteract the growth and postpone the onset of spasticity. In this paper we present a phase-II clinical validation of a robotic exoskeleton in treating subacute post-stroke patients. Methods: Seventeen post-stroke patients participated in 10 daily rehabilitation sessions using the NEUROExos Elbow Module exoskeleton, each one lasting 45 min: the exercises consisted of isokinetic passive mobilization of the elbow, with torque threshold to detect excessive user's resistance to the movement. We investigated the safety by reporting possible adverse events, such as mechanical, electrical or software failures of the device or injuries or pain experienced by the patient. As regards the efficacy, the Modified Ashworth Scale, was identified as primary outcome measure and the NEEM metrics describing elbow joint resistance to passive extension (i.e., maximum extension torque and zero-torque angle) as secondary outcomes. Results: During the entire duration of the treatments no failures or adverse events for the patients were reported. No statistically significant differences were found in the Modified Ashworth Scale scores, between pre-treatment and post-treatment and between post-treatment and follow-up sessions, indicating the absence of spasticity increase throughout (14 days) and after (3–4 months follow-up) the treatment. Exoskeleton metrics confirmed the absence of significant difference in between pre- and post-treatment data, whereas intra-session data highlighted significant differences in the secondary outcomes, toward a decrease of the subject's joint resistance. Conclusions: The results show that our robotic exoskeleton can be safely used for prolonged sessions in post-stroke and suggest that intensive early rehabilitation treatment may prevent the occurrence of spasticity at a later stage. Moreover, the NEEM metrics were found to be reliable compared to the Modified Ashworth Scale and sensitive to revealing intra-session changes of elbow resistance to passive extension, in agreement with clinical evidences. PMID:28553200

Phase-II Clinical Validation of a Powered Exoskeleton for the Treatment of Elbow Spasticity.

PubMed

Crea, Simona; Cempini, Marco; Mazzoleni, Stefano; Carrozza, Maria Chiara; Posteraro, Federico; Vitiello, Nicola

2017-01-01

Introduction: Spasticity is a typical motor disorder in patients affected by stroke. Typically post-stroke rehabilitation consists of repetition of mobilization exercises on impaired limbs, aimed to reduce muscle hypertonia and mitigate spastic reflexes. It is currently strongly debated if the treatment's effectiveness improves with the timeliness of its adoption; in particular, starting intensive rehabilitation as close as possible to the stroke event may counteract the growth and postpone the onset of spasticity. In this paper we present a phase-II clinical validation of a robotic exoskeleton in treating subacute post-stroke patients. Methods: Seventeen post-stroke patients participated in 10 daily rehabilitation sessions using the NEUROExos Elbow Module exoskeleton, each one lasting 45 min: the exercises consisted of isokinetic passive mobilization of the elbow, with torque threshold to detect excessive user's resistance to the movement. We investigated the safety by reporting possible adverse events, such as mechanical, electrical or software failures of the device or injuries or pain experienced by the patient. As regards the efficacy , the Modified Ashworth Scale, was identified as primary outcome measure and the NEEM metrics describing elbow joint resistance to passive extension (i.e., maximum extension torque and zero-torque angle) as secondary outcomes. Results: During the entire duration of the treatments no failures or adverse events for the patients were reported. No statistically significant differences were found in the Modified Ashworth Scale scores, between pre-treatment and post-treatment and between post-treatment and follow-up sessions, indicating the absence of spasticity increase throughout (14 days) and after (3-4 months follow-up) the treatment. Exoskeleton metrics confirmed the absence of significant difference in between pre- and post-treatment data, whereas intra-session data highlighted significant differences in the secondary outcomes, toward a decrease of the subject's joint resistance. Conclusions: The results show that our robotic exoskeleton can be safely used for prolonged sessions in post-stroke and suggest that intensive early rehabilitation treatment may prevent the occurrence of spasticity at a later stage. Moreover, the NEEM metrics were found to be reliable compared to the Modified Ashworth Scale and sensitive to revealing intra-session changes of elbow resistance to passive extension, in agreement with clinical evidences.

Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

PubMed Central

Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

2015-01-01

The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

Isometric elbow extensors strength in supine- and prone-lying positions.

PubMed

Abdelzaher, Ibrahim E; Ababneh, Anas F; Alzyoud, Jehad M

2013-01-01

The purpose of this study was to compare isometric strength of elbow extensors measured in supine- and prone-lying positions at elbow flexion angles of 45 and 90 degrees. Twenty-two male subjects under single-blind procedures participated in the study. Each subject participated in both supine-lying and prone-lying measuring protocols. Calibrated cable tensiometer was used to measure isometric strength of the right elbow extensors and a biofeedback electromyography was used to assure no substitution movements from shoulder girdle muscles. The mean values of isometric strength of elbow extensors measured from supine-lying position at elbow flexion angles of 45 and 90 degrees were 11.1  ±  4.2 kg and 13.1  ±  4.6 kg, while those measured from prone-lying position were 9.9  ±  3.6 kg and 12  ±  4.2 kg, respectively. There is statistical significant difference between the isometric strength of elbow extensors measured from supine-lying position at elbow flexion angles of 45 and 90 degrees compared to that measured from prone-lying position (p  <  0.05). The results suggest that in manual muscle testing starting position can affect the isometric strength of elbow extensors since supine-lying starting position is better than prone-lying starting position.

Two-year outcomes of open shoulder anterior capsular reconstruction for instability from severe capsular deficiency.

PubMed

Dewing, Christopher B; Horan, Marilee P; Millett, Peter J

2012-01-01

To document outcomes after anterior capsulolabral reconstruction for recurrent shoulder instability in 15 patients (20 shoulders) who have had multiple failed stabilizations or collagen disorders. Twenty shoulders with recurrent instability underwent revision stabilization with allograft reconstruction of anterior capsulolabral structures, which re-creates the labrum and capsular ligaments. The patients comprised 3 men and 12 women (mean age, 26 years [range, 18 to 38 years]) in whom multiple prior repairs failed and who had disability from continued pain and instability. Patients could choose to undergo either arthrodesis or salvage allograft reconstruction or to live with permanent disability. Of the patients, 5 had Ehlers-Danlos syndrome whereas 10 had hyperlaxity syndromes without genetic confirmation. Failure was defined as further instability surgery. Pain, shoulder function, instability (dislocations/subluxation), and American Shoulder and Elbow Surgeons scores were documented. At follow-up, 9 of 20 shoulders (45%) remained stable. Recurrent instability was reported in 5 shoulders (25%), but the patients chose not to undergo further surgery. In the 14 shoulders without further stabilization (nonfailures), the mean American Shoulder and Elbow Surgeons score increased 43 points at a mean of 3.8 years (range, 2 to 6 years) postoperatively (P < .05). Mean satisfaction with outcome in nonfailures was 7 of 10 points (range, 1 to 10). Six shoulders failed by progressing to instability surgery at a mean of 8.6 months (range, 2.8 to 24 months). In the 6 shoulders that failed, the mean number of prior surgeries was 8 (range, 3 to 15) compared with a mean of 4 prior surgeries (range, 1 to 16) for the 9 nonfailures. Treating patients in whom multiple stabilizations have failed remains challenging. In our series 9 shoulders (45%) remained completely stable at 3.8 years. Recurrent instability (3 reinjuries) requiring further stabilization occurred in 6 (30%). Subsequent treatment for non-instability reasons was performed in 3 (15%). Instability was reported but revision surgery was not performed in 5 (25%). In 8 nonfailures (64%), the patients were highly satisfied with their surgical outcomes. Our results support this salvage procedure as a viable alternative to arthrodesis in young patients with end-stage shoulder instability or collagen disorders. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy?

PubMed

Leis, A Arturo; Smith, Benn E; Kosiorek, Heidi E; Omejec, Gregor; Podnar, Simon

2017-08-01

Recurrent complete ulnar nerve dislocation has been perceived as a risk factor for development of ulnar neuropathy at the elbow (UNE). However, the role of dislocation in the pathogenesis of UNE remains uncertain. We studied 133 patients with complete ulnar nerve dislocation to determine whether this condition is a risk factor for UNE. In all, the nerve was palpated as it rolled over the medial epicondyle during elbow flexion. Of 56 elbows with unilateral dislocation, UNE localized contralaterally in 17 elbows (30.4%) and ipsilaterally in 10 elbows (17.9%). Of 154 elbows with bilateral dislocation, 26 had UNE (16.9%). Complete dislocation decreased the odds of having UNE by 44% (odds ratio = 0.475; P =  0.028), and was associated with less severe UNE (P = 0.045). UNE occurs less frequently and is less severe on the side of complete dislocation. Complete dislocation may have a protective effect on the ulnar nerve. Muscle Nerve 56: 242-246, 2017. © 2016 Wiley Periodicals, Inc.

Golfer's Elbow

MedlinePlus

... your elbow can cause golfer's elbow. This includes painting, raking, hammering, chopping wood, using a computer, doing ... using older golfing irons, consider upgrading to lighter graphite clubs. If you play tennis, a racket with ...

Press-fit bipolar radial head arthroplasty, midterm results.

PubMed

Kodde, Izaäk F; Heijink, Andras; Kaas, Laurens; Mulder, Paul G H; van Dijk, C Niek; Eygendaal, Denise

2016-08-01

Theoretical advantages of bipolar compared with monopolar radial head arthroplasty include better accommodation of radiocapitellar malalignment, reduction of capitellar abrasion, and reduction of stress at the bone-implant interfaces. Our purpose was to report the midterm results of press-fit bipolar radial head arthroplasty. Thirty patients were treated by press-fit bipolar radial head arthroplasty for acute fracture of the radial head, failed earlier treatment, or post-traumatic sequelae. Three patients were lost to follow-up. Results are presented for the remaining 27 patients. At mean follow-up of 48 months (range, 28-73), there had been 3 (11%) revisions. Two involved conversion to prosthetic radiocapitellar hemiarthroplasty for symptomatic capitellar abrasion; a third involved exchange of the articular component (ie, head) for instability. In all, the stems appeared well fixed. A prosthesis in a subluxed position accounted for the 1 (4%) additional radiologic failure. The average flexion-extension arc was 136° (range, 120°-145°), and the average pronation-supination arc was 138° (range, 70°-180°). According to the Mayo Elbow Performance Score, the combined excellent and good results accounted for 70%. The overall midterm outcome of this series of 30 press-fit bipolar radial head arthroplasties can be considered favorable. Although the revision rate was 11%, the stems were well fixed in all. There was 1 (4%) additional radiologic failure. We suggest considering a press-fit bipolar radial head prosthesis for acute comminuted radial head fractures with limited bone loss of the proximal radius. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Resource intensification and osteoarthritis patterns: changes in activity in the prehistoric Sacramento-San Joaquin Delta region.

PubMed

Cheverko, Colleen M; Bartelink, Eric J

2017-10-01

Ethnohistoric accounts and archaeological research from Central California document a shift from the use of lower-cost, high-ranked resources (e.g., large game) toward the greater use of higher-cost, low-ranked resources (e.g., acorns and small seeds) during the Late Holocene (4500-200 BP). The subsistence transition from higher consumption of large game toward an increased reliance on acorns was likely associated with increases in levels of logistical mobility and physical activity. This study predicts that mobility and overall workload patterns changed during this transition to accommodate new food procurement strategies and incorporate new dietary resources during the Late Holocene in Central California. Osteoarthritis prevalence was scored in the shoulder, elbow, hip, and knee of adult individuals (n = 256) from seven archaeological sites in the Sacramento-San Joaquin Delta region. Comparisons were made between osteoarthritis prevalence, sex, age-at-death, and time period using ANCOVAs. The results of this study indicate significant increases in osteoarthritis prevalence in the hip of adult males and females during the Late Period (1200-200 BP), even after correcting for the cumulative effects of age. No differences were observed between the sexes or between time periods for the shoulder, elbow, and knee joints. The temporal increase in hip osteoarthritis supports the hypothesis that there was an increasing need for greater logistical mobility over time to procure key resources away from the village sites. Additionally, the lack of sex differences in osteoarthritis prevalence may suggest that females and males likely performed similar levels of activity during these periods. © 2017 Wiley Periodicals, Inc.

A systematic, multimodality approach to emergency elbow imaging.

PubMed

Singer, Adam D; Hanna, Tarek; Jose, Jean; Datir, Abhijit

2016-01-01

The elbow is a complex synovial hinge joint that is frequently involved in both athletic and nonathletic injuries. A thorough understanding of the normal anatomy and various injury patterns is essential when utilizing diagnostic imaging to identify damaged structures and to assist in surgical planning. In this review, the elbow anatomy will be scrutinized in a systematic approach. This will be followed by a comprehensive presentation of elbow injuries that are commonly seen in the emergency department accompanied by multimodality imaging findings. A short discussion regarding pitfalls in elbow imaging is also included. Copyright © 2015 Elsevier Inc. All rights reserved.

Tennis elbow surgery

MedlinePlus

Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

Evaluating Suit Fit Using Performance Degradation

NASA Technical Reports Server (NTRS)

Margerum, Sarah E.; Cowley, Matthew; Harvill, Lauren; Benson, Elizabeth; Rajulu, Sudhakar

2011-01-01

The Mark III suit has multiple sizes of suit components (arm, leg, and gloves) as well as sizing inserts to tailor the fit of the suit to an individual. This study sought to determine a way to identify the point an ideal suit fit transforms into a bad fit and how to quantify this breakdown using mobility-based physical performance data. This study examined the changes in human physical performance via degradation of the elbow and wrist range of motion of the planetary suit prototype (Mark III) with respect to changes in sizing and as well as how to apply that knowledge to suit sizing options and improvements in suit fit. The methods implemented in this study focused on changes in elbow and wrist mobility due to incremental suit sizing modifications. This incremental sizing was within a range that included both optimum and poor fit. Suited range of motion data was collected using a motion analysis system for nine isolated and functional tasks encompassing the elbow and wrist joints. A total of four subjects were tested with motions involving both arms simultaneously as well as the right arm only. The results were then compared across sizing configurations. The results of this study indicate that range of motion may be used as a viable parameter to quantify at what stage suit sizing causes a detriment in performance; however the human performance decrement appeared to be based on the interaction of multiple joints along a limb, not a single joint angle. The study was able to identify a preliminary method to quantify the impact of size on performance and to develop a means to gauge tolerances around optimal size. More work is needed to improve the assessment of optimal fit and to compensate for multiple joint interactions.

Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair

PubMed Central

Flanagin, Brody A.; Garofalo, Raffaele; Lo, Eddie Y.; Feher, LeeAnne; Castagna, Alessandro; Qin, Huanying; Krishnan, Sumant G.

2016-01-01

Purpose: Arthroscopic transosseous (TO) rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless) rotator cuff repair technique. Materials and Methods: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless) rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM) was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student's t-test to compare the effect of other clinical characteristics on final outcome. Results: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001). Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES) score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%), good in 8 (7.3%), fair in 3 (2.8%), and poor in 3 (2.8%). There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy) compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of injury preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. Conclusions: Arthroscopic TO rotator cuff repair technique leads to statistically significant midterm improvement in ROM and satisfactory midterm subjective outcome scores with low complication/failure rates in patients with average medium-sized rotator cuff tears with minimal fatty infiltration. Further work is required to evaluate radiographic healing rates with this technique and to compare outcomes following suture anchor repair. Level of Evidence: Level IV PMID:26980983

A Comparative Outcome Study of Hamstring Versus Tibialis Anterior and Synthetic Grafts for Deltoid to Triceps Transfers.

PubMed

Dunn, Jennifer A; Mohammed, Khalid D; Beadel, Gordon P; Rothwell, Alastair G; Simcock, Jeremy W

2017-10-01

To assess elbow extension strength and complications after deltoid-triceps transfers using hamstring tendon graft compared with tibialis anterior and synthetic tendon grafts. A retrospective review of deltoid-triceps transfers in patients with tetraplegia performed between 1983 and 2014. Seventy-five people (136 arms) had surgery performed, with the majority undergoing simultaneous bilateral surgery (n = 61; 81%). Tibialis anterior tendon grafts were used in 68 arms, synthetic grafts in 23 arms, and hamstring tendon grafts in 45 arms. The average age at surgery was 31 years. Sixty-three arms (46%) were assessed between 12 and 24 months after surgery. Seventy percent of the group (n = 54) were able to extend their elbow against gravity (grade 3 of 5 or greater) following surgery. Seventy-nine percent of those with hamstring grafts achieved grade 3 of 5 or more compared with 77% with tibialis anterior and 33% with synthetic grafts. There was a statistically significant difference in postsurgery elbow extension between the tibialis anterior group and the synthetic graft group and the hamstring and the synthetic graft group but not between the tibialis anterior and the hamstring group. Complications occurred in 19 arms (14%), the majority occurring immediately after surgery and associated with the wounds. The remaining complications were with the synthetic graft group in which dehiscence of the proximal attachment occurred in 30% of the arms. Autologous tendon grafting is associated with achievement of antigravity elbow extension in a greater proportion of individuals than with prosthetic grafting. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The effects of a 28-Hz vibration on arm muscle activity during isometric exercise.

PubMed

Mischi, Massimo; Cardinale, Marco

2009-03-01

The aim of this study was to evaluate activation and coactivation of biceps and triceps muscles during isometric exercise performed with and without superimposing a vibration stimulation. Twelve healthy volunteers (age = 22.7 +/- 2.6 yr) participated in this study. The subjects performed five trials of isometric elbow flexion and five trials of elbow extension with increasing levels of force in two conditions: vibration (V) and normal loading (C). V stimulation was characterized by a frequency of 28 Hz. Surface EMG activity of biceps and triceps muscles was simultaneously measured by bipolar surface electromyography and assessed by the estimation of the root mean square (RMS) of the electrical recordings over a fixed 5-s interval. Frequency analysis was adopted to estimate the RMS related to muscle activation and to exclude the harmonics generated by movement artifacts due to V. The analysis of the recordings revealed a significant EMG RMS increase when V was applied. On average, the EMG RMS of biceps and triceps during elbow flexion was, respectively, 26.1% (P < 0.05) and 18.2% (P = 0.15) higher than C. During elbow extension, the EMG RMS of biceps and triceps was 77.2% and 45.2% (P < 0.05) higher than C, respectively. The coactivation was assessed as the ratio between the activation of antagonist and agonist muscles during arm flexion and extension tasks. The results revealed an increase of coactivation during V exercise, especially for lighter loads. This study shows that V exercise at 28 Hz produces an increase of the activation and the coactivation of biceps and triceps. This exercise modality seems therefore suitable for various applications.

Nursemaid's Elbow (For Parents)

MedlinePlus

... Parents Parents site Sitio para padres General Health Growth & Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & ... For Parents / Nursemaid's Elbow Print About Nursemaid's Elbow Toddlers and preschoolers are at risk for a common ...

Comparative study of phrenic and intercostal nerve transfers for elbow flexion after global brachial plexus injury.

PubMed

Liu, Yuzhou; Lao, Jie; Zhao, Xin

2015-04-01

Global brachial plexus injuries (BPIs) are devastating events frequently resulting in severe functional impairment. The widely used nerve transfer sources for elbow flexion in patients with global BPIs include intercostal and phrenic nerves. The aim of this study was to compare phrenic and intercostal nerve transfers for elbow flexion after global BPI. A retrospective review of 33 patients treated with phrenic and intercostal nerve transfer for elbow flexion in posttraumatic global root avulsion BPI was carried out. In the phrenic nerve transfer group, the phrenic nerve was transferred to the anterolateral bundle of the anterior division of the upper trunk (23 patients); in the intercostal nerve transfer group, three intercostal nerves were coapted to the anterolateral bundles of the musculocutaneous nerve. The British Medical Research Council (MRC) grading system, angle of elbow flexion, and electromyography (EMG) were used to evaluate the recovery of elbow flexion at least 3 years postoperatively. The efficiency of motor function in the phrenic nerve transfer group was 83%, while it was 70% in the intercostal nerve transfer group. The two groups were not statistically different in terms of the MRC grade (p=0.646) and EMG results (p=0.646). The outstanding rates of angle of elbow flexion were 48% and 40% in the phrenic and intercostal nerve transfer groups, respectively. There was no significant difference of outstanding rates in the angle of elbow flexion between the two groups. Phrenic nerve transfer had a higher proportion of good prognosis for elbow flexion than intercostal nerve transfer, but the effective and outstanding rate had no significant difference for biceps reinnervation between the two groups according to MRC grading, angle of elbow flexion, and EMG. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of elbow and forearm position on contact pressure between the extensor origin and the lateral side of the capitellum.

PubMed

Tanaka, Yoshitaka; Aoki, Mitsuhiro; Izumi, Tomoki; Wada, Takuro; Fujimiya, Mineko; Yamashita, Toshihiko

2011-01-01

Bone-to-tendon contact in the origin of the common extensor tendons is considered to be one of the causes of lateral epicondylitis. Some factors, including elbow and forearm position, varus stress to the elbow, or contraction of the wrist extensor tendons, are considered to affect this bone-to-tendon contact. However, no studies have evaluated the effect of the elbow and forearm position on bone-tendon interface. The purpose of this study is to evaluate the effect of the position of the elbow and forearm on the contact pressure of the tendinous origin of the common wrist and finger extensors. We used 8 fresh cadaveric upper extremities. Contact pressure between the origin of the common extensor tendons and the lateral side of the capitellum was measured with a pressure sensor and was compared among various conditions, including elbow flexion angle (0°, 30°, 60°, and 90°), forearm rotation position (neutral and 81.5° pronation position), and varus stress load of the elbow (none, gravity on the forearm, and gravity on the forearm +1.96 Nm). Contact pressure was also measured during tension force of the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor digitorum communis by 0, 9.8, and 19.6 N. Contact pressure was significantly increased with the elbow extension position, forearm pronation position, and varus stress to the elbow under tension of the extensor carpi radialis longus or extensor carpi radialis brevis. This study provides data about the amount of contact pressure between bone and tendon at the origin of the common extensor tendons in the elbow. This information may lead to a better understanding of, and better treatment for, lateral epicondylitis. Copyright © 2011. Published by Elsevier Inc.

The effect of repetitive baseball pitching on medial elbow joint space gapping associated with 2 elbow valgus stressors in high school baseball players.

PubMed

Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Hall, Toby; Amemiya, Katsuya; Mori, Yoshihisa

2018-04-01

To prevent elbow injury in baseball players, various methods have been used to measure medial elbow joint stability with valgus stress. However, no studies have investigated higher levels of elbow valgus stress. This study investigated medial elbow joint space gapping measured ultrasonically resulting from a 30 N valgus stress vs. gravitational valgus stress after a repetitive throwing task. The study included 25 high school baseball players. Each subject pitched 100 times. The ulnohumeral joint space was measured ultrasonographically, before pitching and after each successive block of 20 pitches, with gravity stress or 30 N valgus stress. Two-way repeated measures analysis of variance and Pearson correlation coefficient analysis were used. The 30 N valgus stress produced significantly greater ulnohumeral joint space gapping than gravity stress before pitching and at each successive 20-pitch block (P < .01). For the 2 stress methods, ulnohumeral joint space gapping increased significantly from baseline after 60 pitches (P < .01). Strong significant correlations were found between the 2 methods for measurement of medial elbow joint space gapping (r = 0.727-0.859, P < .01). Gravity stress and 30 N valgus stress may produce different effects with respect to medial elbow joint space gapping before pitching; however, 30 N valgus stress appears to induce greater mechanical stress, which may be preferable when assessing joint instability but also has the potential to be more aggressive. The present results may indicate that constraining factors to medial elbow joint valgus stress matched typical viscoelastic properties of cyclic creep. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers.

PubMed

Zargarbashi, Ramin; Nabian, Mohammad Hossein; Werthel, Jean-David; Valenti, Philippe

2017-11-01

Scant data are published about different available therapeutic options for restoration of active elbow flexion in arthrogryposis with varying degrees of improvement. In this retrospective study we evaluated medium-term effects of bipolar latissimus dorsi transfer in patients with arthrogryposis. Pedicled latissimus dorsi bipolar muscle transfer was used to restore elbow flexion in 11 patients (13 limbs) with arthrogryposis. Elbow and shoulder range of motions and strength of elbow flexion were measured preoperatively and at the last follow-up. The functional use of the upper limb was examined by observation of activities of daily living and presence of adaptive mechanisms. General satisfaction was assessed at the final follow-up. The patients were a mean age of 5.69 ± 2.49 years. The follow-up period was 27.31 ± 17.8 months. At the last examination, according to transferred muscle function and elbow range of motion, function of 12 limbs was graded as excellent and good, and 1 was graded poor. The active postoperative elbow range of motion was 97.7° ± 34.5°. The general satisfaction of the patients with the surgical results was 92.3%. Activities of daily living were improved in 10 of 13 limbs, but adaptive mechanisms were detected in all patients except 2 at the last follow-up. We suggest pedicled bipolar latissimus dorsi transfer as a reliable therapeutic option to restore active elbow flexion in arthrogryposis with acceptable results regarding regaining range of motion and patient satisfaction. Functional passive elbow range of motion and good quality of latissimus dorsi muscle preoperatively is mandatory. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements

NASA Astrophysics Data System (ADS)

Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

2017-02-01

Objective. Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Approach. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Main results. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. Significance. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements.

PubMed

Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

2017-02-01

Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

Correlation Between Quality of Evidence and Number of Citations in Top 50 Cited Articles on Elbow Medial Ulnar Collateral Ligament Surgery.

PubMed

Jack, Robert A; Sochacki, Kyle R; Morehouse, Hannah A; McCulloch, Patrick C; Lintner, David M; Harris, Joshua D

2018-04-01

Several studies have analyzed the most cited articles in shoulder, elbow, pediatrics, and foot and ankle surgery. However, no study has analyzed the quality of the most cited articles in elbow medial ulnar collateral ligament (UCL) surgery. To (1) identify the top 50 most cited articles related to UCL surgery, (2) determine whether there was a correlation between the top cited articles and level of evidence, and (3) determine whether there was a correlation between study methodological quality and the top cited articles. Systematic review. Web of Science and Scopus online databases were searched to identify the top 50 cited articles in UCL surgery. Level of evidence, number of times cited, year of publication, name of journal, country of origin, and study type were recorded for each study. Study methodological quality was analyzed for each article with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies (MINORS). Correlation coefficients were calculated. The 50 most cited articles were published between 1981 and 2015. The number of citations per article ranged from 20 to 301 (mean ± SD, 71 ± 62 citations). Most articles (92%) were from the United States and were level 3 (16%), level 4 (58%), or unclassified (16%) evidence. There were no articles of level 1 evidence quality. The mean MCMS and MINORS scores were 28.1 ± 13.4 (range, 3-52) and 9.2 ± 3.6 (range, 2-19), respectively. There was no significant correlation between the mean number of citations and level of evidence or quality ( r s = -0.01, P = .917), MCMS ( r s = 0.09, P = .571), or MINORS ( r s = -0.26, P = .089). The top 50 cited articles in UCL surgery constitute a low level of evidence and low methodological quality, including no level 1 articles. There was no significant correlation between the mean number of citations and level of evidence or study methodological quality. However, weak correlations were observed for later publication date and improved level of evidence and methodological quality.

Correlation Between Quality of Evidence and Number of Citations in Top 50 Cited Articles on Elbow Medial Ulnar Collateral Ligament Surgery

PubMed Central

Jack, Robert A.; Sochacki, Kyle R.; Morehouse, Hannah A.; McCulloch, Patrick C.; Lintner, David M.; Harris, Joshua D.

2018-01-01

Background: Several studies have analyzed the most cited articles in shoulder, elbow, pediatrics, and foot and ankle surgery. However, no study has analyzed the quality of the most cited articles in elbow medial ulnar collateral ligament (UCL) surgery. Purpose: To (1) identify the top 50 most cited articles related to UCL surgery, (2) determine whether there was a correlation between the top cited articles and level of evidence, and (3) determine whether there was a correlation between study methodological quality and the top cited articles. Study Design: Systematic review. Methods: Web of Science and Scopus online databases were searched to identify the top 50 cited articles in UCL surgery. Level of evidence, number of times cited, year of publication, name of journal, country of origin, and study type were recorded for each study. Study methodological quality was analyzed for each article with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies (MINORS). Correlation coefficients were calculated. Results: The 50 most cited articles were published between 1981 and 2015. The number of citations per article ranged from 20 to 301 (mean ± SD, 71 ± 62 citations). Most articles (92%) were from the United States and were level 3 (16%), level 4 (58%), or unclassified (16%) evidence. There were no articles of level 1 evidence quality. The mean MCMS and MINORS scores were 28.1 ± 13.4 (range, 3-52) and 9.2 ± 3.6 (range, 2-19), respectively. There was no significant correlation between the mean number of citations and level of evidence or quality (rs = –0.01, P = .917), MCMS (rs = 0.09, P = .571), or MINORS (rs = –0.26, P = .089). Conclusion: The top 50 cited articles in UCL surgery constitute a low level of evidence and low methodological quality, including no level 1 articles. There was no significant correlation between the mean number of citations and level of evidence or study methodological quality. However, weak correlations were observed for later publication date and improved level of evidence and methodological quality. PMID:29780841

Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

PubMed

Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

2017-04-01

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P < .001), and 10.6 ± 3.3 mm (24% ± 39%) at the final assessment (P < .001), showing an increase of the CC distance during the follow-up. Loss of reduction (defined as >25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Fluoroscopically guided closed reduction and internal fixation of fractures of the lateral portion of the humeral condyle: prospective clinical study of the technique and results in ten dogs.

PubMed

Cook, J L; Tomlinson, J L; Reed, A L

1999-01-01

To report a technique for fluoroscopically guided closed reduction with internal fixation of fractures of the lateral portion of the humeral condyle (FLHC) and determine the long-term results in 10 clinical cases. Prospective clinical case study. Ten dogs with 11 fractures. Fractures of the lateral portion of the humeral condyle were stabilized with transcondylar screws and Kirschner wires. Closed reduction and implant placement were achieved using intraoperative fluoroscopic guidance. After fracture repair, postoperative radiographs were evaluated for articular alignment and implant placement. Dogs were evaluated after surgery by means of lameness scores, elbow range of motion (ROM), radiographic assessment, and owner evaluation of function. Postoperative reduction was considered anatomic in 6 fractures with all other fractures having <1.5 mm of malreduction. Follow-up was available for 9 patients from 9 to 21 months after surgery. All of the fractures had healed. One minor (wire migration) and one major (implant failure) complication occurred. Mean lameness scores were 0 (n = 6), 0.5 (n = 2), and 1 (n = 1) at the time of final follow-up. No significant differences were found in follow-up ROM values between affected and unaffected elbows. All of the dogs in this study regained 90-100% of full function, based on owner assessment. Fluoroscopic guidance for closed reduction and internal fixation of FLHC in dogs is an effective technique.

Simultaneous bilateral elbow dislocation with bilateral medial epicondyle fractures in a 13-year-old female gymnast with hyperlaxity

PubMed Central

Bauer, Stefan; Dunne, Ben; Whitewood, Colin

2012-01-01

Bilateral simultaneous elbow dislocations are extremely rare and have only been described in 12 cases. In the paediatric population unilateral elbow dislocations are rare with 3–6% of all elbow injuries and there are only few studies describing this injury exclusively in children. There is only one case report of a paediatric patient who sustained a simultaneous bilateral elbow dislocation with medial epicondyle fractures. We present a second paediatric case of simultaneous bilateral elbow dislocation with associated displaced bilateral medial epicondyle fractures in a gymnast with joint hyperlaxity (3 of 5 Wynne-Davies criteria) treated with closed reduction and short-term immobilisation (3 weeks). The patient returned to full trampoline gymnastics between 4 and 5 months postinjury and made an uneventful recovery. PMID:23234820

Scapulothoracic Dissociation: Evaluation and Management.

PubMed

Choo, Andrew M; Schottel, Patrick C; Burgess, Andrew R

2017-05-01

Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Radiographic evaluation includes measurement of the scapular index on a nonrotated chest radiograph and assessment for either a distracted clavicle fracture or a disrupted acromioclavicular or sternoclavicular joint. Although vascular injury occurs in most patients, emergent surgery is performed only in patients with either limb-threatening ischemia or active arterial hemorrhage. Management of neurologic injury can be delayed if necessary. The location and severity of neurologic injury determine whether observation, nerve grafting, nerve transfer, or above-elbow amputation is performed. Skeletal stabilization procedures include plate fixation of clavicle fractures and reduction of distracted acromioclavicular or sternoclavicular joints. The extent of neurologic injury determines clinical outcomes. Medical Outcomes Study 36-Item Short Form scores are significantly lower in patients with complete brachial plexus avulsion injury than in patients with postganglionic injury.

Motor fatigability in persons with multiple sclerosis: Relation between different upper limb muscles, and with fatigue and the perceived use of the arm in daily life.

PubMed

Severijns, Deborah; Van Geel, Fanny; Feys, Peter

2018-01-01

Motor fatigability is increasingly acknowledged in persons with MS (pwMS). It is unknown whether fatigability is generalized across upper limb muscles and relates to fatigue and perceived difficulties in upper limb use. This observational case-controlled study included twenty PwMS (median EDSS = 3, range 1.5-6.5) and twenty healthy controls who performed 30″ sustained maximal muscle contractions for index finger abduction, hand grip, elbow flexion and shoulder abduction. A static fatigue index (SFI) was calculated to assess motor fatigability for each muscle group. PwMS completed the Fatigue Severity Scale (FSS) and Modified Fatigue Index Scale (MFIS), to quantify severity and perceived impact of fatigue and the Manual Ability Measure (MAM-36) reflecting perceived difficulty in using the upper limbs. Comparisons between groups and muscles was made by t-tests. Associations between outcomes were calculated with correlation coefficients. Fatigue was highest in pwMS. PwMS showed preserved muscle strength and a greater motor fatigability in elbow flexors compared to healthy controls. SFI of elbow flexors and shoulder abductors were associated, and contributed to FSS and MFIS. SFI of elbow flexors and finger abductors predicted half of the variation in MAM-36. Increased motor fatigability was only present in elbow flexors of PwMS, indicating that expression of motor fatigability is not generalized. Fatigability was associated with perceived fatigue (impact) and daily life upper limb use. Results are preliminary given the small sample size with predominantly persons with mild MS. Copyright © 2017 Elsevier B.V. All rights reserved.

Kinematic and kinetic comparisons between American and Korean professional baseball pitchers.

PubMed

Escamilla, Rafael; Fleisig, Glen; Barrentine, Steven; Andrews, James; Moorman, Claude

2002-07-01

The purpose of this study was to quantify and compare kinematic, temporal, and kinetic characteristics of American and Korean professional pitchers in order to investigate differences in pitching mechanics, performance, and injury risks among two different cultures and populations of baseball pitchers. Eleven American and eight Korean healthy professional baseball pitchers threw multiple fastball pitches off an indoor throwing mound positioned at regulation distance from home plate. A Motion Analysis three-dimensional automatic digitizing system was used to collect 200 Hz video data from four electronically synchronized cameras. Twenty kinematic, six temporal, and 11 kinetic variables were analyzed at lead foot contact, during the arm cocking and arm acceleration phases, at ball release, and during the arm deceleration phase. A radar gun was used to quantify ball velocity. At lead foot contact, the American pitchers had significantly greater horizontal abduction of the throwing shoulder, while Korean pitchers exhibited significantly greater abduction and external rotation of the throwing shoulder. During arm cocking, the American pitchers displayed significantly greater maximum shoulder external rotation and maximum pelvis angular velocity. At the instant of ball release, the American pitchers had significantly greater forward trunk tilt and ball velocity and significantly less knee flexion, which help explain why the American pitchers had 10% greater ball velocity compared to the Korean pitchers. The American pitchers had significantly greater maximum shoulder internal rotation torque and maximum elbow varus torque during arm cocking, significantly greater elbow flexion torque during arm acceleration, and significantly greater shoulder and elbow proximal forces during arm deceleration. While greater shoulder and elbow forces and torques generated in the American pitchers helped generate greater ball velocity for the American group, these greater kinetics may predispose this group to a higher risk of shoulder and elbow injuries.

Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals

PubMed Central

Kearns, Gary; Wang, Sharon

2012-01-01

This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS. PMID:23633888

Does the Length of Elbow Flexors and Visual Feedback Have Effect on Accuracy of Isometric Muscle Contraction in Men after Stroke?

PubMed Central

Juodzbaliene, Vilma; Darbutas, Tomas; Skurvydas, Albertas

2016-01-01

The aim of the study was to determine the effect of different muscle length and visual feedback information (VFI) on accuracy of isometric contraction of elbow flexors in men after an ischemic stroke (IS). Materials and Methods. Maximum voluntary muscle contraction force (MVMCF) and accurate determinate muscle force (20% of MVMCF) developed during an isometric contraction of elbow flexors in 90° and 60° of elbow flexion were measured by an isokinetic dynamometer in healthy subjects (MH, n = 20) and subjects after an IS during their postrehabilitation period (MS, n = 20). Results. In order to evaluate the accuracy of the isometric contraction of the elbow flexors absolute errors were calculated. The absolute errors provided information about the difference between determinate and achieved muscle force. Conclusions. There is a tendency that greater absolute errors generating determinate force are made by MH and MS subjects in case of a greater elbow flexors length despite presence of VFI. Absolute errors also increase in both groups in case of a greater elbow flexors length without VFI. MS subjects make greater absolute errors generating determinate force without VFI in comparison with MH in shorter elbow flexors length. PMID:27042670

Normative values of isometric elbow strength in healthy adults: a systematic review.

PubMed

Kotte, Shamala H P; Viveen, Jetske; Koenraadt, Koen L M; The, Bertram; Eygendaal, Denise

2018-07-01

Post-traumatic deformities such as biceps tendon rupture or (peri-)articular fractures of the elbow are often related to a decrease in muscle strength. Postoperative evaluation of these deformities requires normative values of elbow strength. The purpose of this systematic review was to determine these normative values of isometric elbow strength in healthy adults resulting from studies evaluating this strength (i.e. flexion, extension, pronation and supination strength). The databases of PubMed, EMBASE and Web of Sciences were searched and screened for studies involving the isometric elbow strength as measured in asymptomatic volunteers. The quality of the studies was assessed and studies of low quality were excluded. Nineteen studies met the inclusion criteria and were of sufficiently high quality to be included in the present review. In these studies, elbow strength was measured in a total of 1880 healthy volunteers. The experimental set-up and devices used to measure elbow strength varied between studies. Using some assumptions, a normative values table was assembled. Large standard deviations of normative values in combination with different measurement devices used, as well as the different measurement positions of the subjects, demonstrated that there is no consensus about measuring the isometric elbow strength and therefore the normative values have to be interpreted with caution.

Biomechanical performance of baseball pitchers with a history of ulnar collateral ligament reconstruction.

PubMed

Fleisig, Glenn S; Leddon, Charles E; Laughlin, Walter A; Ciccotti, Michael G; Mandelbaum, Bert R; Aune, Kyle T; Escamilla, Rafael F; MacLeod, Toran D; Andrews, James R

2015-05-01

A relatively high number of active professional baseball pitchers have a history of ulnar collateral ligament reconstruction (UCLr) on their throwing elbow. Controversy exists in the literature about whether professional baseball pitchers regain optimal performance after return from UCLr. It has been suggested that pitchers may have different biomechanics after UCLr, but this has not been previously tested. It was hypothesized that, compared with a control group without a history of UCLr, professional pitchers with a history of UCLr would have (1) significantly different throwing elbow and shoulder biomechanics; (2) a shortened stride, insufficient trunk forward tilt, and excessive shoulder horizontal adduction, characteristics associated with "holding back" or being tentative; (3) late shoulder rotation; and (4) improper shoulder abduction and trunk lateral tilt. Controlled laboratory study. A total of 80 active minor league baseball pitchers (and their 8 Major League Baseball organizations) agreed to participate in this study. Participants included 40 pitchers with a history of UCLr and a matched control group of 40 pitchers with no history of elbow or shoulder surgery. Passive ranges of motion were measured for each pitcher's elbows and shoulders, and then 23 reflective markers were attached to his body. The pitcher took as many warm-up pitches as desired and then threw 10 full-effort fastballs for data collection. Ball speed was recorded with a radar gun. The reflective markers were tracked with a 10-camera, 240-Hz automated motion analysis system. Eleven biomechanical parameters were computed for each pitch and then averaged for each participant. Demographic, range of motion, and biomechanical parameters were compared between the UCLr group and the control group by use of Student t tests (significance set at P<.05). All hypotheses were rejected, as there were no differences in pitching biomechanics between the UCLr group and the control group. There were also no differences in passive range of motion between the 2 groups. Compared with a control group, active professional pitchers with a history of UCLr displayed no significant differences in shoulder and elbow passive range of motion and no significant differences in elbow and shoulder biomechanics. Clinical studies have previously shown that 10% to 33% of professional pitchers do not return to their preinjury level; however, the current study showed that those pitchers who successfully return to professional baseball after UCLr pitch with biomechanics similar to that of noninjured professionals. © 2015 The Author(s).

Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review

PubMed Central

Behr, Ian; Blint, Andy; Trenhaile, Scott

2013-01-01

Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome. PMID:26403884

A comparative analysis of speed profile models for wrist pointing movements.

PubMed

Vaisman, Lev; Dipietro, Laura; Krebs, Hermano Igo

2013-09-01

Following two decades of design and clinical research on robot-mediated therapy for the shoulder and elbow, therapeutic robotic devices for other joints are being proposed: several research groups including ours have designed robots for the wrist, either to be used as stand-alone devices or in conjunction with shoulder and elbow devices. However, in contrast with robots for the shoulder and elbow which were able to take advantage of descriptive kinematic models developed in neuroscience for the past 30 years, design of wrist robots controllers cannot rely on similar prior art: wrist movement kinematics has been largely unexplored. This study aimed at examining speed profiles of fast, visually evoked, visually guided, target-directed human wrist pointing movements. One thousand three-hundred ninety-eight (1398) trials were recorded from seven unimpaired subjects who performed center-out flexion/extension and abduction/adduction wrist movements and fitted with 19 models previously proposed for describing reaching speed profiles. A nonlinear, least squares optimization procedure extracted parameters' sets that minimized error between experimental and reconstructed data. Models' performances were compared based on their ability to reconstruct experimental data. Results suggest that the support-bounded lognormal is the best model for speed profiles of fast, wrist pointing movements. Applications include design of control algorithms for therapeutic wrist robots and quantitative metrics of motor recovery.

Assessment of eccentric exercise-induced muscle damage of the elbow flexors by tensiomyography.

PubMed

Hunter, Angus M; Galloway, Stuart D R; Smith, Iain J; Tallent, Jamie; Ditroilo, Massimiliano; Fairweather, Malcolm M; Howatson, Glyn

2012-06-01

Exercise induced muscle damage (EIMD) impairs maximal torque production which can cause a decline in athletic performance and/or mobility. EIMD is commonly assessed by using maximal voluntary contraction (MVC), creatine kinase (CK) and muscle soreness. We propose as an additional technique, tensiomyography (TMG), recently introduced to measure mechanical and muscle contractile characteristics. The purpose of this study was to determine the validity of TMG in detecting changes in maximal torque following EIMD. Nineteen participants performed eccentric elbow flexions to achieve EIMD on the non- dominant arm and used the dominant elbow flexor as a control. TMG parameters, MVC and rate of torque development (RTD) were measured prior to EIMD and repeated for another six consecutive days. Creatine kinase, muscle soreness and limb girth were also measured during this period. Twenty four hours after inducing EIMD, MVC torque, RTD and TMG maximal displacement had significantly (p<0.01) declined by 37%, 44% and 31%, respectively. By day 6 MVC, RTD and TMG recovered to 12%, 24% and 17% of respective pre-EIMD values. In conclusion, as hypothesised TMG maximal displacement significantly followed other standard EIMD responses. This could therefore be useful in detecting muscle damage from impaired muscle function and its recovery following EIMD. Copyright © 2012 Elsevier Ltd. All rights reserved.

The utility of the KJOC score in professional baseball in the United States.

PubMed

Franz, Justin O; McCulloch, Patrick C; Kneip, Chris J; Noble, Philip C; Lintner, David M

2013-09-01

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire has been shown by previous studies to be more sensitive than other validated subjective measurement tools in the detection of upper extremity dysfunction in overhead-throwing athletes. The primary objective was to establish normative data for KJOC scores in professional baseball players in the United States. The secondary objectives were to evaluate the effect of player age, playing position, professional competition level, history of injury, history of surgery, and time point of administration on the KJOC score. Cross-sectional study; Level of evidence, 3. From 2011 to 2012, a total of 203 major league and minor league baseball players within the Houston Astros professional baseball organization completed the KJOC questionnaire. The questionnaire was administered at 3 time points: spring training 2011, end of season 2011, and spring training 2012. The KJOC scores were analyzed for significant differences based on player age, injury history, surgery history, fielding position, competition level, self-reported playing status, and time point of KJOC administration. The average KJOC score among healthy players with no history of injury was 97.1 for major league players and 96.8 for minor league players. The time point of administration did not significantly affect the final KJOC score (P = .224), and KJOC outcomes did not vary with player age (r = -0.012; P = .867). Significantly lower average KJOC scores were reported by players with a history of upper extremity injury (86.7; P < .001) and upper extremity surgery (75.4; P < .0001). The KJOC results did vary with playing position (P = .0313), with the lowest average scores being reported by pitchers (90.9) and infielders (91.3). This study establishes a quantitative baseline for the future evaluation of professional baseball players with the KJOC score. Age and time of administration had no significant effect on the outcome of the KJOC score. Missed practices or games within the previous year because of injury were the most significant demographic predictors of lower KJOC scores. The KJOC score was shown to be a sensitive measurement tool for detecting subtle changes in the upper extremity performance of the professional baseball population studied.

Elbow Injuries and Disorders

MedlinePlus

... Many things can make your elbow hurt. A common cause is tendinitis, an inflammation or injury to the tendons that attach muscle to bone. Tendinitis of the elbow is a sports injury, often from playing tennis or golf. You ...

Elbow flexor and extensor muscle weakness in lateral epicondylalgia.

PubMed

Coombes, Brooke K; Bisset, Leanne; Vicenzino, Bill

2012-05-01

To evaluate whether deficits of elbow flexor and extensor muscle strength exist in lateral epicondylalgia (LE) in comparison with a healthy control population. Cross-sectional study. 150 participants with unilateral LE were compared with 54 healthy control participants. Maximal isometric elbow flexion and extension strength were measured bilaterally using a purpose-built standing frame such that gripping was avoided. The authors found significant side differences in elbow extensor (-6.54 N, 95% CI -11.43 to -1.65, p=0.008, standardised mean difference (SMD) -0.45) and flexor muscle strength (-11.26 N, 95% CI -19.59 to -2.94, p=0.009, SMD -0.46) between LE and control groups. Within the LE group, only elbow extensor muscle strength deficits between sides was significant (affected-unaffected: -2.94 N, 95% CI -5.44 to -0.44). Small significant deficits of elbow extensor and flexor muscle strength exist in the affected arm of unilateral LE in comparison with healthy controls. Notably, comparing elbow strength between the affected and unaffected sides in unilateral epicondylalgia is likely to underestimate these deficits. Trial Registration Australian New Zealand Clinical Trials Register ACTRN12609000051246.

Impingement of Droplets in 90 deg Elbows with Potential Flow

NASA Technical Reports Server (NTRS)

Hacker, Paul T.; Brun, Rinaldo J.; Boyd, Bemrose

1953-01-01

Trajectories were determined for droplets in air flowing through 90 deg elbows especially designed for two-dimensional potential motion with low pressure losses. The elbows were established by selecting as walls of each elbow two streamlines of the flow field produced by a complex potential function that establishes a two-dimensional flow around a 90 deg bend. An unlimited number of elbows with slightly different shapes can be established by selecting different pairs of streamlines as walls. The elbows produced by the complex potential function selected are suitable for use in aircraft air-intake ducts. The droplet impingement data derived from the trajectories are presented along with equations in such a manner that the collection efficiency, the area, the rate, and the distribution of droplet impingement can be determined for any elbow defined by any pair of streamlines within a portion of the flow field established by the complex potential function. Coordinates for some typical streamlines of the flow field and velocity components for several points along these streamlines are presented in tabular form.

Humeral Torsion as a Risk Factor for Shoulder and Elbow Injury in Professional Baseball Pitchers.

PubMed

Noonan, Thomas J; Thigpen, Charles A; Bailey, Lane B; Wyland, Douglas J; Kissenberth, Michael; Hawkins, Richard J; Shanley, Ellen

2016-09-01

Numerous studies have demonstrated that humeral retrotorsion is increased in the dominant arms of throwing athletes. No study has clearly defined the relationship between humeral retrotorsion and shoulder and elbow injury. Uninjured professional pitchers will display more dominant humeral torsion (HT) than professional pitchers who sustain shoulder injuries but less than pitchers who sustain elbow injuries. Case-control study; Level of evidence, 3. Pitchers from the Colorado Rockies professional baseball organization were recruited for participation for this prospective injury study from 2009 to 2013. HT was assessed using indirect ultrasonographic techniques and was measured prospectively in 255 pitchers before each spring training (average of 2 trials). From the beginning of the preseason to the end of the postseason, overuse upper extremity injuries (shoulder or elbow) were tracked for each participating athlete. All athletes who reported pain or injury to their coach were referred to the organization's athletic trainer for evaluation and classification of each injury. The difference in HT was calculated by subtracting measurement of the dominant arm from the nondominant arm, and 3 separate mixed-model analyses of variance (side × injury group) were used to compare the dominant and nondominant HT between all pitchers who developed an arm injury (shoulder and elbow combined), as well as comparing pitchers who developed a shoulder or elbow injury to those who did not miss games due to shoulder or elbow injury (α = .05). During the course of the study, 60 arm (30 shoulder; 30 elbow) injuries were observed; 195 pitchers did not suffer an injury. There were no differences when HT was compared between all injured (shoulder and elbow injuries combined) and uninjured pitchers (P = .13; effect size 0.14). There was a significant interaction effect showing that pitchers who suffered a shoulder injury displayed 4° less dominant humeral retrotorsion compared with pitchers without injury (P = .04) and that pitchers with elbow injury displayed 5° greater humeral retrotorsion (P = .04). In addition, those who suffered an ulnar collateral ligament injury requiring reconstruction (n = 17) also displayed 4(o) greater dominant retrotorsion and 5° less nondominant humeral retrotorsion compared with pitchers who did not suffer an injury (n = 195; P = .05). There was not a significant difference between nondominant HT among pitchers who sustained shoulder and elbow injuries and pitchers without injury. The results of this study show a contrast in dominant humeral retrotorsion between pitchers who suffered shoulder and elbow injuries compared with those without an injury. Pitchers who sustained shoulder injuries had less dominant humeral retrotorsion compared with noninjured pitchers. In contrast, pitchers who sustained time-loss elbow injuries displayed increased humeral retrotorsion compared with noninjured pitchers. Together, these results suggest that increased adaptive humeral retrotorsion is protective against shoulder injuries but a harmful contributor for elbow injuries in professional pitchers. This is the first study to show differing injury risk profiles for shoulder and elbow injury. © 2016 The Author(s).

The role of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis.

PubMed

Chahal, Jaskarndip; Van Thiel, Geoffrey S; Mall, Nathan; Heard, Wendell; Bach, Bernard R; Cole, Brian J; Nicholson, Gregory P; Verma, Nikhil N; Whelan, Daniel B; Romeo, Anthony A

2012-11-01

Despite the theoretic basis and interest in using platelet-rich plasma (PRP) to improve the potential for rotator cuff healing, there remains ongoing controversy regarding its clinical efficacy. The objective of this systematic review was to identify and summarize the available evidence to compare the efficacy of arthroscopic rotator cuff repair in patients with full-thickness rotator cuff tears who were concomitantly treated with PRP. We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and PubMed for eligible studies. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed using a random effects model to arrive at summary estimates of treatment effect with associated 95% confidence intervals. Five studies (2 randomized and 3 nonrandomized with comparative control groups) met the inclusion criteria, with a total of 261 patients. Methodologic quality was uniformly sound as assessed by the Detsky scale and Newcastle-Ottawa Scale. Quantitative synthesis of all 5 studies showed that there was no statistically significant difference in the overall rate of rotator cuff retear between patients treated with PRP and those treated without PRP (risk ratio, 0.77; 95% confidence interval, 0.48 to 1.23). There were also no differences in the pooled Constant score; Simple Shoulder Test score; American Shoulder and Elbow Surgeons score; University of California, Los Angeles shoulder score; or Single Assessment Numeric Evaluation score. PRP does not have an effect on overall retear rates or shoulder-specific outcomes after arthroscopic rotator cuff repair. Additional well-designed randomized trials are needed to corroborate these findings. Level III, systematic review of Level I, II, and III studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Elbow tendinopathy.

PubMed

Pitzer, Michael E; Seidenberg, Peter H; Bader, Dov A

2014-07-01

Overuse injuries of the lateral and medial elbow are common in sport, recreational activities, and occupational endeavors. They are commonly diagnosed as lateral and medial epicondylitis; however, the pathophysiology of these disorders demonstrates a lack of inflammation. Instead, angiofibroblastic degeneration is present, referred to as tendinosis. As such, a more appropriate terminology for these conditions is epicondylosis. This is a clinical diagnosis, and further investigations are only performed to rule out other clinical entities after conventional therapy has failed. Yet, most patients respond to conservative measures with physical therapy and counterforce bracing. Corticosteroid injections are effective for short-term pain control but have not demonstrated long-term benefit. Copyright © 2014 Elsevier Inc. All rights reserved.

Natural course in tennis elbow--lateral epicondylitis after all?

PubMed

Zeisig, Eva

2012-12-01

Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.

Finite Element Analysis and Experimental Study on Elbow Vibration Transmission Characteristics

NASA Astrophysics Data System (ADS)

Qing-shan, Dai; Zhen-hai, Zhang; Shi-jian, Zhu

2017-11-01

Pipeline system vibration is one of the significant factors leading to the vibration and noise of vessel. Elbow is widely used in the pipeline system. However, the researches about vibration of elbow are little, and there is no systematic study. In this research, we firstly analysed the relationship between elbow vibration transmission characteristics and bending radius by ABAQUS finite element simulation. Then, we conducted the further vibration test to observe the vibration transmission characteristics of different elbows which have the same diameter and different bending radius under different flow velocity. The results of simulation calculation and experiment both showed that the vibration acceleration levels of the pipeline system decreased with the increase of bending radius of the elbow, which was beneficial to reduce the transmission of vibration in the pipeline system. The results could be used as reference for further studies and designs for the low noise installation of pipeline system.

Effective utilization of gravity during arm downswing in keystrokes by expert pianists.

PubMed

Furuya, S; Osu, R; Kinoshita, H

2009-12-01

The present study investigated a skill-level-dependent interaction between gravity and muscular force when striking piano keys. Kinetic analysis of the arm during the downswing motion performed by expert and novice piano players was made using an inverse dynamic technique. The corresponding activities of the elbow agonist and antagonist muscles were simultaneously recorded using electromyography (EMG). Muscular torque at the elbow joint was computed while excluding the effects of gravitational and motion-dependent interaction torques. During descending the forearm to strike the keys, the experts kept the activation of the triceps (movement agonist) muscle close to the resting level, and decreased anti-gravity activity of the biceps muscle across all loudness levels. This suggested that elbow extension torque was produced by gravity without the contribution of agonist muscular work. For the novices, on the other hand, a distinct activity in the triceps muscle appeared during the middle of the downswing, and its amount and duration were increased with increasing loudness. Therefore, for the novices, agonist muscular force was the predominant contributor to the acceleration of elbow extension during the downswing. We concluded that a balance shift from muscular force dependency to gravity dependency for the generation of a target joint torque occurs with long-term piano training. This shift would support the notion of non-muscular force utilization for improving physiological efficiency of limb movement with respect to the effective use of gravity.

Closed retrograde multiple intramedullary Kirschner wires fixation for humeral shaft fractures with the limb flexed over an articulated support

PubMed Central

Sié, Essoh J.B.; Kacou, Aka D.; Traoré, A.; Mobiot, C.; Bamba, I.; Lambin, Y.

2014-01-01

Objective To evaluate the results of multiple closed intramedullary Kirschner wiring via a supracondylar entry point for humeral shaft fractures. Patients and methods The charts of 37 patients with humeral shaft fractures treated with the Hackethal's technique between January 2007 and December 2011 were reviewed retrospectively. The operation was performed with the patient lying in supine (n = 22) or lateral (n = 15) position. The elbow was flexed over an articulated support with the arm kept in a vertical position. Thirty-three patients were available for final evaluation with a mean follow-up delay of 14 (range, 6–24) months. We were concerned about fracture union, range of motion of the shoulder and the elbow, and complications. Final evaluation used the criteria by Qidwai. Results Bone union rate was 94%. Restriction of ranges of motion of the shoulder more than 20° was noticed in two patients due to protruding wires. Three patients developed limitation of elbow extension owing to backing out of the wires. The overall results were excellent (n = 26; 79%), good (n = 4; 12%), and poor (n = 3; 9%). Conclusion Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction. PMID:25983469

Racquet string tension directly affects force experienced at the elbow: implications for the development of lateral epicondylitis in tennis players

PubMed Central

Mohandhas, Badri R; Makaram, Navnit; Drew, Tim S; Wang, Weijie; Arnold, Graham P

2016-01-01

Background Lateral epicondylitis (LE) occurs in almost half of all tennis players. Racket-string tension is considered to be an important factor influencing the development of LE. No literature yet exists that substantiates how string-tension affects force transmission to the elbow, as implicated in LE development. We establish a quantitative relationship between string-tension and elbow loading, analyzing tennis strokes using rackets with varying string-tensions. Methods Twenty recreational tennis players simulated backhand tennis strokes using three rackets strung at tensions of 200 N, 222 N and 245 N. Accelerometers recorded accelerations at the elbow, wrist and racket handle. Average peak acceleration was determined to correlate string-tension with elbow loading. Results Statistically significant differences (p < 0.05) were observed when average peak acceleration at the elbow at 200 N string-tension (acceleration of 5.58 m/s2) was compared with that at 222 N tension (acceleration of 6.83 m/s2) and 245 N tension (acceleration of 7.45 m/s2). The 200 N racket induced the least acceleration at the elbow. Conclusions Although parameters determining force transmission to the elbow during a tennis stroke are complex, the present study was able to control these parameters, isolating the effect of string-tension. Lower string-tensions transmit less force to the elbow in backhand strokes. Reducing string-tension should be considered favourably with respect to reducing the risk of developing LE. PMID:27583017

Changes in head and neck position have a greater effect on elbow joint position sense in people with whiplash-associated disorders.

PubMed

Knox, Joanna Joy; Beilstein, Darren Jay; Charles, Scott Darren; Aarseth, Geir Arne; Rayar, Shivanthi; Treleaven, Julia; Hodges, Paul William

2006-01-01

It has been shown that perception of elbow joint position is affected by changes in head and neck position. Further, people with whiplash-associated disorders (WAD) present with deficits in upper limb coordination and movement. This study is aimed to determine whether the effect of changes in head position on elbow joint position error (JPE) is more pronounced in people with WAD, and to determine whether this is related to the participant's pain and anxiety levels. Nine people with chronic and disabling WAD and 11 healthy people participated in this experiment. The ability to reproduce a position at the elbow joint was assessed after changes in the position of the head and neck to 30 degrees , and with the head in the midline. Pain was monitored in WAD participants. Absolute elbow JPE with the head in neutral was not different between WAD and control participants (P=0.5). Changes in the head and neck position increased absolute elbow JPE in the WAD group (P<0.05), but did not affect elbow JPE in the control group (P=0.4). There was a connection between pain during testing and the effect of changes in head position on elbow JPE (P<0.05). Elbow JPE is affected by movement of the head and neck, with smaller angles of neck rotation in people with WAD than in healthy individuals. This observation may explain deficits in upper limb coordination in people with WAD, which may be due to the presence of pain or reduced range of motion in this population.

Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer

PubMed Central

Cuéllar, Vanessa G.; Ghiassi, Alidad; Sharpe, Frances

2016-01-01

Introduction: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. Methods: Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength. Results: Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome. Conclusions: This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm. PMID:27757363

Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer.

PubMed

Stevanovic, Milan V; Cuéllar, Vanessa G; Ghiassi, Alidad; Sharpe, Frances

2016-09-01

In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength. Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome. This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm.

Hip Arthroscopy in High-Level Baseball Players.

PubMed

Byrd, J W Thomas; Jones, Kay S

2015-08-01

To report the results of hip arthroscopy among high-level baseball players as recorded by outcome scores and return to baseball. All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score. On review of all procedures performed over a 12-year period, 44 hips were identified among 41 intercollegiate or professional baseball players who had achieved 2-year follow-up. Among the 41 players, follow-up averaged 45 months (range, 24 to 120 months), with a mean age of 23 years (range, 18 to 34 years). There were 23 collegiate (1 bilateral) and 18 professional (2 bilateral) baseball players, including 10 Major League Baseball players. Of the 8 Major League Baseball pitchers, 6 (75%) also underwent ulnar collateral ligament elbow surgery. Improvement in the modified Harris Hip Score averaged 13 points (from 81 points preoperatively to 94 points postoperatively); a paired-samples t test determined that this mean improvement of 13 points was statistically significant (P < .001). Players returned to baseball after 42 of 44 procedures (95%) at a mean of 4.3 months (range, 3 to 8 months), with 90% regaining the ability to participate at their previous level of competition. There were no complications. Three players (1 bilateral) underwent repeat arthroscopy. This study supports the idea that arthroscopic treatment for a variety of hip pathologies in high-level baseball players provides a successful return to sport and improvement in functional outcome scores. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Reliability, validity, and minimal detectable change of the push-off test scores in assessing upper extremity weight-bearing ability.

PubMed

Mehta, Saurabh P; George, Hannah R; Goering, Christian A; Shafer, Danielle R; Koester, Alan; Novotny, Steven

2017-11-01

Clinical measurement study. The push-off test (POT) was recently conceived and found to be reliable and valid for assessing weight bearing through injured wrist or elbow. However, further research with larger sample can lend credence to the preliminary findings supporting the use of the POT. This study examined the interrater reliability, construct validity, and measurement error for the POT in patients with wrist conditions. Participants with musculoskeletal (MSK) wrist conditions were recruited. The performance on the POT, grip isometric strength of wrist extensors was assessed. The shortened version of the Disabilities of the Arm, Shoulder and Hand and numeric pain rating scale were completed. The intraclass correlation coefficient assessed interrater reliability of the POT. Pearson correlation coefficients (r) examined the concurrent relationships between the POT and other measures. The standard error of measurement and the minimal detectable change at 90% confidence interval were assessed as measurement error and index of true change for the POT. A total of 50 participants with different elbow or wrist conditions (age: 48.1 ± 16.6 years) were included in this study. The results of this study strongly supported the interrater reliability (intraclass correlation coefficient: 0.96 and 0.93 for the affected and unaffected sides, respectively) of the POT in patients with wrist MSK conditions. The POT showed convergent relationships with the grip strength on the injured side (r = 0.89) and the wrist extensor strength (r = 0.7). The POT showed smaller standard error of measurement (1.9 kg). The minimal detectable change at 90% confidence interval for the POT was 4.4 kg for the sample. This study provides additional evidence to support the reliability and validity of the POT. This is the first study that provides the values for the measurement error and true change on the POT scores in patients with wrist MSK conditions. Further research should examine the responsiveness and discriminant validity of the POT in patients with wrist conditions. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Body position reproducibility and joint alignment stability criticality on a muscular strength research device

NASA Astrophysics Data System (ADS)

Nunez, F.; Romero, A.; Clua, J.; Mas, J.; Tomas, A.; Catalan, A.; Castellsaguer, J.

2005-08-01

MARES (Muscle Atrophy Research and Exercise System) is a computerized ergometer for neuromuscular research to be flown and installed onboard the International Space Station in 2007. Validity of data acquired depends on controlling and reducing all significant error sources. One of them is the misalignment of the joint rotation axis with respect to the motor axis.The error induced on the measurements is proportional to the misalignment between both axis. Therefore, the restraint system's performance is critical [1]. MARES HRS (Human Restraint System) assures alignment within an acceptable range while performing the exercise (results: elbow movement:13.94mm+/-5.45, Knee movement: 22.36mm+/- 6.06 ) and reproducibility of human positioning (results: elbow movement: 2.82mm+/-1.56, Knee movement 7.45mm+/-4.8 ). These results allow limiting measurement errors induced by misalignment.

THROWING INJURIES IN THE ADOLESCENT ATHLETE

PubMed Central

Thigpen, Chuck

2013-01-01

Introduction: Adolescents ranging in age from 11–15 (early‐mid adolescence) comprise the largest percentage of baseball and softball athletes in the United States. Shoulder and elbow injuries are commonly experienced by these athletes with baseball pitchers and softball position players most likely to be injured. Common Injuries: Physeal injury often termed “Little League” shoulder or elbow is common and should be differentiated from soft tissue injuries such as biceps, rotator cuff, or UCL injuries. Regardless of diagnosis, rehabilitation of these athletes’ shoulder and elbow injuries provide a unique challenge given their rapidly changing physical status. Treatment: Common impairments include alterations in shoulder range of motion, decreased muscle performance, and poor neuromuscular control of the scapula, core, and lower extremity. A criterion based, progressive rehabilitation program is presented. Discharge from formal rehabilitation should occur only when the athlete has demonstrated a resolution of symptoms, acceptable ROM, muscle performance, and neuromuscular control while progressing through a symptom free return to sport. Prevention of Reinjury: Reintegration into the desired level of sport participation should be guided by the sports medicine professional with a focus on long‐term durability in sport performance as well as injury prevention. A prevention program which includes parent, coach, and athlete education, regular screening to identify those athletes at the highest risk, and monitoring athletes for the development of risk factors or warning signs of injury over the course of participation is indicated. Level of Evidence: 5 PMID:24175142

A Biomechanical Comparison of the Long Snap in Football Between High School and University Football Players.

PubMed

Chizewski, Michael G; Alexander, Marion J L

2015-08-01

Limited previous research was located that examined the technique of the long snap in football. The purpose of the study was to compare the joint movements, joint velocities, and body positions used to perform fast and accurate long snaps in high school (HS) and university (UNI) athletes. Ten HS and 10 UNI subjects were recruited for filming, each performing 10 snaps at a target with the fastest and most accurate trial being selected for subject analysis. Eighty-three variables were measured using Dartfish Team Pro 4.5.2 video analysis software, with statistical analysis performed using Microsoft Excel and SPSS 16.0. Several significant comparisons to long snapping technique between groups were noted during analysis; however, the body position and movement variables at release showed the greatest number of significant differences. The UNI athletes demonstrated significantly higher release velocity and left elbow extension velocity, with significantly lower release height and release angle than the HS group. Total snap time (release time + total flight time) was determined to have the strongest correlation to release velocity for the HS group (r = -0.915) and UNI group (r = -0.918). The study suggests HS long snappers may benefit from less elbow flexion and more knee flexion in the backswing (set position) to increase release velocity. University long snappers may benefit from increased left elbow extension range of motion during force production and decreased shoulder flexion at critical instant to increase long snap release velocity.

78 FR 68907 - Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

... Forearm Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits... Control No. 2900- NEW (Elbow and Forearm Conditions Disability Benefits Questionnaire)'' in any... Benefits Questionnaire)''. SUPPLEMENTARY INFORMATION: Title: Elbow and Forearm Conditions Disability...

High temperature lined conduits, elbows and tees

DOEpatents

De Feo, Angelo; Drewniany, Edward

1982-01-01

A high temperature lined conduit comprising, a liner, a flexible insulating refractory blanket around and in contact with the liner, a pipe member around the blanket and spaced therefrom, and castable rigid refractory material between the pipe member and the blanket. Anchors are connected to the inside diameter of the pipe and extend into the castable material. The liner includes male and female slip joint ends for permitting thermal expansion of the liner with respect to the castable material and the pipe member. Elbows and tees of the lined conduit comprise an elbow liner wrapped with insulating refractory blanket material around which is disposed a spaced elbow pipe member with castable refractory material between the blanket material and the elbow pipe member. A reinforcing band is connected to the elbow liner at an intermediate location thereon from which extend a plurality of hollow tubes or pins which extend into the castable material to anchor the lined elbow and permit thermal expansion. A method of fabricating the high temperature lined conduit, elbows and tees is also disclosed which utilizes a polyethylene layer over the refractory blanket after it has been compressed to maintain the refractory blanket in a compressed condition until the castable material is in place. Hot gases are then directed through the interior of the liner for evaporating the polyethylene and setting the castable material which permits the compressed blanket to come into close contact with the castable material.