Science.gov

Sample records for human elbow flexor

  1. Human forearm position sense after fatigue of elbow flexor muscles

    PubMed Central

    Walsh, L D; Hesse, C W; Morgan, D L; Proske, U

    2004-01-01

    After a period of eccentric exercise of elbow flexor muscles of one arm in young, adult human subjects, muscles became fatigued and damaged. Damage indicators were a fall in force, change in resting elbow angle and delayed onset of soreness. After the exercise, subjects were asked to match the forearm angle of one arm, whose position was set by the experimenter, with their other arm. Subjects matched the position of the unsupported reference arm, when this was unexercised, with a significantly more flexed position in their exercised indicator arm. Errors were in the opposite direction when the reference arm was exercised. The size of the errors correlated with the drop in force. Less consistent errors were observed when the reference arm was supported. A similar pattern of errors was seen after concentric exercise, which does not produce muscle damage. The data suggested that subjects were using as a position cue the perceived effort required to maintain a given forearm angle against the force of gravity. The fall in force from fatigue after exercise meant more effort was required to maintain a given position. That led to matching errors between the exercised and unexercised arms. It was concluded that while a role for muscle spindles in kinaesthesia cannot be excluded, detailed information about static limb position can be derived from the effort required to support the limb against the force of gravity. PMID:15181165

  2. Reduced short-interval intracortical inhibition after eccentric muscle damage in human elbow flexor muscles.

    PubMed

    Pitman, Bradley M; Semmler, John G

    2012-09-01

    The purpose of this study was to use paired-pulse transcranial magnetic stimulation (TMS) to examine the effect of eccentric exercise on short-interval intracortical inhibition (SICI) after damage to elbow flexor muscles. Nine young (22.5 ± 0.6 yr; mean ± SD) male subjects performed maximal eccentric exercise of the elbow flexor muscles until maximal voluntary contraction (MVC) force was reduced by ∼40%. TMS was performed before, 2 h after, and 2 days after exercise under Rest and Active (5% MVC) conditions with motor-evoked potentials (MEPs) recorded from the biceps brachii (BB) muscle. Peripheral electrical stimulation of the brachial plexus was used to assess maximal M-waves, and paired-pulse TMS with a 3-ms interstimulus interval was used to assess changes in SICI at each time point. The eccentric exercise resulted in a 34% decline in strength (P < 0.001), a 41% decline in resting M-wave (P = 0.01), changes in resting elbow joint angle (10°, P < 0.001), and a shift in the optimal elbow joint angle for force production (18°, P < 0.05) 2 h after exercise. This was accompanied by impaired muscle strength (27%, P < 0.001) and increased muscle soreness (P < 0.001) 2 days after exercise, which is indicative of muscle damage. When the test MEP amplitudes were matched between sessions, we found that SICI was reduced by 27% in resting and 23% in active BB muscle 2 h after exercise. SICI recovered 2 days after exercise when muscle pain and soreness were present, suggesting that delayed onset muscle soreness from eccentric exercise does not influence SICI. The change in SICI observed 2 h after exercise suggests that eccentric muscle damage has widespread effects throughout the motor system that likely includes changes in motor cortex. PMID:22837166

  3. The Effects of Elbow Joint Angle Change on the Elbow Flexor Muscle Activation in Pulley with Weight Exercise

    PubMed Central

    Kang, Taewook; Seo, Youngjoon; Park, Jaehoon; Dong, Eunseok; Seo, Byungdo; Han, Dongwook

    2013-01-01

    [Purpose] This research investigated the effect of angular variation of flexion of the elbow joint on the muscle activation of elbow flexor muscles. [Subjects] The research subjects were 24 male college students with a dominant right hand who had no surgical or neurological disorders and gave their prior written consent to participation with full knowledge of the method and purpose of this study. [Methods] The subjects' shoulder joints stayed in the resting position, and the elbow joint was positioned at angles of 55°, 70°, and 90°. The angle between the pulley with weights and forearm stayed at 90°. Surface electromyography was used to measure muscle activities. Three measurements were made at each elbow angle, and every time the angle changed, two minutes rest was given. [Result] The muscle activities of the elbow flexors showed significant changes with change in the elbow joint angle, except for the biceps brachii activities between the angles of 55° and 70° of elbow flexion. The muscle activities of the biceps brachii and brachioradialis showed angle-related changes in the order of 55°, which showed the biggest value, followed by 70° and 90°. [Conclusion] In order to improve muscle strength of the elbow flexor using a pulley system, it seems more effective to have a 90° angle between the pulley with weights and the forearm when the muscle is stretched to a length 20% greater than its resting position. PMID:24259930

  4. 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

    Kurtzer, Isaac; Meriggi, Jenna; Parikh, Nidhi; Saad, Kenneth

    2016-04-01

    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.

  5. Acute effects of caffeine on strength and muscle activation of the elbow flexors.

    PubMed

    Trevino, Michael A; Coburn, Jared W; Brown, Lee E; Judelson, Daniel A; Malek, Moh H

    2015-02-01

    The purpose of this study was to examine the effects of caffeine on strength and muscle activation of the elbow flexors. Thirteen recreationally active male volunteers (mean ± SD, age: 21.38 ± 1.26 years) came to the laboratory 4 times. Visit 1 served as a familiarization visit. During visits 2 through 4, subjects ingested a randomly assigned drink, with or without caffeine (0, 5, or 10 mg·kg of body mass), and performed 3 maximal isometric muscle actions of the elbow flexors 60 minutes after ingestion. Maximal strength and rate of torque development (RTD) were recorded. Electromyographic (EMG) and mechanomyographic (MMG) amplitude and frequency, and electromechanical delay (EMD), and phonomechanical delay (PMD) were measured from the biceps brachii. The results indicated that the ingestion of 0 (placebo), 5, or 10 mg·kg of body mass of caffeine did not significantly influence (p > 0.05) peak torque, RTD, normalized EMG amplitude or frequency, normalized MMG amplitude, or EMD and PMD. Normalized MMG frequency was significantly lower (p ≤ 0.05) following ingestion of 5 mg·kg of body mass of caffeine compared with the placebo trial. This was most likely an isolated finding because MMG frequency was the only variable to have a significant difference across all trials. The results suggested that ingestion of either 5 or 10 mg·kg of body mass of caffeine does not provide an ergogenic effect for the elbow flexors during isometric muscle actions.

  6. Acute effects of caffeine on strength and muscle activation of the elbow flexors.

    PubMed

    Trevino, Michael A; Coburn, Jared W; Brown, Lee E; Judelson, Daniel A; Malek, Moh H

    2015-02-01

    The purpose of this study was to examine the effects of caffeine on strength and muscle activation of the elbow flexors. Thirteen recreationally active male volunteers (mean ± SD, age: 21.38 ± 1.26 years) came to the laboratory 4 times. Visit 1 served as a familiarization visit. During visits 2 through 4, subjects ingested a randomly assigned drink, with or without caffeine (0, 5, or 10 mg·kg of body mass), and performed 3 maximal isometric muscle actions of the elbow flexors 60 minutes after ingestion. Maximal strength and rate of torque development (RTD) were recorded. Electromyographic (EMG) and mechanomyographic (MMG) amplitude and frequency, and electromechanical delay (EMD), and phonomechanical delay (PMD) were measured from the biceps brachii. The results indicated that the ingestion of 0 (placebo), 5, or 10 mg·kg of body mass of caffeine did not significantly influence (p > 0.05) peak torque, RTD, normalized EMG amplitude or frequency, normalized MMG amplitude, or EMD and PMD. Normalized MMG frequency was significantly lower (p ≤ 0.05) following ingestion of 5 mg·kg of body mass of caffeine compared with the placebo trial. This was most likely an isolated finding because MMG frequency was the only variable to have a significant difference across all trials. The results suggested that ingestion of either 5 or 10 mg·kg of body mass of caffeine does not provide an ergogenic effect for the elbow flexors during isometric muscle actions. PMID:25029005

  7. Firing of antagonist small-diameter muscle afferents reduces voluntary activation and torque of elbow flexors.

    PubMed

    Kennedy, David S; McNeil, Chris J; Gandevia, Simon C; Taylor, Janet L

    2013-07-15

    During muscle fatigue, firing of small-diameter muscle afferents can decrease voluntary activation of the fatigued muscle. However, these afferents may have a more widespread effect on other muscles in the exercising limb. We examined if the firing of fatigue-sensitive afferents from elbow extensor muscles in the same arm reduces torque production and voluntary activation of elbow flexors. In nine subjects we examined voluntary activation of elbow flexors by measuring changes in superimposed twitches evoked by transcranial magnetic stimulation of the motor cortex during brief (2-3 s) maximal voluntary contractions (MVC). Inflation of a blood pressure cuff following a 2-min sustained MVC blocked blood flow to the fatigued muscle and maintained firing of small-diameter afferents. After a fatiguing elbow flexion contraction, maximal flexion torque was lower (26.0 ± 4.4% versus 67.9 ± 5.2% of initial maximal torque; means ± s.d.; P < 0.001) and superimposed twitches were larger (4.1 ± 1.1% versus 1.8 ± 0.2% ongoing MVC, P = 0.01) with than without ischaemia. After a fatiguing elbow extensor contraction, maximal flexion torque was also reduced (82.2 ± 4.9% versus 91.4 ± 2.3% of initial maximal torque; P = 0.007), superimposed twitches were larger (2.7 ± 0.7% versus 1.3 ± 0.2% ongoing MVC; P = 0.02) and voluntary activation lower (81.6 ± 8.2% versus 95.5 ± 6.9%; P = 0.04) with than without ischaemia. After a fatiguing contraction, voluntary drive to the fatigued muscles is reduced with continued input from small-diameter muscle afferents. Furthermore, fatigue of the elbow extensor muscles decreases voluntary drive to unfatigued elbow flexors of the same arm. Therefore, firing of small-diameter muscle afferents from one muscle can affect voluntary activation and hence torque generation of another muscle in the same limb. PMID:23652589

  8. Inter-Rater Reliability of the Modified Ashworth Scale and Modified Modified Ashworth Scale in Assessing Poststroke Elbow Flexor Spasticity

    ERIC Educational Resources Information Center

    Kaya, Taciser; Goksel Karatepe, Altinay; Gunaydin, Rezzan; Koc, Aysegul; Altundal Ercan, Ulku

    2011-01-01

    The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade "1+" of the MAS and redefining grade "2". The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity.…

  9. Comparison in muscle damage between maximal voluntary and electrically evoked isometric contractions of the elbow flexors.

    PubMed

    Jubeau, Marc; Muthalib, Makii; Millet, Guillaume Y; Maffiuletti, Nicola A; Nosaka, Kazunori

    2012-02-01

    This study compared between maximal voluntary (VOL) and electrically stimulated (ES) isometric contractions of the elbow flexors for changes in indirect markers of muscle damage to investigate whether ES would induce greater muscle damage than VOL. Twelve non-resistance-trained men (23-39 years) performed VOL with one arm and ES with the contralateral arm separated by 2 weeks in a randomised, counterbalanced order. Both VOL and ES (frequency 75 Hz, pulse duration 250 μs, maximally tolerated intensity) exercises consisted of 50 maximal isometric contractions (4-s on, 15-s off) of the elbow flexors at a long muscle length (160°). Changes in maximal voluntary isometric contraction torque (MVC), range of motion, muscle soreness, pressure pain threshold and serum creatine kinase (CK) activity were measured before, immediately after and 1, 24, 48, 72 and 96 h following exercise. The average peak torque over the 50 isometric contractions was greater (P < 0.05) for VOL (32.9 ± 9.8 N m) than ES (16.9 ± 6.3 N m). MVC decreased greater and recovered slower (P < 0.05) after ES (15% lower than baseline at 96 h) than VOL (full recovery). Serum CK activity increased (P < 0.05) only after ES, and the muscles became more sore and tender after ES than VOL (P < 0.05). These results showed that ES induced greater muscle damage than VOL despite the lower torque output during ES. It seems likely that higher mechanical stress imposed on the activated muscle fibres, due to the specificity of motor unit recruitment in ES, resulted in greater muscle damage. PMID:21573775

  10. Ultrasonographic assessment of the flexor pronator muscles as a dynamic stabilizer of the elbow against valgus force.

    PubMed

    Otoshi, Kenichi; Kikuchi, Shinichi; Shishido, Hiroaki; Konno, Shinichi

    2014-01-01

    Flexor pronator muscles (FPMs) play a key role in stabilizing the elbow joint against valgus forces. However, no studies have investigated the in vivo kinematics of FPMs against these forces on the elbow. This study aimed to clarify the in vivo contribution of each FPM as a dynamic stabilizer in a clinical situation.Twelve healthy volunteers participated in this study. Verbal informed consent was obtained from all subjects. The elbow was flexed to 90 degrees, and the forearm was placed in the neutral position. Manual valgus stress was applied to the elbow joint until maximal shoulder external rotation was achieved. The width of the ulnohumeral joint space and the ulnar shift of the sublime tubercle were measured before and after isometric contraction of FPMs using ultrasonography.The horizontal distances were decreased 1.1±0.6 mm after forearm pronation, 0.6±0.5 mm after wrist palmar flexion, 0.1±0.4 mm after wrist ulnar flexion, and 0.2±0.5 mm after finger flexion. Significant changes were observed during forearm pronation, wrist palmar flexion, and finger flexion but not during wrist ulnar flexion (p<0.05). The sublime tubercle was significantly shifted 0.5±0.1 mm medially after forearm pronation, 0.2±0.1 mm medially after wrist palmar flexion, and 0.1±0.1 mm laterally after wrist ulnar flexion and finger flexion (p<0.05). The FPMs, especially the pronator teres and the flexor carpi radialis, function as dynamic stabilizers against elbow valgus stress. The results of this study may be useful in developing injury prevention and rehabilitation strategies for throwing injuries of the elbow. PMID:25283981

  11. Magnetic Versus Electrical Stimulation in the Interpolation Twitch Technique of Elbow Flexors

    PubMed Central

    Lampropoulou, Sofia I.; Nowicky, Alexander V.; Marston, Louise

    2012-01-01

    new application of peripheral magnetic stimulation as an alternative to the conventional ITT for the assessment of BB voluntary activation. Key points The study compared peripheral electrical and magnetic stimulation in the assessment of voluntary activation using single pulse twitch interpolation of elbow flexors. Key similarities between magnetic and electrical stimulation in the assessment of voluntary activation with the single pulse Interpolation Twitch Technique were revealed. Voluntary activation at maximal contractions were similar for the two methods of stimulation and the twitch-voluntary force best fit with nonlinear functions for both magnetic and electrical stimulation. The fundamental similarities in voluntary activation assessment of elbow flexor, m. Biceps Brachii with these two methods of stimulation support the application of peripheral magnetic stimulation using the conventional Interpolation Twitch Technique. The painless assessment of voluntary activation with peripheral magnetic stimulation may strengthen its acceptance for clinical use in neuromuscular assessment. PMID:24150083

  12. Dynamic stability of the elbow: electromyographic analysis of the flexor pronator group and the extensor group in pitchers with valgus instability.

    PubMed

    Hamilton, C D; Glousman, R E; Jobe, F W; Brault, J; Pink, M; Perry, J

    1996-01-01

    The medical collateral ligament is a common site of injury in baseball pitchers, causing substantial morbidity and loss of pitching time. Twenty-six skilled baseball pitchers with medial collateral ligament insufficiency were studied before surgery with high-speed cinematography and fine-wire electromyography of eight muscles around the elbow. Data from the pitchers with injured elbows were compared with data obtained from uninjured pitchers. The flexor carpi radialis muscle in the pitchers with medial collateral ligament deficiencies revealed significantly decreased firing during the acceleration and deceleration phase of the fastball when compared with that of the pitchers with normal elbows, and the flexor carpi radialis muscle was significantly depressed during the early cocking and deceleration phases. The extensor muscles revealed slightly increased activity in the injured elbows; however, this was not statistically significant. Although the muscles of the flexor pronator group (especially the flexor carpi ulnaris muscle and the flexor digitorum superficialis muscles) are anatomically positioned to provide dynamic stability of the elbow, they did not demonstrate increased electrical activity in pitchers with medial collateral ligament deficiencies. This finding suggests that the muscles on the medial side of the elbow do not supplant the role of the medial collateral ligament during the fastball pitch.

  13. Do rhythms exist in elbow flexor torque, oral temperature and muscle thickness during normal waking hours?

    PubMed

    Buckner, Samuel L; Dankel, Scott J; Counts, Brittany R; Barnett, Brian E; Jessee, Matthew B; Mouser, J Grant; Halliday, Tanya M; Loenneke, Jeremy P

    2016-06-01

    The purpose of the current study was to examine the influence of "time" on isometric elbow flexion torque, body temperature and muscle size without interrupting the sleep wake cycle in college aged males. Two hours following the participants normal wake time, oral temperature was measured, followed by muscle thickness of the upper and lower body using ultrasound, as well as elbow flexor torque via a maximal voluntary contraction (MVC). Measurements were repeated every 2h for 12h (Time points 1-7). To examine the repeatability of the rhythm, participants returned and completed the same procedures as before within 14days of their first circadian visit (Circadian visit 2). There was no time×day interaction for body temperature (p=0.29), nor were there main effects for time (p=0.15) or day (p=0.74). For MVC, there was no time×day interaction (p=0.93) or main effect for day (p=0.50), however, there was a main effect for time (p=0.01). MVC at time points 1 (86.4±6.4Nm) and 2 (87.1±6.2Nm) was greater than time points 4 (84.2±6.6Nm) and 6 (83.4±6.8Nm, p<0.05). Additionally, time point 5 MVC was greater than time point 4. For upper body muscle thickness, there was no time×day interaction (p=0.34), nor was there a main effect for day (p=0.38), or time (p=0.06). For lower body muscle thickness, there was no time×day interaction (p=0.57), nor was there a main effect for day (p=0.75), or time (p=0.13). Cosinor analyses revealed no group level rhythms for oral temperature, muscle thickness or strength (p>0.05), however, there were some individual rhythms noted for muscle thickness and strength. Results suggest that, when accounting for an individuals normal wake time, circadian rhythms of strength, temperature and muscle thickness are not apparent in most individuals.

  14. Development of the human elbow joint.

    PubMed

    Mérida-Velasco, J A; Sánchez-Montesinos, I; Espín-Ferra, J; Mérida-Velasco, J R; Rodríguez-Vázquez, J F; Jiménez-Collado, J

    2000-02-01

    Many studies have been published on the development of the human elbow joint, but authors disagree on its morphogenetic timetable. Most discrepancies center on the cavitation of the elbow joint (including the humeroradial, humeroulnar, and superior radioulnar joints), and the organization of the tunnel of the ulnar nerve. We summarize our observations on the development of the elbow joint in 49 serially sectioned human embryonic (n = 28) and fetal (n = 21) upper limbs. During week 12, ossification begins in the epiphyses of the elements comprising the elbow joint. At the end of the embryonic period, the shallow groove between the posterior aspect of the medial epicondyle and the olecranon process, begins to be visible. The elbow joint cavity appears in O'Rahilly stage 21 (51 days) at the level of the humeroulnar and humeroradial interzones. Formation of the cavity begins at the medialmost portion of the humeroradial interzone and the lateralmost portion of the humeroulnar interzone. The annular ligament begins to develop in O'Rahilly stage 21 (51 days), and the superior radioulnar joint cavity appears between this ligament and the lateral aspect of the head of the radius during O'Rahilly stage 23 (56 days). We established the morphogenetic timetable of the human elbow joint.

  15. Flexor bias of joint position in humans during spaceflight

    NASA Technical Reports Server (NTRS)

    McCall, G. E.; Goulet, C.; Boorman, G. I.; Roy, R. R.; Edgerton, V. R.

    2003-01-01

    The ability to estimate ankle and elbow joint position was tested before, during, and after a 17-day spaceflight. Subjects estimated targeted joint angles during isovelocity (IsoV) joint movements with agonist muscle groups either active or relaxed. These movements included elbow extension (EE) and elbow flexion (EF), and plantarflexion (PF) and dorsiflexion (DF) of the ankle. Subjects also estimated these joint positions while moving the dynamometer at their chosen (variable) velocity (VarV) during EE and PF. For IsoV tests, no differences were observed between active and passive movements for either the ankle or elbow. Compared with those of pre-flight test days, estimates of targeted elbow joint angles were approximately 5 degrees to 15 degrees more flexed in-flight, and returned toward the pre-flight values during recovery. The spaceflight effects for the ankle were inconsistent and less prevalent than those for the elbow. The VarV PF test condition for the 120 degrees target angle at the ankle exhibited approximately 5 degrees to 7 degrees more DF target angle estimates in-flight compared with those pre- or post-flight. In contrast, during IsoV PF there was a tendency for ankle estimates to be approximately 2 degrees to 3 degrees more PF after 2-3 days exposure to spaceflight. These data indicate that during spaceflight the perception of elbow extension is greater than actuality, and are consistent with the interpretation that microgravity induced a flexor bias in the estimation of the actual elbow joint position. Moreover, these effects in joint proprioception during spaceflight were observed in individual isolated single-joint movements during tasks in which vestibular function in maintaining posture were minimal.

  16. Evaluation of the peak torque, total work, average power of flexor-estensor and prono-supinator muscles of the elbow in baseball players.

    PubMed

    Costantino, Cosimo; Vaienti, Enrico; Pogliacomi, Francesco

    2003-08-01

    The Authors, after a short analysis on biomechanics of the elbow during throwing in baseball, show the movements of the elbow during the different phases of the throw and the stabilizing action of the ulnar collateral ligament, flexor-pronator muscles of the wrist, anconeus and brachial triceps muscles. Aim of this study is the evaluation of the peak torque, total work and average power of the flexor-extensor and pronator-supinator muscles of the elbows in professional baseball players. Isokinetic test data show that a mayor peak torque in flexo-extension at power and resistance test in the pitchers compared to the strikers. Whereas the strikers show a higher peak torque in pronation at the resistance test. This may happen because during a baseball match the ball is hit many times by the bat and the pronator muscle of the wrist are notably stimulated and reinforced.

  17. Effect of pre-exercise phototherapy applied with different cluster probe sizes on elbow flexor muscle fatigue.

    PubMed

    Rossato, Mateus; Dellagrana, Rodolfo A; Lanferdini, Fábio J; Sakugawa, Raphael L; Lazzari, Caetano D; Baroni, Bruno M; Diefenthaeler, Fernando

    2016-08-01

    Phototherapy has been used for reducing muscle fatigue. In view of the various types of phototherapy cluster probes available in the market, the purpose of this study was to compare the effects of a similar phototherapy dosage with two different cluster probes on elbow flexor muscle fatigue: small cluster probe (SC = 9 diodes; 7.5 cm(2)) vs. large cluster probe (LC = 33 diodes; 30.2 cm(2)). Ten physically active male aged 18-35 years participate in a randomized, crossover, double-blind, placebo-controlled trial, which each participant was submitted to the same testing protocol in four sessions (separated by at least 48 h) with different treatments: LC-phototherapy, SC-phototherapy, LC-placebo, and SC-placebo. The elbow flexion maximal isometric voluntary contraction (MIVC) was performed before and after a fatigue protocol (60 % of MIVC until exhaustion). Electromyography (EMG) of the biceps brachii muscle was collected during all testing procedure. Phototherapy with dose of 60 J per muscle [LC: 33 diodes = 5 lasers (850 nm), 12 LEDs (670 nm), 8 LEDs (880 nm), and 8 LEDs (950 nm); SC: 9 diodes = 5 lasers (850 nm) and 4 LEDs (670 nm)] or placebo applications occurred before fatigue protocol. Two-way ANOVA (treatment and time factors) and one-way ANOVA were used, followed by LSD post hoc. Time to exhaustion was significantly higher in active LC (15 %; p = 0.031) and SC (14 %; p = 0.038) in comparison with their respective placebo treatments, without differences between LC and SC (p > 0.05) or between placebo conditions (p > 0.05). This larger exercise tolerance in phototherapy conditions was not accompanied by a higher decrement in the volunteers' maximal strength capacity (11-15 %; p > 0.05 for all). EMG signals presented no difference between the four condition tested here. In both large and small cluster probes (according parameters tested in this study) led to reduced fatigue in elbow flexor muscles, without

  18. Prior Heat Stress Effects Fatigue Recovery of the Elbow Flexor Muscles

    PubMed Central

    Iguchi, Masaki; Shields, Richard K.

    2011-01-01

    Introduction Long-lasting alterations in hormones, neurotransmitters and stress proteins after hyperthermia may be responsible for the impairment in motor performance during muscle fatigue. Methods Subjects (n = 25) performed a maximal intermittent fatigue task of elbow flexion after sitting in either 73 or 26 deg C to examine the effects of prior heat stress on fatigue mechanisms. Results The heat stress increased the tympanic and rectal temperatures by 2.3 and 0.82 deg C, respectively, but there was full recovery prior to the fatigue task. While prior heat stress had no effects on fatigue-related changes in volitional torque, EMG activity, torque relaxation rate, MEP size and SP duration, prior heat stress acutely increased the pre-fatigue relaxation rate and chronically prevented long-duration fatigue (p < 0.05). Discussion These findings indicate that prior passive heat stress alone does not alter voluntary activation during fatigue, but prior heat stress and exercise produce longer-term protection against long-duration fatigue. PMID:21674526

  19. Bilateral Knee Extensor Fatigue Modulates Force and Responsiveness of the Corticospinal Pathway in the Non-fatigued, Dominant Elbow Flexors

    PubMed Central

    Šambaher, Nemanja; Aboodarda, Saied Jalal; Behm, David George

    2016-01-01

    Exercise-induced fatigue affects muscle performance and modulates corticospinal excitability in non-exercised muscles. The purpose of this study was to investigate the effect of bilateral knee extensor fatigue on dominant elbow flexor (EF) maximal voluntary force production and corticospinal excitability. Transcranial magnetic, transmastoid electrical and brachial plexus electrical stimulation (BPES) were used to investigate corticospinal, spinal, and muscle excitability of the dominant EF before and after a bilateral knee extensor fatiguing protocol or time matched rest period (control). For both sessions three stimuli were delivered every 1.5 s during the three pre-test time points and during the 1st, 3rd, 6th, 9th and 12th post-test 5 s EF isometric maximal voluntary contractions (MVC). In both conditions, overall, EF MVC force (p < 0.001) decreased progressively from repetition #1 to #12 during the post-test MVC protocol. EF MVC force (p < 0.001, ES = 0.9, Δ10.3%) decrements were more pronounced in the knee extensor fatigue intervention condition. In addition, there were no significant differences between conditions for biceps brachii electromyographic (EMG) activity (p = 0.43), motor evoked potentials (MEPs) amplitude (p = 0.908) or MEP silent period (SP; p = 0.776). However, the fatigue condition exhibited a lower MEP/cervicomedullary MEP (CMEP) ratio (p = 0.042, ES = 2.5, Δ25%) and a trend toward higher CMEP values (p = 0.08, ES = 0.5, Δ20.4%). These findings suggest that bilateral knee extensor fatigue can impair performance and modulate corticospinal excitability of the EF. PMID:26869902

  20. Sensitivity of different areas of the flexor aspect of the human forearm to corticosteroid-induced skin blanching.

    PubMed

    Meyer, E; Smith, E W; Haigh, J M

    1992-10-01

    The intensity of corticosteroid-induced blanching has been found to vary at different areas of the flexor aspect of the human forearm. A retrospective analysis of 38,880 observations of skin blanching in 56 volunteers was conducted to assess the sensitivity of forearm skin to betamethasone 17-valerate. The mid-forearm appears to be more sensitive to the blanching response than do the areas close to the wrist or elbow. These results indicate that each preparation under evaluation should be applied to several sites along the forearm when using the human skin blanching assay in order to obtain an accurate comparative assessment of corticosteroid release from topical delivery vehicles.

  1. Static torque-angle relation of human elbow joint estimated with artificial neural network technique.

    PubMed

    Uchiyama, T; Bessho, T; Akazawa, K

    1998-06-01

    Static relations between elbow joint angle and torque at constant muscle activity in normal volunteers were investigated with the aid of an artificial neural network technique. A subject sat on a chair and moved his upper- and forearm in a horizontal plane at the height of his shoulder. The subject was instructed to maintain the elbow joint at a pre-determined angle. The wrist was then pulled to extend the elbow joint by the gravitational force of a weight hanging from a pulley. Integrated electromyograms (IEMGs), elbow and shoulder joint angles and elbow joint torque were measured. Then the relation among IEMGs, joint angles and torque was modeled with the aid of the artificial neural network, where IEMGs and joint angles were the inputs and torque was the output. After back propagation learning, we presented various combinations of IEMGs, shoulder and elbow joint angles to the model and estimated the elbow joint torque to obtain the torque-angle relation for constant muscle activation. The elbow joint torque increased and then decreased with extension of the elbow joint. This suggests that if the forearm is displaced from an equilibrium point, the torque angle relation would not act like a simple spring. In a view of the musculoskeletal structure of the elbow joint, the relation between the elbow joint angle and the moment arm of the elbow flexor muscles seems to have a dominant effect on the torque-angle relation. PMID:9755039

  2. Comparison of modified Kessler tendon suture at different levels in the human flexor digitorum profundus tendon and porcine flexors and porcine extensors: an experimental biomechanical study.

    PubMed

    Havulinna, J; Leppänen, O V; Järvinen, T L N; Göransson, H

    2011-10-01

    This study compared the biomechanical behaviour of repairs in the human flexor digitorum profundus tendon in zones I, II and III with repairs of different segments of the porcine flexor tendon of the second digit and the extensor digiti quarti proprius tendon, in order to assess the validity of porcine tendons as models for human flexor tendon repairs. These porcine tendons were selected after comparing their size with the human flexor digitorum profundus tendon. The tendon repairs were done in three segments of each porcine tendon and repairs in the human tendons were done in zones I,II and III. Ten tendons in each group yielded a total of 90 specimens. A modified Kessler repair was done with 3-0 coated braided polyester suture and subjected to uniaxial tensile testing. In human flexor tendons, the ultimate force was higher in zones I and II than in zone III. The porcine flexor digitorum profundus tendon from the second digit and the proximal segment of the extensor digiti quarti proprius tendon behaved similarly to the human flexor tendon in zone III and can be considered as surrogates for the human flexor tendon. PMID:21816887

  3. A Comparison of Total and Intrinsic Muscle Stiffness Among Flexors and Extensors of the Ankle, Knee and Elbow

    NASA Technical Reports Server (NTRS)

    Lemoine, Sandra M.

    1997-01-01

    This study examined 3 methods that assessed muscle stiffness. Muscle stiffness has been quantified by tissue reactive force (transverse stiffness), vibration, and force (or torque) over displacement. Muscle stiffness also has two components: reflex (due to muscle sensor activity) and intrinsic (tonic firing of motor units, elastic nature of actin and myosin cross bridges, and connective tissue). This study compared three methods of measuring muscle stiffness of agonist-antagonist muscle pairs of the ankle, knee and elbow.

  4. Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury.

    PubMed

    Smith, Andrew C; Mummidisetty, Chaithanya K; Rymer, William Zev; Knikou, Maria

    2014-11-01

    In humans, a chronic spinal cord injury (SCI) impairs the excitability of pathways mediating early flexor reflexes and increases the excitability of late, long-lasting flexor reflexes. We hypothesized that in individuals with SCI, locomotor training will alter the behavior of these spinally mediated reflexes. Nine individuals who had either chronic clinically motor complete or incomplete SCI received an average of 44 locomotor training sessions. Flexor reflexes, elicited via sural nerve stimulation of the right or left leg, were recorded from the ipsilateral tibialis anterior (TA) muscle before and after body weight support (BWS)-assisted treadmill training. The modulation pattern of the ipsilateral TA responses following innocuous stimulation of the right foot was also recorded in 10 healthy subjects while they stepped at 25% BWS to investigate whether body unloading during walking affects the behavior of these responses. Healthy subjects did not receive treadmill training. We observed a phase-dependent modulation of early TA flexor reflexes in healthy subjects with reduced body weight during walking. The early TA flexor reflexes were increased at heel contact, progressively decreased during the stance phase, and then increased throughout the swing phase. In individuals with SCI, locomotor training induced the reappearance of early TA flexor reflexes and changed the amplitude of late TA flexor reflexes during walking. Both early and late TA flexor reflexes were modulated in a phase-dependent pattern after training. These new findings support the adaptive capability of the injured nervous system to return to a prelesion excitability and integration state.

  5. Acute medial elbow ruptures.

    PubMed

    Norwood, L A; Shook, J A; Andrews, J R

    1981-01-01

    Disruption of the ulnar collateral ligament, flexor muscles, and anterior elbow capsule may result from valgus vector forces and subsequently cause difficulty in throwing, pulling, pushing and catching. Complete medial elbow tears were diagnosed acutely in four elbows by abduction stress tests at 15 degrees of flexion. Three elbows had associated ulnar nerve compression. We repaired torn medial structures by direct suture without ligamentous reconstruction. We also decompressed ulnar nerves and performed one anterior transposition. Full range of motion, strength, and return to previous functional level was attained without infection, neurovascular compression, or myositis ossificans.

  6. Orthopedic applications of acellular human dermal allograft for shoulder and elbow surgery.

    PubMed

    Acevedo, Daniel C; Shore, Brett; Mirzayan, Raffy

    2015-07-01

    Shoulder and elbow tendon injuries are some of the most challenging problems to treat surgically. Tendon repairs in the upper extremity can be complicated by poor tendon quality and, often times, poor healing. Extracellular matrices, such as human dermal allografts, have been used to augment tendon repairs in shoulder and elbow surgery. The indications and surgical techniques regarding the use of human dermal allograft continue to evolve. This article reviews the basic science, rationale for use, and surgical applications of human dermal allograft in shoulder and elbow tendon injuries.

  7. The senses of force and heaviness at the human elbow joint.

    PubMed

    Brooks, Jack; Allen, Trevor J; Proske, Uwe

    2013-05-01

    The present-day view of the neural basis for the senses of muscle force and heaviness is that they are generated centrally, within the brain, from copies of motor commands. A corollary of the motor discharge generates a sense of effort which underlies these sensations. In recent experiments on force and heaviness sensations using thumb flexor muscles, a rather different explanation has been invoked: Subjects were proposed to rely predominantly on inputs of a peripheral origin, in particular, the signals of muscle spindles. The present experiments have been carried out at the elbow joint to determine whether these new ideas apply more widely. The effects of fatigue of elbow flexor muscles have been studied in force and heaviness matching tasks using three exercise regimes, a sustained maximum voluntary contraction (MVC), a maintained contraction of 35 % MVC, and a maintained contraction of 35 % MVC combined with muscle vibration at 80 Hz. In force-matching experiments, subjects were required to contract both arms and while the reference arm generated the target force under visual control, it was matched by the indicator arm without visual feedback. During the 100 % MVC exercise, force in the exercising reference arm fell rapidly to almost a half of its original value over 90 s while force in the indicator did not fall, leading to a significant overestimation of the reference force. During the 35 % MVC exercise, subjects also overestimated the reference force and this persisted at 5 and 10 min after the exercise. When 35 % MVC was combined with vibration, the amount by which the indicator arm overestimated the reference force was significantly reduced. In heaviness matching experiments, subjects could move their arms through a small range. The reference arm was loaded with a weight, and weights were added or removed from the indicator until heaviness felt the same in the two arms. There was a small, but significant fall in the matching weight used after 100 % MVC

  8. Strict actions of the human wrist flexors: A study with an electrical neuromuscular stimulation method.

    PubMed

    Narita, Aya; Sagae, Masaaki; Suzuki, Katsuhiko; Fujita, Takaaki; Sotokawa, Tasuku; Nakano, Haruki; Naganuma, Makoto; Sato, Toshiaki; Fujii, Hiromi; Nito, Mitsuhiro; Hashizume, Wataru; Ogino, Toshihiko; Naito, Akira

    2015-08-01

    In order to elucidate strict actions of the human wrist flexors, motion and force produced by electrical neuromuscular stimulation (ENS) to each of musculus (m.) flexsor carpi radialis (FCR) and m. flexsor carpi ulnaris (FCU) with the prone, semiprone, and supine forearm were studied in ten healthy human subjects. Abduction, extension, adduction, and flexion directions were represented by, respectively, 0°, 90°, 180°, and 270°. ENS to FCR and FCU produced motion in direction of, respectively, 273° (mean) and 265° with the prone, 249° and 232° with the semiprone, and 242° and 229° with the supine forearm to the maximal range. Direction/strength (Nm) of force by ENS to FCR and FCU were, respectively, 298°/1.16 and 239°/1.70 with the prone, 279°/1.30 and 241°/1.62 with the semiprone, and 267°/1.24 and 227°/2.04 with the supine forearm. ENS to FCR exhibited force of 20-29% of maximal flexion and 7-15% of maximal abduction or 1-4% of maximal adduction and that to FCU force of 24-28% of maximal flexion and 15-25% of maximal adduction. The force study results suggest that FCU is a flexor rather than an adductor with every forearm position. FCR should be a flexor rather than an abductor with the prone and semiprone and a flexor with the supine forearm. The action of FCR as the abductor should diminish with supinating the forearm. PMID:25921817

  9. Interlimb communication to the knee flexors during walking in humans

    PubMed Central

    Stevenson, Andrew J T; Geertsen, Svend S; Andersen, Jacob B; Sinkjær, Thomas; Nielsen, Jens B; Mrachacz-Kersting, Natalie

    2013-01-01

    A strong coordination between the two legs is important for maintaining a symmetric gait pattern and adapting to changes in the external environment. In humans as well as animals, receptors arising from the quadriceps muscle group influence the activation of ipsilateral muscles. Moreover, strong contralateral spinal connections arising from quadriceps and hamstring afferents have been shown in animal models. Therefore, the aims of the present study were to assess if such connections also exist in humans and to elucidate on the possible pathways. Contralateral reflex responses were investigated in the right leg following unexpected unilateral knee joint rotations during locomotion in either the flexion or extension direction. Strong reflex responses in the contralateral biceps femoris (cBF) muscle with a mean onset latency of 76 ± 6 ms were evoked only from ipsilateral knee extension joint rotations in the late stance phase. To investigate the contribution of a transcortical pathway to this response, transcranial magnetic and electrical stimulation were applied. Motor evoked potentials elicited by transcranial magnetic stimulation, but not transcranial electrical stimulation, were facilitated when elicited at the time of the cBF response to a greater extent than the algebraic sum of the cBF reflex and motor evoked potentials elicited separately, indicating that a transcortical pathway probably contributes to this interlimb reflex. The cBF reflex response may therefore be integrated with other sensory input, allowing for responses that are more flexible. We hypothesize that the cBF reflex response may be a preparation of the contralateral leg for early load bearing, slowing the forward progression of the body to maintain dynamic equilibrium during walking. PMID:23918771

  10. Vortical flow in human elbow joints: a three-dimensional computed tomography modeling study.

    PubMed

    Adikrishna, Arnold; Kekatpure, Aashay L; Tan, Jun; Lee, Hyun-Joo; Deslivia, Maria Florencia; Jeon, In-Ho

    2014-10-01

    The human elbow joint has been regarded as a loose hinge joint, with a unique helical motion of the axis during extension-flexion. This study was designed to identify the helical axis in the ulnohumeral joint during elbow extension-flexion by tracking the midpoint between the coronoid tip and the olecranon tip of the proximal ulna in a three-dimensional (3D) computed tomography (CT) image model. The elbows of four volunteers were CT-scanned at four flexion angles (0°, 45°, 90°, and 130°) at neutral rotation with a custom-made holding device to control any motion during scanning. Three-dimensional models of each elbow were reconstructed and a 3D ulnohumeral joint at 45°, 90°, and 130° was superimposed onto a fully extended joint (0°) by rotating and translating each 3D ulnohumeral joint along the axes. The midpoints of the olecranon and coronoid tips were interpolated using cubic spline technique and the dynamic elbow motion was plotted to determine the motion of the helical axis. The means and standard deviations were subsequently calculated. The average midpoint pattern of joint motion from extension to flexion was elliptical-orbit-like when projected onto a sagittal plane and continuously translated a mean 2.14 ± 0.34 mm (range, 1.83-2.52 mm) to the lateral side during elbow extension-flexion. In 3D space, the average midpoint pattern of the ulnohumeral joint resembles a vortical flow, spinning along an imaginary axis, with an inconsistent radius from 0° to 130° flexion. The ulnohumeral joint axis both rotates and translates during elbow extension-flexion, with a vortex-flow motion occurring during flexion in 3D model analysis. This motion should be considered when performing hinged external fixation, total elbow replacement and medial collateral ligament reconstruction surgery.

  11. Human ankle plantar flexor muscle-tendon mechanics and energetics during maximum acceleration sprinting.

    PubMed

    Lai, Adrian; Schache, Anthony G; Brown, Nicholas A T; Pandy, Marcus G

    2016-08-01

    Tendon elastic strain energy is the dominant contributor to muscle-tendon work during steady-state running. Does this behaviour also occur for sprint accelerations? We used experimental data and computational modelling to quantify muscle fascicle work and tendon elastic strain energy for the human ankle plantar flexors (specifically soleus and medial gastrocnemius) for multiple foot contacts of a maximal sprint as well as for running at a steady-state speed. Positive work done by the soleus and medial gastrocnemius muscle fascicles decreased incrementally throughout the maximal sprint and both muscles performed more work for the first foot contact of the maximal sprint (FC1) compared with steady-state running at 5 m s(-1) (SS5). However, the differences in tendon strain energy for both muscles were negligible throughout the maximal sprint and when comparing FC1 to SS5. Consequently, the contribution of muscle fascicle work to stored tendon elastic strain energy was greater for FC1 compared with subsequent foot contacts of the maximal sprint and compared with SS5. We conclude that tendon elastic strain energy in the ankle plantar flexors is just as vital at the start of a maximal sprint as it is at the end, and as it is for running at a constant speed. PMID:27581481

  12. Tendon elastic strain energy in the human ankle plantar-flexors and its role with increased running speed.

    PubMed

    Lai, Adrian; Schache, Anthony G; Lin, Yi-Chung; Pandy, Marcus G

    2014-09-01

    The human ankle plantar-flexors, the soleus and gastrocnemius, utilize tendon elastic strain energy to reduce muscle fiber work and optimize contractile conditions during running. However, studies to date have considered only slow to moderate running speeds up to 5 m s(-1). Little is known about how the human ankle plantar-flexors utilize tendon elastic strain energy as running speed is advanced towards maximum sprinting. We used data obtained from gait experiments in conjunction with musculoskeletal modeling and optimization techniques to calculate muscle-tendon unit (MTU) work, tendon elastic strain energy and muscle fiber work for the ankle plantar-flexors as participants ran at five discrete steady-state speeds ranging from jogging (~2 m s(-1)) to sprinting (≥8 m s(-1)). As running speed progressed from jogging to sprinting, the contribution of tendon elastic strain energy to the positive work generated by the MTU increased from 53% to 74% for the soleus and from 62% to 75% for the gastrocnemius. This increase was facilitated by greater muscle activation and the relatively isometric behavior of the soleus and gastrocnemius muscle fibers. Both of these characteristics enhanced tendon stretch and recoil, which contributed to the bulk of the change in MTU length. Our results suggest that as steady-state running speed is advanced towards maximum sprinting, the human ankle plantar-flexors continue to prioritize the storage and recovery of tendon elastic strain energy over muscle fiber work.

  13. 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 ...

  14. Operative technique for human composite flexor tendon allograft procurement and engraftment.

    PubMed

    DeGeorge, Brent R; Rodeheaver, George T; Drake, David B

    2014-01-01

    Devastating volar hand injuries with significant damage to the pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. Postoperative adhesion formation and lack of suitable donor material for tendon autograft are 2 fundamental problems that continue to challenge the hand surgeon. In 1967, Erle E. Peacock, Jr, described a technique of flexor tendon reconstruction using cadaveric composite flexor tendon allograft, which consisted of both the flexor digitorum profundus and superficialis tendons in their respective fibro-osseous sheaths consisting of the digital pulley structures and the underlying periosteum and volar plates. This technique never gained widespread acceptance due to concerns regarding tissue antigenicity, infectious disease transmission, and the rising popularity of the method of Hunter for silastic rod-based flexor tendon reconstruction initially described during the same period. With modern-day advances in tissue processing with acellularization and extensive donor screening for transmissible diseases, this technique should be revisited to address the reconstructive needs of patients with extensive volar soft tissue and tendon injury. Herein, we describe the operative technique of composite flexor tendon procurement and reconstruction with key modifications from the initial technique described by Peacock for improved composite construct elevation, soft tissue inset, and bony attachment.

  15. Facilitation from flexor digitorum superficialis to extensor carpi radialis in humans.

    PubMed

    Nito, Mitsuhiro; Hashizume, Wataru; Miyasaka, Takuji; Suzuki, Katsuhiko; Sato, Toshiaki; Fujii, Hiromi; Shindo, Masaomi; Naito, Akira

    2016-08-01

    Effects of low-threshold afferents from the flexor digitorum superficialis (FDS) to the extensor carpi radialis (ECR) motoneurons were examined using a post-stimulus time-histogram (PSTH) and electromyogram-averaging (EMG-A) methods in eight healthy human subjects. In the PSTH study in five of the eight subjects, electrical conditioning stimuli (ES) to the median nerve branch innervating FDS with the intensity below the motor threshold induced excitatory effects (facilitation) in 39 out of 92 ECR motor units. In 11 ECR motor units, the central synaptic delay of the facilitation was -0.1 ± 0.3 ms longer than that of the homonymous facilitation of ECR. Mechanical conditioning stimuli (MS) to FDS with the intensity below the threshold of the tendon(T)-wave-induced facilitation in 51 out of 51 ECR motor units. With the EMG-A method, early and significant peaks were produced by ES and MS in all the eight subjects. The difference between latencies of the peaks by ES and MS was almost equivalent to that of the Hoffmann- and T-waves of FDS by ES and MS. The peak was diminished by tonic vibration stimuli to FDS. These findings suggest that a facilitation from FDS to ECR exists in humans and group Ia afferents mediate the facilitation through a monosynaptic path. PMID:27010723

  16. Oligosynaptic inhibition of group I afferents between the brachioradialis and flexor carpi radialis in humans.

    PubMed

    Kobayashi, Shinji; Hayashi, Masahiro; Shinozaki, Katsuhiro; Nito, Mitsuhiro; Hashizume, Wataru; Miyasaka, Takuji; Shindo, Masaomi; Naito, Akira

    2016-09-01

    Spinal reflex arcs mediated by low threshold afferents between the brachioradialis (BR) and flexor carpi radialis (FCR) were studied in eleven healthy human subjects using a post-stimulus time-histogram method. Electrical conditioning stimuli (ES) to the radial nerve branch innervating BR with the intensity below the motor threshold (MT) induced an early and significant trough (inhibition) in 32/85 FCR motor units (MUs) in 9/9 subjects. Such inhibition was never provoked by cutaneous stimulation. The central synaptic delay (CSD) of the inhibition was approximately 1.1ms longer than that of the homonymous FCR facilitation. ES to the median nerve branch innervating FCR with the intensity below MT induced an inhibition in 27/71 BR-MUs in 10/10 subjects. CSD of the inhibition was about 1.1ms longer than that of the homonymous BR facilitation. These findings suggest that inhibition between BR and FCR exists in humans. Group I afferents seem to mediate the inhibition through an oligo(di or tri)-synaptic path. PMID:26996830

  17. Magnetic resonance imaging of the elbow.

    PubMed

    Steinbach, L S; Fritz, R C; Tirman, P F; Uffman, M

    1997-11-01

    Magnetic resonance imaging (MRI) provides useful information regarding the elbow joint. Many abnormalities seen in the elbow are a result of trauma, often from sports such as baseball and tennis. Elbow problems are frequently related to the medial tension-lateral compression phenomenon where repeated valgus stress produces flexor-pronator strain, ulnar collateral ligament sprain, ulnar traction spurring, and ulnar neuropathy. The lateral compression causes osteochondritis dissecans of the capitellum and radial head, degenerative arthritis, and loose bodies. Other elbow abnormalities seen on MRI include radial collateral ligament injuries, biceps and triceps tendon injuries, other nerve entrapment syndromes, loose bodies, osseous and soft tissue trauma, arthritis, and masses, including bursae.

  18. Enhanced propriospinal excitation from hand muscles to wrist flexors during reach-to-grasp in humans.

    PubMed

    Giboin, Louis-Solal; Lackmy-Vallée, Alexandra; Burke, David; Marchand-Pauvert, Véronique

    2012-01-01

    In humans, propriospinal neurons located at midcervical levels receive peripheral and corticospinal inputs and probably participate in the control of grip tasks, but their role in reaching movements, as observed in cats and primates, is still an open question. The effect of ulnar nerve stimulation on flexor carpi radialis (FCR) motor evoked potential (MEP) was tested during reaching tasks and tonic wrist flexion. Significant MEP facilitation was observed at the end of reach during reach-to-grasp but not during grasp, reach-to-point, or tonic contractions. MEP facilitation occurred at a longer interstimulus interval than expected for convergence of corticospinal and afferent volleys at motoneuron level and was not paralleled by a change in the H-reflex. These findings suggest convergence of the two volleys at propriospinal level. Ulnar-induced MEP facilitation was observed when conditioning stimuli were at 0.75 motor response threshold (MT), but not 1 MT. This favors an increased excitability of propriospinal neurons rather than depression of their feedback inhibition, as has been observed during tonic power grip tasks. It is suggested that the ulnar-induced facilitation of FCR MEP during reach may be due to descending activation of propriospinal neurons, assisting the early recruitment of large motoneurons for rapid movement. Because the feedback inhibitory control is still open, this excitation can be truncated by cutaneous inputs from the palmar side of the hand during grasp, thus assisting movement termination. It is concluded that the feedforward activation of propriospinal neurons and their feedback control may be involved in the internal model, motor planning, and online adjustments for reach-to-grasp movements in humans.

  19. 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)...

  20. 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)...

  1. 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)...

  2. 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)...

  3. 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)...

  4. Elbow replacement

    MedlinePlus

    Cooney WP, Morrey BF. Elbow arthroplasty: Historical perspective and emerging concepts. In: Morrey BF, Sanchez-Sotlo J. The Elbow and Its Disorders . 4th ed. Philadelphia, PA; Elsevier Saunders; 2009: ...

  5. In vivo measurement of fascicle length and pennation of the human anconeus muscle at several elbow joint angles

    PubMed Central

    Stevens, Daniel E; Smith, Cameron B; Harwood, Brad; Rice, Charles L

    2014-01-01

    Ultrasound imaging has facilitated the reliable measure of the architectural variables fascicle length (LF) and pennation angle (PA), at rest and during static and dynamic contractions in many human skeletal muscles in vivo. Despite its small size and very modest contribution to elbow extension torque, the anconeus muscle has proven a useful model for the study of neuromuscular function in health and disease. Recent single motor unit (MU) studies in the anconeus have reported discrete and identifiable individual trains of MU potentials from intramuscular electromyography (EMG) recordings during dynamic elbow extensions. It is unknown whether the anconeus has unique architectural features related to alterations in LF and PA throughout the elbow joint range of motion that may help explain these high-quality recordings. Previous anatomical studies have investigated this muscle in cadavers and at mainly one elbow joint angle. The purpose of this study was to measure in vivo PA and LF of the anconeus muscle in a relaxed state at different degrees of elbow flexion using ultrasonography. Ultrasound images were collected from 10 healthy males (25 ± 3 years) at 135°, 120°, 90°, 45°, and 0° of elbow flexion. Average values of LF decreased by 6 mm (10%), 6 mm (12%), and 4 mm (9%) from 135–120°, 120–90°, and 90–45° of elbow flexion, respectively, whereas average PA values increased by 1° (9%), 1° (8%), and 2° (14%) from 135–120°, 120–90°, and 45–0°, respectively. The results indicate that anconeus muscle architecture is dynamic, undergoing moderate changes with elbow joint excursion that are similar to other limb muscles reported elsewhere. The data obtained here are more comprehensive and representative of architectural changes at various elbow joint positions than those data reported in cadaveric studies. Furthermore, the results of this study indicate that despite experiencing similar relative changes in muscle architecture to other skeletal

  6. INTRASYNOVIAL FLEXOR TENDON REPAIR: A BIOMECHANICAL STUDY OF VARIATIONS IN SUTURE APPLICATION IN HUMAN CADAVERA

    PubMed Central

    Nelson, GN; Potter, R; Ntouvali, E; Silva, MJ; Boyer, MI; Gelberman, RH; Thomopoulos, S

    2013-01-01

    To improve the functional outcomes of intrasynovial tendon suture, prior experiments evaluated individual technical modifications used in the repair process. Few studies, however, have assessed the combinatorial effects of those suture modifications in an integrated biomechanical manner, including a sample size sufficient to make definitive observations on repair technique. 256 flexor tendon repairs were performed in cadavera, and biomechanical properties were determined. The effects of five factors for flexor tendon repair were tested: core suture caliber (4-0 or 3-0), number of sutures crossing the repair site (4- or 8-strand), core suture purchase (0.75 cm or 1.2 cm), peripheral suture caliber (6-0 or 5-0), and peripheral suture purchase (superficial or 2 mm). Significant factors affecting the properties of the repair were the number of core suture strands and the peripheral suture purchase. The least significant factors were core suture purchase and peripheral suture caliber. The choice of core suture caliber affected the properties of repair marginally. Based on these results, we recommend that surgeons continue to focus on multi-strand repair methods, as the properties of 8-strand repairs were far better than those of 4-strand repairs. To resist gap formation and enhance repair strength, a peripheral suture with 2mm purchase is also recommended. Finally, since core suture caliber affected some biomechanical properties, including the failure mode, a 3-0 suture could be considered, provided that future in vivo studies can confirm that gliding properties are not adversely influenced. PMID:22457145

  7. Muscle activity-torque-velocity relations in human elbow extensor muscles.

    PubMed

    Uchiyama, T; Akazawa, K

    1999-01-01

    With the aid of an artificial neural network technique, we investigated relationships between the torque and extending velocity of an elbow at constant muscle activation in healthy volunteers. Each subject sat on a chair and was able to move his upper- and forearm on a shoulder-high horizontal plane. First, with the gravitational force of a weight hanging from a pulley, the subject's wrist was pulled to flex the elbow. Next, the subject was instructed to extend his elbow joint at a constant velocity. Integrated electromyograms (IEMGs), elbow joint angle and torque were measured while the elbow was being extending. Then the relationships among these three variables were modeled using an artificial neural network where IEMGs, joint angle and velocity were the inputs, and torque was the output. After back propagation learning, we presented various combinations of IEMGs, elbow joint angle and velocity to the model, and estimated the elbow joint torque to obtain the torque-velocity relationship for constant muscle activation. The torque decreased in a nearly linear manner as the velocity increased. This was caused by slow extending velocity and was explained by Hill's equation at slow velocity. PMID:10718668

  8. Influence of vibration on mechanical power and electromyogram activity in human arm flexor muscles.

    PubMed

    Bosco, C; Cardinale, M; Tsarpela, O

    1999-03-01

    The aim of this study was to evaluate the influence of vibration on the mechanical properties of arm flexors. A group of 12 international level boxers, all members of the Italian national team, voluntarily participated in the experiment: all were engaged in regular boxing training. At the beginning of the study they were tested whilst performing forearm flexion with an extra load equal to 5% of the subjects' body mass. Following this. one arm was given the experimental treatment (E; mechanical vibration) and the other was the control (no treatment). The E treatment consisted of five repetitions lasting 1-min each of mechanical vibration applied during arm flexion in isometric conditions with 1 min rest between them. Further tests were performed 5 min immediately after the treatment on both limbs. The results showed statistically significant enhancement of the average power in the arm treated with vibrations. The root mean square electromyogram (EMGrms) had not changed following the treatment but, when divided by mechanical power, (P) as an index of neural efficiency, it showed statistically significant increases. It was concluded that mechanical vibrations enhanced muscle P and decreased the related EMG/P relationship in elite athletes. Moreover, the analysis of EMGrms recorded before the treatment and during the treatment itself showed an enormous increase in neural activity during vibration up to more than twice the baseline values. This would indicate that this type of treatment is able to stimulate the neuromuscular system more than other treatments used to improve neuromuscular properties.

  9. Tennis elbow

    MedlinePlus

    ... using a screwdriver) can lead to this condition. Painters, plumbers, construction workers, cooks, and butchers are all ... pressed near where it attaches to the upper arm bone, over the outside of the elbow Pain ...

  10. Flexor digitorum longus tendoscopy.

    PubMed

    Lui, Tun Hing

    2012-01-01

    The flexor digitorum longus tendon is susceptible to injury along its entire course, and lacerations, ruptures, longitudinal tears, and stenosing tenosynovitis have all been reported. Moreover, this tendon is commonly used for reconstruction of dysfunctional posterior tibial and Achilles tendons. Traditionally, surgery involving the flexor digitorum longus tendon was performed via open incision. We describe a technique of flexor digitorum longus tendoscopy that may encourage the future development of a minimally invasive approach to flexor digitorum longus tendon procedures. PMID:22727339

  11. Ulnar collateral ligament of the elbow.

    PubMed

    Safran, Marc; Ahmad, Christopher S; Elattrache, Neal S

    2005-11-01

    Recent advances in the diagnosis and treatment of the overhead athlete's elbow has led the medical community to understand that the ulnar collateral ligament (UCL) of the elbow is more commonly injured than originally thought. Injury can result in secondary symptoms and problems in other regions of the elbow. Sports requiring an overhead motion, such as throwing a ball, hitting a ball overhead, or serving a tennis ball, imparts a valgus stress on the elbow that is resisted by the UCL. Throwing sidearm or hitting a forehand in tennis, squash, or racquetball may also impart a valgus stress to the elbow. Repeated or excessive valgus stress places a force on the UCL that may result in injury to the ligament. Injury to the UCL may result in problems in other areas of the elbow, including the ulnar nerve, the flexor-pronator musculotendinous unit, the radiocapitellar joint and the posterior compartment of the elbow, in addition to being a cause of loose bodies within the elbow. This article reviews the anatomy, biomechanics, and pathophysiology of injury to the UCL and injuries to the other structures that result from UCL injury. Also reviewed are patient history, examination techniques, tests that help confirm the diagnosis of UCL injury, and treatment of the injured UCL.

  12. The role of human ankle plantar flexor muscle-tendon interaction and architecture in maximal vertical jumping examined in vivo.

    PubMed

    Farris, Dominic James; Lichtwark, Glen A; Brown, Nicholas A T; Cresswell, Andrew G

    2016-02-01

    Humans utilise elastic tendons of lower limb muscles to store and return energy during walking, running and jumping. Anuran and insect species use skeletal structures and/or dynamics in conjunction with similarly compliant structures to amplify muscle power output during jumping. We sought to examine whether human jumpers use similar mechanisms to aid elastic energy usage in the plantar flexor muscles during maximal vertical jumping. Ten male athletes performed maximal vertical squat jumps. Three-dimensional motion capture and a musculoskeletal model were used to determine lower limb kinematics that were combined with ground reaction force data in an inverse dynamics analysis. B-mode ultrasound imaging of the lateral gastrocnemius (GAS) and soleus (SOL) muscles was used to measure muscle fascicle lengths and pennation angles during jumping. Our results highlighted that both GAS and SOL utilised stretch and recoil of their series elastic elements (SEEs) in a catapult-like fashion, which likely serves to maximise ankle joint power. The resistance of supporting of body weight allowed initial stretch of both GAS and SOL SEEs. A proximal-to-distal sequence of joint moments and decreasing effective mechanical advantage early in the extension phase of the jumping movement were observed. This facilitated a further stretch of the SEE of the biarticular GAS and delayed recoil of the SOL SEE. However, effective mechanical advantage did not increase late in the jump to aid recoil of elastic tissues.

  13. Effects of gamma irradiation and repetitive freeze-thaw cycles on the biomechanical properties of human flexor digitorum superficialis tendons.

    PubMed

    Ren, Dejie; Sun, Kang; Tian, Shaoqi; Yang, Xu; Zhang, Cailong; Wang, Wenhao; Huang, Hongjie; Zhang, Jihua; Deng, Yujie

    2012-01-10

    An increasing number of tissue banks have begun to focus on gamma irradiation and freeze-thaw in the reconstruction of anterior cruciate ligaments using allografts. The purpose of this study was to evaluate the biomechanical properties of human tendons after exposure to gamma radiation and repeated freeze-thaw cycles and to compare them with fresh specimens. Forty flexor digitorum superficialis tendons were surgically procured from five fresh cadavers and divided into four groups: fresh tendon, gamma irradiation, freeze-thaw and gamma irradiation+freeze-thaw. The dose of gamma irradiation was 25 kGy. Each freeze-thaw cycle consisted of freezing at -80 °C for 7 day and thawing at 25 °C for 6 h. These tendons underwent 4 freeze-thaw cycles. Biomechanical properties were analyzed during load-to-failure testing. The fresh tendons were found to be significantly different in ultimate load, stiffness and ultimate stress relative to the other three groups. The tendons of the gamma+freeze-thaw group showed a significant decrease in ultimate load, ultimate stress and stiffness compared with the other three groups. Gamma irradiation and repeated freezing-thawing (4 cycles) can change the biomechanical properties. However, no significant difference was found between these two processes on the effect of biomechanical properties. It is recommended that gamma irradiation (25 kGy) and repetitive freeze-thaw cycles (4 cycles) should not be adopted in the processing of the allograft tendons.

  14. Time-varying stiffness of human elbow joint during cyclic voluntary movement.

    PubMed

    Bennett, D J; Hollerbach, J M; Xu, Y; Hunter, I W

    1992-01-01

    The objective of this study was to determine the extent to which subjects modulate their elbow joint mechanical properties during ongoing arm movement. Small pseudo-random force disturbances were applied to the wrist with an airjet actuator while subjects executed large (1 rad) elbow joint movements. Using a lumped parameter model of the muscle, tendon and proprioceptive feedback dynamics, a time-varying system identification technique was developed to analyze the phasic changes in the elbow joint's mechanical response. The mechanical properties were found to be time-varying, and well approximated by a quasi-linear second-order model. The stiffness of the arm was found to drop during movement. The arm was always underdamped, with the damping ratio changing during movement. Inertia estimates were constant and consistent with previous measurements. Overall, the moving arm was found to be very compliant, with a peak stiffness value less than the lowest value measured during posture, and a natural frequency of less than 3 Hz. Changing the speed of movement, or the load from gravity, changed the stiffness measured, but not in strict proportion to the change in net muscle torque.

  15. MR imaging of the elbow in the injured athlete.

    PubMed

    Wenzke, Daniel R

    2013-03-01

    This article summarizes key MR imaging findings in common athletic elbow injuries including little leaguer's elbow, Panner disease, osteochondritis dissecans, olecranon stress fracture, occult fracture, degenerative osteophyte formation, flexor-pronator strain, ulnar collateral ligament tear, lateral ulnar collateral ligament and radial collateral ligament tear, lateral epicondylitis, medial epicondylitis, biceps tear, bicipitoradial bursitis, triceps tear, olecranon bursitis, ulnar neuropathy, posterior interosseous nerve syndrome, and radial tunnel syndrome. The article also summarizes important technical considerations in elbow MR imaging that enhance image quality and contribute to the radiologist's success.

  16. Magnetic resonance imaging of sports injuries of the elbow.

    PubMed

    Thornton, Raymond; Riley, Geoffrey M; Steinbach, Lynne S

    2003-02-01

    Many abnormalities seen in the elbow result from trauma, often from sports such as baseball and tennis. Elbow problems are frequently related to the medial tension-lateral compression phenomenon, where repeated valgus stress produces flexor-pronator strain, ulnar collateral ligament sprain, ulnar traction spurring, and ulnar neuropathy. Lateral compression causes osteochondral lesions of the capitellum and radial head, degenerative arthritis, and loose bodies. Other elbow abnormalities seen on magnetic resonance imaging include radial collateral ligament injuries, biceps and triceps tendon injuries, other nerve entrapment syndromes, loose bodies, osseous and soft-tissue trauma, arthritis, and masses, including bursae.

  17. Rate modulation of human anconeus motor units during high-intensity dynamic elbow extensions.

    PubMed

    Cowling, Brianna L; Harwood, Brad; Copithorne, David B; Rice, Charles L

    2016-08-01

    Investigations of high-intensity isometric fatiguing protocols report decreases in motor unit firing rates (MUFRs), but little is known regarding changes in MUFRs following fatigue induced by high-intensity dynamic contractions. Our purpose was to evaluate MUFRs of the anconeus (an accessory elbow extensor) and elbow extension power production as a function of time to task failure (TTF) during high-velocity fatiguing concentric contractions against a moderately heavy resistance. Fine-wire intramuscular electrode pairs were inserted into the anconeus to record MUs in 12 male participants (25 ± 3 yr), over repeated sessions on separate days. MUs were tracked throughout a three-stage, varying load dynamic elbow extension protocol designed to extend the task duration for >1 min thereby inducing substantial fatigue. Mean MUFRs and peak power were calculated for three relative time ranges: 0-15% TTF (beginning), 45-60% TTF (middle) and 85-100% TTF (end). Mean duration of the overall fatigue protocol was ∼80 s. Following the protocol, isometric maximum voluntary contraction (MVC), highest velocity at 35% MVC load, and peak power decreased 37, 60, and 64% compared with baseline, respectively. Data from 20 anconeus MUs tracked successfully throughout the protocol indicated a reduction in MUFRs in relation to power loss from 36 Hz/160 W (0-15% TTF) to 28 Hz/97 W (45-60% TTF) to 23 Hz/43 W (85-100% TTF). During these high-intensity maximal effort concentric contractions, anconeus MUFRs decreased substantially (>35%). Although the absolute MUFRs were higher in the present study than those reported previously for other muscles during sustained high-intensity isometric tasks, the relative decrease in MUFRs was similar between the two tasks. PMID:27283910

  18. 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.

  19. [Elbow tendinopathy].

    PubMed

    Dumusc, A; Zufferey, P

    2015-03-11

    The lateral and medial epicondylitis is often manifested in a professional or in a sport context leading to repetitive wrist movements. The diagnosis is primarily clinical. Additional tests are indicated in chronic evolution and in searching for differential diagnoses. Elbow X-ray can be completed with ultrasound or MRI, the most efficient but expensive diagnostic procedure. There is no consensus on treatment. After a period of rest, stretching then strengthening exercises are recommended. Corticosteroid injections may provide a short-term beneficial effect. Platelet-Rich Plasma injections have recently gained notoriety. In case of failure of treatment, surgery is possible, but only in a minority of patients.

  20. Tennis elbow

    PubMed Central

    2011-01-01

    Introduction Lateral pain in the elbow affects up to 3% of the population, and is considered an overload injury of the extensor tendons of the forearm where they attach at the lateral epicondyle. Although usually self-limiting, symptoms may persist for over 1 year in up to 20% of people. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for tennis elbow? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, autologous whole blood injections, corticosteroid injections, combination physical therapies, exercise, extracorporeal shock wave therapy, iontophoresis, low-level laser therapy, manipulation, non-steroidal anti-inflammatory drugs (oral and topical), orthoses (bracing), platelet-rich plasma injections, pulsed electromagnetic field treatment, surgery, and ultrasound. PMID:21708051

  1. Stenosing flexor tenosynovitis.

    PubMed

    Kraemer, B A; Young, V L; Arfken, C

    1990-07-01

    A review of 253 consecutive digits with stenosing flexor tenosynovitis was done to clarify the respective role of steroid injection and surgical release in the management of stenosing flexor tenosynovitis. Treatment selection was based on the patient's age and severity of presenting complaints. In patients aged 10 years or more, analysis showed no statistically significant difference between results with steroid injection and surgical release. Surgical treatment was associated with higher cost and more complications. Based on this review, we recommend up to three injections of 20 mg of triamcinolone into the digital flexor sheath as the initial management of nonlocking, stenosing flexor tenosynovitis in adults. Initial management by surgical release is reserved for children and patients with digits locked in flexion.

  2. Hip flexor strain - aftercare

    MedlinePlus

    ... such as sprinting, kicking, and changing direction while running or moving, can stretch and tear the hip flexors. Runners, people who do martial arts, and football, soccer, and hockey players are more likely to have ...

  3. Elbow tendinopathy

    PubMed Central

    Longo, Umile Giuseppe; Franceschetti, Edoardo; Rizzello, Giacomo; Petrillo, Stefano; Denaro, Vincenzo

    2012-01-01

    Summary Lateral epicondylosis is a common pathology of the upper extremity. The origin of the ECRB is the most commonly cited anatomic location of lateral epicondylosis pathology. Histologic examination shows the features of a failed healing response, with absence of acute inflammatory cells. The typical patient with lateral epicondylosis is an adult in the fourth or fifth decade of life, with no difference about the sex. Diagnosis is based on history and physical examination. The role of imaging is to confirm the diagnosis. The most consistent symptom of lateral epicondylosis is pain over the lateral aspect of the elbow. Therapeutic modalities for lateral epicondylosis vary widely and lack definitive evidence. Open, percutaneous or arthroscopic surgery is recommended when functional disability and pain persist after 6 to 12 months of nonoperative management. Future studies using validated clinical measures and imaging are needed to determine the best management for patients with lateral epicondylosis. PMID:23738284

  4. The effects of forearm fatigue on baseball fastball pitching, with implications about elbow injury.

    PubMed

    Wang, Lin-Hwa; Lo, Kuo-Cheng; Jou, I-Ming; Kuo, Li-Chieh; Tai, Ta-Wei; Su, Fong-Chin

    2016-01-01

    This study investigated the contribution of flexor muscles to the forearm through fatigue; therefore, the differences in forearm mechanisms on the pitching motion in fastball were analysed. Fifteen baseball pitchers were included in this study. Ultrasonographical examination of participants' ulnar nerve in the cubital tunnel with the elbow extended and at 45°, 90° and 120° of flexion was carried. A three-dimensional motion analysis system with 14 reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the flexor carpi ulnaris, flexor carpi radialis and extensor carpi radialis muscles of the dominant arm. Flexor carpi ulnaris muscle activity showed a significant difference during the acceleration phase, with a peak value during fastball post-fatigue (P = 0.02). Significant differences in the distance between ulnar nerve and medial condyle on throwing arm and non-throwing arm were observed as the distance increased with the elbow movement from 0° to 120° of flexion (P = 0.01). The significant increase of the flexor carpi ulnaris muscle activity might be responsible for maintaining the stability of the wrist joint. The increased diameter might compress the ulnar nerve and cause several pathological changes. Therefore, fatigue in baseball pitchers still poses a threat to the ulnar nerve because the flexor carpi ulnaris and flexor carpi radialis all originate from the medial side of the elbow, and the swelling tendons after fatigue might be a key point.

  5. The contribution of motor commands to position sense differs between elbow and wrist

    PubMed Central

    Walsh, Lee D; Proske, Uwe; Allen, Trevor J; Gandevia, Simon C

    2013-01-01

    Recent studies have suggested that centrally generated motor commands contribute to the perception of position and movement at the wrist, but not at the elbow. Because the wrist and elbow experiments used different methods, this study was designed to resolve the discrepancy. Two methods were used to test both the elbow and wrist (20 subjects each). For the wrist, subjects sat with their right arm strapped to a device that restricted movement to the wrist. Before each test, voluntary contraction of wrist flexor or extensor muscles controlled for muscle spindle thixotropy. After relaxation, the wrist was moved to a test angle. Position was indicated either with a pointer, or by matching with the contralateral wrist, under two conditions: when the reference wrist was relaxed or when its muscles were contracted isometrically (30% maximum). The elbow experiment used the same design to measure position sense in the passive elbow and with elbow muscles contracting (30% maximum). At the wrist when using a pointer, muscle contraction altered significantly the perceived wrist angle in the direction of contraction by 7 deg [3 deg, 12 deg] (mean [95% confidence interval]) with a flexor contraction and 8 deg [4 deg, 12 deg] with an extensor contraction. Similarly, in the wrist matching task, there was a change of 13 deg [9 deg, 16 deg] with a flexor contraction and 4 deg [1 deg, 8 deg] with an extensor contraction. In contrast, contraction of elbow flexors or extensors did not alter significantly the perceived position of the elbow, compared with rest. The contribution of central commands to position sense differs between the elbow and the wrist. PMID:24099798

  6. Flexor pulley reconstruction.

    PubMed

    Dy, Christopher J; Daluiski, Aaron

    2013-05-01

    Flexor pulley reconstruction is a challenging surgery. Injuries often occur after traumatic lacerations or forceful extension applied to an acutely flexed finger. Surgical treatment is reserved for patients with multiple closed pulley ruptures, persistent pain, or dysfunction after attempted nonoperative management of a single pulley rupture, or during concurrent or staged flexor tendon repair or reconstruction. If the pulley cannot be repaired primarily, pulley reconstruction can be performed using graft woven into remnant pulley rim or looping graft around the phalanx. Regardless of the reconstructive technique, the surgeon should emulate the length, tension, and glide of the native pulley. PMID:23660059

  7. The effect of core suture flexor tendon repair techniques on gliding resistance during static cycle motion and load to failure: a human cadaver study

    PubMed Central

    Moriya, T.; Larson, M. C.; Zhao, C.; An, K.-N.; Amadio, P. C.

    2011-01-01

    The purpose of this study was to describe a modification of the Massachusetts General Hospital (MMGH) tendon repair and to compare it with three other suture techniques. Twenty human flexor digitorum profundus (FDP) tendons were randomly assigned to the modified Pennington (MP) suture and the MMGH suture. These were compared to the modified Kessler (MK) and Massachusetts General Hospital (MGH) sutures, using data from a previous study. All tendons were repaired with a similar epitendinous stitch and core sutures of 4-0 FiberWire. There was no significant difference in the normalized gliding resistance within the two-strand or four-strand core repair groups. The MP suture had significantly higher 2 mm gap force and ultimate load to failure than the MK suture. The MMGH suture had significantly higher 2 mm gap force and maximum failure ultimate load than the MGH suture. All repairs failed by knot unravelling. PMID:21987278

  8. Tennis elbow surgery

    MedlinePlus

    ... over. It creates small, painful tears in the tendons in your elbow. This injury can be caused ... chopping with a knife. The outside (lateral) elbow tendon is most commonly injured. The inside (medial) and ...

  9. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies

    PubMed Central

    Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit

    2013-01-01

    In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered. PMID:27582910

  10. Elbow Injuries and Disorders

    MedlinePlus

    ... and fluid. Muscles and tendons help the elbow joint move. When any of these structures is hurt or diseased, you have elbow problems. Many things can make your elbow hurt. A common cause is tendinitis, an inflammation or injury to the tendons that attach muscle to bone. ...

  11. Elbow joint adductor moment arm as an indicator of forelimb posture in extinct quadrupedal tetrapods.

    PubMed

    Fujiwara, Shin-ichi; Hutchinson, John R

    2012-07-01

    Forelimb posture has been a controversial aspect of reconstructing locomotor behaviour in extinct quadrupedal tetrapods. This is partly owing to the qualitative and subjective nature of typical methods, which focus on bony articulations that are often ambiguous and unvalidated postural indicators. Here we outline a new, quantitatively based forelimb posture index that is applicable to a majority of extant tetrapods. By determining the degree of elbow joint adduction/abduction mobility in several tetrapods, the carpal flexor muscles were determined to also play a role as elbow adductors. Such adduction may play a major role during the stance phase in sprawling postures. This role is different from those of upright/sagittal and sloth-like creeping postures, which, respectively, depend more on elbow extensors and flexors. Our measurements of elbow muscle moment arms in 318 extant tetrapod skeletons (Lissamphibia, Synapsida and Reptilia: 33 major clades and 263 genera) revealed that sprawling, sagittal and creeping tetrapods, respectively, emphasize elbow adductor, extensor and flexor muscles. Furthermore, scansorial and non-scansorial taxa, respectively, emphasize flexors and extensors. Thus, forelimb postures of extinct tetrapods can be qualitatively classified based on our quantitative index. Using this method, we find that Triceratops (Ceratopsidae), Anhanguera (Pterosauria) and desmostylian mammals are categorized as upright/sagittally locomoting taxa.

  12. Ultrasound guided alcohol neurolysis of musculocutaneous nerve to relieve elbow spasticity in hemiparetic stroke patients.

    PubMed

    Lee, Dong Gyu; Jang, Sung Ho

    2012-01-01

    Proper management of elbow spasticity is important in stroke rehabilitation. We investigated the effect and safety of ultrasound guided alcohol neurolysis of the MC nerve for controlling elbow flexor spasticity in hemiparetic stroke patients. Ten hemiparetic stroke patients with severe elbow spasticity were recruited for this study. We identified the MC nerve using ultrasound and performed neurolysis with 35% ethyl alcohol. The severity of spasticity was assessed using the modified Ashworth scale (MAS) score and associated reaction (AR) of elbow flexor. During the 2 months follow-up period, both MAS score and AR were reduced in all 10 patients. Before treatment, the mean MAS score was 3.4 ± 0.5, and this improved to 0.1 ± 0.3 immediately post-neurolysis, 1.8 ± 1.0 at one month and 1.9 ± 0.8 at two months (p < 0.001). The mean change of AR of the affected elbow was significantly decreased, from 75.2 ± 30.0° before neurolysis to 24.8 ± 21.3° immediately post-neurolysis, 35.5 ± 24.7° at 1 month and 40.8 ± 25.1° at 2 months (p < 0.001). Ultrasound guided MC nerve block is an effective and safe procedure for relieving localized spasticity of the elbow flexor.

  13. Cortical and Spinal Excitability during and after Lengthening Contractions of the Human Plantar Flexor Muscles Performed with Maximal Voluntary Effort

    PubMed Central

    Hahn, Daniel; Hoffman, Ben W.; Carroll, Timothy J.; Cresswell, Andrew G.

    2012-01-01

    This study was designed to investigate the sites of potential specific modulations in the neural control of lengthening and subsequent isometric maximal voluntary contractions (MVCs) versus purely isometric MVCs of the plantar flexor muscles, when there is enhanced torque during and following stretch. Ankle joint torque during maximum voluntary plantar flexion was measured by a dynamometer when subjects (n = 10) lay prone on a bench with the right ankle tightly strapped to a foot-plate. Neural control was analysed by comparing soleus motor responses to electrical nerve stimulation (M-wave, V-wave), electrical stimulation of the cervicomedullary junction (CMEP) and transcranial magnetic stimulation of the motor cortex (MEP). Enhanced torque of 17±8% and 9±8% was found during and 2.5–3 s after lengthening MVCs, respectively. Cortical and spinal responsiveness was similar to that in isometric conditions during the lengthening MVCs, as shown by unchanged MEPs, CMEPs and V-waves, suggesting that the major voluntary motor pathways are not subject to substantial inhibition. Following the lengthening MVCs, enhanced torque was accompanied by larger MEPs (p≤0.05) and a trend to greater V-waves (p≤0.1). In combination with stable CMEPs, increased MEPs suggest an increase in cortical excitability, and enlarged V-waves indicate greater motoneuronal output or increased stretch reflex excitability. The new results illustrate that neuromotor pathways are altered after lengthening MVCs suggesting that the underlying mechanisms of the enhanced torque are not purely mechanical in nature. PMID:23166794

  14. An electromyographic analysis of the elbow in pitching.

    PubMed

    Sisto, D J; Jobe, F W; Moynes, D R; Antonelli, D J

    1987-01-01

    Elbow injuries are common in baseball pitchers. Curve balls are thought to increase this risk, particularly if the athlete begins throwing this pitch at an early age. The purpose of this paper is to identify forearm muscle firing patterns during the pitching cycle in an effort to understand this etiology. Dynamic EMG was performed on eight collegiate pitchers to evaluate extensor digitorum communis, brachioradialis, flexor carpi radialis, flexor digitorum superficialis, extensor carpi radialis longus, extensor carpi radialis brevis, pronator teres, and supinator. Each subject threw a fast ball and curve ball, which were filmed at 450 frames per second and synchronized with the EMG. These signals were converted from analog to digital records. Results showed low to moderate activity in all muscles during all phases of the pitch. The function is probably positioning to accept the transfer of energy from the larger trunk and girdle structures. The most notable difference between the fast ball and curve ball is a slight increase in the extensor carpi radialis longus and extensor carpi radialis brevis activity during late cocking, acceleration, and follow-through of the curve ball as compared to the fast ball. This difference, however, is not significant. In addition, there was no significant difference between the fast ball and the curve ball in the flexor-pronator group in any phase. We cannot substantiate that medial elbow problems are a result of an increase in the use of flexor muscles during the curve ball pitch.

  15. Fractionation of 50kGy electron beam irradiation: effects on biomechanics of human flexor digitorum superficialis tendons treated with ascorbate.

    PubMed

    Wei, Wei; Liu, Yujie; Yang, Xu; Tian, Shaoqi; Liu, Chao; Zhang, Yang; Xu, Zhaoning; Hu, Baiqiang; Tian, Zhen; Sun, Kang

    2013-02-22

    The electron beam (Ebeam) irradiation has begun to be considered as an efficient alternative to gamma irradiation in the sterilization of allografts in the reconstruction of anterior cruciate ligament. The purpose of this study was to evaluate the biomechanical properties of human tendons after exposure to electron beam and free radical scavenger ascorbate. Forty human flexor digitorum superficialis tendons were prepared from five fresh cadavers and divided randomly into four groups: A, fresh (0kGy); B, 50kGy Ebeam irradiation; C, fractionated 50kGy Ebeam irradiation; D, fractionated 50kGy Ebeam on ascorbate-treated tendons. The fractionation of 50kGy was achieved by repeated irradiation of 2.5kGy for 20 repetitions. Biomechanical properties were analyzed during load-to-failure testing. The fresh tendons were found to be significant different in ultimate load, ultimate elongation relative to tendons in group B. Statistical differences were found between group B and C in ultimate load. No differences were detected between group A and C in all the parameters. Compare tendons in group C and D, significant differences were found in ultimate load and ultimate stress. It is recommended that fractionated 50kGy electron beam irradiation and free radical scavenger ascorbate should be applied in the sterilization of allografts tendons.

  16. Topsy-turvy locomotion: biomechanical specializations of the elbow in suspended quadrupeds reflect inverted gravitational constraints

    PubMed Central

    Fujiwara, Shin-ichi; Endo, Hideki; Hutchinson, John R

    2011-01-01

    Some tetrapods hang upside down from tree branches when moving horizontally. The ability to walk in quadrupedal suspension has been acquired independently in at least 14 mammalian lineages. During the stance (supportive) phase of quadrupedal suspension, the elbow joint flexor muscles (not the extensors as in upright vertebrates moving overground) are expected to contract to maintain the flexed limb posture. Therefore muscular control in inverted, suspended quadrupeds may require changes of muscle control, and even morphologies, to conditions opposite to those in upright animals. However, the relationships between musculoskeletal morphologies and elbow joint postures during the stance phase in suspended quadrupeds have not been investigated. Our analysis comparing postures and skeletal morphologies in Choloepus (Pilosa), Pteropus (Chiroptera), Nycticebus (Primates) and Cynocephalus (Dermoptera) revealed that the elbow joints of these animals were kept at flexed angles of 70–100 ° during the stance phase of quadrupedal suspension. At these joint angles the moment arms of the elbow joint flexors were roughly maximized, optimizing that component of antigravity support. Our additional measurements from various mammalian species show that suspended quadrupeds have relatively small extensor/flexor ratios in both muscle masses and maximum moment arms. Thus, in contrast to the pattern in normal terrestrial quadrupeds, suspended quadrupeds emphasize flexor over extensor muscles for body support. This condition has evolved independently multiple times, attendant with a loss or reduction of the ability to move in normal upright postures. PMID:21477151

  17. Elbow mass flow meter

    DOEpatents

    McFarland, Andrew R.; Rodgers, John C.; Ortiz, Carlos A.; Nelson, David C.

    1994-01-01

    Elbow mass flow meter. The present invention includes a combination of an elbow pressure drop generator and a shunt-type mass flow sensor for providing an output which gives the mass flow rate of a gas that is nearly independent of the density of the gas. For air, the output is also approximately independent of humidity.

  18. Development of the deep flexor tendons and lumbricalis muscle in the hand and foot: a histological study using human mid-term foetuses.

    PubMed

    Cho, K H; Kim, J H; Ha, Y S; Murakami, G; Cho, B H; Abe, S

    2012-08-01

    To revisit foetal development of the deep flexor tendons of the hand and foot, we examined the paraffin-embedded histology of 20 mid-term foetuses at 8-15 weeks of estimated gestational age (35-118 mm crown-rump length or CRL). At 8-9 weeks, in front of the metacarpal bones, the flexor pollicis longus and flexor digitorum profundus (FDP) muscles provided a plate-like, common tendon from which the lumbricalis muscles originated. However, in the foot, we had no evidence of such a common tendon. The flexor pollicis tendon was separated from the common tendon at 9-10 weeks possibly due to mechanical stress from the laterally growing thumb. Notably, at the lumbricalis muscle origins at 10-12 weeks, the FDP and flexor digitorum longus tendons remained undifferentiated and the primitive tenocytes were dispersed from them. The dispersed cells seemed to develop into an interface tissue between the lumbricalis muscle fibre and the deep tendon. In 3 of 5 specimens at 15 weeks, we found an excess number of the FDP tendons (5-7) in the proximal side of the lumbricalis muscle origin. However, the excess tendons dispersed in the lumbricalis muscle origin. The development of the lumbricalis muscle origin might follow the tendon splitting for four fingers. However, conversely, we hypothesised that the developing lumbricalis muscles re-arranged the deep flexor tendons to provide a configuration of one deep tendon per one finger (or toe). The quadrates plantae muscle seemed not to contribute on the re-arrangement.

  19. Elbow pain in pediatrics.

    PubMed

    Crowther, Marshall

    2009-06-01

    The pediatric and adolescent elbow is subject to both acute and chronic overuse injuries. The practitioner should develop a classification system to evaluate all such injuries, with first focusing on whether the injury represents an acute episode or rather it represents a more chronic problem. In addition, localizing the area of pain as being either medial, lateral, or posterior can better help differentiate the diagnosis. Youth baseball pitchers and throwers are particularly at risk for overuse injuries of the elbow, most of which are related to an injury mechanism termed "valgus extension overload". The most common entity related to this is termed "Little Leaguer's Elbow." Treatment is usually conservative, but for some injuries surgery may be required, especially for displaced medial epicondylar avulsion fractures. Other acute injuries also should be easily recognizable by the general clinician including annular ligament displacement (nursemaid's elbow) which represents one of the most common upper extremity injuries presenting to emergency rooms in youngsters under the age of 6. Most studies seem to indicate a hyperpronation reduction technique may be more successful then the flexion/supination technique. It is also important to have an awareness of some of the common elbow fractures seen in the younger patient, in particularly supracondylar fractures owing to their high propensity for complications. When evaluating the elbow for fractures, it is necessary to have an understanding of the appearance of the ossification centers seen on the pediatric elbow.

  20. The elbow and its disorders

    SciTech Connect

    Morrey, B.F.

    1985-01-01

    This book contains 49 chapters. Some of the chapter titles are: Diagnostic Radiographic Techniques of the Elbow; Radiography of the Pediatric Elbow; Muscle and Tendon Trauma: Tennis Elbow; Nerve Injuries; Tendon Injurires about the Elbow; and Ligamentous and Articular Injuries in the Athlete.

  1. Medial epicondylitis - golfer's elbow

    MedlinePlus

    ... be more likely to develop it, such as: Painters Plumbers Construction workers Cooks Assembly-line workers Computer ... gently pressed where it attaches to the upper arm bone, over the inside of the elbow. Pain ...

  2. Tennis elbow surgery - discharge

    MedlinePlus

    Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Soon after surgery, severe pain will decrease, but you may have mild soreness for 3 to 6 months.

  3. The thrower's elbow.

    PubMed

    Patel, Ronak M; Lynch, T Sean; Amin, Nirav H; Calabrese, Gary; Gryzlo, Stephen M; Schickendantz, Mark S

    2014-07-01

    Overhead throwing activities expose the elbow to tremendous valgus stress, making athletes vulnerable to a specific constellation of injuries. Although baseball players, in particular pitchers, are the athletes affected most commonly, overhead throwing athletes in football, volleyball, tennis, and javelin tossing also are affected. The purpose of this review is to review the anatomy, biomechanics, pathophysiology, and treatment of elbow disorders related to overhead throwing athletes. Although focus is on management of ulnar collateral ligament injuries, all common pathologies are discussed.

  4. Restoration of Elbow Flexion.

    PubMed

    Loeffler, Bryan J; Lewis, Daniel R

    2016-08-01

    Active elbow flexion is required to position the hand in space, and loss of this function is debilitating. Nerve transfers or nerve grafts to restore elbow flexion may be options when the target muscle is viable, but in delayed reconstruction when the biceps and brachialis are atrophied or damaged, muscle transfer options should be considered. Muscle transfer options are discussed with attention to the advantages and disadvantages of each transfer option. PMID:27387075

  5. The thrower's elbow.

    PubMed

    Patel, Ronak M; Lynch, T Sean; Amin, Nirav H; Calabrese, Gary; Gryzlo, Stephen M; Schickendantz, Mark S

    2014-07-01

    Overhead throwing activities expose the elbow to tremendous valgus stress, making athletes vulnerable to a specific constellation of injuries. Although baseball players, in particular pitchers, are the athletes affected most commonly, overhead throwing athletes in football, volleyball, tennis, and javelin tossing also are affected. The purpose of this review is to review the anatomy, biomechanics, pathophysiology, and treatment of elbow disorders related to overhead throwing athletes. Although focus is on management of ulnar collateral ligament injuries, all common pathologies are discussed. PMID:24975763

  6. Medial elbow stability. Clinical implications.

    PubMed

    Pincivero, D M; Heinrichs, K; Perrin, D H

    1994-08-01

    Medial elbow injuries of athletes, such as baseball pitchers and javelin throwers, can prove to be debilitating and may have a negative effect on performance. The most significant injury to the elbow occurs is an ulnar collateral ligament (UCL) sprain or rupture, which compromises the medial stability of the elbow joint. It has been found that the anterior oblique portion of the UCL is the primary stabiliser of the elbow, and that trauma to this complex may significantly hinder normal elbow function. An accurate diagnosis will dictate the degree of injury to the elbow as well as determine the most appropriate means of treatment.

  7. 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. PMID:27468667

  8. Tennis Elbow (Lateral Epicondylitis)

    MedlinePlus

    ... to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength. New Developments Platelet-rich plasma (PRP) is currently being investigated for its effectiveness ...

  9. Elbow mass flow meter

    DOEpatents

    McFarland, A.R.; Rodgers, J.C.; Ortiz, C.A.; Nelson, D.C.

    1994-08-16

    The present invention includes a combination of an elbow pressure drop generator and a shunt-type mass flow sensor for providing an output which gives the mass flow rate of a gas that is nearly independent of the density of the gas. For air, the output is also approximately independent of humidity. 3 figs.

  10. 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.

  11. Prosthetic elbow joint

    NASA Technical Reports Server (NTRS)

    Weddendorf, Bruce C. (Inventor)

    1994-01-01

    An artificial, manually positionable elbow joint for use in an upper extremity, above-elbow, prosthetic is described. The prosthesis provides a locking feature that is easily controlled by the wearer. The instant elbow joint is very strong and durable enough to withstand the repeated heavy loadings encountered by a wearer who works in an industrial, construction, farming, or similar environment. The elbow joint of the present invention comprises a turntable, a frame, a forearm, and a locking assembly. The frame generally includes a housing for the locking assembly and two protruding ears. The forearm includes an elongated beam having a cup-shaped cylindrical member at one end and a locking wheel having a plurality of holes along a circular arc on its other end with a central bore for pivotal attachment to the protruding ears of the frame. The locking assembly includes a collar having a central opening with a plurality of internal grooves, a plurality of internal cam members each having a chamfered surface at one end and a V-shaped slot at its other end; an elongated locking pin having a crown wheel with cam surfaces and locking lugs secured thereto; two coiled compression springs; and a flexible filament attached to one end of the elongated locking pin and extending from the locking assembly for extending and retracting the locking pin into the holes in the locking wheel to permit selective adjustment of the forearm relative to the frame. In use, the turntable is affixed to the upper arm part of the prosthetic in the conventional manner, and the cup-shaped cylindrical member on one end of the forearm is affixed to the forearm piece of the prosthetic in the conventional manner. The elbow joint is easily adjusted and locked between maximum flex and extended positions.

  12. Conversion of a surgical elbow arthrodesis to total elbow arthroplasty.

    PubMed

    Rog, Dominik; Zuckerman, Lee M; Riedel, Barth

    2015-01-01

    Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior. PMID:25815223

  13. Management of tennis elbow

    PubMed Central

    Chesterton, Linda S; Mallen, Christian D; Hay, Elaine M

    2011-01-01

    Clinical question What is the best treatment for tennis elbow? Results Despite a wealth of research, there is no true consensus on the most efficacious management of tennis elbow especially for effective long-term outcomes. Corticosteroid injections do show large pain-relieving effects in the short term but are associated with risks of adverse events and long-term reoccurrence. Advice with a “wait and see” approach is recommended as the first-line treatment in primary care for most cases. In the medium term physiotherapy and or low-level laser therapy may be effective. Implementation Rule out alternative diagnosis. Onward referral may be indicated if the condition does not resolve after 12 months. PMID:24198571

  14. Pitcher's elbow in adolescents.

    PubMed

    Grana, W A; Rashkin, A

    1980-01-01

    Intraarticular and periarticular changes of the elbow secondary to the throwing motion have been documented in pitchers of all ages, Although others have focused attention on children, this study evaluates a group of 73 older pitchers (average age 17 years). Forty-two (58%) players reported pain while throwing at the time of evaluation (before interscholastic play) or developed pain during the season. However, only four (5%) missed one or more pitching rotations. No significant relationships were found between occurrence of symptoms and number of seasons played, individual pitching traits, asymmetry on physical examination, or asymmetry on radiographic evaluation of the elbow. In the symptomatic group there tended to be a slightly greater number of seasons' experience (average 7.8 seasons vs. 6.0 seasons) and more players with asymmetry upon physical examination. We believe this study supports the concept that increasing age and exposure, along with other factors as yet unquantitated, may determine the occurrence of symptoms in pitchers.

  15. A study of the anatomy and repair strengths of porcine flexor and extensor tendons: are they appropriate experimental models?

    PubMed

    Mao, W F; Wu, Y F; Zhou, Y L; Tang, J B

    2011-10-01

    Although both porcine flexor and extensor tendons have been used in tendon repair research, no studies have specifically studied the anatomical differences and repair strengths in both types of tendons. We used 12 pig trotters to observe the anatomy of these tendons and compared the 2 mm gap and ultimate strengths of flexor and extensor tendons. There were four annular (A1, A2, A3, and A4) pulleys and one oblique pulley, which form a fibro-osseous tunnel for the flexor tendons, but the anatomy of the porcine extensor tendons was markedly different from the human flexor or extensor tendons. The diameter of flexor tendons was significantly greater than that of the extensors. The 2 mm gap and ultimate strengths of the flexor tendon with either two-strand or four-strand repairs were significantly greater than those of the extensor tendon. We conclude that the porcine flexor tendon systems are similar to those in the human, but the extensor tendons are not similar to either the flexor or extensor tendons in humans. Flexor and extensor tendons have different repair strengths which should be taken into account when interpreting findings from investigations using these tendons.

  16. 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.

  17. Elbow Trauma in the Athlete.

    PubMed

    Redler, Lauren H; Dines, Joshua S

    2015-11-01

    In caring for athletes, the physician must be able to accurately diagnose and appropriately treat all forms of elbow injuries. Traumatic injuries to the elbow are common in the athlete. The late cocking phase of throwing produces tremendous valgus stress on the elbow that can lead to medial epicondyle avulsion fractures in adolescents or rupture of the medial ulnar collateral ligament in skeletally mature overhead throwers, such as baseball pitchers and javelin throwers. Common traumatic elbow injuries suffered by athletes, surgical techniques for operative repair of these injuries, as well as postoperative rehabilitation protocols and the clinical results are presented.

  18. Gliding Resistance and Strength of a Braided Polyester/Monofilament Polyethylene Composite (FiberWire®) Suture in Human Flexor Digitorum Profundus Tendon Repair: An In-Vitro Biomechanical Study

    PubMed Central

    Silva, Jose M.; Zhao, Chunfeng; An, Kai-Nan; Zobitz, Mark E.; Amadio, Peter C.

    2009-01-01

    Purpose While the strength of a tendon repair is clearly important, the friction of the repair is also a relevant consideration. The purpose of this study was to characterize the frictional coefficient, gliding resistance and breaking strength of suture materials and a suture construct commonly used for flexor tendon repair. Methods We measured the friction coefficients of 3-0 braided nylon enclosed in a smooth nylon outer shell (Supramid, S. Jackson, Alexandria, VA), 3-0 braided polyester coated with polybutilate (Ethibond, Ethicon, Somerville, NJ), and a 3-0 braided polyester/monofilament polyethylene composite (FiberWire, Arthrex, Naples, FL) sutures. We also measured the gliding resistance, linear breaking strength and resistance to gapping of zone 2 modified Pennington tendon repairs with the two lowest friction sutures in 20 human cadaveric flexor digitorum profundus (FDP) tendons. Results The braided polyester/monofilament polyethylene composite had a significantly lower friction coefficient (0.054) than either the coated polyester (0.076) or nylon (0.130) sutures (p<0.001). The gliding resistances of the repaired tendons with braided/monofilament polyethylene composite suture and coated, braided polyester were similar (p> 0.05). The strength of the two repairs, force to produce a 2mm gap, and resistance to gap formation than coated, braided polyester repairs were also not significantly different. Conclusion Braided polyester composite is a low friction suture material. However, when this suture was used for tendon repair with a locking suture technique, it did not show a significant effect on the gliding resistance and repair strength compared with the same repair using coated polyester suture. PMID:19121735

  19. [Elbow injuries in childhood].

    PubMed

    Weise, K; Schwab, E; Scheufele, T M

    1997-04-01

    Fractures and dislocations of the elbow are some of the most common injuries in childhood and adolescence. The majority occur in sport and play activities, e.g., a fall from gymnastics apparatus or a bike, or from popular sports items, such as skateboards or in-line skates. The injuries can be divided into pure dislocations of the joint and fractures of the distal humerus, proximal radius and ulna, or combinations of both. In addition, extra- and intraarticular fracture types are defined, with the latter as partial or complete joint lesions. Dislocations of the elbow joint or the radial head can occur as single injuries or in combination with a fracture. Supracondylar fractures and avulsion fractures of the medial epicondyle are the most frequent extraarticular lesions of the distal humerus. Fractures of the lateral condyle prevail is incomplete intraarticular lesions. In the forearm, radial head and neck fractures are predominant while typical and atypical Monteggia injuries have a special status. The complex joint construction and the age-dependent appearance of the epiphyseal ossification centers sometimes make a correct radiological diagnosis difficult. The trauma history and an exact, clinical examination help to verify the injury, as do comparative X-ray studies of the uninjured side when necessary (but not routinely). Unlike other anatomical areas, most elbow injuries-even in the growing skeleton-are treated operatively. Hereby, the growth plates have to be respected using minimal amounts of small implants. Additional immobilization in a cast for 2-4 weeks is necessary in most cases but does not lead to a functional deficit-in contrast to adults. The implants should be removed as early as possible. Despite all therapeutic efforts, a significant number of late sequelae, such as malunions and functional impairment, can be seen. The rate of long-term complications increases in cases of untreated displacement of fragments or joint instability. Corrective

  20. Pediatric elbow injuries in athletes.

    PubMed

    Makhni, Eric C; Jegede, Kola A; Ahmad, Christopher S

    2014-09-01

    Elbow injuries in pediatric and adolescent population represent a spectrum of pathology that can range from medial tension injuries to posterior shear injuries. Elbow injuries in this population continue to rise in parallel with the increase in youth participation in sports both throughout the calendar year and across multiple sports. Many of these injuries are noncontact and are attributed to overuse. Evaluation and management of youth and adolescent athletic elbow injuries requires knowledge of developmental anatomy, injury pathophysiology, and established treatment algorithms. Furthermore, risk factors contributing to elbow injuries must be recognized, with education and recommendations for safe play continually advocated. This education--of parents, athletes, and coaches--is paramount in reducing the climbing incidence of elbow injuries in our youth athletes.

  1. Modulation of Stretch Reflexes of the Finger Flexors by Sensory Feedback From the Proximal Upper Limb Poststroke

    PubMed Central

    Hoffmann, Gilles; Kamper, Derek G.; Kahn, Jennifer H.; Rymer, William Z.; Schmit, Brian D.

    2009-01-01

    Neural coupling of proximal and distal upper limb segments may have functional implications in the recovery of hemiparesis after stroke. The goal of the present study was to investigate whether the stretch reflex response magnitude of spastic finger flexor muscles poststroke is influenced by sensory input from the shoulder and the elbow and whether reflex coupling of muscles throughout the upper limb is altered in spastic stroke survivors. Through imposed extension of the metacarpophalangeal (MCP) joints, stretch of the relaxed finger flexors of the four fingers was imposed in 10 relaxed stroke subjects under different conditions of proximal sensory input, namely static arm posture (3 different shoulder/elbow postures) and electrical stimulation (surface stimulation of biceps brachii or triceps brachii, or none). Fast (300°/s) imposed stretch elicited stretch reflex flexion torque at the MCP joints and reflex electromyographic (EMG) activity in flexor digitorum superficialis. Both measures were greatest in an arm posture of 90° of elbow flexion and neutral shoulder position. Biceps stimulation resulted in greater MCP stretch reflex flexion torque. Fast imposed stretch also elicited reflex EMG activity in nonstretched heteronymous upper limb muscles, both proximal and distal. These results suggest that in the spastic hemiparetic upper limb poststroke, sensorimotor coupling of proximal and distal upper limb segments is involved in both the increased stretch reflex response of the finger flexors and an increased reflex coupling of heteronymous muscles. Both phenomena may be mediated through changes poststroke in the spinal reflex circuits and/or in the descending influence of supraspinal pathways. PMID:19571191

  2. Murine Flexor Tendon Injury and Repair Surgery.

    PubMed

    Ackerman, Jessica E; Loiselle, Alayna E

    2016-01-01

    Tendon connects skeletal muscle and bone, facilitating movement of nearly the entire body. In the hand, flexor tendons (FTs) enable flexion of the fingers and general hand function. Injuries to the FTs are common, and satisfactory healing is often impaired due to excess scar tissue and adhesions between the tendon and surrounding tissue. However, little is known about the molecular and cellular components of FT repair. To that end, a murine model of FT repair that recapitulates many aspects of healing in humans, including impaired range of motion and decreased mechanical properties, has been developed and previously described. Here an in-depth demonstration of this surgical procedure is provided, involving transection and subsequent repair of the flexor digitorum longus (FDL) tendon in the murine hind paw. This technique can be used to conduct lineage analysis of different cell types, assess the effects of gene gain or loss-of-function, and to test the efficacy of pharmacological interventions in the healing process. However, there are two primary limitations to this model: i) the FDL tendon in the mid-portion of the murine hind paw, where the transection and repair occur, is not surrounded by a synovial sheath. Therefore this model does not account for the potential contribution of the sheath to the scar formation process. ii) To protect the integrity of the repair site, the FT is released at the myotendinous junction, decreasing the mechanical forces of the tendon, likely contributing to increased scar formation. Isolation of sufficient cells from the granulation tissue of the FT during the healing process for flow cytometric analysis has proved challenging; cytology centrifugation to concentrate these cells is an alternate method used, and allows for generation of cell preparations on which immunofluorescent labeling can be performed. With this method, quantification of cells or proteins of interest during FT healing becomes possible. PMID:27684281

  3. 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... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  4. 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... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  5. 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... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  6. 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... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  7. 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... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  8. Anconeus epitrochlearis as a source of medial elbow pain in baseball pitchers.

    PubMed

    Li, Xinning; Dines, Joshua S; Gorman, Matthew; Limpisvasti, Orr; Gambardella, Ralph; Yocum, Lou

    2012-07-01

    Medial elbow pain is reported in 18% to 69% of baseball players aged of 9 and 19 years. This is due to the large valgus stresses focused on the medial side of the elbow during overhead activities. In overhead throwers and pitchers, pain can be attributed to valgus extension overload with resultant posteromedial impingement, overuse of the flexor-pronator musculature resulting in medial epicondylitis, or occasional muscle tears or ruptures. The anconeus epitrochlearis is a known cause of cubital tunnel syndrome and has been postulated as a source of medial elbow pain in overhead athletes. This article describes the cases of 3 right-handed baseball pitchers with persistent right-sided medial elbow pain during throwing despite a prolonged period of rest, physical therapy, and nonsteroidal anti-inflammatory drugs. Two patients had symptoms of cubital tunnel syndrome as diagnosed by electromyogram and nerve conduction studies and the presence of the anconeus epitrochlearis muscle per magnetic resonance imaging. All patients underwent isolated release of the anconeus muscle without ulnar nerve transposition and returned to their previous levels of activity. The diagnosis and treatment of pitchers who present with medial-sided elbow pain can be complex. The differential should include an enlarged or inflamed anconeus epitrochlearis muscle as a possible cause. Conservative management should be the first modality. However, surgical excision with isolated release of the muscle can be successful in returning patients with persistent pain despite a trial of conservative management to their previous levels of function.

  9. Computing muscle, ligament, and osseous contributions to the elbow varus moment during baseball pitching

    PubMed Central

    Buffi, James H.; Werner, Katie; Kepple, Tom; Murray, Wendy M.

    2014-01-01

    Baseball pitching imposes a dangerous valgus load on the elbow that puts the joint at severe risk for injury. The goal of this study was to develop a musculoskeletal modeling approach to enable evaluation of muscle-tendon contributions to mitigating elbow injury risk in pitching. We implemented a forward dynamic simulation framework that used a scaled biomechanical model to reproduce a pitching motion recorded from a high school pitcher. The medial elbow muscles generated substantial, protective, varus elbow moments in our simulations. For our subject, the triceps generated large varus moments at the time of peak valgus loading; varus moments generated by the flexor digitorum superficialis were larger, but occurred later in the motion. Increasing muscle-tendon force output, either by augmenting parameters associated with strength and power or by increasing activation levels, decreased the load on the ulnar collateral ligament. Published methods have not previously quantified the biomechanics of elbow muscles during pitching. This simulation study represents a critical advancement in the study of baseball pitching and highlights the utility of simulation techniques in the study of this difficult problem. PMID:25281409

  10. Computing muscle, ligament, and osseous contributions to the elbow varus moment during baseball pitching.

    PubMed

    Buffi, James H; Werner, Katie; Kepple, Tom; Murray, Wendy M

    2015-02-01

    Baseball pitching imposes a dangerous valgus load on the elbow that puts the joint at severe risk for injury. The goal of this study was to develop a musculoskeletal modeling approach to enable evaluation of muscle-tendon contributions to mitigating elbow injury risk in pitching. We implemented a forward dynamic simulation framework that used a scaled biomechanical model to reproduce a pitching motion recorded from a high school pitcher. The medial elbow muscles generated substantial, protective, varus elbow moments in our simulations. For our subject, the triceps generated large varus moments at the time of peak valgus loading; varus moments generated by the flexor digitorum superficialis were larger, but occurred later in the motion. Increasing muscle-tendon force output, either by augmenting parameters associated with strength and power or by increasing activation levels, decreased the load on the ulnar collateral ligament. Published methods have not previously quantified the biomechanics of elbow muscles during pitching. This simulation study represents a critical advancement in the study of baseball pitching and highlights the utility of simulation techniques in the study of this difficult problem.

  11. ARTHROSCOPIC TREATMENT OF ELBOW STIFFNESS

    PubMed Central

    Vieira, Luis Alfredo Gómez; Dal Molin, Fabio Farina; Visco, Adalberto; Fernandes, Luis Filipe Daneu; dos Santos, Murilo Cunha Rafael; Cardozo Filho, Nivaldo Souza; Gómez Cordero, Nicolas Gerardo

    2015-01-01

    To present the arthroscopic surgical technique and the evaluation of the results from this technique for treating elbow stiffness. Methods: Between April 2007 and January 2010, ten elbows of ten patients with elbow stiffness underwent arthroscopic treatment to release the range of motion. The minimum follow-up was 11 months, with an average of 27 months. All the patients were male and their average age was 32.8 years (ranging from 22 to 48 years). After the arthroscopic treatment, they were followed up weekly in the first month and every three months thereafter. The clinical evaluation was made using the criteria of the University of California at Los Angeles (UCLA). Results: All the patients were satisfied with the results from the arthroscopic treatment. The average UCLA score was 33.8 points. Conclusion: Arthroscopic treatment for elbow stiffness is a minimally invasive surgical technique that was shown to be efficient for treating this complication. PMID:27027027

  12. Rehabilitation of the thrower's elbow.

    PubMed

    Wilk, Kevin E; Reinold, Michael M; Andrews, James R

    2003-12-01

    The elbow joint is susceptible to injuries in the overhead athlete due to the large amount of forces observed during the act of throwing. Injuries often occur due to repetitive microtrauma nature of throwing. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether post-injury or postsurgical, must follow a progressive and sequential order to ensure that healing tissues are not overstressed. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control. The purpose of this article is to provide an overview of a multiphased rehabilitation program for the thrower's elbow. In addition, rehabilitation for specific nonoperative and postoperative pathologies often observed in the throwing athlete is discussed.

  13. Rehabilitation of the thrower's elbow.

    PubMed

    Wilk, Kevin E; Reinold, Michael M; Andrews, James R

    2004-10-01

    The elbow joint is frequently injured in the overhead athlete, due to the large amount of forces in throwing. Injuries often occur due to repetitive microtrauma, especially in pitching. Rehabilitation following injury or surgery is vital to fully restore normal elbow function and return the athlete to competition as quickly and safely as possible. Elbow rehabilitation must follow a progressive and sequential order to ensure that healing tissues have not been compromised. Emphasis is on restoring full motion, muscular strength, and neuromuscular control, and gradually applying loads to healing tissue. This article provides an overview of a multiphased rehabilitation program for the thrower's elbow. Rehabilitation for specific nonoperative and postoperative pathologies often observed in the throwing athlete is also discussed.

  14. Case report: accessory head of the deep forearm flexors

    PubMed Central

    JONES, M.; ABRAHAMS, P. H.; SAÑUDO, J. R.

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875) and these have subsequently been reported with variable attachments (Wood, 1868; Macalister, 1875; Turner, 1879; Schäfer & Thane, 1894; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Kida, 1988; Tountas & Bergman, 1993). The accessory heads of the deep flexors of the forearm (Gantzer's muscles) have been described as 2 different small bellies which insert either into FPL or FDP. There are no previous reports which have mentioned the existence of an accessory muscle which inserts into both of the 2 deep flexors of the forearm as in the case presented here. PMID:9306208

  15. Complex Pediatric Elbow Injury: An Uncommon Case

    PubMed Central

    Sharma, H; Ayer, R; Taylor, GR

    2005-01-01

    Background There is paucity of literature describing complex elbow trauma in the pediatric population. We described a case of an uncommon pediatric elbow injury comprised of lateral condyle fracture associated with posterolateral dislocation of elbow. Case presentation A 12-year-old boy sustained a direct elbow trauma and presented with Milch type II lateral condyle fracture associated with posterolateral dislocation of elbow. Elbow dislocation was managed by closed reduction. The elbow stability was assessed under general anaesthesia, followed by open K-wiring for the lateral condylar fracture fixation. The patient had an uneventful recovery with an excellent outcome at 39 months follow-up. Conclusion Complex pediatric elbow injuries are quite unusual to encounter, the management of such fractures can be technically demanding. Concomitant elbow dislocation should be managed by closed reduction followed by open reduction and internal fixation (K-wires or cannulated screws) of the lateral condyle fracture. PMID:15757518

  16. Pyogenic Flexor Tenosynovitis Caused by Shewanella algae.

    PubMed

    Fluke, Erin C; Carayannopoulos, Nikoletta L; Lindsey, Ronald W

    2016-07-01

    Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately.

  17. Arthroscopic tennis elbow release.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2015-01-01

    Lateral epicondylitis, originally referred to as tennis elbow, affects between 1% and 3% of the population and is usually found in patients aged 35 to 50 years. Although it was initially thought that lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon and in any of the associated structures. Most cases of lateral epicondylitis respond to appropriate nonsurgical treatment protocols, which include medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal or ultrasound ablation devices. However, when these protocols are unsuccessful, surgical measures may be appropriate and have a high rate of success. The results of arthroscopic surgical procedures have documented satisfactory results, with improvement rates reported between 91% and 97.7%. Recent advances in arthroscopic repair and plication of these lesions, along with recognizing the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide excellent results. PMID:25745908

  18. Arthroscopic tennis elbow release.

    PubMed

    Savoie, Felix H; VanSice, Wade; O'Brien, Michael J

    2010-03-01

    Lateral epicondylitis, originally referred to as "tennis elbow," affects between 1% and 3% of the population and is usually noted in patients aged between 35 and 50 years old. Although it was first thought lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon in any of these associated structures. Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols. Nonoperative management includes medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices. When these are unsuccessful, however, surgical measures may be performed with a high rate of success. Satisfactory results of the arthroscopic surgical procedures have been documented, with reported improvement rates of 91% to 97.7%. The recent advances in arthroscopic repair and plication of these lesions, along with the recognition of the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide results superior to other measures. PMID:20188266

  19. Evaluation of the numeric rating scale for perception of effort during isometric elbow flexion exercise.

    PubMed

    Lampropoulou, Sofia; Nowicky, Alexander V

    2012-03-01

    The aim of the study was to examine the reliability and validity of the numerical rating scale (0-10 NRS) for rating perception of effort during isometric elbow flexion in healthy people. 33 individuals (32 ± 8 years) participated in the study. Three re-test measurements within one session and three weekly sessions were undertaken to determine the reliability of the scale. The sensitivity of the scale following 10 min isometric fatiguing exercise of the elbow flexors as well as the correlation of the effort with the electromyographic (EMG) activity of the flexor muscles were tested. Perception of effort was tested during isometric elbow flexion at 10, 30, 50, 70, 90, and 100% MVC. The 0-10 NRS demonstrated an excellent test-retest reliability [intra class correlation (ICC) = 0.99 between measurements taken within a session and 0.96 between 3 consecutive weekly sessions]. Exploratory curve fitting for the relationship between effort ratings and voluntary force, and underlying EMG showed that both are best described by power functions (y = ax ( b )). There were also strong correlations (range 0.89-0.95) between effort ratings and EMG recordings of all flexor muscles supporting the concurrent criterion validity of the measure. The 0-10 NRS was sensitive enough to detect changes in the perceived effort following fatigue and significantly increased at the level of voluntary contraction used in its assessment (p < 0.001). These findings suggest the 0-10 NRS is a valid and reliable scale for rating perception of effort in healthy individuals. Future research should seek to establish the validity of the 0-10 NRS in clinical settings.

  20. Ultrasound assessment of the elbow.

    PubMed

    Radunovic, Goran; Vlad, Violeta; Micu, Mihaela C; Nestorova, Rodina; Petranova, Tzvetanka; Porta, Francesco; Iagnocco, Annamaria

    2012-06-01

    Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spectrum of rheumatic and orthopedic conditions, representing a possible substitute to magnetic resonance imaging for evaluation of soft tissues of the elbow. Musculoskeletal ultrasound (US) shows many advantages over other imaging modalities, probably the most important being its capability to perform a dynamic assessment of musculoskeletal elements with patient's partnership and observation during examination. In addition, ultrasonography is cost effective, easy available, and has excellent and multiplanar capability to visualize superficial soft tissue structures. Among all imaging procedures, US is highly accepted by patients. US assessment of the elbow requires good operator experience in the assessment of normal anatomy, and suitable high-quality equipment. US of the elbow provides detailed information including joint effusions, medial and lateral epicondylitis, tears of the distal biceps and triceps tendons, radial and ulnar collateral ligament tears, ulnar nerve entrapment, cubital or olecranon bursitis and intra-articular loose bodies. The aim of this paper is to review the screening technique and the basic normal and pathological findings in elbow US.

  1. 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

  2. Editorial Commentary: Just a Bit Outside: Elbow Ulnar Collateral Ligament Research Requires Critical Appraisal.

    PubMed

    Dugas, Jeffrey R

    2016-07-01

    Elbow ulnar collateral ligament reconstruction (UCLR) in Major League Baseball players using either a docking technique or a modified Jobe technique (modified to avoid flexor-pronator detachment) is effective treatment in experienced hands. The study of UCLR in Major League Baseball players requires recording and reporting of the actual number of athletes treated by individual surgeons using different techniques, to determine practice patterns. Absent these data, and with poor response rate by the solicited physicians (41%), survey results may be misleading. In addition, although transient ulnar neuritis may occur during UCLR, permanent ulnar neuropathy is exceedingly rare.

  3. Editorial Commentary: Just a Bit Outside: Elbow Ulnar Collateral Ligament Research Requires Critical Appraisal.

    PubMed

    Dugas, Jeffrey R

    2016-07-01

    Elbow ulnar collateral ligament reconstruction (UCLR) in Major League Baseball players using either a docking technique or a modified Jobe technique (modified to avoid flexor-pronator detachment) is effective treatment in experienced hands. The study of UCLR in Major League Baseball players requires recording and reporting of the actual number of athletes treated by individual surgeons using different techniques, to determine practice patterns. Absent these data, and with poor response rate by the solicited physicians (41%), survey results may be misleading. In addition, although transient ulnar neuritis may occur during UCLR, permanent ulnar neuropathy is exceedingly rare. PMID:27373177

  4. Dry Arthroscopy of the Elbow

    PubMed Central

    Phadnis, Joideep; Bain, Gregory

    2015-01-01

    Dry arthroscopy is attractive because it affords an unsurpassed clarity of view and minimizes swelling. The elbow is a challenging joint to assess arthroscopically; however, dry arthroscopy has some particular benefits in the elbow. The primary benefit is the quality of the tissue definition, but dry arthroscopy also increases the working time for surgery by reducing swelling and results in less postoperative discomfort for the patient. With dry arthroscopy, all joint surfaces are covered in synovial fluid, which reflects light, to provide a clearer image of the joint surfaces and depth of field. The air-fluid interface provides an uninterrupted appreciation of the synovial recesses and tissue perfusion. This article describes the technique and indications for dry elbow arthroscopy, which will allow other surgeons to reap the benefits of dry arthroscopy without the need for special equipment or changes in their basic technique. PMID:26759772

  5. Pediatric throwing injuries about the elbow.

    PubMed

    DaSilva, M F; Williams, J S; Fadale, P D; Hulstyn, M J; Ehrlich, M G

    1998-02-01

    Pediatric elbow injuries that result from repetitive throwing-type activities are common. These injuries differ from those seen in adults, because of anatomic differences. The purpose of this paper is twofold: first, to review the anatomy of the elbow and the mechanics of the throwing motion about the elbow, and second, to discuss the diagnosis, treatment, rehabilitation, and prevention of pediatric throwing injuries of the elbow.

  6. Endoscopic Ganglionectomy of the Elbow

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning. PMID:26870641

  7. Analysis of elbow-joints misalignment in upper-limb exoskeleton.

    PubMed

    Malosio, Matteo; Pedrocchi, Nicola; Vicentini, Federico; Tosatti, Lorenzo Molinari

    2011-01-01

    This paper presents advantages of introducing elbow-joints misalignments in an exoskeleton for upper limb rehabilitation. Typical exoskeletons are characterized by axes of the device as much as possible aligned to the rotational axes of human articulations. This approach leads to advantages in terms of movements and torques decoupling, but can lead to limitations nearby the elbow singular configuration. A proper elbow axes misalignment between the exoskeleton and the human can improve the quality of collaborative rehabilitation therapies, in which a correct torque transmission from human articulations to mechanical joints of the device is required to react to torques generated by the patient.

  8. Effect of electrode location on surface electromyography changes due to eccentric elbow flexor exercise.

    PubMed

    Piitulainen, Harri; Bottas, Reijo; Linnamo, Vesa; Komi, Paavo; Avela, Janne

    2009-10-01

    Experiments were carried out to determine whether the location of electrodes has an effect on eccentric exercise-induced changes in surface electromyography (sEMG) variables in the biceps brachii muscle. sEMG signals were recorded with a grid of 64 electrodes before and up to 4 days post-exercise. Root mean square (RMS) and mean power frequency (MNF) were calculated for: (1) each channel; (2) as an average of all channels; and (3) as an average of individual channel rows and columns. Mean muscle-fiber conduction velocity (CV) was estimated similarly but was based on double-differential channels. Maximal isometric voluntary torque decreased 21.3 +/- 5.6% post-exercise. The average sEMG variables decreased after the exercise and recovered 2 days (RMS and CV) or 4 days (MNF) post-exercise. Site-dependent changes were observed in sEMG variables. We conclude that site-dependent changes in sEMG variables after eccentric exercise can be detected and are influenced in part by anatomical factors.

  9. Flexor pulley system: anatomy, injury, and management.

    PubMed

    Zafonte, Brian; Rendulic, Dora; Szabo, Robert M

    2014-12-01

    Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the once-held dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function. PMID:25459958

  10. Coexistent digital gouty and infective flexor tenosynovitis.

    PubMed

    Akram, Qasim; Hughes, Michael; Muir, Lindsay

    2016-01-01

    Flexor tenosynovitis of the hand is often caused by trauma or infection. Gouty tenosynovitis is an uncommon presentation of the condition and is usually misdiagnosed as infection with the patient undergoing surgery. The coexistence of infection and gout causing flexor tenosynovitis has never been described before in the literature; we report the first ever case and emphasise the importance of its awareness for optimal treatment. A 54-year-old man was initially diagnosed and treated as having infective flexor tenosynovitis and, later, due to a lack of improvement in his symptoms, was discovered to also have gout. We review the literature and suggest management strategy for use in daily clinical practice, including an algorithm, for this presentation. PMID:27358092

  11. Tennis elbow. Anatomical, epidemiological and therapeutic aspects.

    PubMed

    Verhaar, J A

    1994-10-01

    Five studies of tennis elbow are presented. Epidemiological studies showed an incidence of tennis elbow between 1 and 2%. The prevalence of tennis elbow in women between 40 and 50 years of age was 10%. Half of the patients with tennis elbow seek medical attention. Local corticosteroid injections were superior to the physiotherapy regime of Cyriax. Release of the common forearm extensor origin resulted in 70% excellent or good results one year after operation and 89% at five years. Anatomical investigations and nerve conduction studies of the Radial Tunnel Syndrome supported the hypothesis that the Lateral Cubital Force Transmission System is involved in the pathogenesis of tennis elbow.

  12. 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.

  13. Review of management of unstable elbow fractures

    PubMed Central

    Ozel, Omer; Demircay, Emre

    2016-01-01

    Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstable fractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury. PMID:26807356

  14. Elbow and Shoulder Lesions of Baseball Players*

    PubMed Central

    2008-01-01

    George Eli Bennett was born in Claryville, NY, in the Catskill Mountains, in 1885 [3]. His parents both died by the time he was 11, leaving him the need to work while going to school, but he excelled in school and sports. He played semipro baseball at the age of 16. After high school he work in various jobs in the Midwest before he could afford to attend the University of Maryland Medical School, from which he graduated in 1908. At the age of 25 in 1910, he joined the staff at the Johns Hopkins Hospital, where he remained until his resignation in 1947. Dr. Bennett was one of a few men who served as President of both the American Orthopaedic Association and the American Academy of Orthopaedic Surgeons. While Dr. Bennett made many contributions to orthopaedic surgery, including children’s and nonoperative orthopaedics, he was best known for his work in sports medicine (undoubtedly related to his being a gifted athlete). His fame extended well beyond the orthopaedic community, for he treated many famous athletes. Sports Illustrated recognized him upon his death in an article entitled, “Mender of Immortals” [4]. His intimate knowledge of sports undoubtedly contributed to his sage judgments. At an emotional dinner in 1958 many famous athletes sometimes tearfully paid tribute to Dr. Bennett. Joe Garagiola commented on the occasion, “After listening to that all-star team of players Dr. Bennett has mended, I’m sorry I didn’t break my leg” [4]. Among Dr. Bennett’s many publications, including those related to sports, we have chosen one [2] of two articles [1,2] he wrote on elbow and shoulder problems in baseball players. He described the now well-known degenerative changes and periarticular calcific deposits that occur in the elbows and shoulders of pitchers. Some of these, he suggested, were not symptomatic and he advised against treatment. Dr. Bennett commented, however, “Since professional athletes are human beings, not supermen, general health often

  15. Functional restoration of elbow extension after spinal-cord injury using a neural network-based synergistic FES controller.

    PubMed

    Giuffrida, Joseph P; Crago, Patrick E

    2005-06-01

    Individuals with a C5/C6 spinal-cord injury (SCI) have paralyzed elbow extensors, yet retain weak to strong voluntary control of elbow flexion and some shoulder movements. They lack elbow extension, which is critical during activities of daily living. This research focuses on the functional evaluation of a developed synergistic controller employing remaining voluntary elbow flexor and shoulder electromyography (EMG) to control elbow extension with functional electrical stimulation (FES). Remaining voluntarily controlled upper extremity muscles were used to train an artificial neural network (ANN) to control stimulation of the paralyzed triceps. Surface EMG was collected from SCI subjects while they produced isometric endpoint force vectors of varying magnitude and direction using triceps stimulation levels predicted by a biomechanical model. ANNs were trained with the collected EMG and stimulation levels. We hypothesized that once trained and implemented in real-time, the synergistic controller would provide several functional benefits. We anticipated the synergistic controller would provide a larger range of endpoint force vectors, the ability to grade and maintain forces, the ability to complete a functional overhead reach task, and use less overall stimulation than a constant stimulation scheme.

  16. An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency.

    PubMed

    Glousman, R E; Barron, J; Jobe, F W; Perry, J; Pink, M

    1992-01-01

    Electromyography and high-speed film were used to examine the muscle activity in the elbows of pitchers with medial collateral ligament insufficiency compared to the activity in uninjured elbows. Ten competitive baseball pitchers with medial collateral insufficiency and 30 uninjured competitive pitchers were tested while throwing the fastball and the curveball. The extensor carpi radialis brevis and longus in the injured pitchers showed greater activity than in the uninjured pitchers for both pitches. The triceps, flexor carpi radialis, and pronator teres all showed less activity in the injured pitchers during the fastball, but only the triceps had less activity during the curveball. The differences were seen during the late cocking and acceleration phases, which place the greatest stress on the medial collateral ligament. If the flexor carpi radialis and pronator teres were substituting for the deficient medial collateral ligament and functioning as dynamic stabilizers, one would expect enhanced muscle activity. However, the opposite was found. This pattern of asynchronous muscle action with medial collateral ligament injury may predispose the joint to further injury. The muscular differences seen are critical to the understanding of the pathomechanics of patients with medial collateral ligament deficiency, and provide a basis for rehabilitation.

  17. Use of quantitative intra-operative electrodiagnosis during partial ulnar nerve transfer to restore elbow flexion: the treatment of eight patients following a brachial plexus injury.

    PubMed

    Suzuki, O; Sunagawa, T; Yokota, K; Nakashima, Y; Shinomiya, R; Nakanishi, K; Ochi, M

    2011-03-01

    The transfer of part of the ulnar nerve to the musculocutaneous nerve, first described by Oberlin, can restore flexion of the elbow following brachial plexus injury. In this study we evaluated the additional benefits and effectiveness of quantitative electrodiagnosis to select a donor fascicle. Eight patients who had undergone transfer of a simple fascicle of the ulnar nerve to the motor branch of the musculocutaneous nerve were evaluated. In two early patients electrodiagnosis had not been used. In the remaining six patients, however, all fascicles of the ulnar nerve were separated and electrodiagnosis was performed after stimulation with a commercially available electromyographic system. In these procedures, recording electrodes were placed in flexor carpi ulnaris and the first dorsal interosseous. A single fascicle in the flexor carpi ulnaris in which a high amplitude had been recorded was selected as a donor and transferred to the musculocutaneous nerve. In the two patients who had not undergone electrodiagnosis, the recovery of biceps proved insufficient for normal use. Conversely, in the six patients in whom quantitative electrodiagnosis was used, elbow flexion recovered to an M4 level. Quantitative intra-operative electrodiagnosis is an effective method of selecting a favourable donor fascicle during the Oberlin procedure. Moreover, fascicles showing a high-amplitude in reading flexor carpi ulnaris are donor nerves that can restore normal elbow flexion without intrinsic loss.

  18. Role of flexors in knee stability.

    PubMed

    Chen, C Y; Jiang, C C; Jan, M H; Lai, J S

    1995-05-01

    The muscle strength of knee extensors is commonly used as an indicator of a patient's functional recovery following reconstruction of the anterior cruciate ligament (ACL). The knee flexors are dynamic stabilizers that prevent tibial anterior displacement and may reinforce the function of the ACL. The purpose of this study was to examine the relationship of knee flexor performance assessed by isokinetic dynamometer and clinical evaluations including KT-1000 stability tests, shuttle run tests, thigh and calf circumference and range of motion of the knee joint. Ten patients who received ACL reconstruction over a 3- to 5-year period were included in this study, as were 15 normal controls who were tested for comparison. There was no significant difference in the time taken for the shuttle run test between normal controls and patients who underwent ACL, but there was a positive correlation between the shuttle run test and laxity of the knee joint. The knee laxity of ACL patients was significantly greater than that of the normal controls under passive anterior force. However, no significant difference was seen in the stability test under active contraction of the knee extensors. In addition, a positive correlation was seen between the KT-1000 knee ligament arthrometry test results and both torque acceleration energy and the average power of the flexors. These results suggest that physical therapy for patients following ACL reconstruction should emphasize the explosiveness of knee flexors to help strengthen the dynamic stability of the knee joint and motor performance.

  19. Flexor digitorum superficialis rupture: a case report.

    PubMed

    Culver, J E

    1976-04-01

    A rupture of the musculotendinous junction of the flexor digitorum superficialis to the index finger in a baseball pitcher is described. No underlying abnormality could be detected. Because of loss of strength and dexterity, repair of the rupture was accomplished with an improved result.

  20. Deformities of the elbow in achondroplasia.

    PubMed

    Kitoh, Hiroshi; Kitakoji, Takahiko; Kurita, Kazuhiro; Katoh, Mitsuyasu; Takamine, Yuji

    2002-07-01

    Lack of full extension of the elbow is a common abnormality in patients with achondroplasia. We studied 23 patients (41 elbows) clinically and radiologically. Extension of the elbow was assessed clinically and the angle of posterior bowing of the distal humerus was measured from lateral radiographs. There was limited extension of the elbow in 28 (68.3%) and the mean loss of extension was 13.1 degrees. Posterior bowing of the humerus was seen in all elbows with a mean angle of 17.0 degrees. There was a positive correlation between these two measurements. Posterior bowing greater than 20 degrees caused a loss of full elbow extension. Posterior dislocation of the radial head was seen in nine elbows (22.0%). The mean loss of extension of the elbows was 28.7 degrees which was significantly greater than that of these elbows in which the head was not dislocated (8.7 degrees), although posterior bowing was not significantly different between these two groups (19.3 degrees and 16.3 degrees). Posterior bowing of the distal humerus is a principal cause of loss of extension of the elbow. Posterior dislocation of the radial head causes further limitation of movement in the more severely affected joints. PMID:12188484

  1. Throwing injuries of the elbow.

    PubMed

    Jobe, F W; Nuber, G

    1986-10-01

    With the burgeoning popularity of racquet and throwing sports in our society, an increasing awareness of the elbow injuries sustained with repetitive upper extremity activity is important. Particular attention should be paid to proper technique, equipment, and duration of activity, and preventive measures should be taken. In the adolescent or adult individual who sustains elbow injury, it is imperative that the treating physician recognize the pathologic stage early in order to minimize the consequences of these activities. Only with a thorough history and physical examination of this complex joint and a firm understanding of the forces generated during activity will the sports medicine physician entertain the proper diagnosis and initiate a treatment protocol that is likely to be successful.

  2. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves.

    PubMed

    De Maeseneer, Michel; Brigido, Monica Kalume; Antic, Marijana; Lenchik, Leon; Milants, Annemieke; Vereecke, Evie; Jager, Tjeerd; Shahabpour, Maryam

    2015-04-01

    The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne. Slightly more distally the ulnar nerve courses between the two heads of the flexor carpi ulnaris. An accessory muscle, the anconeus epitrochlearis can cover the ulnar nerve at the cubital tunnel, and is easily identified on ultrasound. The radial nerve divides in a superficial sensory branch and a deep motor branch. The motor branch, the posterior interosseous nerve, courses under the arcade of Frohse where it enters the supinator muscle. At the level of the dorsal wrist the posterior interosseous nerve is located at the deep aspect of the extensor

  3. Pseudoelastic Nitinol-Based Device for Relaxation of Spastic Elbow in Stroke Patients

    NASA Astrophysics Data System (ADS)

    Viscuso, S.; Pittaccio, S.; Caimmi, M.; Gasperini, G.; Pirovano, S.; Villa, E.; Besseghini, S.; Molteni, F.

    2009-08-01

    A compliant brace (EDGES) promoting spastic elbow relaxation was designed to investigate the potentialities of pseudoelastic NiTi in orthotics. By exploiting its peculiar characteristics, EDGES could improve elbow posture without constraining movements and thus avoiding any pain to the patient. A commercial Ni50.7-Ti49.3 alloy heat treated at 400 °C 1 h + WQ was selected for this application. A prototype of EDGES was assembled with two thermoplastic shells connected by polycentric hinges. Four 2-mm-diameter NiTi bars were encastred in the upper-arm shell and let slide along tubular fixtures on the forearm. Specially designed bending tests demonstrated suitable moment-angle characteristics. Two post-stroke subjects (aged 62 and 64, mild elbow flexors spasticity) wore EDGES for 1 week, at least 10 h a day. No additional treatment was applied during this period or the following week. A great improvement (20° ± 5°) of the resting position was observed in both patients as early as 3 h after starting the treatment. Acceptability was very good. A slight decrease in spasticity was also observed in both subjects. All the effects disappeared 1 week after discontinuation. EDGES appears to be a good alternative to traditional orthoses in terms of acceptability and effectiveness in improving posture, especially whenever short-term splinting is planned.

  4. Nutrient pathways of flexor tendons in primates

    SciTech Connect

    Manske, P.R.; Lesker, P.A.

    1982-09-01

    The perfusion and diffusion pathways to the flexor profundus tendons of 40 monkeys were investigated by measuring the uptake of tritiated proline by various tendon segments. In the absence of all vascular connections, the process of diffusion provides nutrients to all areas of flexor tendon and in this study the process of diffusion was greater. The distal segment of tendon was observed to be profused most rapidly. The proximal tendon segment is perfused from both the muscular-tendinous junction and the vinculum longus; vincular segment perfusion is via the vinculum longus vessels alone; central segment perfusion is shared by the vinculum longus and vinculum brevis vasculature. The distal segment uptake is by both the process of diffusion or vinculum brevis perfusion. The osseous attachment at the distal phalanx contributes little to tendon nutrition.

  5. Concerns on little league elbow.

    PubMed

    Wells, M J; Bell, G W

    1995-09-01

    Little League elbow is a common overuse injury that will become more prevalent as more youths participate in baseball programs and other sports that involve overhead arm activities. The condition is highly treatable if diagnosed early in its development. Symptoms such as swelling and limited range of motion usually indicate an advanced overuse condition. Prevention and treatment should emphasize education of athletes, parents, and coaches about coaches about its etiology. Factors involved are proper pitching mechanics, stretching and strengthening programs, improving early recognition, and, most importantly, limiting the number of pitches thrown daily.

  6. Concerns on Little League Elbow

    PubMed Central

    Wells, Michael J.; Bell, Gerald W.

    1995-01-01

    Little League elbow is a common overuse injury that will become more prevalent as more youths participate in baseball programs and other sports that involve overhead arm activities. The condition is highly treatable if diagnosed early in its development. Symptoms such as swelling and limited range of motion usually indicate an advanced overuse condition. Prevention and treatment should emphasize education of athletes, parents, and coaches about coaches about its etiology. Factors involved are proper pitching mechanics, stretching and strengthening programs, improving early recognition, and, most importantly, limiting the number of pitches thrown daily. PMID:16558344

  7. Effect of flexor sheath integrity on nutrient uptake by chicken flexor tendons

    SciTech Connect

    Peterson, W.W.; Manske, P.R.; Lesker, P.A.

    1985-12-01

    The effect of varying degrees of flexor sheath integrity (sheath excised, incised, or incised and repaired) on the uptake of /sub 2/H-proline by chicken flexor tendons in Zone II was studied. The tendons were either: normal and uninjured, lacerated and repaired, or uninjured except for vinculum longum ligation. Different degrees of sheath integrity did not influence the uptake of /sub 2/H-proline by the tendons. The tendon does not appear to be dependent on a synovial environment for nutrients and is capable of obtaining these nutrients by diffusion from the surrounding extracellular tissue fluid. Diffusion is the primary nutrient pathway to the flexor tendon in this area, because removing its major vascular attachment (i.e., the vinculum longum) did not effect proline uptake. Careful closure of the sheath with restoration of a synovial environment does not appear to be necessary for tendon nutrition.

  8. Humeral windows in revision total elbow arthroplasty

    PubMed Central

    Salama, Amir; Stanley, David

    2016-01-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  9. The posttraumatic stiff elbow: an update.

    PubMed

    Mellema, Jos J; Lindenhovius, Anneluuk L C; Jupiter, Jesse B

    2016-06-01

    Posttraumatic elbow stiffness is a disabling condition that remains challenging to treat despite improvement of our understanding of the pathogenesis of posttraumatic contractures and new treatment regimens. This review provides an update and overview of the etiology of posttraumatic elbow stiffness, its classification, evaluation, nonoperative and operative treatment, and postoperative management.

  10. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  11. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).

    PubMed

    Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther

    2014-01-01

    Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries. PMID:23962872

  12. Biomechanics of the elbow in sports.

    PubMed

    Loftice, Jeremy; Fleisig, Glenn S; Zheng, Nigel; Andrews, James R

    2004-10-01

    In throwing activities, the elbow is sometimes stressed to its biomechanical limits. In this article, forces, torques, angular velocities, and muscle activity about the elbow are reviewed for the baseball pitch, the football pass, the javelin throw, the windmill softball pitch, the tennis serve, and the golf swing. The elbow goes through rapid extension in baseball pitching (about 2400 degrees/s) and rapid flexion in the javelin throw (about 1900 degrees/s). During baseball pitching, the elbow joint is subject to a valgus torque reaching 64 Nm, and requires proximal forces as high as 1000 N to prevent elbow distraction. The ulnar collateral ligament (UCL) rupture in baseball pitching, lateral epicondylitis in the tennis backhand, and other injury mechanisms are also discussed. PMID:15474219

  13. Ultrasonographic Differentiation of Lateral Elbow Pain.

    PubMed

    Obuchowicz, R; Bonczar, M

    2016-05-01

    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

  14. History and examination of the thrower's elbow.

    PubMed

    Cain, E Lyle; Dugas, Jeffrey R

    2004-10-01

    Overhead throwing motion imparts enormous forces on the elbow. Repetitive near-failure loads lead to chronic adaptive changes and occasionally acute injury to bone, ligaments, and the elbow's muscle-tendon complexes. Physicians treating the thrower must thoroughly understand the complex anatomy and function of the elbow joint and throwing biomechanics to diagnose and treat elbow pathology. Evaluation of elbow pain begins with a thorough, detailed throwing history, including symptom duration, location of pain, timing during phases of throwing motion, and associated symptoms. Physical examination should include inspection, range of motion, palpation, and specific tests to better define the pathology. A detailed history and physical examination often lead the astute clinician to the proper diagnosis and treatment without reliance on ancillary testing.

  15. Biomechanics of the elbow in sports.

    PubMed

    Loftice, Jeremy; Fleisig, Glenn S; Zheng, Nigel; Andrews, James R

    2004-10-01

    In throwing activities, the elbow is sometimes stressed to its biomechanical limits. In this article, forces, torques, angular velocities, and muscle activity about the elbow are reviewed for the baseball pitch, the football pass, the javelin throw, the windmill softball pitch, the tennis serve, and the golf swing. The elbow goes through rapid extension in baseball pitching (about 2400 degrees/s) and rapid flexion in the javelin throw (about 1900 degrees/s). During baseball pitching, the elbow joint is subject to a valgus torque reaching 64 Nm, and requires proximal forces as high as 1000 N to prevent elbow distraction. The ulnar collateral ligament (UCL) rupture in baseball pitching, lateral epicondylitis in the tennis backhand, and other injury mechanisms are also discussed.

  16. 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

  17. 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.

  18. An Unusual Cause of Flexor Tenosynovitis: Streptococcus mitis

    PubMed Central

    Ulucay, Cağatay; Ozler, Turhan

    2014-01-01

    Summary: Streptococcus mitis is a commensal organism of the human oropharynx that rarely causes infection in healthy individuals. Herein, we describe a previously healthy 35-year-old woman who presented with acute pyogenic flexor tenosynovitis of the left index finger due to S. mitis infection. The patient’s infection was treated successfully via surgical and medical interventions, and during follow-up, it was determined that she was complement component C3 deficient. Tenosynovitis is an emergent clinical syndrome that can result in permanent disability or amputation. To the best of our knowledge, this case report is the first to describe tenosynovitis due to S. mitis; in addition, it highlights the importance of initiating therapy with antibiotics that are effective against this rare pathogen. PMID:25587497

  19. Flexor digitorum profundus tendon tension during finger manipulation.

    PubMed

    Tanaka, Tatsuro; Amadio, Peter C; Zhao, Chunfeng; Zobitz, Mark E; An, Kai-Nan

    2005-01-01

    Abstract The purpose of this study was to measure the tension in the flexor digitorum profundus (FDP) tendon in zone II and the digit angle during joint manipulations that replicate rehabilitation protocols. Eight FDP tendons from eight human cadavers were used in this study. The dynamic tension in zone II of the tendon and metacarpophalangeal (MCP) joint angle were measured in various wrist and digit positions. Tension in the FDP tendon increased with MCP joint extension. There was no tension with the finger fully flexed and wrist extended (synergistic motion), but the tendon force reached 1.77 +/- 0.43 N with the MCP joint hyperextended 45 degrees with the distal interphalangeal and proximal interphalangeal joints flexed. The combination of wrist extension and MCP joint hyperextension with the distal interphalangeal and proximal interphalangeal joints fully flexed, what the authors term "modified synergistic motion," produced a modest tendon tension and may be a useful alternative configuration to normal synergistic motion in tendon rehabilitation.

  20. 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.

  1. Tendon ruptures: mallet, flexor digitorum profundus.

    PubMed

    Yeh, Peter C; Shin, Steven S

    2012-08-01

    Mallet injuries are the most common closed tendon injury in the athlete. Flexor digitorum profundus ruptures are rare in baseball, but are common injuries in contact sports. The diagnosis for each condition is based on clinical examination, although radiographs should be evaluated for a possible bony component. Treatment for mallet injury depends on the athlete's goals of competition and understanding of the consequences of any treatment chosen. Gripping, throwing, and catching would be restricted or impossible with the injured finger immobilized. Treatment of FDP ruptures is almost always surgical and requires reattachment of the torn tendon to the distal phalanx.

  2. Outcomes evaluation of the athletic elbow.

    PubMed

    Freehill, Michael T; Mannava, Sandeep; Safran, Marc R

    2014-09-01

    The high-level athletic population poses difficulty when evaluating outcomes in orthopedic surgery, given generally good overall health and high function at baseline. Subtle differences in performance following injury or orthopedic surgery are hard to detect in high-performance athletes using standard outcome metrics; however, attaining these subtle improvements after injury or surgery are key to an athletes' livelihood. Outcome measures serve as the cornerstone for critical evaluation of clinical outcomes following orthopedic surgery or injury. In the age of "evidence-based medicine" and "pay-for-performance" accountability for surgical intervention, understanding clinically relevant outcome measures is essential for careful review of the published literature, as well as one's own critical review of surgical performance. The purpose of this manuscript is to evaluate clinical outcome measures in the context of the athletic elbow. An emphasis will be placed on evaluation of the 5 most clinically relevant outcome measures for sports-related elbow outcomes: (1) American Shoulder and Elbow Committee; (2) Mayo Elbow Performance Index; (3) Andrews-Timmerman [and its precursor the (4) Andrews-Carson]; and (5) Kerlan-Jobe Orthopaedic Clinic overhead athlete score. A final outcome measure that will be analyzed is "return to play" statistics, which has been published in various studies of athletes' recovery from elbow surgery, as well as, the outcomes metric known as the "Conway-Jobe scale." Although there is no perfect outcomes score for the athletic elbow, the Kerlan-Jobe Orthopaedic Clinic score is the only outcomes tool developed and validated for outcomes for elbow injuries in the overhead athlete, as compared with the Andrew-Timmerman and Conway-Jobe metrics, which were not validated outcome measures for the elbow in this patient population. Despite the Disabilities of Arm, Shoulder, Hand (DASH) (and DASH-Sport module) being validated in the general population, this

  3. LATERAL EPICONDYLITIS OF THE ELBOW

    PubMed Central

    Cohen, Marcio; da Rocha Motta Filho, Geraldo

    2015-01-01

    Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population. The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis and the mechanism of injury is associated with overloading. Nonsurgical treatment is the preferred method, and this includes rest, physiotherapy, cortisone infiltration, platelet-rich plasma injections and use of specific immobilization. Surgical treatment is recommended when functional disability and pain persist. Both the open and the arthroscopic surgical technique with resection of the degenerated tendon tissue present good results in the literature. PMID:27047843

  4. Elbow arthroscopy in a mostly athletic population.

    PubMed

    Ward, W G; Anderson, T E

    1993-03-01

    The effectiveness of elbow arthroscopy was assessed in 35 consecutive patients (primarily weight lifters and baseball players) treated by one surgeon. The most commonly treated lesions were loose bodies and impinging spurs. Most elbow problems resulted from repetitive or acute athletic trauma. Repetitive stress injuries usually involved the athlete's dominant arm (91%). A standardized rating system demonstrated significant improvement at 24 months' average follow-up. Flexion and extension improved an average of 9 and 6 degrees, respectively. Elbow arthroscopy appears to be a safe and effective treatment for athletes, allowing most a full return to participation in sports.

  5. The role of carbon fibre as a flexor tendon substitute.

    PubMed

    Rawlins, R

    1983-06-01

    Experiments have been carried out on Rhesus monkeys to determine the effectiveness of carbon fibre as a flexor tendon substitute. Though the strength, flexibility and capacity to induce a neotendon make carbon fibre an ideal flexor tendon substitute, induction of fibrosis and accompanying increase in bulk of the implant resulted in failure.

  6. Should we think about wrist extensor after flexor tendon repair?

    PubMed Central

    Ferreira, Aline M; Tanaka, Denise M; Barbosa, Rafael I; Marcolino, Alexandre M; Elui, Valeria MC; Mazzer, Nilton

    2013-01-01

    Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair. Design: Cross-sectional clinical measurement study. Setting: Laboratory for biomechanics and rehabilitation. Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age. Intervention: Volunteers performed an isometric standardized gripping task. Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis. Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated. Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary. PMID:26770674

  7. Stenosing flexor tenosynovitis following a rattlesnake bite.

    PubMed

    Lee, Lydia; Yao, Jeffrey

    2010-07-01

    Snakebite victims have been described previously in orthopedic literature in regard to complications such as compartment syndrome and carpal tunnel syndrome. We introduce a previously unreported complication of stenosing flexor tenosynovitis in a patient bitten by a rattlesnake. After being bitten in her right forearm, the patient experienced mild systemic symptoms of fever and nausea and was assessed at an outside hospital, where it was determined that she did not suffer from envenomation and therefore did not require antivenin therapy. She presented to our institution 1 week later with signs and symptoms of acute, new-onset right thumb flexor tenosynovitis, with pain and tenderness at the level of the A1 pulley of the thumb, with intermittent triggering. She also presented the following week with ipsilateral carpal tunnel syndrome. The patient reported no such symptoms prior to the snakebite. Given the recent development of these conditions after her snakebite, in addition to her history of endocrine disorders, we believe that our patient suffered from envenomation that led to these complications. Nonoperative measures including splinting and steroid injections were taken, with mixed results, and surgical intervention was necessary. While the proper management of snakebites is controversial, especially in regard to the administration of antivenin, we believe our patient would have benefitted from immediate evaluation and consideration for antivenin. PMID:20608624

  8. Elbow injuries in the throwing athlete.

    PubMed

    Kancherla, Vamsi K; Caggiano, Nicholas M; Matullo, Kristofer S

    2014-10-01

    High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft tissue and bony stabilizing structures of the elbow undergo progressive structural changes and can succumb to injury. Modern diagnostic modalities, including plain radiographs, computed tomography, and magnetic resonance imaging, in addition to arthroscopy, can aid in diagnosis. Although nonoperative management is often successful, surgical intervention may be necessary before allowing return to play.

  9. Elbow injuries in the throwing athlete.

    PubMed

    Kancherla, Vamsi K; Caggiano, Nicholas M; Matullo, Kristofer S

    2014-10-01

    High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft tissue and bony stabilizing structures of the elbow undergo progressive structural changes and can succumb to injury. Modern diagnostic modalities, including plain radiographs, computed tomography, and magnetic resonance imaging, in addition to arthroscopy, can aid in diagnosis. Although nonoperative management is often successful, surgical intervention may be necessary before allowing return to play. PMID:25199426

  10. Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping

    PubMed Central

    Farris, Dominic James; Hicks, Jennifer L.; Delp, Scott L.; Sawicki, Gregory S.

    2014-01-01

    Experiments have shown that elastic ankle exoskeletons can be used to reduce ankle joint and plantar-flexor muscle loading when hopping in place and, in turn, reduce metabolic energy consumption. However, recent experimental work has shown that such exoskeletons cause less favourable soleus (SO) muscle–tendon mechanics than is observed during normal hopping, which might limit the capacity of the exoskeleton to reduce energy consumption. To directly link plantar-flexor mechanics and energy consumption when hopping in exoskeletons, we used a musculoskeletal model of the human leg and a model of muscle energetics in simulations of muscle–tendon dynamics during hopping with and without elastic ankle exoskeletons. Simulations were driven by experimental electromyograms, joint kinematics and exoskeleton torque taken from previously published data. The data were from seven males who hopped at 2.5 Hz with and without elastic ankle exoskeletons. The energetics model showed that the total rate of metabolic energy consumption by ankle muscles was not significantly reduced by an ankle exoskeleton. This was despite large reductions in plantar-flexor force production (40–50%). The lack of larger metabolic reductions with exoskeletons was attributed to increases in plantar-flexor muscle fibre velocities and a shift to less favourable muscle fibre lengths during active force production. This limited the capacity for plantar-flexors to reduce activation and energy consumption when hopping with exoskeleton assistance. PMID:25278469

  11. Evaluation of elbow pain in adults.

    PubMed

    Kane, Shawn F; Lynch, James H; Taylor, Jonathan C

    2014-04-15

    The elbow is a complex joint designed to withstand a wide range of dynamic exertional forces. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior. The history should include questions about the onset of pain, what the patient was doing when the pain started, and the type and frequency of athletic and occupational activities. Lateral and medial epicondylitis are two of the more common diagnoses and often occur as a result of occupational activities. Patients have pain and tenderness over the affected tendinous insertion that are accentuated with specific movements. If lateral and medial epicondylitis treatments are unsuccessful, ulnar neuropathy and radial tunnel syndrome should be considered. Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing. Biceps tendinopathy is a relatively common source of pain in the anterior elbow; history often includes repeated elbow flexion with forearm supination and pronation. Olecranon bursitis is a common cause of posterior elbow pain and swelling. It can be septic or aseptic, and is diagnosed based on history, physical examination, and bursal fluid analysis if necessary. Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions. Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain. Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures.

  12. Open Galeazzi fracture with ipsilateral elbow dislocation.

    PubMed

    Adanır, Oktay; Yüksel, Serdar; Beytemur, Ozan; Güleç, M Akif

    2016-08-01

    Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°.

  13. Open Galeazzi fracture with ipsilateral elbow dislocation.

    PubMed

    Adanır, Oktay; Yüksel, Serdar; Beytemur, Ozan; Güleç, M Akif

    2016-08-01

    Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°. PMID:27499325

  14. Hindfoot endoscopy for accessory flexor digitorum longus and flexor hallucis longus tenosynovitis.

    PubMed

    Ogut, Tahir; Ayhan, Egemen

    2011-03-01

    We present a case report involving the flexor digitorum accessorius longus (FDAL) tendon which travels through a fibro-osseous tunnel together with the flexor hallucis longus (FHL) tendon, causing a stenosing tenosynovitis. The patient was admitted with posteromedial ankle pain and diagnosed clinically as FHL tenosynovitis. We found two tendons in the tunnel during hindfoot endoscopy. The stenosis was relieved by endoscopic debridement. After the operation, we checked the MRI images and observed two tendons. We concluded that the accessory tendon was the FDAL. Two years later the patient was admitted with the same symptoms. We excised the FDAL muscle and the patient's symptoms resolved. The FDAL muscle is a cause of FHL tenosynovitis. Because of its variability and mostly asymptomatic nature, it may not be noticed it on an MRI scan. Hindfoot endoscopy is a safe tool for the diagnosis of this condition and curative treatment is afforded by excision of the FDAL muscle. PMID:21276556

  15. Active tendon implants in flexor tendon reconstruction.

    PubMed

    Hunter, J M; Singer, D I; Jaeger, S H; Mackin, E J

    1988-11-01

    Forty-five active flexor tendon implants were evaluated after placement in scarred tendon beds of digits II through V. The implant is constructed of silicone rubber with a Dacron core, terminating in a loop proximally and a metal plate distally. Modification of the implant during the period of study has improved its reliability and longevity. The improvement in total active motion (TAM) averaged 72 degrees during implant functioning (stage I) in a group of digits that before operation were classified as 78% Boyes grade 5 (salvage). Complication rate during stage I was 11% (5 out of 45). Of the 27 digits evaluated after implant replacement by tendon autograft (stage II), there was an overall improvement in 62 degrees total active motion with 70% of digits being Boyes grade 5. Many of the complications were believed to be avoidable with experience. This study demonstrates the feasibility of an active tendon implant and the possibility of a permanent prosthesis. PMID:2976074

  16. AIDS and the lung. 1--AIDS, aprons, and elbow grease: preventing the nosocomial spread of human immunodeficiency virus and associated organisms.

    PubMed Central

    Hanson, P J; Collins, J V

    1989-01-01

    Epidemiological evidence indicates that transmission of human immunodeficiency virus (HIV) other than by direct inoculation or sexual contact is extremely rare. HIV has, however, been found on fibreoptic bronchoscopes used on patients with AIDS and there is a clear theoretical risk of transmission by bronchoscopy. Applied experiments have underlined the importance of cleaning equipment thoroughly and have shown the limitations of disinfection. Infection control policies should be revised to meet the following four basic requirements: (1) all precautions should apply to all patients alike--that is, whether infectious or not; (2) equipment should be cleaned thoroughly in detergent immediately after use to remove body secretions and reduce contamination; (3) staff who may be exposed to body secretions should wear simple barrier clothing routinely; and (4) contaminated bronchoscopes should be disinfected for 20 minutes in 2% alkaline glutaraldehyde after cleaning. PMID:2688178

  17. Disorders of the Flexor Hallucis Longus and Os Trigonum.

    PubMed

    Rungprai, Chamnanni; Tennant, Joshua N; Phisitkul, Phinit

    2015-10-01

    Os trigonum syndrome with disease of the flexor hallucis longus tendon, so-called stenosing flexor tenosynovitis, is a common cause of posterior ankle impingement. Conservative treatment is the recommended first line of treatment, with secondary treatment options of either open or arthroscopic os trigonum excision with flexor hallucis longus retinaculum release. The arthroscopic approaches have gained popularity in the past decade because of less scarring, less postoperative pain, minimal overall morbidity, and earlier return to activities. However, comprehensive understanding of the anatomy of the posterior ankle is crucial to warrant successful outcomes and minimizing complications. PMID:26409593

  18. Disorders of the Flexor Hallucis Longus and Os Trigonum.

    PubMed

    Rungprai, Chamnanni; Tennant, Joshua N; Phisitkul, Phinit

    2015-10-01

    Os trigonum syndrome with disease of the flexor hallucis longus tendon, so-called stenosing flexor tenosynovitis, is a common cause of posterior ankle impingement. Conservative treatment is the recommended first line of treatment, with secondary treatment options of either open or arthroscopic os trigonum excision with flexor hallucis longus retinaculum release. The arthroscopic approaches have gained popularity in the past decade because of less scarring, less postoperative pain, minimal overall morbidity, and earlier return to activities. However, comprehensive understanding of the anatomy of the posterior ankle is crucial to warrant successful outcomes and minimizing complications.

  19. Change in EMG with skin friction at different frequencies during elbow flexion.

    PubMed

    Sugawara, Hitoshi; Shimose, Ryota; Tadano, Chigaya; Ushigome, Nobuyuki; Muro, Masuo

    2013-06-01

    Modulation of muscle activation in superficial and deeper regions may be induced by tactile stimulation. The purpose of this study was to examine changes in muscle activation with skin friction. Subjects performed an isometric elbow flexion at 30% maximal voluntary cotraction (MVC) with skin friction at different frequencies (0.5-2.7 Hz). Surface electromyography (S-EMG) and intramuscular EMG were obtained from the elbow flexor muscles (BBS: short head of biceps brachii, BBL: long head of biceps brachii, BRA: brachialis). S-EMG activity decreased at a higher frequency of 2.7 Hz and increased linearly with an increase in skin friction frequency (0.5-2.7 Hz) in BBS. A decrease in high-threshold motor unit (HT-MU) firing rate in superficial regions and an increase in low-threshold motor unit (LT-MU) firing rate in deeper regions were observed with skin friction (2.7 Hz) in BBS. The actions of inhibitory interneurons may be influenced by cutaneous afferent input with skin friction. Muscle activation of BBS depended on the intensity of the stimulus. Skin friction over BBS results in an inhibitory response in superficial regions of BBS, most likely due to the increase in firing rate of low-threshold cutaneous mechanoreceptors.

  20. Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study.

    PubMed

    Król, Piotr; Franek, Andrzej; Durmała, Jacek; Błaszczak, Edward; Ficek, Krzysztof; Król, Barbara; Detko, Ewa; Wnuk, Bartosz; Białek, Lidia; Taradaj, Jakub

    2015-09-29

    The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm(2)) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.

  1. Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study

    PubMed Central

    Król, Piotr; Franek, Andrzej; Durmała, Jacek; Błaszczak, Edward; Ficek, Krzysztof; Król, Barbara; Detko, Ewa; Wnuk, Bartosz; Białek, Lidia; Taradaj, Jakub

    2015-01-01

    The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm2) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity. PMID:26557197

  2. Plant thorn synovitis of elbow in children

    PubMed Central

    Bharti, Ajay; Mohan, Kriti; Kumar, Snajay; Kumar, Vineet

    2014-01-01

    Four rare cases of plant thorn synovitis of left elbow were admitted at our institution, which were initially misdiagnosed as partially treated septic arthritis of elbow or Juvenile inflammatory arthritis. All of them were of paediatric age group. Symptoms included pain, swelling, and decreased range of motion of affected joint. On examination synovitis was present in all patients. Roentgenograms & Ultrasonography were inconclusive in all patients, Definitive diagnosis was made only after arthrotomy, Thorn fragments (Acacia arabica) were recovered from the hypertrophied synovium & subtotal synovectomy was done and sent for histopathological examination. All patients improved after surgery with mean residual flexion deformity of 12.5 ± 2.86°. Plant thorn induced synovitis of elbow is rare, it must be included in the differential diagnosis of monoarthritis of elbow and a high index of suspicion is needed for retained thorn fragments in elbow joint causing synovitis. Its optimal treatment is arthrotomy, foreign body removal and total/subtotal synovectomy. PMID:25983510

  3. Nomenclatural review of long digital forelimb flexors in carnivores.

    PubMed

    Spoor, C F; Badoux, D M

    1986-12-01

    A hitherto-unknown atavistic muscle in the dog initiated a review of the literature on the homologies and nomenclature of the forelimb flexors in carnivores and man. A consequence is that we recommend a revision of the nomenclature in the Nomina Anatomica Veterinaria (Ithaca, New York, 1983) so that it is in agreement with the Nomina Anatomica (Wilkins, Baltimore, 1983). This revision mainly consists of the incorporation of the terms M. palmaris longus and Mm. flexores breves manus.

  4. [Chronic bony instability of the elbow joint].

    PubMed

    Geßmann, J; Königshausen, M; Schildhauer, T A; Seybold, D

    2016-10-01

    The high stability of the elbow joint is provided by the congruent articular surfaces in combination with soft tissue stabilizers. The main osseous contributor of elbow stability is the coronoid, which is therefore referred to as a primary stabilizer. The radial head as a secondary stabilizer together with the medial collateral ligament assures valgus stability and together with the coronoid it assures posterolateral stability. Insufficiency of the osseous stabilizers may lead to difficulties in the treatment of chronic dislocation and complex instability. Thereby reconstruction of the osseous constraints of the elbow joint is not performed in isolation from addressing insufficient soft-tissue stabilizers. Bony stabilizers and reconstructional procedures are discussed in this review.

  5. Bilateral osteochondritis dissecans of the elbow in a female pitcher.

    PubMed

    Williamson, L R; Albright, J P

    1996-11-01

    We report a case of a 17-year-old female pitcher with bilateral elbow osteochondritis dissecans. Osteochondritis of the elbow is a well-known disorder affecting pitchers and other individuals who sustain repetitive microtrauma to the elbow. Elbow osteochondritis has been described infrequently in female athletes. The incidence and reporting patterns of this disease are likely to increase as more female athletes participate in organized sports.

  6. Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients.

    PubMed

    Huang, Han-Wei; Ju, Ming-Shaung; Lin, Chou-Ching K

    2016-05-01

    The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent.

  7. Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients.

    PubMed

    Huang, Han-Wei; Ju, Ming-Shaung; Lin, Chou-Ching K

    2016-05-01

    The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent. PMID:26765753

  8. Elbow Dislocation with Complete Triceps Avulsion

    PubMed Central

    Karuppiah, S. V.; Knox, D.

    2014-01-01

    Radio-ulnar Fracture dislocation of the elbow is a high-energy trauma which can be associated with significant ligamentous injury in adults. We report an unusual triad of injury in a patient with avulsion injury of the triceps. This injury can be thought of as a variant of “terrible triad” with dislocation of radio-ulnar joint, radial head fracture, and medial collateral ligament injury with avulsion of the triceps. Elbow has to be stabilized with early repair of the ligaments for a successful outcome. PMID:24876982

  9. Understanding shoulder and elbow injuries in baseball.

    PubMed

    Limpisvasti, Orr; ElAttrache, Neal S; Jobe, Frank W

    2007-03-01

    Repetitive overhead throwing exerts significant mechanical stress on the shoulder and elbow joint; this stress can lead to developmental anatomic changes in the young thrower. Asymptomatic pathology in the shoulder and elbow joint is prevalent and, with overuse, can progress to disabling injury. Joint injury occurs as a result of the body's inability to properly coordinate motion segments during the pitching delivery, leading to further structural damage. Identifying and preventing overuse is the key to avoiding injury, particularly in the young pitcher. Injury prevention and rehabilitation should center on optimizing pitching mechanics, core strength, scapular control, and joint range of motion.

  10. Elbow injuries in young baseball players.

    PubMed

    Whiteside, J A; Andrews, J R; Fleisig, G S

    1999-06-01

    The demands that throwing places on the vulnerable immature elbow frequently produce multiple injuries. Significant clues in the history include persistent medial elbow soreness, stiffness, and discomfort that lead to poor performance. Diagnosis involves identifying the injury sites by palpation and x-rays that pinpoint growth-plate separation or osteochondral changes. Nonoperative treatment, which can proceed if growth-plate separation at the medial apophysis is less than 3 mm, involves stretching, strengthening, sport-specific activities, and interval throwing. Prevention includes conditioning, limiting the number of pitches, and using age guidelines for learning new pitches.

  11. Middle phalanx skeletal morphology in the hand: can it predict flexor tendon size and attachments?

    PubMed

    Marzke, Mary W; Shrewsbury, Marvin M; Horner, Kristin E

    2007-10-01

    Specific sites on the palmar diaphysis of the manual middle phalanges provide attachment for the flexor digitorum superficialis (FDS) tendon. It has been assumed in the literature that lateral palmar fossae on these bones reflect locations for these attachments and offer evidence for relative size of the flexor tendon. This assumption has led to predictions about relative FDS muscle force potential from sizes of fossae on fossil hominin middle phalanges. Inferences about locomotor capabilities of fossil hominins in turn have been drawn from the predicted force potential of the flexor muscle. The study reported here provides a critical first step in evaluating hypotheses about behavioral implications of middle phalangeal morphology in fossil hominins, by testing the hypothesis that the lateral fossae reflect the size of the FDS tendon and the location of the terminal FDS tendon attachments on the middle phalanx. The middle phalangeal region was dissected in 43 individuals from 16 primate genera, including humans. Qualitative observations were made of tendon attachment locations relative to the lateral fossae. Length measurements of the fossae were tested as predictors of FDS tendon cross-sectional area and of FDS attachment tendon lengths. Our results lead to the conclusion that the hypothesis must be rejected, and that future attention should focus on functional implications of the palmar median bar associated with the lateral fossae.

  12. Gliding resistance of flexor tendon associated with carpal tunnel pressure: a biomechanical cadaver study.

    PubMed

    Zhao, Chunfeng; Ettema, Anke M; Berglund, Lawrence J; An, Kai-Nan; Amadio, Peter C

    2011-01-01

    The purpose of this study was to investigate the effect of carpal tunnel pressure on the gliding characteristics of flexor tendons within the carpal tunnel. Eight fresh human cadaver wrists and hands were used. A balloon was inserted into the carpal tunnel to elevate the pressure. The mean gliding resistance of the middle finger flexor digitorum superficialis tendon was measured with the following six conditions: (1) as a baseline, before balloon insertion; (2) balloon with 0 mmHg pressure; (3) 30 mmHg; (4) 60 mmHg; (5) 90 mmHg; (6) 120 mmHg. The gliding resistance of flexor tendon gradually increased as the carpal tunnel pressure was elevated. At pressures above 60 mmHg, the increase in gliding resistance became significant compared to the baseline condition. This study helps us to understand the relationship between carpal tunnel pressure, which is elevated in the patient with carpal tunnel syndrome (CTS) and tendon gliding resistance, which is a component of the work of flexion. These findings suggest that patients with CTS may have to expend more energy to accomplish specific motions, which may in turn affect symptoms of hand pain, weakness and fatigue, seen commonly in such patients.

  13. Static analysis of a piping system with elbows

    SciTech Connect

    Bryan, B.J.

    1994-03-01

    Vibration tests of elbows to failure were performed in Japan in the early 1970s. The piping system included two elbows and an eccentric mass. Tests were run both pressurized and unpressurized. This report documents a static analysis of the piping system in which the elbows are subjected to out of plane bending. The effects of internal pressure and material plasticity are investigated.

  14. Clinical Outcomes Study of the Nexel Total Elbow

    ClinicalTrials.gov

    2016-07-08

    Elbow Joint Destruction; Post-traumatic Lesions; Ankylosed Joints; Advanced Rheumatoid Arthritis; Joint Instability or Loss of Motion; Acute Comminuted Articular Fracture of Elbow Joint Surfaces; Bone Loss Contributing to Elbow Instability; Bilateral Ankylosis From Causes Other Than Active Sepsis; Post-traumatic, or Degenerative Arthritis With Incapacitating Pain

  15. Flexor carpi radialis tendon ultrasound pictorial essay.

    PubMed

    Luong, Dien Hung; Smith, Jay; Bianchi, Stefano

    2014-06-01

    Disorders of the flexor carpi radialis tendon (FCRt) are often missed even though they are a relatively frequent cause of volar radial wrist pain. They can manifest as tenosynovitis, tendinopathy, synovial sheath cysts with or without scaphoid-trapezoid-trapezium (STT) joint pathology, and partial or complete rupture. Because FCRt disorders often present with non-specific symptoms and a non-diagnostic clinical examination, imaging is often necessary for accurate evaluation and therapeutic planning. Conventional radiography provides good visualization of the neighboring bones and joints, as well as rare intratendinous calcifications. MRI enables evaluation of the FCRt and adjacent anatomical structures with excellent tissue resolution. In comparison, ultrasound (US) evaluation of the FCRt is less commonly described in the radiology literature, despite its affordability, exquisite soft tissue resolution, and the advantages of quick, dynamic diagnostic imaging. This pictorial essay describes and demonstrates the normal anatomy of the FCRt, its US examination technique and normal US appearance, and US findings of clinically relevant FCRt disorders.

  16. 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.

  17. Rehabilitation of the Overhead Athlete's Elbow.

    PubMed

    Wilk, Kevin E; Macrina, Leonard C; Cain, E Lyle; Dugas, Jeffrey R; Andrews, James R

    2012-09-01

    The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive overuse, leading to tissue failure. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether following injury or postsurgical, must follow a progressive and sequential order, building on the previous phase, to ensure that healing tissues are not compromised. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control while gradually applying loads to healing tissue. In addition, when one is creating a rehabilitation plan for athletes, it is imperative to treat the entire upper extremity, core, and legs to create and dissipate the forces generated at each joint.

  18. Baseball adaptation for below-elbow prosthesis.

    PubMed

    Truong, X T; Erickson, R; Galbreath, R

    1986-06-01

    A baseball bat adaptation to improve the handling with below-elbow prosthesis is described. The adaptation consists of a ball and socket joint unit interposed between wrist and hand prostheses. A patient who had forearm amputation successfully used the adaptation to play softball.

  19. Decreased Brain Neurokinin-1 Receptor Availability in Chronic Tennis Elbow

    PubMed Central

    Linnman, Clas; Catana, Ciprian; Svärdsudd, Kurt; Appel, Lieuwe; Engler, Henry; Långström, Bengt; Sörensen, Jens; Furmark, Tomas; Fredrikson, Mats; Borsook, David; Peterson, Magnus

    2016-01-01

    Substance P is released in painful and inflammatory conditions, affecting both peripheral processes and the central nervous system neurokinin 1 (NK1) receptor. There is a paucity of data on human brain alterations in NK1 expression, how this system may be affected by treatment, and interactions between central and peripheral tissue alterations. Ten subjects with chronic tennis elbow (lateral epicondylosis) were selected out of a larger (n = 120) randomized controlled trial evaluating graded exercise as a treatment for chronic tennis elbow (lateral epicondylosis). These ten subjects were examined by positron emission tomography (PET) with the NK1-specific radioligand 11C-GR205171 before, and eight patients were followed up after treatment with graded exercise. Brain binding in the ten patients before treatment, reflecting NK1-receptor availability (NK1-RA), was compared to that of 18 healthy subjects and, longitudinally, to the eight of the original ten patients that agreed to a second PET examination after treatment. Before treatment, patients had significantly lower NK1-RA in the insula, vmPFC, postcentral gyrus, anterior cingulate, caudate, putamen, amygdala and the midbrain but not the thalamus and cerebellum, with the largest difference in the insula contralateral to the injured elbow. No significant correlations between brain NK1-RA and pain, functional severity, or peripheral NK1-RA in the affected limb were observed. In the eight patients examined after treatment, pain ratings decreased in everyone, but there were no significant changes in NK1-RA. These findings indicate a role for the substance P (SP) / NK1 receptor system in musculoskeletal pain and tissue healing. As neither clinical parameters nor successful treatment response was reflected in brain NK1-RA after treatment, this may reflect the diverse function of the SP/NK1 system in CNS and peripheral tissue, or a change too small or slow to capture over the three-month treatment. PMID:27658244

  20. Measurement of fatigue in knee flexor and extensor muscles.

    PubMed

    Kawabata, Y; Senda, M; Oka, T; Yagata, Y; Takahara, Y; Nagashima, H; Inoue, H

    2000-04-01

    In order to examine fatigue of the knee flexor and extensor muscles and to investigate the characteristics of muscular fatigue in different sports, a Cybex machine was used to measure muscle fatigue and recovery during isokinetic knee flexion and extension. Eighteen baseball players, 12 soccer players and 13 marathon runners were studied. Each subject was tested in the sitting position and made to perform 50 consecutive right knee bends and stretches at maximum strength. This was done 3 times with an interval of 10 min between each series. The peak torque to body weight ratio and the fatigue rate were determined in each case. In all subjects, the peak torque to body weight ratio was higher for extensors than flexors. Over the 3 trials, the fatigue rate of extensors showed little change, while that of flexors had a tendency to increase. In each subject, knee extensors showed a high fatigue rate but a quick recovery, while knee flexors showed a low fatigue rate but a slow recovery. As the marathon runners had the smallest fatigue rates for both flexors and extensors, we concluded that marathon runners had more stamina than baseball players and soccer players.

  1. Quantification of regional blood flow to canine flexor tendons

    SciTech Connect

    Weidman, K.A.; Simonet, W.T.; Wood, M.B.; Cooney, W.P.; Ilstrup, D.M.

    1984-01-01

    Although the blood supply and the microcirculation of flexor tendons have been studied and defined extensively using qualitative methods, the quantitative assessment of blood flow has been lacking because of the limitations of the available experimental techniques. The authors studied the regional blood supply to the flexor tendons of dogs by the technique of radionuclide-labeled microspheres. Seven adult mongrel dogs were used. Microsphere injection and tissue-counting techniques previously used for other tissues were applied. Samples of proximal, isthmus, and distal portions of the profundus and superficialis flexor tendons were harvested from each digital unit of available limbs from each dog. Mean (+/- SE) flows (ml/100 g dry tissue/min) were proximal profundus 1.78 +/- 0.60 and superficialis 7.10 +/- 1.50. The differences were significant. The study suggests that regional variation in blood flow to canine digital flexor tendons exists, so that a single value for blood flow to these tendons is not relevant. Furthermore, the study supports the concept of dual (vascular and synovial) nutrition to the digital flexor tendons in dogs. These observations may have implications regarding tendon repair techniques.

  2. Clinical Outcomes After Posterior Open Elbow Arthrolysis for Posttraumatic Elbow Stiffness

    PubMed Central

    Birjandi Nejad, Ali; Ebrahimzadeh, Mohammad Hosein; Moradi, Ali

    2014-01-01

    Background: Loss of motion is a well-known complication after elbow trauma and in severe cases, arthrolysis of elbow is the procedure of choice. The posterior approach might have some advantages especially in post-traumatic patients who have undergone the same surgical approach in the past. Objectives: The aim of this study was to evaluate the short-term outcomes of elbow arthrolysis through posterior approach. Moreover, we assessed the effect of operation on the patients’ quality of life. Patients and Methods: During a retrospective-cohort study, the medical records of 14 patients (12 men, two women) whose range of movement had been limited post-traumatically and had undergone elbow arthrolysis with posterior approach were reviewed. Before intervention, the patients had a flexion less than 100 degrees or an extension lag of 30 degrees or more. For evaluation of the final outcomes, they were invited to participate in our study and the final range of motion, visual analogue score (VAS), disability of arm, shoulder and hand (DASH), Mayo elbow score (MES) and short form health survey (SF-36) scores were measured in the patients. Results: Mean age of the participants was 28.7 years. The interval from initial injury and arthrolysis was 16 months and the patients were followed for 14 months. The mean range of motion in patients before surgery was 35.8 degrees, which was increased to a mean of 108.9 after the surgery, indicating a 73.1 degrees improvement. The means of VAS, DASH, Mayo elbow and SF-36 scores in the patients were 1.6, 34, 68 and 43, respectively. A significant inverse correlation was found between the preoperative range of motion and final range of motion. Conclusions: According to our results, elbow arthrolysis through posterior approach could be an effective technique with low complications. Since the final range of motion improved significantly, it might be a valuable method in promoting the patients’ quality of life. PMID:25599069

  3. Phaeohyphomycosis infection leading to flexor tendon rupture: a case report.

    PubMed

    Chahal, Jaskarndip; Dhotar, Herman S; Anastakis, Dimitri J

    2009-09-01

    A rare previously unreported cause of flexor tendon rupture is described. A 66-year-old man presented with a fully extended left middle finger, accompanied by swelling and purulent drainage. Prior to presentation, he had received a steroid injection for left middle finger stenosing tenosynovitis and subsequently developed culture-proven phaeohyphomycosis fungal infection and secondary enterococcal bacterial infection, requiring pharmacotherapy and incision, drainage, and debridement for abscess formation. Clinical and magnetic resonance imaging findings were consistent with the diagnosis of closed flexor tendon rupture of the left middle finger. Antifungal and antibiotic therapy followed by two-stage flexor tendon reconstruction was performed. Six months postoperatively, full passive range of motion was achieved and the proximal interphalangeal and distal interphalangeal joints of the left middle finger actively flexed to 125 degrees and 90 degrees, respectively. PMID:19259746

  4. The Epidemiology of Reoperation After Flexor Pulley Reconstruction

    PubMed Central

    Dy, Christopher J.; Lyman, Stephen; Schreiber, Joseph J.; Do, Huong T.; Daluiski, Aaron

    2013-01-01

    Purpose We used a statewide database to determine the incidence of pulley reconstruction and to evaluate the influence of demographics on reoperation. We hypothesized that age, insurance status, and concomitant nerve or tendon procedure would influence the likelihood of reoperation. Methods We used the Statewide Planning and Research Cooperative System ambulatory surgery database from New York, which represents all outpatient surgery in the state. Patients who had flexor pulley reconstruction from 1998 to 2009 were identified using Current Procedural Terminology 4 codes. Subsequent surgery records for these patients were identified through 2010, allowing at least 1 year follow-up. Concomitant nerve procedure and flexor tendon repair/reconstruction were identified. The type and timing of subsequent procedures, including tenolysis and repeat pulley reconstruction, were recorded. Univariate statistics were calculated to compare age, sex, and payer type between patients with and without reoperation. A multivariable, logistic regression model was used to evaluate the association of the demographics with the chances of having reoperation. Results There were 623 patients who had flexor pulley reconstruction from 1998 to 2009. The incidence of pulley reconstruction was 0.27 per 100,000 persons, with an annual frequency of 52 procedures. There were 39 (6%) reoperations. There was no difference in age, concomitant nerve or tendon repair, or workers’ compensation between patients with and without reoperation. Regression modeling showed a higher likelihood among men of having reoperation. Conclusions Flexor pulley reconstructions are rare. One-quarter of surgeons performed only one flexor pulley reconstruction over a 12-year period. The 6% reoperation rate is similar to our previous findings for flexor tendon repair using similar methodology. Our report provides information that may be useful in counseling patients. Type of study/level of evidence Prognostic II. PMID

  5. Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction.

    PubMed

    Wei, David H; Terrono, Andrew L

    2015-10-01

    Swan neck deformity, or hyperextension of the proximal interphalangeal joint, may occur secondary to trauma, rheumatoid arthritis, cerebral palsy, or Ehlers-Danlos syndrome, and can be treated with tenodesis of one slip of the flexor digitorum sublimis tendon. This technique has several variations, differing primarily in the specific location and method that a single slip of the flexor digitorum sublimis tendon is secured, but they all serve to create a static volar restraint against hyperextension. Options include tunneling the tendon through the bone of the proximal phalanx, attaching the tendon to the A1 or A2 pulley, or securing the tendon with bone anchors in the proximal phalanx. PMID:26328902

  6. Biomechanics of the elbow during baseball pitching.

    PubMed

    Werner, S L; Fleisig, G S; Dillman, C J; Andrews, J R

    1993-06-01

    By understanding pitching biomechanics, therapists can develop better preventive and rehabilitative programs for pitchers. The purpose of this study was to quantify and explain the joint motions, loads, and muscle activity that occur at the elbow during baseball pitching. Seven healthy, adult pitchers were examined with synchronized high-speed video digitization and surface electromyography. Elbow extension before ball release corresponded with a decrease in biceps activity and an increase in triceps activity. A varus torque of 120 Nm, acting to resist valgus stress, occurred near the time of maximum shoulder external rotation. Previous cadaveric research showed that the ulnar collateral ligament by itself cannot withstand a valgus load of this magnitude. Triceps, wrist flexorpronator, and anconeus activity during peak valgus stress suggests that these muscles may act as dynamic stabilizers to assist the ulnar collateral ligament in preventing valgus extension overload. PMID:8343786

  7. A New Illusion at Your Elbow.

    PubMed

    Brugger, Peter; Meier, Rebekka

    2015-02-01

    On experiencing distal-proximal tactile motion on the volar side of the forearm starting at the wrist, subjects significantly anticipate touch of the elbow crook. This illusion, popular as a children's game, was quantified in ninety participants (forty-seven women) on both arms. As a top-down explanation of the illusion, we discuss a model of Bayesian inferences. As a bottom-up contribution, we consider afterdischarges of cortical neurons, which receive input from skin mechanoreceptors specifically driven by slow-motion tactile stimuli. Like previously described illusions, the elbow crook illusion is larger on the nondominant arm. Women showed a smaller illusion than men, giving testimony to their reportedly superior cutaneous sensitivity. PMID:26561974

  8. Rehabilitation of the elbow following sports injury.

    PubMed

    Ellenbecker, Todd S; Pieczynski, Tad E; Davies, George J

    2010-01-01

    Evaluation of the athlete with an elbow injury involves a complete upper extremity approach and a corresponding treatment approach that addresses the identified deficiencies to restore normal function. A significant focus should be placed on the proximal aspect of the upper extremity in addition to the obvious distal injury. A detailed review of the available treatment modalities fails to identify any clear definitive choice to address pain levels; however, a combination of modalities and appropriate exercise can be used in the early rehabilitation phases. The use of a total arm strengthening program along with evaluation of the athlete's sport mechanics is required to successfully return the patient back to their preinjury level of function. A supervised interval sport return program is also a necessary component of the complete rehabilitation program for the athlete with an elbow injury.

  9. Biomechanics of the elbow during baseball pitching.

    PubMed

    Werner, S L; Fleisig, G S; Dillman, C J; Andrews, J R

    1993-06-01

    By understanding pitching biomechanics, therapists can develop better preventive and rehabilitative programs for pitchers. The purpose of this study was to quantify and explain the joint motions, loads, and muscle activity that occur at the elbow during baseball pitching. Seven healthy, adult pitchers were examined with synchronized high-speed video digitization and surface electromyography. Elbow extension before ball release corresponded with a decrease in biceps activity and an increase in triceps activity. A varus torque of 120 Nm, acting to resist valgus stress, occurred near the time of maximum shoulder external rotation. Previous cadaveric research showed that the ulnar collateral ligament by itself cannot withstand a valgus load of this magnitude. Triceps, wrist flexorpronator, and anconeus activity during peak valgus stress suggests that these muscles may act as dynamic stabilizers to assist the ulnar collateral ligament in preventing valgus extension overload.

  10. Spastic Paralysis of the Elbow and Forearm.

    PubMed

    Gharbaoui, Idris; Kania, Katarzyna; Cole, Patrick

    2016-02-01

    As the physiologic recovery period concludes, the patient is evaluated for surgical procedures that may rebalance muscle function and correct deformity. Upper extremity function is the product of complex and highly sophisticated mechanisms working in unison, and a careful, systematic preoperative evaluation is critical. A good function of the hand cannot be achieved without adequate position of the shoulder, elbow, forearm, and wrist. The goals of surgery must be practical and clearly understood by the patient and the family. PMID:26869862

  11. Radiofrequency Microtenotomy for Elbow Epicondylitis: Midterm Results.

    PubMed

    Tasto, James P; Richmond, John M; Cummings, Jeffrey R; Hardesty, Renee; Amiel, David

    2016-01-01

    We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety and midterm effectiveness of microtenotomy using a radiofrequency probe to treat chronic tendinosis of the elbow. All patients had failed conservative treatment for 6 months. The radiofrequency-based microtenotomy was performed using the Topaz Microdebrider (ArthroCare). Patients were followed annually for up to 9 years postoperatively. Pain status was documented using a visual analog scale self-reported measure. Eighty consecutive patients with tendinosis of the elbow were enrolled; 69 patients were treated for lateral epicondylitis and 11 for medial epicondylitis. The duration of follow-up ranged from 6 months to 9 years (mean, 2.5 years). Ninety-one percent of the patients reported a successful outcome. Within the lateral epicondylitis group, the preoperative visual analog scale improved from 6.9 to 1.3 postoperatively and demonstrated an 81% improvement (P ≤ .01). For the medial epicondylitis patients, the preoperative visual analog scale improved from 6.1 to 1.3 after surgery, a 79% improvement (P ≤ .01). No complications were reported. Radiofrequency-based microtenotomy is a safe and effective procedure for elbow epicondylitis. The results are durable with successful outcomes observed at 9 years after surgery.

  12. Radiofrequency Microtenotomy for Elbow Epicondylitis: Midterm Results.

    PubMed

    Tasto, James P; Richmond, John M; Cummings, Jeffrey R; Hardesty, Renee; Amiel, David

    2016-01-01

    We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety and midterm effectiveness of microtenotomy using a radiofrequency probe to treat chronic tendinosis of the elbow. All patients had failed conservative treatment for 6 months. The radiofrequency-based microtenotomy was performed using the Topaz Microdebrider (ArthroCare). Patients were followed annually for up to 9 years postoperatively. Pain status was documented using a visual analog scale self-reported measure. Eighty consecutive patients with tendinosis of the elbow were enrolled; 69 patients were treated for lateral epicondylitis and 11 for medial epicondylitis. The duration of follow-up ranged from 6 months to 9 years (mean, 2.5 years). Ninety-one percent of the patients reported a successful outcome. Within the lateral epicondylitis group, the preoperative visual analog scale improved from 6.9 to 1.3 postoperatively and demonstrated an 81% improvement (P ≤ .01). For the medial epicondylitis patients, the preoperative visual analog scale improved from 6.1 to 1.3 after surgery, a 79% improvement (P ≤ .01). No complications were reported. Radiofrequency-based microtenotomy is a safe and effective procedure for elbow epicondylitis. The results are durable with successful outcomes observed at 9 years after surgery. PMID:26761915

  13. Biomechanical study of the pitching elbow.

    PubMed

    Hang, Y S; Lippert, F G; Spolek, G A; Frankel, V H; Harrington, R M

    1979-01-01

    Medial-tension injuries of the pitching elbow are well recognized. One contributing factor is the extreme valgus which has been noted to occur during the acceleration phase of throwing. It is hypothesized that breaking pitches generate higher medial loading because of the pronation and supination required to impart spin to the ball. The pitching motion is a complex action of all body segments to produce maximum linear and angular acceleration of the ball. The purpose of this study was to correlate elbow loading with pitching style. We measured the forearm segment for axial and tangential (varus-valgus plane) acceleration using accelerometers attached to the forearm and hand. Muscle activity was measured by EMG. Forearm rotation was assessed by stroboscopic photography. Despite different delivery styles when throwing breaking pitches, each pitcher demonstrated patterns of muscle activity and acceleration which were similar. Deceleration forces were lower than acceleration forces. Pronation and supination were documented and contribute to the direction of ball spin. Accelerometers can be used to evaluate pitching mechanics. We suggest that the main factors causing an elbow injury are the amount of throwing and the force with which the ball is thrown.

  14. Epidemiology of Nursemaid’s Elbow

    PubMed Central

    Vitello, Sarah; Dvorkin, Ronald; Sattler, Steven; Levy, David; Ung, Lyncean

    2014-01-01

    Introduction To provide an epidemiological description of radial head subluxation, also known as nursemaid’s elbow, from a database of emergency department visits. Methods We conducted a retrospective medical record review of patients 6 years of age and younger, who presented to the ED between January 1, 2005, and December 31, 2012, and were diagnosed with nursemaid’s elbow. Inclusion criteria consisted of chart information, including date, unique account number, medical record number, weight, age, sex, and arm affected. Exclusion criteria included any charts with missing or incomplete data. Results There were 1,228 charts that met inclusion criteria. The majority of patients were female (60%). The mean age was 28.6 months (±12.6). The left arm was affected 60% of the time. Most of the included patients were over the 75th percentile for weight and more than one quarter were over the 95th percentile in each gender. Conclusion The average age of children presenting with nursemaid’s elbow was 28.6 months. Females were affected more than males, and the left arm was predominately affected. Most patients were above the 75th percentile for weight and more than one quarter were over the 95th percentile for weight. PMID:25035767

  15. Elbow magnetic resonance imaging: imaging anatomy and evaluation.

    PubMed

    Hauptfleisch, Jennifer; English, Collette; Murphy, Darra

    2015-04-01

    The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI.Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, basic imaging parameters, compartmental pathology, and finally applications of some novel MRI techniques. PMID:25835585

  16. Arthroscopic debridement and irrigation of periprosthetic total elbow infection.

    PubMed

    Mastrokalos, Dimitrios S; Zahos, Konstantinos A; Korres, Dimitrios; Soucacos, Panayotis N

    2006-10-01

    We report on a case of arthroscopic treatment of septic arthritis of the elbow joint in a 65-year-old man with an elbow endoprosthesis. Two months after arthroplasty of the elbow joint, the patient developed acute septic arthritis of the right elbow. Methicillin-sensitive Staphylococcus aureus was identified as the causative organism. Six days after the onset of symptoms, the patient was treated with a single arthroscopic procedure of the infected periprosthetic joint, including irrigation with 5 L of Ringer's lactate solution, debridement, and partial synovectomy with a 4.5-mm curved shaver. Intravenous antibiotic therapy was also used for 3 months including rifampicine and fucidic acid according to the intraoperative cultures. The acutely infected total elbow arthroplasty could be cured without removal of the endoprosthesis of the elbow. Ten months postoperatively, the patient remains free of symptoms and his blood rates are within normal limits.

  17. Elbow magnetic resonance imaging: imaging anatomy and evaluation.

    PubMed

    Hauptfleisch, Jennifer; English, Collette; Murphy, Darra

    2015-04-01

    The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI.Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, basic imaging parameters, compartmental pathology, and finally applications of some novel MRI techniques.

  18. 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.

  19. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy.

    PubMed

    Batista, Jorge Pablo; Del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  20. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    PubMed Central

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  1. Single-Stage Flexor Tendon Grafting: Refining the Steps.

    PubMed

    Fletcher, Derek R; McClinton, Michael A

    2015-07-01

    Single-stage tendon grafting for reconstruction of zone I and II flexor tendon injuries is a challenging procedure in hand surgery. Careful patient selection, strict indications, and adherence to sound surgical principles are mandatory for return of digital motion. PMID:26026357

  2. Antibody elbow angles are influenced by their light chain class

    SciTech Connect

    Stanfield, R; Zemla, A; Wilson, I; Rupp, B

    2006-01-12

    We have examined the elbow angles for 365 different Fab fragments, and observe that Fabs with lambda light chains have adopted a wider range of elbow angles than their kappa-chain counterparts, and that the lambda light chain Fabs are frequently found with very large (>195{sup o}) elbow angles. This apparent hyperflexibility of lambda-chain Fabs may be due to an insertion in their switch region, which is one residue longer than in kappa chains, with glycine occurring most frequently at the insertion position. A new, web-based computer program that was used to calculate the Fab elbow angles is also described.

  3. An uncommon elbow injury in a baseball player.

    PubMed

    Mehallo, Christopher J

    2004-03-01

    A 21-year-old right-hand dominant minor league catcher injured his left elbow while running to first base after batting the ball. The first baseman, in his attempt to catch the throw to first, tripped the patient. The patient landed on his outstretched left hand, then tucked in his arm and landed on his left elbow. The patient denied any sensation of elbow dislocation and continued playing for a few more innings, until swelling and diminished range of motion affected his ability to catch. The patient iced his elbow immediately after he stopped playing.

  4. [Bilateral elbow dislocation related to Essex-Lopresti injury].

    PubMed

    Romero Pérez, B; Marcos García, A; Medina Henríquez, J A; Muratore Moreno, G

    2012-01-01

    Elbow dislocation is second in frequency, after the shoulder, whereas bilateral dislocation is uncommon, even less than dislocations with concurrent associated fractures. One of the least frequent associations is the Essex-Lopresti injury which consists of a fracture of the radial head affecting the distal radioulnar joint with injury to the interosseous membrane. This is a case of bilateral elbow dislocation, one of the elbows associated with the Essex-Lopresti injury. During treatment, the premature closed reduction prevails, previously making sure the elbow is stable, the premise which will determine the orthopedic or surgical treatment of the injury.

  5. Comparison Between Corrosion Behavior of Copper and Stainless Steel 90° Elbow and Failure Investigation of 90° Copper Elbow

    NASA Astrophysics Data System (ADS)

    Fouad, Mohamed Ahmed; Zewail, Taghreed Mohamed; Amine, Nieven Abbas; El-Tawail, Yehia Ahmed

    2016-06-01

    Frequently found in elbow, erosion failures may lead to the leakage of pipes and even damage the whole system. Erosion is a form of material degradation that involves electrochemical corrosion and mechanical wear processes encountered on the surface of metal pipes. Research on the erosion-corrosion mechanism indicates that the erosion mainly results from the interactions between the elbow surface and the fluid traveling along the surface. Corrosion behavior of 90° copper and stainless steel elbow was studied. Scanning electron microscopy was processed on the 90° copper elbow to show the surface morphology of the failed copper elbow. Failure investigation was carried out on 90° copper elbow to determine failure location and failure causes.

  6. Multimodality Imaging of the Painful Elbow: Current Imaging Concepts and Image-Guided Treatments for the Injured Thrower's Elbow.

    PubMed

    Gustas, Cristy N; Lee, Kenneth S

    2016-09-01

    Elbow pain in overhead sport athletes is not uncommon. Repetitive throwing can lead to chronic overuse and/or acute injury to tendons, ligaments, bones, or nerves about the elbow. A thorough history and physical examination of the thrower's elbow frequently establishes the diagnosis for pain. Imaging can provide additional information when the clinical picture is unclear or further information is necessary for risk stratification and treatment planning. This article focuses on current imaging concepts and image-guided treatments for injuries commonly affecting the adult throwing athlete's elbow. PMID:27545422

  7. Pediatric flexor tendon injuries: A 10-year outcome analysis

    PubMed Central

    Sikora, Sheena; Lai, Michelle; Arneja, Jugpal S

    2013-01-01

    BACKGROUND: Primary flexor tendon repair was first introduced in the 1960s. Since then, major advances in the understanding of flexor tendon anatomy and biology have led to improved outcomes following repair. Relative to the adult population, sparse knowledge exists as to which operative and postoperative treatments are most successful in children. This is due, in part, to the rarity of pediatric tendon lacerations compared with the adult population, but also related to challenges when working with smaller anatomy and the decreased compliance in children with respect to rehabilitation protocols. Published reports indicate that the incidence of ‘good’ flexor tendon repair outcomes is as low as 53%. OBJECTIVE: To determine the injury pattern and demographics of pediatric flexor tendon injuries involving zones I, II and III over the past decade, and to report results and identify treatment paradigms that are associated with optimal outcomes. METHODS: A retrospective chart review of all flexor tendon injuries involving zones I, II and III between April 2001 and December 2010 was performed. Parameters reviewed included demographics, injury mechanism, repair technique, outcomes and complications. RESULTS: A total of 47 patients with a median age of eight years experienced 100 tendon injuries. The most common cause of injury was glass (n=22), with the most common digit injured being the small finger (n=30). Tendon injuries included the following: flexor digitorum superficialis (n=46); flexor digitorum profundus (n=45), flexor pollicis longus (n=8); and adductor pollicis longus (n=1). Zone III had the highest number of injuries (n=47), followed by zone II (n=39). Ninety tendons were repaired using polyester suture, the most common size being 4-0. The modified Kessler technique was used in the majority of cases (n=62). Only 22 tendons underwent an epitendinous repair. Splint immobilization was used in 30 patients and a full cast in 17. The median duration of

  8. Lateral elbow tendinopathy: Evidence of physiotherapy management.

    PubMed

    Dimitrios, Stasinopoulos

    2016-08-18

    Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation. PMID:27622145

  9. Lateral elbow tendinopathy: Evidence of physiotherapy management

    PubMed Central

    Dimitrios, Stasinopoulos

    2016-01-01

    Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation. PMID:27622145

  10. Erosion resistant elbow for solids conveyance

    DOEpatents

    Everett, J.W.

    1984-10-23

    An elbow and process for fabrication for use in particulate material conveyancing comprises a curved outer pipe, a curved inner pipe having the same radius of curvature as the outer pipe, concentric with and internal to the outer pipe, comprising an outer layer comprised of a first material and an inner layer comprised of a second material wherein said first material is characterized by high erosion resistance when impinged by particulate material and wherein said second material is characterized by high tensile strength and flexibility, and an inner pipe supporting means for providing support to said inner pipe, disposed between said inner pipe and said outer pipe. 4 figs.

  11. Erosion resistant elbow for solids conveyance

    DOEpatents

    Everett, James W.

    1984-10-23

    An elbow and process for fabrication for use in particulate material conveyancing comprising a curved outer pipe, a curved inner pipe having the same radius of curvature as the outer pipe, concentric with and internal to the outer pipe, comprising an outer layer comprised of a first material and an inner layer comprised of a second material wherein said first material is characterized by high erosion resistance when impinged by particulate material and wherein said second material is characterized by high tensile strength and flexibility, and an inner pipe supporting means for providing support to said inner pipe, disposed between said inner pipe and said outer pipe.

  12. POST-TRAUMATIC STIFFNESS OF THE ELBOW

    PubMed Central

    Filh, Geraldo Motta; Galvão, Marcus Vinicius

    2015-01-01

    Elbow stiffness is a common problem after joint trauma, causing functional impairment of the upper limb. The severity of the dysfunction depends on the nature of the initial trauma and the treatment used. Appropriate clinical evaluation and complementary examinations are essential for therapeutic planning. Several surgical techniques are now available and the recommendation must be made in accordance with patient characteristics, degree of joint limitation and the surgeon's skill. Joint incongruence and degeneration have negative effects on the prognosis, but heterotrophic ossification alone has been correlated with a favorable surgical prognosis. PMID:27022563

  13. Lateral elbow tendinopathy: Evidence of physiotherapy management.

    PubMed

    Dimitrios, Stasinopoulos

    2016-08-18

    Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.

  14. Lateral elbow tendinopathy: Evidence of physiotherapy management

    PubMed Central

    Dimitrios, Stasinopoulos

    2016-01-01

    Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.

  15. Shoulder-elbow exoskeleton as rehabilitation exerciser

    NASA Astrophysics Data System (ADS)

    Ianoşi, A.; Dimitrova, A.; Noveanu, S.; Tătar, O. M.; Mândru, D. S.

    2016-08-01

    This paper presents a 2 degree of freedom exoskeleton designed for the rehabilitation of the shoulder and elbow movement in the sagittal plane; a semi-portable design strategy was chosen, which enables an easy attachment to a standard medical chair as well as the patient upper limb. A dedicated driver enables the control from a graphical user interface, which also provides the option of customized rehabilitation exercises. The potential of future improvements is assessed, and recommendations of research direction are made in order to broaden the usability of the proposed device.

  16. Elbow Injuries in the Young Throwing Athlete.

    PubMed

    Oshlag, Benjamin L; Ray, Tracy R

    2016-01-01

    Baseball pitchers and other throwing athletes place their elbows under tremendous stresses, making them vulnerable to a number of unique injuries. Skeletally immature throwers in particular are at a greater risk for growth plate and other bony injuries, due to the relative strengths of these tissues and the kinematics involved in throwing. Care should be taken to fully evaluate these injuries based on the particular history and presentation to properly direct treatment and rehabilitation. Patients, as well as other athletes, coaches, and families, also should be made aware of the significant risk factors for these injuries, especially those regarding pitch limits, proper mechanics, and sufficient rest.

  17. Elbow Injuries in the Young Throwing Athlete.

    PubMed

    Oshlag, Benjamin L; Ray, Tracy R

    2016-01-01

    Baseball pitchers and other throwing athletes place their elbows under tremendous stresses, making them vulnerable to a number of unique injuries. Skeletally immature throwers in particular are at a greater risk for growth plate and other bony injuries, due to the relative strengths of these tissues and the kinematics involved in throwing. Care should be taken to fully evaluate these injuries based on the particular history and presentation to properly direct treatment and rehabilitation. Patients, as well as other athletes, coaches, and families, also should be made aware of the significant risk factors for these injuries, especially those regarding pitch limits, proper mechanics, and sufficient rest. PMID:27618241

  18. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes.

    PubMed

    Azar, F M; Andrews, J R; Wilk, K E; Groh, D

    2000-01-01

    Over a 6-year period, the senior author (JRA) performed 91 ulnar collateral ligament reconstructions (N = 78) or repairs (N = 13). All patients were male and between the ages of 15 and 39 years (average, 21.6). Thirty-seven patients (41%) were professional baseball players, 41 (45%) were collegiate baseball players, and 7 (7.7%) were high school or recreational players. Subcutaneous ulnar nerve transposition with stabilization of the nerve with fascial slings of the flexor pronator mass was performed in all patients, and additional procedures were performed in 27 patients (29.7%), including 22 excisions of posteromedial olecranon osteophytes. Average follow-up was 35.4 months. Ten patients had preoperative ulnar nerve symptoms, nine of whom had complete resolution of symptoms after surgery. Complications occurred in eight patients. The average time from surgery to initiation of the interval throwing program was 3.4 months, and the average time to return to competitive throwing was 9.8 months. Sixty-seven patients (74%) were available for follow-up; of these, 53 (79%) had returned to their previous levels of competition or to a higher level. Reconstruction of the ulnar collateral ligament, with transposition and stabilization of the ulnar nerve and appropriate rehabilitation, was found to be effective in correcting medial instability of the elbow and allowed most athletes to return to previous levels of play in less than 1 year.

  19. Nerve injuries about the elbow in the athlete.

    PubMed

    Harris, Joshua D; Lintner, David M

    2014-09-01

    The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery.

  20. MR imaging of the elbow in baseball pitchers.

    PubMed

    Ouellette, Hugue; Bredella, Miriam; Labis, John; Palmer, William E; Torriani, Martin

    2008-02-01

    Baseball pitcher throwing biomechanics are important to understanding the pathophysiology and magnetic resonance (MR) imaging appearances of injuries in baseball pitchers. Baseball pitchers experience repetitive excessive valgus forces at the elbow. Typical injuries are secondary to medial joint distraction, lateral joint compression, and rotatory forces at the olecranon. MR imaging is useful for evaluation of the elbow in baseball pitchers.

  1. Nerve injuries about the elbow in the athlete.

    PubMed

    Harris, Joshua D; Lintner, David M

    2014-09-01

    The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery. PMID:25077754

  2. Locating the wrist of an elbow-type manipulator

    NASA Astrophysics Data System (ADS)

    Crochetiere, W. J.

    1984-06-01

    An elbow-type manipulator with a shoulder offset may assume a given wrist position in as many as four different configurations (shoulder right/left, elbow up/down). The inverse kinematic solution that defines each of these configurations for a PUMA 560 robot arm is derived trigonometrically. This solution is also compared to a previously reported solution.

  3. [Elbow problems associated with sports injuries in children].

    PubMed

    Demirhan, Mehmet; Güneşli, Taner

    2004-01-01

    Elbow problems associated with sports injuries may result from overuse, micro- or macrotraumas. Overuse injuries are frequent and are often closely related to mechanical characteristics of sports. Sports-related elbow injuries mainly occur in sports involving throwing such as baseball and javelin throwing, which require forced valgus and extension of the elbow, predisposing it to overuse injuries. Overuse injuries in child athletes are generally defined as Little League elbow, the most common of which are medial epicondyle apophysitis, osteochondritis dissecans of the capitellum, radial head deformation, flexion contractures, and injuries to the olecranon. Most of these injuries can be healed without or with minimal sequelae by early diagnosis and proper treatment. Therefore, mechanisms of, and risk factors for, elbow problems encountered in pediatric athletes should be well-understood in order to avoid the risks for a permanent deformity in the child's anatomy.

  4. Medial collateral ligament reconstruction in the baseball Pitcher's elbow.

    PubMed

    Erne, Holger C; Zouzias, Ioannis C; Rosenwasser, Melvin P

    2009-08-01

    Pitchers are prone to elbow injuries because of high and repetitive valgus stresses on the elbow. The anterior bundle of the medial ulnar collateral ligament (MCL) of the elbow is the primary restraint and is often attenuated with time, leading to functional incompetence and ultimate failure. Pitchers with a history of medial elbow pain, reduced velocity, and loss of command may have an MCL injury in evolution. Physical examination and imaging can confirm the diagnosis. Treatment begins with rest and activity modification. All medial elbow pain is not MCL injury. Surgery is considered only for talented athletes who wish to return to competitive play and may include elite scholastic and other collegiates and professionals. The technique for MCL reconstruction was first described in 1986. Many variations have been offered since then, which can result in predictable outcomes, allowing many to return to the same level of competitive play.

  5. 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.

  6. Restricted differentiation potential of progenitor cell populations obtained from the equine superficial digital flexor tendon (SDFT).

    PubMed

    Williamson, Kate Ann; Lee, Katie Joanna; Humphreys, William James Edward; Comerford, Eithne Josephine Veronica; Clegg, Peter David; Canty-Laird, Elizabeth Gail

    2015-06-01

    The aim of this study was to characterize stem and progenitor cell populations from the equine superficial digital flexor tendon, an energy-storing tendon with similarities to the human Achilles tendon, which is frequently injured. Using published methods for the isolation of tendon-derived stem/progenitor cells by low-density plating we found that isolated cells possessed clonogenicity but were unable to fully differentiate towards mesenchymal lineages using trilineage differentiation assays. In particular, adipogenic differentiation appeared to be restricted, as assessed by Oil Red O staining of stem/progenitor cells cultured in adipogenic medium. We then assessed whether differential adhesion to fibronectin substrates could be used to isolate a population of cells with broader differentiation potential. However we found little difference in the stem and tenogenic gene expression profile of these cells as compared to tenocytes, although the expression of thrombospondin-4 was significantly reduced in hypoxic conditions. Tendon-derived stem/progenitor cells isolated by differential adhesion to fibronectin had a similar differentiation potential to cells isolated by low density plating, and when grown in either normoxic or hypoxic conditions. In summary, we have found a restricted differentiation potential of cells isolated from the equine superficial digital flexor tendon despite evidence for stem/progenitor-like characteristics. PMID:25877997

  7. Restricted differentiation potential of progenitor cell populations obtained from the equine superficial digital flexor tendon (SDFT)

    PubMed Central

    Humphreys, William James Edward; Comerford, Eithne Josephine Veronica; Clegg, Peter David; Canty‐Laird, Elizabeth Gail

    2015-01-01

    ABSTRACT The aim of this study was to characterize stem and progenitor cell populations from the equine superficial digital flexor tendon, an energy‐storing tendon with similarities to the human Achilles tendon, which is frequently injured. Using published methods for the isolation of tendon‐derived stem/progenitor cells by low‐density plating we found that isolated cells possessed clonogenicity but were unable to fully differentiate towards mesenchymal lineages using trilineage differentiation assays. In particular, adipogenic differentiation appeared to be restricted, as assessed by Oil Red O staining of stem/progenitor cells cultured in adipogenic medium. We then assessed whether differential adhesion to fibronectin substrates could be used to isolate a population of cells with broader differentiation potential. However we found little difference in the stem and tenogenic gene expression profile of these cells as compared to tenocytes, although the expression of thrombospondin‐4 was significantly reduced in hypoxic conditions. Tendon‐derived stem/progenitor cells isolated by differential adhesion to fibronectin had a similar differentiation potential to cells isolated by low density plating, and when grown in either normoxic or hypoxic conditions. In summary, we have found a restricted differentiation potential of cells isolated from the equine superficial digital flexor tendon despite evidence for stem/progenitor‐like characteristics. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 33:849–858, 2015. PMID:25877997

  8. Gliding characteristics between flexor tendons and surrounding tissues in the carpal tunnel: a biomechanical cadaver study.

    PubMed

    Zhao, Chunfeng; Ettema, Anke M; Osamura, Naoki; Berglund, Lawrence J; An, Kai-Nan; Amadio, Peter C

    2007-02-01

    The purpose of this study was to investigate the gliding characteristics of flexor tendons within the carpal tunnel with varied wrist positions and tendon motion styles, which may help us to understand the relationship between carpal tunnel syndrome (CTS) and repetitive hand motion. Eight fresh human cadaveric wrists and hands were used. The peak (PGR) and mean (MGR) gliding resistance of the middle finger flexor digitorum superficialis tendon were measured with the wrist in 0, 30, and 60 degrees of flexion and extension. While moving all three fingers together, the PGR at 60 degrees flexion was significantly higher than that at 0, 30, or 60 degrees extension. While moving the middle finger alone, the PGR at 60 and 30 degrees flexion was significantly higher than the PGR at 60 degrees extension. The PGR moving the middle finger FDS alone was significantly greater than that for all three digits moving together in 0, 30, and 60 degrees flexion. Differential finger motion with wrist flexion elevated the tendon gliding resistance in the carpal tunnel, which may be relevant in considering the possible role of wrist position and activity in the etiology of CTS.

  9. Amplitude transitions of swimmers and flexors in viscoelastic fluids

    NASA Astrophysics Data System (ADS)

    Guy, Robert; Thomases, Becca

    2015-11-01

    In both theoretical and experimental studies of the effect of fluid elasticity on micro-organism swimming, very different behavior has been observed for small and large amplitude strokes. We present simulations of an undulatory swimmer in an Oldroyd-B fluid and show that the resulting viscoelastic stresses are a nonlinear function of the amplitude. Specifically, there appears to be an amplitude dependent transition that is key to obtaining a speed-up over the Newtonian swimming speed. To understand the physical mechanism of the transition, we examine the stresses in a time-symmetric oscillatory bending beam, or flexor. We compare the flow in a neighborhood of the flexor tips with a large-amplitude oscillatory extensional flow, and we see similar amplitude dependent transitions. We relate these transitions to observed speed-ups in viscoelastic swimmers.

  10. Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo.

    PubMed

    Thorfinn, J; Angelidis, I K; Gigliello, L; Pham, H M; Lindsey, D; Chang, J

    2012-02-01

    Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.

  11. Entrapment of the flexor hallucis longus tendon following ankle arthrodesis.

    PubMed

    Keith, Troy; Robinson, Andrew H N

    2016-03-01

    Impingement following arthroscopic ankle arthrodesis has not been reported in the literature previously. We present a case report of a 68-year-old male 9 months following an uncomplicated arthroscopic ankle fusion presenting with persistent posteromedial ankle pain. Flexor hallucis longus (FHL) tendon impingement resulting from a prominent os trigonum was identified. This was successfully treated utilising hindfoot endoscopy with excision of the os trigonum and FHL release.

  12. Partial Flexor Tendon Laceration Assessment: Interobserver and Intraobserver Reliability.

    PubMed

    Barker, B Justin; Kolovich, Gregory P; Klinefelter, Ryan D

    2016-01-01

    Accurate assessment of partial-thickness flexor tendon lacerations in the hand is difficult owing to the subjectivity of evaluation. In this study, we created 12 partial-thickness flexor tendon lacerations in a cadaveric hand, evaluated the accuracy of 6 orthopedic residents and 4 fellowship-trained hand surgeons in estimating the percentage thickness of each laceration, and assessed the groups' interobserver and intraobserver agreement. The 10 participants estimated each laceration independently and on 2 separate occasions and indicated whether they would repair it. The actual thickness of each laceration was calculated from measurements made with a pair of digital microcalipers. Overall estimates differed significantly from calibrated measurements. Estimates grouped by residents and fellowship-trained hand surgeons also differed significantly. Third-year residents were the most accurate residents, and fellowship-trained hand surgeons were more accurate than residents. Overall interobserver agreement was poor for both readings. There was moderate overall intraobserver agreement. Fellowship-trained hand surgeons and first-year residents had the highest intraobserver agreement. These results highlight the difficulty in accurately assessing flexor tendon lacerations. Accuracy appears not to improve with surgeon experience. PMID:26991579

  13. Absence of the flexor digitorum longus tendon: an MRI study.

    PubMed

    Magra, Merzesh; Taqvi, Syed; Cooper, Robert; Blundell, Chris M; Davies, Mark B

    2012-11-01

    Flexor digitorum longus (FDL) is the primary flexor of the lateral four toes. It is a reliable source of tendon for transfer surgery. We present a case whereby a patient who required a reconstruction for adult acquired flatfoot deformity using FDL as a dynamic structure for transfer was found to have an absent FDL tendon at the time of operation, necessitating the use of flexor hallucis longus (FHL) instead. This unusual finding prompted us to investigate the frequency of absence of the FDL tendon. We reviewed our hospital MRI database of foot and ankle images specifically looking for patients with absence of this tendon. After randomization, 756 images were reviewed independently by two surgeons and a consultant musculoskeletal radiologist. No instances of an absent FDL tendon were identified. In conclusion, the frequency of absence of the FDL tendon is less than 1 in 750. Surgeons who require FDL for tendon transfer surgery need not image the foot preoperatively to anticipate the need for the use of FHL as an alternative. PMID:22334461

  14. A biomechanical study of pediatric flexor profundus tendon repair

    PubMed Central

    Al-Thunayan, Turki A.; Al-Zahrani, Mohammed T.; Hakeem, Ahmad A.; Al-Zahrani, Fahad M.; Al-Qattan, Mohammad M.

    2016-01-01

    Objectives: To investigate the tensile strength of repaired flexor profundus tendons in young lambs, which would be equivalent to repairs in children older than 2 years of age. Methods: A comparative in-vitro experimental study conducted at King Saud University, Riyadh, Kingdom of Saudi Arabia from October 2014 to December 2015. We utilized 30 flexor profundus tendons of young lambs with a width of 4 mm. All tendons were repaired with a 4-strand repair technique using 4/0 polypropylene core sutures. In group I (n=10 tendons), 2 separate figure-of-eight sutures were applied. In group II (n=10 tendons), simple locking sutures were added to the corners of 2 separate figure-of-eight sutures. In group III (n=10 tendons), the locked cruciate repair was used. All tendon repairs were tested to single-cycle tensile failure. Results: There was no significant difference between groups II and III with regards to gap and breaking forces; and all forces of these 2 groups were significantly higher than the forces in group I. Conclusion: It was concluded that 4 mm-wide pediatric flexor tendons allow a 4-strand repair and the use of 4/0 sutures. The use of locking sutures increases the tensile strength to values that may allow protective mobilization in children. PMID:27570850

  15. Effect of pulley excision on flexor tendon biomechanics.

    PubMed

    Peterson, W W; Manske, P R; Bollinger, B A; Lesker, P A; McCarthy, J A

    1986-01-01

    Flexor tendon function following excision of various portions of the fibro-osseous pulley system was measured biomechanically using a tensile testing machine. The biomechanical parameters measured were tendon excursion (the excursion of the tendon required to fully flex the digit) and work of flexion (the area under the force-excursion curve, representing all the forces that resist tendon flexion). In this experiment, work of flexion included the forces necessary to accomplish full digital flexion against a 15-g counter-weight, as well as the frictional forces that resist tendon gliding. The results indicate that the work of flexion was affected to a greater degree by pulley loss than was tendon excursion, suggesting that it is a more sensitive measurement of tendon function. A2 was found to be the single most important pulley for flexor tendon function, followed by A4. However, both A2 and A4 had to be present if near-normal hand function was to be achieved; sacrificing the A1 pulley was not associated with a significant loss of flexion. The "pulley effect" of the skin and soft tissue as a supplement to the fibro-osseous pulleys in reducing tendon bow-stringing was also noted. Although the parameters of tendon excursion and work of flexion were used in this study to determine the effect of pulley loss on tendon function, they can also be used to evaluate other flexor tendon studies, such as pulley reconstruction.

  16. Toe Flexor Strength, Flexibility and Function and Flexor Hallucis Longus Tendon Morphology in Dancers and Non-Dancers.

    PubMed

    Rowley, K Michael; Jarvis, Danielle N; Kurihara, Toshiyuki; Chang, Yu-Jen; Fietzer, Abbigail L; Kulig, Kornelia

    2015-09-01

    Tendinopathy of the flexor hallucis longus (FHL), colloquially referred to as "dancer's tendinitis," is a common condition in dancers and attributed to high demand on this muscle in positions of extreme ankle plantarflexion and metatarsophalangeal (MTP)) flexion and extension. Despite such a high prevalence, there has been little research into preventative or nonsurgical interventions. As a means to identify potential targets for prevention and intervention, this study aimed to characterize toe flexors in dancers by measuring strength, flexibility, function, and FHL tendon morphology. Dancers (n=25) were compared to non-dancers (n=25) in toe flexor isometric strength, first MTP joint range of motion, foot longitudinal arch flexibility, balance ability, endurance during modified heel raises without use of the toes, and FHL tendon thickness, cross-sectional area, and peak spatial frequency. Significant differences were found in functional first MTP joint extension (dancers 101.95°, non-dancers 91.15°, p<0.001), balance ability during single-leg stance on the toes (dancers 11.43 s, non-dancers 5.90 s, p=0.013), and during modified heel raises (dancers 22.20 reps, non-dancers 28.80 reps, p=0.001). Findings indicate that dancers rely on toe flexors more than non-dancers to complete balance and heel raise tasks. Efficacy of using this modified heel raise task with the toes off the edge of a block as a means to train larger plantarflexors and as a nonsurgical intervention should be studied in the future. Improving interventions for FHL tendinopathy will be impactful for dancers, in whom this condition is highly prevalent.

  17. Regional Variation Is Present in Elbow Capsules after Injury

    PubMed Central

    Germscheid, Niccole M.; Hildebrand, Kevin A.

    2010-01-01

    Myofibroblast numbers and α-smooth muscle actin expression are increased in anterior joint capsules of patients with posttraumatic elbow contractures. The purpose of our study was to determine whether these changes occur regionally or throughout the entire joint capsule. We hypothesized that the α-smooth muscle actin mRNA expression and the myofibroblast numbers in posterior joint capsules would be elevated in elbows obtained from patients with posttraumatic joint contractures compared with joint capsules obtained from organ donor elbows without contractures. Semiquantitative reverse transcription-polymerase chain reaction was used to evaluate relative mRNA levels of α-smooth muscle actin. Glyceraldehyde-3-phosphate dehydrogenase was used to normalize the levels. Immunohistochemical analysis was used to determine the myofibroblast cell numbers. Higher α-smooth muscle actin mRNA levels were observed in elbows of patients with contractures compared with organ donor elbows without contractures. Immunohistochemical studies determined that myofibroblast numbers and the percentage of total cells that were myofibroblasts were elevated (2–2.5-fold) in the joint capsules from patients with posttraumatic joint contractures compared with similar tissue obtained from organ donor elbows without contractures. These results suggest elevated myofibroblast numbers occur throughout the whole joint capsule in posttraumatic elbow contractures, although there is some regional variation. PMID:17001766

  18. Complications of Open Elbow Arthrolysis in Post-Traumatic Elbow Stiffness: A Systematic Review

    PubMed Central

    Yan, Hede; Sun, Yangbai; Chen, Wei; Chen, Shuai; Fan, Cunyi

    2015-01-01

    Objective The objective of this study was to systematically review the literature for a more comprehensive understanding of the complications of open elbow arthrolysis in patients with post-traumatic elbow stiffness and provide a reference for better prevention and treatment of them. Methods The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for therapeutic studies with a set of inclusion and exclusion criteria. Data were extracted from selected articles, and a statistical analysis was performed to evaluate related factors and management of the complications. Results Twenty-eight articles published between 1989 and 2013, involving 810 patients, were included. Most of the complications included in the selected articles were nerve complications, heterotopic ossification, elbow instability, infection, pin-related complications and repeat elbow contracture. The total complication rate was 24.3% ± 3.0%, and the reoperation rate was 34.0%. Furthermore, the statistical analysis revealed that preoperative range of motion (β = -0.004, P = 0.01) and proportion of female (β = 0.336, P = 0.04) were the independent factors affecting the total complication rate. Conclusions Various risk factors are related to each of the complications, and we found that patients with less preoperative ROM and a higher proportion of female gender may point to a higher total complication rate. Therefore, to further improve the overall outcomes of this procedure, more and larger prospective studies should be performed to further elucidate the effects of prophylactic interventions targeting the risk factors, thus improving the methods of prevention and treatment of complications. PMID:26383106

  19. Reduction of erosion in elbows due to flow modifications: Final report, Phase 1. [Elbows

    SciTech Connect

    Johnson, E.K.; Means, K.H.; Eyler, R.L.; Holtzworth, J.D.

    1987-11-01

    The objective of this project is to investigate the concept of flow-field modification as a method for reducing erosion in bends (elbows) used in pneumatic transport systems. Flow field modifications were primarily accomplished by injecting air at selected locations within the bends. Part I of this project shows the feasibility of the concept. Part II of this project will include further experiments and analysis, leading to a design methodology for incorporating this concept into piping systems. This report represents the final report for Part I of this project. This report contains a survey of the literature dealing with the erosion in bends (elbows) and the fundamental subjects of erosion and two-phase, gas-solids, flow. Based on this literature survey, a pneumatic transport test loop was constructed. Several bend designs were tested, using sand, under a variety of operating conditions. The results of this exploratory effort indicate that modifying the flow field in a bend with jets may: (1) decrease erosion; (2) change the erosion pattern with the same amount of erosion; or (3) significantly increase the erosion process. Data indicate that the erosion rate may be reduced by low-velocity jets for high phase-density flow. Apparently the interaction of jets with dilute phase-density flow tends to accelerate the erosion process. It is recommended that the project be continued in order to more fully understand the process and its capabilities to solve the difficult technical problem of erosion in bends (elbows).

  20. Observations on an evaporative, elbow thermosyphon

    SciTech Connect

    Lock, G.S.H.; Fu, J. )

    1993-05-01

    The performance of the evaporative elbow system was found to be superior to that of the nonevaporative system, but comparable to the performance of the linear system. The parametric role of the evaporator wall temperature, the condenser wall temperature, and the vapor saturation temperature was demonstrated, each revealing a similar monotonic effect. With the evaporator upright, the data were found to be similar to, but displaced from, the upright condenser data. The upright evaporator gave the better performance, but not overwhelmingly so. The limit of performance with the condenser upright was found to be dictated by evaporator dryout. In the upright evaporator configuration, the limit may be attributed to flooding in the poorly draining condenser; this limit was indistinguishable from geyser behavior at low vapor pressures. 16 refs., 3 figs.

  1. Early reduction in toe flexor strength is associated with physical activity in elderly men

    PubMed Central

    Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Yokochi, Takashi

    2016-01-01

    [Purpose] To compare the toe flexor, hand grip and knee extensor strengths of young and elderly men, and to examine the association between toe flexor strength and physical activity or inactivity levels. [Subjects and Methods] Young (n=155, 18–23 years) and elderly (n=60, 65–88 years) men participated in this study. Toe flexor, hand grip, and knee extensor strength were measured. Physical activity (time spent standing/walking per day) and inactivity (time spent sitting per day) were assessed using a self-administered questionnaire. [Results] Toe flexor, hand grip, and knee extensor strength of the elderly men were significantly lower than those of the young men. Standing/walking and sitting times of the elderly men were lower than those of the young men. Toe flexor strength correlated with hand grip and knee extensor strength in both groups. In elderly men, toe flexor strength correlated with standing/walking time. In comparison to the young men’s mean values, toe flexor strength was significantly lower than knee extensor and hand grip strength in the elderly group. [Conclusion] The results suggest that age-related reduction in toe flexor strength is greater than those of hand grip and knee extensor strengths. An early loss of toe flexor strength is likely associated with reduced physical activity in elderly men. PMID:27313353

  2. Delayed diagnosis of brain tumor in a patient with flexor spasms and spastic foot drop

    PubMed Central

    Paliwal, V. K.; Malhotra, H. S.; Sharma, R.; Shukla, Rakesh

    2008-01-01

    Flexor spasms are involuntary muscle contractions comprising dorsiflexion at the ankle and flexion at the knee and the hip, occurring as a result of nociceptive spinal release reflex. The presence of flexor spasms generally suggests a lesion in the spinal cord. Foot drop is usually seen with lesions of lumbosacral roots, peripheral nerves or muscles. We hereby present a patient with a rare combination of spastic foot drop and flexor spasms due to a brain tumor. The possible underlying pathophysiological mechanisms resulting in flexor spasms due to a cerebral lesion are briefly discussed. PMID:19893685

  3. Early reduction in toe flexor strength is associated with physical activity in elderly men.

    PubMed

    Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Yokochi, Takashi

    2016-05-01

    [Purpose] To compare the toe flexor, hand grip and knee extensor strengths of young and elderly men, and to examine the association between toe flexor strength and physical activity or inactivity levels. [Subjects and Methods] Young (n=155, 18-23 years) and elderly (n=60, 65-88 years) men participated in this study. Toe flexor, hand grip, and knee extensor strength were measured. Physical activity (time spent standing/walking per day) and inactivity (time spent sitting per day) were assessed using a self-administered questionnaire. [Results] Toe flexor, hand grip, and knee extensor strength of the elderly men were significantly lower than those of the young men. Standing/walking and sitting times of the elderly men were lower than those of the young men. Toe flexor strength correlated with hand grip and knee extensor strength in both groups. In elderly men, toe flexor strength correlated with standing/walking time. In comparison to the young men's mean values, toe flexor strength was significantly lower than knee extensor and hand grip strength in the elderly group. [Conclusion] The results suggest that age-related reduction in toe flexor strength is greater than those of hand grip and knee extensor strengths. An early loss of toe flexor strength is likely associated with reduced physical activity in elderly men. PMID:27313353

  4. [Total Elbow Replacement - Implantation of the Latitude Prosthesis (Tornier)].

    PubMed

    Hackl, M; Wegmann, K; Leschinger, T; Ries, C; Burkhart, K J; Müller, L

    2015-10-01

    Due to technical progress, the indication for total elbow arthroplasty could be expanded in recent years. As a result, the demand regarding functionality and mobility of the replaced joint has risen as well. Elbow arthroplasty has to be considered as technically demanding. Only with detailed knowledge of this surgical procedure and its possible intraoperative pitfalls can one provide the best possible results. In this instructional video we explain the implantation of the Latitude elbow prosthesis (Tornier) putting emphasis on the correct approach as well as implantation of the prosthesis and subsequent wound closure.

  5. Lateral compartment cartilage changes and lateral elbow pain.

    PubMed

    Rajeev, Aysha; Pooley, Joseph

    2009-02-01

    The aim of our study is to document the arthroscopic findings in resistant lateral elbow pain. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with lateral elbow pain resistant to conservative treatment. We found established degenerative changes involving articular cartilage in 68 patients (59%). In 60 of these 68 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with a normal appearance of the articular cartilage of the medial compartment. Primary lateral compartment arthritis is more common than previously thought, it mostly affects a young population and could easily be misdiagnosed as lateral epicondylitis.

  6. Human flexor tendon tissue engineering: revitalization of biostatic allograft scaffolds.

    PubMed

    Woon, Colin Y L; Farnebo, Simon; Schmitt, Taliah; Kraus, Armin; Megerle, Kai; Pham, Hung; Yan, Xinrui; Gambhir, Sanjiv S; Chang, James

    2012-12-01

    Cadaveric tendon allografts form a readily available and underutilized source of graft material. Because of their material properties, allografts are biomechanically and biologically superior to synthetic scaffolds. However, before clinical use, allografts must undergo decellularization to reduce immunogenicity and oxidation to increase porosity, leaving a nonvital biostatic scaffold. Ex vivo seeding, or revitalization, is thought to hasten graft incorporation and stimulate intrinsic tendon healing, permitting early mobilization and return to function. In this study, we examined physical and biochemical augmentation methods, including scaffold surface scoring (physical) and rehydration of lyophilized scaffolds in serum (biochemical). Scaffolds were divided into four groups: (1) scored scaffolds, (2) lyophilized scaffolds rehydrated in fetal calf serum (FCS), (3) scaffolds both scored and rehydrated in FCS, and (4) control scaffolds. Scaffolds were reseeded with adipose-derived stem cells (ADSCs). Reseeding efficacy was quantified by a live cell and total cell assays and qualified histologically with hematoxylin and eosin, live/dead and SYTO green nucleic acid stains, TUNEL apoptosis stains, procollagen stains, and transmission electron microscopy. Scaffold-seeded cell viability at up to 2 weeks in vitro and up to 4 weeks in vivo was demonstrated with bioluminescent imaging of scaffolds seeded with luciferase-positive ADSCs. The effect of seeding on scaffold biomechanical properties was demonstrated with evaluation of ultimate tensile stress (UTS) and an elastic modulus (EM). We found that scaffold surface scoring led to an increase in live and total cell attachment and penetration (MTS assay, p<0.001 and DNA assay, p=0.003, respectively). Histology confirmed greater total cell number in both construct core and surface in scored compared with unscored constructs. Cells reseeded on scored constructs displayed reduced apoptosis, persistent procollagen production, and had a similar ultrastructural relationship to the surrounding matrix as native tenocytes on transmission electron microscopy. Rehydration of lyophilized scaffolds in serum did not improve reseeding. Seeded constructs demonstrated greater UTS and EM than unseeded constructs. Scaffolds seeded with ADSC-luc2-eGFP demonstrated persistent viability for at least 2 weeks in vitro. In conclusion, tendon surface scoring increases surface and core reseeding in vitro and may be incorporated as a final step in allograft processing before clinical implantation.

  7. Elbow functional compensation using a lightweight magnetorheological clutch.

    PubMed

    Clemente, Alejandro Martín; Caballero, Antonio Flores; Rojas, Dolores Blanco; Copaci, Dorin-Sabin; Lorente, Luis Moreno

    2011-01-01

    There are many applications for which a patient needs functional compensation due to motor disorders in daily activities. Classic research has focused on robotics solutions in terms of actuators or motors, but the point of this paper is to analyze new solutions combining both biological and artificial structures, in order to improve standard developments. Nowadays wearable Robots are taking an important role in rehabilitation purposes, due to this issue lots of new designs are emerging, but most of them are not still prepared to be used in terms of autonomy, weight, etc. Under the Hybrid Neuroprosthetic and Neurorobotic devices for Functional Compensation and Rehabilitation (HYPER) project, new actuator technologies have been developed in order to improve the adaptability and portability of rehabilitation devices. The designed device is based on a lightweight magnetorheological (MR) clutch which is able to transmit torque from a motor to the injured joint. Though it is intended to work in human upper limb (elbow mainly), other future designs will also be studied for other human joints. Simulation results using Simulink®, MSC Adams®and MSMS®are reported to illustrate the viability of the proposed device. PMID:22255513

  8. Paediatric biepicondylar elbow fracture dislocation - a case report.

    PubMed

    Meta, Mahendrakumar; Miller, David

    2010-01-01

    Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments. PMID:20950437

  9. Elbow injuries: getting kids back in the game.

    PubMed

    Southard, Jennifer A; Benson, Eric C

    2011-10-01

    Elbow injuries are increasingly common in children and young adults who participate in team sports nearly year-round. This review--and the tables that accompany it--can help you help them safely return to play.

  10. Prevention of elbow injuries in youth baseball pitchers.

    PubMed

    Fleisig, Glenn S; Weber, Adam; Hassell, Nina; Andrews, James R

    2009-01-01

    There is concern among sports medicine practitioners that the number of youth baseball pitchers with elbow injuries appears to be increasing. Research points to overuse as the principle risk factor. The risk of elbow pain in youth pitchers is correlated with the number of pitches thrown in a game and in a season. Adolescents who competitively pitch more than 85 pitches per game, more than 8 months out of a year, or with arm fatigue are several times more likely to require elbow surgery. Poor pitching mechanics also appear to contribute to injury risk. Existing research does not show a significant correlation between curveballs and injury. Adults should help youth pitchers avoid fatigue, overuse, and improper mechanics. If elbow pain develops, the youth pitcher should be evaluated by a sports medicine physician.

  11. Evaluation of the medial elbow in the throwing athlete.

    PubMed

    Creighton, R Alexander; Bach, Bernard R; Bush-Joseph, Charles A

    2006-06-01

    The valgus forces generated by throwing athletes can cause injuries and permanently damage the medial elbow structures. Clinicians must have a clear understanding of the ulnar collateral ligament complex and the associated medial elbow structures at risk in these athletes. Taking a detailed history, conducting a physical examination, and obtaining imaging studies will aid in making the correct diagnosis and giving these injuries the appropriate treatment. Pain around the medial elbow is of concern to throwing athletes, coaches, and medical staff. Valgus forces generated by the throwing motion add considerable stress to the medial elbow structures and thus potentially cause injury. Baseball players, particularly pitchers, are most often affected, but athletes participating in sports such as football, volleyball, water polo, tennis, and javelin throwing can also be affected.

  12. Flexor Tendon Sheath Ganglions: Results of Surgical Excision

    PubMed Central

    Spencer, Edwin E.

    2007-01-01

    The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient’s medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath. PMID:18780066

  13. 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

  14. 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

  15. Glomus tumour of the elbow: an unusual complication of surgery

    PubMed Central

    Stanton, Jeremy; Arya, Anand

    2016-01-01

    Glomus tumours of the elbow remain a challenge to diagnose correctly and efficiently. We present a case of a glomus tumour as a complication of elbow surgery. This has not been described previously. This case highlights the possibility of injury as a causative factor in these tumours and the difficulty in differentiating them from postoperative neuromas by clinical presentation and ultrasound imaging alone. PMID:27583019

  16. Pediatric Elbow and Wrist Pathology Related to Sports Participation.

    PubMed

    Ellington, Matthew D; Edmonds, Eric W

    2016-10-01

    Pediatric overuse injuries are becoming more prevalent in today's society with more children competitively playing year-round sports at a younger age. The importance of prompt diagnosis and treatment is paramount to the treatment for these injuries, second only to rest and activity modification. This article will focus on overuse injuries of the upper extremity, specifically: little league elbow, elbow osteochondritis dissecans, and gymnast wrist. It will also discuss the pathophysiology, diagnosis, imaging, and treatment of each of these entities. PMID:27637661

  17. Inner Synovial Membrane Footprint of the Anterior Elbow Capsule: An Arthroscopic Boundary

    PubMed Central

    Kamineni, Srinath; Bachoura, Abdo; Sasaki, Koichi; Reilly, Danielle; Harris, Kate N.; Sinai, Anthony; Deane, Andrew

    2015-01-01

    Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release. PMID:26380112

  18. Current Concepts in Examination and Treatment of Elbow Tendon Injury

    PubMed Central

    Ellenbecker, Todd S.; Nirschl, Robert; Renstrom, Per

    2013-01-01

    Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to optimally design treatment programs for rehabilitation and prevention. Evidence Acquisitions: The PubMed database was searched in January 2012 for English-language articles pertaining to elbow tendon injury. Results: Detailed information on tendon pathophysiology was found along with incidence of elbow injury in overhead athletes. Several evidence-based reviews were identified, providing a thorough review of the recommended rehabilitation for elbow tendon injury. Conclusions: Humeral epicondylitis is an extra-articular tendon injury that is common in athletes subjected to repetitive upper extremity loading. Research is limited on the identification of treatment modalities that can reduce pain and restore function to the elbow. Eccentric exercise has been studied in several investigations and, when coupled with a complete upper extremity strengthening program, can produce positive results in patients with elbow tendon injury. Further research is needed in high-level study to delineate optimal treatment methods. PMID:24427389

  19. 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.

  20. ARTHROSCOPIC TREATMENT OF POST-TRAUMATIC ELBOW STIFFNESS

    PubMed Central

    Júnior, Jose Carlos Garcia; Zabeu, Jose Luis Amim; Junior, Ivaldo Angelo Cintra; Mattos, Carlos Augusto; Myrrha, Jesely Pereira

    2015-01-01

    To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. Methods: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months afterwards and were rated using the Mayo elbow performance score (MEPS). Results: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3° and of MEPS, 85.4. Conclusion: Arthroscopic release might enable better intra-articular viewing and enhance the options for changing strategy during surgery, reducing surgical trauma and enabling early rehabilitation. This technique can reach similar or better results than open surgery. The disadvantages of arthroscopy are the long learning curve and higher cost of the procedure. Neurovascular complications are reported with both techniques. To avoid such problems, the protocol for portal construction must be rigorously followed. Arthroscopic release was shown to be a safe and effective option for achieving range-of-motion gains in cases of post-traumatic stiff elbow. PMID:27042641

  1. New, specific ultrasonographic findings for the diagnosis of pulled elbow

    PubMed Central

    Lee, Yu Sung; Sohn, You Dong; Oh, Young Teak

    2014-01-01

    Objective Among infants and preschool children with complaint of upper extremity immobility, pulled elbow, also known as nursemaid’s elbow or radial head subluxation is the most common cause presenting to pediatric emergency departments. However, proper tools to diagnose pulled elbow remain limited. We conducted a study to determine the feasibility of ultrasonography in diagnosing pulled elbow. Methods Infants and preschool children presenting to an urban emergency department with the complaint of upper extremity immobility between April and July 2013 were enrolled. The following ultrasonographic information was recorded: (1) whether there was a change in the shape of the supinator muscle, (2) whether there was an annular ligament in place, and (3) whether there was an enlargement of the synovial fringe. We used the affected arms’ ultrasonographic images as the study group and opposite arms’ ultrasonographic images as the control group. Results When we diagnosed pulled elbow using ultrasonographic findings (i.e., the annular ligament was not in place), we found the following results: sensitivity, 64.9% (95% CI, 47.5% to 79.8%); specificity, 100.0% (95% CI, 90.5% to 100.0%); positive predictive value, 100.0% (95% CI, 85.8% to 100.0%); and negative predictive, 74.0% (95% CI, 59.7% to 85.4%). Conclusion A pulled elbow can easily be confirmed by ultrasonography when the annular ligament is displaced.

  2. Chondroma within the flexor hallucis longus tendon sheath. A case report and literature review.

    PubMed

    Brahms, M A; Fumich, R M

    1978-01-01

    Chondromas in tendon sheaths are a rare entity proviously reported in the flexor sheaths on the hand and possibly the foot. This is the first reported case of condroma of the flexor hallucis longus tendon sheath at the ankle region. A literature review with regard to pathogenesis, classification, and recurrence has been presented.

  3. An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad

    PubMed Central

    Hamada, Daisuke; Matsuura, Tetsuya; Sugiura, Kosuke; Higuchi, Tadahiro; Suzue, Naoto; Goto, Tomohiro; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a “catching” sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. PMID:26613057

  4. Factors affecting the ultrasonic properties of equine digital flexor tendons.

    PubMed

    Miles, C A; Fursey, G A; Birch, H L; Young, R D

    1996-01-01

    The velocity, attenuation and apparent backscattering coefficient of 6-11-MHz ultrasound were measured in three orthogonal directions in equine deep digital flexor (DDF) and superficial digital flexor (SDF) tendons at 0 degree C. Ultrasonic measurements were examined for correlation with tendon water, collagen, DNA and glycosaminoglycans contents, determined by chemical analyses and with structure observed by scanning electron microscopy. The SDF tendon contained more water, more DNA (i.e., more cells), less collagen and less glycosaminoglycans and exhibited lower velocities and attenuations than the DDF tendon. Velocities were governed primarily by the adiabatic bulk modulus and density, perturbed by a highly direction-dependent rigidity. Ultrasound propagating across tendon generated frequency-independent backscattering which appeared to derive from the large interfaces between the fascicles, while along the fibres backscattering varied as f3.62 +/- 0.88 and appeared to derive from small structures such as collagen fibres. The mechanisms by which ultrasound is attenuated by tendon remain unknown.

  5. Subcutaneous rupture of the flexor hallucis longus tendon: a case report.

    PubMed

    Noda, Daisuke; Yoshimura, Ichiro; Kanazawa, Kazuki; Hagio, Tomonobu; Naito, Masatoshi

    2012-01-01

    It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head. PMID:22153296

  6. Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

    PubMed Central

    Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun

    2016-01-01

    [Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball. PMID:27630405

  7. Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump.

    PubMed

    Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun

    2016-08-01

    [Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball. PMID:27630405

  8. Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

    PubMed Central

    Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun

    2016-01-01

    [Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball.

  9. Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump.

    PubMed

    Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun

    2016-08-01

    [Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball.

  10. Influence of Combinations of Shoulder, Elbow and Trunk Orientation on Elbow Joint Loads in Youth Baseball Pitchers

    PubMed Central

    Tanaka, Hiroshi; Hayashi, Toyohiko; Inui, Hiroaki; Ninomiya, Hiroki; Muto, Tomoyuki; Nobuhara, Katsuya

    2016-01-01

    Objectives: Shoulder and elbow pain in youth baseball pitchers is a well-recognized phenomenon. Common problems in pitching mechanics that can lead to injury begin with stride foot contact. The purpose of this study was to address the relationships between the combinations of shoulder, elbow and trunk orientation at the instant of stride foot contact and elbow joint loads in youth baseball pitchers. Methods: A total of 143 Japanese male youth baseball pitchers participated in this study after providing written informed consents approved by the hospital’s institutional review board. The procedures to be performed were also explained to their parent(s) or legal guardian(s). Each participant was not currently injured or recovering from an injury at time of testing. For data collection of baseball pitching, a set of 14-mm spherical reflective markers was placed on the skin overlying 34 anatomical landmarks determined. Subsequently, a motion capture three-dimensional automatic digitizing system was used to collect 500-Hz from 7 charge-coupled-device synchronized cameras was set up around the regulation pitching mound in an indoor laboratory. After performing a preparation routine of stretching and warm-up pitching, each player pitch to 5 fastball pitches off the pitching mound to a catcher at the regulation distance of 16 m for youth pitchers. The best pitch thrown for a strike was chosen for kinematic and kinetic analysis. The local coordinate systems were used to calculate 3-dimesional rotation at the trunk, shoulder and elbow using the typical Eulerian sequence. Afterward, the standard inverse dynamic equation was used to estimate resultant joint forces and torques at throwing shoulder and elbow. In order to normalize data between subjects, forces and torques were expressed as percent using body weight and height. A multiple regression analysis was carried out to assess the combined effects of shoulder (external rotation, abduction and horizontal adduction), elbow

  11. Muscle fibre types of the lumbrical, interossei, flexor, and extensor muscles moving the index finger.

    PubMed

    Hwang, Kun; Huan, Fan; Kim, Dae Joong

    2013-09-01

    The aim of this study was to determine the fibre types of the muscles moving the index fingers in humans. Fifteen forearms of eight adult cadavers were used. The sampled muscles were the first lumbrical (LM), first volar interosseous (VI), first dorsal interosseus (DI), second flexor digitorum profundus (FDP), second flexor digitorum superficialis (FDS), and extensor digitorum (ED). Six micrometer thick sections were stained for fast muscle fibres. The procedure was performed by applying mouse monoclonal anti-skeletal myosin antibody (fast) and avidin-biotin peroxidase complex staining. Rectangular areas (0.38 mm × 0.38 mm) were photographed and the boundaries of the muscle areas were marked on the translucent film. The numbers and sizes of the muscle fibres in each part were evaluated by the image analyser program and calculated per unit area (1 mm(2)). The proportion of the fast fibres was significantly (p = 0.012) greater in the intrinsic muscles (55.7 ± 17.1%) than in the extrinsic muscles (45.9 ± 17.1%). Among the six muscles, the VI had a significantly higher portion (59.3%) of fast fibres than the FDS (40.6%) (p = 0.005) or the FDP (45.1%) (p = 0.023). The density of the non-fast fibres was significantly (p = 0.015) greater in the extrinsic muscles (539.2 ± 336.8/mm(2)) than in the intrinsic muscles (383.4 ± 230.4/mm2). Since the non-fast fibres represent less fatigable fibres, it is thought that the extrinsic muscles have higher durability against fatigue, and the intrinsic muscles, including the LM, should move faster than the FDS or FDP because the MP joint should be flexed before the IP joint to grip an object.

  12. Muscle fibre types of the lumbrical, interossei, flexor, and extensor muscles moving the index finger.

    PubMed

    Hwang, Kun; Huan, Fan; Kim, Dae Joong

    2013-09-01

    The aim of this study was to determine the fibre types of the muscles moving the index fingers in humans. Fifteen forearms of eight adult cadavers were used. The sampled muscles were the first lumbrical (LM), first volar interosseous (VI), first dorsal interosseus (DI), second flexor digitorum profundus (FDP), second flexor digitorum superficialis (FDS), and extensor digitorum (ED). Six micrometer thick sections were stained for fast muscle fibres. The procedure was performed by applying mouse monoclonal anti-skeletal myosin antibody (fast) and avidin-biotin peroxidase complex staining. Rectangular areas (0.38 mm × 0.38 mm) were photographed and the boundaries of the muscle areas were marked on the translucent film. The numbers and sizes of the muscle fibres in each part were evaluated by the image analyser program and calculated per unit area (1 mm(2)). The proportion of the fast fibres was significantly (p = 0.012) greater in the intrinsic muscles (55.7 ± 17.1%) than in the extrinsic muscles (45.9 ± 17.1%). Among the six muscles, the VI had a significantly higher portion (59.3%) of fast fibres than the FDS (40.6%) (p = 0.005) or the FDP (45.1%) (p = 0.023). The density of the non-fast fibres was significantly (p = 0.015) greater in the extrinsic muscles (539.2 ± 336.8/mm(2)) than in the intrinsic muscles (383.4 ± 230.4/mm2). Since the non-fast fibres represent less fatigable fibres, it is thought that the extrinsic muscles have higher durability against fatigue, and the intrinsic muscles, including the LM, should move faster than the FDS or FDP because the MP joint should be flexed before the IP joint to grip an object. PMID:23692210

  13. Impact of Ulnar Collateral Ligament Tear on Posteromedial Elbow Biomechanics.

    PubMed

    Anand, Prashanth; Parks, Brent G; Hassan, Sheref E; Osbahr, Daryl C

    2015-07-01

    Ulnar collateral ligament insufficiency has been shown to result in changes in contact pressure and contact area in the posteromedial elbow. This study used new digital technology to assess the effect of a complete ulnar collateral ligament tear on ulnohumeral contact area, contact pressure, and valgus laxity throughout the throwing motion. Nine elbow cadaveric specimens were tested at 90° and 30° of elbow flexion to simulate the late cocking/early acceleration and deceleration phases of throwing, respectively. A digital sensor was placed in the posteromedial elbow. Each specimen was tested with valgus torque of 2.5 Nm with the anterior band of the ulnar collateral ligament intact and transected. A camera-based motion analysis system was used to measure valgus inclination of the forearm with the applied torque. At 90° of elbow flexion, mean contact area decreased significantly (107.9 mm(2) intact vs 84.9 mm(2) transected, P=.05) and average maximum contact pressure increased significantly (457.6 kPa intact vs 548.6 kPa transected, P<.001). At 30° of elbow flexion, mean contact area decreased significantly (83.9 mm(2) intact vs 65.8 mm(2) transected, P=.01) and average maximum contact pressure increased nonsignificantly (365.9 kPa intact vs 450.7 kPa transected, P=.08). Valgus laxity increased significantly at elbow flexion of 90° (1.1° intact vs 3.3° transected, P=.01) and 30° (1.0° intact vs 1.7° transected, P=.05). Ulnar collateral ligament insufficiency was associated with significant changes in contact area, contact pressure, and valgus laxity during both relative flexion (late cocking/early acceleration phase) and relative extension (deceleration phase) moments during the throwing motion arc.

  14. Resistance exercise prevents plantar flexor deconditioning during bed rest

    NASA Technical Reports Server (NTRS)

    Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.

    1997-01-01

    Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional

  15. The biomechanics of tennis elbow. An integrated approach.

    PubMed

    Roetert, E P; Brody, H; Dillman, C J; Groppel, J L; Schultheis, J M

    1995-01-01

    Tennis elbow afflicts 40% to 50% of the average, recreational tennis players; most of these players more than 30 years of age. Tennis elbow is thought to be the result of microtrauma, the overuse and inflammation at the origin of the ECRB as a result of repeated large impact forces created when the ball hits the racket in the backhand stroke. Several authors have found that EMG activity in the ECRB, the muscle and tendon complex afflicted in tennis elbow, is high during the acceleration and early follow-through phases of the groundstrokes and during the cocking phase of the serve. Unfortunately, none of the authors gave evidence to support the claim that muscle activity in the ECRB at ball contact is high. In the one-handed backhand, the torques at impact (17-24 nm) will be absorbed by the tendons of the elbow. Giangarra and his colleagues observed that the two-handed backhand "allows the forces at ball impact to be transmitted through the elbow rather than absorbed by the tissues at the elbow." Other authors have reported that players using a two-handed backhand will rarely develop lateral epicondylitis, because the helping arm appears to absorb more energy and changes the mechanics of the swing. As seen by Morris and colleagues, Giangarra and associates, and Leach and colleagues, players who utilize the two-handed backhand have a very low incidence of tennis elbow. These three studies conclude that the two-handed backhand stroke is probably the most effective backhand stroke to prevent lateral tennis elbow. Studies show that wrist extensors are highly involved in all strokes (serve, forehand, and both one- and two-handed backhand strokes). This relatively high involvement (40%-70% MVC) throughout play may result in overload of this muscular group. Thus, tennis elbow may be caused simply by continued use of this muscular system in all strokes, and not just because of the high forces absorbed at impact. Another theory concerning impact states that if the extensor

  16. Computational Fluid Dynamic simulations of pipe elbow flow.

    SciTech Connect

    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 mesh 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

  17. A SIMULATION ANALYSIS OF THE COMBINED EFFECTS OF MUSCLE STRENGTH AND SURGICAL TENSIONING ON LATERAL PINCH FORCE FOLLOWING BRACHIORADIALIS TO FLEXOR POLLICIS LONGUS TRANSFER

    PubMed Central

    Mogk, Jeremy P.M.; Johanson, M. Elise; Hentz, Vincent R.; Saul, Katherine R.; Murray, Wendy M.

    2010-01-01

    Biomechanical simulations of tendon transfers performed following tetraplegia suggest that surgical tensioning influences clinical outcomes. However, previous studies have focused on the biomechanical properties of only the transferred muscle. We developed simulations of the tetraplegic upper limb following transfer of the brachioradialis (BR) to the flexor pollicis longus (FPL) to examine the influence of residual upper limb strength on predictions of post-operative transferred muscle function. Our simulations included the transfer, ECRB, ECRL, the three heads of the triceps, brachialis, and both heads of the biceps. Simulations were integrated with experimental data, including EMG and joint posture data collected from five individuals with tetraplegia and BR-FPL tendon transfers during maximal lateral pinch force exertions. Given a measured co-activation pattern for the non-paralyzed muscles in the tetraplegic upper limb, we computed the highest activation for the transferred BR for which neither the elbow nor the wrist flexor moment was larger than the respective joint extensor moment. In this context, the effects of surgical tensioning were evaluated by comparing the resulting pinch force produced at different muscle strength levels, including patient-specific scaling. Our simulations suggest that extensor muscle weakness in the tetraplegic limb limits the potential to augment total pinch force through surgical tensioning. Incorporating patient-specific muscle volume, EMG activity, joint posture, and strength measurements generated simulation results that were comparable to experimental results. Our study suggests that scaling models to the population of interest facilitates accurate simulation of post-operative outcomes, and carries utility for guiding and developing rehabilitation training protocols. PMID:21092963

  18. Open Versus Arthroscopic Tennis Elbow Release

    PubMed Central

    Leiter, Jeff; Clark, Tod; McRae, Sheila; Dubberley, James; MacDonald, Peter B.

    2016-01-01

    Objectives: The primary objective of this study was to determine if quality of life and function are different following arthroscopic versus open tennis elbow release surgery. Based on retrospective studies, both approaches have been found to be beneficial, but no prospective randomized comparison has been conducted to date. Methods: Following a minimum six-months of conservative treatment, seventy-one patients (>16 yrs old) were randomized intraoperatively to undergo either arthroscopic or open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength. Study assessments took place pre-, and 6-week, 3-, 6-, and 12-months post-surgery. Comparisons between groups and within groups over time were conducted using repeated measures ANOVA. A minimal clinically significant difference for the DASH had been previously identified as 15 points, and was used to compare groups as well at 12-months post-operative (Beaton et al. 2001). Results: Fifteen women and 19 men underwent the open procedure with a mean age of 47.1 years (6.7) and 13 women and 21 men were in the arthroscopic group with a mean age of 45.0 (6.9). No pre-surgery differences were found between groups based on age, sex, DASH or VAS scores. Both groups demonstrated a significant improvement in subjective measures and grip strength by 12-months post-surgery, and no significant differences were found between groups at any time point. The DASH, our primary outcome, decreased from a mean (SD) of 47.5 (14.5) pre-surgery to 21.9 (21.8) at 12-months post-surgery in the Open group and from 52.7 (16.0) to 22.6 (21.1) in the Arthroscopic group. VAS-pain scores (%) decreased in the Open group from 62.5 (17.2) pre-operatively to 30.0 (26.5) at 12-months. In the arthroscopic group, scores decreased from 63.7 (15.9) to 26.2 (24.6). Grip strength (kg) increased on the affected side from 23.6 (14.9) to 29.3 (16.3) and 21.4 (15.4) to

  19. Bony injuries about the elbow in the throwing athlete.

    PubMed

    Andrews, J R

    1985-01-01

    Tremendous valgus stress during the acceleration phase of pitching is the primary cause of elbow injury in the pitcher. Lateral compression injuries are usually found in pitchers in their early teens, and osteochondritis dissecans is the primary underlying cause. Severe flexion contractures and even partial ankylosis of the elbow may occur. Prognosis after surgery is generally poor. Medial tension injuries with either soft-tissue damage or bony damage usually require surgery. The medial collateral ligament should be considered the primary stabilizer against the valgus-vector overload. The medial collateral ligament or bony avulsion form the medial compartment of the elbow should be primarily corrected. Results of early surgical correction to these lesions should produce excellent results. Pitchers with extension block injuries are generally older, more experienced athletes than those without such injuries. These pitchers have had symptoms for some time with progressive loss of full extension of the elbow and increasing pain. Valgus extension overload can be surgically corrected by an open surgical approach or an operative arthroscopic approach. Basically these approaches are palliative, and progression of symptoms at a later date may be expected. Finally, the postoperative rehabilitation of any elbow problem is extremely important and should be preplanned for the specific lesion treated.

  20. On the phenomenology of the perforating vein of the elbow.

    PubMed

    Lomonte, Carlo; Basile, Carlo

    2009-01-01

    The perforating veins, as the name suggests, are the veins that perforate the muscular aponeuroses ensuring communication between the superficial and the deep veins. Located at the bend of the elbow, almost constantly, there is a vein, named perforating vein of the elbow, which is of great interest to the nephrologist who is responsible for the management of vascular access for hemodialysis (HD). It represents, in fact, because of its intrinsic characteristics and topographical reasons, a valuable resource for the creation of a vascular access for HD, especially in obese patients, elderly patients, diabetics, and patients affected by peripheral vasculopathy. Arterio-venous fistulae (AVF) constructed with the perforating vein of the elbow are relatively easy to perform, have an excellent patency rate, a low incidence of early thrombosis, adequate flows, and a low incidence of the steal syndrome. In other types of AVFs, the perforating vein of the elbow subtracts flow to the superficial veins slowing or preventing their full maturation, and can become a problem in measuring the blood flow of the AVF. But still, its presence can maintain patent a fistula in case of poor compliance of the superficial veins, while awaiting for interventional procedures able to accelerate a subsequent maturation. This review intends to explore the role that the perforating vein of the elbow plays in the physiology and pathology of the AVF, in relation to the issues that most frequently occur in clinical practice. PMID:19573011

  1. Bone marrow injection: A novel treatment for tennis elbow

    PubMed Central

    Singh, Ajit; Gangwar, Devendra Singh; Singh, Shekhar

    2014-01-01

    Objective: The objective of this prospective study was assessment of efficacy of bone marrow aspirate (BMA) (containing plasma rich in growth factors and mesenchymal stem cells) injection in treatment of tennis elbow. Materials and Methods: A total of 30 adult patients of previously untreated tennis elbow were administered single injection of BMA. This concentrate was made by centrifugation of iliac BMA at 2000 rpm for 20-30 min and only upper layer containing platelet rich plasma and mononuclear cells was injected. Assessment was performed at baseline, 2 weeks, 6 weeks and 12 weeks using Patient-rated Tennis Elbow Evaluation (PRTEE) score. Results: Baseline pre-injection mean PRTEE score was 72.8 ± 6.97 which decreased to a mean PRTEE score of 40.93 ± 5.94 after 2 weeks of injection which was highly significant (P < 0.0001). The mean PRTEE score at 6 week and 12 week follow-up was 24.46 ± 4.58 and 14.86 ± 3.48 respectively showing a highly significant decrease from baseline scores (P < 0.0001). Conclusion: Treatment of tennis elbow patients with single injection of BMA showed a significant improvement in short to medium term follow-up. In future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken. PMID:25097421

  2. Movement stability analysis of surface electromyography-based elbow power assistance.

    PubMed

    Kwon, Suncheol; Kim, Yunjoo; Kim, Jung

    2014-04-01

    The use of power assistive devices that use surface electromyography (SEMG) signals may be limited by the noisy nature of SEMG signals. The aim of this study was to investigate the variation in human movement stability while the amount of SEMG-based assistive power was changed. A robotic device provided a torque that was proportional to the torque estimated by SEMG for assisting human movements, and 12 volunteers participated in the elbow flexion experiments. The maximum finite-time Lyapunov exponent (MFTLE), the average logarithmic rate of the divergence of neighboring trajectories, and the variability of the kinematic data were used to quantify the stability of the assisted elbow movements. The stability provided by the MFTLE decreased as the amount of assistive torque increased with respect to the amount of human torque. The kinematic variability increased with the increase in assistive torque. Therefore, by ensuring that the amount of SEMG-based assistive torque is less than the amount of human torque, the assistance may provide relatively natural movements. This study is the first to quantify movement stability as SEMG-based assistive power is applied. This study can provide a foundation for determining the appropriate amount of SEMG-based assistive power.

  3. A histological study of macroscopically normal equine digital flexor tendons.

    PubMed

    Webbon, P M

    1978-10-01

    The normal appearance of the superficial (SFT) and deep (DFT) digital flexor tendons was described and the difference between their histological structures was emphasised. Further differences were recognised between different sites from the same tendon and between tendons in the fore and hind limbs of the same animal. Both of the tendons underwent changes with age but although a number of alterations in the histological appearance were described, a particular change, involving a patchy loss of stainable nuclei, was found at the common site of SFT injuries. While this appearance has been seen in injured tendons and described as tendon necrosis, the author warns that no cause and effect relationship has been established between the acellularity and the clinical lesions. Neither is it certain that the loss of tendon cells results in mechanical weakness of the tendon.

  4. Determining flexor-tendon repair techniques via soft computing

    NASA Technical Reports Server (NTRS)

    Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.

    2001-01-01

    An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

  5. Assessing Finger Joint Biomechanics by Applying Equal Force to Flexor Tendons In Vitro Using a Novel Simultaneous Approach

    PubMed Central

    Yang, Tai-Hua; Lu, Szu-Ching; Lin, Wei-Jr; Zhao, Kristin; Zhao, Chunfeng; An, Kai-Nan; Jou, I-Ming; Lee, Pei-Yuan

    2016-01-01

    Background The flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) are critical for finger flexion. Although research has recently focused on these tendons’ coactivity, their contributions in different tasks remain unclear. This study created a novel simultaneous approach to investigate the coactivity between the tendons and to clarify their contributions in different tasks. Methods Ten human cadaveric hands were mounted on our custom frame with the FDS and FDP of the third finger looped through a mechanical pulley connected to a force transducer. Joint range of motion, tendon excursion and loading force were recorded during individual joint motion and free joint movement from rest to maximal flexion. Each flexor tendon’s moment arm was then calculated. Results In individual motions, we found that the FDP contributed more than the FDS in proximal interphalangeal (PIP) joint motion, with an overall slope of 1.34 and all FDP-to-FDS excursion (P/S) ratios greater than 1.0 with force increase. However, the FDP contributed less than the FDS in metacarpophalangeal (MCP) joint motion, with an overall slope of 0.95 and P/S ratios smaller than 1.0 throughout the whole motion except between 1.9% and 13.1% force. In free joint movement, the FDP played a greater role than the FDS, with an overall ratio of 1.37 and all P/S ratios greater than 1.0. Conclusions The new findings include differences in finger performance and excursion amounts between the FDS and FDP throughout flexion. Such findings may provide the basis for new hand models and treatments. PMID:27513744

  6. The Effect of Suture Preloading on the Force to Failure and Gap Formation After Flexor Tendon Repair

    PubMed Central

    Vanhees, Matthias; Thoreson, Andrew R.; Larson, Dirk R.; Amadio, Peter C.; An, Kai-Nan; Zhao, Chunfeng

    2014-01-01

    Purpose Gap formation is a common and severe complication after flexor tendon repair that can affect the outcome and prolong tendon healing. The purpose of this study was to investigate the effect that a pretensional force applied to the suture during tendon repair has on the repair strength and force that causes gap formation. Methods We used a total of 48 flexor digitorum profundus tendons from 12 human cadaver hands. We employed a core tendon suture, using the modified Pennington technique, and a running suture for flexor tendon repair. Before tying the knots of the core suture, we preloaded the sutures in each tendon end 0, 5, 10, or 15 N for 10 seconds to compare the effect of loading magnitude on repaired tendon peak force to failure and force causing gap formation. Results The force to form a gap of 2 mm in the 15-N preload group was significantly increased compared with the 0-N and 5-N preload groups. At the 3-mm gap formation, the force of all preload groups was significantly higher than the nonpreload group. The peak force with a preload of 10 N and 15 N was significantly higher than 0-N preload. Conclusions These findings suggest that pretensioning with 10 to 15 N at the suture–tendon interface before tying the knot has a beneficial effect on both the tendon gap formation and the peak force to failure. Clinical relevance When the surgeons perform tendon repair, pretensioning at the suture–tendon conjunction will increase the repair strength. PMID:23261189

  7. Temporal response of canine flexor tendon to limb suspension

    PubMed Central

    Thoreson, Andrew R.; Cha, Stephen S.; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C.

    2010-01-01

    Tendon disuse, or stress deprivation, frequently accompanies clinical disorders and treatments, yet the metabolism of tendons subject to stress deprivation has rarely been investigated systematically. The effects of stress deprivation on canine flexor tendon were investigated in this study. One adult canine forepaw was suspended for 21 or 42 days. Control forepaws were collected from dogs that had no intervention on their limbs and paws. The expression of collagen I and III was not significantly altered in the tendons disused for 21 days but was significantly decreased at 42 days (P < 0.03). The expression of collagen II, aggrecan, decorin, and fibronectin was significantly decreased in the tendons in the suspended limbs at 21 days (P < 0.002) and further reduced at 42 days. With stress deprivation, the expression of matrix metalloproteinase 2 (MMP2) was significantly increased (P < 0.004) at 21 and 42 days. The expression of MMP3 was significantly decreased at 21 and 42 days (P < 0.03). The expression of MMP13 was not altered with stress deprivation at 21 and 42 days. The expression of MMP14 was significantly increased at 21 days (P = 0.0015) and returned to the control level at 42 days. Tissue inhibitor of metalloproteinase 1 (TIMP1) expression was decreased after the limbs were suspended for 42 days (P = 0.0043), but not 21 days. However, TIMP2 expression was not significantly different from control at 21 or 42 days. Furthermore, the cross-sectional area of the stress-deprived tendons at 42 days was decreased compared with the control group (P < 0.01). The intervention method in this study did not result in any alteration of stiffness of the tendon. Our study demonstrated that stress deprivation decreases the anabolic process and increases the catabolic process of extracellular matrix in flexor tendon. PMID:20947711

  8. 78 FR 68907 - Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... AFFAIRS Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire... Forearm Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER INFORMATION... Control No. 2900-NEW (Elbow and Forearm Conditions Disability Benefits Questionnaire)''....

  9. 78 FR 36308 - Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... AFFAIRS Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire... Disability Benefits Questionnaire)'' in any correspondence. During the comment period, comments may be viewed.... SUPPLEMENTARY INFORMATION: Title: Elbow and Forearm Conditions Disability Benefits Questionnaire, VA Form...

  10. Romantic Resonances in the Rhetoric of Peter Elbow's "Writing Without Teachers."

    ERIC Educational Resources Information Center

    Yager, Kristi

    1996-01-01

    Seeks to uncover the historical roots within English Romanticism of Peter Elbow's thinking in order to show the depth and complexity of his assumptions about writing. Implicitly refutes charges questioning the intellectual credibility of Elbow's work. (TB)

  11. Common medial elbow injuries in the adolescent athlete.

    PubMed

    Leahy, Ian; Schorpion, Melissa; Ganley, Theodore

    2015-01-01

    Recently there has been increased year-round sports participation among children and adolescents with limited to no rest periods. This has led to increases in pediatric repetitive stress injuries, once considered a rarity. Whether in the throwing athlete or in the athlete that experiences repetitive axial loading; increased medial tension and overload syndromes can lead to stress reactions and fractures. This occurs in the developing athlete due to the bone being weaker than the surrounding tendons and ligaments. The medial elbow is a high stress area and is susceptible to many conditions including apophysitis , avulsion fractures and ulnar collateral ligament disruption. Valgus stress can cause injury to the medial elbow which can lead to increased lateral compression, Panner's disease and osteochondral lesions of the capitellum and olecranon. The purpose of this manuscript is to review common elbow disorders in the adolescent population, outline management and highlight important features of rehabilitation. PMID:25840494

  12. [Radiographical changes in the elbow joints of chainsaw operators].

    PubMed

    Une, H; Kondo, S; Goto, M

    1985-05-01

    The purpose of this study is to clarify the relation between the labor history of chainsaw operators and changes in their elbow joints. Osteophytic and degenerative changes on X-ray films of the elbow joints were compared quantitatively between chainsaw operators and a control group of age-matched road maintenance workers. Subjects were divided into three groups according to length of chainsaw use. Although no statistically significant differences were found among the three groups, radiographical examination showed significant changes (p less than 0.05) in the subjects as compared with the controls. Because of other labor factors that were not considered, the existence of a dose-response relationship between elbow damage and length of chainsaw use cannot be confirmed from this study, but such a relationship is suggested.

  13. Chiropractic management of elbow tendinopathy following a sports related trauma

    PubMed Central

    Gliedt, Jordan A.; Daniels, Clinton J.

    2014-01-01

    Objective: This report describes chiropractic management of a case of sub-acute elbow pain and swelling with Active Release Technique® and acupuncture. Case presentation: A 41-year-old male presented to a chiropractic clinic with a primary complaint of elbow pain and swelling following a fall while playing basketball five weeks prior. Intervention and Outcome: Treatment consisted of two sessions of needle acupuncture and one treatment of Active Release Techniques® (ART) applied to the left elbow region. Conclusions: The patient’s outcomes indicated a quick resolution of subjective complaints and objective findings with the chosen treatment. Further research is needed to demonstrate safety, clinical effectiveness, and cost effectiveness when compared to other treatments. PMID:24587497

  14. End effects on elbows subjected to moment loadings. [PWR; BWR

    SciTech Connect

    Rodabaugh, E.C.; Moore, S.E.

    1982-01-01

    So-called end effects for moment loadings on short-radius and long-radius butt welding elbows of various arc lengths are investigated with a view toward providing more accurate design formulas for critical piping systems. Data developed in this study, along with published information, were used to develop relatively simple design equations for elbows attached at both ends to long sections of straight pipe. These formulas are the basis for an alternate ASME Code procedure for evaluating the bending moment stresses in Class 1 nuclear piping (ASME Code Case N-319). The more complicated problems of elbows with other end conditions, e.g., flanges at one or both ends, are also considered. Comparisons of recently published experimental and theoretical studies with current industrial code design rules for these situations indicate that these rules also need to be improved.

  15. Flexor carpi radialis tendinitis caused by malunited trapezial ridge fracture in a professional baseball player.

    PubMed

    Soejima, Osamu; Iida, Hiroyuki; Naito, Masatoshi

    2002-01-01

    Flexor carpi radialis tendinitis is an uncommon cause of pain experienced over the flexor aspect of the wrist. It may be a primary condition caused by overuse syndrome, or it may be a secondary condition associated with osteoarthritis of the carpometacarpal joint of the thumb, osteoarthritis of the scaphotrapezial joint, scaphoid fracture, or scaphoid cyst. We present a case report of flexor carpi radialis tendinitis caused by a malunited trapezial ridge fracture, in a professional baseball player who was treated successfully by excision of the malunited trapezial ridge fragment.

  16. [Flexor hallucis longus tendon rupture as an impingement lesion induced by os trigonum instability].

    PubMed

    Lohrer, H

    2006-03-01

    A Flexor hallucis longus tendon lesion induced by an unstable Os trigonum has not been described heretofore. A 39 years old karateka complained increasing load induced pain at the posteromedial ankle. Because of this, he was unable to take part in sports activities. Clinical, X-ray and MRI investigation assumed a Flexor hallucis longus tendon tear induced by an impingeing Os trigonum. At surgery a longitudinal and a partial transverse tendon tear was present. The Flexor hallucis longus tendon pulley was narrowed by a partially unstable Os trigonum. Tendon reconstruction, Os trigonum removal and early functional posttreatment resulted in full ability in sport, leisure-time activities and profession five months later.

  17. Determination of equine deep digital flexor muscle volume based on distances between anatomical landmarks.

    PubMed

    Hardeman, L C; van der Meij, B R; Lamers, A A H; van der Kolk, J H; Back, W; Wijnberg, I D

    2014-10-01

    In equine medicine the use of Botox® is experimental. Dosages are determined from human treatment-protocols and limited numbers of equine studies. Determination of target-muscle volume can be helpful to extrapolate human dosages. The aim of the study was to calculate a formula enabling the estimation of the deep digital flexor muscle (DDFM) volume based on distances between anatomical landmarks. Nineteen cadaveric limbs were collected and distance A (top of olecranon to Os carpi accessorium) and B (circumference of limb) were measured. Converting mathematical formulas, C was calculated: π × (((0.5B)/π)(2)) × A. DDFM volume was determined by water displacement. Linear Regression Analysis was used to analyse data. The line best fitting the observed points was: Ln(volume[ml]) = -1.89 + 0.98 × Ln(value C[cm(3)]). Correlation was highest when natural logarithm was applied to both variables and was 0.97. The calculated formula enables estimating DDFM volume of a living horse. This estimated volume can be useful to apply human Botox® treatment-protocols. PMID:25264361

  18. Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs--an in vitro biomechanical study.

    PubMed

    McDonald, E; Gordon, J A; Buckley, J M; Gordon, L

    2013-05-01

    Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength. PMID:22745156

  19. Tuberculous arthritis of the elbow joint: A case report

    PubMed Central

    Yazıcı, Ayten; Kayan, Gökçen; Yaylacı, Selçuk; Demir, Mustafa Volkan; Karakeçe, Engin; Tamer, Ali; Karabay, Oğuz

    2016-01-01

    Tuberculous arthritis of the elbow joint is rare. A 57-year-old male patient presented with swelling, pain, and redness of the elbow. The symptoms first appeared one month ago; he was given antibiotic treatment after the diagnosis of septic arthritis at another center. The patient who did not improve with treatment was diagnosed with tuberculous arthritis according to the culture and was started on antituberculosis treatment. Tuberculous arthritis usually presents with chronic arthritis. However, it can also present in patients with septic arthritis. PMID:27733947

  20. Osteochondritis dissecans of the elbow: diagnosis, treatment, and prevention.

    PubMed

    Hall, T L; Galea, A M

    1999-02-01

    Osteochondritis dissecans (OCD) is an inflammation of the bone and cartilage that usually affects adolescents and young adults. A 16-year-old baseball player who had chronic elbow pain illustrates the typical course of OCD of the elbow. Radiographs may be diagnostic, but bone scan is a more sensitive diagnostic tool, and magnetic resonance imaging offers information for staging and characterization of lesions. If symptoms do not resolve with rest, surgery is recommended, including loose-body removal with curettage or drilling. The prognosis is good with early diagnosis and treatment. Left untreated, OCD may progress to degenerative joint disease. Prevention includes strengthening and stretching exercises and limits on throwing activities.

  1. Debridement for osteoarthritis of the elbow in athletes.

    PubMed

    Oka, Y

    1999-01-01

    The results of surgical treatment for osteoarthritis of the elbow in athletes were investigated. Athletic activities consisted mainly of judo wrestling and baseball; and included 26 elbows. The mean age was 32 years. The radiological changes were mild in most cases. Debridement consisted of resecting osteophytes and removing loose bodies. Pain scores were improved, and the range of movement was improved by an average of 24 degrees with an average follow-up of 4 years and 2 months. Recurrence of mild symptoms occurred in most cases.

  2. Magnetic Resonance Arthrography of the Wrist and Elbow.

    PubMed

    LiMarzi, Gary M; O'Dell, M Cody; Scherer, Kurt; Pettis, Christopher; Wasyliw, Christopher W; Bancroft, Laura W

    2015-08-01

    Magnetic resonance (MR) arthrography of the wrist and elbow is useful for detecting a variety of intra-articular pathologies. MR dictations should address whether intrinsic ligament tears of the wrist are partial-thickness or full-thickness, and involve the dorsal, membranous, and/or volar components of the ligaments. With regard to elbow soft tissue pathology, partial-thickness tears of the anterior band of the ulnar collateral ligament in overhead-throwing athletes are well evaluated with MR arthrography. MR arthrography also is helpful in staging osteochondritis dissecans of the capitellum, caused by repetitive valgus impaction injury in adolescent or young adult baseball pitchers.

  3. Acute elbow injuries in the National Football League.

    PubMed

    Kenter, K; Behr, C T; Warren, R F; O'Brien, S J; Barnes, R

    2000-01-01

    We performed a retrospective review to evaluate acute medial collateral ligament injuries of the elbow in professional football players from 1991 to 1996 (5 seasons). There were 5 acute medial collateral ligament injuries in 4 players (1 player with bilateral involvement). All injuries occurred with the hand planted on the playing surface while a valgus or hyperextension force was applied to the elbow. There were 2 centers, both involved with long-snapping situations, 1 running back, and 1 quarterback. All elbows had valgus instability on physical examination. Despite this instability, all players were able to function without operative reconstruction of the medial collateral ligament. No evidence of valgus instability was seen at the time of follow-up (average, 3.4 years). Next, we reviewed all acute elbow injuries in the National Football League from the same 5-season period. Ninety-one acute elbow injuries were reviewed. Overall, there were 70 (76.9%) elbow sprains, 16 (17.6%) dislocation/subluxation patterns, 4 (4.4%) fractures, and 1 (1.1%) miscellaneous injury. Review of the acute elbow sprains revealed 39 (55.7%) hyperextension injuries, 14 (20%) medial collateral ligament injuries, 2 (2.9%) lateral collateral ligament sprains, and 15 (21.4%) nonspecific sprains. The epidemiology of the 14 medial collateral ligament injuries was studied in more detail. The 2 most common mechanisms of injury were blocking at the line of scrimmage (50%) and the application of a valgus force with the hand planted on the playing surface (29%). There were 8 linemen, 4 receivers, 1 running back, and 1 quarterback. All injuries were managed with nonoperative treatment. The average time lost was 0.64 games (range, 0 to 4). We report 19 acute medial collateral ligament injuries of the elbow in elite football players, 2 of whom are considered overhead throwing athletes, who were able to function at a competitive level without surgical repair or reconstruction, in contrast to baseball

  4. Ulnar Collateral Ligament Reconstruction of the Elbow

    PubMed Central

    Erickson, Brandon J.; Chalmers, Peter N.; Bush-Joseph, Charles A.; Verma, Nikhil N.; Romeo, Anthony A.

    2015-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in both professional and high-level athletes. Purpose: To determine the effect of technique and level of play with UCLR on return to sport (RTS). Hypothesis: When comparing different surgical techniques or preoperative level of sports participation, there is no difference in rate of RTS after UCLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting UCLR outcomes with level of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Descriptive statistics were calculated, and 2-proportion 2-sample z-test calculators with α = .05 were used to compare RTS between level of play and technique. Results: Twenty studies (2019 patients/elbows; mean age, 22.13 ± 4 years; 97% male; mean follow-up, 39.9 ± 16.2 months) were included. The majority of patients were baseball players (94.5%), specifically pitchers (80%). The most common level of play was collegiate (44.6%). Palmaris longus (71.2%) and the American Sports Medicine Institute (ASMI) technique (65.6%) were the most common graft choice and surgical technique, respectively. There was a pooled 86.2% RTS rate, and 90% of players scored excellent/good on the Conway-Jobe scale. RTS rates were higher among collegiate athletes (95.5%) than either high school (89.4%, P = .023) or professional athletes (86.4%, P < .0001). RTS rates were higher for the docking technique (97.0%, P = .001) and the ASMI technique (93.3%, P = .0034) than the Jobe technique (66.7%). Conclusion: UCLR is performed most commonly in collegiate athletes. Collegiate athletes have the highest RTS rate

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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... 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...

  10. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    PubMed Central

    Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  11. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

    PubMed

    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

  12. Os trigonum syndrome with flexor hallucis longus tenosynovitis in a professional football referee.

    PubMed

    Cooper, M E; Wolin, P M

    1999-07-01

    The presentation of posterior ankle pain in any patient poses a diagnostic dilemma. The os trigonum syndrome and flexor hallucis longus stenosing tenosynovitis have been reported to occur in professional and amateur ballet dancers. It is important to consider these diagnoses in a patient who is not a dancer, as is shown in the case presented here. The patient in this case is a professional referee who injured his ankle while working on artificial turf. The treatment for os trigonum syndrome and flexor hallucis longus tenosynovitis is initially conservative, but in refractory cases, surgical removal of the os and release of the flexor hallucis longus tendon can be successfully performed. This is the first reported case of os trigonum syndrome and flexor hallucis longus tenosynovitis presenting simultaneously in a patient who is not a dancer.

  13. Reconstruction of Attritional Rupture of Flexor Tendons with Fascia Lata Graft Following Distal Radius Fracture Malunion.

    PubMed

    Bhat, A K; Acharya, A M; Soni, N

    2016-10-01

    Incidence of multiple flexor tendon rupture following distal radius fractures is rare with very few cases being reported in literature. We present an unusual case of a patient who had come to us with complaints of weakness and paresthesia of the right hand of one month prior and with a past history of dorsal plating for distal radius fracture nine years ago. Radiographs showed a distal radius fracture malunion with intact dorsal plate and protrusion of screws through the volar cortex. On exploration, attritional ruptures of all digital flexors were found with sparing of the Flexor Pollicis Longus tendon. The fibrous mass was excised and flexors reconstructed with a fascia lata graft. Attempt was made to correct the malunion with radial and ulnar osteotomies. At one year the patient had excellent restoration of digital flexion. PMID:27595963

  14. Rupture of Flexor Pollicis Longus Tendon: A Complication of Volar Locking Plating of the Distal Radius.

    PubMed

    Rajeev, Aysha Sethunathan; Sreverthana, Shanaka; Harrison, John

    2010-08-01

    We report an unusual case of complete rupture of the flexor pollicis longus tendon following volar locking plating for a distal radius fracture. We believe that the prominence of a distal locking screw head predisposed to the rupture of the tendon. We highlight that correctly attaching the distal locking screws to the plate is essential for obtaining the correct biomechanics of the device and preventing flexor tendon rupture.

  15. Repair of flexor carpi radialis tendon laceration at the wrist in a professional ice hockey player.

    PubMed

    Hepper, Clifford T; Boyer, Martin

    2011-06-01

    The flexor carpi radialis is a wrist flexor and radial deviator with half the relative strength of flexor carpi ulnaris. In the majority of patients, the flexor carpi radialis tendon is expendable and is routinely used for various reconstructive procedures about the hand and wrist. Isolated flexor carpi radialis lacerations at the wrist are rare. Flexor carpi radialis tendon ruptures, which have been reported in association with distal radius fractures, longstanding osteoarthritis, and percutaneous treatment of scaphoid fractures, are usually treated non-operatively. We report a case of a traumatic laceration of the flexor carpi radialis tendon at the wrist in a professional ice hockey player. Surgical repair and rehabilitation using established principles for intrasynovial flexor tendon repair allowed return to sport at the professional level in 2 months.Tension-free core suture repair was performed with a modified-Kessler, 4-strand repair using a double-stranded 4-0 Supramid suture. A running epitendinous suture was then placed around the circumference of the tendon with 6-0 Prolene. Immobilization of the wrist in 20° of flexion was maintained for 2 weeks. Full active and passive digital motion was allowed immediately postoperatively and continued throughout the rehabilitation. Therapy was initiated at 2 weeks postoperatively with full passive wrist flexion and passive wrist extension to a dorsal block of 20°. At 4 weeks postoperatively, a dorsal splint was fabricated to keep the wrist in neutral. At this time, active extension to a dorsal block of zero and full passive flexion was allowed. Active wrist flexion without resistance was begun at 6 weeks, and full strengthening was allowed at 8 weeks postoperatively. The patient returned to sport at the professional level shortly thereafter. At latest follow-up, the patient has been able to fully participate in professional ice hockey without pain or functional limitation. PMID:21667915

  16. Effects of extensor and flexor group I afferent volleys on the excitability of individual soleus motoneurones in man

    PubMed Central

    Ashby, Peter; Labelle, Keith

    1977-01-01

    The contour of the postsynaptic potential (PSP) produced in a neurone by an afferent volley can be derived from the contour of the post-stimulus time histogram (PSTH) of that neurone when it is discharging rhythmically. In the present study the PSTH of the firing of individual soleus motor units after stimulation of the popliteal or peroneal nerve was used to explore the effects of extensor and flexor group I afferent volleys on the excitability of single soleus motoneurones in man. Extensor group I volleys resulted in an early peak of increased impulse density in the PSTH of 75% of soleus motoneurones. The latency suggests an analogy with the Ia EPSP. The mean duration of the peak of increased impulse density, equivalent to the rise time of the EPSP, was 3.6 ms. Flexor group I volleys result in a period of reduced impulse density in the PSTH of five out of nine soleus motoneurones. The latency suggests an analogy with the Ia IPSP. We conclude that this method could be used to explore the afferent connections to single motoneurones in man and to derive some of the characteristics of the postsynaptic potentials from a variety of afferent nerve fibres in single human motoneurones. PMID:599368

  17. Loss coefficient measurements for flat oval elbows and transitions

    SciTech Connect

    Townsend, B.; Khodabakhsh, F.; Idem, S.

    1996-12-31

    Zero-length loss coefficients were measured for several flat oval elbow and transition fittings over a range of Reynolds numbers from 20,000 to 600,000. Least-squares curve fitting was employed to fit a linear function to the loss coefficient data, with the intercept forced to zero. Local loss coefficient values for each fitting are presented.

  18. [Case report and literature review: elbow fracture dislocation in children].

    PubMed

    Guzmdn, R; Rincón, D; Camacho, J

    2015-01-01

    Elbow dislocation in children is a very infrequent traumatic event which was first described by Stimson in 1900 and then by Tachdjian in 1990. Its estimated incidence ranges from 3% to 6% of all elbow injuries, peaking at 13-14 years. Elbow trauma is classified considering the direction in which the proximal radioulnar joint shifts with respect to the humerus, into posterior and anterior dislocation. The former is the most frequent and accounts for 95% of cases. Elbow fracture dislocation is an even rarer event. The incidence rate of avulsion fracture of the medial epicondyle is 25-36%, of the lateral condyle 4%, of the olecranon 1.7%, of the radial head 8%, of the coronoid process 3.5%, and others, 3.5%. At present there is no consensus in the literature on how to treat this type of lesions, particularly because some authors advocate nonsurgical management, while others propose surgical management as the definitive treatment. What is clear, however, is that a late diagnosis or untimely treatment may affect the child's growth and lead to serious complications. The purpose of this study is to share our experience and good results with the surgical management of these infrequent cases.

  19. Cyriax physiotherapy for tennis elbow/lateral epicondylitis.

    PubMed

    Stasinopoulos, D; Johnson, M I

    2004-12-01

    Tennis elbow or lateral epicondylitis is one of the most common lesions of the arm with a well defined clinical presentation, which significantly impacts on the community. Many treatment approaches have been proposed to manage this condition. One is Cyriax physiotherapy. The effectiveness and reported effects of this intervention are reviewed.

  20. 48. View of typical 90 degree elbow located at horizontal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    48. View of typical 90 degree elbow located at horizontal corner with output (to scanner radar system control switch) waveguide on top and return wave on bottom of photograph. - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK

  1. Arthroscopic management of the painful total elbow arthroplasty

    PubMed Central

    Bain, Gregory I

    2015-01-01

    Background Failure of total elbow arthroplasty is more common than after other major joint arthroplasties and is often a result of aseptic loosening, peri-prosthetic infection, fracture and instability. Infection can be a devastating complication, yet there are no established guidelines for the pre-operative diagnosis of total elbow peri-prosthetic infection. This is because pre-operative clinical, radiographic and biochemical tests are often unreliable. Methods Using three case examples, a standardized protocol for the clinical and arthroscopic assessment of the painful total elbow arthroplasty is described. This is used to provide a mechanical and microbiological diagnosis of the patient’s pain. Results There have been no complications resulting from the use of this technique in the three patients described, nor in any other patient to date. Conclusions The staged protocol described in the present study, utilizing arthroscopic assessment, has refined the approach to the painful total elbow arthroplasty because it directly influences the definitive surgical management of the patient. It is recommended that other surgeons follow the principles outlined in the present study when faced with this challenging problem. PMID:27583000

  2. Elbow arthroplasty: where are we today? A narrative review.

    PubMed

    Degreef, Ilse

    2016-04-01

    Background The elbow joint is a complex compound articulation, with a linking role within the upper limb kinematics. Its hinge function allows for proper placement of our working instrument (the hand) in the space surrounding us, directed by the shoulder joint. Both reliable mobility and stability are essential elements to allow for consistent bridging of the distance we aim to achieve in common daily activities. Sufficient flexion and extension are required to ensure both the patients' independence and the dignity. Next to the hinge, a radio-ulnar rotation with precise co-operation of forearm and wrist spin enhances the linking function with accurate precision instrument manipulation. Arthritis of the elbow joint or cubarthritis, whether primary or secondary, may not be as highly prevalent as hip or knee arthritis, but its impact on daily live certainly cannot be underestimated. Methods Current treatment options for failing cubarthritis are reviewed. Results Surgical techniques to reconstruct or replace the elbow joint are currently increasingly efficient with mounting long-term outcome reports. Debridement techniques including open or arthroscopic Outerbridge-Kashiwaghi procedure often delays joint replacement. Implants for joint arthroplasty focus on the ulna-humeral joint mostly with semi-constrained linked techniques, but there is a trend towards total joint replacement including the radiocapitellar joint. Conclusion In this independent review article, elbow joint failure due to cubarthritis and an overview of its current state-of-the-art orthopaedic treatment algorithm is presented, with its indications, advantages, risks and outcome. PMID:27385293

  3. Managing the stiff elbow: operative, nonoperative, and postoperative techniques.

    PubMed

    Dávila, Sylvia A; Johnston-Jones, Karen

    2006-01-01

    Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture. PMID:16713873

  4. Overhead throwing injuries of the shoulder and elbow.

    PubMed

    Anderson, Mark W; Alford, Bennett A

    2010-11-01

    Injuries to the shoulder and elbow are common in athletes involved in sporting activities that require overhead motion of the arm. An understanding of the forces involved in the throwing motion, the anatomic structures most at risk, and the magnetic resonance imaging appearances of the most common associated injuries can help to improve diagnostic accuracy when interpreting imaging studies in these patients. PMID:21094403

  5. Numerical simulation of the erosion in the 90° elbow

    NASA Astrophysics Data System (ADS)

    Deng, Yunzhong; Liu, Yinhe; Chen, Jianying; Zhang, Yongjian

    2013-07-01

    In the process of natural gas transportation, cement production and coal-fired power, the gas-solid two-phase flow exists widely in pipelines. The existence of solid particles may cause the erosion of the pipeline, especially in the elbow of the pipeline. Equations used to predict erosion rate are usually obtained from well-controlled experimental tests for solid particles carried in a gas or liquid flow. The particle impact speed and impact angle affect the erosion process and are two major parameters in most erosion equations. In this paper, the erosion of 90° elbow was studied by using Computational Fluid Dynamics (CFD), Discrete Particle Model (DPM) and erosion equations. The maximum erosion rate and the erosion position were reported. Particle size does not influence the erosion rate when particle size is bigger than a certain degree. When the mass ratio of sand loading to fluid is less than 1, erosion ratio is proportional to the loading mass. The erosion rate is lower for larger radius elbow, and the erosion rate is greatly declined by using the plugged tee instead of an elbow.

  6. Evaluation of elbow and shoulder problems in professional baseball pitchers.

    PubMed

    Grana, William A; Boscardin, James B; Schneider, Herman J; Takao, Scott H; Vera, Tomas; Goin, Scott G

    2007-06-01

    When a professional athlete injures an elbow or shoulder, the uninjured joint must receive as much attention as the injured joint. Is there a relationship between injury of one joint and subsequent injury of the other joint? In the prospective study reported here, we created a database (a) to determine whether injury to one joint was more likely to result in a problem with the other joint and (b) to analyze for trends and correlations. A survey was administered to all pitchers on a professional baseball team to collect data about shoulder and elbow problems during their careers. Eighty-four pitchers (737 seasons of experience, 52 index injuries) were evaluated. Of the injured players, 27 were treated surgically. Risk for later injury was 4.6 times larger for players who had an index surgery than for those who had not. Of the players who had ulnar collateral ligament (UCL) reconstruction, 42% later sustained a shoulder injury. No player with rotator cuff surgery sustained a subsequent elbow or shoulder injury. There were significantly more upper extremity injuries with right-handed throwers. An elbow injury was more likely to result in shoulder problems, specifically after UCL reconstruction. Players who required surgery were almost 5 times more likely to have a later injury or surgery than players who did not require surgery.

  7. Overhead throwing injuries of the shoulder and elbow.

    PubMed

    Anderson, Mark W; Alford, Bennett A

    2010-11-01

    Injuries to the shoulder and elbow are common in athletes involved in sporting activities that require overhead motion of the arm. An understanding of the forces involved in the throwing motion, the anatomic structures most at risk, and the magnetic resonance imaging appearances of the most common associated injuries can help to improve diagnostic accuracy when interpreting imaging studies in these patients.

  8. Acute shoulder and elbow dislocations in the athlete.

    PubMed

    Burra, Giridhar; Andrews, James R

    2002-07-01

    Dislocations of the elbow are less common than shoulder dislocations. The primary treatment is conservative, with a conscious effort toward early mobilization. Recurrence is rare, and improvement in function and motion can be expected for up to 1 year. Operative treatment should be reserved for baseball pitchers and cases of complex instability.

  9. Finite element evaluation of erosion/corrosion affected reducing elbow

    SciTech Connect

    Basavaraju, C.

    1996-12-01

    Erosion/corrosion is a primary source for wall thinning or degradation of carbon steel piping systems in service. A number of piping failures in the power industry have been attributed to erosion/corrosion. Piping elbow is one of such susceptible components for erosion/corrosion because of increased flow turbulence due to its geometry. In this paper, the acceptability of a 12 in. x 8 in. reducing elbow in RHR service water pump discharge piping, which experienced significant degradation due to wall thinning in localized areas, was evaluated using finite element analysis methodology. Since the simplified methods showed very small margin and recommended replacement of the elbow, a detailed 3-D finite element model was built using shell elements and analyzed for internal pressure and moment loadings. The finite element analysis incorporated the U.T. measured wall thickness data at various spots that experienced wall thinning. The results showed that the elbow is acceptable as-is until the next fuel cycle. FEA, though cumbersome, and time consuming is a valuable analytical tool in making critical decisions with regard to component replacement of border line situation cases, eliminating some conservatism while not compromising the safety.

  10. Rehabilitation of the Overhead Athlete’s Elbow

    PubMed Central

    Wilk, Kevin E.; Macrina, Leonard C.; Cain, E. Lyle; Dugas, Jeffrey R.; Andrews, James R.

    2012-01-01

    The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive overuse, leading to tissue failure. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether following injury or postsurgical, must follow a progressive and sequential order, building on the previous phase, to ensure that healing tissues are not compromised. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control while gradually applying loads to healing tissue. In addition, when one is creating a rehabilitation plan for athletes, it is imperative to treat the entire upper extremity, core, and legs to create and dissipate the forces generated at each joint. PMID:23016113

  11. Do autologous blood and PRP injections effectively treat tennis elbow?

    PubMed

    Widstrom, Luke; Slattengren, Andrew

    2016-09-01

    Both approaches reduce pain, but the improvement with platelet-rich plasma (PRP) is not clinically meaningful. Autologous blood injections (ABIs) are more effective than corticosteroid injections for reducing pain and disability in patients with tennis elbow in both the short and long term.

  12. Elbow arthroplasty: where are we today? A narrative review.

    PubMed

    Degreef, Ilse

    2016-04-01

    Background The elbow joint is a complex compound articulation, with a linking role within the upper limb kinematics. Its hinge function allows for proper placement of our working instrument (the hand) in the space surrounding us, directed by the shoulder joint. Both reliable mobility and stability are essential elements to allow for consistent bridging of the distance we aim to achieve in common daily activities. Sufficient flexion and extension are required to ensure both the patients' independence and the dignity. Next to the hinge, a radio-ulnar rotation with precise co-operation of forearm and wrist spin enhances the linking function with accurate precision instrument manipulation. Arthritis of the elbow joint or cubarthritis, whether primary or secondary, may not be as highly prevalent as hip or knee arthritis, but its impact on daily live certainly cannot be underestimated. Methods Current treatment options for failing cubarthritis are reviewed. Results Surgical techniques to reconstruct or replace the elbow joint are currently increasingly efficient with mounting long-term outcome reports. Debridement techniques including open or arthroscopic Outerbridge-Kashiwaghi procedure often delays joint replacement. Implants for joint arthroplasty focus on the ulna-humeral joint mostly with semi-constrained linked techniques, but there is a trend towards total joint replacement including the radiocapitellar joint. Conclusion In this independent review article, elbow joint failure due to cubarthritis and an overview of its current state-of-the-art orthopaedic treatment algorithm is presented, with its indications, advantages, risks and outcome.

  13. [Tenotomy of carpal and digital flexor tendons for correction of congenital neuromyodysplasia in a calf].

    PubMed

    Sohrt, J T; Heppelmann, M; Rehage, J; Staszyk, C

    2013-01-01

    In a 7-day-old heifer calf, a bilateral flexural deformity of the forelimbs involving the digital flexor tendons, the suspensory ligament and the ulnar and radial carpal flexor tendons was diagnosed. After 2 weeks of conservative treatment consisting of manual stretching of the legs and the application of splints and wooden blocks, which were glued to the soles and extended beyond the tip of the claws, the right forelimb could be extended sufficiently to allow weight bearing, whereas the left forelimb could be passively extended to only approximately 120°. Therefore, tenotomy of the ulnar carpal flexor tendon, the digital flexor tendons and the suspensory ligament was carried out in the left leg. A support bandage was then applied to the leg for 8 weeks, after which the carpus and fetlock could be completely extended passively. Flexural deformity of the carpus caused by contracture of the carpal flexor tendons was treated by means of a tenotomy of the ulnar carpal flexor tendon proximal to the accessory carpal bone, which allowed preservation of the carpal tunnel and avoided the risk of iatrogenic damage to nerves and the carpal joint capsule. PMID:23608892

  14. The Epidemiology and Health Care Burden of Tennis Elbow

    PubMed Central

    Sanders, Thomas L.; Kremers, Hilal Maradit; Bryan, Andrew J.; Ransom, Jeanine E.; Smith, Jay; Morrey, Bernard F.

    2015-01-01

    Background Lateral elbow tendinosis (epicondylitis) is a common condition both in primary care and specialty clinics. Purpose To evaluate the natural history (ie, incidence, recurrence, and progression to surgery) of lateral elbow tendinosis in a large population. Study Design Descriptive epidemiology study. Methods The study population comprised a population-based incidence cohort of patients with new-onset lateral elbow tendinosis between January 1, 2000, and December 31, 2012. The medical records of a 10% random sample (n = 576) were reviewed to ascertain information on patient and disease characteristics, treatment modalities, recurrence, and progression to surgery. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 US population. Results The age- and sex-adjusted annual incidence of lateral elbow tendinosis decreased significantly over time from 4.5 per 1000 people in 2000 to 2.4 per 1000 in 2012 (P <.001). The recurrence rate within 2 years was 8.5% and remained constant over time. The proportion of surgically treated cases within 2 years of diagnosis tripled over time, from 1.1% during the 2000–2002 time period to 3.2% after 2009 (P <.00001). About 1 in 10 patients with persistent symptoms at 6 months required surgery. Conclusion The decrease in incidence of lateral elbow tendinosis may represent changes in diagnosis patterns or a true decrease in disease incidence. Natural history data can be used to help guide patients and providers in determining the most appropriate course at a given time in the disease process. The study data suggest that patients without resolution after 6 months of onset may have a prolonged disease course and may need surgical intervention. PMID:25656546

  15. 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. PMID:27151700

  16. Paediatric medial epicondyle fracture without elbow dislocation associated with intra-articular ulnar nerve entrapment

    PubMed Central

    Elbashir, Mohamed; Domos, Peter; Latimer, Mark

    2015-01-01

    Elbow fractures are not uncommon in children, and some are associated with neurovascular injuries. Having a nerve injury in an elbow fracture without dislocation is rare and was not described in the literature. Here, we have reported probably the first case of an ulnar nerve injury in an elbow fracture without dislocation. A 9-year-old female presented to the emergency department after falling off a monkey bar. She had a painful, swollen and tender right elbow with no history or clinical signs of an elbow dislocation but had complete ulnar nerve palsy. She was managed initially with analgesia and plaster application and was taken directly to the operating theatre. Examination under anaesthesia revealed no elbow joint instability. The ulnar nerve was found entrapped between the trochlea and proximal ulna, intra-articularly. The medial epicondyle was also found avulsed from the humerus, with an incarcerated medial epicondylar fragment in the elbow joint. PMID:26546588

  17. Arthroscopic fenestration of the distal humerus: a viable option for painful elbow impingement in sportsmen.

    PubMed

    Degreef, Ilse

    2009-10-01

    Open ulnohumeral arthroplasty, also known as the Outerbridge-Kashiwaghi procedure, is performed in elbow arthritis to relieve pain and improve the range of motion. A similar technique of distal humeral fenestration is applied in elbow arthroscopy to achieve pain relief in degenerative elbow arthritis. We report a possible new indication in young sportsmen with recurrent posterior elbow impingement. A professional javelin thrower and a basketball player with recurrent loose bodies, posterior impingement and a minimal extension lack were free of complaints and resumed all sports activities within 6 weeks after an arthroscopic fenestration of the distal humerus. Their elbow function remained perfect within a 2 year follow-up period. We suggest that arthroscopic ulnohumeral arthroplasty is a viable option in sportsmen with recurrent loose bodies and elbow locking due to ongoing elbow arthritis.

  18. Laser tissue welding and repair of digital flexor tendons

    NASA Astrophysics Data System (ADS)

    Drew, P. J.; Kiernan, Michael N.; MacGregor, A. D.; Clement, Marc

    1996-01-01

    Injuries involving division of the flexor tendons of the hand are a common surgical problem. Sutured repairs must be strong enough to withstand early active movement. Experiments were designed to assess the strength of bonds formed between tendon sections as a result of heating (1) under controlled conditions in a water bath and (2) using a carbon dioxide laser (laser tissue welding). The load (N) and stress (N/cm2) required to disrupt thermal bonds between bovine tendon sections heated for 4 minutes in water peaked at 62 degrees Celsius (13N, 11.3N/cm2). Further experiments revealed the optimal time period for heating to be 9 minutes (21.5N, 20.6N/cm2). A threshold effect was apparent at these parameters. The in vitro strength of sutured, laser welded and sutured and laser welded tendon repairs was compared in a rabbit model. Laser welding alone did not produce repairs as strong as sutured repairs. It did, however, augment the strength of sutured repair. This effect was maximal at a power of 0.1 W.

  19. Technical and biological modifications for enhanced flexor tendon repair

    PubMed Central

    Kim, H. Mike; Nelson, Gregory; Thomopoulos, Stavros; Silva, Matthew J.; Das, Rosalina; Gelberman, Richard H.

    2010-01-01

    Clinical outcomes after intra-synovial flexor tendon repair have been substantially improved over the past two decades through advances in tendon suture techniques and postoperative rehabilitation methods. Nevertheless, complications such as repair site elongation (i.e., gap formation) and rupture continue to occur frequently. Experimental studies have shown that repair site strength fails to increase in the first three weeks following tendon suture. After three weeks, the strength and rigidity of the repair site improves significantly, a process that continues for several months. Formation of a repair site gap during the early rehabilitation period has been shown to considerably delay the accrual of repair site strength over time. Thus, it is of prime importance that the method of tendon suture achieves and maintains a stiff and strong repair site during the early healing interval by maintaining close approximation of the tendon stumps and by stimulating, where possible, the intrinsic repair response. In this review we describe recent efforts to enhance the integrity of the immature repair site. We focus on two major areas of advancement: surgical technique modifications and manipulation of the biologic and biochemical environment. PMID:20513584

  20. Effects of Stress Deprivation on Lubricin Synthesis and Gliding of Flexor Tendons in a Canine Model in Vivo

    PubMed Central

    Sun, Yu-Long; Zhao, Chunfeng; Jay, Gregory D.; Schmid, Thomas M.; An, Kai-Nan; Amadio, Peter C.

    2013-01-01

    Background: Lubricin facilitates boundary lubrication of cartilage. The synthesis of lubricin in cartilage is regulated by mechanical stimuli, especially shear force. Lubricin is also found in flexor tendons. However, little is known about the effect of mechanical loading on lubricin synthesis in tendons or about the function of lubricin in flexor tendons. The purpose of this study was to investigate the relationship of mechanical loading to lubricin expression and gliding resistance of flexor tendons. Methods: Flexor tendons were harvested from canine forepaws that had been suspended without weight-bearing for twenty-one days and from the contralateral forepaws that had been allowed free motion. Lubricin expression in each flexor tendon was investigated with real-time RT-PCR (reverse transcription polymerase chain reaction) and immunohistochemistry. Lubricin in the flexor tendon was extracted and quantified with ELISA (enzyme-linked immunosorbent assay). The friction between the flexor tendon and the proximal pulley was measured. Results: The non-weight-bearing flexor tendons had a 40% reduction of lubricin expression (p < 0.01) and content (p < 0.01) compared with the flexor tendons in the contralateral limb. However, the gliding resistance of the tendons in the non-weight-bearing limb was the same as that of the tendons on the contralateral, weight-bearing side. Conclusions: Mechanical loading affected lubricin expression in flexor tendons, resulting in a 40% reduction of lubricin content, but these changes did not affect the gliding resistance of the flexor tendons. Clinical Relevance: The gliding resistance of flexor tendons was not affected after a period of limited motion. This suggests that physical activity after a short period of limited motion does not lead to wear of intact tendons and their surrounding tissue. PMID:23389791

  1. Effect of maturation and aging on material and ultrasonographic properties of equine superficial digital flexor tendon.

    PubMed

    Gillis, C; Sharkey, N; Stover, S M; Pool, R R; Meagher, D M; Willits, N

    1995-10-01

    Results of studies in human beings and other species have indicated that aging significantly influences the strength, modulus of elasticity, and energy storage ability of tendon. We wanted to determine the effects of aging on the material and ultrasonographic properties of equine superficial digital flexor (SDF) tendon. Ultrasonographic measurements of left forelimb SDF tendon cross-sectional area and mean echogenicity were made in 23 standing horses ranging in age from 2 to 23 years. All horses had not been in work for a minimum of 6 months prior to the study. After euthanasia, left forelimb bone-muscle-tendon-bone specimens were mounted in a materials testing system. The SDF tendon was cyclically loaded sinusoidally 100 times at 0.5 Hz from 1.5 to 5.0% strain, then was submitted to 10-minute creep-and-stress relaxation tests. Modulus of elasticity, load at 3% strain, and creep-and-stress relaxation were determined for each specimen. A significant positive correlation was found between elastic modulus and age. Correlation was not found between age and SDF tendon cross-sectional area or mean echogenicity. When 2-year-old horses were compared with older horses, the latter had tendons with a significantly (P = 0.007) greater modulus of elasticity. The authors conclude that increasing age through maturity is associated with a corresponding increase in equine SDF tendon elastic modulus.

  2. Unusual Closed Traumatic Avulsion of Both Flexor Tendons in Zones 1 and 3 of the Little Finger.

    PubMed

    Soro, Marie-Aimée Päivi; Christen, Thierry; Durand, Sébastien

    2016-01-01

    Closed tendon avulsion of both flexor tendons in the same finger is an extremely rare condition. We encountered the case of a patient who presented a rupture of the flexor digitorum profundus in zone 1 and flexor digitorum superficialis in zone 3 in the little finger. This occurrence has not been reported previously. We hereby present our case, make a review of the literature of avulsion of both flexor tendons of the same finger, and propose a treatment according to the site of the ruptures. PMID:27656304

  3. Unusual Closed Traumatic Avulsion of Both Flexor Tendons in Zones 1 and 3 of the Little Finger

    PubMed Central

    Durand, Sébastien

    2016-01-01

    Closed tendon avulsion of both flexor tendons in the same finger is an extremely rare condition. We encountered the case of a patient who presented a rupture of the flexor digitorum profundus in zone 1 and flexor digitorum superficialis in zone 3 in the little finger. This occurrence has not been reported previously. We hereby present our case, make a review of the literature of avulsion of both flexor tendons of the same finger, and propose a treatment according to the site of the ruptures. PMID:27656304

  4. Unusual Closed Traumatic Avulsion of Both Flexor Tendons in Zones 1 and 3 of the Little Finger

    PubMed Central

    Durand, Sébastien

    2016-01-01

    Closed tendon avulsion of both flexor tendons in the same finger is an extremely rare condition. We encountered the case of a patient who presented a rupture of the flexor digitorum profundus in zone 1 and flexor digitorum superficialis in zone 3 in the little finger. This occurrence has not been reported previously. We hereby present our case, make a review of the literature of avulsion of both flexor tendons of the same finger, and propose a treatment according to the site of the ruptures.

  5. Medial elbow joint laxity in professional baseball pitchers. A bilateral comparison using stress radiography.

    PubMed

    Ellenbecker, T S; Mattalino, A J; Elam, E A; Caplinger, R A

    1998-01-01

    Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 +/- 0.97 mm, while the nondominant elbow opened 0.88 +/- 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 +/- 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.

  6. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.

    PubMed

    Egol, Kenneth A; Tsai, Peter; Vazques, Oscar; Tejwani, Nirmal C

    2011-02-01

    Treating intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for distal humeral fractures treated with total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular distal humerus fractures (Orthopaedic Trauma Association types 13B and 13C) by 1 of 2 surgeons. Demographic and operative data were obtained, charts were reviewed, and patients were asked to have their outcomes evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Twenty-two patients (23 elbows) were identified, and 2 of these (3 elbows) were excluded. Of the remaining 20 patients, 9 had undergone cemented, semiconstrained TEA as initial treatment, and 11 had undergone ORIF. These 2 groups were compared. Mean follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the TEA and ORIF groups with respect to demographic factors. Final elbow range of motion was 92° flexion-extension arc (arthroplasty group) and 98° (fixation group). Two patients in the arthroplasty group and 2 in the fixation group died. For the remaining patients, mean DASH scores were 30.2 (arthroplasty) and 32.1 (fixation), and mean MEPI scores were 79 (arthroplasty) and 85 (fixation). These differences were not statistically significant. Four TEAs developed radiographic loosening by a mean of 15 months, and 1 of these underwent revision with good outcome. Ten of the 11 fractures in the fixation group healed radiographically; the 1 nonunion with collapse continued to be asymptomatic. Two patients in the fixation group underwent contracture release after union for limited elbow range of motion. Many factors come into play in the

  7. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.

    PubMed

    Egol, Kenneth A; Tsai, Peter; Vazques, Oscar; Tejwani, Nirmal C

    2011-02-01

    Treating intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for distal humeral fractures treated with total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular distal humerus fractures (Orthopaedic Trauma Association types 13B and 13C) by 1 of 2 surgeons. Demographic and operative data were obtained, charts were reviewed, and patients were asked to have their outcomes evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Twenty-two patients (23 elbows) were identified, and 2 of these (3 elbows) were excluded. Of the remaining 20 patients, 9 had undergone cemented, semiconstrained TEA as initial treatment, and 11 had undergone ORIF. These 2 groups were compared. Mean follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the TEA and ORIF groups with respect to demographic factors. Final elbow range of motion was 92° flexion-extension arc (arthroplasty group) and 98° (fixation group). Two patients in the arthroplasty group and 2 in the fixation group died. For the remaining patients, mean DASH scores were 30.2 (arthroplasty) and 32.1 (fixation), and mean MEPI scores were 79 (arthroplasty) and 85 (fixation). These differences were not statistically significant. Four TEAs developed radiographic loosening by a mean of 15 months, and 1 of these underwent revision with good outcome. Ten of the 11 fractures in the fixation group healed radiographically; the 1 nonunion with collapse continued to be asymptomatic. Two patients in the fixation group underwent contracture release after union for limited elbow range of motion. Many factors come into play in the

  8. Elbow and knee joint for hard space suits

    NASA Technical Reports Server (NTRS)

    Vykukal, H. C.

    1986-01-01

    An elbow or knee joint for a hard space suit or similar usage is formed of three serially connected rigid sections which have truncated spherical configurations. The ends of each section form solid geometric angles, and the sections are interconnected by hermetically sealed ball bearings. The outer two sections are fixed together for rotation in a direction opposite to rotation of the center section. A preferred means to make the outer sections track each other in rotation comprises a rotatable continuous bead chain which engages sockets circumferentially spaced on the facing sides of the outer races of the bearings. The joint has a single pivot point and the bearing axes are always contained in a single plane for any articulation of the joint. Thus flexure of the joint simulates the coplanar flexure of the knee or elbow and is not susceptible to lockup.

  9. Flow resistance of ice slurry in bends and elbow pipes

    NASA Astrophysics Data System (ADS)

    Niezgoda-Żelasko, B.; Żelasko, J.

    2014-08-01

    The present paper covers the flow of ice slurry made of a 10.6% ethanol solution through small-radius bends and elbow pipes. The paper presents the results of experimental research on the flow resistances of Bingham-fluid ice slurry in bends and elbows. The research, performed for three pipe diameters and a relative bend radius of 1<=D/di<=2, has made it possible to take into consideration the influence of friction resistances as well the of the flow geometry on the total local resistance coefficients. The study attempts to make the local resistance coefficient dependent on the Dean number defined for a generalized Reynolds number according to Metzner-Reade

  10. [Secondary ligament instabilities in the area of the elbow joint].

    PubMed

    Wirth, C J

    1988-08-01

    Secondary capsular or ligamentous injuries around the elbow joint, which are generally a rare finding, can give rise to medial, lateral, anterior, and posterior instability. Medial instability is especially bothersome during sporting activities, such as javelin throwing and baseball, and requires tightening or replacement of the ulnar collateral ligament. On the lateral side it is particularly the subluxation of the head of the radius that makes surgical tightening of the annular ligament essential. Anterior instability, which would cause the joint to dislocate anteriorly, is extremely rare and does not lead to secondary problems. Posterolateral, chronically recurrent, dislocation of the elbow joint, however, is intolerable for the patient, and many operative stabilizing procedures have been performed, mostly in isolated patients, in attempts at correction. The current method of choice consists in tightening of the dorsoradial capsular pouch in combination with osseous refixation of the slack radial ligament.

  11. TERRIBLE TRIAD OF THE ELBOW: EVALUATION OF SURGICAL TREATMENT

    PubMed Central

    Gomide, Leandro Cardoso; Campos, Dagoberto de Oliveira; Ribeiro de Sá, José Maria; Pamfílio de Sousa, Marcelo Rangel; do Carmo, Thiago Correa; Brandão Andrada, Fernando

    2015-01-01

    Objectives: To evaluate the epidemiology of and surgical results from treating elbow fracture-dislocations, including only the cases in which dislocation is associated with fracture of the coronoid process and the radial head (terrible triad). Methods: Nineteen patients were evaluated: 12 males and 7 females. The medical records were analyzed to gather data about the mechanism of injury, fracture pattern, time elapsed until surgery and type of procedure applied. A clinical assessment was made to measure elbow range of motion, and the MEPS questionnaire was applied. Results: The most common mechanism of injury in our sample was a fall from a height (12 patients). All the patients underwent surgical treatment and the mean time elapsed between the date of the injury and the surgery was 16.1 days. The mean follow-up was 50.3 months. The mean range of flexion-extension obtained was 112° and the mean range of pronation-supination obtained was 127.9°. The mean score from the MEPS questionnaire was 86 points, and excellent and good results were obtained for 15 patients (79%). The time elapsed until surgery, final flexion-extension range greater than 100° and flexion contracture of less than 30° were shown to have a statistically significant relationship with a good final clinical result. Five patients had complications, of which three cases related to peripheral nerves, one case to pseudarthrosis and one case to recurrent instability. Conclusions: Despite the severity of the injuries found in the terrible triad of the elbow, most of the patients evaluated here achieved elbow stability with good clinical results. The factors that led to better clinical results were surgery not more than 14 days after the injury, flexion-extension range greater than 100° and flexion contracture less than 30°. PMID:27027024

  12. Osseous manifestations of elbow stress associated with sports activities.

    PubMed

    Gore, R M; Rogers, L F; Bowerman, J; Suker, J; Compere, C L

    1980-05-01

    The radiographic manifestations of musculoskeletal stress at the elbow associated with racket and throwing sports are reported in 29 symptomatic amateur, juvenile, and professional athletes. Five major categories of stress are identified: diffuse, humeral shaft, medial tension, lateral compression, and extension stress. The osseous changes produced by these stresses include bony hypertrophy, loose bodies, traction spur formation, osteochondral and humeral shaft fractures in the adult, and epiphyseal and apophyseal hypermaturity or avulsion in the youngster.

  13. Humeral fracture between a total elbow and total shoulder arthroplasty.

    PubMed

    Mavrogenis, Andreas F; Angelini, Andrea; Guerra, Enrico; Rotini, Roberto

    2011-04-01

    This article presents a case of a 71-year-old woman with a humeral fracture between a cementless reverse total shoulder arthroplasty and a cemented total elbow arthroplasty and discusses our treatment plan. Surgical treatment was performed after the patient was informed of possible complications and the benefits of surgery including: early, complete restoration of arm anatomy, greater functional improvement of the adjacent joints, and increased risk of nonunion with nonoperative treatment.The fracture was comminuted and extended proximally around the shoulder prosthesis. Through the posterior approach, the radial nerve was identified and protected. Both prostheses were found firmly fixed to bone. The fracture around the shoulder prosthesis was reduced first using a strut allograft and reduction clamps. Next, arm alignment restoration and distal humerus reduction were performed. The construct was neutralized with a 3.5-mm locking plate spanning the whole length of the humerus. The locking plate was positioned posterolaterally and the strut medially in a 90° to 90° configuration secured with wires and cables.A hinged elbow brace was applied for 6 weeks postoperatively. Active range of motion exercises of the wrist and hand and passive motion of the elbow and shoulder were started at 4 to 5 days postoperatively. At 2 weeks postoperatively, passive motion of the elbow and shoulder progressed to strengthening exercises. Thereafter, the patient underwent several weeks of physical therapy to restore motion, strength, and function of the upper extremity with instructions not to overload the arm and avoid heavy work and sports for as long as 1 year. At 10 months postoperatively, radiographs of the arm showed a stable construct; the patient had resumed full activities of daily living. PMID:21469626

  14. 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

  15. Anatomical study on the innervation of the elbow capsule☆

    PubMed Central

    Cavalheiro, Cristina Schmitt; Filho, Mauro Razuk; Rozas, João; Wey, João; de Andrade, Antonio Marcos; Caetano, Edie Benedito

    2015-01-01

    Objectives To put forward an anatomical description of the innervation of the elbow capsule, illustrated through morphological analysis on dissections. Methods Thirty elbows from fresh fixed adult cadavers aged 32–74 years, of both sexes, were dissected. Results Among the dissected arms, we observed that the median nerve did not have any branches in two arms, while it had one branch in five arms, two branches in two arms, three branches in ten arms, four branches in nine arms and five branches in two arms. The radial nerve did not have any branches in two arms, while it had one branch in two arms, two branches in nine arms, three branches in ten arms, four branches in five arms and five branches in two arms. The ulnar nerve did not have any branches in three arms, while it had one branch in six arms, two branches in four arms, three branches in five arms, four branches in seven arms, five branches in four arms and six branches in one arm. Conclusions We observed branches of the radial, ulnar and medial nerves in the elbow joint, and a close relationship between their capsular and motor branches. PMID:27218079

  16. Effect of Elbow Position on Short-segment Nerve Conduction Study in Cubital Tunnel Syndrome

    PubMed Central

    Liu, Zhu; Jia, Zhi-Rong; Wang, Ting-Ting; Shi, Xin; Liang, Wei

    2016-01-01

    Background: The appropriate elbow position of short-segment nerve conduction study (SSNCS) to diagnose cubital tunnel syndrome (CubTS) is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods: In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow full extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland–Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results: Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group's latency and compound muscle action potential (CMAP) of each segment at 70° elbow flexion by SSNCS was compared with full extension position, no statistically significant difference were found (all P > 0.05). Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated (all P < 0.01), except the latency of segment of 4 cm to 6 cm above elbow (P = 0.43), and the latency (P = 0.15) and the CMAP (P = 0.06) of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland–Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow (2 cm above the elbow and 2 cm below it), latency at elbow full extension and 70° flexion were strong direct associated (r = 0.83, P < 0.01; r = 0.55, P < 0.01), and so did the CMAP (r = 0.49, P < 0.01; r = 0.72, P < 0.01). There was no statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with

  17. Temporal muscle activation assessment by ultrasound imaging during flexor withdrawal reflex and voluntary contraction.

    PubMed

    Jose, Gomez-Tames; Shuto, Nakamura; Jose, Gonzalez; Wenwei, Yu

    2013-01-01

    Activating flexor reflexes by electrical stimulation has been used as a mechanism to initiate the swing phase or to enhance it for spinal cord injured patients. However, it is necessary to know their contraction dynamics in order to artificially induce them at the right moment of a walking cycle. This requires understanding the temporal activation pattern of both surface and deep muscles simultaneously. This study aimed at developing a system to measure and analyze the temporal activation of both surface and deep muscles during voluntary contraction and flexor reflexes (also called withdrawal reflexes) using ultrasound imaging. A set of experiments were done to verify the validity of the system, while exploring the temporal pattern of muscle activation during flexor reflexes. As a result, we were able to quantify the surface and deep muscle activity by measuring the muscle thickness, pennation angle and long-axis displacement, from the ultrasound images.

  18. Maximum isometric knee flexor and extensor muscle contractions: normal patterns of torque versus time.

    PubMed

    Murray, M P; Baldwin, J M; Gardner, G M; Sepic, S B; Downs, W J

    1977-06-01

    Isometric torque of the knee flexor and extensor muscles were recorded for 5 seconds at three knee joint positions. The subjects included healthy men in age groups from 20 to 35 and 45 to 65 years of age. The amplitudes and duration of peak torque and the time to peak torque were measured for each contraction. Peak torque was usually maintaned less than 0.1 second and never longer than 0.9 second. At each of the three angles, the mean extensor muscle torque was higher than the mean flexor muscle torque in both age groups, and the mean torque for both muscle group was higher among the younger than among the older man. The highest average torque was recorded at the knee angle of 60 degrees for the extensor muscles and 45 degrees for the flexor muscles, but this was not always a stereotyped response either for a given individual or among individuals.

  19. Modified flexor digitorum superficialis slip technique for A4 pulley reconstruction.

    PubMed

    Odobescu, A; Radu, A; Brutus, J-P; Gilardino, M S

    2010-07-01

    We describe a variation in the A4 pulley reconstruction technique using one slip of the flexor digitorum superficialis insertion and report the results of a biomechanical analysis of this reconstruction in cadavers. While conserving the distal bony insertion, one slip of flexor digitorum superficialis is transferred over the flexor digitorum profundus tendon and sutured to the contralateral superficialis slip insertion. This creates a new pulley at the base of the original A4 pulley that can be adjusted to accommodate an FDP repair of increased bulk. We found a 57% reduction in excess excursion due to bowstringing when compared with no repair. Furthermore the repairs were sturdy, 94% of specimens maintaining their integrity when a proximally directed force of 50 N was applied. PMID:20427405

  20. Effect of elbow position on radiographic measurements of radio-capitellar alignment

    PubMed Central

    Sandman, Emilie; Canet, Fanny; Petit, Yvan; Laflamme, G-Yves; Athwal, George S; Rouleau, Dominique M

    2016-01-01

    AIM: To evaluate the effect of different elbow and forearm positions on radiocapitellar alignment. METHODS: Fifty-one healthy volunteers were recruited and bilateral elbow radiographs were taken to form a radiologic database. Lateral elbow radiographs were taken with the elbow in five different positions: Maximal extension and forearm in neutral, maximal flexion and forearm in neutral, elbow at 90° and forearm in neutral, elbow at 90° and forearm in supination and elbow at 90° and forearm in pronation. A goniometer was used to verify the accuracy of the elbow’s position for the radiographs at a 90° angle. The radiocapitellar ratio (RCR) measurements were then taken on the collected radiographs using the SliceOmatic software. An orthopedic resident performed the radiographic measurements on the 102 elbows, for a total of 510 lateral elbow radiographic measures. ANOVA paired t-tests and Pearson coefficients were used to assess the differences and correlations between the RCR in each position. RESULTS: Mean RCR values were -2% ± 7% (maximal extension), -5% ± 9% (maximal flexion), and for elbow at 90° and forearm in neutral -2% ± 5%, supination 1% ± 6% and pronation 1% ± 5%. ANOVA analyses demonstrated significant differences between the RCR in different elbow and forearm positions. Paired t-tests confirmed significant differences between the RCR at maximal flexion and flexion at 90°, and maximal extension and flexion. The Pearson coefficient showed significant correlations between the RCR with the elbow at 90° - maximal flexion; the forearm in neutral-supination; the forearm in neutral-pronation. CONCLUSION: Overall, 95% of the RCR values are included in the normal range (obtained at 90° of flexion) and a value outside this range, in any position, should raise suspicion for instability. PMID:26925383

  1. The relationship of trigger finger and flexor tendon volar migration after carpal tunnel release.

    PubMed

    Lee, S K; Bae, K W; Choy, W S

    2014-09-01

    It has been suggested that the increased frequency of trigger finger (TF) after carpal tunnel release (CTR) may be caused by the volar migration of the flexor tendons at the wrist altering the tendon biomechanics at the A1 pulley. This hypothesis has not been validated. We performed pre- and post-operative ultrasonography (USG) on the affected wrists of 92 patients who underwent CTR. Pre-operative USG was performed in neutral with no tendon loading; post-operative USG was performed in neutral unloaded and in various positions of wrist flexion whilst loading the flexor tendons with gripping. The mean volar migration of the flexor tendons after CTR was 2.2 (SD 0.4) mm in the unloaded neutral position. It was 1.8 (SD 0.4) mm in patients who did not develop TF and 2.5 (SD 0.5) mm in those who did (p = 0.0067). In loaded wrist flexion, the mean volar migration of flexor tendons after CTR in patients who did not develop TF and those who did was 2.1 and 3.0 mm in 0° flexion; 3.2 and 3.9 mm in 15° flexion; 4.3 and 5.1 mm in 30° flexion; and 4.9 and 5.8 mm in 45° flexion, respectively. There were significant differences between patients with and without TF at each flexion angle. Our data indicate that patients with greater volar migration of the flexor tendons after CTR are more likely to develop TF. This conclusion supports the hypothesis that the occurrence of TF after CTR may be caused by the bowstringing effects of the flexor tendons.

  2. Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft.

    PubMed

    Jen, Chi Loong; Tan, James Chung Hui

    2016-01-01

    Neuropathic arthropathy of the elbow is a rare condition, which is disabling and difficult to treat. Initial treatment is conservative and arthrodesis is rarely indicated. We describe an unusual case of progressive unilateral elbow swelling in a 37-year-old female domestic helper. She was found to have neuropathic arthropathy of her right elbow secondary to underlying cervico-thoracic syringomyelia. She underwent decompression of the syringomyelia before underdoing elbow fusion. Her elbow was initially immobilized in a cast to minimize bony fragmentation and soft tissue swelling. Serial X-rays were performed with a regular change of cast as the swelling subsided. When there was no further radiological evidence of bony fragmentation, elbow fusion at 60° was performed using a two-plate technique at 7 months after the initial presentation. With well-preserved ipsilateral hand function, she was could still perform household chores despite having a fused elbow. Radiological evidence of successful elbow fusion was documented at 23 weeks after surgery. There were no complications. If elbow fusion is considered, we recommend a trial of immobilization in the preferred angle of fusion to assess the patient's suitability. Factors such as the young age of a patient and good quality bone may also contribute to the success of the fusion. PMID:27583001

  3. US of the elbow: indications, technique, normal anatomy, and pathologic conditions.

    PubMed

    Konin, Gabrielle P; Nazarian, Levon N; Walz, Daniel M

    2013-01-01

    The elbow, a synovial hinge joint, is a common site of disease. Ultrasonography (US) has become an important imaging modality for evaluating pathologic conditions of the elbow. This powerful imaging tool has the advantages of outstanding spatial resolution, clinical correlation with direct patient interaction, dynamic assessment of disease, and the ability to guide interventions. Unlike most other imaging modalities, US allows the contralateral elbow to be imaged simultaneously, providing an internal control and comparison with normal anatomy. A useful approach to US evaluation of the elbow is to divide it into four compartments: anterior, lateral, medial, and posterior. US of the elbow has varied clinical applications, including evaluation and treatment of lateral and medial epicondylitis, imaging of biceps and triceps musculotendinous injuries, evaluation of ulnar collateral ligament laxity, diagnosis of joint effusions and intraarticular bodies, and evaluation of peripheral nerves for neuropathy and subluxation. US can also be used to evaluate soft-tissue masses about the elbow. Knowledge of the normal US anatomy of the elbow, familiarity with the technique of elbow US, and awareness of the US appearances of common pathologic conditions of the elbow along with their potential treatment options will optimize radiologists' diagnostic assessment and improve patient care. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.334125059/-/DC1.

  4. Diagnosis and Treatment of Work-Related Ulnar Neuropathy at the Elbow.

    PubMed

    Carter, Gregory T; Weiss, Michael D; Friedman, Andrew S; Allan, Christopher H; Robinson, Larry

    2015-08-01

    Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome and occurs most commonly at the elbow due to mechanical forces that produce traction or ischemia to the nerve. The primary symptom associated with UNE is diminished sensation or dysesthesias in the fourth or fifth digits, often coupled with pain in the proximal medial aspect of the elbow. Treatment may be conservative or surgical, but optimal management remains controversial. Surgery should include exploration of the ulnar nerve throughout its course around the elbow and release of all compressive structures. PMID:26231962

  5. Lateral collateral ligament deficiency of the elbow joint: A modeling approach.

    PubMed

    Rahman, Munsur; Cil, Akin; Bogener, James W; Stylianou, Antonis P

    2016-09-01

    A computational model capable of predicting the effects of lateral collateral ligament deficiency of the elbow joint would be a valuable tool for surgical planning and prediction of the long-term consequences of ligament deficiency. The purpose of this study was to simulate lateral collateral ligament deficiency during passive flexion using a computational multibody elbow joint model and investigate the effects of ligament insufficiency on the kinematics, ligament loads, and articular contact characteristics (area, pressure). The elbow was placed initially at approximately 20° of flexion and a 345 mm vertical downward motion profile was applied over 40 s to the humerus head. The vertical displacement induced flexion from the initial position to a maximum flexion angle of 135°. The study included simulations for intact, radial collateral ligament deficient, lateral ulnar collateral ligament deficient, and combined radial and lateral ulnar collateral ligament deficient elbow. For each condition, relative bone kinematics, contact pressure, contact area, and intact ligament forces were predicted. Intact and isolated radial collateral ligament deficient elbow simulations were almost identical for all observed outcomes. Minor differences in kinematics, contact area and pressure were observed for the isolated lateral ulnar collateral ligament deficient elbow compared to the intact elbow, but no elbow dislocation was detected. However, sectioning both ligaments together induced substantial differences in kinematics, contact area, and contact pressure, and caused complete dislocation of the elbow joint. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1645-1655, 2016.

  6. Elbow joint disorders in relation to vibration exposure and age in stone quarry workers.

    PubMed

    Sakakibara, H; Suzuki, H; Momoi, Y; Yamada, S

    1993-01-01

    Elbow joint disorders were studied in relation to vibration exposure and age in 74 male stone quarry workers who operated mainly chipping hammers and sometimes rock drills. They were examined for range of active motion in elbow extension and flexion, and by means of radiographs of the elbow joint. Effects of age and vibratory tool operation on the elbow joint were statistically estimated using multiple regression analysis. In the analysis of all subjects, including those aged over 60 years, age was significantly related to the range of motion in extension and to radiographic changes in both elbows, and the duration of vibratory tool operation was associated with the range of right elbow flexion. Among subjects under the age of 60 years, duration of vibratory tool operation showed a significant dose-effect relationship to the range of flexion and radiographic changes in the right elbow, but there was no significant relationship with age. The present results suggest that the operation of chipping hammers and rock drills contributes to elbow joint disorders or osteoarthrosis, even when the effect of age is taken into account. Besides vibration exposure, it may be necessary to consider various loads on the elbow joint such as firmly grasping and pressing the tool against stones with the arm bent at about 90 degrees, and carrying stones.

  7. Snapping annular ligament of the elbow joint in the throwing arms of young brothers.

    PubMed

    Aoki, Mitsuhiro; Okamura, Kenji; Yamashita, Toshihiko

    2003-10-01

    We examined young brothers with symptomatic snapping elbow in the throwing arm. Arthroscopic examination confirmed the mechanism of snapping, in which loose and protruded annular ligament-like tissue covered the volar half of the radial head in elbow extension and uncovered the radial head in deep elbow flexion. Arthroscopic resection of the annular ligament-like tissue was performed in one brother. Histologic examination of the removed tissue showed degenerated ligament tissue. Excision of loose annular ligament abolished snapping. Contralateral elbows of the brothers also showed similar asymptomatic snapping. Researchers suggest that a hereditary factor contributing to loose annular ligament and repetitive microtrauma from throwing is the cause of symptoms.

  8. Zone 2 flexor tendon injuries: Venturing into the no man's land

    PubMed Central

    Kotwal, Prakash P; Ansari, Mohammed Tahir

    2012-01-01

    Flexor tendon injuries are seen commonly yet the management protocols are still widely debated. The advances in suture techniques, better understanding of the tendon morphology and its biomechanics have resulted in better outcomes. There has been a trend toward the active mobilization protocols with development of multistrand core suture techniques. Zone 2 injuries remain an enigma for the hand surgeons even today but the outcome results have definitely improved. Biomolecular modulation of tendon repair and tissue engineering are now the upcoming fields for future research. This review article focuses on the current concepts in the management of flexor tendon injuries in zone 2. PMID:23325961

  9. Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome.

    PubMed

    Winkes, Michiel B; Teijink, Joep A; Scheltinga, Marc R

    2016-01-01

    We discuss a case of a 26-year-old man, a motorcycle racer, who presented with progressive pain, weakness and swelling of his right forearm and loss of power in his index finger, experienced during motor racing. Chronic exertional compartment syndrome (CECS) of both flexor and extensor compartments of his forearm was diagnosed by dynamic intracompartmental muscle pressure measurements. After fasciotomies, all symptoms were resolved and the patient was able to improve on his preinjury racing skills, without any limitations. A literature review and a surgical 'how-to' for correct release of the extensor and deep flexor compartments of the forearm are provided. PMID:27080851

  10. Traumatic simultaneous rupture of both flexor tendons in a finger of an athlete.

    PubMed

    Tan, Virak; Mundanthanam, George; Weiland, Andrew J

    2005-10-01

    We report a case of traumatic simultaneous disruption of both finger flexor tendons in a professional athlete. The novelties in this report are (1) the location of the rupture (FDS at midsubstance and FDP at insertion) and (2) the proposition that a normal but diminutive FDS tendon is a contributing factor in the rupture. We recommend that simultaneous rupture of the normal flexor tendons be treated in a similar manner as tendon lacerations. Primary repair, if possible, is the treatment of choice in these acute injuries. Tendon grafting should be reserved for subacute or chronic cases in which restoration of active finger flexion is needed.

  11. Carpal tunnel syndrome caused by a giant cell tumour of the flexor tendon sheath.

    PubMed

    Meek, Marcel F; Sheikh, Zahid A; Quinton, David N

    2014-02-01

    A 76-year-old woman developed right carpal tunnel syndrome after being conservatively treated for tenosynovitis of the flexor tendons with associated mild carpal tunnel syndrome. A magnetic resonance imaging scan showed a tumour in the carpal tunnel. Re-exploration showed that the median nerve was being compressed by a giant cell tumour of the flexor tendon sheaths. Appropriate imaging is advised in patients with additional findings (such as swelling) or in patients with secondary carpal tunnel syndrome and incomplete response to conservative treatment, to exclude a space-occupying lesion.

  12. Endoscopic Loose Body Removal From Zone 2 Flexor Hallucis Longus Tendon Sheath.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Tenosynovial chondromatosis can occur in the flexor hallucis longus tendon sheath. Complete synovectomy and removal of the loose bodies comprise the treatment of choice. An open procedure requires extensive soft-tissue dissection because the flexor hallucis longus tendon is a deep structure except at the hallux. A tendoscopy approach to synovectomy and removal of loose bodies has the advantage of minimally invasive surgery. This technical note outlines pearls and pitfalls and provides a step-by-step guide to performing this procedure. PMID:27656363

  13. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation.

    PubMed

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-04-16

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved.

  14. Analysis of the gliding pattern of the canine flexor digitorum profundus tendon through the A2 pulley.

    PubMed

    Uchiyama, Shigeharu; Amadio, Peter C; Berglund, Lawrence J; An, Kai-Nan

    2008-01-01

    Friction between a tendon and its pulley was first quantified using the concept of the arc of contact. Studies of human tendons conformed closely to a theoretical nylon cable/nylon rod model. However, we observed differences in measured friction that depended on the direction of motion in the canine model. We hypothesized that fibrocartilaginous nodules in the tendon affected the measurements and attempted to develop a theoretical model to explain the observations we made. Two force transducers were connected to each end of the canine flexor digitorum profundus tendon and the forces were recorded when it was moved through the A2 pulley toward a direction of flexion by an actuator and then reversed a direction toward extension. The changes of a force as a function of tendon excursion were evaluated in 20 canine paws. A bead cable/rod model was developed to simulate the canine tendon-pulley complex. To interpret the results, a free-body diagram was developed. The two prominent fibrocartilaginous nodules in the tendon were found to be responsible for deviation from a theoretical nylon cable gliding around the rod model, in a fashion analogous to the effect of the patella on the quadriceps mechanism. A bead cable/rod model qualitatively reproduced the findings observed in the canine tendon-pulley complex. Frictional coefficient of the canine flexor tendon-pulley was 0.016+/-0.005. After accounting for the effect created by the geometry of two fibrocartilaginous nodules within the tendon, calculation of frictional force in the canine tendon was possible. PMID:18328488

  15. Computed tomographic identification of dysplasia and progression of osteoarthritis in dog elbows previously assigned OFA grades 0 and 1.

    PubMed

    Kunst, Chelsea M; Pease, Anthony P; Nelson, Nathan C; Habing, Greg; Ballegeer, Elizabeth A

    2014-01-01

    Elbow dysplasia is a heritable disease that is a common cause of lameness and progressive elbow osteoarthritis in young large breed dogs. The Orthopedic Foundation for Animals (OFA) screens elbow radiographs, and assigns grades 0-3 based on presence and severity of bony proliferation on the anconeal process. Grade 1 is assigned when less than 3 mm is present and considered positive for dysplasia. We investigated the incidence of elbow dysplasia and progression of osteoarthritis in elbows with grades 0 and 1 in 46 elbows screened at least 1 year previously, using CT as a gold standard and with the addition of CT absorptiometry. The incidence of dysplasia based on CT was 62% in grade 0, and 75% in grade 1 elbows, all of which had medial coronoid disease. Progressive osteoarthritis at recheck was consistent with elbow dysplasia. The sensitivity and specificity of the OFA grade for elbow dysplasia compared to CT findings was 75% and 38%, respectively. Increased bone mineral density of the medial coronoid process as characterized by osteoabsorptiometry warrants further investigation with respect to elbow dysplasia. Proliferation on the anconeal process without CT evidence of dysplasia or osteoarthritis was present in 20% of the elbows, and is theorized to be an anatomic variant or enthesopathy of the olecranon ligament/synovium. Results of our study suggest that the "anconeal bump" used for elbow screening by the OFA is a relatively insensitive characteristic, and support the use of CT for identifying additional characteristics of elbow dysplasia.

  16. The effect of knee joint angle on plantar flexor power in young and old men.

    PubMed

    Dalton, Brian H; Allen, Matti D; Power, Geoffrey A; Vandervoort, Anthony A; Rice, Charles L

    2014-04-01

    Human adult aging is associated with a loss of strength, contractile velocity and hence, power. The principal plantar flexors, consisting of the bi-articular gastrocnemeii and the mono-articular soleus, appear to be affected differently by the aging process. However, the age-related effect of knee joint angle on the torque-angular velocity relationship and power production of this functionally important muscle group is unknown. The purpose was to determine whether flexing the knee, thereby reducing the gastrocnemius contribution to plantar flexion, would exacerbate the age-related decrements in plantar flexion power, or shift the torque-angular velocity relationship differently in older compared with young men. Neuromuscular properties were recorded from 10 young (~25 y) and 10 old (~78 y) men with the knee extended (170°) and flexed (90°), in a randomized order. Participants performed maximal voluntary isometric contractions (MVCs), followed by maximal velocity-dependent shortening contractions at pre-set loads, ranging from 15 to 75% MVC. The young men were ~20-25% stronger, ~12% faster and ~30% more powerful than the old for both knee angles (P<0.05). In both age groups, isometric MVC torque was ~17% greater in the extended than flexed knee position, with no differences in voluntary activation (>95%). The young men produced 7-12% faster angular velocities in the extended knee position for loads ≤30% MVC, but no differences at higher loads; whereas there were no detectable differences in angular velocity between knee positions in the old across all relative loads. For both knee angles, young men produced peak power at 43.3±9.0% MVC, whereas the old men produced peak power at 54.8±7.9% MVC. These data indicate that the young, who have faster contracting muscles compared with the old, can rely more on velocity than torque for generating maximal power.

  17. 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

  18. Electromyographic analysis of elbow function in tennis players.

    PubMed

    Morris, M; Jobe, F W; Perry, J; Pink, M; Healy, B S

    1989-01-01

    Muscle activity about the elbow during tennis strokes in nine professional and collegiate level players was studied using indwelling EMG and high speed photography. Eight muscles were evaluated for the serve, forehand, and backhand strokes. The serve was divided into six stages and the ground strokes into four stages. EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity was obtained. Analysis of variance and Turkey tests were then done to assess statistical significance (P less than 0.05). The ground strokes showed low activity in all muscles tested during the preparation phase. During the acceleration phase, both the backhand and forehand showed a generalized increase in all muscle activity. Both strokes showed marked activity of the wrist extensors and, in addition, the forehand showed high activity in the brachialis and biceps. In the follow-through phase, there was a generalized decrease in muscle activity. The serve showed low activity in all muscles tested during the wind-up phase. The wrist extensors increased their activity in the cooking phase, with marked activity in late cooking. The pronator teres and the triceps showed increased activity in the acceleration phase. Follow-through phase showed low muscle activity except for the biceps, which increased in late follow-through. In conclusion, the muscles of the elbow help stabilize the elbow as a unit during the ground strokes in these high level players. Power in the serve comes from increased activity in the triceps and pronator teres. The predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury. PMID:2757127

  19. Electromyographic analysis of elbow function in tennis players.

    PubMed

    Morris, M; Jobe, F W; Perry, J; Pink, M; Healy, B S

    1989-01-01

    Muscle activity about the elbow during tennis strokes in nine professional and collegiate level players was studied using indwelling EMG and high speed photography. Eight muscles were evaluated for the serve, forehand, and backhand strokes. The serve was divided into six stages and the ground strokes into four stages. EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity was obtained. Analysis of variance and Turkey tests were then done to assess statistical significance (P less than 0.05). The ground strokes showed low activity in all muscles tested during the preparation phase. During the acceleration phase, both the backhand and forehand showed a generalized increase in all muscle activity. Both strokes showed marked activity of the wrist extensors and, in addition, the forehand showed high activity in the brachialis and biceps. In the follow-through phase, there was a generalized decrease in muscle activity. The serve showed low activity in all muscles tested during the wind-up phase. The wrist extensors increased their activity in the cooking phase, with marked activity in late cooking. The pronator teres and the triceps showed increased activity in the acceleration phase. Follow-through phase showed low muscle activity except for the biceps, which increased in late follow-through. In conclusion, the muscles of the elbow help stabilize the elbow as a unit during the ground strokes in these high level players. Power in the serve comes from increased activity in the triceps and pronator teres. The predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury.

  20. Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting

    PubMed Central

    Mon, Daniel; Zakynthinaki, María S.; Cordente, Carlos A.; Antón, Antonio J. Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López

    2015-01-01

    The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting. PMID:26121145

  1. EFFECT OF USING WRIST ORTHOSES ON FOREARM FLEXOR AND EXTENSOR MUSCLE ACTIVATION

    PubMed Central

    Novais Van Petten, Adriana Maria Valladão; Ávila, Antônio Ferreira

    2015-01-01

    Objective: To investigate the effect of using wrist immobilization orthoses made from different materials, on activation of the flexor and extensor musculature of the forearm while performing specific tasks. Methods: Twenty-six adults, with an average age of 26.2 years, underwent the Jebsen-Taylor functional hand test and the grip strength test (Jamar® dynamometer) under three conditions: free hand, wearing a composite orthosis and wearing a thermoplastic orthosis. The tests were carried out using the dominant hand only. During the tests, surface electrodes were attached to the flexor and extensor muscles of the forearm to record the muscle electrical activity. The results obtained under the three conditions were compared and analyzed using the Wilcoxon statistical test. Results: Significant differences in muscle activation were found between using the free hand and using any of the orthoses. There was no significant difference in muscle activation between the two types of orthosis. A decrease in activity of the extensor muscles of the forearm was observed during all the tasks, as well as an increase in activation of the flexor muscles with the use of the orthoses. Conclusion: These results are important for defining whether an orthosis should be prescribed during the rehabilitation process for a wide range of disorders, such as tendinitis of the flexors and extensors of the wrist and fingers, as well as for predicting the length of time for which these devices should be used. PMID:27022523

  2. Plantar flexor neuromuscular adjustments following match-play football in hot and cool conditions.

    PubMed

    Girard, O; Nybo, L; Mohr, M; Racinais, S

    2015-06-01

    We assessed neuromuscular fatigue and recovery of the plantar flexors after playing football with or without severe heat stress. Neuromuscular characteristics of the plantar flexors were assessed in 17 male players at baseline and ∼30 min, 24, and 48 h after two 90-min football matches in temperate (∼20 °C and 55% rH) and hot (∼43 °C and 20% rH) environments. Measurements included maximal voluntary strength, muscle activation, twitch contractile properties, and rate of torque development and soleus EMG (i.e., root mean square activity) rise from 0 to 30, -50, -100, and -200 ms during maximal isometric contractions for plantar flexors. Voluntary activation and peak twitch torque were equally reduced (-1.5% and -16.5%, respectively; P < 0.05) post-matches relative to baseline in both conditions, the latter persisting for at least 48 h, whereas strength losses (∼5%) were not significant. Absolute explosive force production declined (P < 0.05) 30 ms after contraction onset independently of condition, with no change at any other epochs. Globally, normalized rate of force development and soleus EMG activity rise values remained unchanged. In football, match-induced alterations in maximal and rapid torque production capacities of the plantar flexors are moderate and do not differ after competing in temperate and hot environments.

  3. Action of tizanidine on responses of forearm flexors and extensors to torque disturbances.

    PubMed Central

    Mackel, R; Brink, E E; Nakajima, Y

    1984-01-01

    The effects of tizanidine on the electromyographic responses of forearm flexors and extensors to torque disturbances were studied in normal subjects. Tizanidine had a strong depressive action on all the reflex responses, and on muscle background activity. It is concluded that the action on reflexes is not specific, but secondary to decreased spinal cord excitability. PMID:6502168

  4. Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running.

    PubMed

    Timmins, R G; Opar, D A; Williams, M D; Schache, A G; Dear, N M; Shield, A J

    2014-08-01

    The aim of this study was to determine whether declines in knee flexor strength following overground repeat sprints were related to changes in hamstrings myoelectrical activity. Seventeen recreationally active men completed maximal isokinetic concentric and eccentric knee flexor strength assessments at 180°/s before and after repeat sprint running. Myoelectrical activity of the biceps femoris (BF) and medial hamstrings (MHs) was measured during all isokinetic contractions. Repeated measures mixed model [fixed factors = time (pre- and post-repeat sprint) and leg (dominant and nondominant), random factor = participants] design was fitted with the restricted maximal likelihood method. Repeat sprint running resulted in significant declines in eccentric, and concentric, knee flexor strength (eccentric = 26 ± 4 Nm, 15% P < 0.001; concentric 11 ± 2 Nm, 10% P < 0.001). Eccentric BF myoelectrical activity was significantly reduced (10%; P = 0.035). Concentric BF and all MH myoelectrical activity were not altered. The declines in maximal eccentric torque were associated with the change in eccentric BF myoelectrical activity (P = 0.013). Following repeat sprint running, there were preferential declines in the myoelectrical activity of the BF, which explained declines in eccentric knee flexor strength.

  5. [Research on minimally invasive release treatment of stenosing tenosynovitis of flexor digitorum].

    PubMed

    Luo, Tao; Liu, Jing

    2013-05-01

    The minimally invasive release treatment of TCM Small Needle-Knife for the stenosing tenosynovitis of flexor digtorum-"trigger finger" has a more satisfied efficacy. In recent years, many clinicians use self-made small sharp scalpels, iris knives, small sickles, push shear knives, and other improved alternatives to instead of the traditional small needle-knives. Changing the original small needle-knife vertical stabbed cutting method, take a mini-incision, along the traveling direction of flexor tendon make a vertical hook cut, pick cut, straight push cut and any other cuts, completely cut the stenosis of the tendon sheath pulley, to achieve the release therapeutic purposes. The experience of most scholars is: Detailed and thorough understanding refers to the anatomical level of the flexor tendon and surrounding tissue, the structural relationship; Strictly adhere to the indications of minimally invasive release therapy; Proficiency in a dedicated minimally invasive release needle-knives, scalpels, and standardized methods of operation; Accurate positioning before surgery, in surgery traveling direction along flexor tendon, continuous incision to release the middle along the tendon. It can achieve the same or even higher incision release efficacy than the traditional treatment, at the same time also avoids common adverse complications. PMID:23937042

  6. Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting.

    PubMed

    Mon, Daniel; Zakynthinaki, María S; Cordente, Carlos A; Antón, Antonio J Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López

    2015-01-01

    The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting.

  7. Monosynaptic reflexes in the superficial forearm flexors in man and their clinical significance.

    PubMed

    Deschuytere, J; Rosselle, N; De Keyser, C

    1976-06-01

    Indirect motor responses with the characteristics of the H wave were recorded from the flexor carpi radialis and the palmaris longus muscles in normal adults. A series of experiments has been performed, constituting circumstantial arguments for the monosynaptic nature of these reflex responses. The findings in pathological conditions, which corroborated this point of view, are documented briefly.

  8. Flexor Digitorum Longus Tendon Transfer and Modified Kidner Technique in Posterior Tibial Tendon Dysfunction.

    PubMed

    Maskill, James T; Pomeroy, Gregory C

    2016-01-01

    The modified Kidner procedure and flexor digitorum longus tendon transfer are common procedures used today when addressing posterior tibial tendon dysfunction. These techniques are often used in conjunction with a combination of osteotomies to correct flatfoot deformity, and have been proved to be reliable and predictable. PMID:26590720

  9. Considerations in the surgical use of the flexor sheath and pulley system.

    PubMed

    Lowrie, A G; Lees, V C

    2014-01-01

    The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery. The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses. PMID:24170491

  10. Effect of flexor sheath integrity on tendon gliding: a biomechanical and histologic study.

    PubMed

    Peterson, W W; Manske, P R; Kain, C C; Lesker, P A

    1986-01-01

    The effect on tendon gliding of flexor sheath excision versus incision/closure following primary flexor tendon repair was examined biomechanically and histologically in forty-one chickens. There was no significant difference in either the tendon excursion required to fully flex the digit or in the work of flexion (the integration of the forces that resist tendon gliding during excursion) between the sheath excised and sheath closed groups. The results were unaffected by postoperative immobilization or intermittent passive motion. Histologically, it was noted that at 3 weeks the healing tendon was surrounded by a layer of granulation tissue that was nearly identical in both the sheath excised and the sheath closed digits. Of note was the finding that a synovial lining could not be identified in those digits that had previously undergone sheath closure. However, at 6 weeks postoperatively, a new gliding surface could be identified surrounding the tendon in both the sheath excised and the sheath closed digits. This study indicates that closure of the flexor sheath after primary tendon repair does not improve tendon gliding as measured biomechanically. Despite its repair, the flexor sheath does not maintain its synovial characteristics as demonstrated histologically, and a new sheath must subsequently be formed.

  11. Recovery Kinetics of Knee Flexor and Extensor Strength after a Football Match

    PubMed Central

    Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C.; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K.; Douroudos, Ioannis I.; Margonis, Konstantinos; Gioftsidou, Asimenia; Fouris, Andreas D.; Jamurtas, Athanasios Z.; Koutedakis, Yiannis; Fatouros, Ioannis G.

    2015-01-01

    We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12h, 36h and 60h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12h, 36h and 60h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12h (both limbs) and 36h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36h at 60°/s and for 60h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical

  12. Recovery kinetics of knee flexor and extensor strength after a football match.

    PubMed

    Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K; Douroudos, Ioannis I; Margonis, Konstantinos; Gioftsidou, Asimenia; Flouris, Andreas D; Fouris, Andreas D; Jamurtas, Athanasios Z; Koutedakis, Yiannis; Fatouros, Ioannis G

    2015-01-01

    We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12 h, 36 h and 60 h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12 h, 36 h and 60 h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60 h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12 h (both limbs) and 36 h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36 h at 60°/s and for 60 h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players

  13. Conservative management of the post-traumatic stiff elbow: a physiotherapist’s perspective

    PubMed Central

    2016-01-01

    Elbow stiffness is a common consequence following trauma with the management of this condition posing a challenge to therapists and surgeons alike. This paper discusses the role of conservative treatment, such as exercise and splinting, in the prevention and management of the stiff elbow, along with a review of available evidence, to justify their usage. PMID:27583012

  14. 21 CFR 888.3150 - Elbow joint metal/polymer 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 constrained cemented prosthesis. 888.3150 Section 888.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer constrained cemented prosthesis. (a) Identification. An elbow joint...

  15. 21 CFR 888.3150 - Elbow joint metal/polymer 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 constrained cemented prosthesis. 888.3150 Section 888.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer constrained cemented prosthesis. (a) Identification. An elbow joint...

  16. 21 CFR 888.3150 - Elbow joint metal/polymer 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 constrained cemented prosthesis. 888.3150 Section 888.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer constrained cemented prosthesis. (a) Identification. An elbow joint...

  17. Elbow moment and forces at the hands during swing-through axillary crutch gait.

    PubMed

    Reisman, M; Burdett, R G; Simon, S R; Norkin, C

    1985-05-01

    We investigated swing-through axillary crutch gait (nonweight bearing on the left lower extremity) to determine the effects of gait speed, crutch length, and handle position on the forces exerted at the hands and on the moments exerted about the elbow joints. Ten healthy subjects, skilled in swing-through crutch gait, walked at three speeds using fitted crutches, at a fixed speed with four different crutch lengths, and at a fixed speed with four different handle positions. We collected ground reaction forces that exerted simultaneously on the right crutch and motion data with a force plate and three high-speed movie cameras. A biomechanical model was developed to calculate the forces exerted at the right hand and the moments exerted about the right elbow joint. Changing gait speed from slow to the normal gait of the subject showed statistically significant effects (p less than .05) on the forces at the hand. When we changed crutch heights for the subjects, we found no significant effects on the forces at the subjects' hands. Changing handle position significantly affected the moment at the elbow. Increasing the elbow-flexion angle above 30 degrees by raising the crutch handle 1 to 2 in resulted in a 100 percent increase in elbow-extension moment. We found a correlation of .82 between actual average elbow-flexion angle and elbow-extension moment. Changing gait speed or crutch length did not affect elbow moment.

  18. Fracture behavior of circumferentially surface-cracked elbows. Technical report, October 1993--March 1996

    SciTech Connect

    Kilinski, T.; Mohan, R.; Rudland, D.; Fleming, M.

    1996-12-01

    This report presents the results from Task 2 of the Second International Piping Integrity Research Group (IPIRG-2) program. The focus of the Task 2 work was directed towards furthering the understanding of the fracture behavior of long-radius elbows. This was accomplished through a combined analytical and experimental program. J-estimation schemes were developed for both axial and circumferential surface cracks in elbows. Large-scale, quasi-static and dynamic, pipe-system, elbow fracture experiments under combined pressure and bending loads were performed on elbows containing an internal surface crack at the extrados. In conjunction with the elbow experiments, material property data were developed for the A106-90 carbon steel and WP304L stainless steel elbow materials investigated. A comparison of the experimental data with the maximum stress predictions using existing straight pipe fracture prediction analysis methods, and elbow fracture prediction methods developed in this program was performed. This analysis was directed at addressing the concerns regarding the validity of using analysis predictions developed for straight pipe to predict the fracture stresses of cracked elbows. Finally, a simplified fitting flaw acceptance criteria incorporating ASME B2 stress indices and straight pipe, circumferential-crack analysis was developed.

  19. 21 CFR 888.3150 - Elbow joint metal/polymer 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 constrained cemented prosthesis. 888.3150 Section 888.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer constrained cemented prosthesis. (a) Identification. An elbow joint...

  20. 21 CFR 888.3150 - Elbow joint metal/polymer 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 constrained cemented prosthesis. 888.3150 Section 888.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer constrained cemented prosthesis. (a) Identification. An elbow joint...

  1. 78 FR 41290 - Establishment of Class E Airspace; Elbow Lake, MN

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-10

    ... establish Class E airspace at Elbow Lake Municipal--Pride of the Prairie Airport, Elbow Lake, MN (78 FR... 12866; (2) is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR 11034... read as follows: Authority: 49 U.S.C. 106(g), 40103, 40113, 40120; E. O. 10854, 24 FR 9565, 3 CFR,...

  2. Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow

    PubMed Central

    Shamsoddini, Alireza; Hollisaz, Mohammad Taghi

    2013-01-01

    Background Tennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow. Objectives This study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow. Patients and Methods Thirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively. Results Among the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001. Conclusions The taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients. PMID:24350156

  3. Treatment of severe osteochondritis dissecans of the elbow using osteochondral grafts from a rib.

    PubMed

    Oka, Y; Ikeda, M

    2001-07-01

    We treated a patient with extensive osteochondritis dissecans of the elbow by an osteochondral graft from a rib. It had consolidated seven months after operation. When seen at follow-up, after seven years and eight months, the elbow was free from pain with an improvement in the range of movement of 24 degrees.

  4. Cortical voluntary activation of the human knee extensors can be reliably estimated using transcranial magnetic stimulation.

    PubMed

    Sidhu, Simranjit K; Bentley, David J; Carroll, Timothy J

    2009-02-01

    The objective of this study was to determine if a transcranial magnetic stimulation (TMS) method of quantifying the degree to which the motor cortex drives the muscles during voluntary efforts can be reliably applied to the human knee extensors. Although the technique for estimating "cortical" voluntary activation (VA) is valid and reliable for elbow flexors and wrist extensors, evidence that it can be applied to muscles of the lower limb is necessary if twitch interpolation with TMS is to be widely used in research or clinical practice. Eight subjects completed two identical test sessions involving brief isometric knee extensions at forces ranging from rest to maximal voluntary contraction (MVC). Electromyographic (EMG) responses to TMS of the motor cortex and electrical stimulation of the femoral nerve were recorded from the rectus femoris (RF) and biceps femoris (BF) muscles, and knee extension twitch forces evoked by stimulation were measured. The amplitude of TMS-evoked twitch forces decreased linearly between 25% and 100% MVC (r(2) > 0.9), and produced reliable estimations of resting twitch and VA (ICC(2,1) > 0.85). The reliability and size of cortical measures of VA were comparable to those derived from motor nerve stimulation when the resting twitches were estimated on the basis of as few as three TMS trials. Thus, TMS measures of VA may provide a reliable and valid tool in studies investigating central fatigue due to exercise and neurological deficits in neural drive in the lower limbs. PMID:19034956

  5. Effects of the optimal flexor/extensor ratio on G-tolerance

    PubMed Central

    Park, Jung Sub; Choi, Jean; Kim, Jung Woon; Jeon, Sang Yun; Kang, Sunghwun

    2016-01-01

    [Purpose] The aim of this study was to examine the flexor/extensor ratio of the knee joints and compare it with the results of Korean Air Force students in G-tolerance test. [Subjects and Methods] The body composition of Korea Air Force students (n=77) was measured by an impedance method. A muscular function test was performed using a Humac Norm (USA) at angular speeds of 60°/sec and 240°/sec and an isokinetic muscular function test was also conducted. [Results] In the failed C and passing groups, muscle mass and fat percentages were significantly higher than those of students in the failed A group. The BMI of the failed C and passing groups were significantly higher than that of the failed A group. The group that passed had a significantly higher value of left knee 60°/sec flexion peak torque than the failed B group. Moreover, the total work of left knee extension of the failed C group and the passing group was significantly higher than that of the failed A group. The C group and the passing group had significantly higher values of the trunk 60°/sec flexor/extensor ratio than the failed A group, and the total work flexor/extensor ratio of the passing group was significantly higher than that of the failed A group. [Conclusions] Based on these results, balance the right and left knee flexor/extensor ratio, and a high flexor/extensor ratio of the trunk are required to endure a high G-tolerance test (+6G/30 sec). Moreover, an improvement in the maximum muscular strength is necessary to endure a situation of rapidly increasing acceleration in the early stage. PMID:27799715

  6. Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

    PubMed

    Hernández-Cortés, P; Caba, M; Gómez-Sánchez, R; Gómez-Morales, M

    2011-11-09

    The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.

  7. Quality and Quantity of the Elbow Arthroscopy Literature: A Systematic Review and Meta-Analysis.

    PubMed

    Erickson, Brandon J; Chalmers, Peter N; Cvetanovich, Gregory L; Frank, Rachel M; Romeo, Anthony A; Harris, Joshua D

    2016-01-01

    The purpose of this article is to perform a systematic review and meta-analysis of elbow arthroscopy literature to answer the following questions: "Across the world, what demographic of patients are undergoing elbow arthroscopy, what are the most common indications for elbow arthroscopy, and how good is the evidence?" The authors hypothesized that patients who undergo elbow arthroscopy will be chiefly age <40 years, the most common indication for elbow arthroscopy will be a release/débridement, and the evidence regarding elbow arthroscopy will be poor. Also, no significant differences will exist in elbow arthroscopy publications, subjects, outcomes, and techniques based on continent/country of publication. A systematic review was registered with the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) and performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using 3 publicly available databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using 1-way analysis of variance (ANOVA) to compare between continents and Pearson's correlation coefficients to evaluate changes over time. In total, 112 studies were included (3093 subjects; 3168 elbows; 64% male; mean 34.9 ± 14.68 years. Mean 33.4 ± 26.02 months follow-up. Most studies were level IV evidence (94.6%) and had a low Modified Coleman Methodology Score (MCMS) (mean 28.1 ± 8.06). From 1985 through 2013, the number of publications significantly increased with time (P = .004) in all continents. The 3 most common indications for elbow arthroscopy were osteochondritis dissecans (OCD), lateral epicondylitis, and release and débridement. The number of reported cases for the 3 most common indications significantly

  8. Static progressive versus three-point elbow extension splinting: a mathematical analysis.

    PubMed

    Chinchalkar, Shrikant J; Pearce, Joshua; Athwal, George S

    2009-01-01

    Elbow joint contractures are often treated by using static progressive, dynamic, turnbuckle, or serial static splinting. These splint designs are effective in regaining functional elbow range of motion due to the high forces applied to the contracted tissues; however, regaining terminal elbow extension remains a challenge. Static progressive splints are commonly used to initiate treatment, however, are considered less effective in regaining terminal extension. Recently, the concept of converting a static progressive splint into a three-point static progressive splint (TPSPS) to regain terminal extension has been introduced. This paper mathematically analyzes the compressive and rotational forces in static progressive and TPSPSs. Our hypothesis was that three-point static progressive splinting was superior to the standard static progressive elbow extension splint in applying rotational forces to the elbow at terminal extension.

  9. Simplified inelastic analysis procedure to evaluate a butt-welded elbow end

    SciTech Connect

    Dhalla, A.K.

    1981-01-01

    In a thin-walled piping network, the end of an elbow welded to a straignt pipe constitutes one of the highly stressed cross-sections that require structural evaluation. Explicit rules are not provided in the ASME Code for structural evaluation of the elbow ovalization and fabrication effects at the welded end. This paper presents a conservative semi-analytical procedure that can be used with simplified inelastic analysis to evaluate the elbow cross section welded to the straight pipe. The concept of carry-over factors is used to obtain ovalization stresses or strains at the elbow end. The stresses introduced by material and geometric nonuniformities in the fabrication process are then added to the ovalization stresses to complete structural evluation of the girth butt-welded elbow joint.

  10. Recovery of elbow function in voluntary positioning of the hand following hemiplegia due to stroke.

    PubMed Central

    Wing, A M; Lough, S; Turton, A; Fraser, C; Jenner, J R

    1990-01-01

    Elbow movement during voluntary positioning of the hand (with the arm supported against gravity) is described in a longitudinal study of five patients recovering from hemiplegia due to stroke. Over a twelve month period, four of the patients improved their speed of movement, three exhibiting slightly better recovery of elbow extension, one of flexion. In some instances co-contraction of the elbow agonist and antagonist (measured just before the onset of movement) decreased with time after stroke. The effects of contrasting movements at the shoulder on elbow movement were also studied. Estimates of recovery were generally similar whether patients kept the shoulder still or made movements that were synergic or counter-synergic to those of the elbow. PMID:2313299

  11. Pollical oblique ligament in humans and non-human primates.

    PubMed

    Shrewsbury, Marvin

    2003-04-01

    A morphological study of the oblique ligament in the thumb is presented. The ligament was consistently described in human specimens and compared with dissections of non-human primates from different species. The oblique ligament was found in some, but not all, specimens in each of the following species examined: chimpanzee, orangutan, gibbon, anubis baboon, hamadryas baboon, squirrel monkey, lemur and marmoset. A revised identity of the oblique ligament is proposed as a reinforced distal border of a fibro-osseous annular pollical flexor sheath and whose function is not independent of the flexor sheath. The constant presence and tendinous trait of the pollical oblique ligament in humans, when compared with non-human primates, supports the notion that the oblique ligament strengthens the pollical flexor sheath in humans for restraint of the flexor pollicis longus tendon during forceful precision pinching. A derivation of the pollical oblique ligament is considered as representing a vestigial radial limb of a flexor pollicis superficialis tendon in the thumb.

  12. Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger

    PubMed Central

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo

    2016-01-01

    Objective: This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). Method: A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. Results: In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. Conclusion: The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering. PMID:27099639

  13. Outcome of elbow surgery in professional baseball players.

    PubMed

    Andrews, J R; Timmerman, L A

    1995-01-01

    We reviewed the records of 72 professional baseball players who underwent arthroscopic or open elbow surgery. The most common diagnoses were posteromedial olecranon osteophyte (65%), ulnar collateral ligament injury (25%), and ulnar neuritis (15%). Intraarticular loose bodies were found in 39% of the patients. Fifty-nine patients (82%) were observed for a minimum of 24 months, with an average of 42 months' followup. Forty-seven players (80%) returned to play for a minimum of one season (73% at the same or higher level of play), and 17% of the players retired initially because of their elbow injury. One third of the players required two or more surgical procedures, with 25% of these patients requiring an ulnar collateral ligament reconstruction after removal of a posteromedial olecranon osteophyte. The patients with posteromedial olecranon osteophytes had the highest rate of reoperation, and patients who underwent ulnar collateral ligament reconstruction had a higher rate of return to play. The incidence of ulnar collateral ligament injuries was most likely underestimated in this group of athletes, with initial treatment directed at the secondary injuries instead of the primary ulnar collateral ligament injury.

  14. Assessment of elbow extensors endurance in young athletes.

    PubMed

    Popadic Gacesa, J Z; Nedeljkovic, A; Ponorac, N; Krulanovic, R; Grujic, N G

    2012-12-01

    The aim of this study was to compare different endurance parameters of elbow extensors between senior and junior athletes. A group of 23 junior (16.2 ± 0.8 years, BMI 21.8 ± 2.9 kg/m(2)) and 16 senior athletes (23.1 ± 6.2 y, BMI 23.6 ± 4.2 kg/m(2)) volunteered for the study. Strength measurements were performed on the isoacceleration dynamometer (5 sets of 10 maximal elbow extensions, 1 min resting period between each set). The following strength parameters were measured: maximal strength (MS), endurance strength (ES), fatigue rate (FR) and decrease in strength (DS). Both arms triceps brachii muscle mass (MM) was calculated using a series of cross-sectional images of upper arms obtained by the MRI. Triceps brachii muscle mass for both arms in senior athletes showed significantly higher values (1286.9 ± 323.7 g) compared to young athletes (948.9 ± 171.1 g, p<0.01). ES was 50% higher in seniors, while FR was 10% higher in juniors. MS was 35% higher in seniors, but no difference was discovered when this parameter was expressed in relation to muscle mass. DS was significantly different between juniors and seniors, except in absolute values. No significant correlation was found between triceps brachii muscle mass and FR or DS. Different values of strength decrease throughout multiple contractions could be attributed to different characteristics of various sports.

  15. RESULTS FROM BI-CONTACT® TOTAL ELBOW ARTHROPLASTY: MULTICENTER STUDY

    PubMed Central

    Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; de Sousa, Augusto Tadeu Barros; Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Ikemoto, Roberto Yukio; Murachovsky, Joel; Matsumoto, Marcelo Hide; Tamaoki, Marcel Jun Sugawara; Neto, Arnaldo Amado Ferreira

    2015-01-01

    Objective: To describe the initial experience of four orthopedic clinics from using Bi-Contact® total elbow arthroplasty (TEA), reporting the results and complications of the procedure. Methods: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. Results: The majority of the patients were female (74%), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83%), rheumatoid arthritis (32.61%), primary osteoarthrosis (8.7%), acute fractures (6.52%) and heterotopic ossification (2.17%). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57% of the cases, and the main ones were infection (28.26%), need for revision (28.26%), intraoperative fracture (15.22%) and aseptic loosening (15.22%). Conclusion: Bi-Contact® TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture. PMID:27027055

  16. Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature

    PubMed Central

    Chin, Brian; Cheung, Kevin; Farhangkhoee, Hana; Thoma, Achilleas

    2015-01-01

    Proliferative flexor tenosynovitis of the hand is an inflammatory process involving the synovial sheaths surrounding the tendons. It is most commonly caused by infection, but may also be caused by overuse, diabetes and rheumatic conditions such as rheumatoid arthritis and crystal arthropathies. The present report describes two patients with severe proliferative tenosynovitis, who developed a fistula between the tendon sheath and skin after instrumentation, resulting in persistent synovial drainage. After failing conservative management, both patients were managed with extensive flexor tenosynovectomy to prevent inoculation of bacteria into the flexor sheath. The presentation, management and outcome of each case is described in addition to a discussion of the literature on tenosynovial fistulas. PMID:26090353

  17. Ulnar Collateral Ligament Reconstruction of the Elbow: The Docking Technique.

    PubMed

    Camp, Christopher L; Dines, Joshua S; Voleti, Pramod B; James, Evan W; Altchek, David W

    2016-06-01

    Reconstruction of the ulnar collateral ligament (UCL) is one of the most commonly performed surgical procedures in overhead throwing athletes. Since its initial description, the procedure has undergone a number of technical modifications and advancements. This has resulted in multiple described techniques for UCL reconstruction. One of the most commonly performed UCL reconstruction methods is the docking technique. It has the advantages of minimizing injury to the flexor-pronator mass, avoiding the ulnar nerve, allowing robust graft tensioning, and reducing the amount of bone removed from the medial epicondyle compared with previously described techniques. This article provides a detailed description and video demonstration of how to perform this technique. When precise surgical steps are followed and postoperative rehabilitation appropriately progresses, this procedure has a well-documented history of reliably returning athletes to competitive throwing. PMID:27656372

  18. Ulnar Collateral Ligament Reconstruction of the Elbow: The Docking Technique.

    PubMed

    Camp, Christopher L; Dines, Joshua S; Voleti, Pramod B; James, Evan W; Altchek, David W

    2016-06-01

    Reconstruction of the ulnar collateral ligament (UCL) is one of the most commonly performed surgical procedures in overhead throwing athletes. Since its initial description, the procedure has undergone a number of technical modifications and advancements. This has resulted in multiple described techniques for UCL reconstruction. One of the most commonly performed UCL reconstruction methods is the docking technique. It has the advantages of minimizing injury to the flexor-pronator mass, avoiding the ulnar nerve, allowing robust graft tensioning, and reducing the amount of bone removed from the medial epicondyle compared with previously described techniques. This article provides a detailed description and video demonstration of how to perform this technique. When precise surgical steps are followed and postoperative rehabilitation appropriately progresses, this procedure has a well-documented history of reliably returning athletes to competitive throwing.

  19. The role of shoulder maximum external rotation during throwing for elbow injury prevention in baseball players.

    PubMed

    Miyashita, Koji; Urabe, Yukio; Kobayashi, Hirokazu; Yokoe, Kiyoshi; Koshida, Sentaro; Kawamura, Morio; Ida, Kunio

    2008-01-01

    The objective of the present study was to examine whether the passive range of shoulder external rotation (ER), the maximum shoulder external rotation angle (MER) during throwing, and the ratio of MER to ER are related to the incidence of the elbow injury. A mixed design with one between-factor (a history of the elbow injury) and two within-factors (ER and MER) was used to analyze the difference between baseball players with and without a history of medial elbow pain. Twenty high school baseball players who had experienced the medial elbow pain within the previous month but who were not experiencing the pain on the day of the experiment were recruited (elbow-injured group). Another twenty baseball players who had never experienced the medial elbow pain were also used for testing (control group). MER during throwing, ER, and the ratio of MER to ER were obtained in both of the group. A Mann-Whitney test was used for the group comparison (p < 0.05). The ratio of MER to ER was significantly greater in the elbow-injured group (1.52 ± 0.19) than that in the control group (1.33 ± 0.23) (p = 0.008). On the other hand, there was no statistical significance in MER and ER between two groups. The findings of the study indicate that MER/ER relation could be associated with the incidence of the elbow injury in baseball players. Key pointsIt is accepted that the greatest elbow valgus stress appears at the position of shoulder maximum external rotation (MER) in the acceleration phase of the throwing movement. As a consequence, shoulders with restricted range of motion of external rotation (ER) compensate with a valgus stress on their elbow joints.In this study, we evaluated the relation between MER and ER of shoulder in players with/without elbow injuries.The result of this study demonstrated that the elbow injured group showed significantly greater MER/ER relation than the control group.The current finding suggests that great MER combined with the ROM restriction may be one of

  20. 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

  1. A rare cause of chronic elbow pain in an adolescent baseball player: a case report

    PubMed Central

    Wasylynko, David

    2016-01-01

    Objective: To present a case of chronic elbow pain as a result of a hidden underlying osteochondral defect. Clinical Features: A 17-year old baseball player presented with chronic lateral elbow pain. Examination revealed swelling of the elbow with signs of possible ligament, muscle, and tendon injury. Diagnosis and Treatment: Although there was apparent soft-tissue injury, the elbow swelling created immediate suspicion of a more serious underlying condition. Examination revealed a swollen and tender elbow, with plain x-ray confirming a subchondral bone disorder (osteochondral defect) of the capitellum. Surgical repair was performed by an orthopedic surgeon using DeNovo NT Natural Tissue Grafts: the implantation of small pieces of juvenile joint cartilage into the affected area, using glue-like fibrin. Rehabilitation of the elbow began immediately following surgery. Summary: Examination and imaging indicated that elbow pain in an adolescent baseball player could be from multiple sources, however, the chronic swelling raised suspicion of a condition requiring immediate and further investigation. PMID:27713578

  2. Radiographic determinants of the elbow rotation axis: experimental identification and quantitative validation.

    PubMed

    Bottlang, M; O'Rourke, M R; Madey, S M; Steyers, C M; Marsh, J L; Brown, T D

    2000-09-01

    This study identifies new radiographic indices to approximate the location of the elbow rotational axis. With use of electromagnetic motion tracking source data, the average rotational axis of the ulnohumeral articulation was calculated in seven cadaveric specimens. Quasi-lateral radiographs of the elbow specimens were then analyzed to identify radiographic landmarks of the elbow axis in the lateral view. The spatial relationships of these landmarks with the elbow aligned on-axis were contrasted with their relationships in eight distinct off-axis alignments. Elbow axis orientation in the transverse plane (internal/external rotation) was identified by the location of a dense intramedullary cortical line, appearing in the projection of the distal humerus in relation to the periosteal surface of the posterior cortex of the humerus. This intramedullary line corresponds to the posteromedial cortex of the distal humerus. Correct alignment occurred when this line laid 27.1+/-3.7% of the anteroposterior humeral diameter anterior from the periosteal surface of the posterior cortex. Axis orientation in the coronal plane (abduction/adduction) was identified by the concentric appearance of radiographic arcs formed by the capitellum, trochlear sulcus, and medial trochlear flange. Using these radiographic indices, three orthopaedic surgeons were able to fluoroscopically align the elbow along the axis of rotation with an accuracy of 3.7+/-1.8 degrees. These results are immediately applicable to fluoroscopic identification of the elbow axis. This technique can be used to increase the accuracy of hinge placement during application of hinged external fixation or distraction arthroplasty.

  3. STIFF ELBOW TREATMENT BY INTERPOSING ARTHROPLASTY ASSOCIATED TO HINGED EXTERNAL FIXATOR

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; Silva, Luciana Andrade da; Junior, Nelson Gennaro; Checchia, Sergio Luiz

    2015-01-01

    Objective: Assess the results of the elbow/fascia lata interposing arthroplasty technique associated to the use of a hinged external fixator in the treatment of stiff elbow. Methods: Between 2001 and 2006, five cases of stiff elbow were operated and followed up by the Shoulder and Elbow Group of the Santa Casa Misericórdia de São Paulo Medical Sciences School, establishing the following as inclusion criteria: patients with below-functional elbow range of motion associated to degeneration on that joint, for whom total prosthesis had not been indicated. Patients' ages ranged from 21 to 55 years (mean: 38). Male gender was prevalent (four cases), and, in all cases, the dominant side was operated. Concerning etiology, two cases of infectious arthritis sequels, one post-trauma sequel, and two rheumatoid arthritis were found. Preoperative range of motion ranged from 20° to 30° of flexion-extension; in two cases, fixed contracture existed in flexion at 30° and 65°. The patients were assessed according to Bruce-modified AMA criteria. Results: The mean follow up time was 54 months. All patients showed improvement of the Bruce index, which, preoperatively, was 43.5, increasing to 88.2 postoperatively. We found two excellent cases, one good, one fair, and one poor. Conclusion: Fascia lata interposing arthroplasty associated to the use of a dynamic external fixator on stiff elbows is a feasible alternative for patients not indicated to total elbow arthroplasty. PMID:27022516

  4. The influence of elbow joint kinematics on wrist speed in cricket fast bowling.

    PubMed

    Middleton, Kane Jytte; Alderson, Jacqueline Anne; Elliott, Bruce Clifford; Mills, Peter Michael

    2015-01-01

    This modelling study sought to describe the relationships between elbow joint kinematics and wrist joint linear velocity in cricket fast bowlers, and to assess the sensitivity of wrist velocity to systematic manipulations of empirical joint kinematic profiles. A 12-camera Vicon motion analysis system operating at 250 Hz recorded the bowling actions of 12 high performance fast bowlers. Empirical elbow joint kinematic data were entered into a cricket bowling specific "Forward Kinematic Model" and then subsequently underwent fixed angle, angular offset and angle amplification manipulations. A combination of 20° flexion and 20° abduction at the elbow was shown to maximise wrist velocity within the experimental limits. An increased elbow flexion offset manipulation elicited an increase in wrist velocity. Amplification of elbow joint flexion-extension angular displacement indicated that, contrary to previous research, elbow extension range of motion and angular velocity at the time of ball release were negatively related to wrist velocity. Some relationships between manipulated joint angular waveforms and wrist velocity were non-linear, supporting the use of a model that accounts for the non-linear relationships between execution and outcome variables in assessing the relationships between elbow joint kinematics and wrist joint velocity in cricket fast bowlers.

  5. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals.

    PubMed

    Kearns, Gary; Wang, Sharon

    2012-05-01

    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.

  6. Independent effects of weight and mass on plantar flexor activity during walking: implications for their contributions to body support and forward propulsion

    PubMed Central

    McGowan, C. P.; Neptune, R. R.; Kram, R.

    2008-01-01

    The ankle plantar flexor muscles, gastrocnemius (Gas) and soleus (Sol), have been shown to play important roles in providing body support and forward propulsion during human walking. However, there has been disagreement about the relative contributions of Gas and Sol to these functional tasks. In this study, using independent manipulations of body weight and body mass, we examined the relative contribution of the individual plantar flexors to support and propulsion. We hypothesized that Gas and Sol contribute to body support, whereas Sol is the primary contributor to forward trunk propulsion. We tested this hypothesis by measuring muscle activity while experimentally manipulating body weight and mass by 1) decreasing body weight using a weight support system, 2) increasing body mass alone using a combination of equal added trunk load and weight support, and 3) increasing trunk loads (increasing body weight and mass). The rationale for this study was that muscles that provide body support would be sensitive to changes in body weight, whereas muscles that provide forward propulsion would be sensitive to changes in body mass. Gas activity increased with added loads and decreased with weight support but showed only a small increase relative to control trials when mass alone was increased. Sol activity showed a similar increase with added loads and with added mass alone and decreased in early stance with weight support. Therefore, we accepted the hypothesis that Sol and Gas contribute to body support, whereas Sol is the primary contributor to forward trunk propulsion. PMID:18556431

  7. Progression of Heterotopic Ossification around the Elbow after Trauma

    PubMed Central

    ter Meulen, Dirk P.; Nota, Sjoerd P.F.T.; Hageman, Michiel G.J.S.; Ring, David C.

    2016-01-01

    Background: This study addresses the null hypothesis that there is no expansion of heterotopic ossification (HO) in the elbow beyond what can be seen early on. Methods: The area of HO was measured on lateral radiographs of 38 consecutive patients that had operative treatment of HO between 2000 and 2013. Measurements from radiographs obtained between 3 to 7 weeks were compared to measurements from radiographs made 3 months or more after injury. Results: There was no significant difference between the average area of HO on the first (median 2.8 square centimeters, Q1: 1.5, Q3: 5.1) and later radiographs (median of 2.8 square centimeters, Q1: 1.4, Q3: 5.0) (P = 0.99). Conclusion: According to our results the area of HO does not expand beyond what can be seen early in the disease process. PMID:27517067

  8. 3D modeling and raytracing in RPV elbows and nozzles

    SciTech Connect

    Koshy, M.; Isenberg, J.

    1995-12-31

    Three dimensional geometric modeling and ray tracing are used to develop ultrasound inspection procedures for nozzles safe ends and elbows in nuclear reactor pressure vessels and other structures containing cracks or voids. B-spline and analytic conic sections are used to generate 3D outer surfaces and interfaces between regions of contrasting impedance. Voids representing flaws are implanted in the inspection volume. Ray tracing in comer trap or normal incidence is performed to evaluate coverage in pulse-echo or pitch-catch mode. In one scenario, the coverage obtained from search units is designed to achieve the required degree of coverage. Physical experiments have been conducted in which artificially-generated flaws in inner blend regions of reactor pressure vessels are inspected using ultrasound from 2.25 mhz transducers. Predicted and measured positions of search units from which the flaws can be detected compare favorably.

  9. [Treatment of united or malunited fractures of the elbow].

    PubMed

    Eijer, H; Schafroth, M; Marti, R K

    2001-09-01

    Nonunions and malunions around the elbow are often due to incorrect initial treatment of a fracture. We have to differentiate between nonunions and malunion of adults and children. There are general principles for the treatment of nonunions and malunions of the distal humerus. They should not always be treated by decortication, internal fixation and bone graft. Removal of non-united fragments or a correction osteotomy may be good alternatives. A correct surgical approach and a biologically accurate osteosynthesis are necessary for good joint mobility, whereby the most difficult problem is to regain extension. An arthrolysis is not normally necessary during the first operation of a non- or malunion. It can be carried out, if necessary, on removal of implants. If these principles are followed, then the operation is usually successful and the patient satisfied. If treatment fails, the possibility of a joint replacement or an arthrodesis should not be forgotten.

  10. A Conservatively Managed Anatomical Variant of the Flexor Digitorum Superficialis Muscle in the Hand.

    PubMed

    Chatterton, Benjamin D; Moores, Thomas S; Heinz, Nicholas; Datta, Praveen; Smith, Kevin D; Thomas, Peter B M

    2016-04-01

    Anomalous flexor digitorum superficialis muscles in the hand are an uncommon phenomenon, and therefore present challenges in diagnosis and management. We report a case of a 16-year-old girl presenting with a painful, slowly enlarging palmar swelling. The swelling was investigated with ultrasound and magnetic resonance imaging, and was found to be an anomalous muscle belly of the flexor digitorum superficialis muscle. After careful consideration, multidisciplinary discussion, and thorough imaging, the patient was treated successfully without surgical exploration or excision, in comparison to previously reported cases. The patient was pain free and had no concerns at 8-month follow-up, demonstrating the value of conservative management in these cases. PMID:27616828

  11. Flexor tendon synovitis of the hand as first manifestation of atypical tuberculosis.

    PubMed

    Krapohl, Björn D; Kömürcü, Fercan; Stöckl-Hiesleitner, Sabine; Deutinger, Maria

    2007-02-01

    We present the case of a 73-year old patient suffering from chronic flexor tendon synovitis of the wrist with carpal tunnel syndrome. He underwent synovectomy and median nerve release. Primary bacteriology was negative. Histology of the excised synovia revelead non-caseating granuloma as typical for sarcoidosis. Further screening for sarcoidosis was negative. Culture of a sample harvested from the poorly healing wound was finally positive for Mycobacterium tuberculosis. Tuberculostatic treatment was started and the wound gradually healed. To the best of our knowledge, this is the first reported case of atypical non-caseating and sarcoidosis-like granulomas of the flexor tendon synovia of the hand as first manifestation of tuberculosis.

  12. Elbow Radiographic Anatomy: Measurement Techniques and Normative Data

    PubMed Central

    Goldfarb, Charles A.; Patterson, J. Megan M.; Sutter, Melanie; Krauss, Melissa; Steffen, Jennifer A.; Galatz, Leesa

    2011-01-01

    Background An increase in elbow pathology in adolescents has paralleled an increase in sports participation. Evaluation and classification of these injuries is challenging because of limited information regarding normal anatomy. The purpose of this study was to evaluate normal radiographic anatomy in adolescents to establish parameters for diagnosing abnormal development. Established and new measurements were evaluated for reliability and variance based on age and sex. Methods Three orthopaedic surgeons independently and in a standardized fashion evaluated the normal anteroposterior and lateral elbow radiographs of 178 adolescent and young adult subjects. Fourteen measurements were performed including radial neck- shaft angle, articular surface angle, articular surface morphologic assessment (subjective and objective evaluation of the patterns of ridges and sulci), among others. We performed a statistical analysis by age and sex for each measure and assessed for inter and intra-observer reliability. Results The distal humerus articular surface was relatively flat in adolescence and became more contoured with age as objectively demonstrated by increasing depth of the trochlear and trochleocapitellar sulci, and decreasing trochlear notch angle. Overall measurements were similar between males and females, with an increased carrying angle in females. There were several statistically significant differences based on age and sex but these were small and unlikely to be clinically significant. Inter and intra-observer reliability were variable; some commonly utilized tools had poor reliability. Conclusions Most commonly utilized radiographic measures were consistent between sexes, across the adolescent age group, and between adolescents and young adults. Several commonly used assessment tools show poor reliability. Level of evidence Basic Science Study, Anatomic Study, Imaging PMID:22329911

  13. An exercise programme for the management of lateral elbow tendinopathy

    PubMed Central

    Stasinopoulos, D; Stasinopoulou, K; Johnson, M

    2005-01-01

    Background: Home exercise programmes and exercise programmes carried out in a clinical setting are commonly advocated for the treatment of lateral elbow tendinopathy (LET), a very common lesion of the arm with a well-defined clinical presentation. The aim of this study is to describe the use and effects of strengthening and stretching exercise programmes in the treatment of LET. Eccentric exercises: Slow progressive eccentric exercises for LET should be performed with the elbow in extension, forearm in pronation, and wrist in extended position (as high as possible). However, it is unclear how the injured tendon, which is loaded eccentrically, returns to the starting position without experiencing concentric loading and how the "slowness" of eccentric exercises should be defined. Nor has the treatment regimen of the eccentric exercises of a supervised exercise programme been defined. Stretching exercises: Static stretching is defined as passively stretching a given muscle-tendon unit by slowly placing and maintaining it in a maximal position of stretch. We recommend the position should be held for 30–45 s, three times before and three times after eccentric exercises during each treatment session with a 30 s rest interval between each procedure. The treatment region of static stretching exercises when a supervised exercise programme is performed is unknown. Discussion: A well designed trial is needed to study the effectiveness of a supervised exercise programme for LET consisting of eccentric and static stretching exercises. The issues relating to the supervised exercise programme should be defined so that therapists can replicate the programme. PMID:16306504

  14. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results

    PubMed Central

    Watts, Adam C; Bain, Gregory I

    2016-01-01

    There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author’s experience, to better describe the indications, surgical technique and outcomes after this procedure. PMID:27583016

  15. Ultrasound of the elbow: Examination techniques and US appearance of the normal and pathologic joint.

    PubMed

    Draghi, F; Danesino, G M; de Gautard, R; Bianchi, S

    2007-06-01

    Ultrasound studies are frequently requested for the work-up of patients with local elbow pain, which is generally caused by overuse syndromes, trauma, inflammatory diseases, or neuropathies. The technique used to examine this joint will vary to some extent depending on the precise location of the pain and other clinical findings. The aim of this article is to describe the standard technique used for elbow ultrasound, the normal anatomy of the joint, and the appearance on ultrasound of normal elbow anatomy and the alterations associated with some of the more common disorders affecting this joint.

  16. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results.

    PubMed

    Phadnis, Joideep; Watts, Adam C; Bain, Gregory I

    2016-07-01

    There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure. PMID:27583016

  17. Advances in the management of medial elbow pain in baseball pitchers.

    PubMed

    Salyapongse, Aaron; Hatch, Joshua D

    2003-10-01

    Overhead-throwing athletes, particularly baseball pitchers, subject their elbows to tremendous amounts of valgus stress during the throwing motion. As a result of this stress, baseball pitchers are at considerable risk for injury. The proper functioning and stability of the elbow depends upon the bony articulations and soft tissue structures. The stresses placed across the elbow joint with repetitive throwing can lead to injury. Although the majority of injuries encountered are overuse injuries, acute injuries can also occur. Proper and timely diagnosis and treatment of these throwers is critical, to allow for the athlete's successful return to competition.

  18. Imaging Injuries in Throwing Sports Beyond the Typical Shoulder and Elbow Pathologies.

    PubMed

    Read, Paul J; Morrison, William B

    2016-09-01

    This review article describes injuries that occur in the upper extremities of athletes less commonly than those typically discussed with shoulders and elbows. A survey of osseous, musculotendinous, ligamentous, and neurovascular injuries is presented along with associated imaging findings and standard treatment options. This article does not focus on the classic throwing injuries of the shoulder or elbow; the goal is to survey injuries in throwing sports that involve structures away from the glenohumeral, acromioclavicular, or elbow joints. The goal of this article is to introduce readers to these less common injuries, describe their clinical presentations, and characterize their typical imaging appearances. PMID:27545424

  19. The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath.

    PubMed

    Havulinna, J; Leppänen, O V; Göransson, H

    2013-09-01

    In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component. PMID:23315625

  20. Hip flexor muscle size, strength and recruitment pattern in patients with acetabular labral tears compared to healthy controls.

    PubMed

    Mendis, M Dilani; Wilson, Stephen J; Hayes, David A; Watts, Mark C; Hides, Julie A

    2014-10-01

    Acetabular labral tears are a source of hip pain and are considered to be a precursor to hip osteoarthritis. Hip flexor muscles contribute to hip joint stability and function but it is unknown if their size and function is altered in the presence of labral pathology. This study aimed to investigate hip flexor muscle size, strength and recruitment pattern in patients with hip labral pathology compared to control subjects. 12 subjects diagnosed with an unilateral acetabular labral tear were compared to 12 control subjects matched for age and gender. All subjects underwent magnetic resonance imaging (MRI) of their lumbo-pelvic region. Average muscle cross-sectional area (CSA) of the iliacus, psoas, iliopsoas, sartorius, tensor fascia latae and rectus femoris muscles were measured. Hip flexion strength was measured by an externally fixed dynamometer. Individual muscle recruitment pattern during a resisted hip flexion exercise task was measured by muscle functional MRI. Hip flexor muscle strength was found to be decreased in patients with labral pathology compared to control subjects (p < 0.01). No difference between groups or sides was found for hip flexor muscle size (all p > 0.17) and recruitment pattern (all p > 0.53). Decreased hip flexor muscle strength may affect physical function in patients with hip labral pathology by contributing to altered gait patterns and functional tasks. Clinical rehabilitation of these patients may need to include strengthening exercises for the hip flexor muscles.

  1. Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair.

    PubMed

    Geary, Michael B; Orner, Caitlin A; Bawany, Fatima; Awad, Hani A; Hammert, Warren C; O'Keefe, Regis J; Loiselle, Alayna E

    2015-01-01

    Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the

  2. Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair.

    PubMed

    Geary, Michael B; Orner, Caitlin A; Bawany, Fatima; Awad, Hani A; Hammert, Warren C; O'Keefe, Regis J; Loiselle, Alayna E

    2015-01-01

    Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the

  3. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    NASA Astrophysics Data System (ADS)

    Ayad, K. E.; El Gohary, H. M.; Abd Elrahman, M.; Abd El Mejeed, S. F.; Bekheet, A. B.

    2009-09-01

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  4. Enhanced Zone II Flexor Tendon Repair through a New Half Hitch Loop Suture Configuration

    PubMed Central

    Thomopoulos, Stavros; Gelberman, Richard H.

    2016-01-01

    This study evaluated the impact of a new half hitch loop suture configuration on flexor tendon repair mechanics. Cadaver canine flexor digitorum profundus tendons were repaired with 4- or 8-strands, 4–0 or 3–0 suture, with and without half hitch loops. An additional group underwent repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand repairs by 21% when 4–0, and 33% when 3–0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor tendon repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period. PMID:27101409

  5. Effects of lubricant and autologous bone marrow stromal cell augmentation on immobilized flexor tendon repairs.

    PubMed

    Zhao, Chunfeng; Ozasa, Yasuhiro; Shimura, Haruhiko; Reisdorf, Ramona L; Thoreson, Andrew R; Jay, Gregory; Moran, Steven L; An, Kai-Nan; Amadio, Peter C

    2016-01-01

    The purpose of the study was to test a novel treatment that carbodiimide-derivatized-hyaluronic acid-lubricin (cd-HA-lubricin) combined cell-based therapy in an immobilized flexor tendon repair in a canine model. Seventy-eight flexor tendons from 39 dogs were transected. One tendon was treated with cd-HA-lubricin plus an interpositional graft of 8 × 10(5) BMSCs and GDF-5. The other tendon was repaired without treatment. After 21 day of immobilization, 19 dogs were sacrificed; the remaining 20 dogs underwent a 21-day rehabilitation protocol before euthanasia. The work of flexion, tendon gliding resistance, and adhesion score in treated tendons were significantly less than the untreated tendons (p < 0.05). The failure strength of the untreated tendons was higher than the treated tendons at 21 and 42 days (p < 0.05). However, there is no significant difference in stiffness between two groups at day 42. Histologic analysis of treated tendons showed a smooth surface and viable transplanted cells 42 days after the repair, whereas untreated tendons showed severe adhesion formation around the repair site. The combination of lubricant and cell treatment resulted in significantly improved digit function, reduced adhesion formation. This novel treatment can address the unmet needs of patients who are unable to commence an early mobilization protocol after flexor tendon repair. PMID:26177854

  6. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    SciTech Connect

    Ayad, K. E.; Abd El Mejeed, S. F.; El Gohary, H. M.; Abd Elrahman, M.; Bekheet, A. B.

    2009-09-27

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  7. PET-Scan Shows Peripherally Increased Neurokinin 1 Receptor Availability in Chronic Tennis Elbow: Visualizing Neurogenic Inflammation?

    PubMed Central

    Peterson, Magnus; Svärdsudd, Kurt; Appel, Lieuwe; Engler, Henry; Aarnio, Mikko; Gordh, Torsten; Långström, Bengt; Sörensen, Jens

    2013-01-01

    In response to pain, neurokinin 1 (NK1) receptor availability is altered in the central nervous system. The NK1 receptor and its primary agonist, substance P, also play a crucial role in peripheral tissue in response to pain, as part of neurogenic inflammation. However, little is known about alterations in NK1 receptor availability in peripheral tissue in chronic pain conditions and very few studies have been performed on human beings. Ten subjects with chronic tennis elbow were therefore examined by positron emission tomography (PET) with the NK1 specific radioligand [11C]GR205171 before and after treatment with graded exercise. The radioligand signal intensity was higher in the affected arm as compared with the unaffected arm, measured as differences between the arms in volume of voxels and signal intensity of this volume above a reference threshold set as 2.5 SD above mean signal intensity of the unaffected arm before treatment. In the eight subjects examined after treatment, pain ratings decreased in all subjects but signal intensity decreased in five and increased in three. In conclusion, NK1 receptors may be activated, or up-regulated in the peripheral, painful tissue of a chronic pain condition. This up-regulation does, however, have moderate correlation to pain ratings. The increased NK1 receptor availability is interpreted as part of ongoing neurogenic inflammation and may have correlation to the pathogenesis of chronic tennis elbow. Trial Registration ClinicalTrials.gov NCT00888225 http://clinicaltrials.gov/ PMID:24155873

  8. Relationship between joint motion and flexor tendon force in the canine forelimb.

    PubMed

    Lieber, R L; Amiel, D; Kaufman, K R; Whitney, J; Gelberman, R H

    1996-11-01

    To increase in vivo tendon force and gliding after flexor tendon repair, a variety of modifications to the methods by which protective passive motion is administered have been advocated. To determine the relationship between the prime variables, wrist and digital position, muscle activation, and in vivo tendon force, a clinically relevant canine model was developed. Force was measured in the flexor tendon during several joint manipulation paradigms: single-finger flexion-extension with the wrist flexed (group 1F), single-finger flexion-extension with the wrist extended (group 1E), four-finger flexion-extension with the wrist flexed (group 4F), four-finger flexion-extension with the wrist extended (group 4E), and synergistic wrist and finger motion where wrist extension and finger flexion were performed simultaneously, followed by wrist flexion and finger extension (group SYN). In addition, tendon force was measured during electric stimulation of the proximal flexor muscle mass. Passive tendon force with the wrist extended (groups 1E and 4E) was two to three times greater than that measured with the wrist flexed, independent of the number of digits moved. With the wrist extended, peak tendon force reached 1,997 g +/- 194 g during single-digit manipulation (group 1E), compared to only 853 g +/- 104 g with the wrist flexed during the same maneuver (group 1F). Statistical comparison between means revealed that groups 1E and 4E were significantly different from groups 1F, 4F, and SYN (p < .005). There were no significant differences between groups 1E and 4E or between groups 1F, 4F, and SYN (p > .200). Active muscle force elicited by electrical stimulation and passive force varied dramatically as the wrist was flexed from full extension 3460 g +/- 766 g to full flexion 427 g +/- 239 g (p < .001). Simultaneously, passive tension decreased from 940 g +/- 143 g with wrist extended to 76 g +/- 37 g with the wrist flexed. These data indicate that wrist position has the

  9. Canine elbow dysplasia and primary lesions in German shepherd dogs in France.

    PubMed

    Remy, D; Neuhart, L; Fau, D; Genevois, J P

    2004-05-01

    Five hundred and twenty German shepherd dogs were screened for elbow dysplasia. The following primary lesions were analysed: joint incongruity (JI), fragmented medial coronoid process (FCP), osteochondrosis or osteochondritis of the medial humeral condyle and ununited anconeal process (UAP). Three radiographic views were used for each joint to achieve a definitive diagnosis. The prevalence of elbow dysplasia was 19.4 per cent. The most frequent lesion was JI (16.3 per cent), followed by FCP (11.3 per cent). UAP was diagnosed rarely (1.1 per cent). Combinations of lesions were very frequent (42.2 per cent of the dysplastic elbows). Although these results may be biased due to prescreening of dogs with UAP, it should be highlighted that JI and FCP occur frequently in German shepherd dogs and are probably the most common primary lesions of elbow dysplasia, although they have been under-reported until now. PMID:15163051

  10. Approach to MRI of the Elbow and Wrist: Technical Aspects and Innovation

    PubMed Central

    Johnson, Dustin; Stevens, Kathryn J.; Riley, Geoffrey; Shapiro, Lauren; Yoshioka, Hiroshi; Gold, Garry E.

    2015-01-01

    The technology of wrist and elbow MRI imaging is advancing at a dramatic rate. MRI of the wrist and elbow is now commonly performed at medium and higher field strengths with more specialized surface coils and with more variable pulse sequences and post processing techniques than ever before. High field imaging and improved coils lead to an increased signal to noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is also improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging such as postoperative patient imaging, cartilage mapping, and molecular imaging. In this review, we consider technical advances in hardware and software of wrist and elbow MR imaging along with their clinical applications. PMID:26216768

  11. Canine elbow dysplasia and primary lesions in German shepherd dogs in France.

    PubMed

    Remy, D; Neuhart, L; Fau, D; Genevois, J P

    2004-05-01

    Five hundred and twenty German shepherd dogs were screened for elbow dysplasia. The following primary lesions were analysed: joint incongruity (JI), fragmented medial coronoid process (FCP), osteochondrosis or osteochondritis of the medial humeral condyle and ununited anconeal process (UAP). Three radiographic views were used for each joint to achieve a definitive diagnosis. The prevalence of elbow dysplasia was 19.4 per cent. The most frequent lesion was JI (16.3 per cent), followed by FCP (11.3 per cent). UAP was diagnosed rarely (1.1 per cent). Combinations of lesions were very frequent (42.2 per cent of the dysplastic elbows). Although these results may be biased due to prescreening of dogs with UAP, it should be highlighted that JI and FCP occur frequently in German shepherd dogs and are probably the most common primary lesions of elbow dysplasia, although they have been under-reported until now.

  12. Elbow septic arthritis associated with pediatric acute leukemia: a case report and literature review.

    PubMed

    Uemura, Takuya; Yagi, Hirohisa; Okada, Mitsuhiro; Yokoi, Takuya; Shintani, Kosuke; Nakamura, Hiroaki

    2015-01-01

    Acute leukemia in children presents with various clinical manifestations that mimic orthopaedic conditions. The association of septic arthritis of the elbow with acute leukemia is very rare, and the correct diagnosis of acute leukemia is often established only after treatment of the septic arthritis. In this article, we present a three-year-old child patient with elbow septic arthritis related to acute leukemia, diagnosed promptly by bone marrow aspiration on the same day as emergency surgical debridement of the septic elbow joint due to the maintenance of a high index of suspicion, and treated with chemotherapy as soon as possible. The emergency physician and orthopaedist must recognize unusual patterns of presentation like this. Since delay in initiating treatment of septic arthritis may result in growth disturbance, elbow septic arthritis associated with pediatric acute leukemia must be treated promptly and appropriately. Early diagnosis is a good prognostic feature of childhood acute leukemia.

  13. Mega Prosthetic Replacement of Elbow for Resistant Nonunion of Distal Humerus

    PubMed Central

    Vaishya, Raju; Vijay, Vipul; Pandit, Ram Sagar; Agarwal, Amit K

    2016-01-01

    Introduction: Fractures of the distal humerus are a rare entity accounting for approximately 2% of the humeral fractures. Non union of the distal humerus is further rare and poses a major challenge. These fractures usually respond to open reduction and bone grafting but some may fail multiple surgical attempts at union and hence are labelled as “resistant” non union. We report a case of resistant non union of the distal humerus which was managed by total elbow arthroplasty. Case Presentation: A 49-year-old male presented to the out patient department with history of a compound comminuted fracture of the distal end of the humerus approximately 25 years back. The fracture was treated with multiple debridements and plaster cast application. There was involvement of the radial and the ulnar nerves as well. The patient continued to use the disabled upper limb with severe difficulties in activities of daily living (ADL). The patient finally presented to us for regaining some range of motion and improvement in his ADL. In view of the grossly distorted anatomy, bone loss and chronic nature of the problem, patient was offered total elbow arthroplasty. The Wadsworth extensile posterior approach was used for exposure of the non union site. The fragments were found to be small, osteoporotic and deformed. In view of the distorted anatomy, the elbow was finally salvaged with mega-prosthetic replacement of the elbow. Posterior elbow splint was used for 2 weeks and active as well as passive range of motion was started after that. The post-operative Mayo elbow score improved from 50 to 80 and the patient was able to achieve a range of motion from 10 degrees to 110 degrees. Conclusion: Total elbow arthroplasty can be used as a salvage procedure for resistant non union of the elbow with failed multiple failed attempts at union. It can also be used as a definitive procedure for severely distorted non union with massive bone loss with satisfactory functional results. PMID:27703937

  14. Solitary Giant Intramuscular Myxoid Neurofibroma Resulting in an above Elbow Amputation

    PubMed Central

    Chennakeshaviah, Gururajaparasad; Ravishankar, Sunila; Maggad, Rangaswamy; Manjunath, G. V.

    2012-01-01

    Neurofibromas are uncommon benign tumours and are still rarer in intramuscular locations. They are not detected until they cause a significant damage to the neighbouring tissues. We present a case of a giant intramuscular myxoid neurofibroma of the left forearm which eroded the radius and ulna, restricting the movements at the elbow and wrist joints and causing wrist drop resulting in an above elbow amputation. It was diagnosed by histopathology and was later confirmed by immunohistochemistry. PMID:23198230

  15. Biomechanics and development of the elbow in the young throwing athlete.

    PubMed

    Hutchinson, Mark R; Wynn, Shawn

    2004-10-01

    This article reviews basic concepts in fundamental elbow biomechanics, particularly how they relate to the skeletally immature elbow in throwing athletes. Adult phases of throwing and the forces generated in each phase are compared with the developmental phases of throwing in children. The impact of elevated forces, poor mechanics, and poor coordination are emphasized as they relate to potential areas of injury in the skeletally immature. Finally, concepts in prevention focused on biomechanics are offered.

  16. Overuse upper extremity injuries in the skeletally immature patient: beyond Little League shoulder and elbow.

    PubMed

    Marshall, Kelley W

    2014-11-01

    Overuse injuries of the shoulder and elbow are common in the skeletally immature throwing athlete. This review goes beyond describing the classic imaging findings of Little League shoulder and elbow and probes deeper into new insights suggesting a unifying etiology of metaphyseal or metaphyseal equivalent injury as the cause of many of the bony lesions described. Injury patterns change depending on the athlete's skeletal maturation, and the spectrum of abnormalities is reviewed.

  17. Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

    PubMed Central

    Ooi, Adrian; Ng, Jonathan; Chui, Christopher; Goh, Terence; Tan, Bien Keem

    2016-01-01

    Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n = 5), regional pedicled (n = 7), and free (n = 8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction. PMID:27313886

  18. Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow.

    PubMed

    Barrentine, S W; Fleisig, G S; Whiteside, J A; Escamilla, R F; Andrews, J R

    1998-12-01

    Underhand pitching has received minimal attention in the sports medicine literature. This may be due to the perception that, compared with overhead pitching, the underhand motion creates less stress on the arm, which results in fewer injuries. The purpose of this study was to calculate kinematic and kinetic parameters for the pitching motion used in fast pitch softball. Eight female fast pitch softball pitchers were recorded with a four-camera system (200 Hz). The results indicated that high forces and torques were experienced at the shoulder and elbow during the delivery phase. Peak compressive forces at the elbow and shoulder equal to 70-98% of body weight were produced. Shoulder extension and abduction torques equal to 9-10% of body weight x height were calculated. Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion. The demand on the biceps labrum complex to simultaneously resist glenohumeral distraction and produce elbow flexion makes this structure susceptible to overuse injury.

  19. ASSESMENT OF ARTHROSCOPIC ELBOW SYNOVECTOMY OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; Ortiz, Rodrigo Tormin; Mariz Pinto, Eduardo César Moreira; Checchia, Sergio Luis

    2015-01-01

    Objective: To review functional outcomes of arthroscopic elbow synovectomy in patients with rheumatoid arthritis. Methods: Between May 1999 and December 2005, 15 patients were submitted to elbow synovectomy using an arthroscopic approach. Three cases were bilateral, totaling 18 elbows. There were two male and 13 female patients. The mean age was 44 years and five months. The mean time of previous diagnosis was six years and eight months. All patients reported preoperative pain, and on seven elbows, instability was present. The mean preoperative values for joint motion were: flexion, 118°; extension, −24°, supine, 80°, and; prone, 71°. Result: The mean postoperative follow-up time was 39 months. The mean postoperative joint motion was 133° for flexion, −20° for extension, 84° supine, and 78° prone. On nine elbows (50%) an improved postoperative range of motion was reported, reaching functional levels. Twelve cases (66.6%) showed pain resolution or improvement to a level not interfering on the activities of daily life. According to Bruce's assessment method, the results were as follows: seven excellent, three good, two fair and six poor results, with an average of 85.5 points. Synovitis recurrence was found in six cases (33.3%), and evolution to osteoarthrosis was found in four (22.2%). Conclusion: Arthroscopic elbow synovectomy in patients with rheumatoid arthritis leads to pain improvement in 66.6% of the cases; however, it does not cause a significant range of motion improvement. PMID:27077058

  20. Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow.

    PubMed

    Barrentine, S W; Fleisig, G S; Whiteside, J A; Escamilla, R F; Andrews, J R

    1998-12-01

    Underhand pitching has received minimal attention in the sports medicine literature. This may be due to the perception that, compared with overhead pitching, the underhand motion creates less stress on the arm, which results in fewer injuries. The purpose of this study was to calculate kinematic and kinetic parameters for the pitching motion used in fast pitch softball. Eight female fast pitch softball pitchers were recorded with a four-camera system (200 Hz). The results indicated that high forces and torques were experienced at the shoulder and elbow during the delivery phase. Peak compressive forces at the elbow and shoulder equal to 70-98% of body weight were produced. Shoulder extension and abduction torques equal to 9-10% of body weight x height were calculated. Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion. The demand on the biceps labrum complex to simultaneously resist glenohumeral distraction and produce elbow flexion makes this structure susceptible to overuse injury. PMID:9836172

  1. Relationship between throwing mechanics and elbow valgus in professional baseball pitchers.

    PubMed

    Werner, Sherry L; Murray, Tricia A; Hawkins, Richard J; Gill, Thomas J

    2002-01-01

    Valgus elbow stress leads to medial tension and lateral compression injuries in baseball pitchers of all ages. This study was undertaken to investigate the relationship between elbow stress in professional baseball pitchers and the kinematic parameters of pitching mechanics. This was done in an attempt to understand valgus extension overload better and in an effort to improve preventive and rehabilitative protocols. High-speed video data were collected on 40 professional pitchers in game situations during the 1998 and 1999 Cactus League season in Arizona, as part of Major League Baseball Spring Training. A multiple linear regression analysis was used to relate elbow valgus to kinematic parameters of pitching mechanics. The resulting analysis produced an adjusted multiple R2 value of 0.974, indicating that nearly 100% of the variance in valgus stress on the elbow was explained by the parameters in the regression equation. This ability to explain over 97% of the variance in valgus stress is significant. The parameters of pitching mechanics related to elbow valgus may be assessed and optimized, if necessary, in order to decrease the magnitude of elbow stress in pitching.

  2. Climbing-specific finger flexor performance and forearm muscle oxygenation in elite male and female sport climbers.

    PubMed

    Philippe, Marc; Wegst, Daniel; Müller, Tom; Raschner, Christian; Burtscher, Martin

    2012-08-01

    Climbing performance relies to a great extent on the performance of the finger flexor muscles. Only a few studies investigated this performance in top class climbers and only one study compared gender-specific differences. This study investigated the climbing-specific finger flexor strength and endurance and related muscular oxygenation in 12 elite female and male climbers and 12 non-climbers. After the assessment of maximum voluntary finger flexor contraction (MVC), two isometric finger flexor endurance tests were performed at 40% MVC until exhaustion. A continuous isometric test was followed by an intermittent isometric test (10 s contraction, 3 s rest). Changes in oxygenation of finger flexor muscles were recorded using near infrared spectroscopy. MVC and strength-to-weight ratio were greater in climbers than non-climbers (P = 0.003; P < 0.001) and greater in men than women (P < 0.001; P = 0.002). Time to task failure for the intermittent test and the force-time integrals for the continuous and the intermittent test were also significantly greater in climbers (P = 0.030; P = 0.027; P = 0.005). During the intermittent test, re-oxygenation of the working muscles was faster in climbers (P < 0.05) without gender-specific differences. Close correlations were demonstrated between the best on-sight climbing performance and strength-to-weight ratio (r (2) = 0.946, P < 0.001) only in female climbers. The superior intermittent finger flexor endurance of climbers over non-climbers may be explained by the faster re-oxygenation of the finger flexor muscles during the short rest phases.

  3. Apparent Transverse Compressive Material Properties of the Digital Flexor Tendons and the Median Nerve in the Carpal Tunnel

    PubMed Central

    Main, Erin K; Goetz, Jessica E; Rudert, M James; Goreham-Voss, Curtis M; Brown, Thomas D

    2011-01-01

    Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3kPa, α =8.5 for the superficial tendons, μ=39.4kPa, α=9.2 for the deep tendons, μ=24.9kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome. PMID:21194695

  4. Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players.

    PubMed

    Chalker, Wade J; Shield, Anthony J; Opar, David A; Keogh, Justin W L

    2016-01-01

    Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler's and batter's mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries. PMID:26925310

  5. Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players

    PubMed Central

    Chalker, Wade J.; Shield, Anthony J.; Opar, David A.

    2016-01-01

    Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler’s and batter’s mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries. PMID:26925310

  6. Long Term Results in Refractory Tennis Elbow Using Autologous Blood

    PubMed Central

    Gani, Naseem ul; Khan, Hayat Ahmad; Kamal, Younis; Farooq, Munir; Jeelani, Hina; Shah, Adil Bashir

    2014-01-01

    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. PMID:25568727

  7. Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression.

    PubMed

    Herrnstadt, Gil; Menon, Carlo

    2016-01-01

    Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor

  8. Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression

    PubMed Central

    Herrnstadt, Gil; Menon, Carlo

    2016-01-01

    Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor

  9. Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression.

    PubMed

    Herrnstadt, Gil; Menon, Carlo

    2016-01-01

    Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor

  10. Shoulder and elbow kinematics in throwing of young baseball players.

    PubMed

    Ishida, Kazuyuki; Murata, Masahiro; Hirano, Yuichi

    2006-07-01

    In this study we compared the kinematic features of the throwing motion between young baseball players of different age groups. Forty-four Japanese baseball players aged 6.1 to 12.3 years who regularly played baseball, including pitchers and position players, had their throwing actions analyzed three-dimensionally using high speed videography. Of this sample, 26 players aged above 9 years of age were categorized as the senior group, while the remaining 18 were categorized as the junior group. Senior group throwers had greater height and body mass, and produced a greater ball speed than junior group throwers. The throwing arm movement of senior group throwers was similar to that of adult skilled players. However, in the junior group throwers, the shoulder horizontal adduction angle was larger during the arm acceleration phase, and the maximum angular velocities of elbow extension and shoulder internal rotation occurred later than in senior group throwers. These results indicate that players aged above 9 years can acquire a mature throwing arm movement, while players younger than that will use an immature motion. A possible reason why these differences were shown is that the official baseball is relatively heavy for junior group throwers; they would be better advised to use a lighter ball in throwing practice.

  11. Mechanical solution for a mechanical problem: Tennis elbow

    PubMed Central

    Rothschild, Bruce

    2013-01-01

    Lateral epicondylitis is a relatively common clinical problem, easily recognized on palpation of the lateral protuberance on the elbow. Despite the “itis” suffix, it is not an inflammatory process. Therapeutic approaches with topical non-steroidal anti-inflammatory drugs, corticosteroids and anesthetics have limited benefit, as would be expected if inflammation is not involved. Other approaches have included provision of healing cytokines from blood products or stem cells, based on the recognition that this repetitive effort-derived disorder represents injury. Noting calcification/ossification of tendon attachments to the lateral epicondyle (enthesitis), dry needling, radiofrequency, shock wave treatments and surgical approaches have also been pursued. Physiologic approaches, including manipulation, therapeutic ultrasound, phonophoresis, iontophoresis, acupuncture and exposure of the area to low level laser light, has also had limited success. This contrasts with the benefit of a simple mechanical intervention, reducing the stress on the attachment area. This is based on displacement of the stress by use of a thin (3/4-1 inch) band applied just distal to the epicondyle. Thin bands are required, as thick bands (e.g., 2-3 inch wide) simply reduce muscle strength, without significantly reducing stress. This approach appears to be associated with a failure rate less than 1%, assuming the afflicted individual modifies the activity that repeatedly stresses the epicondylar attachments. PMID:23878775

  12. 'Lateral elbow tendinopathy' is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis.

    PubMed

    Stasinopoulos, Dimitrios; Johnson, Mark I

    2006-01-01

    A plethora of terms that have been used to describe lateral epicondylitis including tennis elbow (TE), epicondylalgia, tendonitis, tendinosis and tendinopathy. These terms usually have the prefix extensor or lateral elbow. Lateral elbow tendinopathy seems to be the most appropriate term to use in clinical practice because other terms make reference to inappropriate aetiological, anatomical and pathophysiological terms. The correct diagnostic term is important for the right treatment. PMID:16843614

  13. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training.

    PubMed

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0-100, 100-200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114

  14. Wrist and digital joint motion produce unique flexor tendon force and excursion in the canine forelimb.

    PubMed

    Lieber, R L; Silva, M J; Amiel, D; Gelberman, R H

    1999-02-01

    The force and excursion within the canine digital flexor tendons were measured during passive joint manipulations that simulate those used during rehabilitation after flexor tendon repair and during active muscle contraction, simulating the active rehabilitation protocol. Tendon force was measured using a small buckle placed upon the tendon while excursion was measured using a suture marker and video analysis method. Passive finger motion imposed with the wrist flexed resulted in dramatically lower tendon force (approximately 5 N) compared to passive motion imposed with the wrist extended (approximately 17 N). Lower excursions were seen at the level of the proximal interphalangeal joint with the wrist flexed (approximately 1.5 mm) while high excursion was observed when the wrist was extended or when synergistic finger and wrist motion were imposed (approximately 3.5 mm). Bivariate discriminant analysis of both force and excursion data revealed a natural clustering of the data into three general mechanical paradigms. With the wrist extended and with either one finger or four fingers manipulated, tendons experienced high loads of approximately 1500 g and high excursions of approximately 3.5 mm. In contrast, the same manipulations performed with the wrist flexed resulted in low tendon forces (4-8 N) and low tendon excursions of approximately 1.5 mm. Synergistic wrist and finger manipulation provided the third paradigm where tendon force was relatively low (approximately 4 N) but excursion was as high as those seen in the groups which were manipulated with the wrist extended. Active muscle contraction produced a modest tendon excursion (approximately 1 mm) and high or low tendon force with the wrist extended or flexed, respectively. These data provide the basis for experimentally testable hypotheses with regard to the factors that most significantly affect functional recovery after digital flexor tendon injury and define the normal mechanical operating characteristics

  15. The Snapping Elbow Syndrome as a Reason for Chronic Elbow Neuralgia in a Tennis Player – MR, US and Sonoelastography Evaluation

    PubMed Central

    Łasecki, Mateusz; Olchowy, Cyprian; Pawluś, Aleksander; Zaleska-Dorobisz, Urszula

    2014-01-01

    Summary Background Ulnar neuropathy is the second most common peripheral nerve neuropathy after median neuropathy, with an incidence of 25 cases per 100 000 men and 19 cases per 100 000 women each year. Skipping (snapping) elbow syndrome is an uncommon cause of pain in the posterior-medial elbow area, sometimes complicated by injury of the ulnar nerve. One of the reason is the dislocation of the abnormal insertion of the medial triceps head over the medial epicondyle during flexion and extension movements. Others are: lack of the Osboune fascia leading to ulnar nerve instability and focal soft tissue tumors (fibromas, lipomas, etc). Recurrent subluxation of the nerve at the elbow results in a tractional and frictional neuritis with classical symptoms of peripheral neuralgia. As far as we know snapping triceps syndrome had never been evaluated in sonoelastography. Case Report A 28yo semi-professional left handed tennis player was complaining about pain in posterior-medial elbow area. Initial US examination suggest golfers elbow syndrome which occurs quite commonly and has a prevalence of 0.3–0.6% in males and 0–3–1.1% in women and may be associated (approx. 50% of cases) with ulnar neuropathy. However subsequently made MRI revealed unusual distal triceps anatomy, moderate ulnar nerve swelling and lack of medial epicondylitis symptoms. Followed (second) US examination and sonoelastography have detected slipping of the both ulnar nerve and the additional band of the medial triceps head. Discussion Snapping elbow syndrome is a poorly known medical condition, sometimes misdiagnosed as the medial epicondylitis. It describes a broad range of pathologies and anatomical abnormalities. One of the most often reasons is the slipping of the ulnar nerve as the result of the Osborne fascia/anconeus epitrochlearis muscle absence. Simultaneously presence of two or more “snapping reasons” is rare but should be always taken under consideration. Conclusions There are no

  16. Avulsion Injuries of the Flexor Digitorum Profundus Tendon: An Unclassified Pattern of Injury.

    PubMed

    Abdul Azeem, Mokhtar; Marwan, Yousef; Esmaeel, Ali

    2015-01-01

    Closed avulsion of the flexor digitorum profundus (FDP) tendon is classified based on the impact of injury on the management plan. In this report, we present a case with unclassified pattern of FDP tendon avulsion. The injury involves an intra-articular fracture of the volar part of distal phalanx of the little finger resulting into two bony fragments, one attached to the retracted avulsed tendon and another separated and incarcerated at A4 pulley, and an intact dorsal cortex of the phalanx. Based on that, we recommend the development of a new classification scheme for this condition.

  17. Measuring force transfers in the deep flexors of the musician's hand: theoretical analysis, clinical examples.

    PubMed

    Leijnse, J N

    1997-09-01

    In the present paper the anatomical and functional interdependencies which regularly exist between the deep flexor tendons of the different fingers are modelled. The model results are validated by measurements on real hands. The results show that intertendinous force transfers may be caused by (i) coactivation of muscle fibres inserting in different tendons, and (ii) passive connections between tendons or muscle bellies. The coactivation is validated by the measuring results of a hand in which all intertendinous connections were surgically removed. The present models and measurements are currently used for diagnosis of hand problems in musicians at our hand clinic.

  18. Tissue engineering in flexor tendon surgery: current state and future advances.

    PubMed

    Galvez, M G; Crowe, C; Farnebo, S; Chang, J

    2014-01-01

    Tissue engineering of flexor tendons addresses a challenge often faced by hand surgeons: the restoration of function and improvement of healing with a limited supply of donor tendons. Creating an engineered tendon construct is dependent upon understanding the normal healing mechanisms of the tendon and tendon sheath. The production of a tendon construct includes: creating a three-dimensional scaffold; seeding cells within the scaffold; encouraging cellular growth within the scaffold while maintaining a gliding surface; and finally ensuring mechanical strength. An effective construct incorporates these factors in its design, with the ultimate goal of creating tendon substitutes that are readily available to the reconstructive hand surgeon.

  19. Bilateral avulsion of ring finger flexor digitorum profundus tendons during contact sport: a case report.

    PubMed

    Lin, Frank; McDonald, Anthony

    2007-01-01

    We report on the case of a 14-year-old patient with bilateral avulsion of flexor digitorum profundus (FDP) in both ring fingers. This was noted four days after a basketball match. At surgical exploration both FDP were ruptured with the ends located at A2 and A3 pulleys. These were repaired with excellent functional results. While FDP avulsions can often occur affecting the ring finger this is the first reported case of a patient presenting with a bilateral injury affecting the ring finger on both sides.

  20. Structural changes of the carpal tunnel, median nerve and flexor tendons in MRI before and after endoscopic carpal tunnel release.

    PubMed

    Momose, Toshimitsu; Uchiyama, Shigeharu; Kobayashi, Seneki; Nakagawa, Hiroyuki; Kato, Hiroyuki

    2014-01-01

    The purpose of this study is to investigate the structural changes of the carpal tunnel, median nerve, and flexor tendons in magnetic resonance imaging (MRI) before and after endoscopic carpal tunnel release (ECTR). We studied 36 hands undergoing ECTR. In MRI, the cross-sectional area of the carpal tunnel and the median nerve at the hamate and the pisiform levels were measured. The distance from the volar side of carpal bone to the median nerve or tendons and the volar displacement were measured. In post-operative MRI, the transverse carpal ligament could not be well delineated and the carpal tunnel was significantly enlarged both at the hamate and pisiform levels. The median nerve was enlarged at the hamate level. The median nerve and flexor tendons significantly moved to the volar side. The volar displacement of the median nerve and flexor digitorum superficialis in the long and ring fingers was greater than the other tendons.