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Sample records for human elbow flexor

  1. Maximal force, voluntary activation and muscle soreness after eccentric damage to human elbow flexor muscles.

    PubMed

    Prasartwuth, O; Taylor, J L; Gandevia, S C

    2005-08-15

    Muscle damage reduces voluntary force after eccentric exercise but impaired neural drive to the muscle may also contribute. To determine whether the delayed-onset muscle soreness, which develops approximately 1 day after exercise, reduces voluntary activation and to identify the possible site for any reduction, voluntary activation of elbow flexor muscles was examined with both motor cortex and motor nerve stimulation. We measured maximal voluntary isometric torque (MVC), twitch torque, muscle soreness and voluntary activation in eight subjects before, immediately after, 2 h after, 1, 2, 4 and 8 days after eccentric exercise. Motor nerve stimulation and motor cortex stimulation were used to derive twitch torques and measures of voluntary activation. Eccentric exercise immediately reduced the MVC by 38 +/- 3% (mean +/- s.d., n = 8). The resting twitch produced by motor nerve stimulation fell by 82 +/- 6%, and the estimated resting twitch by cortical stimulation fell by 47 +/- 15%. While voluntary torque recovered after 8 days, both measures of the resting twitch remained depressed. Muscle tenderness occurred 1-2 days after exercise, and pain during contractions on days 1-4, but changes in voluntary activation did not follow this time course. Voluntary activation assessed with nerve stimulation fell 19 +/- 6% immediately after exercise but was not different from control values after 2 days. Voluntary activation assessed by motor cortex stimulation was unchanged by eccentric exercise. During MVCs, absolute increments in torque evoked by nerve and cortical stimulation behaved differently. Those to cortical stimulation decreased whereas those to nerve stimulation tended to increase. These findings suggest that reduced voluntary activation contributes to the early force loss after eccentric exercise, but that it is not due to muscle soreness. The impairment of voluntary activation to nerve stimulation but not motor cortical stimulation suggests that the activation

  2. Maximal force, voluntary activation and muscle soreness after eccentric damage to human elbow flexor muscles

    PubMed Central

    Prasartwuth, O; Taylor, JL; Gandevia, SC

    2005-01-01

    Muscle damage reduces voluntary force after eccentric exercise but impaired neural drive to the muscle may also contribute. To determine whether the delayed-onset muscle soreness, which develops ∼1 day after exercise, reduces voluntary activation and to identify the possible site for any reduction, voluntary activation of elbow flexor muscles was examined with both motor cortex and motor nerve stimulation. We measured maximal voluntary isometric torque (MVC), twitch torque, muscle soreness and voluntary activation in eight subjects before, immediately after, 2 h after, 1, 2, 4 and 8 days after eccentric exercise. Motor nerve stimulation and motor cortex stimulation were used to derive twitch torques and measures of voluntary activation. Eccentric exercise immediately reduced the MVC by 38 ± 3% (mean ±s.d., n = 8). The resting twitch produced by motor nerve stimulation fell by 82 ± 6%, and the estimated resting twitch by cortical stimulation fell by 47 ± 15%. While voluntary torque recovered after 8 days, both measures of the resting twitch remained depressed. Muscle tenderness occurred 1–2 days after exercise, and pain during contractions on days 1–4, but changes in voluntary activation did not follow this time course. Voluntary activation assessed with nerve stimulation fell 19 ± 6% immediately after exercise but was not different from control values after 2 days. Voluntary activation assessed by motor cortex stimulation was unchanged by eccentric exercise. During MVCs, absolute increments in torque evoked by nerve and cortical stimulation behaved differently. Those to cortical stimulation decreased whereas those to nerve stimulation tended to increase. These findings suggest that reduced voluntary activation contributes to the early force loss after eccentric exercise, but that it is not due to muscle soreness. The impairment of voluntary activation to nerve stimulation but not motor cortical stimulation suggests that the activation deficit lies in the

  3. Effect of elbow joint angle on force-EMG relationships in human elbow flexor and extensor muscles.

    PubMed

    Doheny, Emer P; Lowery, Madeleine M; Fitzpatrick, David P; O'Malley, Mark J

    2008-10-01

    The purpose of this study was to examine the effect of joint angle on the relationship between force and electromyogram (EMG) amplitude and median frequency, in the biceps, brachioradialis and triceps muscles. Surface EMG were measured at eight elbow angles, during isometric flexion and extension at force levels from 10% to 100% of maximum voluntary contraction (MVC). Joint angle had a significant effect on MVC force, but not on MVC EMG amplitude in all of the muscles examined. The median frequency of the biceps and triceps EMG decreased with increasing muscle length, possibly due to relative changes in electrode position or a decrease in muscle fibre diameter. The relationship between EMG amplitude and force, normalised with respect to its maximum force at each angle, did not vary with joint angle in the biceps or brachioradialis muscles over all angles, or in the triceps between 45 degrees and 120 degrees of flexion. These results suggest that the neural excitation level to each muscle is determined by the required percentage of available force rather than the absolute force required. It is, therefore, recommended that when using surface EMG to estimate muscle excitation, force should be normalised with respect to its maximum value at each angle.

  4. Effects of aging and sex on voluntary activation and peak relaxation rate of human elbow flexors studied with motor cortical stimulation.

    PubMed

    Molenaar, Joery P; McNeil, Chris J; Bredius, Marlous S; Gandevia, Simon C

    2013-08-01

    Data are equivocal on whether voluntary activation is preserved or decreased in old compared to young adults. Further, data are scant on the effect of age on the rate of muscle relaxation when the muscle is contracting voluntarily. Assessment of both measures with transcranial magnetic stimulation (TMS) yields information which cannot be obtained with traditional peripheral nerve stimulation. Hence, voluntary activation and peak relaxation rate of the elbow flexors were assessed with TMS during repeated maximal efforts in 30 men and 28 women between the ages of 22-84 years. Voluntary activation was similar for the two sexes (P = 0.154) and was not affected by age in men (96.2 ± 2.7 %; P = 0.887) or women (95.1 ± 3.0 %; P = 0.546). Men had a significantly faster peak rate of relaxation than women in absolute units (-880.0 ± 223.2 vs. -360.2 ± 78.5 Nm/ s, respectively; P < 0.001) and when normalized to subject strength (-12.5 ± 2.1 vs. -8.7 ± 1.0 s(-1), respectively; P < 0.001). Absolute and normalized relaxation rates slowed with age in men (P = 0.002 and P = 0.006, respectively), but not women (P = 0.142 and P = 0.950, respectively). Across the age range studied, all subjects, regardless of age or sex, were able to achieve high voluntary activation scores for the elbow flexors (~95 %). In contrast, peak relaxation rate was markedly faster in men than women and slowed with age in men but not women. Normalization of relaxation rates to strength did not affect the influence of age or sex.

  5. The effects of elbow joint angle change on the elbow flexor muscle activation in pulley with weight exercise.

    PubMed

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

    2013-09-01

    [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.

  6. 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

  7. A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment

    PubMed Central

    Aliu, Oluseyi; Samra, Saleh; Lewis, Eric

    2007-01-01

    A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient’s treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma. PMID:18780113

  8. Knee extension fatigue attenuates repeated force production of the elbow flexors.

    PubMed

    Halperin, Israel; Aboodarda, Saied J; Behm, David G

    2014-01-01

    Non-local muscle fatigue has been demonstrated with unilateral activities, where fatiguing one limb alters opposite limb forces. Fewer studies have examined if non-local fatigue occurs with unrelated muscles. The purpose of this study was to investigate if knee extensors fatigue alters elbow flexors force and electromyography (EMG) activity. Eighteen males completed a control and fatiguing session (randomised). Blood lactate was initially sampled followed by three maximal voluntary contractions (MVC) with the elbow flexors and two with the knee extensors. Thereafter, subjects either sat (control) or performed five sets of bilateral dynamic knee extensions to exhaustion using a load equal to the dominant limb MVC (1-min rest between sets). Immediately afterwards, subjects were assessed for blood lactate and unilateral knee extensors MVC, and after 1 min performed a single unilateral elbow flexor MVC. Two minutes later, subjects performed 12 unilateral elbow flexor MVCs (5 s contraction/10 s rest) followed by a third blood lactate test. Compared to control, knee extensor force dropped by 35% (p < 0.001; ES = 1.6) and blood lactate increased by 18% (p < 0.001; ES = 2.8). Elbow flexor forces were lower after the fatiguing protocol only during the last five MVCs (p < 0.05; ES = ∼ 0.58; ∼ 5%). No changes occurred between conditions in EMG. Elbow flexor forces significantly decreased after knee extensors fatigue. The effect was revealed during the later stages of the repeated MVCs protocol, demonstrating that non-local fatigue may have a stronger effect on repeated rather than on single attempts of maximal force production.

  9. 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.

  10. Terrible triad elbow fracture-dislocation with triceps and flexor-pronator mass avulsion.

    PubMed

    Gajendran, Varun K; Bishop, Julius A

    2015-02-01

    Terrible triad elbow injuries, consisting of fractures of the radial head and coronoid with ulnohumeral dislocation, are challenging to treat. They require a comprehensive understanding of the complex anatomy of the elbow to effectively treat all of the pathology and create a stable, congruent joint. The authors present a case of a terrible triad injury with avulsion of the triceps and flexor-pronator mass after a low-energy fall in a young patient. Although most terrible triad fracture-dislocations can be successfully treated with coronoid fixation, radial head fixation or replacement, and repair of the lateral collateral ligament complex, this case involved a completely circumferential injury to the elbow. The coronoid and anterior capsule were disrupted anteriorly, the radial head and lateral collateral ligament complex were disrupted laterally, the triceps was disrupted posteriorly, and the flexor-pronator mass was disrupted medially. Although the authors prefer to address most terrible triad injuries through a lateral approach, they suspected a circumferential injury preoperatively and elected to use a single posterior incision to address all of the pathology conveniently. This injury required treatment of all disrupted structures, because the elbow remained unstable until the triceps and flexor-pronator mass avulsions were ultimately repaired. With any elbow fracture-dislocation, surgeons should look for evidence of additional injuries that do not fit the commonly described patterns, because they may necessitate modifications to the treatment plan. Given the relatively common complications of stiffness and instability despite modern surgical techniques, additional injuries may further compromise functional outcomes unless they are addressed properly.

  11. Assessment of Muscle Pain Induced by Elbow-Flexor Eccentric Exercise

    PubMed Central

    Lau, Wing Yin; Blazevich, Anthony J.; Newton, Michael J.; Wu, Sam Shi Xuan; Nosaka, Kazunori

    2015-01-01

    Context: Delayed-onset muscle soreness (DOMS) is a common muscle pain that many people experience and is often used as a model of acute muscle pain. Researchers have reported the effects of various interventions on DOMS, but different DOMS assessment protocols used in these studies make it difficult to compare the effects. Objective: To investigate DOMS characteristics after elbow-flexor eccentric exercise to establish a standardized DOMS assessment protocol. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Ten healthy, untrained men (21–39 years). Intervention(s): Participants performed 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors. Main Outcome Measure(s): Indirect muscle-damage markers were maximal voluntary isometric contraction torque, range of motion, and serum creatine kinase activity. Muscle pain was assessed before exercise, immediately postexercise, and 1 to 5 days postexercise using (1) a visual analog scale (VAS), (2) a category ratio-10 scale (CR-10) when applying static pressure and palpation at different sites (3, 9, and 15 cm above the elbow crease), and (3) pressure-pain thresholds (PPTs) at 50 sites (pain mapping). Results: Maximal voluntary isometric contraction and range of motion decreased and creatine kinase activity increased postexercise, indicating muscle damage. Palpation induced greater pain than static pressure, and longitudinal and transverse palpations induced greater pain than circular palpation (P < .05). The PPT was lower in the medial region before exercise, but the pain-sensitive regions shifted to the central and distal regions of the biceps brachii at 1 to 3 days postexercise (P < .05). The VAS was correlated with the CR-10 scale (r = 0.91, P < .05) but not with the PPT (r = −0.28, P = .45). Conclusions: The way in which muscles are assessed affects the pain level score. This finding suggests that pain level and pain threshold cannot be used

  12. Older adults use a unique strategy to lift inertial loads with the elbow flexor muscles.

    PubMed

    Graves, A E; Kornatz, K W; Enoka, R M

    2000-04-01

    The purpose of this study was to determine the effect of age on the ability to exert steady forces and to perform steady flexion movements with the muscles that cross the elbow joint. An isometric task required subjects to exert a steady force to match a target force that was displayed on a monitor. An anisometric task required subjects to raise and lower inertial loads so that the angular displacement around the elbow joint matched a template displayed on a monitor. Steadiness was measured as the coefficient of variation of force and as the normalized standard deviation of wrist acceleration. For the isometric task, steadiness as a function of target force decreased similarly for old adults and young adults. For the anisometric task, steadiness increased as a function of the inertial load and there were significant differences caused by age. Old adults were less steady than young adults during both shortening and lengthening contractions with the lightest loads. Furthermore, old adults were least steady when performing lengthening contractions. These behaviors appear to be associated with the patterns of muscle activation. These results suggest that different neural strategies are used to control isometric and anisometric contractions performed with the elbow flexor muscles and that these strategies do not change in parallel with advancing age.

  13. 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.…

  14. Difference in the magnitude of muscle damage between elbow flexors and knee extensors eccentric exercises

    PubMed Central

    Saka, Tolga; Akova, Bedrettin; Yazici, Zeynep; Sekir, Ufuk; Gür, Hakan; Ozarda, Yesim

    2009-01-01

    The aim of this study was to investigate the difference in the magnitude of muscle damage between maximal eccentric exercises of the elbow flexors (EF) and knee extensors (KE). Twelve sedentary male volunteers participated in the study. Range of motion (ROM), isometric peak torque (IPT), delayed onset of muscle soreness (DOMS), creatine kinase activity (CK), and myoglobin concentration (Mb) were evaluated before, immediately after, and on the 1st , 2nd, 3rd , and 7th days following exercise. Total work (TW) during exercises was recorded and corrected by muscle volume (TWc). TWc was greater (p < 0.01) for EF [24 (2) joule·cm-3] than for KE [7 (0.4) joule·cm-3]. Increases in CK on the 2nd , 3rd , and 7th days (p < 0.01) and increases in Mb on the 1st , 2nd , 3rd , and 7th days were significantly (p<0.01) larger for EF than for KE. The decline in IPT was greater (p < 0.05- 0.01) for EF at all test occasions compared with KE. The results of this study demonstrate that the magnitude of muscle damage is greater and the recovery is slower following maximal eccentric exercise of the EF than of the KE for sedentary males. Key points The magnitude of muscle damage is greater and the recovery is slower following maximal eccentric exercise of the EF than of the KE for sedentary males. This may be because of the higher total eccentric work per muscle unit in elbow flexors. PMID:24150563

  15. Assessment of eccentric exercise-induced muscle damage of the elbow flexors by tensiomyography.

    PubMed

    Hunter, Angus M; Galloway, Stuart D R; Smith, Iain J; Tallent, Jamie; Ditroilo, Massimiliano; Fairweather, Malcolm M; Howatson, Glyn

    2012-06-01

    Exercise induced muscle damage (EIMD) impairs maximal torque production which can cause a decline in athletic performance and/or mobility. EIMD is commonly assessed by using maximal voluntary contraction (MVC), creatine kinase (CK) and muscle soreness. We propose as an additional technique, tensiomyography (TMG), recently introduced to measure mechanical and muscle contractile characteristics. The purpose of this study was to determine the validity of TMG in detecting changes in maximal torque following EIMD. Nineteen participants performed eccentric elbow flexions to achieve EIMD on the non- dominant arm and used the dominant elbow flexor as a control. TMG parameters, MVC and rate of torque development (RTD) were measured prior to EIMD and repeated for another six consecutive days. Creatine kinase, muscle soreness and limb girth were also measured during this period. Twenty four hours after inducing EIMD, MVC torque, RTD and TMG maximal displacement had significantly (p<0.01) declined by 37%, 44% and 31%, respectively. By day 6 MVC, RTD and TMG recovered to 12%, 24% and 17% of respective pre-EIMD values. In conclusion, as hypothesised TMG maximal displacement significantly followed other standard EIMD responses. This could therefore be useful in detecting muscle damage from impaired muscle function and its recovery following EIMD.

  16. Effect of eccentric contraction velocity on muscle damage in repeated bouts of elbow flexor exercise.

    PubMed

    Barroso, Renato; Roschel, Hamilton; Ugrinowitsch, Carlos; Araújo, Rubens; Nosaka, Kazunori; Tricoli, Valmor

    2010-08-01

    Eccentric exercise induces muscle damage, but controversy exists concerning the effect of contraction velocity on the magnitude of muscle damage, and little is known about the effect of contraction velocity on the repeated-bout effect. This study examined slow (60 degrees.s(-1)) and fast (180 degrees.s(-1)) velocity eccentric exercises for changes in indirect markers of muscle damage following 3 exercise bouts that were performed every 2 weeks. Fifteen young men were divided into 2 groups based on the velocity of eccentric exercise: 7 in the Ecc60 (60 degrees.s(-1)) group, and 8 in the Ecc180 (180 degrees.s(-1)) group. The exercise consisted of 30 maximal eccentric contractions of the elbow flexors at each velocity, in which the elbow joint was forcibly extended from 60 degrees to 180 degrees (full extension) on an isokinetic dynamometer. Changes in maximal voluntary isometric contraction strength, range of motion, muscle soreness, and plasma creatine kinase activity before and for 4 days after the exercise were compared in the 2 groups using a mixed-model analysis (groupxboutxtime). No significant differences between groups were evident for changes in any variables following exercise bouts; however, the changes were significantly smaller (p<0.05) after the second and third bouts than after the first bout. These results indicate that the contraction velocity does not influence muscle damage or the repeated-bout effect.

  17. Effects of prior dynamic leg exercise on static effort of the elbow flexors.

    PubMed

    Yates, J W; Gladden, L B; Cresanta, M K

    1983-09-01

    The isometric endurance of the elbow flexors was determined in a control condition and subsequent to a maximal effort exercise bout on a cycle ergometer in seven subjects. Maximum voluntary contraction (MVC), peak rate of tension development (+dP/dt), peak rate of tension relaxation (-dP/dt), one-half contraction time, and one-half relaxation time were also measured. Each subject was tested on four occasions: two control and two experimental sessions. During the control sessions each subject held 40% of MVC to exhaustion, whereas the experimental session included a 1-min maximal effort exercise bout on a cycle ergometer 6 min prior to the isometric endurance task. Arterialized blood samples were drawn and analyzed for lactate, pH, PCO2, and PO2. Plasma bicarbonate was calculated from the Henderson-Hasselbalch equation. Subsequent to the cycle ergometer bout, blood lactate concentration rose from 0.8 to 11 mM, pH decreased from 7.43 to 7.20, PCO2 decreased from 40 to 32 Torr, and plasma bicarbonate decreased from 26 to 12 mM. When compared with the control values, no significant changes were evident for any muscle contractile properties following the cycle ergometer bout. However, isometric endurance was significantly reduced from 115.0 +/- 7.2 to 86.3 +/- 7.3 s.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. 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.

  19. Eight-Week Vibration Training of the Elbow Flexors by Force Modulation: Effects on Dynamic and Isometric Strength.

    PubMed

    Xu, Lin; Cardinale, Marco; Rabotti, Chiara; Beju, Bogdan; Mischi, Massimo

    2016-03-01

    Vibration exercise (VE) has been suggested as an effective method to improve strength and power capabilities. However, the underlying mechanisms in response to VE are still unclear. A pulley-like VE system, characterized by sinusoidal force applications has been developed and tested for proof of concept in a previous study. The aim of this study was to evaluate the effects of such force modulation on elbow flexors strength and compare it with conventional methods. Forty subjects were randomly divided into 4 groups of 10: the vibration group (VG), the no-vibration group (NVG), the dumbbell group (DG), and the control group (CG). Biceps curl exercises were used to train the elbow flexors 2 times a week for 8 weeks. Subjects in the VG were trained using a ramp-up baseline with superimposed 30 Hz sinusoidal vibration whereas the subjects in the NVG were trained using the same baseline but without vibration. Subjects in the DG were trained using dumbbells, and the subjects in the CG were not trained. The isometric break force (IBF) and 1 repetition maximum (1RM) of the subject's dominant arm were assessed before and after the 8-week training period. The VG achieved 1RM improvement (22.7%) larger than the NVG (10.8%) and comparable with the DG (22.3%). Differences in IBF gains following the training period among the training groups were found to be not significant. Our results support the inclusion of the proposed VE in strength training programs aimed at improving dynamic strength on the elbow flexors.

  20. 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.

  1. The origin of activity in the biceps brachii muscle during voluntary contractions of the contralateral elbow flexor muscles.

    PubMed

    Zijdewind, Inge; Butler, Jane E; Gandevia, Simon C; Taylor, Janet L

    2006-11-01

    During strong voluntary contractions, activity is not restricted to the target muscles. Other muscles, including contralateral muscles, often contract. We used transcranial magnetic stimulation (TMS) to analyse the origin of these unintended contralateral contractions (termed "associated" contractions). Subjects (n = 9) performed maximal voluntary contractions (MVCs) with their right elbow-flexor muscles followed by submaximal contractions with their left elbow flexors. Electromyographic activity (EMG) during the submaximal contractions was matched to the associated EMG in the left biceps brachii during the right MVC. During contractions, TMS was delivered to the motor cortex of the right or left hemisphere and excitatory motor evoked potentials (MEPs) and inhibitory (silent period) responses recorded from left biceps. Changes at a spinal level were investigated using cervicomedullary stimulation to activate corticospinal paths (n = 5). Stimulation of the right hemisphere produced silent periods of comparable duration in associated and voluntary contractions (218 vs 217 ms, respectively), whereas left hemisphere stimulation caused a depression of EMG but no EMG silence in either contraction. Despite matched EMG, MEPs elicited by right hemisphere stimulation were approximately 1.5-2.5 times larger during associated compared to voluntary contractions (P < 0.005). Similar inhibition of the associated and matched voluntary activity during the silent period suggests that associated activity comes from the contralateral hemisphere and that motor areas in this (right) hemisphere are activated concomitantly with the motor areas in the left hemisphere. Comparison of the MEPs and subcortically evoked potentials implies that cortical excitability was greater in associated contractions than in the matched voluntary efforts.

  2. Impaired neuromuscular function during isometric, shortening, and lengthening contractions after exercise-induced damage to elbow flexor muscles.

    PubMed

    Turner, Tanya S; Tucker, Kylie J; Rogasch, Nigel C; Semmler, John G

    2008-08-01

    The purpose of this study was to examine the effect of exercise-induced damage of the elbow flexor muscles on steady motor performance during isometric, shortening, and lengthening contractions. Ten healthy individuals (age 22+/-4 yr) performed four tasks with the elbow flexor muscles: a maximum voluntary contraction, a one repetition maximum (1 RM), an isometric task at three joint angles (short, intermediate, and long muscle lengths), and a constant-load task during slow (approximately 7 degrees/s) shortening and lengthening contractions. Task performance was quantified as the fluctuations in wrist acceleration (steadiness), and electromyography was obtained from the biceps and triceps brachii muscles at loads of 10, 20, and 40% of 1 RM. Tasks were performed before, immediately after, and 24 h after eccentric exercise that resulted in indicators of muscle damage. Maximum voluntary contraction force and 1-RM load declined by approximately 45% immediately after exercise and remained lower at 24 h ( approximately 30% decrease). Eccentric exercise resulted in reduced steadiness and increased biceps and triceps brachii electromyography for all tasks. For the isometric task, steadiness was impaired at the short compared with the long muscle length immediately after exercise (P<0.01). Furthermore, despite no differences before exercise, there was reduced steadiness for the shortening compared with the lengthening contractions after exercise (P=0.01), and steadiness remained impaired for shortening contractions 24 h later (P=0.01). These findings suggest that there are profound effects for the performance of these types of fine motor tasks when recovering from a bout of eccentric exercise.

  3. Limb position sense, proprioceptive drift and muscle thixotropy at the human elbow joint.

    PubMed

    Tsay, A; Savage, G; Allen, T J; Proske, U

    2014-06-15

    These experiments on the human forearm are based on the hypothesis that drift in the perceived position of a limb over time can be explained by receptor adaptation. Limb position sense was measured in 39 blindfolded subjects using a forearm-matching task. A property of muscle, its thixotropy, a contraction history-dependent passive stiffness, was exploited to place muscle receptors of elbow muscles in a defined state. After the arm had been held flexed and elbow flexors contracted, we observed time-dependent changes in the perceived position of the reference arm by an average of 2.8° in the direction of elbow flexion over 30 s (Experiment 1). The direction of the drift reversed after the arm had been extended and elbow extensors contracted, with a mean shift of 3.5° over 30 s in the direction of elbow extension (Experiment 2). The time-dependent changes could be abolished by conditioning elbow flexors and extensors in the reference arm at the test angle, although this led to large position errors during matching (±10°), depending on how the indicator arm had been conditioned (Experiments 3 and 4). When slack was introduced in the elbow muscles of both arms, by shortening muscles after the conditioning contraction, matching errors became small and there was no drift in position sense (Experiments 5 and 6). These experiments argue for a receptor-based mechanism for proprioceptive drift and suggest that to align the two forearms, the brain monitors the difference between the afferent signals from the two arms.

  4. 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

  5. Magnetic versus electrical stimulation in the interpolation twitch technique of elbow flexors.

    PubMed

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

    2012-01-01

    The study compared peripheral magnetic with electrical stimulation of the biceps brachii m. (BB) in the single pulse Interpolation Twitch Technique (ITT). 14 healthy participants (31±7 years) participated in a within-subjects repeated-measures design study. Single, constant-current electrical and magnetic stimuli were delivered over the motor point of BB with supramaximal intensity (20% above maximum) at rest and at various levels of voluntary contraction. Force measurements from right elbow isometric flexion and muscle electromyograms (EMG) from the BB, the triceps brachii m. (TB) and the abductor pollicis brevis m. (APB) were obtained. The twitch forces at rest and maximal contractions, the twitch force-voluntary force relationship, the M-waves and the voluntary activation (VA) of BB between magnetic and electrical stimulation were compared. The mean amplitude of the twitches evoked at MVC was not significantly different between electrical (0.62 ± 0.49 N) and magnetic (0.81 ± 0.49 N) stimulation (p > 0.05), and the maximum VA of BB was comparable between electrical (95%) and magnetic (93%) stimulation (p > 0. 05). No differences (p >0.05) were revealed in the BB M-waves between electrical (13.47 ± 0.49 mV.ms) and magnetic (12.61 ± 0.58 mV.ms) stimulation. The TB M-waves were also similar (p > 0.05) but electrically evoked APB M-waves were significantly larger than those evoked by magnetic stimulation (p < 0.05). The twitch-voluntary force relationship over the range of MVCs was best described by non-linear functions for both electrical and magnetic stimulation. The electrically evoked resting twitches were consistently larger in amplitude than the magnetically evoked ones (mean difference 3.1 ± 3.34 N, p < 0.05). Reduction of the inter-electrodes distance reduced the twitch amplitude by 6.5 ± 6.2 N (p < 0.05). The fundamental similarities in voluntary activation assessment of BB with peripheral electrical and magnetic stimulation point towards a promising

  6. Low-Frequency Fatigue Assessed as Double to Single Twitch Ratio after Two Bouts of Eccentric Exercise of the Elbow Flexors

    PubMed Central

    Janecki, Damian; Jaskólska, Anna; Marusiak, Jarosław; Jaskólski, Artur

    2016-01-01

    The aim of this study was to assess low-frequency fatigue as a double to single twitch ratio after repeated eccentric exercise of the elbow flexors. Maximal isometric torque, single and double twitch responses and low-frequency fatigue were assessed on the elbow flexors in 16 untrained male volunteers before, immediately after, 24 and 48 hours following two bouts of eccentric exercise consisted of 30 repetitions of lowering a dumbbell adjusted to ~75% of each individual’s maximal isometric torque. Maximal isometric torque and electrically evoked responses decreased significantly in all measurements after the first bout of eccentric exercise (p < 0.05). In measurements performed at 24 and 48 hours after the second bout both maximal voluntary isometric torque and electrically evoked contractions were significantly higher than in measurements performed after the first bout (p < 0.05). Although low-frequency fatigue significantly increased up to 48 hours after each bout of eccentric exercise, its values at 24 and 48 hours after the second bout were significantly lower than at respective time points after the first bout (p < 0.05). Double to single twitch ratio could be used as a sensitive tool in the evaluation of muscle recovery and adaptation to repeated eccentric exercise. Key points First bout of eccentric (ECC) exercise of the elbow flexors muscles induced repeated bout effect that lead to faster recovery of the low-frequency fatigue, the maximal torque of voluntary and electrically evoked contractions, and smaller soreness sensation, when the exercise are repeated 2-3 weeks later. Double (DT) to single twitch (ST) ratio could be used as a sensitive tool in the evaluation of muscle recovery and adaptation to repeated eccentric exercise. The single twitch and DT to ST ratios seem to be more susceptible for minimal force deficits that could occur even after repeated ECC where repeated bout effect should confer the protection after subsequent muscle damage. PMID

  7. Development of an equation to predict muscle volume of elbow flexors for men and women with a wide range of age.

    PubMed

    Akagi, Ryota; Takai, Yohei; Kato, Emika; Wakahara, Taku; Ohta, Megumi; Kanehisa, Hiroaki; Fukunaga, Tetsuo; Kawakami, Yasuo

    2010-03-01

    The present study examined the age-related changes in muscle thickness (MT) and volume (MV) of elbow flexors and developed a prediction equation of the MV based on the MT applicable to men and women with a wide range of age. The MT and MV were determined from a single ultrasonographic image and multiple magnetic resonance imaging scans, respectively, in 72 men and 75 women aged 19-77 year. As a result of examining the age-MT and age-MV relationships by calculation of partial correlation coefficients with the control variable of gender, MV was decreased with aging whereas the corresponding decline in MT was not significant. The subjects were randomly separated into either a validation (38 men and 42 women) or a cross-validation (34 men and 33 women) group, and a multiple regression equation to estimate MV using not only MT but also upper arm length (L), age and gender as independent variables [MV (cm(3)) = 60.8 x MT (cm) + 6.48 x L (cm) - 0.709 x age (year) + 51.4 x gender (0 women, 1 men) - 187.4] was validated and cross-validated. Thus, the prediction equation for MV of elbow flexors newly developed was shown to be applicable to men and women with a wide range of age.

  8. Low-Frequency Fatigue Assessed as Double to Single Twitch Ratio after Two Bouts of Eccentric Exercise of the Elbow Flexors.

    PubMed

    Janecki, Damian; Jaskólska, Anna; Marusiak, Jarosław; Jaskólski, Artur

    2016-12-01

    The aim of this study was to assess low-frequency fatigue as a double to single twitch ratio after repeated eccentric exercise of the elbow flexors. Maximal isometric torque, single and double twitch responses and low-frequency fatigue were assessed on the elbow flexors in 16 untrained male volunteers before, immediately after, 24 and 48 hours following two bouts of eccentric exercise consisted of 30 repetitions of lowering a dumbbell adjusted to ~75% of each individual's maximal isometric torque. Maximal isometric torque and electrically evoked responses decreased significantly in all measurements after the first bout of eccentric exercise (p < 0.05). In measurements performed at 24 and 48 hours after the second bout both maximal voluntary isometric torque and electrically evoked contractions were significantly higher than in measurements performed after the first bout (p < 0.05). Although low-frequency fatigue significantly increased up to 48 hours after each bout of eccentric exercise, its values at 24 and 48 hours after the second bout were significantly lower than at respective time points after the first bout (p < 0.05). Double to single twitch ratio could be used as a sensitive tool in the evaluation of muscle recovery and adaptation to repeated eccentric exercise.

  9. Effect of Creatine Supplementation on Muscle Damage and Repair Following Eccentrically-Induced Damage to the Elbow Flexor Muscles

    PubMed Central

    McKinnon, Neal B.; Graham, Mitchell T.; Tiidus, Peter M.

    2012-01-01

    We investigated effects of creatine (Cr) supplementation (CrS) on exercise-induced muscle damage. Untrained males and females (N = 27) ages 18-25, with no CrS history in the past 4 months, were randomly assigned to CrS (creatine and carbohydrate) (n = 9), placebo (P) (carbohydrate only) (n = 9), or control (C) (no supplements) groups (n = 9). Participants followed a 5-day Cr loading protocol of 40 g·day-1, divided for 5 days prior to exercise, reduced to 10 g g·day-1 for 5 days following exercise. Testing consisted of 5 maximal isometric contractions at 90 arm flexion with the preferred arm on a CYBEX NORM dynamometer, assessed prior to, immediately following, and 24, 48, 72, and 96 hours post muscle-damaging procedures. Damage was induced to the elbow flexor muscles using 6 sets of 10 eccentric contractions at 75 °/sec, 90 °/sec and 120 °/sec. Participants were asked to rate their muscle soreness on a scale of 1-10. Data was analyzed using repeated-measures ANOVA, with an alpha of 0.05. No significant differences were found between muscle force loss and rate of recovery or muscle soreness between groups over the 96 hr recovery period (p > 0.05). Across all 3 experimental groups an initial decrease in force was observed, followed by a gradual recovery. Significant differences were found between baseline and all others times (p = 0.031,0 .022, 0.012, 0.001 respectively), and between the 48 hour and 96 hour time periods (p = 0.034). A weak negative correlation between subjectively rated muscle soreness and mean peak isometric force loss (R2 = 0.0374 at 96 hours), suggested that muscle soreness and muscle force loss may not be directly related. In conclusion, 5 days of Cr loading, followed by a Cr maintenance protocol did not reduce indices of muscle damage or speed recovery of upper body muscles following eccentrically induced muscle damage. Key points Creatine supplementation has been suggested as a means to diminish exercise induced muscle damage and speed

  10. Position sense at the human elbow joint measured by arm matching or pointing.

    PubMed

    Tsay, Anthony; Allen, Trevor J; Proske, Uwe

    2016-10-01

    Position sense at the human elbow joint has traditionally been measured in blindfolded subjects using a forearm matching task. Here we compare position errors in a matching task with errors generated when the subject uses a pointer to indicate the position of a hidden arm. Evidence from muscle vibration during forearm matching supports a role for muscle spindles in position sense. We have recently shown using vibration, as well as muscle conditioning, which takes advantage of muscle's thixotropic property, that position errors generated in a forearm pointing task were not consistent with a role by muscle spindles. In the present study we have used a form of muscle conditioning, where elbow muscles are co-contracted at the test angle, to further explore differences in position sense measured by matching and pointing. For fourteen subjects, in a matching task where the reference arm had elbow flexor and extensor muscles contracted at the test angle and the indicator arm had its flexors conditioned at 90°, matching errors lay in the direction of flexion by 6.2°. After the same conditioning of the reference arm and extension conditioning of the indicator at 0°, matching errors lay in the direction of extension (5.7°). These errors were consistent with predictions based on a role by muscle spindles in determining forearm matching outcomes. In the pointing task subjects moved a pointer to align it with the perceived position of the hidden arm. After conditioning of the reference arm as before, pointing errors all lay in a more extended direction than the actual position of the arm by 2.9°-7.3°, a distribution not consistent with a role by muscle spindles. We propose that in pointing muscle spindles do not play the major role in signalling limb position that they do in matching, but that other sources of sensory input should be given consideration, including afferents from skin and joint.

  11. 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.

  12. 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.

  13. Elevations in ostensibly anabolic hormones with resistance exercise enhance neither training-induced muscle hypertrophy nor strength of the elbow flexors

    PubMed Central

    West, Daniel W. D.; Burd, Nicholas A.; Tang, Jason E.; Moore, Daniel R.; Staples, Aaron W.; Holwerda, Andrew M.; Baker, Steven K.

    2010-01-01

    The aim of our study was to determine whether resistance exercise-induced elevations in endogenous hormones enhance muscle strength and hypertrophy with training. Twelve healthy young men (21.8 ± 1.2 yr, body mass index = 23.1 ± 0.6 kg/m2) trained their elbow flexors independently for 15 wk on separate days and under different hormonal milieu. In one training condition, participants performed isolated arm curl exercise designed to maintain basal hormone concentrations (low hormone, LH); in the other training condition, participants performed identical arm exercise to the LH condition followed immediately by a high volume of leg resistance exercise to elicit a large increase in endogenous hormones (high hormone, HH). There was no elevation in serum growth hormone (GH), insulin-like growth factor (IGF-1), or testosterone after the LH protocol but significant (P < 0.001) elevations in these hormones immediately and 15 and 30 min after the HH protocol. The hormone responses elicited by each respective exercise protocol late in the training period were similar to the response elicited early in the training period, indicating that a divergent postexercise hormone response was maintained over the training period. Muscle cross-sectional area (CSA) increased by 12% in LH and 10% in HH (P < 0.001) with no difference between conditions (condition × training interaction, P = 0.25). Similarly, type I (P < 0.01) and type II (P < 0.001) muscle fiber CSA increased with training with no effect of hormone elevation in the HH condition. Strength increased in both arms, but the increase was not different between the LH and HH conditions. We conclude that exposure of loaded muscle to acute exercise-induced elevations in endogenous anabolic hormones enhances neither muscle hypertrophy nor strength with resistance training in young men. PMID:19910330

  14. Functional anatomy of the human digital flexor pulley system.

    PubMed

    Lin, G T; Amadio, P C; An, K N; Cooney, W P

    1989-11-01

    The anatomy of 55 cadaver digits was studied, both statistically and with simulated active motion using weights attached to the flexor tendons. The modified description of Doyle and Blythe accurately described the anatomy observed. Serial pulley sectioning showed two types of bowstringing, both of which affected the relationship of tendon excursion to joint motion. The most constant, resulting in 15% loss of motion for a fixed tendon excursion, occurred over the concave surfaces of the proximal and middle phalanges. Bowstringing at the proximal interphalangeal joint was present only after 30 degrees of flexion had occurred, because of the convexity of the phalangeal condyles.

  15. Intramuscular EMG from the hip flexor muscles during human locomotion.

    PubMed

    Andersson, E A; Nilsson, J; Thorstensson, A

    1997-11-01

    The purpose was to investigate the activation pattern of five major hip flexor muscles and its adaptation to changing speed and mode of progression. A total of 11 healthy subjects performed walking and running on a motor-driven treadmill at speeds ranging from 1.0 to 6.0 m s-1. Intramuscular fine-wire electrodes were used to record myoelectric signals from the iliacus, psoas, sartorius, rectus femoris and tensor fascia latae muscles. The basic pattern, with respect to number of activation periods, remained the same irrespective of speed and mode of progression. However, differences in the relative duration and timing of onset of activation occurred between individual muscles. Over the speed range in walking, a progressively earlier onset was generally seen for the activation period related to hip flexion. Changes in EMG amplitude were measured in the iliacus and psoas muscles and showed a marked increase and difference between walking and running at speeds above 2.0 m s-1. Thus, the alternating flexion-extension movements at the hip during locomotion appear to be governed by a rather fixed 'neural program' which normally only needs minor modulations to accomplish the adjustments accompanying an increase in speed of progression as well as a change from walking to running.

  16. 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

  17. Development of a physical model of the human elbow joint using polyacrylonitrile fibers

    NASA Astrophysics Data System (ADS)

    Gonzalez, Roger V.; Thielman, Jeffrey L.

    1998-07-01

    A physical model of the human elbow joint was designed using the polymer fiber polyacrylonitrile (PAN), developed at the University of New Mexico. The elbow model uses six PAN fiber bundles, as artificial muscles, to create the forces needed for elbow movement. These six fiber bundles were designed to imitate the major muscles that cross the human elbow joint. Four distinct movement tasks (elbow flexion/extension and forearm pronation/supination) were designed into the physical mode. Several steps were taken to meet this objective. First, the mechanical properties of the PAN fibers were characterized using the techniques developed by A. V. Hill, and compared with his results. The results show that the fiber mechanical properties have similarities to human muscle properties, and thus permitting a realistic elbow model to be developed. Second, a method of encasing the individual bundles of fibers was developed. The encasing lengthens and shortens with the fibers, prevents fluid leakage, and does not deteriorate given the acid and base fluid components. Third, a method of supplying and removing the activating fluids was developed. This system is chemically resistant, provides a method for controlling inlet and exit fluid flow, and allows for complete fluid exchange in less than 5 seconds. Finally, a microcontroller was incorporated to provide joint position and velocity control based on joint potentiometers and provide real-time feedback of joint positions. Using these components, a human elbow joint system was developed that allows movement in two degrees of freedom. Due to the characteristics of the PAN fiber bundles, the elbow joint was slower and weaker than originally designed. System improvements relate closely to increasing fiber bundle force and decreasing the reaction time constant.

  18. Thumb and finger forces produced by motor units in the long flexor of the human thumb

    PubMed Central

    Yu, W S; Kilbreath, S L; Fitzpatrick, R C; Gandevia, S C

    2007-01-01

    The uncommonly good proprioceptive performance of the long flexor of the thumb, flexor pollicis longus (FPL), may add significantly to human manual dexterity. We investigated the forces produced by FPL single motor units during a weak static grip involving all digits by spike-triggered averaging from single motor units, and by averaging from twitches produced by intramuscular stimulation. Nine adult subjects were studied. The forces produced at each digit were used to assess how forces produced in FPL are distributed to the fingers. Most FPL motor units produced very low forces on the thumb and were positively correlated with the muscle force at recruitment. Activity in FPL motor units commonly loaded the index finger (42/55 units), but less commonly the other fingers (P < 0.001). On average, these motor units produced small but significant loading forces on the index finger (∼5.3% of their force on the thumb) with the same time-to-peak force as the thumb (∼50 ms), but had no significant effect on other fingers. However, intramuscular stimulation within FPL did not produce significant forces in any finger. Coherence at 2–10 Hz between the thumb and index finger force was twice that for the other finger forces and the coherence to the non-index fingers was not altered when the index finger did not participate in the grasp. These results indicate that, within the long-term coordinated forces of all digits during grasping, FPL motor units generate forces highly focused on the thumb with minimal peripheral transfer to the fingers and that there is a small but inflexible neural coupling to the flexors of the index finger. PMID:17656436

  19. Tennis Elbow

    MedlinePlus

    Tennis elbow Overview By Mayo Clinic Staff Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and ...

  20. 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 ...

  1. Efficiency of the flexor tendon pulley system in human cadaver hands.

    PubMed

    Rispler, D; Greenwald, D; Shumway, S; Allan, C; Mass, D

    1996-05-01

    The efficiency of the flexor tendon system was examined in a human cadaver model. Pulleys were randomly sectioned, and the results were evaluated on the basis of the tendon excursion, force generated at the fingertip, and the work (force multiplied by distance) involved, as compared to the intact pulley system. When a single minor pulley (A1 or A5) was cut, there was no statistical difference in work efficiency or excursion efficiency from controls. Cutting all minor pulleys (A1, A3, A5) lead to a significant loss in excursion efficiency. The intact three pulley systems of A2, A3, and A4 were near normal and statistically better than A2 and A4 together for work efficiency. Cutting one of the major pulleys (A2, A4) resulted in significant changes in efficiency, but what was unexpected was to find an 85% loss of both work and excursion efficiency for the loss of A4 but only an excursion difference of 94% for the loss of A2. Our findings demonstrated that in this model, with the influence of the skin removed, A4 absence produced the largest biomechanically measured efficiency changes and that a combination of A2, A3, and A4 was necessary to preserve both work and excursion efficiency.

  2. Paired Associative Stimulation Induces Change in Presynaptic Inhibition of Ia Terminals in Wrist Flexors in Humans

    PubMed Central

    Russmann, Heike; Shamim, Ejaz A.; Meunier, Sabine; Hallett, Mark

    2010-01-01

    Enhancements in the strength of corticospinal projections to muscles are induced in conscious humans by paired associative stimulation (PAS) to the motor cortex. Although most of the previous studies support the hypothesis that the increase of the amplitude of motor evoked potentials (MEPs) by PAS involves long-term potentiation (LTP)-like mechanism in cortical synapses, changes in spinal excitability after PAS have been reported, suggestive of parallel modifications in both cortical and spinal excitability. In a first series of experiments (experiment 1), we confirmed that both flexor carpi radialis (FCR) MEPs and FCR H reflex recruitment curves are enhanced by PAS. To elucidate the mechanism responsible for this change in the H reflex amplitude, we tested, using the same subjects, the hypothesis that enhanced H reflexes are caused by a down-regulation of the efficacy of mechanisms controlling Ia afferent discharge, including presynaptic Ia inhibition and postactivation depression. To address this question, amounts of both presynaptic Ia inhibition of FCR Ia terminals (D1and D2 inhibitions methods; experiment 2) and postactivation depression (experiment 3) were determined before and after PAS. Results showed that PAS induces a significant decrease of presynaptic Ia inhibition of FCR terminals, which was concomitant with the facilitation of the H reflex. Postactivation depression was unaffected by PAS. It is argued that enhancement of segmental excitation by PAS relies on a selective effect of PAS on the interneurons controlling presynaptic inhibition of Ia terminals. PMID:20538768

  3. Comparison of elasticity of human tendon and aponeurosis in knee extensors and ankle plantar flexors in vivo.

    PubMed

    Kubo, Keitaro; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2005-05-01

    The purposes of this study were to compare the elasticity of tendon and aponeurosis in human knee extensors and ankle plantar flexors in vivo and to examine whether the maximal strain of tendon was correlated to that of aponeurosis. The elongation of tendon and aponeurosis during isometric knee extension (n = 23) and ankle plantar flexion (n = 22), respectively, were determined using a real-time ultrasonic apparatus, while the participants performed ramp isometric contractions up to voluntary maximum. To calculate the strain values from the measured elongation, we measured the respective length of tendon and aponeurosis. For the knee extensors, the maximal strain of aponeurosis (12.1 +/- 2.8 %) was significantly greater than that of the patella tendon (8.3 +/- 2.4 %), p < 0.001. On the contrary, the maximal strain of Achilles tendon (5.9 +/- 1.4 %) was significantly greater than that of aponeurosis in ankle plantar flexors (2.7 +/- 1.4 %), p < 0.001. Furthermore, for both knee extensors and ankle plantar flexors there was no significant correlation between maximal strain of tendon and aponeurosis. These results would be important for understanding the different roles of tendon and aponeurosis during human movements and for more accurate muscle modeling.

  4. Distribution of the forces produced by motor unit activity in the human flexor digitorum profundus

    PubMed Central

    Kilbreath, S L; Gorman, R B; Raymond, J; Gandevia, S C

    2002-01-01

    In humans, the flexor digitorum profundus (FDP), which is a multi-tendoned muscle, produces forces that flex the four distal interphalangeal joints of the fingers. We determined whether the force associated with activity in a single motor unit in the FDP was confined to a single finger or distributed to more than one finger during a natural grasp. The discharge of single low-threshold motor units (n = 69) was recorded at sites across the muscle during weak voluntary grasping involving all fingers and spike-triggered averaging of the forces under each of the finger pads was used to assess the distribution pattern. Spike-triggered averaging revealed that time-locked changes in force occurred under the ‘test’ finger (that finger on which the unit principally acted) as well as under the ‘non-test’ fingers. However, for the index-, middle- and ring-finger units, the changes in force under non-test fingers were typically small (< 20 % of those under the test finger). For little-finger units, the mean changes in force under the adjacent ring finger were large (>50 % of those under the test finger). The distribution of forces by little-finger units differed significantly from that for each of the other three fingers. Apart from increases in force under non-test fingers, there was occasional unloading of adjacent fingers (22/267 combinations), usually affecting the index finger. The increases in force under the test finger correlated significantly with the background force for units acting on the middle, ring and little fingers. During a functional grasp, the activity of single units in the FDP allows for a relatively selective control of forces at the tips of the index, middle and ring fingers, but this is limited for little-finger units. PMID:12181299

  5. 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)...

  6. 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)...

  7. 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)...

  8. 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)...

  9. 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)...

  10. Task dependent gain regulation of spinal circuits projecting to the human flexor carpi radialis.

    PubMed

    Carroll, Timothy J; Baldwin, Evan R L; Collins, David F

    2005-03-01

    In humans, the flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles act as antagonists during wrist flexion-extension and as functional synergists during radial deviation. In contrast to the situation in most antagonist muscle pairs, Renshaw cells innervated by the motor neurons of each muscle inhibit the motoneurons, but not Ia inhibitory interneurons, of the opposite motor pool. Here we compared gain regulation of spinal circuits projecting to FCR motoneurons during two tasks: flexion and radial deviation of the wrist. We also investigated the functional consequences of this organisation for maximal voluntary contractions (MVCs). Electromyographic (EMG) recordings were taken from FCR, ECR longus and ECR brevis using fine-wire electrodes and electrical stimulation was delivered to the median and radial nerves. Ten volunteers participated in three experiments. 1. To study the regulation of the Renshaw cell-mediated, inhibitory pathway from ECR to FCR motoneurons, forty stimuli were delivered to the radial nerve at 50% of the maximal M-wave amplitude for ECR brevis. Stimuli were delivered during both isometric wrist flexions and radial deviation actions with an equivalent EMG amplitude in FCR (approximately 5% wrist flexion MVC). 2. To explore the homonymous Ia afferent pathway to FCR motoneurons, 50 stimuli were delivered to the median nerve at intensities ranging from below motor threshold to at least two times that which evoked a maximal M-wave during wrist flexion and radial deviation (matched FCR EMG at approximately 5% wrist flexion MVC). 3. EMG amplitude was measured during MVCs in wrist flexion, extension and radial deviation. There was no significant difference in the inhibition of FCR EMG induced via ECR-coupled Renshaw cells between radial deviation and wrist flexion. However, the mean FCR H-reflex amplitude was significantly (P<0.05) greater during wrist flexion than radial deviation. Furthermore, EMG amplitude in FCR and ECR brevis was

  11. Friction between human finger flexor tendons and pulleys at high loads.

    PubMed

    Schweizer, A; Frank, O; Ochsner, P E; Jacob, H A C

    2003-01-01

    A method was developed to indirectly measure friction between the flexor tendons and pulleys of the middle and ring finger in vivo. An isokinetic movement device to determine maximum force of wrist flexion, interphalangeal joint flexion (rolling in and out) and isolated proximal interphalangeal (PIP) joint flexion was built. Eccentric and concentric maximum force of these three different movements where gliding of the flexor tendon sheath was involved differently (least in wrist flexion) was measured and compared. Fifty-one hands in 26 male subjects were evaluated. The greatest difference between eccentric and concentric maximum force (29.9%) was found in flexion of the PIP joint. Differences in the rolling in and out movement (26.8%) and in wrist flexion (14.5%) were significantly smaller. The force of friction between flexor tendons and pulleys can be determined by the greater difference between eccentric and concentric maximum force provided by the same muscles in overcoming an external force during flexion of the interphalangeal joints and suggests the presence of a non-muscular force, such as friction. It constitutes of 9% of the eccentric flexion force in the PIP joint and therefore questions the low friction hypothesis at high loads.

  12. Monitoring elbow isometric contraction by novel wearable fabric sensing device

    NASA Astrophysics Data System (ADS)

    Wang, Xi; Tao, Xiaoming; So, Raymond C. H.; Shu, Lin; Yang, Bao; Li, Ying

    2016-12-01

    Fabric-based wearable technology is highly desirable in sports, as it is light, flexible, soft, and comfortable with little interference to normal sport activities. It can provide accurate information on the in situ deformation of muscles in a continuous and wireless manner. During elbow flexion in isometric contraction, upper arm circumference increases with the contraction of elbow flexors, and it is possible to monitor the muscles’ contraction by limb circumferential strains. This paper presents a new wireless wearable anthropometric monitoring device made from fabric strain sensors for the human upper arm. The materials, structural design and calibration of the device are presented. Using an isokinetic testing system (Biodex3®) and the fabric monitoring device simultaneously, in situ measurements were carried out on elbow flexors in isometric contraction mode with ten subjects for a set of positions. Correlations between the measured values of limb circumferential strain and normalized torque were examined, and a linear relationship was found during isometric contraction. The average correlation coefficient between them is 0.938 ± 0.050. This wearable anthropometric device thus provides a useful index, the limb circumferential strain, for upper arm muscle contraction in isometric mode.

  13. Nursemaid's elbow

    MedlinePlus

    ... enable JavaScript. Nursemaid's elbow is a dislocation of a bone in the elbow called the radius. Dislocation means the bone slips out of its normal position. The injury is also called radial head dislocation. Causes Nursemaid's elbow is a common condition in young children. It generally affects ...

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

    PubMed

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

    2014-11-01

    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 muscles

  15. Elbow arthroscopy.

    PubMed

    Dodson, Christopher C; Nho, Shane J; Williams, Riley J; Altchek, David W

    2008-10-01

    Arthroscopy of the elbow was originally considered to be an unsafe procedure because of the small size of the elbow joint capsule and its proximity to several crucial neurovascular structures. Over the past decade, however, the procedure has become safer and more effective. These improvements can be attributed to a better understanding of elbow anatomy and of the disorders about the elbow as well as to advances in arthroscopic equipment and surgical technique. The most common indications for elbow arthroscopy include removal of loose bodies, synovectomy, débridement and/or excision of osteophytes, capsular release, and the assessment and treatment of osteochondritis dissecans. More recent advances have expanded the indications of elbow arthroscopy to include fracture management (eg, radial head fractures) and the treatment of lateral epicondylitis.

  16. [Elbow pain].

    PubMed

    Viikari-Juntura, Eira; Miintyselkii, Pekka; Havulinna, Jouni

    2010-01-01

    Pain and disability in the elbow are not as common as in the neck, shoulder or wrist, for example. The elbow may, however, present disorders that may in a prolonged state be difficult and cause significant loss of working capacity. These include epicondylitis, osteoarthritis and entrapment of the ulnar nerve.

  17. 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.

  18. Golfer's Elbow

    MedlinePlus

    ... curling the wrists during a biceps exercise, can overload the elbow muscles and tendons. In addition, any ... an instructor to check your form to avoid overload on muscles. Use the right equipment. If you' ...

  19. Elbow replacement

    MedlinePlus

    ... humerus in the upper arm The ulna and radius in the lower arm (forearm) The artificial elbow joint has two or three stems made of high-quality metal. A metal and plastic hinge joins the stems together ...

  20. [Elbow dislocation].

    PubMed

    de Pablo Márquez, B; Castillón Bernal, P; Bernaus Johnson, M C; Ibañez Aparicio, N M

    2017-03-09

    Elbow dislocation is the most frequent dislocation in the upper limb after shoulder dislocation. Closed reduction is feasible in outpatient care when there is no associated fracture. A review is presented of the different reduction procedures.

  1. Tennis elbow

    MedlinePlus

    ... side view References Adams JE, Steinmann SP. Elbow tendinopathies and tendon ruptures. In: Wolfe SW, Hotchkiss RN, ... PA: Elsevier; 2017:chap 25. Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: ...

  2. Human upper-limb force capacities evaluation with robotic models for ergonomic applications: effect of elbow flexion.

    PubMed

    Hernandez, Vincent; Rezzoug, Nasser; Jacquier-Bret, Julien; Gorce, Philippe

    2016-01-01

    The aim of this study was to apply models derived from the robotics field to evaluate the human upper-limb force generation capacity. Four models were compared: the force ellipsoid (FE) and force polytope (FP) based on unit joint torques and the scaled FE (SFE) and scaled FP (SFP) based on maximum isometric joint torques. The four models were assessed from four upper-limb postures with varying elbow flexion (40°, 60°, 80° and 100°) measured by an optoelectronic system and their corresponding isometric joint torques. Ten subjects were recruited. Three specific ellipsoids and polytopes parameters were compared: isotropy, principal force orientation and volume. Isotropy showed that the ellipsoids and polytopes were elongated. The angle between the two ellipsoids main axis and the two polytopes remained low but increased with the elbow flexion. The FE and FP volumes increased and those of SFE and SFP decreased with the elbow flexion. The interest and limits of such models are discussed in the framework of ergonomics and rehabilitation.

  3. Differential displacement of the human soleus and medial gastrocnemius aponeuroses during isometric plantar flexor contractions in vivo.

    PubMed

    Bojsen-Møller, Jens; Hansen, Philip; Aagaard, Per; Svantesson, Ulla; Kjaer, Michael; Magnusson, S Peter

    2004-11-01

    The human triceps surae muscle-tendon complex is a unique structure with three separate muscle compartments that merge via their aponeuroses into the Achilles tendon. The mechanical function and properties of these structures during muscular contraction are not well understood. The purpose of the study was to investigate the extent to which differential displacement occurs between the aponeuroses of the medial gastrocnemius (MG) and soleus (Sol) muscles during plantar flexion. Eight subjects (mean +/- SD; age 30 +/- 7 yr, body mass 76.8 +/- 5.5 kg, height 1.83 +/- 0.06 m) performed maximal isometric ramp contractions with the plantar flexor muscles. The experiment was performed in two positions: position 1, in which the knee joint was maximally extended, and position 2, in which the knee joint was maximally flexed (125 degrees ). Plantarflexion moment was assessed with a strain gauge load cell, and the corresponding displacement of the MG and Sol aponeuroses was measured by ultrasonography. Differential shear displacement of the aponeurosis was quantified by subtracting displacement of Sol from that of MG. Maximal plantar flexion moment was 36% greater in position 1 than in position 2 (132 +/- 20 vs. 97 +/- 11 N.m). In position 1, the displacement of the MG aponeurosis at maximal force exceeded that of the Sol (12.6 +/- 1.7 vs. 8.9 +/- 1.5 mm), whereas in position 2 displacement of the Sol was greater than displacement of the MG (9.6 +/- 1.0 vs. 7.9 +/- 1.2 mm). The amount and "direction" of shear between the aponeuroses differed significantly between the two positions across the entire range of contraction, indicating that the Achilles tendon may be exposed to intratendinous shear and stress gradients during human locomotion.

  4. Simple Elbow Dislocation.

    PubMed

    Armstrong, April

    2015-11-01

    Simple elbow dislocation refers to those elbow dislocations that do not involve an osseous injury. A complex elbow dislocation refers to an elbow that has dislocated with an osseous injury. Most simple elbow dislocations are treated nonoperatively. Understanding the importance of the soft tissue injury following a simple elbow dislocation is a key to being successful with treatment.

  5. Medial Elbow Exposure for Coronoid Fractures: FCU-Split Versus Over-the-Top

    DTIC Science & Technology

    2013-12-01

    margin of the mass anteriorly) was split and the pronator teres was released from the medial epicondyle and reflected off the anterior elbow capsule and...ORIGINAL ARTICLE Medial Elbow Exposure for Coronoid Fractures: FCU-Split Versus Over-the-Top Jeannie Huh, MD,* Chad A. Krueger, MD,* Michael J...fractures is unknown. The purpose of this study was to quantitatively compare the osseous and ligamentous exposure of the medial elbow using the flexor

  6. Position sense at the human forearm after conditioning elbow muscles with isometric contractions.

    PubMed

    Tsay, A; Allen, T J; Proske, U

    2015-09-01

    These experiments were designed to test the idea that, in a forearm position-matching task, it is the difference in afferent signals coming from the antagonist muscles of the forearm that determines the perceived position of the arm. In one experiment, flexor and then extensor muscles of the reference arm were conditioned by isometric voluntary contractions while the arm was held at the test angle, approximately 45° from the horizontal. At the same time, indicator arm flexor muscles were contracted while the arm was flexed, or extensors were contracted while it was extended. After an indicator flexor contraction, during matching, subjects made large errors in the direction of flexion, by 9.3° relative to the reference arm and after an indicator extensor contraction by 7.4° in the direction of extension. In the second experiment, with reference muscles conditioned as before, slack was introduced in indicator muscles by a combination of muscle contraction and stretch. This was expected to lower levels of afferent activity in indicator muscles. The subsequent matching experiment yielded much smaller errors than before, 1.4° in the direction of flexion. In both experiments, signal levels coming from the reference arm remained the same and what changed was the level of indicator signal. The fact that matching errors were small when slack was introduced in indicator muscles supported the view that the signal coming from reference muscles was also small. It was concluded that the brain is concerned with the signal difference from the antagonist pair of each arm and with the total signal difference between the two arms.

  7. 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.

  8. Tennis Elbow (Lateral Epicondylitis)

    MedlinePlus

    .org Tennis Elbow (Lateral Epicondylitis) Page ( 1 ) Tennis elbow, or lateral epicondyliti s, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause ...

  9. 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.

  10. [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.

  11. Tennis Elbow

    PubMed Central

    Bullard, J. A. A.

    1982-01-01

    Certain types of activity, particularly the wielding of a tennis racquet, put undue stress on the muscles of the forearm. The result can be extremely incapacitating as well as resistant to treatment. The earlier specific measures are introduced, the greater the success of conservative treatment. To provide this approach the physician must be aware of the multiple factors involved in the game. The backhand stroke appears to cause more problems than the forehand. Inexperienced players use the power of their elbows far more than the power of their whole bodies. Changes of technique or equipment may therefore be necessary. PMID:21286104

  12. The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

    PubMed Central

    Fuss, F K

    1991-01-01

    The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2050566

  13. Contribution of central vs. peripheral factors to the force loss induced by passive stretch of the human plantar flexors.

    PubMed

    Trajano, Gabriel S; Seitz, Laurent; Nosaka, Kasunori; Blazevich, Anthony J

    2013-07-15

    The purpose of the present research was to identify the contribution of central vs. peripheral factors to the force loss after passive muscle stretching. Thirteen men randomly performed both a 5-min constant-torque stretch of the plantar flexors on an isokinetic dynamometer and a resting condition on 2 separate days. The triceps surae electromyogram (EMG) was recorded simultaneously with plantar flexor isometric torque. Measures of central drive, including the EMG amplitude normalized to the muscle compound action potential amplitude (EMG/M), percent voluntary activation and first volitional wave amplitude, and measures of peripheral function, including the twitch peak torque, 20-to-80-Hz tetanic torque ratio and torque during 20-Hz stimulation preceded by a doublet, were taken before and immediately and 15 min after each condition. Peak torque (-15.7%), EMG/M (-8.2%), and both twitch (-9.4%) and 20-Hz peak torques (-11.5%) were reduced immediately after stretch but recovered by 15 min. There were strong correlations between the torque loss and the reductions in central drive parameters (r = 0.65-0.93). Torque recovery was also strongly correlated with the recovery in EMG/M and percent voluntary activation (r = 0.77-0.81). The moderate decreases in measures of peripheral function were not related to the torque loss or recovery. These results suggest that 1) central factors were strongly related to the torque reduction immediately after stretch and during torque recovery; and 2) the muscle's contractile capacity was moderately reduced, although these changes were not associated with the torque reduction, and changes in excitation-contraction coupling efficiency were not observed.

  14. 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.

  15. Rheumatoid flexor tenosynovitis and rupture.

    PubMed

    Ferlic, D C

    1996-08-01

    Rheumatoid flexor tenosynovitis at the wrist can cause locking, limitation of motion, nerve compression, and rupture of tendons. To prevent and treat these conditions, a flexor tenosynovectomy, combined with nerve decompression and tendon reconstruction as indicated, is necessary. If tendons are ruptured, the flexor pollicis longus and profundus to the index finger are most commonly affected. On the fingers flexor tenosynovitis can also cause locking, decrease in range of motion and rupture tendons. Flexor tenosynovitis of the fingers should be treated with decompression of the tendons health with preservation of the pulley system.

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

    PubMed

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

    2013-12-01

    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.

  17. Elbow Injuries and Disorders

    MedlinePlus

    ... Many things can make your elbow hurt. A common cause is tendinitis, an inflammation or injury to the tendons that attach muscle to bone. Tendinitis of the elbow is a sports injury, often from playing tennis or golf. You ...

  18. Tennis elbow surgery

    MedlinePlus

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is usually an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  19. [Arthroscopy of the elbow].

    PubMed

    Bojanić, Ivan; Smoljanović, Tomislav; Mahnik, Alan

    2010-01-01

    Elbow arthroscopy has become an indispensable method of surgical care of injuries and their consequences and damages that affect the elbow. The advantages of elbow arthroscopy in comparison to classical open surgery are multiple. Primarily, arthroscopy allows an excellent view of intra-articular structures and thus a detailed overview of the entire joint which enables us to perform complete surgery without opening the joint. Furthermore, morbidity is significantly smaller, rehabilitation is faster, and return to daily activities is also faster. Basic requirements for successful application of elbow arthroscopy are careful planning of the procedure, very good knowledge of regional anatomy of the elbow, strictly following the rules of performing the procedure, good technique and an experienced surgeon. Pathologies that can currently be addressed arthroscopically include osteochondritis dissecans of elbow, lateral epicondylitis, synovial plica syndrome, elbow osteoarthritis, elbow contracture, as well as the diseases where the synovectomy is needed, such as rheumatoid arthritis, pigmented villonodular synovitis, synovial chondromatosis and hemophiliac synovitis.

  20. Tennis elbow surgery - discharge

    MedlinePlus

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

  1. Elbow Synovial Fold Syndrome

    DTIC Science & Technology

    2007-12-01

    Density MR with arrows The clinical differential diagnosis of plica syndrome includes lateral epicondylitis (aka tennis elbow ), loose bodies... Elbow Synovial Fold Syndrome Radiology Corner Elbow Synovial Fold Syndrome Guarantor: CPT Amit Sanghi, USA, MC FS Contributors: CPT Amit...the case of a 17 year old female with elbow synovial fold syndrome (aka plica synovialis). The etiology is thought to be related to repetitive

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

    PubMed

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

    2014-01-01

    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.

  3. Flexor tendon injuries. Part 5. Flexor tenolysis, rehabilitation and results.

    PubMed

    Strickland, J W

    1987-03-01

    In this five-part series, we have attempted to review our current understanding of flexor tendon anatomy, physiology, biomechanics, healing and adhesion formation around a repaired tendon. The methods of acute flexor tendon repair, conventional free tendon grafting, staged flexor tendon reconstruction and pulley restoration have been discussed as well as flexor tenolysis, rehabilitation and results. From these articles it may be seen that flexor tendon surgery is a complex and difficult art which requires a thorough appreciation of the normal flexor tendon system, the exact status of that system following injury and a strong understanding of the techniques which may be best utilized to restore flexor tendon function. The procedures described require both technical skill and experience and postoperative therapy programs must be carefully instituted based on the unique status of each patient. With the important advances occurring in many areas of flexor tendon surgery, it is realistic to believe that in the near future the techniques described in these articles may be substantially altered and modified. Results will continue to improve until the patient and surgeon can realistically expect to return most digits to nearly full function after flexor tendon interruption.

  4. Electrically Driven Prosthetic Elbow.

    DTIC Science & Technology

    The invention relates to an improved electrically driven prosthetic elbow wherein the elbow is capable of being rigidly locked into place in any...desired position, and upon driving the arm to the fully extended position, the elbow is automatically unlocked.

  5. Nursemaid's Elbow (For Parents)

    MedlinePlus

    ... move of the arm. A child with nursemaid's elbow has some arm pain when the injury happens, but it doesn't ... t cause deformity or swelling. An arm or elbow injury that causes severe pain might be a sign of an elbow fracture ( ...

  6. Elbow fractures and dislocations.

    PubMed

    Little, Kevin J

    2014-07-01

    Elbow fractures are common in pediatric patients. Most injuries to the pediatric elbow are stable and require simple immobilization; however, more severe fractures can occur, often requiring operative stabilization and/or close monitoring. This article highlights the common fractures and dislocations about the pediatric elbow and discusses the history, evaluation, and treatment options for specific injuries.

  7. Post-exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation.

    PubMed

    Yamane, Motoi; Teruya, Hiroyasu; Nakano, Masataka; Ogai, Ryuji; Ohnishi, Norikazu; Kosaka, Mitsuo

    2006-03-01

    The influence of regular post-exercise cold application to exercised muscles trained by ergometer cycling (leg muscles) or handgrip exercise using a weight-loaded handgrip ergometer (forearm flexor muscles) was studied in human volunteers. Muscle loads were applied during exercise programs three to four times a week for 4-6 weeks. Besides measuring parameters characterizing muscle performance, femoral and brachial artery diameters were determined ultrasonographically. Training effects were identified by comparing pre- and post-training parameters in matched groups separately for the trained limbs cooled after exercise by cold-water immersion and the corresponding trained limbs kept at room temperature. Significant training effects were three times more frequent in the control than in the cold group, including increases in artery diameters in the control but not in the cold group. It is concluded that training-induced molecular and humoral adjustments, including muscle hyperthermia, are physiological, transient and essential for training effects (myofiber regeneration, muscle hypertrophy and improved blood supply). Cooling generally attenuates these temperature-dependent processes and, in particular, hyperthermia-induced HSP formation. This seems disadvantageous for training, in contrast to the beneficial combination of rest, ice, compression and elevation in the treatment of macroscopic musculo-tendinous damage.

  8. Posttraumatic stiff elbow

    PubMed Central

    Mittal, Ravi

    2017-01-01

    Posttraumatic stiff elbow is a frequent and disabling complication and poses serious challenges for its management. In this review forty studies were included to know about the magnitude of the problem, causes, pathology, prevention, and treatment of posttraumatic stiff elbow. These studies show that simple measures such as internal fixation, immobilization in extension, and early motion of elbow joint are the most important steps that can prevent elbow stiffness. It also supports conservative treatment in selected cases. There are no clear guidelines about the choice between the numerous procedures described in literature. However, this review article disproves two major beliefs-heterotopic ossification is a bad prognostic feature, and passive mobilization of elbow causes elbow stiffness. PMID:28216745

  9. Chronically unreduced elbow dislocations.

    PubMed

    Lyons, Robert P; Armstrong, April

    2008-02-01

    This article focuses on various methods to treat the chronically unreduced elbow. There are only a few small series published in the literature on which to base treatment options. Anatomic features pertinent to the discussion of the chronically unstable elbow are highlighted. The spectrum of treatment options includes open reduction, internal fixation and ligament reconstruction, external fixation, and elbow arthroplasty. The indications, operative technique, and results of each treatment modality are explored.

  10. Irreducible posterolateral elbow dislocation.

    PubMed

    Atkinson, Cameron T; Pappas, Nick D; Lee, Donald H

    2014-02-01

    Elbow dislocations are a high-energy traumatic event resulting in loss of congruence of a stable joint. The majority of elbow dislocations can be reduced by closed means and treated conservatively. We present a case of an irreducible elbow dislocation with reduction blocked by the radial head buttonholed through the lateral ligamentous complex. We performed open reduction with release followed by repair of the lateral ligamentous complex. Clinicians need to understand this unique variant of an elbow dislocation to appropriately treat this operative injury.

  11. A neuromusculoskeletal model to simulate the constant angular velocity elbow extension test of spasticity.

    PubMed

    Koo, Terry K K; Mak, Arthur F T

    2006-01-01

    We developed a neuromusculoskeletal model to simulate the stretch reflex torque induced during a constant angular velocity elbow extension by tuning a set of physiologically-based parameters. Our model extended past modeling efforts in the investigation of elbow spasticity by incorporating explicit musculotendon, muscle spindle, and motoneuron pool models in each prime elbow flexor. We analyzed the effects of changes in motoneuron pool and muscle spindle properties as well as muscle mechanical properties on the biomechanical behavior of the elbow joint observed during a constant angular velocity elbow extension. Results indicated that both motoneuron pool thresholds and gains could be substantially different among muscles. In addition, sensitivity analysis revealed that spindle static gain and motoneuron pool threshold were the most sensitive parameters that could affect the stretch reflex responses of the elbow flexors during a constant angular velocity elbow extension, followed by motoneuron pool gain, and spindle dynamic gain. It is hoped that the model will contribute to the understanding of the underlying mechanisms of spasticity after validation by more elaborate experiments, and will facilitate the future development of more specific treatment of spasticity.

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

    PubMed

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

    2011-08-01

    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.

  13. 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

  14. 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.

  15. Incidence and morphology of accessory heads of flexor pollicis longus and flexor digitorum profundus (Gantzer's muscles)

    PubMed Central

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

    1997-01-01

    In 1813 Gantzer described 2 accessory muscles in the human forearm which bear his name (Wood, 1868; Macalister, 1875; Testut, 1884; Le Double, 1897). The more frequent of the 2 accessory muscles or ‘accessorius ad pollicem’ was found to arise from the coronoid process of the ulna, coursing distally to attach into the flexor pollicis longus muscle (flexor pollicis longus accessory head, FPLah). The less frequently observed or ‘accessorius ad flexorem profundum digitorum’ was again found to arise from the coronoid process and course to join into the flexor digitorum profundus (flexor digitorum profundus accessory head, FDPah). Since their initial description, they have been examined in further detail by a number of authors (Wood, 1868; Macalister, 1875; Le Double, 1897; Dykes & Anson, 1944; Mangini, 1960; Malhotra et al. 1982; Dellon & McKinnon, 1987; Kida, 1988). These studies, most of them focusing on the FPLah, all show different results of prevalence, origin, insertion, relations and nerve supply. We undertook this study with the aim of providing a more accurate account of the detailed morphology of both accessory muscles because of the above-mentioned inconsistent anatomical descriptions and the lack of information as to important aspects such as vascular supply, morphology (shape and length) and the coexistence of both accessory heads. PMID:9419002

  16. Elbow replacement - discharge

    MedlinePlus

    ... the rest of your life. Play golf or tennis, or throw objects (such as a ball) for the rest of your life. Do any activities that make you lift your elbow over and over, such as shoveling or shooting ...

  17. Medial epicondylitis - golfer's elbow

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007638.htm Medial epicondylitis - golfer's elbow To use the sharing features on this page, please enable JavaScript. Medial epicondylitis is soreness or pain on the inside of ...

  18. Tennis elbow: a review.

    PubMed

    Noteboom, T; Cruver, R; Keller, J; Kellogg, B; Nitz, A J

    1994-06-01

    Tennis elbow is a common yet sometimes complex musculoskeletal condition affecting many patients treated by physical therapists. The purpose of this article is to review the anatomy, clinical examination, differential diagnosis, conservative care, and surgical treatment for tennis elbow or lateral epicondylitis. Particular attention is given to determining the precise pathological cause of lateral epicondylitis, with consideration of intrinsic and extrinsic factors associated with this condition. This information should assist health care practitioners who treat patients with this disorder.

  19. 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.

  20. Elbow Pain After a Fall: Nursemaid's Elbow or Fracture?

    PubMed

    Cohen-Rosenblum, Anna; Bielski, Robert J

    2016-06-01

    Nursemaid's elbow and elbow fractures are both common causes of acute elbow pain, but the mechanism of injury is quite different. In children, falls frequently go unwitnessed and children are often inaccurate when recounting the sequences of a fall, making the mechanism difficult to ascertain. A common clinical mistake is to treat all elbow injuries as a nursemaid's elbow. When the mechanism of injury is unknown, radiographs should be used to help make the diagnosis. Occult fractures, also known as "hairline" elbow fractures, may not be visible on initial X-rays, but clues to the diagnosis, especially the posterior fat pad, can be helpful in evaluation. When an occult fracture is suspected based on history and radiographic findings, the patient's elbow should be immobilized, not manipulated. This article also reviews successful reduction maneuvers for nursemaid's elbow. [Pediatr Ann. 2016;45(6):e214-e217.].

  1. Archery-related injuries of the hand, forearm, and elbow.

    PubMed

    Rayan, G M

    1992-10-01

    The five patients reported herein had various archery-related injuries of the upper extremities. Acute injuries included arrow laceration of a digital nerve and artery, contusion of forearm skin and subcutaneous tissue, and compression neuropathy of digital nerves from the bowstring. Chronic injuries included bilateral medial epicondylitis and median nerve compression at the wrist, de Quervain's tenosynovitis, and median nerve compression at the elbow. Essential measures for archery safety include use of archery protective gear, use of a light-weight bow, conditioning of the forearm flexor muscles, and modifications in drawing the bowstring.

  2. Elbow Dislocations in Contact Sports.

    PubMed

    Morris, Mark S; Ozer, Kagan

    2017-02-01

    Elbow dislocations are more common in athletes than in the general population. Simple elbow dislocations should be managed with early range of motion and early return to sport, even with high-level contact athletes. Patients with instability on examination or with complex elbow dislocations may require surgical intervention. Overall, the outcomes after simple elbow dislocations are excellent and athletes should be able to return to play without significant limitations.

  3. 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.

  4. Pyogenic flexor tenosynovitis in children.

    PubMed

    Luria, Shai; Haze, Amir

    2011-08-01

    Pyogenic flexor tenosynovitis is an uncommon, emergent hand infection. The literature lacks any description of the disease and the variability of its manifestations in young children. We describe 3 cases. Two cases were diagnosed and treated promptly, and the third presented late, with atypical clinical signs, causing a delay in his diagnosis and treatment and stressing the caution to be taken with the evaluation of these children with signs of hand infection.

  5. Lateral Elbow Tendinopathy

    PubMed Central

    Bhabra, Gev; Wang, Allan; Ebert, Jay R.; Edwards, Peter; Zheng, Monica; Zheng, Ming H.

    2016-01-01

    Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. The term tendinopathy is used to describe chronic overuse tendon disorders encompassing a group of pathologies, a spectrum of disease. This review details the pathophysiology of tendinopathy and tendon healing as an introduction for a system grading the severity of tendinopathy, with each of the 4 grades displaying distinct histopathological features. Currently, there are a large number of nonoperative treatments available for lateral elbow tendinopathy, with little guidance as to when and how to use them. In fact, an appraisal of the clinical trials, systematic reviews, and meta-analyses studying these treatment modalities reveals that no single treatment reliably achieves outstanding results. This may be due in part to the majority of clinical studies to date including all patients with chronic tendinopathy rather than attempting to categorize patients according to the severity of disease. We relate the pathophysiology of the different grades of tendinopathy to the basic science principles that underpin the mechanisms of action of the nonoperative treatments available to propose a treatment algorithm guiding the management of lateral elbow tendinopathy depending on severity. We believe that this system will be useful both in clinical practice and for the future investigation of the efficacy of treatments. PMID:27833925

  6. 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.

  7. 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.

  8. Pyogenic flexor tenosynovitis leading to an amputation.

    PubMed

    Evgeniou, Evgenios; Iyer, Srinivasan

    2012-08-24

    Flexor tenosynovitis is an aggressive closed-space infection of the digital flexor tendon sheaths of the hand. We present a case of pyogenic flexor tenosynovitis in an immunocompromised patient and discuss the importance of early diagnosis and referral to a specialist hand surgery unit. A 61-year-old man visited his general practitioner because of swelling and tenderness of his left index finger. The patient was discharged on oral antibiotics but returned 4 days after because of deterioration of his symptoms and was referred to a plastic surgery unit. A diagnosis of flexor tenosynovitis was made and the patient required multiple debridements in theatre, resulting in the amputation of the infected finger. Pyogenic flexor tenosynovitis is a relatively common but often misdiagnosed hand infection. Patients with suspected flexor tenosynovitis should be referred and treated early to avoid significant morbidity, especially when risk factors for poor prognosis are present.

  9. Muscle stiffness, strength loss, swelling and soreness following exercise-induced injury in humans.

    PubMed Central

    Howell, J N; Chleboun, G; Conatser, R

    1993-01-01

    1. In order to study injury-related changes in muscle stiffness, injury to the elbow flexors of thirteen human subjects was induced by a regimen of eccentric exercise. 2. Passive stiffness over an intermediate range of elbow angles was measured with a device which held the relaxed arm of the subject in the horizontal plane and stepped it through the range of elbow angles from 90 deg to near full extension at 180 deg. The relation between static torque and elbow angle was quite linear over the first 50 deg and was taken as stiffness. 3. Stiffness over this range of angles more than doubled immediately after exercise and remained elevated for about 4 days, and may result from low level myofibrillar activation induced by muscle stretch. 4. Arm swelling was biphasic; arm circumference increased by about 3% immediately after exercise, fell back toward normal, then increased by as much as 9% and remained elevated for as long as 9 days. 5. Ultrasound imaging showed most of the swelling immediately following the exercise to be localized to the flexor muscle compartment; subsequent swelling involved other tissue compartments as well. 6. Muscle strength declined by almost 40% after the exercise and recovery was only slight 10 days later; the half-time of recovery appeared to be as long as 5-6 weeks. PMID:8229798

  10. 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.

  11. MR Imaging of the Elbow.

    PubMed

    Binaghi, Daniela

    2015-08-01

    Almost all movements of the upper extremities during routine daily life and many athletic activities require a painless and stable elbow joint. Studying the elbow is a diagnostic challenge because of its complex anatomy. MR imaging is an extremely important tool in the evaluation of common elbow disorders, the spectrum of which ranges from obvious acute lesions to chronic overuse injuries whose imaging manifestations can be subtle.

  12. Clinical biomechanics of the elbow.

    PubMed

    Lockard, Margary

    2006-01-01

    This paper describes the biomechanics of the articulations of the elbow joint that is relevant to therapists who design rehabilitation programs for patients following injuries or surgeries to the elbow. Individual and combined joint movements required for function such as activities of daily living are discussed, including normal arthrokinematics and the components that contribute to joint stability. The strain behavior of the nerves that cross the elbow is also reviewed. Therapists will understand the complexities of the biomechanics of the elbow that is necessary to design safe and effective rehabilitation programs.

  13. Concerns on Little League Elbow.

    ERIC Educational Resources Information Center

    Wells, Michael J.; Bell, Gerald W.

    1995-01-01

    Little league elbow is a common overuse injury resulting from repetitive valgus stress on the elbow during overhead throwing. Prevention and treatment should emphasize education of athletes, parents, and coaches about its etiology. The paper examines bone development, noting that the condition is highly treatable if diagnosed in early development.…

  14. Pediatric complex divergent elbow dislocation.

    PubMed

    van Wagenberg, Jan-Maarten F; van Huijstee, Pieter J; Verhofstad, Michiel H J

    2011-01-01

    A divergent dislocation of the elbow is a very rare injury, and only a few cases have been described in the literature. It is characterized as a dorsal dislocation of the ulnohumeral joint combined with a lateral dislocation of the proximal radius. All three articulations of the elbow joint are involved. Like in our case, it can be accompanied by an avulsion fracture of the coronoid and a distal radius fracture. For correct understanding of the injury, proper radiographic studies are imperative. In contrast to some earlier reports that advise a conservative approach, we performed a very aggressive operative treatment. To ensure anatomic reconstruction of the elbow, surgical exposure of the various injuries was performed first. After gross reduction of the joint dislocation, definitive osteosynthesis of the distal radius fracture was performed. Subsequently, the coronoid process and lateral collateral ligament could be repaired anatomically, improving the stability of the elbow. An uneventful recovery with excellent elbow motion and stability was achieved.

  15. [Flexor pulleys of the fingers. Anatomy, biomechanics, reconstruction].

    PubMed

    Hahn, P; Lanz, U

    1996-09-01

    Primary or secondary flexor tendon surgery occasionally leads to damaged flexor pulleys. Insufficient pulley reconstruction causes loss of finger function by bow stringing of the flexor tendon. This paper reviews the anatomy and biomechanics of the flexor pulley system. Different techniques of reconstruction are discussed.

  16. 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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2014-12-01

    Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. Contraindications, technical considerations, and favorable outcomes following treatment with elbow arthroscopy require careful patient evaluation, a thorough understanding of anatomic principles, and proper patient positioning and portal selection to guide preoperative planning and overall patient care. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.

  19. Flexor tendon repair in zone III.

    PubMed

    Al-Qattan, Mohammad M

    2011-01-01

    There is a paucity of the literature on the outcome of zone III flexor tendon injuries. In this paper, we report on the results of zone III flexor tendon repair in 35 consecutive adult patients with clean cut lacerations of both flexor tendons in 42 fingers. There were 25 men and 10 women with an average age of 32 years. Repair of both flexor tendons was performed using 'figure of eight' core sutures and a continuous epitendinous suture. Postoperatively, an immediate active range of motion protocol was applied to ensure full active extension of the interphalangeal joints. The results were assessed using the Strickland-Glogovac grading system. There were no ruptures. One patient with two injured fingers developed complex regional pain syndrome and the final outcome was fair in both fingers. In the remaining 34 patients (40 fingers), 33 patients (38 fingers) had an excellent outcome and the remaining patient (two fingers) had a good outcome.

  20. 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.

  1. 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.

  2. Surgical management of unstable elbow dislocation without intra-articular fracture

    PubMed Central

    Micic, Ivan; Kim, Shin-Yoon; Park, Il-Hyung; Kim, Poong-Taek

    2008-01-01

    The purpose of this study was to describe soft tissue injury patterns and report the clinical results of primary ligament repair with use of protected early mobilisation in unstable elbow dislocations with pure capsulo-ligamentous injuries. Twenty-four patients who presented with traumatic unstable elbow dislocation without associated intra-articular fracture were reviewed. Anatomical repair was performed using metal anchor screws and the bone tunnel method. Ligament avulsion was noted in 55% for the medial collateral ligament, 80% for the lateral collateral ligament, 60% for the flexor tendon and 80% for the extensor tendon. The overall mean Mayo Elbow Performance Score was 93.2. Brachial artery injuries occurred in two elbows. Heterotopic calcification was noted in 14 patients and there was one severe traumatic arthrosis. This study showed a high incidence of reattachable avulsion injuries to ligaments, tendon/muscle and capsule in unstable elbow dislocations. Primary ligament repair coupled with early rehabilitation provided satisfactory outcomes at two to four years postoperatively. PMID:18677481

  3. 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

  4. 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.

  5. Calcific periarthritis of the elbow presenting as acute tennis elbow.

    PubMed

    Jawad, F; Jawad, A S M

    2014-01-01

    A 28-year-old woman presented with sudden acute lateral epicondylitis. There was no history of preceding trauma or repetitive use of the arm. Because of the acute onset and signs of acute inflammation, an X-ray was arranged. The X-ray showed a hyperdense calcified elongated globule distal to the lateral epicondyle. A diagnosis of calcific periarthritis (calcium apatite) of the elbow was made. Calcific periarthritis has rarely been reported as a cause of acute elbow pain.

  6. Management of the elbow joint.

    PubMed

    Heim, M; Beeton, K; Blamey, G; Goddard, N

    2012-07-01

    The elbow is a complex joint that is prone to bleeding episodes. These features as well as the close proximity of the ulnar nerve and the need to use the elbow in many activities of daily living can lead to a range of symptoms including recurrent bleeds, pain, instability or loss of range of movement and nerve compression. Conservative management includes splinting and proprioceptive retraining monitored by a physiotherapist who is a musculoskeletal expert in hemophilia care. In the event that conservative measures are not successful a range of surgical options may be indicated including elbow replacement. These approaches continue to be evaluated in both the short and long term in order to determine the most effective treatment for the symptomatic elbow.

  7. 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

  8. Simultaneous shoulder and elbow dislocation.

    PubMed

    Cobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih

    2014-05-23

    Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice.

  9. Simultaneous shoulder and elbow dislocation

    PubMed Central

    Çobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih

    2014-01-01

    Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice. PMID:24859563

  10. [Injuries of the elbow joint].

    PubMed

    Lill, H; Voigt, C

    2004-10-01

    Injuries of the elbow joint increase along with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics is important for understanding injury patterns, specific diagnosis, and therapy. Here we classify the most frequent elbow injuries such as dislocation, ligamentous instability, and fracture of the radial head, processus coronoideus, olecranon, and distal humerus based on joint anatomy, biomechanics, clinical examination, and imaging. Specific therapies are described.

  11. TENNIS ELBOW IN INDUSTRY

    PubMed Central

    Sinclair, A.

    1965-01-01

    This paper briefly reviews the present state of knowledge concerning the various factors involved in the aetiology of tennis elbow and the possible pathological lesions underlying the condition. Two series of cases are considered in greater detail. The first series, consisting of 37 cases, was treated by physical methods only, viz., manipulation, ultrasonic radiation, and short wave diathermy. The results were disappointing since little more than half the number were improved by sonation although subsequent diathermy did improve the majority of those who did not respond. But physical treatment is shown to be time consuming and variable in its results. The second series was treated by local infiltration of the painful area by hydrocortisone and, of the 38 cases, only one proved unsuccessful after one or two injections. The reduction in treatment-time and the fact that no special equipment is necessary are some of the obvious advantages in this form of treatment. The paper concludes with a discussion on the rationale of treatment and some additional aetiological factors which are in favour of an inflammatory, rather than a traumatic, basis for the condition. PMID:14278802

  12. 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.

  13. 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.

  14. 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

  15. Electromyography and mechanomyography of elbow agonists and antagonists in Parkinson disease.

    PubMed

    Marusiak, Jarosław; Jaskólska, Anna; Jarocka, Ewa; Najwer, Wojciech; Kisiel-Sajewicz, Katarzyna; Jaskólski, Artur

    2009-08-01

    The purpose of this study was to assess the electromyographic (EMG) and mechanomyographic (MMG) activities of agonist and antagonist muscles in Parkinson disease patients during maximal isometric elbow contraction in flexion and extension. Ten elderly females with Parkinson disease (average age 75 years) and 10 age-matched healthy females were tested. The torque and the EMG and MMG signals from biceps brachii and triceps brachii were recorded during sustained maximal voluntary isometric contraction of the elbow flexors and extensors. There were no intergroup differences in the EMG and MMG activities of agonist and antagonist muscles or in torque. This might be because the Parkinson subjects were tested during their medication "ON" phase, or perhaps maximal isometric contraction (MVC) induced greater active muscle stiffness that affected the MMG signal. Muscle Nerve 40: 240-248, 2009.

  16. Acute flexor tendon repairs in zone II.

    PubMed

    Coats, Robert W; Echevarría-Oré, Julio C; Mass, Daniel P

    2005-05-01

    Flexor tendon repair in zone II is still a technically demanding procedure, but the outcomes have become more predictable and satisfying. Of keystone importance for obtaining the goals of normal strength and gliding of repaired flexor tendons are an atraumatic surgical technique, an appropriate suture material, a competent pulley system, and the use of early motion rehabilitation protocols. The overall goal of hand and finger function also implies timely addressing of neurovascular injuries. New devices such as the TenoFix (Ortheon Medical; Winter Park, Florida) have shown adequate strength in the laboratory but are bulky and untested for work of flexion. Insufficient clinical data and high cost may prevent widespread use.

  17. Flexor Tendon Pulley Injuries in Rock Climbers.

    PubMed

    King, Elizabeth A; Lien, John R

    2017-02-01

    Closed pulley ruptures are rare in the general population but occur more frequently in rock climbers due to biomechanical demands on the hand. Injuries present with pain and swelling over the affected pulley, and patients may feel or hear a pop at the time of injury. Sequential pulley ruptures are required for clinical bowstringing of the flexor tendons. Ultrasound confirms diagnosis of pulley rupture and evaluates degree of displacement of the flexor tendons. Isolated pulley ruptures frequently are treated conservatively with early functional rehabilitation. Sequential pulley ruptures require surgical reconstruction. Most climbers are able to return to their previous activity level.

  18. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint humeral (hemi-elbow) metallic uncemented prosthesis is a device intended to be implanted made of...

  19. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint humeral (hemi-elbow) metallic uncemented prosthesis is a device intended to be implanted made of...

  20. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint humeral (hemi-elbow) metallic uncemented prosthesis is a device intended to be implanted made of...

  1. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint humeral (hemi-elbow) metallic uncemented prosthesis is a device intended to be implanted made of...

  2. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... uncemented prosthesis. 888.3180 Section 888.3180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint humeral (hemi-elbow) metallic uncemented prosthesis is a device intended to be implanted made of...

  3. Elbow disorders in throwing athletes.

    PubMed

    Gerbino, Peter G

    2003-07-01

    Skeletally immature throwing athletes are injured when they throw too frequently or use throwing styles and pitches that overstress their elbows. Despite safety guidelines for throwing that recommend throwing more than 300, but less than 600, pitches per season, compliance is almost impossible to monitor, given multiple opportunities for throwing abuse away from organized, supervised league play. All throwers should avoid the side-arm throwing style. Pitchers should not play in multiple leagues, should not play hard-throwing positions when not pitching, and should not pitch when having elbow or shoulder pain. When the elbow becomes painful, pitching should cease and a thorough evaluation performed. Once the diagnosis is made, appropriate nonoperative treatment is undertaken. Operative intervention in this age group uncommonly is needed. Rehabilitation includes identifying and eliminating causative risk factors. Educating the athlete, coach, and parents results in a longer, pain-free throwing career and enhanced enjoyment of the sport.

  4. Inverse Kinematics for a Parallel Myoelectric Elbow

    DTIC Science & Technology

    2001-10-25

    Inverse Kinematics for a Parallel Myoelectric Elbow A. Z. Escudero, Ja. Álvarez, L. Leija. Center of Research and Advanced Studies of the IPN...replacement above elbow are serial mechanisms driven by a DC motor and they include only one active articulation for the elbow [1]. Parallel mechanisms...are rather scarce [2]. The inverse kinematics model of a 3-degree of freedom parallel prosthetic elbow mechanism is reported. The mathematical

  5. Plantar flexor moment arm and muscle volume predict torque-generating capacity in young men.

    PubMed

    Baxter, Josh R; Piazza, Stephen J

    2014-03-01

    Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R(2) < 0.322) and with muscle moment arm at each speed (0.323 < R(2) < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size.

  6. Elbow extension in the C5 quadriplegic using functional neuromuscular stimulation.

    PubMed

    Miller, L J; Peckham, P H; Keith, M W

    1989-07-01

    A system has been designed to provide overhead reach in C5/6 quadriplegic subjects using functional neuromuscular stimulation (FNS) for control of the triceps muscle. The system uses the position of the arm in space as the input command, relieving the user from having to supply a conscious command signal. By measuring the position of the arm, the magnitude of the gravitational and passive torques opposing elbow extension can be calculated. This torque is counteracted by electrical activation of the triceps muscle, with the appropriate stimulus parameters determined from the recruitment characteristics of each electrode. Sufficient stimulus is applied to produce full elbow extension. Intermediate elbow angles are achieved using voluntary elbow flexor torque to counteract the effects of the stimulation. System performance was tested in two subjects. Subjects were asked to reach targets with and without stimulation, with loads up to 500 g in the hand. Using the FNS system, subjects were able to successfully reach the target positions above the horizontal that were inaccessible without stimulation.

  7. Endoscopic Ganglionectomy of the Elbow.

    PubMed

    Lui, Tun Hing

    2015-12-01

    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.

  8. [Flexor tendon pulley system: anatomy, pathology, treatment].

    PubMed

    Moutet, F

    2003-02-01

    Flexor tendon pulley has been very early noticed and described. Terminology usually accepted recognizes 6 arcifom pulleys (A0 to A5) and 3 cruciform pulleys (C1 to C3). Anatomy and physiology of this flexor tendon gliding and reflection system at the level of the digital sheet are exposed. The integrity necessity of this system became obvious regarding the flexor tendons repair. Four main pathologies may be concerned: the trigger finger congenital or progressive, due to a chondroid metaplasia of the A1 pulley; tenosynovial ganglions arising at the weak point between A1 and A2 pulley; lesions of the flexor tendon sheet during traumatic lacerations or surgical repairs; quite experimental lesions creating isolated ruptures of one or several pulleys which occur during sport practice, especially high level rock climbing. The repair techniques are exposed to allow to graduate and hierarchy the reparation technique regarding the pathology. A2 and A4 repair is always indicated. The best reconstruction material is an extensor retinaculum graft. But its poor surface available often draws to use conventional palmaris longus free graft.

  9. Elbow dislocation with ipsilateral distal radius fracture

    PubMed Central

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-01-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer. PMID:24082758

  10. Elbow dislocation with ipsilateral distal radius fracture.

    PubMed

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-07-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer.

  11. 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

  12. Sensory-motor equivalence: manual aiming in C6 tetraplegics following musculotendinous transfer surgery at the elbow.

    PubMed

    Robinson, Mark A; Hayes, Spencer J; Bennett, Simon J; Barton, Gabor J; Elliott, Digby

    2010-09-01

    Cervical spinal lesions at C6 result in paralysis of the triceps brachii while leaving deltoid and elbow flexor function intact. We examined the spatial-temporal characteristics of goal-directed aiming movements performed by C6 tetraplegics who had undergone musculotendinous transfer surgery in which the posterior deltoid replaces the triceps as the elbow extensor. On some trials, liquid crystal goggles were used to eliminate vision of the limb and target upon movement initiation. Although tetraplegic participants achieved the same degree of movement accuracy/consistency as control participants, their movement times were longer regardless of whether the movements were made away from (elbow extension) or towards the body (elbow flexion). Longer movement times were related to lower peak velocities, and not the symmetry of the aiming profiles. The tetraplegic participants were no more dependent on visual feedback for limb regulation than control participants. Although the characteristics of the movement trajectories were surprisingly similar, in both vision conditions, tetraplegics required more real and proportional time to reduce spatial variability in the limb's trajectory for elbow extensions. Our results indicate that the sensorimotor system is adaptable and that the representations governing limb control are not muscle specific.

  13. 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

  14. Effects of apomorphine on flexor reflex and periodic limb movement.

    PubMed

    Paradiso, Guillermo; Khan, Farooq; Chen, Robert

    2002-05-01

    It has been suggested that periodic leg movements (PLM) and spinal flexor reflex (FR) share common mechanisms. Although dopaminergic agents improve PLM in humans and strongly influence spinal FR circuitry in animal studies, its effects on FR have not been documented in humans. We describe a 65-year-old man with PLM after overnight withdrawal of dopaminergic agents. The electromyographic pattern of spontaneous PLM closely resembled that of the FR elicited by medial plantar nerve stimulation. Thirty minutes after subcutaneous injection of apomorphine, both PLM and FR were completely abolished. These findings demonstrate that dopaminergic agents can suppress exaggerated FR in humans, and support the hypothesis of common mechanisms for PLM and FR.

  15. The elbow: diagnosis and treatment of common injuries.

    PubMed

    Sellards, Robb; Kuebrich, Chris

    2005-03-01

    This article deals with common injuries to the elbow. Elbow anatomy is reviewed. Diagnosis and treatment of pronator syndrome,lateral epicondylitis (tennis elbow), radial tunnel syndrome, posterior interosseous nerve syndrome, medial epicondylitis (golfer's elbow), ulnar collateral ligament injury, cubital tunnel syndrome,posterolateral rotatory instability, distal biceps injuries, tricepstendon injuries, and posterior elbow impingement are discussed.

  16. Lateral epicondylitis of the elbow.

    PubMed

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

    2013-04-01

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

  17. Changes in motor cortical excitability during human muscle fatigue.

    PubMed Central

    Taylor, J L; Butler, J E; Allen, G M; Gandevia, S C

    1996-01-01

    1. The excitability of the motor cortex was investigated during fatiguing con of the elbow flexors in human subjects. During sustained contractions at 30 and 1 voluntary force (MVC), the short-latency electromyographic responses (EMG) evoke brachii and brachioradialis by transcranial magnetic stimulation increased in si EMG in the elbow flexors following the evoked muscle potential (silent period), duration during a sustained MVC but not during 30% MVCs nor during a sustained M muscle (adductor pollicis). 2. When the blood supply to brachioradialis was blocked with sphygmomanometer cuff sustained MVC, the changes in EMG responses to transcranial stimulation rapidly control values, This suggests that changes in these responses during fatigue wer small-diameter muscle afferents. 3. Tendon vibration during sustained MVCs indicated that the changes in the resp cortial stimulation were not mediated by reduced muscle spindle inputs. 4. Muscle action potentials evoked in brachioradialis by electrical stimulation cervicomedullary junction did not increase in size during sustained MVCs. Thus, cortically evoked responses during sustained MVCs reflects a change in cortical Although the silent period following cervicomedullary stimulation lengthened, it substantially shorter than the cortically evoked silent period. 5. The altered EMG responses to transcranial stimulation during fatigue suggest exitation and increased inhibition in the motor cortex. As these changes were un manipulation of afferent input they presumably result from intrinsic cortical pr altered voluntary drive to the motor cortex. Images Figure 1 PMID:8821148

  18. Elbow arthroscopy for posttraumatic arthrosis.

    PubMed

    Geib, Timothy M; Savoie, Felix H

    2009-01-01

    Posttraumatic stiffness is a common complication after injury to the elbow. The loss of motion may significantly limit an individual's ability to perform normal activities of daily living. If conservative measures including medication, physical therapy, static splinting, and selective injection fail to restore functional range of motion, surgical intervention may be warranted. Open procedures have been described with reasonable success in restoring motion. However, arthroscopic techniques may provide several advantages in these patients who have often undergone previous extensive open surgery.

  19. A biomechanical study of the flexor digitorum superficialis: effects of digital pulley excision and loss of the flexor digitorum profundus.

    PubMed

    Hamman, J; Ali, A; Phillips, C; Cunningham, B; Mass, D P

    1997-03-01

    Many reports have been devoted to characterizing the significance of the pulleys for the flexor digitorum profundus (FDP). However, no comparable work has been published on the flexor digitorum superficialis (FDS). This study characterized the FDS in a human cadaver model. Eleven fresh-frozen cadaver hands were used. By using a tensiometer, data were gathered for tendon excursion, tendon load, and work of flexion. Changes in efficiency were caused by excision of annular pulleys A1, A2, A3, and the palmar aponeurotic pulley. We also measured the effect of FDP excision on FDS efficiency. Sectioning of the A2 and A3 pulleys together caused statistically significant losses of efficiency in all three parameters (work, load, and excursion). When the FDP was removed from a finger with an intact pulley system, losses in both work and excursion efficiencies were significant. Removing the FDP while cutting different pulleys caused significant decrease in FDS excursion efficiency. We conclude that A2 and A3 are the most important pulleys for maintaining normal FDS function, and that the presence of the FDP in the digital sheath is essential for optimal FDS excursion efficiency.

  20. DESIGN OF AN ELECTRICALLY POWERED PROSTHETIC ELBOW.

    DTIC Science & Technology

    The electrically powered elbow design effort was initiated to develop a useful prosthetic component for severely handicapped persons. Preliminary...minimum static capacity of 300 pound-inches, and a no-load lifting velocity of ten revolutions per minute. In addition, the elbow was to provide continuous...the design criteria were not fulfilled but several elbow units were built for clinical evaluation. Recommendations for future design efforts are given. (Author)

  1. Magnetic resonance imaging of the elbow.

    PubMed

    Stevens, Kathryn J

    2010-05-01

    Elbow pain is frequently encountered in clinical practice and can result in significant morbidity, particularly in athletes. Magnetic resonance imaging (MRI) is an excellent diagnostic imaging tool for the evaluation of soft tissue and osteochondral pathology around the elbow. Recent advances in magnetic field strength and coil design have lead to improved spatial resolution and superior soft tissue contrast, making it ideal for visualization of complex joint anatomy. This article describes the normal imaging appearances of anatomy around the elbow and reviews commonly occurring ligamentous, myotendinous, neural, and bursal pathology around the elbow.

  2. Rupture of all digital flexors following Colles' fracture.

    PubMed

    Iyer, Srinivasan; Basu, Indraneil; Kaba, Rahim; Pabari, Amit

    2012-10-01

    Flexor tendon rupture following a Colles' fracture is a rare complication with only a handful of cases reported since the initial report in 1932. We present a case in which all digital flexor tendons ruptured within 6 months of a Colles' fracture. Previous reported cases have demonstrated rupture of either the radial or ulnar digital flexors but this case is the first in which all the digital flexors have been involved. This case report highlights the clinical implications of this rare occurrence and stresses the importance of accurate reduction and thorough clinical examination following bony injuries to the wrist.

  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. Salvage of elbow function in chronic complex elbow fracture dislocation with total elbow arthroplasty: a case report.

    PubMed

    Ramesh, Muthu; Foead, Agus Iwan; Ali, Anuar Bin; Devadasan, Benard

    2013-08-01

    In patients with an elbow fracture dislocation the incidence of radial head fracture is 36%, where as coronoid process fractures occur in 13%, and olecranon fractures in 4% of patients. Combination of all these fractures with a 'terrible triad' is rarely reported in the literature. We describe a 40 year old lady involved in a polytrauma who had head injury, pnuemothorax and an open fracture dislocation of the left elbow. The Injury Severity Score initially on admission was 44. She presented with chronic elbow instability with pain 1 year later. A semi constrained total elbow arthroplasty (TEA) with a Coonrad-Morrey prosthesis was performed in this complex injury involving fractures of the coronoid, olecranon, proximal third of the ulna and radial head malunion with heterotrophic ossification around the elbow joint. Although the survivorship of total elbow replacements has improved, it is still a procedure reserved to older patients with low functional demand. At 1-year follow-up, the patient had full range in flexion and extension. The Mayo Elbow Performance Score (MEPS) was 100. TEA is a procedure which gains function and stability in a terrible triad elbow.

  5. Fibromatosis of the flexor pollicus longus tendon

    PubMed Central

    Damkat-Thomas, L; Black, CE; Herbert, K

    2010-01-01

    An unusual case of fibromatosis of the dominant left flexor pollicus longus (FPL) in a thirteen year old schoolboy. Initially presenting with pain in the thenar eminence and difficulty flexing the metacarpal phalangeal joint (MPJ), other symptoms include locking, triggering and difficulty writing. MRI showed a 4cm segment of thickened abnormal tendon. Intra-operatively three 1cm nodules were excised from the FPL while preserving the tendon. Histopathology reported the nodules as fibromatosis. A literature search revealed that this has not previously been reported although symptomatic tendon sheath fibromas have. Our patient achieved a good result following surgical intervention and the two year review has shown no complications. PMID:24946359

  6. 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.

  7. Chitosan prevents adhesion during rabbit flexor tendon repair via the sirtuin 1 signaling pathway.

    PubMed

    Chen, Qiang; Lu, Hui; Yang, Hu

    2015-09-01

    Chitosan has been demonstrated to exert potent anti-adhesive activity during tendon repair; however, the underlying molecular mechanisms remain unclear. The present study aimed to investigate the preventive effects of chitosan on adhesion in rabbit tendon repair, and to investigate the role of the sirtuin (SIRT)1 signaling pathway in this process. A total of 30 rabbits were divided randomly into three equal groups: Group 1, saline treatment; group 2, chitosan treatment; and group 3, chitosan + nicotinamide treatment. The flexor tendon of each of the rabbits was injured, and subsequently each rabbit was injected with the one of the reagents. Six weeks post‑surgery, all of the rabbits were sacrificed and their flexor tendons were harvested for subsequent evaluation of adhesion. Western blotting was used to determine the protein expression levels of specific signaling molecules. An MTT assay was conducted to evaluate the viability of human tenocytes and flow cytometry was used to analyze the apoptotic rate of the cells. The present study demonstrated that treatment with chitosan relieved adhesion in the rabbits with flexor tendon injuries. In addition, chitosan treatment increased SIRT1 expression, and reduced acetylated p65 and p53 expression in the tendons. The effects of chitosan on the tendons were attenuated by treatment with nicotinamide (a SIRT1 inhibitor). In the human tenocytes, pretreatment with chitosan resulted in an inhibition of interleukin (IL)‑1β‑induced apoptosis. Furthermore, chitosan reversed the IL‑1β‑induced downregulation of SIRT1 and upregulation of acetylated p65 and p53. Furthermore, downregulation of Sirt1 by RNA interference abrogated the effects of chitosan on the levels of p65 and p53 acetylation, and the rate of tenocyte apoptosis. In conclusion, chitosan treatment prevented adhesion via the SIRT1 signaling pathway during rabbit flexor tendon repair. These results indicate that SIRT1 may be targeted for therapeutic

  8. Unilateral congenital elbow luxation in a dachshund

    PubMed Central

    Fafard, Alain R.

    2006-01-01

    Congenital elbow luxation was diagnosed in a 12-week-old, intact male, dachshund with a lateral elbow prominence and mild lameness of the right forelimb. Closed reduction of the radial head, ulnar ostectomy, and external stabilization of the joint were performed. Function was returned to the limb, but radial head and ulnar subluxation persisted. PMID:17017659

  9. 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.

  10. LABORATORY EVALUATION OF THE USAMBRL ELECTRIC ELBOW.

    DTIC Science & Technology

    A laboratory evaluation was conducted on the United States Army Medical Biomechanical Research Laboratory’s electric elbow including cyclic and...functional tests. During the course of this evaluation a number of deficiencies were revealed; however, the overall results were acceptable. Finally, by introducing some modifications the elbow was considerably improved. (Author)

  11. Recurrent elbow dislocation--an uncommon presentation.

    PubMed

    Sunderamoorthy, D; Smith, A; Woods, D A

    2005-09-01

    A 58 year old female attended our A&E department following a fall in the garden with swelling and bruising of the right arm and the elbow. Anteroposterior and lateral radiographs were interpreted as showing a normal elbow joint. A diagnosis of soft tissue injury to the elbow was made and the patient was discharged with advice. She returned 2 days later, did not have an x ray, and again given advice. Three weeks later she was referred back to A&E by the general practitioner with persistent swelling of the elbow. Further radiographs showed a posterolateral dislocation of the elbow. The elbow was reduced under sedation but was subsequently dislocated at follow up, and was treated by external fixator and transolecranon pin. The fixator was removed at 4 weeks and the elbow was then stable. This case highlights that recurrent elbow dislocations due to significant ligament injuries can present in joint and subsequently dislocate. A high index of suspicion is necessary and appropriate referral to the specialist must be made to avoid the morbidity associated with recurrent dislocation. It also emphasises the need to always assess the patient on his or her own merits despite previously normal investigations.

  12. Impact of physiotherapy on the functional status of elbow and knee joints and quality of life in patients with hemophilia.

    PubMed

    Wojna, Dorota; Anwajler, Joanna; Mladzka, Irena; Ostrowska, Bozena; Skolimowski, Tadeusz

    2006-06-30

    Background. The objective of our research was to assess the impact of physiotherapy on the frequency of intraarticular and intramuscular hemorrhages and on elbow and knee joint function, in hemophilic patients. Material and methods. We examined 22 boys, 6-14 years of age, suffering from hemophilia A. The research program included patient history in respect to intraarticular hemorrhages in elbows and knees before therapy, observation of intra-articular bleeding during physiotherapy, goniometric measurements of the range of movement in the elbow and knee, measurement of the circumference of the arm, forearm, thigh and calf, and momentum dynamometric measurements of the relative and absolute force of the flexors and extensors of the lower leg at the knee joints and of the forearm at the elbow joints, in static conditions. The treatment program included deficit coagulant agent replacement therapy, physiotherapy, and kinesitherapy. Results. The physiotherapy program we applied resulted in a considerable improvement in mobility, as well as increased muscle strength and mass. Conclusions. Our research showed that, due to the application of the appropriate replacement treatment, there was a decrease in the frequency and size of intraarticular hemorrhages, despite intense rehabilitation and physical activity.

  13. 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.

  14. 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

  15. Bilateral flexor tendon contracture following onychectomy in 2 cats.

    PubMed

    Cooper, Maureen A; Laverty, Peter H; Soiderer, Emily E

    2005-03-01

    Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes.

  16. Bilateral flexor tendon contracture following onychectomy in 2 cats

    PubMed Central

    2005-01-01

    Abstract Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646

  17. 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

  18. Surgery of the rheumatoid elbow.

    PubMed Central

    Souter, W A

    1990-01-01

    I suggest that for too long the problem of the rheumatoid elbow, particularly the need for surgical intervention, has been underestimated. Where the latter has been advocated the philosophy has been adopted that synovectomy and debridement with excision of the head of the radius is probably all that is required, or that in the late case excision arthroplasty may yield an adequate result. I suggest that these approaches are no longer tenable. Synovectomy and debridement with or without excision of the head of the radius does indeed retain an extremely valuable place in the management of stage 1, 2, and early stage 3 disease. In the later stages of the disease, however, serious consideration must now be given to total joint replacement, the results of which can be remarkably successful and durable, and the complications from which can now be contained within acceptable limits provided that the operating team is fully experienced. It must also be stressed how necessary it is in the medical or combined clinic to pursue careful clinical and radiological monitoring of the rheumatoid elbow so that signs of dangerous deterioration can be recognised early, and surgery applied at a time when optimal conditions for the particular surgical weapons to be used still exist. Images PMID:2241304

  19. Anodal transcranial direct current stimulation of the motor cortex induces opposite modulation of reciprocal inhibition in wrist extensor and flexor.

    PubMed

    Lackmy-Vallée, Alexandra; Klomjai, Wanalee; Bussel, Bernard; Katz, Rose; Roche, Nicolas

    2014-09-15

    Transcranial direct current stimulation (tDCS) is used as a noninvasive tool to modulate brain excitability in humans. Recently, several studies have demonstrated that tDCS applied over the motor cortex also modulates spinal neural network excitability and therefore can be used to explore the corticospinal control acting on spinal neurons. Previously, we showed that reciprocal inhibition directed to wrist flexor motoneurons is enhanced during contralateral anodal tDCS, but it is likely that the corticospinal control acting on spinal networks controlling wrist flexors and extensors is not similar. The primary aim of the study was to explore the effects of anodal tDCS on reciprocal inhibition directed to wrist extensor motoneurons. To further examine the supraspinal control acting on the reciprocal inhibition between wrist flexors and extensors, we also explored the effects of the tDCS applied to the ipsilateral hand motor area. In healthy volunteers, we tested the effects induced by sham and anodal tDCS on reciprocal inhibition pathways innervating wrist muscles. Reciprocal inhibition directed from flexor to extensor muscles and the reverse situation, i.e., reciprocal inhibition, directed from extensors to flexors were studied in parallel with the H reflex technique. Our main finding was that contralateral anodal tDCS induces opposing effects on reciprocal inhibition: it decreases reciprocal inhibition directed from flexors to extensors, but it increases reciprocal inhibition directed from extensors to flexors. The functional result of these opposite effects on reciprocal inhibition seems to favor wrist extension excitability, suggesting an asymmetric descending control onto the interneurons that mediate reciprocal inhibition.

  20. The effects of eye coordination during deep cervical flexor training on the thickness of the cervical flexors

    PubMed Central

    Moon, Hyun-Ju; Goo, Bong-Oh; Kwon, Hae-Yeon; Jang, Jun-Hyeok

    2015-01-01

    [Purpose] The purpose of this study was to identify changes in the thicknesses of the cervical flexors according to eye coordination during deep cervical flexor training. [Subjects and Methods] Twenty normal adults were randomly selected, and during their deep cervical flexor training and eye tracking, the thicknesses of the longus colli and the sternocleidomastoid were measured using ultrasonic waves. [Results] The thickness of the longus colli statistically significantly increased when deep cervical flexor training and eye coordination were performed simultaneously. However, the thickness of the sternocleidomastoid did not show statistically significant differences according to eye coordination. [Conclusion] Eye coordination during deep cervical flexor training is likely to increase the thickness of the longus colli selectively. PMID:26834355

  1. 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.

  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. Finite Element Analysis of Pipe Elbows.

    DTIC Science & Technology

    1980-02-01

    AD-AO81 077 DAVD TAYLOR NAVAL SHIP RESEARCH AND DEVELOPMENT CE--ETC F/B 13/11 FINITE ELEMENT ANALYSIS OF PIPE ELBOWS .(U) FE SO M S MARCUS, B C...TAYLOR NAVAL SHIP i RESEARCH AND DEVELOPMENT CENTER Bethesda, Md. 20084 4 FINITE ELEMENT ANALYSIS OF PIPE ELBOWS by 0 Melvyn S. Marcus and Gordon C...a 90-degree pipe elbow to determine principal stresses due to internal pressure, inplane bending, out-of-plane bending, and torsion moment loadings

  4. Pressure Loss in Ducts with Compound Elbows

    DTIC Science & Technology

    1943-02-01

    Report LOSS IN DUCTS WITH COMPOUND ELBOWS By John R. Weske Case School of Applied Science NACA N A c JI LE&.lJ/J \\ 9 **Y @woti AERONAUT WASHINGTON...AEROHATJTICS ADVANCE RESTRICTED REPORT ● -. PRESWRE U)SS IN DUCTS WITH C-ND ELBOWS By John R; Weske SUMMARY . Results are presented of’measurmneut of the...pressure drop and, h some oases, of the velooity distribution in ocxupound elbows WRS undertaken for the purposo of furnishing to the designer of duetIng

  5. Irreducible posterolateral elbow dislocation: a rare injury.

    PubMed

    Fenelon, Christopher; Zafar, Muhammed M; Sheridan, Gerard Anthony; Kearns, Stephen

    2016-12-30

    Posterolateral dislocation of the elbow is an injury commonly treated in the emergency department by closed reduction. Very rarely it can be irreducible and require open reduction. Only four cases of irreducible posterolateral elbow dislocation have been described in the literature over the past 50 years. We report the case of a 20-year-old man who sustained such an injury. Open reduction was performed and revealed the radial head protruding or 'buttonholing' through the lateral collateral ligament complex. This case highlights that continued closed reduction of the elbow should not be attempted, as a mechanical block to reduction can occur making reduction impossible.

  6. 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

  7. LATERAL EPICONDYLITIS OF THE ELBOW.

    PubMed

    Cohen, Marcio; da Rocha Motta Filho, Geraldo

    2012-01-01

    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.

  8. An Overview of the Management of Flexor Tendon Injuries

    PubMed Central

    Griffin, M; Hindocha, S; Jordan, D; Saleh, M; Khan, W

    2012-01-01

    Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines. PMID:22431948

  9. Management of tennis elbow by Agnikarma.

    PubMed

    Mahanta, Vyasadeva; Dudhamal, Tukaram S; Gupta, Sanjay Kumar

    2013-01-01

    Tennis elbow is a painful condition and causes restricted movement of forearm which requires treatment for long period. Till date only symptomatic treatments are available like use of anti-inflammatory analgesic drugs, steroids injection, physiotherapy, exercise etc. But none of these provide satisfactory result. Long term use of anti-inflammatory, analgesic drugs and steroids injection is also not free from the adverse effects. Usually, 'wait-and-see policy' of treatment guideline is recommended in most of medical texts. According to Ayurveda, snayugata vata can be correlated with the condition of tennis elbow. Sushruta has advised Agnikarma for disorders of snayu (ligaments and tendons), asthi (bone), siddhi (joints) etc. Hence, in this study a case of tennis elbow (snayugata vata) was treated by Agnikarma, along with administration of powder of Ashwagandha and Navajivana Rasa orally, for a period of 03 weeks. This combination therapy provided considerable relief in pain and movement of the elbow joint.

  10. Management of tennis elbow by Agnikarma

    PubMed Central

    Mahanta, Vyasadeva; Dudhamal, Tukaram S.; Gupta, Sanjay Kumar

    2013-01-01

    Tennis elbow is a painful condition and causes restricted movement of forearm which requires treatment for long period. Till date only symptomatic treatments are available like use of anti-inflammatory analgesic drugs, steroids injection, physiotherapy, exercise etc. But none of these provide satisfactory result. Long term use of anti-inflammatory, analgesic drugs and steroids injection is also not free from the adverse effects. Usually, ‘wait-and-see policy’ of treatment guideline is recommended in most of medical texts. According to Ayurveda, snayugata vata can be correlated with the condition of tennis elbow. Sushruta has advised Agnikarma for disorders of snayu (ligaments and tendons), asthi (bone), siddhi (joints) etc. Hence, in this study a case of tennis elbow (snayugata vata) was treated by Agnikarma, along with administration of powder of Ashwagandha and Navajivana Rasa orally, for a period of 03 weeks. This combination therapy provided considerable relief in pain and movement of the elbow joint. PMID:23741162

  11. Elbow spasticity during passive stretch-reflex: clinical evaluation using a wearable sensor system

    PubMed Central

    2013-01-01

    Background Spasticity is a prevalent chronic condition among persons with upper motor neuron syndrome that significantly impacts function and can be costly to treat. Clinical assessment is most often performed with passive stretch-reflex tests and graded on a scale, such as the Modified Ashworth Scale (MAS). However, these scales are limited in sensitivity and are highly subjective. This paper shows that a simple wearable sensor system (angle sensor and 2-channel EMG) worn during a stretch-reflex assessment can be used to more objectively quantify spasticity in a clinical setting. Methods A wearable sensor system consisting of a fibre-optic goniometer and 2-channel electromyography (EMG) was used to capture data during administration of the passive stretch-reflex test for elbow flexor and extensor spasticity. A kinematic model of unrestricted passive joint motion was used to extract metrics from the kinematic and EMG data to represent the intensity of the involuntary reflex. Relationships between the biometric results and clinical measures (MAS, isometric muscle strength and passive range of motion) were explored. Results Preliminary results based on nine patients with varying degrees of flexor and extensor spasticity showed that kinematic and EMG derived metrics were strongly correlated with one another, were correlated positively (and significantly) with clinical MAS, and negatively correlated (though mostly non-significant) with isometric muscle strength. Conclusions We conclude that a wearable sensor system used in conjunction with a simple kinematic model can capture clinically relevant features of elbow spasticity during stretch-reflex testing in a clinical environment. PMID:23782931

  12. Miscellaneous conditions about the elbow in athletes.

    PubMed

    McFarland, Edward G; Gill, Harpreet S; Laporte, Dawn M; Streiff, Michael

    2004-10-01

    This article reviews some of the conditions about the elbow in athletes or active individuals. The conditions discussed are synovial plica of elbow, radiocapitellar arthritis, congenital dislocation of the radial head, radio-ulnar synostosis, hemophilia and rheumatoid arthritis. In the past, people who had these conditions were instructed to avoid athletic activities; however, they are now being counseled to remain active and to try to exercise on a regular basis.

  13. Elbow Imaging in Sport: Sports Imaging Series.

    PubMed

    Bucknor, Matthew D; Stevens, Kathryn J; Steinbach, Lynne S

    2016-04-01

    Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.

  14. Elbow dislocation with irreparable fracture radial head

    PubMed Central

    Tanna, Dilip

    2013-01-01

    Background: Treatment of elbow dislocation with irreparable radial head fracture needs replacement of radial head to achieve stability of elbow. An alternate method in cases of elbow dislocation with radial head fracture can be resection of radial head with repair of medial collateral ligament. We report a retrospective analysis of cases of elbow dislocation with irreparable radial head treated by excision head of radius and repair of MCL. Materials and Methods: Nine patients of elbow dislocation with associated irreparable fractures of the head of the radius were included in this analysis (6 F:3 M, Age: 35-47 years). Radial head excision was done through the lateral approach and MCL was sutured using no 3 Ethibond using medial approach. Above elbow plaster was given for 6 weeks and gradual mobilization was done thereafter. All patients were assessed at final followup using Mayo elbow performance score (MEPS). Results: Mean followup was 19.55 ± 7.12 months (range 14-36 months). There was no extension deficit when compared to opposite side with mean range of flexion of 138.8° ± 6.97° (range 130 -145°). Mean pronation was 87.7° ± 4.4° (range 80-90°) and mean supination was 87.7 ± 4.62° (range 80-90°). The mean MEPS was 98.8 ± 3.33 (range 90-100). No patient had pain, sensory complaints, subluxation or redislocation. All were able to carry out their daily activities without disability. Conclusion: Radial head excision with MCL repair is an acceptable option for treatment of patients with elbow dislocation and irreparable radial head fracture. PMID:23798760

  15. 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.

  16. 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°.

  17. Zone III flexor tendon injuries - A proposed modification to rehabilitation.

    PubMed

    Chinchalkar, Shrikant J; Pipicelli, Joey G; Agur, Anne; Athwal, George S

    2015-01-01

    In this manuscript, these authors have utilized years of clinical experience to suggest rehabilitation modifications for Zone III flexor tendon injuries. - VictoriaPriganc, PhD, OTR, CHT, CLT, Practice Forum Editor.

  18. Vascularized dorsal digital fascial flap improves flexor tendon repairs.

    PubMed

    Sun, L-Q; Zhao, G; Gao, S-H; Chen, C

    2014-09-01

    We report a new method of flexor tendon repair in zone II using a standard modified Kessler technique combined with a vascularized dorsal fascial flap from the finger pedicled on a dorsal cutaneous branch of the proper digital artery, which is placed as a mechanical barrier between the flexor digitorum superficialis and profundus tendons. The functional outcomes of 14 patients (Group A) with flexor tendon repairs in zone II by this new technique were compared with those of 32 patients (Group B) with flexor tendon repairs in zone II using a standard modified Kessler technique only. Patients in Group A had a higher proportion of excellent results (on the modified Strickland system) and more movement in the distal interphalangeal joint than the patients in Group B.

  19. 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.

  20. The flexor tendon pulley system and rock climbing.

    PubMed

    Crowley, Timothy P

    2012-06-01

    Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed.

  1. Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis.

    PubMed

    Lui, Tun Hing

    2015-10-01

    Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus.

  2. Spontaneous Flexor Tendon Rupture Due to Atraumatic Chronic Carpal Instability

    PubMed Central

    Miranda, B. H.; Cerovac, S.

    2014-01-01

    Background Spontaneous flexor tendon rupture is considered to be invariably associated with previous hand/wrist injury or systemic disease such as rheumatoid arthritis. Case Description A 54-year-old man presented with a 4-month history of mild ulnar wrist pain and spontaneous left little finger flexion loss in the absence of distant/recent trauma and systemic arthropathy. Surgical exploration confirmed a zone IV left little finger flexor digitorum profundus (FDP5) attritional rupture (100%), ring finger flexor digitorum profundus (FDP4) attenuation (40%) and a disrupted lunotriquetral ligament and volar-ulnar wrist capsule. Volar subluxation of the narrowed carpal tunnel resulted in flexor tendon attrition against the hamate hook. A side-to-side tendon transfer was performed along with a lunotriquetral ligament repair and temporary Kirschner wire fixation. At 6 months the patient had full active, synchronous flexion of the ring and little fingers and reduced wrist pain. Literature Review Traumatic flexor tendon ruptures have been reported following distal radius/hamate hook fractures, from carpal bone osteophytes, accessory carpal bones and intraosseous ganglia. Attritional ruptures caused by chronic, degenerative carpal pathology are less common. Clinical Relevance This case highlights an unusual cause of flexor tendon rupture due to chronic carpal instability. PMID:25032080

  3. 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

  4. Primary total elbow replacement in a patient with old unreduced complex posterior elbow dislocation.

    PubMed

    Kanakaraddi, Sandeep

    2013-01-01

    A 65-year-old female presented with history of a fall on an outstretched hand 2 months back and with complaints of pain, limitation of movement of right elbow, and inability to carry out her daily routine activities. On examination, there was swelling and tenderness at the elbow, three point relation was altered, had fixed flexion deformity of 50° with range of motion from 50° to 60°. Radiographs showed neglected old unreduced posterior elbow dislocation, fractures of radial head, and coronoid process. Patient was treated with total elbow replacement using 3rd generation sloppy hinged elbow prosthesis. At 3 weeks, range of motion was from 30° to 120°. At 6 weeks follow-up, patient was able to do her routine activities independently with ROM of 20° to 140° and minimum pain.

  5. 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.

  6. 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.

  7. Electromyography of wrist and finger flexor muscles in olive baboons (Papio anubis).

    PubMed

    Patel, Biren A; Larson, Susan G; Stern, Jack T

    2012-01-01

    Some non-human primates use digitigrade hand postures when walking slowly on the ground. As a component of an extended limb, a digitigrade posture can help minimize wrist joint moments thereby requiring little force production directly from wrist flexors (and/or from the assistance of finger flexors) to maintain limb posture. As a consequence, less active muscle volume would be required from these anti-gravity muscles and overall metabolic costs associated with locomotion could be reduced. To investigate whether the use of digitigrade hand postures during walking in primates entails minimal use of anti-gravity muscles, this study examined electromyography (EMG) patterns in both the wrist and finger flexor muscles in facultatively digitigrade olive baboons (Papio anubis) across a range of speeds. The results demonstrate that baboons can adopt a digitigrade hand posture when standing and moving at slow speeds without requiring substantial EMG activity from distal anti-gravity muscles. Higher speed locomotion, however, entails increasing EMG activity and is accompanied by a dynamic shift to a more palmigrade-like limb posture. Thus, the ability to adopt a digitigrade hand posture by monkeys is an adaptation for ground living, but it was never co-opted for fast locomotion. Rather, digitigrady in primates appears to be related to energetic efficiency for walking long distances.

  8. 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

  9. Severe injury of bilateral elbow joints with unilateral terrible triad of the elbow and unilateral suspected terrible triad of the elbow complicated with olecranon fracture: one case report

    PubMed Central

    Zha, Guoqing; Niu, Xiaofeng; Yu, Weiguang; Xiao, Liangbao

    2015-01-01

    Terrible triad of the elbow is characterized as posterior dislocation of the elbow joint accompanied by the fractures of the radial head and coronoid process of the ulna, which is rarely seen in clinical practice, especially because the mild fracture is barely detected by imaging method In this study, we reported one case of serious complex bilateral elbow injury, presenting with unilateral typical terrible triad of the elbow and suspected terrible triad of the elbow complicated with olecranon fracture on the other side. Clinical experience was obtained during the diagnosis and treatment procedures. PMID:26550399

  10. Musculoskeletal ultrasound: elbow imaging and procedures.

    PubMed

    Lee, Kenneth S; Rosas, Humberto G; Craig, Joseph G

    2010-09-01

    Elbow injuries, both acute and chronic sports-related cases, have increased over the last decade. With one in every four members of a household participating in sports, both clinics and radiology departments are seeing more patients with elbow pain. High-resolution ultrasound is well suited for evaluating the elbow. Ultrasound is growing in popularity and fast becoming another modality that the radiologist can use to help diagnose elbow pathology. With advancing transducer technology and accessibility, ultrasound offers focused and real-time high-resolution imaging of tendons, ligaments, and nerve structures. Its advantages include the use of safe nonionizing radiation, accessibility, and cost effectiveness. Another unique advantage is its ability for dynamic assessment of tendon and ligament structures such as in cases of partial tears of the medial ulnar collateral ligament or ulnar nerve dislocation. It is also easy to assess the contralateral side as a control. Ultrasound is also useful in therapeutic guided injections for its multiplanar capability and clear visualization of major vessels and nerves. We discuss the unique application of ultrasound in evaluating common elbow pathology and in advanced ultrasound-guided treatments such as dextrose prolotherapy and platelet-rich plasma.

  11. Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)

    MedlinePlus

    ... boney ridge of the medial epicondyle. Because this stretching can irritate the nerve, keeping your elbow bent ... from getting caught on the bony ridge and stretching when you bend your elbow. This procedure is ...

  12. Golf Injuries to the Hand, Wrist, or Elbow

    MedlinePlus

    ... left hand for a right handed player). Medial Epicondylitis , also known as “golfer’s elbow,” is a painful ... on the outer aspect of the elbow (Lateral Epicondylitis) is more common. Hamate bone fractures occur when ...

  13. Ultrasonography of the hand, wrist, and elbow.

    PubMed

    Bodor, Marko; Fullerton, Brad

    2010-08-01

    High-frequency diagnostic ultrasonography of the hand, wrist and elbow has significant potential to improve the quality of diagnosis and care provided by neuromuscular and musculoskeletal specialists. In patients referred for weakness, pain and numbness of the hand, wrist or elbow, diagnostic ultrasonography can be an adjunct to electrodiagnosis and help in identifying ruptured tendons and treating conditions such as carpal tunnel syndrome or trigger finger. Use of a small high-frequency (>10-15 MHz) transducer, an instrument with a blunt pointed tip to enhance sonopalpation and a model of the hand, wrist and elbow is advised to enhance visualization of small anatomical structures and complex bony contours. A range of conditions, including tendon and ligament ruptures, trigger finger, de Quervain tenosynovitis, intersection syndrome, lateral epicondylitis, and osteoarthritis, is described along with detailed ultrasonography-guided injection techniques for carpal tunnel syndrome and trigger finger.

  14. Chronic Elbow Dislocation: Evaluation and Management.

    PubMed

    Donohue, Kenneth W; Mehlhoff, Thomas L

    2016-07-01

    Chronic elbow dislocation is defined as a dislocation that has remained unreduced for >2 weeks. The soft-tissue and skeletal changes that develop during this time usually prevent successful closed reduction. These changes include the development of extensive intra-articular fibrotic tissue, as well as contracture of the triceps, collateral ligaments, and elbow capsule. Ulnar nerve involvement and associated fractures may also be present. Because treatment of chronic elbow dislocation is challenging, a stepwise approach is used in the evaluation and management of this condition. No large series of data are available to guide treatment. Most patients are treated on the basis of the surgeon's anecdotal experience. Treatment typically involves open reduction, often with the use of hinged external fixators. The role of triceps lengthening or primary collateral ligament reconstruction remains a topic of debate.

  15. Acute traumatic posterior elbow dislocation in children.

    PubMed

    Lieber, Justus; Zundel, Sabine M; Luithle, Tobias; Fuchs, Jörg; Kirschner, Hans-Joachim

    2012-09-01

    Traumatic posterior dislocation of the elbow is often associated with significant morbidity and incomplete recovery. The aim of this study was to retrospectively analyse the outcome of 33 children (median age 10.8 years). Patients underwent reduction and assessment of stability under general anaesthesia. Pure dislocations (n=10) were immobilized, whereas unstable fractures (n=23) were stabilized. Refixation of ligaments was performed if stability was not achieved by fracture stabilization alone. Immobilization was continued for 26 (pure dislocations) or 35 days (associated injuries), respectively. Results were excellent (n=9) or good (n=1) after pure dislocation. Results were excellent (n=15), good (n=7) or poor (n=1) in children with associated injuries. Accurate diagnosis, concentric stable reduction of the elbow as well as stable osteosynthesis of displaced fractures are associated with good results in children with acute posterior elbow dislocations.

  16. Posterolateral rotatory instability of the elbow.

    PubMed

    Anakwenze, Oke A; Kancherla, Vamsi K; Iyengar, Jaicharan; Ahmad, Christopher S; Levine, William N

    2014-02-01

    Symptomatic posterolateral rotatory instability (PLRI) results from a lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. Often, symptoms and examination characteristics are subtle and can be easily misdiagnosed. Therefore, a thorough history and provocative physical examination maneuvers are important to correctly establish the diagnosis. Patients frequently have a history of elbow trauma such as an episode(s) of elbow dislocation, prior surgery, or previous cortisone injections. Radiographs and advanced imaging can aid in the diagnosis, and examination under anesthesia, manipulation with arthroscopic visualization, and/or stress radiographs can be confirmatory. Symptomatic cases of PLRI can be effectively treated with a repair or isometric ligament reconstruction.

  17. Development of a motion-controlled in vitro elbow testing system.

    PubMed

    Dunning, Cynthia E; Gordon, Karen D; King, Graham J W; Johnson, James A

    2003-05-01

    Joint simulators can be used to study motion pathways of a human joint, to investigate changes in joint stability following injury, and to formulate improved reconstructive and rehabilitative procedures. Our objectives were: to develop a laboratory-based, motion-controlled elbow testing apparatus capable of simulating tendon (muscle) loading and displacement in a cadaveric specimen; to describe its performance while testing stable and unstable elbows; and to compare its operation to that of a previously designed load-controlled device. Velocity control of a pneumatic actuator was achieved using a custom-written, closed-loop feedback controller. This actuator was incorporated into an elbow testing system that used additional pneumatic actuators and a combination of motion- and load-control to achieve desired motions. Simulations achieved with this apparatus demonstrated small magnitudes of error in actuator position and highly repeatable flexion pathways with the specimens positioned in vertical, varus, and valgus orientations. The repeatability in motion pathways generated in both a stable and unstable elbow model was equivalent to or better than for similar tests performed using the load-controlled system, and the velocity of the resulting elbow motion was more reproducible.

  18. Tips to avoid nerve injury in elbow arthroscopy

    PubMed Central

    Hilgersom, Nick F J; Oh, Luke S; Flipsen, Mark; Eygendaal, Denise; van den Bekerom, Michel P J

    2017-01-01

    Elbow arthroscopy is a technical challenging surgical procedure because of close proximity of neurovascular structures and the limited articular working space. With the rising number of elbow arthroscopies being performed nowadays due to an increasing number of surgeons performing this procedure and a broader range of indications, a rise in complications is foreseen. With this editorial we hope to create awareness of possible complications of elbow arthroscopy, particularly nerve injuries, and provide a guideline to avoid complications during elbow arthroscopy. PMID:28251060

  19. Wind swept elbow: injury pattern and reconstruction.

    PubMed

    Ozer, Kagan; Ipaktchi, Kyros

    2013-01-01

    Sweeping injuries of the elbow characterized by traumatic loss of medial or lateral epicondyles, collateral ligaments, and surrounding soft tissue result in loss of joint stability. Reconstruction of medial or lateral collateral ligaments is challenging due to loss of the cortical bone and the resultant difficulty in identifying the isometric attachment point. We describe a unique injury pattern and a surgical technique to restore joint stability using a bone tendon (Achilles) allograft. The technique was applied to 4 consecutive patients with a mean age of 35 (22-57) years and a mean follow-up of 20 months. Three patients with the lateral sweep injury had losses of the lateral epicondyle, lateral collateral ligament along with radial nerve palsy in 2. One patient with the medial sweep injury lost the medial epicondyle, medial collateral ligament, and had ulnar nerve palsy. All patients had an unstable ulnohumeral joint and underwent bone-tendon allograft (Achilles) reconstruction. The elbow joint was covered with a rotational radial forearm flap in 1 patient: myofasciocutaneous-free gracilis flap in 1 and rotational fasciomyocutaneous latissimus dorsi flap in 2 patients. One patient had an open reduction and internal fixation of distal third humerus shaft fracture, intercalary nerve grafting to the ulnar nerve, and repair of the brachial artery. At the final follow-up, average elbow motion was 115 degrees. Radiographic bone-to-bone healing was achieved in all patients. According to the American Shoulder and Elbow Surgeon's Assessment; average patient rated pain, function, and satisfaction scores were 3.4, 2.3, and 5, respectively. The average Disabilities of the Arm, Shoulder and Hand questionnaire score was 25. The use of bone-tendon allograft to reconstruct collateral ligaments of the elbow restored the elbow stability with a satisfactory functional outcome (evidence: level 4).

  20. Total Elbow Arthroplasty for Distal Humerus Fractures.

    PubMed

    Harmer, Luke S; Sanchez-Sotelo, Joaquin

    2015-11-01

    Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures.

  1. Elbow dislocation with complete triceps avulsion.

    PubMed

    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.

  2. 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

  3. Terrible Triad Injuries of the Elbow.

    PubMed

    Chen, Neal C; Ring, David

    2015-11-01

    The treatment of terrible triad injuries of the elbow continues to evolve. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. In the elbow with persistent instability after repair of these elements, application of a static external fixation, hinged external fixation, ulnohumeral joint pinning, or an internal hinge may be needed. In patients who undergo treatment after the acute injury period, the coronoid may require reconstruction using radial head autograft, iliac crest autograft, olecranon autograft, or allograft.

  4. Radiographic Evaluation of Common Pediatric Elbow Injuries

    PubMed Central

    DeFroda, Steven F.; Hansen, Heather; Gil, Joseph A.; Hawari, Ashraf H.; Cruz, Aristides I.

    2017-01-01

    Normal variations in anatomy in the skeletally immature patient may be mistaken for fracture or injury due to the presence of secondary centers of ossification. Variations in imaging exist from patient to patient based on sex, age, and may even vary from one extremity to the other on the same patient. Despite differences in the appearance of the bony anatomy of the elbow there are certain landmarks and relationships, which can help, distinguish normal from abnormal. We review common radiographic parameters and pitfalls associated in the evaluation of pediatric elbow imaging. We also review common clinical diagnoses in this population. PMID:28286625

  5. The Cellular Biology of Flexor Tendon Adhesion Formation

    PubMed Central

    Wong, Jason K.F.; Lui, Yin H.; Kapacee, Zoher; Kadler, Karl E.; Ferguson, Mark W. J.; McGrouther, Duncan A.

    2009-01-01

    Intrasynovial flexor tendon injuries of the hand can frequently be complicated by tendon adhesions to the surrounding sheath, limiting finger function. We have developed a new tendon injury model in the mouse to investigate the three-dimensional cellular biology of intrasynovial flexor tendon healing and adhesion formation. We investigated the cell biology using markers for inflammation, proliferation, collagen synthesis, apoptosis, and vascularization/myofibroblasts. Quantitative immunohistochemical image analysis and three-dimensional reconstruction with cell mapping was performed on labeled serial sections. Flexor tendon adhesions were also assessed 21 days after wounding using transmission electron microscopy to examine the cell phenotypes in the wound. When the tendon has been immobilized, the mouse can form tendon adhesions in the flexor tendon sheath. The cell biology of tendon healing follows the classic wound healing response of inflammation, proliferation, synthesis, and apoptosis, but the greater activity occurs in the surrounding tissue. Cells that have multiple “fibripositors” and cells with cytoplasmic protrusions that contain multiple large and small diameter fibrils can be found in the wound during collagen synthesis. In conclusion, adhesion formation occurs due to scarring between two damaged surfaces. The mouse model for flexor tendon injury represents a new platform to study adhesion formation that is genetically tractable. PMID:19834058

  6. Clinical Outcomes Study of the Nexel Total Elbow

    ClinicalTrials.gov

    2017-01-10

    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

  7. 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.

  8. 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.

  9. No man's land revisited: the primary flexor tendon repair controversy.

    PubMed

    Newmeyer, William L; Manske, Paul R

    2004-01-01

    New surgical procedures, novel concepts, and/or the presentation of very good results with an apparently discredited technique meet varying degrees of resistance among the establishment of any profession. In hand surgery this phenomenon was exemplified in a striking fashion with the presentation of a controversial report entitled, "Primary repair of flexor tendons in no man's land" by Kleinert, Kutz, Ashbell, and Martinez of Louisville, KY, at the 1967 American Society for Surgery of the Hand (ASSH) annual meeting. The discussant, Joseph Boyes, expressed such skepticism that a special ASSH committee was appointed to go to Louisville and review the results to determine if they were as good as claimed. They were, and today primary flexor tendon repair is the procedure of choice for most flexor tendon lacerations.

  10. 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

  11. Current treatment concepts for "terrible triad" injuries of the elbow.

    PubMed

    Bohn, Kevin; Ipaktchi, Kyros; Livermore, Meryl; Cao, Jue; Banegas, Rodrigo

    2014-12-01

    Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. If left untreated, they commonly result in functional compromise and poor outcomes. The "terrible triad" injury is classically described as a combination of a coronoid process and radial head fractures, as well as a posterolateral elbow dislocation. Surgical treatment to restore stable elbow range of motion has evolved in the past few decades based on increased understanding of elbow biomechanics and the anatomy of these injuries. This article highlights current concepts in the treatment of these complicated injuries.

  12. "Chiefs for Change" Elbows into Policy Fight

    ERIC Educational Resources Information Center

    McNeil, Michele

    2012-01-01

    Amid the cacophony of special interests fighting to be heard in statehouses and on Capitol Hill, a cadre of current and former chief state school officers is elbowing its way into the nation's education debate at a time when states are taking more control of K-12 education. A little more than a year old, Chiefs for Change is an invitation-only…

  13. Primary flexor tendon surgery: the search for a perfect result.

    PubMed

    Elliot, David; Giesen, Thomas

    2013-05-01

    Repair of the divided flexor tendon to achieve normal, or near normal, function is an unsolved problem, with each result still uncertain. The authors believe the way forward in primary flexor tendon surgery clinically is by use of strengthened but simpler sutures, appropriate venting of the pulley system, and maintaining early rehabilitation. However, there needs also be consideration of patient factors and other aspects. Research needs to continue more widely, in both the laboratory and the clinical environment, to find ways of better modifying adhesions after surgical repair of the tendon.

  14. 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.

  15. A variant of flexor carpi ulnaris causing ulnar nerve compression.

    PubMed Central

    al-Qattan, M M; Duerksen, F

    1992-01-01

    Anatomical variations of the muscles and nerves around the wrist are common. Knowledge of such variations is derived from 2 sources: anatomical dissections and clinically reported cases. We present a case of duplication of the tendon of flexor carpi ulnaris with splitting of the ulnar nerve. The ulnar slip of the tendon was inserted into the pisiform bone and the radial slip into the proximal phalanx of the ring finger. The anatomical literature and the clinically reported cases of variations of the flexor carpi ulnaris are reviewed. Images Fig. 1 PMID:1452475

  16. Reduced elbow extension torque during vibrations.

    PubMed

    Friesenbichler, Bernd; Coza, Aurel; Nigg, Benno M

    2012-08-31

    Impact sports and vibration platforms trigger vibrations within soft tissues and the skeleton. Although the long-term effects of vibrations on the body have been studied extensively, the acute effects of vibrations are little understood. This study determined the influence of acute vibrations at different frequencies and elbow angles on maximal isometric elbow extension torque and muscle activity. Vibrations were generated by a pneumatic vibrator attached to the lever of a dynamometer, and were applied on the forearm of 15 healthy female subjects. The subjects were instructed to push maximally against the lever at three different elbow angles, while extension torque and muscle activity were quantified and compared between vibration and non-vibration (control) conditions. A change in vibration frequency had no significant effects on torque and muscle activity although vibrations in general decreased the maximal extension torque relative to the control by 1.8% (±5.7%, p>0.05), 7.4% (±7.9%, p<0.01), and 5.0% (±8.2%, p<0.01) at elbow angles of 60°, 90°, and 120°, respectively. Electromyographic activity increased significantly between ∼30% and 40% in both triceps and biceps with vibrations. It is speculated that a similar increase in muscle activity between agonist and antagonist, in combination with an unequal increase in muscle moment arms about the elbow joint, limit the maximal extension torque during exposure to vibrations. This study showed that maximal extension torque decreased during vibration exposure while muscle activity increased and suggests that vibrations may be counterproductive during activities requiring maximal strength but potentially beneficial for strength training.

  17. 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

  18. Flexor Tendon Repair Postoperative Rehabilitation: The Saint John Protocol

    PubMed Central

    Higgins, Amanda

    2016-01-01

    Summary: The Saint John Protocol describes a rehabilitation program of up to half a fist of protected true active finger flexion beginning 3 to 5 days after flexor tendon repair. We no longer use full fist place and hold. We illustrate with film and text the reasons for these changes. PMID:27975032

  19. History and Nomenclature of Multistrand Repairs in Digital Flexor Tendons.

    PubMed

    Savage, Robert; Tang, Jin Bo

    2016-02-01

    Multistrand core suture repairs have become the mainstay of digital flexor tendon repair in recent decades. Here we briefly describe the history of the development of these multistrand repair methods and their correct nomenclature. A historical account, their evolution, the correct use of nomenclature, and some technical points are reviewed.

  20. Clinical outcome after percutaneous flexor tenotomy in forefoot surgery.

    PubMed

    Debarge, Romain; Philippot, Rémy; Viola, Jérémy; Besse, Jean Luc

    2009-10-01

    The aim of this study was to evaluate the outcome of the percutaneous flexor tenotomy. We compared the results of two groups. The first group included 23 patients who underwent forefoot surgery without percutaneous flexor tenotomy, and the second group included 50 patients who underwent the same procedure combined with percutaneous flexor tenotomy for claw toe deformities, secondary to shortening metatarsal Scarf osteotomy. The average follow-up was 11.6 months. Three algoneurodystrophies were noted. No delayed wound healing was observed. Functional dissatisfaction rate (18% vs.17.4%) and toe pulp contact defect (12% vs. 8.7%) were not significantly different in the two groups. Toe grasping defect rate (10% vs. 4.3%) was superior in the tenotomy group. Five recurring claw toe deformities of the second toe were noted in the tenotomy group. Percutaneous flexor tenotomy is a simple, rapid, and efficient method to correct reducible secondary claw toe deformities. However, despite a significant postoperative loss of toe grasping function, no patient reported major dissatisfaction.

  1. Acute Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon Treated with Primary Flexor Digitorum Superficialis Transfer: A Novel Technique of Management

    PubMed Central

    Sasi, P. Kiran; Mahapatra, Swagath; Raj Pallapati, Samuel C.; Thomas, Binu P.

    2016-01-01

    Traumatic musculotendinous junction avulsions are rare injuries except in avulsion amputations. They pose a significant challenge to the treating surgeon. We present a 24-year-old male who sustained an open musculotendinous avulsion of the flexor pollicis longus tendon. He was treated with primary tendon transfer using the flexor digitorum superficialis of ring finger, in flexor zone 3. The functional result at 10 months following surgery was excellent. PMID:27019757

  2. The biceps muscle from shoulder to elbow.

    PubMed

    Stevens, Kathryn; Kwak, Andrew; Poplawski, Stephen

    2012-09-01

    The biceps brachii plays an integral role in movement of the shoulder and elbow, and pathology can occur in athletes of all ages. Injuries of the proximal biceps tendon can be seen in overhead athletes as a result of chronic impingement, tendon instability, or tensile overload, often with accompanying lesions of the labrum or rotator cuff. Presentation may be insidious or can be precipitated by an acute event. Injuries to the distal biceps are more common in athletes involved in strength training such as weightlifters, or occasionally in contact sports. Although injury to the proximal and distal biceps can often be diagnosed clinically, MRI is an excellent imaging modality to evaluate the extent of disease and involvement of adjacent structures. This article reviews the anatomy of the biceps brachii from the shoulder to elbow and discusses commonly occurring pathology of the biceps and adjacent anatomical structures.

  3. 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.

  4. Above-elbow arm replantation during pregnancy.

    PubMed

    Haws, M J; Erdmann, D; Brown, R E

    1996-01-01

    We report a successful replantation of an above-elbow amputated left arm in a 26-year-old female with a good, functional, long-term result. The patient was at 18 weeks estimated gestational age at the time of surgery. Major upper extremity replantation during pregnancy has not been previously described in the literature. Current operative and perioperative aspects, including considerations that favored microsurgical replantation in this unusual case, are discussed.

  5. Spastic Paralysis of the Elbow and Forearm

    PubMed Central

    Gharbaoui, Idris; Kania, Katarzyna; Cole, Patrick

    2016-01-01

    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

  6. 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.

  7. Terrible triad injury of the elbow: current concepts.

    PubMed

    Mathew, Paul K; Athwal, George S; King, Graham J W

    2009-03-01

    Fracture-dislocations of the elbow remain among the most difficult injuries to manage. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. The primary goal of surgical fixation is to stabilize the elbow to permit early motion. Recent literature has improved our understanding of elbow anatomy and biomechanics along with the pathoanatomy of this injury, thereby allowing the development of a systematic approach for treatment and rehabilitation. Advances in knowledge combined with improved implants and surgical techniques have contributed to better outcomes.

  8. 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.

  9. Ligamentous and capsular restraints to experimental posterior elbow joint dislocation.

    PubMed

    Deutch, Søren R; Olsen, Bo S; Jensen, Steen L; Tyrdal, Stein; Sneppen, Otto

    2003-10-01

    Pathological external forearm rotation (PEFR) relates to posterolateral elbow joint instability, and is considered a possible requisite step in a simple posterior elbow joint dislocation. The aim of this study was to evaluate the capsuloligamentous restraint to PEFR. In all, 18 elbow joint specimens were examined in a joint analysis system developed for experimental elbow dislocation. Sequential cutting of capsule and ligaments followed by stability testing provided specific data relating to each capsuloligamentous structure. The primary stabilizers against PEFR in the extended elbow were the anterior capsule and the lateral collateral ligament complex (LCLC), whereas in the flexed elbow the anterior capsule did not have a stabilizing effect. In flexed joint positions, the LCLC seems to be the only immediate stabilizer against PEFR, and thereby against posterolateral instability and possibly against posterior dislocation. The medial collateral ligament did not have any immediate stabilizing effect, but it prevented the final step of the posterior dislocation.

  10. Natural course in tennis elbow--lateral epicondylitis after all?

    PubMed

    Zeisig, Eva

    2012-12-01

    Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.

  11. Injury Criteria for Dynamic Hyperextension of the Female Elbow Joint

    DTIC Science & Technology

    2006-11-01

    1 INJURY CRITERIA FOR DYNAMIC HYPEREXTENSION OF THE FEMALE ELBOW JOINT Stefan M. Duma*, Gail A. Hansen, Eric A. Kennedy, Joel D. Stitzel...Laboratory Fort Rucker, AL 36362 ABSTRACT This paper describes an analysis to develop dynamic hyperextension injury criteria for the female elbow ...joint. Dynamic hyperextension tests were performed on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point

  12. Successful Closed Reduction of a Lateral Elbow Dislocation

    PubMed Central

    Fukuzawa, Takuma; Mitsui, Katsuhiro

    2016-01-01

    In this report, we present a case of lateral elbow dislocation treated with closed reduction. Lateral elbow dislocation is rare, and a closed reduction is reported with even less frequency. The reduction can be hindered by swelling and soft tissue interposition, and we describe the use of a nonoperative reduction technique performed under mild sedation with early physiotherapy to avoid joint stiffness. No additional complication was observed, and the normal range of elbow movement and function was obtained by early physiotherapy. PMID:28097029

  13. Successful Closed Reduction of a Lateral Elbow Dislocation.

    PubMed

    Watanabe, Kenya; Fukuzawa, Takuma; Mitsui, Katsuhiro

    2016-01-01

    In this report, we present a case of lateral elbow dislocation treated with closed reduction. Lateral elbow dislocation is rare, and a closed reduction is reported with even less frequency. The reduction can be hindered by swelling and soft tissue interposition, and we describe the use of a nonoperative reduction technique performed under mild sedation with early physiotherapy to avoid joint stiffness. No additional complication was observed, and the normal range of elbow movement and function was obtained by early physiotherapy.

  14. 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.

  15. 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.

  16. [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.

  17. Biepicondylar fracture presenting with elbow dislocation: a case report

    PubMed Central

    2012-01-01

    Introduction Biepicondylar fracture of the elbow is very rare, and to date there have only been three reports of this injury and its treatment in the English scientific literature. This case report evaluates the surgical internal fixation of a biepicondylar fracture of the elbow with an associated dislocation. Case presentation We report the case of a 15-year-old Turkish girl with a biepicondylar fracture dislocation of the left elbow. Open reduction and an internal fixation operation were applied. There were no complications. Conclusion In these injuries, open reduction and internal fixation appear to be a good method to restore elbow stability and function. PMID:22938048

  18. 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.

  19. Ultrasound of the digital flexor system: Normal and pathological findings☆

    PubMed Central

    Bianchi, S.; Martinoli, C.; de Gautard, R.; Gaignot, C.

    2007-01-01

    Recent improvements in ultrasound (US) software and hardware have markedly increased the role of this imaging modality in the evaluation of the musculoskeletal system. US is currently one of the main imaging tools used to diagnose and assess most tendon, muscle, and ligament disorders. Compared with magnetic resonance imaging, US is much less expensive; it has no contraindications and is also widely available. Diseases affecting the digital flexor system (DFS) require early diagnosis if treatment is expected to limit functional impairment of the hand. US scans performed with high-resolution, broad-band transducers allows superb visualization of the flexor tendons of the hand and the annular digital pulleys. In addition, dynamic US can be used to assess movement of the tendon within the pulleys during passive or active joint movements. This article examines the anatomy and US appearance of the normal DFS and reviews the US findings associated with the most common disorders affecting it. PMID:23396583

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. Changes in hip flexor passive compliance do not account for improvement in vertical jump performance after hip flexor static stretching.

    PubMed

    Wakefield, C Brent; Cottrell, G Trevor

    2015-06-01

    To date, there is limited research investigating stretching of antagonist muscles and its effects on agonist muscle function. The purpose of this research was to investigate the effects of pre-static stretching (pre-SS) of the hip flexor musculature on passive hip extension range of motion (ROM) and vertical jump height. Fifteen subjects reported to the laboratory on 4 separate days (D1, D2, D3, and D4). D1 was for familiarization, while on D2 to D4, subjects randomly completed 1 of 3 intervention conditions; no stretch (CON), hip flexor stretch (HFS), or hip extensor stretch (HES). Subject's pre- and post-intervention hip extension ROM were measured before performing 3 sets of pre- and post-maximal counter-movement vertical jumps. Vertical jump height was normalized to baseline for data analysis. A repeated-measures ANOVA with post hoc paired sample t-tests revealed a significant increase in vertical jump height in the HFS condition (1.74% ± 0.73; p ≤ 0.05) when compared with CON (-1.34% ± 0.96) or HES (-1.74% ± 0.65) conditions. There was also a significant increase in hip extension ROM after the HFS stretching protocol (6.5 ± 2.75%; p ≤ 0.05) when compared with the CON protocol (-1.73 ± 3.26); however, no significant difference when compared with the HES protocol (1.84 ± 2.79). A correlation analysis showed that the relative hip laxity of each subject had no effect on response to either condition nor did the magnitude of hip ROM change predict improvement in vertical jump. These results suggest that performing SS of the hip flexors may enhance vertical jump performance independent of changes in passive compliance of the hip flexor muscular tendon unit.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  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. ELBOW ULNAR NEUROPATHY: TREATMENT BY ANTERIOR TRANSPOSITION OF THE ULNAR NERVE

    PubMed Central

    Neder, Antonio Tufi; Alves, Regina de Azevedo; Pardini, Arlindo Gomes; Riberto, Marcelo; Mazer, Milton

    2016-01-01

    ABSTRACT Objectives: Retrospective clinical evaluation of 31 patients who underwent ulnar nerve decompression at the elbow and subcutaneous anterior transposition. Methods: From January 2000 to December 2013, 71 patients underwent subcutaneous anterior transposition of the ulnar nerve. Thirty-one patients returned for evaluation. The mean follow-up period was 60 months. Patients were evaluated for the degree of satisfaction after surgery, paresthesia, pain, Tinel sign, Froment test and sensitivity test by esthesiometer, muscle strength of the intrinsic muscles and deep flexor of the fifth digit, visual analogic pain scale (VAS) and were subjected to the QuickDash questionnaire. Results: Thirty-nine per cent of patients had compression on the right side and 61% on the left side. Sixty-one percent were idiopathic, 35% post traumatic and 3% had Poems syndrome. Forty-eight per cent of patients were very much satisfied after surgery and 52% were satisfied. Forty-eight per cent had paresthesia after surgery and 52% did not. Conclusion: The ulnar neurolysis of the cubital tunnel with anterior subcutaneous transposition is a safe and effective technique for treating idiopathic or post-traumatic compressive neuropathy, with high success rate and excellent function for activities of daily living. Level of Evidence IV, Case Series. PMID:28243170

  11. Pressure loss in elbow pipes of unplasticized polyvinyl chloride.

    PubMed

    Iwasaki, T; Ojima, J

    1996-01-01

    In the ductwork of local exhaust systems, 90 degrees elbow pipes (JIS K 6739) are commonly used to alter the direction of airflow; thus, are important components of polyvinyl chloride (PVC) ducts. Pressure loss in 90 degrees PVC elbow pipes was investigated by measuring static pressure, and the characteristics of airflow was determined. First, a linear decrease in static pressure was observed at points of the downstream side beyond a distance of 10 times the diameter (10d) from the flanged round opening of the smooth VU ducts (JIS K6741). The linear decrease was also observed at points of the downstream side located at distances of greater than 30d from the elbow pipe. Coefficients of loss in the PVC elbow pipes were found to be constant for the Reynolds numbers ranging from 3.38 x 10(4) to 5.96 x 10(5) for all diameters examined, and a chart of pressure loss was constructed with these coefficients. The coefficients of loss in PVC elbow pipes were not equivalent to those of metal stamped elbows for any R/d. However, the differences in the coefficients between the metal stamped elbow and the PVC elbow were smaller with larger R/d values.

  12. Simultaneous bilateral elbow dislocation in an international gymnast

    PubMed Central

    Syed, A. A.; O'Flanagan, J.

    1999-01-01

    Elbow dislocation is a rare injury in elite athletes. We report an unusual case of simultaneous bilateral elbow dislocations with a unilateral radial head fracture in an international female athlete competing on the asymmetrical bars. These injuries require prompt reduction and immediate mobilisation if an abrupt end to a promising career is to be prevented. 




 PMID:10205699

  13. Metallic radial head arthroplasty improves valgus stability of the elbow.

    PubMed

    King, G J; Zarzour, Z D; Rath, D A; Dunning, C E; Patterson, S D; Johnson, J A

    1999-11-01

    The stabilizing influence of radial head arthroplasty was studied in eight medial collateral ligament deficient anatomic specimen elbows. An elbow testing apparatus, which used computer controlled pneumatic actuators to apply tendon loading, was used to simulate active elbow flexion. The motion pathways of the elbow were measured using an electromagnetic tracking device, with the forearm in supination and pronation. As a measure of stability, the maximum varus to valgus laxity over the range of elbow flexion was determined from the difference between varus and valgus gravity loaded motion pathways. After transection of the medial collateral ligament, the radial head was excised and replaced with either a silicone or one of three metallic radial head prostheses. Medial collateral ligament transection caused a significant increase in the maximum varus to valgus laxity to 18.0 degrees +/- 3.2 degrees. After radial head excision, this laxity increased to 35.6 degrees +/- 10.3 degrees. The silicone implant conferred no increase in elbow stability, with a maximum varus to valgus laxity of 32.5 degrees +/- 15.5 degrees. All three metallic implants improved the valgus stability of the medial collateral ligament deficient elbow, providing stability similar to the intact radial head. The use of silicone arthroplasty to replace the radial head in the medial collateral ligament deficient elbow must be questioned. Metallic radial head arthroplasty provides improved valgus stability, approaching that of an intact radial head.

  14. 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.

  15. Diagnosis and surgical management of flexor digitorum accessorius longus-induced tarsal tunnel syndrome.

    PubMed

    Wittmayer, Brian C; Freed, Lewis

    2007-01-01

    The flexor digitorum accessorius longus is a rare muscular occurrence in the lower extremity. It has been reported as an etiology of tarsal tunnel syndrome through prior case reports. By means of individual case study, we revisit flexor digitorum accessorius longus as a cause of tarsal tunnel syndrome. This case study discusses diagnosis along with surgical treatment of tarsal tunnel syndrome induced by the presence of flexor digitorum accessorius longus.

  16. Pediatric open elbow dislocation without fracture: A case report

    PubMed Central

    Polat, Gökhan; Karademir, Gökhan; Akgül, Turgut; Ceylan, Hasan Hüseyin

    2014-01-01

    INTRODUCTION Elbow dislocations in children are rare injuries. These injuries are often in the form of complex injuries that is accompanied by the median nerve damage and medial epicondyle fracture in the pediatric age group. Open elbow dislocation without fracture in the pediatric age group has been reported very rarely in the literature. PRESENTATION OF CASE The purpose of this study is to present an 8-year-old patient who has open elbow dislocation without fracture accompanying with brachial artery injury. In the clinical examination of the patient, there was an open wound in the transverse antecubital region. After repair of brachial artery injury, open reduction was performed under general anesthesia. In the postoperative clinical examination at 6 months, left elbow flexion was 140°, extension was full and there were no deficit in the supination and pronation of the forearm. DISCUSSION Elbow dislocation without fracture in pediatric patients is a very rare injury. Usually the trauma mechanism of elbow dislocation is falling on outstretched hand with elbow in approximately 30° of flexion. However our patient had fallen on outstretched hand with elbow in full extension. Although this type of trauma mechanism is typical for supracondylar humerus fractures in pediatric age group, in our patient an open posterior elbow dislocation without fracture had occurred. CONCLUSION Pediatric elbow dislocations are rare injuries and the management of these injuries can be technically demanding due to concurrent neurovascular injuries. An open dislocation without fracture is very rare and it should be treated with immediate intervention, an effective teamwork and good rehabilitation. PMID:25460475

  17. Management of an Uncomplicated Posterior Elbow Dislocation

    PubMed Central

    Blackard, Douglas; Sampson, Jo-Ann

    1997-01-01

    Objective: To present a case of an uncomplicated posterior elbow dislocation in a US World Cup athlete and discuss her rehabilitation. Background: Traditional protocol for management of this injury has been splint immobilization for several weeks, but research suggests a shortened duration of immobilization and early active motion. Differential Diagnosis: Elbow dislocation with possible fracture. Treatment: The dislocation was reduced and a compression bandage and sling were applied. The sports medicine staff and athlete determined that rehabilitation would involve limited immobilization with a posterior splint. Also, active range-of- motion exercises were to be incorporated early in the range-of- motion program to decrease pain at the articulation. Uniqueness: The athlete was not immobilized and her aggressive five-phase rehabilitation program progressed according to decrease in inflammation and increase in range of motion and strength. Conclusions: Shortened immobilization and return to World Championship competition 6 weeks postinjury had no longterm adverse effects on the athlete. ImagesFig 1.Fig 2.Fig 3.Fig 4.Fig. 5. PMID:16558436

  18. Evaluation and Management of Elbow Tendinopathy

    PubMed Central

    Taylor, Samuel A.; Hannafin, Jo A.

    2012-01-01

    Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury. PMID:23016111

  19. Output of human motoneuron pools to corticospinal inputs during voluntary contractions.

    PubMed

    Martin, P G; Gandevia, S C; Taylor, J L

    2006-06-01

    This study investigated transmission of corticospinal output through motoneurons over a wide range of voluntary contraction strengths in humans. During voluntary contraction of biceps brachii, motor evoked potentials (MEPs) to transcranial magnetic stimulation of the motor cortex grow up to about 50% maximal force and then decrease. To determine whether the decrease reflects events at a cortical or spinal level, responses to stimulation of the cortex and corticospinal tract (cervicomedullary motor evoked potentials, CMEPs) as well as maximal M-waves (M(max)) were recorded during strong contractions at 50 to 100% maximum. In biceps and brachioradialis, MEPs and CMEPs (normalized to M(max)) evoked by strong stimuli decreased during strong elbow flexions. Responses were largest during contractions at 75% maximum and both potentials decreased by about 25% M(max) during maximal efforts (P < 0.001). Reductions were smaller with weaker stimuli, but again similar for MEPs and CMEPs. Thus the reduction in MEPs during strong voluntary contractions can be accounted for by reduced responsiveness of the motoneuron pool to stimulation. During strong contractions of the first dorsal interosseous, a muscle that increases voluntary force largely by frequency modulation, MEPs declined more than in either elbow flexor muscle (35% M(max), P < 0.001). This suggests that motoneuron firing rates are important determinants of evoked output from the motoneuron pool. However, motor cortical output does not appear to be limited at high contraction strengths.

  20. 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

  1. The senses of active and passive forces at the human ankle joint.

    PubMed

    Savage, G; Allen, T J; Proske, U

    2015-07-01

    The traditional view of the neural basis for the sense of muscle force is that it is generated at least in part within the brain. Recently it has been proposed that force sensations do not arise entirely centrally and that there is a contribution from peripheral receptors within the contracting muscle. Evidence comes from experiments on thumb flexor and elbow flexor muscles. Here we have studied the sense of force in plantar flexor muscles of the human ankle, looking for further evidence for such a mechanism. The active angle-torque curve was measured for muscles of both legs, and for each muscle, ankle angles were identified on the ascending and descending limbs of the curve where active forces were similar. In a plantar flexion force matching task, subjects were asked to match the force in one foot, generated on the ascending limb of the curve, with force in the other foot, generated on the descending limb. It was hypothesised that despite active forces being similar, the sensation generated in the more stretched muscle should be greater because of the contribution from its peripheral stretch receptors, leading to an overestimation of the force in the stretched muscle. It was found that provided that the comparison was between active forces, there was no difference in the forces generated by the two legs, supporting the central hypothesis for the sense of force. When total forces were matched, including a component of passive force due to muscle stretch, subjects seemed to ignore the passive component. Yet subjects had an acute sense of passive force, provided that the muscles remained relaxed. It was concluded that subjects had two senses, a sense of active force, generated centrally, and a sense of passive force, or perhaps muscle stretch, generated within the muscle itself.

  2. Functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion in replantation or revascularisation of above-elbow amputations.

    PubMed

    Parmaksizoglu, F; Beyzadeoglu, T

    2003-01-01

    Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.

  3. Human Joint Articulation and Motion-Resistive Properties

    DTIC Science & Technology

    1987-04-01

    eWantinue Got ,ewrse it nescwery end identify by block number) a .GRoUP sue. to Biomechanics, elbow complex, joint kinematics, joint sinus, joint restoring...necessary and identify by Maock number) Three-dimensional joint kinematics and motion resistive properties were measured for tUse shioulder, hip and elbow ...HUMAN HUMERO- ELBOW COMPLEX... 83 5.1 Introduction . . . . . . . . . . . . . . . . .. . 83 5.2 Determination of the Humero- elbow Complex Sinus

  4. Tarsal tunnel syndrome and flexor hallucis longus tendon hypertrophy.

    PubMed

    Rodriguez, D; Devos Bevernage, B; Maldague, P; Deleu, P-A; Leemrijse, T

    2010-11-01

    Tarsal tunnel syndrome (TTS) defines an entrapment neuropathy of the posterior tibial nerve or one of its branches, within the tarsal tunnel. Numerous etiologies have been described explaining this entrapment, including trauma, space-occupying lesions, foot deformities, etc. We present an unreported cause of a space-occupying lesion in the etiology of TTS, namely the combination of a hypertrophic long distally extended muscle belly of the flexor hallucis longus and repetitive ankle motion. Surgical debulking of the muscle belly in the posterior ankle compartment resolved all symptoms.

  5. Elbow Stiffness Secondary to Elbow Joint Osteoid Osteoma, a Diagnostic Dilemma.

    PubMed

    Ebrahimzadeh, Mohamad H; Choghadeh, Meysam Fathi; Moradi, Ali; Kalati, Hamid Hejrati; Jafarian, Amir Hossein

    2015-04-01

    We present a 23-year-old man with distal humerus osteoid osteoma referring to our hospital with pain and progressive stiffness. The patient has been suffering from the disease for two years without a certain diagnosis. The radiographies of elbow did not reveal the pathology but further CT scan and MRI studies demonstrated the tumor. The en block resection of the tumor resolved the pain immediately but range of motion remained restricted.

  6. 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).

  7. [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.

  8. Iatrogenic radial neck fracture on closed reduction of elbow dislocation.

    PubMed

    Ellanti, Prasad; O'Farrell, Dermot

    2013-11-01

    Traumatic dislocation of the elbow is rare in children and can most often be managed in the emergency department using procedural sedation and closed reduction with good functional outcome. Radiographs must be evaluated for associated avulsions and fractures around the elbow. We present the case of a 14-year-old girl who sustained a fracture of the radial neck subsequent to repeated attempts at closed reduction of a pure posterior elbow dislocation that was missed on postreduction radiographs. Careful use of reduction techniques and avoidance of repeated forceful manipulations is emphasized.

  9. Elbow joint luxation in a 1-month-old foal.

    PubMed

    Rubio-Martínez, L M; Vázquez, F J; Romero, A; Ormazábal, J R

    2008-01-01

    This paper reports on luxation of the elbow joint without concomitant fracture in a 1-month-old foal. Conservative treatment, with closed reduction and full-limb bandaging, including caudal and lateral splints, seemed successful initially, however, failed to provide enough stability and luxation recurred, and open reduction and surgical placement of prosthetic collateral ligaments was required. Luxation of the elbow joint should be considered when acute non-weight bearing forelimb lameness occurs associated with pain and swelling in the area of the elbow in young foals. Closed reduction failed to provide sufficient joint stability.

  10. 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.

  11. Phenol block for hip flexor muscle spasticity under ultrasonic monitoring.

    PubMed

    Koyama, H; Murakami, K; Suzuki, T; Suzaki, K

    1992-11-01

    Hip flexor spasticity, which is often associated with central nervous system (CNS) diseases, is a major impediment in rehabilitation. In order to cope with this problem, lumbar nerve blocking techniques developed by Meelhuysen and major and minor psoas muscle blocking techniques developed by Awad have been used in combination with physical therapies. Based on these techniques, we conducted major and minor psoas muscle phenol block (motor point block or intramuscular nerve block) under ultrasonic monitoring. Phenol block was conducted in nine patients with cerebral infarction (13 blocking procedures) and three with spinal cord injuries (six blocking procedures) while keeping them in a lateral position with the operation side upside. The beginning of the femoral nerves and part of the lumbar artery were visualized by ultrasound in some patients. As a result of the improvement of hip flexor spasticity, the range of hip joint motion (determined by the Mundale technique, prone hip extension and Thomas test) improved shortly after blocking. When physical therapy was conducted after blocking, improvement of skin care management was observed in eight cases, ability to keep in a stable sitting position in nine, improvement of a standing posture in three, increases in the ability to walk in two and alleviation of pain in three. Although nerve block is reported to result in hematoma, decreases in muscle force, pain, cystic/rectal disorders and hypogonadism, we have observed no such complication in our patients.

  12. Flexor carpi ulnaris transplant and its use in cerebral palsy.

    PubMed

    GREEN, W T; BANKS, H H

    1962-10-01

    In our experience, transplantation of the flexor carpi ulnaris is the single best procedure to improve function of the wrist and hand in cerebral palsy. It aids dorsiflexion and supination and, at the same time, preserves active motion of the wrist. This is highly desirable since finger control may be seriously impaired in cerebral palsy and the additional motion provided at the wrist may be most helpful. In fact, since using this procedure we have found that fusion of the wrist is rarely indicated. A good result from a flexor carpi ulnaris transplant depends first upon the careful choice of the patient for the procedure.Requirements for the best function from the transplant include reasonable finger control preoperatively with passive flexibility of the hand, wrist, and forearm; stereognosis of the involved hand; reasonable intelligence; high motivation of the patient and family; and a thorough postoperative regimen.The difference between a good result and a poor result was often the thoroughness of the postoperative care. The value of both exercise and support for the part cannot be overemphasized nor can one underestimate the importance of the interest and ambitions of the patient and his family. The procedure should be postponed until the age when the individual may be expected to cooperate in the training of the transplant.

  13. ELBOW, 2-1/2 INCH SIZE WITH HALF CYCLE ALTERNATOR

    DTIC Science & Technology

    An elbow 2-1/2 in. size with half cycle alternator was designed and developed for use by very short above elbow , shoulder disarticulation and fore...quarter amputees. The elbow provides the amputee with a means of positively locking the forearm with respect to the arm in 13 separate positions of...system to the elbow unit and terminal device. Forearm rotation is permitted between the top portion of the elbow unit and the turntable to which the

  14. AN EXPERIMENTAL INVESTIGATION OF SECONDARY FLOW IN AN ACCELERATING, RECTANGULAR ELBOW WITH 90 deg OF TURNING

    DTIC Science & Technology

    Secondary flow tests were conducted on an accelerating elbow with 90 deg. of turning designed for prescribed velocities that eliminate boundary-layer...plane walls of the elbow by spoilers upstream of the elbow inlet. The passage vortex associated with secondary flows appears to be near the suction...surface and away from the plane wall of the elbow at the exit and does not have appreciable span-wise motion as it moves downstream from the elbow exit. As

  15. In vivo tissue interaction between the transverse carpal ligament and finger flexor tendons.

    PubMed

    Gabra, Joseph N; Gordon, Joshua L; Marquardt, Tamara L; Li, Zong-Ming

    2016-10-01

    The transverse carpal ligament (TCL) is a component of the flexor pulley system of the wrist, keeping the flexor tendons in place by resisting their volar displacement. The purpose of this study was to investigate the in vivo biomechanical interaction between the TCL and flexor tendons in response to tendon tensioning with the wrist at various postures. In eight healthy subjects, the flexor digitorum superficialis and profundus tendons were tensioned by isometrically applying loads (5, 10, and 15N) to the index finger while the wrist posture was at 20° extension, neutral, 20° flexion, and 40° flexion. The TCL and flexor tendons were imaged at the distal carpal tunnel cross section using ultrasound. The volar-dorsal positions of the tendons, TCL arch height, and TCL-tendon distances were calculated. With increasing wrist flexion, the flexor tendons moved volarly, the TCL arch height increased, and the TCL-tendon distances decreased, indicating that the flexor tendons contacted the TCL and pushed it volarly. The TCL-tendon interaction was amplified by the combination of finger loading and wrist flexion. This study provides in vivo evidence of the biomechanical interaction between the TCL and flexor tendons. Repetitive TCL-tendon interactions may implicate the interacting tissues and the median nerve resulting in tissue maladaptation and nerve compression.

  16. The role of hind limb flexor muscles during swimming in the toad, Bufo marinus.

    PubMed

    Gillis, Gary B

    2007-01-01

    Most work examining muscle function during anuran locomotion has focused largely on the roles of major hind limb extensors during jumping and swimming. Nevertheless, the recovery phase of anuran locomotion likely plays a critical role in locomotor performance, especially in the aquatic environment, where flexing limbs can increase drag on the swimming animal. In this study, I use kinematic and electromyographic analyses to explore the roles of four anatomical flexor muscles in the hind limb of Bufo marinus during swimming: m. iliacus externus, a hip flexor; mm. iliofibularis and semitendinosus, knee flexors; and m. tibialis anticus longus, an ankle flexor. Two general questions are addressed: (1) What role, if any, do these flexors play during limb extension? and (2) How do limb flexors control limb flexion? Musculus iliacus externus exhibits a large burst of EMG activity early in limb extension and shows low levels of activity during recovery. Both m. iliofibularis and m. semitendinosus are biphasically active, with relatively short but intense bursts during limb extension followed by longer and typically weaker secondary bursts during recovery. Musculus tibialis anticus longus becomes active mid way through recovery and remains active through the start of extension in the next stroke. In conclusion, flexors at all three joints exhibit some activity during limb extension, indicating that they play a role in mediating limb movements during propulsion. Further, recovery is controlled by a complex pattern of flexor activation timing, but muscle intensities are generally lower, suggesting relatively low force requirements during this phase of swimming.

  17. 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

  18. 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.

  19. 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.

  20. Stainless-steel elbows formed by spin forging

    NASA Technical Reports Server (NTRS)

    1964-01-01

    Large seamless austenitic stainless steel elbows are fabricated by spin forging /rotary shear forming/. A specially designed spin forging tool for mounting on a hydrospin machine has been built for this purpose.

  1. Elbow dislocation secondary to fall during police arrest.

    PubMed

    Stevenson, R J; Clark, K; Kelliher, T

    2014-02-01

    A case of total elbow dislocation with significant swelling and loss of distal pulses during police arrest is described. To date, this specific injury in relation to police arrest has not been described in the literature. Whilst attempting to remove the detainee from a public transport vehicle, the patient and the officers involved fell to the ground with his arm slightly flexed. He was handcuffed to the rear and taken to the police office. Whilst there, it was noted that his left elbow was swelling dramatically and he complained of pain. The detainee and officers attended the emergency room and he was found to have a total dislocation of the left elbow and vascular compromise of the limb. The elbow was promptly reduced with sedation and a post reduction angiogram demonstrated injury to the tissues surrounding the brachial artery.

  2. Paediatric biepicondylar elbow fracture dislocation - a case report

    PubMed Central

    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

  3. Anterior elbow dislocation with potential compartment syndrome: a case report.

    PubMed

    Queipo-de-Llano Temboury, Alfonso; Lara, Jorge Mariscal; Fernadez-de-Rota, Antonio; Queipo-de-Llano, Enrique

    2007-03-01

    Anterior elbow dislocation is an infrequent lesion, usually produced by direct trauma to the proximal ulna after a fall on the elbow in flexion, and is often associated with soft tissue injuries. The authors report a case of a complex injury produced by a high-energy trauma in the right arm of a 65-year-old patient. His limb was trapped inside an industrial spin-dryer, resulting in a closed anterior elbow dislocation, diaphyseal ulnar shaft, radial styloid process fractures, and an associated compartment syndrome. The injury mechanism and its treatment are described to better manage the soft tissue injury and early elbow mobilization using the FEARM hinged external fixator. A good result was achieved, with almost complete restoration of the patient's arm functions, and he has returned to his previous working activities.

  4. A clinically oriented comprehensive pictorial review of canine elbow anatomy.

    PubMed

    Constantinescu, Gheorghe M; Constantinescu, Ileana A

    2009-02-01

    The clinically oriented canine elbow anatomy in its complexity earned a high importance in surgery especially after multiple imaging modalities have been used in the benefit of diagnosis and treatment of canine elbow disorders. The bony, joint, and muscular structures, the arteries, the veins and the nerves supplying the elbow are described and illustrated in textbooks and atlases in the context of the comparative anatomy. Nevertheless, there is no publication focused on all of these structures described together from the skin to the bones in a systematic and topographic order, nor through cross and/or sagittal and coronal sections. The figures used in this article are original and drawn after dissection, cross, sagittal, and coronal sections of the elbow structures. The sections are correlated to the multiple imaging modalities shown in the next article.

  5. 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.

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

    PubMed

    Meta, Mahendrakumar; Miller, David

    2010-10-15

    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.

  7. Infected total elbow arthroplasty treated by cemented arthrodesis.

    PubMed

    Lui, Tun Hing

    2014-03-22

    A lady had suffered from deep infection of the GSB III prosthesis of her right elbow. The infection could not be controlled by repeated debridement. Finally, cemented arthrodesis was performed and the infection was eradicated.

  8. Modeling of Human Joint Structures.

    DTIC Science & Technology

    1982-09-01

    Radial Lateral " epicondyle Olecranon Radius Ulna Figure 3. Lateral aspect of the right elbow joint. -17- Annular Ligament This strong band encircles... elbow joint, knee joint, human joints, shoulder joint, ankle joint, joint models, hip joint, ligaments. 20. ABSTRACT (Continue on reverse side If...ligaments. -A rather extended discussion of the articulations and anatomical descriptions of the elbow , shoulder, hip, knee and ankle joints are

  9. Successful closed suction drain management of a canine elbow hygroma.

    PubMed

    Pavletic, M M; Brum, D E

    2015-07-01

    A 1-year-old castrated male St. Bernard dog presented to Angell Animal Medical Center with bilateral elbow hygromas which had been present for several weeks. The largest hygroma involving the left elbow was managed with a closed suction (active) drain system to continuously collapse the hygroma pocket over a 3-week period. Soft bedding was used to protect the elbows from further impact trauma to the olecranon areas. Following drain removal, there was no evidence of hygroma recurrence based on periodic examinations over an 18-month period. The smaller non-operated right elbow hygroma had slightly enlarged during this period. Closed suction drain management of the hygroma proved to be a simple and economical method of collapsing the left elbow hygroma. This closed drainage system eliminated the need for the postoperative bandage care required with the use of the Penrose (passive) drain method of managing elbow hygromas. The external drain tube should be adequately secured in order to minimise the risk of its inadvertent displacement.

  10. [Elbow dislocation in childhood. Long-term observational study].

    PubMed

    Frongia, G; Günther, P; Romero, P; Kessler, M; Holland-Cunz, S

    2012-02-01

    Traumatic dislocation of the elbow is rare in children with an incidence of 3-6% of all elbow injuries. In the literature the outcome after elbow dislocation in childhood is rarely discussed. In the present study 33 children treated in our clinic from 2001 to 2008 with an acute traumatic dislocation of the elbow were retrospectively included. All events were unilateral whereby 1 child (3%) showed a recurrence of elbow dislocation after 9 weeks, 30% had a pure dislocation, 70% had a concomitant fracture, 55% showed a fracture of the medial epicondyle, 6% a fracture of the lateral epicondyle and 9% a further fracture. Of the fractures 83% required open reduction with osteosynthesis. After an average of 4.5 years 20 children (61%) were clinically examined. There were no instabilities of the joint and only minor clinical limitations of the range of motion. The established Mayo elbow performance score showed good to excellent results for all children. Despite severe joint trauma with frequently accompanying fractures, post-traumatic functional deficits are rarely limiting, independent of the accompanying fracture. The frequency of recurrence is low and instabilities were not seen.

  11. 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.

  12. 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

  13. The study of elbow injury in male adult kendo players

    PubMed Central

    Kishi, Shinya; Yoshida, Munehito

    2017-01-01

    [Purpose] Elbow injury in male adult kendo players was investigated and examined in order to obtain an indicator of prophylaxis of injury. [Subjects and Methods] The subjects were 22 male adult kendo players aged 25 to 60 years old, and presence or absence of pain, range of motion, and muscle strength in the elbow joints were investigated. In addition, among athletes with limited range of motion (ROM) in the elbow joints, three athletes who had received an explanation and had provided informed consent underwent CT, and the images were examined. [Result] As a result, posterior pain and decreased range of extension motion in the right elbow were noted in 86% of the subjects, and the CT images showed free bone fragments and osteophytes in the olecranon. Also, characteristics were noted that extension muscle strength was stronger than flexion muscle strength in elbow muscle strength. [Conclusion] Based on these results, characteristic disorders in male adult kendo players include an impingement disorder in the posterior region of the right elbow. PMID:28356645

  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. Flow Tests of an NACA-designed Supercharger Inlet Elbow and the Effects of Various Components on the Flow Characteristics at the Elbow Outlet

    DTIC Science & Technology

    1946-10-01

    ttil~.t,..,,#~ 1a NATIONALADVISORYCOMMIITEE FORAERONAUTICS TECHNICALNOTE No. 1148 FLOWTESTSOFANNACA-DESIGNEDSUPERCHARGERINLET ELBOW ...thecenterlineofthepassageperpendiculartotheplaneofthe bend. Thisvane pointofbending cm.1.dbe removed elbow . A schematic etiendsfrom1$ inchesupstremofthet.ni%ial- totheelbowoutletandwassodestgnedthatit...sipatedbeforeenteringthetestunit. Theair”=s-”exhauste~o thea.@ospherethrougha straightductof thesm. crosssection andareaas theoutletofthe, elbow . Airwassuppliedat 40

  16. 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.

  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

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

    2011-02-24

    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.

  18. Sporadic Inclusion Body Myositis Manifesting as Isolated Muscle Weakness of the Finger Flexors Three Years after Disease Onset

    PubMed Central

    Suwa, Yuichi; Suzuki, Naoki; Soga, Temma; Harada, Ryuhei; Shibui, Aya; Kuroda, Hiroshi; Izumi, Rumiko; Tateyama, Maki; Nakashima, Ichiro; Sonoo, Masahiro; Aoki, Masashi

    2016-01-01

    Sporadic inclusion body myositis (sIBM) is a chronic progressive myopathy characterized by muscle weakness of both the quadriceps femoris and finger flexors. We herein present the case of a typical male patient with sIBM, which manifested as the isolated weakness of the finger flexors three years after the disease onset. We have identified several patients with sIBM in our cohort with muscle weakness of the flexors but not the quadriceps femoris. Examination of the flexor digitorum profundus muscle is important for the early and proper diagnosis of sIBM, even if a patient only presents with isolated finger flexor muscle weakness. PMID:27904121

  19. 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

  20. Ultrasonic guided wave propagation in pipes with elbows

    NASA Astrophysics Data System (ADS)

    Breon, Luke J.

    Guided wave inspection of pipelines is an important and growing area of Non-Destructive Evaluation (NDE). This technique can be used for remote inspection or monitoring of buried pipelines, or pipelines with insulation. Guided waves are sensitive to flaws such as corrosion pits and cracks. They can be used to locate flaws existing on either the outer or the inner surface of a pipe. Guided wave energy focusing can be performed to concentrate guided wave energy at particular combinations of circumferential and axial locations in straight pipes. When it can be used, this practice enhances the circumferential resolution of defects. Elbows in a piping system are sufficiently disruptive to guided wave energy that the focusing methods used in practical inspections of straight pipe have not been extended to the region beyond an elbow. Counter-intuitively, elbows with a 45 degree bend are more harmful to guided waves than those with a 90 degree bend. A simple and elegant explanation for this phenomenon is provided in this dissertation. Theoretical advancements to guided wave physics propagating around an elbow have tended to be few and slow. This is at least partly due to the complexity of the mathematics involved in the conventional description of guided wave mechanics. Parametric focusing for pipes with bends has not been previously possible as it is for straight sections of pipes. While some techniques such as time-reversal mirrors and blind finite-element-method modeling have existed for focusing beyond elbows, these techniques have been limited and largely of academic value. Also, the understanding of wave behavior in a pipe elbow has in the past been generally unclear. Consequently, signal interpretation has also been very limited for guided waves initiating in, or returning from, the far side of an elbow. A new approach to understanding guided wave propagation is developed in this work. This understanding consists of the idea that the pathway a guided wave will take

  1. 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

  2. Treatment of acute and chronic elbow instability with a hinged external fixator after fracture dislocation.

    PubMed

    Zilkens, Christoph; Graf, Markus; Anastasiadis, Alexandros; Smajic, Samir; Muhr, Gert; Kälicke, Thomas

    2009-04-01

    This is a retrospective analysis of the clinical and radiological outcome in 24 patients with acute or chronic posttraumatic elbow instability, who were treated with open reduction, internal fixation and a hinged external fixator. The instability was acute after elbow fracture dislocation in 11 cases; the other 13 had chronic posttraumatic instability of the elbow. Concentric stability and a sufficient range of motion of the elbow joint were achieved in all cases. The addition of a hinged external fixator in noncompliant patients, who underwent open reduction and internal fixation of an acute or chronic posttraumatic unstable elbow, allows early intensive mobilisation and can improve the clinical outcome after these complex elbow injuries.

  3. Prevention of Elbow Injuries in Youth Baseball Pitchers

    PubMed Central

    Fleisig, Glenn S.; Andrews, James R.

    2012-01-01

    Context: Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers. Evidence Acquisition: PubMed was searched for epidemiologic, biomechanical, and clinical studies of elbow injuries in baseball (keywords: “youth OR adolescent” AND baseball AND pitching AND “ulnar collateral ligament OR elbow”; published January 2000 – April 2012). Studies with relevance to youth baseball pitchers were reviewed. Relevant references from these articles were also retrieved and reviewed. Original data, insight, and recommendations were added. Results: The majority of baseball elbow injuries are noncontact injuries to the dominant arm resulting from repetitive pitching. Five percent of youth pitchers suffer a serious elbow or shoulder injury (requiring surgery or retirement from baseball) within 10 years. The risk factor with the strongest correlation to injury is amount of pitching. Specifically, increased pitches per game, innings pitched per season, and months pitched per year are all associated with increased risk of elbow injury. Pitching while fatigued and pitching for concurrent teams are also associated with increased risk. Pitchers who also play catcher have an increased injury risk, perhaps due to the quantity of throws playing catcher adds to the athlete’s arm. Another risk factor is poor pitching biomechanics. Improper biomechanics may increase the torque and force produced about the elbow during each pitch. Although throwing breaking pitches at a young age has been suggested as a risk factor, existing clinical, epidemiologic, and biomechanical data do not support this claim. Conclusions: Some elbow injuries to youth baseball pitchers can be prevented with safety rules, recommendations, education, and common sense. Scientific and medical organizations have published safety rules and recommendations, with emphasis on prevention of overuse and pitching while fatigued. Strength

  4. Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle

    PubMed Central

    Herrin, Sean O.

    2017-01-01

    Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies. PMID:28210274

  5. Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle.

    PubMed

    Bale, Logan S W; Herrin, Sean O

    2017-01-01

    Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies.

  6. The effect of baclofen on the hind limb flexor reflex of the spinal rat.

    PubMed

    Sypniewska, M

    1979-01-01

    The effect of baclofen on the hind limb flexor reflex of the spinal rat was studied. Baclofen inhibited the flexor reflex, this effect not being antagonized by picrotoxin and bicuculline. Baclofen reduced the stimulating action of quipazine and LSD, had no effect on the clonidine-induced reflex stimulation, but inhibited the flexor reflex stimulation induced by amphetamine and fenfluramine. The results obtained bring forth some doubts as to the GABA-mimetic action of baclofen. The action of baclofen on the spinal cord seems to be directed mainly to the presynaptic part of the noradrenergic and serotonergic systems.

  7. 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.

  8. 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

  9. [The traffic elbow. A series of 9 cases].

    PubMed

    Sané, A-D; Ndaw, M; Diémé, C; Coulibaly-Ndiaye, N F; Ndiaye, A; Sy, M H; Mbaye, B; Sèye, S I L

    2007-01-01

    "Traffic elbow" is a condition occurring when high energy trauma involves a patient's elbow resting on the window of the car or completely outside it. This is a prospective study over 30 months of 9 patients with "traffic elbow" and therefore sufferring complex open trauma to the elbow. There were 8 men and 1 woman with a median delay of 4 hours before arrival in hospital. The dominant member was affected in 3 cases. The severity of the lesions, using the Mangled Extremity Severity Score (MESS), was more than 7, comprising lesions corresponding to type 1 of the complex trauma of the superior member (TCMS) in 2 patients and a MESS score of between 3 and 6 corresponding to types 2 or 3 of the TCMS for the other 7 patients. The therapeutic possibilities are limited considering the frequent context of polytrauma. In 4 cases we performed a debridement and external humero-ulnar fixation, in 3 cases a debridement and stabilization with Kirschner's wires completed by a fenestrated cast, and in 2 cases a lifesaving amputation. All patients, except those that had had amputation, developed deep sepsis that resolved after adequate treatment. Assessment of the non-amputee patients according to the Mayo Performance Score, yielded more than 70% of bad results. The authors stress the gravity of these lesions whose prognosis is guarded both concerning mobility of the elbow and the frequent neurovascular complications.

  10. The posterolateral plica: a cause of refractory lateral elbow pain.

    PubMed

    Ruch, David S; Papadonikolakis, Anastasios; Campolattaro, Robert M

    2006-01-01

    Lateral epicondylitis is one of the most common upper extremity pain syndromes. We report the results of patients in whom conservative treatment was unsuccessful and who were finally treated arthroscopically for symptomatic plicae. Ten patients (mean age, 40 years [range, 18-60 years]) who were misdiagnosed as having lateral epicondylitis were included in this study. Examination revealed the site of maximal tenderness to be posterior to the lateral epicondyle and centered at the posterior radiocapitellar joint. Preoperatively, all patients received conservative treatment (physical therapy or corticosteroid injections [or both]). The mean follow-up was 25 months (range, 6-68 months). The mean score on the Disabilities of the Arm, Shoulder and Hand questionnaire was 9 (range, 0-37). Preoperatively, 7 patients had full elbow range of motion; however, in 3 patients, there was a loss of extension at the elbow ranging from 7 degrees to 20 degrees preoperatively. The range of elbow motion was full in all patients postoperatively. No patient demonstrated posterolateral pain after the operation. Synovial plicae of the elbow may be the cause of lateral elbow pain in patients with vague clinical symptoms. Arthroscopic management may provide a successful treatment option for such patients.

  11. Osteoarticular and Total Elbow Allograft Reconstruction With Severe Bone Loss

    PubMed Central

    Busfield, Benjamin T.; Khorshad, Daniel S.; Hornicek, Francis J.; Mankin, Henry J.

    2008-01-01

    Osteoarticular allograft reconstruction is an option in patients with massive periarticular elbow bone loss secondary to tumor surgery or trauma. Our consecutive series consisted of 18 patients with tumors and one patient with trauma. Reconstruction consisted of 16 hemiarticular allografts and three total elbow osteoarticular allografts; patients had a minimum followup of 2 years (mean, 9.9 years; range, 2–12 years). For patients who had hemiarticular allografts, 14 of 16 were able to return to their preoperative level of occupational function, with one patient experiencing failure of the allograft from infection. For the three patients who had total elbow allograft reconstructions, all had degenerative changes develop after surgery and two of the allografts failed. Complications occurred in six of 19 patients. Hemiarticular elbow allograft reconstruction is useful for limb salvage with massive bone loss. Total elbow allograft reconstructions have a high failure rate in the mid-term. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196394

  12. 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 ).

  13. 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

  14. Correlation between neck slope angle and deep cervical flexor muscle thickness in healthy participants.

    PubMed

    Ishida, Hiroshi; Suehiro, Tadanobu; Kurozumi, Chiharu; Ono, Koji; Ando, Suguru; Watanabe, Susumu

    2015-10-01

    The purpose of this study was to clarify the correlation between neck slope angle and deep cervical flexor muscle thickness in healthy subjects. Forty-two healthy male (20.7 ± 2.6 years old) participated in this study. Neck slope angle was measured in a relaxed sitting posture. The deep cervical flexor muscle thickness was measured in a relaxed supine posture. The correlations between neck slope angle and normalized muscle thickness relative to body mass index were determined using Pearson's correlation coefficient. There was a moderate positive correlation between neck slope angle and normalized muscle thickness (r = 0.414, P = 0.006). The result demonstrated that participants with lower neck slope angles had smaller muscle thicknesses of the deep cervical flexor muscles. It appears that the deep cervical flexor muscle thickness might be associated with neck slope angle in a relaxed sitting posture.

  15. Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus Tendon Treated by Tendoscopy.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Tendosynovial chondromatosis of the foot and ankle is a rare disease entity. We reported 3 patients with tenosynovial osteochondromatosis of flexor hallucis longus. They were successfully treated by arthroscopic synovectomy and removal of the loose bodies.

  16. 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)

  17. 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)''....

  18. 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...

  19. Force Depression in Plantar Flexors Exists Equally in Plantar Flexed and Dorsiflexed Regions

    PubMed Central

    Fukutani, Atsuki; Misaki, Jun; Isaka, Tadao

    2017-01-01

    Isometric muscle force attained during isometric contractions decreases after active shortening compared to that attained during purely isometric contractions. This phenomenon is called residual force depression. The aim of this study was to examine whether residual force depression occurs in human plantar flexors in both plantar flexed and dorsiflexed region. In addition, the magnitude of fascicle shortening was evaluated because not only muscle force but also fascicle shortening during active shortening are considered to affect force depression. Eleven male subjects were recruited. All muscle contractions were evoked by muscle belly-electrical stimulation. In the reference trials, isometric plantar flexion (PF) was performed at 0° and 15° of PF. In the residual force depression trials, the following two contractions were conducted: (1) muscles were activated isometrically at 15° of dorsiflexion, then actively shortened to 0° of PF (long condition) and (2) muscles were activated isometrically at 0° of PF, then actively shortened to 15° of PF (short condition). Isometric joint torque obtained 4.9 s after the onset of contraction was compared between the reference and residual force depression trials at the same joint angle to calculate the magnitude of residual force depression. At the same time point, fascicle length and pennation angle were obtained from ultrasonographic images to examine whether the muscle architecture affected residual force depression. As a result, residual force depression was confirmed in both the long and short length conditions (long: 87.1 ± 9.1%, short: 92.1 ± 7.8%) while the magnitude was not different (p = 0.182). The fascicle length and pennation angle were not different between the reference and residual force depression trials (p = 0.291–0.906). These results indicate that residual force depression occurs in the physiological range of motion in the human plantar flexors, and this phenomenon is not related to muscle

  20. Complications of common hand and wrist surgery procedures: flexor and extensor tendon surgery.

    PubMed

    Fischer, Lauren H; Abzug, Joshua M; Osterman, A Lee; Stern, Peter J; Chang, James

    2014-01-01

    Orthopaedic and hand surgeons frequently treat disorders of the flexor and extensor tendon systems. Common conditions, such as trigger finger, de Quervain tenosynovitis, extensor tendon injury, and zone II flexor tendon injury, can be challenging to treat. Complications that limit normal hand function still occur despite advances in surgical techniques and therapy protocols. It is helpful to be aware of the complications related to the treatment of these hand disorders and understand surgical techniques to minimize their frequency.

  1. DYNAMIC SONOGRAPHY OF THE EQUINE METACARPO(TARSO)PHALANGEAL DIGITAL FLEXOR TENDON SHEATH.

    PubMed

    DiGiovanni, Daria L; Rademacher, Nathalie; Riggs, Laura M; Baumruck, Rebecca A; Gaschen, Lorrie

    2016-11-01

    Palmar/plantar annular desmitis is a common disease that may be associated with adhesions and structures affecting the flexor tendons, which requires tenoscopy to diagnose. The purpose of this descriptive study was to develop a dynamic sonographic technique for evaluating the motion of normal equine flexor tendons in relation to the palmar/plantar annular ligament and to compare findings with horses previously diagnosed with palmar/plantar annular desmitis. Ten healthy adult horses were examined prospectively and the images of four horses diagnosed with palmar/plantar annular desmitis were retrospectively evaluated. Dynamic sonography was performed at the level of the metacarpo/metatarsophalangeal joint by maximally extending and flexing the interphalangeal joints. Palmar/plantar annular ligament thickness (mm), size of any gap between the flexor tendons, and subjectively increased angulation of the long linear echoes of the superficial digital flexor tendon were measured. The presence of gliding motion between the palmar/plantar annular ligament and superficial digital flexor tendon was determined by consensus. Twenty-eight healthy control limbs (16 hind/12 fore) and four with palmar/plantar annular desmitis (3 hind/1 fore) were evaluated. Controls had unrestricted gliding motion between the palmar/plantar annular ligament and flexor tendons and zero to 13° of angulation of the long linear echoes. The four affected horses had restricted gliding motion and between 20-35° angulation of the long linear echoes. Dynamic ultrasound is a feasible technique for detecting restricted flexor tendon and palmar/plantar annular ligament gliding motion, as well as subjectively increased angulation of the long linear echoes of the flexor tendon in affected horses compared with controls and warrants further investigation.

  2. 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.

  3. Speed's Procedure Used to Treat Chronic Elbow Dislocation.

    PubMed

    Thomas, D K

    2015-11-05

    In this report, operative treatment of chronic elbow dislocation using Speed's technique is described. Reports on this phenomenon are infrequent. This clinically important pathology is quite uncommon but impacts negatively on a patient's functionality and normal daily activities. We present the case of a 53-year old woman with a missed diagnosis of elbow dislocation. The patient was unable to function because of pain, stiffness and loss of motion. Her diagnosis was missed in the emergency department and in a general practitioner's office. A correct diagnosis was made three months later. The consultant organized an early date for surgery. The definitive treatment entailed open reduction, VY plasty of triceps and supplementary fixation using K wires through the elbow joint (Speed's Procedure). The occurrence, patho-mechanics, operative technique and its outcome are discussed.

  4. Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies

    DTIC Science & Technology

    2011-11-01

    ORIGINAL ARTICLE Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies Todd Feathers, MD, Daniel Stinner, MD, Kevin Kirk... elbow . Methods: A cadaveric study was conducted using 36 thawed, fresh-frozen forequarter amputations. An elbow arthrotomy was made in the posterocen...joint. The elbow joint was then loaded with saline mixed with methylene blue. During the injection, the known arthrotomy site was observed for leakage

  5. Opening the Black Box: Evaluating the Pediatric Athlete With Elbow Pain.

    PubMed

    Soma, David B

    2016-03-01

    Evaluation and treatment of pediatric elbow injuries in sport can be difficult because of the complex anatomy, evolving bony and cartilaginous composition, and multiple varied forces applied during athletic competition. In addition, youth sports are now putting even greater demands on the elbow of young athletes. It is important to understand the risk factors for injury, age-appropriate conditions affecting the elbow, proper treatment of these conditions, and prevention strategies for elbow injuries in this young athletic population.

  6. Simultaneous Knee Extensor Muscle Action Induces an Increase in Voluntary Force Generation of Plantar Flexor Muscles.

    PubMed

    Suzuki, Takahito; Shioda, Kohei; Kinugasa, Ryuta; Fukashiro, Senshi

    2017-02-01

    Suzuki, T, Shioda, K, Kinugasa, R, and Fukashiro, S. Simultaneous knee extensor muscle action induces an increase in voluntary force generation of plantar flexor muscles. J Strength Cond Res 31(2): 365-371, 2017-Maximum activation of the plantar flexor muscles is required for various sporting activities that involve simultaneous plantar flexion and knee extension. During a multi-joint movement, activation of the plantar flexor muscles is affected by the activity of the knee extensor muscles. We hypothesized that coactivation of the plantar flexor muscles and knee extensor muscles would result in a higher plantar flexion torque. To test this hypothesis, 8 male volunteers performed maximum voluntary isometric action of the plantar flexor muscles with and without isometric action of the knee extensor muscles. Surface electromyographic data were collected from 8 muscles of the right lower limb. Voluntary activation of the triceps surae muscles, evaluated using the interpolated twitch technique, significantly increased by 6.4 percentage points with intentional knee extensor action (p = 0.0491). This finding is in line with a significant increase in the average rectified value of the electromyographic activity of the vastus lateralis, fibularis longus, and soleus muscles (p = 0.013, 0.010, and 0.045, respectively). The resultant plantar flexion torque also significantly increased by 11.5% of the predetermined maximum (p = 0.031). These results suggest that higher plantar flexor activation coupled with knee extensor activation facilitates force generation during a multi-joint task.

  7. Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

    PubMed

    Cavadas, P C; Pérez-García, A; Thione, A; Lorca-García, C

    2015-03-01

    The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established.

  8. Functional outcomes after fixation of "terrible triad" elbow fracture dislocations.

    PubMed

    Fitzgibbons, Peter G; Louie, Dexter; Dyer, George Sinclair Mitchell; Blazar, Philip; Earp, Brandon

    2014-04-01

    Historically, the published literature on "terrible triad" injuries has shown a high rate of unacceptable results. The use of systematic treatment protocols may improve functional outcome. The authors performed a retrospective study of all patients aged 18 years or older who underwent surgical treatment for "terrible triad" elbow fracture dislocation at their institution over a period 7 years. Surgical treatment involved fixation or replacement of the radial head, repair of the anterior capsule or coronoid fracture in most cases, and repair of the lateral collateral ligament. Outcomes included grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and a visual analog score for pain as well as radiographic assessment of arthritis, maintenance of reduction, and development of heterotopic ossification. Eighteen patients were identified and 11 enrolled. Seven patients had suture fixation of the coronoid fragment and anterior capsule, 2 had screw fixation, and 2 had no repair of the coronoid. The radial head was replaced in 9 patients and repaired in 1, and a fracture fragment was excised in another. The average follow-up was 38 months. The average arc of motion of the injured elbow was 112° and that of the contralateral elbow was 142°. The average DASH score was 19.7 (scale, 0-100). The average visual analog score for pain was 2.2 (scale, 0-10). No patients had recurrent elbow instability. Three patients underwent further surgical procedures, all for loss of motion. The authors concluded that a systematic approach to the fixation of "terrible triad" elbow fracture dislocations can provide predictable elbow stability and functional range of motion in the medium term.

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

    PubMed

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

    2016-09-01

    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.

  10. 78 FR 18267 - Proposed Establishment of Class E Airspace; Elbow Lake, MN

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... the Prairie Airport. The FAA is taking this action to enhance the safety and management of Instrument... Municipal- Pride of the Prairie Airport, Elbow Lake, MN. Controlled airspace is needed for the safety and... would establish controlled airspace at Elbow Lake Municipal-Pride of the Prairie Airport, Elbow Lake,...

  11. [Anterior dislocation of the elbow joint without peri-articular fracture in an adult].

    PubMed

    Chbani, B; Lahrach, K; Amar, M-F; Ibnlkadi, K; Elmoubaker, S; Bennani, A; Marzouki, A; Boutayeb, F

    2012-12-01

    In view of the comparative frequency of posterior dislocations of the elbow, it is rather remarkable that anterior dislocations of that joint should be among the rarest of injuries [1]. Our case is one of the first cases of anterior dislocation of the elbow without any periarticular fracture or pre-existing deformities around the elbow [2].

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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

  18. Fractures and Dislocations About the Elbow and Their Adverse Sequelae: Contemporary Perspectives.

    PubMed

    Horrigan, Patrick; Braman, Jonathan P; Harrison, Alicia

    2016-01-01

    Fractures and dislocations of the elbow can result in adverse outcomes. The elbow is a unique joint that allows for great mobility but is predisposed to instability, either simple or complex, in traumatic settings. Even simple elbow instability, in which no fracture is present, may be associated with tremendous soft-tissue injury. Surgical treatment is often required for complex instability in which various fractures are present. The treatment goals for fixation of elbow fractures and dislocations include stable fracture fixation, a stable concentrically reduced joint, and early range of motion. Continued pain, stiffness, and instability as well as heterotopic ossification are common sequelae of elbow fractures and dislocations.

  19. Elbow arthroscopy: setup, portal placement, and simple procedures.

    PubMed

    Ahmad, Christopher S; Vitale, Mark A

    2011-01-01

    Elbow arthroscopy has become an accepted treatment for numerous elbow conditions, including loose bodies, lateral epicondylitis, contractures, painful osteophytes, synovitis, osteochondritis dissecans, synovial plica, and osteoarthritis. It is absolutely necessary that the treating surgeon have complete knowledge of elbow anatomy. Three options exist for patient positioning: supine, prone, and lateral decubitus. Standard arthroscopic probes, grasping forceps, punches, and motorized shavers and burrs are used in the procedure. Retractors are essential for visualizing, exposing, and protecting nerves. Specially designed capsular biters can be used to develop a plane between the capsule and the surrounding soft tissues to facilitate capsulotomy and capsulectomy. Among elbow arthroscopists, the sequence of portal placement varies; however, there is little variation in the exact location of portal placement because of neurovascular constraints. Loose body removal and extensor carpi radialis brevis release for lateral epicondylitis are common procedures suitable for the beginning arthroscopist. For beginning and advanced procedures, the surgeon's skill and competence must be at a level consistent with the procedure to avoid complications.

  20. Surgical Treatment of Tennis Elbow; Minimal Incision Technique

    PubMed Central

    Amroodi, Morteza Nakhaei; Mahmuudi, Ali; Salariyeh, Mostafa; Amiri, Arash

    2016-01-01

    Background: When non-operative treatment of tennis elbow fails; a surgical procedure can be performed to improve the associated symptoms. Different surgical techniques for treatment of lateral epicondylitis are prescribed. The purpose of this study was to evaluate the clinical outcomes of surgical treatment for tennis elbow based on small incision techniques. Methods: This technique was performed on 24 consecutive patients between June 2011 and July 2013. Outcomes were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE), Nirschl’s staging system and visual analog scale (VAS) for pain and satisfaction criteria. Results: There were 15 female and 9 male patients in the study. The mean duration of symptoms before surgery was 3.7 years. The average duration of follow-up was 34.8 months. The post-operative outcome was good to excellent in most patients. The mean VAS score improved from 7.2 to 3.5 points. The total PRTEE improved from 68.7 to 15.8 points. Conclusion: This procedure provides a low complication rate which is associated with a high rate of patient satisfaction. Therefore, we suggest this option after failed conservative management of tennis elbow. PMID:27847851

  1. [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.

  2. The Unstable Elbow: Current Concepts in Diagnosis and Treatment.

    PubMed

    Tashjian, Robert Z; Wolf, Brian R; van Riet, Roger P; Steinmann, Scott P

    2016-01-01

    Elbow instability is common and may occur after a variety of injuries, including falls or direct blows. Instability can be classified as either acute or chronic. Acute instability is classified as simple (without fracture) or complex (with associated fracture). Chronic instability is classified as a chronically dislocated or recurrently unstable elbow. Recurrent instability commonly presents as isolated medial or lateral collateral ligament insufficiency. A chronically dislocated elbow is often more complex, involving both osseous and ligamentous injuries. The treatment of simple dislocations typically involves closed reduction and nonsurgical management. Chronic recurrent lateral and medial collateral ligament insufficiencies have very different clinical characteristics, but definitive treatment frequently involves ligament reconstruction. Complex instability usually requires surgery, which includes open reduction and internal fixation of coronoid and olecranon fractures, repair or replacement of radial head fractures, and lateral collateral ligament repair. Medial collateral ligament repair and/or external fixation are rarely required to restore stability. It is important for surgeons to understand current concepts in the diagnosis and management of acute and chronic elbow instability as well as the preferred surgical treatments and techniques for the management of these injuries.

  3. 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.

  4. 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

  5. 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

  6. Guided wave propagation and scattering in pipeworks comprising elbows

    NASA Astrophysics Data System (ADS)

    Bakkali, Marouane El; Lhémery, Alain; Baronian, Vahan; Berthelot, François

    2014-02-01

    Guided waves (GW) are used to inspect pipeworks in various industries. Specific features of pipeworks lead to complex scattering phenomena. Simulations tools able to handle such a complexity must be developed to help interpretation and to optimize testing configurations. They must handle both long range propagation and local scattering phenomena. Here, a modal formulation is derived to deal with pipeworks comprising arbitrarily curved elbows linking otherwise straight pipes. First, the semi-analytic finite element method is extended in curvilinear coordinates to predict guided modes in elbows. Then, GW scattering at the junction of a straight pipe with an elbow is investigated. Modal solutions in both parts being known, the mode matching method is derived to compute modal reflection and transmission coefficients given as elements of a scattering matrix. Further, the global scattering matrix of a pipework comprising an arbitrary number of elbows linking straight pipes is considered. A general formulation presented in this conference series is used which handles multiple scattering phenomena that possibly arise. Interestingly, the computation of both modal solution and the scattering matrix with mode-matching method only requires meshing the pipe section. Examples illustrate the various steps.

  7. The effect of transcutaneous electrical nerve stimulation on postural sway on fatigued dorsi-plantar flexor.

    PubMed

    Yu, JaeHo; Lee, SoYeon; Kim, HyongJo; Seo, DongKwon; Hong, JiHeon; Lee, DongYeop

    2014-01-01

    The application of transcutaneous electrical nerve stimulation (TENS) enhances muscle weakness and static balance by muscle fatigue. It was said that TENS affects decrease of the postural sway. On the other hand, the applications of TENS to separate dorsi-plantar flexor and the comparison with and without visual input have not been studied. Thus, the aim of this study was to compare the effects of TENS on fatigued dorsi-plantar flexor with and without visual input. 13 healthy adult males and 12 females were recruited and agreed to participate as the subject (mean age 20.5 ± 1.4, total 25) in this study after a preliminary research. This experiment was a single group repeated measurements design in three days. The first day, after exercise-induced fatigue, the standing position was maintained for 30 minutes and then the postural sway was measured on eyes open(EO) and eyes closed(EC). The second, TENS was applied to dorsi flexor in standing position for 30 minutes after conducting exercise-induced fatigue. On the last day, plantar flexor applied by TENS was measured to the postural sway on EO and EC after same exercise-induced fatigue. The visual input was not statistically difference between the groups. However, when compared of dorsi-plantar flexor after applied to TENS without visual input, the postural sway of plantar flexor was lower than the dorsi flexor (p< 0.05). As the result, the application of TENS in GCM clinically decreases the postural sway with visual input it helps to stable posture control and prevent to falling down.

  8. A Pilot Study of Individual Muscle Force Prediction during Elbow Flexion and Extension in the Neurorehabilitation Field

    PubMed Central

    Hou, Jiateng; Sun, Yingfei; Sun, Lixin; Pan, Bingyu; Huang, Zhipei; Wu, Jiankang; Zhang, Zhiqiang

    2016-01-01

    This paper proposes a neuromusculoskeletal (NMS) model to predict individual muscle force during elbow flexion and extension. Four male subjects were asked to do voluntary elbow flexion and extension. An inertial sensor and surface electromyography (sEMG) sensors were attached to subject's forearm. Joint angle calculated by fusion of acceleration and angular rate using an extended Kalman filter (EKF) and muscle activations obtained from the sEMG signals were taken as the inputs of the proposed NMS model to determine individual muscle force. The result shows that our NMS model can predict individual muscle force accurately, with the ability to reflect subject-specific joint dynamics and neural control solutions. Our method incorporates sEMG and motion data, making it possible to get a deeper understanding of neurological, physiological, and anatomical characteristics of human dynamic movement. We demonstrate the potential of the proposed NMS model for evaluating the function of upper limb movements in the field of neurorehabilitation. PMID:27916853

  9. Mechanical properties of the flexor digitorum profundus tendon attachment.

    PubMed

    Felder, Jerrod J; Guseila, Loredana M; Saranathan, Archana; Shary, Timothy J; Lippitt, Steven B; Elias, John J

    2013-12-01

    The current study was performed to determine the strength and rigidity of the intact flexor digitorum profundus (FDP) tendon attachment and compare the rigidity at the attachment site to the rigidity within a more proximal part of the tendon. Eight cadaveric index fingers were tested to failure of the FDP tendon. Lines were drawn on each tendon with India ink stain at the position of the attachment to bone and 5 mm and 10 mm proximally. Each test was recorded using a high resolution video camera. A minimum of six images per test were used for analysis of tissue deformation. The centroid of each line was computationally identified to characterize the deformation of the tendon between the lines. Force vs. deformation curves were generated for the 5 mm region representing the tendon attachment and the 5 mm region adjacent to the attachment. Stiffness measurements were generated for each curve, and normalized by the initial length to determine the rigidity. The failure strength ranged from 263 N to 548 N, with rigidity values ranging from 2201 N/(mm/mm) to 8714 N/(mm/mm) and from 3459 N/(mm/mm) to 6414 N/(mm/mm) for the attachment and the tendon proximal to the attachment, respectively. The rigidity did not vary significantly between the attachment and proximal tendon based on a Wilcoxon signed rank test (p = 0.2). The measured strength and rigidity establish biomechanical properties for the FDP tendon attachment to bone.

  10. Anterior Dislocation of Elbow Joint-Case Report of A Rare Injury

    PubMed Central

    Kumar, Rakesh; Sekhawat, Vishal; Sankhala, SS; Bijarnia, Isha

    2014-01-01

    Introduction: In view of the comparative frequency of posterior dislocations of the elbow, it is rather remarkable that anterior dislocations of that joint should be among the rarest of injuries. Authors report a case of acute anterior dislocation with old fracture of medial epicondyle. Case Report: 22 years old male presented with acute pain and tenderness with deformity of right elbow joint and inability to move the elbow joint after he fell down during an episode of seizure. There was no neurovascular deficit. Radiological examination confirmed anterior dislocation of elbow joint with an ununited medial epicondyle fracture. Elbow was reduced under general anesthesia in emergency operation theatre. Conclusion: Anterior dislocation of elbow is very rare. Early diagnosis and proper reduction of dislocation is key of normal functioning of elbow joint. PMID:27298973

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

    PubMed

    Elbashir, Mohamed; Domos, Peter; Latimer, Mark

    2015-11-05

    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.

  12. Fractures and dislocations of the elbow: a return to the basics.

    PubMed

    Athwal, George S; Ramsey, Matthew L; Steinmann, Scott P; Wolf, Jennifer Moriatis

    2011-01-01

    Elbow instability is classified as simple or complex. Complex elbow instability, an elbow dislocation with associated fractures, had historically poor outcomes. Most complex elbow dislocations render the elbow unstable, necessitating surgical treatment. The primary goal of surgery is to restore sufficient stability to the critical anatomy to initiate early range of motion, which has been shown to be a key factor for a successful outcome. Recent literature has improved the understanding of elbow anatomy, biomechanics, and the pathoanatomy of complex instability, thereby allowing the development of systematic approaches for treatment and rehabilitation. These advances in knowledge combined with improved implants and surgical techniques have translated into better outcomes for patients with simple and complex elbow instability.

  13. 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

  14. Biomechanical analysis of flexor digitorum profundus and superficialis in grip-strength generation.

    PubMed

    Kaufmann, Robert A; Kozin, Scott H; Mirarchi, Adam; Holland, Burt; Porter, Scott

    2007-09-01

    Grip strength is generated through extrinsic flexor tendon and intrinsic muscle actuation. In the study reported here, we analyzed the grip-generating properties of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons during grip-strength generation. In vivo gripping was reproduced in 11 cadaveric forearms through pneumatic tensioning of flexor tendons. A Jamar dynamometer (TEC, Clifton, NJ) was positioned in the hand at varying degrees of angulation measured between the Jamar compression axis and the second metacarpal. Maximum gripping strength during isolated FDP and FDS tensioning generated maximum compressive forces at different angles (P < .0001). The isolated FDP showed continued increased grip strength with larger angles and was most effective when the dynamometer handle was in contact with the distal phalanx. The isolated FDS was most effective at smaller angles when the handle made contact with the middle phalanx. The isolated FDS shows an initial increase in grip strength as the contact point moves toward the middle phalanx (P < .01) and then a tendency for grip strength to decline as the contact point moves over the distal phalanx (P < .01). The FDP and FDS tendons demonstrate unique abilities to generate compression on a dynamometer. This knowledge is important to consider when evaluating grip strength in patients who have injured the extrinsic finger flexors.

  15. 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.

  16. Innervation of the elbow joint: Is total denervation possible? A cadaveric anatomic study.

    PubMed

    De Kesel, Renata; Van Glabbeek, Francis; Mugenzi, Dominique; De Vos, Joris; Vermeulen, Katrien; Van Renterghem, Debbie; Bortier, Hilde; Schuind, Frédéric

    2012-09-01

    The aim of this anatomical study was to find out if total denervation of the elbow joint is technically feasible. The endbranches of the brachial plexus of eight fresh-frozen upper arm cadavers were dissected with optical loupe magnification. All major nerves of the upper limb (except the axillary and the medial brachial cutaneous nerve) give some terminal articular endbranches to the elbow. The articular endbranches arise from muscular endbranches, cutaneous endbranches, or arise straight from the main nerves of the brachial plexus. A topographic diagram was made of the different nerves innervating the elbow joint. The ulno-posterior part of the elbow is innervated by the ulnar nerve and some branches of medial antebrachial cutaneous nerve. The radial-posterior part of the elbow is innervated exclusively by the radial nerve. The ulno-anterior part of the elbow is innervated by the median nerve and the musculocutaneous nerve. The radio-anterior part of the elbow is innervated by the radial nerve and the musculocutaneous nerve. These elbow innervation findings are relevant to both anatomical and clinical field as they provide evidence that the total denervation of the elbow joint is impossible. Nevertheless, partial denervation, like denervation of the lateral epicondyle or the ulnar part of elbow, is technically possible.

  17. Expression of Dlx5 and Dlx6 during specification of the elbow joint.

    PubMed

    Ferrari, Deborah; Kosher, Robert A

    2006-01-01

    The onset of elbow joint formation in the developing limb is characterized morphologically by the conversion of differentiated chondrocytes at the site of incipient joint formation into the densely packed flattened cells of the joint interzone. However, experimental studies have indicated that the elbow joint is specified well before joint interzone formation by a distinctive population of precursor cells located at the site in the developing limb bud at which the elbow joint will subsequently form. Here we show that during specification of the elbow joint in the chick limb bud, the homeodomain transcription factors Dlx5 and Dlx6 are highly expressed by a discrete group of cells that encompass the prospective elbow joint. The Dlx5- and Dlx6-expressing cells at the prospective elbow joint are located where the differentiating humerus branches into the radius and ulna. Thus, Dlx5 and Dlx6 are the earliest molecular markers of the presumptive elbow joint yet described. The onset of Dlx5 expression in the region of the presumptive elbow joint is shortly followed by the initiation of expression amongst the Dlx5-expressing cells of Gdf5, which encodes a secreted signaling molecule that is involved in regulating the onset of joint formation. These results suggest that Dlx genes may be involved in specification of the elbow joint and/or in providing positional information that specifies the site at which the elbow joint will form.

  18. 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.

  19. Reliability of ultrasound to measure morphology of the toe flexor muscles

    PubMed Central

    2013-01-01

    Background Measuring the strength of individual foot muscles is very challenging; however, measuring muscle morphology has been shown to be associated with strength. A reliable method of assessing foot muscle atrophy and hypertrophy would therefore be beneficial to researchers and clinicians. Thus, the aim of this study was to evaluate the test-retest intra-observer reliability of ultrasound to measure the morphology of the primary toe flexor muscles. Method The abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae and abductor digiti minimi muscles in the foot, and the flexor digitorum longus and flexor hallucis longus muscles in the shank were assessed in five males and five females (mean age = 32.1 ± 10.1 years). Muscles were imaged using a GE Venue 40 ultrasound (6-9 or 7.6-10.7 MHz transducer) in a random order, and on two occasions 1-6 days apart. Muscle thickness and cross-sectional area were measured using Image J software with the assessor blinded to muscle and day of scan. Intraclass correlation coefficients (ICC) and limits of agreement were calculated to assess day-to-day repeatability of the measurements. Results The method was found to have good reliability (ICC = 0.89-0.99) with limits of agreement between 8-28% of the relative muscle size. Conclusion The protocol described in this paper showed that ultrasound is a reliable method to measure morphology of the toe flexor muscles. The portability and advantages of ultrasound make it a useful tool for clinical and research settings. PMID:23557252

  20. Effects of Age on Strength and Morphology of Toe Flexor Muscles.

    PubMed

    Mickle, Karen J; Angin, Salih; Crofts, Gillian; Nester, Christopher J

    2016-12-01

    Study Design Descriptive, cross-sectional. Background Age-related muscle atrophy is common in lower-limb muscles. We therefore speculated that foot muscles may also diminish with age. However, there is a paucity of literature characterizing foot muscle strength and morphology, and any relationship between these 2, in older people. Objective To compare the strength and size of the toe flexor muscles of older adults relative to their younger counterparts. Methods Seventeen young adults with a normal foot type were matched by sex and body mass index to 17 older adults with a normal foot type, from an available sample of 41 younger (18 to 50 years of age) and 44 older (60 or more years of age) adults. Among the matched groups (n = 34), muscle thickness and cross-sectional area for 5 intrinsic and 2 extrinsic toe flexor muscles were obtained using ultrasound. Toe strength was assessed using a pressure platform. Differences in toe flexor strength and muscle size between the young and older matched groups were determined using analysis of covariance (controlling for height). Correlations between strength and size of the toe flexor muscles of the pooled group (n = 34) were also calculated. Results Toe strength and the thickness and cross-sectional area of most foot muscles were significantly reduced in the older adults (P<.05). Hallux and toe flexor strength values were strongly correlated with the size of the intrinsic toe flexor muscles. Conclusion The smaller foot muscles appear to be affected by sarcopenia in older adults. This could contribute to reduced toe flexion force production and may affect the ability of older people to walk safely. Interventions aimed at reversing foot muscle atrophy in older people require further investigation. J Orthop Sports Phys Ther 2016;46(12):1065-1070. Epub 29 Oct 2016. doi:10.2519/jospt.2016.6597.

  1. The Washington Regimen: rehabilitation of the hand following flexor tendon injuries.

    PubMed

    Dovelle, S; Heeter, P K

    1989-12-01

    This article describes the use of the "Washington Regimen" of early controlled motion in the rehabilitation of flexor tendon injuries of the hand. This regimen is derived from a combination of Kleinert's controlled active extension with rubber-hand passive flexion, Duran's controlled passive techniques, and the modification of the Kleinert orthosis that uses a palmar pulley system. Based on results of clinical investigations, this regimen of early controlled motion appears effective in inhibiting peritendinous scarring, joint contractures, and other complications that commonly occur secondary to flexor tendon repairs. A six-week staged regimen of postoperative rehabilitation is presented. Splint design, exercise regimen, and rationale for treatment are reviewed.

  2. 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

  3. Intratendinous ganglion of the hand: two case reports occurring in the extensor digitorum communis and the flexor digitorum superficialis tendon

    PubMed Central

    Senda, Hiroya; Mizutani, Jun; Okamoto, Hideki

    2017-01-01

    Abstract An intratendinous ganglion of the hand is a rare entity, and only one case report of flexor tendon has been published in the English literature. We herein report two cases of an intratendinous ganglion occurring in the extensor digitorum communis and flexor digitorum superficialis tendon, respectively. PMID:28164147

  4. Flexor digitorum accessorius causing tarsal tunnel syndrome in a paediatric patient: A case report and review of the literature.

    PubMed

    Molloy, A P; Lyons, R; Bergin, D; Kearns, S R

    2015-06-01

    The flexor digitorium accessorius muscle is an unusual anatomical variant found in the posteromedial aspect of the hindfoot and ankle. As previously described, its location predisposes patients to developing tarsal tunnel syndrome. This case illustrates the diagnosis, treatment and resolution of tarsal tunnel syndrome in a paediatric patient, secondary to the presence of flexor digitorium accessorius muscle.

  5. One-stage treatment of deep infection following repair of Achilles tendon rupture with flexor hallucis longus transfer.

    PubMed

    Lee, Kang; Moon, Jeong Seok; Seo, Jeong Gook; Lee, Woo Chun

    2009-03-01

    We present one-stage treatment of deep infection following repair of Achilles tendon rupture using flexor hallucis longus transfer. Flexor hallucis longus was used not only to connect the defect in Achillles tendon, but also to control the soft tissue infection with its abundant blood supply, simultaneously. The clinical results for the two patients in this report were excellent without major complication.

  6. Irreducible anterior dislocation of the elbow without associated fracture.

    PubMed

    Gyawali, Gopal Prasad; Pokharel, Bishnu; Pokharel, Rohit Kumar

    2013-01-01

    Anterior dislocation of the elbow joint is a rare entity and is usually associated with injuries to surrounding bony and soft tissues. Simple dislocation of the joint is managed conservatively. An eight years old girl had traumatic anterior dislocation of the elbow joint with intact distal neurovascular status. X-rays showed no associated bony injury. Close reductions failed. Per operative findings showed no intra-articular fracture and the radial head was button holed into the anterior joint capsule. Reduction was achieved openly and maintained in a posterior slab for four weeks. Active and assisted mobilization started after removal of the slab. At ten month follow-up there was almost full range of movement of the joint.

  7. Current concepts in the management of complex elbow trauma.

    PubMed

    Morrey, B F

    2009-06-01

    Complex instability of the elbow, also known as fracture dislocation of the elbow, is one of the most challenging injuries of the musculoskeletal system. A clear understanding of the biomechanics of the joint with special focus on the relative contributions of the articular components and the ligamentous constraints is critical to the proper management of these injuries. The accurate recognition and implications of associated injuries offers a rationale for approaching these difficult problems by appropriately addressing the elements of the trauma. Further, doing so in a timely fashion enhances the outcome. Currently, even the most devastating of injuries are felt to have a more favourable prognosis than was present in the past if the principles contained herein are followed.

  8. Posttraumatic elbow arthritis in the young adult: evaluation and management.

    PubMed

    Sears, Benjamin W; Puskas, Gabor J; Morrey, Mark E; Sanchez-Sotelo, Joaquin; Morrey, Bernard F

    2012-11-01

    Degenerative joint disease following trauma to the elbow is difficult to manage in any patient. However, this condition becomes substantially more challenging in the young, active population. Increased activity demands and limited functional capacity of total elbow arthroplasty mean that joint arthroplasty should be regarded as a salvage procedure. The primary goal of treatment is to restore a pain-free or minimally painful functional joint while preserving future surgical options. This requires accurate assessment of the primary patient complaint, be it terminal pain and stiffness or pain along the entire arc of motion. Patients who report stiffness and pain at terminal motion may benefit from arthroscopic or open osteocapsular débridement. Those with advanced degenerative changes and pain throughout the entire arc of motion may require joint resurfacing with interposition arthroplasty, partial joint arthroplasty, or total joint arthroplasty.

  9. 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.

  10. Pseudotumor due to metallosis after total elbow arthroplasty

    PubMed Central

    Rotini, Roberto; Bettelli, Graziano; Cavaciocchi, Michele; Savarino, Lucia

    2017-01-01

    The incidence of primary total elbow arthroplasty (TEA) in young patients is increasing. The indications for revision surgery are also rising. Here, we report a rare case of pseudotumor detected in a patient 16 years after TEA. Intraoperative findings revealed a necrotic mass characterized by a conspicuous metallosis in the soft tissues around the prosthesis, which caused ulnar nerve dislocation. Due to this anatomical change, a lesion of the nerve was accidentally produced during revision surgery. The case report emphasizes that the indications for elbow replacement, as well as the patient education about the permanent physical limitations, should be carefully considered. Moreover, the high risks of complications related to the revision procedure and pseudotumor removal need to be addressed before surgery. The technique should be done carefully and a preliminary thorough imaging should be performed, since a newly formed mass can cause significant distortion of the anatomy. PMID:28216759

  11. 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

  12. Psychometric properties of the Mayo Elbow Performance Score.

    PubMed

    Celik, Derya

    2015-06-01

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

  13. Simplified analytical dynamic model for a parallel prosthetic elbow.

    PubMed

    Mendoza-Vazquez, Rafael; Escudero-Uribe, Apolo Z; Fernandez-Mulia, Raul

    2007-01-01

    A three degree of freedom elbow prosthesis impelled by linear actuators disposed in parallel is modeled by the Lagrange-Euler method. The method proposes to replace a parallel mechanism with an equivalent serial topology with the purpose of calculating the Lagrangian, however the parallel topology is used for the calculus of forces and torques. The result is a simplification in the mathematical analysis without an important loss in precision.

  14. Spontaneous Zone III rupture of the flexor tendons of the ulnar three digits in elderly Korean farmers.

    PubMed

    Lee, G J; Kwak, S; Kim, H K; Ha, S H; Lee, H J; Baek, G H

    2015-03-01

    Spontaneous flexor tendon rupture is a rare condition and the aetiology is not clear. We report 12 elderly Korean farmers with spontaneous flexor tendon ruptures. We found the rupture in the dominant hand in ten patients. A rupture in the little finger was found in all 12 patients (seven with both flexor tendons ruptured and five with only the profundus ruptured), in the ring finger in four patients (the profundus ruptured in all and both flexor tendons in two patients), and in the middle finger a partial rupture of the profundus in one patient. The tendons were ruptured close to the hook of the hamate. Repetitive friction between the flexor tendons and the hamate hook may cause the ruptures. The hamate hook was excised and the ruptured profundus tendons were reconstructed with tendon transfers with quite favourable functional recovery at follow-up of 1 to 2 years. The ruptured superficialis tendons were not reconstructed. Level of Evidence IV.

  15. Effect of Heat Preconditioning by Microwave Hyperthermia on Human Skeletal Muscle After Eccentric Exercise

    PubMed Central

    Saga, Norio; Katamoto, Shizuo; Naito, Hisashi

    2008-01-01

    The purpose of this study was to clarify whether heat preconditioning results in less eccentric exercise-induced muscle damage and muscle soreness, and whether the repeated bout effect is enhanced by heat preconditioning prior to eccentric exercise. Nine untrained male volunteers aged 23 ± 3 years participated in this study. Heat preconditioning included treatment with a microwave hyperthermia unit (150 W, 20 min) that was randomly applied to one of the subject’s arms (MW); the other arm was used as a control (CON). One day after heat preconditioning, the subjects performed 24 maximal isokinetic eccentric contractions of the elbow flexors at 30°·s-1 (ECC1). One week after ECC1, the subjects repeated the procedure (ECC2). After each bout of exercise, maximal voluntary contraction (MVC), range of motion (ROM) of the elbow joint, upper arm circumference, blood creatine kinase (CK) activity and muscle soreness were measured. The subjects experienced both conditions at an interval of 3 weeks. MVC and ROM in the MW were significantly higher than those in the CON (p < 0.05) for ECC1; however, the heat preconditioning had no significant effect on upper arm circumference, blood CK activity, or muscle soreness following ECC1 and ECC2. Heat preconditioning may protect human skeletal muscle from eccentric exercise-induced muscle damage after a single bout of eccentric exercise but does not appear to promote the repeated bout effect after a second bout of eccentric exercise. Key pointsThere have been few studies about the effects of heat preconditioning on muscle damage caused by eccentric exercise and the repeated bout effect after a second bout of eccentric exercise.Heat preconditioning with microwave hyperthermia may attenuate eccentric exercise-induced muscle damage.Heat preconditioning does not enhance the repeated bout effect. PMID:24150151

  16. Iatrogenic selective lesion of the median nerve at the elbow.

    PubMed

    Di Fabio, Roberto; Casali, Carlo; Pierelli, Francesco

    2010-03-01

    A lesion of the median nerve may occur as a consequence of a compression by a haematoma or for a direct damage of the axons caused by a needle insertion. To date, no investigation reported a very selective lesion of the median nerve at the elbow, with the suffering limited only to the fibres for the first digit. A 53 year-old left-handed violinist underwent an arterial blood gas drawing. The patient complained immediately of an electrical shock impression going down the arm, followed by pin sensation into the first finger. A tingling sensation associated with numbness in the first fingertip and difficulty in the index-thumb pinch became progressively evident. The ENG-EMG findings showed an impairment mainly of the sensory fibres innervating the first digit and a drop of the motor action potential amplitude when the nerve was stimulated at the elbow. We reported a very partial lesion of the left median nerve at the elbow in a violinist who had a selective involvement of the fibres for his first digit. Even minimal lesions of the median nerve may impair severely the quality of life of patients.

  17. 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

  18. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures.

    PubMed

    Rineer, Craig A; Ruch, David S

    2009-03-01

    Lateral and medial epicondylitis are common causes of elbow pain in the general population, with the lateral variety being more common than the medial by a ratio reportedly ranging from 4:1 to 7:1. Initially thought to be an inflammatory condition, epicondylitis has ultimately been shown to result from tendinous microtearing followed by an incomplete reparative response. Numerous nonoperative and operative treatment options have been employed in the treatment of epicondylitis, without the emergence of a single, consistent, universally accepted treatment protocol. Tendon ruptures about the elbow are much less frequent, but result in more significant disability and loss of function. Distal biceps tendon ruptures typically occur in middle-aged males as a result of an event that causes a sudden, eccentric contraction of the biceps. Triceps tendon ruptures are exceedingly rare but usually have a similar etiology with a forceful eccentric contraction of the triceps that causes avulsion of the tendon from the olecranon. The diagnosis of these injuries is not always readily made. Complete ruptures of the biceps or triceps tendons have traditionally been treated surgically with good results. With regard to biceps ruptures, there continues to be debate about the best surgical approach, as well as the best method of fixation of tendon to bone. This article is not meant to be an exhaustive review of the broad topics of elbow tendinopathy and tendon ruptures, but rather is a review of recently published information on the topics that will assist the clinician in diagnosis and management of these conditions.

  19. Spontaneous divergent elbow dislocation after Sauve-Kapandji procedure.

    PubMed

    Moritomo, Hisao; Izawa, Kazutaka; Murase, Tsuyoshi; Hashimoto, Hideo; Goto, Akira; Masatomi, Takashi

    2003-01-01

    This is a report on an unusual complication of the Sauve-Kapandji procedure in patients with rheumatoid arthritis. Two women with rheumatoid arthritis who previously had an ipsilateral Sauve-Kapandji procedure experienced spontaneous transverse divergent elbow dislocations without evident trauma. Their radiographs showed medial dislocation of the proximal ulna, which was separated from the radial head. The radial head and distal end of the ulnar shaft showed remarkable instability by a pronation and supination motion without the radial and ulnar shafts being separated from each other. Stress radiographic examination showed significant loosening of all ligaments except the medial collateral ligament around the elbow and did not show disruption of the interosseous membrane. A unique chronic twist radioulnar dissociation which consists of gross instability of the radial head and the distal ulna without disruption of the interosseous membrane was considered to cause instability of the humeroulnar joint, which results in medial dislocation of the proximal ulna. This report suggests that there is a direct cause and effect relationship between the residual distal ulnar instability and the development of transverse divergent dislocation of the elbow in patients with rheumatoid arthritis after the Sauve-Kapandji procedure.

  20. Microscopic and histological examination of the mouse hindpaw digit and flexor tendon arrangement with 3D reconstruction

    PubMed Central

    Wong, Jason; Bennett, William; Ferguson, Mark W J; McGrouther, Duncan A

    2006-01-01

    Mice are currently the species of choice for the in vivo study of injury, but few detailed anatomical descriptions have been made of rodent digits, limiting their use for the investigation of intrasynovial tendon healing. In this study a detailed microscopic and histological investigation was performed using C57/BL6 and Tie2 LacZ reporter gene transgenic mice. Serial-sectioned mouse hindpaw digits were characterized using haematoxylin and eosin, Masson's trichrome (collagen), Alcian blue (fibrocartilage), Miller's stain (elastin) and TRITC-phalloidin (cellular cytoskeleton) staining. Digital vasculature was demonstrated using FITC-labelled dextran perfusion studies supplemented with LacZ expression in Tie2 LacZ transgenic mice digits. Imaging of the digit used a combination of brightfield and confocal microscopy with three-dimensional reconstruction. Our findings demonstrated that the mouse hindpaw possesses deep and superficial flexor tendons within a synovial sheath comparable with that found in other mammalian species. The intrasynovial tendons were avascular and had regions of fibrocartilaginous specialization relating to areas of compression. Corresponding vascular networks were demonstrated around the sheath using Tie2 LacZ mice and FITC-perfused hindpaws. Furthermore, there is an area of digit where both deep and superficial tendons reside between two pulleys, similar to zone 2 in the human hand where it would be possible to study intrasynovial tendon injury and adhesion formation. In conclusion, although the dimensions of the mouse digit pose technical challenges for surgical intervention, we have identified a model for the study of flexor tendon injury that will permit future genetic manipulation studies. PMID:17005025

  1. [Therapeutically effect of the physical procedures on the elbow contractures in children with supracondylar humerus fractures].

    PubMed

    Jandrić, S Dj

    2007-01-01

    Supracondylar humerus fractures are the most common fracture around the elbow in the pediatric population. These fractures in children may lead to functional disturbance with loss or reduction of range of motion in the elbow joint. The aim of this study was to investigate the effect of the physical therapy on the range of the motion of the elbow joint in the post-traumatic elbow contractures in the childhood after supracondylar fractures. We analyzed in this research 34 children (average age 8.57+/-2.94 years) with elbow contractures that were treated by physical therapy after orthopedic treatment. Functional outcome was presented in degree from 1 to 3 (Flynn). The difference in the grade at the beginning and the end of the therapy is statistically significant (t=16.38, p<0.001). 91.18 %, of the children had excellent result. Complex of various therapeutically physical procedures can significant improve range of motion of the elbow joint.

  2. Three-dimensional motion analysis in the elbow joint position sense in children

    PubMed Central

    Hong, So-Young; Song, Chiang-Soon; Hong, Ki-Hoon

    2016-01-01

    [Purpose] The purpose of this study was to investigate the difference in elbow joint position sense in children. [Subjects and Methods] Nineteen healthy children volunteered as subjects for this study. Joint position sense was assessed by asking the children to flex their elbows between 30° to 110° while blindfolded. The error range of elbow movement was analyzed with Compact Measuring System 10 for three-dimensional motion. To analyze data, descriptive statistics and paired t-test analysis were performed by using IBM SPSS Statistics 20.0. [Results] A significantly lower error was found in 30° right elbow flexion than 110° right elbow flexion (p<0.05). No significant difference was found between 30° and 110° left elbow flexion. [Conclusion] These results indicate that in children, joint position sense errors decrease as joint angles approach 30° flexion. PMID:28174442

  3. Elbow locking in a patient with a congenital radial head dislocation: Case report.

    PubMed

    Kim, H-J; Kim, P-T; Lee, H-J; Deslivia, M F

    2017-01-10

    Snapping elbow is a rare condition, which has various possible causes such as impinged plica, annular ligament, or other extra-articular causes. We report a case of 15-year-old boy who had snapping elbow and sudden-onset flexion contracture of the elbow. Simple radiographs showed bilateral anterior dislocation of hypoplastic radial heads. Magnetic resonance images with the elbow extended as much as possible showed that the annular ligament hemmed the dislocated radial neck. By surgical incision of the annular ligament which checkreined the radial neck, the patients could regain full extension of the elbow. We recommend careful consideration of surgical excision of ligamentous structure which blocks extension in the patients who have history of snapping elbow with congenital radial head dislocation.

  4. SPOT CHECK AND LABORATORY TESTS OF USAMBRL ELECTROMECHANICAL ELBOWS FOR LARGE SCALE CLINICAL EVALUATION.

    DTIC Science & Technology

    Twenty-four electromechanical elbows fabricated for a large-scale clinical evaluation were checked for functionality with two of the units being...the elbow center. The brass screws which stabilize the gear sector were changed. This produced a noticeable improvement. Other areas in the evaluation...were at an acceptable level of performance. Finally, all elbows were functional and considered acceptable for the clinical evaluation. (Author)

  5. Increasing Elbow Torque Output of Stroke Patients by EMG-Controlled External Torque

    DTIC Science & Technology

    2007-11-02

    Abstract- A control algorithm for using homogenic EMG to control external assisting torque is developed for improving the elbow capability of...sacrificing performance. Keywords - Elbow , EMG, assisting torque, stroke I. INTRODUCTION Hemiparesis, which means partial loss of muscle strength...system to increase the total torque capability of the elbow for this class of patients. The system was controlled by surface EMG of biceps and

  6. Stress Indices and Flexibility Factors for 90-Degree Piping Elbows with Straight Pipe Extensions.

    DTIC Science & Technology

    1982-02-01

    FACTORS FOR 90-DEGREE PIPING ELBOWS WITH STRAIGHT PIPE EXTENS IONS cn by oA. J. Quezon and G. C. Everstine a% APPROVED FOR PUBLIC RELEASE: DISTRIBUTION...FLEXIBILITY FACTORS FOR 90-DEGREE PIPING ELBOWS WITH STRAIGHT PIPE EXTENSIONS 6. PERFORMING OrG. REPORT NUMBER = 7. AUTHOR(e S. CONTRACT OR GRANT NUMBER(e...NOTES 19. KEY WORDS (Continue on reverse elde If neceeeary and Identify by bloc, number) Piping Finite Element Flexibility Factor Elbow NASTRAN Bend

  7. Mechanically Evoked Torque and Electromyographic Responses During Passive Elbow Extension in Upper Limb Tension Test Position

    DTIC Science & Technology

    2007-11-02

    elbow extension. The second was an electromyographic (EMG) protocol, which allowed recording of EMG from 10 shoulder and arm muscles during the...controlled passive elbow extension as the last component of ULTT1. A battery-operated micro-switch held by the subject, generated digital rectangular...propose that increased detectable resistance during elbow extension at ULTT1 position involves the protective reflex activation of the shoulder and arm

  8. Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal fractures: a case report.

    PubMed

    Kose, O; Durakbasa, M O; Islam, N C

    2008-04-01

    Elbow dislocation associated with both ipsilateral radial and ulnar shaft fractures is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a case of an 80-year-old woman who had a posterolateral elbow dislocation and ipsilateral radial and ulnar shaft fractures and underwent closed reduction and plate fixation. She had an excellent outcome after 22 months of follow-up.

  9. Elbow clinical, ultrasonographic and radiographic study in patients with inflammatory joint diseases.

    PubMed

    Uson, Jacqueline; Miguélez-Sánchez, Roberto; de Los Riscos, Marina; Martínez-Blasco, María Jesús; Fernández-Espartero, Cruz; Villaverde-García, Virginia; Garrido, Jesús; Naredo, Esperanza

    2016-03-01

    The main objective of this cross-sectional observational study was to investigate the relationship between clinical, ultrasonographic (US) and radiographic elbow features in patients with inflammatory joint diseases (IJD). The secondary objective was to evaluate the association between regional clinical elbow diagnoses and imaging findings. Consecutive patients with IJD attending follow-up visits were assessed for elbow pain and standardized elbow examination. Seven regional clinical diagnoses were defined. Digital elbow radiographs were read for 9 abnormalities. A standardized elbow grayscale (GS) and power Doppler (PD) scan recorded 13 defined abnormalities. Analysis encompassed 361 clinical, 361 US and 340 radiographic elbow assessments from 181 patients. US and clinical assessments showed an overall higher agreement than radiographic and clinical assessments (68.8 vs 59.1%, p = 0.001). When structural US abnormalities were compared with radiographic findings, agreement was slightly higher than when comparing all US abnormalities with radiographic findings (77.3%, k 0.533 and 73.5%, k 0.492). Enthesophytes, the most common abnormalities, were not associated with clinical findings. Subclinical US-synovitis and US-enthesopathy were found, respectively, in 17.3 and 14.1% of the clinically normal elbows. Clinical elbow arthritis prevalence and bias-adjusted kappa (PABAK) agreement was good for radiographic fat pad sign, PD-synovitis and GS-synovitis. Clinical elbow enthesopathy PABAK agreement was moderate for GS-enthesopathy and radiographic calcifications. US showed acceptable agreement with clinical and radiographic assessments for detecting elbow inflammatory and structural abnormalities in patients with IJD. Because US detected more abnormalities than radiography and has the capability to detect more subclinical abnormalities, US may be potentially used as a first-line elbow diagnostic tool in this clinical setting.

  10. 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

  11. 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.

  12. Growth factor and protease expression during different phases of healing after rabbit deep flexor tendon repair.

    PubMed

    Berglund, M E; Hart, D A; Reno, C; Wiig, M

    2011-06-01

    The purpose of the study was to contribute to the mapping of molecular events during flexor tendon healing, in particular the growth factors insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF) and nerve growth factor (NGF), matrix metalloproteinases (MMP-3 and MMP-13) and their inhibitors (tissue inhibitors of metalloproteinases, TIMP-1 and TIMP-3, and the protease cathepsin K. In a rabbit model of flexor tendon injury, the mRNA expression for the growth factors, MMPs and TIMPs were measured in tendon and tendon sheath tissue at several time points (3, 6, 21, and 42 days) representing different phases of the healing process. We found that MMP-13 remained increased during the study period, whereas MMP-3 returned to normal levels within the first week after injury. TIMP-3 was down-regulated in the tendon sheaths. Cathepsin K was up-regulated in tendons and sheaths after injury. NGF was present in both tendons and sheaths, but unaltered. IGF-1 exhibited a late increase in the tendons, while VEGF was down-regulated at the later time points. In conclusion, we have demonstrated the presence of NGF in flexor tendons. MMP-13 expression appears to play a more protracted role in flexor tendon healing than MMP-3. The relatively low levels of endogenous IGF-1 and VEGF mRNA following injury support their potential beneficial role as exogenous modulators to optimize tendon healing and strength without increasing adhesion formation.

  13. Reconstruction of a congenitally absent flexor pollicis longus in an adult

    PubMed Central

    Shamsian, Negin; Exton, Rebecca; Shibu, MM

    2010-01-01

    Congenital absence of the flexor pollicis longus (FPL) is an unusual finding that is frequently associated with thumb hypoplasia. Isolated FPL absence is the rarest of the congenital thumb anomalies. The present article describes a patient with a congenitally absent FPL, and discusses the chosen method of reconstruction. PMID:22131842

  14. Tendoscopic Excision of an Intratendinous Ganglion in the Flexor Hallucis Longus Tendon: A Case Report.

    PubMed

    Endo, Jun; Yamaguchi, Satoshi; Sasho, Takahisa

    2016-01-01

    Intratendinous ganglion cysts are rare lesions of unknown etiology that originate within a tendon. We report the case of a 34-year-old female with an intratendinous ganglion in the plantar portion of the flexor hallucis longus tendon. The intratendinous ganglion recurred after ultrasound-guided needle aspiration. Tendoscopic excision of the intratendinous ganglion cyst achieved a satisfactorily result without recurrence.

  15. 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.

  16. 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

  17. A Rare Combination of Complex Elbow Dislocation and Distal Radial Fracture in Adults

    PubMed Central

    Vaishya, Raju; Krishnan, Midhun; Agarwal, Amit Kumar

    2016-01-01

    Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. The case was treated operatively. We describe two possible mechanisms of injury for these rare injury types. The case underlines the importance of assessing the wrist in the case of an elbow fracture and vice versa. PMID:28003939

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

    PubMed Central

    Jen, Chi Loong

    2015-01-01

    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

  19. 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.

  20. Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review.

    PubMed

    Behr, Ian; Blint, Andy; Trenhaile, Scott

    2013-12-01

    Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome.

  1. Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review

    PubMed Central

    Behr, Ian; Blint, Andy; Trenhaile, Scott

    2013-01-01

    Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome. PMID:26403884

  2. A Rare Combination of Complex Elbow Dislocation and Distal Radial Fracture in Adults.

    PubMed

    Vaishya, Raju; Krishnan, Midhun; Vijay, Vipul; Agarwal, Amit Kumar

    2016-11-08

    Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. The case was treated operatively. We describe two possible mechanisms of injury for these rare injury types. The case underlines the importance of assessing the wrist in the case of an elbow fracture and vice versa.

  3. 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.

  4. Incipient malunion of an isolated humeral trochlea fracture treated with an elbow hemiarthroplasty: case report.

    PubMed

    Lechasseur, Benoit; Laflamme, Mélissa; Leclerc, Alexandre; Bédard, Anne-Marie

    2015-02-01

    We report the case of a 49-year-old woman with severe elbow ankylosis 10 weeks after a trochlea fracture treated with open reduction and internal fixation. Imaging confirmed failure of open reduction and internal fixation with a displaced and severely damaged trochlea. We treated the nascent malunited trochlea and associated elbow ankylosis with a distal humeral hemiarthroplasty and circumferential elbow arthrolysis. The patient regained functional range of motion of the elbow and had minimal pain. Distal humeral hemiarthroplasty, which has been indicated for acute fractures involving the capitellum or the entire distal humerus, may also be indicated for certain isolated complex fractures of the trochlea.

  5. 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

  6. Intracellular autogenetic and synergistic effects of muscular contraction on flexor motoneurones

    PubMed Central

    Green, D. G.; Kellerth, J.-O.

    1967-01-01

    1. Intracellular records have been taken from cat motoneurones innervating flexor muscles of the hind limb. Contractions of the ankle flexors tibialis anterior and extensor digitorum longus were elicited by stimulation of the peripheral end of the cut L 7 ventral root and the reflex effects of these contractions were recorded in silent and repetitively firing motoneurones. 2. Contraction usually produces a hyperpolarizing response inside flexor motoneurones. This hyperpolarization is tension-sensitive in the sense that when, at constant muscle extension, the strength of the contraction is increased, the magnitude of the inhibitory response is augmented. 3. Increasing the resting length of the muscles, while using a stimulus of constant strength to the ventral root, causes this inhibitory response to increase in some cells. More often, however, the hyperpolarization caused by contraction is gradually reduced in duration and/or amplitude as the muscles are extended. 4. Even with the muscles slackened, so that they develop no tension at their ends, contraction usually produces prominent hyperpolarization of the motoneurones. 5. By passing polarizing currents or injecting chloride ions through the intracellular micro-electrode, the hyperpolarizing potentials produced by contraction of the slack and extended muscles are shown to be, at least in part, genuinely post-synaptic inhibitory events. 6. When the neurone is fired repetitively by injected current, the `silent period' in contraction corresponds to the hyperpolarization of the post-synaptic membrane. 7. Monosynaptic testing of the flexor motoneurone pool has been used to confirm the essential features of the intracellularly recorded activity. 8. Acutely spinalizing the animal increases the magnitude of the inhibitory responses caused by contraction. 9. Recordings from dorsal root fibres show that Golgi tendon organs of the ankle flexors are very sensitive to contraction and are indeed often activated by the

  7. 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

  8. 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.

  9. Ulnar Collateral Ligament and Elbow Adaptations in High School Baseball Pitchers

    PubMed Central

    Marshall, Nathan E.; Keller, Robert A.; Van Holsbeeck, Marnix; Moutzouros, Vasilios

    2015-01-01

    Background: Baseball pitchers have adaptive changes in the soft tissues of the throwing elbow. Hypothesis: High school baseball pitchers would show adaptive changes in the ulnar collateral ligament (UCL), such as calcifications and hypoechoic foci, thickening, and increased ulnohumeral joint laxity, on dynamic ultrasound (DUS). Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Twenty-two asymptomatic high school pitchers, designated as their primary position by their coach, underwent DUS and physical examination of the throwing and nonthrowing elbows prior to the start of the season. UCL substance consistency and thickness, ulnohumeral joint space widening, and soft tissue elbow structures were evaluated. Results: The mean age of the cohort was 16.9 years. Calcifications of the UCL were similar, being present in 7 of 22 (32%) throwing elbows versus 8 of 22 (36%) nonthrowing elbows (P = 0.11). UCL hypoechoic foci also were similar between elbows: 2 of 22 (9%) throwing elbows versus 0 of 22 nonthrowing elbows (P = 0.11). UCL thickness was also found to be similar in both elbows (throwing arm, 6.54 mm vs nonthrowing, 6.71 mm; P = 0.48). Ulnohumeral joint laxity unloaded (throwing arm, 3.13 mm vs nonthrowing, 3.17 mm; P = 0.835) and loaded (throwing arm, 3.87 mm vs nonthrowing arm, 4.11 mm; P = 0.30) was similar between elbows. Throwing elbows showed posteromedial olecranon spurring in 36%, effusions in 27%, and synovitis in 9%. Conclusion: High school pitchers show limited adaptive changes in the elbow, including UCL calcifications, hypoechoic foci, posteromedial olecranon spurring, and effusions. However, these changes are similar to those seen in the nonthrowing elbow, and these younger athletes lack findings seen in professional and collegiate pitchers such as UCL thickening and increased ulnohumeral joint space laxity. Clinical Relevance: Preseason ultrasound examination of the high school pitching elbow lacks the adaptive changes to the

  10. Preliminary Study on Continuous Recognition of Elbow Flexion/Extension Using sEMG Signals for Bilateral Rehabilitation

    PubMed Central

    Song, Zhibin; Zhang, Songyuan

    2016-01-01

    Surface electromyography (sEMG) signals are closely related to the activation of human muscles and the motion of the human body, which can be used to estimate the dynamics of human limbs in the rehabilitation field. They also have the potential to be used in the application of bilateral rehabilitation, where hemiplegic patients can train their affected limbs following the motion of unaffected limbs via some rehabilitation devices. Traditional methods to process the sEMG focused on motion pattern recognition, namely, discrete patterns, which are not satisfactory for use in bilateral rehabilitation. In order to overcome this problem, in this paper, we built a relationship between sEMG signals and human motion in elbow flexion and extension on the sagittal plane. During the conducted experiments, four participants were required to perform elbow flexion and extension on the sagittal plane smoothly with only an inertia sensor in their hands, where forearm dynamics were not considered. In these circumstances, sEMG signals were weak compared to those with heavy loads or high acceleration. The contrastive experimental results show that continuous motion can also be obtained within an acceptable precision range. PMID:27775573

  11. Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature.

    PubMed

    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.

  12. Heterotopic ossification of the elbow after closed reduction and retrograde intramedullary nailing for radial neck fracture treated by anconeus interposition.

    PubMed

    Sreenivas, T; Menon, Jagdish; Nataraj, A R

    2013-12-01

    Heterotopic ossification around the elbow can lead to considerable functional disability. We describe a case of a 42-year-old man who developed heterotopic ossification of his elbow after closed reduction of the elbow dislocation and radial neck fracture and retrograde intramedullary nailing for radial neck fracture. During the follow-up after initial surgery, movements of the elbow were gradually deteriorated and diagnosed as heterotopic ossification of the elbow. Implant removal, radial head excision along with heterotopic mass, and also interposition of the anconeus muscle resulted in improvement of his elbow mobility. At 18 months of follow-up, patient had elbow flexion arc of 15°-110°, 70° of supination, and 50° of pronation without recurrence of heterotopic ossification. The uniqueness of this case lies in the treatment of heterotopic ossification of the elbow to prevent its recurrence, which was developed after retrograde intramedullary nailing for radial neck fracture following closed reduction.

  13. TGF-beta1 Suppresses Plasmin and MMP Activity in Flexor Tendon Cells via PAI-1: Implications for Scarless Flexor Tendon Repair

    PubMed Central

    Farhat, Youssef M.; Al-Maliki, Alaa A.; Easa, Anas; O’Keefe, Regis J.; Schwarz, Edward M.; Awad, Hani A.

    2014-01-01

    Flexor tendon injuries caused by deep lacerations to the hands are a challenging problem as they often result in debilitating adhesions that prevent the movement of the afflicted fingers. Evidence exists that tendon adhesions as well as scarring throughout the body are largely precipitated by the pleiotropic growth factor, TGF-β1, but the effects of TGF-β1 are poorly understood in tendon healing. Using an in vitro model of tendon healing, we previously found that TGF-β1 causes gene expression changes in tenocytes that are consistent with scar tissue and adhesion formation, including upregulation of the anti-fibrinolytic protein, PAI-1. Therefore, we hypothesized that TGF-β1 contributes to scarring and adhesions by reducing the activity of proteases responsible for ECM degradation and remodeling, such as plasmin and MMPs, via upregulation of PAI-1. To test our hypothesis, we examined the effects of TGF-β1 on the protease activity of tendon cells. We found that flexor tendon tenocytes treated with TGF-β1 had significantly reduced levels of active MMP-2 and plasmin. Interestingly, the effects of TGF-β1 on protease activity were completely abolished in tendon cells from homozygous PAI-1 KO mice, which are unable to express PAI-1. Our findings support the hypothesis that TGF-β1 induces PAI-1, which suppresses plasmin and plasmin-mediated MMP activity, and provide evidence that PAI-1 may be a novel therapeutic target for preventing adhesions and promoting a scarless, regenerative repair of flexor tendon injuries. PMID:24962629

  14. Features selection and classification to estimate elbow movements

    NASA Astrophysics Data System (ADS)

    Rubiano, A.; Ramírez, J. L.; El Korso, M. N.; Jouandeau, N.; Gallimard, L.; Polit, O.

    2015-11-01

    In this paper, we propose a novel method to estimate the elbow motion, through the features extracted from electromyography (EMG) signals. The features values are normalized and then compared to identify potential relationships between the EMG signal and the kinematic information as angle and angular velocity. We propose and implement a method to select the best set of features, maximizing the distance between the features that correspond to flexion and extension movements. Finally, we test the selected features as inputs to a non-linear support vector machine in the presence of non-idealistic conditions, obtaining an accuracy of 99.79% in the motion estimation results.

  15. Submuscular transposition for the ulnar nerve at the elbow.

    PubMed

    Posner, M A

    1984-01-01

    Forty patients who underwent submuscular transpositions of the ulnar nerve at the elbow (41 operations) were evaluated. A grading system was formulated to compare the preoperative and postoperative condition of each patient with respect to tenderness over the nerve, numbness, paresthesia, and muscle weakness. Thirty-seven of the 41 cases showed an improvement in grade. Of the 34 cases that demonstrated muscle weakness preoperatively, 25 improved following surgery, including five patients who had severe intrinsic muscle weakness with clawing of the ring and little finger. Muscle reattachment following nerve transposition was secure, even in a professional athlete.

  16. Design and characterization of a powered elbow prosthesis.

    PubMed

    Bennett, Daniel A; Mitchell, Jason; Goldfarb, Michael

    2015-01-01

    This paper describes the design of a powered elbow prosthesis, which incorporates a belt and cable drive transmission with a brushless DC motor to achieve an output torque of approximately 18.4 Nm, a backdrive torque of 1.5 Nm, and a speed of up to 360 deg/s while remaining within the anthropomorphic envelope with regard to mass and size. The measured torque and speed of the prosthesis is commensurate with nominal capability of the natural limb (for purposes of performing activities of daily living).

  17. [Circumscribed myositis ossificans of the elbow: about a case].

    PubMed

    Nhamoucha, Yassine; Alaoui, Othmane; Alaoui, Charifa; Abdellaoui, Hicham; Tazi, Mohammed; Oukhoya, Mohammed; Chater, Lamyae; Atarraf, Karima; Arroud, Mounir; Afifi, Abderahman

    2016-01-01

    Circumscribed myositis ossificans (CMO) is a heterotopic ossification of the striated muscles. Its location at the level of the elbow is rare. It occurs in young patients, often following trauma as it can also develop without experiencing any traumatic event. Its predominant location is at the level of the larger muscles limbs root (gluteus, deltoid) or of the areas which are most exposed to direct shocks (the quadriceps in more than 40% of post-traumatic cases). Our study aims to highlight the aspects of a circumscribed myositis ossificans in conventional radiology and tomodensitometry to avoid potential diagnostic confusion with a malignant bone tumor.

  18. 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...

  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. 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...

  2. 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...

  3. 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.

  4. Image-guided elbow interventions: a literature review of interventional treatment options

    PubMed Central

    Sorani, Alan

    2016-01-01

    Over the years, a wide range of image-guided interventional therapies have been used in treating different elbow pathologies, many of which are predominantly based on anecdotal and low-level study findings. This article critically assesses the existing literature and discusses the efficacy of the most commonly utilized interventional procedures for elbow pathology. PMID:26206415

  5. 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

  6. Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study

    PubMed Central

    Karaduman, Mert; Okkaoglu, Mustafa Caner; Sesen, Hakan; Taskesen, Anil; Ozdemir, Mahmut; Altay, Murat

    2016-01-01

    Purpose To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique. Method A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements. Results VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength. Conclusion The PRP seems to be better for pain relief and functionality in the short and mid-term periods. PMID:26955228

  7. Open antero-lateral dislocation of the elbow. A case report

    PubMed Central

    Alonso, Juan A; Roy, Bibas R; Shaw, David L

    2002-01-01

    Background Open dislocations are infrequent, often associated with damage to the neuro vascular structures. We present an unusual case of an open antero-lateral dislocation of the elbow, which was not associated with any vascular or neural injury. Case presentation A 34 year female dance instructor sustained an open dislocation of her elbow. Surgical exploration was undertaken. No major neurovascular injury was present. There was almost complete disruption of all the muscular and ligamentous attachments to the distal humerus and the proximal radius and ulna, which were not formally repaired during surgery. The elbow was found to be very unstable, and was placed in a back slab. The functional recovery was complete in about six months, the patient regaining full range of elbow movement. Elbow dislocations without associate fractures are adequately treated by manipulation and reduction, in spite of the almost complete disruption of the soft tissues around the joint. PMID:11806760

  8. Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases.

    PubMed

    Madhar, M; Saidi, H; Fikry, T; Cermak, K; Moungondo, F; Schuind, F

    2013-10-01

    Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.

  9. Complete Brachial Artery Transection following closed Posterior Elbow Dislocation: A Rare Case Report

    PubMed Central

    C, JayanthKumar B; Sampath, Deepak; N, Hanumantha Reddy; Motukuru, Vishnu

    2015-01-01

    Introduction: Vascular injury associated withclosed posterior elbow dislocations is rare and it usually occurs along with open dislocation, anterior dislocation, penetrating injuries, dislocations associated with fracture. We report such a case of closed posterior elbow dislocation with complete brachial artery rupture. Case Report: A 58 years old lady sustained posterior dislocation of right elbow following a fall at home. She presented three days later with complaints of severe pain, swelling around the right elbow and numbness of fingers following a closed reduction done elsewhere. Computed graft angiography showed complete transection of brachialartery. Patient was treated with thrombectomy, right great saphenous vein graft interposition repair of brachial artery and forearm fasciotomy. Conclusion: Vascular injuries associated with posterior elbow dislocation are very rare, but high index of suspicion of arterial injury need to be thought off and repeated vascular examination during pre and post reduction stage should be done to prevent complications. PMID:27299092

  10. Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report

    PubMed Central

    Mazzini, Juan Pretell

    2009-01-01

    Introduction Elbow dislocations in children are uncommon injuries. Dislocations with associated fractures or so-called complex dislocations of the elbow can be challenging to diagnose and treat. Case presentation A 14-year-old male had a posterolateral elbow dislocation after a fall. Closed reduction with traction was performed. Radiographs after initial reduction showed a fragment entrapped into the humero-cubital joint. Computerized tomography scan showed the fragment belonging to the medial epicondyle. Open reduction and internal fixation with a 3.0 millimeter cannulated screw was performed, with restoring of the normal function of the elbow at final follow up. Conclusion Elbow dislocations in children can be associated with bone lesions. These injuries must be suspected to avoid misleading diagnosis and achieve good results. PMID:19829829

  11. Elbow joint stability in relation to forced external rotation: An experimental study of the osseous constraint.

    PubMed

    Deutch, Søren R; Jensen, Steen L; Olsen, Bo S; Sneppen, Otto

    2003-01-01

    The objective of this study was to evaluate the osseous constraint related to forced forearm external rotation as the initial stage in a posterior elbow dislocation. Six joint specimens without soft tissues were examined in a joint analysis system developed for simulation of dislocation. The osseous stability, expressed as the maximal torque needed for pathologic external forearm rotation, increased from varus to valgus stress (P =.0001) and from 10 degrees to 90 degrees of elbow flexion (P =.012) and also tended to increase from forearm supination to pronation. The work of pathologic external forearm rotation until the point of maximal torque decreased from a maximum in full extension to a minimum at 30 degrees of elbow flexion (P =.03). The elbow in a slightly flexed position, varus stress, and forearm external rotation trauma might be the important biomechanical factors in the posterior elbow dislocation, and they might serve as guidelines during clinical investigation for posterolateral instability.

  12. [A method for reconstruction of the A1 retinaculum in the flexor pollicis longus sheath with extensor pollicis brevis tendon].

    PubMed

    Chmiel, Z

    1996-01-01

    An original method for A1 retinaculum reconstruction of flexor pollicis longus sheath with extensor pollicis brevis tendon is presented. Reconstructed retinaculum is very strong. Loss of extensor pollicis brevis did not impaired thumb function.

  13. 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

  14. Contribution of hind limb flexor muscle afferents to the timing of phase transitions in the cat step cycle.

    PubMed

    Hiebert, G W; Whelan, P J; Prochazka, A; Pearson, K G

    1996-03-01

    1. In this investigation, we tested the hypothesis that muscle spindle afferents signaling the length of hind-leg flexor muscles are involved in terminating extensor activity and initiating flexion during walking. The hip flexor muscle iliopsoas (IP) and the ankle flexors tibialis anterior (TA) and extensor digitorum longus (EDL) were stretched or vibrated at various phases of the step cycle in spontaneously walking decerebrate cats. Changes in electromyogram amplitude, duration, and timing were then examined. The effects of electrically stimulating group I and II afferents in the nerves to TA and EDL also were examined. 2. Stretch of the individual flexor muscles (IP, TA, or EDL) during the stance phase reduced the duration of extensor activity and promoted the onset of flexor burst activity. The contralateral step cycle also was affected by the stretch, the duration of flexor activity being shortened and extensor activity occurring earlier. Therefore, stretch of the flexor muscles during the stance phase reset the locomotor rhythm to flexion ipsilaterally and extension contralaterally. 3. Results of electrically stimulating the afferents from the TA and EDL muscles suggested that different groups of afferents were responsible for the resetting of the step cycle. Stimulation of the TA nerve reset the locomotor step cycle when the stimulus intensity was in the group II range (2-5 xT). By contrast, stimulation of the EDL nerve generated strong resetting of the step cycle in the range of 1.2-1.4 xT, where primarily the group Ia afferents from the muscle spindles would be activated. 4. Vibration of IP or EDL during stance reduced the duration of the extensor activity by similar amounts to that produced by muscle stretch or by electrical stimulation of EDL at group Ia strengths. This suggests that the group Ia afferents from IP and EDL are capable of resetting the locomotor pattern generator. Vibration of TA did not affect the locomotor rhythm. 5. Stretch of IP or

  15. [Developments in suture techniques of hand flexor tendon injuries during the last fifteen years].

    PubMed

    Bíró, Vilmos

    2016-02-07

    In the reconstruction of hand flexor tendon injuries it is fundamental to select the best suture technique, which makes possible early, active postoperative mobilization and achievement of the best results. The author reviews the development of suture techniques of the flexor tendon injuries during the last fifteen years, and discusses experimental tendon reconstruction results as well as clinical outcomes. The author describes the importance of different tendon suture materials, the significance of the pulley system of the fingers, the stretching between the sutured tendon ends by tendon sutures and, finally, the importance of the moving course in the reconstructed tendon. He states, that the wide-range adoption of the discussed modern tendon sutures would be necessary for better postoperative results.

  16. Zone 2 lacerations of both flexor tendons of all fingers in the same patient.

    PubMed

    Al-Qattan, M M

    2011-03-01

    Over an eight-year period, the author has treated five males (mean age of 31 years) with clean-cut zone 2 lacerations of both flexor tendons of all fingers using the same surgical technique (profundus only repair using three 'figure of eight' core sutures and proximal venting of the pulley system) and the same postoperative mobilization programme (a dorsal blocking splint with immediate active motion that allowed full extension at the interphalangeal joints). There were no ruptures of the repaired 20 fingers. At final follow-up (mean of 22 months after surgery), the outcome was considered excellent in 12 fingers, good in four fingers and fair in the remaining four fingers by the Strickland-Glogovac criteria. The outcome was similar in all four fingers for every patient supporting the hypothesis of previous studies that the outcome of repair of clean-cut flexor tendon lacerations in zone 2 is related to the psychological and biologic characteristics of the patient.

  17. Deep digital flexor tenotomy for treatment of severe laminitis in a cow.

    PubMed

    Gayle, J M; Burrell, G A; Anderson, K L; Redding, W R; Blikslager, A T

    2001-09-01

    A first-calf Guernsey cow was referred for evaluation of severe udder edema, mastitis, metritis, and ketosis. During the course of treatment, the cow became recumbent and was unable to rise. Intensive treatment resulted in the cow being able to stand for short periods with the aid of a sling. However, severe pressure necrosis of the udder and ongoing mastitis made performance of a complete mastectomy necessary. After surgery, the cow's condition improved, although assistance in standing was still required. Radiography of the distal phalanges revealed severe rotation in the right lateral and left medial digits of the hind limbs. The laminitis was nonresponsive to medical management; therefore, a deep digital flexor tenotomy was performed in the affected claws. The procedure provided almost immediate relief of signs of foot pain and resulted in ability to stand without assistance. Deep digital flexor tenotomy should be considered when treating cows with severe laminitis.

  18. A rare case of an accessory flexor hallucis longus causing tarsal tunnel syndrome.

    PubMed

    Lin, D; Williams, C; Zaw, H

    2014-09-01

    Tarsal tunnel syndrome (TTS) is a rare entrapment neuropathy of the tibial nerve within the fibro-osseous tarsal tunnel for which multiple etiologies, including trauma, congenital foot abnormalities and space occupying lesions, have been described. We present an unusual case of TTS caused by an accessory Flexor Hallucis Longus (FHL) tendon. Surgical excision led to a complete resolution of symptoms and improved the quality of life of our patient.

  19. Differential Effects of Unilateral Concentric Vs. Eccentric Exercise on the Dominant and Nondominant Forearm Flexors.

    PubMed

    Beck, Travis W; Ye, Xin; Wages, Nathan P

    2016-03-01

    The purpose of this study was to compare the electromyographic (EMG) intensity patterns after unilateral concentric vs. eccentric exercise in the dominant (DOM) and nondominant (NONDOM) forearm flexors. Twenty-six men (mean ± SD: age, 24.0 ± 3.7 years) volunteered to perform a maximal isometric muscle action of the DOM and NONDOM forearm flexors before (PRE) and immediately after (POST) a series of maximal concentric isokinetic or maximal eccentric isokinetic muscle actions of the DOM forearm flexors. The concentric isokinetic and eccentric isokinetic muscle actions were performed on separate days that were randomly ordered. However, in both cases, the subjects performed 6 sets of 10 maximal muscle actions. A bipolar surface EMG signal was detected from the biceps brachii of the DOM and NONDOM limbs during the PRE and POST isometric muscle actions. The signals were then analyzed with a wavelet analysis, and the resulting intensity patterns were classified with a paired pattern classification procedure. The results indicated that the EMG intensity patterns could be correctly classified into their respective PRE vs. POST categories with an accuracy rate that was significantly better than random (20 of 26 patterns = 76.9% accuracy) but only for the DOM limb following the eccentric muscle actions. All other classifications were not significantly better than random. These findings indicated that eccentric exercise had a significant influence on the muscle activation pattern for the forearm flexors. It is possible that the muscle damage resulting from eccentric exercise affects muscle spindle or golgi tendon organ or both activity, thereby altering the muscle activation pattern.

  20. The prevalence of accessory heads of the flexor pollicis longus and the flexor digitorum profundus muscles in Egyptians and their relations to median and anterior interosseous nerves.

    PubMed

    El Domiaty, M A; Zoair, M M; Sheta, A A

    2008-02-01

    Entrapment neuropathy in the forearm is not uncommon. Surgical interference for nerve decompression should be preceded by accurate diagnosis of the exact cause and site of the nerve entrapment. The aim of the present study was to investigate the prevalence of accessory heads of the flexor pollicis longus and flexor digitorum profundus muscles (FPLah) and (FDPah) in Egyptians and their topographical relationship with both the median nerve and its anterior interosseous branch. A total of 42 upper limbs of embalmed cadavers, 36 from males and 6 from females, were examined to elucidate the prevalence of both the FPLah and the FDPah muscles, their origin, insertion, nerve supply and morphology. The distribution of these two muscles in the right and left male and female upper limbs and their relationship to the anterior interosseous and median nerves were recorded. The total lengths of both accessory muscles and the lengths of their fleshy bellies and tendons were also measured. The FPLah was found to be present more frequently (61.9%) than it was absent, whereas the FDPah was observed in only 14.24% of the specimens examined. The combination of the accessory muscles in the same forearm was noticed in 9.52% of cases. As regards side, the FPLah appeared in 77.7% of the right forearms and in 50% of the left, while the FDPah was found in only 25% of the left forearms. The accessory muscles showed no single morphology, as the FPLah appeared fusiform in 53.8%, slender in 30.8% and voluminous fusiform in 15.4%, while the FDPah was slender in 66.6% and triangular in 33.3% of specimens. The FPLah arose mainly from the under surface of flexor digitorum superficialis, while the FDPah took its origin from the under surface of flexor digitorum superficialis or from the medial epicondyle. The insertion of the FPLah was mainly into the upper third of the FPL tendon, while the FDPah tendon joined the tendons of the flexor digitorum profundus muscle to the index or middle and ring

  1. 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.

  2. Direct end-to-end repair of flexor pollicis longus tendon lacerations.

    PubMed

    Nunley, J A; Levin, L S; Devito, D; Goldner, R D; Urbaniak, J R

    1992-01-01

    Between 1976 and 1986, 38 consecutive acute isolated flexor pollicis longus lacerations were repaired. This study excluded all replanted or mutilated digits and all lacerations with associated fracture. Average follow-up was 26 months. Tendon rehabilitation was standardized. Range of motion and pinch strength were measured postoperatively. Seventy-four percent (28/38) of the flexor pollicis longus injuries occurred in zone II. Neurovascular injury occurred in 82% of the lacerations, and this correlated with the zone of tendon injury. In 21% of the patients (8/38) both digital nerves and arteries were transected. Postoperative thumb interphalangeal motion averaged 35 degrees and key pinch strength was 81% that of the uninjured thumb. One rupture occurred in a child. Laceration of the flexor pollicis longus is likely to involve damage to neurovascular structures, and repair may be necessary. Direct end-to-end repairs within the pulley system do at least as well as delayed tendon reconstruction and do not require additional procedures.

  3. Effects of Lubricant and Autologous Bone Marrow Stromal Cell Augmentation on Immobilized Flexor Tendon Repairs

    PubMed Central

    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 × 105 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

  4. The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.

    PubMed

    Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki

    2011-12-01

    Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues.

  5. 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.

  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. 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

  8. A Newly Designed Tennis Elbow Orthosis With a Traditional Tennis Elbow Strap in Patients With Lateral Epicondylitis

    PubMed Central

    Saremi, Hossein; Chamani, Vahid; Vahab-Kashani, Reza

    2016-01-01

    Background Lateral epicondylitis is a common cause of pain and upper limb dysfunction. The use of counterforce straps for treatment of lateral epicondylitis is widespread. This kind of orthosis can be modified to have a greater effect on relieving pain by reducing tension on the origin of the extensor pronator muscles. Objectives To determine the immediate effects of a newly designed orthosis on pain and grip strength in patients with lateral epicondylitis. Materials and Methods Twelve participants (six men and six women) were recruited (mean age = 41 ± 6.7 years) and evaluated for pain and grip strength in three sessions. A 48-hour break was taken between each session. The first session was without any orthosis, the second session was with the new modified tennis elbow orthosis, and the third session was with a conventional tennis elbow strap. Results Both counterforce straps were effective. However, significantly more improvement was observed in pain and grip strength after using the newly modified orthosis (P < 0.05). Conclusions The newly designed strap reduces pain more effectively and improves grip strength by causing greater localized pressure on two regions with different force applications (two component vectors versus one). PMID:28180116

  9. 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

  10. Elbow fracture-dislocation combined with Galeazzi fracture in adult: A case report and literature review

    PubMed Central

    Asadollahi, Saeed; Shepherd, David; Hau, Raphael C.

    2013-01-01

    INTRODUCTION Galeazzi fracture associated with ipsilateral posterior elbow dislocation and radial head fracture is a rare pattern of injury. Few reports exist that describes this injury pattern and its treatment. We describe a case report of simultaneous occurrence of Galeazzi fracture and ipsilateral dislocation of elbow. PRESENTATION OF CASE A 58 year-old female presented with Galeazzi fracture and posterior elbow dislocation associated with radial head fracture of left upper extremity. This was managed with closed reduction of the elbow, open reduction and internal fixation of the radial shaft fracture and K-wire stabilisation of the unstable distal radioulnar joint. Prophylactic fasciotomy was performed. At 10 months follow-up, the outcome was favourable with the American shoulder and elbow surgeon score of 92 and the disabilities of the arm, shoulder and hand score of 18. DISCUSSION The presumed mechanism of the injury was a forceful axial loading of a hyperpronated forearm and extended elbow. Our literature review shows that this pattern of injury occurs as a result of high energy trauma in young individuals, and successful outcome can be achieved by addressing each component of this complex injury individually. CONCLUSION Simultaneous occurrence of elbow dislocation and Galeazzi fracture seems to be the result of extreme axial force and unique position of upper extremity at the time of impact. Individualised approach to each component of this injury can result in favourable outcome. PMID:23726112

  11. Elbow denervation in dogs: development of an in vivo surgical procedure and pilot testing.

    PubMed

    Zamprogno, Helia; Hash, Jon; Hulse, Don A; Lascelles, B Duncan X

    2011-11-01

    The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on limb function was assessed in vivo in four dogs with the elbow randomly selected for the procedure. Primary outcome measures were static bodyweight distribution and distal limb mechanical sensory thresholds; secondary outcome measures were subjectively scored lameness, neurological function and pain on manipulation. Histology was performed on all resected tissues to determine whether nerves had been resected. Denervation was achieved by separate medial and lateral surgical approaches. In testing the developed surgical protocol, 111/130 resected samples contained nerve tissue in the healthy cadaveric elbows and 18/20 in the in vivo study. Limb function and sensation were not altered by elbow joint denervation. The protocol developed for denervation of the canine elbow appears feasible and does not result in any sensory or motor deficits of the forelimb.

  12. 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

  13. Use of the Taguchi method for biomechanical comparison of flexor-tendon-repair techniques to allow immediate active flexion. A new method of analysis and optimization of technique to improve the quality of the repair.

    PubMed

    Singer, G; Ebramzadeh, E; Jones, N F; Meals, R

    1998-10-01

    The current trend toward early active flexion after repair of the flexor tendons necessitates a stronger repair than that provided by a modified Kessler technique with use of 4-0 nylon suture. The purpose of the current study was to determine, with use of the Taguchi method of analysis, the strongest and most consistent repair of the flexor tendons. Flexor tendons were obtained from fresh-frozen hands of human cadavera. Eight flexor tendons initially were repaired with the modified Kessler technique with use of 4-0 nylon core suture and 6-0 nylon epitenon suture. A test matrix was used to analyze a total of twenty variables in sixty-four tests. These variables included eight techniques for core-suture repair, four types of core suture, two sizes of core suture, four techniques for suture of the epitenon, and two distances from the repair site for placement of the core suture. After each repair, the specimens were mounted in a servohydraulic mechanical testing machine for tension-testing to failure. The optimum combination of variables was determined, with the Taguchi method, to be an augmented Becker technique with use of 3-0 Mersilene core suture, placed 0.75 centimeter from the cut edge with volar epitenon suture. The four-strand, double modified Kessler technique provided the second strongest repair. Five tendons that had been repaired with use of the optimum combination then were tested and compared with tendons that had been repaired with the standard modified Kessler technique. With the optimum combination of variables, the strength of the repair improved from a mean (and standard deviation) of 17.2 +/- 2.9 to 128 +/- 5.6 newtons, and the stiffness improved from a mean of 4.6 to 16.2 newtons per millimeter.

  14. Rehabilitation After Posterolateral Dislocation of the Elbow in a Collegiate Football Player: A Case Report

    PubMed Central

    Uhl, Tim L.; Gould, Michelle; Gieck, Joe H.

    2000-01-01

    Objective: To describe a functional rehabilitation program for a football player with a grade 2 posterolateral elbow dislocation to facilitate early return to competition. Background: Conservative management of a posterior dislocation of the elbow is common. The elbow is the second most frequently dislocated large joint in adults. Two common mechanisms of dislocation are hyperextension and posterolateral rotation. Prolonged immobilization can be detrimental to regaining full range of motion and function of the elbow, whereas early directed rehabilitation may lead to early return to normal function. Differential Diagnosis: Elbow dislocation with medial collateral ligament rupture, elbow subluxation, elbow dislocation with neurovascular compromise, or supracondylar fracture. Treatment: The athlete received immediate care of reduction and immobilization in a 90° posterior splint followed by a radiologic evaluation. Postreduction treatment included a short immobilization period and early initiation of protected active and resistive range-of-motion exercises. The athlete was able to return to full football activities in 3 weeks. He competed for the rest of the season with the elbow braced and taped, with no recurring incidents of instability. Uniqueness: The time to return to full participation was rapid. The medial collateral ligament was intact, as determined by magnetic resonance imaging. The athlete has since been followed for 2 football seasons and has not demonstrated any detrimental effects due to his early return. Conclusions: Early determination of the status of the medial collateral ligament through physical examination or imaging combined with early directed rehabilitation of a posterolateral elbow instability enabled this athlete to respond well. He regained pain-free full range of motion, strength, and function, allowing full participation in football at the Division I level with no recurring incidence of dislocation. Imagesp109-a PMID:16558601

  15. 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.

  16. Project Themis: PIV Measurement of Elbow Flow through a Flow Conditioner

    DTIC Science & Technology

    2011-12-01

    Charts 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Project Themis: PIV Measurement of Elbow Flow through a Flow...Project Themis: PIV Measurement of Elbow Flow through a Flow Conditioner Benjamin Miller AFRL/RZSE (Jackson and Tull) Air Force Research...Max power = 20mJ @ 1kHz • Phantom V210 • 2,000 frames per second 45 CFM hose 90 ̊ long curve elbow VORTAB L/D = 30 • VORTAB placed one

  17. Lateral sided snapping elbow caused by a meniscus: two case reports and literature review.

    PubMed

    Kang, Shin-Taek; Kim, Tae-Ho

    2010-06-01

    Lateral sided snapping elbow is an unusual condition, and it is apt to be misdiagnosed as lateral epicondylitis. The causes of lateral sided snapping elbow have been attributed to intraarticular loose bodies, instability, synovial plicae and torn annular ligament. We report our experiences for treating lateral sided snapping elbow caused by a meniscus in the radio-humeral joint. In the present cases, the cause of snapping was detected using double contrast arthrogram under fluoroscopic control, and histology revealed that it was a meniscus. Complete removal of the meniscus allowed immediate relief of the symptom, and there was no recurrence in both cases.

  18. Convergent and divergent dislocation of the pediatric elbow: two case reports and comprehensive review of literature.

    PubMed

    Parikh, Shital N; Lykissas, Marios G; Mehlman, Charles T; Sands, Steven; Herrera-Soto, Jose; Panchal, Anand; Crawford, Alvin H

    2014-03-01

    Convergent and divergent pediatric elbow dislocations are rare injuries. When properly diagnosed and treated without delay, both types of dislocations have a good prognosis. We describe a case of convergent elbow dislocation in a 16-year-old boy. The patient underwent operative intervention and demonstrated full range of motion at the 4-year follow-up. Our second case describes an 11-year-old boy with a divergent elbow dislocation associated with an ipsilateral distal radius fracture and distal radioulnar joint dislocation. The patient showed full range of motion 1 year after closed reduction and casting and had no residual deformities or abnormalties.

  19. [Posteromedial dislocation of the elbow with lateral condyle and coronoid process fractures: a case report].

    PubMed

    Mirouse, G; Corcos, P; Casabianca, L; Guillon, P

    2014-02-01

    We report the occurrence of a rare injury in a teenager not yet described in the literature: the association of posteromedial elbow dislocation, lateral condyle and coronoid process fractures. The treatment required fixation of lateral condyle and coronoid process thanks to lateral and medial approaches and capsular fixation. This lesion is unstable, such as the terrible triad described in adults. It requires external and anterior stabilization of the elbow. The management of such injuries of the elbow is complex. It must consider both bone and ligament instability, and risk of injury to growth plates.

  20. Posteromedial dislocation of the elbow with lateral condyle fracture in children.

    PubMed

    Cheng, Pen-Gang; Chang, Wei-Ning; Wang, Matthew N

    2009-02-01

    Posteromedial dislocation of the elbow with lateral condyle fracture is a rare injury, and only a few cases have been reported in the literature. We report 3 children who had posteromedial dislocation of the elbow with Milch type II lateral condylar fracture of the distal humerus. Major complications included malunion, nonunion of the fracture, heterotophic calcification and elbow subluxation. From our experience and a review of the literature, open anatomical reduction and internal fixation of the lateral condyle fracture is the mainstay of treatment for these children. Poor reduction of the lateral condyle fracture results in incongruity of the joint surface and leads to poor results.

  1. Concurrent palmar lunate dislocation and posterior elbow dislocation: a case report.

    PubMed

    Papanna, Madhavan Chikkapapanna; Al-Hadithy, Nawfal; Sarkar, J S

    2011-12-01

    We report a rare case of concurrent palmar lunate dislocation of the left wrist combined with a posterior dislocation of the left elbow joint in a 40-year-old man. He sustained both injuries after falling onto his outstretched left hand. The elbow was reduced by the closed method. The wrist was treated with open reduction with carpal tunnel decompression and fixation with a Kirschner wire through the volar approach. Both the scapholunate and radioscaphocapitate ligaments were also repaired. At month 3, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a porter.

  2. 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.

  3. Liquid metal flow in a large-radius elbow with a uniform magnetic fluid

    SciTech Connect

    Moon, T.J.; Walker, J.S.

    1988-07-01

    This paper treats the liquid-metal flow in an elbow between two straight, rectangular ducts. There is a uniform magnetic field in the plane of the elbow. The duct has thin, electrically conducting walls. The Hartmann number and the interaction parameter are assumed to be large, while the magnetic Reynolds number is assumed to be small. Solutions for the velocity at each cross section of the elbow and for the pressure drop due to three-dimensional effects are presented. 10 refs., 5 figs.

  4. Elbow joint stability following experimental osteoligamentous injury and reconstruction.

    PubMed

    Deutch, Søren R; Jensen, Steen L; Tyrdal, Stein; Olsen, Bo S; Sneppen, Otto

    2003-01-01

    Elbow joint dislocation was simulated in cadaveric specimens to quantify laxity induced by radial head and coronoid process lesions, either alone or in combination with collateral ligament insufficiency. The effects of lateral ligament reconstruction and radial head prosthesis replacement were also considered. Absence of the radial head and the coronoid process induced rotatory laxity of 145% and 128% (both P <.01), respectively, compared with the intact joint. When both were absent, the joints subluxated regardless of collateral ligament status. Isolated radial head prosthesis implantation prevented this subluxation, and laxity almost normalized. Lateral collateral ligament reconstruction prevented major laxity even in the absence of the radial head. Lateral collateral ligament reconstruction and radial head prosthetic replacement yielded restraint against gross instability in the maximal unstable situation (terrible triad). The lateral collateral ligament is the prime stabilizer to external rotation, and reconstruction of this alone, even with an absent radial head, is beneficial.

  5. Maximum force levels in different positions of shoulder and elbow.

    PubMed

    Castro, C; De la Vega, E; Báez, G; Carrasco, F

    2012-01-01

    The number of occupational diseases in Mexico is alarming and clearly it is important to do studies with the purpose of improving the design of workstations. The objective of this research is to determine the maximum force levels in different positions of shoulder and elbow. An experiment was conducted with 16 subjects between 18 and 28 years old: 8 male and 8 female. We considered 16 different positions, working with the right and left arm to perform the tasks of pull and push. The tasks consisted of pushing or pulling a dynamometer for a period of 3 seconds as hard as possible. The results were presented in tables. The tables show the mean, standard deviation and range of force levels in different positions.

  6. Braking of fast and accurate elbow flexions in the monkey.

    PubMed Central

    Flament, D; Hore, J; Vilis, T

    1984-01-01

    The processes responsible for braking fast and accurate elbow movements were studied in the monkey. The movements studied were made over different amplitudes and against different inertias . All were made to the same end position. Only fast movements that showed the typical biphasic or triphasic pattern of activity in agonists and antagonists were analysed in detail. For movements made over different amplitudes and at different velocities there was symmetry between the acceleration and deceleration phases of the movements. For movements of the same amplitude performed at different velocities there was a direct linear relation between peak velocity and both the peak acceleration (and integrated agonist burst) and peak deceleration (and integrated antagonist burst). The slopes of these relations and their intercept with the peak velocity axis were a function of movement amplitude. This was such that for large and small movements of the same peak velocity and the same end position (i) peak acceleration and phasic agonist activity were larger for the small movements and (ii) peak deceleration and phasic antagonist activity were larger for the small movements. The slope of these relations and the symmetry between acceleration and deceleration were not affected by the addition of an inertial load to the handle held by the monkey. The results indicate that fast and accurate elbow movements in the monkey are braked by antagonist activity that is centrally programmed. As all movements were made to the same end position, the larger antagonist burst in small movements, made at the same peak velocity as large movements, cannot be due to differences in the viscoelastic contribution to braking (cf. Marsden, Obeso & Rothwell , 1983).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6737291

  7. Long term results in refractory tennis elbow using autologous blood.

    PubMed

    Gani, Naseem Ul; Khan, Hayat Ahmad; Kamal, Younis; Farooq, Munir; Jeelani, Hina; Shah, Adil Bashir

    2014-10-27

    Tennis elbow (TE) is one of the commonest myotendinosis. Different treatment options are available and autologous blood injection has emerged as the one of the acceptable modalities of treatment. Long term studies over a larger group of patients are however lacking. The purpose of this study was to evaluate these patients on longer durations. One-hundred and twenty patients of TE, who failed to respond to conventional treatment including local steroid injections were taken up for this prospective study over the period from year 2005 to 2011 and were followed up for the minimum of 3 years (range 3-9 years). Two mL of autologous blood was taken from the ipsilateral limb and injected into the lateral epicondyle. The effectiveness of the procedure was assessed by Pain Rating Sscale and Nirschl Staging, which was monitored before the procedure, at first week, monthly for first three months, at 6 months and then 3 monthly for first year, six monthly for next 2 years and then yearly. Statistical analysis was done and a P value of <0.05 was taken as significant. The patients (76 females and 44 males) were evaluated after procedure. The mean age group was 40.67±8.21. The mean follow up was 5.7±1.72 (range 3 to 9 years). The mean pain score and Nirschl stage before the procedure was 3.3±0.9 and 6.2±0.82 respectively. At final follow up the pain score and Nirschl were 1.1±0.9 and 1.5±0.91 respectively. Autologous blood injection was found to be one of the modalities for treatment of TE. Being cheap, available and easy method of treatment, it should be considered as a treatment modality before opting for the surgery. Universal guidelines for the management of tennis elbow should be made as there is lot of controversy regarding the treatment.

  8. 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

  9. 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

  10. 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.

  11. Muscle-Pair Specific Distribution and Grip-Type Modulation of Neural Common Input to Extrinsic Digit Flexors

    PubMed Central

    Winges, Sara A.; Johnston, Jamie A.; Santello, Marco

    2007-01-01

    To gain insight into the synergistic control of hand muscles, we have recently quantified the strength of correlated neural activity across motor units from extrinsic digit flexors during a five-digit object-hold task. We found stronger synchrony and coherence across motor units from thumb and index finger flexor muscle compartment than between the thumb flexor and other finger flexor muscle compartments. The present study of two-digit object hold was designed to determine the extent to which such distribution of common input among thumb-finger flexor muscle compartments, revealed by holding an object with five digits, is preserved when varying the functional role of a given digit pair. We recorded normal force exerted by the digits and electrical activity of single motor units from muscle flexor pollicis longus (FPL) and two compartments of the m. flexor digitorum profundus (FDP2 and FDP3; index and middle finger, respectively). Consistent with our previous results from five-digit grasping, synchrony and coherence across motor units from FPL-FDP2 was significantly stronger than in FPL-FDP3 during object hold with two digits [common input strength: 0.49 ± 0.02 and 0.35 ± 0.02 (means ± SE), respectively; peak coherence: 0.0054 and 0.0038, respectively]. This suggests that the distribution of common neural input is muscle-pair specific regardless of grip type. However, the strength of coherence, but not synchrony, was significantly stronger in two- versus five-digit object hold for both muscle combinations, suggesting the periodicity of common input is sensitive to grip type. PMID:16723414

  12. Parallel reflex pathways from flexor muscle afferents evoking resetting and flexion enhancement during fictive locomotion and scratch in the cat.

    PubMed

    Stecina, Katinka; Quevedo, Jorge; McCrea, David A

    2005-11-15

    Reflex actions of muscle afferents in hindlimb flexor nerves were examined on ipsilateral motoneurone activity recorded in peripheral nerves during midbrain stimulation-evoked fictive locomotion and during fictive scratch in decerebrate cats. Trains of stimuli (15-30 shocks at 200 Hz) were delivered during the flexion phase at intensities sufficient to activate both group I and II afferents (5 times threshold, T). In many preparations tibialis anterior (TA) nerve stimulation terminated ongoing flexion and reset the locomotor cycle to extension (19/31 experiments) while extensor digitorum longus (EDL) stimulation increased and prolonged the ongoing flexor phase activity (20/33 preparations). The effects of sartorius, iliopsoas and peroneus longus muscle afferent stimulation were qualitatively similar to those of EDL nerve. Resetting to extension was seen only with higher intensity stimulation (5T) while ongoing flexor activity was often enhanced at group I intensity (2T) stimulation. The effects of flexor nerve stimulation were qualitatively similar during fictive scratch. Reflex reversals were consistently observed in some fictive locomotor preparations. In those cases, EDL stimulation produced a resetting to extension and TA stimulation prolonged the ongoing flexion phase. Occasionally reflex reversals occurred spontaneously during only one of several stimulus presentations. The variable and opposite actions of flexor afferents on the locomotor step cycle indicate the existence of parallel spinal reflex pathways. A hypothetical organization of reflex pathways from flexor muscle afferents to the spinal pattern generator networks with competing actions of group I and group II afferents on the flexor and extensor portions of this central circuitry is proposed.

  13. Pain-Related Brain Activity Evoked by Active and Dynamic Arm Movement: Delayed-Onset Muscle Soreness as a Promising Model for Studying Movement-Related Pain in Humans

    PubMed Central

    Matsuda, Yoichi; Kan, Shigeyuki; Uematsu, Hironobu; Shibata, Masahiko; Fujino, Yuji

    2015-01-01

    Objective To demonstrate delayed-onset muscle soreness (DOMS) is a suitable model for the study of movement-evoked pain, we attempted to identify brain regions specifically involved in pain evoked by active and dynamic movement under DOMS condition. Subject Twelve healthy volunteers Methods DOMS was induced in the left upper-arm flexor muscles by an eccentric elbow contraction exercise. Movement-evoked pain in the affected muscles was evaluated just before (day 0) and after (days 1–7 and 30) the exercise using a visual analog scale. Subjects underwent functional magnetic resonance imaging scans while performing repeated elbow flexion on day 2 (DOMS condition) and day 30 (painless condition). We compared brain activity between the DOMS and painless conditions. Results Movement-evoked pain reached peak intensity on day 2 and disappeared by day 30 in all subjects. No subject felt pain at rest on either of these days. Contralateral primary motor cortex (M1), parietal operculum and bilateral presupplementary motor area (pre-SMA) showed greater activity during active and dynamic arm movement with DOMS than during the same movement without pain. There was no difference in activation of brain regions known collectively as the “pain matrix,” except for the parietal operculum, between the two conditions. Conclusion Active and dynamic movement with pain selectively evoked activation of M1, pre-SMA, and parietal operculum, as assessed using DOMS. Our results demonstrate that DOMS is a promising experimental model for the study of movement-evoked pain in humans. PMID:25929675

  14. 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

  15. Alignment-Free, Self-Calibrating Elbow Angles Measurement using Inertial Sensors.

    PubMed

    Muller, Philipp; Begin, Marc-Andre; Schauer, Thomas; Seel, Thomas

    2016-12-14

    Due to their relative ease of handling and low cost, inertial measurement unit (IMU)-based joint angle measurements are used for a widespread range of applications. These include sports performance, gait analysis and rehabilitation (e.g. Parkinson's disease monitoring or post-stroke assessment). However, a major downside of current algorithms, recomposing human kinematics from IMU data, is that they require calibration motions and/or the careful alignment of the IMUs with respect to the body segments. In this article, we propose a new method, which is alignment-free and self-calibrating using arbitrary movements of the user and an initial zero reference arm pose. The proposed method utilizes real-time optimization to identify the two dominant axes of rotation of the elbow joint. The performance of the algorithm was assessed in an optical motion capture laboratory. The estimated IMU-based angles of a human subject were compared to the ones from a marker-based optical tracking system. The self-calibration converged in under 9.5 s on average and the RMS errors with respect to the optical reference system were 2.7° for the flexion/extension and 3.8° for the pronation/supination angle. Our method can be particularly useful in the field of rehabilitation, where precise manual sensorto- segment alignment as well as precise, predefined calibration movements are impractical.

  16. A Segmental Approach to Imaging of Sports-Related Injuries of the Pediatric Elbow

    PubMed Central

    Dwek, Jerry R.

    2012-01-01

    Context: The imaging of pediatric sports injuries of the elbow requires an understanding of the interaction between biomechanical forces common in sports and the developing skeleton. Evidence Acquisition: A PubMed search was performed using the terms elbow, radiology, and sports with the search limited to children up to 18 years of age. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the changing nature of sports injuries about the pediatric elbow. Results: A clear progression of injuries about the elbow can be identified as the skeleton matures. Sports most commonly associated with injuries in the pediatric age group were baseball and gymnastics. Conclusions: Most pediatric sports injuries result from overhand throwing, especially in baseball or gymnastics. The manifestation of the injuries shifts as the physes progress toward closure. PMID:23016119

  17. 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.

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

    PubMed

    Vedrine, Bertrand

    2017-04-01

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

  19. Effect of Reynolds number on flow and mass transfer characteristics of a 90 degree elbow

    NASA Astrophysics Data System (ADS)

    Fujisawa, Nobuyuki; Ikarashi, Yuya; Yamagata, Takayuki; Taguchi, Syoichi

    2016-11-01

    The flow and mass transfer characteristics of a 90 degree elbow was studied experimentally by using the mass transfer measurement by plaster dissolution method, the surface flow visualization by oil film method and stereo PIV measurement. The experiments are carried out in a water tunnel of a circular pipe of 56mm in diameter with a working fluid of water. The Reynolds number was varied from 30000 to 200000. The experimental result indicated the change of the mass transfer coefficient distribution in the elbow with increasing the Reynolds number. This phenomenon is further examined by the surface flow visualization and measurement of secondary flow pattern in the elbow, and the results showed the suggested change of the secondary flow pattern in the elbow with increasing the Reynolds numbers.

  20. [Elbow reconstruction with massive total osteoarticular allograft: early failure due to instability].

    PubMed

    Delloye, C; Cornu, O; Dubuc, J-E; Vincent, A; Barbier, O

    2004-06-01

    Total elbow allografts were implanted for the treatment of trauma-induced bone defects in three patients between 1986 and 1990. Six allografts were implanted and finally explanted. The longest follow-up for an implanted allograft was five years. Allografts had to be removed because of nonunion in one patient and gross instability in the others. A constrained elbow prosthesis was implanted in all three patients. This short series illustrates mid-term failure to be expected with total elbow allografts, mainly due to instability. Accordingly, we no longer recommend the use of total elbow allografts alone as a salvage procedure for bony defects. If an allograft is needed, it should be implanted with a prosthesis.