Total elbow replacement.

Elbow joint replacement is performed primarily in patients with severe elbow pain and elbow joint destruction caused by rheumatoid arthritis. The capitellocondylar implant is the prototype of the nonconstrained elbow resurfacing implant. Successful total elbow joint replacement can result in pain relief and improve rotation and flexion of the arm. Outpatient and inpatient nursing intervention in coordination with occupational therapy promotes optimum function.     

Anterior dislocation of the ulnar-humeral joint in a so-called 'pulled elbow'

We describe an unusual case of a missed anterior dislocation of the elbow joint in a 1 year old girl who presented with a pulled elbow. To our knowledge, this is the first report of anterior dislocation as a result of a pulled elbow in the literature. We would like to highlight the rarity of this presentation and the importance of chronological assessment and management in the accident and emergency department.     

Anterior dislocation of the ulnar‐humeral joint in a so‐called ‘pulled elbow'

We describe an unusual case of a missed anterior dislocation of the elbow joint in a 1 year old girl who presented with a pulled elbow. To our knowledge, this is the first report of anterior dislocation as a result of a pulled elbow in the literature. We would like to highlight the rarity of this presentation and the importance of chronological assessment and management in the accident and emergency department.     

Reconstruction of coronoid process of the ulna: a literature review

As a pivotal part of the elbow joint structure, the coronoid process of the ulna plays a vital role in maintaining elbow joint stability. Loss of coronoid process height causes instability of the elbow joint depending on the fracture characteristics and size. The diagnosis and treatment of coronoid process fractures has gained widespread attention from orthopedic surgeons. Nevertheless, few reports have described reconstruction of coronoid process fractures and defects that affect elbow joint stability. Treatment of elbow joint instability induced by coronoid process defects is challenging because most cases are complicated by other elbow joint injuries. Moreover, the clinical efficacy remains unclear. The present narrative review was performed to examine the research progress on reconstruction of the coronoid process. The findings of this review provide evidence for clinical repair and reconstruction of coronoid process defects and contribute to the published literature on this topic.     

Einsatzmöglichkeiten der Sonographie am Ellenbogengelenk

Useful imaging of the elbow joint after clinical examination is a common problem. X-ray visualization allows sensitive detection of bony lesions. However, the majority of clinical manifestations are related to changes of the periarticular soft tissue or joint fluid collection. Ultrasound imaging of the normal and abnormal anatomy of the elbow joint is well established. This article presents the standardized procedure for ultrasound examination of the elbow joint.     

Evaluation of the effects of different treatments for the elbow joint using joint proprioception and surface electromyography

[Purpose] The purpose of this study was to examine the immediate effects of strength training and neuromuscular joint facilitation (NJF) distal resistance training on muscle strength and proprioception. [Subjects] The subjects were 15 young healthy people (29.3±4.1 y, 166.8±7.1 cm, 62.4 ± 11.6 ky). [Methods] Two isometric contraction techniques were applied on the elbow joint: elbow joint flexion muscle strength training (MST) and the elbow joint flexion pattern of NJF. Muscle strength (measured by surface electromyography [sEMG]) and joint position errors of the left upper limb were measured before and after one intervention session of MST and NJF. [Results] The decrease in error in elbow flexion angle repetition represented the improvement resulting from NJF. sEMG of the biceps brachii showed significant increases in the maximum discharge and average discharge after the intervention. [Conclusion] This result suggests that elbow joint proprioception and muscle strength can be improved by NJF together with proximal resistance training.Key words: Neuromuscular joint facilitation, Joint position error, Elbow joint proprioception     

Elbow rheumatoid elbow: surgical treatment options

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by peripheral polyarthritis. The elbow joint is estimated to be involved in 20 to 65 % of the patients with RA. The development of new pharmacologic agents and the adoption of early therapeutic interventions have translated into milder forms of polyarticular destruction. As a result, the traditional crippled rheumatoid patient has been replaced by rheumatoid patients with higher activity levels, higher expectations, and more demands on any reconstructive procedures performed. When nonoperative treatment is insufficient, surgery may be considered. Arthroscopic synovectomy has become the procedure of choice for rheumatoid patients with uncontrolled symptoms. Patients with more advanced joint destruction can be considered for elbow arthroplasty. Interposition arthroplasty may be considered for patients interested in avoiding the potential complications of elbow arthroplasty.     

41例臂丛神经损伤的随访研究及疗效分析

目的观察臂丛神经损伤后的恢复情况。方法将41例臂丛神经损伤患者分为未手术组11例、神经松解组17例和神经修复组13例，采用Mallett肩功能评分和Gilbert肘关节功能评分随访观察预后，评价未手术组自然恢复情况和手术组的疗效。结果疗效评定未手术组优9例、良1例、差1例；神经松解组优良2例、中1例、可1例、差13例；神经修复组肩关节功能优良2例、肘关节功能优良4例。结论臂丛神经损伤单纯手术效果不甚理想，应结合术后康复治疗。     

Ultrasound of the elbow: Examination techniques and US appearance of the normal and pathologic joint

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.     

持续被动运动治疗肘关节僵硬的疗效观察

目的观察关节持续被动运动对上肢骨折及肘关节脱位后肘关节僵硬的疗效。方法上肢骨关节损伤后肘关节僵硬患者42例,分为治疗组和对照组,各21例。治疗组以关节持续被动运动(CPM)为主,辅以综合康复治疗。对照组只接受辅助的综合康复治疗。结果治疗后治疗组肘关节屈伸和旋转活动范围均大于对照组,两组间差异均具有显著性意义(P<0.01)。结论持续被动运动对上肢骨折及肘关节脱位后肘关节僵硬具有治疗作用。     

Can elbow extension be used as a test of clinically significant injury?

BACKGROUND: The objective of this study was to evaluate whether a simple test of full elbow extension was a reliable indicator of bone/joint injury at the elbow joint. METHODS: In this prospective study, patients with acute elbow injuries were asked to fully extend the injured elbow. Radiologists blinded to the results of the extension test interpreted the radiographs. RESULTS: Of 114 patients with acute elbow injury entered into the study, 110 underwent adiographic evaluation. Inability to extend the elbow was found in 37 of 38 patients with bone injury. Only 1 of 54 patients who were able to fully extend the elbow was found to have bone/joint injury. The sensitivity and specificity of the elbow-extension test for identification of bone/joint injury was 97% and 69%, respectively. CONCLUSIONS: The elbow-extension test can be used as a sensitive clinical screening test for patients with acute elbow injuries.     

Diagnostic and therapeutic injection of the elbow region

Joint injection of the elbow is a useful diagnostic and therapeutic tool for the family physician. In this article, the injection procedures for the elbow joint, medial and lateral epicondylitis, and olecranon bursitis are reviewed. Persistent pain related to inflammatory conditions responds well to injection in the region. Indications for elbow joint injection include osteoarthritis and rheumatoid arthritis. Corticosteroid injection is an accepted treatment option for medial and lateral epicondylitis. Olecranon bursa aspiration and injection are useful when that bursa is inflamed. The proper techniques, choice and quantity of pharmaceuticals, and appropriate follow-up essential for effective outcomes are discussed.     

高频超声与MRI诊断儿童肘关节微小骨折的临床价值探讨

目的探讨高频超声(HFUS)与核磁共振成像(MRI)在儿童肘关节微小骨折中的应用价值。方法选取2019年5月至2020年11月本院收治的57例疑似肘关节微小骨折患儿,均行HFUS与MRI检查,根据MRI诊断结果将患儿分为骨折组(n=26)、无骨折组(n=31),比较两组一般资料、超声征象和参数,分析超声征象和参数与儿童肘关节微小骨折关系,探究超声征象和参数诊断儿童肘关节微小骨折的价值。结果 HFUS与MRI诊断儿童肘关节微小骨折的一致性为96.49%,Kappa值为0.942,95%CI:0.765~1.118(P<0.05);骨折组、无骨折组肌肉损伤或血肿、脂肪垫征阳性、关节积液、骨皮质连续性中断分布及肘前脂肪垫厚度比较,差异有统计学意义(P<0.05);肌肉损伤或血肿、脂肪垫征阳性、关节积液、骨皮质连续性中断分布及肘前脂肪垫厚度均与儿童肘关节微小骨折相关(P<0.05);脂肪垫征阳性诊断儿童肘关节微小骨折的敏感度、特异度均为100%;肌肉损伤或血肿、关节积液、骨皮质连续性中断、肘前脂肪垫厚度诊断儿童肘关节微小骨折的AUC分别为0.766、0.699、0.673、0.835。结论 HFUS诊断儿童肘关节微小骨折与MRI结果具有一致性,可直观显示脂肪垫阳性征、肌肉损伤征,为临床诊治儿童肘关节微小骨折提供有效影像学技术支持。     

Elbow load during pushup at various forearm rotations

OBJECTIVE: Elbow joint loading was evaluated during pushup exercises at various forearm rotations. DESIGN: Subjects were asked to perform pushup in various forearm rotations: neutral, 90 degrees internal rotation, and 90 degrees external rotation. BACKGROUND: Training with pushup exercise is good for the muscles and joints of the upper extremities. However, excessive shear forces on the elbow might lead to injuries to either normal trainees or to handicapped people, especially for those who rely on elbow prosthesis. METHODS: The kinematics and kinetics of the elbow joint were investigated under various forearm rotations. RESULTS: The loading biomechanics of the elbow joint differed with various forearm rotations. It was noted that greater posterior and varus forces of the elbow are encountered with internal rotation of the hand position and, consequently, full forearm pronation. CONCLUSIONS: Pushup with hands in internally rotated position should be prevented so as to avoid excessive shear forces or moments. RELEVANCE: Knowledge of elbow kinematics and kinetics may be helpful in preventing injuries by reducing the elbow shear force with changes of forearm rotation.     

Joint angle-dependence of elbow flexor activation levels during isometric and isokinetic maximum voluntary contractions

Objective. The influences of elbow joint angle and the type of contraction on the activation levels of biceps brachii and brachioradialis during maximum voluntary isometric and isokinetic contractions were investigated.

Design. A within-session repeated measures design.

Background. Activation of synergistic elbow flexor muscles has been reported to be affected disparately by elbow joint angle and contraction type.

Methods. Ten subjects performed concentric isokinetic, eccentric isokinetic, and isometric maximum voluntary contractions of the elbow flexor muscles. For the isokinetic contractions the activation levels of two ranges of motion were compared. For the isometric contractions the activation levels at two joint angles were compared. The activation levels of the biceps brachii and brachioradialis acquired simultaneously using bipolar surface electrodes and a surface electrode array were compared.

Results. Results from the electrode array were similar to those acquired using conventional bipolar electrodes. The activation of biceps brachii was significantly affected by joint angle during concentric isokinetic and isometric maximum voluntary contractions. The activation of brachioradialis was significantly affected by joint angle only during eccentric isokinetic maximum voluntary contractions.

Conclusions. The results confirm that joint angle and contraction type contribute to the distinction between the activation of synergistic elbow flexor muscles during isometric and isokinetic contractions.Relevance

The results point to the complexity of control of elbow joint synergists and raise questions about the plasticity of this dependency of elbow flexor activation on joint angle. Solutions to these questions are of importance in the areas of upper extremity rehabilitation and modeling the upper extremity neuromechanics.     

Throwing kinematics and elbow varus torque relative to ball size in junior baseball players

[Purpose] The purpose of this study was to investigate changes in the shoulder and elbow joint angles, upper limb angular velocities, and elbow varus torque when throwing balls of two different sizes. [Participants and Methods] The pitching motion of 26 junior baseball players was analyzed using an optical motion capture system. The balls used were a standard baseball and a small ball of equal weight. Shoulder external rotation/abduction and elbow flexion were measured. The maximum values of shoulder joint internal rotation, elbow joint extension, wrist flexion angular velocity, and elbow joint varus torque were also evaluated. The ball velocity was determined as an index of pitching performance. [Results] The shoulder external rotation and elbow flexion angles were higher when pitching with a small ball. The joint angular velocity was also significantly higher when pitching with a small ball for all items examined. The ball speed was significantly higher with the small ball. The maximum varus torque of the elbow joint divided by the ball velocity was significantly lower for the small ball. [Conclusion] For a junior baseball player with a small hand length, using a small ball enables pitching with low stress on the elbow joint.     

屈肘肩顶法与手牵足蹬法治疗肩关节脱位的疗效分析

目的：比较屈肘肩顶法与手牵足蹬法对于复位肩关节脱位的疗效。方法2012年1月-2012年12月,共治疗肩关节前脱位72例,常规运用了两种手法复位治疗方法,将其分为两组,分别采用屈肘肩顶法（n=36）和手牵足蹬法（n=36）复位。结果采用屈肘肩顶法有6例首次复位失败,采用手牵足蹬法有10例首次复位失败,最终所有患者肩关节功能恢复佳。2组治疗方法比较,屈肘肩顶法较手牵足蹬法复位效率更高,但肩关节功能和活动度恢复无明显差别。结论屈肘肩顶法和手牵足蹬法治疗肩关节前脱位均可获得较好的肩关节功能和活动度,而屈肘肩顶法在复位成功率方面具有优越性,值得临床推广。     

儿童肘部骨骺的超声解剖及临床价值

目的：对儿童肘部进行超声检查，了解肘部骨骺的超声声像图表现，并用超声检查对4例肘部骨骺损伤进行评价。方法：对0～5岁、5^ ～8岁、8^ ～14岁各20～40侧儿童肘部进行超声检查并对其骨骺声像图进行观察，对4例肘部损伤进行超声检查并随访2周～4月。结果：超声检查可以对骨骺的解剖情况进行观察，动态检查可观察完整性及连续性；骨骺软骨的超声声像图表现为弱回声，骨化中心出现呈强回声，各年龄组依骨化中心是否出现及大小各骨骺的超声声像图表现有一定差异；4例儿童肘部损伤超声声像图表现均能作出诊断并对损伤的具体情况作出评估，在随访中可对损伤的修复情况作出一定了解。结论：超声检查儿童肘部可了解一般检查不能了解的骨骺解剖学情况，对儿童肘部骨骺损伤作出评价并在随访中具有一定的实用价值。     

Endoprosthesis implantation in the elbow joint

Previously used total elbow prostheses were mainly constrained hinged implants. Their early clinical results were favourable but they failed due to a high rate of loosening already a few years after implantation. The cause for the early loosening was the great forces across the elbow joint which were directly transmitted to the prosthesis-bone interface in these implants. Therefore, these implants were abandoned. Afterwards, unlinked, semiconstrained or non-constrained resurfacing devices were introduced. In these devices, the soft tissues constrain the joint and therefore absorb part of the transmitted forces. The rates of loosening were significantly improved and rarely the cause of early failure. But resurfacing implants require intact condyles and collateral ligaments. These implants can, therefore, only be used in a limited number of indications, and postoperative instabilities are known complications. The currently most frequently used device is the semiconstrained Coonrad-Morrey prosthesis. It is a floppy hinge which allows valgus-varus and rotational laxities. Therefore, a part of the forces across the elbow joint are absorbed by the soft tissues. The loosening rate is not a clinical problem any more, and is with 4% 10 years after implantation (rheumatoid arthritis) similar to that of total hip or knee replacement. Furthermore, this device is stabilised with a small anterior flange to the anterior cortex of the humeral shaft. Condyles and collateral ligaments are therefore not necessary neither for short nor for long-term stability. The Coonrad-Morrey total elbow prosthesis can therefore be used for almost every indication, such as severe destruction of the elbow joint and even in case of complete loss of the distal humerus. The long-term outcome with this prosthesis for the treatment of rheumatoid arthritis is favourable with 96% of very good and good results. Function is restored with an average flexion of 131 degrees, a mean loss of extension of 28 degrees, and an unrestricted pronation and supination. The rate of complications for patients with rheumatoid arthritis is 10%. Similarly, the results for Coonrad-Morrey total elbow replacement for posttraumatic arthrosis are favourable with 83% of satisfactory results. Most patients consider their elbow as improved compared to preoperatively, but pain relief is obtained only in three quarters of the patients. The rate of complications is high with 30%, indicating the total elbow replacement is contraindicated for strenuous labour and sports activities.     

Multiple rare causes of post-traumatic elbow stiffness in an adolescent patient: A case report and review of literature

BACKGROUND Joint stiffness after elbow surgery is not a rare complication,and is always accompanied by deformity.The causes of joint stiffness are multiple in different patients,and divided into intrinsic and extrinsic causes.Herein,we report an unusual case of posttraumatic elbow stiffness due to multiple and rare causes.CASE SUMMARY A 19-year-old male was hospitalized with the loss of motion of the left elbow for over ten years.Left limb computed tomography revealed left elbow stiffness with bony block and connection.The patient underwent surgery,and the etiology of joint stiffness was found to be a rare combination of common and uncommon causes.During an 18-mo follow-up period,the patient’s left elbow had normal motion and he was symptom-free.CONCLUSION However,this case combined with multiple and rare causes highlights that the patient with scar physique is likely to be accompanied with more severe soft tissue,nerve contracture,and heterotypic ossification,even during recurrence.