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The American Journal of Medicine Apr 2013Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Repetitive... (Review)
Review
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.
Topics: Aged; Arthroscopy; Elbow Joint; Female; Humans; Male; Middle Aged; Tendons; Tennis Elbow; Tenotomy
PubMed: 23398951
DOI: 10.1016/j.amjmed.2012.09.018 -
Seminars in Musculoskeletal Radiology Aug 2021The stability of the elbow is based on a combination of primary (static) and secondary stabilizers (dynamic). In varus stress, the bony structures and the lateral ulnar...
The stability of the elbow is based on a combination of primary (static) and secondary stabilizers (dynamic). In varus stress, the bony structures and the lateral ulnar collateral ligament (LUCL) are the primary stabilizers, and in valgus stress, the ulnar collateral ligament (UCL) is the primary stabilizer. The flexor and extensor tendons crossing the elbow joint act as secondary stabilizers. Elbow instability is commonly divided into acute traumatic and chronic instability. Instability of the elbow is a continuum, with complete dislocation as its most severe form.Posterolateral rotatory instability is the most common elbow instability and can be detected at imaging both in the acute as well as the chronic phase. Imaging of suspected elbow instability starts with radiographs. Depending on the type of injury suspected, it is followed by magnetic resonance imaging (MRI) or computed tomography evaluation for depiction of a range of soft tissue and osseous injures. The most common soft tissue injuries are tears of the LUCL and the radial collateral ligament; the most common osseous injuries are an osseous LUCL avulsion, a fracture of the coronoid process, and a radial head fracture.Valgus instability is the second most common instability and mostly detected in the chronic phase, with valgus extension overload the dominant pattern of injury. The anterior part of the UCL is insufficient in valgus extension overload due to repetitive medial tension seen in many overhead throwing sports, with UCL damage readily seen at MRI.
Topics: Collateral Ligaments; Elbow; Elbow Joint; Humans; Joint Dislocations; Joint Instability; Tendons
PubMed: 34706387
DOI: 10.1055/s-0041-1735467 -
European Journal of Orthopaedic Surgery... Feb 2023Lateral epicondylitis, also known as tennis elbow, is an overuse tendinopathy of the common extensor origin of the elbow in patients involved in repetitive movement of... (Review)
Review
Lateral epicondylitis, also known as tennis elbow, is an overuse tendinopathy of the common extensor origin of the elbow in patients involved in repetitive movement of the wrist and forearm. Lateral epicondylitis is a self-limiting condition, with operative management only recommended in severe, recalcitrant cases. This article reviews the recent updates on operative and non-operative management of lateral epicondylitis.
Topics: Humans; Elbow; Tennis Elbow; Elbow Joint; Upper Extremity; Wrist Joint
PubMed: 35031850
DOI: 10.1007/s00590-021-03181-z -
Journal of Shoulder and Elbow Surgery Oct 2022Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion. However, no results have been reported for motor-cognitive intervention programs in post-traumatic elbow stiffness management. The objective was to investigate the efficacy of graded motor imagery (GMI) in post-traumatic elbow stiffness.
METHODS
Fifty patients with post-traumatic elbow stiffness (18 female; mean age, 41.9 ± 10.9 years) were divided into 2 groups. The GMI group (n = 25) received a program consisting of left-right discrimination, motor imagery, and mirror therapy (twice a week for 6 weeks); the structured exercise (SE) group (n = 25) received a program consisting of range-of-motion, stretching, and strengthening exercises (twice a week for 6 weeks). Both groups received a 6-week home exercise program. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The secondary outcomes were the active range of motion (AROM), visual analog scale (VAS), Tampa Scale for Kinesiophobia (TSK), muscle strength of elbow flexors and extensors, grip strength, left-right discrimination, and Global Rating of Change. Patients were assessed at baseline, at the end of treatment (12 sessions), and a 6-week follow-up.
RESULTS
The results indicated that both GMI and SE interventions significantly improved outcomes (P < .05). After a 6-week intervention, the DASH score was significantly improved with a medium effect size in the GMI group compared with the SE group, and improvement continued at the 6-week follow-up (F = 3.10, P = .01). The results with a medium to large effect size were also significant for elbow flexion AROM (P = .02), elbow extension AROM (P = .03), VAS-activity (P = .001), TSK (P = .01), and muscle strength of elbow flexors and elbow extensors (P = .03) in favor of the GMI group.
CONCLUSION
The GMI is an effective motor-cognitive intervention program that might be applied to the rehabilitation of post-traumatic elbow stiffness to improve function, elbow AROM, pain, fear of movement-related pain, and muscle strength.
Topics: Adult; Elbow; Elbow Joint; Female; Humans; Joint Diseases; Middle Aged; Pain; Range of Motion, Articular; Treatment Outcome
PubMed: 35803550
DOI: 10.1016/j.jse.2022.05.031 -
Emergency Radiology Jun 2019Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the... (Review)
Review
Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. The injury is usually associated with typical soft-tissue disruptions (with common involvement of the lateral collateral ligament complex, elbow joint capsule, as well as the common extensor and flexor-pronator tendons) that are best understood in the context of injury mechanism as well as the role and relevance of the various elbow stabilizers. The goals of this article are to review the pertinent anatomy, mechanism of injury, classification and imaging of terrible triad injuries of the elbow with brief descriptions of treatment, and complications of this complex injury.
Topics: Elbow; Humans; Joint Capsule; Joint Dislocations; Ligaments, Articular; Postoperative Complications; Radius Fractures; Tendon Injuries; Ulna Fractures; Elbow Injuries
PubMed: 30690677
DOI: 10.1007/s10140-019-01676-1 -
Hand Clinics Aug 2002Reconstruction of elbow extension is an established treatment with a high degree of patient satisfaction. The D-T transfer is the most common method and has the...
Reconstruction of elbow extension is an established treatment with a high degree of patient satisfaction. The D-T transfer is the most common method and has the advantage of inducing no serious complications; however, it necessitates a long period of healing and recovery. The Bi-T transfer is used much less frequently and, in the author's opinion, has few advantages compared with the D-T transfer. It is somewhat less time consuming to perform, and the rehabilitation period is a few weeks shorter. This method, however, has several drawbacks, including difficulties in learning to use the muscle as an extensor and a reduction of elbow flexion strength, which might result in a subjective functional loss. What is the best treatment for patients with a posterior deltoid that has a strength grade of 2 or 3: a D-T or Bi-T transfer or functional electrical stimulation? Today, this question is impossible to answer. The author is convinced that the optimal postoperative regimen for a reconstructed elbow extension has not been found yet.
Topics: Activities of Daily Living; Elbow Joint; Humans; Muscle, Skeletal; Postoperative Care; Quadriplegia; Range of Motion, Articular; Tendon Transfer
PubMed: 12474596
DOI: 10.1016/s0749-0712(02)00083-5 -
Instructional Course Lectures 1998
Review
Topics: Arthroplasty; Biomechanical Phenomena; Elbow Joint; Humans; Muscle Contraction; Muscle, Skeletal; Tendon Injuries; Tendons; Elbow Injuries
PubMed: 9571412
DOI: No ID Found -
European Radiology Aug 2017To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological... (Comparative Study)
Comparative Study
PURPOSE
To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation.
MATERIALS AND METHODS
Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies.
RESULTS
Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%).
CONCLUSION
Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology.
KEY POINTS
• Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis. • Combination of B-mode US and SEL in lateral epicondylitis correlates to histology. • Combination of both modalities provides improved sensitivity without loss of specificity.
Topics: Aged; Aged, 80 and over; Biopsy; Cadaver; Elasticity Imaging Techniques; Elbow Joint; Female; Humans; Male; Sensitivity and Specificity; Tendons; Tennis Elbow; Ultrasonography
PubMed: 28058481
DOI: 10.1007/s00330-016-4711-x -
Hand Clinics Nov 2015Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including... (Review)
Review
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.
Topics: Arthroplasty, Replacement, Elbow; Elbow Joint; Elbow Prosthesis; Fracture Fixation, Internal; Humans; Humeral Fractures; Prosthesis Fitting; Elbow Injuries
PubMed: 26498549
DOI: 10.1016/j.hcl.2015.06.008 -
Acta Chirurgiae Orthopaedicae Et... 2021This introduction to ultrasound evaluation of the elbow describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and...
This introduction to ultrasound evaluation of the elbow describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on effusion detection, ulnar nerve imaging, and commonly injured tendons assessment. This article also describes some common pitfalls to avoid when starting with musculoskeletal ultrasonography (e.g. positioning issues, unsolicited artifacts). Key words: tendons, elbow tendinopathy, golfer's elbow, tennis elbow, musculoskeletal, protocol, ultrasound, common extensor tendon, common flexor tendon, ulnar nerve.
Topics: Elbow; Elbow Joint; Humans; Tendons; Ultrasonography
PubMed: 34593096
DOI: No ID Found