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The Journal of Hand Surgery Feb 2017The elbow comprises a complex of bony and ligamentous stabilizers that provide both primary and secondary constraints to elbow instability. Through trauma and overuse,... (Review)
Review
The elbow comprises a complex of bony and ligamentous stabilizers that provide both primary and secondary constraints to elbow instability. Through trauma and overuse, classic instability patterns arise by loss of these important stabilizers. The diagnosis of elbow instability can made using specific examination maneuvers and testing to diagnose the clinical pattern. This article reviews the elbow's unique anatomy and biomechanical characteristics and these are applied when reviewing the maneuvers and testing used to diagnose elbow instability.
Topics: Biomechanical Phenomena; Collateral Ligaments; Elbow Joint; Humans; Joint Instability
PubMed: 28160902
DOI: 10.1016/j.jhsa.2016.11.025 -
Orthopaedics & Traumatology, Surgery &... Feb 2021Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and... (Review)
Review
Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and ligament lesions, with high more-or-less long-term risk of residual instability, stiffness, pain and osteoarthritis. During the last 20 years, pathologic, biomechanical and clinical knowledge has greatly progressed. Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. Surgery aims to restore perfect stability by sequential anatomic repair, enabling early mobilization to prevent onset of stiffness. The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. Some aspects of treatment are controversial: systematic medial collateral ligament repair, or use of an articulated external fixator. Finally, we propose a simple algorithm to guide repair.
Topics: Elbow; Elbow Joint; Fracture Fixation, Internal; Humans; Joint Dislocations; Radius Fractures; Range of Motion, Articular; Treatment Outcome; Ulna Fractures
PubMed: 33333276
DOI: 10.1016/j.otsr.2020.102784 -
European Journal of Sport Science Jul 2023The biarticular triceps brachii long head (TB) is lengthened more in the overhead than neutral arm position. We compared triceps brachii hypertrophy after elbow...
The biarticular triceps brachii long head (TB) is lengthened more in the overhead than neutral arm position. We compared triceps brachii hypertrophy after elbow extension training performed in the overhead vs. neutral arm position. Using a cable machine, 21 adults conducted elbow extensions (90-0°) with one arm in the overhead (Overhead-Arm) and the other arm in the neutral (Neutral-Arm) position at 70% one-repetition maximum (1RM), 10 reps/set, 5 sets/session, 2 sessions/week for 12 weeks. Training load was gradually increased (+5% 1RM/session) when the preceding session was completed without repetition failure. 1RM of the assigned condition and MRI-measured muscle volume of the TB, monoarticular lateral and medial heads (TB), and whole triceps brachii (Whole-TB) were assessed pre- and post-training. Training load and 1RM increased in both arms similarly (+62-71% at post, = 0.285), while their absolute values/weights were always lower in Overhead-Arm (-34-39%, < 0.001). Changes in muscle volume in Overhead-Arm compared to Neutral-Arm were 1.5-fold greater for the TB (+28.5% vs. +19.6%, Cohen's = 0.61, < 0.001), 1.4-fold greater for the TB (+14.6% vs. +10.5%, = 0.39, = 0.002), and 1.4-fold greater for the Whole-TB (+19.9% vs. +13.9%, = 0.54, < 0.001). In conclusion, triceps brachii hypertrophy was substantially greater after elbow extension training performed in the overhead versus neutral arm position, even with lower absolute loads used during the training.Growing evidence suggests that resistance training at long muscle lengths promotes muscle hypertrophy, but its practical applications are yet to be explored.Triceps brachii muscle hypertrophy was substantially greater after cable elbow extension training performed in the overhead than neutral arm position, particularly in the biarticular triceps brachii long head, even with lower absolute loads lifted (i.e. lower mechanical stress to muscles/joints).Cable elbow extension training should be performed in the overhead rather than neutral arm position if one aims to maximise muscle hypertrophy of the triceps brachii or to prevent atrophy of this muscle.
Topics: Adult; Humans; Elbow; Elbow Joint; Muscle, Skeletal; Resistance Training; Hypertrophy
PubMed: 35819335
DOI: 10.1080/17461391.2022.2100279 -
Journal of Physiotherapy Jan 2021
Topics: Elbow; Elbow Joint; Hand; Humans; Wrist; Wrist Joint
PubMed: 33272874
DOI: 10.1016/j.jphys.2020.11.005 -
Acta Orthopaedica Et Traumatologica... May 2018The aim of this study was to investigate the functional role of each head of the triceps brachii muscle, depending on the angle of shoulder elevation, and to compare...
OBJECTIVE
The aim of this study was to investigate the functional role of each head of the triceps brachii muscle, depending on the angle of shoulder elevation, and to compare each muscle force and activity by using a virtual biomechanical simulator and surface electromyography.
METHODS
Ten healthy participants (8 males and 2 females) were included in this study. The mean age was 29.2 years (23-45). Each participant performed elbow extension tasks in five different degrees (0, 45, 90, 135, and 180°) of shoulder elevation with three repetitions. Kinematics data and surface electromyography signal of each head of the triceps brachii were recorded. Recorded kinematics data were then applied to an inverse kinematics musculoskeletal modeling software function (OpenSim) to analyze the triceps brachii's muscle force. Correlation between muscle force, muscle activity, elbow extension, and shoulder elevation angle were compared and analyzed for each head of triceps brachii.
RESULTS
At 0° shoulder elevation, the long head of the triceps brachii generates a significantly higher muscle force and muscle activation than the lateral and medial heads (p < 0.05). While at 90°, 135° and 180° shoulder elevation, the medial head of the triceps brachii showed a significantly higher muscle force than the long and the lateral heads (p < 0.05).
CONCLUSIONS
Each head of the triceps brachii has a different pattern of force and activity during different shoulder elevations. The long head contributes to elbow extension more at shoulder elevation and the medial head takes over at 90° and above of shoulder elevation. This study provides further understanding of triceps brachii's for clinicians and health trainers who need to investigate the functional role of the triceps brachii in detail.
Topics: Adult; Biomechanical Phenomena; Elbow; Elbow Joint; Electromyography; Female; Healthy Volunteers; Humans; Male; Motion; Muscle, Skeletal; Shoulder
PubMed: 29503079
DOI: 10.1016/j.aott.2018.02.005 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be... (Review)
Review
Elbow fracture is frequent in children, and often requires surgery. There are many potential sequelae: neurovascular, ligamentous and osseous. Some are liable to be overlooked, due to young age and the cartilaginous nature of the joint. There is little bone remodeling in the elbow and displacement fracture, and especially supracondylar or lateral condyle fracture, has to be corrected rigorously, notably in older children. In case of lateral tilt in fracture of the neck of the radial head, on the other hand, remodeling is effective. Deformity in cubitus varus and cubitus valgus leads to neurological lesions and instability. Treatment should be early, with adapted surgery in expert hands. Post-traumatic stiffness is rare. Early intensive physiotherapy is unsuited to children and could worsen the stiffness due to inflammation. Lateral condyle non-union is a classic complication of fracture. Simple percutaneous screwing is a useful option. The equivalent in the medial epicondyle is well-tolerated, and simple monitoring now suffices. Late posterolateral rotational instability is a poorly known complication. It should be considered in case of cubitus varus that becomes painful after a long asymptomatic course. Radiocapitellar subluxation is seen on X-ray. Residual radial head dislocation after primary treatment (Monteggia lesion) responds well to the Bouyala technique of ulnar flexion osteotomy associated to annular ligament repair, without requiring ligament reconstruction.
Topics: Child; Humans; Elbow Fractures; Fractures, Bone; Elbow Joint; Ulna; Joint Dislocations
PubMed: 36302449
DOI: 10.1016/j.otsr.2022.103454 -
Applied Ergonomics Apr 2023This systematic review updates a previous systematic review on work-related physical and psychosocial risk factors for elbow disorders. Medline, Embase, Web of Science,... (Review)
Review
This systematic review updates a previous systematic review on work-related physical and psychosocial risk factors for elbow disorders. Medline, Embase, Web of Science, Cochrane Central and PsycINFO were searched for studies on associations between work-related physical or psychosocial risk factors and the occurrence of elbow disorders. Two independent reviewers selected eligible studies and assessed risk of bias (RoB). Results of studies were synthesized narratively. We identified 17 new studies and lateral epicondylitis was the most studied disorder (13 studies). Five studies had a prospective cohort design, eight were cross-sectional and four were case-control. Only one study had no items rated as high RoB. Combined physical exposure indicators (e.g. physical exertion combined with elbow movement) were associated with the occurrence of lateral epicondylitis. No other consistent associations were observed for other physical and psychosocial exposures. These results prevent strong conclusions regarding associations between work-related exposures, and the occurrence of elbow disorders.
Topics: Humans; Elbow; Tennis Elbow; Prospective Studies; Occupational Diseases; Elbow Joint
PubMed: 36493677
DOI: 10.1016/j.apergo.2022.103952 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Chronic elbow instability in adults mainly consists of valgus instability and posterolateral instability. They most often occur because of ligament damage following... (Review)
Review
Chronic elbow instability in adults mainly consists of valgus instability and posterolateral instability. They most often occur because of ligament damage following elbow dislocation but can also occur due to repeated microtrauma. The aim of ligament stabilization surgery is always the same: recreate the anatomy and function of the original ligament. Extensive knowledge of the elbow's anatomical structures and biomechanics is crucial to understanding why the elbow is unstable and how to treat it. In this review, we will explain how elbow instability develops, what types of grafts are available and which reconstruction techniques can be used for posterolateral or valgus instability. LEVEL OF EVIDENCE: 3.
Topics: Humans; Adult; Elbow; Elbow Joint; Collateral Ligaments; Joint Instability; Plastic Surgery Procedures
PubMed: 36273505
DOI: 10.1016/j.otsr.2022.103449 -
Elbow Kinematics and Function Following Treatment with Open Arthrolysis and Hinged External Fixator.Orthopaedic Surgery Aug 2023Open arthrolysis (OA) combined with hinged external fixator (HEF) is a promising surgical option for patients with elbow stiffness. This study aimed to investigate elbow...
OBJECTIVE
Open arthrolysis (OA) combined with hinged external fixator (HEF) is a promising surgical option for patients with elbow stiffness. This study aimed to investigate elbow kinematics and function following a combined treatment with OA and HEF in elbow stiffness cases.
METHODS
Patients treated with OA with or without HEF due to elbow stiffness were recruited between August 2017 and July 2019. Elbow flexion-extension motion and function (Mayo elbow performance scores, MEPS) were recorded and compared between patients with and without HEF during a 1-year follow-up period. Additionally, those with HEF were assessed by dual fluoroscopy at week 6 postoperatively. Flexion-extension and varus-valgus motions, as well as ligament insertion distances of the anterior medial collateral ligament (AMCL) and lateral ulnar collateral ligament (LUCL), were compared between the surgical and intact sides.
RESULTS
This study included 42 patients, of which 12 with HEF demonstrated a similar flexion-extension angle and range of motion (ROM) and MEPS as the other patients. In patients with HEF, the surgical elbows showed limitations in flexion-extension (maximal flexion, 120.5° ± 5.3° vs 140.4° ± 6.8°; maximal extension, 13.1° ± 6.0° vs 6.4° ± 3.0°; ROM, 107.4° ± 9.9° vs 134.0° ± 6.8°; all Ps < 0.01) compared with the contralateral sides. During elbow flexion, a gradual valgus-to-varus transition of the ulna, increase in the AMCL insertion distance, and steady change in the LUCL insertion distance were observed, with no significant differences between the bilateral sides.
CONCLUSIONS
Patients treated with OA and HEF demonstrated similar elbow flexion-extension motion and function to those treated with OA alone. Although the use of HEF could not restore an intact flexion-extension ROM and might result in some minor but not significant changes in kinematics, it contributed to clinical outcomes comparable to that of the treatment with OA alone.
Topics: Humans; Elbow; Biomechanical Phenomena; Elbow Injuries; Elbow Joint; External Fixators; Joint Diseases; Range of Motion, Articular; Treatment Outcome
PubMed: 37052066
DOI: 10.1111/os.13714 -
Journal of ISAKOS : Joint Disorders &... Feb 2024
Topics: Humans; Elbow; Joint Diseases; Elbow Joint
PubMed: 37813307
DOI: 10.1016/j.jisako.2023.09.009