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Operative release of ankylosis of the elbow due to heterotopic ossification. Surgical technique.

BACKGROUND: Although uncommon, complete ankylosis of the elbow secondary to heterotopic ossification results in severe disability. The results of surgical management remain unclear. METHODS: A single surgeon used a consistent operative technique to treat complete osseous ankylosis of the elbow in eleven limbs in seven patients after severe burns and in nine elbows in eight patients after trauma. The elbows in the burn cohort were more often ankylosed in extension (average, 47 degrees of flexion) compared with those in the trauma cohort (66 degrees of flexion), and they had more skin problems …

Which motor nerve conduction study is best in ulnar neuropathy at the elbow?

There is debate regarding how best to utilize ulnar motor nerve conduction velocity (MNCV) to identify ulnar neuropathy at the elbow (UNE). We used receiver operator characteristic (ROC) curves to compare absolute across-elbow MNCV with MNCV difference between elbow and forearm segments (VDIF) when recording from abductor digiti minimi (ADM) and first dorsal interosseous (FDI) muscles. Also, we determined how their utility was impacted by low amplitudes of compound muscle action potentials (CMAPs). We studied 85 subjects with UNE and 77 subjects with carpal tunnel syndrome but without clinical…

Free fillet flap of the hand for elbow preservation in nonreplantable forearm amputation.

The use of non-replantable amputated parts for reconstruction of the stump is a well-established technique. The use of a free fillet flap of the hand and forearm for elbow preservation in massive trauma of the upper extremity is reported in two cases. These free flaps allowed for covering and preserving a functional elbow and a more useful stump.

The role of supinator in the pathogenesis of chronic lateral elbow pain: a biomechanical study.

The relative contributions of the forearm extensors to the tensile force at the lateral epicondyle were examined by implanting a force transducer in the common extensor tendon of four soft fixed cadaver elbows and sequentially stretching each muscle arising from the lateral epicondye. Extensor carpi radialis brevis and extensor digitorum communis produced the largest increases while the superficial head of supinator produced a moderate increase in tensile force in the common extensor tendon. Extensor carpi radialis longus and extensor carpi ulnaris had no significant effect. Radial tunnel pres…

Предсказание добровольной активации, силы и выносливости локтейных сгибателей у пациентов постполио.

Для изучения долгосрочных последствий полиомиелита с помощью интерполяции были исследованы максимальная добровольная сила и добровольная активация мышц сгибания локтей у 177 пациентов постполиологической клиники. В ходе 45-минутных упражнений мышечной выносливости было изучено 142 пациента, и были исследованы предсказания о поврежденных мышечных свойствах. Двадцать девять из 177 пациентов (16,4%) пострадали от добровольного привода к своим мышцам сгибания локтей, однако лишь 16 (9,0%) заметно снизили прочность на сгибание локтей, несмотря на то, что 74 (41,8%) сообщили о том, что они были снач

Совпадение в аннотации оригинала
To examine the long-term effects of polio, maximal voluntary strength and voluntary activation of elbow flexor muscles of 177 patients from a postpolio clinic were investigated using twitch interpolation. Muscle endurance was studied in 142 patients during 45 min of submaximal exercise, and predictors of impaired muscle performance were investigated. Twenty-…

The upper limb in cerebral palsy: surgical management of shoulder and elbow deformities.

The authors report a simple chart that offers a comprehensive picture of spasticity of the upper limb and provides a more objective method of recording data. Distinction is made between fixed postures and the residual active range of motion at the shoulder and elbow. The presence and function of the muscles can be identified easily on dynamic EMG studies, which are essential for understanding the degree of spasticity and dyssynergy related to a single muscle. When spasticity of the upper arm is managed with a global approach and objectives are defined clearly in advance with the patient and ca…

Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.

BACKGROUND: In the absence of a randomized, prospective study comparing different surgical approaches for decompression of the ulnar nerve at the elbow, the choice of an approach relies on the individual surgeon's training and experience. The present report describes the results of a prospective, long-term evaluation of the musculofascial lengthening technique in a large series of patients. In these patients, the degree of ulnar nerve compression was staged with use of a numerical grading system that included measures of both motor and sensory function. METHODS: From 1985 through 1991, 121 co…

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

We examined young brothers with symptomatic snapping elbow in the throwing arm. Arthroscopic examination confirmed the mechanism of snapping, in which loose and protruded annular ligament-like tissue covered the volar half of the radial head in elbow extension and uncovered the radial head in deep elbow flexion. Arthroscopic resection of the annular ligament-like tissue was performed in one brother. Histologic examination of the removed tissue showed degenerated ligament tissue. Excision of loose annular ligament abolished snapping. Contralateral elbows of the brothers also showed similar asym…

Prospective evaluation of biceps to triceps and deltoid to triceps for elbow extension in tetraplegia.

PURPOSE: The purpose of this study was to evaluate and compare the deltoid to triceps and biceps to triceps transfers for restoration of elbow extension in young persons with tetraplegia. METHODS: This was a prospective randomized study. Sixteen arms of 9 subjects between 8 and 20 years of age with cervical-level spinal cord injuries were assigned randomly to undergo either a deltoid to triceps transfer or a biceps to triceps transfer. All arms were followed-up prospectively for at least 2 years after surgery. RESULTS: Elbow extension was restored in 8 arms via the deltoid and in 8 arms via …

[Ultrasound detection of dislocation of the ulnar nerve from the sulcus of the elbow joint].

BACKGROUND: Chronic ulnar nerve subluxation out of the sulcus in the elbow region may be a rare reason for undefined chronic disorders in the medial elbow aspect. METHODS: We report two cases: A 38 years old male patient reports recurrent painful disorders including paresthesia of the 4th and 5th fingers. A 12 years old boy shows a palpable band in the medial elbow region without pain. RESULTS: In both patients, the ulnar nerve was completely identified, both in transverse and longitudinal planes. Sonomorphology and echogeneity were the same as in the controlateral limb. Ulnar nerve subluxat…

Ulnar nerve strains at the elbow: the effect of in situ decompression and medial epicondylectomy.

Strains were measured in the ulnar nerve at the elbow in 10 unembalmed, intact cadavers by using a microstrain gauge. In each cadaver, strains in the ulnar nerve behind the medial epicondyle, occurring between 60 degrees and 140 degrees flexion, were calculated for the following 3 conditions: (1) initial strain before in situ decompression, (2) strain after in situ decompression, and (3) strain after in situ decompression plus medial epicondylectomy. The average strain for each group was compared by using the paired Students t-test with multiple comparisons. The average initial percent strain …

[Treatment of elbow joint ankylosis by repair of articular surface with periosteal autograft].

OBJECTIVE: To evaluate the clinical effect of periosteal autograft in repair of ankylosis of elbow joint. METHODS: From May 1985 to November 1999, 18 cases of elbow joints ankylosis (6 cases of osteo-ankylosis, 12 cases of fibroankylosis) were treated by repairing articular surface with periosteal autografting. Out of 18 cases, 13 were caused by old dislocation and fracture of elbow joints, 3 by late rheumatoid arthritis, and 2 by old total joint tuberculosis. In this surgical approach, periosteum from upper end of tibia was transplanted into articular surface after correction of the elbow jo…

Bony changes at the lateral epicondyle of possible significance in tennis elbow syndrome.

Examination of a large number (1232) of elbows from skeletal specimens revealed that 16% displayed a characteristic pattern of bone formation exactly underlying the area of exquisite point tenderness at the lateral humeral epicondyle found in clinical cases of tennis elbow. These changes are usually not seen on standard roentgenograms and can be missed, even at the time of surgery, because this area is not commonly exposed in standard tennis elbow approaches. In a group of clinical cases of tennis elbow (20 patients), similar bony changes could be demonstrated in the majority (60%) of patients…

Gender, body mass and age as risk factors for ulnar mononeuropathy at the elbow.

Factors that predispose patients to ulnar mononeuropathy at the elbow (UME) are poorly defined. We compared 112 electrodiagnostic reports which met criteria for definite or probable UME to 104 reports which excluded UME. Male gender was strongly associated with definite (OR = 6.9, 95% CI = 2.4-20.4; P < 0.001) and all UME (OR = 2.2, 95% CI = 1.2-4.1; P = 0.010) after controlling for age and body mass index (BMI). Among men, UME was associated with increasing age (P = 0.008) but not a decreased BMI. Women, however, demonstrated an association between decreased BMI and UME (OR = 2.3, 95% CI = 1.…

Canine elbow dysplasia. The early radiographic detection of fragmentation of the coronoid process.

Ununited anconeal process, osteochondrosis, and fragmentation of the coronoid process (FCP), separately or together, comprise canine elbow dysplasia. Radiographic detection of ununited anconeal process or osteochondrosis is common, whereas identification of an FCP is often inferred by finding joint incongruity and secondary changes. Early identification of FCP can be improved by evaluating the elbow joint for subtle changes visible early in the course of this disease. Proper radiographic technique and positioning are essential in optimizing identification of the changes associated with mild or…

Intra-articular osteoid osteoma at the elbow: report of a case and review of the literature.

Osteoid osteoma is a benign tumor that may occur in almost any part of any bone. Diagnosis can be difficult, particularly when it is intra-articular. In these cases, osteoid osteoma may present initially with symptoms suggestive of inflammatory arthritis, degenerative joint disease, neoplasm, or infection. We report a case of intra-articular osteoid osteoma in a teenager who presented with a monoarthritis of the elbow. The patient did not have a typical pattern of pain, did not have the typical relief with anti-inflammatory agents, and misinterpretation of the radiographs led to a delay in the…

Neurolysis of the musculocutaneous nerve with alcohol to treat poststroke elbow flexor spasticity.

OBJECTIVE: To evaluate the effectiveness of alcohol in neurolysis of the musculocutaneous nerve for the treatment of elbow flexor spasticity in individuals with a stroke. DESIGN: Case series. SETTING: Outpatient clinic of a tertiary rehabilitation facility. PARTICIPANTS: Twenty patients with a mean age of 62.8 years and poststroke duration of 12.3 months with elbow flexor spasticity. INTERVENTION: Musculocutaneous nerve block of the hemiplegic upper extremity with 50% ethyl alcohol. OUTCOME MEASURES: The severity of spasticity as assessed by the modified Ashworth scale (MAS) score and the…

The posterior fat pad sign in association with occult fracture of the elbow in children.

BACKGROUND: An elevated posterior fat pad visible on a lateral radiograph of a child's elbow following trauma is generally considered to be suggestive of an intracapsular fracture about the elbow. However, in previous studies, the prevalence of fracture in elbows with an elevated posterior fat pad and no other radiographic evidence of fracture has ranged from only 6 percent (two of thirty-one) to 29 percent (nine of thirty-one). We are not aware of any prospective studies, limited to children, on the value of an elevated posterior fat pad as an indicator of an occult fracture about the elbow. …

An experimental model of tennis elbow in rats: a study of the contribution of the nervous system.

The contribution of the sensory and autonomic nervous system to experimentally induced tennis elbow or lateral epicondylalgia was investigated by analyses of the release of neuropeptides from sensory (substance P, SP, neurokinin A, NKA, calcitonin gene-related peptide, CGRP) and sympathetic (neuropeptide Y, NPY) nerves. SP, CGRP, NKA, NPY-like immunoreactivity (-LI) was studied in rats cerebrospinal fluid (CSF), plasma and perfusates (PF) from the enthesis of the extensor carpi radialis brevis (ECRB) of the right elbow at 2, 6 and 24 h following 0.01 ml injection of either complete Freund adju…

[Restoration of flexion of the elbow joint in patients with old injuries of the brachial plexus].

Examination of 23 patients with complete disorder of the flexion function due to irreversible injury of plexus brachialis. The translocation of m. triceps brachii in 8 patients, m. latissimus dorsi--in 8, m. sternocleidomastoideus--in 5, m. pectoralis major transposition was conducted in 1-5 years after the injury for the m. biceps brachii function substitution. The most complete restoration of flexion in articulation ulnaris was achieved after m. latissimus dorsi transposition. Good result was achieved after m. triceps brachii transposition conduction.