elbow

Reconstruction after pan-plexus root avulsions often includes gracilis free functioning muscle transfer. For elbow flexion reconstruction, the free functioning muscle transfer distal tendon is inserted into the biceps tendon or more distally (i.e., flexor digitorum profundus/flexor pollicis longus tendons) for combined elbow and finger flexion; the theoretical drawback of the latter approach is weaker elbow flexion. The authors compared elbow flexion strength with a biceps tendon versus a flexor digitorum profundus/flexor pollicis longus tendon attachment to determine which insertion point resulted in better elbow flexion. Thirty-nine patients underwent free functioning muscle transfer with either a biceps tendon or a distal attachment. Groups were compared on postoperative elbow flexion strength, preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores, range of motion, and other surgical and demographic characteristics. A biomechanical analys...

Lateral epicondylitis is one of the commonest musculoskeletal conditions. The etiology of lateral epicondylitis is poorly understood. In spite of long duration for treatment protocol recurrence rate is common. Objective: The present study was undertaken to compare the effect of Maitland mobilization and conservative treatment in lateral epicondylitis. Method: 60 subjects diagnosed with lateral epicondylitis were included in the study. Functional status of patient was evaluated using upper extremity functional index scale. The data was collected by questionnaire form and was analyzed using SPSS 14.0 and graph pad 6.7 version. Correlation of pain and hand grip was done using Pearson correlation coefficient. Result: 80% of cases were in the age group between 30-40 years and 20% were more than 40 years. 33.33% was males and 66.66% females. The mean pain on was in group A was 3.43 and in group B it was 4.2 by the end of 9 th week. Mean pain free grip strength improved in group A 19.96 as...

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...

The conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (± standard deviation [SD] in years) ...

The authors describe their experience in the treatment of the lesions of the distal tendon of the biceps through the anatomic insertion with Mitek® mini-anchors using Henry anterior single-incision access. From 1996 to 2007, 12 patients, all male, average age 51.2 years, were treated for a lesion of the distal tendon of the biceps. In all cases, post-operative pain according to the visual analogical scale, the articular motion of the elbow, the occurrence of neurological disorders and the formation of ectopic ossifications appreciated by radiographies were evaluated. Furthermore, the patient’s satisfaction and the impact on his quality of life were assessed using the DASH questionnaire. The results that were evaluated at an average follow-up of 65.6 months were satisfactory: in two cases a temporary deficit in the innervation area of the radial nerve occurred; in two cases ossifications formed at the tendon insertion level but with no clinical repercussions. All patients returned to...

This describes the indivisible anastomosis of the main stem of median nerve with ulnar nerve through cubital tunnel followed by the anomaly of ulnar artery that appears as superficial ulnar artery. Both anomalies are found during the anatomical dissection of a grown-up male cadaver, on his right arm. Such case is very rare as, in the literature available to us, it has not been described.

Lateral epicondylitis is a common source of elbow pain. Though it is often a self-limited condition, refractory lateral epicondylitis can lead to problems with activities of daily living and sometimes requires sick leave from work. Therefore prompt treatment is essential. Histopathologic studies have suggested that lateral epicondylitis is a tendinopathy, associated with apoptosis and autophagy, rather than a tendonitis associated with inflammation. Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis. Researchers have recently begun to investigate the use of biologics as potential treatment options for lateral epicondylitis. Autologous blood preparations including platelet rich plasma (PRP) and autologous whole blood injections (ABIs) have been proposed in order to deliver growth factors and other nutrients to the diseased tendon. ...

OBJECT The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries. METHODS Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs. Both the posterior division and the branch to the middle deltoid were used in 2 upper limbs, and the anterior division of the axillary nerve in the final 2 limbs. For thumb and finger extension reconstruction, the nerve to the supinator was transferred to the posterior interosseous nerve. RESULTS In 22 of the 27 recipient nerves, a peripheral type of palsy with muscle denervation was identified. At an average of 19 months follow-up, elbow strength scored M4 in 11 upper limbs and M3 in 2, according to the British Medi...

Floating dislocated elbow is an extremely rare injury, only a few cases were reported. We present here a case of the constellation
of skeletal trauma which associates a proximal humerus fracture, distal radius fracture and elbow dislocation. Through the
literature review we will include clinical, radiological, therapeutic and functional results of this injury

The aims of this study were: (i) to determine kinematic, kinetic, and electromyographic characteristics of Junzuki karate punch in professional karate athletes; (ii) to identify biomechanical parameters that correlate with punch force and lead to a higher punching performance; (iii) to verify the presence of muscle co-activation in the upper limb, trunk, and lower limb muscles. Data were collected from nine experienced karatekas from the Accademia Italiana Karate e Arti Marziali during the execution of the specific punch. Mean punch forces (181.2 N) delivered to the target, the range of motion of both right and left knees (1.13 and 0.82 rad) and right elbow (1.49 rad) joints, and the angles at impact (knee: 0.81 and 0.91 rad; elbow: 1.19 rad) in the sagittal plane were computed. Furthermore, the trunk rotational angular acceleration (63.1 rads), force related to the lower limbs (550.2 and 425.1 N), and co-activation index for the upper limb (36.1% and 34.7%), trunk (24.5% and 16%), ...

Background: Acupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP. Methods: Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/ or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included. Results: All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conve...

The purpose of the study was a development and verification of a model to quantify elbow joint spaces focusing on posterolateral rotatory instability. The model was tested for feasibility and applied to open and arthroscopic surgeries. A mathematical kinematic model was created, consisting of two segments representing the humerus and radius and ulna. Model calculations of the joint opening were compared with direct measurements on a mechanical model with attached marker arrays, and compared with values determined by a digital sliding caliper in order to evaluate the mathematical kinematic rigid body model of the elbow joint. Joint angles predicted by the mathematical model were compared with values determined by a two axis goniometer. The evaluation showed significant accordance (intercorrelation coefficient ≥0.8). The highest difference was 1.54° (root mean square: 0.46°) for all movement conditions. Ligament transaction at the open surgery situation affected an increase in joint o...

Popular fitness literature suggests that varying the elbow range of motion (ROM) during the Military press can lead up to specific muscle isolation especially for deltoid and trapezius muscles. The purpose of the study was to examine the effect of ROM at different loads on the electromyographic (EMG) activity of 8 preselected muscles. Six experienced lifters performed 3 sets of 10 repetitions, each one with a different ROM: the first one with a final elbow angle of 90 degrees (R1); the second with 135 degrees (R2), and the last one with a final elbow angle of 180 degrees (R3). Three resistances were chosen (no load, 30% of one repetition maximum [1-RM], and 70% of 1-RM), and sets were separated by 5 minutes rest. Electromyographic surface electrodes were placed on the clavicular head of pectoralis major, anterior deltoid, medial deltoid (MD), posterior deltoid (PD), upper trapezius, middle trapezius (MT), long head of triceps, and teres minor (TM). Analysis of variance showed a significant increase of rmsEMG activation with the widest ROM for each muscle and for each load condition except in MT and TM and PD with no load. The results showed that the use of the widest ROM increased the EMG activity of all the muscles selected with respect to the closest one, whereas this effect is not totally confirmed with the employment of R2. In addition, the use of intermediate ROMs was able to isolate the activity of the MD with respect to the trapezius only in the condition of the heaviest load. This suggests to coaches that in strength development programs the employment of an incomplete ROM can reduce the involvement of the trapezius without decreasing medium deltoid activation only with heavy loads.

OBJECTIVE Pan-brachial plexus injury (PBPI), involving C5-T1, disproportionately affects young males, causing lifelong disability and decreased quality of life. The restoration of elbow flexion remains a surgical priority for these patients. Within the first 6 months of injury, transfer of spinal accessory nerve (SAN) fascicles via a sural nerve graft or intercostal nerve (ICN) fascicles to the musculocutaneous nerve can restore elbow flexion. Beyond 1 year, free-functioning muscle transplantation (FFMT) of the gracilis muscle can be used to restore elbow flexion. The authors present the first cost-effectiveness model to directly compare the different treatment strategies available to a patient with PBPI. This model assesses the quality of life impact, surgical costs, and possible income recovered through restoration of elbow flexion. METHODS A Markov model was constructed to simulate a 25-year-old man with PBPI without signs of recovery 4.5 months after injury. The management optio...