Elbow pain and anatomy

BACKGROUND: Lateral epicondylitis usually stems from overuse and failed tendon healing. Following attempt of conservative management, surgery is often considered, although there is variation in techniques and outcomes cited in the literature. METHODS: This retrospective review analyzed 293 operative patients for lateral epicondylitis following conservative management. The primary outcome was change in pain from preoperative status, including pain-free, improved, unchanged, or worse...

Glenoid superior biceps-labral pathology diagnosis, treatment and outcomes is an evolving area of shoulder surgery. Historically, described as SLAP tears (Superior Labrum Anterior Posterior) these lesions were identified as a source of pain in throwing athletes. Diagnosis and treatments applied to these SLAP lesions resulted in less than optimal outcomes in some patients and a prevailing sense of confusion. The purpose of this paper is to perform a re-appraisal of the anatomy, examination, imaging and diagnosis by the ASES/SLAP Biceps Study Group...

RATIONALE: Because of the complicated anatomy and considerable change in size and morphology with age in teenagers, the appropriate internal fixator of coronal shear fracture of distal humerus is difficult to choose, and therefore, the fixation of this kind of fracture is difficult and controversial. Furthermore, distal humeral fractures in teenagers often involve the epiphysis, the rigid fixation of fracture and the simultaneous minimally invasive and protection of the epiphysis are contradictory...

BACKGROUND: The objective of this study was to retrospectively review clinical and radiographic outcomes of patients who underwent corrective osteotomies for clavicle malunion and internal fixation for nonunion using a combination of virtual surgical planning, patient-specific 3D printed clavicles, and 3D printed cutting guides manufactured at the point of care. METHODS: Between 2015 and 2021, 18 patients underwent corrective osteotomy for a clavicle malunion (7 shoulders) or internal fixation for a clavicle nonunion (11 shoulders)...

BACKGROUND: Lateral epicondylitis (LE) is a common source of elbow pain. Treatment options include physical therapy (PT), corticosteroid injection, or surgery, but the efficacy of each remains unclear. In this study, we compare Patient-Reported Outcomes Measurement Information System (PROMIS) scores between patients treated both operatively and nonoperatively for LE. METHODS: Patients presenting to a tertiary academic medical center from February 2015 to December 2018 with a diagnosis of LE were identified...

INTRODUCTION: The lateral ulnar collateral ligament (LUCL) is considered one of the main stabilizers of the elbow. However, its anatomical description is not well established. Imaging techniques do not always have agreed upon parameters for the study of this ligament. Therefore, herein, we studied the macro and microanatomy of the LUCL to establish its morphological and morphometric characteristics more precisely. MATERIALS AND METHODS: Fifty-five fresh-frozen human elbows underwent dissection of the lateral collateral ligament...

Although often described as a self-limiting condition and likely to resolve on its own, high recurrence rates and extended sick leave frame a need for effective non-surgical treatment for people with lateral elbow tendinopathy. The interrelationship of histological and structural changes to the tendon, the associated impairments in motor control, and potential changes in pain processing may all drive symptoms. This clinical practice guideline covers the epidemiology, functional anatomy and pathophysiology, risk factors, clinical course, prognosis, differential diagnosis, tests and measures, and interventions for managing lateral elbow tendinopathy in the physical therapy clinic...

Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers...

OBJECTIVE: To define a standardized comprehensive sonographic approach for evaluating the different histo-anatomical compartments of the lateral elbow. DESIGN: Using high-frequency US probes, we tried to match the anatomical features of the lateral elbow and its different sonographic patterns in patients with the diagnosis of lateral epicondylitis. Moreover, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation...

BACKGROUND: Despite increased utilization of conservative measures for displaced olecranon fractures in elderly patients, in whom operative fixation may be complicated by coexisting comorbidities and declining bone quality, the noninferiority of nonoperative management has yet to be proven. The purpose of this study was to review nonoperative management of displaced olecranon fractures in the elderly patient population. METHODS: A literature search of the PubMed database was performed using the term olecranon fracture ...

BACKGROUND: Patients with partial rupture of the distal biceps tendon can present with vague elbow pain and weakness. Understanding of the anatomy and aetiology of this disease is essential to management. Patients can present with a single or multiple traumatic events or with a chronic degenerative history. On clinical examination, patients will have an intact tendon making the diagnosis more challenging. Clinicians, therefore, should have a high index of suspicion and should actively look for this pathology...

Acrometastasis, referring to metastases located distal to the elbow and knee, is a rare observation. The most common primary cancer site is the lungs, followed by colorectal, breast and genitourinary tract locations. We present a case of a 54-year-old woman with a 25-pack-year smoking history, chronic obstructive pulmonary disease and squamous cell carcinoma of the lung diagnosed at age 50. Upon physical examination, in the distal phalanx of the fourth finger of the right hand, there was a hypervascularized swelling, purplish and painful...

Background: The new da Vinci single port (SP) robotic platform has great appeal for pediatric surgery. To assess its efficacy and identify potential challenges, 7 adolescents underwent SP cholecystectomy. Materials and Methods: The surgeon controls three fully wristed elbowed instruments, and the first fully wristed da Vinci endoscope through a single 2.5 cm cannula. Instruments can reach 24 cm deep and triangulate distally. Instruments can also reach anatomy anywhere within 360° of port placement. A vertical incision was made through the umbilicus for port access...

Distal radius fractures (DRFs) are among the most common fractures in the United States. Despite their high incidence, there is no consensus on the optimal type of cast or splint to treat these fractures. The purpose of this systematic review is to evaluate the available literature pertaining to the outcomes for different constructs used to conservatively treat DRFs. A literature search of PubMed, Medline, and Embase was conducted to identify research comparing the outcomes of various immobilization mechanisms...

Avascular necrosis (AVN), one of the most common therapy-related and debilitating side effects of antileukemic treatment, can adversely affect a patient's long-term quality of life. Our case study presents a young woman with bilateral elbow AVN and hip AVN after acute lymphoblastic leukemia treatment, with a unique treatment strategy for her elbow pain. The treatment strategy included elbow joint denervation with arthroscopic debridement and distal humerus core decompression. The goal of this procedure was to improve symptomatic pain while retaining bone stock in the distal humerus hopefully allowing better function of the patient's elbow...

BACKGROUND: Radial tunnel syndrome arises due to compression of the radial nerve through the radial tunnel.[1,5] The radial nerve divides into superficial and deep branches in the forearm. The deep branch travels posteriorly through the heads of the supinator where compression commonly occurs.[3,9,7] This syndrome results in pain in the hand and forearm with no motor weakness.[8] This condition can be treated conservatively with splinting and anti-inflammatory medication.[2,4,6] For cases of refractory radial tunnel syndrome, surgical management can be considered...

BACKGROUND: The Latitude total elbow prosthesis is a third-generation implant, developed to restore the natural anatomy of the elbow. Literature on this prosthesis is scarce. Aim of this study is to analyze the mid-term results of the Latitude total elbow prosthesis. METHODS: Sixty-two patients (21M, 41F) were retrospectively evaluated. Mean age at surgery was 65 years (range 28-87). Main indication for surgery was inflammatory arthritis. Outcome measures were complications and re-operations, self-reported physical functioning, pain, satisfaction, objectively measured physical functioning, and radiological signs of loosening...

BACKGROUND: Reverse shoulder arthroplasty (RSA) with a lateralized design is thought to improve outcomes. Our aim was to compare RSA with the classic Grammont prosthesis against a prosthesis with 135° inclination and a lateralized glenosphere for cuff deficient shoulders. METHODS: Patients with irreparable massive posterosuperior rotator cuff tear Hamada Grade 1-3 underwent RSA and were documented prospectively up to 24 months post-surgery. Comparative RSA groups were: "lateralized" (L) with 135° humeral inclination and 36+4 mm lateralized glenosphere (n = 44) and "Grammont" (G) with 155° humeral inclination and 36+2 mm eccentric glenosphere (n = 23)...

Introduction: Osteoid osteoma (OO) is a benign osteoblastic skeletal lesion commonly affecting the diaphysis of long bones. Intra-articular lesions, which present with atypical symptoms, are uncommon and elbow joint involvement is only rarely reported. Conservative treatment is ineffective and surgical excision or ablation is the therapeutic goal in symptomatic patients. Minimally invasive surgery is gaining popularity as a less morbid alternative in joints as opposed to open surgical excision...

Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles...