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Objectives: The elbow of Nacholapithecus has been extensively described qualitatively, however its ulnar morphology has never been the focus of an in‐depth quantitative analysis before. Hence, our main aim is quantifying the proximal ulnar morphology in Nacholapithecus and exploring whether it is similar to those of Equatorius and Griphopithecus as previously reported. Materials and Methods: We compared Nacholapithecus proximal ulnar morphology with a sample of extant and extinct anthropoids through principal component analysis and agglomerative hierarchical cluster analysis. Moreover, we calculated the Cophenetic Correlation Coefficient and checked for taxonomical group mean differences through MANOVA and pairwise post‐hoc comparisons, as well as the phylogenetic signal in the variables used. Results: The Nacholapithecus ulna displays a moderately long and relatively narrow olecranon, a relatively wide trochlear surface‐radial notch width, and a relatively thin sigmoid notch depth. These features resemble those of large papionins and chimpanzees, and some extinct taxa, mainly Equatorius. Discussion: Results presented here reinforce previous inferences on the functional morphology of the Nacholapithecus elbow, showing adaptations for general quadrupedal behaviors. However, other derived features (e.g., a relatively wide trochlear surface) might be associated with the ape‐like traits described for its distal humerus (e.g., wide trochlear groove), thus displaying a combination of primitive and derived features in the proximal ulna. Finally, affinities with large papionins could suggest the presence of some terrestrial habits in Nacholapithecus. However, the lack of evidence in the rest of the skeleton prevents us from suggesting terrestrial affinities in this taxon in a conclusive manner. [ABSTRACT FROM AUTHOR]

Elbow trauma can lead to joint contracture and reduced range of motion (ROM). Nonsurgical interventions can improve ROM, but in some cases capsule release surgery is required. Although surgery can improve ROM, it often does not restore full ROM. Thus, alternatives are needed. One approach is to target activated myofibroblasts, which are commonly associated with fibrotic tissue. Mechanical and biochemical cues drive a feedback loop that can result in normal or pathological healing. We hypothesize that this feedback loop exists in joint contracture and can be manipulated so that myofibroblast activity is reduced, normal healing is achieved, and ROM is improved. We previously demonstrated that blebbistatin can inhibit myofibroblast contractile forces and reduce collagen synthesis in vitro. Thus, the purpose of this study was to assess the use of blebbistatin in an animal model of elbow contracture, which was induced in 7 groups of 4 rats each (n = 28). All elbows were mechanically and histologically tested. The uninjured contralateral elbows of each rat were used as a control group. Capsule release surgery significantly improved (p < 0.01) outcomes 1 week after surgery compared to injury alone and was not significantly different from uninjured elbows. Three weeks after surgery, outcomes worsened, indicating joint stiffening consistent with what is observed clinically. The addition of blebbistatin did not significantly improve outcomes. Future work will investigate relationships among treatment, fibrotic tissue deposition, myofibroblast activity, and biomechanics to determine if blebbistatin is a useful adjunctive therapy for treating joint contracture. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common presentation to the Paediatric Emergency Department (PED). Fifty per cent of children present following an unwitnessed injury or with an atypical history. Furthermore, examination can be difficult in an upset or frightened child meaning the precise location of the injury is not always easily identifiable. Many children receive upper limb x‐rays unnecessarily and others undergo attempted reduction for suspected pulled elbow when a fracture is the cause of their pain.To evaluate the ability of point‐of‐care ultrasound (POCUS) to correctly identify cases of suspected pulled elbow.A retrospective review of patients aged 0–5 years presenting to the PED of our large District General Hospital from November 2020 to November 2022. We reviewed the electronic medical records of all patients presenting with a triage category of ‘elbow Injury’. We excluded patients presenting with obvious deformity, significant swelling and history of road traffic collision or other major trauma mechanism such as a fall from a height. POCUS was carried out by the authors according to pre‐existing clinical protocols.Thirty‐seven patients underwent POCUS. Twenty‐nine had a typical history and all had a positive POCUS for pulled elbow. Of the remaining eight patients with an atypical history, three were found to have a positive POCUS compared to unaffected elbow. Five patients with an atypical history had negative POCUS findings and were diagnosed as soft tissue injuries after further assessment. All 32 with positive sonographic signs had a final diagnosis of pulled elbow, meaning the specificity was 100% (47.8–100) (P = 0.00003). The sensitivity was 100%.Use of POCUS by appropriately trained clinicians, as an extension of a clinical examination, in this retrospective study reliably confirmed pulled elbow. This has the potential to reduce both unnecessary radiation as well as the time in the emergency department for the child and their carers. [ABSTRACT FROM AUTHOR]

Objective: To explored the dynamic changes of split phenomenon in multiple antagonistic muscle groups among amyotrophic lateral sclerosis (ALS) patients. Methods: One hundred and twenty limb‐onset ALS patients were followed up regularly with an interval of 3 months. Two clinicians collected the muscle strength of elbow extensor‐flexor, wrist flexor‐extensor, knee extensor‐flexor and ankle flexor‐extensor individually. Results: Significant differences in muscles strength were observed between flexors and extensors of elbow, wrist, knee, and ankle (p < 0.05). The frequency of split phenomenon of elbow extensor‐flexor was 15.1%, 13.8%, 19.1%, 17.8%, and 12.5% at the baseline, 3‐, 6‐, 9‐, and 12‐month follow‐up points, respectively. For wrist flexor‐extensor, the frequency was 20.8%, 18.2%, 18.6%, 19.9%, and 20.4%, respectively. For knee extensor‐flexor, the frequency was 3.0%, 8.0%, 7.6%, 8.4%, and 8.9%, respectively. For ankle flexor‐extensor, the frequency was 8.8%, 9.2%, 10.9%, 15.4%, and 15.7%, respectively. For muscles with 3–4 levels of muscle strength, significant dissociation of muscle strength was common, especially among patients with a slow progression rate. Conclusion: Split phenomenon of muscle strength between antagonistic muscles was common in limb‐onset ALS patients. Muscle strength and progression rate were influence factors of the split phenomenon. As disease progressed, the split phenomenon gradually became obvious, and might then slowly disappeared due to the loss of LMNs. [ABSTRACT FROM AUTHOR]

Eccentric upper‐body exercise performed 24 h prior to high‐altitude decompression has previously been shown to aggravate venous gas emboli (VGE) load. Yet, it is unclear whether increasing the muscle mass recruited (i.e., upper vs. whole‐body) during eccentric exercise would exacerbate the decompression strain. Accordingly, this study aimed to investigate whether the total muscle mass recruited during eccentric exercise influences the decompression strain. Eleven male participants were exposed to a simulated altitude of 24,000 ft for 90 min on three separate occasions. Twenty‐four hours before each exposure, participants performed one of the following protocols: (i) eccentric whole‐body exercise (ECCw; squats and arm‐cycling exercise), (ii) eccentric upper‐body exercise (ECCu; arm‐cycling), or (iii) no exercise (control). Delayed onset muscle soreness (DOMS) and isometric strength were evaluated before and after each exercise intervention. VGE load was evaluated at rest and after knee‐ and arm‐flex provocations using the 6‐graded Eftedal–Brubakk scale. Knee extensor (−20 ± 14%, P = 0.001) but not elbow flexor (−12 ± 18%, P = 0.152) isometric strength was reduced 24 h after ECCw. ECCu reduced elbow flexor isometric strength at 24 h post‐exercise (−18 ± 10%, P < 0.001). Elbow flexor DOMS was higher in the ECCu (median 6) compared with ECCw (5, P = 0.035). VGE scores were higher following arm‐flex provocations in the ECCu (median (range), 3 (0–4)) compared with ECCw (2 (0–3), P = 0.039) and control (0 (0–2), P = 0.011), and in ECCw compared with control (P = 0.023). VGE were detected earlier in ECCu (13 ± 20 min) compared with control (60 ± 38 min, P = 0.021), while no differences were noted between ECCw (18 ± 30 min) and control or ECCu. Eccentric exercise increased the decompression strain compared with control. The VGE load varied depending on the body region but not the total muscle mass recruited. Highlights: What is the central question of this study?Does exercise‐induced muscle damage (EIMD) resulting from eccentric exercise influence the presence of venous gas emboli (VGE) during a 90 min continuous exposure at 24,000 ft?What is the main finding and its importance?EIMD led to an earlier manifestation and greater VGE load compared with control. However, the decompression strain was dependent on the body region but not the total muscle mass recruited. [ABSTRACT FROM AUTHOR]

In the transportation of grain particles, elbow wear is a pressing concern. A novel approach to mitigate this involves introducing a lateral air supplement rotation mechanism that enables swirling transportation. We assessed the integration of this device at angles of 45°, 55°, and 65° to the central axis of the main pipeline. While the multiphase flow velocity within the main conduit was held constant at 20 m/s, the lateral device's airflow velocities were tested at 20, 30, and 40 m/s. Utilizing the CFD–DEM simulation for grain particle transportation around bends, our findings indicated that an optimal arrangement was with the lateral device at 55° relative to the main pipeline, with an airflow speed of 30 m/s. This setup fostered a forward particle spiral, drastically diminishing wear on the pipe wall. Experimental evaluations corroborated the simulation's outcomes. [ABSTRACT FROM AUTHOR]

The flexible electronic sensor is a critical component of wearable devices, generally requiring high stretchability, excellent transmittance, conductivity, self‐healing capability, and strong adhesion. However, designing ion‐conducting elastomers meeting all these requirements simultaneously remains a challenge. In this study, a novel approach is presented to fabricate highly stretchable, transparent, and self‐healing ion‐conducting elastomers, which are synthesized via photo‐polymerization of two polymerizable deep eutectic solvents (PDESs) monomers, i.e., methacrylic acid (MAA)/choline chloride (ChCl) and itaconic acid (IA)/ChCl. The as‐prepared ion‐conducting elastomers possess outstanding properties, including high transparency, conductivity, and the capability to adhere to various substrates. The elastomers also demonstrate ultra‐stretchability (up to 3900%) owing to a combination of covalent cross‐linking and noncovalent cross‐linking. In addition, the elastomers can recover up to 3250% strain and over 94.5% of their original conductivity after self‐healing at room temperature for 5 min, indicating remarkable mechanical and conductive self‐healing abilities. When utilized as strain sensors to monitor real‐time motion of human fingers, wrist, elbow, and knee joints, the elastomers exhibit stable and strong repetitive electrical signals, demonstrating excellent sensing performance for large‐scale movements of the human body. It is anticipated that these ion‐conducting elastomers will find promising applications in flexible and wearable electronics. [ABSTRACT FROM AUTHOR]

Quantifying movement coordination in cross‐country (XC) skiing, specifically the technique with its elemental forms, is challenging. Particularly, this applies when trying to establish a bidirectional transfer between scientific theory and practical experts' knowledge as expressed, for example, in ski instruction curricula. The objective of this study was to translate 14 curricula‐informed distinct elements of the V2 ski‐skating technique (horizontal and vertical posture, lateral tilt, head position, upper body rotation, arm swing, shoulder abduction, elbow flexion, hand and leg distance, plantar flexion, ski set‐down, leg push‐off, and gliding phase) into plausible, valid and applicable measures to make the technique training process more quantifiable and scientifically grounded. Inertial measurement unit (IMU) data of 10 highly experienced XC skiers who demonstrated the technique elements by two extreme forms each (e.g., anterior versus posterior positioning for the horizontal posture) were recorded. Element‐specific principal component analyses (PCAs)—driven by the variance produced by the technique extremes—resulted in movement components that express quantifiable measures of the underlying technique elements. Ten measures were found to be sensitive in distinguishing between the inputted extreme variations using statistical parametric mapping (SPM), whereas for four elements the SPM did not detect differences (lateral tilt, plantar flexion, ski set‐down, and leg push‐off). Applicability of the established technique measures was determined based on quantifying individual techniques through them. The study introduces a novel approach to quantitatively assess V2 ski‐skating technique, which might help to enhance technique feedback and bridge the communication gap that often exists between practitioners and scientists. [ABSTRACT FROM AUTHOR]

Introduction: Although resistance training is frequently prescribed for people with haemophilia (PWH), no previous meta‐analyses have quantified the effect of this intervention on muscle strength, nor the implications of the intervention's modality and duration. Aim: (1) To determine the effects of resistance training on muscle strength in adults with haemophilia; (2) To determine the most effective duration and modality among the exercise protocols. Methods: A systematic search from inception until 28 November 2023 was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases. We included randomised controlled trials or before‐after studies that involved resistance training without other physiotherapy co‐interventions. Study selection, data extraction and risk of bias assessment were independently performed by two reviewers. Disagreements were resolved in consultation with a third author. The level of evidence was determined according to the GRADE methodology. Results: Seven studies were included. Measurements of knee extensor strength and elbow extensor strength were included in the meta‐analysis. Subgroup analysis showed significant effects for both elastic resistance protocols (SMD: 0.54; 95% CI: 0.02–1.07) and conventional training (isometric and weight‐based equipment) (SMD: 0.88; 95% CI: 0.50–1.25), demonstrating small and moderate effect sizes respectively. Additionally, both protocols of duration 5–7 weeks (SMD: 1.16, 95% CI: 0.63–1.69) as well as those of duration ≥8 weeks (SMD: 0.57, 95% CI: 0.20–0.94) showed a significant difference. Conclusion: Resistance training is effective in improving muscle strength of the knee and elbow extensors in PWH. Both elastic resistance and conventional training show benefits. [ABSTRACT FROM AUTHOR]

Purpose: Radial head arthroplasty (RHA) reestablishes elbow stability after complex radial head fracture, but complication rates are high, possibly due to inappropriate implant sizing. Knowledge of impact of radial head implant diameter on elbow kinematics is limited and warranted. This study evaluated elbow kinematics of different radial head implant diameters after RHA using dynamic radiostereometric analysis (dRSA). Methods: Eight human donor arms were examined with dRSA during elbow flexion with the forearm in unloaded neutral position, and in supinated‐ and pronated position without and with 10N either varus or valgus load, respectively. Elbow kinematics were examined before and after RHA with head diameters of anatomical size, −2 mm (undersized), and +2 mm (oversized). The ligaments were kept intact by use of step‐cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from CT, and by AutoRSA software bone models were matched with dRSA recordings. The elbow kinematics were described using anatomical coordinate systems. Results: Compared to the native radial head during elbow flexion, the anatomical sized RHA shifted 2.0 mm in ulnar direction during unloaded pronated forearm position. The undersized RHA shifted 1.5 mm in posterior direction and 2.1 mm in ulnar direction during unloaded pronated forearm position and increased the varus angle by 2.4° during supinated loaded forearm position. The oversized RHA shifted 1.6 mm in radial direction during loaded supinated forearm position. Conclusions: The anatomically sized RHA should be preferred as it maintained native elbow kinematics the best. The kinematic changes with oversized and undersized RHA diameters were small, suggesting forgiveness for the RHA diameter size. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Aim: Patients undergoing haemodialysis have reduced muscle strength and impaired activities of daily living (ADL). We examined possible relationship between difficult ADL and corresponding muscle weakness in elderly haemodialysis patients. Methods: This was a single‐centre, cross‐sectional study. Patient‐reported ADL difficulty was examined using a questionnaire in six ADL using upper limbs (eating, grooming and dressing) and lower limbs (bathing, toileting and locomotion). We measured six muscle strengths by dynamometers of shoulder flexion, shoulder abduction, elbow flexion, handgrip, hip abduction and knee extension. The muscle strength with the lowest Z‐score was considered as the weakest muscle strength for the patient. Results: The six scores of ADL difficulty were all inversely associated with the six muscle strengths in the 81 total participants of whom 71 individuals (87.7%) had any ADL difficulty. Among the six measurements of muscle strength, handgrip strength showed the highest associations with all ADL difficulties. In 25 patients who perceived that the most difficult ADL was an activity using upper limbs, the common weakest muscle strengths were the hip abduction, handgrip and elbow flexion. In 44 patients who perceived that the most difficult ADL was an activity using lower limbs, knee extension was the most prevalent weakest muscle strength. Conclusion: This study suggested preferential relationship between the most difficult ADL and corresponding muscle weakness in elderly haemodialysis patients. This finding may be useful in prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: Allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is a potentially curative treatment for hematological malignancies. Several complications following allo‐HSCT, such as graft‐versus‐host disease, infection, and malnutrition, often cause physical dysfunction, and the assessment of physical function and evaluation of muscle mass are incompletely performed. Use of ultrasound (US) allows muscle mass measurement in patients with poor general conditions. In allo‐HSCT recipients, the correlation between physical function and muscle thickness, as measured by US, remains unclear. Objective: To clarify whether muscle thickness measured by US correlated with physical function in allo‐HSCT recipients. Design: A single‐center prospective cohort study. Setting: Hospital. Patients: Ninety‐two patients underwent allo‐HSCT at our hospital from April 2017 to March 2019. Interventions: Not applicable. Main Outcome Measure(s): Biceps and quadriceps muscle thickness measured by US, grip strength, isometric muscle strength (elbow flexion and knee extension), and 6‐minute walking test (6MWT) before allo‐HSCT and on days 30, 90, 180, 1 year, and 2 years after allo‐HSCT. The implementation rates of these assessments were also investigated. Results: Correlations were observed between biceps thickness and elbow flexion muscle strength/grip strength before allo‐HSCT, on days 30, 90, 180, 1 year, and 2 years after allo‐HSCT (r = 0.71/0.74, 0.73/0.72, 0.70/0.79, 0.67/0.75, 0.72/0.75, and 0.85/0.79, respectively, all p <.001). At the same time points, quadriceps thickness moderately correlated with knee extensor strength (r = 0.49, 0.50, 0.45, 0.64, 0.61, and 0.58, all p <.001). However, biceps and quadriceps thicknesses did not correlate with the 6MWT. The percentages of patients measured with US and 6MWT were 93.4% and 82.4% (p =.01) on day 30 and 97.5% and 87.8% (p =.02) on day 90, respectively. Conclusions: US assessment may be a useful alternative method for estimating muscle strength in fragile allo‐HSCT recipients, particularly when physical function assessment is difficult to quantify. [ABSTRACT FROM AUTHOR]

Objective: To analyze the factors associated with low functional mobility in older adults residing in Alcobaça, BA. Methods: This is an epidemiological survey with a cross‐sectional design, conducted in 2015 with 473 older adults (62.4% women; mean age 70.2 ± 8.2 years) from Alcobaça, BA. The interview script addressed sociodemographic characteristics, health, and behavioral aspects. Functional mobility was assessed using the Short Physical Performance Battery (≤6 points). Inferential analyses were conducted using the Mann–Whitney U test and Poisson regression (with robust variance and estimation of prevalence ratios and their respective 95.0% confidence intervals). Results: The prevalence of low functional mobility was 9.6%, with associated factors including the use of alcoholic beverages (PR = 1.7, 95% CI: 1.01–1.13) and the number of repetitions in elbow flexion (PR = 1.01, 95% CI: 1.01–1.05). Additionally, older adults with low mobility had lower height, thigh circumference, and lower performance in handgrip strength tests, elbow flexion, and flexibility. They also spent more time in sedentary behavior and less time in physical activity compared to older adults with preserved mobility (p < 0.05). Conclusion: Older adults with low mobility exhibit poorer values in anthropometric parameters, lower performance in motor tests, spend less time engaged in physical activities, and more time in sedentary behavior. [ABSTRACT FROM AUTHOR]

This study aimed to examine the influence of elbow and forearm postures, as well as sex, on the perception of grip force in a sample of individuals without any known health conditions. A total of 21 healthy participants (10 women and 11 men) from college were included and completed a force reproducibility assignment with four elbow and forearm positions (full pronation, supination, and extension, and at 90° of flexion) at three force levels (10%, 30%, and 50% of maximal voluntary isometric contraction [MVIC]). Our results show that participants were more sensitive in detecting variations in their grip force when their elbow was in full supination (14.1 ± 8.5% MVIC, p <.05) and full extension (13.8 ± 10.1% MVIC, p <.01) than when it was at 90° of flexion (19.9 ± 20.1% MVIC). The normalized absolute error exhibited comparable patterns among both male and female participants. Specifically, when the working range of the muscles increased (as indicated by higher maximum voluntary isometric contraction values in males), the accuracy decreased (as reflected by the more significant absolute error in men). Moreover, men exhibited a greater degree of both constant and variable error than women. Recent research indicates that the prevalence of musculoskeletal disorders is higher in women than in males. The results we obtained may contribute to developing strategies to reduce injury risk. [ABSTRACT FROM AUTHOR]

Background and Purpose: There is a significant impact of musculoskeletal disorders (MSDs) on individuals of all ages, professions, and fields from various countries worldwide, leading to a negative impact on quality of life and overall health outcomes. The study was conducted to investigate the association between Burnout syndrome (BS) and MSDs among physiotherapists in Saudi Arabia. Methods: A cross‐sectional study was carried out. Physiotherapists of either gender and with no known co‐morbidities and who were not suffering from recent injuries and accidents were included in the study. The Copenhagen Burnout Inventory was used to determine the level of burnout. Musculoskeletal disorders were analyzed using the Standardized Nordic Questionnaire (NMQ). The chi‐square test was used to observe the association between two categorical variables and a p‐value <0.05 was considered to be statistically significant. Results: A total of 133 participants were recruited and it was observed that 70 (53%) participants had low burnout levels (BoL). It was revealed that 65 (49%) had trouble in the neck and visited a physician clinic, 47 (35%) had trouble in the lower back during the last 12 months, 60 (45%) had trouble in the upper back during the last 12 months that prevented the normal activity and 13 (9.8%) participants had trouble in the shoulders during the last 7 days. History of chronic disease, education, practice setting, and smoking status with Burnout level was statistically significant. Trouble in the upper back, elbow, wrist/hands, hips/thighs, ankle/feet, and neck were also found to be significant. Conclusion: The outcomes revealed that a few demographic factors such as education, practice setting, smoking status, and chronic disease history were significantly associated with BS. Furthermore, it was observed that MSD had a significant impact on BoL. [ABSTRACT FROM AUTHOR]

Failure of endochondral ossification due to interruption of the vascular supply to the epiphyseal cartilage is a critical step in the development of osteochondritis dissecans (OCD). Herein we describe the vascular architecture of the distal humeral epiphyseal cartilage in pigs and identify characteristic features that have been associated with sites predisposed to OCD development across species. Distal humeral specimens were harvested from pigs (n = 5, ages = 1, 10, 18, 30, and, 42 days old) and imaged at 9.4T magnetic resonance imaging (MRI) using a 3D gradient recalled echo sequence. The MRI data were processed using a quantitative susceptibility mapping (QSM) pipeline to visualize the vascular architecture. Specimens were also evaluated histologically to identify the presence of ischemic epiphyseal cartilage necrosis (osteochondrosis [OC]‐latens) and associated failure of endochondral ossification (OC‐manifesta). The QSM data enabled visualization of two distinct vascular beds arising from the perichondrium at the lateral and medial aspects of the distal humeral epiphysis. Elongated vessels originating from these beds coursed axially to supply the lateral and medial thirds of epiphyseal cartilage. At 18 days of age and older, a shift from perichondrial to transosseous blood supply was noted axially, which appeared more pronounced on the lateral side. This shift coincided with histologic identification of OC‐latens (30‐ and 42‐day‐old specimens) and OC‐manifesta (18‐ and 42‐day‐old specimens) lesions in the corresponding regions. The vascular anatomy and its evolution at the distal humeral epiphysis closely resembles that previously reported at predilection sites of knee OCD, suggesting a shared pathophysiology between the knee and elbow joints. [ABSTRACT FROM AUTHOR]

Background: Narrowband ultraviolet B (NB‐UVB) phototherapy promotes stability and repigmentation in vitiligo. No studies have compared targeted NB‐UVB with whole‐body NB‐UVB in treatment of acral vitiligo. Objectives: This randomized split‐body study compared whole‐body NB‐UVB with targeted NB‐UVB in inducing stability and repigmentation in acral vitiligo. Methods: Thirty‐two patients with bilaterally symmetrical acral vitiligo lesions (distal to elbows and knees) were recruited. Patients received whole‐body NB‐UVB treatment, with one hand and one foot shielded until elbow and knee, followed by targeted NB‐UVB treatment on the shielded side. Patients were assessed at 4‐week intervals for 24 weeks using Vitiligo Disease Activity (VIDA) score, Vitiligo Skin Activity Score (VSAS), Vitiligo Area Scoring Index (determined through fingertip method, using the method to calculate facial‐VASI) and degree of repigmentation. Results: After 12 weeks, 87.5% of patients achieved a VIDA score of 3, with none having active disease at 24 weeks. Over 50% repigmentation was observed in 42.2% and 37.5% of limbs in whole‐body and targeted groups, respectively (p =.95). No improvement in F‐VASI scores of hands and feet (distal to wrist and ankles) was noted with either modality over the 24‐week period. Conclusion: Our study showed comparable repigmentation rates between whole‐body and targeted NB‐UVB groups. Limited effectiveness of phototherapy in repigmentation of hands and feet underscores an important therapeutic gap. [ABSTRACT FROM AUTHOR]

Aim: Joint damage due to haemarthrosis can be effectively monitored with point‐of care ultrasound using the Haemophilia Early Arthropathy Detection with US (HEAD‐US) scoring system. A post hoc comparative analysis of the joint status of patients with severe haemophilia A (HA) or B (HB) was performed. Methods: The databases of two observational, cross‐sectional studies that recruited patients with HA or HB from 12 Spanish centres were analysed to compare the status of the elbows, knees and ankles in patients with severe disease according to treatment modality. The HEAD‐US score was calculated in both studies by the same trained operators. Results: Overall, 95 HA and 41 HB severe patients were included, with a mean age of 35.2 ± 11.8 and 32.7 ± 14.2 years, respectively. The percentage of patients who received prophylaxis, over on‐demand (OD) treatment, was much higher in HA (91.6%) than in HB (65.8%) patients. With a similar number of target joints, the HEAD‐US score was zero in 6.3% HA and 22.0% HB patients (p <.01), respectively. The HA population showed significantly worse HEAD‐US scores. Whilst osteochondral damage occurred more frequently in patients OD or tertiary prophylaxis, our data suggest that articular damage is less prominent in primary/secondary prophylaxis, regardless of the type of haemophilia. These latter treatment modalities were also associated with a lower prevalence of synovial hypertrophy, particularly in HB patients. Conclusion: This post hoc analysis indicates that joint status seems to be significantly influenced by haemophilia type (HA or HB) and treatment modality in these severe Spanish populations with severe disease. Continuing HEAD‐US monitoring for the early detection and management of intra‐articular abnormalities, as well as more efficiently tailored therapies should be warranted. [ABSTRACT FROM AUTHOR]

Perforating lichen nitidus is a rare subtype of lichen nitidus, with approximately 11 cases reported worldwide. Lesions typically present in young male patients at sites prone to mechanical irritation, including the hands, feet, forearms, elbows, and knees. Classic histopathologic features of perforating lichen nitidus show a lymphohistiocytic infiltrate within the papillary dermis between hyperplastic rete ridges with transepidermal elimination of dermal contents. Very few cases are reported in the literature of lichen nitidus and its association with atopic dermatitis. This is the first case describing perforating lichen nitidus in a patient with a history of atopic dermatitis being treated with dupilumab injections. Lesions of perforating lichen nitidus worsened with successful treatment of atopic dermatitis. These findings suggest a unique pathophysiology of perforating lichen nitidus lesions. [ABSTRACT FROM AUTHOR]

Eccentric contractions of the wrist extensors worsen lateral epicondylitis (LE), whose pathophysiology may involve sex differences in wrist torque. This study aimed to investigate sex differences in wrist torque in patients with LE. The wrist extension and flexion torques of 22 patients with LE (11 males and 11 females) were measured. Maximum muscle output over time was measured for 20 s, initial torque was defined as muscle strength, and the degree of eccentric contraction was quantified and defined as the eccentric contraction index (ECI). The affected/unaffected side ratio of the wrist extensor, extensor/flexor ratio of muscle strength, and affected/unaffected side difference of ECI between sexes were statistically analyzed. Furthermore, correlations between wrist extensor torque, ECI, and Visual Analog Scale of pain during the examination were evaluated. Females were found to display lower affected/unaffected side ratios of the wrist extensor and wrist extension/flexion ratios for the affected side, compared with males; however, no differences were found in the wrist extension/flexion ratios for the unaffected side in both sexes. Additionally, females presented with larger differences between the affected and unaffected sides in the ECI. Based on correlations between wrist torques, ECI, and pain, females tended to suppress muscle output to prevent pain from eccentric contraction of wrist extensors more than males, which would induce an imbalance in muscle strength of the wrist extensors and flexors. This imbalance may result in chronic eccentric contraction of the wrist extensors with gripping, exacerbating LE. [ABSTRACT FROM AUTHOR]

Introduction/Aims: A common concept is that traumatic nerve injuries are more likely axonal, and that compressive neuropathies are more likely demyelinating. The purpose of this study was to compare traumatic versus non‐traumatic ulnar neuropathy at the elbow (UNE) to look for electrodiagnostic differences between the two groups. Methods: A retrospective 3 year review of UNE patients at two academic health science centers was conducted. Patients were grouped into acute traumatic UNE versus chronic non‐traumatic UNE based on clinical history. Electrodiagnostic measurements were compared between the two groups. Results: There were 50 subjects with acute traumatic UNE and 41 with chronic non‐traumatic UNE. Mean age and sex distribution were similar but those with traumatic UNE had a 7 month duration of symptoms, while those with chronic UNE had 29 month duration (p <.001). All electrodiagnostic measurements were similar between the two groups including compound muscle action potential amplitudes, motor conduction velocities, frequency of conduction block, sensory nerve studies, and needle electromyography. Discussion: We did not find a difference between the two groups. One should not make inferences regarding acuity or etiology based on electrodiagnostic features alone. [ABSTRACT FROM AUTHOR]

There is evidence of a link between disease activity in vitiligo and clinical visible signs such as confetti‐like depigmentation, Koebner phenomenon and hypochromic areas/borders. Despite its established value, dermatologists and researchers continue to have a limited understanding of the vitiligo disease activity signs. The primary goal of this study was to identify 'hot spots' of disease activity signs in vitiligo patients in order to improve detection in clinical practice. Furthermore, the prevalence, clinical profiles of predisposed patients, interrelationship between the disease activity signs and potential pitfalls in the recognition of the signs were evaluated. The Vitiligo Signs of Activity Score (VSAS) was used to score the presence of the disease activity signs in 441 non‐segmental and 57 segmental vitiligo patients. More detailed predilection areas were scored in a subset of patients, using 65 predefined body locations. At least one disease activity sign was observed in 51.0% and 8.8% of the non‐segmental and segmental vitiligo patients, respectively. Confetti‐like depigmentation was most observed on the elbows, Koebner phenomenon on the back of the hands, and hypochromic areas/borders in the armpits. The three signs were significantly more observed in patients with more involved body locations. Moreover, hypochromic areas/borders were more common in younger patients. Confetti‐like depigmentation had the highest interrelationship with the other signs and was the easiest to recognise. Knowledge around hot spots of the disease activity signs will enhance and simplify their detection in clinical practice. Based on the results, confetti‐like depigmentation appears to be the most straightforward sign to evaluate. [ABSTRACT FROM AUTHOR]

Background: Most studies have discussed variations in facial skin colour based on age, gender, and anatomical site within a specific ethnic group. However, skin pigmentation on the body is also a concern for many people. Aim: The aim of this study is to gather baseline data for Chinese young females, conduct a comprehensive assessment of body skin pigmentation, and create a body skin pigmentation map. Method: Individual type angle (ITA°) was registered by CL 400 and melanin index (MI) was registered by MX 18 in 100 body points of 20 Chinese females. A total of 12,000 measurements were recorded. Result: Our results showed significant differences among the symmetrical points on both sides of the body, including the clavicle, inner wrists, groin, inner ankle, elbow, armpit, waist side, the space between the thumb and index finger, instep, back shoulder, and popliteal space. Of all the points tested on the body, the points with the most severe skin pigmentation were the back of the neck, the heel, the elbow, and the popliteal space. Conclusion: This is the first comprehensive study of skin pigmentation conducted on the human body. In young Chinese women, the points with the most severe skin pigmentation were the back of the neck, heels, elbows, and the popliteal space. [ABSTRACT FROM AUTHOR]

Although the term articularis cubiti muscle is incorporated in the official anatomical nomenclature, only sparse data about its appearance are available. It is usually described as few fibres originating from the medial head of the triceps brachii muscle and inserting to the capsule of the elbow joint. However, the most recent observations regarding the morphological relations in the posterior elbow region point towards the absence of a well‐defined muscle. Therefore, this study was designed to verify the existence of the articularis cubiti muscle in question and to compile more data on the topographical features of the subtricipital area near the posterior aspect of the elbow. To address these questions, 20 embalmed upper limbs were dissected, and seven samples were collected for histological analysis. The laboratory findings were then correlated with 20 magnetic resonance imaging (MRI) scans of the elbow. Consequently, a narrative review of literature was performed to gain more information on the discussed muscle in a historical context. Upon the anatomical dissection, muscular fibres running from the posterior aspect of the shaft of the humerus to the elbow joint capsule and olecranon were identified in 100% of cases. Histologically, the connection with the joint capsule was provided via winding bands of connective tissue. On MRIs, the muscular fibres resembled a well‐demarcated thin muscle located underneath the medial head of the triceps brachii muscle. Combined with the review of literature, we concluded that the constant articularis cubiti muscle originates from the posterior shaft of the humerus and attaches indirectly to the posterior aspect of the elbow joint capsule and directly to the superior portion of the olecranon. The obtained results slightly differ from the modern description, but are in agreement with the original publication, which has become misinterpreted throughout time. Presumably, the misused description has led to questioning the existence of an independent muscle. Moreover, our findings attribute to the articularis cubiti muscle, a function in pulling on the posterior aspect of the elbow joint capsule to prevent its entrapment, and possibly also a minor role in extension of the forearm. The presented results should be taken into consideration when intervening with the posterior aspect of the elbow joint because the articularis cubiti muscle poses a consistently appearing landmark. [ABSTRACT FROM AUTHOR]

Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26–7.5%. The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published. The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously. In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven. [ABSTRACT FROM AUTHOR]

Objective: The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. Methods: The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant–Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t‐tests was used for follow‐up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant–Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. Results: There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant–Murley shoulder function score at the last follow‐up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). Conclusion: A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture. [ABSTRACT FROM AUTHOR]

Canine elbow incongruity is a condition that may be associated with the development of dysplastic lesions of the elbow; namely, medial coronoid process disease, osteochondrosis of the humeral condyle and ununited anconeal process. Axial elbow incongruity (either short radius or short ulna syndrome) may predispose to the development of elbow osteoarthritis. Surgical correction of incongruity has previously been described in an effort to improve lameness and mitigate progression of osteoarthritis, although a system by which to achieve measured and precise adjustment of congruity of both the radius and ulna has been lacking. This case series describes use of a novel acute correction surgery, canine elbow realignment osteotomy for correction of axial elbow incongruency in four dogs. [ABSTRACT FROM AUTHOR]

Little is known about gender differences in stiffness of forearm muscles during voluntary actions. This study aimed to investigate the effect of forearm rotation on flexor carpi ulnaris (FCU) stiffness in men and women during submaximal handgrip contractions. During a single session, measurements were made on 20 young participants (9 females). Two positions of the forearm were compared in random order with the elbow flexed 90 degrees: (i) neutral position and (ii) maximal supination. In each position, participants performed two submaximal handgrip contractions at 25% and 50% of maximal voluntary contraction, while compressive stiffness was collected using a hand myometer (MyotonPRO). A mixed repeated measurement ANOVA was applied to assess the interaction between gender, forearm position, and contraction intensity. The FCU stiffness is affected by handgrip contraction intensity (p < 0.001), gender (p < 0.001), BMI (p = 0.009), and forearm rotation (p = 0.007). Only the gender factor was found to have significant interaction with forearm rotation (p = 0.037). Men's FCU was stiffer than women's in both positions and contraction intensities (p < 0.05). Only in men a significant increase in FCU stiffness was observed when comparing contraction intensities at both forearm positions (p < 0.05), as well as when the forearm was rotated from neutral to supine at both intensities (p < 0.05). In conclusion, FCU stiffness during handgrip contraction differed significantly between men and women. Women have fewer stiffness changes in FCU when performing different levels of handgrip contraction. We also observed that only men increased FCU stiffness by changing the forearm position from neutral to supine position for both handgrip intensities. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) guided intra‐articular elbow injections are commonly performed in clinical practice. Objective: To describe a proximal to distal approach for US‐guided intra‐articular elbow injection. Design: Cadaveric study. Settings: Academic institution. Methods: Both elbows of a single cadaver were injected with green‐colored water‐diluted latex dye using the US‐guided proximal to distal approach. In the left elbow, the needle was kept in situ; in the right elbow, the needle was removed. Subsequently, a layer‐by‐layer anatomical dissection was performed in both elbows. Main Outcome Measures: Presence and distribution of the latex dye and location of the needle tip within the elbow joint capsule. Results: Anatomical dissection of both elbows confirmed the correct intra‐articular position of the needle tip in the left elbow as well as correct placement of the latex dye bilaterally. During layer‐by‐layer dissection of the left elbow, the position of the radial nerve was observed anterior to the needle. Conclusions: This cadaveric observation demonstrated that the US‐guided proximal to distal approach is a convenient technique to access the elbow joint. Compared to the previously described techniques, the in‐plane, proximal to distal approach may provide excellent needle visibility during the entire procedure, precisely targeting the articular space. The preliminary data need to be validated in additional clinical studies. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Bicipitoradial bursitis is an unusual cause of cubital fossa pain in PsA patients. Bedside Ultrasound is a valuable tool to correlate the source of pain in rheumatic and musculoskeletal diseases. [ABSTRACT FROM AUTHOR]

Purpose: Bone tumors around the elbow are rare, with frequently delayed diagnosis. The current study aimed to assess the functional and oncological outcomes of limb salvage surgery for primary benign aggressive or malignant bone tumors around the elbow. Methods: We conducted a retrospective review of patients with primary aggressive benign and malignant bone tumors around the elbow treated with limb salvage surgery between 1995 and 2020 at a single musculoskeletal oncology center. The minimum follow-up period was 24 months. Functional results were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the last follow‐up visit. Local recurrence, chest metastasis, and complications were recorded. Results: This study included 30 patients, 19 males and 11 females, with a mean age of 25.4 ± 14.2 years. The tumor location was the distal humerus (n = 21), proximal radius (n = 5), and proximal ulna (n = 4). Reconstruction was done by elbow fusion using fibular graft (n = 10), mobile endoprosthesis (n = 9), excision arthroplasty (n = 7), and extracorporeal freezing and reimplantation (n = 4). The mean follow-up period was 36.2 ± 21.3 months. The median follow-up MSTS score was 27 [Interquartile range (IQR): 26–30]. Skeletally immature patients had a significantly higher MSTS score. The rate of postoperative complications was 26.7%. Conclusion: Limb salvage surgery with different reconstructive options for benign aggressive and malignant bone tumors around the elbow can achieve good functional and oncological outcomes. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Summary: A yearling Oldenburg filly presented for acute severe forelimb lameness, localised to the cubital joint by intrasynovial anaesthesia. Computed tomographic examination of the elbow under general anaesthesia revealed a region of osseous resorption surrounded by a sclerotic rim within the medial epicondyle of the humerus. The lesion was confirmed via arthroscopy and treated with debridement and subsequent intra‐articular stem cell therapy. The authors describe a resorptive subchondral bone lesion in a previously undescribed location within the elbow. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Chondrosarcoma, although rare in the distal radius, poses significant challenges. Early diagnosis through incisional biopsy is essential. Surgical resection with margin control and fibular grafting can be effective, but vigilant surveillance is crucial due to its aggressive nature. Metastasis demands consideration of additional interventions or palliative care. Chondrosarcomas constitute a rarity in the upper limbs, and their occurrence in the distal radius is even rarer with only one case previously documented. We report a case of distal radius chondrosarcoma in a 35‐year‐old female patient who presented with pain and swelling in her left wrist. Following an initial examination, an incisional biopsy was performed, confirming the diagnosis of dedifferentiated chondrosarcoma. The patient underwent a marginal resection of the distal radius and first carpal with ipsilateral fibular and locking compression plate fixation. Unfortunately, despite the interventions, the patient experienced recurrent swelling and ultimately required below‐elbow amputation, followed by above elbow amputation due to metastasis. Unfortunately, the patient passed away due to recurrence and metastasis. [ABSTRACT FROM AUTHOR]

Patients had pulmonary nodules discovered on a variety of imaging modalities (77 via whole lung CT, 8 via partial lung CT and 15 via nuclear medicine studies). A thorough analysis of patient history, previous imaging studies and other investigations as well as clinical examination could negate the use of CT brain studies for all patients with first-episode psychosis at Nepean Blue Mountains Local Health District with imaging studies only performed for a subset of patients that require it for further evaluation. MRI may be more useful when imaging younger patients due to lower radiation exposure, and higher reported accuracy of MRI than CT in diagnosing diverticulitis in younger patients (4). The positive diagnosis rate of computed tomography scans performed for symptomatic Neutropaen... V Chang 1, E Liang 2 and P Schmidt 3 1 Griffith University, School of Medicine and Dentistry, Queensland, Australia, 2 Princess Al... B Purpose: b The use of computed tomography (CT) to locate the source of infection in patients with febrile neutropaenia has been documented as early as 1996. Junior doctors do not understand contrast phases in CT imaging - results from a single-centre... A Ajjikuttira 1, M Gandhi 1, C Hacking 1 and A Coulthard 1,2 1 Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, 2 Department of Medici... B Purpose: b Cross sectional computed tomography (CT) is an important investigation in the clinician's arsenal. [Extracted from the article]

Angiogenesis and accompanying nerve fibres might cause unsettling joint pain. Studies have suggested that transcatheter arterial embolisation (TAE) of these abnormal neovessels could relieve pain and symptoms in patients with upper limb joint pain refractory to conventional treatment. This study aims to investigate the efficacy and safety of TAE in treating chronic pain of shoulder and elbow joints that have been resistant to other treatments. Using six databases, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. The primary outcome involved changes in the visual analogue scale (VAS) after TAE; while secondary outcomes involved comparing other parameters where relevant. Average VAS decreased from baseline, then at 1 day, 1 week, 1 month, 3 months, 4 months, 6 months, 1 year, 2 years and 44 months (7.5 at baseline vs. 4.7, 4.3, 3.4, 2.1, 2.5, 1.2, 0.7, 1.1 and 0.1, respectively). Average Quick‐DASH scores decreased from baseline, then at 1, 3 and 6 months (61.3 at baseline vs. 30.6, 19.3 and 6.9, respectively). Minor adverse events were reported in 27/143 (18.9%) patients, where they resolved spontaneously or with oral analgesia. TAE is a possible treatment option for refractory shoulder and elbow joint pain; however, randomised controlled trials are still required. [ABSTRACT FROM AUTHOR]

Objective: To analyze the association between preoperative electrodiagnostic (EDX) studies and postoperative pain and functional outcomes following ulnar nerve decompression and/or transposition for ulnar neuropathy at the elbow (UNE). Literature Survey: Protocol was submitted and database search was conducted by an experienced librarian of all available studies in the English language from 1990 to June 8, 2022. Databases included Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Scopus. Methodology: Inclusion criteria consisted of randomized controlled trials, prospective and retrospective longitudinal studies, and studies involving adults ≥18 years of age who underwent ulnar nerve decompression and/or transposition for UNE. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta‐analysis was not performed. Synthesis: A total of 289 studies were screened, and 8 retrospective cohort studies met inclusion criteria comprising 762 patients. A decreased or absent preoperative sensory nerve action potential amplitude (SNAP) showed significance with worse postoperative outcomes. The presence of preoperative conduction block showed significance in higher quality studies. There was limited evidence for slow preoperative motor conduction velocities or preoperative electromyography (EMG) abnormalities and postoperative outcomes. Overall quality assessment demonstrated that two studies had "good," four "fair," and two "poor" quality of evidence. Certainty in evidence was "low" due to risk of bias. Conclusions: A decreased or absent preoperative ulnar SNAP may predict worse postoperative outcomes. Per higher quality studies, preoperative conduction block at the elbow may also predict worse postoperative outcomes. Careful interpretation is required with a full understanding of the limited evidence, risk of bias, and low certainty in evidence to support the use of preoperative EDX to predict postoperative outcomes in UNE. [ABSTRACT FROM AUTHOR]

Posterior olecranon fracture dislocations (POFDs) were considered posterior Monteggia lesions, which were less described in the literature. The purpose of this study was to provide a systematic review of the diagnosis, treatment, prognosis, and complications of POFDs in adults. A systematic review was performed to identify all relevant studies on the POFDs in the PubMed, Web of Science, Embase, and MEDLINE databases. The methodological quality of the studies was scored using the Methodological Index for Non‐Randomized Studies (MINORS). A total of 117 patients were identified in the nine studies selected. The high‐energy injuries accounted for 42.7% of the included studies. The rates of concomitant coronoid process, radial head fractures, and lateral collateral ligament injury were 84.6% (99/117), 87.2% (102/117), and 5% (6/117), respectively. The procedure was performed with a dorsal mid longitudinal approach to reconstruct all injury components. The postoperative clinical scores included the Broberg/Morrey rating, with a mean rating of excellent or good at 66%, the mean DASH score was 20.6, and the mean ASES score was 83. The flexion and extension arc and forearm rotation arcs were 100° and 134°, respectively. Complications included arthrosis in 28.2% (33/117) of cases, fracture nonunion or delayed union in 9.4% (11/117) of cases, heterotopic ossification in 7% (8/117) of cases, and the re‐operation rate was 16% (19/117). There was nearly no postoperative ulnohumeral instability. The main characteristics of POFDs were disruptions of the trochlear notch, including the olecranon and coronoid processes, and severe radial head fractures, while the lateral collateral ligament was spared. Although the POFDs had a low frequency of instability, the prognosis was relatively poor. The POFDs should be considered independently. [ABSTRACT FROM AUTHOR]

Introduction: The frame index (FI), based on measurements of elbow breadth and height, is the body frame size parameter most frequently used in child and adolescent populations to assess skeletal robustness. In 2018, the first FI reference percentiles were elaborated with data of boys and girls aged 0–18 years from different European populations. In Argentina, the FI reference values were published in 2022. Objective: The present study aims to compare the Argentine (AR) and European (EU) FI reference percentiles to evaluate possible variation in bone robustness between populations. Methods: The values of the 3rd, 50th and 97th percentiles of the AR and EU FI references for boys and girls aged 4–14 years were compared using the Wilcoxon test (p <.05). Percentage differences between means (PDM) were calculated to analyze the magnitude of the differences between both references. The R 3.2.0 program was used to plot the percentile curves. Results: The FI reference values were lower in AR than in EU in both the 3rd and the 50th percentiles, regardless of sex and age. Conversely, the AR reference values of the 97th percentile were higher than the EU values at most ages. Conclusions: The comparison of the AR and EU FI references showed similar age and sex growth patterns. However, differences in percentile values between populations were observed, highlighting the importance of having local references for the evaluation of skeletal robustness. [ABSTRACT FROM AUTHOR]

Nerve transfer or grafting surgery to restore elbow flexion in peripheral nerve injuries has been an effective technique, but alters neuromuscular control compared with healthy individuals. This study compared neuromuscular control in the elbow flexors of 11 unimpaired control subjects and 11 adult patients with traumatic brachial plexus injury who underwent a nerve transfer or grafting procedure to the biceps motor branch to restore elbow flexion. The subjects performed a series of trials to generate a specific percentage of their maximum elbow torque. Each trial had an increasing and decreasing stairstep torque pattern that the subjects were asked to match. The amount of time that the subject's elbow torque was maintained within 5% of the target torque was calculated. The hypothesis was that there was a significant difference in the neuromuscular control between the two groups during elbow isometric torque generation. A secondary hypothesis was that a relationship existed between the neuromuscular control and the torque level for each group. The results demonstrated that neuromuscular control was different between the groups and there were significant differences in how torque levels are generated. The control group more easily modulated their myoelectric activation and achieved greater neuromuscular control variability with varying torque demand. The nerve transfer or grafting group could not modulate their myoelectric activation with changing torque demands. Further studies focusing on the improvement of neuromuscular control are needed to optimize functional outcomes in nerve injury patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Lateral and medial epicondylitis are relatively common diseases, but they do not improve quickly and are known to reduce patients' quality of life. Much research has been done on Platelet‐Rich Plasma (PRP) as a treatment for lateral epicondylitis, but research on medial epicondylitis is lacking. The purpose of this study is to compare: (i) the pain intensity; and (ii) the functional outcome between the simultaneous treatment of medial and lateral epicondylitis and the treatment of only lateral or medial epicondylitis using PRP. Methods: In this retrospective study, 209 patients treated with PRP on epicondylitis between March 2018 and December 2021 were enrolled. Simultaneous treatment was underwent 68 patients (group I). Seventy patients were treated for lateral epicondylitis (group II). The remaining 71 patients were treated for medial epicondylitis (group III). The visual analogue scale for pain (VAS) and the Mayo elbow performance score (MEPS) were evaluated for clinical outcomes at the initial visit and 6 months after injection. Results: VAS for pain and MEPS showed significant improvement in all three groups compared to before treatment. There was no significant difference between three groups on –ΔVAS (P > 0.05). However, in case of ΔMEPS, group III showed significantly lower compared to groups II and III (P < 0.05). No patients showed worsening of symptoms or complications during the treatment. Conclusion: PRP injection for the patient with elbow medial and lateral epicondylitis can be treated effectively simultaneously in terms of pain. From a functional point of view, the effect of simultaneous treatment may be lessened than in the case of only lateral and medial treatment. [ABSTRACT FROM AUTHOR]

Objective: Complications related to triceps after total elbow arthroplasty (TEA) have become a major surgical concern. The triceps‐preserving approach has the advantage of not disturbing the insertion of triceps but is disadvantaged by the reduced exposure of the elbow joint. The aim of this study was to investigate the clinical and radiological outcomes of TEA with a triceps‐preserving approach and to compare the outcomes of TEA to treat arthropathy with that of TEA to treat acute distal humerus fracture. Methods: From January 2010 to December 2018, 23 patients undergoing primary TEAs were retrospectively reviewed with a mean follow‐up time of 92.6 months (range, 52–136 months). Each TEA was performed using the triceps‐preserving approach with a semi‐constrained Coonrad–Morrey prosthesis. Patient demographics, range of motion (ROM), pain visual analogue scale (VAS), and triceps strength (Medical Research Council [MRC] scale) were compared before and after surgery. The Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiographic outcome, and complications were evaluated at follow‐up. Results: In total, seven males and 16 females were included in this study, with a mean age of 66.1 years (range:46–85 years). By the last follow‐up, pain had been significantly relieved in all patients. The average MEPS in the arthropathy group and fracture group were 90.8 ± 10.3 points (range: 68–98 points) and 91.7 ± 0.4 (range: 76–100 points), respectively. The average DASH of the arthropathy group and fracture group was 37.3 ± 18.8 points (range: 18–52 points) and 38.4 ± 20.1 (range: 16–60 points). At the last follow‐up after surgery, the mean flexion arcs in the arthropathy group and fracture group were 100.4° ± 24.1° and 97.8° ± 28.1°, respectively. The mean pro‐supination arcs in the arthropathy group and fracture group were 142.4° ± 15.2° and 139.2° ± 17.5°, respectively. There were no significant differences in clinical outcomes between the two groups (P ≥ 0.05). Triceps strength was normal (MRC grade V) in 15 elbows and good in eight elbows. None of the cases experienced weakness of the triceps strength, infection, periprosthetic fractures, or prosthesis breakage. Conclusions: The clinical and radiographical outcomes of TEA with the triceps‐preserving approach were satisfactory in patients with distal humerus fracture, osteoarthritis and rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Objective: Olecranon osteotomy and paratricipital approaches were widely used in the treatment of type C distal humerus fracture but some disadvantages exist, so a combined medial and lateral approach was designed. The objective of this study was to investigate and compare the clinical outcomes of combined medial and lateral approach with the paratricipital approach in open reduction and internal fixation of type C distal humerus fractures. Methods: From May 2018 to April 2020, 37 patients with type C distal humerus fracture who accepted open reduction and internal fixation in our hospital were enrolled in this study. All cases were randomly divided into two groups according to the surgical approach: combined medial and lateral approach group (19 cases), paratricipital approach group (18 cases). All of the patients received open reduction and double vertical plates fixation. The operation and follow‐up indexes, including operation time, blood loss, incision length, triceps muscle strength, flexion‐extension arc of elbow and forearm rotation arc, were recorded and compared. Caja score was used to assess the quality of fractures reduction. Mayo Elbow Performance Score (MEPS) was used to evaluate the elbow function in the follow‐up. Complications such as incision infection, ulnar nerve injury, degenerative osteoarthritis, and heterotopic ossification were analyzed. Results: The differences in age, gender, and AO classification of fractures between two groups were not statistically significant (p > 0.05). The sum of medial and lateral incision length of combined approach group was longer than the midline incision of paratricipital approach group (15.4 ± 0.8 vs. 14.6 ± 0.8, p < 0.05), but there was no significant difference in operation time (103.5 ± 10.2 vs. 106.0 ± 8.8, p > 0.05), blood loss (71.3 ± 24.5 vs. 72.8 ± 24.6, p > 0.05), and Caja score (16.05 ± 5.67 vs. 15.56 ± 5.66, p > 0.05). During the follow‐up, the MEPS of combined approach group was higher than that of paratricipital approach group at 3 months postoperatively (80.5 ± 5.7 vs. 68.9 ± 8.1, p < 0.05), but there was no significant difference in MEPS at 6 months postoperatively (83.9 ± 6.6 vs. 79.7 ± 7.0, p > 0.05) and at the last follow‐up (86.8 ± 7.1 vs. 86.9 ± 7.7, p > 0.05) between the two groups. There was no significant difference in triceps muscle strength (p > 0.05), flexion‐extension arc (126.8 ± 5.3 vs. 128.9 ± 6.0, p > 0.05), and forearm rotation arc (163.2 ± 5.3 vs. 163.6 ± 4.8, p > 0.05) at the last follow‐up. Although the incidence of complication of combined approach group (15.8%) was lower than that of paratricipital approach group (22.2%), the difference was not statistically significant (p > 0.05). Conclusions: The combined medial and lateral approach was an effective and safe way of open reduction and internal fixation for type C distal humerus fractures. Compared with the paratricipital approach, the combined medial and lateral approach could restore the elbow function more quickly postoperatively, and the long‐term results were comparable. [ABSTRACT FROM AUTHOR]

Objective: Studies on extremely severe elbow stiffness after chronic dislocation in children are scarce. This study aims to investigate the choice of surgical treatment modalities and to analyze their treatment efficacy in children with chronic elbow dislocation with extremely severe periarticular stiffness. Methods: Data of 21 children with chronic elbow dislocation with extremely severe periarticular stiffness diagnosed and treated in our department between February 2015 and February 2021 were retrospectively analyzed. Twenty boys and one girl were included in the study, their mean age was 11 ± 2.5 years, and they had concomitant distal humerus fractures. For the treatment protocol, all children with extremely severe elbow stiffness were treated with open arthrolysis, and elbow joint stability was intraoperatively assessed. All children performed passive functional exercises the day after surgery. The elbow flexion and extension angles, range of motion (ROM), and Mayo score were evaluated preoperatively and at the final follow‐up. Results: Of the 21 children, only one had recurrent severe stiffness of the elbow joint after surgery; nevertheless, the function was still improved compared with that before surgery. Preoperatively, the mean elbow extension and flexion angles were 72.2° ± 12.7° and 93.6° ± 11.1°, respectively, and the range of motion (ROM) of the elbow joint was 17.8° ± 8.3°. At the final follow‐up, the mean elbow extension and flexion angles were 22.7° ± 18.6° and 118.8° ± 15.4°, respectively, and the elbow joint ROM was 96.1° ± 17.4°. The differences in the preoperative and postoperative ROMs, flexion angles, and extension angles of the elbow joint were significant (p < 0.01). The MEPS at the final follow‐up was 78.57 ± 14.24, which was significantly higher than preoperative (29.76 ± 10.89), and the excellent rate was 81%. Conclusion: Open arthrolysis and open reduction and internal fixation of the elbow joint are effective in treating chronic elbow dislocation with extremely severe stiffness in children. [ABSTRACT FROM AUTHOR]

There is considerable controversy regarding the optimal approach (open vs arthroscopic) of releasing and/or debridement for the treatment of tennis elbow (TE). The aim of this study was to determine the clinical outcomes of the two techniques by quantitatively synthesizing outcome data. The study was performed by searching the PubMed, EMBASE, Ovid, and Elsevier databases between January 1995 and April 2022 for a minimum follow‐up of 6 months. The searching strategy was "(tennis elbow [Title/Abstract] OR lateral epicondylitis [Title/Abstract]) AND (open [Title/Abstract] OR arthroscopic [Title/Abstract] OR release [Title/Abstract] OR debridement [Title/Abstract] OR surgery [Title/Abstract])". The quality of each study was investigated using the Coleman Methodology Score. In total, 1411 (693 open, 718 arthroscopic) elbows in 1392 patients who underwent releasing and debridement for tennis elbow were identified. The mean Coleman Methodology Score for the included studies was 55.2 ± 8.6 (open: 55.0 ± 9.4, arthroscopic: 55.8 ± 8.2). Improved clinical results were achieved after treatment with either open or arthroscopic treatment. The surgical success rate was 95.6% in open surgery and 92.4% in arthroscopic management. The complication rates were 2.2% and 1.5% for open and arthroscopic procedures, respectively. Similar subjective and objective outcomes, and surgical success rate were observed in patients with both techniques. Patients who had undergone arthroscopic release seemed to return to work earlier (5.3 weeks vs 7.1 weeks). To draw more definite conclusions, high‐quality long‐term follow‐up randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

Objective: The suitability of in situ cast fixation for treating Gartland IIA humeral supracondylar fractures has remained controversial due to concerns regarding loss of elbow flexion. This study aimed to assess the instant loss of elbow flexion after Gartland IIA humeral supracondylar fractures based on the relationship between the anterior marginal line of the humerus and capitellum in the lateral view. Methods: This simulation study was conducted with normal radiographs using Adobe Photoshop 14.0, followed by verification using clinical cases. Standard lateral views of normal elbows of children were collected from January 2008 to February 2020. Adobe Photoshop was used to simulate Gartland IIA supracondylar fractures with different degrees of angulation in the sagittal plane. A formula was deduced to assess flexion loss, and this method was verified in three cases. The data were grouped by age, and the relationship between elbow flexion loss and age, as well as the angulation of the fracture, was analyzed using a one‐way or multivariate ANOVA. Results: There was a flexion loss of 19° (11–30°) when the anterior margin line of the humerus was tangential to the capitellum. This loss increased with age at injury (r = 0.731, P = 0.000). Moreover, the difference in angulation in the sagittal plane also influenced the extent of elbow flexion loss (r = −0.739, P = 0.000). The more horizontal the fracture line in the lateral view, the greater the loss of elbow flexion. Conclusion: Instant elbow flexion loss after Gartland IIA humeral supracondylar fractures increases with age at the time of injury and decreases with angulation in the sagittal plane. When the anterior margin of the humerus is tangential to the capitellum, there will be an average loss of 19° in elbow flexion. These findings provide a quantitative reference for clinical decision‐making in the treatment of Gartland IIA supracondylar fractures. [ABSTRACT FROM AUTHOR]

Background: Auslan is used by the Australian deaf community and relies heavily on hand, wrist, and elbow movement. Upper limb injury or dysfunction may require surgical intervention to alleviate pain and provide a stable skeleton for function, leading to partial or complete reduction in motion. The aim of this study was to assess the wrist, forearm, and elbow motion required to communicate via Auslan, to tailor optimal interventions in this population. Methods: A biomechanical analysis was conducted on two native Auslan communicators, who signed 28 pre‐selected and common Auslan words and phrases. Results: Sagittal plane wrist and elbow motion was found to be of greater importance than axial plane forearm rotation. Relative elbow flexion and generous wrist motion was common for many of the words and phrases, while end‐range elbow extension was not recorded. Conclusion: The maintenance of wrist and elbow motion should be prioritized when selecting surgical interventions for patients who communicate using Auslan. [ABSTRACT FROM AUTHOR]

Background and purpose: Intramuscular blood flow increases during physical activity and may be quantified immediately following exercise using power Doppler sonography. Post‐exercise intramuscular blood flow is reduced in patients with muscular dystrophy, associated with disease severity and degenerative changes. It is not known if intramuscular blood flow is reduced in patients with neuropathy, nor if it correlates with muscle strength and structural changes. The aim was to determine whether blood flow is reduced in patients with polyneuropathy due to Charcot–Marie–Tooth disease type 1 (CMT1) and to compare more affected distal to less affected proximal muscles. Methods: This was a cross‐sectional study including 21 healthy volunteers and 17 CMT patients. Power Doppler ultrasound was used to quantify post‐exercise intramuscular blood flow in distal (gastrocnemius) and proximal (elbow flexor) muscles. Intramuscular blood flow was compared to muscle echo intensity, muscle strength, disease severity score, patient age and electromyography. Results: Polyneuropathy patients showed reduced post‐exercise blood flow in both gastrocnemius and elbow flexors compared to controls. A more prominent reduction was seen in the gastrocnemius (2.51% vs. 10.34%, p < 0.0001) than in elbow flexors (4.48% vs. 7.03%, p < 0.0001). Gastrocnemius intramuscular blood flow correlated with muscle strength, disease severity and age. Receiver operating characteristic analysis showed that quantification of intramuscular blood flow was superior to echo intensity for detecting impairment in the gastrocnemius (area under the curve 0.962 vs. 0.738, p = 0.0126). Conclusion: Post‐exercise intramuscular blood flow is reduced in CMT1 polyneuropathy. This reduction is present in both impaired distal and minimally affected proximal muscles, indicating it as an early marker of muscle impairment due to neuropathy. [ABSTRACT FROM AUTHOR]