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Background: Aim of this paper is to validate a procedure for correcting elbow flexion contracture in patients suffering from brachial plexus neonatal palsy sequelae during their teens. Elbow flexion contracture represents an unsolved problem in the natural history of obstetric brachial plexus palsy (OBPP) because of the consistent deformity recurrence. Following a previous paper, in which an original technique was proposed in a small sample of patients, the authors show the possible correction of the deformity in a larger group of patients. Methods: The procedure includes a combination of a posterior approach to the elbow with olecranon tip section and an anterior one with capsulotomy and soft tissue release to improve elbow range of motion. A series of 26 patients, who underwent the procedure, were checked out in medium and long term. Collected data were age, type of brachial plexus palsy, length of hospitalization, duration of surgery, preoperative and postoperative elbow range of motion, preoperative and postoperative DASH scores and satisfaction scores. Explaining further details about the procedure, the Authors report their results, including a statistical analysis. Results: At the final follow-up, the mean increase of elbow extension was about 22°. Functional outcomes were successful as well, with a mean increase of 10 points of DASH score. Over 75% of patients were fully satisfied with their outcome. Conclusions: The outcome has confirmed the good efficacy of the procedure in increasing elbow extension but also in improving cosmetic appearance in adolescents suffering from flexed elbow in OBPP sequelae. [ABSTRACT FROM AUTHOR]

Asymptomatic elbow abnormalities are relatively common in young baseball players, but the factors responsible are unclear. To prospectively identify risk factors related to symptom manifestation in asymptomatic elbow abnormalities, we recruited 573 baseball players (age: 7–14 years) at a pre-participation medical/physical examination in the preseason who were right-handed and had asymptomatic medial elbow abnormalities on ultrasound (US). Baseline preseason and postseason participant characteristics were assessed. A "symptomatic" elbow was defined as an elbow with medial elbow joint problems that prevented ball throwing for ≥ 8 days. After exclusions, 82 players were enrolled, of whom 22 (26.8%) developed a symptomatic elbow. In univariate analyses, the external and internal rotation strengths of the dominant shoulder were significantly greater in the symptomatic group than in the asymptomatic group (P = 0.021). Multivariate logistic regression analysis showed that the internal rotation strength of the dominant shoulder was a significant independent risk factor (odds ratio = 1.091, P = 0.027) for developing a symptomatic elbow. In young asymptomatic baseball players with abnormalities in the medial elbow region of the dominant arm on US, stronger preseason internal rotation strength of the dominant shoulder was a significant independent risk factor for the development of a "symptomatic" elbow. [ABSTRACT FROM AUTHOR]

Introduction. Distal arthrogryposis type 5D (DA5D) is an autosomal recessive disease. The clinical symptoms include contractures of the joints of limbs, especially camptodactyly of the hands and/or feet, unilateral ptosis, a round-shaped face, arched eyebrows, and micrognathia, without ophthalmoplegia. ECEL1 is a DA5D causative gene that encodes a membrane-bound metalloprotease. ECEL1 plays important roles in the final axonal arborization of motor nerves in limb skeletal muscles and neuromuscular junction formation during prenatal development. Methods. A DA5D family with webbing of the elbows and fingers was recruited. We performed whole-exome sequencing (WES) and filtered mutations by disease-causing genes of arthrogryposis multiplex congenita (AMC). Mutational analysis and cosegregation confirmation were then performed. Results. We identified novel compound heterozygous mutations of ECEL1 (NM_004826: c.69C>A, p.C23 ∗ and c.1810G>A, p.G604R) in the proband. Conclusions. We detected causative mutations in a DA5D family, expanding the spectrum of known ECEL1 mutations and contributing to the clinical diagnosis of DA5D. [ABSTRACT FROM AUTHOR]

Introduction. Distal arthrogryposis type 5D (DA5D) is an autosomal recessive disease. The clinical symptoms include contractures of the joints of limbs, especially camptodactyly of the hands and/or feet, unilateral ptosis, a round-shaped face, arched eyebrows, and micrognathia, without ophthalmoplegia. ECEL1 is a DA5D causative gene that encodes a membrane-bound metalloprotease. ECEL1 plays important roles in the final axonal arborization of motor nerves in limb skeletal muscles and neuromuscular junction formation during prenatal development. Methods. A DA5D family with webbing of the elbows and fingers was recruited. We performed whole-exome sequencing (WES) and filtered mutations by disease-causing genes of arthrogryposis multiplex congenita (AMC). Mutational analysis and cosegregation confirmation were then performed. Results. We identified novel compound heterozygous mutations of ECEL1 (NM_004826: c.69C>A, p.C23* and c.1810G>A, p.G604R) in the proband. Conclusions. We detected causative mutations in a DA5D family, expanding the spectrum of known ECEL1 mutations and contributing to the clinical diagnosis of DA5D. [ABSTRACT FROM AUTHOR]

Background: Pedobarographic analyses detect pressure redistribution among limbs and within limbs in humans, equids and dogs. The main objective of this study was to assess the usefulness of a set of pedobarographic parameters for the detection of lameness, as well as for its suitability for assessing the effects of therapies against osteoarthritis in dogs. With this purpose, eleven large-breed lame dogs with unilateral osteoarthritis due to elbow dysplasia were evaluated using a pressure platform prior to (D0) and after 3 months (D90) of treatment with mavacoxib, a COX-2 selective NSAID. The obtained parameters were: pressure distribution between lame and sound limbs, as well as paw area, mean pressure, and peak pressure of both lame and sound limbs. Results: The results showed statistical differences in all these parameters between lame and sound limbs at D0; however, at D90, differences were significantly decreased as result of the treatment, indicating a substantial functional recovery under the study design conditions. Conclusions: The provided data prove the suitability of this novel technique in canine models for the quantitative and objective assessment of lameness, but also for the evaluation of treatments for lameness caused by articular pain. [ABSTRACT FROM AUTHOR]

Ganglion of the anterolateral elbow is rare and may be associated with compression neuropathy of the radial nerve or its branches. Open ganglionectomy implies extensive soft tissue dissection. We present a case of anterolateral elbow ganglion without any compression neuropathy. This was successfully treated with endoscopic ganglionectomy. [ABSTRACT FROM AUTHOR]

Successful treatment of the chronic persistent elbow instability is a challenge for orthopedic surgeons. In this form, it is important to recognize and restore the osseous stabilizer in order to obtain the concentric reduction. In the present report, we describe a case of such injury with irreparable radial head treated with patient-specific radial head prosthesis which was created with 3D printing technology. To our knowledge, this is the first report in clinical use of this kind of prosthesis for the radial head fracture. At a 24-month follow-up visit, the patient was satisfied with the functional outcomes. The Mayo Elbow Performance Index (MEPI) increased from 20 points at the preoperative day to 85 points, and the patient-based Disabilities of the Arm, Shoulder, and Hand (DASH) was reduced from 88.33 points to 28.33 points. Due to the favorable result, replacement of the radial head with the patient-specific implant could be a useful treatment for the irreparable radial head in chronic persistent elbow instability. [ABSTRACT FROM AUTHOR]

This study investigates the inter-tester repeatability of an upper limb direct kinematic (ULDK) model specifically for the reporting of elbow flexion-extension (FE) during overhead sporting movements, such as cricket bowling. The ULDK model consists of an upper arm and a forearm connected with a 6° of freedom elbow joint. The ULDK model was assessed for inter-tester repeatability by calculating elbow FE during cricket bowling in two sessions, with unique testers applying the kinematic marker set in each session. Analysis of both elbow FE time-varying waveforms (statistical parametric mapping = 0% time different) and extracted discrete events (no statistical differences, strong correlations > 0.9) support that this model is inter-tester repeatable at assessing elbow FE within the context of cricket bowling. This model is recommended as a framework in future studies for measuring elbow kinematics during other overhead sporting tasks, with recommendations for further participant-specific considerations. Graphical abstract ᅟ. [ABSTRACT FROM AUTHOR]

Background. In individuals with hemiparetic stroke, reaching with the paretic arm can be impaired by abnormal muscle coactivation. Prior trails for improving upper extremity functions after stroke have underestimated the role of gravitational force in motor planning and execution. Objective. The aims this trial were to study the effect of gravity as a facilitator for elbow extension and to estimate the immediate and retention effects of task specific training of elbow extensors on upper extremity function after stroke. Methods. Twenty-six right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received treatment through two phases. Phase one included training for the elbow extensors in an antigravity position. Phase two included a set of task specific exercise for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by Nine-Hole Peg Test and Fugl-Meyer upper extremity. Goniometry was used for measuring elbow extension and forearm supination active ranges of motion. Results. Significant improvements were observed in Nine-Hole Peg Test, Fugl-Meyer upper extremity, and ranges of motion at postintervention and follow-up compared to preintervention at P≤0.05. Conclusions. The results of this study provide an evidence that antigravity positions can be used as a centrally presented facilitator of elbow extension. Additionally, task specific training was effective in improving upper extremity function and elbow extension range of motion. [ABSTRACT FROM AUTHOR]

Nerve entrapment syndromes of the upper extremity are associated with structural abnormalities or by an intrinsic abnormality of the nerve. Nerve entrapment syndromes generally have a typical clinical presentation, and findings on physical examination and in conjunction with electrodiagnostic studies imaging is used to evaluate the cause, severity, and etiology of the entrapment. With the development of high-frequency linear array transducers (12-24 MHz), ultrasound (US) is incomparable in terms of spatial resolution to depict morphological aspects and changes in nerves. US can identify the abnormalities causing entrapment, such as fibrous bands, ganglia, anomalous muscles, and osseous deformities, with the advantage of dynamic assessment under active and passive examination. US is a unique diagnostic modality that allows superb visualization of both large and small peripheral terminal nerve branches of the upper extremity and enables the correct diagnosis of various nerve entrapment syndromes. [ABSTRACT FROM AUTHOR]

Background: The objective of our study was to analyze, under fluoroscopy, joint angulation of uninjured elbows and elbows with distinct induced collateral ligament injury.Methods: Twelve elbow specimens were tested for varus and valgus joint angulation using 4 different examination methods (application of both varus and valgus stress by each of 2 examiners [Examiner 1 and Examiner 2] and application of 1 and 2 Nm of torque using a calibrated electric force scale) in 4 elbow positions (in full extension with 90° of supination and 90° of pronation, and in 30° of flexion with 90° of supination and 90° of pronation). Six elbow specimens were examined under varus stress at each of 5 sequential stages: (1) intact, (2) transection of the lateral ulnar collateral ligament (LUCL), (3) complete transection of the lateral collateral ligament complex (LCLC), (4) transection of the anterior aspect of the capsule (AC), and (5) transection of the medial collateral ligament (MCL). An additional 6 elbow specimens were examined under valgus stress at 5 sequential stages: (1) intact, (2) transection of the anteromedial collateral ligament (AML), (3) complete transection of the MCL, (4) transection of the AC, and (5) transection of the LCLC. Examinations under fluoroscopy were made to measure the joint angulation. Intraclass correlation coefficients (ICCs) were calculated.Results: Testing of the intact elbow specimen by both examiners showed a joint angulation of <5°. Transection of the LUCL led to a varus joint angulation of 4.3° to 7.0°, and transection of the AML resulted in a valgus joint angulation of 4.9° to 8.8°. Complete dissection of the respective collateral ligament complex resulted in a joint angulation of 7.9° to 13.4° (LCLC) and 9.1° to 12.3° (MCL), and additional transection of the AC led to a joint angulation of >20° in some positions in both the medial and the lateral series. Under varus stress, elbow dislocations occurred only after dissection of the LCLC+AC (26% of the examinations) and additional dissection of the MCL (59%). Under valgus stress, elbow dislocations occurred only after dissection of the MCL+AC (30%) and additional dissection of the LCLC (47%). Very good to excellent ICCs were found among Examiners 1 and 2 and the tests done with the standardized torques at stages 1 through 4.Conclusions: Dynamic fluoroscopy makes it possible to distinguish among different stages of collateral ligament injury of the elbow and therefore might be helpful for guiding treatment of simple elbow dislocations.Clinical Relevance: Assessment of collateral ligament injury with varus and valgus stress testing under fluoroscopy is an easily available method and is often used as the imaging modality of choice to determine the degree of elbow laxity. The technique and results described in this study should form the basis for additional clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare different grades of elbow stiffness and investigate demographic, injury, and treatment factors potentially associated with the development of severe elbow stiffness.Methods: We performed a retrospective study involving 169 patients with post-traumatic elbow stiffness between June 2014 and June 2016. Patient demographics, injury, and treatment details were reviewed. Patients were classified into three groups according to the elbow motion. Ordinal regression analyses were performed to examine the independent factors.Results: Patients were classified into: mild (49 patients), moderate (59 patients), and severe (61 patients) groups. Patients with severe stiffness had a significantly worse elbow functional performance. Univariate ordinal regression revealed that severe elbow stiffness was associated with high-energy injury (odds ratio [OR] 4.73), olecranon fracture (OR 1.92), fracture-dislocation (OR 2.28), and open fracture (OR 3.24). Multivariate regression showed that higher-energy injuries were associated with severe stiffness (OR 4.45, p = 0.003).Conclusions: Elbow stiffness after fracture surgery often results in joint stiffness. Severe stiffness often resulted in more significant functional impairment. Our study suggested that high-energy injuries were associated with the development of severe elbow stiffness. [ABSTRACT FROM AUTHOR]

Medial epicondyle entrapment after an acute fracture dislocation of the elbow is a common finding in the pediatric population, but a rare finding in adults. We present a case of an adult patient diagnosed with a traumatic fracture dislocation of the elbow joint with intra-articular entrapment of the medial epicondyle. After initial evaluation, closed reduction was done. Stability testing after reduction showed an unstable joint; thus, open reduction and internal fixation was decided. [ABSTRACT FROM AUTHOR]

Background Injury to distal portion of posterior cord of brachial plexus leads to palsy of radial and axillary nerves. Symptoms are usually motor deficits of the deltoid muscle; triceps brachii muscle; and extensor muscles of the wrist, thumb, and fingers. Tendon transfers, nerve grafts, and nerve transfers are options for surgical treatment of proximal radial nerve palsy to restore some motor functions. Tendon transfer is painful, requires a long immobilization, and decreases donor muscle strength; nevertheless, nerve transfer produces promising outcomes. We present a patient with proximal radial nerve palsy following a blunt injury undergoing triple nerve transfer. Case Description The patient was involved in a motorcycle accident with complete palsy of the radial and axillary nerves. After 6 months, on admission, he showed spontaneous recovery of axillary nerve palsy, but radial nerve palsy remained. We performed triple nerve transfer, fascicle of ulnar nerve to long head of the triceps branch of radial nerve, flexor digitorum superficialis branch of median nerve to extensor carpi radialis brevis branch of radial nerve, and flexor carpi radialis branch of median nerve to posterior interosseous nerve, for restoration of elbow, wrist, and finger extensions, respectively. Conclusions Our experience confirmed functional elbow, wrist, and finger extensions in the patient. Triple nerve transfer restores functions of the upper limb in patients with debilitating radial nerve palsy after blunt injuries. [ABSTRACT FROM AUTHOR]

The article presents a case study of male Golden Retriever for analysis of subcutaneous mass present at caudolateral region of left elbow joint. Topics discussed include extension of tissue mass towards antebrachium's proximal region; diagnosis of extraskeletal mesenchymal chondrosarcomas issue in the Retriever; and assessment of mineralization concerns for soft and bone tissues tumors in the dog through computed tomography (CT) approaches.

Key Clinical Message It is often difficult to treat for elbow contractures by malformation of bones. We planned a mobilization of elbow with using three-dimensional full-scale bone modeling. We found it was effective to use it in preoperative planning because we could recognize the elements of contractures in every deformity. [ABSTRACT FROM AUTHOR]

Background The present study quantifies the field of view (FOV) from standard arthroscopy portals and aims to identify anatomical regions where the FOV is limited. Methods Eleven cadaveric elbows were examined through standard anteromedial, anterolateral and posterior portals. The FOV was marked with dye using a spinal needle. The articular surfaces were then exposed and the percentage FOV seen was calculated. FOV percentage areas were compared using a Student’s t-test (JMP, version 10, SAS Institute Inc., Cary, NC, USA). P < 0.05 was considered statistically significant. Results The mean (SD) FOV percentage area seen from the anteromedial portal and anterolateral portal was 91.69% (3.63%) and 92.03% (3.93%), respectively, for the anterior humerus articular surface. There was no significant difference in the mean FOV percentage area seen from the anteromedial and anterolateral portals (p = 0.99). The mean (SD) FOV percentage area of the posterior humerus articular surface was 84.69% (2.28%). The mean (SD) FOV percentage area seen of the radial head and trochlear was 16.05% (2.66%) and 4.14% (1.76%), respectively. Conclusions The present study is the first to quantify the FOV of elbow arthroscopy. The majority of the anterior and posterior humerus articular surface can be seen through standard portals. The limitations in FOV are primarily confined to the radial head and trochlear notch. [ABSTRACT FROM AUTHOR]

Prosthetic replacement of the elbow joint has continued to improve over time. Widespread implantation of certain designs has led to identification a few successful elements of elbow arthroplasty, as well as several opportunities for improvement. Current hot topics in elbow arthroplasty include triceps-preserving exposures, implantation of components with better-expected wear performance, management of the ulnar nerve, prevention of infection, and the development of successful cementless components. Total elbow arthroplasty has the potential to improve pain, function and quality of life for many patients with articular destruction secondary to inflammatory arthropathy or as a consequence of trauma. Continued advances in this field are key to make this operation as reliable and lasting as hip or knee arthroplasty. [ABSTRACT FROM AUTHOR]

Objective To explore the utility of neurologic examination to predict the pathophysiology of ulnar nerve lesions in patients with ulnar neuropathies at the elbow (UNE). Methods We prospectively recruited consecutive patients with suspected UNE. Four blinded investigators took a history and performed neurologic, electrodiagnostic (EDx) and ultrasonographic (US) examinations. In patients with axonal UNE, conduction block and conduction slowing, the pathophysiologies of UNE and neurologic examination findings were compared. Results We found significant differences in muscle bulk and strength of the ulnar hand muscles between 96 arms with axonal UNE, 34 with conduction block, and 45 with isolated conduction slowing. Severe muscle atrophy and weakness (0–3/5 on MRC) predicted axonal UNE, and moderate weakness (−4/5 on MRC) with normal muscle bulk predicted UNE with conduction block. Using more restrictive criteria for axonal and conduction block UNE, muscle strength of 4–5/5 on MRC was predictive of isolated conduction slowing. Conclusion Although we found significant differences in patterns of muscle bulk and strength between groups of UNE patients with different UNE pathophysiologies, in the majority of arms, neurologic examination could not reliably predict UNE pathophysiology. Significance Results confirm that nerve conduction studies are essential for determination of the pathophysiology of ulnar neuropathy at the elbow. [ABSTRACT FROM AUTHOR]

Background: Soft tissue defects on the posterior aspect of the elbow are commonly seen in patients treated with internal fixation for fractures around the elbow joint. An axial flap based on the radial recurrent artery (RRA) is very useful for such defects, especially if a posterior midline arm incision has been taken for skeletal fixation. The aim of this study is to describe the usefulness of RRA flap (based on the RRA) in the management of such defects. Materials and Methods: We present a retrospective analysis of 4 cases managed with the RRA flap for soft tissue reconstruction of defects around the elbow joint at our institute from January 2015 to August 2016. All the patients were males with a history of exposed implant following internal fixation of olecranon/distal humerus fracture. The size of defects ranged from 4 cm × 4 cm to 7 cm × 5 cm. Results of the analysis are presented here. Results: All flaps survived completely. There was no infection, hematoma or distal neurovascular deficit. There was minimal donor site morbidity. Conclusion: The RRA flap is a useful, simple flap for defects around the elbow joint in select patients providing one stage, reliable, cosmetically acceptable coverage. [ABSTRACT FROM AUTHOR]

Limited recommendations of wheelchair configurations for court sports have been identified in the published literature. To accommodate the wide range of impairments in wheelchair rugby, players are given a point score that reflects their impairment. Players have regularly been grouped as high-, mid-, or low-point players in research, with high-point players having greater levels of muscle function compared with other classifications. This research documented the wheelchair configurations of elite Australian wheelchair rugby players across classification groups. Significant differences ( p < 0.05) were found for increased seat height and decreased seat depth for high-point players compared with low- and mid-point groups, respectively. Low-point players displayed reduced wheelchair mass compared with high- and mid-point players, as well as increased frame length. Camber angles showed no significant differences across the classification groups. The incorporation of anthropometric measures, such as the elbow angle at the top dead center, was also investigated. While elbow angle showed no significant differences, seat height-to-total arm length ratio was higher for high-point players. Participants also completed surveys detailing their perception of the effect of altering wheelchair configurations. It is suggested that wheelchair configurations should consider an individual's anthropometrics, impairment, training history, and court role to promote optimal performance, with predictive modeling having the potential to reduce the associated time and cost. [ABSTRACT FROM AUTHOR]

Background: Congenital proximal radioulnar synostosis is the most common congenital disease of the elbow joints and forearms. Methods: This was a prospective study of 12 consecutive children (14 forearms) who presented to the National Institute of Neuromotor System in Egypt between September 2012 and September 2013 with severe congenital proximal radioulnar synostosis, having a mean pronation deformity of 70.7° (range 60°-85°), and who underwent operative correction by single-session double-level rotational osteotomy and percutaneous intramedullary K-wires of both the radius and ulna. Ten forearms were type III, and four were type II according to Cleary and Omer classification. The mean age at the time of surgery was 5 years and 2 months (range 4 years and 10 months to 6 years and 5 months). They were evaluated for functional results after rotational corrective osteotomy at a mean interval of 30.4 months (range 24-36 months) by physical examination and radiographs. Results: All children had a mean pronation deformity correction of 59.8° (range 30°-90°) reaching a final position of 20°-30° of pronation in the affected dominant extremities and 20° of supination in the affected non-dominant extremities after osteotomy. All children showed improvement in functional activities, with no loss of correction or non-union in any child, and no circulatory disturbances, neuropathies, or hypertrophic scars. Conclusion: Minimally invasive single-session double-level rotation osteotomy of the proximal ulna and distal radius with percutaneous intramedullary K-wire fixation is a safe, technically simple and efficient procedure which corrects pronation deformity. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of axial traction during MR arthrography (MRA) of the elbow joint on joint space widening, contrast dispersion between opposing cartilage surfaces and cartilage surface visibility. Methods: 11 patients with elbow MRA with and without axial traction were prospectively studied. Two radiologists independently measured the elbow joint space width and semi-quantitatively graded contrast material dispersion between the opposing cartilage surfaces as well as the articular cartilage surface visibility before and after traction. The detection and visibility of articular cartilage defects were also compared before and after traction. Patients were instructed to report on pain or any other symptoms during elbow traction. Results: No patient reported discomfort, pain or any other symptoms related to traction on immediate and intermediate-term follow-up. Joint space width increased, more at the radiocapitellar joint space (Δ = 0.63 mm, p = 0.005) than at the ulnotrochlear joint space (Δ = 0.17 mm, p = 0.012), with contrast dispersion into the radiocapitellar joint and cartilage visibility of the radiocapitellar joint space significantly improving after traction (all p < 0.05). All of these parameters also improved at the ulnotrochlear joint, although this did not reach statistical significance. Traction improved the visibility of cartilage defects. Conclusion: This is the first study to evaluate the effect of traction on MRA of the elbow joint. This technique is safe and technically feasible. Traction MRA improves the cartilage surface visibility and cartilage defect visibility. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the influence of the joint position on elbow flexors and extensors torque in healthy individuals and to compare the modeling of peak torque-angle relationships with polynomial functions and cubic splines. Fifteen male volunteers (between 19 and 24 years) were measured anthropometric parameters and peak, isometric-torque with isokinetic dynamometer at the following angles: 10, 20, 30. 45, 60, 75, 90, 105, 115 and 125°. It was found that the maximumal peak-torque (Nm) is generated at 75" in flexors and extensors at significant increase (p <0.05, one way ANOVA, Bonferoni post hoc test) in angular positions between 45" and 75° as compared with the rest angles tested. The torque of the flexors was greater than that of the extensors (p <0.05) in the area of the flexion, within the range of 90"-115". The maximal isometric force decreased in a narrow range and never fell below 60% with the extensors and 70% with the flexors at any of the tested angles. It was established a moderate correlation (r>0.5, coefficient of Pearson) in both muscle groups between: - height and peak torque (at 30° and 45° for extensors and 115° for flexors); and - muscle mass and torque (at 45° for extensors and 105°, 115° and 125° for flexors). It was only with the flexors, that moderate to significant correlations were observed between peak torque and body mass (105° and 115°), lean body mass (105°, 115" and 125") and body mass index (105°). The modeling of peak torque-angular position relationship with polynomials of fourth degree was considered optimal, according to the two criteria applied, only for extensors. With the flexors the assessment by the two criteria was ambiguous. The approximative curves in modeling with polynomials did not cover all points, including the maximum peak torque, which is not the global maximum of the optimal function. However this was achieved by interpolating cubic spline curves. It was found in the present study, that the peak, isometrictorque of the elbow flexors and extensors in healthy males: (1) is maximal at the angular position of 75° and is not reduced by more than 30% with the flexors and 40% with the extensors, at any of the tested positions: (2) correlates with anthropometric parameters, which is most manifested for the height and muscle mass in both muscle groups: and (3) is preferable to be modeled with cubic splines, compared to polynomial functions. The specifics of the torque profile as a function of the angular position is determined by the initial length of the muscles and their synergic contribution to the net torque. [ABSTRACT FROM AUTHOR]

Background: Youth baseball has been associated with elbow pain and elbow abnormalities, leading to the implementation of throwing and pitching guidelines. The purpose of the current study was to examine elbow abnormalities on magnetic resonance imaging (MRI) in asymptomatic Little League baseball players and to correlate these findings with the players' throwing history and physical examinations.Methods: A prospective study of Little League players who were 10 to 13 years of age was performed. Players were recruited prior to the start of the season and underwent bilateral elbow MRI. All players underwent a physical examination and responded to a questionnaire addressing their playing history and any arm pain. The MRIs were read by 2 radiologists. Responses on the questionnaire and physical examination findings were compared between subjects with and without positive MRI findings utilizing chi-square and analysis of variance techniques.Results: Twenty-six players were enrolled. The majority (77%) were right-handed and 14 (54%) were a pitcher and/or catcher. Nine players (35%) had 12 positive MRI findings: 7 findings of edema or signal change of the medial epicondyle apophysis, 2 findings of fragmentation of the medial epicondyle, and 3 findings of edema or signal change of the sublime tubercle. The prevalence of positive MRI findings and a history of arm pain were not greater in pitchers and catchers compared with other players. Players with a positive MRI finding demonstrated greater reduction in shoulder internal rotation (12°) compared with the nondominant arm (3°) (p = 0.04). The two factors associated with a positive MRI finding were year-round play (47% of year-round players compared with 11% of non-year-round players; p < 0.01) and working with a private coach (71% compared with 21%; p = 0.02). Additionally, a history of pain was associated with year-round play and a private coach (p < 0.05).Conclusions: MRI abnormalities involving the medial aspect of the elbow are common in year-round Little League baseball players, especially those with internal rotation deficits and private coaches. Although Little League guidelines potentially lessen abnormalities seen in pitchers, further refinement of these guidelines addressing year-round play, pain, and private coaching should be considered.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow.Methods: Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators.Results: A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months.Conclusions: The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction.Clinical Relevance: The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stiffness of the elbow is a common finding after elbow trauma. Restoration of motion in the posttraumatic stiff elbow is difficult, time consuming, and requires high patient compliance. We have evaluated the long-term effect of an open elbow arthrolysis in the posttraumatic stiff elbow.Methods: We evaluated 43 patients (14 women, 29 men) with a median age of 47(16-78) years operated with open arthrolysis for a posttraumatic stiff elbow. The median follow-up time was 41(12-204) months. The patients were hospitalized median 12(4-14) days, with daily physiotherapy and NSAID. 36 patients tolerated continuous passive motion (CPM) for 11(0-42) days. 35 patients had a well-functioning brachial plexus anesthesia for median 7(1-18) days. We used the paired 2-tailed T-test in our statistical analysis.Results: Preoperatively the patients had a median flexion of 110(30-160)°, extension 40(10-90)°, and the total flexion-extension sector (F/E) was 50(0-110)°. At follow-up the patients had a median flexion of 132(75-151)° and extension of 23(8-84)°, which indicate a median gain of 42(-50-114)°. The subjective functional scores (Mayo Elbow Score, EQ5D, Q-Dash, and VAS for pain) were satisfying, and most of the patients (81 %) would have done the operation once again knowing the outcome. We had 5 temporary ulnar neuropraxias, one became permanent and in addition ankylotic, one temporary radial neuropraxia, two superficial wound infections, and one transient hematoma.Conclusion: Open arthrolysis of the posttraumatic stiff elbow is associated with reliable clinical and functional long-term outcomes. [ABSTRACT FROM AUTHOR]

Congenital dislocation of the radial head (CDRH), a congenital anomaly of the elbow, can cause symptoms such as joint stiffness, snapping, locking, or pain, however the diagnosis is sometimes made incidentally from x-rays. The treatment goal is to ameliorate the symptoms and obtain a joint with a full range of motion. This paper presents a case of unilateral CDRH that was asymptomatic until adolescence, when locking and snapping developed. Several treatment options are described in the literature. Although the conventional and computer-assisted external fixator systems are used in several clinical pictures such as extremity deformities, joint contractures and fixation of acute fractures etc a computer-assisted external fixator system has not been used for CDRH. We successfully performed ulnar dorsal translation and a lengthening osteotomy with a computer-assisted external fixator to reduce the radial head indirectly and had satisfactory functional and clinical results. [ABSTRACT FROM AUTHOR]

Background: Nodular fasciitis most often occurs within subcutaneous tissues, but may also arise within skeletal muscle, dermis, vessels, peripheral nerves and, although rarely, within joints. Knowledge regarding the cause of aneurysmal bone cysts, its natural history, and the results of treatment is limited. Secondary aneurysmal bone cysts are associated with other neoplastic processes. Intra-articular nodular fasciitis in the elbow joint has not been reported previously, nor has the development of aneurysmal bone cyst secondary to intra-articular nodular fasciitis in the elbow joint. Case presentation: We report an unusual case of a Japanese 13-year-old boy who presented with a 1-year history of right elbow pain. The onset of pain was insidious, without antecedent trauma. On physical examination, the range of motion of the elbow was limited. Grip strength was reduced in the affected extremity. Incisional biopsy was performed and histologic findings revealed nodular fasciitis in the elbow joint. After tumor excision, a secondary aneurysmal bone cyst in the distal humerus developed. Endoscopy-assisted curettage and artificial bone grafting were performed. One year after surgery, a plain radiography showed no recurrence, and the patient returned to his daily activities without any symptoms. Conclusion: An aneurysmal bone cyst in the distal humerus developed after excision of intra-articular nodular fasciitis arising in the elbow. The secondary aneurysmal bone cyst successfully healed after endoscopy-assisted curettage and artificial bone grafting. The findings of this case suggest that these two tumors reside in the same biologic spectrum defined as USP6-induced tumors. [ABSTRACT FROM AUTHOR]

The article presents case study of a 18-year-old right-hand dominant woman, who had enlarged right medial elbow mass and disturbed paresthesias. It states that though the patient had no past history of soft tissue tumors, neurocutaneous disorders and neuropathy, yet the soft tissue mass of the patient's right elbow was found to be elongated. It discusses that the blood cell count was found normal, and further examination of the patient led to diagnosis of Intraneural perineurioma.

Purpose: Spastic flexion deformity of the elbow is mainly mediated by the biceps brachii and the brachialis muscles, innervated by the musculocutaneous nerve. Selective neurectomy of the musculocutaneous nerve showed promising results to relieve excessive spasticity in the long term but lacks of a consensual surgical strategy. The aim of the study was to describe the distal branching pattern of the motor branches of the musculocutaneous nerve in an attempt to develop guidelines for surgery. Methods: Sixteen arms of fresh cadaver specimen were dissected. We recorded the site of each primary and terminal motor branch as a percentage of the distance from the coracoid process to the lateral epicondyle. Results: The biceps muscle was innervated by one to five primary motor branches. The first branch emerged from the nerve at an average of 37.1 % of the arm length, and the most distal terminal branch at 55.7 %. The brachialis muscle received one to three primary branches. The first branch exited the nerve at an average of 51.7 % of the arm length and the last terminal branch at 69.3 %. The average number of terminal branches dedicated to the biceps and the brachialis muscles were, respectively, 7.9 and 6.5. Conclusions: According to our findings, we recommend to dissect the musculocutaneous nerve between 18 and 75 % of the distance between the coracoid process and the lateral epicondyle to identify the motor terminal branches to the biceps brachii and the brachialis muscle, sparing sensory branches. [ABSTRACT FROM AUTHOR]

Background Elbow contractures can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed clinical implications beyond the affected extremity. Reciprocal arm swing in normal gait has been shown to increase stability and reduce energy expenditure. The importance of arm swing has been clinically demonstrated in patients with cerebral palsy, stroke and Parkinson's disease. We hypothesized that elbow contractures would result in an abnormal spatio-temporal gait parameters. Methods Forty volunteer subjects walked on the Gaitmat II which provided real-time analysis of temporal and distance gait parameters. Five conditions were tested: no brace (control 1), elbow brace unlocked (control 2) and brace locked in 30°, 90° or 120° flexion (simulating fixed elbow contractures). Condition order was randomized for each subject. Each condition consisted of five walking trials. Results All three fixed elbow conditions (120°, 90° and 30°) demonstrated significantly decreased gait velocity (1.37, 1.39 and 1.39 m/s) and stride length (1.45, 1.46 and 1.46 m) compared to the control condition (1.42 m/s and 1.48 m, respectively). Single limb stance and double support times were decreased and increased, respectively, compared to control. There was no significant difference in cadence or limb asymmetry in the three fixed elbow conditions. Conclusions Despite well-established functional limitations in elbow contracture patients and importance of arm swing in normal gait, the impact of elbow contractures on gait is unknown. This study demonstrates that simulated elbow contracture results in significant differences in spatio-temporal gait parameters suggesting that elbow contractures have a broader functional impact beyond the affected extremity. Level of evidence II. [ABSTRACT FROM AUTHOR]

The aim of this study was to measure and compare kinesthetic sensitivity in children with developmental coordination disorder (DCD) and typically developing (TD) children between 6 and 11 years old. 30 children with DCD aged 6 to 11 years (5 in each age group) and 30 TD children participated in the study. Participants placed their forearms on a passive motion apparatus which extended the elbow joint at constant velocities between 0.15 and 1.35° s −1 . Participants were required to concentrate on detection of passive arm motion and press a trigger held in their left hand once they sensed it. The detection time was measured for each trial. The DCD group was significantly less sensitive in detection of passive motion than TD children. Further analysis of individual age groups revealed that kinesthetic sensitivity was worse in DCD than TD children for age groups beyond six years of age. Our findings suggested that individual with DCD lag behind their TD counterparts in kinesthetic sensitivity. Between the ages of 7 and 11 years the difference between groups is quantifiable and significant with 11 year old children with DCD performing similar to 7 year old TD children. [ABSTRACT FROM AUTHOR]

One hundred and five Labrador dogs were randomly divided into two groups to determine the number of animals that develop elbow dysplasia when treated with an oral supplement compared to untreated ones. Efficacy of the oral treatment was also evaluated once illness was diagnosed. The supplement (Hyaloral) contained hyaluronic acid, hydrolysed collagen, glucosainine, chondroitin sulphate, and gamma oryzanol. Clinical evaluation of the elbow joints was completed at months 3, 6, 12, and 20 by orthopaedic evaluations, radiography, serologic and blood analysis, and veterinarian evaluation of dysplasia symptoms. All side effects were recorded. In the control group, 33.3 % of the dogs developed radiographic evidence of elbow dysplasia compared to 18.5% in the treated group. Symptoms of dysplasia at 12 months differed between the treated (12.5%) and control (61.5%) animals, and were significantly different at 20 months (p < 0.05). Differences in lameness along with movement and swelling of the elbows between groups were observed after 12 months. The treated group had improved significantly by the last visit (p < 0.05). No adverse side effects were reported. In conclusion, oral treatment with Hyaloral may have a potential cumulative action that provides protection against dysplasia and significantly improves symptoms of elbow dysplasia. [ABSTRACT FROM AUTHOR]

Patella cubiti is a rare elbow anomaly in which either the entire olecranon or a part of it remains separate from the proximal ulna. Pain and stiffness are the usual presenting symptoms while some patients are diagnosed incidentally following a minor trauma. Our case report is of a 24-year-old male wrestler with bilateral patella cubiti which was painful on right side and asymptomatic on the left. We also mention an additional cause of pain in patella cubiti-intra-articular loose bodies. These loose bodies were removed surgically and the patient remained asymptomatic at 6-months follow-up. Presence of growth disturbance in the secondary epiphyseal centre of first lumbar vertebra supports the 'developmental theory' of origin of patella cubiti. A compilation of data available in the literature on patella cubiti has been included. [ABSTRACT FROM AUTHOR]

The article presents a study that aims at reviewing patients who underwent a surgical release for the treatment of post-traumatic elbow stiffness during a 36-month period. It describes the methodology of the study which included serial measurement of the motion range and the shortened version of the Disabilities of the Arm, Shoulder and Hand scores. The study found that elbow stiffness should be tackled in both the sagittal and rotational motion planes.

Controversy exists regarding the optimal treatment of isolated fractures of the capitellum that are not amenable to open reduction and internal fixation. Excision of the capitellum could result in instability of the elbow, though only limited the clinical or laboratory evidence exists to support this outcome. The aim of our study was to determine if capitellum excision leads to significant instability by measuring the relative change in varus-valgus displacement of the elbow. The varus-valgus displacement was recorded in 11 cadaveric elbows before and after isolated excision of the capitellum. Specimens were testing in varus-loaded and valgus-loaded positions with and without a 1 kg weight on the forearm. The varus-valgus displacement at the elbow was measured using a 3D motion capture system. Capitellum excision did not significantly change varus-valgus displacements in either the adducted, varus, or valgus position of the elbow ( p = 0.80, p = 0.28, p = 0.51). Furthermore, the addition of the 1 kg external functional load to the forearm did not produce a significant change in the varus and valgus loaded positions ( p = 0.16, p = 0.36). Our results demonstrate that excision of the capitellum in the setting of intact ligamentous structures does not result in significant instability in either the adducted varus loaded or valgus loaded positions of the elbow. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:346-350, 2014. [ABSTRACT FROM AUTHOR]

This case report details a caudal unilateral traumatic elbow luxation in a 4-year-old male neutered Labrador following a road traffic trauma. This is a highly unusual injury in the dog. The pathogenesis and successful treatment by closed reduction followed by stabilisation with a temporary transarticular external skeletal fixator are discussed. The dog was assessed at 4 weeks and 6 months after surgery. Findings at 6 months after treatment demonstrated a normal gait with no pain or crepitation. A mild amount of soft tissue thickening around the elbow was noted.Therange ofmotion of the elbow was limited to 45 degrees of flexion and 150 degrees of extension. This is the first case of a traumatic caudal luxation of the elbow in a dog described in the English veterinary literature and the first report of successful management of an elbow luxation in a dog by closed reduction and temporary transarticular fixation. [ABSTRACT FROM AUTHOR]

Highlights: [•] Presence of (a)symmetric tonic neck reflexes (ATNR & STNR) in healthy adults was studied. [•] Subjects were measured while seated on hand and feet. [•] Kinematics of neck and elbows were recorded while the neck was flexed, extended, and rotated. [•] Correlations between neck and elbow angles showed clear effects of ATNR & STNR in most subjects. [Copyright &y& Elsevier]

Objective: To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods: Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. Results: Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe). Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01) was found in injuries of CET and lateral ulnar collateral ligament (LUCL). Conclusion: Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL. [ABSTRACT FROM AUTHOR]

Abstract: Electroencephalographic (EEG) studies have well established that motor cortex (M1) activity ~20Hz decreases during muscular contraction and increases as soon as contraction stops, which are known as event-related desynchronization (ERD) and event-related synchronization (ERS), respectively. ERD is supposed to reflect M1 activation, sending information to recruited muscles, while the process underlying ERS is interpreted either as active cortical inhibition or as processing of sensory inputs. Investigation of the process behind ERD/ERS in people with spinal cord injury (SCI) would be particularly relevant since their M1 remains effective despite decreased sensorimotor abilities. In this study, we recorded net joint torque and EEG in 6 participants with cervical SCI and 8 healthy participants who performed isometric elbow flexion at 3 force levels. Multifaceted EEG analysis was introduced to assess ERD/ERS according to their amplitude, frequency range and duration. The results revealed that net joint torque increased with the required force level for all participants and time to contraction inhibition was longer in the SCI group. At the cortical level, ERD/ERS frequency ranges increased with the required force level in all participants, indicating that the modulation of cortical activity with force level is preserved after SCI. However, ERS amplitude decreased only in SCI participants, which may be linked to delayed contraction inhibition. All in all, cortical modulation of frequency range and amplitude could reflect two different kinds of neural communication. [Copyright &y& Elsevier]

Résumé: Les pertes de substance de la région du coude peuvent poser problème à tout chirurgien plasticien. En effet, cette région se caractérise par des tissus fins et très mobiles ; sa reconstruction doit être durable dans le temps, résistante aux mouvements, aux forces de cisaillement et à l’appui externe auxquels elle est soumise. Les lambeaux perforants en hélice apparaissent une option intéressante dans la reconstruction des pertes de substance du coude. Nous rapportons le cas clinique d’un patient ayant bénéficié de l’exérèse d’un mélanome de la région du coude. Après réunion de concertation pluridisciplinaire et reprise de marges, une reconstruction par lambeau perforant en hélices a été réalisée. Un pédicule perforant de la région brachiale latérale était repéré et utilisé. Le résultat postopératoire en termes de couverture et de fonction était jugé très satisfaisant. Les lambeaux perforants en hélice apparaissent une solution fiable et intéressante dans la prise en charge des reconstructions du coude. [ABSTRACT FROM AUTHOR]

This study investigated the changes in muscular activity and tissue oxygenation while lifting and lowering a load of 20, 40, 60 or 80 % of one repetition maximum (1RM) with elbow flexor muscles until failure. The surface electromyogram (EMG) was recorded in biceps brachii (BB), brachioradialis (BRD) and triceps brachii (TB). For BB, a tissue oxygenation index (TOI) and a normalized total hemoglobin index (nTHI) were recorded by near-infrared spectroscopy. The number of repetitions decreased with the increase in load ( P < 0.001), and the four loading conditions induced a decrease in MVC force immediately after failure ( P < 0.001). The average of rectified EMG amplitude (aEMG) of elbow flexors increased for all loads during muscle shortening (SHO) and lengthening (LEN) phases of the movement ( P < 0.05), except for the 80 % load during LEN phase. At failure, the aEMG was greater during the SHO than the LEN phase ( P < 0.05), except for the 20 % load. TOI decreased for all loads and phases ( P < 0.05) but less ( P < 0.01) for the 20 % than 60 and 80 % loads ( P < 0.01), and for LEN compared with SHO phase. At failure, TOI was negatively associated with aEMG during the SHO ( r = 0.99) and LEN ( r = 0.82) phases, while TOI and aEMG were positively associated with load magnitude ( r > 0.90) in both movement phases. This study emphasizes the influence of load magnitude and movement phase (SHO and LEN) on neuromuscular and oxydative adjustments during movements that involve lifting and lowering a load until failure. [ABSTRACT FROM AUTHOR]

Conversion disorder is presented by deficits in voluntary motor (such as paralysis) or sensory functions (blindness) that are not explained by known physical disorder and are not related to known anatomical sections. Symptoms or deficits are usually of short duration and most patients remit spontaneously. Recurrence is also common. This paper reports a 17-year-old girl with psycho-flexed elbow as a conversion reaction from ten Years earlier. This was a unique case in terms of clinical features and duration of the illness. [ABSTRACT FROM AUTHOR]

Purpose: Acute elbow instability leading to dislocation is thought to be a spectrum initiated by an injury to the lateral stabilizing structures of the elbow. Previous cadaveric studies have shown elbow dislocations to occur in flexion. The purpose of this study was to analyze videographic evidence of the deforming forces and upper extremity position during elbow dislocations. We sought to corroborate previous biomechanics studies with in vivo observations. Methods: We included 62 YouTube.com videos with a clear videographic view of an elbow dislocation. Three senior elbow surgeons independently evaluated arm position at the time of dislocation, along with the suspected deforming forces at the elbow based on these positions. Results: Of the 62 visualized elbow dislocation events, the vast majority (92%) dislocated at or near full extension. The most common arm positions were forearm pronation (68%) with shoulder abduction (97%) and forward flexion (63%). The typical elbow deforming forces were a valgus moment (89%), an axial load (90%), and progressive supination (94%). We identified 4 discrete patterns of arm position and deforming forces. Conclusions: Acute elbow dislocations in vivo occur in relative extension irrespective of forearm position, a finding distinct from previous cadaveric studies. The most common mechanism appears to involve a valgus moment to an extended elbow, which suggests a requisite disruption of the medial collateral ligament, the known primary constraint to valgus force. These videographic findings suggest that some acute elbow dislocations may result from acute valgus instability and therefore are distinct in nature and mechanism from posterolateral rotatory instability. This information could lead to improved understanding of the sequence of structural failure, modification of rehabilitation protocols, and overall treatment. Type of study/level of evidence: Diagnostic IV. [ABSTRACT FROM AUTHOR]

Background: Limited forearm rotation is a frequent combined disorder in elbow stiffness. If the radial head cannot be saved during open arthrolysis, prosthetic replacement might be considered because it enhances stability and allows early motion. Methods: In this study we retrospectively analyzed the outcome of 8 patients (7 men, 1 woman) who underwent open arthrolysis and simultaneous prosthetic replacement after resection of the radial head to restore elbow range of motion and forearm rotation. Patients were a mean age of 31.7 years (range, 22-40 years). Results: Postoperatively, the mean (range) active range of motion improved from 29.4° (0°-70°) to 113.1° (80°-135°), mean (range) supination increased from 38.8° (0°-80°) to 77.5° (50°-90°), and mean (range) pronation improved from 18.8° (0°-80°) to 68.8° (50°-80°). The Mayo Elbow Performance Score improved from a mean (range) of 57.5 (50-70) to 92.5 (85-100) points. No elbow valgus instability was detected over a mean duration of 26 months of follow-up. The implant was considered stable in all patients. Conclusions: Open arthrolysis and prosthetic replacement of the radial head are effective in treating elbow stiffness with associated rotation limitation after resection of the radial head. [ABSTRACT FROM AUTHOR]

The elbow region is an anatomical area of frequent attention to the plastic surgeon, in situations where a scar may limits upper limb mobility, as when a defect of coverage involves exposing of noble elements. The procedures to be considered for coverage of soft tissue defects in this area are: grafts, local, regional, distant and free flaps. We present a series of 9 clinical cases operated on in the period between January 2004 and May 2006, with a mean follow up of 2 years. [ABSTRACT FROM AUTHOR]

Summary: Perforator-based propeller flaps permit flap rotation up to 180°. This ability to transfer skin from one longitudinal axis to another has led to the increasing use of perforator-based propeller flaps in extremity reconstruction, especially lower-extremity reconstruction. However, the application of perforator-based propeller flaps to upper-extremity reconstruction is still limited. This article reports two cases of successful reconstruction of elbow region defects with radial collateral artery perforator (RCAP)-based propeller flaps. The elbow region has a variety of perforators available for perforator-based propeller flap reconstruction. Among them, the RCAP seems to be one of the most reliable options. This is because there are less anatomical variations of perforators'' location on the lateral upper arm than on the medial upper arm. By using an RCAP perforator as a flap pedicle, the small-to-medium sized defects (<6 cm in diameter) around elbow regions can be closed primarily without skin grafts. [Copyright &y& Elsevier]