Volkmann's ischaemic contracture: a complication following elbow injuries.
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Elbow injuries are commonly seen in accident departments. Patients with possible bony injuries to the elbow were assessed to see if inability to fully extend the elbow was a good indicator of bony injury and hence the need for X-ray. The sensitivity of this test was 90.7% (95% confidence limits 80.7-100.7) and the specificity 69.5% (95% confidence limits 60.3-78.7). Use of this simple test would reduce both radiography costs and unnecessary exposure to radiation.
With the burgeoning popularity of racquet and throwing sports in our society, an increasing awareness of the elbow injuries sustained with repetitive upper extremity activity is important. Particular attention should be paid to proper technique, equipment, and duration of activity, and preventive measures should be taken. In the adolescent or adult individual who sustains elbow injury, it is imperative that the treating physician recognize the pathologic stage early in order to minimize the consequences of these activities. Only with a thorough history and physical examination of this complex joint and a firm understanding of the forces generated during activity will the sports medicine physician entertain the proper diagnosis and initiate a treatment protocol that is likely to be successful.
Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.
Presented is an outline of the anatomy, biomechanics and function of the elbow joint, as it relates to normal and sporting activities. A variety of elbow injuries, including fractures of the olecranon, radial head and distal humerus are presented with appropriate methods of treatment. The aim to return patients to early functional activity is stressed. Soft tissue and more chronic over-use problems are briefly discussed, and a treatment regimen presented. In general, elbow injuries which involve acute fractures, dislocations and ligament injuries should be treated aggressively, in order to achieve early functional mobility. The more chronic over-use elbow problems should be viewed with a certain caution, and results are not as predictable following treatment of such injuries and over-use problems.
Elbow dislocations are most often the result of a hyperextension mechanism with the forearm levered and displaced posterior to the humerus. Recurrent instability and arterial disruption are uncommon sequelae of this injury. Any asymmetry in distal pulses after joint reduction demands a study of arterial anatomy (arteriogram or duplex scan) to rule out avulsion or intimal damage.
The most common elbow injuries appear to have a pathophysiology that is microtrauma based but with multifactorial origin. This pathophysiology is a process of gradual degeneration on a cellular and tissue level, with resulting alterations that predispose to more overt injury as the athlete responds to the inherent demands of the sport. This process is similar to injury patterns described at the foot, knee, and shoulder. Evaluation frameworks can be used to describe the clinical changes that are detectable, and to evaluate all of the various components that may play a role in the causes of these injuries.
STUDY OBJECTIVE: To determine whether comparison radiographic views of the uninjured elbow result in increased diagnostic accuracy in elbow trauma. DESIGN: Physicians were provided with a short clinical summary and asked to interpret radiographs of the injured elbow or of both the injured and the uninjured elbow in a randomized fashion. SETTING: The radiology department in a university hospital. METHODS: Fifty sets of radiographs from 25 children with elbow injuries were reviewed by two residents, two emergency physicians, and one pediatric radiologist using a standard classification of injuries. For each child, there were two sets of radiographs: one of the injured elbow and one of both the injured and the uninjured elbow. Descriptive statistics were used to report the results. kappa statistics were used to determine interobserver and intraobserver agreement. Missed diagnoses were divided into those that were clinically relevant and those that were not. RESULTS: The overall percentage of correct diagnoses (one versus two elbow radiographs) were as follows: residents, 69% versus 70%; emergency physicians, 62% versus 67%; and pediatric radiologist, 74% versus 72% (P greater than .05). kappa scores for interobserver variability and intrarater agreement were in the moderate range (.383 to .805; kappa, .08). Clinically relevant diagnoses were missed by trainees and emergency physicians regardless of whether radiographs of just the injured elbow or both the injured and the uninjured elbow were interpreted. Incorrect radiograph interpretations were due to false-positives in 17 of 23 cases. CONCLUSION: Comparison radiographs of the uninjured elbow did not improve diagnostic accuracy in elbow trauma in the pediatric emergency department.
Elbow injuries may limit participation in sports and occupational endeavors, as well as activities of daily living. Conventional radiography is the appropriate initial screening technique for evaluation of possible osseous injury or arthritis/arthrosis, but often it offers little information concerning soft-tissue derangement, which is a common source of dysfunction. MR imaging can evaluate these soft tissue to assist in diagnosis, as well as in planning treatment and assessing response to treatment. This essay illustrates MR findings of both the chronic overuse and the more acute traumatic soft-tissue injuries involving ligaments, tendons, muscles, and neurovascular structures, as well as radiographically occult osteochondral injuries.
Most elbow injuries result not from acute trauma but from repetitive microtrauma and chronic stress overload of the joint. Such "overuse" injuries may be difficult to diagnose clinically. Occasionally, even acute traumatic injuries may be occult radiographically and difficult to detect. In patients with elbow pain of uncertain origin, MR imaging may improve diagnostic specificity and accuracy. In this essay, characteristic MR imaging findings in common traumatic and overuse syndromes of the elbow are illustrated.
Pediatric elbow injuries that result from repetitive throwing-type activities are common. These injuries differ from those seen in adults, because of anatomic differences. The purpose of this paper is twofold: first, to review the anatomy of the elbow and the mechanics of the throwing motion about the elbow, and second, to discuss the diagnosis, treatment, rehabilitation, and prevention of pediatric throwing injuries of the elbow.
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Tremendous valgus stress during the acceleration phase of pitching is the primary cause of elbow injury in the pitcher. Lateral compression injuries are usually found in pitchers in their early teens, and osteochondritis dissecans is the primary underlying cause. Severe flexion contractures and even partial ankylosis of the elbow may occur. Prognosis after surgery is generally poor. Medial tension injuries with either soft-tissue damage or bony damage usually require surgery. The medial collateral ligament should be considered the primary stabilizer against the valgus-vector overload. The medial collateral ligament or bony avulsion form the medial compartment of the elbow should be primarily corrected. Results of early surgical correction to these lesions should produce excellent results. Pitchers with extension block injuries are generally older, more experienced athletes than those without such injuries. These pitchers have had symptoms for some time with progressive loss of full extension of the elbow and increasing pain. Valgus extension overload can be surgically corrected by an open surgical approach or an operative arthroscopic approach. Basically these approaches are palliative, and progression of symptoms at a later date may be expected. Finally, the postoperative rehabilitation of any elbow problem is extremely important and should be preplanned for the specific lesion treated.
The most common elbow injuries include lateral and medial tennis elbow tendinitis, ulnar nerve dysfunction, and medial ligament sprain. Treatment includes proper rehabilitation and control of abuse. Surgery, when indicated, is directed to the correction of specific pathologic tissue change without harm to adjacent normal tissue.
An unusual elbow injury occurring as a result of a poorly executed breakfall in judo is recorded. The treatment, possible mechanism and outcome are described. The poor prognosis of severe lesions is emphasised with reference to current literature.
Injuries of the elbow joint increase along with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics is important for understanding injury patterns, specific diagnosis, and therapy. Here we classify the most frequent elbow injuries such as dislocation, ligamentous instability, and fracture of the radial head, processus coronoideus, olecranon, and distal humerus based on joint anatomy, biomechanics, clinical examination, and imaging. Specific therapies are described.
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