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The influence of ageing on the force-velocity-power characteristics of human elbow flexor muscles.
Valour, D; Ochala, J; Ballay, Y; Pousson, M
The purpose of this study was to quantify the effects of ageing on the maximal power (P(max)) of the elbow flexor muscles and to determine the impact of velocity on the loss of power in older people. Sixteen elderly subjects (7 men and 9 women, age range 61-78 years) and 17 young subjects (11 men and 6 women, age range 18-27 years) participated in this study. Maximal elbow flexions were performed against increasing inertia. The maximal force (F(max)), maximal shortening velocity (V(max)), P(max), dynamic constants (a, b and a/F(max)), optimal force (F(opt)), optimal velocity (V(opt)) and V(opt)/V(max) were determined from Hill's equation. Myoelectrical activity (EMG) of the biceps and triceps muscles was quantified as an root mean square (RMS) value. F(max), V(max), P(max), F(opt), and V(opt) were significantly lower in elderly than in young subjects (28, 31, 45, 24 and 28% lower, respectively; p<0.05), whereas a/F(max) and V(opt)/V(max) were not different between the two age groups. In women, the greater decrease in P(max) appears to be more dependent on V(opt) than F(opt). In addition, V(max) decreased with age in women but not in men. The absence of significant differences between age groups in normalised RMS values indicates that P(max) and V(max) loss with increasing age could result more from changes in the properties of contractile element than from changes in muscular activity. PMID:12670625
Gross ultrastructural changes and necrotic fiber segments in elbow flexor muscles after maximal voluntary eccentric action in humans.
Lauritzen, Fredrik; Paulsen, Gøran; Raastad, Truls; Bergersen, Linda Hildegard; Owe, Simen Gylterud
Eccentric muscle actions are associated with ultrastructural changes. The severity and types of change depend on the nature of the stimulation protocol, and on the method for assessing such changes, and can be regarded as a continuum from mild changes to pathological-like changes. Most studies describing more severe changes have been performed on animals and only a few in humans, some using electrical stimuli. Hence, a debate has emerged on whether voluntary actions are associated with the pathological-like end of the continuum. The aim of this study was to determine whether severe muscle damage, i.e., extensive ultrastructural changes, is confined to animal studies and studies on humans using electrical stimuli. Second, because there is no generally approved method to quantify the degree of muscle damage, we compared two published methods, analyzing the Z disks or sarcomeres, as well as novel analyses of pathological-like changes. A group of untrained subjects performed 70 voluntary maximal eccentric muscle actions using the elbow flexors. On the basis of large reductions in maximal force-generating capacity (on average, -62 +/- 3% immediately after exercise, and -35 +/- 6% 9 days later), five subjects were selected for further analysis. Biopsies were taken from m. biceps brachii in both the exercised and nonexercised arm. In exercised muscle, more disrupted (13 +/- 4 vs. 3 +/- 3%) and destroyed (15 +/- 6 vs. 0%) Z disks were found compared with nonexercised muscle. A significant proportion of exercised myofibers had focal (85 +/- 5 vs. 11 +/- 7%), moderate (65 +/- 7 vs. 11 +/- 6%), and extreme (38 +/- 9 vs. 0%) myofibrillar disruptions. Hypercontracted myofibrils, autophagic vacuoles, granular areas, central nuclei, and necrotic fiber segments were found to various degrees. The present study demonstrates that the more severe end of the continuum of ultrastructural changes occurs in humans after voluntary exercise when maximal eccentric muscle actions are involved
The effect of sustained low-intensity contractions on supraspinal fatigue in human elbow flexor muscles
Søgaard, Karen; Gandevia, Simon C; Todd, Gabrielle; Petersen, Nicolas T; Taylor, Janet L
Subjects quickly fatigue when they perform maximal voluntary contractions (MVCs). Much of the loss of force is from processes within muscle (peripheral fatigue) but some occurs because voluntary activation of the muscle declines (central fatigue). The role of central fatigue during submaximal contractions is not clear. This study investigated whether central fatigue developed during prolonged low-force voluntary contractions. Subjects (n = 9) held isometric elbow flexions of 15% MVC for 43 min. Voluntary activation was measured during brief MVCs every 3 min. During each MVC, transcranial magnetic stimulation (TMS) was followed by stimulation of either brachial plexus or the motor nerve of biceps brachii. After nerve stimulation, a resting twitch was also evoked before subjects resumed the 15% MVC. Perceived effort, elbow flexion torque and surface EMG from biceps, brachioradialis and triceps were recorded. TMS was also given during the sustained 15% MVC. During the sustained contraction, perceived effort rose from ∼2 to ∼8 (out of 10) while ongoing biceps EMG increased from 6.9 ± 2.1% to 20.0 ± 7.8% of initial maximum. Torque in the brief MVCs and the resting twitch fell to 58.6 ± 14.5 and 58.2 ± 13.2% of control values, respectively. EMG in the MVCs also fell to 62.2 ± 15.3% of initial maximum, and twitches evoked by nerve stimulation and TMS grew progressively. Voluntary activation calculated from these twitches fell from ∼98% to 71.9 ± 38.9 and 76.9 ± 18.3%, respectively. The silent period following TMS lengthened both in the brief MVCs (by ∼40 ms) and in the sustained target contraction (by ∼18 ms). After the end of the sustained contraction, the silent period recovered immediately, voluntary activation and voluntary EMG recovered over several minutes while MVC torque only returned to ∼85% baseline. The resting twitch showed no recovery. Thus, as well as fatigue in the muscle, the prolonged low-force contraction produced progressive central
Viscosity of the flexor muscles of the elbow joint under maximum contraction condition.
Niku, S; Henderson, J M
The maximum contractile moments developed by the elbow flexors of eleven normal subjects at different elbow angles were measured, both isometrically and at various shortening velocities. The results were used to predict the damping coefficient of the viscous element of the elbow flexor muscles and soft tissue under maximum contraction condition for various angles and shortening velocities. PMID:2808437
Rhythmic Isometric Fatigue Patterns of the Elbow Flexors and Knee Extensors
ERIC Educational Resources Information Center
Ordway, George A.; And Others
During a rhythmic, all-out task, the rates of fatigue experienced by elbow flexor and knee extendor muscle groups tend to differ, with the elbow flexors fatiguing more rapidly initially, but reaching a plateau at a relatively higher level than the knee extensors. (Author)
Flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.
Okamoto, Syunro; Tada, Kaoru; Ai, Hachinota; Tsuchiya, Hiroyuki
The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty. PMID:25400974
Flexor Carpi Ulnaris Muscle Flap for Soft Tissue Reconstruction after Total Elbow Arthroplasty
Okamoto, Syunro; Ai, Hachinota; Tsuchiya, Hiroyuki
The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty. PMID:25400974
Shahani, Bhagwan T.; Young, Robert R.
One type of flexor reflex, that recorded from the tibialis anterior muscle in response to electrical stimulation of the sole of the foot, was studied in normal subjects and patients with several neurological disorders. Normally this reflex consists of two components, the second of which is related to the actual withdrawal. The first component, normally of lower threshold, is difficult to evoke in patients with chronic spinal cord or discrete cerebral lesions, whereas it has an unusually low threshold and is very clearly seen in those with Parkinson's disease. In patients with spinal cord disease, the exaggerated flexor reflexes are seen at long latencies after relatively small stimuli. During the early phase of recovery from spinal transection, both components may be seen and are, therefore, spinal in origin. Studies of patients with the sensory neuropathy of Friedreich's ataxia suggest that the afferent fibres responsible for these flexor reflexes are the small myelinated fibres. Recovery curves demonstrate very long-lasting changes in flexor reflex excitability in normal subjects and patients with `spasticity' from spinal lesions. This differs in patients with `spasticity' from lesions rostral to the brain-stem. Examples in man of such physiological phenomena as reciprocal inhibition, local sign, habituation, temporal and spatial summation are discussed. Images PMID:5122389
A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment
Aliu, Oluseyi; Samra, Saleh; Lewis, Eric
A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient's treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma. PMID:18780113
Knee extension fatigue attenuates repeated force production of the elbow flexors.
Halperin, Israel; Aboodarda, Saied J; Behm, David G
Non-local muscle fatigue has been demonstrated with unilateral activities, where fatiguing one limb alters opposite limb forces. Fewer studies have examined if non-local fatigue occurs with unrelated muscles. The purpose of this study was to investigate if knee extensors fatigue alters elbow flexors force and electromyography (EMG) activity. Eighteen males completed a control and fatiguing session (randomised). Blood lactate was initially sampled followed by three maximal voluntary contractions (MVC) with the elbow flexors and two with the knee extensors. Thereafter, subjects either sat (control) or performed five sets of bilateral dynamic knee extensions to exhaustion using a load equal to the dominant limb MVC (1-min rest between sets). Immediately afterwards, subjects were assessed for blood lactate and unilateral knee extensors MVC, and after 1 min performed a single unilateral elbow flexor MVC. Two minutes later, subjects performed 12 unilateral elbow flexor MVCs (5 s contraction/10 s rest) followed by a third blood lactate test. Compared to control, knee extensor force dropped by 35% (p < 0.001; ES = 1.6) and blood lactate increased by 18% (p < 0.001; ES = 2.8). Elbow flexor forces were lower after the fatiguing protocol only during the last five MVCs (p < 0.05; ES = ∼ 0.58; ∼ 5%). No changes occurred between conditions in EMG. Elbow flexor forces significantly decreased after knee extensors fatigue. The effect was revealed during the later stages of the repeated MVCs protocol, demonstrating that non-local fatigue may have a stronger effect on repeated rather than on single attempts of maximal force production. PMID:24766625
Firing of antagonist small-diameter muscle afferents reduces voluntary activation and torque of elbow flexors.
Kennedy, David S; McNeil, Chris J; Gandevia, Simon C; Taylor, Janet L
During muscle fatigue, firing of small-diameter muscle afferents can decrease voluntary activation of the fatigued muscle. However, these afferents may have a more widespread effect on other muscles in the exercising limb. We examined if the firing of fatigue-sensitive afferents from elbow extensor muscles in the same arm reduces torque production and voluntary activation of elbow flexors. In nine subjects we examined voluntary activation of elbow flexors by measuring changes in superimposed twitches evoked by transcranial magnetic stimulation of the motor cortex during brief (2-3 s) maximal voluntary contractions (MVC). Inflation of a blood pressure cuff following a 2-min sustained MVC blocked blood flow to the fatigued muscle and maintained firing of small-diameter afferents. After a fatiguing elbow flexion contraction, maximal flexion torque was lower (26.0 ± 4.4% versus 67.9 ± 5.2% of initial maximal torque; means ± s.d.; P < 0.001) and superimposed twitches were larger (4.1 ± 1.1% versus 1.8 ± 0.2% ongoing MVC, P = 0.01) with than without ischaemia. After a fatiguing elbow extensor contraction, maximal flexion torque was also reduced (82.2 ± 4.9% versus 91.4 ± 2.3% of initial maximal torque; P = 0.007), superimposed twitches were larger (2.7 ± 0.7% versus 1.3 ± 0.2% ongoing MVC; P = 0.02) and voluntary activation lower (81.6 ± 8.2% versus 95.5 ± 6.9%; P = 0.04) with than without ischaemia. After a fatiguing contraction, voluntary drive to the fatigued muscles is reduced with continued input from small-diameter muscle afferents. Furthermore, fatigue of the elbow extensor muscles decreases voluntary drive to unfatigued elbow flexors of the same arm. Therefore, firing of small-diameter muscle afferents from one muscle can affect voluntary activation and hence torque generation of another muscle in the same limb. PMID:23652589
Elbow torques and EMG patterns of flexor muscles during different isometric tasks.
Caldwell, G E; Van Leemputte, M
This paper examines the torque responses and EMG activity levels in four muscles acting at the elbow joint during different combinations of one- and two- degree of freedom isometric torque production (single and dual tasks, respectively). Flexor and supinator/pronator torques and surface EMG signals from m. biceps brachii, m. brachialis, m. brachioradialis and m. triceps brachii were measured in 16 male subjects while they performed maximal effort isometric contractions of pure flexion, pure supination, pure pronation, combined flexion and supination and combined flexion and pronation. In the single tasks, the torque responses were consistent with task requirements, but the dual task results were surprising in that flexor torque levels were reduced as compared to pure flexion, while supinator/pronator torque levels were as high or higher than in pure supination or pronation. Muscle activity levels varied with task, and could not always explain the differences observed in torque responses. These data are discussed within the framework of subpopulations of task-specific motor units within each muscle. The implications of such task-specific muscle units are related to musculoskeletal modelling and previous EMG - torque relationships found at the elbow. PMID:1748080
Inter-Rater Reliability of the Modified Ashworth Scale and Modified Modified Ashworth Scale in Assessing Poststroke Elbow Flexor Spasticity
ERIC Educational Resources Information Center
Kaya, Taciser; Goksel Karatepe, Altinay; Gunaydin, Rezzan; Koc, Aysegul; Altundal Ercan, Ulku
The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade "1+" of the MAS and redefining grade "2". The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity.…
Arm-cycling sprints induce neuromuscular fatigue of the elbow flexors and alter corticospinal excitability of the biceps brachii.
Pearcey, Gregory E P; Bradbury-Squires, David J; Monks, Michael; Philpott, Devin; Power, Kevin E; Button, Duane C
We examined the effects of arm-cycling sprints on maximal voluntary elbow flexion and corticospinal excitability of the biceps brachii. Recreationally trained athletes performed ten 10-s arm-cycling sprints interspersed with 150 s of rest in 2 separate experiments. In experiment A (n = 12), maximal voluntary contraction (MVC) force of the elbow flexors was measured at pre-sprint 1, post-sprint 5, and post-sprint 10. Participants received electrical motor point stimulation during and following the elbow flexor MVCs to estimate voluntary activation (VA). In experiment B (n = 7 participants from experiment A), supraspinal and spinal excitability of the biceps brachii were measured via transcranial magnetic and transmastoid electrical stimulation that produced motor evoked potentials (MEPs) and cervicomedullary motor evoked potentials (CMEPs), respectively, during a 5% isometric MVC at pre-sprint 1, post-sprint 1, post-sprint 5, and post-sprint 10. In experiment A, mean power output, MVC force, potentiated twitch force, and VA decreased 13.1% (p < 0.001), 8.7% (p = 0.036), 27.6% (p = 0.003), and 5.6% (p = 0.037), respectively, from pre-sprint 1 to post-sprint 10. In experiment B, (i) MEPs decreased 42.1% (p = 0.002) from pre-sprint 1 to post-sprint 5 and increased 40.1% (p = 0.038) from post-sprint 5 to post-sprint 10 and (ii) CMEPs increased 28.5% (p = 0.045) from post-sprint 1 to post-sprint 10. Overall, arm-cycling sprints caused neuromuscular fatigue of the elbow flexors, which corresponded with decreased supraspinal and increased spinal excitability of the biceps brachii. The different post-sprint effects on supraspinal and spinal excitability may illustrate an inhibitory effect on supraspinal drive that reduces motor output and, therefore, decreases arm-cycling sprint performance. PMID:26799694
Do rhythms exist in elbow flexor torque, oral temperature and muscle thickness during normal waking hours?
Buckner, Samuel L; Dankel, Scott J; Counts, Brittany R; Barnett, Brian E; Jessee, Matthew B; Mouser, J Grant; Halliday, Tanya M; Loenneke, Jeremy P
The purpose of the current study was to examine the influence of "time" on isometric elbow flexion torque, body temperature and muscle size without interrupting the sleep wake cycle in college aged males. Two hours following the participants normal wake time, oral temperature was measured, followed by muscle thickness of the upper and lower body using ultrasound, as well as elbow flexor torque via a maximal voluntary contraction (MVC). Measurements were repeated every 2h for 12h (Time points 1-7). To examine the repeatability of the rhythm, participants returned and completed the same procedures as before within 14days of their first circadian visit (Circadian visit 2). There was no time×day interaction for body temperature (p=0.29), nor were there main effects for time (p=0.15) or day (p=0.74). For MVC, there was no time×day interaction (p=0.93) or main effect for day (p=0.50), however, there was a main effect for time (p=0.01). MVC at time points 1 (86.4±6.4Nm) and 2 (87.1±6.2Nm) was greater than time points 4 (84.2±6.6Nm) and 6 (83.4±6.8Nm, p<0.05). Additionally, time point 5 MVC was greater than time point 4. For upper body muscle thickness, there was no time×day interaction (p=0.34), nor was there a main effect for day (p=0.38), or time (p=0.06). For lower body muscle thickness, there was no time×day interaction (p=0.57), nor was there a main effect for day (p=0.75), or time (p=0.13). Cosinor analyses revealed no group level rhythms for oral temperature, muscle thickness or strength (p>0.05), however, there were some individual rhythms noted for muscle thickness and strength. Results suggest that, when accounting for an individuals normal wake time, circadian rhythms of strength, temperature and muscle thickness are not apparent in most individuals. PMID:27020314
Effects of aging on force, velocity, and power in the elbow flexors of males.
Toji, Hideki; Kaneko, Masahiro
The effect of aging on muscular power development was investigated by determining the force-velocity relationship. The muscle cross-sectional area (CSA) was estimated by the thickness of the elbow flexors. The subjects were 19 elderly males aged 69.1+/-3.7 years old (G-70 group), 15 middle-aged males aged 50.9+/-3.5 years old (G-50), and 19 young males aged 21.2+/-1.3 years old (G-20). The G-70 group had the slowest shortening velocities under various load conditions, resulting in the lowest force-velocity relationship. The maximum values for force (Fmax), velocity (Vmax), power (Pmax), dynamic constants (a, b), and the a/Fmax ratio were determined using Hill's equation. The a/Fmax ratio determines the degree of concavity in the force-velocity curve. The a/Fmax ratio was greatest in G-70, followed by those in G-50 and G-20, while the maximum values for force (Fmax), velocity (Vmax), and power (Pmax) were significantly lower in G-70 than in the other groups. Fmax and Pmax per CSA were lowest in G-70, and Vmax per unit muscle length was also lowest in G-70 as compared to the other age groups. The ratio of G-70/G-20 was greatest in Pmax (69.6%), followed by Fmax (75.3%) and Vmax (83.4%). However, there were no significant differences in CSA among the 3 age groups. Our findings suggest that muscle force and shortening velocity may decline gradually in the process of aging attributed to declining muscle function rather than CSA. PMID:18174666
Functional linkages between motor cortical cells and elbow flexor muscles. Evidence for and characteristics of postspike facilitation.
Fourment, A; Belhaj-Saïf, A; Maton, B
1. Two monkeys (Macaca fascicularis) making high-level but submaximal isometric flexions of the elbow were investigated for the output effect of motor cortical cells on the electromyogram (EMG) activity of two main elbow flexors using the method of spike-triggered averaging of rectified EMGs (STAs). 2. Monkeys were trained to perform individual isometric contractions for > 2 s, and two series of > or = 20 contractions, the second series being at a greater force. EMG electrodes pairs were implanted in the biceps brachii and brachioradialis. A total of 257 cortical cells were found that discharged with the active and passive movements of the elbow. We examined the EMG postspike facilitations (PSFs) produced in either one or the two flexors for only those cells that discharged during the isometric contraction, and provoked PSFs in the two series of contractions. 3. The main characteristics of the EMG isometric contractions in the agonists were analyzed. Spectral analysis showed that the increases in the EMG median frequency with force stabilized at the force levels performed by monkeys. Cross correlation methods showed no cross talk between agonists. 4. The 26 selected cortical cells had a regular discharge frequency. Ten cells did not change frequency with a 22-30% force increase, 14 cells discharged at a higher frequency, and 2 cells discharged at a lower frequency. For single-cell frequencies of 5-65 Hz, interspike intervals < 10 ms were rare: the median and modal intervals were 20-30 ms. 5. The significance of PSFs with respect to the EMG background noise was estimated statistically. STAs from successive epochs under identical load conditions, and STAs performed at a distance from the trigger, showed that PSFs were authentic postspike effects and not sudden EMG changes synchronized by chance with the triggering cell. The features distinguishing PSF from secondary postspike EMG changes or coactivation and task-related effects were studied in simultaneous STAs of
Flexor bias of joint position in humans during spaceflight
NASA Technical Reports Server (NTRS)
McCall, G. E.; Goulet, C.; Boorman, G. I.; Roy, R. R.; Edgerton, V. R.
The ability to estimate ankle and elbow joint position was tested before, during, and after a 17-day spaceflight. Subjects estimated targeted joint angles during isovelocity (IsoV) joint movements with agonist muscle groups either active or relaxed. These movements included elbow extension (EE) and elbow flexion (EF), and plantarflexion (PF) and dorsiflexion (DF) of the ankle. Subjects also estimated these joint positions while moving the dynamometer at their chosen (variable) velocity (VarV) during EE and PF. For IsoV tests, no differences were observed between active and passive movements for either the ankle or elbow. Compared with those of pre-flight test days, estimates of targeted elbow joint angles were approximately 5 degrees to 15 degrees more flexed in-flight, and returned toward the pre-flight values during recovery. The spaceflight effects for the ankle were inconsistent and less prevalent than those for the elbow. The VarV PF test condition for the 120 degrees target angle at the ankle exhibited approximately 5 degrees to 7 degrees more DF target angle estimates in-flight compared with those pre- or post-flight. In contrast, during IsoV PF there was a tendency for ankle estimates to be approximately 2 degrees to 3 degrees more PF after 2-3 days exposure to spaceflight. These data indicate that during spaceflight the perception of elbow extension is greater than actuality, and are consistent with the interpretation that microgravity induced a flexor bias in the estimation of the actual elbow joint position. Moreover, these effects in joint proprioception during spaceflight were observed in individual isolated single-joint movements during tasks in which vestibular function in maintaining posture were minimal.
Human flexor reflex modulation during cycling.
Brown, D A; Kukulka, C G
1. Human flexor reflex (HFR) responses were elicited during ergometer cycling in neurologically intact humans with the objective of understanding the influence of lower limb muscle activity on phase-dependent reflex modulation during movement. The experimental setup permitted control over background muscle activity and stimulus intensity without significantly interfering with the cycling motion. 2. All experiments involved cycling on an ergometer at a set rate and workload. A 333-Hz, 15-ms pulse train of electrical stimulation was randomly delivered to the skin over the tibial nerve at the ankle at selected lower limb positions. In the first group of experiments, subjects were stimulated at six cycling phases while pedaling with normal, phasic ankle activity (free-form cycling). The second and third group of experiments involved stimulation under static limb positioning conditions and during active pedaling while subjects were asked to maintain a consistent background level of isolated tibialis anterior (TA) or soleus (SOL) electromyographic (EMG) activity. 3. Control criteria were established to assure similar isolated muscle EMG levels and sensory stimulation intensities throughout the experiments. With the aid of the application of a lower extremity brace and visual EMG feedback, SOL and TA activity were confined by the subject to a narrow range during the task of cycling. Stimulus consistency was achieved through maintenance of flexor hallucis brevis M-waves to within an envelope encompassing the mean value +/- 5% of the maximum M-wave amplitude in all experimental conditions. 4. When the subject's limb was statically positioned, the HFR responses in the SOL muscle showed no significant changes in pattern when compared at various limb positions. During cycling with consistent SOL activity, a response waveform pattern of early-latency-long-duration depression was followed by a later-latency facilitation response in all positions except the initial power phase
Evaluation of the peak torque, total work, average power of flexor-estensor and prono-supinator muscles of the elbow in baseball players.
Costantino, Cosimo; Vaienti, Enrico; Pogliacomi, Francesco
The Authors, after a short analysis on biomechanics of the elbow during throwing in baseball, show the movements of the elbow during the different phases of the throw and the stabilizing action of the ulnar collateral ligament, flexor-pronator muscles of the wrist, anconeus and brachial triceps muscles. Aim of this study is the evaluation of the peak torque, total work and average power of the flexor-extensor and pronator-supinator muscles of the elbows in professional baseball players. Isokinetic test data show that a mayor peak torque in flexo-extension at power and resistance test in the pitchers compared to the strikers. Whereas the strikers show a higher peak torque in pronation at the resistance test. This may happen because during a baseball match the ball is hit many times by the bat and the pronator muscle of the wrist are notably stimulated and reinforced. PMID:14509917
Effects of eccentric training on torque-angular velocity-power characteristics of elbow flexor muscles in older women.
Valour, D; Rouji, M; Pousson, M
The purpose of this study was to investigate the potential of eccentric training to improve elbow flexor muscle power in elderly subjects. Fourteen older female volunteers (age range 60-78 years) were randomly assigned into either a training group (TG) or a control group (CG). For the TG, the 21-session 7-week eccentric training program consisted of 5x6 eccentric muscle actions at 60-100% of concentric three maximal repetitions. Before and after training, maximal elbow flexions were performed against increasing inertia. Maximal isokinetic elbow flexions at four angular velocities (eccentric actions, -60 degrees s(-1), -30 degrees rads(-1); concentric actions, 30, 60 degrees s(-1)) and maximal isometric actions were also performed. Maximal power (Pmax) and an index of maximal shortening velocity (VImax)were determined. For all action conditions, the myoelectric activities of the biceps and the triceps brachii muscles were recorded and quantified as a root mean square (RMS) value. In the TG, maximal torque developed under isometric, isokinetic and inertial conditions increased significantly after training (ranging from 11 to 19%). Pmax and VImax also increased significantly (31.3 and 25.9%, respectively). These parameters remained unchanged in the CG. The RMS activity of the biceps and triceps muscles was not affected by eccentric training for all action conditions excepting the eccentric condition at -30 degrees s(-1) where the RMS activity of the biceps increased significantly. The gains in maximal torque, Pmax and VImax observed after training would result more from intramuscular modifications than from changes in muscular activity, except for eccentric condition at -30 degrees s(-1) where the torque gains could also be partly explained by a reduction in inhibition of the motor unit pool. PMID:15036395
Effect of pre-exercise phototherapy applied with different cluster probe sizes on elbow flexor muscle fatigue.
Rossato, Mateus; Dellagrana, Rodolfo A; Lanferdini, Fábio J; Sakugawa, Raphael L; Lazzari, Caetano D; Baroni, Bruno M; Diefenthaeler, Fernando
Phototherapy has been used for reducing muscle fatigue. In view of the various types of phototherapy cluster probes available in the market, the purpose of this study was to compare the effects of a similar phototherapy dosage with two different cluster probes on elbow flexor muscle fatigue: small cluster probe (SC = 9 diodes; 7.5 cm(2)) vs. large cluster probe (LC = 33 diodes; 30.2 cm(2)). Ten physically active male aged 18-35 years participate in a randomized, crossover, double-blind, placebo-controlled trial, which each participant was submitted to the same testing protocol in four sessions (separated by at least 48 h) with different treatments: LC-phototherapy, SC-phototherapy, LC-placebo, and SC-placebo. The elbow flexion maximal isometric voluntary contraction (MIVC) was performed before and after a fatigue protocol (60 % of MIVC until exhaustion). Electromyography (EMG) of the biceps brachii muscle was collected during all testing procedure. Phototherapy with dose of 60 J per muscle [LC: 33 diodes = 5 lasers (850 nm), 12 LEDs (670 nm), 8 LEDs (880 nm), and 8 LEDs (950 nm); SC: 9 diodes = 5 lasers (850 nm) and 4 LEDs (670 nm)] or placebo applications occurred before fatigue protocol. Two-way ANOVA (treatment and time factors) and one-way ANOVA were used, followed by LSD post hoc. Time to exhaustion was significantly higher in active LC (15 %; p = 0.031) and SC (14 %; p = 0.038) in comparison with their respective placebo treatments, without differences between LC and SC (p > 0.05) or between placebo conditions (p > 0.05). This larger exercise tolerance in phototherapy conditions was not accompanied by a higher decrement in the volunteers' maximal strength capacity (11-15 %; p > 0.05 for all). EMG signals presented no difference between the four condition tested here. In both large and small cluster probes (according parameters tested in this study) led to reduced fatigue in elbow flexor muscles, without
A comparison of the effects of concentric versus eccentric exercise on force and position sense at the human elbow joint.
Brockett, C; Warren, N; Gregory, J E; Morgan, D L; Proske, U
It is generally accepted that our sense of limb position and movement is provided, in part, by signals from muscle spindles, while the sense of muscle force derives from signals in tendon organs. Experiments are described here, using human subjects, in which the effects of eccentric and concentric exercise of elbow flexor muscles are compared on the sense of forearm position and the sense of tension in elbow flexors. Subjects were required to compress a preloaded spring with one arm, carrying out a concentric contraction in elbow flexors, then flexors of the other arm released the spring from compression and thereby carried out an eccentric contraction. The force of the spring was adjusted to be 20% maximum voluntary contraction (MVC), and each subject carried out a minimum of 120 contractions. Position sense was measured in blindfolded subjects by placing one forearm at a set angle and asking subjects to match it by positioning the other arm. Over 4 days postexercise, subjects placed the eccentrically exercised arms in a more extended position than the concentrically exercised arm suggesting that they thought the muscle was shorter than it actually was. In a force-matching task, subjects systematically undershot the target 10% MVC with their eccentrically exercised arm. Since it is known that eccentric exercise is associated with damage to muscle fibres, it is postulated that this leads to a disturbance of muscle receptors, the muscle spindles and tendon organs. PMID:9401745
Prior Heat Stress Effects Fatigue Recovery of the Elbow Flexor Muscles
Iguchi, Masaki; Shields, Richard K.
Introduction Long-lasting alterations in hormones, neurotransmitters and stress proteins after hyperthermia may be responsible for the impairment in motor performance during muscle fatigue. Methods Subjects (n = 25) performed a maximal intermittent fatigue task of elbow flexion after sitting in either 73 or 26 deg C to examine the effects of prior heat stress on fatigue mechanisms. Results The heat stress increased the tympanic and rectal temperatures by 2.3 and 0.82 deg C, respectively, but there was full recovery prior to the fatigue task. While prior heat stress had no effects on fatigue-related changes in volitional torque, EMG activity, torque relaxation rate, MEP size and SP duration, prior heat stress acutely increased the pre-fatigue relaxation rate and chronically prevented long-duration fatigue (p < 0.05). Discussion These findings indicate that prior passive heat stress alone does not alter voluntary activation during fatigue, but prior heat stress and exercise produce longer-term protection against long-duration fatigue. PMID:21674526
Bilateral Knee Extensor Fatigue Modulates Force and Responsiveness of the Corticospinal Pathway in the Non-fatigued, Dominant Elbow Flexors.
Šambaher, Nemanja; Aboodarda, Saied Jalal; Behm, David George
Exercise-induced fatigue affects muscle performance and modulates corticospinal excitability in non-exercised muscles. The purpose of this study was to investigate the effect of bilateral knee extensor fatigue on dominant elbow flexor (EF) maximal voluntary force production and corticospinal excitability. Transcranial magnetic, transmastoid electrical and brachial plexus electrical stimulation (BPES) were used to investigate corticospinal, spinal, and muscle excitability of the dominant EF before and after a bilateral knee extensor fatiguing protocol or time matched rest period (control). For both sessions three stimuli were delivered every 1.5 s during the three pre-test time points and during the 1st, 3rd, 6th, 9th and 12th post-test 5 s EF isometric maximal voluntary contractions (MVC). In both conditions, overall, EF MVC force (p < 0.001) decreased progressively from repetition #1 to #12 during the post-test MVC protocol. EF MVC force (p < 0.001, ES = 0.9, Δ10.3%) decrements were more pronounced in the knee extensor fatigue intervention condition. In addition, there were no significant differences between conditions for biceps brachii electromyographic (EMG) activity (p = 0.43), motor evoked potentials (MEPs) amplitude (p = 0.908) or MEP silent period (SP; p = 0.776). However, the fatigue condition exhibited a lower MEP/cervicomedullary MEP (CMEP) ratio (p = 0.042, ES = 2.5, Δ25%) and a trend toward higher CMEP values (p = 0.08, ES = 0.5, Δ20.4%). These findings suggest that bilateral knee extensor fatigue can impair performance and modulate corticospinal excitability of the EF. PMID:26869902
Bilateral Knee Extensor Fatigue Modulates Force and Responsiveness of the Corticospinal Pathway in the Non-fatigued, Dominant Elbow Flexors
Šambaher, Nemanja; Aboodarda, Saied Jalal; Behm, David George
Exercise-induced fatigue affects muscle performance and modulates corticospinal excitability in non-exercised muscles. The purpose of this study was to investigate the effect of bilateral knee extensor fatigue on dominant elbow flexor (EF) maximal voluntary force production and corticospinal excitability. Transcranial magnetic, transmastoid electrical and brachial plexus electrical stimulation (BPES) were used to investigate corticospinal, spinal, and muscle excitability of the dominant EF before and after a bilateral knee extensor fatiguing protocol or time matched rest period (control). For both sessions three stimuli were delivered every 1.5 s during the three pre-test time points and during the 1st, 3rd, 6th, 9th and 12th post-test 5 s EF isometric maximal voluntary contractions (MVC). In both conditions, overall, EF MVC force (p < 0.001) decreased progressively from repetition #1 to #12 during the post-test MVC protocol. EF MVC force (p < 0.001, ES = 0.9, Δ10.3%) decrements were more pronounced in the knee extensor fatigue intervention condition. In addition, there were no significant differences between conditions for biceps brachii electromyographic (EMG) activity (p = 0.43), motor evoked potentials (MEPs) amplitude (p = 0.908) or MEP silent period (SP; p = 0.776). However, the fatigue condition exhibited a lower MEP/cervicomedullary MEP (CMEP) ratio (p = 0.042, ES = 2.5, Δ25%) and a trend toward higher CMEP values (p = 0.08, ES = 0.5, Δ20.4%). These findings suggest that bilateral knee extensor fatigue can impair performance and modulate corticospinal excitability of the EF. PMID:26869902
Comparison of modified Kessler tendon suture at different levels in the human flexor digitorum profundus tendon and porcine flexors and porcine extensors: an experimental biomechanical study.
Havulinna, J; Leppänen, O V; Järvinen, T L N; Göransson, H
This study compared the biomechanical behaviour of repairs in the human flexor digitorum profundus tendon in zones I, II and III with repairs of different segments of the porcine flexor tendon of the second digit and the extensor digiti quarti proprius tendon, in order to assess the validity of porcine tendons as models for human flexor tendon repairs. These porcine tendons were selected after comparing their size with the human flexor digitorum profundus tendon. The tendon repairs were done in three segments of each porcine tendon and repairs in the human tendons were done in zones I,II and III. Ten tendons in each group yielded a total of 90 specimens. A modified Kessler repair was done with 3-0 coated braided polyester suture and subjected to uniaxial tensile testing. In human flexor tendons, the ultimate force was higher in zones I and II than in zone III. The porcine flexor digitorum profundus tendon from the second digit and the proximal segment of the extensor digiti quarti proprius tendon behaved similarly to the human flexor tendon in zone III and can be considered as surrogates for the human flexor tendon. PMID:21816887
Static torque-angle relation of human elbow joint estimated with artificial neural network technique.
Uchiyama, T; Bessho, T; Akazawa, K
Static relations between elbow joint angle and torque at constant muscle activity in normal volunteers were investigated with the aid of an artificial neural network technique. A subject sat on a chair and moved his upper- and forearm in a horizontal plane at the height of his shoulder. The subject was instructed to maintain the elbow joint at a pre-determined angle. The wrist was then pulled to extend the elbow joint by the gravitational force of a weight hanging from a pulley. Integrated electromyograms (IEMGs), elbow and shoulder joint angles and elbow joint torque were measured. Then the relation among IEMGs, joint angles and torque was modeled with the aid of the artificial neural network, where IEMGs and joint angles were the inputs and torque was the output. After back propagation learning, we presented various combinations of IEMGs, shoulder and elbow joint angles to the model and estimated the elbow joint torque to obtain the torque-angle relation for constant muscle activation. The elbow joint torque increased and then decreased with extension of the elbow joint. This suggests that if the forearm is displaced from an equilibrium point, the torque angle relation would not act like a simple spring. In a view of the musculoskeletal structure of the elbow joint, the relation between the elbow joint angle and the moment arm of the elbow flexor muscles seems to have a dominant effect on the torque-angle relation. PMID:9755039
A Comparison of Total and Intrinsic Muscle Stiffness Among Flexors and Extensors of the Ankle, Knee and Elbow
NASA Technical Reports Server (NTRS)
Lemoine, Sandra M.
This study examined 3 methods that assessed muscle stiffness. Muscle stiffness has been quantified by tissue reactive force (transverse stiffness), vibration, and force (or torque) over displacement. Muscle stiffness also has two components: reflex (due to muscle sensor activity) and intrinsic (tonic firing of motor units, elastic nature of actin and myosin cross bridges, and connective tissue). This study compared three methods of measuring muscle stiffness of agonist-antagonist muscle pairs of the ankle, knee and elbow.
Changes in supraspinal and spinal excitability of the biceps brachii following brief, non-fatiguing submaximal contractions of the elbow flexors in resistance-trained males.
Aboodarda, Saied Jalal; Copithorne, David B; Pearcey, Gregory E P; Button, Duane C; Power, Kevin E
The purpose of the current study was to assess the effects of 5 brief (2s), intermittent, submaximal elbow flexors voluntary contractions at 50% of maximal voluntary contraction (MVC) on measures of central (i.e. supraspinal and spinal) excitability. Supraspinal and spinal excitability of the biceps brachii were assessed via transcranial magnetic stimulation (TMS) of the motor cortex and transmastoid electrical stimulation (TMES) of the corticospinal tract, respectively. TMS-induced motor-evoked potentials (MEPs), TMES-induced cervicomedullary-evoked potentials (CMEPs), Erb's point peripheral nerve stimulation and MVC were assessed prior to and following submaximal voluntary contractions at 50% of MVC. The MEP to CMEP ratio increased (584±77.2%; p=0.011) and CMEP amplitudes decreased (62±3.0%; p=0.02) immediately post-exercise. MVC force output did not change immediately post-exercise. The results suggest that brief, non-fatiguing intermittent submaximal voluntary contractions transiently enhance supraspinal excitability while decreasing spinal excitability. The impact of these changes on one's ability to generate or maintain force production remains unknown. PMID:26415709
Interlimb communication to the knee flexors during walking in humans
Stevenson, Andrew J T; Geertsen, Svend S; Andersen, Jacob B; Sinkjær, Thomas; Nielsen, Jens B; Mrachacz-Kersting, Natalie
A strong coordination between the two legs is important for maintaining a symmetric gait pattern and adapting to changes in the external environment. In humans as well as animals, receptors arising from the quadriceps muscle group influence the activation of ipsilateral muscles. Moreover, strong contralateral spinal connections arising from quadriceps and hamstring afferents have been shown in animal models. Therefore, the aims of the present study were to assess if such connections also exist in humans and to elucidate on the possible pathways. Contralateral reflex responses were investigated in the right leg following unexpected unilateral knee joint rotations during locomotion in either the flexion or extension direction. Strong reflex responses in the contralateral biceps femoris (cBF) muscle with a mean onset latency of 76 ± 6 ms were evoked only from ipsilateral knee extension joint rotations in the late stance phase. To investigate the contribution of a transcortical pathway to this response, transcranial magnetic and electrical stimulation were applied. Motor evoked potentials elicited by transcranial magnetic stimulation, but not transcranial electrical stimulation, were facilitated when elicited at the time of the cBF response to a greater extent than the algebraic sum of the cBF reflex and motor evoked potentials elicited separately, indicating that a transcortical pathway probably contributes to this interlimb reflex. The cBF reflex response may therefore be integrated with other sensory input, allowing for responses that are more flexible. We hypothesize that the cBF reflex response may be a preparation of the contralateral leg for early load bearing, slowing the forward progression of the body to maintain dynamic equilibrium during walking. PMID:23918771
Elbow arthroscopy: treatment of the thrower's elbow.
O'Holleran, James D; Altchek, David W
The athlete's elbow has been described as one of the last frontiers in orthopaedic sports medicine. It has been considered separately from other athletic injuries because of the unique constellation of pathology that results from repetitive overhead throwing. Tremendous gains in understanding the complex interplay between the dynamic and static stabilizers of the athlete's elbow have occurred over the past decade. The desire to treat these injuries in a minimally invasive manner has driven the development of techniques and instrumentation for elbow arthroscopy, a successful and essential technique in the treatment of the thrower's elbow. Medial collateral ligament injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans of the capitellum have all been described as consequences of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can each be present in conjunction with these conditions or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these conditions to form a comprehensive differential diagnosis for an athlete with elbow pain. The surgeon treating the athlete's elbow should be comfortable with both open and arthroscopic treatments. An understanding of the anatomy and biomechanics of the thrower's elbow is essential for good patient care. The preoperative evaluation should focus on a thorough history and physical examination, as well as specific diagnostic imaging modalities. PMID:16958443
Human ankle plantar flexor muscle-tendon mechanics and energetics during maximum acceleration sprinting.
Lai, Adrian; Schache, Anthony G; Brown, Nicholas A T; Pandy, Marcus G
Tendon elastic strain energy is the dominant contributor to muscle-tendon work during steady-state running. Does this behaviour also occur for sprint accelerations? We used experimental data and computational modelling to quantify muscle fascicle work and tendon elastic strain energy for the human ankle plantar flexors (specifically soleus and medial gastrocnemius) for multiple foot contacts of a maximal sprint as well as for running at a steady-state speed. Positive work done by the soleus and medial gastrocnemius muscle fascicles decreased incrementally throughout the maximal sprint and both muscles performed more work for the first foot contact of the maximal sprint (FC1) compared with steady-state running at 5 m s(-1) (SS5). However, the differences in tendon strain energy for both muscles were negligible throughout the maximal sprint and when comparing FC1 to SS5. Consequently, the contribution of muscle fascicle work to stored tendon elastic strain energy was greater for FC1 compared with subsequent foot contacts of the maximal sprint and compared with SS5. We conclude that tendon elastic strain energy in the ankle plantar flexors is just as vital at the start of a maximal sprint as it is at the end, and as it is for running at a constant speed. PMID:27581481
Tendon elastic strain energy in the human ankle plantar-flexors and its role with increased running speed.
Lai, Adrian; Schache, Anthony G; Lin, Yi-Chung; Pandy, Marcus G
The human ankle plantar-flexors, the soleus and gastrocnemius, utilize tendon elastic strain energy to reduce muscle fiber work and optimize contractile conditions during running. However, studies to date have considered only slow to moderate running speeds up to 5 m s(-1). Little is known about how the human ankle plantar-flexors utilize tendon elastic strain energy as running speed is advanced towards maximum sprinting. We used data obtained from gait experiments in conjunction with musculoskeletal modeling and optimization techniques to calculate muscle-tendon unit (MTU) work, tendon elastic strain energy and muscle fiber work for the ankle plantar-flexors as participants ran at five discrete steady-state speeds ranging from jogging (~2 m s(-1)) to sprinting (≥8 m s(-1)). As running speed progressed from jogging to sprinting, the contribution of tendon elastic strain energy to the positive work generated by the MTU increased from 53% to 74% for the soleus and from 62% to 75% for the gastrocnemius. This increase was facilitated by greater muscle activation and the relatively isometric behavior of the soleus and gastrocnemius muscle fibers. Both of these characteristics enhanced tendon stretch and recoil, which contributed to the bulk of the change in MTU length. Our results suggest that as steady-state running speed is advanced towards maximum sprinting, the human ankle plantar-flexors continue to prioritize the storage and recovery of tendon elastic strain energy over muscle fiber work. PMID:24948642
The forces generated at the human elbow joint in response to imposed sinusoidal movements of the forearm
Joyce, G. C.; Rack, Peter M. H.; Ross, H. F.
1. The mechanical resistance of the human forearm has been measured during imposed sinusoidal flexion-extension movements of the elbow joint. 2. The force required to move the limb can be divided into components required to move the mass, and components required to overcome the resistance offered by elastic and frictional properties of the muscles and other soft tissues. 3. When during a vigorous flexing effort the limb was subjected to a small amplitude sinusoidal movement each extension was followed by a considerable reflex contraction of the flexor muscles. At low frequencies of movement this reflex provided an added resistance to extension, but at 8-12 Hz the delay in the reflex pathway was such that the reflex response to extension occurred after the extension phase of the movement was over and during the subsequent flexion movement. The reflex activity then assisted the movement whereas at other frequencies it impeded it. 4. The reflex response to movement increased as the subject exerted a greater flexing force. 5. Small movements generated a relatively larger reflex response than big ones. 6. Even with large amplitudes of movement when the reflex activity was relatively small, the limb resisted extension with a high level of stiffness; this was comparable with the short range stiffness of muscles in experimental animals. 7. The fact that at some frequencies the reflex response assisted the movement implies that with appropriate loading the limb could undergo a self-sustaining oscillation at those frequencies. PMID:4420490
Vortical flow in human elbow joints: a three-dimensional computed tomography modeling study.
Adikrishna, Arnold; Kekatpure, Aashay L; Tan, Jun; Lee, Hyun-Joo; Deslivia, Maria Florencia; Jeon, In-Ho
The human elbow joint has been regarded as a loose hinge joint, with a unique helical motion of the axis during extension-flexion. This study was designed to identify the helical axis in the ulnohumeral joint during elbow extension-flexion by tracking the midpoint between the coronoid tip and the olecranon tip of the proximal ulna in a three-dimensional (3D) computed tomography (CT) image model. The elbows of four volunteers were CT-scanned at four flexion angles (0°, 45°, 90°, and 130°) at neutral rotation with a custom-made holding device to control any motion during scanning. Three-dimensional models of each elbow were reconstructed and a 3D ulnohumeral joint at 45°, 90°, and 130° was superimposed onto a fully extended joint (0°) by rotating and translating each 3D ulnohumeral joint along the axes. The midpoints of the olecranon and coronoid tips were interpolated using cubic spline technique and the dynamic elbow motion was plotted to determine the motion of the helical axis. The means and standard deviations were subsequently calculated. The average midpoint pattern of joint motion from extension to flexion was elliptical-orbit-like when projected onto a sagittal plane and continuously translated a mean 2.14 ± 0.34 mm (range, 1.83-2.52 mm) to the lateral side during elbow extension-flexion. In 3D space, the average midpoint pattern of the ulnohumeral joint resembles a vortical flow, spinning along an imaginary axis, with an inconsistent radius from 0° to 130° flexion. The ulnohumeral joint axis both rotates and translates during elbow extension-flexion, with a vortex-flow motion occurring during flexion in 3D model analysis. This motion should be considered when performing hinged external fixation, total elbow replacement and medial collateral ligament reconstruction surgery. PMID:25100632
Pulled hip flexor - aftercare; Hip flexor injury - aftercare; Hip flexor tear - aftercare; Iliopsoas strain - aftercare; Strained iliopsoas muscle - aftercare; Torn iliopsoas muscle - aftercare; Psoas strain - aftercare
Operative technique for human composite flexor tendon allograft procurement and engraftment.
DeGeorge, Brent R; Rodeheaver, George T; Drake, David B
Devastating volar hand injuries with significant damage to the pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. Postoperative adhesion formation and lack of suitable donor material for tendon autograft are 2 fundamental problems that continue to challenge the hand surgeon. In 1967, Erle E. Peacock, Jr, described a technique of flexor tendon reconstruction using cadaveric composite flexor tendon allograft, which consisted of both the flexor digitorum profundus and superficialis tendons in their respective fibro-osseous sheaths consisting of the digital pulley structures and the underlying periosteum and volar plates. This technique never gained widespread acceptance due to concerns regarding tissue antigenicity, infectious disease transmission, and the rising popularity of the method of Hunter for silastic rod-based flexor tendon reconstruction initially described during the same period. With modern-day advances in tissue processing with acellularization and extensive donor screening for transmissible diseases, this technique should be revisited to address the reconstructive needs of patients with extensive volar soft tissue and tendon injury. Herein, we describe the operative technique of composite flexor tendon procurement and reconstruction with key modifications from the initial technique described by Peacock for improved composite construct elevation, soft tissue inset, and bony attachment. PMID:24691346
Facilitation from flexor digitorum superficialis to extensor carpi radialis in humans.
Nito, Mitsuhiro; Hashizume, Wataru; Miyasaka, Takuji; Suzuki, Katsuhiko; Sato, Toshiaki; Fujii, Hiromi; Shindo, Masaomi; Naito, Akira
Effects of low-threshold afferents from the flexor digitorum superficialis (FDS) to the extensor carpi radialis (ECR) motoneurons were examined using a post-stimulus time-histogram (PSTH) and electromyogram-averaging (EMG-A) methods in eight healthy human subjects. In the PSTH study in five of the eight subjects, electrical conditioning stimuli (ES) to the median nerve branch innervating FDS with the intensity below the motor threshold induced excitatory effects (facilitation) in 39 out of 92 ECR motor units. In 11 ECR motor units, the central synaptic delay of the facilitation was -0.1 ± 0.3 ms longer than that of the homonymous facilitation of ECR. Mechanical conditioning stimuli (MS) to FDS with the intensity below the threshold of the tendon(T)-wave-induced facilitation in 51 out of 51 ECR motor units. With the EMG-A method, early and significant peaks were produced by ES and MS in all the eight subjects. The difference between latencies of the peaks by ES and MS was almost equivalent to that of the Hoffmann- and T-waves of FDS by ES and MS. The peak was diminished by tonic vibration stimuli to FDS. These findings suggest that a facilitation from FDS to ECR exists in humans and group Ia afferents mediate the facilitation through a monosynaptic path. PMID:27010723
Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is ... injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow . Golfers ...
Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...
21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow)...
21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow)...
21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow)...
21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow)...
21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888.3170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow)...
Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans.
Blazevich, A J; Cannavan, D; Waugh, C M; Miller, S C; Thorlund, J B; Aagaard, P; Kay, A D
The neuromuscular adaptations in response to muscle stretch training have not been clearly described. In the present study, changes in muscle (at fascicular and whole muscle levels) and tendon mechanics, muscle activity, and spinal motoneuron excitability were examined during standardized plantar flexor stretches after 3 wk of twice daily stretch training (4 × 30 s). No changes were observed in a nonexercising control group (n = 9), however stretch training elicited a 19.9% increase in dorsiflexion range of motion (ROM) and a 28% increase in passive joint moment at end ROM (n = 12). Only a trend toward a decrease in passive plantar flexor moment during stretch (-9.9%; P = 0.15) was observed, and no changes in electromyographic amplitudes during ROM or at end ROM were detected. Decreases in H(max):M(max) (tibial nerve stimulation) were observed at plantar flexed (gastrocnemius medialis and soleus) and neutral (soleus only) joint angles, but not with the ankle dorsiflexed. Muscle and fascicle strain increased (12 vs. 23%) along with a decrease in muscle stiffness (-18%) during stretch to a constant target joint angle. Muscle length at end ROM increased (13%) without a change in fascicle length, fascicle rotation, tendon elongation, or tendon stiffness following training. A lack of change in maximum voluntary contraction moment and rate of force development at any joint angle was taken to indicate a lack of change in series compliance of the muscle-tendon unit. Thus, increases in end ROM were underpinned by increases in maximum tolerable passive joint moment (stretch tolerance) and both muscle and fascicle elongation rather than changes in volitional muscle activation or motoneuron pool excitability. PMID:24947023
Cooney WP, Morrey BF. Elbow arthroplasty: Historical perspective and emerging concepts. In: Morrey BF, Sanchez-Sotlo J. The Elbow and Its Disorders . 4th ed. Philadelphia, PA; Elsevier Saunders; 2009: ...
Muscle contribution to elbow joint valgus stability.
Lin, Fang; Kohli, Navjot; Perlmutter, Sam; Lim, Dohyung; Nuber, Gordon W; Makhsous, Mohsen
Repetitive valgus stress of the elbow can result in excessive strain or rupture of the native medial ulnar collateral ligament (MUCL). The flexor-pronator mass (FPM) may be particularly important for elbow valgus stability in overhead-throwing athletes. The aim of this study was to identify the relative contribution of each muscle of the FPM--that is, the flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), flexor carpi radialis (FCR), and pronator teres (PT)--and of the extensor-supinator mass, including the extensor carpi ulnaris (ECU), extensor digitorum communis (EDC), extensor carpi radialis longus and brevus, and brachioradialis, to elbow valgus stability at 45 degrees and 90 degrees of elbow flexion angles. Eight fresh-frozen elbow specimens (mean age at death, 73.75 +/- 14.07 years) were tested. With the skin and subcutaneous tissue removed but all muscles left intact, each individual muscle of the FPM and extensor-supinator mass was loaded at 3 levels of force. During loading, strain on the MUCL and the kinematics of the elbow were measured simultaneously. Kinematic measurements were later repeated when the MUCL was fully cut. At 45 degrees and 90 degrees of elbow flexion, individual loading of the FCU, FDS, and FCR caused significant relief to the MUCL whereas the PT produced no significant change. Furthermore, of these flexor muscles, the FCU provided the greatest MUCL relief at both 45 degrees and 90 degrees . In contrast, loading of the ECU at 45 degrees of elbow flexion produced a significant increase in MUCL strain. All FPM muscles caused significant elbow varus movement at both 45 degrees and 90 degrees when loaded individually. At 90 degrees , the FCU created more motion than both the FCR and PT but not the FDS, and the FDS created more motion than the PT. The EDC and ECU created significant valgus movement at 45 degrees and 90 degrees , which became insignificant when the MUCL was transected. Our study suggested that the FCU, FDS, and
Influence of vibration on mechanical power and electromyogram activity in human arm flexor muscles.
Bosco, C; Cardinale, M; Tsarpela, O
The aim of this study was to evaluate the influence of vibration on the mechanical properties of arm flexors. A group of 12 international level boxers, all members of the Italian national team, voluntarily participated in the experiment: all were engaged in regular boxing training. At the beginning of the study they were tested whilst performing forearm flexion with an extra load equal to 5% of the subjects' body mass. Following this. one arm was given the experimental treatment (E; mechanical vibration) and the other was the control (no treatment). The E treatment consisted of five repetitions lasting 1-min each of mechanical vibration applied during arm flexion in isometric conditions with 1 min rest between them. Further tests were performed 5 min immediately after the treatment on both limbs. The results showed statistically significant enhancement of the average power in the arm treated with vibrations. The root mean square electromyogram (EMGrms) had not changed following the treatment but, when divided by mechanical power, (P) as an index of neural efficiency, it showed statistically significant increases. It was concluded that mechanical vibrations enhanced muscle P and decreased the related EMG/P relationship in elite athletes. Moreover, the analysis of EMGrms recorded before the treatment and during the treatment itself showed an enormous increase in neural activity during vibration up to more than twice the baseline values. This would indicate that this type of treatment is able to stimulate the neuromuscular system more than other treatments used to improve neuromuscular properties. PMID:10090628
A novel approach using tendon vibration of the human flexor carpi radialis muscle to study spinal reflexes.
Tsang, Kenneth; de Bruin, Hubert; Archambeault, Mark
Although most muscle spindle investigations have used the cat model and invasive measurement techniques, several investigators have used microneurography to record from the Ia and II fibres in humans during tendon vibration. In these studies the muscle spindle primary endings are stimulated using transverse vibration of the tendon at reflex sub-threshold amplitudes. Others have used low amplitude vibration and the stretch evoked M-wave response to determine reflex properties during both agonist and antagonist voluntary contractions. In the past we have developed a PC based instrument that uses Labview and a linear servomotor to study tendon reflex properties by recording stretch evoked M-wave responses from single tendon taps or electrical stimuli to the afferent nerve. In this paper we describe a further development of this system to provide precise vibrations of the tendon up to 65 Hz with amplitudes up to 4 mm. The resultant M-wave train is extracted from background noise via phase coherent subtractive filtering. Test results from vibrating the human distal flexor carpi radialis tendon at 10 and 30 Hz, for relaxed, slight flexion and slight extension, are also presented. PMID:19163861
The role of human ankle plantar flexor muscle-tendon interaction and architecture in maximal vertical jumping examined in vivo.
Farris, Dominic James; Lichtwark, Glen A; Brown, Nicholas A T; Cresswell, Andrew G
Humans utilise elastic tendons of lower limb muscles to store and return energy during walking, running and jumping. Anuran and insect species use skeletal structures and/or dynamics in conjunction with similarly compliant structures to amplify muscle power output during jumping. We sought to examine whether human jumpers use similar mechanisms to aid elastic energy usage in the plantar flexor muscles during maximal vertical jumping. Ten male athletes performed maximal vertical squat jumps. Three-dimensional motion capture and a musculoskeletal model were used to determine lower limb kinematics that were combined with ground reaction force data in an inverse dynamics analysis. B-mode ultrasound imaging of the lateral gastrocnemius (GAS) and soleus (SOL) muscles was used to measure muscle fascicle lengths and pennation angles during jumping. Our results highlighted that both GAS and SOL utilised stretch and recoil of their series elastic elements (SEEs) in a catapult-like fashion, which likely serves to maximise ankle joint power. The resistance of supporting of body weight allowed initial stretch of both GAS and SOL SEEs. A proximal-to-distal sequence of joint moments and decreasing effective mechanical advantage early in the extension phase of the jumping movement were observed. This facilitated a further stretch of the SEE of the biarticular GAS and delayed recoil of the SOL SEE. However, effective mechanical advantage did not increase late in the jump to aid recoil of elastic tissues. PMID:26685172
Muscle activity-torque-velocity relations in human elbow extensor muscles.
Uchiyama, T; Akazawa, K
With the aid of an artificial neural network technique, we investigated relationships between the torque and extending velocity of an elbow at constant muscle activation in healthy volunteers. Each subject sat on a chair and was able to move his upper- and forearm on a shoulder-high horizontal plane. First, with the gravitational force of a weight hanging from a pulley, the subject's wrist was pulled to flex the elbow. Next, the subject was instructed to extend his elbow joint at a constant velocity. Integrated electromyograms (IEMGs), elbow joint angle and torque were measured while the elbow was being extending. Then the relationships among these three variables were modeled using an artificial neural network where IEMGs, joint angle and velocity were the inputs, and torque was the output. After back propagation learning, we presented various combinations of IEMGs, elbow joint angle and velocity to the model, and estimated the elbow joint torque to obtain the torque-velocity relationship for constant muscle activation. The torque decreased in a nearly linear manner as the velocity increased. This was caused by slow extending velocity and was explained by Hill's equation at slow velocity. PMID:10718668
Traumatic flexor tendon injuries.
Lapegue, F; Andre, A; Brun, C; Bakouche, S; Chiavassa, H; Sans, N; Faruch, M
The flexor system of the fingers consisting of flexor tendons and finger pulleys is a key anatomic structure for the grasping function. Athletes and manual workers are particularly at risk for closed injuries of the flexor system: ruptured pulleys, ruptures of the flexor digitorum profundus from its distal attachment ("jersey finger"), and less frequently, ruptures of the flexor digitorum superficialis and of the lumbrical muscles. Open injuries vary more and their imaging features are more complex since tendons may be torn in several locations, the locations may be unusual, the injuries may be associated with nerve and vascular injuries, fibrosis… Sonography is the best imaging modality to associate with the clinical exam for it allows an experienced physician to make an accurate and early diagnosis, crucial to appropriate early treatment planning. PMID:26564614
Stretch reflex responses in the human elbow joint during a voluntary movement.
Bennett, D J
1. The responsiveness of the stretch reflex is modulated during human voluntary limb movements. The influence of this modulation on the limb mechanical properties (stiffness) was investigated. 2. Subjects were taught to replicate accurately a rapid (4.0 rad s-1) targeted elbow flexion movement of 1 rad. From the onset of 12% of the trials a sinusoidal position disturbance (0.05 rad) was superimposed on the normal (trained) movement trajectory. The net joint torque (muscle torque) resisting these stretches was computed from measurements of applied torque, acceleration and limb inertia. Electromyographic (EMG) responses in the triceps brachii (TB), brachialis (Br) and biceps brachii (BB) were monitored. 3. The EMG responses to sinusoidal stretches applied early in the movement were less than those responses to perturbations applied when the arm neared the target (especially in the antagonist muscle TB). These EMG responses caused fluctuations in the resistance to the perturbation (stiffness), as described below. 4. When the perturbation frequency was low (< 4 Hz) the resistance of the elbow muscles to the stretch increased as the arm approached the target (48% increase). In contrast, when the stretch frequency was 7 Hz the resistance decreased by 63%. This decrease can be explained by the increased reflex response, since at 7 Hz the reflex response is probably timed so that it assists, rather than resists, the stretching as a result of loop delays. This reflex timing was confirmed by observing that, after abruptly stopping the sinusoidal stretch, the reflex response persisted for 100 ms and was indeed in a direction that would have reduced the resistance, had the perturbation continued. 5. The time course of the net muscle stiffness was estimated for frequencies ranging from 4 to 8 Hz and for each 40 ms interval a Nyquist plot was constructed, forming a C-shaped curve as frequency was varied. The size of this curve gave a measure of the stiffness resulting from
Medial epicondylitis - golfer's elbow
Baseball elbow; Suitcase elbow ... to the bone on the inside of your elbow. When you use these muscles over and over ... when using a screwdriver) can lead to golfer's elbow. People in certain jobs may be more likely ...
Your elbow joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the elbow joint move. When any of these structures is hurt or diseased, you have elbow problems. Many things can make your elbow hurt. ...
... such as sprinting, kicking, and changing direction while running or moving, can stretch and tear the hip flexors. Runners, people who do martial arts, and football, soccer, and hockey players are more likely to have ...
... new elbow as soon as 12 weeks after surgery. Complete recovery can take up to a year. There will be limits to how much weight you can lift. Lifting too heavy of a ... the parts. Talk to your doctor or nurse about your limitations.
Time-varying stiffness of human elbow joint during cyclic voluntary movement.
Bennett, D J; Hollerbach, J M; Xu, Y; Hunter, I W
The objective of this study was to determine the extent to which subjects modulate their elbow joint mechanical properties during ongoing arm movement. Small pseudo-random force disturbances were applied to the wrist with an airjet actuator while subjects executed large (1 rad) elbow joint movements. Using a lumped parameter model of the muscle, tendon and proprioceptive feedback dynamics, a time-varying system identification technique was developed to analyze the phasic changes in the elbow joint's mechanical response. The mechanical properties were found to be time-varying, and well approximated by a quasi-linear second-order model. The stiffness of the arm was found to drop during movement. The arm was always underdamped, with the damping ratio changing during movement. Inertia estimates were constant and consistent with previous measurements. Overall, the moving arm was found to be very compliant, with a peak stiffness value less than the lowest value measured during posture, and a natural frequency of less than 3 Hz. Changing the speed of movement, or the load from gravity, changed the stiffness measured, but not in strict proportion to the change in net muscle torque. PMID:1577114
Dy, Christopher J; Daluiski, Aaron
Flexor pulley reconstruction is a challenging surgery. Injuries often occur after traumatic lacerations or forceful extension applied to an acutely flexed finger. Surgical treatment is reserved for patients with multiple closed pulley ruptures, persistent pain, or dysfunction after attempted nonoperative management of a single pulley rupture, or during concurrent or staged flexor tendon repair or reconstruction. If the pulley cannot be repaired primarily, pulley reconstruction can be performed using graft woven into remnant pulley rim or looping graft around the phalanx. Regardless of the reconstructive technique, the surgeon should emulate the length, tension, and glide of the native pulley. PMID:23660059
Rate modulation of human anconeus motor units during high-intensity dynamic elbow extensions.
Cowling, Brianna L; Harwood, Brad; Copithorne, David B; Rice, Charles L
Investigations of high-intensity isometric fatiguing protocols report decreases in motor unit firing rates (MUFRs), but little is known regarding changes in MUFRs following fatigue induced by high-intensity dynamic contractions. Our purpose was to evaluate MUFRs of the anconeus (an accessory elbow extensor) and elbow extension power production as a function of time to task failure (TTF) during high-velocity fatiguing concentric contractions against a moderately heavy resistance. Fine-wire intramuscular electrode pairs were inserted into the anconeus to record MUs in 12 male participants (25 ± 3 yr), over repeated sessions on separate days. MUs were tracked throughout a three-stage, varying load dynamic elbow extension protocol designed to extend the task duration for >1 min thereby inducing substantial fatigue. Mean MUFRs and peak power were calculated for three relative time ranges: 0-15% TTF (beginning), 45-60% TTF (middle) and 85-100% TTF (end). Mean duration of the overall fatigue protocol was ∼80 s. Following the protocol, isometric maximum voluntary contraction (MVC), highest velocity at 35% MVC load, and peak power decreased 37, 60, and 64% compared with baseline, respectively. Data from 20 anconeus MUs tracked successfully throughout the protocol indicated a reduction in MUFRs in relation to power loss from 36 Hz/160 W (0-15% TTF) to 28 Hz/97 W (45-60% TTF) to 23 Hz/43 W (85-100% TTF). During these high-intensity maximal effort concentric contractions, anconeus MUFRs decreased substantially (>35%). Although the absolute MUFRs were higher in the present study than those reported previously for other muscles during sustained high-intensity isometric tasks, the relative decrease in MUFRs was similar between the two tasks. PMID:27283910
Total elbow arthroplasty - discharge; Endoprosthetic elbow replacement - discharge ... You had surgery to replace your elbow joint with artificial joint parts (prosthetics). The surgeon made a cut (incision) in the back of your upper or lower arm and ...
The effects of forearm fatigue on baseball fastball pitching, with implications about elbow injury.
Wang, Lin-Hwa; Lo, Kuo-Cheng; Jou, I-Ming; Kuo, Li-Chieh; Tai, Ta-Wei; Su, Fong-Chin
This study investigated the contribution of flexor muscles to the forearm through fatigue; therefore, the differences in forearm mechanisms on the pitching motion in fastball were analysed. Fifteen baseball pitchers were included in this study. Ultrasonographical examination of participants' ulnar nerve in the cubital tunnel with the elbow extended and at 45°, 90° and 120° of flexion was carried. A three-dimensional motion analysis system with 14 reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the flexor carpi ulnaris, flexor carpi radialis and extensor carpi radialis muscles of the dominant arm. Flexor carpi ulnaris muscle activity showed a significant difference during the acceleration phase, with a peak value during fastball post-fatigue (P = 0.02). Significant differences in the distance between ulnar nerve and medial condyle on throwing arm and non-throwing arm were observed as the distance increased with the elbow movement from 0° to 120° of flexion (P = 0.01). The significant increase of the flexor carpi ulnaris muscle activity might be responsible for maintaining the stability of the wrist joint. The increased diameter might compress the ulnar nerve and cause several pathological changes. Therefore, fatigue in baseball pitchers still poses a threat to the ulnar nerve because the flexor carpi ulnaris and flexor carpi radialis all originate from the medial side of the elbow, and the swelling tendons after fatigue might be a key point. PMID:26484578
Pitzer, Michael E; Seidenberg, Peter H; Bader, Dov A
Overuse injuries of the lateral and medial elbow are common in sport, recreational activities, and occupational endeavors. They are commonly diagnosed as lateral and medial epicondylitis; however, the pathophysiology of these disorders demonstrates a lack of inflammation. Instead, angiofibroblastic degeneration is present, referred to as tendinosis. As such, a more appropriate terminology for these conditions is epicondylosis. This is a clinical diagnosis, and further investigations are only performed to rule out other clinical entities after conventional therapy has failed. Yet, most patients respond to conservative measures with physical therapy and counterforce bracing. Corticosteroid injections are effective for short-term pain control but have not demonstrated long-term benefit. PMID:24994055
Bullard, J. A. A.
Certain types of activity, particularly the wielding of a tennis racquet, put undue stress on the muscles of the forearm. The result can be extremely incapacitating as well as resistant to treatment. The earlier specific measures are introduced, the greater the success of conservative treatment. To provide this approach the physician must be aware of the multiple factors involved in the game. The backhand stroke appears to cause more problems than the forehand. Inexperienced players use the power of their elbows far more than the power of their whole bodies. Changes of technique or equipment may therefore be necessary. PMID:21286104
The contribution of motor commands to position sense differs between elbow and wrist
Walsh, Lee D; Proske, Uwe; Allen, Trevor J; Gandevia, Simon C
Recent studies have suggested that centrally generated motor commands contribute to the perception of position and movement at the wrist, but not at the elbow. Because the wrist and elbow experiments used different methods, this study was designed to resolve the discrepancy. Two methods were used to test both the elbow and wrist (20 subjects each). For the wrist, subjects sat with their right arm strapped to a device that restricted movement to the wrist. Before each test, voluntary contraction of wrist flexor or extensor muscles controlled for muscle spindle thixotropy. After relaxation, the wrist was moved to a test angle. Position was indicated either with a pointer, or by matching with the contralateral wrist, under two conditions: when the reference wrist was relaxed or when its muscles were contracted isometrically (30% maximum). The elbow experiment used the same design to measure position sense in the passive elbow and with elbow muscles contracting (30% maximum). At the wrist when using a pointer, muscle contraction altered significantly the perceived wrist angle in the direction of contraction by 7 deg [3 deg, 12 deg] (mean [95% confidence interval]) with a flexor contraction and 8 deg [4 deg, 12 deg] with an extensor contraction. Similarly, in the wrist matching task, there was a change of 13 deg [9 deg, 16 deg] with a flexor contraction and 4 deg [1 deg, 8 deg] with an extensor contraction. In contrast, contraction of elbow flexors or extensors did not alter significantly the perceived position of the elbow, compared with rest. The contribution of central commands to position sense differs between the elbow and the wrist. PMID:24099798
Fractionation of 50kGy electron beam irradiation: effects on biomechanics of human flexor digitorum superficialis tendons treated with ascorbate.
Wei, Wei; Liu, Yujie; Yang, Xu; Tian, Shaoqi; Liu, Chao; Zhang, Yang; Xu, Zhaoning; Hu, Baiqiang; Tian, Zhen; Sun, Kang
The electron beam (Ebeam) irradiation has begun to be considered as an efficient alternative to gamma irradiation in the sterilization of allografts in the reconstruction of anterior cruciate ligament. The purpose of this study was to evaluate the biomechanical properties of human tendons after exposure to electron beam and free radical scavenger ascorbate. Forty human flexor digitorum superficialis tendons were prepared from five fresh cadavers and divided randomly into four groups: A, fresh (0kGy); B, 50kGy Ebeam irradiation; C, fractionated 50kGy Ebeam irradiation; D, fractionated 50kGy Ebeam on ascorbate-treated tendons. The fractionation of 50kGy was achieved by repeated irradiation of 2.5kGy for 20 repetitions. Biomechanical properties were analyzed during load-to-failure testing. The fresh tendons were found to be significant different in ultimate load, ultimate elongation relative to tendons in group B. Statistical differences were found between group B and C in ultimate load. No differences were detected between group A and C in all the parameters. Compare tendons in group C and D, significant differences were found in ultimate load and ultimate stress. It is recommended that fractionated 50kGy electron beam irradiation and free radical scavenger ascorbate should be applied in the sterilization of allografts tendons. PMID:23261247
Elbow joint adductor moment arm as an indicator of forelimb posture in extinct quadrupedal tetrapods
Fujiwara, Shin-ichi; Hutchinson, John R.
Forelimb posture has been a controversial aspect of reconstructing locomotor behaviour in extinct quadrupedal tetrapods. This is partly owing to the qualitative and subjective nature of typical methods, which focus on bony articulations that are often ambiguous and unvalidated postural indicators. Here we outline a new, quantitatively based forelimb posture index that is applicable to a majority of extant tetrapods. By determining the degree of elbow joint adduction/abduction mobility in several tetrapods, the carpal flexor muscles were determined to also play a role as elbow adductors. Such adduction may play a major role during the stance phase in sprawling postures. This role is different from those of upright/sagittal and sloth-like creeping postures, which, respectively, depend more on elbow extensors and flexors. Our measurements of elbow muscle moment arms in 318 extant tetrapod skeletons (Lissamphibia, Synapsida and Reptilia: 33 major clades and 263 genera) revealed that sprawling, sagittal and creeping tetrapods, respectively, emphasize elbow adductor, extensor and flexor muscles. Furthermore, scansorial and non-scansorial taxa, respectively, emphasize flexors and extensors. Thus, forelimb postures of extinct tetrapods can be qualitatively classified based on our quantitative index. Using this method, we find that Triceratops (Ceratopsidae), Anhanguera (Pterosauria) and desmostylian mammals are categorized as upright/sagittally locomoting taxa. PMID:22357261
Elbow joint adductor moment arm as an indicator of forelimb posture in extinct quadrupedal tetrapods.
Fujiwara, Shin-ichi; Hutchinson, John R
Forelimb posture has been a controversial aspect of reconstructing locomotor behaviour in extinct quadrupedal tetrapods. This is partly owing to the qualitative and subjective nature of typical methods, which focus on bony articulations that are often ambiguous and unvalidated postural indicators. Here we outline a new, quantitatively based forelimb posture index that is applicable to a majority of extant tetrapods. By determining the degree of elbow joint adduction/abduction mobility in several tetrapods, the carpal flexor muscles were determined to also play a role as elbow adductors. Such adduction may play a major role during the stance phase in sprawling postures. This role is different from those of upright/sagittal and sloth-like creeping postures, which, respectively, depend more on elbow extensors and flexors. Our measurements of elbow muscle moment arms in 318 extant tetrapod skeletons (Lissamphibia, Synapsida and Reptilia: 33 major clades and 263 genera) revealed that sprawling, sagittal and creeping tetrapods, respectively, emphasize elbow adductor, extensor and flexor muscles. Furthermore, scansorial and non-scansorial taxa, respectively, emphasize flexors and extensors. Thus, forelimb postures of extinct tetrapods can be qualitatively classified based on our quantitative index. Using this method, we find that Triceratops (Ceratopsidae), Anhanguera (Pterosauria) and desmostylian mammals are categorized as upright/sagittally locomoting taxa. PMID:22357261
Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies
Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit
In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered. PMID:27582910
Comparison of electromyogram spectra with force spectra during human elbow tremor.
Matthews, P B; Muir, R B
1. The tremor that develops when the elbow is flexed against a spring attached at the wrist has been analysed by determining the 'power' spectrum of the demodulated surface e.m.g. recorded from two of the active muscles, biceps and brachioradialis. This was compared with the corresponding force spectrum obtained by analysis of the force developed at the fixed end of the spring (normally one of stiffness 2.8 N/mm); this force is directly proportional to the movement at the wrist. 2. When the subject was maintaining a high target force (100-160 N), with the aid of a visual display, the tremor was large with a large sharply tuned peak in the force spectrum and there was a clear peak at the same frequency in the e.m.g. spectrum. The coherence (gamma) between the force peak and the corresponding e.m.g. peak typically had a value of 0.95 or above, indicating a high degree of correlation. 3. On developing the same target force against a rigid restraint (70 N/mm) the peak in the force spectrum was absent or very much smaller and less sharply tuned. More particularly, the tremor-related peak seen in the e.m.g. spectrum under compliant conditions was no longer present under rigid conditions. 4. At low target forces (20-40 N) with compliant loading there was a small peak in the force spectrum but no peak could be detected in the e.m.g. spectrum. With increasing target force the mechanical tremor increased considerably and a peak progressively emerged from above the background level in the e.m.g. spectrum, accompanied by the development of a corresponding peak in the coherence spectrum. Thus the difference in detectability of peaks in the e.m.g. and force spectra might simply result from differences in the background 'noise' level of the two types of spectra. 5. Changing the spring stiffness in the range 0.7-12.5 N/mm altered the frequency of the mechanically recorded tremor by 1.5-2 Hz and the peak in the e.m.g. spectrum shifted in approximate correspondence. 6. The findings
Nursemaid's Elbow (For Parents)
... Lessons? Visit KidsHealth in the Classroom What Other Parents Are Reading Upsetting News Reports? What to Say ... Pregnant? Your Baby's Growth Nursemaid's Elbow KidsHealth > For Parents > Nursemaid's Elbow Print A A A Text Size ...
Tennis elbow surgery - discharge
... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed ...
Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is usually an outpatient surgery. This means you will not stay in the hospital overnight. You will be ...
Topsy-turvy locomotion: biomechanical specializations of the elbow in suspended quadrupeds reflect inverted gravitational constraints.
Fujiwara, Shin-ichi; Endo, Hideki; Hutchinson, John R
Some tetrapods hang upside down from tree branches when moving horizontally. The ability to walk in quadrupedal suspension has been acquired independently in at least 14 mammalian lineages. During the stance (supportive) phase of quadrupedal suspension, the elbow joint flexor muscles (not the extensors as in upright vertebrates moving overground) are expected to contract to maintain the flexed limb posture. Therefore muscular control in inverted, suspended quadrupeds may require changes of muscle control, and even morphologies, to conditions opposite to those in upright animals. However, the relationships between musculoskeletal morphologies and elbow joint postures during the stance phase in suspended quadrupeds have not been investigated. Our analysis comparing postures and skeletal morphologies in Choloepus (Pilosa), Pteropus (Chiroptera), Nycticebus (Primates) and Cynocephalus (Dermoptera) revealed that the elbow joints of these animals were kept at flexed angles of 70-100 ° during the stance phase of quadrupedal suspension. At these joint angles the moment arms of the elbow joint flexors were roughly maximized, optimizing that component of antigravity support. Our additional measurements from various mammalian species show that suspended quadrupeds have relatively small extensor/flexor ratios in both muscle masses and maximum moment arms. Thus, in contrast to the pattern in normal terrestrial quadrupeds, suspended quadrupeds emphasize flexor over extensor muscles for body support. This condition has evolved independently multiple times, attendant with a loss or reduction of the ability to move in normal upright postures. PMID:21477151
Topsy-turvy locomotion: biomechanical specializations of the elbow in suspended quadrupeds reflect inverted gravitational constraints
Fujiwara, Shin-ichi; Endo, Hideki; Hutchinson, John R
Some tetrapods hang upside down from tree branches when moving horizontally. The ability to walk in quadrupedal suspension has been acquired independently in at least 14 mammalian lineages. During the stance (supportive) phase of quadrupedal suspension, the elbow joint flexor muscles (not the extensors as in upright vertebrates moving overground) are expected to contract to maintain the flexed limb posture. Therefore muscular control in inverted, suspended quadrupeds may require changes of muscle control, and even morphologies, to conditions opposite to those in upright animals. However, the relationships between musculoskeletal morphologies and elbow joint postures during the stance phase in suspended quadrupeds have not been investigated. Our analysis comparing postures and skeletal morphologies in Choloepus (Pilosa), Pteropus (Chiroptera), Nycticebus (Primates) and Cynocephalus (Dermoptera) revealed that the elbow joints of these animals were kept at flexed angles of 70–100 ° during the stance phase of quadrupedal suspension. At these joint angles the moment arms of the elbow joint flexors were roughly maximized, optimizing that component of antigravity support. Our additional measurements from various mammalian species show that suspended quadrupeds have relatively small extensor/flexor ratios in both muscle masses and maximum moment arms. Thus, in contrast to the pattern in normal terrestrial quadrupeds, suspended quadrupeds emphasize flexor over extensor muscles for body support. This condition has evolved independently multiple times, attendant with a loss or reduction of the ability to move in normal upright postures. PMID:21477151
A neuromusculoskeletal model to simulate the constant angular velocity elbow extension test of spasticity.
Koo, Terry K K; Mak, Arthur F T
We developed a neuromusculoskeletal model to simulate the stretch reflex torque induced during a constant angular velocity elbow extension by tuning a set of physiologically-based parameters. Our model extended past modeling efforts in the investigation of elbow spasticity by incorporating explicit musculotendon, muscle spindle, and motoneuron pool models in each prime elbow flexor. We analyzed the effects of changes in motoneuron pool and muscle spindle properties as well as muscle mechanical properties on the biomechanical behavior of the elbow joint observed during a constant angular velocity elbow extension. Results indicated that both motoneuron pool thresholds and gains could be substantially different among muscles. In addition, sensitivity analysis revealed that spindle static gain and motoneuron pool threshold were the most sensitive parameters that could affect the stretch reflex responses of the elbow flexors during a constant angular velocity elbow extension, followed by motoneuron pool gain, and spindle dynamic gain. It is hoped that the model will contribute to the understanding of the underlying mechanisms of spasticity after validation by more elaborate experiments, and will facilitate the future development of more specific treatment of spasticity. PMID:15908257
Abnormal force--EMG relations in paretic limbs of hemiparetic human subjects.
Tang, A; Rymer, W Z
The relations between surface EMG and isometric force generated by elbow flexor muscles were compared in normal and paretic limbs of 17 hemiparetic human subjects. Similar analyses were performed on both arms of 11 normal subjects. In almost half of the hemiparetic subjects examined (8/17), the slope of the relation between elbow flexion force and surface EMG, measured over the biceps-brachialis and brachioradialis muscle groups was increased in the paretic limb. A mechanism based on anomalous reductions in mean motor unit discharge rate in paretic muscles is advanced as the most likely cause of the findings. PMID:7299407
Peter Elbow's Rhetoric of Reading.
ERIC Educational Resources Information Center
Gardiner, Ellen
Claims that Peter Elbow's rhetoric of reading has been oversimplified by applications of taxonomic critiques. Shows how Elbow not only does not ignore the social, but that in fact Elbow's rhetoric tends to try to control it. (HB)
Torques generated at the human elbow joint in response to constant position errors imposed during voluntary movements.
Bennett, D J
The stiffness of the human elbow joint was investigated during targeted, 1.0-rad voluntary flexion movements at speeds ranging from slow (1.5 rad/s) to very fast (6.0 rad/s). A torque motor produced controlled step position errors in the execution of the movements. The steps began at the onset of movement, rose to an amplitude of 0.15 rad in 100 ms, and had a duration equal to movement duration. The net joint torque (muscle torque) resisting the step perturbation was computed from the applied torque, the joint acceleration, and the limb inertia. Subjects resisted the imposed step changes with approximately step changes in the net muscle torque. The mean resistance torque divided by the step amplitude was computed and is referred to as the stiffness. The stiffness increased with the voluntary movement speed, over the range of speeds (1.5-6 rad/s). The stiffness increased linearly with the magnitude of the net muscle torque on the unperturbed trials (referred to as "background torque"). The stiffness changed by only 20% when the step amplitude ranged from 0.05 to 0.15 rad. The mechanical resonant frequency (fr), estimated from the average stiffness estimates, ranged from 0.8 to 3.0 Hz. The resonant frequency approximately equaled the principal frequency component of the movement fm. On average: fr = 0.96 fm +0.46. During the fixed, 100-ms rise time of the step, the resistance was not linearly related to the background torque. At slower speeds the resistance was relatively greater during this rise time. However, when the imposed step perturbation was modified so that its rise time occurred in a time proportional to the movement duration (rather than in the fixed, 100-ms, time), the muscle torque resisting the motor during this rise time was proportional to the background torque. When these modified step responses were plotted on a time scale normalized to the movement duration, they all had approximately the same shape. Apparently the muscle viscosity scaled with the
McFarland, Andrew R.; Rodgers, John C.; Ortiz, Carlos A.; Nelson, David C.
Elbow mass flow meter. The present invention includes a combination of an elbow pressure drop generator and a shunt-type mass flow sensor for providing an output which gives the mass flow rate of a gas that is nearly independent of the density of the gas. For air, the output is also approximately independent of humidity.
.org Elbow (Olecranon) Bursitis Page ( 1 ) Bursae are thin, slippery sacs located throughout the body that act as cushions between bones and so ... more fluid will accumulate in the bursa and bursitis will develop. Cause Elbow bursitis can occur for ...
... above and below the injured elbow (including the shoulder and wrist) from moving, if possible. Take the child to your health care provider's office or an emergency room. Your provider will fix the dislocation by gently flexing the elbow and rotating the ...
Morrey, B.F.
This book contains 49 chapters. Some of the chapter titles are: Diagnostic Radiographic Techniques of the Elbow; Radiography of the Pediatric Elbow; Muscle and Tendon Trauma: Tennis Elbow; Nerve Injuries; Tendon Injurires about the Elbow; and Ligamentous and Articular Injuries in the Athlete.
Primary total elbow arthroplasty
Kumar, Suresh; Mahanta, Sunayan
Background: Primary total elbow arthroplasty (TEA) is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years). The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained) hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80°) and average pronation was 70° (range 60-80°). Average flexion was 135° (range 130-135°). However, in 5 cases, there was loss of 15 to 35° (average 25°) of extension (45°) out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100). Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18%) out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head were replaced
... weeks before you can drive. Your surgeon or physical therapist will tell you when it is ok. You ... elbow and arm stronger. Ask your surgeon or physical therapist how much weight you can lift. You may ...
Patel, Ronak M; Lynch, T Sean; Amin, Nirav H; Calabrese, Gary; Gryzlo, Stephen M; Schickendantz, Mark S
Overhead throwing activities expose the elbow to tremendous valgus stress, making athletes vulnerable to a specific constellation of injuries. Although baseball players, in particular pitchers, are the athletes affected most commonly, overhead throwing athletes in football, volleyball, tennis, and javelin tossing also are affected. The purpose of this review is to review the anatomy, biomechanics, pathophysiology, and treatment of elbow disorders related to overhead throwing athletes. Although focus is on management of ulnar collateral ligament injuries, all common pathologies are discussed. PMID:24975763
Loeffler, Bryan J; Lewis, Daniel R
Active elbow flexion is required to position the hand in space, and loss of this function is debilitating. Nerve transfers or nerve grafts to restore elbow flexion may be options when the target muscle is viable, but in delayed reconstruction when the biceps and brachialis are atrophied or damaged, muscle transfer options should be considered. Muscle transfer options are discussed with attention to the advantages and disadvantages of each transfer option. PMID:27387075
Ultrasound-Guided Elbow Procedures.
Sussman, Walter I; Williams, Christopher J; Mautner, Ken
High-resolution ultrasonography can help clinicians visualize key anatomic structures of the elbow and guide periarticular and intra-articular injections. Historically, most procedures done around the elbow have been done using landmark guidance, and few studies have reported the accuracy of ultrasonography-guided injections in the elbow region. This article reviews common musculoskeletal disorders about the elbow that can be evaluated with ultrasonography, reviews the literature on ultrasonography-guided injections of the elbow region, and describes the senior author's preferred approach for the most commonly performed elbow region injections. PMID:27468667
The thrower's elbow: arthroscopic treatment of valgus extension overload syndrome.
O'Holleran, James D; Altchek, David W
Injury to the medial collateral ligament of the elbow (MCL) can be a career-threatening injury for an overhead athlete without appropriate diagnosis and treatment. It has been considered separately from other athletic injuries due to the unique constellation of pathology that results from repetitive overhead throwing. The past decade has witnessed tremendous gains in understanding of the complex interplay between the dynamic and static stabilizers of the athlete's elbow. Likewise, the necessity to treat these problems in a minimally invasive manner has driven the development of sophisticated techniques and instrumentation for elbow arthroscopy. MCL injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans (OCD) of the capitellum have all been described as sequelae of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can all be present in conjunction with these problems or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these problems in order to form a comprehensive differential diagnosis for an athlete presenting with elbow pain, and he or she must be comfortable with the variety of open and arthroscopic treatments available to best serve the patient. An understanding of the anatomy and biomechanics of the thrower's elbow is critical to the care of this population. The preoperative evaluation should focus on a thorough history and physical examination, as well as on specific diagnostic imaging modalities. Arthroscopic setup, including anesthesia, patient positioning, and portal choices will be discussed. Operative techniques in the anterior and posterior compartments will be reviewed, as well as postoperative rehabilitation and surgical results. Lastly, complications
Multiple forearm robotic elbow configuration
Fisher, J.J.
This patent describes a dual forearmed robotic elbow configuration comprises a main arm having a double elbow from which two coplanar forearms depend, two actuators carried in the double elbow for moving the forearms, and separate, independent end effectors, operated by a cable carried from the main arm through the elbow, is attached to the distal end of each forearm. Coiling the cables around the actuators prevents bending or kinking when the forearms are rotated 360 degrees. The end effectors can have similar or different capabilities. Actuator canisters within the dual elbow are modular for rapid replacement or maintenance. Coarse and fine resolver transducers within the actuators provide accurate position referencing information.
Multiple forearm robotic elbow configuration
Fisher, John J.
A dual forearmed robotic elbow configuration comprises a main arm having a double elbow from which two coplanar forearms depend, two actuators carried in the double elbow for moving the forearms, and separate, independent end effectors, operated by a cable carried from the main arm through the elbow, is attached to the distal end of each forearm. Coiling the cables around the actuators prevents bending or kinking when the forearms are rotated 360 degrees. The end effectors can have similar or different capabilities. Actuator cannisters within the dual elbow are modular for rapid replacement or maintenance. Coarse and fine resolver transducers within the actuators provide accurate position referencing information.
Tennis Elbow (Lateral Epicondylitis)
... to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength. New Developments Platelet-rich plasma (PRP) is currently being investigated for its effectiveness ...
McFarland, A.R.; Rodgers, J.C.; Ortiz, C.A.; Nelson, D.C.
The present invention includes a combination of an elbow pressure drop generator and a shunt-type mass flow sensor for providing an output which gives the mass flow rate of a gas that is nearly independent of the density of the gas. For air, the output is also approximately independent of humidity. 3 figs.
NASA Technical Reports Server (NTRS)
Weddendorf, Bruce C. (Inventor)
An artificial, manually positionable elbow joint for use in an upper extremity, above-elbow, prosthetic is described. The prosthesis provides a locking feature that is easily controlled by the wearer. The instant elbow joint is very strong and durable enough to withstand the repeated heavy loadings encountered by a wearer who works in an industrial, construction, farming, or similar environment. The elbow joint of the present invention comprises a turntable, a frame, a forearm, and a locking assembly. The frame generally includes a housing for the locking assembly and two protruding ears. The forearm includes an elongated beam having a cup-shaped cylindrical member at one end and a locking wheel having a plurality of holes along a circular arc on its other end with a central bore for pivotal attachment to the protruding ears of the frame. The locking assembly includes a collar having a central opening with a plurality of internal grooves, a plurality of internal cam members each having a chamfered surface at one end and a V-shaped slot at its other end; an elongated locking pin having a crown wheel with cam surfaces and locking lugs secured thereto; two coiled compression springs; and a flexible filament attached to one end of the elongated locking pin and extending from the locking assembly for extending and retracting the locking pin into the holes in the locking wheel to permit selective adjustment of the forearm relative to the frame. In use, the turntable is affixed to the upper arm part of the prosthetic in the conventional manner, and the cup-shaped cylindrical member on one end of the forearm is affixed to the forearm piece of the prosthetic in the conventional manner. The elbow joint is easily adjusted and locked between maximum flex and extended positions.
Conversion of a surgical elbow arthrodesis to total elbow arthroplasty.
Rog, Dominik; Zuckerman, Lee M; Riedel, Barth
Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior. PMID:25815223
A musculoskeletal model of the elbow joint complex
NASA Technical Reports Server (NTRS)
Gonzalez, Roger V.; Barr, Ronald E.; Abraham, Lawrence D.
This paper describes a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. Musculotendon parameters and the skeletal geometry were determined for the musculoskeletal model in the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing both isometric and ballistic elbow joint complex movements. In general, the model predicted kinematic and muscle excitation patterns similar to what was experimentally measured.
Pyogenic Flexor Tenosynovitis Caused by Shewanella algae.
Fluke, Erin C; Carayannopoulos, Nikoletta L; Lindsey, Ronald W
Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately. PMID:27206398
Flexor tendon repair in zone III.
Al-Qattan, Mohammad M
There is a paucity of the literature on the outcome of zone III flexor tendon injuries. In this paper, we report on the results of zone III flexor tendon repair in 35 consecutive adult patients with clean cut lacerations of both flexor tendons in 42 fingers. There were 25 men and 10 women with an average age of 32 years. Repair of both flexor tendons was performed using 'figure of eight' core sutures and a continuous epitendinous suture. Postoperatively, an immediate active range of motion protocol was applied to ensure full active extension of the interphalangeal joints. The results were assessed using the Strickland-Glogovac grading system. There were no ruptures. One patient with two injured fingers developed complex regional pain syndrome and the final outcome was fair in both fingers. In the remaining 34 patients (40 fingers), 33 patients (38 fingers) had an excellent outcome and the remaining patient (two fingers) had a good outcome. PMID:20807720
Concerns on Little League Elbow.
ERIC Educational Resources Information Center
Wells, Michael J.; Bell, Gerald W.
Little league elbow is a common overuse injury resulting from repetitive valgus stress on the elbow during overhead throwing. Prevention and treatment should emphasize education of athletes, parents, and coaches about its etiology. The paper examines bone development, noting that the condition is highly treatable if diagnosed in early development.…
The role of biceps brachii and brachioradialis for the control of elbow flexion and extension movements.
von Werder, Sylvie Charlotte Frieda Anneliese; Disselhorst-Klug, Catherine
How do synergistic muscles interact, when their contraction aims at stabilizing and fine-tuning a movement, which is induced by the antagonistic muscle? The aim of the study was to analyze the interaction of biceps and brachioradialis during fine-tuning control tasks in comparison to load bearing ones. The surface electromyogram of biceps, brachioradialis and triceps were examined in 15 healthy subjects in dynamic flexion and extension movements with different combinations of contraction levels, joint angles and angular velocities. The measurements were conducted in two configurations, where the torque due to an external load opposes the rotational direction of the elbow flexion (load bearing tasks) or the elbow extension (fine-tuning tasks). Whereas during load bearing control tasks, similar muscular activation of biceps and brachioradialis was observed for all joint angles, angular velocities and external loads, during fine-tuning control tasks a significant difference of the muscular activation of both flexors was observed for 1kg, F(3.639,47.305)=2.864, p=0.037, and 5kg of external load, F(1.570,21.976)=6.834, p=0.008. The results confirm the synergistic muscular activation of both flexors during load bearing tasks, but suggest different control strategies for both flexors when they comprise a fine-tuning control task. PMID:27061680
Pediatric elbow injuries in athletes.
Makhni, Eric C; Jegede, Kola A; Ahmad, Christopher S
Elbow injuries in pediatric and adolescent population represent a spectrum of pathology that can range from medial tension injuries to posterior shear injuries. Elbow injuries in this population continue to rise in parallel with the increase in youth participation in sports both throughout the calendar year and across multiple sports. Many of these injuries are noncontact and are attributed to overuse. Evaluation and management of youth and adolescent athletic elbow injuries requires knowledge of developmental anatomy, injury pathophysiology, and established treatment algorithms. Furthermore, risk factors contributing to elbow injuries must be recognized, with education and recommendations for safe play continually advocated. This education--of parents, athletes, and coaches--is paramount in reducing the climbing incidence of elbow injuries in our youth athletes. PMID:25077752
Computing muscle, ligament, and osseous contributions to the elbow varus moment during baseball pitching
Buffi, James H.; Werner, Katie; Kepple, Tom; Murray, Wendy M.
Baseball pitching imposes a dangerous valgus load on the elbow that puts the joint at severe risk for injury. The goal of this study was to develop a musculoskeletal modeling approach to enable evaluation of muscle-tendon contributions to mitigating elbow injury risk in pitching. We implemented a forward dynamic simulation framework that used a scaled biomechanical model to reproduce a pitching motion recorded from a high school pitcher. The medial elbow muscles generated substantial, protective, varus elbow moments in our simulations. For our subject, the triceps generated large varus moments at the time of peak valgus loading; varus moments generated by the flexor digitorum superficialis were larger, but occurred later in the motion. Increasing muscle-tendon force output, either by augmenting parameters associated with strength and power or by increasing activation levels, decreased the load on the ulnar collateral ligament. Published methods have not previously quantified the biomechanics of elbow muscles during pitching. This simulation study represents a critical advancement in the study of baseball pitching and highlights the utility of simulation techniques in the study of this difficult problem. PMID:25281409
Flexor pulley system: anatomy, injury, and management.
Zafonte, Brian; Rendulic, Dora; Szabo, Robert M
Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the once-held dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function. PMID:25459958
Biomechanical effects of dissecting flexor carpi ulnaris.
Kreulen, M; Smeulders, M J C; Hage, J J; Huijing, P A
Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer. PMID:12931805
Coexistent digital gouty and infective flexor tenosynovitis.
Akram, Qasim; Hughes, Michael; Muir, Lindsay
Flexor tenosynovitis of the hand is often caused by trauma or infection. Gouty tenosynovitis is an uncommon presentation of the condition and is usually misdiagnosed as infection with the patient undergoing surgery. The coexistence of infection and gout causing flexor tenosynovitis has never been described before in the literature; we report the first ever case and emphasise the importance of its awareness for optimal treatment. A 54-year-old man was initially diagnosed and treated as having infective flexor tenosynovitis and, later, due to a lack of improvement in his symptoms, was discovered to also have gout. We review the literature and suggest management strategy for use in daily clinical practice, including an algorithm, for this presentation. PMID:27358092
Plantar flexor moment arm and muscle volume predict torque-generating capacity in young men
Baxter, Josh R.
Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R2 < 0.322) and with muscle moment arm at each speed (0.323 < R2 < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size. PMID:24371016
The CS Sulfation Motifs 4C3, 7D4, 3B3[-]; and Perlecan Identify Stem Cell Populations and Their Niches, Activated Progenitor Cells and Transitional Areas of Tissue Development in the Fetal Human Elbow.
Hayes, Anthony J; Hughes, Clare E; Smith, Susan M; Caterson, Bruce; Little, Christopher B; Melrose, James
We compared the immunohistochemical distribution of (1) the novel chondroitin sulfate (CS) sulfation motifs 7D4, 4C3, and 3B3[-], (2) native heparan sulfate (HS) and Δ-HS "stubs" generated by heparitinase III digestion and (3) the HS-proteoglycan (PG), perlecan, in the fetal human elbow joint. Putative stem cell populations associated with hair bulbs, humeral perichondrium, humeral and ulnar rudiment stromal/perivascular tissues expressed the CS motifs 4C3, 7D4, and 3B3[-] along with perlecan in close association but not colocalized. Chondrocytes in the presumptive articular cartilage of the fetal elbow expressed the 4C3 and 7D4 CS sulfation motifs consistent with earlier studies on the expression of these motifs in knee cartilage following joint cavitation. This study also indicated that hair bulbs, skin, perichondrium, and rudiment stroma were all perlecan-rich progenitor cell niches that contributed to the organization and development of the human fetal elbow joint and associated connective tissues. One of the difficulties in determining the precise role of stem cells in tissue development and repair processes is their short engraftment period and the lack of specific markers, which differentiate the activated stem cell lineages from the resident cells. The CS sulfation motifs 7D4, 4C3, and 3B3[-] decorate cell surface PGs on activated stem/progenitor cells and thus can be used to identify these cells in transitional areas of tissue development and in repair tissues and may be applicable to determining a more precise mode of action of stem cells in these processes. Isolation of perlecan from 12 to 14 week gestational age fetal knee rudiments demonstrated that perlecan in these fetal tissues was a HS-CS hybrid PG further supporting roles for CS in tissue development. PMID:27068010
Simultaneous closed rupture of flexor digitorum superficialis and flexor digitorum profundus tendons in the middle finger: a case report
Jordan, Robert W.; Lotfi, Naeil; Shyamalan, Gunaratnam
Abstract A 20-year-old man suffered a closed rupture of both flexor tendons in the middle finger while playing rugby. Primary repair of the flexor digitorum profundus and excision of the flexor digitorum superficialis was performed. At follow up he reported a Disabilities of the Arm, Shoulder and Hand score of 0 and unrestricted return to activities.
[Fractures of the elbow joint].
Nowak, T E; Dietz, S O; Burkhart, K J; Müller, L P; Rommens, P M
Fractures around the elbow joint comprise fractures of the distal humerus, the radial head, the olecranon and the coronoid process. Combined lesions are particularly demanding for the surgeon. Accurate knowledge of the anatomy and of the biomechanics is an essential requirement for a specific diagnosis and therapy. A stable and painless movable elbow joint is essential for most of the activities of daily living. Risk factors for the development of posttraumatic elbow joint arthrosis are non-anatomically reconstructed joint surfaces, axial malalignment of the joint axis and untreated concomitant injuries. Modern angular stable and anatomically preshaped implants facilitate a biomechanically adequate osteosynthesis and avoid or decrease functional impairment. In consideration of an increasing number of osteoporotic elbow joint fractures, endoprosthetic replacement has gained significance. PMID:22271056
Vieira, Luis Alfredo Gómez; Dal Molin, Fabio Farina; Visco, Adalberto; Fernandes, Luis Filipe Daneu; dos Santos, Murilo Cunha Rafael; Cardozo Filho, Nivaldo Souza; Gómez Cordero, Nicolas Gerardo
To present the arthroscopic surgical technique and the evaluation of the results from this technique for treating elbow stiffness. Methods: Between April 2007 and January 2010, ten elbows of ten patients with elbow stiffness underwent arthroscopic treatment to release the range of motion. The minimum follow-up was 11 months, with an average of 27 months. All the patients were male and their average age was 32.8 years (ranging from 22 to 48 years). After the arthroscopic treatment, they were followed up weekly in the first month and every three months thereafter. The clinical evaluation was made using the criteria of the University of California at Los Angeles (UCLA). Results: All the patients were satisfied with the results from the arthroscopic treatment. The average UCLA score was 33.8 points. Conclusion: Arthroscopic treatment for elbow stiffness is a minimally invasive surgical technique that was shown to be efficient for treating this complication. PMID:27027027
Arthroscopic Treatment of Stiff Elbow
Blonna, Davide; Bellato, Enrico; Marini, Eleonora; Scelsi, Michele; Castoldi, Filippo
Contracture of the elbow represents a disabling condition that can impair a person's quality of life. Regardless of the event that causes an elbow contracture, the conservative or surgical treatment is usually considered technically difficult and associated with complications. When the conservative treatment fails to restore an acceptable range of motion in the elbow, open techniques have been shown to be successful options. More recently the use of arthroscopy has become more popular for several reasons. These reasons include better visualization of intra-articular structures, less tissue trauma from open incisions, and potentially the ability to begin early postoperative motion. The purpose of this paper is to review the indications, complications, and results of arthroscopic management of a stiff elbow. PMID:22084755
Simultaneous shoulder and elbow dislocation
Çobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih
Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice. PMID:24859563
A Physiological Dynamic Testing Machine for the Elbow Joint
Kiene, Johannes; Wendlandt, Robert; Heinritz, Marcus; Schall, Angelika; Schulz, Arndt-Peter
Background: The aim of our study was to develop a test setup combining realistic force transmission with physiological movement patterns at a frequency that mimicked daily use of the elbow, to assess implants in orthopedic joint reconstruction and trauma surgery. Methods: In a multidisciplinary approach, an in vitro biomechanical testing machine was developed and manufactured that could simulate the repetitive forceful movement of the human elbow joint. The construction involved pneumatic actuators. An aluminum forearm module enabled movements in 3 degrees of freedom, while motions and forces were replicated via force and angular sensors that were similar to in vivo measurements. Results: In the initial testing, 16 human elbow joint specimens were tested at 35 Nm in up to 5000 cycles at a range of 10° extension to 110° flexion. The transmitted forces led to failure in 9 out of the 16 tested specimens, significantly more often in females and small specimens. Conclusions: It is possible to construct a testing machine to simulate nearly physiological repetitive elbow motions. The prototype has a number of technical deficiencies that could be modified. When testing implants for the human elbow with cadaver specimens, the specimen has to be chosen according to the intended use of the implant under investigation. PMID:23667406
Instability of the elbow treated with semiconstrained total elbow arthroplasty.
Ramsey, M L; Adams, R A; Morrey, B F
The results of nineteen semiconstrained modified Coonrad-Morrey total elbow arthroplasties performed in nineteen patients to treat instability were evaluated at an average of seventy-two months (range, twenty-five to 128 months) postoperatively. Preoperatively, all patients had either a flail elbow or gross instability of the elbow that prevented useful function of the extremity. The instability of sixteen elbows was the result of a traumatic injury or of the treatment of such an injury. The most recent result was satisfactory for sixteen elbows and unsatisfactory for three. The average overall Mayo elbow performance score increased from 44 points preoperatively to 86 points postoperatively. At the most recent follow-up examination, no elbow was unstable. The average arc of flexion was from 25 degrees (range, 0 to 60 degrees) to 128 degrees (range, 30 to 142 degrees), which represented a 58-degree increase from the preoperative average arc. Sixteen patients had little or no pain after the arthroplasty. There were four complications in four patients. Three complications (loosening of the humeral component in one patient and a fracture of the ulnar component in two) occurred postoperatively; all three were treated with a revision procedure. The other complication (a fracture of the olecranon) occurred intraoperatively and was treated with tension-band fixation; the most recent outcome was not affected. Radiographically, one patient had complete (type-V) radiolucency about the humeral component. None of the nine patients for whom true anteroposterior radiographs were available had evidence of wear of the bushings. The bone graft behind the anterior flange of the humeral prosthesis was mature in fourteen elbows, incomplete in two, and resorbed in two. One patient was excluded from this analysis because radiographs were not available. Instability of the elbow resulting in the inability to use the extremity is a challenging clinical situation. However, in patients who
Editorial Commentary: Just a Bit Outside: Elbow Ulnar Collateral Ligament Research Requires Critical Appraisal.
Dugas, Jeffrey R
Elbow ulnar collateral ligament reconstruction (UCLR) in Major League Baseball players using either a docking technique or a modified Jobe technique (modified to avoid flexor-pronator detachment) is effective treatment in experienced hands. The study of UCLR in Major League Baseball players requires recording and reporting of the actual number of athletes treated by individual surgeons using different techniques, to determine practice patterns. Absent these data, and with poor response rate by the solicited physicians (41%), survey results may be misleading. In addition, although transient ulnar neuritis may occur during UCLR, permanent ulnar neuropathy is exceedingly rare. PMID:27373177
Secondary repair of flexor tendon injuries.
Battiston, B; Triolo, P F; Bernardi, A; Artiaco, S; Tos, P
Tendon adhesions or even secondary ruptures causing severe hand functional impairment still represent a frequent complication after repair of flexor tendon injuries. Secondary treatment of these problems includes tenolysis, one or two stages flexor tendons reconstruction by grafts or even the use of tendon prosthesis. The mechanism and severity of injury, the status of the surrounding tissues and injured finger, the presence of associated lesions, the age of the patient, post-operative management, patient motivation and the surgeon's skill, may all have implications in the final outcome of the tendon reconstruction. A correct evaluation of the problem by means of classifications such as the one described by Boyes, may help the surgeon in choosing the appropriate technique. PMID:23347767
[Flexor tendon repair: a short story].
Moutet, F; Corcella, D; Forli, A; Mesquida, V
This short story of flexor tendon repair aims to illustrate hesitations and wanderings of this surgery. Obviously tendon repair was very early considered, but it developed and diffused rather lately. It became a routine practice only in 20th century. This was due on the one hand, in Occident, to the Galen's dogmatic interdiction, on the other hand, to the repair difficulties of this paradoxical structure. Actually tendon is made of fibroblasts and collagen (sticky substances), and then its only goal is to move. According to this necessity, whatever the used techniques are, gliding is the final purpose. Technical evolutions are illustrated by historical contributions to flexor tendon surgery of several "giants" of hand surgery. PMID:24837978
Nutrient pathways of flexor tendons in primates
Manske, P.R.; Lesker, P.A.
The perfusion and diffusion pathways to the flexor profundus tendons of 40 monkeys were investigated by measuring the uptake of tritiated proline by various tendon segments. In the absence of all vascular connections, the process of diffusion provides nutrients to all areas of flexor tendon and in this study the process of diffusion was greater. The distal segment of tendon was observed to be profused most rapidly. The proximal tendon segment is perfused from both the muscular-tendinous junction and the vinculum longus; vincular segment perfusion is via the vinculum longus vessels alone; central segment perfusion is shared by the vinculum longus and vinculum brevis vasculature. The distal segment uptake is by both the process of diffusion or vinculum brevis perfusion. The osseous attachment at the distal phalanx contributes little to tendon nutrition.
Haptic Recreation of Elbow Spasticity
Kim, Jonghyun; Damiano, Diane L.
The aim of this paper is to develop a haptic device capable of presenting standardized recreation of elbow spasticity. Using the haptic device, clinicians will be able to repeatedly practice the assessment of spasticity without requiring patient involvement, and these practice opportunities will help improve accuracy and reliability of the assessment itself. Haptic elbow spasticity simulator (HESS) was designed and prototyped according to mechanical requirements to recreate the feel of elbow spasticity. Based on the data collected from subjects with elbow spasticity, a mathematical model representing elbow spasticity is proposed. As an attempt to differentiate the feel of each score in Modified Ashworth Scale (MAS), parameters of the model were obtained respectively for three different MAS scores 1, 1+, and 2. The implemented haptic recreation was evaluated by experienced clinicians who were asked to give MAS scores by manipulating the haptic device. The clinicians who participated in the study were blinded to each other's scores and to the given models. They distinguished the three models and the MAS scores given to the recreated models matched 100% with the original MAS scores from the patients. PMID:22275660
Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations
Zellner, Johannes; Koller, Michael; Nerlich, Michael; Lenich, Andreas
This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness. PMID:24228180
Effect of flexor sheath integrity on nutrient uptake by chicken flexor tendons
Peterson, W.W.; Manske, P.R.; Lesker, P.A.
The effect of varying degrees of flexor sheath integrity (sheath excised, incised, or incised and repaired) on the uptake of /sub 2/H-proline by chicken flexor tendons in Zone II was studied. The tendons were either: normal and uninjured, lacerated and repaired, or uninjured except for vinculum longum ligation. Different degrees of sheath integrity did not influence the uptake of /sub 2/H-proline by the tendons. The tendon does not appear to be dependent on a synovial environment for nutrients and is capable of obtaining these nutrients by diffusion from the surrounding extracellular tissue fluid. Diffusion is the primary nutrient pathway to the flexor tendon in this area, because removing its major vascular attachment (i.e., the vinculum longum) did not effect proline uptake. Careful closure of the sheath with restoration of a synovial environment does not appear to be necessary for tendon nutrition.
Changes in motor cortical excitability during human muscle fatigue.
Taylor, J L; Butler, J E; Allen, G M; Gandevia, S C
1. The excitability of the motor cortex was investigated during fatiguing con of the elbow flexors in human subjects. During sustained contractions at 30 and 1 voluntary force (MVC), the short-latency electromyographic responses (EMG) evoke brachii and brachioradialis by transcranial magnetic stimulation increased in si EMG in the elbow flexors following the evoked muscle potential (silent period), duration during a sustained MVC but not during 30% MVCs nor during a sustained M muscle (adductor pollicis). 2. When the blood supply to brachioradialis was blocked with sphygmomanometer cuff sustained MVC, the changes in EMG responses to transcranial stimulation rapidly control values, This suggests that changes in these responses during fatigue wer small-diameter muscle afferents. 3. Tendon vibration during sustained MVCs indicated that the changes in the resp cortial stimulation were not mediated by reduced muscle spindle inputs. 4. Muscle action potentials evoked in brachioradialis by electrical stimulation cervicomedullary junction did not increase in size during sustained MVCs. Thus, cortically evoked responses during sustained MVCs reflects a change in cortical Although the silent period following cervicomedullary stimulation lengthened, it substantially shorter than the cortically evoked silent period. 5. The altered EMG responses to transcranial stimulation during fatigue suggest exitation and increased inhibition in the motor cortex. As these changes were un manipulation of afferent input they presumably result from intrinsic cortical pr altered voluntary drive to the motor cortex. Images Figure 1 PMID:8821148
IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).
Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther
Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries. PMID:23962872
Endoscopic Ganglionectomy of the Elbow
Lui, Tun Hing
Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning. PMID:26870641
Endoscopic Ganglionectomy of the Elbow.
Lui, Tun Hing
Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning. PMID:26870641
Posttraumatic elbow contractures: targeting neuroinflammatory fibrogenic mechanisms.
Monument, Michael J; Hart, David A; Salo, Paul T; Befus, A Dean; Hildebrand, Kevin A
Posttraumatic elbow stiffness remains a common and challenging clinical problem. In the setting of a congruent articular surface, the joint capsule is regarded as the major motion-limiting anatomic structure. The affected joint capsule is characterized by irreversible biomechanical and biochemical fibrogenic changes strikingly similar to those observed in many other fibroproliferative human conditions. Studies in humans and preclinical animal models are providing emergent evidence that neuroinflammatory mechanisms are critical upstream events in the pathogenesis of posttraumatic connective tissue fibrogenesis. Maladaptive recruitment and activation of mast cell infiltrates coupled with the aberrant expression of growth factors such as transforming growth factor-beta, nerve growth factor, and neuropeptides such as substance P are common observations in posttraumatic joint contractures and many other fibroproliferative disorders. Blockade of these factors is providing promising evidence that if treatment is timed correctly, the fibrogenic process can be interrupted or impeded. This review serves to highlight opportunities derived from these recent discoveries across many aberrant fibrogenic disorders as we strive to develop novel, targeted antifibrotic prevention and treatment strategies for posttraumatic elbow stiffness. PMID:24005582
An Interview with Peter Elbow.
ERIC Educational Resources Information Center
Peinado, Kelly
Solicits the opinion of writing specialist Peter Elbow on two-year colleges, whether writing can be taught, whether literature has a place in the composition classroom, and whether teachers with literature degrees make good writing teachers. Discusses what works with developmental writers, and other topics. (PA)
An Unusual Cause of Flexor Tenosynovitis: Streptococcus mitis
Ulucay, Cağatay; Ozler, Turhan
Summary: Streptococcus mitis is a commensal organism of the human oropharynx that rarely causes infection in healthy individuals. Herein, we describe a previously healthy 35-year-old woman who presented with acute pyogenic flexor tenosynovitis of the left index finger due to S. mitis infection. The patient's infection was treated successfully via surgical and medical interventions, and during follow-up, it was determined that she was complement component C3 deficient. Tenosynovitis is an emergent clinical syndrome that can result in permanent disability or amputation. To the best of our knowledge, this case report is the first to describe tenosynovitis due to S. mitis; in addition, it highlights the importance of initiating therapy with antibiotics that are effective against this rare pathogen. PMID:25587497
Review of management of unstable elbow fractures
Ozel, Omer; Demircay, Emre
Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstable fractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury. PMID:26807356
A new device for flexor tendon injuries.
Dymarczyk, M
Managing the treatment of patients with zone II flexor tendon injuries for successful outcomes has always been a challenge for the hand therapist. Working closely with the patient to help ensure follow-through with the protocol is frequently necessary. If a patient is compliant, the therapist's concern then becomes one of "scar wars" (to use a phrase coined by Ken Flowers). Early active range of motion and tendon gliding are critical parts of most programs. This author has developed a new idea in conjunction with the Indiana Hand Center protocol. PMID:11511017
Elbow and Shoulder Lesions of Baseball Players*
George Eli Bennett was born in Claryville, NY, in the Catskill Mountains, in 1885 [3]. His parents both died by the time he was 11, leaving him the need to work while going to school, but he excelled in school and sports. He played semipro baseball at the age of 16. After high school he work in various jobs in the Midwest before he could afford to attend the University of Maryland Medical School, from which he graduated in 1908. At the age of 25 in 1910, he joined the staff at the Johns Hopkins Hospital, where he remained until his resignation in 1947. Dr. Bennett was one of a few men who served as President of both the American Orthopaedic Association and the American Academy of Orthopaedic Surgeons. While Dr. Bennett made many contributions to orthopaedic surgery, including children's and nonoperative orthopaedics, he was best known for his work in sports medicine (undoubtedly related to his being a gifted athlete). His fame extended well beyond the orthopaedic community, for he treated many famous athletes. Sports Illustrated recognized him upon his death in an article entitled, "Mender of Immortals" [4]. His intimate knowledge of sports undoubtedly contributed to his sage judgments. At an emotional dinner in 1958 many famous athletes sometimes tearfully paid tribute to Dr. Bennett. Joe Garagiola commented on the occasion, "After listening to that all-star team of players Dr. Bennett has mended, I'm sorry I didn't break my leg" [4]. Among Dr. Bennett's many publications, including those related to sports, we have chosen one [2] of two articles [1,2] he wrote on elbow and shoulder problems in baseball players. He described the now well-known degenerative changes and periarticular calcific deposits that occur in the elbows and shoulders of pitchers. Some of these, he suggested, were not symptomatic and he advised against treatment. Dr. Bennett commented, however, "Since professional athletes are human beings, not supermen, general health often
Should we think about wrist extensor after flexor tendon repair?
Ferreira, Aline M; Tanaka, Denise M; Barbosa, Rafael I; Marcolino, Alexandre M; Elui, Valeria MC; Mazzer, Nilton
Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair. Design: Cross-sectional clinical measurement study. Setting: Laboratory for biomechanics and rehabilitation. Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age. Intervention: Volunteers performed an isometric standardized gripping task. Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis. Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated. Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary. PMID:26770674
Bilateral flexor tendon contracture following onychectomy in 2 cats.
Cooper, Maureen A; Laverty, Peter H; Soiderer, Emily E
Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646
Bilateral flexor tendon contracture following onychectomy in 2 cats
Abstract Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646
Deformities of the elbow in achondroplasia.
Kitoh, Hiroshi; Kitakoji, Takahiko; Kurita, Kazuhiro; Katoh, Mitsuyasu; Takamine, Yuji
Lack of full extension of the elbow is a common abnormality in patients with achondroplasia. We studied 23 patients (41 elbows) clinically and radiologically. Extension of the elbow was assessed clinically and the angle of posterior bowing of the distal humerus was measured from lateral radiographs. There was limited extension of the elbow in 28 (68.3%) and the mean loss of extension was 13.1 degrees. Posterior bowing of the humerus was seen in all elbows with a mean angle of 17.0 degrees. There was a positive correlation between these two measurements. Posterior bowing greater than 20 degrees caused a loss of full elbow extension. Posterior dislocation of the radial head was seen in nine elbows (22.0%). The mean loss of extension of the elbows was 28.7 degrees which was significantly greater than that of these elbows in which the head was not dislocated (8.7 degrees), although posterior bowing was not significantly different between these two groups (19.3 degrees and 16.3 degrees). Posterior bowing of the distal humerus is a principal cause of loss of extension of the elbow. Posterior dislocation of the radial head causes further limitation of movement in the more severely affected joints. PMID:12188484
Proportional myoelectric control of a virtual object to investigate human efferent control.
Gordon, Keith E; Ferris, Daniel P
We used proportional myoelectric control of a one-dimensional virtual object to investigate differences in efferent control between the proximal and distal muscles of the upper limbs. Eleven subjects placed one of their upper limbs in a brace that restricted movement while we recorded electromyography (EMG) signals from elbow flexors/extensors or wrist flexors/extensors during isometric contractions. By activating their muscles, subjects applied virtual forces to a virtual object using a real-time computer interface. The magnitudes of these forces were proportional to EMG amplitudes. Subjects used this proportional EMG control to move the virtual object through two tracking tasks, one with a static target and one with a moving target (i.show $132#e., a sine wave). We hypothesized that subjects would have better control over the virtual object using their distal muscles rather than using their proximal muscles because humans typically use more distal joints to perform fine motor tasks. The results indicated that there was no difference in subjects' ability to control virtual object movements when using either upper arm muscles or forearm muscles. These results suggest that differences in control accuracy between elbow joint movements and wrist joint movements are more likely to be a result of motor practice, proprioceptive feedback or joint mechanics rather than inherent differences in efferent control. PMID:15258714
The effects of eye coordination during deep cervical flexor training on the thickness of the cervical flexors
Moon, Hyun-Ju; Goo, Bong-Oh; Kwon, Hae-Yeon; Jang, Jun-Hyeok
[Purpose] The purpose of this study was to identify changes in the thicknesses of the cervical flexors according to eye coordination during deep cervical flexor training. [Subjects and Methods] Twenty normal adults were randomly selected, and during their deep cervical flexor training and eye tracking, the thicknesses of the longus colli and the sternocleidomastoid were measured using ultrasonic waves. [Results] The thickness of the longus colli statistically significantly increased when deep cervical flexor training and eye coordination were performed simultaneously. However, the thickness of the sternocleidomastoid did not show statistically significant differences according to eye coordination. [Conclusion] Eye coordination during deep cervical flexor training is likely to increase the thickness of the longus colli selectively. PMID:26834355
Surgical approaches to the elbow.
Cheung, Emilie V; Steinmann, Scott P
Surgical exposures for complex injuries about the elbow are technically demanding because of the high density of neurologic, vascular, and ligamentous elements around the elbow. The posterior approaches (ie, olecranon osteotomy, triceps-reflecting, triceps-splitting, triceps-reflecting anconeus pedicle flap, paratricipital) include techniques used to navigate the area around the triceps tendon and anconeus muscle. These approaches may be extended to gain access to the entire joint. The ulnar nerve, the anterior and posterior capsules, and the coronoid process are addressed by means of a medial approach. Lateral approaches are useful in addressing pathology at the radial head, capitellum, coronoid process, and anterior and posterior capsules. These approaches may be combined to address complex pathology in the setting of fracture fixation, arthroplasty, and capsular release. PMID:19411644
Pseudoelastic Nitinol-Based Device for Relaxation of Spastic Elbow in Stroke Patients
NASA Astrophysics Data System (ADS)
Viscuso, S.; Pittaccio, S.; Caimmi, M.; Gasperini, G.; Pirovano, S.; Villa, E.; Besseghini, S.; Molteni, F.
A compliant brace (EDGES) promoting spastic elbow relaxation was designed to investigate the potentialities of pseudoelastic NiTi in orthotics. By exploiting its peculiar characteristics, EDGES could improve elbow posture without constraining movements and thus avoiding any pain to the patient. A commercial Ni50.7-Ti49.3 alloy heat treated at 400 °C 1 h + WQ was selected for this application. A prototype of EDGES was assembled with two thermoplastic shells connected by polycentric hinges. Four 2-mm-diameter NiTi bars were encastred in the upper-arm shell and let slide along tubular fixtures on the forearm. Specially designed bending tests demonstrated suitable moment-angle characteristics. Two post-stroke subjects (aged 62 and 64, mild elbow flexors spasticity) wore EDGES for 1 week, at least 10 h a day. No additional treatment was applied during this period or the following week. A great improvement (20° ± 5°) of the resting position was observed in both patients as early as 3 h after starting the treatment. Acceptability was very good. A slight decrease in spasticity was also observed in both subjects. All the effects disappeared 1 week after discontinuation. EDGES appears to be a good alternative to traditional orthoses in terms of acceptability and effectiveness in improving posture, especially whenever short-term splinting is planned.
Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping
Farris, Dominic James; Hicks, Jennifer L.; Delp, Scott L.; Sawicki, Gregory S.
Experiments have shown that elastic ankle exoskeletons can be used to reduce ankle joint and plantar-flexor muscle loading when hopping in place and, in turn, reduce metabolic energy consumption. However, recent experimental work has shown that such exoskeletons cause less favourable soleus (SO) muscle–tendon mechanics than is observed during normal hopping, which might limit the capacity of the exoskeleton to reduce energy consumption. To directly link plantar-flexor mechanics and energy consumption when hopping in exoskeletons, we used a musculoskeletal model of the human leg and a model of muscle energetics in simulations of muscle–tendon dynamics during hopping with and without elastic ankle exoskeletons. Simulations were driven by experimental electromyograms, joint kinematics and exoskeleton torque taken from previously published data. The data were from seven males who hopped at 2.5 Hz with and without elastic ankle exoskeletons. The energetics model showed that the total rate of metabolic energy consumption by ankle muscles was not significantly reduced by an ankle exoskeleton. This was despite large reductions in plantar-flexor force production (40–50%). The lack of larger metabolic reductions with exoskeletons was attributed to increases in plantar-flexor muscle fibre velocities and a shift to less favourable muscle fibre lengths during active force production. This limited the capacity for plantar-flexors to reduce activation and energy consumption when hopping with exoskeleton assistance. PMID:25278469
[Ankylosis of the elbow joint].
Zilch, H; Steuer, G
The authors present a definition of the ankylosis of the elbow joint as well as of arthrolysis and arthroplasty and give a detailed description of the factors causing the ankylosis. The indication of arthrolysis and the operation time are discussed, the surgical method is described in detail. The type of follow-up treatment is of special importance. Results from literature are communicated. PMID:7157545
Primary and Posttraumatic Arthritis of the Elbow
Biswas, Debdut; Wysocki, Robert W.; Cohen, Mark S.
Whether degenerative joint disease of the elbow may be the result of primary or posttraumatic etiologies, arthritis of the elbow commonly leads to pain, loss of motion, and functional disability. A detailed history and focused physical examination, in combination with imaging modalities, can help localize the origin of symptoms and help direct treatment. Although nonoperative treatment is the initial therapy for arthritis of the elbow, surgical interventions may provide substantial relief to the appropriately selected patient. PMID:23781338
Biological Augmentation of Flexor Tendon Repair: A Challenging Cellular Landscape.
Loiselle, Alayna E; Kelly, Meghan; Hammert, Warren C
Advances in surgical technique and rehabilitation have transformed zone II flexor tendon injuries from an inoperable no-man's land to a standard surgical procedure. Despite these advances, many patients develop substantial range of motion-limiting adhesions after primary flexor tendon repair. These suboptimal outcomes may benefit from biologic augmentation or intervention during the flexor tendon healing process. However, there is no consensus biological approach to promote satisfactory flexor tendon healing; we propose that insufficient understanding of the complex cellular milieu in the healing tendon has hindered the development of successful therapies. This article reviews recent advances in our understanding of the cellular components of flexor tendon healing and adhesion formation, including resident tendon cells, synovial sheath, macrophages, and bone marrow-derived cells. In addition, it examines molecular approaches that have been used in translational animal models to improve flexor tendon healing and gliding function, with a specific focus on progress made using murine models of healing. This information highlights the importance of understanding and potentially exploiting the heterogeneity of the cellular environment during flexor tendon healing, to define rational therapeutic approaches to improve healing outcomes. PMID:26652792
Salvage of elbow function in chronic complex elbow fracture dislocation with total elbow arthroplasty: a case report.
Ramesh, Muthu; Foead, Agus Iwan; Ali, Anuar Bin; Devadasan, Benard
In patients with an elbow fracture dislocation the incidence of radial head fracture is 36%, where as coronoid process fractures occur in 13%, and olecranon fractures in 4% of patients. Combination of all these fractures with a 'terrible triad' is rarely reported in the literature. We describe a 40 year old lady involved in a polytrauma who had head injury, pnuemothorax and an open fracture dislocation of the left elbow. The Injury Severity Score initially on admission was 44. She presented with chronic elbow instability with pain 1 year later. A semi constrained total elbow arthroplasty (TEA) with a Coonrad-Morrey prosthesis was performed in this complex injury involving fractures of the coronoid, olecranon, proximal third of the ulna and radial head malunion with heterotrophic ossification around the elbow joint. Although the survivorship of total elbow replacements has improved, it is still a procedure reserved to older patients with low functional demand. At 1-year follow-up, the patient had full range in flexion and extension. The Mayo Elbow Performance Score (MEPS) was 100. TEA is a procedure which gains function and stability in a terrible triad elbow. PMID:24145266
Zone III flexor tendon injuries - A proposed modification to rehabilitation.
Chinchalkar, Shrikant J; Pipicelli, Joey G; Agur, Anne; Athwal, George S
In this manuscript, these authors have utilized years of clinical experience to suggest rehabilitation modifications for Zone III flexor tendon injuries. - VictoriaPriganc, PhD, OTR, CHT, CLT, Practice Forum Editor. PMID:26089286
Nerve Transfers to Restore Elbow Function.
Bulstra, Liselotte F; Shin, Alexander Y
The purpose of this article is to provide an overview of the various nerve transfer options for restoration of elbow function. This article describes nerve transfer strategies for elbow flexion and extension including the indications, limitations, and expected outcomes based on current literature. PMID:27094889
Humeral windows in revision total elbow arthroplasty.
Peach, Chris A; Salama, Amir; Stanley, David
The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011
The posttraumatic stiff elbow: an update.
Mellema, Jos J; Lindenhovius, Anneluuk L C; Jupiter, Jesse B
Posttraumatic elbow stiffness is a disabling condition that remains challenging to treat despite improvement of our understanding of the pathogenesis of posttraumatic contractures and new treatment regimens. This review provides an update and overview of the etiology of posttraumatic elbow stiffness, its classification, evaluation, nonoperative and operative treatment, and postoperative management. PMID:26984466
The flexor tendon pulley system and rock climbing.
Crowley, Timothy P
Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed. PMID:23730085
Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis.
Lui, Tun Hing
Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus. PMID:26697294
Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis
Lui, Tun Hing
Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus. PMID:26697294
Biomechanics of the elbow in sports.
Loftice, Jeremy; Fleisig, Glenn S; Zheng, Nigel; Andrews, James R
In throwing activities, the elbow is sometimes stressed to its biomechanical limits. In this article, forces, torques, angular velocities, and muscle activity about the elbow are reviewed for the baseball pitch, the football pass, the javelin throw, the windmill softball pitch, the tennis serve, and the golf swing. The elbow goes through rapid extension in baseball pitching (about 2400 degrees/s) and rapid flexion in the javelin throw (about 1900 degrees/s). During baseball pitching, the elbow joint is subject to a valgus torque reaching 64 Nm, and requires proximal forces as high as 1000 N to prevent elbow distraction. The ulnar collateral ligament (UCL) rupture in baseball pitching, lateral epicondylitis in the tennis backhand, and other injury mechanisms are also discussed. PMID:15474219
The effect of different ranges of motion on local dynamic stability of the elbow during unloaded repetitive flexion-extension movements.
Gsell, Kelsey Y; Beaudette, Shawn M; Graham, Ryan B; Brown, Stephen H M
Local dynamic stability (LDS) of movement is controlled primarily by active muscles, and is known to be influenced by factors such as movement speed and inertial load. Other factors such as muscle length, the length of the target trajectory, and the resistance of passive tissues through ranges of motion (ROM) may also influence LDS. This study was designed to examine the effect of ROM, which impacts each of the aforementioned factors, on LDS of the elbow. 16 participants performed 30 unloaded, repetitive, flexion-extension movements of the elbow with varying (1) angular displacement magnitudes: 40° and 80°; (2) locations of ROM: mid-range, flexion end-range, extension end-range; and (3) rotated positions of the forearm: pronated and supinated. LDS was calculated using a finite time Lyapunov analysis of angular elbow flexion-extension kinematic data. EMG-based muscle activation and co-contraction data were also examined for possible mechanisms of stabilization. Results showed no changes in LDS with any movement condition; however, there were significant effects on muscle activation with ROM location and forearm rotated position. This suggests that a consistent level of LDS of the elbow through varying ROMs is maintained, at least in part, by the active control of the elbow flexor and extensor muscles. PMID:26048713
Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative?
Kabakaş, Fatih; Uğurlar, Meriç; Turan, Derya Bayirli; Yeşiloğlu, Nebil; Mersa, Berkan; Özçelik, İsmail Bülent
The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery. PMID:26418769
Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients.
Huang, Han-Wei; Ju, Ming-Shaung; Lin, Chou-Ching K
The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent. PMID:26765753
Post-traumatic elbow rotational stiffness
Ling, Samuel KK; Faan, Yan Sui; Lui, Paulina WY; Ngai, Wai Kit
Background The elbow is an important but complex structure, with movement in both the sagittal plane in flexion and extension, as well as the rotational plane in forearm supination and pronation. Trauma is a common cause of elbow stiffness, which significantly hampers daily function. There are currently no gold-standard management guidelines for post-traumatic elbow stiffness, and most of the published literature focuses solely on the sagittal plane of motion. Methods This is a retrospective case series reviewing all patients who underwent a surgical release for treatment of post-traumatic elbow stiffness during a 36-month period. Motion range and the shortened version of the Disabilities of the Arm, Shoulder and Hand scores were serially measured and analyzed. Results The results obtained showed that both the sagittal and rotational range of motion directly influenced upper limb function; however, the relationship between these two motion planes was weak, meaning that both sagittal and rotational motion in the elbow need be addressed individually. Post-traumatic elbow stiffness could be aptly managed by various surgical approaches, including arthroscopic-assisted procedures; these were all effective in increasing both the sagittal and rotational range of motion. More importantly, this gain in range translated to a statistically significant improvement in upper limb function. Conclusions Management of elbow stiffness needs to be tackled in both the sagittal and rotational motion planes.
High temperature lined conduits, elbows and tees
De Feo, Angelo; Drewniany, Edward
A high temperature lined conduit comprising, a liner, a flexible insulating refractory blanket around and in contact with the liner, a pipe member around the blanket and spaced therefrom, and castable rigid refractory material between the pipe member and the blanket. Anchors are connected to the inside diameter of the pipe and extend into the castable material. The liner includes male and female slip joint ends for permitting thermal expansion of the liner with respect to the castable material and the pipe member. Elbows and tees of the lined conduit comprise an elbow liner wrapped with insulating refractory blanket material around which is disposed a spaced elbow pipe member with castable refractory material between the blanket material and the elbow pipe member. A reinforcing band is connected to the elbow liner at an intermediate location thereon from which extend a plurality of hollow tubes or pins which extend into the castable material to anchor the lined elbow and permit thermal expansion. A method of fabricating the high temperature lined conduit, elbows and tees is also disclosed which utilizes a polyethylene layer over the refractory blanket after it has been compressed to maintain the refractory blanket in a compressed condition until the castable material is in place. Hot gases are then directed through the interior of the liner for evaporating the polyethylene and setting the castable material which permits the compressed blanket to come into close contact with the castable material.
Outcomes evaluation of the athletic elbow.
Freehill, Michael T; Mannava, Sandeep; Safran, Marc R
The high-level athletic population poses difficulty when evaluating outcomes in orthopedic surgery, given generally good overall health and high function at baseline. Subtle differences in performance following injury or orthopedic surgery are hard to detect in high-performance athletes using standard outcome metrics; however, attaining these subtle improvements after injury or surgery are key to an athletes' livelihood. Outcome measures serve as the cornerstone for critical evaluation of clinical outcomes following orthopedic surgery or injury. In the age of "evidence-based medicine" and "pay-for-performance" accountability for surgical intervention, understanding clinically relevant outcome measures is essential for careful review of the published literature, as well as one's own critical review of surgical performance. The purpose of this manuscript is to evaluate clinical outcome measures in the context of the athletic elbow. An emphasis will be placed on evaluation of the 5 most clinically relevant outcome measures for sports-related elbow outcomes: (1) American Shoulder and Elbow Committee; (2) Mayo Elbow Performance Index; (3) Andrews-Timmerman [and its precursor the (4) Andrews-Carson]; and (5) Kerlan-Jobe Orthopaedic Clinic overhead athlete score. A final outcome measure that will be analyzed is "return to play" statistics, which has been published in various studies of athletes' recovery from elbow surgery, as well as, the outcomes metric known as the "Conway-Jobe scale." Although there is no perfect outcomes score for the athletic elbow, the Kerlan-Jobe Orthopaedic Clinic score is the only outcomes tool developed and validated for outcomes for elbow injuries in the overhead athlete, as compared with the Andrew-Timmerman and Conway-Jobe metrics, which were not validated outcome measures for the elbow in this patient population. Despite the Disabilities of Arm, Shoulder, Hand (DASH) (and DASH-Sport module) being validated in the general population, this
Debridement arthroplasty for osteoarthritis of the elbow.
Oka, Y; Ohta, K; Saitoh, I
For treatment of osteoarthritis of the elbow, the authors use debridement arthroplasty with a medial or lateral approach. Thirty-eight elbows in 36 patients treated with this procedure were examined. The age of the patients ranged from 20 to 71 years, with a mean age of 41.7 years. Cubital tunnel syndrome was present in 16 of the 38 (42%) elbows. The operations were performed through a lateral approach in four elbows, a lateral approach with medial skin incision for ulnar nerve neurolysis in 16 elbows, a medial approach in 10 elbows, and a medial plus a lateral approach in eight elbows. The followup ranged from 2 years to 12.1 years, with an average of 5.9 years. Complete pain relief or minimal elbow pain was reported in 95% of patients who had surgical treatment. The average gain in motion was 6 degrees extension and 18 degrees flexion. Results for the various surgical approaches did not show a statistically significant difference. Recurrence of bony spurs and ridges was analyzed additionally in 18 selected patients who could be observed more than 5 years after surgery (range, 5-12 years). Redevelopment of bony spurs on the coronoid process and olecranon tip occurred in all 18 patients, but those changes were graded as mild in 13 (74%) patients and moderate in five (16%) patients and were accompanied by no pain or slight pain. Elbow arthroplasty as used by the authors produces stable and reliable results for relief of pain, gains in range of motion, and the absence of recurrence of significant osteoarthritis. PMID:9646755
Cohen, Marcio; da Rocha Motta Filho, Geraldo
Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population. The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis and the mechanism of injury is associated with overloading. Nonsurgical treatment is the preferred method, and this includes rest, physiotherapy, cortisone infiltration, platelet-rich plasma injections and use of specific immobilization. Surgical treatment is recommended when functional disability and pain persist. Both the open and the arthroscopic surgical technique with resection of the degenerated tendon tissue present good results in the literature. PMID:27047843
Treatment of complex elbow fracture-dislocations.
Chan, Kevin; King, Graham J W; Faber, Kenneth J
Successful management of complex elbow fracture-dislocations requires, in part, recognition of the overall injury pattern, which can aid in the identification of concomitant bony and soft tissue injuries. Trans-olecranon fracture-dislocations are best treated surgically with stable anatomic restoration of the trochlear notch. Terrible triad elbow injuries are believed to be caused by a valgus posterolateral force. Although select terrible triad injuries can be managed non-operatively, the majority of injuries are treated with stable surgical repair to allow early elbow motion. Unlike terrible triads, varus posteromedial forces are theorized to cause anteromedial coronoid fractures. These are usually associated with LCL disruptions, but do not have concomitant MCL or radial head injuries. A subset of anteromedial coronoid fractures can also be managed non-operatively. Internal fixation is recommended for injuries associated with large fracture fragments or elbow instability preventing early motion. PMID:26984334
Elbow joint instability: A kinematic model.
Olsen, B S; Henriksen, M G; Søjbjerg, J O; Helmig, P; Sneppen, O
The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus stress and in forced external and internal rotation. The mean maximum laxity in valgus stress and forced external rotation were 5.7° and 13.2°. The forearms of the elbow joint specimens were transfixed in maximum pronation. During valgus and varus stress the corresponding spontaneous ulnar rotation of the specimens was recorded. The reproducibility of the instability pattern suggests that this model is suitable for evaluating stabilizing procedures aimed at correction of elbow joint instability before these procedures are introduced into patient care. PMID:22959690
Management of tennis elbow by Agnikarma
Mahanta, Vyasadeva; Dudhamal, Tukaram S.; Gupta, Sanjay Kumar
Tennis elbow is a painful condition and causes restricted movement of forearm which requires treatment for long period. Till date only symptomatic treatments are available like use of anti-inflammatory analgesic drugs, steroids injection, physiotherapy, exercise etc. But none of these provide satisfactory result. Long term use of anti-inflammatory, analgesic drugs and steroids injection is also not free from the adverse effects. Usually, 'wait-and-see policy' of treatment guideline is recommended in most of medical texts. According to Ayurveda, snayugata vata can be correlated with the condition of tennis elbow. Sushruta has advised Agnikarma for disorders of snayu (ligaments and tendons), asthi (bone), siddhi (joints) etc. Hence, in this study a case of tennis elbow (snayugata vata) was treated by Agnikarma, along with administration of powder of Ashwagandha and Navajivana Rasa orally, for a period of 03 weeks. This combination therapy provided considerable relief in pain and movement of the elbow joint. PMID:23741162
Elbow dislocation with irreparable fracture radial head
Tanna, Dilip
Background: Treatment of elbow dislocation with irreparable radial head fracture needs replacement of radial head to achieve stability of elbow. An alternate method in cases of elbow dislocation with radial head fracture can be resection of radial head with repair of medial collateral ligament. We report a retrospective analysis of cases of elbow dislocation with irreparable radial head treated by excision head of radius and repair of MCL. Materials and Methods: Nine patients of elbow dislocation with associated irreparable fractures of the head of the radius were included in this analysis (6 F:3 M, Age: 35-47 years). Radial head excision was done through the lateral approach and MCL was sutured using no 3 Ethibond using medial approach. Above elbow plaster was given for 6 weeks and gradual mobilization was done thereafter. All patients were assessed at final followup using Mayo elbow performance score (MEPS). Results: Mean followup was 19.55 ± 7.12 months (range 14-36 months). There was no extension deficit when compared to opposite side with mean range of flexion of 138.8° ± 6.97° (range 130 -145°). Mean pronation was 87.7° ± 4.4° (range 80-90°) and mean supination was 87.7 ± 4.62° (range 80-90°). The mean MEPS was 98.8 ± 3.33 (range 90-100). No patient had pain, sensory complaints, subluxation or redislocation. All were able to carry out their daily activities without disability. Conclusion: Radial head excision with MCL repair is an acceptable option for treatment of patients with elbow dislocation and irreparable radial head fracture. PMID:23798760
Elbow stress indices using finite element analysis
NASA Astrophysics Data System (ADS)
Yu, Lixin
Section III of the ASME Boiler and Pressure Vessel Code (the Code) specifies rules for the design of nuclear power plant components. NB-3600 of the Code presents a simplified design method using stress indices---Scalar Coefficients used the modify straight pipe stress equations so that they can be applied to elbows, tees and other piping components. The stress indices of piping components are allowed to be determined both analytically and experimentally. This study concentrates on the determination of B2 stress indices for elbow components using finite element analysis (FEA). First, the previous theoretical, numerical and experimental investigations on elbow behavior were comprehensively reviewed, as was the philosophy behind the use of stress indices. The areas of further research was defined. Then, a comprehensive investigation was carried out to determine how the finite element method should be used to correctly simulate an elbow's structural behavior. This investigation included choice of element type, convergence of mesh density, use of boundary restraint and a reconciliation study between FEA and laboratory experiments or other theoretical formulations in both elastic and elasto-plastic domain. Results from different computer programs were also compared. Reasonably good reconciliation was obtained. Appendix II of the Code describes the experimental method to determine B2 stress indices based on load-deflection curves. This procedure was used to compute the B2 stress indices for various loading modes on one particular elbow configuration. The B2 stress indices thus determined were found to be about half of the value calculated from the Code equation. Then the effect on B2 stress indices of those factors such as internal pressure and flange attachments were studied. Finally, the investigation was extended to other configurations of elbow components. A parametric study was conducted on different elbow sizes and schedules. Regression analysis was then used to
Elbow injuries in the throwing athlete.
Kancherla, Vamsi K; Caggiano, Nicholas M; Matullo, Kristofer S
High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft tissue and bony stabilizing structures of the elbow undergo progressive structural changes and can succumb to injury. Modern diagnostic modalities, including plain radiographs, computed tomography, and magnetic resonance imaging, in addition to arthroscopy, can aid in diagnosis. Although nonoperative management is often successful, surgical intervention may be necessary before allowing return to play. PMID:25199426
Symptomatic Elbow Ganglion Causing Pronator Syndrome
Rockwell, W. Bradford
Summary: Descriptions of ganglion cysts date back to 400 BC. Ganglions causing peripheral nerve compression have been described most notably at the wrist. Ganglion compression of the median nerve at the elbow is rare. We report a case of a palmar elbow ganglion causing median nerve compression and the clinical presentation of pronator syndrome. After removal of the ganglion and median nerve decompression, the patient's symptoms fully resolved. PMID:25289303
Open Galeazzi fracture with ipsilateral elbow dislocation.
Adanır, Oktay; Yüksel, Serdar; Beytemur, Ozan; Güleç, M Akif
Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°. PMID:27499325
Evaluation of elbow pain in adults.
Kane, Shawn F; Lynch, James H; Taylor, Jonathan C
The elbow is a complex joint designed to withstand a wide range of dynamic exertional forces. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior. The history should include questions about the onset of pain, what the patient was doing when the pain started, and the type and frequency of athletic and occupational activities. Lateral and medial epicondylitis are two of the more common diagnoses and often occur as a result of occupational activities. Patients have pain and tenderness over the affected tendinous insertion that are accentuated with specific movements. If lateral and medial epicondylitis treatments are unsuccessful, ulnar neuropathy and radial tunnel syndrome should be considered. Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing. Biceps tendinopathy is a relatively common source of pain in the anterior elbow; history often includes repeated elbow flexion with forearm supination and pronation. Olecranon bursitis is a common cause of posterior elbow pain and swelling. It can be septic or aseptic, and is diagnosed based on history, physical examination, and bursal fluid analysis if necessary. Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions. Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain. Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures. PMID:24784124
Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study
Król, Piotr; Franek, Andrzej; Durmała, Jacek; Błaszczak, Edward; Ficek, Krzysztof; Król, Barbara; Detko, Ewa; Wnuk, Bartosz; Białek, Lidia; Taradaj, Jakub
The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm2) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity. PMID:26557197
Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction.
Wei, David H; Terrono, Andrew L
Swan neck deformity, or hyperextension of the proximal interphalangeal joint, may occur secondary to trauma, rheumatoid arthritis, cerebral palsy, or Ehlers-Danlos syndrome, and can be treated with tenodesis of one slip of the flexor digitorum sublimis tendon. This technique has several variations, differing primarily in the specific location and method that a single slip of the flexor digitorum sublimis tendon is secured, but they all serve to create a static volar restraint against hyperextension. Options include tunneling the tendon through the bone of the proximal phalanx, attaching the tendon to the A1 or A2 pulley, or securing the tendon with bone anchors in the proximal phalanx. PMID:26328902
Quantifying elbow extension and elbow hyperextension in cricket bowling: a case study of Jenny Gunn.
King, Mark A; Yeadon, Maurice R
In this study a method for determining elbow extension and elbow abduction for a cricket bowling delivery was developed and assessed for Jenny Gunn who has hypermobility in both elbows and whose bowling action has been repeatedly queried by umpires. Bowling is a dynamic activity which is assessed visually in real time in a cricket match by an umpire. When the legality of a bowler's action is questioned by an umpire a quantitative analysis is undertaken using a marker based motion analysis system. This method of quantifying elbow extension should agree with a visual assessment of when the arm is "straight" and should minimise the effects of marker movement. A set of six markers on the bowling arm were used to calculate elbow angles. Differences of up to 1° for elbow extension and up to 2° for elbow abduction were found when angles calculated from the marker set for static straight arm trials were compared with measurements taken by a chartered sports physiotherapist. In addition comparison of elbow extension angles at ball release calculated from the markers during bowling trials with those measured from high speed video also showed good agreement with mean differences of 0°±2°. PMID:22548307
Effect of training with neuromuscular electrical stimulation on elbow flexion strength.
R Holcomb, William
Neuromuscular electrical stimulation (NMES) may be used to prevent strength loss associated with post-surgical immobilization. Most studies testing the effectiveness of NMES have trained the knee extensors. The purpose of this investigation was to test the effectiveness of NMES when training the elbow flexors. Twenty-four students were randomly assigned to one of three groups: NMES training, isometric training or control. Testing and training were completed using a Biodex™ dynamometer. After a standard warm-up, subjects were positioned on the Biodex™ with left shoulder in anatomical neutral, elbow flexed to 90(o) and forearm supinated. Subjects performed three maximum isometric contractions of 5 seconds duration, with 1 min rest between repetitions. Average peak torque during three repetitions was calculated. Subjects trained on three days per week for four weeks. Training included 15 maximum contractions of 15 seconds duration with 45 seconds recovery between repetitions. Russian current was delivered by a Forte™ 400 Combo via electrodes placed over ends of biceps brachii. A maximum tolerable ramped intensity was delivered with frequency of 90 bps and duty cycle of 15:45. After training, subjects were post-tested in a manner identical to pretest. Mean normalized strength data were analyzed using a 3 (Group) x 2 (Test) ANOVA. The Group x Test interaction was significant. Post-hoc analyses revealed that the voluntary training group (normalized means of 0.49 to 0.71 for the pretest and post-test, respectively) had a significantly greater increase than the other two groups, which were not significantly different from each other. The lack of significant strength gains with NMES was likely due to low average training intensity, which was only 20.4% of MVIC. Based on these results, NMES training may not be an effective alternative to voluntary training in healthy subjects. Key PointsTraining the elbow flexors with voluntary isometric contractions produced
AIDS and the lung. 1--AIDS, aprons, and elbow grease: preventing the nosocomial spread of human immunodeficiency virus and associated organisms.
Hanson, P J; Collins, J V
Epidemiological evidence indicates that transmission of human immunodeficiency virus (HIV) other than by direct inoculation or sexual contact is extremely rare. HIV has, however, been found on fibreoptic bronchoscopes used on patients with AIDS and there is a clear theoretical risk of transmission by bronchoscopy. Applied experiments have underlined the importance of cleaning equipment thoroughly and have shown the limitations of disinfection. Infection control policies should be revised to meet the following four basic requirements: (1) all precautions should apply to all patients alike--that is, whether infectious or not; (2) equipment should be cleaned thoroughly in detergent immediately after use to remove body secretions and reduce contamination; (3) staff who may be exposed to body secretions should wear simple barrier clothing routinely; and (4) contaminated bronchoscopes should be disinfected for 20 minutes in 2% alkaline glutaraldehyde after cleaning. PMID:2688178
Flexor digitorum brevis tendon transfer to the flexor digitorum longus tendon according to Valtin in posttraumatic flexible claw toe deformity due to extrinsic toe flexor shortening.
Gonçalves, H; Kajetanek, C; Graff, W; Thiongo, M; Laporte, C
Claw toe deformity after posterior leg compartment syndrome is rare but incapacitating. When the mechanism is flexor digitorum longus (FDL) shortening due to ischemic contracture of the muscle after posterior leg syndrome, a good treatment option is the Valtin procedure in which the flexor digitorum brevis (FDB) is transferred to the FDL after FDL tenotomy. The Valtin procedure reduces the deformity by lengthening and reactivating the FDL. Here, we report the outcomes of FDB to FDL transfer according to Valtin in 10 patients with posttraumatic claw toe deformity treated a mean of 34 months after the injury. Toe flexion was restored in all 10 patients, with no claw toe deformity even during dorsiflexion of the ankle. PMID:25703152
Severe injury of bilateral elbow joints with unilateral terrible triad of the elbow and unilateral suspected terrible triad of the elbow complicated with olecranon fracture: one case report
Zha, Guoqing; Niu, Xiaofeng; Yu, Weiguang; Xiao, Liangbao
Terrible triad of the elbow is characterized as posterior dislocation of the elbow joint accompanied by the fractures of the radial head and coronoid process of the ulna, which is rarely seen in clinical practice, especially because the mild fracture is barely detected by imaging method In this study, we reported one case of serious complex bilateral elbow injury, presenting with unilateral typical terrible triad of the elbow and suspected terrible triad of the elbow complicated with olecranon fracture on the other side. Clinical experience was obtained during the diagnosis and treatment procedures. PMID:26550399
Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy
Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi
Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592
Single-Stage Flexor Tendon Grafting: Refining the Steps.
Fletcher, Derek R; McClinton, Michael A
Single-stage tendon grafting for reconstruction of zone I and II flexor tendon injuries is a challenging procedure in hand surgery. Careful patient selection, strict indications, and adherence to sound surgical principles are mandatory for return of digital motion. PMID:26026357
Looped Versus Single-Stranded Flexor Tendon Repairs: A Cadaveric Mechanical Study
Calfee, Ryan P.; Boone, Sean; Stepan, Jeffrey G.; Osei, Daniel A.; Thomopoulos, Stavros; Boyer, Martin I.
Purpose To compare the tensile properties of 4-strand modified Kessler flexor tendon repairs using a looped or single-stranded suture. Methods We evaluated the mechanical properties of 4-strand Kessler zone II core suture repairs using either looped or single-stranded suture in human flexor digitorum profundus and flexor pollicis longus tendons. Forty repairs were performed on tendons from bilateral cadaveric hands: 20 matched tendons were divided into equal groups of 3-0 looped and 3-0 single-strand repairs and 20 additional matched tendons were divided into equal groups of 4-0 looped and 4-0 single-strand repairs. Repaired tendons were tested in uniaxial tension to failure to determine mechanical properties and failure modes. Data were analyzed to determine the effect of repair type (ie, looped vs single-stranded) for each suture caliber (ie, 3-0 and 4-0). Results Single-strand repairs with 3-0 suture demonstrated a significantly greater maximum load to failure and a significantly higher force at 2-mm gap compared with repairs with looped 3-0 suture. All 8 looped repairs with 3-0 suture failed by suture pullout whereas 7 of 8 repairs with 3-0 single-stranded suture failed by suture breakage. The mechanical properties of looped versus single-stranded repairs with 4-0 caliber suture were not statistically different. Repairs with 4-0 caliber suture failed by suture breakage in 8 of 10 single-strand repairs and failed by suture pullout in 6 of 10 repairs with looped suture. Conclusions In a time-0 ex vivo human cadaveric core suture model, the mechanical properties of a 4-strand repair using 3-0 single-stranded suture were significantly better than the same 4-strand repair performed with looped suture. Clinical relevance Four-strand flexor tendon repairs with 3-0 suture are mechanically superior when performed with single-strand suture versus looped suture. PMID:25801581
Development and evaluation of a musculoskeletal model of the elbow joint complex.
Gonzalez, R V; Hutchins, E L; Barr, R E; Abraham, L D
This paper describes the development and evaluation of a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. The length, velocity, and moment arm for each of the eight musculotendon actuators were based on skeletal anatomy and joint position. Musculotendon parameters were determined for each actuator and verified by comparing analytical moment-angle curves with experimental joint torque data. The parameters and skeletal geometry were also utilized in the musculoskeletal model for the analysis of ballistic (rapid-directed) elbow joint complex movements. The key objective was to develop a computational model, guided by parameterized optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and to determine the effects of forearm and elbow position on the recruitment of individual muscles during a variety of ballistic movements. The model was partially verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing both isometric and ballistic elbow joint complex movements. This verification lends credibility to the time-varying muscle force predictions and the recruitment of muscles that contribute to both elbow flexion-extension and forearm pronation-supination. PMID:8833072
[Total elbow arthroplasty. Indications, operative technique and results after implantation of an Acclaim elbow prosthesis].
Lerch, K; Tingart, M; Trail, I; Grifka, J
Total elbow arthroplasty has become a reliable treatment option for patients with rheumatoid arthritis as well as primary or posttraumatic arthrosis. The aim of this study is to present the indications, operative technique and results for the implantation of an Acclaim elbow prosthesis. Case reports are given to demonstrate the indications for prosthesis implantation. Furthermore, the follow-up results are reported for 65 patients after implantation of an Acclaim prosthesis. Pre- and postoperative pain were evaluated using the visual analogue scale. The pain level decreased from 8.0 to 2.3 postoperatively. After implantation of an elbow prosthesis, there was a significant improvement in the range of motion. The mean flexion increased from 103 degrees preoperatively to 140 degrees postoperatively. An increase of 10 degrees was found for both supination and pronation. Complications included temporary ulnary nerve irritation in seven patients, intraoperative fractures in four cases and postoperative elbow dislocation in one case. In conclusion, total elbow arthroplasty results in a reduction of pain and an improvement in elbow movement. However, selection of the right patient is important. Patients are advised not to lift heavy objects or to perform hard physical work. If patients' compliance can not be ensured preoperatively, no total elbow arthroplasty should be performed. PMID:12955197
The effect of marker placement around the elbow on calculated elbow extension during bowling in cricket.
Yeadon, Maurice R; King, Mark A
The elbow extension angle during bowling in cricket may be calculated from the positions of markers attached around the shoulder, elbow and wrist using an automated laboratory-based motion analysis system. The effects of two elbow-marker sets were compared. In the first, a pair of markers was placed medially and laterally close to the condyles while in the second a triad of markers was placed on the back of the upper arm close to the elbow. The root mean square (RMS) difference in elbow extension angle between the two methods at four key instants was 8° for 12 fast bowlers and 4° for 12 spin bowlers. When evaluated against video estimates of the elbow extension angle for the fast bowlers, the elbow extension angle calculated using the pair method had an RMS error of 2° while the triad method had an RMS error of 8°. The corresponding errors for the spin bowlers were 3° and 5°, respectively. It is thought that the greater errors associated with the triad is a consequence of soft tissue movement in this dynamic activity. This is consistent with the finding of greater error for the fast bowlers compared with the spin bowlers. PMID:25682835
Ipsilateral motor cortical responses to TMS during lengthening and shortening of the contralateral wrist flexors
Howatson, Glyn; Taylor, Mathew B.; Rider, Patrick; Motawar, Binal R.; McNally, Michael P.; Solnik, Stanislaw; DeVita, Paul; Hortobágyi, Tibor
Unilateral lengthening contractions provide a greater stimulus for neuromuscular adaptation than shortening contractions in the active and non-active contralateral homologous muscle, although little is known of the potential mechanism. Here we examined the possibility that corticospinal and spinal excitability vary in a contraction-specific manner in the relaxed right flexor carpi radialis (FCR) when humans perform unilateral lengthening and shortening contractions of the left wrist flexors at the same absolute force. Corticospinal excitability in the relaxed right FCR increased more during lengthening than shortening at 80 and 100% of maximum voluntary contraction (MVC). Short-interval intracortical inhibition (SICI) diminished during shortening contractions and it became nearly abolished during lengthening. Intracortical facilitation (ICF) lessened during shortening but increased during lengthening. Interhemispheric inhibition (IHI) to the "non-active" motor cortex diminished during shortening and became nearly abolished during lengthening at 90% MVC. The amplitude of the H-reflex in the relaxed right FCR decreased during and remained depressed for 20 s after lengthening and shortening of the left wrist flexors. We discuss the possibility that instead of the increased afferent input, differences in the descending motor command and activation of brain areas that link function of the motor cortices during muscle lengthening vs. shortening may cause the contraction-specific modulation of ipsilateral motor cortical output. In conclusion, ipsilateral M1 responses to TMS are contraction-specific; unilateral lengthening and shortening contractions reduced contralateral spinal excitability but uniquely modulated ipsilateral corticospinal excitability and the networks involved in intracortical and interhemispheric connections, which may have clinical implications. PMID:21219480
Ultrasonography of the hand, wrist, and elbow.
Bodor, Marko; Fullerton, Brad
High-frequency diagnostic ultrasonography of the hand, wrist and elbow has significant potential to improve the quality of diagnosis and care provided by neuromuscular and musculoskeletal specialists. In patients referred for weakness, pain and numbness of the hand, wrist or elbow, diagnostic ultrasonography can be an adjunct to electrodiagnosis and help in identifying ruptured tendons and treating conditions such as carpal tunnel syndrome or trigger finger. Use of a small high-frequency (>10-15 MHz) transducer, an instrument with a blunt pointed tip to enhance sonopalpation and a model of the hand, wrist and elbow is advised to enhance visualization of small anatomical structures and complex bony contours. A range of conditions, including tendon and ligament ruptures, trigger finger, de Quervain tenosynovitis, intersection syndrome, lateral epicondylitis, and osteoarthritis, is described along with detailed ultrasonography-guided injection techniques for carpal tunnel syndrome and trigger finger. PMID:20797547
Operative treatment of nonunions about the elbow.
Gallay, S H; McKee, M D
Nonunions about the elbow present a great challenge to the orthopaedic surgeon. Recent advances have enabled the surgeon to achieve much improved results. The current study outlines the treatment of nonunions of the distal humerus, proximal ulna (including olecranon, Monteggia, and coronoid nonunions), and radial head and neck nonunions. The historic problems of treating these nonunions included the use of inadequate fixation, the poor understanding of the role of soft tissue surgery in the treatment of the stiff elbow, and the failure of previous postoperative rehabilitation protocols. Advances made in the techniques of soft tissue treatment, modern methods of stable internal fixation, and early postoperative rehabilitation all have made an exceptional difference in the surgeon's ability to treat these most complex problems. The current study will provide the reader with a greater understanding of nonunions about the elbow, clinical and technical details for their treatment, and the expected results after treatment. PMID:10660704
Brachial Artery Injury Accompanying Closed Elbow Dislocations
Harnarayan, Patrick; Cawich, Shamir O.; Harnanan, Dave; Budhooram, Steve
Introduction Brachial artery injuries from elbow dislocations are uncommon, but they may lead to disastrous consequences if the diagnosis is delayed. Presentation of case We report a case of a patient who sustained a fall onto the elbow, with dislocation and brachial artery injury, despite an ipsilateral radial pulse being palpable. Discussion Clinicians should maintain a high index of suspicion for brachial injury when patients present with a fall onto the elbow coupled with signs suggestive of fracture-dislocation, nerve injury and/or signs of limb ischemia. Frank ischamia, however, is uncommon as there is a rich collateral anastomosis in the upper limb. Conclusion A high index of suspicion should be maintained in order to make the diagnosis early. Exploration with excision of the injured segment and reverse vein interposition grafting is the treatment of choice in these cases. PMID:25644552
Surgical management of the elderly elbow.
Gibbs, V N; Middleton, R; Rees, J L
The elbow has a major role in helping with the positioning of the hand in space. Any pathology of the joint can result in pain, loss of function and difficulties with activities of daily living. With an increasingly elderly population the degenerative conditions affecting the elbow are becoming more prevalent. Besides traumatic injury, the more commonly encountered problems are osteoarthritis, inflammatory arthritis, nerve compression and stiffness. An awareness of these conditions is important for those who provide care to this patient group. Whilst many of these conditions can be managed conservatively in primary care, some patients are referred to secondary care and elect for surgical treatments. This review considers the surgical treatments for the common elbow pathologies in the elderly population, including the potential complications associated with such treatments. PMID:27451319
Development and evaluation of a musculoskeletal model of the elbow joint complex
NASA Technical Reports Server (NTRS)
Gonzalez, Roger V.; Hutchins, E. L.; Barr, Ronald E.; Abraham, Lawrence D.
This paper describes the development and evaluation of a musculoskeletal model that represents human elbow flexion-extension and forearm pronation-supination. The length, velocity, and moment arm for each of the eight musculotendon actuators were based on skeletal anatomy and position. Musculotendon parameters were determined for each actuator and verified by comparing analytical torque-angle curves with experimental joint torque data. The parameters and skeletal geometry were also utilized in the musculoskeletal model for the analysis of ballistic elbow joint complex movements. The key objective was to develop a computational model, guided by parameterized optimal control, to investigate the relationship among patterns of muscle excitation, individual muscle forces, and movement kinematics. The model was verified using experimental kinematic, torque, and electromyographic data from volunteer subjects performing ballistic elbow joint complex movements.
Odyssey of an elbow synovial chondromatosis.
Sachinis, Nikolaos P; Sinopidis, Chris; Baliaka, Aggeliki; Givissis, Panagiotis
Synovial chondromatosis of the elbow is an uncommon condition. However, a chondrosarcoma arising from the former is remarkably rare. The authors report a case of an elbow chondrosarcoma secondary to synovial chondromatosis in a 38-year-old woman. Before the development of chondrosarcoma, the patient underwent 3 operations and 3 sessions of radiosynovectomy because of continuous recurrence of synovial chondromatosis on the left elbow. After the last radiosynovectomy, magnetic resonance imaging and biopsy showed a grade II chondrosarcoma secondary to synovial chondromatosis. The patient underwent further surgery and custom-made arthroplasty because of aseptic loosening of the prosthesis. Four months after the last intervention, 3 subcutaneous nodes appeared on the patient's elbow and were histologically found to be a recurrence of chondrosarcoma (grade III). Amputation by disarticulation of the shoulder was performed in addition to biopsy of another subcutaneous node on the abdomen. The biopsy showed metastasis of chondrosarcoma. At final follow-up, the patient had lung metastasis 7 years after the initial diagnosis. A reason for the manifestation of primary synovial chondromatosis and its progression to chondrosarcoma has not been found. Synovial chondromatosis progressing to chondrosarcoma in the elbow was reported in only 1 case, with no clear initial diagnosis. The role of radiosynovectomy in the development of chondrosarcoma is unknown, and no reports have described the treatment of elbow synovial chondromatosis. Although synovial chondromatosis is benign, its metaplastic nature is a marker of possible malignancy, especially with signs of recurrence and aggression. The role of radiosynovectomy in malignant changes should be examined in future studies. PMID:25611422
Pitcher's elbow: medial elbow pain in the overhead-throwing athlete.
Rossy, William H; Oh, Luke S
Overhead athletes subject their elbows to significant valgus stresses throughout the throwing cycle. A steady rise in the number of medial-sided elbow injuries over the years has lead to increased awareness regarding the pathophysiology of the "pitcher's elbow." As our understanding of the functional anatomy and throwing biomechanics has become more sophisticated, we have seen a concurrent improvement in the outcomes associated with managing these injuries. Despite this improvement, continued anatomical and biomechanical research is still needed to further optimize outcomes and return to sport. PMID:27260266
Peter Elbow, Kenneth Burke, and the Idea of Magic.
ERIC Educational Resources Information Center
Briggs, John C.
Asserts that the works of Peter Elbow and Kenneth Burke are valuable reference points because they problematize fundamental assumptions within the field of composition that pluralism and factional perspectives typically elide. Describes Elbow's rhetorical magic and shows how magic illuminates Burke's effort. Wonders whether Elbow and Burke…
Static analysis of a piping system with elbows
Bryan, B.J.
Vibration tests of elbows to failure were performed in Japan in the early 1970s. The piping system included two elbows and an eccentric mass. Tests were run both pressurized and unpressurized. This report documents a static analysis of the piping system in which the elbows are subjected to out of plane bending. The effects of internal pressure and material plasticity are investigated.
Clinical Outcomes Study of the Nexel Total Elbow
Elbow Joint Destruction; Post-traumatic Lesions; Ankylosed Joints; Advanced Rheumatoid Arthritis; Joint Instability or Loss of Motion; Acute Comminuted Articular Fracture of Elbow Joint Surfaces; Bone Loss Contributing to Elbow Instability; Bilateral Ankylosis From Causes Other Than Active Sepsis; Post-traumatic, or Degenerative Arthritis With Incapacitating Pain
Arthroplasty of the elbow in rheumatoid arthritis.
Kimura, C; Vainio, K
The study consists of 208 elbow arthroplasties performed on rheumatoid arthritic patients. A straight resection of the joint was used in 53 cases and a modified Hass arthroplasty with skin interposition in 155 cases. The average postoperative range of motion in these groups was 100 degrees and 96 degrees respectively. Postoperatively the joint was painless in 81 and 67% of the elbows respectively. The Hass arthroplasty gave a better stability and extension power. The most common complications were paresthesias in the region of the ulnar nerve and bone resorption in the region of the ulnar nerve and bone resorption in the region of the olecranon fossa. PMID:779734
Terrible Triad Injuries of the Elbow.
Chen, Neal C; Ring, David
The treatment of terrible triad injuries of the elbow continues to evolve. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. In the elbow with persistent instability after repair of these elements, application of a static external fixation, hinged external fixation, ulnohumeral joint pinning, or an internal hinge may be needed. In patients who undergo treatment after the acute injury period, the coronoid may require reconstruction using radial head autograft, iliac crest autograft, olecranon autograft, or allograft. PMID:26440743
Total Elbow Arthroplasty for Distal Humerus Fractures.
Harmer, Luke S; Sanchez-Sotelo, Joaquin
Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures. PMID:26498549
Multiple forearm robotic elbow configuration background of the invention
Fisher, J.J.
A dual forearmed robotic elbow configuration comprises a main arm having a double elbow from which two coplanar forearms depend, two actuators carried in the double elbow for moving the forearms, and separate, independent end effectors, operated by a cable carried from the main arm through the elbow, is attached to the distal end of each forearm. Coiling the cables around the actuators prevents bending or kinking when the forearms are rotated 360 degrees. The end effectors can have similar or different capabilities. Acutator canisters within the dual elbow are modular for rapid replacement or maintenance. Coarse and fine resolver transducers within the actuators provide accurate position referencing information. 3 figs.
Amplitude transitions of swimmers and flexors in viscoelastic fluids
NASA Astrophysics Data System (ADS)
Guy, Robert; Thomases, Becca
In both theoretical and experimental studies of the effect of fluid elasticity on micro-organism swimming, very different behavior has been observed for small and large amplitude strokes. We present simulations of an undulatory swimmer in an Oldroyd-B fluid and show that the resulting viscoelastic stresses are a nonlinear function of the amplitude. Specifically, there appears to be an amplitude dependent transition that is key to obtaining a speed-up over the Newtonian swimming speed. To understand the physical mechanism of the transition, we examine the stresses in a time-symmetric oscillatory bending beam, or flexor. We compare the flow in a neighborhood of the flexor tips with a large-amplitude oscillatory extensional flow, and we see similar amplitude dependent transitions. We relate these transitions to observed speed-ups in viscoelastic swimmers.
Surgery for ganglia of the flexor tendon sheath
Finsen, Vilhjalmur; Håberg, Øyvind; Borchgrevink, Grethe Elisabeth
There are very few reports in the literature on the results of surgery for ganglia of the flexor tendon sheaths of the digits. We reviewed 24 patients operated for flexor tendon sheath ganglia 8 (3–11) years previously. Two operations were for recurrences and one of these recurred again. There was one permanent digital nerve injury and one patient complained of cold sensibility. VAS (0=best; 100=worst) for mean general complaints from the hand was remembered as 51 before surgery and was 5 at review. Mean pain at review was reported as VAS 4 and general satisfaction with the operation as VAS 3. All stated that they would have consented to surgery if they had known the outcome in advance. We conclude that the results of surgery are good, although complications do occur. PMID:23705064
Ultrasound of the digital flexor system: Normal and pathological findings☆
Bianchi, S.; Martinoli, C.; de Gautard, R.; Gaignot, C.
Recent improvements in ultrasound (US) software and hardware have markedly increased the role of this imaging modality in the evaluation of the musculoskeletal system. US is currently one of the main imaging tools used to diagnose and assess most tendon, muscle, and ligament disorders. Compared with magnetic resonance imaging, US is much less expensive; it has no contraindications and is also widely available. Diseases affecting the digital flexor system (DFS) require early diagnosis if treatment is expected to limit functional impairment of the hand. US scans performed with high-resolution, broad-band transducers allows superb visualization of the flexor tendons of the hand and the annular digital pulleys. In addition, dynamic US can be used to assess movement of the tendon within the pulleys during passive or active joint movements. This article examines the anatomy and US appearance of the normal DFS and reviews the US findings associated with the most common disorders affecting it. PMID:23396583
Restricted differentiation potential of progenitor cell populations obtained from the equine superficial digital flexor tendon (SDFT)
Humphreys, William James Edward; Comerford, Eithne Josephine Veronica; Clegg, Peter David; Canty‐Laird, Elizabeth Gail
ABSTRACT The aim of this study was to characterize stem and progenitor cell populations from the equine superficial digital flexor tendon, an energy‐storing tendon with similarities to the human Achilles tendon, which is frequently injured. Using published methods for the isolation of tendon‐derived stem/progenitor cells by low‐density plating we found that isolated cells possessed clonogenicity but were unable to fully differentiate towards mesenchymal lineages using trilineage differentiation assays. In particular, adipogenic differentiation appeared to be restricted, as assessed by Oil Red O staining of stem/progenitor cells cultured in adipogenic medium. We then assessed whether differential adhesion to fibronectin substrates could be used to isolate a population of cells with broader differentiation potential. However we found little difference in the stem and tenogenic gene expression profile of these cells as compared to tenocytes, although the expression of thrombospondin‐4 was significantly reduced in hypoxic conditions. Tendon‐derived stem/progenitor cells isolated by differential adhesion to fibronectin had a similar differentiation potential to cells isolated by low density plating, and when grown in either normoxic or hypoxic conditions. In summary, we have found a restricted differentiation potential of cells isolated from the equine superficial digital flexor tendon despite evidence for stem/progenitor‐like characteristics. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 33:849–858, 2015. PMID:25877997
"Chiefs for Change" Elbows into Policy Fight
ERIC Educational Resources Information Center
McNeil, Michele
Amid the cacophony of special interests fighting to be heard in statehouses and on Capitol Hill, a cadre of current and former chief state school officers is elbowing its way into the nation's education debate at a time when states are taking more control of K-12 education. A little more than a year old, Chiefs for Change is an invitation-only…
Medial elbow injury in young throwing athletes
Gregory, Bonnie; Nyland, John
Summary This report reviews the anatomy, overhead throwing biomechanics, injury mechanism and incidence, physical examination and diagnosis, diagnostic imaging and conservative treatment of medial elbow injuries in young throwing athletes. Based on the information a clinical management decision-making algorithm is presented. PMID:23888291
Spring ligament reconstruction using the autogenous flexor hallucis longus tendon.
Lee, Woo-Chun; Yi, Young
The calcaneonavicular (spring) ligament complex is the soft tissue most often seen to fail in flatfoot pathology and is associated with deformity of the talonavicular joint. The spring ligament complex supports the talar head, preventing it from displacing into excessive plantar flexion/adduction. An anatomical reconstruction of the spring ligament should replicate this function. A new method of spring ligament reconstruction using autogenous flexor hallucis longus tendon transfer is reported. PMID:24992052
Volar wrist ganglion excision through the flexor carpi radialis sheath.
Sawyer, Gregory A; DaSilva, Manuel F; Akelman, Edward
Volar wrist ganglions are much less frequent than their dorsal counterparts but provide much more surgical trepidation due to their proximity to the radial artery. With the majority arising from the radiocarpal joint, we have found that entering the flexor carpi radialis sheath and accessing the ganglion through the floor of the sheath allows for a relatively safe excision of these benign hand tumors. PMID:22913995
Effect of pulley excision on flexor tendon biomechanics.
Peterson, W W; Manske, P R; Bollinger, B A; Lesker, P A; McCarthy, J A
Flexor tendon function following excision of various portions of the fibro-osseous pulley system was measured biomechanically using a tensile testing machine. The biomechanical parameters measured were tendon excursion (the excursion of the tendon required to fully flex the digit) and work of flexion (the area under the force-excursion curve, representing all the forces that resist tendon flexion). In this experiment, work of flexion included the forces necessary to accomplish full digital flexion against a 15-g counter-weight, as well as the frictional forces that resist tendon gliding. The results indicate that the work of flexion was affected to a greater degree by pulley loss than was tendon excursion, suggesting that it is a more sensitive measurement of tendon function. A2 was found to be the single most important pulley for flexor tendon function, followed by A4. However, both A2 and A4 had to be present if near-normal hand function was to be achieved; sacrificing the A1 pulley was not associated with a significant loss of flexion. The "pulley effect" of the skin and soft tissue as a supplement to the fibro-osseous pulleys in reducing tendon bow-stringing was also noted. Although the parameters of tendon excursion and work of flexion were used in this study to determine the effect of pulley loss on tendon function, they can also be used to evaluate other flexor tendon studies, such as pulley reconstruction. PMID:3950813
Partial Flexor Tendon Laceration Assessment: Interobserver and Intraobserver Reliability.
Barker, B Justin; Kolovich, Gregory P; Klinefelter, Ryan D
Accurate assessment of partial-thickness flexor tendon lacerations in the hand is difficult owing to the subjectivity of evaluation. In this study, we created 12 partial-thickness flexor tendon lacerations in a cadaveric hand, evaluated the accuracy of 6 orthopedic residents and 4 fellowship-trained hand surgeons in estimating the percentage thickness of each laceration, and assessed the groups' interobserver and intraobserver agreement. The 10 participants estimated each laceration independently and on 2 separate occasions and indicated whether they would repair it. The actual thickness of each laceration was calculated from measurements made with a pair of digital microcalipers. Overall estimates differed significantly from calibrated measurements. Estimates grouped by residents and fellowship-trained hand surgeons also differed significantly. Third-year residents were the most accurate residents, and fellowship-trained hand surgeons were more accurate than residents. Overall interobserver agreement was poor for both readings. There was moderate overall intraobserver agreement. Fellowship-trained hand surgeons and first-year residents had the highest intraobserver agreement. These results highlight the difficulty in accurately assessing flexor tendon lacerations. Accuracy appears not to improve with surgeon experience. PMID:26991579
Reduced elbow extension torque during vibrations.
Friesenbichler, Bernd; Coza, Aurel; Nigg, Benno M
Impact sports and vibration platforms trigger vibrations within soft tissues and the skeleton. Although the long-term effects of vibrations on the body have been studied extensively, the acute effects of vibrations are little understood. This study determined the influence of acute vibrations at different frequencies and elbow angles on maximal isometric elbow extension torque and muscle activity. Vibrations were generated by a pneumatic vibrator attached to the lever of a dynamometer, and were applied on the forearm of 15 healthy female subjects. The subjects were instructed to push maximally against the lever at three different elbow angles, while extension torque and muscle activity were quantified and compared between vibration and non-vibration (control) conditions. A change in vibration frequency had no significant effects on torque and muscle activity although vibrations in general decreased the maximal extension torque relative to the control by 1.8% (±5.7%, p>0.05), 7.4% (±7.9%, p<0.01), and 5.0% (±8.2%, p<0.01) at elbow angles of 60°, 90°, and 120°, respectively. Electromyographic activity increased significantly between ∼30% and 40% in both triceps and biceps with vibrations. It is speculated that a similar increase in muscle activity between agonist and antagonist, in combination with an unequal increase in muscle moment arms about the elbow joint, limit the maximal extension torque during exposure to vibrations. This study showed that maximal extension torque decreased during vibration exposure while muscle activity increased and suggests that vibrations may be counterproductive during activities requiring maximal strength but potentially beneficial for strength training. PMID:22771229
Toe Flexor Strength, Flexibility and Function and Flexor Hallucis Longus Tendon Morphology in Dancers and Non-Dancers.
Rowley, K Michael; Jarvis, Danielle N; Kurihara, Toshiyuki; Chang, Yu-Jen; Fietzer, Abbigail L; Kulig, Kornelia
Tendinopathy of the flexor hallucis longus (FHL), colloquially referred to as "dancer's tendinitis," is a common condition in dancers and attributed to high demand on this muscle in positions of extreme ankle plantarflexion and metatarsophalangeal (MTP)) flexion and extension. Despite such a high prevalence, there has been little research into preventative or nonsurgical interventions. As a means to identify potential targets for prevention and intervention, this study aimed to characterize toe flexors in dancers by measuring strength, flexibility, function, and FHL tendon morphology. Dancers (n=25) were compared to non-dancers (n=25) in toe flexor isometric strength, first MTP joint range of motion, foot longitudinal arch flexibility, balance ability, endurance during modified heel raises without use of the toes, and FHL tendon thickness, cross-sectional area, and peak spatial frequency. Significant differences were found in functional first MTP joint extension (dancers 101.95°, non-dancers 91.15°, p<0.001), balance ability during single-leg stance on the toes (dancers 11.43 s, non-dancers 5.90 s, p=0.013), and during modified heel raises (dancers 22.20 reps, non-dancers 28.80 reps, p=0.001). Findings indicate that dancers rely on toe flexors more than non-dancers to complete balance and heel raise tasks. Efficacy of using this modified heel raise task with the toes off the edge of a block as a means to train larger plantarflexors and as a nonsurgical intervention should be studied in the future. Improving interventions for FHL tendinopathy will be impactful for dancers, in whom this condition is highly prevalent. PMID:26395616
Anatomical study of the musculus deltoideus and musculus flexor carpi ulnaris in 3 species of wild birds.
Canova, Marco; Bedoni, Carla; Harper, Valeria; Rambaldi, Anna Maria; Bombardi, Cristiano; Grandis, Annamaria
Given the limited information regarding the anatomy of the thoracic limb in European avian species, we decided to investigate the related muscles in the grey heron (Ardea cinerea), in the eurasian buzzard (Buteo buteo), and in the common kestrel (Falco tinnunculus). Therefore we performed a stratigraphic dissection of the wing in 3 subjects. The pars major and minor of the musculus deltoideus, despite being roughly in line with those reported by other authors in other species, displayed unique features. Concerning the pars propatagialis of the musculus deltoideus, from what was observed in the grey heron, we believe this structure can contribute to maintain the propatagial tension. In this way vibrations of this structure, which could cause diminished lift, are avoided. Moreover the peculiarity evidenced in the distal insertion of the common kestrel could influence the control of the pronation-supination of the wing during hovering. With respect to the musculus flexor carpi ulnaris, we believe the presence of a sesamoid-like structure at the base tendon, found in the grey heron and in the eurasian buzzard, may help complete the articular surfaces of the elbow. This study shows interesting data on species not previously examined and provides a possible functional correlation between the peculiarity observed and the kind of flight of each species. PMID:26681506
Early reduction in toe flexor strength is associated with physical activity in elderly men
Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Yokochi, Takashi
[Purpose] To compare the toe flexor, hand grip and knee extensor strengths of young and elderly men, and to examine the association between toe flexor strength and physical activity or inactivity levels. [Subjects and Methods] Young (n=155, 18–23 years) and elderly (n=60, 65–88 years) men participated in this study. Toe flexor, hand grip, and knee extensor strength were measured. Physical activity (time spent standing/walking per day) and inactivity (time spent sitting per day) were assessed using a self-administered questionnaire. [Results] Toe flexor, hand grip, and knee extensor strength of the elderly men were significantly lower than those of the young men. Standing/walking and sitting times of the elderly men were lower than those of the young men. Toe flexor strength correlated with hand grip and knee extensor strength in both groups. In elderly men, toe flexor strength correlated with standing/walking time. In comparison to the young men's mean values, toe flexor strength was significantly lower than knee extensor and hand grip strength in the elderly group. [Conclusion] The results suggest that age-related reduction in toe flexor strength is greater than those of hand grip and knee extensor strengths. An early loss of toe flexor strength is likely associated with reduced physical activity in elderly men. PMID:27313353
A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.
Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M
Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293
Souter arthroplasty for elbows with severe destruction.
Ikävalko, Mikko; Belt, Eero A; Kautiainen, Hannu; Lehto, Matti U K
One hundred fifty-eight primary Souter elbow arthroplasties were done on 134 patients (121 women) with severe joint destruction (Larsen Grade 5) or large bone defects or both. Joint replacement operations were done at our institution from 1985-1997. The study group comprised 156 joints in 132 patients with rheumatoid arthritis or other variants of chronic inflammatory joint disease, one in a patient with osteoarthritis, and one patient with posttraumatic arthrosis. The mean age of the patients at the time of surgery was 57 years (range, 26-81 years) and the mean disease duration was 27 years (tinge, 2-70 years). Radiographically, severe bone defects were detected in 100 humeri and 134 ulnas. Retentive (snap-fit) ulnar components were implanted in 110 joints, and bone grafts were used on 26 humeri and 14 ulnas. Major complications led to five early and 16 late reoperations in 19 patients. Four reoperations were done because of dislocation and eight because of aseptic loosening. One reoperation was done because of early infection and five were done because of late infection. One patient had reoperation because of superficial infection in the bursa olecrani and one triceps tendon rupture also was repaired. One patient had wound repair because of marginal necrosis. In the survival analysis, the cumulative success rate without revision for aseptic loosening at 5 years followup was 97%. Despite the demanding nature of these arthroplasties, the primary results are encouraging. Technically, it is possible to do elbow replacement, even on elbows where the humeral condyles or olecranon or both are missing, if there is sufficient bone left on the diaphyseal areas for primary stem fixation. However, in these extreme cases, the poor general condition of the patient or the difficult soft tissue problems in the elbow region may prove to be a contraindication for joint replacement. PMID:15123937
Spastic Paralysis of the Elbow and Forearm.
Gharbaoui, Idris; Kania, Katarzyna; Cole, Patrick
As the physiologic recovery period concludes, the patient is evaluated for surgical procedures that may rebalance muscle function and correct deformity. Upper extremity function is the product of complex and highly sophisticated mechanisms working in unison, and a careful, systematic preoperative evaluation is critical. A good function of the hand cannot be achieved without adequate position of the shoulder, elbow, forearm, and wrist. The goals of surgery must be practical and clearly understood by the patient and the family. PMID:26869862
Elbow magnetic resonance imaging: imaging anatomy and evaluation.
Hauptfleisch, Jennifer; English, Collette; Murphy, Darra
The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI.Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, basic imaging parameters, compartmental pathology, and finally applications of some novel MRI techniques. PMID:25835585
Early results of the Acclaim elbow replacement.
Bassi, R S; Simmons, D; Ali, F; Nuttall, D; Birch, A; Trail, I A; Stanley, J K
The Acclaim total elbow replacement is a modular system which allows implantation in both unlinked and linked modes. The results of the use of this implant in primary total elbow replacement in 36 patients, operated on between July 2000 and August 2002, are presented at a mean follow-up of 36 months (24 to 49). Only one patient did not have good relief of pain, but all had improved movement and function. No implant showed clinical or radiological loosening, although one had a lucent area in three of seven humeral zones. The short-term results of the Acclaim total elbow replacement are encouraging. However, 11 patients (30.5%) suffered an intra-operative fracture of the humeral condyle. This did not affect the outcome, or the requirement for further surgery, except in one case where the fracture failed to unite. This problem has hopefully been addressed by redesigning the humeral resection guide. Other complications included three cases of ulnar neuropathy (8.3%) and one of deep infection (2.8%). PMID:17463117
Epidemiology of Nursemaid's Elbow
Vitello, Sarah; Dvorkin, Ronald; Sattler, Steven; Levy, David; Ung, Lyncean
Introduction To provide an epidemiological description of radial head subluxation, also known as nursemaid's elbow, from a database of emergency department visits. Methods We conducted a retrospective medical record review of patients 6 years of age and younger, who presented to the ED between January 1, 2005, and December 31, 2012, and were diagnosed with nursemaid's elbow. Inclusion criteria consisted of chart information, including date, unique account number, medical record number, weight, age, sex, and arm affected. Exclusion criteria included any charts with missing or incomplete data. Results There were 1,228 charts that met inclusion criteria. The majority of patients were female (60%). The mean age was 28.6 months (±12.6). The left arm was affected 60% of the time. Most of the included patients were over the 75th percentile for weight and more than one quarter were over the 95th percentile in each gender. Conclusion The average age of children presenting with nursemaid's elbow was 28.6 months. Females were affected more than males, and the left arm was predominately affected. Most patients were above the 75th percentile for weight and more than one quarter were over the 95th percentile for weight. PMID:25035767
Radiofrequency Microtenotomy for Elbow Epicondylitis: Midterm Results.
Tasto, James P; Richmond, John M; Cummings, Jeffrey R; Hardesty, Renee; Amiel, David
We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety and midterm effectiveness of microtenotomy using a radiofrequency probe to treat chronic tendinosis of the elbow. All patients had failed conservative treatment for 6 months. The radiofrequency-based microtenotomy was performed using the Topaz Microdebrider (ArthroCare). Patients were followed annually for up to 9 years postoperatively. Pain status was documented using a visual analog scale self-reported measure. Eighty consecutive patients with tendinosis of the elbow were enrolled; 69 patients were treated for lateral epicondylitis and 11 for medial epicondylitis. The duration of follow-up ranged from 6 months to 9 years (mean, 2.5 years). Ninety-one percent of the patients reported a successful outcome. Within the lateral epicondylitis group, the preoperative visual analog scale improved from 6.9 to 1.3 postoperatively and demonstrated an 81% improvement (P ≤ .01). For the medial epicondylitis patients, the preoperative visual analog scale improved from 6.1 to 1.3 after surgery, a 79% improvement (P ≤ .01). No complications were reported. Radiofrequency-based microtenotomy is a safe and effective procedure for elbow epicondylitis. The results are durable with successful outcomes observed at 9 years after surgery. PMID:26761915
Flexor Tendon Sheath Ganglions: Results of Surgical Excision
Spencer, Edwin E.
The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient's medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath. PMID:18780066
Impingement of Droplets in 60 Deg Elbows with Potential Flow
NASA Technical Reports Server (NTRS)
Hacker, Paul T.; Saper, Paul G.; Kadow, Charles F.
Trajectories were determined for water droplets or other aerosol particles in air flowing through 600 elbows especially designed for two-dimensional potential motion. The elbows were established by selecting as walls of each elbow two streamlines of a flow field produced by a complex potential function that establishes a two-dimensional flow around. a 600 bend. An unlimited number of elbows with slightly different shapes can be established by selecting different pairs of streamlines as walls. Some of these have a pocket on the outside wall. The elbows produced by the complex potential function are suitable for use in aircraft air-inlet ducts and have the following characteristics: (1) The resultant velocity at any point inside the elbow is always greater than zero but never exceeds the velocity at the entrance. (2) The air flow field at the entrance and exit is almost uniform and rectilinear. (3) The elbows are symmetrical with respect to the bisector of the angle of bend. These elbows should have lower pressure losses than bends of constant cross-sectional area. The droplet impingement data derived from the trajectories are presented along with equations so that collection efficiency, area, rate, and distribution of droplet impingement can be determined for any elbow defined by any pair of streamlines within a portion of the flow field established by the complex potential function. Coordinates for some typical streamlines of the flow field and velocity components for several points along these streamlines are presented in tabular form. A comparison of the 600 elbow with previous calculations for a comparable 90 elbow indicated that the impingement characteristics of the two elbows were very similar.
Posterior elbow release and humeral osteotomy for patients with arthrogryposis.
Zlotolow, Dan A; Kozin, Scott H
Children with arthrogryposis often lack the ability to feed themselves, largely due to limited shoulder external rotation and elbow flexion. Patients who can achieve passive elbow flexion through a surgical release but who cannot externally rotate their shoulders are still unable to reach their mouths with their hands. Combining a posterior elbow capsular release with a simultaneous humeral osteotomy in these patients places the forearm and hand in a much better position for function with minimal additional surgical exposure. PMID:22483178
Antibody elbow angles are influenced by their light chain class
Stanfield, R; Zemla, A; Wilson, I; Rupp, B
We have examined the elbow angles for 365 different Fab fragments, and observe that Fabs with lambda light chains have adopted a wider range of elbow angles than their kappa-chain counterparts, and that the lambda light chain Fabs are frequently found with very large (>195{sup o}) elbow angles. This apparent hyperflexibility of lambda-chain Fabs may be due to an insertion in their switch region, which is one residue longer than in kappa chains, with glycine occurring most frequently at the insertion position. A new, web-based computer program that was used to calculate the Fab elbow angles is also described.
[Pitfalls in the diagnosis of occult elbow fractures in children].
Courvoisier, A; Calvelli, N; Bourgeois, E; Eid, A; Griffet, J
Elbow injuries are frequent but occult fractures are difficult to diagnose on x-rays. However, any delay in the diagnosis may severely impair the prognosis of some fractures. Simple tips may help the clinician read x-rays properly and avoid the classical pitfalls of elbow injuries in children. The chronology of appearance of ossification nuclei around the elbow is important to distinguish normal features from abnormality. Drawing simple geometric constructions on the x-rays may clarify most occult elbow fractures in children. PMID:27345552
[Bilateral elbow dislocation related to Essex-Lopresti injury].
Romero Pérez, B; Marcos García, A; Medina Henríquez, J A; Muratore Moreno, G
Elbow dislocation is second in frequency, after the shoulder, whereas bilateral dislocation is uncommon, even less than dislocations with concurrent associated fractures. One of the least frequent associations is the Essex-Lopresti injury which consists of a fracture of the radial head affecting the distal radioulnar joint with injury to the interosseous membrane. This is a case of bilateral elbow dislocation, one of the elbows associated with the Essex-Lopresti injury. During treatment, the premature closed reduction prevails, previously making sure the elbow is stable, the premise which will determine the orthopedic or surgical treatment of the injury. PMID:23177945
The triceps preserving approach to total elbow arthroplasty.
Pierce, T D; Herndon, J H
Elbow arthroplasty most commonly is performed through a posterior approach by detaching or reflecting the triceps off the olecranon. Surgical approaches to the elbow joint that dissociate the triceps from the olecranon have distinct disadvantages. Triceps avulsion, triceps weakness, and wound healing problems have been reported. Such complications necessitate more surgery and predispose the joint to an infection. To avoid these complications a modified posterior approach to the elbow joint that preserves the triceps muscle insertion on the olecranon was used in 10 consecutive elbow arthroplasties. This method provides adequate exposure, allows early rehabilitation, and avoids triceps weakness. PMID:9755773
Comparison Between Corrosion Behavior of Copper and Stainless Steel 90° Elbow and Failure Investigation of 90° Copper Elbow
NASA Astrophysics Data System (ADS)
Fouad, Mohamed Ahmed; Zewail, Taghreed Mohamed; Amine, Nieven Abbas; El-Tawail, Yehia Ahmed
Frequently found in elbow, erosion failures may lead to the leakage of pipes and even damage the whole system. Erosion is a form of material degradation that involves electrochemical corrosion and mechanical wear processes encountered on the surface of metal pipes. Research on the erosion-corrosion mechanism indicates that the erosion mainly results from the interactions between the elbow surface and the fluid traveling along the surface. Corrosion behavior of 90° copper and stainless steel elbow was studied. Scanning electron microscopy was processed on the 90° copper elbow to show the surface morphology of the failed copper elbow. Failure investigation was carried out on 90° copper elbow to determine failure location and failure causes.
Point-of-Care Ultrasound in the Evaluation of Pyogenic Flexor Tenosynovitis.
Cohen, Stephanie G; Beck, Sierra C
A 4-year-old girl presented to the emergency department for evaluation of finger swelling after a dog bite. Point-of-care ultrasound was used to diagnose pyogenic flexor tenosynovitis of the digit after visualizing a fluid collection within the flexor tendon sheath. The patient underwent emergent incision and drainage of the digit with good outcome. PMID:26535504
An atypical presentation of a flexor intratendinous ganglion of the hand.
Chia, Dawn Sinn Yii; Kong, Jun Cheong; Teoh, Lam Chuan
Intratendinous ganglions of the hand are rare. We report an unusual case of a ganglion arising within the flexor tendon in the hand. The intratendinous ganglion arose from the flexor digitorium profundus tendon of the little finger, causing flexion deformity of the finger. PMID:24051457
Multimodality Imaging of the Painful Elbow: Current Imaging Concepts and Image-Guided Treatments for the Injured Thrower's Elbow.
Gustas, Cristy N; Lee, Kenneth S
Elbow pain in overhead sport athletes is not uncommon. Repetitive throwing can lead to chronic overuse and/or acute injury to tendons, ligaments, bones, or nerves about the elbow. A thorough history and physical examination of the thrower's elbow frequently establishes the diagnosis for pain. Imaging can provide additional information when the clinical picture is unclear or further information is necessary for risk stratification and treatment planning. This article focuses on current imaging concepts and image-guided treatments for injuries commonly affecting the adult throwing athlete's elbow. PMID:27545422
Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump
Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun
[Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball.
Differences in Plantar Flexor Fascicle Length and Pennation Angle between Healthy and Poststroke Individuals and Implications for Poststroke Plantar Flexor Force Contributions
Ramsay, John W.; Buchanan, Thomas S.; Higginson, Jill S.
Poststroke plantar flexor muscle weakness has been attributed to muscle atrophy and impaired activation, which cannot collectively explain the limitations in force-generating capability of the entire muscle group. It is of interest whether changes in poststroke plantar flexor muscle fascicle length and pennation angle influence the individual force-generating capability and whether plantar flexor weakness is due to uniform changes in individual muscle force contributions. Fascicle lengths and pennation angles for the soleus, medial, and lateral gastrocnemius were measured using ultrasound and compared between ten hemiparetic poststroke subjects and ten healthy controls. Physiological cross-sectional areas and force contributions to poststroke plantar flexor torque were estimated for each muscle. No statistical differences were observed for any muscle fascicle lengths or for the lateral gastrocnemius and soleus pennation angles between paretic, nonparetic, and healthy limbs. There was a significant decrease (P < 0.05) in the paretic medial gastrocnemius pennation angle compared to both nonparetic and healthy limbs. Physiological cross-sectional areas and force contributions were smaller on the paretic side. Additionally, bilateral muscle contributions to plantar flexor torque remained the same. While the architecture of each individual plantar flexor muscle is affected differently after stroke, the relative contribution of each muscle remains the same. PMID:25147753
Estimation of elbow-induced wrist force with EMG signals using fast orthogonal search.
Mobasser, Farid; Eklund, J Mikael; Hashtrudi-Zaad, Keyvan
In many studies and applications that include direct human involvement-such as human-robot interaction, control of prosthetic arms, and human factor studies-hand force is needed for monitoring or control purposes. The use of inexpensive and easily portable active electromyogram (EMG) electrodes and position sensors would be advantageous in these applications compared to the use of force sensors, which are often very expensive and require bulky frames. Multilayer perceptron artificial neural networks (MLPANN) have been used commonly in the literature to model the relationship between surface EMG signals and muscle or limb forces for different anatomies. This paper investigates the use of fast orthogonal search (FOS), a time-domain method for rapid nonlinear system identification, for elbow-induced wrist force estimation. It further compares the forces estimated using FOS with the forces estimated by MLPANN for the same human anatomy under an ensemble of operational conditions. In this paper, the EMG signal readings from upper arm muscles involved in elbow joint movement and sensed elbow angular position and velocity are utilized as inputs. A single degree-of-freedom robotic experimental testbed has been constructed and used for data collection, training and validation. PMID:17405375
Muscle fibre types of the lumbrical, interossei, flexor, and extensor muscles moving the index finger.
Hwang, Kun; Huan, Fan; Kim, Dae Joong
The aim of this study was to determine the fibre types of the muscles moving the index fingers in humans. Fifteen forearms of eight adult cadavers were used. The sampled muscles were the first lumbrical (LM), first volar interosseous (VI), first dorsal interosseus (DI), second flexor digitorum profundus (FDP), second flexor digitorum superficialis (FDS), and extensor digitorum (ED). Six micrometer thick sections were stained for fast muscle fibres. The procedure was performed by applying mouse monoclonal anti-skeletal myosin antibody (fast) and avidin-biotin peroxidase complex staining. Rectangular areas (0.38 mm × 0.38 mm) were photographed and the boundaries of the muscle areas were marked on the translucent film. The numbers and sizes of the muscle fibres in each part were evaluated by the image analyser program and calculated per unit area (1 mm(2)). The proportion of the fast fibres was significantly (p = 0.012) greater in the intrinsic muscles (55.7 ± 17.1%) than in the extrinsic muscles (45.9 ± 17.1%). Among the six muscles, the VI had a significantly higher portion (59.3%) of fast fibres than the FDS (40.6%) (p = 0.005) or the FDP (45.1%) (p = 0.023). The density of the non-fast fibres was significantly (p = 0.015) greater in the extrinsic muscles (539.2 ± 336.8/mm(2)) than in the intrinsic muscles (383.4 ± 230.4/mm2). Since the non-fast fibres represent less fatigable fibres, it is thought that the extrinsic muscles have higher durability against fatigue, and the intrinsic muscles, including the LM, should move faster than the FDS or FDP because the MP joint should be flexed before the IP joint to grip an object. PMID:23692210
21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.
Code of Federal Regulations, 2010 CFR
... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the... joint humeral (hemi-elbow) metallic uncemented prosthesis shall have an approved PMA or a...
21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.
Code of Federal Regulations, 2011 CFR
... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the... joint humeral (hemi-elbow) metallic uncemented prosthesis shall have an approved PMA or a...
Development and use of an animal model to study post-traumatic stiffness and contracture of the elbow.
Lake, Spencer P; Castile, Ryan M; Borinsky, Stephanie; Dunham, Chelsey L; Havlioglu, Necat; Galatz, Leesa M
Post-traumatic joint stiffness (PTJS) of the elbow is a debilitating condition that poses unique treatment challenges. While previous research has implicated capsular tissue in PTJS, much regarding the development and progression of this condition remains unknown. The objective of this study was to develop an animal model of post-traumatic elbow contracture and evaluate its potential for studying the etiology of PTJS. The Long-Evans rat was identified as the most appropriate species/breed for development due to anatomical and functional similarities to the human elbow joint. Two surgical protocols of varying severity were utilized to replicate soft tissue damage seen in elbow subluxation/dislocation injuries, including anterior capsulotomy and lateral collateral ligament transection, followed by 6 weeks of unilateral joint immobilization. Following sacrifice, flexion-extension mechanical joint testing demonstrated decreased range-of-motion and increased stiffness for injured-immobilized limbs compared to control and sham animals, where functional impact correlated with severity of injury. Histological evaluation showed increased cellularity, adhesion, and thickness of capsule tissue in injured limbs, consistent with clinical evidence. To our knowledge, this is the first animal model capable of examining challenges unique to the anatomically and biomechanically complex elbow joint. Future studies will use this animal model to investigate mechanisms responsible for PTJS. PMID:26177969
Edifying Violence: Peter Elbow and the Pedagogical Paradox.
ERIC Educational Resources Information Center
Briggs, John Channing
Presents a critique of the common practice of writing instruction advocated by the well-known theorist Peter Elbow. Focuses on the paradox of pedagogical authority in writing classrooms. Reviews Elbow's writings in light of the problem of pedagogical authority. (HB)
Nerve injuries about the elbow in the athlete.
Harris, Joshua D; Lintner, David M
The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery. PMID:25077754
Lateral elbow tendinopathy: Evidence of physiotherapy management
Dimitrios, Stasinopoulos
Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation. PMID:27622145
Elbow Injuries in the Young Throwing Athlete.
Oshlag, Benjamin L; Ray, Tracy R
Baseball pitchers and other throwing athletes place their elbows under tremendous stresses, making them vulnerable to a number of unique injuries. Skeletally immature throwers in particular are at a greater risk for growth plate and other bony injuries, due to the relative strengths of these tissues and the kinematics involved in throwing. Care should be taken to fully evaluate these injuries based on the particular history and presentation to properly direct treatment and rehabilitation. Patients, as well as other athletes, coaches, and families, also should be made aware of the significant risk factors for these injuries, especially those regarding pitch limits, proper mechanics, and sufficient rest. PMID:27618241
Erosion resistant elbow for solids conveyance
Everett, J.W.
An elbow and process for fabrication for use in particulate material conveyancing comprises a curved outer pipe, a curved inner pipe having the same radius of curvature as the outer pipe, concentric with and internal to the outer pipe, comprising an outer layer comprised of a first material and an inner layer comprised of a second material wherein said first material is characterized by high erosion resistance when impinged by particulate material and wherein said second material is characterized by high tensile strength and flexibility, and an inner pipe supporting means for providing support to said inner pipe, disposed between said inner pipe and said outer pipe. 4 figs.
Erosion resistant elbow for solids conveyance
Everett, James W.
An elbow and process for fabrication for use in particulate material conveyancing comprising a curved outer pipe, a curved inner pipe having the same radius of curvature as the outer pipe, concentric with and internal to the outer pipe, comprising an outer layer comprised of a first material and an inner layer comprised of a second material wherein said first material is characterized by high erosion resistance when impinged by particulate material and wherein said second material is characterized by high tensile strength and flexibility, and an inner pipe supporting means for providing support to said inner pipe, disposed between said inner pipe and said outer pipe.
Filh, Geraldo Motta; Galvão, Marcus Vinicius
Elbow stiffness is a common problem after joint trauma, causing functional impairment of the upper limb. The severity of the dysfunction depends on the nature of the initial trauma and the treatment used. Appropriate clinical evaluation and complementary examinations are essential for therapeutic planning. Several surgical techniques are now available and the recommendation must be made in accordance with patient characteristics, degree of joint limitation and the surgeon's skill. Joint incongruence and degeneration have negative effects on the prognosis, but heterotrophic ossification alone has been correlated with a favorable surgical prognosis. PMID:27022563
Lateral elbow tendinopathy: Evidence of physiotherapy management.
Dimitrios, Stasinopoulos
Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation. PMID:27622145
Resistance exercise prevents plantar flexor deconditioning during bed rest
NASA Technical Reports Server (NTRS)
Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.
Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional
[Elbow problems associated with sports injuries in children].
Demirhan, Mehmet; Güneşli, Taner
Elbow problems associated with sports injuries may result from overuse, micro- or macrotraumas. Overuse injuries are frequent and are often closely related to mechanical characteristics of sports. Sports-related elbow injuries mainly occur in sports involving throwing such as baseball and javelin throwing, which require forced valgus and extension of the elbow, predisposing it to overuse injuries. Overuse injuries in child athletes are generally defined as Little League elbow, the most common of which are medial epicondyle apophysitis, osteochondritis dissecans of the capitellum, radial head deformation, flexion contractures, and injuries to the olecranon. Most of these injuries can be healed without or with minimal sequelae by early diagnosis and proper treatment. Therefore, mechanisms of, and risk factors for, elbow problems encountered in pediatric athletes should be well-understood in order to avoid the risks for a permanent deformity in the child's anatomy. PMID:15187462
Massive allograft replacement of hemiarticular traumatic defects of the elbow.
Breen, T; Gelberman, R H; Leffert, R; Botte, M
Four elbow osteoarticular allografts were done for four patients as salvage procedures for unreconstructable elbow fracture malunions. With a mean follow-up of 60 months (range, 12 to 72 months) all elbows were stable, free of pain, and had mean motion of 130 degrees active flexion and 27 degrees of flexion deformity, 67 degrees pronation and 62 degrees supination (preoperative mean: 104 degrees flexion, 42 degrees flexion contracture, 20 degrees pronation, and 34 degrees supination). Complications occurred in two elbows. One had a deep infection necessitating graft removal and subsequent regrafting. The second had an olecranon osteotomy nonunion. Elbow allografting is recommended as a salvage procedure for massive posttraumatic articular defects, bone loss, or malunion when neither arthrodesis nor conventional arthroplasty is indicated. PMID:3066816
Evaluation and Management of Elbow Tendinopathy
Taylor, Samuel A.; Hannafin, Jo A.
Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury. PMID:23016111
Management of an Uncomplicated Posterior Elbow Dislocation
Blackard, Douglas; Sampson, Jo-Ann
Objective: To present a case of an uncomplicated posterior elbow dislocation in a US World Cup athlete and discuss her rehabilitation. Background: Traditional protocol for management of this injury has been splint immobilization for several weeks, but research suggests a shortened duration of immobilization and early active motion. Differential Diagnosis: Elbow dislocation with possible fracture. Treatment: The dislocation was reduced and a compression bandage and sling were applied. The sports medicine staff and athlete determined that rehabilitation would involve limited immobilization with a posterior splint. Also, active range-of- motion exercises were to be incorporated early in the range-of- motion program to decrease pain at the articulation. Uniqueness: The athlete was not immobilized and her aggressive five-phase rehabilitation program progressed according to decrease in inflammation and increase in range of motion and strength. Conclusions: Shortened immobilization and return to World Championship competition 6 weeks postinjury had no longterm adverse effects on the athlete. ImagesFig 1.Fig 2.Fig 3.Fig 4.Fig. 5. PMID:16558436
Avoidance of unfavourable results following primary flexor tendon surgery
Elliot, D.; Giesen, T.
This review describes the biological problems faced by those managing primary flexor tendon injuries and explains why these problems still thwart attempts to achieve normal, or near normal, function after this injury, despite a century of surgical effort. It considers the historical background of the early 20th century attempts to improve the results and analyses the clinical usefulness of more recent research into tendon core and circumferential suture modification, including the authors' work in this field, and changes in post-operative mobilisation over the last 50 years. More recent manipulation of the sheath to improve results and the future possibility of manipulation of adhesions are discussed. It also discusses other factors, e.g., the patient, the experience of the surgeon, the use of therapists, the timing of repair, complex injuries, injuries in zones other than zone 2, which can have a bearing on the results and considers how these can be modified to avoid an unfavourable outcome. PMID:24501468
Determining flexor-tendon repair techniques via soft computing
NASA Technical Reports Server (NTRS)
Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.
An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.
Haemodynamic kinetics and intermittent finger flexor performance in rock climbers.
Fryer, S; Stoner, L; Lucero, A; Witter, T; Scarrott, C; Dickson, T; Cole, M; Draper, N
Currently it is unclear whether blood flow (BF) or muscle oxidative capacity best governs performance during intermittent contractions to failure. The aim of this study was to determine oxygenation kinetics and BF responses during intermittent (10 s contraction: 3 s release) contractions at 40% of MVC in rock climbers of different ability (N=38). Total forearm BF, as well as de-oxygenation and re-oxygenation of the flexor digitorum profundus (FDP) and the flexor carpi radialis (FCR) were assessed. Compared to the control, intermediate and advanced groups, the elite climbers had a significantly (p<0.05) greater force time integral (FTI), MVC and MVC/kg. Furthermore, the elite climbers de-oxygenated the FDP significantly more during the first (7.8, 11.9, 12.4 vs. 15.7 O2%) and middle (7.3, 8.8, 10.4 vs.15.3 O2%) phases of contractions as well as for the FCR during the first phase only (8.3, 7, 11.7 vs. 13.3 O2%). They also had a significantly higher BF upon release of the contractions (656, 701, 764 vs. 971 mL ∙ min(-1)). The higher FTI seen in elite climbers may be attributable to a greater blood delivery, and an enhanced O2 recovery during the 3 s release periods, as well as a superior muscle oxidative capacity associated with the greater de-oxygenation during the 10 s contractions. PMID:25251449
Assessing Finger Joint Biomechanics by Applying Equal Force to Flexor Tendons In Vitro Using a Novel Simultaneous Approach
Yang, Tai-Hua; Lu, Szu-Ching; Lin, Wei-Jr; Zhao, Kristin; Zhao, Chunfeng; An, Kai-Nan; Jou, I-Ming; Lee, Pei-Yuan
Background The flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) are critical for finger flexion. Although research has recently focused on these tendons' coactivity, their contributions in different tasks remain unclear. This study created a novel simultaneous approach to investigate the coactivity between the tendons and to clarify their contributions in different tasks. Methods Ten human cadaveric hands were mounted on our custom frame with the FDS and FDP of the third finger looped through a mechanical pulley connected to a force transducer. Joint range of motion, tendon excursion and loading force were recorded during individual joint motion and free joint movement from rest to maximal flexion. Each flexor tendon's moment arm was then calculated. Results In individual motions, we found that the FDP contributed more than the FDS in proximal interphalangeal (PIP) joint motion, with an overall slope of 1.34 and all FDP-to-FDS excursion (P/S) ratios greater than 1.0 with force increase. However, the FDP contributed less than the FDS in metacarpophalangeal (MCP) joint motion, with an overall slope of 0.95 and P/S ratios smaller than 1.0 throughout the whole motion except between 1.9% and 13.1% force. In free joint movement, the FDP played a greater role than the FDS, with an overall ratio of 1.37 and all P/S ratios greater than 1.0. Conclusions The new findings include differences in finger performance and excursion amounts between the FDS and FDP throughout flexion. Such findings may provide the basis for new hand models and treatments. PMID:27513744
Calculated analysis of the stressed and strain state of pipeline sector elbows
NASA Astrophysics Data System (ADS)
Popov, A. B.
The stressed and strain state of sector-type pipeline elbows is analyzed using the finite element method. Features in which sector elbows of pipelines differ from circular elbows are revealed. Formulas for determining the maximal equivalent stresses in sector elbows are presented.
The tRNA Elbow in Structure, Recognition and Evolution
Zhang, Jinwei; Ferré-D'Amaré, Adrian R.
Prominent in the L-shaped three-dimensional structure of tRNAs is the "elbow" where their two orthogonal helical stacks meet. It has a conserved structure arising from the interaction of the terminal loops of the D- and T-stem-loops, and presents to solution a flat face of a tertiary base pair between the D- and T-loops. In addition to the ribosome, which interacts with the elbow in all three of its tRNA binding sites, several cellular RNAs and many proteins are known to recognize the elbow. At least three classes of non-coding RNAs, namely 23S rRNA, ribonuclease P, and the T-box riboswitches, recognize the tRNA elbow employing an identical structural motif consisting of two interdigitated T-loops. In contrast, structural solutions to tRNA-elbow recognition by proteins are varied. Some enzymes responsible for post-transcriptional tRNA modification even disrupt the elbow structure in order to access their substrate nucleotides. The evolutionary origin of the elbow is mysterious, but, because it does not explicitly participate in the flow of genetic information, it has been proposed to be a late innovation. Regardless, it is biologically essential. Even some viruses that hijack the cellular machinery using tRNA decoys have convergently evolved near-perfect mimics of the tRNA elbow. PMID:26771646
Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs--an in vitro biomechanical study.
McDonald, E; Gordon, J A; Buckley, J M; Gordon, L
Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength. PMID:22745156
Canine hip and elbow dysplasia in UK Labrador retrievers.
Woolliams, J A; Lewis, T W; Blott, S C
This paper examines the outcomes from recent genetic analyses of hip and elbow scores from British Veterinary Association (BVA)/UK Kennel Club (KC) screening programmes targeted at reducing the prevalence of hip dysplasia (HD) and elbow dysplasia in UK Labrador retrievers. The analyses made use of 25,243 hip scores and 3613 elbow scores. Heritabilities (± standard error) for hip score, analysed on a log scale, and for elbow score were 0.35±0.02 and 0.19±0.04, respectively, with a genetic correlation of 0.41±0.09. For both hip and elbow scores, there was a near perfect genetic correlation between the left and right joint; analysis of hip score showed a predictive benefit of using the total of left and right scores rather than worst score and the benefit of using all component scores rather than their aggregate score. Downward genetic trends were observed in both hip and elbow scores, although the latter was consistent with it being correlated to response to genetic change in hip score. Estimated breeding values (EBVs) offered substantial benefits in accuracy and hence genetic progress when compared to the use of phenotypes for both hip and elbow scores. There are major opportunities for improving selection against elbow dysplasia through the use of bivariate evaluations, although progress against dysplasia would be improved by more widespread elbow scoring. The studies highlighted a number of ways in which data recording for addressing complex traits may be improved in the future. Ongoing advances in genomic technology may be utilised for increasing the rate of genetic progress in selection against HD and for complex diseases in general, through the use of genomic evaluations. PMID:21737322
Elbow Stiffness Secondary to Elbow Joint Osteoid Osteoma, a Diagnostic Dilemma
Ebrahimzadeh, Mohamad H.; Choghadeh, Meysam Fathi; Moradi, Ali; Kalati, Hamid Hejrati; Jafarian, Amir Hossein
We present a 23-year-old man with distal humerus osteoid osteoma referring to our hospital with pain and progressive stiffness. The patient has been suffering from the disease for two years without a certain diagnosis. The radiographies of elbow did not reveal the pathology but further CT scan and MRI studies demonstrated the tumor. The en block resection of the tumor resolved the pain immediately but range of motion remained restricted. PMID:26110185
Complications of Open Elbow Arthrolysis in Post-Traumatic Elbow Stiffness: A Systematic Review
Yan, Hede; Sun, Yangbai; Chen, Wei; Chen, Shuai; Fan, Cunyi
Objective The objective of this study was to systematically review the literature for a more comprehensive understanding of the complications of open elbow arthrolysis in patients with post-traumatic elbow stiffness and provide a reference for better prevention and treatment of them. Methods The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for therapeutic studies with a set of inclusion and exclusion criteria. Data were extracted from selected articles, and a statistical analysis was performed to evaluate related factors and management of the complications. Results Twenty-eight articles published between 1989 and 2013, involving 810 patients, were included. Most of the complications included in the selected articles were nerve complications, heterotopic ossification, elbow instability, infection, pin-related complications and repeat elbow contracture. The total complication rate was 24.3% ± 3.0%, and the reoperation rate was 34.0%. Furthermore, the statistical analysis revealed that preoperative range of motion (β = -0.004, P = 0.01) and proportion of female (β = 0.336, P = 0.04) were the independent factors affecting the total complication rate. Conclusions Various risk factors are related to each of the complications, and we found that patients with less preoperative ROM and a higher proportion of female gender may point to a higher total complication rate. Therefore, to further improve the overall outcomes of this procedure, more and larger prospective studies should be performed to further elucidate the effects of prophylactic interventions targeting the risk factors, thus improving the methods of prevention and treatment of complications. PMID:26383106
Reduction of erosion in elbows due to flow modifications: Final report, Phase 1. [Elbows
Johnson, E.K.; Means, K.H.; Eyler, R.L.; Holtzworth, J.D.
The objective of this project is to investigate the concept of flow-field modification as a method for reducing erosion in bends (elbows) used in pneumatic transport systems. Flow field modifications were primarily accomplished by injecting air at selected locations within the bends. Part I of this project shows the feasibility of the concept. Part II of this project will include further experiments and analysis, leading to a design methodology for incorporating this concept into piping systems. This report represents the final report for Part I of this project. This report contains a survey of the literature dealing with the erosion in bends (elbows) and the fundamental subjects of erosion and two-phase, gas-solids, flow. Based on this literature survey, a pneumatic transport test loop was constructed. Several bend designs were tested, using sand, under a variety of operating conditions. The results of this exploratory effort indicate that modifying the flow field in a bend with jets may: (1) decrease erosion; (2) change the erosion pattern with the same amount of erosion; or (3) significantly increase the erosion process. Data indicate that the erosion rate may be reduced by low-velocity jets for high phase-density flow. Apparently the interaction of jets with dilute phase-density flow tends to accelerate the erosion process. It is recommended that the project be continued in order to more fully understand the process and its capabilities to solve the difficult technical problem of erosion in bends (elbows).
A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation
Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.
Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293
Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus Tendon Treated by Tendoscopy.
Lui, Tun Hing
Tendosynovial chondromatosis of the foot and ankle is a rare disease entity. We reported 3 patients with tenosynovial osteochondromatosis of flexor hallucis longus. They were successfully treated by arthroscopic synovectomy and removal of the loose bodies. PMID:25979294
Observations on an evaporative, elbow thermosyphon
Lock, G.S.H.; Fu, J. )
The performance of the evaporative elbow system was found to be superior to that of the nonevaporative system, but comparable to the performance of the linear system. The parametric role of the evaporator wall temperature, the condenser wall temperature, and the vapor saturation temperature was demonstrated, each revealing a similar monotonic effect. With the evaporator upright, the data were found to be similar to, but displaced from, the upright condenser data. The upright evaporator gave the better performance, but not overwhelmingly so. The limit of performance with the condenser upright was found to be dictated by evaporator dryout. In the upright evaporator configuration, the limit may be attributed to flooding in the poorly draining condenser; this limit was indistinguishable from geyser behavior at low vapor pressures. 16 refs., 3 figs.
Elbow functional compensation using a lightweight magnetorheological clutch.
Clemente, Alejandro Martín; Caballero, Antonio Flores; Rojas, Dolores Blanco; Copaci, Dorin-Sabin; Lorente, Luis Moreno
There are many applications for which a patient needs functional compensation due to motor disorders in daily activities. Classic research has focused on robotics solutions in terms of actuators or motors, but the point of this paper is to analyze new solutions combining both biological and artificial structures, in order to improve standard developments. Nowadays wearable Robots are taking an important role in rehabilitation purposes, due to this issue lots of new designs are emerging, but most of them are not still prepared to be used in terms of autonomy, weight, etc. Under the Hybrid Neuroprosthetic and Neurorobotic devices for Functional Compensation and Rehabilitation (HYPER) project, new actuator technologies have been developed in order to improve the adaptability and portability of rehabilitation devices. The designed device is based on a lightweight magnetorheological (MR) clutch which is able to transmit torque from a motor to the injured joint. Though it is intended to work in human upper limb (elbow mainly), other future designs will also be studied for other human joints. Simulation results using Simulink®, MSC Adams®and MSMS®are reported to illustrate the viability of the proposed device. PMID:22255513
Computed Tomographic Tenography of Normal Equine Digital Flexor Tendon Sheath: An Ex Vivo Study
Lacitignola, Luca; De Luca, Pasquale; Guarracino, Alessandro; Crovace, Antonio
Aim of this study was to document the normal computed tomographic tenography findings of digital flexor tendon sheath. Six ex vivo normal equine forelimbs were used. An axial approach was used to inject 185 mg/mL of iopamidol in a total volume of 60 mL into the digital flexor tendon sheaths. Single-slice helical scans, with 5 mm thickness, spaced every 3 mm, for a pitch of 0.6, and with bone algorithm reconstruction, were performed before and after injections of contrast medium. To obtain better image quality for multiplanar reconstruction and 3D reformatting, postprocessing retroreconstruction was performed to reduce the images to submillimetre thickness. Computed tomographic tenography of digital flexor tendon sheaths could visualize the following main tendon structures for every forelimb in contrast-enhanced images as low densities surrounded by high densities: superficial digital flexor tendon, deep digital flexor tendon, manica flexoria, mesotendons, and synovial recess. Results of this study suggest that computed tomographic tenography can be used with accuracy and sensitivity to evaluate the common disorders of the equine digital flexor tendon sheath and the intrathecal structures. PMID:26185709
Writing with Teachers: A Conversation with Peter Elbow.
ERIC Educational Resources Information Center
Bartholomae, David
Provides a complete text of David Bartholomae's speech on the debate with compositionist Peter Elbow regarding the pros and cons of teaching either academic discourse or personal writing modes to undergraduates. (HB)
Stainless-steel elbows formed by spin forging
NASA Technical Reports Server (NTRS)
Large seamless austenitic stainless steel elbows are fabricated by spin forging /rotary shear forming/. A specially designed spin forging tool for mounting on a hydrospin machine has been built for this purpose.
Elbow dislocation secondary to fall during police arrest.
Stevenson, R J; Clark, K; Kelliher, T
A case of total elbow dislocation with significant swelling and loss of distal pulses during police arrest is described. To date, this specific injury in relation to police arrest has not been described in the literature. Whilst attempting to remove the detainee from a public transport vehicle, the patient and the officers involved fell to the ground with his arm slightly flexed. He was handcuffed to the rear and taken to the police office. Whilst there, it was noted that his left elbow was swelling dramatically and he complained of pain. The detainee and officers attended the emergency room and he was found to have a total dislocation of the left elbow and vascular compromise of the limb. The elbow was promptly reduced with sedation and a post reduction angiogram demonstrated injury to the tissues surrounding the brachial artery. PMID:24485437
A review of epidemiology of paediatric elbow injuries in sports.
Magra, Merzesh; Caine, Dennis; Maffulli, Nicola
The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many
Assessment of Effective Ankle Joint Positioning in Strength Training for Intrinsic Foot Flexor Muscles: A Comparison of Intrinsic Foot Flexor Muscle Activity in a Position Intermediate to Plantar and Dorsiflexion with that in Maximum Plantar Flexion Using Needle Electromyography
Hashimoto, Takayuki; Sakuraba, Keishoku
[Purpose] The effectiveness of intrinsic foot flexor strength training performed in the plantar flexion position was examined using needle electromyography. [Subjects] The subjects of this study were 18 healthy men. [Methods] We used needle electromyography to measure the muscle activities of the flexor hallucis brevis (FHB), and the flexor digitorum brevis (FDB) in maximum plantar and an intermediate position. [Results] Significant increases in muscle activities were observed for both FHB and FDB, and the rates of increase from the intermediate position to the plantar flexion position were 43% for FHB and 46% for FDB. [Conclusion] This study demonstrated that it is possible to evaluate intrinsic foot flexors, in addition to the numerous reports on treatment methods focusing on extrinsic foot flexors. Furthermore, the results suggest that toe flexion exercises performed during plantar flexion of the ankle joint are an effective method for intrinsic foot flexor strength training. PMID:24707106
Triceps tendon avulsion and associated injuries of the elbow
Canbora, Kerem; Ozyurek, Selahattin; Gumussuyu, Gurkan; Kose, Ozkan
A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature. PMID:23667221
Capitellocondylar total elbow replacement in late-stage rheumatoid arthritis.
Ovesen, Janne; Olsen, Bo Sanderhoff; Johannsen, Hans Viggo; Søjbjerg, Jens Ole
Between 1994 and 2000, 51 capitellocondylar elbow replacements were inserted in 41 patients. All patients had late-stage rheumatoid arthritis. The mean age at operation was 56 years (range, 25-78 years). There were 12 men and 29 women. At follow-up, 6 patients had died of unrelated causes with the implant in situ and without radiographic loosening, and 1 patient was lost to follow-up. The remaining 43 elbows in 34 patients were followed up clinically and radiographically at a mean of 6.9 years (range, 26-119 months). Relief of pain was complete in 91% of the surviving elbows, and in 9%, there was only mild pain. Pain-free range of motion at follow-up was significantly improved. Flexion increased a mean of 43 degrees ; extension, 16 degrees ; supination, 24 degrees and pronation, 26 degrees . Of the elbows, 7 underwent revision, 3 because of deep infection, 1 for aseptic loosening, and 3 because of instability. Other complications included 2 maltracking elbows, 2 triceps tendon ruptures, 2 cases of operative olecranon bursitis, and 2 ulnar nerve palsies. One elbow showed radiolucent lines of more than 1 mm in the circumference of the ulnar component; none of the other elbows showed any signs of progressive radiographic loosening. At a mean follow-up of 6.9 years, a functional prosthesis was retained in 82.7% of the elbows, and the mean survival of the implant was 8.6 years (95% CI, 7.8-9.5 years). PMID:16015242
Successful closed suction drain management of a canine elbow hygroma.
Pavletic, M M; Brum, D E
A 1-year-old castrated male St. Bernard dog presented to Angell Animal Medical Center with bilateral elbow hygromas which had been present for several weeks. The largest hygroma involving the left elbow was managed with a closed suction (active) drain system to continuously collapse the hygroma pocket over a 3-week period. Soft bedding was used to protect the elbows from further impact trauma to the olecranon areas. Following drain removal, there was no evidence of hygroma recurrence based on periodic examinations over an 18-month period. The smaller non-operated right elbow hygroma had slightly enlarged during this period. Closed suction drain management of the hygroma proved to be a simple and economical method of collapsing the left elbow hygroma. This closed drainage system eliminated the need for the postoperative bandage care required with the use of the Penrose (passive) drain method of managing elbow hygromas. The external drain tube should be adequately secured in order to minimise the risk of its inadvertent displacement. PMID:25640711
Current Concepts in Examination and Treatment of Elbow Tendon Injury
Ellenbecker, Todd S.; Nirschl, Robert; Renstrom, Per
Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to optimally design treatment programs for rehabilitation and prevention. Evidence Acquisitions: The PubMed database was searched in January 2012 for English-language articles pertaining to elbow tendon injury. Results: Detailed information on tendon pathophysiology was found along with incidence of elbow injury in overhead athletes. Several evidence-based reviews were identified, providing a thorough review of the recommended rehabilitation for elbow tendon injury. Conclusions: Humeral epicondylitis is an extra-articular tendon injury that is common in athletes subjected to repetitive upper extremity loading. Research is limited on the identification of treatment modalities that can reduce pain and restore function to the elbow. Eccentric exercise has been studied in several investigations and, when coupled with a complete upper extremity strengthening program, can produce positive results in patients with elbow tendon injury. Further research is needed in high-level study to delineate optimal treatment methods. PMID:24427389
Pressure of Newtonian fluid flow through curved pipes and elbows
NASA Astrophysics Data System (ADS)
Zhang, Hao; Zhang, Xinxin; Sun, Haosen; Chen, Mingjiu; Lu, Xiaoyang; Wang, Yuancheng; Liu, Xueting
Under conditions of high temperature and high pressure, the non-uniformity of pressure loads has intensified the stress concentration which impacts the safety of curved pipes and elbows. This paper focuses on the pressure distribution and flow characteristic in a curved 90° bend pipe with circular cross-sections, which are widely used in industrial applications. These flow and pressure characteristics in curved bend pipes have been researched by employing numerical simulation and theoretical analysis. Based on the dimensionless analysis method a formula for the pressure of Newtonian fluid flow through the elbow pipes is deduced. Also the pressure distributions of several elbows with different curvature ratio R/D are obtained by numerical methods. The influence of these non-dimensional parameters such as non-dimensional curvature ratio, Reynolds number and non-dimensional axial angle α and circumferential angle β on the pressure distribution in elbow pipes is discussed in detail. A number of important results have been achieved. This paper provides theoretical and numerical methods to understand the mechanical property of fluid flow in elbow pipes, to analyze the stress and to design the wall thickness of elbow pipes.
Impingement of Droplets in 90 deg Elbows with Potential Flow
NASA Technical Reports Server (NTRS)
Hacker, Paul T.; Brun, Rinaldo J.; Boyd, Bemrose
Trajectories were determined for droplets in air flowing through 90 deg elbows especially designed for two-dimensional potential motion with low pressure losses. The elbows were established by selecting as walls of each elbow two streamlines of the flow field produced by a complex potential function that establishes a two-dimensional flow around a 90 deg bend. An unlimited number of elbows with slightly different shapes can be established by selecting different pairs of streamlines as walls. The elbows produced by the complex potential function selected are suitable for use in aircraft air-intake ducts. The droplet impingement data derived from the trajectories are presented along with equations in such a manner that the collection efficiency, the area, the rate, and the distribution of droplet impingement can be determined for any elbow defined by any pair of streamlines within a portion of the flow field established by the complex potential function. Coordinates for some typical streamlines of the flow field and velocity components for several points along these streamlines are presented in tabular form.
Accuracy of patient-reported range of elbow motion
Robinson, Paul M; van Rensburg, Lee
Background Patient-reported outcome meaures (PROMs) not only provide valuable insights into subjective indices of joint health, but also may provide limited objective information about range of motion (ROM). We sought to evaluate the accuracy of patient-reported range of elbow motion compared to measured ROM. Methods Sixty clinic patients were recruited, of whom 26 had elbow pathologies and 34 had pathologies other than at the elbow joint. Each patient independently estimated ROM for extension, flexion, pronation and supination before this was measured by a clinician using a universal goniometer, with the mean being the gold standard. Results We found that patients' ROM estimates were significantly different from measured ROM (p < 0.00001 at 95% confidence interval). There was no statistically significant difference between elbow pathology and non-elbow pathology patients' estimated ROM. Conclusions There was great disparity between patient-estimated and measured ROM, although estimates of patients with known elbow pathology did not demonstrate any significant difference from their healthy counterparts. These differences may be too great for patient-estimated range of motion to be used as a reliable tool for assessing outcomes.
An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad.
Hamada, Daisuke; Matsuura, Tetsuya; Sugiura, Kosuke; Higuchi, Tadahiro; Suzue, Naoto; Goto, Tomohiro; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Sairyo, Koichi
We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a "catching" sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. PMID:26613057
An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad
Hamada, Daisuke; Matsuura, Tetsuya; Sugiura, Kosuke; Higuchi, Tadahiro; Suzue, Naoto; Goto, Tomohiro; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Sairyo, Koichi
We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a "catching" sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. PMID:26613057
The Effects of Racket Inertia Tensor on Elbow Loadings and Racket Behavior for Central and Eccentric Impacts
Nesbit, Steven M.; Elzinga, Michael; Herchenroder, Catherine; Serrano, Monika
This paper discusses the inertia tensors of tennis rackets and their influence on the elbow swing torques in a forehand motion, the loadings transmitted to the elbow from central and eccentric impacts, and the racket acceleration responses from central and eccentric impacts. Inertia tensors of various rackets with similar mass and mass center location were determined by an inertia pendulum and were found to vary considerably in all three orthogonal directions. Tennis swing mechanics and impact analyses were performed using a computer model comprised of a full-body model of a human, a parametric model of the racket, and an impact function. The swing mechanics analysis of a forehand motion determined that inertia values had a moderate linear effect on the pronation-supination elbow torques required to twist the racket, and a minor effect on the flexion-extension and valgus-varus torques. The impact analysis found that mass center inertia values had a considerable effect on the transmitted torques for both longitudinal and latitudinal eccentric impacts and significantly affected all elbow torque components. Racket acceleration responses to central and eccentric impacts were measured experimentally and found to be notably sensitive to impact location and mass center inertia values. Key Points Tennis biomechanics. Racket inertia tensor. Impact analysis. Full-body computer model. PMID:24260004
A cross-sectional study of the plantar flexor muscle and tendon during growth.
Kubo, K; Teshima, T; Hirose, N; Tsunoda, N
The purpose of this study was to investigate growth changes in human plantar flexor muscle and tendons. In addition, we ascertained whether growth changes in muscle and tendon were more closely related to skeletal age than chronological age. 22 elementary school children (ESC), 19 junior high school students (JHS), and 23 young adults (ADT) men participated in this study. Maximal strain and hysteresis of tendon structures and cross-sectional area of Achilles tendon were measured using ultrasonography. In addition, skeletal age was assessed using Tanner-Whitehouse III method. Maximal strain of ESC was significantly greater than that of other groups, while no significant difference was observed between JHS and ADT. There was no difference in hysteresis among 3 groups. Relative cross-sectional area (to body mass(2/3)) of ADT was significantly smaller than that of other groups. For ESC and JHS, measured variables of muscle and tendon were significantly correlated to both chronological and skeletal ages. These results suggested that immature musculoskeletal system was protected by more extensible and larger tendon structures in ESC and only by larger tendon structures in JHS, respectively. Furthermore, there were no differences in correlation coefficient values between measured variables of muscle and tendon and chronological or skeletal ages. PMID:24577863
Total elbow arthroplasty in patients who have juvenile rheumatoid arthritis.
Connor, P M; Morrey, B F
Patients who have juvenile rheumatoid arthritis often are seen at a very young age because of severe stiffness and pain in several joints. While total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft tissues and the extremely small bones and intramedullary cavities in these patients. As there is little information in the literature regarding this procedure, we attempted to learn about the long-term results by evaluating nineteen patients (twenty-four elbows) with juvenile rheumatoid arthritis who had been managed with total elbow arthroplasty. At an average of 7.4 years (range, two to fourteen years) after the operation, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 points (range, 55 to 100 points). Twenty-two (96 per cent) of the twenty-three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average arc of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperative arc of flexion began at 35 degrees, with additional flexion to 125 degrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average arc of 73 degrees after the operation, and evaluation of the twenty ipsilateral wrists that were not limited by disease revealed that pronation and supination had been maintained. The average functional score improved from 9 points (range, 0 to 25 points) preoperatively to 23 points (range, 15 to 25 points) postoperatively (p < 0.001). The function of eighteen elbows (78 per cent) did not adversely affect the ability to perform activities of daily living. There were thirteen complications, including one perioperative death, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a
Influence of Combinations of Shoulder, Elbow and Trunk Orientation on Elbow Joint Loads in Youth Baseball Pitchers
Tanaka, Hiroshi; Hayashi, Toyohiko; Inui, Hiroaki; Ninomiya, Hiroki; Muto, Tomoyuki; Nobuhara, Katsuya
Objectives: Shoulder and elbow pain in youth baseball pitchers is a well-recognized phenomenon. Common problems in pitching mechanics that can lead to injury begin with stride foot contact. The purpose of this study was to address the relationships between the combinations of shoulder, elbow and trunk orientation at the instant of stride foot contact and elbow joint loads in youth baseball pitchers. Methods: A total of 143 Japanese male youth baseball pitchers participated in this study after providing written informed consents approved by the hospital's institutional review board. The procedures to be performed were also explained to their parent(s) or legal guardian(s). Each participant was not currently injured or recovering from an injury at time of testing. For data collection of baseball pitching, a set of 14-mm spherical reflective markers was placed on the skin overlying 34 anatomical landmarks determined. Subsequently, a motion capture three-dimensional automatic digitizing system was used to collect 500-Hz from 7 charge-coupled-device synchronized cameras was set up around the regulation pitching mound in an indoor laboratory. After performing a preparation routine of stretching and warm-up pitching, each player pitch to 5 fastball pitches off the pitching mound to a catcher at the regulation distance of 16 m for youth pitchers. The best pitch thrown for a strike was chosen for kinematic and kinetic analysis. The local coordinate systems were used to calculate 3-dimesional rotation at the trunk, shoulder and elbow using the typical Eulerian sequence. Afterward, the standard inverse dynamic equation was used to estimate resultant joint forces and torques at throwing shoulder and elbow. In order to normalize data between subjects, forces and torques were expressed as percent using body weight and height. A multiple regression analysis was carried out to assess the combined effects of shoulder (external rotation, abduction and horizontal adduction), elbow
Results of reconstruction for failed total elbow arthroplasty.
Figgie, M P; Inglis, A E; Mow, C S; Wolfe, S W; Sculco, T P; Figgie, H E
Failure of total elbow arthroplasty leads to difficult and complicated surgical reconstruction. This study evaluates the results of reconstruction after implant removal with respect to pain, motion, and functional ability. Between 1978 and 1985, 11 patients required implant removal. Indications for removal were infection for seven, implant fracture for three, and recurrent dislocation for one. The original diagnosis was rheumatoid arthritis in six elbows and traumatic arthritis in five. The average length of the follow-up period was 5.5 years after implant removal (minimum, two years). Treatment consisted of implant removal and soft-tissue arthroplasty combined with external fixation in ten patients, and attempted arthrodesis with external fixation in one. There were four good, one fair, two poor, and four failed results. Satisfactory results were obtained in seven of the eight elbows in which an anatomic arthroplasty was achieved. This consisted of containment of the ulna by the humeral epicondylar remnants. All eight elbows were pain-free with an average arc of motion of 85 degrees (range, 55 degrees to 120 degrees). They had excellent elbow flexion power; however, triceps strength was often compromised. In the three elbows in which anatomic arthroplasty could not be achieved, one was flail, one was later converted to an arthrodesis with a customized plate, and the third required an immediate arthrodesis. All three were rated as failures. Fractures occurred in five of the 11 elbows. One occurred preoperatively, three occurred intraoperatively, and one occurred postoperatively. All healed satisfactorily during the course of immobilization. The importance of an anatomic arthroplasty when removing a total arthroplasty cannot be overemphasized. Retaining the epicondylar segments is important because satisfactory results were obtained in patients in whom entrapment of the olecranon within the epicondylar ridges was obtained. Such patients can achieve a satisfactory
Prevention of Elbow Injuries in Youth Baseball Pitchers
Fleisig, Glenn S.; Andrews, James R.
Context: Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers. Evidence Acquisition: PubMed was searched for epidemiologic, biomechanical, and clinical studies of elbow injuries in baseball (keywords: "youth OR adolescent" AND baseball AND pitching AND "ulnar collateral ligament OR elbow"; published January 2000 – April 2012). Studies with relevance to youth baseball pitchers were reviewed. Relevant references from these articles were also retrieved and reviewed. Original data, insight, and recommendations were added. Results: The majority of baseball elbow injuries are noncontact injuries to the dominant arm resulting from repetitive pitching. Five percent of youth pitchers suffer a serious elbow or shoulder injury (requiring surgery or retirement from baseball) within 10 years. The risk factor with the strongest correlation to injury is amount of pitching. Specifically, increased pitches per game, innings pitched per season, and months pitched per year are all associated with increased risk of elbow injury. Pitching while fatigued and pitching for concurrent teams are also associated with increased risk. Pitchers who also play catcher have an increased injury risk, perhaps due to the quantity of throws playing catcher adds to the athlete's arm. Another risk factor is poor pitching biomechanics. Improper biomechanics may increase the torque and force produced about the elbow during each pitch. Although throwing breaking pitches at a young age has been suggested as a risk factor, existing clinical, epidemiologic, and biomechanical data do not support this claim. Conclusions: Some elbow injuries to youth baseball pitchers can be prevented with safety rules, recommendations, education, and common sense. Scientific and medical organizations have published safety rules and recommendations, with emphasis on prevention of overuse and pitching while fatigued. Strength
Impact of Ulnar Collateral Ligament Tear on Posteromedial Elbow Biomechanics.
Anand, Prashanth; Parks, Brent G; Hassan, Sheref E; Osbahr, Daryl C
Ulnar collateral ligament insufficiency has been shown to result in changes in contact pressure and contact area in the posteromedial elbow. This study used new digital technology to assess the effect of a complete ulnar collateral ligament tear on ulnohumeral contact area, contact pressure, and valgus laxity throughout the throwing motion. Nine elbow cadaveric specimens were tested at 90° and 30° of elbow flexion to simulate the late cocking/early acceleration and deceleration phases of throwing, respectively. A digital sensor was placed in the posteromedial elbow. Each specimen was tested with valgus torque of 2.5 Nm with the anterior band of the ulnar collateral ligament intact and transected. A camera-based motion analysis system was used to measure valgus inclination of the forearm with the applied torque. At 90° of elbow flexion, mean contact area decreased significantly (107.9 mm(2) intact vs 84.9 mm(2) transected, P=.05) and average maximum contact pressure increased significantly (457.6 kPa intact vs 548.6 kPa transected, P<.001). At 30° of elbow flexion, mean contact area decreased significantly (83.9 mm(2) intact vs 65.8 mm(2) transected, P=.01) and average maximum contact pressure increased nonsignificantly (365.9 kPa intact vs 450.7 kPa transected, P=.08). Valgus laxity increased significantly at elbow flexion of 90° (1.1° intact vs 3.3° transected, P=.01) and 30° (1.0° intact vs 1.7° transected, P=.05). Ulnar collateral ligament insufficiency was associated with significant changes in contact area, contact pressure, and valgus laxity during both relative flexion (late cocking/early acceleration phase) and relative extension (deceleration phase) moments during the throwing motion arc. PMID:26186314
Finite element modelling of plantar pressure beneath the second ray with flexor muscle loading.
Lemmon, DR; Cavanagh, PR
INTRODUCTION:: Little is understood about the effects of flexor loading on plantar pressure distribution. The goal of the current work is to model flexor muscle loading applied to the distal phalanges in order to study the effect of these loads on plantar normal stress (pressure) beneath the metatarsal head. METHODS:: The finite element model is a two-dimensional, plane strain sagittal section incorporating the second metatarsal, proximal phalanx, and plantar and dorsal soft tissue (Figure 1). The metatarsophalangeal joint is simulated by a nodal hinge that transfers loads and produces reasonable kinematic motion between the articular surfaces of the proximal[Figure: see text] phalanx and metatarsal head. Soft tissues are simulated by a uniform continuum. A single flexor tendon passes over the condyle of the metatarsal heads with sliding contact against intervening soft tissue, and is attached to the distal end of the proximal phalanx. A rigid element at the proximal end is fixed by boundary conditions to simulate reactions at the distal cuneiform joint. Material properties of bone are from published values, one tenth the stiffness of bone is used for the flexor tendon, and the soft tissue continuum is hyperelastic using coefficients obtained from compression of the heel plantar fat pad. A 188 N vertical ground reaction force and a flexor tendon load at a 10 degree angle from the X (horizontal) axis are applied to the model. RESULTS:: Figure 2 shows Y direction normal stress distribution along the plantar surface for two load cases: no load and a 250 N load to the flexor tendon. DISCUSSION:: Bending moments at the proximal metatarsal correspond to values obtained by Sharkey et al. Tension in the flexor tendon served to counter the moment in the metatarsal created by the vertical load, and at the same time, to apply an additional axial load. Under flexor loading, focal plantar pressure shifts toward the proximal phalanx and yields a 60% reduction in peak pressure
Isokinetic dynamometry of the knee extensors and flexors in Iranian healthy males and females
Rezaei, Mandana; Ebrahimi, Ismael; Vassaghi- Gharamaleki, Behnoush; Pirali, Milad; Mortaza, Niyousha; Malmir, Kazem; Ghasemi, Kobra; A. Jamshidi, Ali
Background: This paper explores the gender-related bilateral differences of extensor and flexor torques of the knee joint at low and high angular velocities in Iranian healthy males and females. Methods: 70 healthy subjects (29 males (26.61±4.34 yrs and 41 females with average age of 23.07±3.70 yrs)) were participated in this study. Isokinetic peak torque values for knee extensors and flexors in concentric and eccentric contraction modes were measured and flexors and extensors strength ratios (HQR) computed among both dominant and non-dominant legs in lying position at 60 and 180°.s-1angular velocities. Results: There was significant gender-velocity interactions detected for knee flexor to extensor strength ratios presenting that increasing velocity escaled this, ratios in females more than males (p<0.05). There was no gender- velocity-leg side interaction (p>0.05). Bilateral differences were found for eccentric flexor peak torques (p<0.05). By increasing velocity, peak torque values decreased and HQR was increased (p<0.05). Conclusion: Measurement procedures including test position is an important factor when interpreting genderrelated and bilateral differences of isokinetic knee strength ratios in healthy individuals. PMID:25664309
The biomechanics of tennis elbow. An integrated approach.
Roetert, E P; Brody, H; Dillman, C J; Groppel, J L; Schultheis, J M
Tennis elbow afflicts 40% to 50% of the average, recreational tennis players; most of these players more than 30 years of age. Tennis elbow is thought to be the result of microtrauma, the overuse and inflammation at the origin of the ECRB as a result of repeated large impact forces created when the ball hits the racket in the backhand stroke. Several authors have found that EMG activity in the ECRB, the muscle and tendon complex afflicted in tennis elbow, is high during the acceleration and early follow-through phases of the groundstrokes and during the cocking phase of the serve. Unfortunately, none of the authors gave evidence to support the claim that muscle activity in the ECRB at ball contact is high. In the one-handed backhand, the torques at impact (17-24 nm) will be absorbed by the tendons of the elbow. Giangarra and his colleagues observed that the two-handed backhand "allows the forces at ball impact to be transmitted through the elbow rather than absorbed by the tissues at the elbow." Other authors have reported that players using a two-handed backhand will rarely develop lateral epicondylitis, because the helping arm appears to absorb more energy and changes the mechanics of the swing. As seen by Morris and colleagues, Giangarra and associates, and Leach and colleagues, players who utilize the two-handed backhand have a very low incidence of tennis elbow. These three studies conclude that the two-handed backhand stroke is probably the most effective backhand stroke to prevent lateral tennis elbow. Studies show that wrist extensors are highly involved in all strokes (serve, forehand, and both one- and two-handed backhand strokes). This relatively high involvement (40%-70% MVC) throughout play may result in overload of this muscular group. Thus, tennis elbow may be caused simply by continued use of this muscular system in all strokes, and not just because of the high forces absorbed at impact. Another theory concerning impact states that if the extensor
Computational Fluid Dynamic simulations of pipe elbow flow.
Homicz, Gregory Francis
One problem facing today's nuclear power industry is flow-accelerated corrosion and erosion in pipe elbows. The Korean Atomic Energy Research Institute (KAERI) is performing experiments in their Flow-Accelerated Corrosion (FAC) test loop to better characterize these phenomena, and develop advanced sensor technologies for the condition monitoring of critical elbows on a continuous basis. In parallel with these experiments, Sandia National Laboratories is performing Computational Fluid Dynamic (CFD) simulations of the flow in one elbow of the FAC test loop. The simulations are being performed using the FLUENT commercial software developed and marketed by Fluent, Inc. The model geometry and mesh were created using the GAMBIT software, also from Fluent, Inc. This report documents the results of the simulations that have been made to date; baseline results employing the RNG k-e turbulence model are presented. The predicted value for the diametrical pressure coefficient is in reasonably good agreement with published correlations. Plots of the velocities, pressure field, wall shear stress, and turbulent kinetic energy adjacent to the wall are shown within the elbow section. Somewhat to our surprise, these indicate that the maximum values of both wall shear stress and turbulent kinetic energy occur near the elbow entrance, on the inner radius of the bend. Additional simulations were performed for the same conditions, but with the RNG k-e model replaced by either the standard k-{var_epsilon}, or the realizable k-{var_epsilon} turbulence model. The predictions using the standard k-{var_epsilon} model are quite similar to those obtained in the baseline simulation. However, with the realizable k-{var_epsilon} model, more significant differences are evident. The maximums in both wall shear stress and turbulent kinetic energy now appear on the outer radius, near the elbow exit, and are {approx}11% and 14% greater, respectively, than those predicted in the baseline calculation
Bone marrow injection: A novel treatment for tennis elbow
Singh, Ajit; Gangwar, Devendra Singh; Singh, Shekhar
Objective: The objective of this prospective study was assessment of efficacy of bone marrow aspirate (BMA) (containing plasma rich in growth factors and mesenchymal stem cells) injection in treatment of tennis elbow. Materials and Methods: A total of 30 adult patients of previously untreated tennis elbow were administered single injection of BMA. This concentrate was made by centrifugation of iliac BMA at 2000 rpm for 20-30 min and only upper layer containing platelet rich plasma and mononuclear cells was injected. Assessment was performed at baseline, 2 weeks, 6 weeks and 12 weeks using Patient-rated Tennis Elbow Evaluation (PRTEE) score. Results: Baseline pre-injection mean PRTEE score was 72.8 ± 6.97 which decreased to a mean PRTEE score of 40.93 ± 5.94 after 2 weeks of injection which was highly significant (P < 0.0001). The mean PRTEE score at 6 week and 12 week follow-up was 24.46 ± 4.58 and 14.86 ± 3.48 respectively showing a highly significant decrease from baseline scores (P < 0.0001). Conclusion: Treatment of tennis elbow patients with single injection of BMA showed a significant improvement in short to medium term follow-up. In future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken. PMID:25097421
On the phenomenology of the perforating vein of the elbow.
Lomonte, Carlo; Basile, Carlo
The perforating veins, as the name suggests, are the veins that perforate the muscular aponeuroses ensuring communication between the superficial and the deep veins. Located at the bend of the elbow, almost constantly, there is a vein, named perforating vein of the elbow, which is of great interest to the nephrologist who is responsible for the management of vascular access for hemodialysis (HD). It represents, in fact, because of its intrinsic characteristics and topographical reasons, a valuable resource for the creation of a vascular access for HD, especially in obese patients, elderly patients, diabetics, and patients affected by peripheral vasculopathy. Arterio-venous fistulae (AVF) constructed with the perforating vein of the elbow are relatively easy to perform, have an excellent patency rate, a low incidence of early thrombosis, adequate flows, and a low incidence of the steal syndrome. In other types of AVFs, the perforating vein of the elbow subtracts flow to the superficial veins slowing or preventing their full maturation, and can become a problem in measuring the blood flow of the AVF. But still, its presence can maintain patent a fistula in case of poor compliance of the superficial veins, while awaiting for interventional procedures able to accelerate a subsequent maturation. This review intends to explore the role that the perforating vein of the elbow plays in the physiology and pathology of the AVF, in relation to the issues that most frequently occur in clinical practice. PMID:19573011
Visualization of 3D elbow kinematics using reconstructed bony surfaces
NASA Astrophysics Data System (ADS)
Lalone, Emily A.; McDonald, Colin P.; Ferreira, Louis M.; Peters, Terry M.; King, Graham J. W.; Johnson, James A.
An approach for direct visualization of continuous three-dimensional elbow kinematics using reconstructed surfaces has been developed. Simulation of valgus motion was achieved in five cadaveric specimens using an upper arm simulator. Direct visualization of the motion of the ulna and humerus at the ulnohumeral joint was obtained using a contact based registration technique. Employing fiducial markers, the rendered humerus and ulna were positioned according to the simulated motion. The specific aim of this study was to investigate the effect of radial head arthroplasty on restoring elbow joint stability after radial head excision. The position of the ulna and humerus was visualized for the intact elbow and following radial head excision and replacement. Visualization of the registered humerus/ulna indicated an increase in valgus angulation of the ulna with respect to the humerus after radial head excision. This increase in valgus angulation was restored to that of an elbow with a native radial head following radial head arthroplasty. These findings were consistent with previous studies investigating elbow joint stability following radial head excision and arthroplasty. The current technique was able to visualize a change in ulnar position in a single DoF. Using this approach, the coupled motion of ulna undergoing motion in all 6 degrees-of-freedom can also be visualized.
Open Versus Arthroscopic Tennis Elbow Release
Leiter, Jeff; Clark, Tod; McRae, Sheila; Dubberley, James; MacDonald, Peter B.
Objectives: The primary objective of this study was to determine if quality of life and function are different following arthroscopic versus open tennis elbow release surgery. Based on retrospective studies, both approaches have been found to be beneficial, but no prospective randomized comparison has been conducted to date. Methods: Following a minimum six-months of conservative treatment, seventy-one patients (>16 yrs old) were randomized intraoperatively to undergo either arthroscopic or open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength. Study assessments took place pre-, and 6-week, 3-, 6-, and 12-months post-surgery. Comparisons between groups and within groups over time were conducted using repeated measures ANOVA. A minimal clinically significant difference for the DASH had been previously identified as 15 points, and was used to compare groups as well at 12-months post-operative (Beaton et al. 2001). Results: Fifteen women and 19 men underwent the open procedure with a mean age of 47.1 years (6.7) and 13 women and 21 men were in the arthroscopic group with a mean age of 45.0 (6.9). No pre-surgery differences were found between groups based on age, sex, DASH or VAS scores. Both groups demonstrated a significant improvement in subjective measures and grip strength by 12-months post-surgery, and no significant differences were found between groups at any time point. The DASH, our primary outcome, decreased from a mean (SD) of 47.5 (14.5) pre-surgery to 21.9 (21.8) at 12-months post-surgery in the Open group and from 52.7 (16.0) to 22.6 (21.1) in the Arthroscopic group. VAS-pain scores (%) decreased in the Open group from 62.5 (17.2) pre-operatively to 30.0 (26.5) at 12-months. In the arthroscopic group, scores decreased from 63.7 (15.9) to 26.2 (24.6). Grip strength (kg) increased on the affected side from 23.6 (14.9) to 29.3 (16.3) and 21.4 (15.4) to
78 FR 68907 - Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire... Forearm Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER INFORMATION... Control No. 2900-NEW (Elbow and Forearm Conditions Disability Benefits Questionnaire)''....
78 FR 36308 - Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...
Federal Register 2010, 2011, 2012, 2013, 2014
... AFFAIRS Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire... Disability Benefits Questionnaire)'' in any correspondence. During the comment period, comments may be viewed.... SUPPLEMENTARY INFORMATION: Title: Elbow and Forearm Conditions Disability Benefits Questionnaire, VA Form...
Romantic Resonances in the Rhetoric of Peter Elbow's "Writing Without Teachers."
ERIC Educational Resources Information Center
Yager, Kristi
Seeks to uncover the historical roots within English Romanticism of Peter Elbow's thinking in order to show the depth and complexity of his assumptions about writing. Implicitly refutes charges questioning the intellectual credibility of Elbow's work. (TB)
Modified flexor digitorum superficialis slip technique for A4 pulley reconstruction.
Odobescu, A; Radu, A; Brutus, J-P; Gilardino, M S
We describe a variation in the A4 pulley reconstruction technique using one slip of the flexor digitorum superficialis insertion and report the results of a biomechanical analysis of this reconstruction in cadavers. While conserving the distal bony insertion, one slip of flexor digitorum superficialis is transferred over the flexor digitorum profundus tendon and sutured to the contralateral superficialis slip insertion. This creates a new pulley at the base of the original A4 pulley that can be adjusted to accommodate an FDP repair of increased bulk. We found a 57% reduction in excess excursion due to bowstringing when compared with no repair. Furthermore the repairs were sturdy, 94% of specimens maintaining their integrity when a proximally directed force of 50 N was applied. PMID:20427405
End effects on elbows subjected to moment loadings. [PWR; BWR
Rodabaugh, E.C.; Moore, S.E.
So-called end effects for moment loadings on short-radius and long-radius butt welding elbows of various arc lengths are investigated with a view toward providing more accurate design formulas for critical piping systems. Data developed in this study, along with published information, were used to develop relatively simple design equations for elbows attached at both ends to long sections of straight pipe. These formulas are the basis for an alternate ASME Code procedure for evaluating the bending moment stresses in Class 1 nuclear piping (ASME Code Case N-319). The more complicated problems of elbows with other end conditions, e.g., flanges at one or both ends, are also considered. Comparisons of recently published experimental and theoretical studies with current industrial code design rules for these situations indicate that these rules also need to be improved.
Common medial elbow injuries in the adolescent athlete.
Leahy, Ian; Schorpion, Melissa; Ganley, Theodore
Recently there has been increased year-round sports participation among children and adolescents with limited to no rest periods. This has led to increases in pediatric repetitive stress injuries, once considered a rarity. Whether in the throwing athlete or in the athlete that experiences repetitive axial loading; increased medial tension and overload syndromes can lead to stress reactions and fractures. This occurs in the developing athlete due to the bone being weaker than the surrounding tendons and ligaments. The medial elbow is a high stress area and is susceptible to many conditions including apophysitis , avulsion fractures and ulnar collateral ligament disruption. Valgus stress can cause injury to the medial elbow which can lead to increased lateral compression, Panner's disease and osteochondral lesions of the capitellum and olecranon. The purpose of this manuscript is to review common elbow disorders in the adolescent population, outline management and highlight important features of rehabilitation. PMID:25840494
The triceps-preserving approach for semiconstrained total elbow arthroplasty.
Prokopis, Peter M; Weiland, Andrew J
Total elbow arthroplasty (TEA) is a useful tool to relieve pain and provide return to function for many conditions affecting the elbow. For conditions ranging from inflammatory arthropathies to comminuted intra-articular distal humeral fractures in the elderly, TEA is an excellent treatment alternative. Numerous surgical approaches for TEA have been described. Most surgeons use either a direct posterior or posterior-lateral incision. TEA is not without its complications. One such complication is insufficiency of the triceps. Many surgical approaches have been described to try to decrease the possibility of triceps insufficiency. In this article, we describe a new technique not previously described in which, using a posterior incision, the triceps is only dissected from the medial side. With this technique, the tendon insertion on the olecranon, as well as the entire lateral soft-tissue envelope of the elbow, is left undisturbed. PMID:18359644
A Rare Presentation of Ganglion Cyst of the Elbow
Vaishya, Raju; Kapoor, Chirag; Vijay, Vipul
INTRODUCTION: Ganglion cysts are benign soft tissue swellings commonly found in the wrist. The presence of these cysts in the elbow is uncommon, and few case reports have been reported for this condition at this location. These lesions can compress on the neighbouring structures or cause restriction of the joint movement. The awareness of this entity is a must, to arrive at an early diagnosis. MATERIALS AND METHOD: We report a patient with swelling in the anterolateral aspect of the elbow which had been causing intermittent pain for the last 13 months. The MRI revealed a fluid-filled cystic swelling which was communicating with the radio-capitellar joint. RESULTS: The lesion was excised in toto, using anterolateral approach for the elbow, and sent for histopathological examination which confirmed the diagnosis of a ganglion cyst. CONCLUSION: Thus, due to the infrequent presentation, an awareness of this condition is necessary to prevent a delay in diagnosis and its subsequent management. PMID:27493847
Hallux checkrein deformity resulting from the scarring of long flexor muscle belly - case report.
Boszczyk, Andrzej; Zakrzewski, Piotr; Pomianowski, Stanisław
A case of posttraumatic checkrein deformity of the hallux is presented. This deformity is most often caused by scarring of the muscle belly or tethering of the tendon. A 22-year old woman developed a hallux checkrein deformity after a bimaleolar fracture. Intraoperatively, a linear scar tethering the muscle belly to the posterior tibia was observed. Resection of the scar allowed for full flexor hallucis longus mobility. Full hallux range of motion as well as foot function was restored. The cause of the checkrein deformity in our patient was a scar tethering the flexor hallucis belly to the posterior tibia. PMID:25759157
Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome.
Winkes, Michiel B; Teijink, Joep A; Scheltinga, Marc R
We discuss a case of a 26-year-old man, a motorcycle racer, who presented with progressive pain, weakness and swelling of his right forearm and loss of power in his index finger, experienced during motor racing. Chronic exertional compartment syndrome (CECS) of both flexor and extensor compartments of his forearm was diagnosed by dynamic intracompartmental muscle pressure measurements. After fasciotomies, all symptoms were resolved and the patient was able to improve on his preinjury racing skills, without any limitations. A literature review and a surgical 'how-to' for correct release of the extensor and deep flexor compartments of the forearm are provided. PMID:27080851
21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...
21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...
21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...
21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...
21 CFR 888.3160 - Elbow joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Elbow joint metal/polymer semi-constrained... Elbow joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An elbow joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...
[The supinator fat pad in fractures of the elbow joint].
Schunk, K; Grossholz, M; Schild, H
The position of the supinator fat pad is regarded as a valuable sign in fractures of the elbow. In our patients the pad was visible in 277 out of 337 cases (82%). The sign was positive in only 27 out of 55 proximal fractures of the radius (sensitivity 0.49). There was no correlation between the severity of the fracture and the sign. There was marked variation in the distance between the pad and the radius, depending on age, build and projection. Our results indicate that the sign is not suitable for the diagnosis of fracture of the elbow. PMID:2538879
Assessment of tennis elbow using the Marcy Wedge-Pro.
Smith, R W; Mani, R; Cawley, M I; Englisch, W; Eckenberger, P
The Marcy Wedge-Pro (MWP), a device used in training by tennis players, was employed in the assessment of tennis elbow. The MWP was used to measure the ability of patients to perform wrist extension exercises, since pain resulting from this specific activity is a prominent symptom of the condition. The MWP results were compared with clinical measures and found to identify accurately patients who responded to treatment (P < 0.05). This study illustrates the potential of the MWP to assess tennis elbow quantitatively. Images Figure 1 PMID:8130959
Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow.
Jones, G S; Savoie, F H
Twelve patients with flexion contractures of the elbow were managed by arthroscopic release of the proximal capsule and debridement of the olecranon fossa. Postoperatively the mean flexion contracture improved from 38 to 3 degrees with supination improving from 45 to 84 degrees and pronation improving from 80 to 88 degrees. All patients reported a decrease in pain level as well as improvement in motion. There was one severe complication in this series, in which a patient sustained a permanent posterior interosseous nerve palsy. Arthroscopic limited capsular release appears to be satisfactory management modality for flexion contracture of the elbow. PMID:8323612
The variable clinical manifestations of ulnar neuropathies at the elbow.
Stewart, J D
In twenty-five cases of ulnar neuropathy at the elbow, the involvement of the fibres from three sensory and to four motor branches were examined clinically and, where possible, electrophysiologically. Of the sensory fibres, those from the terminal digital nerves were most commonly involved. The fibres to the hand muscles were much more frequently involved than those to the forearm muscles. These findings suggest that in ulnar neuropathies at the elbow there is variable damage to the fascicles within the nerve. PMID:3031220
Shoulder and elbow injuries in the adolescent athlete.
Krabak, Brian J; Alexander, Eric; Henning, Troy
The shoulder and elbow represent two of the most commonly injured joints in the adolescent population. Specific injuries vary by sport and can involve various structures, depending on the mechanism of injury. Unlike the adult shoulder, the immature skeletal structure of the adolescent athlete can lead to several unique injuries. By understanding the special demands placed on the immature shoulder, the sports physician can more effectively treat the resultant injury. This article reviews the diagnosis and management of unique injuries to the shoulder and elbow in the adolescent athlete. PMID:18395648
Debridement arthroplasty for advanced primary osteoarthritis of the elbow. Results of a new technique used for 29 elbows.
Tsuge, K; Mizuseki, T
We report the technique and results of a new method of debridement arthroplasty for advanced primary osteoarthritis of the elbow. Triceps and the periosteum of the olecranon are reflected towards the ulnar side and the joint is opened by dividing the radial collateral ligament. Osteophytes are removed, the olecranon and coronoid fossae are deepened and the fibrosed anterior joint capsule is excised. The degenerative changes are always more advanced on the radial side, with erosion of the capitellum, and it is usually necessary to remodel the head of the radius. In 29 elbows reviewed at a mean of 64 months, the average gain of range of motion was 34 degrees, with good pain relief and improved grip in most patients. Two elbows required reoperation but there were no other serious complications. PMID:8027156
Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors
Background A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature. Methods Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program. Results An median increase of 0.07 (Range [−0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support. Conclusions For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance. PMID
Analysis of the gliding pattern of the canine flexor digitorum profundus tendon through the A2 pulley.
Uchiyama, Shigeharu; Amadio, Peter C; Berglund, Lawrence J; An, Kai-Nan
Friction between a tendon and its pulley was first quantified using the concept of the arc of contact. Studies of human tendons conformed closely to a theoretical nylon cable/nylon rod model. However, we observed differences in measured friction that depended on the direction of motion in the canine model. We hypothesized that fibrocartilaginous nodules in the tendon affected the measurements and attempted to develop a theoretical model to explain the observations we made. Two force transducers were connected to each end of the canine flexor digitorum profundus tendon and the forces were recorded when it was moved through the A2 pulley toward a direction of flexion by an actuator and then reversed a direction toward extension. The changes of a force as a function of tendon excursion were evaluated in 20 canine paws. A bead cable/rod model was developed to simulate the canine tendon-pulley complex. To interpret the results, a free-body diagram was developed. The two prominent fibrocartilaginous nodules in the tendon were found to be responsible for deviation from a theoretical nylon cable gliding around the rod model, in a fashion analogous to the effect of the patella on the quadriceps mechanism. A bead cable/rod model qualitatively reproduced the findings observed in the canine tendon-pulley complex. Frictional coefficient of the canine flexor tendon-pulley was 0.016+/-0.005. After accounting for the effect created by the geometry of two fibrocartilaginous nodules within the tendon, calculation of frictional force in the canine tendon was possible. PMID:18328488
Ulnar Collateral Ligament Reconstruction of the Elbow
Erickson, Brandon J.; Chalmers, Peter N.; Bush-Joseph, Charles A.; Verma, Nikhil N.; Romeo, Anthony A.
Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in both professional and high-level athletes. Purpose: To determine the effect of technique and level of play with UCLR on return to sport (RTS). Hypothesis: When comparing different surgical techniques or preoperative level of sports participation, there is no difference in rate of RTS after UCLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting UCLR outcomes with level of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Descriptive statistics were calculated, and 2-proportion 2-sample z-test calculators with α = .05 were used to compare RTS between level of play and technique. Results: Twenty studies (2019 patients/elbows; mean age, 22.13 ± 4 years; 97% male; mean follow-up, 39.9 ± 16.2 months) were included. The majority of patients were baseball players (94.5%), specifically pitchers (80%). The most common level of play was collegiate (44.6%). Palmaris longus (71.2%) and the American Sports Medicine Institute (ASMI) technique (65.6%) were the most common graft choice and surgical technique, respectively. There was a pooled 86.2% RTS rate, and 90% of players scored excellent/good on the Conway-Jobe scale. RTS rates were higher among collegiate athletes (95.5%) than either high school (89.4%, P = .023) or professional athletes (86.4%, P < .0001). RTS rates were higher for the docking technique (97.0%, P = .001) and the ASMI technique (93.3%, P = .0034) than the Jobe technique (66.7%). Conclusion: UCLR is performed most commonly in collegiate athletes. Collegiate athletes have the highest RTS rate
Fractures and Dislocations About the Elbow and Their Adverse Sequelae: Contemporary Perspectives.
Horrigan, Patrick; Braman, Jonathan P; Harrison, Alicia
Fractures and dislocations of the elbow can result in adverse outcomes. The elbow is a unique joint that allows for great mobility but is predisposed to instability, either simple or complex, in traumatic settings. Even simple elbow instability, in which no fracture is present, may be associated with tremendous soft-tissue injury. Surgical treatment is often required for complex instability in which various fractures are present. The treatment goals for fixation of elbow fractures and dislocations include stable fracture fixation, a stable concentrically reduced joint, and early range of motion. Continued pain, stiffness, and instability as well as heterotopic ossification are common sequelae of elbow fractures and dislocations. PMID:27049181
Irrecoverable pressure loss coefficients for two elbows in series with various orientation angles and separation distances
Coffield, R.D.; McKeown, P.T.; Hammond, R.B.
Test data is described for two ninety degree elbows that are in series for a piping network. Both elbows had a radius of curvature of 1.2. Three relative angles and seven different separation distances were investigated. The overall irrecoverable pressure loss for the two elbows is characterized relative to the irrecoverable pressure loss for a single elbow. In addition to providing design guidance relative to the net irrecoverable pressure loss for multiple elbows, the data provides a data base for helping qualify computational fluid dynamics (CFD) computer codes used to predict the irrecoverable pressure loss in piping systems.
Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting
Mon, Daniel; Zakynthinaki, María S.; Cordente, Carlos A.; Antón, Antonio J. Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López
The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting. PMID:26121145
Flexor carpi ulnaris transfer for radial nerve palsy: functional testing of long-term results.
Raskin, K B; Wilgis, E F
Controversy persists over the use of the flexor carpi ulnaris for transfer to the extensor digitorum communis in the treatment of radial nerve palsy. Six patients with complete, irreparable radial nerve palsies were treated in part with the flexor carpi ulnaris to extensor digitorum communis tendon transfer (standard transfers: pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to the rerouted extensor pollicis longus) and were functionally tested for long-term results. The average follow-up time was 8 years (range, 3-15). A control group was comprised of 10 volunteers of similar demographics. This study evaluates the long-term functional recovery in three categories: range of motion, dynamic power of wrist motion, and functional ability as determined by work simulation techniques. The activities simulated were swinging a hammer, sawing wood, tightening screws, and using pliers. A functional range of motion was maintained in all patients, and the power of wrist motion was sufficient to perform all activities of daily living. The work simulation testing revealed no significant difference between the tendon transfer patients and control group with respect to hand dominance and normal variance. All patients were able to perform the simulated work with the same variance in power as the control group. Despite the obvious anatomic loss, wrist function is not significantly impaired after flexor carpi ulnaris tendon transfer for radial nerve palsy. PMID:8522738
The use of magnetic resonance imaging in diagnosing equine deep digital flexor tendinopathies--own experience.
Jaskólska, M; Adamiak, Z; Zhalniarovich, Y; Przyborowska, P; Peczyński, Z
Deep digital flexor tendinopathy is a common problem in horses of different athletic disciplines. Nowadays, the use of magnetic resonance imaging is considered to be a noninvasive and superior choice for recognizing bone and soft tissue pathologies especially related to difficult to access structures within the hoof capsule. PMID:25286667
Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture
Cavadas, Pedro C.; Rubi, Carlo G.
Summary: A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion. PMID:27200249
Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting.
Mon, Daniel; Zakynthinaki, María S; Cordente, Carlos A; Antón, Antonio J Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López
The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting. PMID:26121145
Novais Van Petten, Adriana Maria Valladão; Ávila, Antônio Ferreira
Objective: To investigate the effect of using wrist immobilization orthoses made from different materials, on activation of the flexor and extensor musculature of the forearm while performing specific tasks. Methods: Twenty-six adults, with an average age of 26.2 years, underwent the Jebsen-Taylor functional hand test and the grip strength test (Jamar® dynamometer) under three conditions: free hand, wearing a composite orthosis and wearing a thermoplastic orthosis. The tests were carried out using the dominant hand only. During the tests, surface electrodes were attached to the flexor and extensor muscles of the forearm to record the muscle electrical activity. The results obtained under the three conditions were compared and analyzed using the Wilcoxon statistical test. Results: Significant differences in muscle activation were found between using the free hand and using any of the orthoses. There was no significant difference in muscle activation between the two types of orthosis. A decrease in activity of the extensor muscles of the forearm was observed during all the tasks, as well as an increase in activation of the flexor muscles with the use of the orthoses. Conclusion: These results are important for defining whether an orthosis should be prescribed during the rehabilitation process for a wide range of disorders, such as tendinitis of the flexors and extensors of the wrist and fingers, as well as for predicting the length of time for which these devices should be used. PMID:27022523
Tendoscopic Excision of an Intratendinous Ganglion in the Flexor Hallucis Longus Tendon: A Case Report.
Endo, Jun; Yamaguchi, Satoshi; Sasho, Takahisa
Intratendinous ganglion cysts are rare lesions of unknown etiology that originate within a tendon. We report the case of a 34-year-old female with an intratendinous ganglion in the plantar portion of the flexor hallucis longus tendon. The intratendinous ganglion recurred after ultrasound-guided needle aspiration. Tendoscopic excision of the intratendinous ganglion cyst achieved a satisfactorily result without recurrence. PMID:25456345
Numerical simulation of the erosion in the 90° elbow
NASA Astrophysics Data System (ADS)
Deng, Yunzhong; Liu, Yinhe; Chen, Jianying; Zhang, Yongjian
In the process of natural gas transportation, cement production and coal-fired power, the gas-solid two-phase flow exists widely in pipelines. The existence of solid particles may cause the erosion of the pipeline, especially in the elbow of the pipeline. Equations used to predict erosion rate are usually obtained from well-controlled experimental tests for solid particles carried in a gas or liquid flow. The particle impact speed and impact angle affect the erosion process and are two major parameters in most erosion equations. In this paper, the erosion of 90° elbow was studied by using Computational Fluid Dynamics (CFD), Discrete Particle Model (DPM) and erosion equations. The maximum erosion rate and the erosion position were reported. Particle size does not influence the erosion rate when particle size is bigger than a certain degree. When the mass ratio of sand loading to fluid is less than 1, erosion ratio is proportional to the loading mass. The erosion rate is lower for larger radius elbow, and the erosion rate is greatly declined by using the plugged tee instead of an elbow.
Synovial chondromatosis caused mechanical snapping elbow: a case report.
Karaman, Ibrahim; Guney, Ahmet; Dogar, Fatih; Oner, Mithat; Bılal, Okkes
Synovial chondromatosis is a rare and benign proliferative disorder of the synovial membrane in joints and bursae. Herein, we present the case of a 34-year-old male with synovial chondromatosis that caused limitation in the elbow joint in terms of mechanical function. PMID:26185473
Synovial chondromatosis caused mechanical snapping elbow: a case report
Karaman, Ibrahim; Guney, Ahmet; Dogar, Fatih; Oner, Mithat; Bılal, Okkes
Synovial chondromatosis is a rare and benign proliferative disorder of the synovial membrane in joints and bursae. Herein, we present the case of a 34-year-old male with synovial chondromatosis that caused limitation in the elbow joint in terms of mechanical function. PMID:26185473
Managing the stiff elbow: operative, nonoperative, and postoperative techniques.
Dávila, Sylvia A; Johnston-Jones, Karen
Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture. PMID:16713873
Guided wave propagation and scattering in pipeworks comprising elbows
NASA Astrophysics Data System (ADS)
Bakkali, Marouane El; Lhémery, Alain; Baronian, Vahan; Berthelot, François
Guided waves (GW) are used to inspect pipeworks in various industries. Specific features of pipeworks lead to complex scattering phenomena. Simulations tools able to handle such a complexity must be developed to help interpretation and to optimize testing configurations. They must handle both long range propagation and local scattering phenomena. Here, a modal formulation is derived to deal with pipeworks comprising arbitrarily curved elbows linking otherwise straight pipes. First, the semi-analytic finite element method is extended in curvilinear coordinates to predict guided modes in elbows. Then, GW scattering at the junction of a straight pipe with an elbow is investigated. Modal solutions in both parts being known, the mode matching method is derived to compute modal reflection and transmission coefficients given as elements of a scattering matrix. Further, the global scattering matrix of a pipework comprising an arbitrary number of elbows linking straight pipes is considered. A general formulation presented in this conference series is used which handles multiple scattering phenomena that possibly arise. Interestingly, the computation of both modal solution and the scattering matrix with mode-matching method only requires meshing the pipe section. Examples illustrate the various steps.
48. View of typical 90 degree elbow located at horizontal ...
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
48. View of typical 90 degree elbow located at horizontal corner with output (to scanner radar system control switch) waveguide on top and return wave on bottom of photograph. - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK
Finite element evaluation of erosion/corrosion affected reducing elbow
Basavaraju, C.
Erosion/corrosion is a primary source for wall thinning or degradation of carbon steel piping systems in service. A number of piping failures in the power industry have been attributed to erosion/corrosion. Piping elbow is one of such susceptible components for erosion/corrosion because of increased flow turbulence due to its geometry. In this paper, the acceptability of a 12 in. x 8 in. reducing elbow in RHR service water pump discharge piping, which experienced significant degradation due to wall thinning in localized areas, was evaluated using finite element analysis methodology. Since the simplified methods showed very small margin and recommended replacement of the elbow, a detailed 3-D finite element model was built using shell elements and analyzed for internal pressure and moment loadings. The finite element analysis incorporated the U.T. measured wall thickness data at various spots that experienced wall thinning. The results showed that the elbow is acceptable as-is until the next fuel cycle. FEA, though cumbersome, and time consuming is a valuable analytical tool in making critical decisions with regard to component replacement of border line situation cases, eliminating some conservatism while not compromising the safety.
Below-the-elbow intervention for Buerger's disease.
Kawarada, Osami; Sakamoto, Shingo; Harada, Koichiro; Noguchi, Teruo; Ogawa, Hisao; Yasuda, Satoshi
An increasing attention has been paid to endovascular therapy for lower limb ischemia in patients with Buerger's disease. However, critical hand ischemia in Buerger's disease patients has been underappreciated despite a tremendous advancement of endovascular therapy for peripheral arterial disease. Herein, we describe endovascular "hand" salvage with a below-the-elbow intervention. PMID:25547258
Overhead throwing injuries of the shoulder and elbow.
Anderson, Mark W; Alford, Bennett A
Injuries to the shoulder and elbow are common in athletes involved in sporting activities that require overhead motion of the arm. An understanding of the forces involved in the throwing motion, the anatomic structures most at risk, and the magnetic resonance imaging appearances of the most common associated injuries can help to improve diagnostic accuracy when interpreting imaging studies in these patients. PMID:21094403
SEMG signal analysis at acupressure points for elbow movement.
Ryait, Hardeep S; Arora, A S; Agarwal, Ravinder
Surface electromyography signals (SEMG) are the most common form of non-invasive-measurement of muscle activities. To acquire proper SEMG for particular limb function, the placement of electrodes on the skin over respective active group of muscles becomes very important. Measurement of SEMG depends on a number of factors/parameters like amplitude, time and frequency domain properties. In the present investigation, analysis was carried firstly; to study the grip force vs. SEMG parameters at acupressure points on arm, using single channel approach. At all the selected acupressure points a linear increment of SEMG was observed. Secondly; to discriminate four elbow movements from different locations on arm using two channel approach with single parameter. The parameter for the analysis chosen was the root of mean of square (RMS) value of SEMG. Further; principal component analysis was used to verify the elbow movement discrimination. Extension and supination were the two operations which were observed to be easy to realize by prosthetic devices. The selection of these locations was done on the basis of acupressure points and anatomy of elbow. Matlab-softscope was used for acquiring the SEMG from line-in input port of PC-sound card. This study will also be helpful for the researchers in understanding the behavior of SEMG for elbow movement in development of prosthetic or exoskeleton devices. PMID:21816622
Arthroscopic management of the painful total elbow arthroplasty
Bain, Gregory I
Background Failure of total elbow arthroplasty is more common than after other major joint arthroplasties and is often a result of aseptic loosening, peri-prosthetic infection, fracture and instability. Infection can be a devastating complication, yet there are no established guidelines for the pre-operative diagnosis of total elbow peri-prosthetic infection. This is because pre-operative clinical, radiographic and biochemical tests are often unreliable. Methods Using three case examples, a standardized protocol for the clinical and arthroscopic assessment of the painful total elbow arthroplasty is described. This is used to provide a mechanical and microbiological diagnosis of the patient's pain. Results There have been no complications resulting from the use of this technique in the three patients described, nor in any other patient to date. Conclusions The staged protocol described in the present study, utilizing arthroscopic assessment, has refined the approach to the painful total elbow arthroplasty because it directly influences the definitive surgical management of the patient. It is recommended that other surgeons follow the principles outlined in the present study when faced with this challenging problem. PMID:27583000
Recovery Kinetics of Knee Flexor and Extensor Strength after a Football Match
Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C.; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K.; Douroudos, Ioannis I.; Margonis, Konstantinos; Gioftsidou, Asimenia; Fouris, Andreas D.; Jamurtas, Athanasios Z.; Koutedakis, Yiannis; Fatouros, Ioannis G.
We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12h, 36h and 60h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12h, 36h and 60h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12h (both limbs) and 36h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36h at 60°/s and for 60h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical
Intracellular autogenetic and synergistic effects of muscular contraction on flexor motoneurones
Green, D. G.; Kellerth, J.-O.
1. Intracellular records have been taken from cat motoneurones innervating flexor muscles of the hind limb. Contractions of the ankle flexors tibialis anterior and extensor digitorum longus were elicited by stimulation of the peripheral end of the cut L 7 ventral root and the reflex effects of these contractions were recorded in silent and repetitively firing motoneurones. 2. Contraction usually produces a hyperpolarizing response inside flexor motoneurones. This hyperpolarization is tension-sensitive in the sense that when, at constant muscle extension, the strength of the contraction is increased, the magnitude of the inhibitory response is augmented. 3. Increasing the resting length of the muscles, while using a stimulus of constant strength to the ventral root, causes this inhibitory response to increase in some cells. More often, however, the hyperpolarization caused by contraction is gradually reduced in duration and/or amplitude as the muscles are extended. 4. Even with the muscles slackened, so that they develop no tension at their ends, contraction usually produces prominent hyperpolarization of the motoneurones. 5. By passing polarizing currents or injecting chloride ions through the intracellular micro-electrode, the hyperpolarizing potentials produced by contraction of the slack and extended muscles are shown to be, at least in part, genuinely post-synaptic inhibitory events. 6. When the neurone is fired repetitively by injected current, the `silent period' in contraction corresponds to the hyperpolarization of the post-synaptic membrane. 7. Monosynaptic testing of the flexor motoneurone pool has been used to confirm the essential features of the intracellularly recorded activity. 8. Acutely spinalizing the animal increases the magnitude of the inhibitory responses caused by contraction. 9. Recordings from dorsal root fibres show that Golgi tendon organs of the ankle flexors are very sensitive to contraction and are indeed often activated by the
Computed tomographic arthrography of the normal canine elbow.
Gendler, Andrew; Keuler, Nicholas S; Schaefer, Susan L
Comprehensive evaluation of canine elbow joint dysfunction includes assessment of articular cartilage, which can noninvasively be performed with contrast arthrography. Aims of this prospective study were to compare positive contrast computed tomographic (CT) arthrography and histomorphometry measures of cartilage thickness in normal canine elbows, and to determine the optimal contrast medium concentration. Thirty-two canine cadaver elbows were examined using multidetector CT, before and after intra-articular administration of iohexol at one of three different concentrations. Articular cartilage thickness was measured on both the CT arthrography images and corresponding histologic specimens. Mean difference (bias) between the CT arthrography and histomorphologic measurements was 0.18 and 0.19 mm in the sagittal and dorsal planes, respectively. Mean bias and precision of CT arthrography measurements made in the sagittal or dorsal reformations were not significantly different from one another. Computed tomographic arthrography measurements from elbows with 75 mg I/ml were significantly larger and had greater bias compared to other contrast medium groups (150 and 37.5 mg I/ml). There was no significant difference in CT arthrography measurement precision between different contrast medium concentrations. Histomorphologic thickness of the articular cartilage overlying the cranial aspect of the ulna (mean 0.32 mm) was significantly thinner than cartilage of the radius (0.36 mm) or humerus (0.36 mm). Findings from this cadaver study indicated that CT arthrography delineates articular cartilage of the normal canine elbow; yields cartilage thickness measures slightly greater than histomorphometry measures; and provides high measurement precision regardless of image plane, contrast medium concentration, or anatomic zone. PMID:25154869
The Epidemiology and Health Care Burden of Tennis Elbow
Sanders, Thomas L.; Kremers, Hilal Maradit; Bryan, Andrew J.; Ransom, Jeanine E.; Smith, Jay; Morrey, Bernard F.
Background Lateral elbow tendinosis (epicondylitis) is a common condition both in primary care and specialty clinics. Purpose To evaluate the natural history (ie, incidence, recurrence, and progression to surgery) of lateral elbow tendinosis in a large population. Study Design Descriptive epidemiology study. Methods The study population comprised a population-based incidence cohort of patients with new-onset lateral elbow tendinosis between January 1, 2000, and December 31, 2012. The medical records of a 10% random sample (n = 576) were reviewed to ascertain information on patient and disease characteristics, treatment modalities, recurrence, and progression to surgery. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 US population. Results The age- and sex-adjusted annual incidence of lateral elbow tendinosis decreased significantly over time from 4.5 per 1000 people in 2000 to 2.4 per 1000 in 2012 (P <.001). The recurrence rate within 2 years was 8.5% and remained constant over time. The proportion of surgically treated cases within 2 years of diagnosis tripled over time, from 1.1% during the 2000–2002 time period to 3.2% after 2009 (P <.00001). About 1 in 10 patients with persistent symptoms at 6 months required surgery. Conclusion The decrease in incidence of lateral elbow tendinosis may represent changes in diagnosis patterns or a true decrease in disease incidence. Natural history data can be used to help guide patients and providers in determining the most appropriate course at a given time in the disease process. The study data suggest that patients without resolution after 6 months of onset may have a prolonged disease course and may need surgical intervention. PMID:25656546
Fractured rheumatoid elbow: treatment with Souter elbow arthroplasty--a clinical and radiologic midterm follow-up study.
Ikävalko, M; Lehto, M U
We report the results in 26 patients who had 32 preoperative fractures treated with Souter elbow arthroplasty. All were rheumatoid patients with a mean disease duration of 29.7 years (range, 10 to 43). Six of the fractures were of the olecranon and 26 of the distal humerus. The time interval between fracture and arthroplasty was 9 months (mean; range, 0 to 48). Fragments were not excised, and osteosynthesis was performed. The follow-up was 2.6 years (mean; range, 0.5 to 8), when 20 of the fractures had united and 12 had not. K-wire fixation, either alone or in combination with cerclage or PDS suture, and bone grafting led to satisfactory results. Union was verified in 14 of 17 cases treated with this technique. There were no severe early complications. Six patients had late complications. In 3 cases, loosening of the humeral component was observed radiologically. One patient had a hematogenous deep infection 4 years after the operation, and 2 patients had avulsion rupture of the triceps tendon. Fracture in the badly destroyed elbow can be more reasonably treated with an arthroplasty than with an attempt of osteosynthesis before arthroplasty. If excision of the fragments is avoided, original, or near original, anatomy of the elbow joint can be better restored and acceptable outcome obtained with elbow arthroplasty. PMID:11408908
Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger
Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo
Objective: This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). Method: A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. Results: In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. Conclusion: The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering. PMID:27099639
Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature.
Chin, Brian; Cheung, Kevin; Farhangkhoee, Hana; Thoma, Achilleas
Proliferative flexor tenosynovitis of the hand is an inflammatory process involving the synovial sheaths surrounding the tendons. It is most commonly caused by infection, but may also be caused by overuse, diabetes and rheumatic conditions such as rheumatoid arthritis and crystal arthropathies. The present report describes two patients with severe proliferative tenosynovitis, who developed a fistula between the tendon sheath and skin after instrumentation, resulting in persistent synovial drainage. After failing conservative management, both patients were managed with extensive flexor tenosynovectomy to prevent inoculation of bacteria into the flexor sheath. The presentation, management and outcome of each case is described in addition to a discussion of the literature on tenosynovial fistulas. PMID:26090353
Cable-based parallel manipulator for rehabilitation of shoulder and elbow movements.
Nunes, Wilgo Moreira; Rodrigues, Lucas Antônio Oliveira; Oliveira, Lucas Paiva; Ribeiro, José Francisco; Carvalho, João Carlos Mendes; Gonçalves, Rogério Sales
In this paper a cable-based system is presented for rehabilitation of the shoulder and elbow movements. Cable-based manipulators have very good kinematic and dynamic characteristics, and they also show other properties such as: transportability and low-cost construction, which make them also suitable for medical applications and rehabilitation. The general robotics structure consists of four cables that allow the movement of vertical flexion-extension, abduction-adduction and horizontal flexion-extension with different limits of movement and speed of the shoulder. The structure can also perform the elbow movements of the flexion-extension. The development of this robotic device is justified by the large number of people with upper limb problems. These problems are due of stroke, polio, arthritis, recovery after accidents or trauma and can be applied to movements of physical therapy. The kinematics model of cable-based parallel robots is obtained similarly to the model obtained from traditional parallel structures. The graphical simulations of the cable-based parallel structure for rehabilitation of the movements of the human arm are presented showing the viability of the proposed structure. Finally preliminary experimental tests are presented. PMID:22275699
Complex and Unstable Simple Elbow Dislocations: A Review and Quantitative Analysis of Individual Patient Data
de Haan, Jeroen; Schep, Niels; Tuinebreijer, Wim; den Hartog, Dennis
Objective: The primary objective of this review of the literature with quantitative analysis of individual patient data was to identify the results of available treatments for complex elbow dislocations and unstable simple elbow dislocations. The secondary objective was to compare the results of patients with complex elbow dislocations and unstable elbow joints after repositioning of simple elbow dislocations, which were treated with an external fixator versus without an external fixator. Search Strategy: Electronic databases MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials. Selection Criteria: Studies were eligible for inclusion if they included individual patient data of patients with complex elbow dislocations and unstable simple elbow dislocations. Data Analysis: The different outcome measures (MEPI, Broberg and Morrey, ASES, DASH, ROM, arthritis grading) are presented with mean and confidence intervals. Main Results: The outcome measures show an acceptable range of motion with good functional scores of the different questionnaires and a low mean arthritis score. Thus, treatment of complex elbow dislocations with ORIF led to a moderate to good result. Treatment of unstable simple elbow dislocations with repair of the collateral ligaments with or without the combination of an external fixator is also a good option. The physician-rated (MEPI, Broberg and Morrey), patient-rated (DASH) and physician- and patient-rated (ASES) questionnaires showed good intercorrelations. Arthritis classification by x-ray is only fairly correlated with range of motion. Elbow dislocations are mainly on the non-dominant side. PMID:20361035
The effect of elbow hyperextension on ball speed in cricket fast bowling.
Felton, P J; King, M A
This study investigates how elbow hyperextension affects ball release speed in fast bowling. A two-segment planar computer simulation model comprising an upper arm and forearm + hand was customised to an elite fast bowler. A constant torque was applied at the shoulder and elbow hyperextension was represented using a damped linear torsional spring at the elbow. The magnitude of the constant shoulder torque and the torsional spring parameters were determined by concurrently matching three performances. Close agreement was found between the simulations and the performances with an average difference of 3.8%. The simulation model with these parameter values was then evaluated using one additional performance. Optimising ball speed by varying the torsional spring parameters found that elbow hyperextension increased ball release speed. Perturbing the elbow torsional spring stiffness indicated that the increase in ball release speed was governed by the magnitude of peak elbow hyperextension and the amount that the elbow recoils back towards a straight arm after reaching peak elbow hyperextension. This finding provides a clear understanding that a bowler who hyperextends at the elbow and recoils optimally will have an increase in ball speed compared to a similar bowler who cannot hyperextend. A fast bowler with 20° of elbow hyperextension and an optimal level of recoil will have increased ball speeds of around 5% over a bowler without hyperextension. PMID:26821838
A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study
Background Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and
Elbow Joint Active Replication in College Pitchers Following Simulated Game Throwing
Manske, Robert; Stovak, Mark; Cox, Kara; Smith, Barbara
Background: Elbow injuries are common in college baseball players. Pitching creates stress and fatigue in and around the elbow. Lack of joint proprioception can contribute to nonphysiological joint loading and injury. Hypothesis: There will be no difference in elbow joint active reproduction sense following a simulated 3-inning pitching sequence. Study Design: Cross-sectional study. Methods: Seventeen collegiate pitchers participated. Each pitcher was bilaterally tested for active elbow range of motion using goniometric technique. Percentages of motion determined positions for further study of elbow joint active replication sense (20%, 35%, 50%, 80%). The elbow was passively taken to a position and held for 10 seconds, then returned to full extension. Pitchers were asked to actively reproduce the angle. The opposite elbow was tested in the same manner. One week later, prethrowing joint position reproduction was tested; then a simulated 3-inning game was thrown. Immediately afterward, elbow joint active replication testing was performed. A repeated-measures analysis of variance analyzed differences. Results: No change in active joint reproduction occurred in the nondominant elbow at any angle tested. Dominant elbows demonstrated significant losses of active joint reproduction following throwing. Significant differences occurred at the 35% and 80% angles (P < .05). Conclusion: Active elbow joint replication sense may be compromised following 3 innings of throwing. Because joint proprioception is thought to be an important component of joint stabilization, an alteration in joint position sense may increase the risk of elbow injury during throwing. Clinical Relevance: Pitching may cause a loss of active elbow joint replication. PMID:23015958
Elbow and knee joint for hard space suits
NASA Technical Reports Server (NTRS)
Vykukal, H. C.
An elbow or knee joint for a hard space suit or similar usage is formed of three serially connected rigid sections which have truncated spherical configurations. The ends of each section form solid geometric angles, and the sections are interconnected by hermetically sealed ball bearings. The outer two sections are fixed together for rotation in a direction opposite to rotation of the center section. A preferred means to make the outer sections track each other in rotation comprises a rotatable continuous bead chain which engages sockets circumferentially spaced on the facing sides of the outer races of the bearings. The joint has a single pivot point and the bearing axes are always contained in a single plane for any articulation of the joint. Thus flexure of the joint simulates the coplanar flexure of the knee or elbow and is not susceptible to lockup.
Flow resistance of ice slurry in bends and elbow pipes
NASA Astrophysics Data System (ADS)
Niezgoda-Żelasko, B.; Żelasko, J.
The present paper covers the flow of ice slurry made of a 10.6% ethanol solution through small-radius bends and elbow pipes. The paper presents the results of experimental research on the flow resistances of Bingham-fluid ice slurry in bends and elbows. The research, performed for three pipe diameters and a relative bend radius of 1<=D/di<=2, has made it possible to take into consideration the influence of friction resistances as well the of the flow geometry on the total local resistance coefficients. The study attempts to make the local resistance coefficient dependent on the Dean number defined for a generalized Reynolds number according to Metzner-Reade
Bimanual elbow exoskeleton: Force based protocol and rehabilitation quantification.
Alavi, N; Herrnstadt, G; Randhawa, B K; Boyd, L A; Menon, C
An aging population, along with the increase in cardiovascular disease incidence that accompanies this demographic shift, is likely to increase both the economic and medical burden associated with stroke in western societies. Rehabilitation, the standard treatment for stroke, can be expanded and augmented with state of the art technologies, such as robotic therapy. This paper expands upon a recent work involving a force-feedback master-slave bimanual exoskeleton for elbow rehabilitation, named a Bimanual Wearable Robotic Device (BWRD). Elbow force data acquired during the execution of custom tasks is analyzed to demonstrate the feasibility of tracking patient progress. Two training tasks that focus on applied forces are examined. The first is called "slave arm follow", which uses the absolute angular impulse as a metric; the second is called "conditional arm static", which uses the rise time to target as a metric, both presented here. The outcomes of these metrics are observed over three days. PMID:26737329
Effect of Elbow Position on Short-segment Nerve Conduction Study in Cubital Tunnel Syndrome
Liu, Zhu; Jia, Zhi-Rong; Wang, Ting-Ting; Shi, Xin; Liang, Wei
Background: The appropriate elbow position of short-segment nerve conduction study (SSNCS) to diagnose cubital tunnel syndrome (CubTS) is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods: In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow full extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland–Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results: Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group's latency and compound muscle action potential (CMAP) of each segment at 70° elbow flexion by SSNCS was compared with full extension position, no statistically significant difference were found (all P > 0.05). Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated (all P < 0.01), except the latency of segment of 4 cm to 6 cm above elbow (P = 0.43), and the latency (P = 0.15) and the CMAP (P = 0.06) of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland–Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow (2 cm above the elbow and 2 cm below it), latency at elbow full extension and 70° flexion were strong direct associated (r = 0.83, P < 0.01; r = 0.55, P < 0.01), and so did the CMAP (r = 0.49, P < 0.01; r = 0.72, P < 0.01). There was no statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with
Prediction of elbow joint contact mechanics in the multibody framework.
Rahman, Munsur; Cil, Akin; Stylianou, Antonis P
Computational multibody musculoskeletal models of the elbow joint that are capable of simultaneous and accurate predictions of muscle and ligament forces, along with cartilage contact mechanics can be immensely useful in clinical practice. As a step towards producing a musculoskeletal model that includes the interaction between cartilage and muscle loading, the goal of this study was to develop subject-specific multibody models of the elbow joint with discretized humerus cartilage representation interacting with the radius and ulna cartilages through deformable contacts. The contact parameters for the compliant contact law were derived using simplified elastic foundation contact theory. The models were then validated by placing the model in a virtual mechanical tester for flexion-extension motion similar to a cadaver experiment, and the resulting kinematics were compared. Two cadaveric upper limbs were used in this study. The humeral heads were subjected to axial motion in a mechanical tester and the resulting kinematics from three bones were recorded for model validation. The maximum RMS error between the predicted and measured kinematics during the complete testing cycle was 2.7mm medial-lateral translation and 9.7° varus-valgus rotation of radius relative to humerus (for elbow 2). After model validation, a lateral ulnar collateral ligament (LUCL) deficient condition was simulated and, contact pressures and kinematics were compared to the intact elbow model. A noticeable difference in kinematics, contact area, and contact pressure were observed for LUCL deficient condition. LUCL deficiency induced higher internal rotations for both the radius and ulna during flexion and an associated medial shift of the articular contact area. PMID:26832391
Cost analysis and outcomes of simple elbow dislocations
Panteli, Michalis; Pountos, Ippokratis; Kanakaris, Nikolaos K; Tosounidis, Theodoros H; Giannoudis, Peter V
AIM: To evaluate the management, clinical outcome and cost implications of three different treatment regimes for simple elbow dislocations. METHODS: Following institutional board approval, we performed a retrospective review of all consecutive patients treated for simple elbow dislocations in a Level I trauma centre between January 2008 and December 2010. Based on the length of elbow immobilisation (LOI), patients were divided in three groups (Group I, < 2 wk; Group II, 2-3 wk; and Group III, > 3 wk). Outcome was considered satisfactory when a patient could achieve a pain-free range of motion ≥ 100° (from 30° to 130°). The associated direct medical costs for the treatment of each patient were then calculated and analysed. RESULTS: We identified 80 patients who met the inclusion criteria. Due to loss to follow up, 13 patients were excluded from further analysis, leaving 67 patients for the final analysis. The mean LOI was 14 d (median 15 d; range 3-43 d) with a mean duration of hospital engagement of 67 d (median 57 d; range 10-351 d). Group III (prolonged immobilisation) had a statistically significant worse outcome in comparison to Group I and II (P = 0.04 and P = 0.01 respectively); however, there was no significant difference in the outcome between groups I and II (P = 0.30). No statistically significant difference in the direct medical costs between the groups was identified. CONCLUSION: The length of elbow immobilization doesn't influence the medical cost; however immobilisation longer than three weeks is associated with persistent stiffness and a less satisfactory clinical outcome. PMID:26301180
Flexor tendon excursion and load during passive and active simulated motion: a cadaver study.
Sapienza, A; Yoon, H K; Karia, R; Lee, S K
The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen. PMID:23221181
A Conservatively Managed Anatomical Variant of the Flexor Digitorum Superficialis Muscle in the Hand.
Chatterton, Benjamin D; Moores, Thomas S; Heinz, Nicholas; Datta, Praveen; Smith, Kevin D; Thomas, Peter B M
Anomalous flexor digitorum superficialis muscles in the hand are an uncommon phenomenon, and therefore present challenges in diagnosis and management. We report a case of a 16-year-old girl presenting with a painful, slowly enlarging palmar swelling. The swelling was investigated with ultrasound and magnetic resonance imaging, and was found to be an anomalous muscle belly of the flexor digitorum superficialis muscle. After careful consideration, multidisciplinary discussion, and thorough imaging, the patient was treated successfully without surgical exploration or excision, in comparison to previously reported cases. The patient was pain free and had no concerns at 8-month follow-up, demonstrating the value of conservative management in these cases. PMID:27616828
Late Removal of Titanium Hardware from the Elbow Is Problematic
Bachoura, Abdo; Yoshida, Ruriko; Lattermann, Christian; Kamineni, Srinath
A retrospective review of 21 patients that underwent bone screw removal from the elbow was studied in relation to the type of metal, duration of implantation, and the location of the screws about the elbow. Screw failure during extraction was the dependent variable. Five of 21 patients experienced hardware failure during extraction. Fourteen patients had titanium alloy implants. In four cases, titanium screws broke during extraction. Compared to stainless steel, titanium screw failure during removal was not statistically significant (P = 0.61). Screw removal 12 months after surgery was more likely to result in broken, retained screws in general (P = 0.046) and specifically for titanium alloy (P = 0.003). Bone screws removed from the distal humerus or proximal ulna had an equal chance of fracturing (P = 0.28). There appears to be a time-related association of titanium alloy bone screw failure during hardware removal cases from the elbow. This may be explained by titanium's properties and osseointegration. PMID:24977074
Anatomical study on the innervation of the elbow capsule☆
Cavalheiro, Cristina Schmitt; Filho, Mauro Razuk; Rozas, João; Wey, João; de Andrade, Antonio Marcos; Caetano, Edie Benedito
Objectives To put forward an anatomical description of the innervation of the elbow capsule, illustrated through morphological analysis on dissections. Methods Thirty elbows from fresh fixed adult cadavers aged 32–74 years, of both sexes, were dissected. Results Among the dissected arms, we observed that the median nerve did not have any branches in two arms, while it had one branch in five arms, two branches in two arms, three branches in ten arms, four branches in nine arms and five branches in two arms. The radial nerve did not have any branches in two arms, while it had one branch in two arms, two branches in nine arms, three branches in ten arms, four branches in five arms and five branches in two arms. The ulnar nerve did not have any branches in three arms, while it had one branch in six arms, two branches in four arms, three branches in five arms, four branches in seven arms, five branches in four arms and six branches in one arm. Conclusions We observed branches of the radial, ulnar and medial nerves in the elbow joint, and a close relationship between their capsular and motor branches. PMID:27218079
Arthroscopic management of the arthritic elbow: indications, technique, and results.
Savoie, F H; Nunley, P D; Field, L D
Twenty-four patients with painful restricted motion of the elbow joint because of an arthritic process were treated with an arthroscopic modification of the open Outerbridge-Kashiwagi procedure. Average preoperative flexion was to 90 degrees (range 60 degrees to 140 degrees), and average extension loss was -40 degrees (range -5 degrees to -60 degrees). The average total arc of motion was 50 degrees. The procedure consisted of arthroscopic debridement, partial resection of the coronoid and olecranon processes, and fenestration of the olecranon fossa. The radial head was excised arthroscopically in 18 of the 24 patients. All patients were reexamined 24 to 60 months after operation (mean 32 months). All patients had a significant decrease in pain as described by a visual analog scale (preoperative 8.2; postoperative 2.2). Average flexion was to 139 degrees (range 95 degrees to 145 degrees), and average extension loss was -8 degrees (range 0 degree to 15 degrees). The average arc of motion was 131 degrees, an improvement of 81 degrees. Arthroscopic ulnohumeral arthroplasty provides satisfactory results in terms of pain control and improved motion. The complication rate is comparable to those reported in series of open ulnohumeral arthroplasties. This procedure seems to be a valuable adjunct in the management of the arthritic elbow, serving as an intermediate step between nonoperative management and elbow replacement surgery. PMID:10389075
Recovery features in ulnar neuropathy at the elbow
Yıldırım, Pelin; Yildirim, Apdullah; Misirlioglu, Tugce Ozekli; Evcili, Gokhan; Karahan, Ali Yavuz; Gunduz, Osman Hakan
[Purpose] This study evaluated the effect of age, sex, and entrapment localization on recovery time in patients treated conservatively for ulnar neuropathy at the elbow. [Subjects] Thirty-five patients (16 women and 15 men) who were diagnosed with ulnar neuropathy at the elbow using short segment conduction studies were evaluated retrospectively. [Methods] Definition of recovey was made based on patient satisfaction. The absence of symptoms was considered as the marker of recovery. Patients who recovered within 0–4 weeks were in Group 1, and patients who recovered within 4 weeks to 6 months were in Group 2. The differences between Group 1 and Group 2 in terms of age, sex and entrapment localization were investigated. [Results] Entrapment was most frequent in the retroepicondylar groove (54.3%). No significant difference was found in terms of age and entrapment localizations between Groups 1 and 2. There was a statistically significant difference between the groups for the male sex. [Conclusion] In ulnar neuropathy at the elbow, age and entrapment localization do not affect recovery time. However, male sex appears to be associated with longer recovery time. PMID:26157226
The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath.
Havulinna, J; Leppänen, O V; Göransson, H
In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component. PMID:23315625
Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair
Geary, Michael B.; Orner, Caitlin A.; Bawany, Fatima; Awad, Hani A.; Hammert, Warren C.; O'Keefe, Regis J.; Loiselle, Alayna E.
Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the
Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair.
Geary, Michael B; Orner, Caitlin A; Bawany, Fatima; Awad, Hani A; Hammert, Warren C; O'Keefe, Regis J; Loiselle, Alayna E
Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the
Rupture of a flexor pollicis longus tendon in Scheie's syndrome. Case report.
Weiss, G G; Ritt, M J; Bos, K E
We describe a case of Scheie's syndrome with a closed rupture of the flexor pollicis longus tendon, probably caused by a combination of extrinsic and intrinsic tendon changes. Early detection of carpal tunnel syndrome in all patients who have some form of mucopolysaccharidosis in which this is a universal occurrence (such as Scheie's syndrome), is recommended. Release of the carpal tunnel prevents long term complications, as described in this case report. PMID:9299691
Genetic evaluation of elbow scores and the relationship with hip scores in UK Labrador retrievers.
Lewis, T W; Ilska, J J; Blott, S C; Woolliams, J A
A linear mixed model analysis of elbow and hip score data from UK Labrador retrievers was used to estimate the heritability of elbow score (0.16-0.19) and to determine a moderate and beneficial genetic correlation with hip score (0.40). A small improvement in the genetic trend of elbow score was observed during the years 2000-2008, equivalent to avoiding only the worst 3-4% of scored dogs for breeding, but close to what may have been anticipated if the current British Veterinary Association-approved guidelines were followed. Calculations suggested that a correlated response to indirect selection on hip score may elicit a greater response than direct selection on elbow score and that the genetic trend in elbow score may be explained as a consequence of the stronger selection pressure that has been placed on hip score. Increases in the accuracy of estimated breeding values for elbow score of 4-7% for dogs with elbow data only and 7-11% for dogs with both hip and elbow score were observed from bivariate analysis of elbow and hip data. A selection index confirmed the benefits of bivariate analysis of elbow and hip score data by identifying increases in accuracy (directly related to the response to selection) of 14% from the use of optimum coefficients compared to use of hip data only. The quantified genetic correlation means that hip score effectively acts as a 'secondary indicator' of elbow score in this breed and the preponderance of hip data means that it acts as a major source of information that may be used to improve the accuracy of estimates of genetic risk for elbow dysplasia. PMID:21737324
Effect of elbow position on radiographic measurements of radio-capitellar alignment
Sandman, Emilie; Canet, Fanny; Petit, Yvan; Laflamme, G-Yves; Athwal, George S; Rouleau, Dominique M
AIM: To evaluate the effect of different elbow and forearm positions on radiocapitellar alignment. METHODS: Fifty-one healthy volunteers were recruited and bilateral elbow radiographs were taken to form a radiologic database. Lateral elbow radiographs were taken with the elbow in five different positions: Maximal extension and forearm in neutral, maximal flexion and forearm in neutral, elbow at 90° and forearm in neutral, elbow at 90° and forearm in supination and elbow at 90° and forearm in pronation. A goniometer was used to verify the accuracy of the elbow's position for the radiographs at a 90° angle. The radiocapitellar ratio (RCR) measurements were then taken on the collected radiographs using the SliceOmatic software. An orthopedic resident performed the radiographic measurements on the 102 elbows, for a total of 510 lateral elbow radiographic measures. ANOVA paired t-tests and Pearson coefficients were used to assess the differences and correlations between the RCR in each position. RESULTS: Mean RCR values were -2% ± 7% (maximal extension), -5% ± 9% (maximal flexion), and for elbow at 90° and forearm in neutral -2% ± 5%, supination 1% ± 6% and pronation 1% ± 5%. ANOVA analyses demonstrated significant differences between the RCR in different elbow and forearm positions. Paired t-tests confirmed significant differences between the RCR at maximal flexion and flexion at 90°, and maximal extension and flexion. The Pearson coefficient showed significant correlations between the RCR with the elbow at 90° - maximal flexion; the forearm in neutral-supination; the forearm in neutral-pronation. CONCLUSION: Overall, 95% of the RCR values are included in the normal range (obtained at 90° of flexion) and a value outside this range, in any position, should raise suspicion for instability. PMID:26925383
Enhanced Zone II Flexor Tendon Repair through a New Half Hitch Loop Suture Configuration
Thomopoulos, Stavros; Gelberman, Richard H.
This study evaluated the impact of a new half hitch loop suture configuration on flexor tendon repair mechanics. Cadaver canine flexor digitorum profundus tendons were repaired with 4- or 8-strands, 4–0 or 3–0 suture, with and without half hitch loops. An additional group underwent repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand repairs by 21% when 4–0, and 33% when 3–0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor tendon repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period. PMID:27101409
Clinical Results of Flexor Tendon Repair in Zone II Using a six Strand Double Loop Technique.
Savvidou, Christiana; Tsai, Tsu-Min
The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation. PMID:26078499
The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.
Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki
Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues. PMID:21813313
Effects of lubricant and autologous bone marrow stromal cell augmentation on immobilized flexor tendon repairs.
Zhao, Chunfeng; Ozasa, Yasuhiro; Shimura, Haruhiko; Reisdorf, Ramona L; Thoreson, Andrew R; Jay, Gregory; Moran, Steven L; An, Kai-Nan; Amadio, Peter C
The purpose of the study was to test a novel treatment that carbodiimide-derivatized-hyaluronic acid-lubricin (cd-HA-lubricin) combined cell-based therapy in an immobilized flexor tendon repair in a canine model. Seventy-eight flexor tendons from 39 dogs were transected. One tendon was treated with cd-HA-lubricin plus an interpositional graft of 8 × 10(5) BMSCs and GDF-5. The other tendon was repaired without treatment. After 21 day of immobilization, 19 dogs were sacrificed; the remaining 20 dogs underwent a 21-day rehabilitation protocol before euthanasia. The work of flexion, tendon gliding resistance, and adhesion score in treated tendons were significantly less than the untreated tendons (p < 0.05). The failure strength of the untreated tendons was higher than the treated tendons at 21 and 42 days (p < 0.05). However, there is no significant difference in stiffness between two groups at day 42. Histologic analysis of treated tendons showed a smooth surface and viable transplanted cells 42 days after the repair, whereas untreated tendons showed severe adhesion formation around the repair site. The combination of lubricant and cell treatment resulted in significantly improved digit function, reduced adhesion formation. This novel treatment can address the unmet needs of patients who are unable to commence an early mobilization protocol after flexor tendon repair. PMID:26177854
Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair
Ayad, K. E.; Abd El Mejeed, S. F.; El Gohary, H. M.; Abd Elrahman, M.; Bekheet, A. B.
Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.
Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair
NASA Astrophysics Data System (ADS)
Ayad, K. E.; El Gohary, H. M.; Abd Elrahman, M.; Abd El Mejeed, S. F.; Bekheet, A. B.
Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.
Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft.
Jen, Chi Loong; Tan, James Chung Hui
Neuropathic arthropathy of the elbow is a rare condition, which is disabling and difficult to treat. Initial treatment is conservative and arthrodesis is rarely indicated. We describe an unusual case of progressive unilateral elbow swelling in a 37-year-old female domestic helper. She was found to have neuropathic arthropathy of her right elbow secondary to underlying cervico-thoracic syringomyelia. She underwent decompression of the syringomyelia before underdoing elbow fusion. Her elbow was initially immobilized in a cast to minimize bony fragmentation and soft tissue swelling. Serial X-rays were performed with a regular change of cast as the swelling subsided. When there was no further radiological evidence of bony fragmentation, elbow fusion at 60° was performed using a two-plate technique at 7 months after the initial presentation. With well-preserved ipsilateral hand function, she was could still perform household chores despite having a fused elbow. Radiological evidence of successful elbow fusion was documented at 23 weeks after surgery. There were no complications. If elbow fusion is considered, we recommend a trial of immobilization in the preferred angle of fusion to assess the patient's suitability. Factors such as the young age of a patient and good quality bone may also contribute to the success of the fusion. PMID:27583001
Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft
Jen, Chi Loong
Neuropathic arthropathy of the elbow is a rare condition, which is disabling and difficult to treat. Initial treatment is conservative and arthrodesis is rarely indicated. We describe an unusual case of progressive unilateral elbow swelling in a 37-year-old female domestic helper. She was found to have neuropathic arthropathy of her right elbow secondary to underlying cervico-thoracic syringomyelia. She underwent decompression of the syringomyelia before underdoing elbow fusion. Her elbow was initially immobilized in a cast to minimize bony fragmentation and soft tissue swelling. Serial X-rays were performed with a regular change of cast as the swelling subsided. When there was no further radiological evidence of bony fragmentation, elbow fusion at 60° was performed using a two-plate technique at 7 months after the initial presentation. With well-preserved ipsilateral hand function, she was could still perform household chores despite having a fused elbow. Radiological evidence of successful elbow fusion was documented at 23 weeks after surgery. There were no complications. If elbow fusion is considered, we recommend a trial of immobilization in the preferred angle of fusion to assess the patient's suitability. Factors such as the young age of a patient and good quality bone may also contribute to the success of the fusion PMID:27583001
The effect of digitisation of the humeral epicondyles on quantifying elbow kinematics during cricket bowling.
Eftaxiopoulou, Theofano; Gupte, Chinmay M; Dear, John P; Bull, Anthony M J
In the sport of cricket the objective of the "no-ball" law is to allow no performance advantage through elbow extension during ball delivery. However, recently it has been shown that even bowlers with actions that are considered within the law show some elbow extension. The objective of this study was to investigate: [1] the effect of elbow orientation during anatomical landmark digitisation and [2] the choice of upper arm tracking cluster on the measurement of elbow angles during cricket bowling. We compared the mean elbow angles for four different elbow postures; with the joint flexed at approximately 130°, 90°, in full extension and with the elbow flexed with the humerus internally rotated, and two upper arm clusters in two different situations: [1] during a controlled movement of pure flexion-extension and [2] during cricket bowling. The digitised postures of the anatomical landmarks where the elbow was extended and at 90° of flexion were more repeatable than the other two postures. The recommendation of this study when analysing cricket bowling is to digitise the humeral epicondyles with the joint flexed at 90°, or in full extension, and to relate their positions to an upper arm cluster fixed close to the elbow. PMID:23879677
Diagnosis and Treatment of Work-Related Ulnar Neuropathy at the Elbow.
Carter, Gregory T; Weiss, Michael D; Friedman, Andrew S; Allan, Christopher H; Robinson, Larry
Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome and occurs most commonly at the elbow due to mechanical forces that produce traction or ischemia to the nerve. The primary symptom associated with UNE is diminished sensation or dysesthesias in the fourth or fifth digits, often coupled with pain in the proximal medial aspect of the elbow. Treatment may be conservative or surgical, but optimal management remains controversial. Surgery should include exploration of the ulnar nerve throughout its course around the elbow and release of all compressive structures. PMID:26231962
Comparison of Two Methods of Finite Element Modeling for Elbows with Unequal Wall Thickness
NASA Astrophysics Data System (ADS)
Dong, Junhua; Bao, Xiangfu; Zheng, Xize
In Finite Element Stress Analysis of elbow, its unequal wall thickness can be obtained by two methods: eccentric circle method and multi-spot spline curve drawed according to wall thickness of elbow. In this work, an elbow with constant inner diameter was taken as an illustration and its simulation results based on these two modeling methods were compared under different ratios of central line bend radius to mean diameter of pipe R/D. It is found that modeling method has no effect on the stress analysis results of elbows. But eccentric circle method has the virtue of being easier to implement and can be used without restriction of R/D, so it is an ideal method of finite element modeling for unequal wall thickness elbows. Because the FEA results of equal thickness elbows are recognizably higher than those of elbows with unequal wall thickness, considering non-uniform thickness of elbows is necessary to set up a reasonable safety evaluation for elbows.
Ganglion Cyst Contiguity of the Flexor Hallusis Longus Tendon in a National Swimmer
Çirci, Esra; Özyalvaç, Osman Nuri; Tüzüner, Tolga; Ermutlu, Cenk
Objectives: Tendinopathy of the flexor hallusis longus tendon is common in the athletes. This case is intended to be reported diagnose and treatment ganglion cyst contiguity of the flexor hallucis longus tendon that located atypical region and adversely affect the athlete's training program. Methods: 25-year-old male national swimmer was assessed with a left ankle pain. He had an intensive training program in the pool using pallets at the everyday. Pain in the left ankle was localized posterior and distal of the medial malleolus . Ankle range of motion and muscle strength was full. Neurovascular examination was normal. Radiography with anterior posterior, lateral and oblique analysis was not any unusual finding. In the evaluation with magnetic resonance imaging, thickening of the tendon sheath and effusion around the flexor hallucis longus was revealed and tendon integrity was exact. Results: Conservative treatment was planned. It was applied non-steroidal anti-inflammatory medicine, modification of the training (without or low weight pallet), platelet rich plasma (two weeks, two times peer weeks). During the six-month follow-up the patient's symptoms improved, but with the increased intensity of training at follow-up complaints started again. Professional athletes who did not respond adequately to conservative treatment surgical exposure were planned. Patient is approached the flexor hallucis longus musculotendinous junction from the posteromedial ankle at the level of the posterior talar tubercles. During the tendon exposure cyst was found at the level of talocalcaneal joint. Excision of the cyst was achieved; its size was 5x5 mm, looking transparent, well defined and soft consistency. Tenolysis is accomplished from superior to inferior to the level of the superior calcaneus. A histopathologic examination result of the cyst consistent with ganglion cyst was detected. Sport-specific training program started at the 6 weeks. There was no recurrence during the 6
Irrecoverable pressure loss coefficients for two out-of-plane piping elbows at high Reynolds number
Coffield, R.D.; Hammond, R.B.; McKeown, P.T.
Pressure drops of multiple piping elbows were experimentally determined for high Reynolds number flows. The testing described has been performed in order to reduce uncertainties in the currently used methods for predicting irrecoverable pressure losses and also to provide a qualification database for computational fluid dynamics (CFD) computer codes. The earlier high Reynolds number correlations had been based on extrapolations over several orders of magnitude in Reynolds number from where the original database existed. Recent single elbow test data shows about a factor of two lower elbow pressure loss coefficient (at 40x 106 Reynolds number) than those from current correlations. This single piping elbow data has been extended in this study to a multiple elbow configuration of two elbows that are 90o out-of-plane relative to each other. The effects of separation distance and Reynolds number have been correlated and presented in a form that can be used for design application. Contrary to earlier extrapolations from low Reynolds numbers (Re c 1.0x 106), a strong Reynolds number dependence was found to exist. The combination of the high Reynolds number single elbow data with the multiple elbow interaction effects measured in this study shows that earlier design correlations are conservative by significant margins at high Reynolds numbers. Qualification of CFD predictions with this new high Reynolds number database will help guide the need for additional high Reynolds number testing of other piping configurations. The study also included velocity measurements at several positions downstream of the first and second test elbows using an ultrasonic flowmeter. Reasonable agreement after the first test elbow was found relative to flow fields that are known to exist from low Reynolds number visual tests and also from CFD predictions. This data should help to qualify CFD predictions of the three-dimensional flow stream downstream of the second test elbow.
Risk of nerve injury during arthroscopy portal placement in the elbow joint: A cadaveric study
Chaware, Prashant N; Santoshi, John A; Pakhare, Abhijit P; Rathinam, Bertha A D
Background: Elbow arthroscopy has become a routine procedure now. However, placing portals is fraught with dangers of injuring the neurovascular structures around elbow. There are not enough data documenting the same amongst the Indians. We aimed to determine the relative distances of nerves around the elbow to the arthroscopy portals and risk of injury in different positions of the elbow. Materials and Methods: Six standard elbow arthroscopy portals were established in 12 cadaveric upper limbs after joint distension. Then using standard dissection techniques all the nerves around the elbow were exposed, and their distances from relevant portals were measured using digital vernier caliper in 90° elbow flexion and 0° extension. Descriptive statistical analysis was used for describing distance of the nerves from relevant portal. Wilcoxon-signed rank test and Friedman's test were used for comparison. Results: There was no major nerve injury at all the portals studied in both positions of the elbow. The total incidence of cutaneous nerve injury was 8.3% (12/144); medial cutaneous nerve of forearm 10/48 and posterior cutaneous nerve of forearm 2/24. No significant changes were observed in the distance of a nerve to an individual portal at 90° flexion or 0° extension position of the elbow. Conclusion: This study demonstrates the risk of injury to different nerves at the standard portals of elbow arthroscopy. In practice, the actual incidence of nerve injury may still be lower. We conclude that elbow arthroscopy is a safe procedure when all precautions as described are duly followed. PMID:26952128
Motor and sensory ulnar nerve conduction velocities: effect of elbow position.
Harding, C; Halar, E
Ulnar motor and sensory nerve conduction velocities (NCV) were studied bilaterally in 20 able-bodied subjects for below elbow (BE) and across elbow (AE) segments to assess the effect of 4 different elbow positions on NCV (0 degrees, 45 degrees, 90 degrees, and 135 degrees). Although constant skin stimulation marker points were used, the AE segment length became progressively longer with increased elbow flexion. At 0 degrees flexion the AE segment motor NCV was found to be slower, and at 45 degrees it was found faster than the BE NCV. At each subsequent elbow flexion position (90 degrees and 135 degrees) there was an erroneous increase in motor and sensory NCV for the AE segments (p less than 0.01). This increase in AE NCV with elbow flexion was mostly due to stretching of skin over the flexed elbow. The nerve itself was observed in 4 cadaver specimens to slide distally with respect to the above elbow skin marker. Since 45 degrees elbow flexion was the position of least variation in motor NCV for AE and BE segments, this degree of elbow flexion appears to be optimum. From these measurements and from literature review neither short AE segment length (less than 10 cm) nor long AE segment length (greater than 15 cm) is optimum for measurement of AE NCV in the assessment of compressive neuropathy at the elbow. Short segments are subject to increased NCV variation while long segments may not detect pathological slowing of NCV only occurring over a short portion of the nerve. PMID:6847360
Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel.
Main, Erin K; Goetz, Jessica E; Rudert, M James; Goreham-Voss, Curtis M; Brown, Thomas D
Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome. PMID:21194695
Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players
Chalker, Wade J.; Shield, Anthony J.; Opar, David A.
Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler's and batter's mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries. PMID:26925310
Electromyographic analysis of elbow function in tennis players.
Morris, M; Jobe, F W; Perry, J; Pink, M; Healy, B S
Muscle activity about the elbow during tennis strokes in nine professional and collegiate level players was studied using indwelling EMG and high speed photography. Eight muscles were evaluated for the serve, forehand, and backhand strokes. The serve was divided into six stages and the ground strokes into four stages. EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity was obtained. Analysis of variance and Turkey tests were then done to assess statistical significance (P less than 0.05). The ground strokes showed low activity in all muscles tested during the preparation phase. During the acceleration phase, both the backhand and forehand showed a generalized increase in all muscle activity. Both strokes showed marked activity of the wrist extensors and, in addition, the forehand showed high activity in the brachialis and biceps. In the follow-through phase, there was a generalized decrease in muscle activity. The serve showed low activity in all muscles tested during the wind-up phase. The wrist extensors increased their activity in the cooking phase, with marked activity in late cooking. The pronator teres and the triceps showed increased activity in the acceleration phase. Follow-through phase showed low muscle activity except for the biceps, which increased in late follow-through. In conclusion, the muscles of the elbow help stabilize the elbow as a unit during the ground strokes in these high level players. Power in the serve comes from increased activity in the triceps and pronator teres. The predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury. PMID:2757127
Short interspike intervals and double discharges of anconeus motor unit action potentials for the production of dynamic elbow extensions.
Harwood, B; Rice, C L
Incidence of double discharges (DDs; >100 Hz) and short interspike intervals (ISIs; >50 to <100 Hz) is reported to vary widely among different muscles and tasks, with a higher incidence in motor unit (MU) trains of fast muscles and for the production of fast contractions in humans. However, it is unclear whether human muscles with a large composition of slower motor units exhibit DDs or short ISIs when activated with maximal synaptic drive, such as those required for maximal velocity dynamic contractions. Thus the purpose of this study was to determine the effect of increasing peak contraction velocity on the incidence of DDs and short ISIs in the anconeus muscle. Seventeen anconeus MUs in 10 young males were recorded across dynamic elbow extensions ranging from low submaximal velocities (16% of maximal velocity) up to maximal velocities. A low incidence of DDs (4%) and short ISIs (29%) was observed among the 583 MU trains recorded. Despite the low incidence in individual MU trains, a majority (71% and 94%, respectively) of MUs exhibited at least one DD or short ISI. The number of short ISIs shared no variance with MU recruitment threshold (R(2) = 0.02), but their distribution was skewed toward higher peak velocities (G = -1.26) and a main effect of peak elbow extension velocity was observed (P < 0.05). Although a greater number of short ISIs was observed with increasing velocity, the low incidence of DDs and short ISIs in the anconeus muscle is likely related to the function of the anconeus as a stabilizer rather than voluntary elbow extensor torque and velocity production. PMID:24554783
Writing in the American Grain: Peter Elbow's and David Bartholomae's Emersonian Pedagogies of Empowerment.
ERIC Educational Resources Information Center
Wiley, Mark
Argues that, although Peter Elbow's and David Bartholomae's pedagogies attempt in different ways to authorize students to write, both rely on the experience and resistance to language as the primary means of empowerment. Suggests that Elbow and Bartholomae must continually defer authority, keeping it suspended between experience and its…
Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow
Shamsoddini, Alireza; Hollisaz, Mohammad Taghi
Background Tennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow. Objectives This study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow. Patients and Methods Thirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively. Results Among the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001. Conclusions The taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients. PMID:24350156
78 FR 41290 - Establishment of Class E Airspace; Elbow Lake, MN
Federal Register 2010, 2011, 2012, 2013, 2014
... establish Class E airspace at Elbow Lake Municipal--Pride of the Prairie Airport, Elbow Lake, MN (78 FR... 12866; (2) is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR 11034... read as follows: Authority: 49 U.S.C. 106(g), 40103, 40113, 40120; E. O. 10854, 24 FR 9565, 3 CFR,...
Fracture behavior of circumferentially surface-cracked elbows. Technical report, October 1993--March 1996
Kilinski, T.; Mohan, R.; Rudland, D.; Fleming, M.
This report presents the results from Task 2 of the Second International Piping Integrity Research Group (IPIRG-2) program. The focus of the Task 2 work was directed towards furthering the understanding of the fracture behavior of long-radius elbows. This was accomplished through a combined analytical and experimental program. J-estimation schemes were developed for both axial and circumferential surface cracks in elbows. Large-scale, quasi-static and dynamic, pipe-system, elbow fracture experiments under combined pressure and bending loads were performed on elbows containing an internal surface crack at the extrados. In conjunction with the elbow experiments, material property data were developed for the A106-90 carbon steel and WP304L stainless steel elbow materials investigated. A comparison of the experimental data with the maximum stress predictions using existing straight pipe fracture prediction analysis methods, and elbow fracture prediction methods developed in this program was performed. This analysis was directed at addressing the concerns regarding the validity of using analysis predictions developed for straight pipe to predict the fracture stresses of cracked elbows. Finally, a simplified fitting flaw acceptance criteria incorporating ASME B2 stress indices and straight pipe, circumferential-crack analysis was developed.
Conservative management of the post-traumatic stiff elbow: a physiotherapist's perspective.
Jones, Val
Elbow stiffness is a common consequence following trauma with the management of this condition posing a challenge to therapists and surgeons alike. This paper discusses the role of conservative treatment, such as exercise and splinting, in the prevention and management of the stiff elbow, along with a review of available evidence, to justify their usage. PMID:27583012
Conservative management of the post-traumatic stiff elbow: a physiotherapist's perspective
Elbow stiffness is a common consequence following trauma with the management of this condition posing a challenge to therapists and surgeons alike. This paper discusses the role of conservative treatment, such as exercise and splinting, in the prevention and management of the stiff elbow, along with a review of available evidence, to justify their usage.
Surgical Procedures of the Elbow: A Nationwide Cross-Sectional Observational Study in the United States
Kinaci, Ahmet; Neuhaus, Valentin; Ring, David
Background: Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States. Methods: We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US. Results: An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis) and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular). Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries. Conclusions: Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable that some of the most common elbow surgeries (those that address enthesopathy and radial head fracture) are some of the most variably utilized and debated. PMID:25692163
A Glomus Tumour of the Elbow: A Case Report and Review of the Literature
Anley, Cameron; Vrettos, Basil; Roche, Stephen; Solomons, Michael
Extradigital glomus tumours are relatively uncommon. We present a case report of a glomus tumour of the elbow and review of the literature with regards to the clinical features, work-up and management of these tumours, to highlight the importance of considering a glomus tumour as part of the differential diagnosis in patient with atypical pain around the elbow.
Features selection and classification to estimate elbow movements
NASA Astrophysics Data System (ADS)
Rubiano, A.; Ramírez, J. L.; El Korso, M. N.; Jouandeau, N.; Gallimard, L.; Polit, O.
In this paper, we propose a novel method to estimate the elbow motion, through the features extracted from electromyography (EMG) signals. The features values are normalized and then compared to identify potential relationships between the EMG signal and the kinematic information as angle and angular velocity. We propose and implement a method to select the best set of features, maximizing the distance between the features that correspond to flexion and extension movements. Finally, we test the selected features as inputs to a non-linear support vector machine in the presence of non-idealistic conditions, obtaining an accuracy of 99.79% in the motion estimation results.
Novel technique for ulnar collateral ligament reconstruction of the elbow.
Acevedo, Daniel C; Lee, Brian; Mirzayan, Raffy
Ulnar collateral ligament (UCL) reconstruction of the elbow has been shown to restore function in overhead athletes with valgus instability. Since the initial description of using bone tunnels for reconstruction, many modifications to the surgical technique have been introduced, including the modified Jobe technique, the docking technique, fixation with interference screws, and button fixation. The authors introduce a technique that uses a button on each of the humeral and ulnar sides for fixation. This method allows proper tensioning of the graft and provides immediate secure fixation that relies on metal implants as opposed to sutures over bone bridges alone. PMID:23127439
Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation
Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy
We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved. PMID:24739650
High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis
Tan, Ai Lyn; Fukuba, Eiji; Halliday, Nicola Ann; Tanner, Steven F; Emery, Paul; McGonagle, Dennis
Objective Dactylitis is a hallmark of psoriatic arthritis (PsA) where flexor tenosynovitis is common. This study explored the microanatomical basis of dactylitis using high-resolution MRI (hrMRI) to visualise the small entheses around the digits. Methods Twelve patients with psoriatic dactylitis (4 fingers, 8 toes), and 10 healthy volunteers (6 fingers, 4 toes) had hrMRI of the digits using a 'microscopy' coil and contrast enhancement. All structures were evaluated including the tendons and ligaments, related enthesis organs, pulleys, volar/plantar plates and tendon sheaths. Results In dactylitis, collateral ligament enthesitis was seen in nine digits (75%), extensor tendon enthesitis in six digits (50%), functional enthesitis (5 digits, 42%), abnormal enhancement at the volar plates (2/5 joints, 40%) and the plantar plate (1/5 joints, 20%). Nine cases (75%) demonstrated flexor tenosynovitis, with flexor tendon pulley/flexor sheath microenthesopathy observed in 50% of all cases. Less abnormalities which were milder was observed in the normal controls, none of whom had any signal changes in the tendon pulleys or fibrous sheaths. Conclusions This study provides proof of concept for a link between dactylitis and 'digital polyenthesitis' including disease of the miniature enthesis pulleys of the flexor tendons, further affirming the concept of enthesitis in PsA. PMID:25261575
Open antero-lateral dislocation of the elbow. A case report
Alonso, Juan A; Roy, Bibas R; Shaw, David L
Background Open dislocations are infrequent, often associated with damage to the neuro vascular structures. We present an unusual case of an open antero-lateral dislocation of the elbow, which was not associated with any vascular or neural injury. Case presentation A 34 year female dance instructor sustained an open dislocation of her elbow. Surgical exploration was undertaken. No major neurovascular injury was present. There was almost complete disruption of all the muscular and ligamentous attachments to the distal humerus and the proximal radius and ulna, which were not formally repaired during surgery. The elbow was found to be very unstable, and was placed in a back slab. The functional recovery was complete in about six months, the patient regaining full range of elbow movement. Elbow dislocations without associate fractures are adequately treated by manipulation and reduction, in spite of the almost complete disruption of the soft tissues around the joint. PMID:11806760
Magnetic resonance imaging findings in 46 elbows with a radial head fracture
Turkenburg, Jeroen L; van Riet, Roger P; Vroemen, Jos P A M; Eygendaal, Denise
Background and purpose Radial head fractures are common, and may be associated with other injuries of clinical importance. We present the results of a standard additional MRI scan for patients with a radial head fracture. Patients and methods 44 patients (mean age 47 years) with 46 radial head fractures underwent MRI. 17 elbows had a Mason type-I fracture, 23 a Mason type-II fracture, and 6 elbows had a Mason type-III fracture. Results Associated injuries were found in 35 elbows: 28 elbows had a lateral collateral ligament lesion, 18 had capitellar injury, 1 had a coronoid fracture, and 1 elbow had medial collateral ligament injury. Interpretation The incidence of associated injuries with radial head fractures found with MRI was high. The clinical relevance should be investigated. PMID:20450424
Complete Brachial Artery Transection following closed Posterior Elbow Dislocation: A Rare Case Report
C, JayanthKumar B; Sampath, Deepak; N, Hanumantha Reddy; Motukuru, Vishnu
Introduction: Vascular injury associated withclosed posterior elbow dislocations is rare and it usually occurs along with open dislocation, anterior dislocation, penetrating injuries, dislocations associated with fracture. We report such a case of closed posterior elbow dislocation with complete brachial artery rupture. Case Report: A 58 years old lady sustained posterior dislocation of right elbow following a fall at home. She presented three days later with complaints of severe pain, swelling around the right elbow and numbness of fingers following a closed reduction done elsewhere. Computed graft angiography showed complete transection of brachialartery. Patient was treated with thrombectomy, right great saphenous vein graft interposition repair of brachial artery and forearm fasciotomy. Conclusion: Vascular injuries associated with posterior elbow dislocation are very rare, but high index of suspicion of arterial injury need to be thought off and repeated vascular examination during pre and post reduction stage should be done to prevent complications. PMID:27299092
Recovery of elbow function in voluntary positioning of the hand following hemiplegia due to stroke.
Wing, A M; Lough, S; Turton, A; Fraser, C; Jenner, J R
Elbow movement during voluntary positioning of the hand (with the arm supported against gravity) is described in a longitudinal study of five patients recovering from hemiplegia due to stroke. Over a twelve month period, four of the patients improved their speed of movement, three exhibiting slightly better recovery of elbow extension, one of flexion. In some instances co-contraction of the elbow agonist and antagonist (measured just before the onset of movement) decreased with time after stroke. The effects of contrasting movements at the shoulder on elbow movement were also studied. Estimates of recovery were generally similar whether patients kept the shoulder still or made movements that were synergic or counter-synergic to those of the elbow. PMID:2313299
Simplified inelastic analysis procedure to evaluate a butt-welded elbow end
Dhalla, A.K.
In a thin-walled piping network, the end of an elbow welded to a straignt pipe constitutes one of the highly stressed cross-sections that require structural evaluation. Explicit rules are not provided in the ASME Code for structural evaluation of the elbow ovalization and fabrication effects at the welded end. This paper presents a conservative semi-analytical procedure that can be used with simplified inelastic analysis to evaluate the elbow cross section welded to the straight pipe. The concept of carry-over factors is used to obtain ovalization stresses or strains at the elbow end. The stresses introduced by material and geometric nonuniformities in the fabrication process are then added to the ovalization stresses to complete structural evluation of the girth butt-welded elbow joint.
Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study.
Ettema, Anke M; Zhao, Chunfeng; Amadio, Peter C; O'Byrne, Megan M; An, Kai-Nan
The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the ulnar tenosynovial bursa. Fibrosis of the SSCT may well affect its gliding characteristics. To investigate this possibility, the relative motion of the flexor tendon and VS was observed during finger flexion in patients undergoing carpal tunnel surgery, and for comparison in hands without CTS, in an in vitro cadaver model. We used a camera to document the gliding motion of the middle finger flexor digitorum superficialis (FDS III) tendon and SSCT in three patients with CTS during carpal tunnel release and compared this with simulated active flexion in three cadavers with no antemortem history of CTS. The data were digitized with the use of Analyze Software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN). In the CTS patients, the SSCT moved en bloc with the tendon, whereas, in the controls the SSCT moved smoothly and separately from the tendon. The ratio of VS to tendon motion was higher for the patients than in the cadaver controls. These findings suggest that in patients with CTS the synovial fibrosis has altered the gliding characteristics of the SSCT. The alterations in the gliding characteristics of the SSCT may affect the ability of the tendons in the carpal tunnel to glide independently from each other, or from the nearby median nerve. These abnormal tendon mechanics may play a role in the etiology of CTS. PMID:16944527
A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis
Background Tenosynovitis is widely accepted to be common in rheumatoid arthritis (RA) and postulated to be the first manifestation of RA, but its true prevalence in early disease and in particular the hand has not been firmly established. The aims of this study were first to investigate the frequency and distribution of finger flexor tenosynovitis using ultrasound in early arthritis, second to compare clinical examination with ultrasound (US) using the latter as the gold standard. Methods 33 consecutive patients who had who were initially diagnosed with polyarthritis and suspected of polyarthritis and clinical suspicion of inflammatory arthritis of the hands and wrists were assessed during consecutive, routine presentations to the rheumatology outpatient clinic. We scanned a total of 165 finger tendons and subsequent comparisons were made using clinical examination. Results Flexor tenosynovitis was found in 17 patients (51.5%) on ultrasound compared with 16 (48.4%) of all patients on clinical examination. Most commonly damaged joint involved on US was the second finger followed by the third, fifth, and fourth. Both modalities demonstrated more pathology on the second and third metacarpophalangeal (MCP) compared with the fourth and fifth MCP. A joint-by-joint comparison of US and clinical examination demonstrated that although the sensitivity, specificities and positive predictive values of clinical examination were relatively high, negative predictive value of clinical examination was low (0.23). Conclusions Our study suggest that clinical examination can be a valuable tool for detecting flexor disease in view of its high specificity and positive predictive values, but a negative clinical examination does not exclude inflammation and an US should be considered. Further work is recommended to standardize definitions and image acquisition for peritendinous inflammation for ultrasound. PMID:21549008
Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training
Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett
Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0–100, 100–200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114
Acute calcific tendinitis of the flexor pollicis longus in an 8-year-old boy.
Kheterpal, Arvin; Zoga, Adam; McClure, Kristen
Calcific tendinitis is a common source of musculoskeletal pain in adults; however, it is rarely encountered in children. Calcific tendinitis is the most commonly encountered manifestation of hydroxyapatite deposition disease, in which calcium hydroxyapatite crystal deposition occurs in tendons. It may cause acute or chronic pain, or may be entirely asymptomatic. We describe a case of acute calcific tendinitis of the flexor pollicis longus tendon in an 8-year-old boy, who initially presented to our department for workup of a mass felt along the volar aspect of the right wrist. PMID:24867130
Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; de Sousa, Augusto Tadeu Barros; Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Ikemoto, Roberto Yukio; Murachovsky, Joel; Matsumoto, Marcelo Hide; Tamaoki, Marcel Jun Sugawara; Neto, Arnaldo Amado Ferreira
Objective: To describe the initial experience of four orthopedic clinics from using Bi-Contact® total elbow arthroplasty (TEA), reporting the results and complications of the procedure. Methods: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. Results: The majority of the patients were female (74%), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83%), rheumatoid arthritis (32.61%), primary osteoarthrosis (8.7%), acute fractures (6.52%) and heterotopic ossification (2.17%). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57% of the cases, and the main ones were infection (28.26%), need for revision (28.26%), intraoperative fracture (15.22%) and aseptic loosening (15.22%). Conclusion: Bi-Contact® TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture. PMID:27027055
The treatment of post-traumatic stiffness of the elbow.
Pignatti, G; Ferrari, D; Tigani, D; Scardovi, M; Trentanti, P; Trentani, F; Giunti, A
The authors present the results observed in 12 patients affected with post-traumatic stiffness of the elbow treated by an external fixator in distraction to obtain functional recovery of range of movement; in all of the cases anterior and posterior release and resection of the apex of the olecranon was carried out, while in 2 cases interposition arthroplasty with freeze-dried dura madre was associated. The series includes 12 cases with a long-term follow-up that ranges from 8 to 33 months after surgery. The mean arch of movement during the preoperative phase was 35 degrees (minimum 0 degree-maximum 90 degrees) in flexion extension and 80 degrees (minimum 0 degree-maximum 150 degrees) in pronosupination. Recovery of mean joint excursion in flexion-extension was 91 degrees and in pronosupination it was 127 degrees. Complications included loosening of the nails in 2 cases, breakage of the nails in 1 case, and transitory deficit of the ulnar nerve in 4 cases. A total of 11 patients (91.66%) declared that they were satisfied with the considerable improvement in their ability to do daily activities. The results of arthroplasty in distraction in the elbow are satisfactory even if much attention must be paid to the selection of the patients because of the intense collaboration that is required during postoperative rehabilitation. PMID:11569362
Kinematic and Electromyographic Analysis of Elbow Flexion During Inertial Exercise
Tracy, James E.; Obuchi, Shuchi; Johnson, Ben
Inertial exercise protocols are currently used clinically to improve and restore normal muscle function even though research to substantiate their effectiveness cannot be cited in the literature. The purpose of this study was to compare simultaneous kinematic and electromyographic (EMG) data obtained from 12 subjects during elbow flexion on the Impulse Inertial Exercise System. Testing sessions consisted of inertial exercise performed using phasic and tonic techniques with loads of: a) 0 kg, b) 2.27 kg, c) 4.54 kg, d) 6.80 kg, e) 9.07 kg. Greater peak angular velocities, peak platform accelerations (change in velocity of platform during elbow flexion), mean and peak triceps brachii muscle EMG activity, and less range of motion were observed during phasic exercise. There was also a general trend for peak angular velocities and peak platform acceleration to increase as the load decreased. No significant difference in mean or peak EMG activity of the biceps brachii muscle was seen between techniques. Clinicians and athletic trainers using inertial exercise should consider both the exercise technique and load characteristics when designing protocols to meet the specific needs of patients. Imagesp255-a PMID:16558345
A splint for controlled active motion after flexor tendon repair. Design, mechanical testing, and preliminary clinical results.
Chow, S P; Stephens, M M; Ngai, W K; So, Y C; Pun, W K; Chu, M; Crosby, C
A splint for controlled active motion after flexor tendon repair is described. It incorporates a single core-coated elastic band passing around a palmar pulley and attached proximally to a spring wire. Its mechanical properties were tested against six other systems. The tension in various systems all rose near full extension. However, the palmar pulley, the spring wire, and the elastic band each could lower the tension significantly. When the bending moments at the interphalangeal joints were measured, all systems produced a peak during the latter part of extension. With the palmar pulley, spring wire, and elastic band, the rise was minimal and in fact, the bending moments diminished near full extension. Initial results in 28 flexor tendon repairs using this splint showed less flexion contracture when compared with 78 flexor tendon repairs using a standard rubber band anchored at the wrist. PMID:2380531
Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori
Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques
Impaired Foot Plantar Flexor Muscle Performance in Individuals With Plantar Heel Pain and Association With Foot Orthosis Use.
McClinton, Shane; Collazo, Christopher; Vincent, Ebonie; Vardaxis, Vassilios
Study Design Controlled laboratory study. Background Plantar heel pain is one of the most common foot and ankle conditions seen in clinical practice, and many individuals continue to have persisting or recurrent pain after treatment. Impaired foot plantar flexor muscle performance is a factor that may contribute to limited treatment success, but reliable methods to identify impairments in individuals with plantar heel pain are needed. In addition, foot orthoses are commonly used to treat this condition, but the implications of orthosis use on muscle performance have not been assessed. Objectives To assess ankle plantar flexor and toe flexor muscle performance in individuals with plantar heel pain using clinically feasible measures and to examine the relationship between muscle performance and duration of foot orthosis use. Methods The rocker-board plantar flexion test (RBPFT) and modified paper grip test for the great toe (mPGTGT) and lesser toes (mPGTLT) were used to assess foot plantar flexor muscle performance in 27 individuals with plantar heel pain and compared to 27 individuals without foot pain who were matched according to age, sex, and body mass. Pain ratings were obtained before and during testing, and self-reported duration of foot orthosis use was recorded. Results Compared to the control group, individuals with plantar heel pain demonstrated lower performance on the RBPFT (P = .001), the mPGTGT (P = .022), and the mPGTLT (P = .037). Longer duration of foot orthosis use was moderately correlated to lower performance on the RBPFT (r = -0.52, P = .02), the mPGTGT (r = -0.54, P = .01), and the mPGTLT (r = -0.43, P = .03). Conclusion Ankle plantar flexor and toe flexor muscle performance was impaired in individuals with plantar heel pain and associated with longer duration of self-reported foot orthosis use. J Orthop Sports Phys Ther 2016;46(8):681-688. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6482. PMID:27374013
Healthy Older Adults Have Insufficient Hip Range of Motion and Plantar Flexor Strength to Walk Like Healthy Young Adults
Anderson, Dennis E.; Madigan, Michael L.
Limited plantar flexor strength and hip extension range of motion (ROM) in older adults are believed to underlie common age-related differences in gait. However, no studies of age-related differences in gait have quantified the percentage of strength and ROM used during gait. We examined peak hip angles, hip torques and plantar flexor torques, and corresponding estimates of functional capacity utilized (FCU), which we define as the percentage of available strength or joint ROM used, in ten young and ten older healthy adults walking under self-selected and controlled (slow and fast) conditions. Older adults walked with about 30% smaller hip extension angle, 28% larger hip flexion angle, 34% more hip extensor torque in the slow condition, and 12% less plantar flexor torque in the fast condition than young adults. Older adults had higher FCU than young adults for hip flexion angle (47% vs. 34%) and hip extensor torque (48% vs. 27%). FCUs for plantar flexor torque (both age groups) and hip extension angle (older adults in all conditions; young adults in self-selected gait) were not significantly <100%, and were higher than for other measures examined. Older adults lacked sufficient hip extension ROM to walk with a hip extension angle as large as that of young adults. Similarly, in the fast gait condition older adults lacked the strength to match the plantar flexor torque produced by young adults. This supports the hypothesis that hip extension ROM and plantar flexor strength are limiting factors in gait and contribute to age-related differences in gait. PMID:24461576
Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries
Sade, Ilgin; İnanir, Murat; Şen, Suzan; Çakmak, Esra; Kablanoğlu, Serkan; Selçuk, Barin; Dursun, Nigar
[Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs.
Musical beat influences corticospinal drive to ankle flexor and extensor muscles in man.
Wilson, Emily M F; Davey, Nick J
Body movements in man are frequently observed in relation to musical rhythms. In this study we have investigated the effect of strongly rhythmic music on corticospinal drive to the ankle extensor and flexor muscles involved in foot tapping. Surface electromyographic (EMG) recordings were made from tibialis anterior (TA) and lateral gastrocnemius (LGN) muscles in 12 normal subjects. Rock music with a strong rhythmic beat or white noise was played. Transcranial magnetic stimulation (TMS) was delivered to the motor cortex in time with the music to produce motor evoked potentials (MEPs) in both muscles while relaxed. During white noise trials nine subjects showed a significant correlation of MEP areas in TA with LGN, compared with only three subjects during music. Overall, there was a significant decrease in the correlation coefficient during music. We conclude that correlated variations in MEP areas between the muscles seen during white noise can be destroyed in the presence of music. This may be due to sub-threshold variations in corticospinal excitability to ankle extensors and flexors, which are time-locked to the musical beat but out of phase with one another. PMID:11909649
Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence
Elliot, David; Giesen, Thomas
As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence. PMID:24459333
A classic improved: minor tweaks yield major benefits in crayfish slow-flexor preparations.
Weller, Cynthia; Hochhaus, A Maren; Wright, T Michael; Mulloney, Brian
Action potentials and the postsynaptic potentials they evoke fill the pages of neuroscience textbooks, but students have relatively few opportunities to record these phenomena on their own. However, the act of making such recordings can be key events in a student's scientific education. The crayfish abdominal slow flexor muscle system is a well-established platform for recording spikes and PSPs. It enables students to see nerves and the muscles they innervate, record spontaneous spikes from several motor axons in these nerves as well as PSPs in their postsynaptic muscle fibers, and interpret these recordings quantitatively. Here we describe an improved method for preparing the slow-flexor system for recording that employs transmitted illumination through the stereo microscope's conventional substage lighting. Oblique transmitted lighting allows students to see the nerve and muscles fibers in each segment clearly and position recording electrodes accurately under visual control. Because students can see the nerves, muscles, and recording electrodes, broken electrode tips are relatively uncommon and the first successful recordings come more quickly. Many kinds of neurons in the CNS have the same pattern of multineuronal, multiterminal innervation that occurs on these muscle fibers. To visualize these innervation patterns on these fibers, we describe an immunohistochemical protocol that labels the GABAergic inhibitory motor axon and all the synaptic vesicles in the synaptic terminals on these muscle fibers. Dual-color images reveal extensive branching of the axons and fields of presynaptic terminals, only some of which are double-labeled for GABA. PMID:25838805
Development of a synthetic replacement for the flexor tendon pulleys--an experimental study.
Peterson, W W; Manske, P R; Lesker, P A; Kain, C C; Schaefer, R K
A method was developed to reconstruct the fibro-osseous pulleys with Nitex, a synthetic material. Nitex is a closely woven fabric constructed from monofilament nylon fibers. Six adult monkeys (24 digits) had excision of the A1 and A2 pulleys; this was followed by reconstruction of the A2 pulley with the Nitex synthetic material. The animals were killed, two at a time, at 4, 8, and 12 weeks to evaluate the effectiveness of the Nitex pulleys. Flexor tendon function was assessed by biomechanical methods with a tensile testing machine to measure the tendon excursion and the work of flexion (the area under the force-excursion curve) necessary to fully flex each digit; these parameters revealed that the Nitex pulleys were capable of preventing tendon bow-stringing and did not significantly impair tendon gliding. The breaking strength of the Nitex pulleys was comparable to that of normal A2 pulleys (for monkeys weighing less than 10 kg) and it was sufficient to allow immediate mobilization of the digits postoperatively without fear of pulley rupture. Histologic examination showed minimal foreign body reaction around the Nitex, and the gliding surface of a Nitex pulley was found to be covered with a smooth layer of fibrous tissue with minimal adhesions to the underlying flexor tendon. The synthetic Nitex pulley appears to have the potential to function as an effective fibro-osseous pulley replacement. PMID:3086425
Debridement Arthroplasty for Post-traumatic Stiff Elbow: Intraoperative Factors Affecting the Clinical Results of Surgical Treatment
Cho, Nam Su; Lim, Chan Teak; Yi, Jin Woong
Background This study evaluated the outcomes of debridement arthroplasty for stiff elbows, as well as the factors affecting clinical outcomes after surgical treatment. Methods Eighteen patients with post-traumatic stiff elbows were treated with debridement arthroplasty using a posterior approach. The mean patient age was 33 years (range, 16 to 59 years), and the average follow-up period was 59 months (range, 24 to 141 months). The patient's ability to perform activities of daily living, including combing their hair, feeding themselves, performing hygiene, and putting on shirt and shoes, were evaluated using the Mayo Elbow Performance Score. Results At the last follow-up, 16 elbows had painless motion. Two patients continued to complain of mild intermittent pain. The flexion and extension improved to 121° and 10° after surgery, respectively, indicating an average 34° increase in elbow flexion range and an average 25° increase in elbow extension range (p < 0.001, p < 0.001). The Mayo Elbow Performance Score at the last follow-up was excellent in nine elbows (50%) and good in nine elbows (50%). Conclusions Debridement arthroplasty is a predictable procedure for the treatment of intractable stiff elbow, provided that the elbow is stable and congruous. PMID:19884994
Estimates of genetic parameters for hip and elbow dysplasia in Finnish Rottweilers.
Mäki, K; Liinamo, A E; Ojala, M
Data from 2,764 Rottweiler dogs born from 1987 to 1996 were analyzed with a Restricted Maximum Likelihood procedure using a mixed linear animal model to obtain variance component estimates for hip and elbow dysplasia. The data included 2,764 hip dysplasia and 2,278 elbow dysplasia records. Hip joints were scored as normal (0), borderline (1), slight (2), moderate (3), and severe (4, 4.5, and 5) hip dysplasia. Elbow joints were graded normal or borderline (0), slight (1), moderate (2), and severe (3) elbow dysplasia. The mean for the hip scores was 1.07 and for the elbow scores .60. Environmental effects influencing hip dysplasia were age, birth year, birth year x season interaction, and experience of the veterinarian responsible for x-raying the dog. For elbow dysplasia, statistically significant effects were age, birth year, sex of the dog, and panelist responsible for each screening. Estimates of heritability for hip and elbow dysplasia were .58 +/- .04 and .31 +/- .04, respectively, with a genetic correlation of .37 +/- .08 between the traits. Genetic improvement of almost one genetic standard deviation was observed in both traits during the 10 yr covered by the data. PMID:10834565
Unstable elbow dislocations: the description and cadaveric feasibility study of a new surgical technique
Harris, Mark; Bishop, Timothy; Bernard, Jason
Introduction: A small proportion of simple elbow dislocations are grossly unstable and joint congruence is not maintained after reduction. In this rare situation operative treatment is indicated. We describe a new intra articular reconstruction that utilises a slip of triceps tendon to provide immediate stability to the elbow. Methods: We assessed 20 cadaveric elbows, measuring the length of triceps tendon available and required to complete the reconstruction. We then sequentially sectioned the ligamentous stabilisers of an elbow before performing the new technique. We measured the displacement and angulation possible at the elbow before and after the reconstruction. Results: All 20 elbows had sufficient triceps tendon length to complete the new technique. Prior to the reconstruction greater than 30 mm of joint distraction and 90 degrees varus or valgus angulation was possible. Following the reconstruction it was not possible to re-dislocate the elbow. Only 2 mm of joint distraction and 10 degrees of varus or valgus angulation were possible with the triceps graft fixed in position. Discussion: This novel technique elegantly avoids many of the problems associated with current methods. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs. PMID:27163079
Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; Silva, Luciana Andrade da; Junior, Nelson Gennaro; Checchia, Sergio Luiz
Objective: Assess the results of the elbow/fascia lata interposing arthroplasty technique associated to the use of a hinged external fixator in the treatment of stiff elbow. Methods: Between 2001 and 2006, five cases of stiff elbow were operated and followed up by the Shoulder and Elbow Group of the Santa Casa Misericórdia de São Paulo Medical Sciences School, establishing the following as inclusion criteria: patients with below-functional elbow range of motion associated to degeneration on that joint, for whom total prosthesis had not been indicated. Patients' ages ranged from 21 to 55 years (mean: 38). Male gender was prevalent (four cases), and, in all cases, the dominant side was operated. Concerning etiology, two cases of infectious arthritis sequels, one post-trauma sequel, and two rheumatoid arthritis were found. Preoperative range of motion ranged from 20° to 30° of flexion-extension; in two cases, fixed contracture existed in flexion at 30° and 65°. The patients were assessed according to Bruce-modified AMA criteria. Results: The mean follow up time was 54 months. All patients showed improvement of the Bruce index, which, preoperatively, was 43.5, increasing to 88.2 postoperatively. We found two excellent cases, one good, one fair, and one poor. Conclusion: Fascia lata interposing arthroplasty associated to the use of a dynamic external fixator on stiff elbows is a feasible alternative for patients not indicated to total elbow arthroplasty. PMID:27022516
Arthroscopic debridement in the treatment of patients with osteoarthritis of the elbow, based on computer simulation.
Miyake, J; Shimada, K; Oka, K; Tanaka, H; Sugamoto, K; Yoshikawa, H; Murase, T
We retrospectively assessed the value of identifying impinging osteophytes using dynamic computer simulation of CT scans of the elbow in assisting their arthroscopic removal in patients with osteoarthritis of the elbow. A total of 20 patients were treated (19 men and one woman, mean age 38 years (19 to 55)) and followed for a mean of 25 months (24 to 29). We located the impinging osteophytes dynamically using computerised three-dimensional models of the elbow based on CT data in three positions of flexion of the elbow. These were then removed arthroscopically and a capsular release was performed. The mean loss of extension improved from 23° (10° to 45°) pre-operatively to 9° (0° to 25°) post-operatively, and the mean flexion improved from 121° (80° to 140°) pre-operatively to 130° (110° to 145°) post-operatively. The mean Mayo Elbow Performance Score improved from 62 (30 to 85) to 95 (70 to 100) post-operatively. All patients had pain in the elbow pre-operatively which disappeared or decreased post-operatively. According to their Mayo scores, 14 patients had an excellent clinical outcome and six a good outcome; 15 were very satisfied and five were satisfied with their post-operative outcome. We recommend this technique in the surgical management of patients with osteoarthritis of the elbow. PMID:24493190
Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries
Szyluk, Karol; Widuchowski, Wojciech; Jasiński, Andrzej; Koczy, Bogdan; Widuchowski, Jerzy
Background The aim of this study was to assess the utility of the Coonrad-Morrey elbow prosthesis in patients with severe elbow dysfunction secondary to rheumatoid arthritis (RA) or post-traumatic elbow dysfunction. Material/Methods The study involved 35 patients followed up for a mean of 36 months. The patients were divided into those with RA (Group I) and those with post-traumatic elbow dysfunction (Group II). Treatment outcomes were evaluated according to the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand Score (Quick DASH). Results According to the MEPS, there were 20 (57.15%) excellent, 12 (34.3%) good, 1 (2.85%) fair, and 2 (5.7%) poor outcomes. The mean post-operative Quick-DASH score for the entire study group was 37.73 points. In subgroup analysis, the MEPS-based evaluation revealed: 14 (70%) excellent, 5 (25%) good, and 1 (5%) satisfactory outcome in Group I, versus 6 (40%) excellent, 7 (46.7%) good, and 2 (13.3%) poor outcomes in Group II. The mean Quick Dash scores were 78.64 points in Group I and 76.36 points in Group II. The final MEPS scores in Group I (p=0.000018) and Group II (p=0.00065) were most markedly influenced by reduction in elbow pain and improvement in the ability to perform activities of daily living (ADL): p=0.000018 in Group I and p=0.000713 in Group II. Conclusions The treatment outcomes confirm the utility of arthroplasty for severe elbow dysfunctions; they were most strongly influenced by pain reduction and improved ability to perform activities of daily living. PMID:23291737
A review of the Liverpool elbow prosthesis from 1974 to 1982.
Soni, R K; Cavendish, M E
Eighty elbows in 65 patients with an average age of 57 years have had two-part non-constrained Liverpool elbow arthroplasties performed since 1974. Fifty-five had rheumatoid arthritis, eight osteoarthritis or ankylosis secondary to injury, one osteochondritis dissecans and one pyknodysostosis. The average preoperative range of movement was 42 degrees to 112 degrees with 47 degrees of pronation and 42 degrees of supination. There was significant gain in the arc of movements at follow-up: 32 degrees in the extension-flexion range (average range 32 degrees to 134 degrees of flexion) and 42 degrees in forearm rotation (average pronation 69 degrees and supination 62 degrees). Before operation severe pain was the predominating symptom in 43 elbows (53.8%) but after replacement there was only moderate pain in five elbows (6.2%). The results were excellent in 42 (52.5%), good in 15 (18.7%), fair in 9 (11.3%) and unsatisfactory or poor in 14 (17.5%). Eight elbows required revision of the arthroplasty: three were post-traumatic, disorganised or osteoarthritic joints, three rheumatoid and both elbows in the patient with pyknodysostosis. Loosening of the prosthesis (particularly the humeral component) was the common factor necessitating revision. Of six rheumatoid elbows needing removal of the implant, four had deep infection, one had a dislodged humeral component as a result of injury and in one a divided olecranon had developed non-union. Rheumatoid elbows benefited more than post-traumatic arthritic elbows from the operation. (ABSTRACT TRUNCATED AT 250 WORDS) PMID:6707062
The Ulnar Nerve at Elbow Extension and Flexion: Assessment of Position and Signal Intensity on MR Images.
Kawahara, Yasuhiro; Yamaguchi, Tetsuji; Honda, Yuzo; Tomita, Yumiko; Uetani, Masataka
Purpose To assess the position and signal intensity of the ulnar nerve at elbow extension and flexion by using magnetic resonance imaging. Materials and Methods Institutional review board approval and written informed consent were obtained. Transverse T2-weighted images were obtained perpendicular to the upper arm in 100 healthy elbows of 50 volunteers (23 men, 27 women; age range, 21-57 years) and nine elbows with ulnar neuropathy (five men, four women; age range, 24-59 years) with extension and 130° of flexion. Ulnar nerve position was classified into three types: no dislocation, subluxation, or dislocation. One-way analysis of variance, paired t tests, Student t tests, and multiple regression analysis were used to analyze correlations between ulnar nerve movement angle during flexion and age, sex, presence of the anconeus epitrochlearis muscle, and ulnar neuropathy and to compare the contrast-to-noise ratio of nerve to muscle between extension and flexion. Results Nerve positions in healthy elbows were as follows: All had no dislocation at extension, and at flexion, 51 of 100 elbows (51.0%) had no dislocation, 30 of 100 elbows (30.0%) had subluxation, and 19 of 100 elbows (19.0%) had dislocation. Nerve movement angle was smaller in elbows with the anconeus epitrochlearis muscle than in those without the muscle (P = .045, .015). Presence of the muscle was the only significant factor associated with nerve movement angle (P = .047, .013). Only dominant elbows with nerve movement angle of less than 15° and nondominant elbows with nerve movement angle of less than 10° showed contrast-to-noise ratio increase at flexion (P = .021-.030). Conclusion Ulnar nerve movement during flexion was apparent in approximately half of healthy elbows and was similar between healthy elbows and elbows with ulnar neuropathy. Nerve signal intensity increased during flexion only in elbows without apparent nerve movement. (©) RSNA, 2016 Online supplemental material is available for this
Approach to MR Imaging of the Elbow and Wrist: Technical Aspects and Innovation.
Johnson, Dustin; Stevens, Kathryn J; Riley, Geoffrey; Shapiro, Lauren; Yoshioka, Hiroshi; Gold, Garry E
Wrist and elbow MR imaging technology is advancing at a dramatic rate. Wrist and elbow MR imaging is performed at medium and higher field strengths with more specialized surface coils and more variable pulse sequences and postprocessing techniques. High field imaging and improved coils lead to an increased signal-to-noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging, such as postoperative patient imaging, cartilage mapping, and molecular imaging. This review considers technical advances in hardware and software and their clinical applications. PMID:26216768
Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results.
Phadnis, Joideep; Watts, Adam C; Bain, Gregory I
There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure. PMID:27583016
Imaging Injuries in Throwing Sports Beyond the Typical Shoulder and Elbow Pathologies.
Read, Paul J; Morrison, William B
This review article describes injuries that occur in the upper extremities of athletes less commonly than those typically discussed with shoulders and elbows. A survey of osseous, musculotendinous, ligamentous, and neurovascular injuries is presented along with associated imaging findings and standard treatment options. This article does not focus on the classic throwing injuries of the shoulder or elbow; the goal is to survey injuries in throwing sports that involve structures away from the glenohumeral, acromioclavicular, or elbow joints. The goal of this article is to introduce readers to these less common injuries, describe their clinical presentations, and characterize their typical imaging appearances. PMID:27545424
Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results
Watts, Adam C; Bain, Gregory I
There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure.
A study of primary stress indices for piping elbows
Macfarlane, D.M.; Boyle, J.T.
The behavior of pipe bends under moment loading is investigated in a parametric study using the elastic compensation technique for finite element analysis. The use of an Ilyushin formulation allows elastic compensation to be applied to shell elements (Boyle et al., 1993). Elastic compensation develops a lower bound limit load, which can be equated to the ASME B{sub 2} stress indices for pipe elbows. Experiments by Touboul et al. (1987) have developed formulae for normalized limit moment and the corresponding B{sub 2} indices for pipe bends in terms of the pipe parameter. This study supports the values for in-plane moment loading and suggests a modification of the formula for out of plane moments. The results for the Ilyushin formulation for elastic compensation are shown to compare well with those of a full elastic-plastic analysis.
Postero‐medial elbow problems in the adult athlete
Eygendaal, D; Safran, M R
The ligamentous, osseous, musculotendinous, and neural structures at the postero‐medial side of the elbow are at risk for various injuries in overhead athletes. The combination of valgus and extension overload during overhead activities results in tensile forces along the medial stabilising structures, with compression on the lateral compartment and shear stress posteriorly. The combination of tensile forces medially and shear forces posteriorly can result in ulnar collateral ligament (UCL) tears, flexor–pronator mass injuries, neuritis of the ulnar nerve, posterior impingement, and olecranon stress fractures. Most symptomatic conditions of the overhead athlete can be treated conservatively initially. In cases where conservative treatment is unsuccessful surgical intervention is indicated. Recent advances in arthroscopic surgical techniques and ligamentous reconstruction ensure that the prognosis for return to pre‐injury level is good. PMID:16632574
Reconstruction of traumatic losses of substance at the elbow.
Battiston, B; Vasario, G; Ciclamini, D; Rollero, L; Tos, P
Traumatic lesions at the elbow involving great loss of substance are uncommon, but represent a significant problem when such cases are referred to a trauma department. Most of these injuries may cause severe final functional impairment, thereby jeopardising future activities, particularly in cases where treatment was delayed or inappropriate. The timing and method of treatment are critical. The trauma may involve soft tissues only, or bone and joint, or several structures at the same time, which results in combined complex tissue defects. Each type of tissue loss should be managed by choosing the most suitable technique from the armamentarium of reconstructive surgery, taking into account different priorities and the optimum timing (immediate or delayed, one- or two-stages). The authors describe a spectrum of indications and techniques that can be useful tools in managing these injuries. PMID:24129326
[Glomus tumor of volar elbow capsule. Case report].
Burnier, M; Erhard, L
Glomus tumors are rare tumors, benign but painful and responsible for a major functional impairment. Although their preferential localization is digital, 35% of glomus tumors are extradigital. Ignorance of this disease characterized by atypical clinical signs and the absence of specific imaging are responsible for a significant diagnostic delay, 7 to 10 years in extradigital forms. Treatment by surgical excision simply ensures immediate disappearance of pain without recurrence in 90% of cases. It is therefore necessary to emphasize the existence of this sometimes debilitating condition benefiting from effective therapeutic solution. We report the case of a glomus tumor of the anterior capsule of the left elbow in a 24-year-old woman with a diagnostic delayed by 12 years. PMID:24394237
The development of a surface arthroplasty for the elbow.
Sorbie, C; Shiba, R; Siu, D; Saunders, G; Wevers, H
Complex kinematics, anatomical features, and load distribution have contributed to the poor function of constrained and semiconstrained cemented arthroplasties of the elbow. Resurfacing by porous-coated components has the potential, by reproduction of normal joint geometry and restoration of ligament balance, to re-create relatively normal kinematics and load-bearing and provide relief of pain. A method was developed to provide information on the geometry of the lower humeral joint surface and olecranon fossa. The information gained was used to design components to resurface the trochlea, capitellum, and olecranon fossa. A technique was also developed to remove a minimal amount of subchondral bone from the ulna and humerus in a precisely directed fashion for exact fit of the porous-coated components. PMID:3720111
Management of Tennis Elbow with sodium hyaluronate periarticular injections
Objectives To determine the efficacy and safety of peri-articular hyaluronic acid injections in chronic lateral epicondylosis (tennis elbow). Design Prospective randomized clinical trial in primary care sport medicine. Patients Three hundred and thirty one consecutive competitive racquette sport athletes with chronic (>3 months) lateral epicondylosis were administered 2 injections (first injection at baseline) into the subcutaneous tissue and muscle 1 cm. from the lateral epicondyle toward the primary point of pain using a two-dimensional fanning technique. A second injection was administered 1 week later. Outcomes measures Assessments were done at baseline, days 7, 14, 30, 90 and 356. Efficacy measures included patient's visual analogue scale (VAS) of pain at rest (0-100 mm) and following assessment of grip strength (0-100 mm). Grip strength was determined using a jamar hydraulic hand dynamometer. Other assessments included patients' global assessment of elbow injury (5 point categorical scale; 1 = no disability, 5 = maximal disability), patients' assessment of normal function/activity (5 point categorical scale), patients/physician satisfaction assessment (10 point categorical scale), time to return to pain-free and disability-free sport and adverse events as per WHO definition. Differences between groups were determined using an intent-to-treat ANOVA. Results Average age of the study population was 49 years (± 12 years). One hundred and sixty-five patients were randomized to the HA and 166 were randomized to the control groups. The change in VAS pain was -6.7 (± 2.0) for HA vs -1.3 (± 1.5) for control (p < 0.001). The VAS post handgrip was -7.8 (± 1.3) vs +0.3 (± 2.0) (p < 0.001) which corresponded to a significant improvement in grip of 2.6 kg in the HA vs control groups (p < 0.01). Statistically significant improvement in patients' global assessment of elbow injury (p < 0.02), patients' assessment of normal function/activity (p < 0.05) and patients
Progression of Heterotopic Ossification around the Elbow after Trauma
ter Meulen, Dirk P.; Nota, Sjoerd P.F.T.; Hageman, Michiel G.J.S.; Ring, David C.
Background: This study addresses the null hypothesis that there is no expansion of heterotopic ossification (HO) in the elbow beyond what can be seen early on. Methods: The area of HO was measured on lateral radiographs of 38 consecutive patients that had operative treatment of HO between 2000 and 2013. Measurements from radiographs obtained between 3 to 7 weeks were compared to measurements from radiographs made 3 months or more after injury. Results: There was no significant difference between the average area of HO on the first (median 2.8 square centimeters, Q1: 1.5, Q3: 5.1) and later radiographs (median of 2.8 square centimeters, Q1: 1.4, Q3: 5.0) (P = 0.99). Conclusion: According to our results the area of HO does not expand beyond what can be seen early in the disease process. PMID:27517067
Elbow Radiographic Anatomy: Measurement Techniques and Normative Data
Goldfarb, Charles A.; Patterson, J. Megan M.; Sutter, Melanie; Krauss, Melissa; Steffen, Jennifer A.; Galatz, Leesa
Background An increase in elbow pathology in adolescents has paralleled an increase in sports participation. Evaluation and classification of these injuries is challenging because of limited information regarding normal anatomy. The purpose of this study was to evaluate normal radiographic anatomy in adolescents to establish parameters for diagnosing abnormal development. Established and new measurements were evaluated for reliability and variance based on age and sex. Methods Three orthopaedic surgeons independently and in a standardized fashion evaluated the normal anteroposterior and lateral elbow radiographs of 178 adolescent and young adult subjects. Fourteen measurements were performed including radial neck- shaft angle, articular surface angle, articular surface morphologic assessment (subjective and objective evaluation of the patterns of ridges and sulci), among others. We performed a statistical analysis by age and sex for each measure and assessed for inter and intra-observer reliability. Results The distal humerus articular surface was relatively flat in adolescence and became more contoured with age as objectively demonstrated by increasing depth of the trochlear and trochleocapitellar sulci, and decreasing trochlear notch angle. Overall measurements were similar between males and females, with an increased carrying angle in females. There were several statistically significant differences based on age and sex but these were small and unlikely to be clinically significant. Inter and intra-observer reliability were variable; some commonly utilized tools had poor reliability. Conclusions Most commonly utilized radiographic measures were consistent between sexes, across the adolescent age group, and between adolescents and young adults. Several commonly used assessment tools show poor reliability. Level of evidence Basic Science Study, Anatomic Study, Imaging PMID:22329911
PET-Scan Shows Peripherally Increased Neurokinin 1 Receptor Availability in Chronic Tennis Elbow: Visualizing Neurogenic Inflammation?
Peterson, Magnus; Svärdsudd, Kurt; Appel, Lieuwe; Engler, Henry; Aarnio, Mikko; Gordh, Torsten; Långström, Bengt; Sörensen, Jens
In response to pain, neurokinin 1 (NK1) receptor availability is altered in the central nervous system. The NK1 receptor and its primary agonist, substance P, also play a crucial role in peripheral tissue in response to pain, as part of neurogenic inflammation. However, little is known about alterations in NK1 receptor availability in peripheral tissue in chronic pain conditions and very few studies have been performed on human beings. Ten subjects with chronic tennis elbow were therefore examined by positron emission tomography (PET) with the NK1 specific radioligand [11C]GR205171 before and after treatment with graded exercise. The radioligand signal intensity was higher in the affected arm as compared with the unaffected arm, measured as differences between the arms in volume of voxels and signal intensity of this volume above a reference threshold set as 2.5 SD above mean signal intensity of the unaffected arm before treatment. In the eight subjects examined after treatment, pain ratings decreased in all subjects but signal intensity decreased in five and increased in three. In conclusion, NK1 receptors may be activated, or up-regulated in the peripheral, painful tissue of a chronic pain condition. This up-regulation does, however, have moderate correlation to pain ratings. The increased NK1 receptor availability is interpreted as part of ongoing neurogenic inflammation and may have correlation to the pathogenesis of chronic tennis elbow. Trial Registration ClinicalTrials.gov NCT00888225 http://clinicaltrials.gov/ PMID:24155873
Ultrasonographic diagnosis of porcupine quill foreign bodies in the plantar flexor tendon sheath region in a heifer.
Mulon, Pierre-Yves; Achard, Damien; Babkine, Marie
A 17-month-old Holstein heifer was presented for persistent enlargement above the right hind fetlock of 1-month's duration. Diffuse plantar soft tissue swelling was present on the radiographs and ultrasonography revealed the presence of multiple porcupine quill extremities embedded in the subcutaneous tissue within the flexor tendon sheath wall. Surgical removal was performed. PMID:21037892
V1 and V2b interneurons secure the alternating flexor-extensor motor activity mice require for limbed locomotion
Zhang, Jingming; Lanuza, Guillermo M.; Britz, Olivier; Wang, Zhi; Siembab, Valerie C.; Zhang, Ying; Velasquez, Tomoko; Alvarez, Francisco J.; Frank, Eric; Goulding, Martyn
SUMMARY The reciprocal activation of flexor and extensor muscles constitutes the fundamental mechanism that tetrapod vertebrates use for locomotion and limb-driven reflex behaviors. This aspect of motor coordination is controlled by inhibitory neurons in the spinal cord; however, the identity of the spinal interneurons that serve this function is not known. Here we show that the production of an alternating flexor-extensor motor rhythm depends on the composite activities of two classes of ventrally-located inhibitory neurons, V1 and V2b interneurons (INs). Abrogating V1 and V2b IN-derived neurotransmission in the isolated spinal cord results in a synchronous pattern of L2 flexor-related and L5 extensor-related locomotor activity. Mice lacking V1 and V2b inhibition are unable to articulate their limb joints and display marked deficits in limb-driven reflex movements. Taken together, these findings identify V1- and V2b-derived neurons as the core interneuronal components of the limb central pattern generator (CPG) that coordinate flexor-extensor motor activity. PMID:24698273
V1 and v2b interneurons secure the alternating flexor-extensor motor activity mice require for limbed locomotion.
Zhang, Jingming; Lanuza, Guillermo M; Britz, Olivier; Wang, Zhi; Siembab, Valerie C; Zhang, Ying; Velasquez, Tomoko; Alvarez, Francisco J; Frank, Eric; Goulding, Martyn
Reciprocal activation of flexor and extensor muscles constitutes the fundamental mechanism that tetrapod vertebrates use for locomotion and limb-driven reflex behaviors. This aspect of motor coordination is controlled by inhibitory neurons in the spinal cord; however, the identity of the spinal interneurons that serve this function is not known. Here, we show that the production of an alternating flexor-extensor motor rhythm depends on the composite activities of two classes of ventrally located inhibitory neurons, V1 and V2b interneurons (INs). Abrogating V1 and V2b IN-derived neurotransmission in the isolated spinal cord results in a synchronous pattern of L2 flexor-related and L5 extensor-related locomotor activity. Mice lacking V1 and V2b inhibition are unable to articulate their limb joints and display marked deficits in limb-driven reflex movements. Taken together, these findings identify V1- and V2b-derived neurons as the core interneuronal components of the limb central pattern generator (CPG) that coordinate flexor-extensor motor activity. PMID:24698273
Neural and Nonneural Contributions to Wrist Rigidity in Parkinson's Disease: An Explorative Study Using the NeuroFlexor
Zetterberg, H.; Frykberg, G. E.; Gäverth, J.; Lindberg, P. G.
Objective. The NeuroFlexor is a novel method incorporating a biomechanical model for the measurement of neural and nonneural contributions to resistance induced by passive stretch. In this study, we used the NeuroFlexor method to explore components of passive movement resistance in the wrist and finger muscles in subjects with Parkinson's disease (PD). Methods. A cross-sectional comparison was performed in twenty-five subjects with PD with clinically identified rigidity and 14 controls. Neural (NC), elastic (EC), and viscous (VC) components of the resistance to passive extension of the wrist were calculated using the NeuroFlexor. Measurements were repeated during a contralateral activation maneuver. Results. PD subjects showed greater total resistance (P < 0.001) and NC (P = 0.002) compared to controls. EC and VC did not differ significantly between groups. Contralateral activation maneuver resulted in increased NC in the PD group but this increase was due to increased resting tension. Total resistance and NC correlated with clinical ratings of rigidity and with bradykinesia. Conclusions. The findings suggest that stretch induced reflex activity, but not nonneural resistance, is the major contributor to rigidity in wrist muscles in PD. The NeuroFlexor is a potentially valuable clinical and research tool for quantification of rigidity. PMID:25685778
Ultrasonic properties of tendon: velocity, attenuation, and backscattering in equine digital flexor tendons.
Miles, C A
Ultrasound velocity, attenuation, and backscattering were measured in vitro in samples of equine digital flexor tendon sandwiched between plane, parallel rexolite buffer rods. The buffer rods were coupled to transmitting and receiving transducers (nominally 10 MHz) mounted in-line and facing one another on the jaws of a digital caliper. Six superficial digital flexor (SDF) tendons and six deep digital flexor (DDF) tendons were measured in three orthogonal directions: along the long axis of the tendon (D), and across the tendon in the dorsal-volar (C), and lateral (L) directions. Substantial anisotropy was apparent in all the measured properties. The velocity data, which in both tendons showed a higher velocity along the fibers than across (e.g., in the DDF tendon at 0 degrees C: 1713 +/- 9 m/s in the D direction compared with 1650 +/- 5 m/s in the C direction), were consistent with a composite comprising stiff fibers embedded in a less stiff medium of lower speed. The apparent backscattering coefficient adjusted for the tissue's frequency-dependent attenuation (e.g., in the C direction of the DDF tendon at 0 degrees C: 7.4 x 10(-3) cm-1 sr-1), was independent of frequency in both transverse directions and larger than that measured along the long axis of the tendon (e.g., in DDF tendon at 0 degrees C: 1.2 x 10(-3) cm-1 sr-1 at 7 MHz) in which direction the apparent backscattering coefficient increased with frequency as f4.0 +/- 1.2. The frequency-independent backscattering was thought to be due to specular reflection from the boundaries between the fascicles, i.e., the bundles of fibers making up the tendon, while backscattering along the axis was due to structures of unknown origin, but of a size much smaller than 45 microns. Attenuation of ultrasound directed along the fibers was higher than that across (at 7 MHz in DDF tendon at 0 degrees C: 58 dB/cm in the D direction compared with 11.3 dB/cm in the C direction). Calculations indicated that the attenuation was
Interprosthetic humeral fracture revision using a tibial allograft total elbow prosthetic composite in a patient with hemophilia A : a case report
Introduction Interprosthetic fractures of the humerus are rare. Revisions of total elbow arthroplasty components in these cases are difficult. We report the first case of a patient with hemophilia who underwent a revision with a tibial allograft prosthetic composite without the need for hardware augmentation. Case presentation A 43-year-old Caucasian man with a history of hemophilia and transfusion-related human immunodeficiency virus and hepatitis B and C presented with an interprosthetic fracture of his humerus after months of pain between his total elbow and total shoulder arthroplasties. Because of the poor remaining bone stock available in his distal humerus, a revision using a barrel-staved tibial allograft prosthetic composite was performed. Our patients' factor VIII level was optimized before the operation and he suffered no major long-term complications at 28 months. His only complication was an incomplete radial nerve palsy that ultimately recovered and left him with some numbness on the dorsum of his hand. Conclusion Careful use of an allograft prosthetic composite is a very reasonable option when a patient experiences an interprosthetic fracture. We have successfully performed revision total elbow arthroplasty for a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation, which resulted in his return to full activities of daily living, minimal pain and full incorporation of the allograft to host bone. PMID:23009283
Cysticercosis of Externsor Carpi Ulnaris – A differential diagnosis for painful swelling at elbow
Agarwal, Sharat; Akhtar, Mohammad Nasim
Introduction: Cysticercosis is an infection by the larval stage (cystcercus cellulosae) of the cestode, Taenia Solium (pork tape worm). It occurs especially in those individuals who live in the endemic areas. After gaining entry into the body, the larva become encysted and may lie in subcutaneous tissue, striated muscle, vitreous humor, or other tissues. Case report: We report an unusual case of cysticercosis of the Extensor carpi ulnaris (ECU) muscle, which presented as localized swelling at the lateral aspect of elbow. The diagnosis was confirmed on the musculoskeletal ultrasonographic examination of the elbow. It revealed the Cysticercus cellulosae as hyperechoic lesion surrounded by fluid. MRI was done later which localized the larval stage in the Extensor carpi ulnaris muscle at elbow. Conclusion: For swelling in the region of elbow in endemic areas of tapeworm infestations, the differential diagnosis of muscle cysticercosis should be kept in mind.
Canine elbow dysplasia and primary lesions in German shepherd dogs in France.
Remy, D; Neuhart, L; Fau, D; Genevois, J P
Five hundred and twenty German shepherd dogs were screened for elbow dysplasia. The following primary lesions were analysed: joint incongruity (JI), fragmented medial coronoid process (FCP), osteochondrosis or osteochondritis of the medial humeral condyle and ununited anconeal process (UAP). Three radiographic views were used for each joint to achieve a definitive diagnosis. The prevalence of elbow dysplasia was 19.4 per cent. The most frequent lesion was JI (16.3 per cent), followed by FCP (11.3 per cent). UAP was diagnosed rarely (1.1 per cent). Combinations of lesions were very frequent (42.2 per cent of the dysplastic elbows). Although these results may be biased due to prescreening of dogs with UAP, it should be highlighted that JI and FCP occur frequently in German shepherd dogs and are probably the most common primary lesions of elbow dysplasia, although they have been under-reported until now. PMID:15163051
Extensive posterior exposure of the elbow. A triceps-sparing approach.
Bryan, R S; Morrey, B F
Difficulty with triceps avulsion or loss of continuity after total elbow arthroplasty has prompted the development of a modified posterior approach to the elbow joint. The characteristic feature of this approach is that the triceps mechanism is reflected from medial to lateral in continuity with the forearm fascia and the olecranon and ulnar periosteum. A variant of the technique reflects the extensor mechanism from lateral to medial. The ulnar collateral ligament may be released from the humerus to provide more exposure, but the ligament must then be securely reattached. This approach, which provides extensive exposure to the elbow joint, has been employed in 49 consecutive total elbow arthroplasties and results show no loss of triceps function and no significant weakness. The approach has proved useful for treatment of intra-articular fractures of the distal end of the humerus and with synovectomy in the rheumatoid arthritic patient. PMID:7083671
Approach to MRI of the Elbow and Wrist: Technical Aspects and Innovation
Johnson, Dustin; Stevens, Kathryn J.; Riley, Geoffrey; Shapiro, Lauren; Yoshioka, Hiroshi; Gold, Garry E.
The technology of wrist and elbow MRI imaging is advancing at a dramatic rate. MRI of the wrist and elbow is now commonly performed at medium and higher field strengths with more specialized surface coils and with more variable pulse sequences and post processing techniques than ever before. High field imaging and improved coils lead to an increased signal to noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is also improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging such as postoperative patient imaging, cartilage mapping, and molecular imaging. In this review, we consider technical advances in hardware and software of wrist and elbow MR imaging along with their clinical applications. PMID:26216768
Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child: A Case Report.
Lee, Young-Keun; Park, Soojin; Lee, Malrey
The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported as irreducible due to flexor tendon entrapment. Here, we describe a patient who sustained a malunited fracture on the right fifth finger proximal phalanx with flexor tendon entrapment after treatment with closed reduction with K-wires fixation.A 13-year-old patient came to the clinic following a bicycle accident 6 weeks ago. He presented with flexion limitation in his small finger on the right hand. During physical examination, the patient felt no pain, and the neurovascular structures were intact. However range of motion (ROM) in his small finger was not normal. Plain radiographs displayed a Salter-Harris type II fracture of the small finger proximal phalanx base and volar angulation with callus formation. During the operation, it was established that the flexor digitorum superficialis (FDS) around the fracture had a severe adhesion, whereas the flexor digitorum profundus (FDP) was entrapped between the volarly displaced metaphyses and the epiphyses and united with the bone. We removed the volarly displaced metaphyses and freed FDP and repaired the A2 pulley. The bone was anatomically fixed with K-wires. In the treatment after the operation, on the 2nd day, the patient was permitted the DIP joint motion by wearing a dynamic splint.At the 12-months follow-up, the patient had regained full ROM with no discomfort and the proximal phalanx growth plate of the small finger closed naturally with normal alignment.When treating a proximal phalangeal base fracture in children, the possibility of flexor tendon entrapment should be considered and should be carefully dealt with in its treatment. PMID:26334897
The clinical and biomechanical effects of fascial-muscular lengthening therapy on tight hip flexor patients with and without low back pain
Avrahami, Daniel; Potvin, Jim R.
Background: Many patients have tight hip flexors with or without low back pain. Manual fascial-muscular lengthening therapy (FMLT) is one commonly used treatment for this population. Objective: Investigate the clinical and biomechanical effects of manual FMLT on tight hip flexor patients with and without low back pain. Methods: A nonrandomized trial, before-and-after experiment with multiple baselines conducted on two different patient populations: 1) Mechanical low back pain patients with tight hip flexors (n = 10) and 2) Asymptomatic group with tight hip flexors (n = 8). Four treatments of manual FMLT were performed on the hip flexor of the two groups of patients over a two-week period. Primary outcome measures over the two-week period were 1) Maximum voluntary trunk flexor and extensor moments, 2) Disability (Roland Morris Disability Questionnaire) and pain (10-cm Visual Analogue Scale), 3) Passive hip extension mobility. Results: Primary outcome analysis involved within-groups comparisons. Maximum voluntary trunk extension demonstrated increases for the low back pain patients. The low back pain patients demonstrated a small, but significant, reduction in disability and pain. Both groups demonstrated an increase in passive hip extension measurements. Conclusion: This preliminary study demonstrated interesting results from manual FMLT on two tight hip flexor patient populations with and without low back pain. However, there were several significant limitations from this study, which restrict the ability to generalize the results. PMID:25550670
Effects of plantar flexor muscle fatigue induced by electromyostimulation on postural coordination.
Ponce, Antoine; Fouque, Florent; Cahouët, Violaine; Martin, Alain
The aim of the present study was to investigate the influence of a modification of an intrinsic capacity (plantar flexor strength) on the implementation of in-phase and anti-phase mode of coordination. Analysis of hip and ankle relative phases during fore-aft tracking task was done before and after an electromyostimulation fatigue protocol on the soleus muscles. Results showed participants used exclusively in-phase and anti-phase modes of coordination, with a sudden switch from one to the other with target frequency increase. Regarding tracking tasks, fatigue induces a decrease of performance for lower frequencies, and a significant decrease of switch frequency (-0.08 Hz) for each subject. In conclusion, changes in mode of coordination implementation suggest that the in-phase mode implementation is highly linked to the strength production capacity at the ankle joint. PMID:17280784
Tenosynovial chondromatosis of the flexor hallucis longus in a 17-year-old girl.
Winters, Nichelle I; Thomson, A Brian; Flores, Raina R; Jordanov, Martin I
Tenosynovial chondromatosis is a benign chondrogenic metaplasia of extra-articular synovial tissue. The most common locations for tenosynovial chondromatosis to develop are the hands and feet. The condition has rarely been reported in children. We present a case of tenosynovial chondromatosis of the flexor hallucis longus in a 17-year-old girl. The presentation was unusual not only due to the location and young age of the patient but also the absence of any palpable mass on physical exam and complete lack of calcification of the cartilage bodies. Initial diagnosis was made by MRI. The patient underwent tenosynovectomy with an excellent postoperative recovery at 6-month follow-up. Histopathology confirmed the diagnosis of tenosynovial chondromatosis. PMID:26008872
Irreducible tongue-type calcaneal fracture due to interposition of flexor hallucis longus.
Wong-Chung, John; O'Longain, Diarmaid; Lynch-Wong, Matthew; Julian, Harriet
We present a rare case of interposition of the flexor hallucis longus (FHL) tendon blocking percutaneous closed reduction of a displaced tongue-type calcaneal fracture, and necessitating open repositioning of the tendon and internal fixation through a single extensile lateral approach. Although not recognized until during surgery, with a high index of suspicion, preoperative diagnosis of this injury combination should be possible on high resolution CT, thus enabling better planning of the procedure. The presence of a small sustentacular fragment, especially if markedly displaced or rotated, should further alert the physician as to increased likelihood of such tendon entrapment within the fracture. In the literature, fracture fixation and extrication of the FHL tendon have been performed via either or both lateral and medial approaches. A medial approach may prove necessary when there is severe displacement or rotation of the sustentacular fragment. Arthroscopically assisted surgery may aid in disengaging the tendon from within the fracture site. PMID:26802813
Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm - A Case Report.
Nayak, Satheesha B; Swamy, Ravindra S; Shetty, Prakashchandra; Maloor, Prasad A; Dsouza, Melanie R
Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis. PMID:27042440
Myofascial force transmission between transferred rat flexor carpi ulnaris muscle and former synergistic palmaris longus muscle
Maas, Huub; Huijing, Peter A.
Summary We investigated the extent of mechanical interaction between rat flexor carpi ulnaris (FCU) and palmaris longus (PL) muscles following transfer of FCU to the distal tendons of extensor carpi radialis brevis and longus (ECRB/L) muscles. Five weeks after recovery from surgery, isometric forces exerted at the distal tendons of FCU and PL were quantified at various FCU lengths. PL was kept at a constant length. Changing the muscle-tendon complex length of transferred FCU (by maximally 3.5 mm) decreased PL force significantly (by 7%). A linear relationship was found between changes in FCU muscle belly length, being a measure of muscle relative positions, and PL force. These results indicate that despite transfer of FCU muscle to the extensor side of the forearm, changing FCU length still affects force transmission of its, now, antagonistic PL muscle. We conclude that a transferred muscle may still be mechanically linked to its former synergistic muscles. PMID:23738260
Management of acute pyogenic flexor tenosynovitis: Literature review and current trends
Giladi, Aviram M.; Malay, Sunitha; Chung, Kevin C.
Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of PFT has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute PFT management. Twenty-eight case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies amongst the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of PFT and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in PFT management. PMID:25670687
[Use of tissue engineering in the reconstruction of flexor tendon injuries of the hand].
Bíró, Vilmos
In his literary analysis, the author describes a novel method applied in the reconstruction of flexor tendon injuries of the hand. This procedure is named tissue engineering, and it is examined mainly under experimental circumstances. After definition of the method and descriptions of literary preliminaries the author discusses the healing process of the normal tendon tissue, then development of the scaffold, an important step of tissue engineering is described. After these topics the introduction of the pluripotent mesenchymal stem cells into the scaffold, and proliferation of these cells and development of the sliding systems are presented. The mechanical resisting ability of the formed tendon tissue is also discussed. Finally, the author concludes that as long as results of experimental research cannot be successfully applied into clinical practice, well-tried tendon reconstruction operations and high quality postoperative rehabilitation are needed. PMID:25639635
Surgical treatment of simple syndactylism with secondary deep digital flexor tendon contracture in a Basset Hound.
Towle, H; Friedlander, K; Ko, R; Aper, R; Breur, G
A five-month-old, female Basset Hound was presented for lameness associated with a fused 3rd and 4th digital pad on the left hind limb (simple incomplete syndactyly), and secondary contracture of the deep digital flexure tendon of the 3rd and 4th digit. An onychectomy of the third phalanx of the third and fourth digits was performed. Following the operation, the dog gained good use of the affected limb for one month until intermittent non-weight bearing lameness developed. A second surgery was performed six months later, partially removing the second phalanx of digits three and four. Follow-up reports indicate that the dog is doing well and is without lameness. This is the first report of deep digital flexor tendon contracture and surgical treatment of this complication in canine simple syndactylism. PMID:17846689
Layered chitosan-collagen hydrogel/aligned PLLA nanofiber construct for flexor tendon regeneration.
Deepthi, S; Nivedhitha Sundaram, M; Deepti Kadavan, J; Jayakumar, R
The aim of our study was to develop a tendon construct of electrospun aligned poly (l-lactic acid) (PLLA) nanofibers, to mimic the aligned collagen fiber bundles and layering PLLA fibers with chitosan-collagen hydrogel, to mimic the glycosaminoglycans of sheath ECM for tendon regeneration. The hydrogel coated electrospun membrane was rolled and an outer coating of alginate gel was given to prevent peritendinous adhesion. The developed constructs were characterized by SEM, FT-IR and tensile testing. Protein adsorption studies showed lower protein adsorption on coated scaffolds compared to uncoated scaffolds. The samples were proven to be non-toxic to tenocytes. The chitosan-collagen/PLLA uncoated scaffolds and alginate gel coated chitosan-collagen/PLLA scaffolds showed good cell proliferation. The tenocytes showed good attachment and spreading on the scaffolds. This study indicated that the developed chitosan-collagen/PLLA/alginate scaffold would be suitable for flexor tendon regeneration. PMID:27561521
Closed traumatic rupture of the flexor pollicis longus tendon in zone T I: a case report.
Uekubo, Kazuaki; Itoh, Soichiro; Yoshioka, Taro
A healthy 41-year-old male suffered a direct blow on the palmar side of his right thumb when folding a table, which slipped along his thumb until it was stopped at the inter-phalangeal (IP) joint, resulting in a complete rupture of the flexor pollicis longus (FPL) tendon in zone T I. The proximal tendon stump was passed through the oblique pulley, fixed to the base of the distal phalanx with a pull-out wire technique and augmented on it using a part of the distal tendon remnant. After removal of the cast and the pull-out wire three weeks postoperatively, range of motion exercise was initiated and good functional recovery was obtained. PMID:25609290
Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial
Background Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a static plaster for different periods of time or so-called functional treatment. Functional treatment is characterized by early active motion within the limits of pain with or without the use of a sling or hinged brace. Theoretically, functional treatment should prevent stiffness without introducing increased joint instability. The primary aim of this randomized controlled trial is to compare early functional treatment versus plaster immobilization following simple dislocations of the elbow. Methods/Design The design of the study will be a multicenter randomized controlled trial of 100 patients who have sustained a simple elbow dislocation. After reduction of the dislocation, patients are randomized between a pressure bandage for 5-7 days and early functional treatment or a plaster in 90 degrees flexion, neutral position for pro-supination for a period of three weeks. In the functional group, treatment is started with early active motion within the limits of pain. Function, pain, and radiographic recovery will be evaluated at regular intervals over the subsequent 12 months. The primary outcome measure is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford elbow score, pain level at both sides, range of motion of the elbow joint at both sides, rate of secondary interventions and complication rates in both groups (secondary dislocation, instability, relaxation), health-related quality of life (Short-Form 36 and EuroQol-5D), radiographic appearance of the elbow joint (degenerative changes and heterotopic ossifications), costs, and cost-effectiveness. Discussion The successful completion of this trial will
Efficient defect detections of elbow pipes using propagation characteristics of guided waves
NASA Astrophysics Data System (ADS)
Yamamoto, Toshihiro; Furukawa, Takashi; Nishino, Hideo
This paper proposes an efficient method of defect detection at elbow part of piping. The comparison between the simulation and experimental results shown in the paper implies regions with high sensitivity correspond to high-amplitude regions. The simulation results show that the locations of high-amplitude regions can be controlled by the center frequency of the input signal. Therefore, efficient defect detection at elbow part can be realized by using a suitable frequency for the target area.
A Preseason Checklist for Predicting Elbow Injury in Little League Baseball Players
Yukutake, Taiki; Kuwata, Masumi; Yamada, Minoru; Aoyama, Tomoki
Background: Despite pitch count limits, the incidence of Little League elbow is increasing. A risk-evaluation tool capable of predicting which players are predisposed to throwing injury could potentially prevent injuries. Purpose: To investigate the effectiveness of a risk factor checklist for predicting elbow injury in Little League baseball players during 1 season. The hypothesis was that a preseason risk-evaluation checklist could predict which players were predisposed to elbow injury. Study Design: Case-control study; Level of evidence, 3. Methods: A preseason risk-evaluation checklist was distributed to Little League baseball teams in Japan. Six months later, a follow-up questionnaire was mailed to determine injuries sustained during the season. Logistic regression analysis was performed, assigning presence or absence of elbow injury during the season as the dependent variable, and an injury risk score (IRS) was developed based on the statistically significant variables. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive validity of the checklist and the optimal cutoff IRS. Results: Data from 389 Little League players were analyzed. Among them, 53 players experienced an elbow injury requiring medical treatment during the season. Six checklist items associated with a medical history of throwing injury, pitch volume, and arm fatigue were found to be significant. Responses to the items could predict the players who were susceptible to injury during the season, with a two-thirds cutoff value for a 6-item checklist (area under the curve, 0.810; sensitivity, 0.717; specificity, 0.771). Conclusion: Results from a 6-item preseason checklist can predict which Little League players are to sustain an elbow injury by the end of the season. Clinical Relevance: The ability to predict which Little League baseball players are predisposed to elbow injury allows parents and coaches to initiate preventive measures in those players
The effect of muscle loading on flexor tendon-to-bone healing in a canine model
Thomopoulos, Stavros; Zampiakis, Emmanouil; Das, Rosalina; Silva, Matthew J.; Gelberman, Richard H.
SUMMARY Previous tendon and ligament studies demonstrated a role for mechanical loading in tissue homeostasis and healing. In uninjured musculoskeletal tissues, increased loading leads to an increase in mechanical properties, while decreased loading leads to a decrease in properties. The role of loading on healing tissues is less clear. We studied tendon-to-bone healing in a canine flexor tendon-to-bone injury and repair model. To examine the effect of muscle loading on healing, repaired tendons were either cut proximally to remove all load from the distal phalanx repair site (unloaded group) or left intact proximally (loaded group). All paws were cast post-operatively and subjected to daily passive motion rehabilitation. Specimens were tested to determine functional properties, biomechanical properties, repair-site gapping, and bone mineral density. Loading across the repair site led to improved functional and biomechanical properties (e.g., stiffness for the loaded group was 8.2 ± 3.9 vs. 5.1 ± 2.5 N/mm for the unloaded group). Loading did not affect bone mineral density or gapping. The formation of a gap between the healing tendon and bone correlated with failure properties. Using a clinically relevant model of flexor tendon injury and repair, we found that muscle loading was beneficial to healing. Complete removal of load by proximal transection resulted in tendon-to-bone repairs with less range of motion and lower biomechanical properties compared to repairs in which the muscle-tendon-bone unit was left intact. PMID:18524009
Contractile properties of muscle fibers from the deep and superficial digital flexors of horses
Chase, P. B.; Hermanson, J. W.; Clark, A. N.; Brunet, N. M.; Bertram, J. E. A.
Equine digital flexor muscles have independent tendons but a nearly identical mechanical relationship to the main joint they act upon. Yet these muscles have remarkable diversity in architecture, ranging from long, unipennate fibers ("short" compartment of DDF) to very short, multipennate fibers (SDF). To investigate the functional relevance of the form of the digital flexor muscles, fiber contractile properties were analyzed in the context of architecture differences and in vivo function during locomotion. Myosin heavy chain (MHC) isoform fiber type was studied, and in vitro motility assays were used to measure actin filament sliding velocity (Vf). Skinned fiber contractile properties [isometric tension (P0/CSA), velocity of unloaded shortening (VUS), and force-Ca2+ relationships] at both 10 and 30°C were characterized. Contractile properties were correlated with MHC isoform and their respective Vf. The DDF contained a higher percentage of MHC-2A fibers with myosin (heavy meromyosin) and Vf that was twofold faster than SDF. At 30°C, P0/CSA was higher for DDF (103.5 ± 8.75 mN/mm2) than SDF fibers (81.8 ± 7.71 mN/mm2). Similarly, VUS (pCa 5, 30°C) was faster for DDF (2.43 ± 0.53 FL/s) than SDF fibers (1.20 ± 0.22 FL/s). Active isometric tension increased with increasing Ca2+ concentration, with maximal Ca2+ activation at pCa 5 at each temperature in fibers from each muscle. In general, the collective properties of DDF and SDF were consistent with fiber MHC isoform composition, muscle architecture, and the respective functional roles of the two muscles in locomotion. PMID:20702801
Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel.
Kociolek, Aaron M; Tat, Jimmy; Keir, Peter J
Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0° and 30° flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures. PMID:25553671
Oxygen recovery kinetics in the forearm flexors of multiple ability groups of rock climbers.
Fryer, Simon M; Stoner, Lee; Dickson, Tabitha G; Draper, Steve B; McCluskey, Michael J; Hughes, Johnathan D; How, Stephen C; Draper, Nick
The purpose of this study was to determine muscle tissue oxidative capacity and recovery in intermediate, advanced, and elite rock climbers. Forty-four male participants performed (a) sustained and (b) intermittent contractions at 40% of maximal volitional contraction (MVC) on a sport-specific fingerboard until volitional fatigue. Near-infrared spectroscopy was used to assess muscle tissue oxygenation during both the exercise and the 5-minutes passive recovery period, in the flexor digitorum profundus (FDP) and flexor carpi radialis (FCR). During the sustained contraction only, muscle tissue deoxygenation (O2 debt) in the FDP and FCR was significantly greater in elite climbers compared with the control, intermediate, and advanced groups (FDP: 32 vs. 15, 19, 22%; FCR: 19 vs. 11, 8, 15%, respectively). However, elite climbers had a significantly quicker time to half recovery (T1/2) than the control and intermediate groups in the FDP (8 vs. 95 and 47 seconds, respectively) and the FCR (7 vs. 30 and 97 seconds, respectively) because the O2% recovered per second being significantly greater (FDP: 4.2 vs. 0.7 and 0.3; FCR: 4.8 vs. 0.1 and 0.2, respectively). Furthermore, during the intermittent contraction, T1/2 in elite climbers was significantly quicker compared with the control and intermediate groups in the FDP (8 vs. 93 and 83 seconds, respectively) and FCR (16 vs. 76 and 50 seconds, respectively). Consequently, lower-level climbers should focus training on specific intermittent fatigue protocols. Competition or elite climbers should make use of appropriate rests on route to aid recovery and increase the chances of reaching the next hold. PMID:25536538
Almeida, Alexandre; Valin, Múrcio Rangel; Ferreira, Ramon; Roveda, Gilberto; de Almeida, Nayvaldo Couto; Agostini, Ana Paula
Objective: To evaluate the results from reconstruction of the anterior cruciate ligament (ACL) using with flexor tendon autografts from the thigh, with analysis on data relating to sex, body mass index (BMI) and associations with lower limb fracture. Methods: A group of 265 patients who underwent knee arthroscopy for the purposes of ACL reconstruction using an ipsilateral graft from the flexor tendon of the thigh between July 6, 2000, and November 19, 2007, were evaluated. Results: One hundred and seventy-six patients were evaluated over a mean period of 34.95 ± 18.8 months (median: 31 months) (IQR: 20-48 months). The minimum evaluation period was 12 months and the maximum was 87 months. One hundred and thirty-eight patients (78.4%) had excellent results, 22 (12.5%) had good results, eight (4.5%) had fair results and eight (4.5%) had poor results. Higher incidence of good and excellent results for the following categories was not considered to be significant: males (p = 0.128), patients with BMI < 25 (p = 0.848), or patients with ACL injuries unrelated to an initial traumatic episode of lower-limb fracture (p = 0.656). Conclusion: The ACL reconstruction technique using tendon autografts from the thigh showed good and excellent results for 91.4% of the sample. Male patients seemed to present a greater tendency towards good and excellent results. No statistically significant difference was found when the results were analyzed in relation to BMI or associations with initial traumatic fracture episodes in the lower limbs. PMID:27022571
Flexor tendon repairs in children: Outcomes from a specialist tertiary centre.
Cooper, L; Khor, W; Burr, N; Sivakumar, B
We evaluate the functional outcomes of early active mobilization (EAM) after paediatric flexor tendon repair at one centre from 2006 to 2013. A generic rehabilitation protocol was used for the first four to six weeks: boxing glove immobilization (<5 years), dorsal blocking splint and cage (5-10 years) or dorsal blocking splint ± cage (10-16 years). Outcomes were assessed using the Total Active Mobilization (TAM) method of the American Society for Surgery of the Hand and original Strickland criteria (OSC). Sixty-three fingers and 99 tendons were identified, in 57 children. Thirty-five per cent (n = 20) were in zone 2, 23% in zone 1, 18% in zone 5, 14% in zone 3 and 2% in zone 4. Good/excellent results were obtained in 82% by the TAM method and 79% by the OSC of those suitable for analysis (56 tendons in 44 children). The surgical approaches used varied in technique and material; a modified Kessler stitch (n = 42) using prolene (n = 60) represented the majority of core sutures. Epitendinous repair was employed in 76% of repairs (n = 75). The median length of hand therapy follow-up was 83.5 days (IQR 43.5-143.75 days). Complications included: one rupture, one post-operative infection requiring washout and three contractures, two requiring re-operation. EAM is a practical and safe way to rehabilitate children after flexor tendon repair, without increasing ruptures or adhesions. Most children under five are managed effectively in a bulky bandage. PMID:25613292
Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction
Ooi, Adrian; Ng, Jonathan; Chui, Christopher; Goh, Terence; Tan, Bien Keem
Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n = 5), regional pedicled (n = 7), and free (n = 8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction. PMID:27313886
Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; Ortiz, Rodrigo Tormin; Mariz Pinto, Eduardo César Moreira; Checchia, Sergio Luis
Objective: To review functional outcomes of arthroscopic elbow synovectomy in patients with rheumatoid arthritis. Methods: Between May 1999 and December 2005, 15 patients were submitted to elbow synovectomy using an arthroscopic approach. Three cases were bilateral, totaling 18 elbows. There were two male and 13 female patients. The mean age was 44 years and five months. The mean time of previous diagnosis was six years and eight months. All patients reported preoperative pain, and on seven elbows, instability was present. The mean preoperative values for joint motion were: flexion, 118°; extension, −24°, supine, 80°, and; prone, 71°. Result: The mean postoperative follow-up time was 39 months. The mean postoperative joint motion was 133° for flexion, −20° for extension, 84° supine, and 78° prone. On nine elbows (50%) an improved postoperative range of motion was reported, reaching functional levels. Twelve cases (66.6%) showed pain resolution or improvement to a level not interfering on the activities of daily life. According to Bruce's assessment method, the results were as follows: seven excellent, three good, two fair and six poor results, with an average of 85.5 points. Synovitis recurrence was found in six cases (33.3%), and evolution to osteoarthrosis was found in four (22.2%). Conclusion: Arthroscopic elbow synovectomy in patients with rheumatoid arthritis leads to pain improvement in 66.6% of the cases; however, it does not cause a significant range of motion improvement. PMID:27077058
[Kocher approach to the elbow and its options].
Bartoníček, J; Naňka, O; Tuček, M
The original Kocher approach was published several times in the 18921907 period. It extends in the interval between the extensor carpi ulnaris and the anconeus and consists in subperiostal release of the lateral collateral ligament (LCL), joint capsule and origin of extensors at the lateral epicondyle and their retraction anteriorly, and a similar release of the anconeus from the distal humerus and its reflection posteriorly. This provides an extensive approach to the elbow. Today this approach is described in the textbooks in various modifications that have little in common with the original description except for the fact that dissection is made in the so called Kocher interval between the extensor carpi ulnaris and the anconeus. Therefore it is often called a limited Kocher approach.The study describes our modification of the Kocher approach that we use primarily in fractures of the head and neck of the radius, in certain fractures of the distal humerus, and also in irreducible dislocations and certain fracture-dislocations of the elbow.The incision is made along the line connecting the lateral epicondyle of the humerus and the border between the proximal and middle thirds of the ulna. The incision is pulled open and the strong, white opalescent common extensor fascia incised in order to identify the interval between the extensor carpi ulnaris and the anconeus. The two muscles are separated by thin vascularized fatty connective tissue which is split in order to expose a typical tendon reinforcing the upper half of the anterior margin of the anconeus. In this phase it is beneficial to detach the origin of the extensor carpi ulnaris from the lateral epicondyle. It facilitates retraction of the extensor carpi ulnaris anteriorly and of the anconeus slightly posteriorly. In contrast with the original Kocher approach, we do not release the anconeus from the lateral epicondyle of the humerus.The muscles are retracted to expose the anterolateral surface of the joint
Neural regulation of rhythmic arm and leg movement is conserved across human locomotor tasks.
Zehr, E Paul; Balter, Jaclyn E; Ferris, Daniel P; Hundza, Sandra R; Loadman, Pamela M; Stoloff, Rebecca H
It has been proposed that different forms of rhythmic human limb movement have a common central neural control ('common core hypothesis'), just as in other animals. We compared the modulation patterns of background EMG and cutaneous reflexes during walking, arm and leg cycling, and arm-assisted recumbent stepping. We hypothesized that patterns of EMG and reflex modulation during cycling and stepping (deduced from mathematical principal components analysis) would be comparable to those during walking because they rely on similar neural substrates. Differences between the tasks were assessed by evoking cutaneous reflexes via stimulation of nerves in the foot and hand in separate trials. The EMG was recorded from flexor and extensor muscles of the arms and legs. Angular positions of the hip, knee and elbow joints were also recorded. Factor analysis revealed that across the three tasks, four principal components explained more than 93% of the variance in the background EMG and middle-latency reflex amplitude. Phase modulation of reflex amplitude was observed in most muscles across all tasks, suggesting activity in similar control networks. Significant correlations between EMG level and reflex amplitude were frequently observed only during static voluntary muscle activation and not during rhythmic movement. Results from a control experiment showed that strong correlation between EMG and reflex amplitudes was observed during discrete, voluntary leg extension but not during walking. There were task-dependent differences in reflex modulation between the three tasks which probably arise owing to specific constraints during each task. Overall, the results show strong correlation across tasks and support common neural patterning as the regulator of arm and leg movement during various rhythmic human movements. PMID:17463036
Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression.
Herrnstadt, Gil; Menon, Carlo
Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor
Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression
Herrnstadt, Gil; Menon, Carlo
Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor
Long Term Results in Refractory Tennis Elbow Using Autologous Blood
Gani, Naseem ul; Khan, Hayat Ahmad; Kamal, Younis; Farooq, Munir; Jeelani, Hina; Shah, Adil Bashir
Tennis elbow (TE) is one of the commonest myotendinosis. Different treatment options are available and autologous blood injection has emerged as the one of the acceptable modalities of treatment. Long term studies over a larger group of patients are however lacking. The purpose of this study was to evaluate these patients on longer durations. One-hundred and twenty patients of TE, who failed to respond to conventional treatment including local steroid injections were taken up for this prospective study over the period from year 2005 to 2011 and were followed up for the minimum of 3 years (range 3-9 years). Two mL of autologous blood was taken from the ipsilateral limb and injected into the lateral epicondyle. The effectiveness of the procedure was assessed by Pain Rating Sscale and Nirschl Staging, which was monitored before the procedure, at first week, monthly for first three months, at 6 months and then 3 monthly for first year, six monthly for next 2 years and then yearly. Statistical analysis was done and a P value of <0.05 was taken as significant. The patients (76 females and 44 males) were evaluated after procedure. The mean age group was 40.67±8.21. The mean follow up was 5.7±1.72 (range 3 to 9 years). The mean pain score and Nirschl stage before the procedure was 3.3±0.9 and 6.2±0.82 respectively. At final follow up the pain score and Nirschl were 1.1±0.9 and 1.5±0.91 respectively. Autologous blood injection was found to be one of the modalities for treatment of TE. Being cheap, available and easy method of treatment, it should be considered as a treatment modality before opting for the surgery. Universal guidelines for the management of tennis elbow should be made as there is lot of controversy regarding the treatment. PMID:25568727
Long term results in refractory tennis elbow using autologous blood.
Gani, Naseem Ul; Khan, Hayat Ahmad; Kamal, Younis; Farooq, Munir; Jeelani, Hina; Shah, Adil Bashir
Tennis elbow (TE) is one of the commonest myotendinosis. Different treatment options are available and autologous blood injection has emerged as the one of the acceptable modalities of treatment. Long term studies over a larger group of patients are however lacking. The purpose of this study was to evaluate these patients on longer durations. One-hundred and twenty patients of TE, who failed to respond to conventional treatment including local steroid injections were taken up for this prospective study over the period from year 2005 to 2011 and were followed up for the minimum of 3 years (range 3-9 years). Two mL of autologous blood was taken from the ipsilateral limb and injected into the lateral epicondyle. The effectiveness of the procedure was assessed by Pain Rating Sscale and Nirschl Staging, which was monitored before the procedure, at first week, monthly for first three months, at 6 months and then 3 monthly for first year, six monthly for next 2 years and then yearly. Statistical analysis was done and a P value of <0.05 was taken as significant. The patients (76 females and 44 males) were evaluated after procedure. The mean age group was 40.67±8.21. The mean follow up was 5.7±1.72 (range 3 to 9 years). The mean pain score and Nirschl stage before the procedure was 3.3±0.9 and 6.2±0.82 respectively. At final follow up the pain score and Nirschl were 1.1±0.9 and 1.5±0.91 respectively. Autologous blood injection was found to be one of the modalities for treatment of TE. Being cheap, available and easy method of treatment, it should be considered as a treatment modality before opting for the surgery. Universal guidelines for the management of tennis elbow should be made as there is lot of controversy regarding the treatment. PMID:25568727
Application of collision detection to assess implant insertion in elbow replacement surgery
NASA Astrophysics Data System (ADS)
Tutunea-Fatan, O. Remus; Bernick, Joshua H.; Lalone, Emily; King, Graham J. W.; Johnson, James A.
An important aspect of implant replacement of the human joint is the fit achieved between the implant and bone canal. As the implant is inserted within the medullary canal, its position and orientation is subjected to a variety of constraints introduced either by the external forces and moments applied by the surgeon or by the interaction of the implant with the cortical wall of the medullary canal. This study evaluated the implant-bone interaction of a humeral stem in elbow replacement surgery as an example, but the principles can also be applied to other joints. After converting CT scan data of the humerus to the parametric NURBS-based representation, a collision detection procedure based on existing Computer-Aided Engineering techniques was employed to control the instantaneous kinematics and dynamics of the insertion of a humeral implant in an attempt to determine its final posture within the canal. By measuring the misalignment between the native flexion-extension (FE) axis of the distal humerus and the prosthesis, a prediction was made regarding the fit between the canal and the implant. This technique was shown to be effective in predicting the final misalignment of the implant axis with respect to the native FE axis of the distal humerus using a cadaver specimen for in-vitro validation.
'Lateral elbow tendinopathy' is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis.
Stasinopoulos, Dimitrios; Johnson, Mark I
A plethora of terms that have been used to describe lateral epicondylitis including tennis elbow (TE), epicondylalgia, tendonitis, tendinosis and tendinopathy. These terms usually have the prefix extensor or lateral elbow. Lateral elbow tendinopathy seems to be the most appropriate term to use in clinical practice because other terms make reference to inappropriate aetiological, anatomical and pathophysiological terms. The correct diagnostic term is important for the right treatment. PMID:16843614
Effect of the vibration board on the strength of ankle dorsal and plantar flexor muscles: a preliminary randomized controlled study.
Costantino, Cosimo; Pogliacomi, Francesco; Soncini, Giovanni
Aim of this preliminary work is to study the effects of the vibration board on the strength of dorsal and plantar flexor muscles of the ankle through a randomized and controlled observation. Sixteen sedentary right-handed females, ranged from 20 to 30 years of age, were selected; they were not affected by previous ankle sprains and were divided into two randomized groups. The study group followed a vibration board training in the orthostatic position with a 60 degrees flexion of the knee in order to direct its mechanical impulses to the inferior limbs. Each patient of the study group performed daily, for 2 weeks, 10 repetitions that lasted 1 minute each (25 hertz of frequency). The control group followed a training protocol including 10 daily sessions for 2 weeks. Each session included 3 series of 10 repetitions of flexi-extension of the foot versus an opposite resistance of an elastic band, 60 centimetres long, that was stretched till 100 cm. Both groups were tested before and after these training programmes by Biodex isokinetic dynamometer in order to quantify the strength of the plantar and dorsal flexor muscles of the dominant ankle. Peak torque, power and total work of the dorsal and plantar flexor muscles were assessed. A power test at an angular velocity of 60 degrees/sec for five repetitions and a resistance test at an angular velocity of 180 degrees/sec. for 20 repetitions were performed. After the final isokinetic test, the results were submitted to a statistic evaluation (T test of Student) in order to analyze any possible significant differences (p < 0.05) among the initial and final values before and after the treatment. The results of the study group compared to the control group showed a significant increase in the power of the dorsal flexor muscles at an angular velocity of 60 degrees/sec and in the peak torque, power and total work of the plantar flexor muscles at an angular velocity of 60 degrees/sec and 180 degrees/sec. We conclude that the use
Mechanical solution for a mechanical problem: Tennis elbow
Rothschild, Bruce
Lateral epicondylitis is a relatively common clinical problem, easily recognized on palpation of the lateral protuberance on the elbow. Despite the "itis" suffix, it is not an inflammatory process. Therapeutic approaches with topical non-steroidal anti-inflammatory drugs, corticosteroids and anesthetics have limited benefit, as would be expected if inflammation is not involved. Other approaches have included provision of healing cytokines from blood products or stem cells, based on the recognition that this repetitive effort-derived disorder represents injury. Noting calcification/ossification of tendon attachments to the lateral epicondyle (enthesitis), dry needling, radiofrequency, shock wave treatments and surgical approaches have also been pursued. Physiologic approaches, including manipulation, therapeutic ultrasound, phonophoresis, iontophoresis, acupuncture and exposure of the area to low level laser light, has also had limited success. This contrasts with the benefit of a simple mechanical intervention, reducing the stress on the attachment area. This is based on displacement of the stress by use of a thin (3/4-1 inch) band applied just distal to the epicondyle. Thin bands are required, as thick bands (e.g., 2-3 inch wide) simply reduce muscle strength, without significantly reducing stress. This approach appears to be associated with a failure rate less than 1%, assuming the afflicted individual modifies the activity that repeatedly stresses the epicondylar attachments. PMID:23878775
Implant alignment in total elbow arthroplasty: conventional vs. navigated techniques
NASA Astrophysics Data System (ADS)
McDonald, Colin P.; Johnson, James A.; King, Graham J. W.; Peters, Terry M.
Incorrect selection of the native flexion-extension axis during implant alignment in elbow replacement surgery is likely a significant contributor to failure of the prosthesis. Computer and image-assisted surgery is emerging as a useful surgical tool in terms of improving the accuracy of orthopaedic procedures. This study evaluated the accuracy of implant alignment using an image-based navigation technique compared against a conventional non-navigated approach. Implant alignment error was 0.8 +/- 0.3 mm in translation and 1.1 +/- 0.4° in rotation for the navigated alignment, compared with 3.1 +/- 1.3 mm and 5.0 +/- 3.8° for the non-navigated alignment. Five (5) of the 11 non-navigated alignments were malaligned greater than 5° while none of the navigated alignments were placed with an error of greater than 2.0°. It is likely that improved implant positioning will lead to reduced implant loading and wear, resulting in fewer implantrelated complications and revision surgeries.
Attempted rapid elbow flexion movements in patients with athetosis.
Hallett, M; Alvarez, N
Voluntary rapid elbow flexion movements were studied in 14 patients with athetosis on the basis of cerebral palsy. When the movement was attempted with one arm, other muscles inappropriate for the task, such as muscles in the opposite limb, were also activated. EMG activity of the biceps and triceps was analysed in detail, and the patterns seen in the different patients were divided into six groups: (1) The normal "ballistic" triphasic pattern, with bursts of normal duration, alternating in biceps and triceps, but the triceps might be activated first, causing the limb to extend rather than flex, (2) The triphasic pattern, with bursts of long duration, (3) Repetitive cycles of the triphasic pattern with particularly long antagonist bursts, apparently limiting the movement in each cycle, (4) Long bursts synchronous in agonist and antagonist muscles, (5) Continuous activity of the agonist, with reduction in activity of the antagonist, (6) Failure to be able to do the task. The pathophysiology of athetosis is that voluntary movement is characterised by excessive muscular activity, most prominently in inappropriate muscles, both extraneous to the task and directly antagonistic. PMID:6886719
Acupuncture Treatment of Lateral Elbow Pain: A Nonrandomized Pilot Study
Liu, Yan-Song; Gadau, Marcus; Zhang, Guo-Xue; Liu, Hao; Wang, Fu-Chun; Zaslawski, Christopher; Li, Tie; Tan, Yuan-Sheng; Berle, Christine; Li, Wei-Hong; Bangrazi, Sergio; Liguori, Stefano; Zhang, Shi-Ping
In planning for a large-scale multicenter trial to evaluate the effect of acupuncture for the treatment of lateral elbow pain, a pilot study was conducted. This was a prospective, investigator- and patient-blinded, nonrandomized, placebo controlled trial. Subjects were evaluated at baseline, before fourth, seventh, and ninth treatment, and at a two-week posttreatment follow-up. The treatment group received unilateral acupuncture at LI 10 and LI 11 at the affected side with manual needle manipulation; the control group received sham-laser acupuncture at the same acupoints. Measures included (i) disabilities of the arm, shoulder, and hand (DASH) questionnaire, (ii) pain-free grip strength (PFGS), and (iii) a visual analogue scale (VAS) for pain. Significant differences in DASH score, PFGS, and VAS between treatment and control group were found at the ninth treatment (n = 20 for each group, P < 0.05). Only DASH showed significant differences compared to the control for all the measurement time points after treatment commenced and appears to be a sensitive and appropriate primary outcome measure for the future multisite trial. Results from this pilot study provided relevant information about treatment efficacy, credibility of control treatment, and sensitivity of different outcome measures for the planning of the future trial. PMID:27006679
The Snapping Elbow Syndrome as a Reason for Chronic Elbow Neuralgia in a Tennis Player – MR, US and Sonoelastography Evaluation
Łasecki, Mateusz; Olchowy, Cyprian; Pawluś, Aleksander; Zaleska-Dorobisz, Urszula
Summary Background Ulnar neuropathy is the second most common peripheral nerve neuropathy after median neuropathy, with an incidence of 25 cases per 100 000 men and 19 cases per 100 000 women each year. Skipping (snapping) elbow syndrome is an uncommon cause of pain in the posterior-medial elbow area, sometimes complicated by injury of the ulnar nerve. One of the reason is the dislocation of the abnormal insertion of the medial triceps head over the medial epicondyle during flexion and extension movements. Others are: lack of the Osboune fascia leading to ulnar nerve instability and focal soft tissue tumors (fibromas, lipomas, etc). Recurrent subluxation of the nerve at the elbow results in a tractional and frictional neuritis with classical symptoms of peripheral neuralgia. As far as we know snapping triceps syndrome had never been evaluated in sonoelastography. Case Report A 28yo semi-professional left handed tennis player was complaining about pain in posterior-medial elbow area. Initial US examination suggest golfers elbow syndrome which occurs quite commonly and has a prevalence of 0.3–0.6% in males and 0–3–1.1% in women and may be associated (approx. 50% of cases) with ulnar neuropathy. However subsequently made MRI revealed unusual distal triceps anatomy, moderate ulnar nerve swelling and lack of medial epicondylitis symptoms. Followed (second) US examination and sonoelastography have detected slipping of the both ulnar nerve and the additional band of the medial triceps head. Discussion Snapping elbow syndrome is a poorly known medical condition, sometimes misdiagnosed as the medial epicondylitis. It describes a broad range of pathologies and anatomical abnormalities. One of the most often reasons is the slipping of the ulnar nerve as the result of the Osborne fascia/anconeus epitrochlearis muscle absence. Simultaneously presence of two or more "snapping reasons" is rare but should be always taken under consideration. Conclusions There are no
Powered ankle exoskeletons reveal the metabolic cost of plantar flexor mechanical work during walking with longer steps at constant step frequency.
Sawicki, Gregory S; Ferris, Daniel P
We examined the metabolic cost of plantar flexor muscle-tendon mechanical work during human walking. Nine healthy subjects walked at constant step frequency on a motorized treadmill at speeds corresponding to 80% (1.00 m s(-1)), 100% (1.25 m s(-1)), 120% (1.50 m s(-1)) and 140% (1.75 m s(-1)) of their preferred step length (L(*)) at 1.25 m s(-1). In each condition subjects donned robotic ankle exoskeletons on both legs. The exoskeletons were powered by artificial pneumatic muscles and controlled using soleus electromyography (i.e. proportional myoelectric control). We measured subjects' metabolic energy expenditure and exoskeleton mechanics during both unpowered and powered walking to test the hypothesis that ankle plantarflexion requires more net metabolic power (W kg(-1)) at longer step lengths for a constant step frequency (i.e. preferred at 1.25 m s(-1)). As step length increased from 0.8 L(*) to 1.4 L(*), exoskeletons delivered approximately 25% more average positive mechanical power (P=0.01; +0.20+/-0.02 W kg(-1) to +0.25+/-0.02 W kg(-1), respectively). The exoskeletons reduced net metabolic power by more at longer step lengths (P=0.002; -0.21+/-0.06 W kg(-1) at 0.8 L(*) and -0.70+/-0.12 W kg(-1) at 1.4 L(*)). For every 1 J of exoskeleton positive mechanical work subjects saved 0.72 J of metabolic energy ('apparent efficiency'=1.39) at 0.8 L(*) and 2.6 J of metabolic energy ('apparent efficiency'=0.38) at 1.4 L(*). Declining ankle muscle-tendon ;apparent efficiency' suggests an increase in ankle plantar flexor muscle work relative to Achilles' tendon elastic energy recoil during walking with longer steps. However, previously stored elastic energy in Achilles' tendon still probably contributes up to 34% of ankle muscle-tendon positive work even at the longest step lengths we tested. Across the range of step lengths we studied, the human ankle muscle-tendon system performed 34-40% of the total lower-limb positive mechanical work but accounted for only 7-26% of
Focal experimental injury leads to widespread gene expression and histologic changes in equine flexor tendons.
Jacobson, Else; Jacobsen, Else; Dart, Andrew J; Mondori, Takamitsu; Horadogoda, Neil; Jeffcott, Leo B; Little, Christopher B; Smith, Margaret M
It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3 cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re
Unilateral Plantar Flexors Static-Stretching Effects on Ipsilateral and Contralateral Jump Measures
da Silva, Josinaldo Jarbas; Behm, David George; Gomes, Willy Andrade; Silva, Fernando Henrique Domingues de Oliveira; Soares, Enrico Gori; Serpa, Érica Paes; Vilela Junior, Guanis de Barros; Lopes, Charles Ricardo; Marchetti, Paulo Henrique
The aim of this study was to evaluate the acute effects of unilateral ankle plantar flexors static-stretching (SS) on the passive range of movement (ROM) of the stretched limb, surface electromyography (sEMG) and single-leg bounce drop jump (SBDJ) performance measures of the ipsilateral stretched and contralateral non-stretched lower limbs. Seventeen young men (24 ± 5 years) performed SBDJ before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) unilateral ankle plantar flexor SS (6 sets of 45s/15s, 70-90% point of discomfort). SBDJ performance measures included jump height, impulse, time to reach peak force, contact time as well as the sEMG integral (IEMG) and pre-activation (IEMGpre-activation) of the gastrocnemius lateralis. Ankle dorsiflexion passive ROM increased in the stretched limb after the SS (pre-test: 21 ± 4° and post-test: 26.5 ± 5°, p < 0.001). Post-stretching decreases were observed with peak force (p = 0.029), IEMG (P<0.001), and IEMGpre-activation (p = 0.015) in the stretched limb; as well as impulse (p = 0.03), and jump height (p = 0.032) in the non-stretched limb. In conclusion, SS effectively increased passive ankle ROM of the stretched limb, and transiently (less than 10 minutes) decreased muscle peak force and pre-activation. The decrease of jump height and impulse for the non-stretched limb suggests a SS-induced central nervous system inhibitory effect. Key points When considering whether or not to SS prior to athletic activities, one must consider the potential positive effects of increased ankle dorsiflexion motion with the potential deleterious effects of power and muscle activity during a simple jumping task or as part of the rehabilitation process. Since decreased jump performance measures can persist for 10 minutes in the stretched leg, the timing of SS prior to performance must be taken into consideration. Athletes, fitness enthusiasts and therapists should
The Artificial Gravity Bed Rest Pilot Project: Effects on Knee Extensor and Plantar Flexor Muscle Groups
NASA Technical Reports Server (NTRS)
Caiozzo, V. J.; Haddad, F.; Lee, S.; Baker, M.; Baldwin, K. M.
The goal of this project was to examine the effects of artificial gravity (2.5 g) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) control (C) group (N=7); and 2) an AG group (N=8), which was exposed to 21 days of bed-rest plus daily 1 hr exposures to AG (2.5 g). This particular experiment was part of an integrated AG Pilot Project sponsored by NASA/Johnson Space Center. The in vivo torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre and post treatment. Also, pre- and post treatment biopsy samples were obtained from both the vastus lateralis and soleus muscles and were used, in part, for a series of analyses on gene expression (mRNA abundance) of key factors implicated in the anabolic versus catabolic state of the muscle. Post/Pre toque-velocity determinations revealed greater decrements in knee extensor performance in the C versus AG group (P less than 0.04). The plantar flexor muscle group of the AG subjects actually demonstrated a net gain in torque-velocity relationship; whereas, in the C group the overall post/pre responses declined (AG vs C; P less than 0.001). Measurements of muscle fiber cross-sectional area (for both muscles) demonstrated a loss of approx. 20% in the C group while no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity (IGF-1, IGF-1 BP4, mechano growth factor, total RNA, and pro-collagen 3a) were higher in the AG group, whereas catabolic markers (myostatin and atrogen) were elevated in the C group. Importantly, these patterns were seen in both muscles. Based on these observations we conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading states. These findings also
Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons
Jacobsen, Else; Dart, Andrew J.; Mondori, Takamitsu; Horadogoda, Neil; Jeffcott, Leo B.; Little, Christopher B.; Smith, Margaret M.
It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re
Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture.
Kang, Dong Yeon
[Purpose] This study investigated the effects of deep cervical flexor training on maintaining forward head posture, muscular endurance, and cervical mobility. It also examined the effectiveness of deep cervical flexor training with a pressure biofeedback unit. [Subjects and Methods] Twenty college students were recruited and randomly assigned to groups that underwent either deep cervical flexor training with a pressure biofeedback unit (experimental group, n=10) or conventional deep cervical flexor training (control group, n=10). The craniovertebral angle of each subject was measured with a lateral-view picture. Neck mobility was assessed using a cervical range of motion device and muscular endurance was measured using a pressure biofeedback unit. Both groups performed conventional deep cervical flexor exercises three times a week for six weeks. The experimental group underwent a pressure biofeedback unit training was 5 to10 minutes/day, thrice a week. [Results] Cervical range of motion in the experimental group increased significantly between the end of training and the end of the four week detraining period, compared to that in control group. [Conclusion] Deep cervical flexor training with a pressure biofeedback unit is a useful method for maintaining neck mobility and muscular endurance in people with forward head posture. PMID:26644676
High-Intensity Running and Plantar-Flexor Fatigability and Plantar-Pressure Distribution in Adolescent Runners
Fourchet, François; Kelly, Luke; Horobeanu, Cosmin; Loepelt, Heiko; Taiar, Redha; Millet, Grégoire
Context: Fatigue-induced alterations in foot mechanics may lead to structural overload and injury. Objectives: To investigate how a high-intensity running exercise to exhaustion modifies ankle plantar-flexor and dorsiflexor strength and fatigability, as well as plantar-pressure distribution in adolescent runners. Design: Controlled laboratory study. Setting: Academy research laboratory. Patients or Other Participants: Eleven male adolescent distance runners (age = 16.9 ± 2.0 years, height = 170.6 ± 10.9 cm, mass = 54.6 ± 8.6 kg) were tested. Intervention(s): All participants performed an exhausting run on a treadmill. An isokinetic plantar-flexor and dorsiflexor maximal-strength test and a fatigue test were performed before and after the exhausting run. Plantar-pressure distribution was assessed at the beginning and end of the exhausting run. Main Outcome Measure(s): We recorded plantar-flexor and dorsiflexor peak torques and calculated the fatigue index. Plantar-pressure measurements were recorded 1 minute after the start of the run and before exhaustion. Plantar variables (ie, mean area, contact time, mean pressure, relative load) were determined for 9 selected regions. Results: Isokinetic peak torques were similar before and after the run in both muscle groups, whereas the fatigue index increased in plantar flexion (28.1%; P = .01) but not in dorsiflexion. For the whole foot, mean pressure decreased from 1 minute to the end (−3.4%; P = .003); however, mean area (9.5%; P = .005) and relative load (7.2%; P = .009) increased under the medial midfoot, and contact time increased under the central forefoot (8.3%; P = .01) and the lesser toes (8.9%; P = .008). Conclusions: Fatigue resistance in the plantar flexors declined after a high-intensity running bout performed by adolescent male distance runners. This phenomenon was associated with increased loading under the medial arch in the fatigued state but without any excessive pronation. PMID:25531143
Closed Rupture of the Flexor Tendon Secondary to Sclerosis of the Hook of the Hamate: A Report of Two Cases.
Yamazaki, Hiroshi; Uchiyama, Shigeharu; Hosaka, Masato; Kato, Hiroyuki
Closed flexor tendon ruptures in the little finger can be caused by fracture or nonunion of the hook of the hamate, but no case of the disorder secondary to the sclerosis and thinning of the hamate hook has been reported. We report two rare cases with this complication due to rough surface of the hamate hook. Carpal tunnel view radiographs and computed tomography showed the sclerosis and thinning of the hook. PMID:27595962
Attritional Rupture of the Little Finger Flexor Digitorum Profundus Tendon in the Carpal Tunnel in a Patient with Acromegaly.
Lee, Munn Yi Tina; Jin, Yeo Chong
Spontaneous rupture of flexor tendons within the carpal tunnel is rare in the absence of rheumatoid arthritis. Other predisposing conditions such as gout, infection, pisotriquetrial osteoarthritis, as well as hook of hamate fracture non-union, have previously been reported. However, tendon ruptures of the hand in the presence of acromegaly, as well as spontaneous ruptures within the carpal tunnel, have not been described in the literature. PMID:27454510
Interfacial area transport across vertical elbows in air-water two-phase flow
NASA Astrophysics Data System (ADS)
Yadav, Mohan Singh
The accurate prediction of two-phase flow using the two-fluid model requires closure relations for the interfacial area concentration ( ai), which can be provided by the interfacial area transport equation (IATE). Models have been developed for the IATE in straight pipe geometries. However, to analyze practical systems, it is important that the IATE accounts for flows in pipes with varying orientation that are interconnected via different flow restrictions. In view of this, the current study performs experiments to investigate the geometric effects of 90- degree vertical elbows in air-water two-phase flows and develops a one-group IATE applicable to vertical-upward-to-horizontal two-phase flows. The experimental facility consists of both vertical and horizontal sections constructed from 50.8 mm inner diameter acrylic pipes that are interconnected via 90-degree glass elbows. The elbows have a radius of curvature of Rc/D = 3 and are installed at L/D = 63 and 244.7 from the inlet. Experiments are performed to characterize the elbow-effect on both global and local two-phase flow parameters. A four-sensor conductivity probe is used to acquire detailed measurements of local two-phase flow parameters at thirteen axial locations along the test section in eight flow conditions that are within the bubbly flow regime at inlet. The measurements show that in bubbly flow conditions, the vertical-upward elbow causes a characteristic bimodal-type bubble distribution and the change in this distribution farther downstream of the elbow corresponds to the dissipation of the elbow-effects. In view of developing the IATE for vertical-upward to horizontal two-phase flows, predictive models for the dissipation length of the elbow-effect and closure relations for advection of gas-phase, pressure loss, and covariance of bubble interactions are developed. The new models are evaluated against the current experimental database. Overall, the model predictions agree with the data within +/-7