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Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review

  • Giorgio Breda;Gianluca De Marco;Pierfranco Cesaraccio;Paolo Pillastrini
    • Clinics in Shoulder and Elbow
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    • 제26권2호
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    • pp.182-190
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    • 2023
  • Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library, the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%-99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%-30.0%) to 69.4% (95% CI, 57.3%-79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained.

팔꿈치관절 굽힘동작시 작업자세에 따른 동원되는 근육의 활동 변화 (Interactions of Elbow Flexors Recruited during Flexion)

  • 이면우;장성록;정의승
    • 대한산업공학회지
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    • 제19권3호
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    • pp.103-111
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    • 1993
  • There are four flexor muscles at elbow-biceps brachii, brachialis, brachioradialis, pronator teres. Muscle exertion force depends on the following conditions : elbow angle, external workload, and endurance time. The objectives of this study are to investigate the variations of the recruitment patterns of four muscles, and to analyze the changes of the role assigned to each muscle during elbow flexion. For three elbow angles, the transition point of type F motor unit of each muscle is inferred and the changes of the role assigned due to exertion level are identified by electromyographic analysis. The results showed that the recruitment pattern of biceps brachii is constant but those of other muscles are varied depending on elbow angle and exertion level. An EMG multiplexor is developed and simultaneous measurement of electromyographic signals of four elbow flexors is possible.

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Arthroscopic Excision of Delayed Diagnosed Intra-articular Osteoid Osteoma of the Elbow: A Case Report

  • Park, Sam Guk;Shin, Duk Seop;Choi, Joon Hyuk;Na, Ho Dong;Park, Jae Woo
    • Clinics in Shoulder and Elbow
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    • 제21권3호
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    • pp.162-168
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    • 2018
  • An intra-articular osteoid osteoma is a very rare cause of elbow pain, and its diagnosis and treatment remain challenging. Delayed diagnosis may lead to arthritic change of the joint. In this study, the authors present the occurrence of intra-articular osteoid osteoma in the right elbow of a 15-year-old male patient who presented with prolonged pain and limited motion owing to delayed diagnosis. After confirming the nidus of osteoid osteoma from radiographic evaluation, the lesion was completely removed arthroscopically. The patient presented a complete relief of symptoms and full range of motion. This is the first domestic report of successful arthroscopic treatment of an intra-articular osteoid osteoma of the elbow.

주관절의 외측방 회전 불안정성에 대한 외측 척측부인대 재건술-1례보고- (Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow Joint - A Case Report -)

  • 문은선;이승기;박철홍
    • Clinics in Shoulder and Elbow
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    • 제1권2호
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    • pp.236-241
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    • 1998
  • 본 교실에서는 주관절에 발생한 후외측방 회전 불안정성에 의한 재발성 탈구 환자에 대해 Nestor 술식을 이용한 외측 척측부인대 재건을 1례 치 험하였다. 주관절의 재발성 탈구의 치료에 있어서는 병인중 가장 많은 후외측방 회전 불안정성에 대한 이해가 필요하며 그에 따른 외측 척측부인대 재건등의 수술적 수기와 술후 적절한 재활 치료가 치료결과에 큰 영향을 미치게 된다.

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Arthroscopic Excision of Intra-articular Osteochondroma of the Elbow: A Case Report

  • Jang, Suk-Hwan;Song, Han-Eui
    • Clinics in Shoulder and Elbow
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    • 제19권3호
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    • pp.172-175
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    • 2016
  • Osteochondromas are one of the most common benign bone tumors usually involving extraarticular metaphysis of long bone. Solitary intra-articular osteochondroma arising from the elbow joint has rarely been reported. We present a case of 23-year-old female who had pain and limited motion of the left elbow as a result of intraarticular osteochondroma of the distal humerus. Arthroscopic excision of the osteochondroma yielded complete relief of symptoms. Absence of recurrence was confirmed radiographically at two years after surgery. To the best of our knowledge, this is the first report of osteochondroma of the elbow successfully treated arthroscopically.

Intramedullary fibula strut bone allograft in a periprosthetic humeral shaft fracture with implant loosening after total elbow arthroplasty

  • Jo, Young-Hoon;Lee, Seung Gun;Kook, Incheol;Lee, Bong Gun
    • Clinics in Shoulder and Elbow
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    • 제23권3호
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    • pp.152-155
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    • 2020
  • Periprosthetic fracture after total elbow replacement surgery is a difficult complication to manage, especially when it comes together with implant loosening. If stem revision and internal fixation of the periprosthetic fracture are performed simultaneously, this would be a very challenging procedure. Most of total elbow replacement implants are cemented type. Cement usage at periprosthetic fracture site may interfere healing of fractured site. Authors underwent internal fixation with use of locking plate and cerclage wire for periprosthetic fracture, allogenous fibular strut bone inserted into the humerus intramedullary canal allowing the fractured site to be more stable without cement usage. At 10-month follow-up, the complete union and good clinical outcome was achieved. We present a novel technique for treating periprosthetic fracture with implant loosening after total elbow replacement surgery, using intramedullary allogenous fibula strut bone graft.

In-plane 굽힘 조건에서 감육엘보우 거동에 미치는 내압의 영향 (Effect of Internal Pressure on the Behavior of Wall Thinned Elbow under In-Plane Bending)

  • 김진원;김태순;박치용
    • 대한기계학회:학술대회논문집
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    • 대한기계학회 2004년도 춘계학술대회
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    • pp.268-273
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    • 2004
  • This study is conducted to clarify the effect of internal pressure on the deformation and collapse behaviors of wall thinned elbow under in-plane bending moment. Thus the nonlinear three-dmensional finite element analyses were performed to obtain the moment-rotation curve of elbow contatining various wall thinning defects located at intrados and extrados under in-plane bending (closing and opening modes) with internal pressure of $0{\sim}15MPa.$ From the results of analysis, the effect of internal of collapse moment of elbow on the global deformation behavior of wall thinned elbow was discussed, and the dependence of collapse moment of elbow on the magnitude of internal pressure was investigated under different loading mode, defect location, and defect shape.

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Tuberculous Tenosynovitis of the Elbow - A Case Report

  • Oh, Chi-Hun;Park, Jung-Ho;Kim, Jung-Wook
    • Clinics in Shoulder and Elbow
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    • 제17권2호
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    • pp.80-83
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    • 2014
  • A 29-year-old man visited our clinic owing to a persistent swelling in the anterior part of the left elbow joint that began one year ago. Through magnetic resonance imaging (MRI), we observed tenosynovitis with multiple rice bodies, and so we performed an excisional biopsy and tenosynovectomy. Through pathology and culture tests, we identified tuberculosis in the tissue biopsy that we harvested intraoperatively. Following the anti-tuberculosis medication relieved the patient's symptoms without recurrence. Since tuberculosis of the elbow occurs only rarely, and the symptoms mimic those of rheumatoid synovitis or of non-specific chronic synovitis, early diagnosis and appropriate treatment are often delayed. The authors report this rare case of tuberculous tenosynovitis of the elbow with a review of the relevant literature.

Anterior interosseous nerve palsy in the early postoperative period after open capsular release for elbow stiffness: a case report

  • Christopher A. Colasanti;Michael Boin;Jacques Hacquebord;Mandeep S. Virk
    • Clinics in Shoulder and Elbow
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    • 제26권4호
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    • pp.462-466
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    • 2023
  • Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication.