Arthroscopic Treatment for Limitation of Motion of the Elbow

Kim, Sung-Jae; Shin, Sang-Jin

doi:10.1097/00003086-200006000-00017

Cited by 120 publications

(66 citation statements)

References 18 publications

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“…Results have been reported for many different applications, including osteophyte debridement for posteromedial impingement, loose body removal, capsular release, treatment of osteochondritis dissecans, and debridement for lateral epicondylitis, as well as debridement for degenerative joint disease and other problems not directly related to the athlete's elbow [40][41][42][43][44][45][46][47][48].…”

Section: Resultsmentioning

confidence: 99%

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

O’Holleran¹,

Altchek

2006

HSS Jrnl

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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 will be reviewed.

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Section: Resultsmentioning

confidence: 99%

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

O’Holleran¹,

Altchek

2006

HSS Jrnl

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“…Much more extensive processes are currently treated arthroscopically, with outcomes and complication rates comparable to open releases. 2,3,12,13,15,21,22,24,28,30 Not surprisingly, arthroscopic treatment of the arthritic elbow appears to provide less relative benefit as the disease process progresses Table 2. 15 lists the results that are currently being reported in the literature (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Arthroscopy of the Stiff Elbow

Peden¹,

Savoie²

2006

Techniques in Orthopaedics

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Summary:The pathology of elbow stiffness can be categorized into both intraarticular and extra-articular derangements, which commonly occur in combination. The etiology of the stiff elbow, likewise, can be classified into nonarthritic causes, such as surgery, trauma and certain systemic conditions, and arthritic causes, such as osteoarthritis and rheumatoid arthritis. Current arthroscopic techniques can be used to successfully manage both the arthrofibrotic and the arthritic elbow, when appropriately indicated. This article will review the indications, management principles and arthroscopic techniques for treating the stiff elbow, highlighting anatomic considerations, and the differences in technical guidelines when treating arthrofibrosis versus arthritis.

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“…Arthroscopic arthrolysis represents a commonly used tool for treatment of elbow stiffness [11][12][13][14][15]23] that can effectively increase the patients' ROM. Nevertheless, nerve injuries have been reported in 2.2% of cases as a result of the close proximity of major nerves to the joint [23], which is why many anatomic studies focused on the location of these nerves-mostly with regard to arthroscopic portal placement [2,6,7,21,31,33].…”

Section: Discussionmentioning

confidence: 99%

Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

Hackl

Lappen

Burkhart

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The median and radial nerves are at risk of iatrogenic injury when performing arthroscopic arthrolysis with anterior capsulectomy. Although prior anatomic studies have identified the position of these nerves, little is known about how elbow positioning and joint insufflation might influence nerve locations. Questions/purposes In a cadaver model, we sought to determine whether (1) the locations of the median and radial nerves change with variation of elbow positioning; and whether (2) flexion and joint insufflation increase the distance of the median and radial nerves to osseous landmarks after correcting for differences in size of the cadaveric specimens. Methods The median and radial nerves were marked with a radiopaque thread in 11 fresh-frozen elbow specimens. Three-dimensional radiographic scans were performed in extension, in 90°flexion, and after joint insufflations in neutral rotation, pronation, and supination. Trochlear and capitellar widths were analyzed. The distances of the median nerve to the medial and anterior edge of the trochlea and to the coronoid were measured. The distances of the radial nerve to the lateral and anterior edge of the capitulum and to the anterior edge of the radial head were measured. We analyzed the mediolateral nerve locations as a percentage function of the trochlear and capitellar widths to control for differences regarding the size of the specimens. Results The mean distance of the radial nerve to the lateral edge of the capitulum as a percentage function of the capitellar width increased from 68% ± 17% in extension to 91% ± 23% in flexion (mean difference = 23%; 95% confidence interval [CI], 5%-41%; p = 0.01). With the numbers available, no such difference was observed Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Department of Anatomy, University of Cologne, Cologne, Germany. regarding the location of the median nerve in relation to the medial border of the trochlea (mean difference = 5%; 95% CI, À13% to 22%; p = 0.309). Flexion and joint insufflation increased the distance of the nerv...

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Arthroscopic Treatment for Limitation of Motion of the Elbow

Cited by 120 publications

References 18 publications

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

Arthroscopy of the Stiff Elbow

Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

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