Elbow MR arthrography with traction

Lee, Ryan K. L.; Griffith, James F.; Yuen, Brian; Ng, Alex Wing Hung; Yeung, D.

doi:10.1259/bjr.20160378

Cited by 14 publications

(14 citation statements)

References 42 publications

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“…Then, manual varus stress test was performed, and an AP fluoroscopic image was acquired. Since a previous study reported that the radiocapitellar joint is 0.47 mm more redundant compared with the ulnohumeral joint [ 10 ], a widening of over 1.5 mm at the radiocapitellar joint was considered as subtle varus instability (Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

Subtle elbow instability associated with lateral epicondylitis

Kwak

Lee

Jeong

et al. 2018

BMC Musculoskelet Disord

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BackgroundIn lateral epicondylitis, even in the absence of apparent instability, subtle instability can be found under anesthesia. We wanted to ascertain the following: (1) how many elbows surgically treated with lateral epicondylitis showed subtle instability during examination under anesthesia (EUA), (2) how effective magnetic resonance imaging (MRI) was in predicting subtle instability, and (3) if any difference existed in preoperative clinical data between elbows with and without subtle instability during EUA.MethodsOne hundred and twenty-two elbows (117 patients) diagnosed with intractable lateral epicondylitis underwent surgical treatment. No elbow showed apparent instability with conventional physical examination. Under general anesthesia, the elbows were examined for subtle instability via fluoroscopy and divided into unstable and stable groups. Potential prognostic factors and functional scores were assessed retrospectively. The MRIs were reviewed again by two radiologists.ResultsSeventeen elbows (unstable group, 13.9%) had subtle instability in EUA, while 105 elbows (stable group, 86.1%) did not. Lateral collateral ligament (LCL) complex injury was noted in the MRIs of 28 elbows. Fifteen elbows showed subtle instability among 28 elbows with abnormal MRI (positive predictive value, 53.6%), while 81 elbows did not show subtle instability among 82 elbows with normal MRI (negative predictive value, 98.7%). The preoperative visual analog scale score was higher in the unstable group than in the stable group (p < 0.001), and a history of multiple corticosteroid injections (≥3) was related to subtle instability in EUA (p = 0.042). Other factors showed no significant differences between both groups.ConclusionsSubtle instability resulting from LCL complex injury was noted in elbows with lateral epicondylitis. This could be visualized with fluoroscopic EUA, and preoperative MRI could be used to exclude subtle instability. Surgeons should consider checking for subtle instability, especially when patients have a history of multiple corticosteroid injections (≥3) or severe pain and MRI indicates instability.

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Section: Methodsmentioning

confidence: 99%

Subtle elbow instability associated with lateral epicondylitis

Kwak

Lee

Jeong

et al. 2018

BMC Musculoskelet Disord

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“…Radiocapitellar joint widening over 1.5 mm seen by magnetic resonance arthrography with traction was associated with subtle varus instability. 16 When performing the EUA, researchers have shown a ''no endpoint'' feeling while performing the varus stress test 27 and that radiocapitellar joint widening of at least 2.5 mm 15 may indicate instability. The current study was unable to show any evidence of a direct relationship between instability presentation as evidenced by clinical workup, imaging modalities, and EUA because of a lack of supporting evidence.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Elbow Instability in Association With Refractory Lateral Epicondylitis: Myth or Fact?

et al. 2021

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Background: Elbow instability, particularly posterolateral rotatory instability (PLRI), has been reported in patients with refractory lateral epicondylitis (LE). However, evidence of diagnostic approach and surgical outcomes is lacking. Purpose: To identify (1) the risk factors, clinical and radiologic-diagnostic characteristics, and (2) the treatment options and clinical outcome of LE with PLRI. Study design: Systematic review. Methods: We searched the PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, Scopus, and EMBASE databases using keywords as well as Medical Subject Headings terms and Emtree using “(lateral epicondylitis OR tennis elbow) AND (instability OR posterolateral rotatory instability)” for English-language studies. We conducted a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: In total, 8 articles comprising 6 level 4 and 2 level 3 studies were identified, including 249 patients (254 elbows). The main triggering factor was heavy labor activity (74/172; 43%). A total of 184 patients (73.9%) received either single (4/184; 2.2%) or multiple (180/184; 97.8%) steroid injections. Clinically, instability was always accompanied by pain in 9% of study individuals. Magnetic resonance imaging (MRI) revealed that radial collateral ligament (RCL) and lateral ulnar collateral ligament (LUCL) lesions were most common (18/79; 23%). The most common surgical procedure performed was arthroscopic RCL plication (62/120; 52%) followed by LUCL reconstruction (30/120; 25%). A ligament patholaxity sign was shown intraoperatively for 64% (44/69). Clinical outcomes ranged from good to excellent in all studies. The most common residual symptom was limited range of motion (11/18; 61%). Conclusion: Instability can coexist and may be associated with refractory LE. The risk factors of instability associated with refractory LE are heavy labor and multiple steroid injections. A systematic approach to identify the clinical and MRI presentation of the condition followed by examination under anesthesia are necessary for affirmative diagnosis, as independent presentations may be misleading.

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“…In developing this technique, we intended to maximize the advantages and compensate for the shortcomings of MRI and CT. The application of axial traction widens the joint space of the radio-capitellar joint and improves visualization of the articular cartilage outline of the humeral capitellum with minimum pain and discomfort [ 30 , 31 ], making the creation of accurate 3D models of the articular cartilage possible, and enabling images with a slice thickness of 0.4 mm to be obtained using a 3D sequence. We used a 7 kg traction weight according to previous studies [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…This procedure is called segmentation, which is crucial for creating better images. While segmenting the articular cartilage, we defined the articular cartilage fissures (ACFs) as the low-intensity lines within the articular cartilage, which penetrate or are perpendicular to the articular surface [ 12 , 15 , 31 , 32 , 33 ]. Articular surface deformity (ASD) was defined as irregularities in the outline of the articular cartilage [ 12 , 15 ] ( Figure 2 ).…”

Section: Methodsmentioning

confidence: 99%

Preoperative Evaluation and Surgical Simulation for Osteochondritis Dissecans of the Elbow Using Three-Dimensional MRI-CT Image Fusion Images

et al. 2021

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We used our novel three-dimensional magnetic resonance imaging-computed tomography fusion images (3D MRI-CT fusion images; MCFIs) for detailed preoperative lesion evaluation and surgical simulation in osteochondritis dissecans (OCD) of the elbow. Herein, we introduce our procedure and report the findings of the assessment of its utility. We enrolled 16 men (mean age: 14.0 years) and performed preoperative MRI using 7 kg axial traction with a 3-Tesla imager and CT. Three-dimensional-MRI models of the humerus and articular cartilage and a 3D-CT model of the humerus were constructed. We created MCFIs using both models. We validated the findings obtained from the MCFIs and intraoperative findings using the following items: articular cartilage fissures and defects, articular surface deformities, vertical and horizontal lesion diameters, the International Cartilage Repair Society (ICRS) classification, and surgical procedures. The MCFIs accurately reproduced the lesions and correctly matched the ICRS classification in 93.5% of cases. Surgery was performed as simulated in all cases. Preoperatively measured lesion diameters exhibited no significant differences compared to the intraoperative measurements. MCFIs were useful in the evaluation of OCD lesions and detailed preoperative surgical simulation through accurate reproduction of 3D structural details of the lesions.

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Elbow MR arthrography with traction

Cited by 14 publications

References 42 publications

Subtle elbow instability associated with lateral epicondylitis

Subtle elbow instability associated with lateral epicondylitis

Systematic Review of Elbow Instability in Association With Refractory Lateral Epicondylitis: Myth or Fact?

Preoperative Evaluation and Surgical Simulation for Osteochondritis Dissecans of the Elbow Using Three-Dimensional MRI-CT Image Fusion Images

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