The Sonographic Posterolateral Rotatory Stress Test for Elbow Instability: A Cadaveric Validation Study

Camp, Christopher L.; O’Driscoll, Shawn W.; Wempe, Michael K.; Smith, Jay

doi:10.1016/j.pmrj.2016.06.014

Cited by 27 publications

(20 citation statements)

References 16 publications

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“…The basic principle of the sonographic measurement used in this study was based on a previously published sonographic technique. 7 The RCJ space was measured in millimeters using the electronic calipers on the ultrasound machine. While maintaining the ultrasound probe as parallel as possible to the lateral-most edge of the radial head, the observers measured the distance from the most proximal point on the radial head closest to the ultrasound probe straight across proximally (in the horizontal plane of the image frame) to the nearest point on the capitellum (distance between lines B and C in Figure 5).…”

Section: Joint Space Measurementmentioning

confidence: 99%

Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament–Capsular Complex

Kwak

Rotman

Rojas

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: There is no consensus how to determine the varus laxity due to the LCL injury using the ultrasonography. There is a risk of lateral collateral ligament injury during or after arthroscopic extensor carpi radialis brevis release for tennis elbow. The equator of the radial head has been suggested as a landmark for the safe zone to not increase this risk; however, the safe zone from the intra-articular space has not been established. Hypothesis: Increased elbow varus laxity due to lateral collateral ligament–capsular complex (LCL-cc) injury could be assessed reliably via ultrasound. Study Design: Descriptive laboratory study. Methods: Eight cadaveric elbows were evaluated using a custom-made machine allowing passive elbow flexion under gravity varus stress. The radiocapitellar joint (RCJ) space was measured via ultrasound at 30° and 90° of flexion during 4 stages: intact elbow (stage 0), release of the anterior one-third of the LCL-cc (stage 1), release of the anterior two-thirds (stage 2), and release of the entire LCL-cc (stage 3). Two observers conducted the measurements separately, and the mean RCJ space in the 3 LCL-cc injury models (stages 1-3) at both flexion angles was compared with that of the intact elbow (stage 0). We also compared the measurements at 30° versus 90° of flexion. Results: At 30° of elbow flexion, the RCJ space increased 2 mm between stages 0 and 2 (95% confidence interval [CI], 1-3 mm; P < .01) and 4 mm between stages 0 and 3 (95% CI, 2-5 mm; P < .01). At 90° of elbow flexion, the RCJ space increased 1 mm between stages 0 and 2 (95% CI, 1-2 mm; P < .01) and 2 mm between stages 0 and 3 (95% CI, 2-3 mm; P < .01). Conclusion: Elbow varus laxity under gravity stress can be reliably assessed via ultrasound by measuring the RCJ space. Clinical Relevance: Because ultrasonographic measurement of the RCJ space can distinguish the increasing varus laxity seen with release of two-thirds or more of the LCL-cc, the anterior one-third of the LCL-cc, based on the diameter of the radial head, can be considered the safe zone in arthroscopic extensor carpi radialis brevis release for tennis elbow.

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Section: Joint Space Measurementmentioning

confidence: 99%

Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament–Capsular Complex

Kwak

Rotman

Rojas

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…For the fluoroscopic examination, the elbow is viewed from a standard lateral projection while a posterolateral rotatory force is applied to the elbow. For dynamic ultrasound (Phillips Ultrasound Systems, Bothell, WA), 6 the probe is placed in the anatomic axial plane connecting the lateral epicondyle to the olecranon (Fig 3A) and the ulnohumeral joint is visualized (Fig 3B). Widening of the ulnohumeral joint is assessed as a posterolateral rotatory stress is applied (Fig 3C), and ulnohumeral laxity (stressed distance e distance at rest) > 4 mm may be indicative of PLRI.…”

Section: Dynamic Imagingmentioning

confidence: 99%

“…Widening of the ulnohumeral joint is assessed as a posterolateral rotatory stress is applied (Fig 3C), and ulnohumeral laxity (stressed distance e distance at rest) > 4 mm may be indicative of PLRI. 6 These techniques and examples of positive tests are further shown in Video 1. Ultrasound can be used to assess the elbow for posterolateral rotatory instability by measuring the extent to which the posterolateral ulnohumeral joint opens when stressed.…”

Section: Dynamic Imagingmentioning

confidence: 99%

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Posterolateral Rotatory Instability of the Elbow: Part II. Supplementary Examination and Dynamic Imaging Techniques

Camp

Smith

O’Driscoll

2017

Arthroscopy Techniques

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Currently, a number of examination and imaging techniques exist for diagnosing posterolateral rotatory instability of the elbow. Although the posterolateral rotatory drawer is the primary examination maneuver, other special tests include the lateral pivot-shift test, prone push-up test, chair push-up test, and tabletop push-up test. In addition, posterolateral rotatory instability can be evaluated using radiography, magnetic resonance imaging, dynamic fluoroscopy, or dynamic ultrasound. In this Technical Note, each of these tests is described in detail. Video instruction is also provided to further explain the techniques and provide examples of positive tests.

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“… 2 , 3 , 4 Although it generally occurs after elbow trauma, other described etiologies include tardy PLRI secondary to cubitus varus deformity, severe lateral epicondylitis (especially treated with repeated corticosteroid injections), or iatrogenic injury after lateral elbow surgery. 1 , 5 , 6 , 7 , 8 Regardless of the mechanism, the injury ultimately leads to posterolateral rotatory subluxation of the radial head and ulna from the humerus. Depending on injury severity, the lateral collateral ligament complex, capsule, and common extensor tendon can be involved; however, the primary restraint to PLRI is the lateral ulnar collateral ligament (LUCL).…”

mentioning

confidence: 99%

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow

Camp

Sánchez-Sotelo

Shields

et al. 2017

Arthroscopy Techniques

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Reconstruction of the lateral ulnar collateral ligament of the elbow is the primary treatment for recurrent symptomatic posterolateral rotatory instability. Although a number of lateral ulnar collateral ligament reconstruction techniques have been described, the docking technique has received general acceptance. In this technique, the graft is passed through a tunnel on the ulnar side and the 2 free limbs are docked into the humerus at the isometric point on the lateral condyle. Advantages of this method of reconstruction include reduced bone removal, decreased soft tissue damage, and precise control of graft tensioning. When precise surgical steps are followed, this technique can be performed in a reliable, efficient, and reproducible manner for patients with posterolateral rotatory instability of the elbow.

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The Sonographic Posterolateral Rotatory Stress Test for Elbow Instability: A Cadaveric Validation Study

Abstract: IV.

Cited by 27 publications

References 16 publications

Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament–Capsular Complex

Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament–Capsular Complex

Posterolateral Rotatory Instability of the Elbow: Part II. Supplementary Examination and Dynamic Imaging Techniques

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow

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