Tennis elbow is a common disease. The current research showed that the basic pathology of tennis elbow is not inflammation, but lateral elbow tendinopathy. Ultrasound image has been frequently used for diagnosis of tennis elbow, it can evaluate the condition of disease and show prognosis. Tennis elbow needs a comprehensive treatment. Most patients can obtain satisfactory effects by non-operation, especially the application of the Sodium hyaluronate, autologous blood and botulinum toxin. The principle of operation is to clear the common extensor tendon and repair or rebuild the tendon dead centre if necessarily. The arthroscopic surgery has the advantages of less invasion, rapid recovery,and become the new chioce for the treatment of tennis elbow. Both open operation and arthroscopic surgery can obtain good effects.
Humans ; Tennis Elbow ; diagnostic imaging ; etiology ; therapy ; Ultrasonography

BACKGROUNDConventional ultrasonography or magnetic resonance (MR) imaging is commonly performed to obtain information about the severity of the disease, location of the injury, and differential diagnosis. The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.

METHODSA single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients (9 men, 19 women; mean age, 48.5 years; age range, 36-67 years) with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls. Greyscale images were described as normal, tendinosis, partial-thickness tear, and full-thickness tear. Sonoelastographic images of the common extensor tendon were analyzed qualitatively (scoring of the elastic spectrum) and quantitatively (based on a color histogram).

RESULTSBoth the imaging methods had high sensitivity, specificity, and accuracy for diagnosing lateral elbow tendinopathy. Considering the clinical diagnosis of lateral elbow tendinopathy, sonoelastography showed significantly higher diagnostic accuracy (96.4%) than ultrasonography (89.5%, P < 0.01). Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows (P < 0.01).

CONCLUSIONSonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.

Adult ; Aged ; Elasticity Imaging Techniques ; methods ; Elbow ; pathology ; Female ; Humans ; Male ; Middle Aged ; Tendinopathy ; diagnosis ; diagnostic imaging ; Tendons ; pathology ; Tennis Elbow ; diagnosis ; diagnostic imaging

Objective To evaluate the diagnostic value of high-frequency ultrasound in the diagnosis of supinator syndrome (SD). Methods Ten patients with supinator syndrome (SD group) and 20 healthy volunteers (control group) underwent ultrasonographic examination. Axial and long-axis views of the radial nerve were taken where the nerves enters the supinator muscle entrance. The maximum transverse diameter and anteroposterior diameter were also measured. Results High-frequency ultrasound clearly revealed the images and course of radial nerve deep branch in two groups. The SD group had swollen nerves and the maximum transverse diameter and anteroposterior diameter were (3.50?0.39)mm and (4.30?0.47)mm,respectively,which were significantly larger than in the control group [(1.10?0.17)mm,t=-29.67,P=0.00;(1.00?0.16)mm,t=-36.72,P=0.00). The causes (including synovial cyst nearby and radial artery recurrent branch) of nerve entrapment were revealed directly in 4 patients in SD group. Conclusions High-frequency ultrasound can clearly display the radial nerve deep branch around the elbow joint. SD patients have swollen nerves at the entrance of the supinator muscle,where the diameters of these nerves are abnormally enlarged.
Case-Control Studies ; Elbow Joint ; diagnostic imaging ; Healthy Volunteers ; Humans ; Nerve Compression Syndromes ; diagnostic imaging ; Radial Nerve ; diagnostic imaging ; Radial Neuropathy ; diagnostic imaging ; Ultrasonography

INTRODUCTIONInjuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODSIn this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTSAmong the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm, while that of the non-dominant arm was 189.14 ± 39.56 mm(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSIONMedial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Adolescent ; Athletes ; Athletic Injuries ; diagnostic imaging ; physiopathology ; Baseball ; Cross-Sectional Studies ; Elbow ; injuries ; Elbow Joint ; diagnostic imaging ; physiopathology ; Humans ; Male ; Radiography

A 15 years old girl was found to have isolated trochlea fracture 10 weeks after an injury caused by a fall on her left elbow. Movement of the elbow was severely restricted. Radiographs showed a half moon-shaped and anterosuperiorly displaced osteochondral fragment. Medial approach capsulotomy of the elbow and excision of the intraarticular adhesions were done to expose the isolated trochlea fracture. Headless screws were used for fixation, combined with bone grafting. The follow-up showed union and excellent functional recovery of the elbow. Isolated trochlea fracture in adults is rare and usually associated with capitellar fractures and/or elbow dislocations. A neglected trochlea fracture is rarely reported in the English language literature to the best of our knowledge. Recognition of isolated trochlea fracture is vital to apprehend the pathomechanics of the injury and to devise a suitable treatment approach.
Adolescent ; Elbow Joint ; diagnostic imaging ; injuries ; Female ; Fracture Fixation, Internal ; Fracture Healing ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Radiography

T-condylar fracture is rare in paediatric age group, especially in skeletally immature children less than 9 years old, with very few cases reported in available literature. We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at another centre before referral to us, 10 days after the injury. The child was diagnosed as having a displaced T-condylar fracture on plain radiograph. Open reduction and internal fixation with K-wires was performed. At 2 years follow-up, the child had good range of motion at elbow with 5°of cubitus varus. With this background we discuss the pertinent principles of management of T-condylar fractures in skele-tally immature children.
Child, Preschool ; Elbow Joint ; injuries ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; Time Factors

OBJECTIVETo study the role of lateral collateral ligament complex on the posterolateral rotatory instability and the relationship between the radiocapitellar ratio (RCR) and the injury of lateral collateral ligament complex on X-ray images.

METHODSTwenty elbow joints from fresh-frozen adult cadavers were used to make osteo-ligamentous elbow specimens. The specimens were fixed with a self-made device to maintain posterolateral rotatory instability of the elbow joint. All the specimens were divided into two groups: group A and group B. Surgical procedures were carried out as follows in the lateral structures of group A: A1, intact specimen; A2, transection of radial ulnar collateral ligament firstly; A3, transection of annular ligament secondly; A4, final transection of the radial collateral ligament. The procedures in group B were carried out as follows: B1, intact specimen; B2, transection of the radial collateral ligament firstly; B3, transection of the annular ligament secondly; B4, final transection of the radial ulnar collateral ligament. Lateral X-ray films of elbow joint were taken, and the radiocapitellar ratio (RCR) was measured by using PACS. All analysis was performed with SPSS 17.0 software.

RESULTSGroup A: the increases in RCR had statistical differences among A1, A2, A3, and A4 groups. Group B: the increases in RCR had no statistical differences among B1, B2 and B3 groups; but the increase in RCR in group B4 was more than that in B1, B2 and B3 groups.

CONCLUSIONThe radial ulnar collateral ligament is a key structure to maintain posterolateral rotatory stability;the radial collateral ligament and the annular ligament are the secondary important structures. There are 4 grades of the posterolateral rotatory instability of the elbow, according to the X-ray imaging classification.

Collateral Ligaments ; injuries ; Elbow Joint ; diagnostic imaging ; physiopathology ; Female ; Humans ; Joint Instability ; diagnostic imaging ; etiology ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Male ; Radiography

The traditional methods of skeletal age estimation mainly include Numeration, Atlas, and Counting scores. In recent years, other new methods were proposed by several scholars. Utilizing image logical characteristics of X-ray film to extrapolate skeletal age is a key means by present forensic medicine workers in evaluating skeletal age. However, there exist some variations when we present the conclusion of skeletal age as an "evidence" directly to the Justice Trial Authority. In order to enhance the accuracy of skeletal age determination, further investigation for appropriate methodology should be undertaken. After a collective study of pertinent domestic and international literatures, we present this review of the research and advancement on skeletal age evaluation methods of X-ray film.
Age Determination by Skeleton/trends* ; Carpal Bones/diagnostic imaging* ; Elbow/diagnostic imaging* ; Female ; Forensic Medicine/methods* ; Hand Bones/diagnostic imaging* ; Humans ; Image Processing, Computer-Assisted/methods* ; Male ; Radius/diagnostic imaging* ; Tomography, X-Ray Computed/methods* ; X-Ray Film

Adult ; Elbow Joint ; injuries ; Female ; Humans ; Musculoskeletal Manipulations ; Shoulder Dislocation ; diagnostic imaging ; pathology ; physiopathology ; therapy ; Shoulder Fractures ; diagnostic imaging ; pathology ; physiopathology ; therapy ; Tomography, X-Ray Computed

Radial head and coronoid fractures without posterior dislocation of the elbow have not been recorded in the literature. There is no literature documenting the combined fractures of the radial head, capitellum and coronoid process together in the same elbow. This is a case report highlighting this combination of fractures in a 30 year old patient treated with open reduction and internal fixation of all three fractures. The patient was followed up for 28 months and had a good range of motion of the elbow without any instability. Thus such a triad with no ligamentous injuries could depict a bony variant of terrible triad and a mechanism for such an injury has also been explained.
Accidents, Traffic ; Adult ; Elbow Joint ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Radius Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed