Elbow ultrasonography is a feasible and useful diagnostic method for the evaluation of tendons, muscles, ligaments, nerves and joints in traumatic or articular disorders as well as for the diagnosis of rare tumorous diseases. This pictorial essay discusses the basic techniques of elbow ultrasonography, sonographic anatomy and various types of elbow pathology with associated sonographic features.
Diagnosis* ; Elbow Joint* ; Elbow* ; Joints ; Ligaments ; Muscles ; Pathology ; Tendons ; Ultrasonography

Some baseball pichers have the symptom-complex of the elbow joint due to repetitive throwing. The Hyperextension overload syndrome is symptom-complex caused by impingement between olecranon tip and fossa during hyperextension of the elbow. The patients of hyperextension overload syndrome is have some pathology of his elbow such as bony spur on olecranon tip, intra-articular loose body or degenerative arthritis. And they complaint of pain or limitation of extension. The authors diagnosed and treated five cases of hyperextension overload syndrome. All of them had flexion contracture. Three cases of them had cubitus valgus. But no had medial instability of the elbow. Three cases of them had tenderness on the olecranon tip. Four patients treated by excision of osteophyte or loose body with arthroscopic or open operative technique.
Baseball ; Contracture ; Elbow Joint ; Elbow ; Humans ; Olecranon Process ; Osteoarthritis ; Osteophyte ; Pathology

The pathologic spectrums of the tennis elbow are varies as lateral epicondylitis, degenerative partial tear of extensor tendon origin, annular ligament lesion, synovial fringe between radio-capitellar joint, bursitis and posterior interosseous nerve pathology. So it is difficult to perform separate treatments for each different pathologic conditions. Conservative treatments for the tennis elbow are consisted of rest, immobilization, non-steroidal anti-inflammatory drugs (NSAID), and local injection of the steroid. Usual success rates of the conservative treatment have been reported approximately more than 90%. Several methods of surgical treatm nt of the resistant tennis elbow have been reported. Authors performed surgical treatment for twelve cases of the resistant tennis elbow from Jan. 1989 to Jan. 1994. Authors modified the Nirschl's technique; flap retraction of the extensor carpi radilais brevis (ECRB) and common extensor tendon to expose the radio-capitellar joint and no reattachment of detached tendons to the lateral epicondyle and side-to-side suture with maximal stretching of the ECRB tendon. Identified pathologic conditions were the degenerative partial tear and friable granulation tissues at the ECRB origin, sclerosis of the lateral epicondyle (ten cases), synovial fringe bewteen the radio-capitellar joint (two cases). In one case, authors couldn't find any abnormal pathologic conditions. Microscopic examinations (two cases) showed angioblastic proliferation, fibrosis, degeneration of the collagen fiber. Among these patients, eleven patients were industrial worker (eight painter, two welder and one carpenter). They have something in common with using hammer mainly. The hammering might be a possible cause of the tennis elbow. After the surgery, the functional recoveries were satisfactory. The final results were four excellent (33.3%) and good (66.6%) by Nirsh & ettrone grading system. The time required to return to the original job were varied from one month to eight months (average 4.3 months).
Bursitis ; Collagen ; Elbow ; Fibrosis ; Granulation Tissue ; Humans ; Immobilization ; Joints ; Ligaments ; Pathology ; Sclerosis ; Sutures ; Tendons ; Tennis Elbow* ; Tennis*

Adult ; Chondromatosis, Synovial ; pathology ; surgery ; Elbow Joint ; pathology ; surgery ; Humans ; Male

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

OBJECTIVETo explore the optimal method for the treatment of the elbow joint stiffness accompanied with neural injury after electrical injury.

METHODSThirty adult cadaver elbows were fixed and dissected to observe the attachments of the ligaments and the muscles around the joint, and its relationship with the major nerves. Ten patients with electric burns with stiffness of the elbow joint were treated by means of loosening the anterior and posterior fascicles of radial and ulnar collateral ligaments, at the same time down shifting the insertion of flexor muscles, replacing the ulnar nerve anteriorly, in order to reconstruct flexor and extension functions of the elbow. The effect was evaluated with biomechanics criteria.

RESULTSThrough anatomical study, it was revealed that contracture of the posterior fascicles of the radial and ulnar collateral ligaments and triceps brachii muscle would result in stiffness of the elbow joint, and contracture due to disuse of the two anterior fascicles of the radial and ulnar collateral ligaments and M.biceps brachii would produce flexion deformity of the elbow joint. Postoperatively, the functions of the elbow joints of all the 10 patients recovered satisfactorily. Follow-up from 1 to 3 years showed no change in the range of flexion and extension movements of the elbows, and on the contrary, mobility of the elbow joints was improved.

CONCLUSIONLoosening of the anterior and posterior fascicles of the two collateral ligaments and replacement of insertions of biceps and triceps are pivotal in the treatment of stiffness of the elbow joint. Meanwhile lowering the origins of forearm flexor muscles on epicondylus and replacing anteriorly the ulnar nerve can further improve the flexion, function of the joint and relieve compression of the nerve.

Adult ; Ankylosis ; etiology ; pathology ; therapy ; Burns, Electric ; complications ; pathology ; therapy ; Elbow Joint ; anatomy & histology ; pathology ; Humans ; Male ; Middle Aged

The natural course of lateral epicondylitis is widely regarded to be self-limiting within 1 year of symptom duration in 90% of all patients. The spectrum of treatments include simple ‘wait and see', bracing, physical therapy, corticosteroid injection, and recently some biologic injection such as autologous blood and platelet rich plasma. However, recalcitrant lateral epicondylitis which are not responding to conservative treatments can be treated with surgical treatment although much remains unclear regarding the ideal treatment. Debates surrounding open procedures are the management for the defect after resection of pathologic tissue, necessity of decortication, selective denervation procedure, etc. Since the trend is changing to minimal invasive surgery and arthroscopic release of extensor carpi radialis brevis tendon are becoming more popular these days, surgical tips and pitfall to obtain good results and avoid complications have been reported recently. Bipolar radiofrequency (RF)-based microtenotomy or percutaneous tendon release is another surgical procedures reported to be effective in lateral epicondylitis. However, there are some patients who present with persistent pain after surgical treatment. Thus, selection of ideal candidates for surgery, thorough evaluation of all pathologies prior to surgery, and adequate surgical procedures would be essential in the surgical treatment of lateral epicondylitis.
Braces ; Denervation ; Humans ; Pathology ; Platelet-Rich Plasma ; Tendons ; Tennis Elbow ; Tenotomy

Adult ; Arnold-Chiari Malformation ; diagnosis ; Elbow Joint ; pathology ; Female ; Humans ; Syringomyelia ; diagnosis

OBJECTIVETo introduce the experiences of applying MR to diagnose the imaging characters in chronic injury of the elbows in athletes.

METHODSFrom September 2005 to May 2008, 40 elbows of 34 athletes, included 21 males and 13 females,aged from 6 to 16 years old, averaged (12.3 +/- 3.1) years were taken axial, saggital and coronal planes MR Imaging.

RESULTSMagnetic resonance imaging showed thickening and effusion of olecranon synovial plicaes, bone marrow edema of lower humeral ossification, radial head, olecranon, ulna coronoid, ulnar collateral ligament trauma in chronic injury of the elbow joint.

CONCLUSIONMRI is a susceptible method for the diagnoses of chronic injury of the elbow.

Adolescent ; Athletic Injuries ; pathology ; Child ; Chronic Disease ; Elbow Joint ; injuries ; Female ; Humans ; Magnetic Resonance Imaging ; Male

Adult ; Elbow ; Giant Cell Tumors ; diagnosis ; pathology ; physiopathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Tendons