A comparative meta-analysis of the efficacy and safety of arthroscopic versus open surgery in patients with lateral epicondylitis.

Background: Lateral epicondylitis frequently necessitates surgical management when non-surgical treatments are ineffective. Anecdotal evidence suggests comparable efficacy between arthroscopic and open surgical repair; however, it is limited by the scarcity of data. This meta-analysis compares between both procedures regarding functional recovery, pain intensity, complications, and return-to-work time. Methods: A detailed systematic review and meta-analysis of research published until February 2024 were performed, comparing arthroscopic and open surgery methods for lateral epicondylitis. The studies were sourced from PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The included studies examined outcomes such as functional recovery, pain intensity, complication rates, and time to return to work. The risk of bias was evaluated using the Cochrane tool for randomized studies and the ROBINS-I tool for non-randomized studies. Results: The meta-analysis included 19 studies with a total of 20,409 participants. The analysis found no significant differences in postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores (Mean Difference [MD] = 0.06; 95 % Confidence Interval [CI]: 0.81 to 0.94; P = 0.89) or Mayo Elbow Performance Scores (MD = 0.31; 95 % CI: 2.33 to 2.95; P = 0.80) between the arthroscopic and open surgical methods. The rates of good-to-excellent recovery, surgical failures, and complications were similar across both techniques. Nevertheless, arthroscopic surgery was associated with a significantly shorter return-to-work period (MD = -1.64 months; 95 % CI: 2.60 to -0.68; P = 0.001) and a temporary increase in grip strength six months after surgery (MD = -1.50 kg; 95 % CI: 2.67 to -0.33; P = 0.012). Conclusions: Arthroscopic and open release techniques for lateral epicondylitis provide similar functional outcomes and complication rates. However, arthroscopic surgery may allow for a quicker return to work, suggesting a potential advantage in the early postoperative period. These findings highlight the need for individualized surgical decision-making based on patient-specific factors and surgeon expertise.

Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy.

PURPOSE: Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30° through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus. METHODS: We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30° and 80°. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation. RESULTS: Following a mean follow-up of 41 months, the average extension gain was 31° (range, 10°-50°). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study. CONCLUSIONS: Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30° flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

CT-based measurement and analysis of distal humerus morphology in healthy adults from Northern China.

BACKGROUND: This study aims to investigate the morphological characteristics of the distal humerus in healthy adults from northern China using computed tomography and three-dimensional reconstruction techniques and compared whether there were diferences in morphology among populations from diferent geographical regions. METHODS: The CT data of 80 patients were imported into Mimics software for three-dimensional reconstruction and measurement. The differences in distal humeral morphological parameters between different genders and sides were compared, and the correlation between the parameters was explored. The distal humeral morphological parameters between Western and Chinese populations based on current and previous pooled results were compared. RESULTS: Thirty-one morphological parameters were measured and analyzed in this study. The average (and standard deviation) of capitellum depth, capitellum width, capitellum height, distal humerus width, epitrochlea width, and humeral metaphyseal width was 10.83 ± 1.18 mm, 17.60 ± 2.06 mm, 21.10 ± 2.03 mm, 44.38 ± 4.07 mm, 12.02 ± 1.90 mm and 58.95 ± 4.86 mm, these parameters were significantly higher (P < 0.001*) in males than females. The capitellum width (r = -0.300, P = 0.007*), anterior lateral trochlear depth (r =-0.227, P = 0.043*), medial crest coronal tangential angle (r = 0.307, P = 0.006*), olecranon fossa volume (r = -0.408, P < 0.001*), olecranon fossa surface area (r = -0.345, P = 0.002*) and coronoid fossa surface area (r = -0.279, P = 0.012*) were significantly correlated with the age of the subjects. In the comparison of people from different regions, the capitellum height, lateral trochlear high, trochlear groove high, trochlear depth and medial trochlear high of the Western population were 23.25 ± 2.56 m, 21.6 ± 2.20 mm, 17.8 ± 2.00 mm, 17.80 ± 2.00 mm, 29.9 ± 4.10 mm, are significantly higher than those in the Chinese population. while capitellum width (15.55 ± 2.68 mm) and capitellum depth (9.00 ± 1.00 mm) were slightly lower. CONCLUSION: The findings provide a basis for the design of distal humeral orthopaedic implants, ensuring greater alignment with the anatomical structure of the distal humerus and improved surgical outcomes. Furthermore, the study provides a reference point for the diagnosis and classification of distal humeral diseases, as well as guidance for patient rehabilitation.

Anconeus Exertional Compartment Syndrome and Posterolateral Rotatory Elbow Instability: A Clinical Association and Rare Cause of Elbow Pain.

Background: Anconeus compartment syndrome is a rarely reported compartment syndrome in the anconeus muscle compartment of the forearm. It has anatomic and pathophysiological associations with posterolateral rotatory instability (PLRI) of the elbow. Purpose: To present the history, management, and outcomes of 4 patients with anconeus compartment syndrome. Secondary aims were to (1) establish normative anconeus pressures and (2) measure the volume of this compartment with and without PLRI in cadavers. Study Design: Case series; Level of evidence, 4. Methods: Four patients with clinical signs of anconeus compartment syndrome (2 gymnasts, 1 swimmer, and 1 footballer/weightlifter) were identified over a 3-year period (2015-2017 inclusive). Patient history, sporting activity, physical examination, anconeus compartment pressures, and treatment outcomes were recorded. Manometry of the anconeus compartment in 2 healthy male controls was performed to establish normative compartment pressures. Anconeus volumetric anatomy and the effect of creating PLRI on compartment volume was investigated in 4 cadaveric elbows. Results: All 4 patients had microtraumatic PLRI, and 2 patients had anconeus hypertrophy. Anconeus compartment pressures at rest and at 2-minutes postexercise were median 28.0 and 67.5 mm Hg, respectively, in the patients and mean 16.5 and 18 mm Hg, respectively, in the controls. Simultaneous fasciotomy and PLRI reconstructive procedures were performed in 2 patients, with outcomes showing full return to competition. Fasciotomy alone was performed in 2 patients to allow return to competition, with both requiring later reconstruction to address PLRI. Cadaver dissection revealed that the anconeus compartment was extremely small and that creation of PLRI reduced the direct volume of the compartment and increased the distance between the anconeus origin and insertion. Conclusion: Our case series demonstrated that anconeus compartment syndrome can occur in upper limb-dominant athletes in the presence of PLRI and anconeus hypertrophy. Pain is relieved by fasciotomy, but definitive treatment of the underlying instability prevents further symptomatology.

Impact of the Hospital Frailty Risk Score on Outcomes following Primary Total Elbow Arthroplasty.

BACKGROUND: The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA. METHODS: The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016 to 2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. non-frail patients. Mean and relative costs, total hospital length of stay (LOS), and discharge disposition for frail and non-frail patients were also compared. RESULTS: We identified 2,049 primary TEA in frail patients and 3,693 in non-frail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; p < 0.001), urinary tract infections (12.3% vs. 0.0%; p < 0.001), transfusions (3.9% vs. 1.1%; p < 0.001), pneumonia (1.1% vs. 0.2%; p < 0.001), acute respiratory distress syndrome (3.2% vs 0.6%; p < 0.001), sepsis (0.7% vs. 0.1%; p < 0.001), and hardware failure (1.2% vs 0.1%; p < 0.001). Frail patients also experienced higher rates of readmission (37% vs. 25%; p < 0.001) and death (1.7% vs. 0.2%; p < 0.001), while being less likely to undergo revision (6.5% vs. 17%; p < 0.001). Frail patients incurred higher healthcare costs ($28,497 vs. $23,377; p < 0.001) and longer LOS (5.3 days vs. 2.6 days; p < 0.001), with reduced likelihood of routine hospital stays (36% vs. 71%; p < 0.001) and increased utilization of short-term hospitalization (p < 0.001), care facilities (p < 0.001), and home health care services (p < 0.001). CONCLUSION: HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.

Terrible Triad Injuries around the Elbow: It is Still a Puzzle? Prospective Study.

Introduction: The "terrible triad" injury of the elbow, consisting of fractures of the coronoid process and radial head along with posterolateral elbow dislocation and refractory instability, has historically led to poor functional outcomes. Traditional treatment focused on bony injuries, but it is now recognized that soft-tissue injuries must also be addressed. Surgical management aims to restore bony and soft-tissue stabilizers, including fixation of the coronoid process and radial head, repair of ligament complexes, and reduction of elbow dislocation. Studies emphasize the importance of early reduction and tailored treatment. This study discusses means and methods of treating this complex injury, highlighting the significance of addressing both bony and soft-tissue injuries for better functional outcomes. Materials and Method: This is a prospective study conducted at a single center and involved 27 consecutive patients diagnosed with terrible triad injuries around the elbow. The objective was to evaluate functional outcomes and complications associated with surgical treatment of terrible triad injuries around the elbow. From July 2017 to October 2018, 27 patients with terrible triad injuries around the elbow were operated on and evaluated for a minimum of 1 year in terms of functional results using the mean elbow performance score (MEPS) and VAS score. The surgical protocol included coronoid fixation or repair of the anterior capsule, radial head fixation or arthroplasty, and repair of the lateral collateral ligament (LCL) in a sequential manner. The medial collateral ligament was repaired if the elbow remained unstable.On follow-up, mean MEPS scores improved significantly. The final mean range of motion of the operated upper limb was as follows: 28.5° of extension deficit (standard deviation [SD] 9.07, range, 10°-40°), 117.5° of flexion (SD 13.18, range, 90°-130°), 70.9° of supination (SD 10.19, range, 40°-85°), and 65.5° of pronation (SD 9.54, range, 40°-80°) at the end of 1 year. A total of 12 patients had complications. Out of the 12 patients, three had elbow arthritis, two had heterotopic ossification, three had radial nerve neuropraxia, two patients had elbow stiffness, and two patients suffered from ulnar nerve neuropathy. Conclusion: Surgical intervention in terrible triad injuries around the elbow in the form of coronoid fixation, radial head fixation, or arthroplasty and soft-tissue repair around the elbow gives satisfactory results at the end of 1 year. Addressing each and every component of fracture in a sequential and step-wise manner is associated with good functional outcomes at the end of 1 year.

Eating Is Living: A Case Report of Post-Traumatic Myositis Ossificans in Elbow.

Introduction: Myositis ossificans (MO) is the most frequent type of heterotopic ossification, occurring in individuals aged 20-40 years within major muscles, and roughly 75% of cases are triggered by trauma. It is most commonly present in locations with a high risk of injury, such as the quadriceps femoris and the arm's flexor muscles, and it is infrequently found in intra-articular sites. Case Report: A 19-year-old male with a history of pain, swelling, and restriction of movements of the right elbow for the last 6 years with a history of difficulty in eating and combing hair with the right hand. History of trauma to his right elbow 6 years ago for which he underwent conservative native treatment with massage. Physical examination found a swelling over the right medial elbow joint of size approximately 7 cm × 6 cm × 3 cm, with no local rise of temperature or tenderness. There was a fixed flexion deformity of 75°. There were no sensory or vascular deficits. Under general anesthesia, through the anterior approach, an irregular bony mass was visualized which was excised. Through a posterior approach, a skin incision was made, subcutaneous tissue dissected, muscles retracted and then a calcified mass visualized over the olecranon process which was excised. The post-operative period was uneventful. Elbow joint mobilization was started from day 2 which showed significant correction of fixed flexion deformity. Conclusion: It is necessary to rule out non-traumatic MO when a patient exhibits radiologically detectable calcification and complains of a painful lump forming in a muscle. The degree of calcification and mature bone growth varies depending on the stage of the lesion. A biopsy of the lesion can rule out malignant transformation. Surgical excision is required for the management of mature lesions.

Return to play after UCL injury in gymnasts.

BACKGROUND: Injuries to the ulnar collateral ligament (UCL) are commonly reported in traditional overhead sports. Conversely, there is a lack of evidence outlining management and return to play (RTP) outcomes for gymnasts. This study aimed to evaluate RTP and patient reported outcomes (PROs) in gymnasts after operative and non-operative treatment of UCL injuries. METHODS: Gymnasts who presented with UCL injury and underwent operative and non-operative treatment were evaluated. Patient reported outcomes were collected via telephone: Conway-Jobe Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) Score, Mayo Elbow Performance (MEP) Score, and quick DASH (qDASH) and Timmerman-Andrews (TA) Elbow Score. RESULTS: Nine patients met inclusion criteria and were available for follow-up. Five were initially treated operatively and four were initially treated non-operatively. The operative group initially consisted of three ulnar collateral ligament reconstructions (UCLR) and two UCL repairs with internal bracing. One patient crossed over to the operative group after failing non-operative treatment and underwent UCLR four months post injury. Overall, 66.7% and 100% of operatively and non-operatively treated gymnasts were able to return to play, respectively. At final follow-up, the operative groups' mean KJOC, MEP, TA, and qDASH scores were: 68.4 ± 7.7, 97.5 ± 2.7, 90.8 ± 10.7, and 1.9 ± 3.0, respectively. For the non-operative group, the mean scores were 67.4 ± 9.0, 71.7 ± 5.8, 71.7 ± 14.4, and 11.4 ± 9.9, respectively. Treatment satisfaction for the operative group was 81.7 ± 27.5 compared to 80.6 ± 34.5 in the non-operative group. Odds ratios indicated no differences between groups. CONCLUSION: Both operative and non-operative interventions for UCL injuries in gymnasts can provide favorable outcomes with respect to return to play and subjective patient-reported outcomes. Further research is warranted to determine optimal treatment, especially regarding indications for operative vs. nonoperative treatment, of UCL injury based on injury severity and location in gymnasts. LEVEL OF EVIDENCE: Case series; Level III Evidence.

Elbow stiffness due to malunited capitellum fracture: A case report and the role of 3D printing in surgical management.

INTRODUCTION: Elbow stiffness is an uncommon condition that significantly impacting a patient's daily activities. Trauma is the most frequent cause of elbow stiffness. However, capitellum fractures are rare, accounting for approximately 1 % of elbow fractures. They are often misdiagnosed due to nonspecific symptoms and the complex anatomy of the elbow joint. CASE PRESENTATION: We report the case of a 54-year-old female who presented with left elbow stiffness eight months after a traumatic incident. On physical examination, her left elbow extension was +10°, and flexion was restricted to 65°, with no limitation in pronation or supination. Imaging studies revealed a malunited capitellum with osteophytes at the posterolateral site of the olecranon. A 3D-printed model of her elbow was created based on a CT scan to aid surgical planning. She underwent capsulectomy and osteotomy and was stabilized with two bioabsorbable P(L/DL)LA pins. Six months postoperatively, the patient's elbow range of motion was fully restored, and no complications were observed. CLINICAL DISCUSSION: Elbow stiffness resulting from the malunion of a capitellum fracture typically necessitates surgical intervention to restore functional movement in the elbow. CONCLUSION: Capitellum fractures are uncommon and frequently underdiagnosed, leading to complications such as elbow stiffness and reduced functionality. Early detection is crucial, as delayed diagnosis can result in complex management due to malunion. 3D printing from CT scans helps surgeons accurately evaluate malunions and plan precise surgical interventions.

Three-dimensional MRI analysis of elbow anatomy and kinematics in children with ulnar dimelia.

Ulnar dimelia often presents with restricted elbow movement. To develop a treatment strategy to improve elbow mobility, a detailed understanding of the skeletal deformity is needed. We created 3-D models of the cartilage and bone in the elbows of four children with ulnar dimelia by segmentation of MRI scans. We analysed the anatomy and performed a kinematic analysis. In all four children, the distal humerus was triangular in shape and consisted of a medial epicondyle, an enlarged lateral epicondyle and an anterior epicondyle. By comparing the 3-D images with conventional radiographs, we found that the projection of the enlarged lateral epicondyle created two longitudinal lines, which is a radiographic hallmark feature of the triangular-shaped distal humerus. In addition, during elbow flexion, the radial forearm bone slides along the lateral trochlea rather than rotates. This knowledge can aid surgeons to plan treatment for improving elbow mobility in ulnar dimelia.Level of evidence: IV.

Exploring elbow kinematics in the central bearded dragon (Pogona vitticeps) using XROMM: Implications for the role of forearm long-axis rotation in non-avian reptile posture and mobility.

The functional morphology and kinematics of the elbow joint remain relatively understudied in squamates. Previous investigations of lizard elbow morphology and kinematics suggest long-axis rotation (LAR) of the radius and ulna during stance allows the manus to remain pronated during forelimb retraction. Using XROMM (X-ray Reconstruction of Moving Morphology), we explored the range of 3D movements and kinematics of the humerus, radius, and ulna in three adult male Central bearded dragons (Pogona vitticeps) during trackway walking. Our data indicate that the elbow joint of P. vitticeps experiences significant rotations in all three dimensions and that the radius and ulna adduct and rotate laterally on their long axes relative to the elbow joint and to one another during stance. These movements allow the distal ends of the radius and ulna to remain in a configuration necessary for manus pronation. These data support previous inferences that the radius and ulna of lizards move independently at the wrist joint. We suggest that independent LAR of the radius and ulna relative to the elbow joint and to one another may be an ancestral mechanism in lizards and perhaps more broadly across non-avian reptiles.

The Incidence of Shoulder and Elbow Injuries in High School and Collegiate Softball Athletes: A Systematic Review.

CONTEXT: Despite increased youth and adolescent participation in fast-pitch softball and the reporting of upper extremity injuries, there remains a relative paucity of research examining shoulder and elbow injuries in high school and collegiate softball athletes. OBJECTIVE: To evaluate the reported incidence, setting, and positional factors associated with shoulder and elbow injuries in high school and collegiate fast-pitch softball players. DATA SOURCES: PubMed, Ovid, Medline, EMBASE, Scopus, Cochrane Central, and Clinicaltrials.gov. STUDY SELECTION: English-language articles reporting the incidence of shoulder and/or elbow injuries occurring in high school or collegiate fast-pitch softball players were included. Biomechanical studies, review articles, abstract only texts, previous systematic reviews, and meta-analyses were excluded. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Two reviewers independently evaluated studies. Data related to the reported incidence of shoulder and elbow injuries, injury setting, position, and rate of return to play after injury were recorded. RESULTS: A total of 22 studies were identified. In high school athletes, shoulder injury rates ranged from 0.88 to 1.14 per 10,000 athletic exposures (AE), with elbow injury rates ranging from 0.41 to 0.71 per 10,000 AE. In collegiate athletes, reported injury rates ranged from 3.76 to 5.93 per 10,000 AE for shoulder and 1.5 to 3.39 per 10,000 AE for elbow injuries. Shoulder and elbow injuries were reported more commonly during competition in high school athletes, and with greater frequency in the practice setting in collegiate athletes. No association between injury incidence and position was appreciated at either the high school or collegiate level. Most (81%-96%) athletes were able to return to sport within 3 weeks of injury. CONCLUSION: The incidence of shoulder and elbow injuries was greater in collegiate softball athletes than in high school athletes.

Creation of a replicable anatomic model of terrible triad of the elbow.

BACKGROUND: Terrible triad of the elbow (TTE) is a complex dislocation associating radial head (RH) and coronoid process (CP) fractures. There is at present no reproducible anatomic model for TTE, and pathophysiology is unclear. The main aim of the present study was to create and validate an anatomic model of TTE. Secondary objectives were to assess breaking forces and relative forearm rotation with respect to the humerus before dislocation. METHODS: An experimental comparative study was conducted on 5 fresh human specimens aged 87.4 ± 8.6 years, testing 10 upper limbs. After dissection conserving the medial and lateral ligaments, interosseous membrane and joint capsule, elbows were reproducibly positioned in maximal pronation and 15° flexion, for axial compression on a rapid (100 mm/min) or slow (10 mm/min) protocol, applied by randomization between the two elbows of a given cadaver, measuring breaking forces and relative forearm rotation with respect to the humerus before dislocation. RESULTS: The rapid protocol reproduced 4 posterolateral and 1 divergent anteroposterior TTE, and the slow protocol 5 posterolateral TTE. Mean breaking forces were 3,126 ± 1,066 N for the lateral collateral ligament (LCL), 3,026 ± 1,308 N for the RH and 2,613 ± 1,120 N for the CP. Comparing mean breaking forces for all injured structures in a given elbow on the rapid protocol found a p-value of 0.033. Comparison of difference in breaking forces in the three structures (LCL, RH and CP) between the slow and rapid protocols found a mean difference of -4%. Mean relative forearm rotation with respect to the humerus before dislocation was 1.6 ± 1.2° in external rotation. CONCLUSIONS: We create and validate an anatomic model of TTE by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min.

Preventing Proximal Radio-Ulnar Joint Screw Penetration during Coronoid Fracture Fixation: A 3D-Digital Modeling and Cadaver Study.

Objective: Intra-articular screw penetration is a probable complication of coronoid fracture fixation. The present study aimed to determine the best radiography technique for visualizing the proximal radioulnar joint (PRUJ) space. Moreover, it aimed to determine the safe angle and length of the screw to avoid PRUJ penetration during coronoid fracture fixation. Methods: The Mimics software was used to construct a three-dimensional model of a healthy man's forearm from a computer tomography scan. It was analyzed using the Solidworks software to determine the X-ray angle that clearly showed the PRUJ space to detect penetration of screws from the coronoid process into the PRUJ and determine the maximum screw angle and length that could be used without intra-articular penetration. To verify these findings, a cadaveric study combined with radiographs was conducted. Results: To visualize PRUJ space, the optimal X-ray angle was 13º lateral to the perpendicular line when the forearm was positioned at full supination. If the coronoid process was segmented into zones 1 (closest to the radioulnar joint) to 4 (farthest from the joint), the screw could only be inserted at a right angle in zone 1. In zones 2, 3, and 4, inclination angles less than 15, 35, and 60 would prevent intra-articular penetration, respectively. Conclusions: The X-rays could visualize the PRUJ space with an anteroposterior radiograph at an angle of 13º ulnar deviation from the perpendicular plane. During coronoid process fracture fixation, shorter screws with less lateral inclination were safer when inserting screws in the zones of the coronoid process adjacent to the PRUJ.

Regeneration of full thickness common extensor tendon tear after percutaneous microfragmented adipose graft.

Tennis elbow, also commonly known as lateral epicondylitis or common extensor tendinosis, is a common musculoskeletal injury in the adult population. Currently, the standard treatment regimen prescribed for this injury involves a combination of rest, physical therapy, bracing and anti-inflammatory medications. If refractory to these conservative measures, platelet-rich plasma has been shown effective. However, in the case of full thickness tears, surgery has remained the only treatment option until now. We present a case report of a 56-year-old man with a diagnosis of a left large full thickness tear and rupture with retraction of his common extensor tendon (CET) following a corticosteroid injection. The patient was treated with microfragmented adipose transfer. He was re-evaluated around 7 weeks and again at 15 weeks post-treatment and demonstrated ultrasound evidence of complete bridging and remodeling of his prior full thickness CET tear and resolution of retraction. This case presents a promising option for patients with full thickness CET tears who would like to refrain from or are unable to have surgery. Further research and possible randomized controlled trials are needed to further assess the full efficacy of microfragmented adipose transfer in the treatment of full thickness CET tears.

Adipose cells from a patient's own body fat are one of the best sources of mesenchymal stem cells (MSC) and growth factors that contribute to the generation of collagen protein fibers. MSC's are versatile cells that can differentiate into a variety of cell types, while collagen is an important component of muscles and tendons, as it provides structure. MSC's can be harvested from one's own fat and then used to help supplement the body's natural repair process of a variety of injured tissues. This case presents a patient with a history of persistent elbow pain caused by a large full-thickness tear and rupture of the common extensor tendon (CET) of the elbow. Full thickness tears are large deep tears that extend across the entirety of the tendon. Generally, partial CET tears of varying severities are some of the most common tendon injuries seen in the elbow and are injuries that historically, are treated with conservative management, such as pain medication, cortisone injection, physical therapy, platelet-rich plasma or surgery once/if conservative interventions fail. Full thickness tears, however, usually require surgery for patients to feel better. In this case, the patient underwent a novel regenerative treatment alternative to surgery, known as microfragmented adipose transfer (MFAT), to repair the torn CET. Fat was harvested from his flanks, was washed and cleaned, then injected into the CET tear of the elbow. He experienced significant improvements in function and pain and tendon healing was documented using ultrasound and MRI imaging. This case supports using MFAT for lateral elbow pain caused by full-thickness CET tears as a novel and significantly less invasive method than surgery. Our case illustrates the need for more research and possible clinical trials evaluating MFAT as a treatment option for common musculoskeletal pathologies.

Neck Range of Motion Prognostic Factors in Association to Shoulder and Elbow Injuries in Professional Baseball Pitchers.

BACKGROUND: Authors have observed an association between cervical spine mobility and arm injury risk in baseball player; however, there is a need to assess the generalizability of cervical measurement data. Assessing the downstream of associations of cervical dysfunction on shoulder and elbow injuries can inform clinical interventions to help reduce future arm injuries. The purpose of this study was to assess the generalizability of neck range of motion measures as arm injury prognostic factors in professional baseball pitchers. METHODS: A prospective cohort of professional baseball pitchers in one Major League Baseball Organization was performed. Pitchers underwent pre-season neck range of motion including cervical flexion, extension, rotation, lateral flexion, and the flexion-rotation test (CFRT) and were followed for the season. The outcome was the occurrence of shoulder or elbow injury. A Cox proportional hazards analysis was performed and reported as hazard ratios (HR) with 95% confidence intervals (95% CI). RESULTS: A total of 88 pitchers were included (Age: 24.2 (2.4); Left-Handed: 21 (23%); Fastball Velocity: 92.3 (1.8)), with 15,942 athlete exposure days collected over the season. Pitcher neck range of motion was assessed (Flexion: 64 (10); Extension: 69 (11); Difference in Lateral Flexion: -1 (7); Difference in Neck Rotation: -2 (9); Difference in CFRT: -1 (7)). A total of 20 arm injuries (Shoulder: 9 (10%); Elbow: 11 (13%); Combined Rate: 1.3 (95% CI: 0.7, 1.7) per 1000 exposure days) were suffered by pitchers during the season. For every degree increase in the difference in dominant (rotating to dominant shoulder) versus non-dominant (rotating to non-dominant shoulder) neck rotation, there was a four-fold increase in arm injury hazard (HR: 4.0 (95% CI: 1.1, 13.9), p = 0.031). No other neck measurements demonstrated prognostic value. CONCLUSIONS: A deficit in dominant versus non-dominant neck rotation was prognostic for pitching arm injury. However, the cervical rotation test did not have prognostic value in this sample. Further research is required to assess the generalizability and scalability of neck range of motion assessment in relation to baseball shoulder and elbow injuries across different competition levels.

Music alters heart rate and psychological responses but not muscle activation during light-intensity isometric exercise.

Listening to music manipulates attention to be more externally focused, which has the potential to improve muscular efficiency. This study aimed to determine the effect of listening to music on muscle activation during an isometric exercise task, and compare this effect to those of other attentional focus conditions. Apparently healthy subjects (n = â€‹35; 16 men/19 women) completed an isometric elbow flexion task for 1 â€‹min in three randomized and counterbalanced conditions: internal focus (INT), external focus with a simple distraction task (EXT), or listening to music (MUS). Muscle activation of the biceps and triceps brachii and heart rate (HR) were recorded throughout the exercise tasks. Ratings of perceived exertion (RPE), affective valence, and motivation were measured at the end of each trial. There was no difference in muscle activation measures among the three conditions. HR during MUS was lower than EXT at 15 â€‹s ([89.4 â€‹± â€‹11.8] beats/min vs. [93.1 â€‹± â€‹12.9] beats/min; p â€‹= â€‹0.018) and 30 â€‹s ([90.6 â€‹± â€‹12.4] beats/min vs. [94.2 â€‹± â€‹12.5] beats/min; p â€‹= â€‹0.026), and lower than INT at 60 â€‹s ([93.3 â€‹± â€‹13.3] beats/min vs. [96.7 â€‹± â€‹12.0] beats/min; p â€‹= â€‹0.016). Overall RPE was higher for INT (13.4 â€‹± â€‹2.2) than for MUS ([12.6 â€‹± â€‹2.0]; p â€‹= â€‹0.020) and EXT ([11.94 â€‹± â€‹2.22]; p â€‹< â€‹0.001). Affective valence was higher for MUS than for INT ([2.7 â€‹± â€‹1.4] vs. [2.1 â€‹± â€‹1.5]; p â€‹= â€‹0.011). Manipulating attentional focus did not alter muscle activation for a light-intensity isometric muscular endurance task, though MUS was reported as more positive and requiring less exertion to complete than INT. Using music can therefore be recommended during light-intensity isometric exercise based on the psychological benefits observed.

[Radial neck fracture in children-"A benign fracture?"] / Die Radiushalsfraktur im Kindesalter ­ "eine gutartige Fraktur"?

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of 8 and 12 years old are more frequently affected, whereby a cubitus valgus variant can be a predisposing factor. The main trauma mechanism is a fall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X­radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while a surgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using a elastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires a comprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.

Comparison of biodegradable and metallic tension-band fixation for paediatric lateral condyle fracture of the elbow.

INTRODUCTION: In our retrospective study we compared the outcomes of paediatric lateral condyle fractures of the elbow fixed by bioabsorbable pins and tension-band sutures or by metallic tension-band with K-wires. MATERIALS AND METHODS: We reviewed the data of children operated on for lateral condyle fractures between 2010 and 2020. Patients were classified as follows: 1. fractures treated with metallic (KW group), 2. fractures treated with resorbable implants (BR group). We compared the distribution of age, sex and fracture type in each group. Operative times of the two techniques were also recorded and compared. We analysed the X-rays taken one year after the injury and measured the following parameters: presence of possible non-union, varus or valgus deviation, lateral spur formation. Patients whose follow-up period was less than one year were excluded. For categorical data, group comparisons were performed with Chi-square test or Fisher's exact test, depending on the sample size. The evaluation of discrete variables was performed with Mann-Whitney U test. RESULTS: 42 patients met the above criteria. We found 19 children in the Kirschner -wire + tansion band wire (KW) group and 23 in the Bioresorbable pin + tension band suture (BR) group. There were no significant differences between the study groups in terms of age, sex, left-right ratio, number of complications, operation time, number of Jacobs II and III cases or follow-up time. The operation time was on average 5 min longer in the bioresorbable group (K-wire mean = 62.1 min, Bioresorbable mean = 67 min), this difference, however, is not statistically significant (P = 0.177). In terms of minor and major complications, there was no statistically significant difference between the two groups. (P = 0.729). CONCLUSIONS: We did not notice any difference between the complication rates of the two methods, so the real advantage of the absorbable implant technique is that no second intervention is necessary. The benefits of using biodegradable implants in various osteosynthesis techniques need further confirmation by randomised trials.