Efecto de la práctica mental kinestésica en la fuerza y actividad mioeléctrica del bíceps braquial, luego de un periodo de inmovilización de codo en adultos-jóvenes sanos / Effects of kinesthetic mental practice in strength and myoelectric activity of the brachialis biceps due to an elbow immobilization period in healthy young adults

RESUMEN: El objetivo de este estudio fue determinar el efecto de la práctica mental kinestésica (PMK) en la fuerza y actividad eléctrica muscular (AEM) del bíceps braquial, luego de un periodo de inmovilización del codo en un grupo de personas adultos jóvenes sanos. Un total de 14 personas (18,64 ± 0,92 años de edad) participaron voluntariamente del estudio, a las cuales se les evaluó la fuerza muscular de prensión y la AEM del bíceps braquial utilizando un dinamómetro de mano y un equipo de electromiografía, respectivamente, antes y después de un periodo de inmovilización del brazo no dominante, y se asignaron aleatoriamente a uno de dos grupos: grupo control (GC) o experimental (GE). El GE realizó PMK: tres series de 15 repeticiones con un minuto de descanso entre series, tres veces al día durante los seis días de inmovilización, mientras que el GC no realizó PKM durante su inmovilización. Al aplicar una prueba de ANOVA de dos vías, no se encontraron diferencias significativas en la fuerza ni en la AEM. Sin embargo, la fuerza del GC disminuyó en 23,75%, mientras que la del GE aumentó en 33,19%. Los resultados sugieren que un periodo de inmovilización del codo de seis días no fue suficiente para que la fuerza ni la AEM disminuyan significativamente, lo que supone que la PMK realizada no es necesaria en periodos menores a seis días.

ABSTRACT: The aim of this study was to determine the effect of kinesthetic mental practice (KMP) on the strength and muscular electrical activity (MEA) of the brachial biceps, after a period of immobilization of the elbow in a group of healthy young adults. A total of 14 volunteer participants (18.64 ± 0.92 years of age) were part in the study. The muscle strength and the AEM of the brachial biceps were assessed using a hand dynamometer and an electromyography equipment, respectively, before and after a period of immobilization of the non-dominant arm. After the pretest, they were randomly assigned to one of two groups: control group (GC) or experimental group (GE). The GE performed 3 sets of 15 repetitions with one-minute rest between sets, three times a day of PMK during the 6 days of immobilization, while the GC did not perform PKM during its immobilization. A 2-way ANOVA test (group x measurement) indicated non-significant differences in strength or AEM. However, the strength of the GC decreased by 23.75%, while increased by 33.19% in the GE. The results suggest that a period of immobilization of the elbow of 6 days was not enough for the strength or the AEM to decrease significantly, which means that the PMK is not necessary in periods of immobilization of less than 6 days.

Two muscular variations in the elbow associated with the anterior interosseous nerve.

The coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.

Accessory bones of the elbow: Prevalence, localization and modified classification.

Accessory bones in the region of the elbow are rare variants with high clinical significance as they may be confused with avulsion fractures. We investigated their prevalence and performed a statistical analysis to support their congenital origin. Their localization was mapped to show their exact site of occurrence. We evaluated anteroposterior and lateral X-ray images of 2413 elbows in a Central European population from which a group of accessory bony structures was selected. Their character was evaluated, and accessory bones were identified. We used logistic regression to evaluate the potential relationship between the occurrence of accessory bones, the age of patients, and the occurrence of calcar olecrani. The prevalence of accessory bones of the elbow in the sample was 0.77%. Our results did not show a statistically significant relationship with the occurrence of calcar olecrani or with the age of patients. The most common type was os subepicondylare mediale (type V) in 0.46%, which was located distal to the medial epicondyle of the humerus, followed by os subepicondylare laterale (type III; 0.21%), situated laterally to the lateral epicondyle of the humerus. In comparison with previous reports, os sesamoideum mediale (type IV) was located more distally. Our data suggest that congenital accessory bones are a rare entity. Knowledge of their exact localization should be considered during diagnosis of avulsion fractures and other unclear diagnoses including accessory bony structures in the elbow region.

Painful, swollen elbow.

Was a recent procedure responsible for this patient's pain?

Prevalence and Clinical Manifestations of the Anconeus Epitrochlearis and Cubital Tunnel Syndrome.

Background: The true prevalence of the anconeus epitrochlearis (AE) and the natural history of cubital tunnel syndrome associated with this anomalous muscle are unknown. The purpose of this study was to evaluate the prevalence of AE and to characterize the preoperative and postoperative features of cubital tunnel syndrome caused by compression from an AE. Methods: All elbow magnetic resonance imaging (MRI) scans and all patients undergoing cubital tunnel surgery during a 20-year period were identified and retrospectively reviewed for the presence of an AE. All patients with an AE identified intra-operatively were matched to patients with no AE identified at surgery based on age, sex, concomitant procedures, and year of surgery. Preoperative and postoperative physical exam findings, electrodiagnostic study results, time to improvement, and reoperations were compared between the groups. Results: A total of 199 patients had an elbow MRI, and 27 (13.6%) patients were noted to have an AE present. Average time to improvement after surgical release was 23.0 days for patients with an AE and 33.2 days for patients with no AE. Twenty-seven patients with an AE noted improvement at the first postoperative visit (68%) compared to 15 patients without an AE (33%). No patients with an AE underwent reoperation for recurrent symptoms (0%) compared with four patients (10%) without an AE. Conclusions: The prevalence of AE in our study is 13.6%. These patients experience quicker and more reliable symptom improvement after surgical release than those without the anomalous muscle.

Severity of ulnar deficiency and its relationship with lower extremity deficiencies.

To assess the characteristics of ulnar deficiency (UD) and their relationship to lower extremity deficiencies, we retrospectively classified 82 limbs with UD in 62 patients, 55% of whom had femoral, fibular, or combined deficiencies. In general, UD severity classification at one level (elbow, ulna, fingers, thumb/first web space) statistically correlated with similar severity at another. Ours is the first study to show that presence of a lower limb deficiency is associated with less severe UD on the basis of elbow, ulnar, and thumb/first web parameters. This is consistent with the embryological timing of proximal upper extremities developing before the lower extremities.

Synovial Haemangioma of the Elbow: A rare paediatric case and imaging dilemma.

Synovial haemangiomas are rare benign vascular proliferations arising in synovium-lined surfaces. While the knee is by far the joint most commonly involved, this condition can also occur in the elbow. We report an eight-year-old boy who presented to the National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia, in 2016 with a left elbow swelling of one year's duration. Magnetic resonance imaging showed a lobulated intra-articular mass with intermediate signal intensity on T1-weighted imaging and low signal punctate and linear structures within the hyperintense mass on T2-weighted imaging. In addition, there was heterogeneous yet avid contrast enhancement on post-gadolinium contrast images. The mass had juxta-articular extension and bony erosion to the coronoid process and the head of the radius. Synovial haemangiomas present a diagnostic dilemma. This report highlights certain imaging characteristics to distinguish this entity from other differential diagnoses.

Ulnar neuropathy as a result of anconeus epitrochlearis.

After carpal tunnel syndrome, cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. Various sites of ulnar nerve compression at the elbow exist, with the most common being between the 2 heads of the flexor carpi ulnaris. Other potential sites include the arcade of Struthers, the space between Osborne's ligament and the medial ulnar collateral ligament, the medial epicondyle, the medial head of the triceps, and the medial intermuscular septum. The anconeus epitrochlearis, an anomalous muscle that runs between the medial aspect of the olecranon and the medial epicondyle, is found in up to 28% of cadavers. Although it is far less common, it must be considered when evaluating a patient with cubital tunnel syndrome. The authors report a 19-year-old man with a 2-month history of atraumatic left elbow pain accompanied by distal motor and sensory symptoms that significantly affected his activities of daily living and quality of life. After a short course of conservative management, surgical excision of the anomalous muscle, along with decompression of the ulnar nerve, was performed because of progression of symptoms. The patient had immediate improvement in subjective symptoms and strength on removal of the anconeus epitrochlearis. As shown in this case report, recovery of both motor and sensory nerve function can be achieved if the source of compression is an anomalous muscle and is treated with early surgical removal.

Absence of radiographic abnormalities in nursemaid's elbows.

BACKGROUND: Disagreement exists between physicians on the usefulness of a prereduction radiograph for diagnosis and treatment of nursemaid's elbows in children. Some evidence suggests that nursemaid's elbows have identifying features on radiographs. This study compares the radiographs of nursemaid's elbows to normal, control elbows in children and hypothesizes that differentiating features do not exist on radiograph. METHODS: For this retrospective case-control study, hospital billing records were searched to identify all patients under age 6 treated with closed reduction for a nursemaid's elbow between November 2005 and October 2009. Twenty-seven nursemaid's elbows were age-matched and sex-matched to 27 normal "comparison view," control elbows. Radiocapitellar line offset, proximal radial length, anterior fat pad angle, and visibility of the posterior fat pad were measured on the radiographs by 2 raters. Their interrater reliability was assessed with intraclass correlations, and the nursemaid's and control elbow measures were compared using Wilcoxon tests. RESULTS: Nursemaid's elbows and healthy control elbows did not differ significantly in offset of the radiocapitellar line from the capitellum center on anteroposterior (P=0.49) or lateral views (P=0.67), in proximal radial length (P=0.95), anterior fat pad angle (P=0.49), or posterior fat pad visibility (P=1.00) on lateral views. CONCLUSIONS: Nursemaid's elbows are indistinguishable from healthy elbows on radiograph. Thus, the term "radial head subluxation" appears to be a misnomer, and prereduction radiographs should only be used to eliminate the possibility of fracture. From a radiologic perspective, nursemaid's elbows remain a diagnosis of exclusion. LEVEL OF EVIDENCE: Therapeutic Level III-retrospective comparative study.

The Liebenberg syndrome: in depth analysis of the original family.

The Liebenberg syndrome was first described in 1973 in a five- generation family. A sixth generation was added in 2001, and in 2009 a hitherto unknown branch of the same family with similar anomalies extended the family tree significantly. This article describes the clinical findings and illustrates the abnormalities with radiographs and three-dimensional computed tomography scans. We discuss the genetic abnormality that causes Liebenberg syndrome, the genomic rearrangement at the PITX1 locus on chromosome 5.The structural variations seem to result in an ectopic expression of paired-like homeodomain transcription factor 1 (PITX1) in the forelimb causing a partial arm-to-leg transformation in these patients.

[Posttraumatic complications on children's elbows]. / Posttraumatische Komplikationen am kindlichen Ellenbogen.

Most fractures during growth affect the upper extremities. Severe fractures with an increased number of complications are mainly localized beyond the elbow joint. Displaced fractures of the elbow joint have limited potential for spontaneous correction as the bones near the elbow joint account for only 20% of growth in length and the possibility of spontaneous correction is already exhausted at the age of 7. The consequences of inadequately reduced elbow fractures, therefore, may adversely affect a patient for his lifetime. Cubitus varus and valgus are the most common deformities following insufficiently treated supracondylar humerus fractures, fractures of the radial or dislocations of the radial head. Posttraumatic deformities of the elbow are usually the result of an insufficient primary therapy and rarely the result of growth disturbances. For the attending surgeon, posttraumatic deformities on a child's elbow are challenging.

Use and functioning of the affected limb in children with unilateral congenital below-elbow deficiency during infancy and preschool age: a longitudinal observational multiple case study.

BACKGROUND: Children with unilateral congenital below elbow deficiency (UCBED) lack a part of an arm, thereby lacking a part of the typical hand function. Little is known on the performance of daily activities in very young children with UCBED, usage of their affected arm with or without prosthesis during play, and neurological condition. AIM: To explore daily activities, the use of the affected limb with or without prosthesis and neurological condition over time in young children with UCBED. DESIGN: A longitudinal observational multiple case study. METHODS: Four children with UCBED were assessed (first assessment at 3-16months) every 6-8months (follow-up 13-49months) with a video-recorded, standardized play session and a neurological examination. Yearly, functioning in daily activities was evaluated using the Pediatric Evaluation of Disability Inventory - Dutch Version (PEDI-NL). Play behaviour was assessed with and without prosthesis, where applicable (n=2). Video-analysis focused on achievement, exploration, variation and adaptability of the affected limb. Behavioural changes over time were plotted and analysed visually. RESULTS: Over time, children with UCBED showed efficient usage of their affected arm during spontaneous play. Prosthesis use seemed to be associated with reduced manipulation, exploration, variation and adaptation. Three children showed minor neurological dysfunction. Functioning in daily activities was comparable to a norm population. CONCLUSION: The short limb of children with UCBED is used as an exploratory, manipulatory and fixating tool from the beginning of infancy. Its value seems to be reflected in these children's normal functioning in daily life. Prosthetic use may lead to less effective performance.

Validity and reliability of the assessment and diagnosis of musculoskeletal elbow disorders using telerehabilitation.

We examined the validity and reliability of a physiotherapy examination of the elbow, using telerehabilitation. The patho-anatomical diagnoses, systems diagnosis and physical examination findings of face-to-face physiotherapy examinations were compared with telerehabilitation examinations. Ten participants attended a single session, during which they were interviewed, a face-to-face physical examination was performed and a remote physical examination was conducted, guided by an examiner at a different location via a telerehabilitation system. Conventional face-to-face physiotherapy physical examination test results, diagnoses and systems diagnoses were compared to those produced by an examiner using the telerehabiliation system. There was substantial agreement for systems diagnosis (73%; P = 0.013) for validity and almost perfect agreement for intra-rater reliability (90%; P = 0.001). The inter-rater reliability had a weaker and non-significant agreement (64%; P = 0.11). Physical examination data demonstrated >68% agreement across all three datasets, between the examination methods. Performing a telerehabilitation physical examination to determine a musculoskeletal diagnosis of the elbow joint complex is both valid and reliable.

Activity and participation of children and adolescents with unilateral congenital below elbow deficiency: an online focus group study.

OBJECTIVE: To assess whether children/adolescents with unilateral congenital below elbow deficiency experience activity or participation limitations and how they deal with those limitations. METHODS: A qualitative study using online focus group interviews was held with 42 children/adolescents (in 3 age groups: 8-12, 13-16, and 17-20 years), 17 parents and 19 health professionals. Questions were posted concerning activities, participation, prosthetic use, psychosocial functioning, and rehabilitation care. This study concerns the first two topics; activities and participation. RESULTS: Children/adolescents experienced only a few limitations, and there were no activities or participation situations that were impossible. The limitations experienced could be attributed mainly to environmental factors, e.g. people who lack knowledge of the child's capacities. Those factors were particularly decisive in transition phases. Children/adolescents and parents described numerous strategies applied to deal with the deficiency. Professionals described fewer strategies and emphasized the use of adaptive devices and prostheses more than other participants did. CONCLUSION: Having unilateral congenital below elbow deficiency did not interfere with any activity, but not all children/adolescents had the ability to perform all activities. The strategies described by children/adolescents in managing their deficiency should be integrated into healthcare by providing realistic education about the various creative solutions and possibilities of adaptive devices and prostheses, and should be combined with specific training.

Fracturas pediátricas de cabeza y cuello de radio / Radial head and neck fractures in children

Objetivo. Analizar los casos de fractura de cabeza y cuello de radio en pacientes pediátricos y compararlos con los de la bibliografía. Material y métodos. Estudio retrospectivo y descriptivo de 21 pacientes pediátricos con fractura de cabeza y cuello de radio, en los que se recogieron los siguientes parámetros: datos demográficos, afección asociada, tipo de fractura, tratamiento, necesidad de rehabilitación, déficit de balance articular, tiempo de recuperación y complicaciones. Resultados. Del total de la serie, 11 eran varones. La edad media fue de 8,3 años. En 14 pacientes el lado lesionado fue el derecho. Doce casos asociaron lesiones en codo ipsilateral. Según la clasificación de Chambers, 15 casos pertenecieron al grupo A, mientras que en la clasificación de Steele-Graham, 12 casos fueron del grupo I. Once pacientes se trataron solo con inmovilización, 4 percutáneamente y 6 mediante reducción abierta y fijación interna (RAFI). Once casos precisaron rehabilitación, de los que 8 no recuperaron movilidad completa. El tiempo medio para obtener el mayor arco de movilidad fue de 4,71 meses. Ocho pacientes presentaron complicaciones, destacando neuroapraxia y la deformidad en valgo del codo. Discusión y conclusiones El tratamiento de la fractura de cabeza y cuello de radio en pacientes pediátricos ha de ser escalonado, desde la simple inmovilización, reducción manual y/o percutánea, hasta la RAFI, la cual cada vez está menos indicada. En este aspecto, debe evitarse la colocación de una aguja transcapitelar y/o la exéresis de la cabeza radial. La complicación más frecuente es el déficit de pronosupinación, sobre todo en casos tratados mediante RAFI. Del resto de las complicaciones observadas, la neuroapraxia del interóseo posterior fue la más común (AU)

Objective. To analyse cases of radial head and neck fractures in children and compare them with the literature. Method. Retrospective and descriptive study of 21 children with radial head and neck fractures. The following parameters were collected: demographics, comorbidity, classification, treatment, need for rehabilitation, lack of range of motion (ROM), time for recovery and complications. Results. The series included 11 males, and the mean age was 8.3 years. The right side was affected in 14 patients. Twelve cases had an associated ipsilateral elbow injury. According to the Chambers classification, 15 cases belonged to group A, while in the Steele-Graham classification, 12 cases were in group I. Eleven patients were treated with immobilization only, 4 percutaneously, and 6 by open reduction and internal fixation (ORIF). Eleven of them needed rehabilitation and despite this, 8 did not achieve full mobility. The mean time to obtain the greatest ROM was 4.71 months. Eight patients had complications, with the most common being neuroapraxia and valgus deformity of the elbow. Discussion and conclusions. Treatment of paediatric radius head and neck fractures must be step-wise, from immobilization only, manual and/or percutaneous reduction, to ORIF, whichever is less indicated. In this respect, both the transcapital needle and/or removal the radius head should be avoided. The most common complication is lack of supination, especially in cases treated by ORIF. The posterior interosseous neuroapraxia was the most common of the rest of complications (AU)

Mixed feelings of children and adolescents with unilateral congenital below elbow deficiency: an online focus group study.

The existing literature is inconsistent about the psychosocial functioning of children and adolescents with Unilateral Congenital Below Elbow Deficiency (UCBED). The objective of this qualitative study was to explore the psychosocial functioning of children and adolescents with UCBED in terms of their feelings about the deficiency and what helps them to cope with those feelings. Additionally, the perspectives of prosthesis wearers and non-wearers were compared, as were the perspectives of children, adolescents, parents and health professionals. Online focus group interviews were carried out with 42 children and adolescents (aged 8-12, 13-16 and 17-20), 16 parents and 19 health professionals. Questions were asked about psychosocial functioning, activities, participation, prosthetic use or non-use, and rehabilitation care. This study concerned remarks about psychosocial functioning. Children and adolescents with UCBED had mixed feelings about their deficiency. Both negative and positive feelings were often felt simultaneously and mainly depended on the way people in the children's environment reacted to the deficiency. People staring affected the children negatively, while support from others helped them to cope with the deficiency. Wearing a prosthesis and peer-to-peer contact were also helpful. Non-wearers tended to be more resilient than prosthesis wearers. Wearers wore their prosthesis for cosmetic reasons and to prevent them from negative reactions from the environment. We recommend that rehabilitation teams make parents aware of their great influence on the psychosocial functioning of their child with UCBED, to adjust or extend the currently available psychosocial help, and to encourage peer-to-peer contact.