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The Effect of Acupuncture on Elbow Joint Sports Injuries Based on Magnetic Resonance Imaging. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9005792. [PMID: 35419078 PMCID: PMC9001099 DOI: 10.1155/2022/9005792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
Purpose. Elbow joint injuries are extremely common in most athletes. Athletes’ chronic elbow injuries can involve multiple complex anatomical structures related to orthopedics. Therefore, it is of great significance to explore the characteristics of magnetic resonance (MR) images of chronic sports injuries of the elbow joint and the influence of acupuncture treatment on MR images and clinical symptoms. Methods. A total of 60 elbow joints of 39 athletes from 15-25 years old were selected for coronal, sagittal, and axial MR scans to observe the image characteristics; 60 elbow joints were randomly divided into acupuncture group and control group and observed changes in MR images and clinical symptoms after acupuncture treatment. Results. After acupuncture treatment, the clinical symptoms were significantly improved. MR images showed that the elbow joint effusion was reduced, and the bone marrow edema was reduced. The effective rate of acupuncture treatment is as high as 100%, while the effective rate of the control group is only 40%. Acupuncture treatment has significantly improved the range of motion of the elbow joint. Conclusion. Acupuncture treatment can significantly relieve athletes’ elbow joint pain and locking symptoms, improve joint range of motion, and is beneficial to recovery of special training and high-level competitive competitions. It is a sensitive, effective, and noninvasive method.
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3D isotropic spine echo MR imaging of elbow: How it helps surgical decisions. Eur J Radiol Open 2022; 9:100410. [PMID: 35281319 PMCID: PMC8904410 DOI: 10.1016/j.ejro.2022.100410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/01/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
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Antil N, Stevens KJ, Lutz AM. Elbow Imaging: Variants and Asymptomatic Findings. Semin Musculoskelet Radiol 2021; 25:546-557. [PMID: 34706384 DOI: 10.1055/s-0041-1729960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
One of the key principles in the interpretation of radiology images is the ability to differentiate between normal and abnormal findings. This article provides a comprehensive overview of normal structures and anatomical variants occurring around the elbow including potential diagnostic pitfalls. We discuss frequently observed anatomical variants found in routine clinical practice associated with osseous, ligamentous, musculotendinous, and neurovascular structures at the elbow that may simulate pathology or predispose to symptoms under specific circumstances.
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Affiliation(s)
- Neha Antil
- Division of Musculoskeletal Imaging, Department of Radiology, Stanford University, School of Medicine, Stanford, California
| | - Kathryn J Stevens
- Division of Musculoskeletal Imaging, Department of Radiology, Stanford University, School of Medicine, Stanford, California
| | - Amelie M Lutz
- Division of Musculoskeletal Imaging, Department of Radiology, Stanford University, School of Medicine, Stanford, California
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Ciccotti MC, Ciccotti MG. Ulnar Collateral Ligament Evaluation and Diagnostics. Clin Sports Med 2020; 39:503-522. [DOI: 10.1016/j.csm.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Porrino J, Wang A, Taljanovic M, Stevens KJ. Comprehensive Update of Elbow Magnetic Resonance Imaging. Curr Probl Diagn Radiol 2020; 50:211-228. [PMID: 32561154 DOI: 10.1067/j.cpradiol.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
We present a comprehensive update of elbow magnetic resonance imaging, detailing the complex anatomy and pathology of the elbow. A variety of pathologies may affect the elbow joint, and many of the symptoms overlap. As such, magnetic resonance imaging of the elbow serves as an invaluable clinical tool for the clinician in the diagnosis and management of patients presenting with elbow pain.
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Affiliation(s)
- Jack Porrino
- Yale University, Radiology and Biomedical Imaging, New Haven, CT.
| | - Annie Wang
- Yale University, Radiology and Biomedical Imaging, New Haven, CT
| | - Mihra Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, AZ
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T 1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation ® in Subjects with Elbow Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030708. [PMID: 31979044 PMCID: PMC7037807 DOI: 10.3390/ijerph17030708] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 12/16/2022]
Abstract
Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain.
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Kim NR, Moon SG, Park JY, Choi JW, Oh KS. Stress ultrasound in baseball players with ulnar collateral ligament injuries: additional value for predicting rehabilitation outcome. J Shoulder Elbow Surg 2017; 26:815-823. [PMID: 28314694 DOI: 10.1016/j.jse.2016.12.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/19/2016] [Accepted: 12/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the additional value of stress ultrasound (US) for predicting rehabilitation outcome in baseball players with ulnar collateral ligament (UCL) injury. METHODS Stress US and magnetic resonance imaging (MRI) in 41 baseball players with UCL injury who received rehabilitation treatment for more than 6 weeks were retrospectively compared between the rehabilitation group (n = 23) and surgery group (n = 18). The MRI grade of UCL injury was assessed as intact continuity, low-grade partial tear, high-grade partial tear, and complete tear. To estimate sonographic joint laxity, we assessed 3 sonographic criteria as present or absent: ligamentous waviness, joint gapping, and intra-articular ring-down artifact. In addition, the presence of concomitant tenderness was checked during stress US. The diagnostic validity of MRI with and without stress US was analyzed as a predictor for the rehabilitation outcome. RESULTS The MRI grade was higher in the surgery group than in the rehabilitation group (P < .001). Sonographic joint laxity showing the ring-down artifact and concomitant tenderness with stress were significantly more frequent in the surgery group (P = .024 and P = .006, respectively). Sensitivity, specificity, and accuracy were 61.1%, 86.9%, and 75.6%, respectively, for MRI alone and 83.3%, 56.5%, and 68.2%, respectively, for the combination of MRI with joint laxity showing the ring-down artifact. For MRI in combination with joint laxity and concomitant tenderness, these values were 72.2%, 82.6%, and 78.0%, respectively. CONCLUSION The addition of stress US showing the ring-down artifact and concomitant tenderness was helpful for predicting the rehabilitation outcome of UCL injuries.
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Affiliation(s)
- Na Ra Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Jin-Young Park
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea; Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Joyner PW, Bruce J, Hess R, Mates A, Mills FB, Andrews JR. Magnetic resonance imaging-based classification for ulnar collateral ligament injuries of the elbow. J Shoulder Elbow Surg 2016; 25:1710-6. [PMID: 27521140 DOI: 10.1016/j.jse.2016.05.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) arthrography has been considered the gold standard for imaging ulnar collateral ligament (UCL) injuries. No classification system has been described for UCL tears to help discuss and guide treatment options. We propose that an MRI-based UCL classification system would correlate with valgus laxity and help predict surgical management. METHODS The MRIs from 240 patients who underwent UCL reconstruction were reviewed and classified according to a system based on severity and location of the UCL injury. Bilateral elbow valgus stress radiographs were used to compare the amount of valgus laxity associated with each grade of UCL injury. Additional data from the imaging review included intraligamentous calcifications, T-sign presence, and a newly described "vacuum sign." RESULTS The amount of valgus stress opening increased with the classification severity as follows: type I, 0.13 mm; type II, 0.20 mm; type III, 0.63 mm; and type IV, 0.76 mm. CONCLUSIONS We propose a new classification for UCL injuries based on MRI findings that helps predict valgus laxity, improve communication, and guide treatment for UCL pathology in throwing athletes.
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Affiliation(s)
- Patrick W Joyner
- Bone & Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
| | - Jeremy Bruce
- Erlanger Health System, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Ryan Hess
- University Specialty Clinics, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Arron Mates
- College of Medicine, The University of South Alabama, Mobile, AL, USA
| | | | - James R Andrews
- The Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, FL, USA
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VanWye WR, Hoover DL, Willgruber S. Physical therapist screening and differential diagnosis for traumatic-onset elbow pain: A case report. Physiother Theory Pract 2016; 32:556-65. [PMID: 27618254 DOI: 10.1080/09593985.2016.1219798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Elbow pain can originate from many sources yet have similar signs and symptoms, thereby presenting differential diagnostic challenges. The elbow is commonly injured, thus requiring all clinicians to possess excellent diagnostic skills. CASE DESCRIPTION A 24-year-old woman slipped and fell on her outstretched left hand, experiencing immediate elbow pain. The same day radiographs were deemed negative by her orthopedist, who referred her to physical therapy with the diagnoses of elbow sprain and contusion. Immediately after examining the patient, the physical therapist consulted with the referring orthopedist. The decision to consult was based on: the mechanism of injury, pain severity out of proportion to the referred diagnoses, significantly limited ROM, abnormal joint end feels, exquisite pain with tactile and tuning fork bony palpation, and positive elbow extension test. OUTCOMES The treating physical therapist shared the above-noted findings with the orthopedist, who overruled and recommended continuing the original prescription of non-steroidal anti-inflammatory medication and physical therapist treatment for four weeks. The physical therapist's updated plan of care at four weeks noted the patient's continued reports of pain, functional limitations, and disability. A magnetic resonance image (MRI) was then ordered, revealing a radial head fracture. DISCUSSION A thorough history and examination by the physical therapist led to clustering of signs and symptoms, allowing for the development of a differential diagnosis list which included occult radial head fracture. All clinicians should be prepared to screen for complex conditions. Timely diagnosis and improved outcomes for clinically complex patients are increasingly necessary in contemporary healthcare reimbursement models.
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Affiliation(s)
- William R VanWye
- a Department of Physical Therapy , Western Kentucky University , Bowling Green , KY , USA
| | - Donald L Hoover
- a Department of Physical Therapy , Western Kentucky University , Bowling Green , KY , USA
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Durur-Subasi I, Durur-Karakaya A, Yildirim OS. Osteochondral Lesions of Major Joints. Eurasian J Med 2015; 47:138-44. [PMID: 26180500 DOI: 10.5152/eurasianjmed.2015.50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/17/2014] [Indexed: 11/22/2022] Open
Abstract
This paper provides information about osteochondral lesions (OCL) and example cases of OCL occurring in major joints, some of which are rarely seen. This simple tutorial is presented in question and answer format.
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Affiliation(s)
- Irmak Durur-Subasi
- Department of Radiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Afak Durur-Karakaya
- Clinic of Radiology, Regional Research and Training Hospital, Erzurum, Turkey
| | - Omer Selim Yildirim
- Department of Orthopedics and Traumatology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Patel RM, Lynch TS, Amin NH, Gryzlo S, Schickendantz M. Elbow Injuries in the Throwing Athlete. JBJS Rev 2014; 2:01874474-201411000-00004. [PMID: 27490404 DOI: 10.2106/jbjs.rvw.n.00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ronak M Patel
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
| | - T Sean Lynch
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
| | - Nirav H Amin
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
| | - Stephen Gryzlo
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North Street Clair, Suite #1350, Chicago, IL 60611
| | - Mark Schickendantz
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
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Abstract
Medial epicondylar tendinopathy, also known as golfer's elbow, is less common than lateral elbow tendinopathy. Overhead throwing athletes and those participating in sports that require repeated forearm pronation and wrist flexion are most commonly affected by this disorder. This problem predominates in amateur as opposed to professional athletes and is also seen more commonly in patients over 40 years of age. This review will begin by outlining the incidence, history, and physical examination of medial epicondylar tendinopathy, including a new clinical test. Imaging modalities, nonoperative, and operative treatments will then be outlined. Finally, future directions will be explored including emerging biological therapies.
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New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc 2012; 20:2535-41. [PMID: 22228377 DOI: 10.1007/s00167-011-1872-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/29/2011] [Indexed: 12/29/2022]
Abstract
PURPOSE To suggest a new model on the most common kind of posterior elbow dislocation using MRI findings on acute elbow injuries. METHODS Fifteen patients with simple elbow dislocation (Group A) and 19 patients sustaining pure ligament injuries (Group B) were enrolled in this study. Using MRI scans, bony contusion at radial head and posterior capitellum (lateral bone contusion) and medial aspect of the ulnohumeral joint (medial bone contusion) were investigated with the injury patterns of the collateral ligament and overlying muscles. In Group A, the injury patterns of the ulnar and lateral ulnar collateral ligaments were classified into distraction or stripping type; in Group B, into rupture or strain. Based on these findings, we speculated the injury mechanism of the elbow dislocation. RESULTS In Group A, posterolateral (PL) dislocation was found in 12 cases of distractive ulnar collateral ligament type and stripping lateral ulnar collateral ligament type, where lateral bone contusion was found in 11 cases. Posteromedial (PM) dislocation was observed in only two cases of distraction type of the LUCL, where medial bone contusion was seen in two cases. In PL dislocation of the elbow joint, we always found more severe damage of soft tissue at the medial side of the elbow joint compared to the lateral side. Lateral bone contusion was speculated to be caused by bony abutment under pathologic forearm external rotation (PFER) and medial bone contusion, by bony abutment under varus stress. In Group B, the ulnar collateral ligament was more commonly injured than the lateral ulnar collateral ligament, and lateral bone contusion accompanied most cases. CONCLUSION PL dislocation is thought to start from the medial side in contrary to PM dislocation beginning at the lateral side. If the disengagement of the coronoid process is not completed due to the insufficient valgus/varus distraction, a coronoid fracture will develop at the same time as the elbow dislocation during PFER.
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