Review of Treatment Choices for Rheumatoid Arthritis Affecting the Elbow

This review article brings us up to date on treatment for the arthritic elbow. Up to half of all patients with rheumatoid arthritis (RA) will have elbow problems. Pain, swelling, and loss of motion in the elbow also affect the hand and shoulder. Patients who also have shoulder problems have an even bigger challenge.

Treatment begins with physical and occupational therapy. The goal is to reduce pain and keep as much motion as possible for as long as possible. Therapists teach patients ways to prevent damage to the joint and nearby tendons and ligaments.

If the disease continues to get worse, surgery may be needed. At first, the doctor may remove part or all of the synovium, the lining of the joint. This operation is called a synovectomy. If synovectomy doesn’t help, the joint may need to be replaced. Rarely, the elbow joint may be surgically fused in place.

Some doctors say treating the shoulder first puts less stress on the elbow. Treating the shoulder first will also decrease any pain from the shoulder affecting the elbow. Others advise elbow surgery first, as this can give more use of the arm right away.

Elbow joint replacement may be needed for some patients with advanced rheumatic elbow disease. New and improved implants and operating techniques make this a good option for patients who put low demand and use on the elbow. Patients who are more active may be at risk for implant loosening and wear.

The authors conclude that early management of elbow arthritis is important. The patient can maintain motion and function for as long as possible before needing surgery. Joint replacement for the elbow is fast-becoming as good as hip and knee replacements in patients with RA.

Serving Up an Effective Treatment for Tennis Elbow

Tennis elbow is the most common elbow problem in adults. This condition, also called lateral epicondylitis, affects the tissues connecting to the “bump” (epicondyle) on the outer part of the elbow. If the problem is on the inside of the elbow, it’s called medial epicondylitis.

There are many ways to treat tennis elbow. Drugs, splinting, bracing, heat or cold, and electrical current are used to help reduce the pain and swelling. The focus of this study was a treatment method called iontophoresis.

Iontophoresis is a way to send a drug into the elbow area. During the treatment, a mild electric current is used to push drugs through the skin. This method has fewer side effects compared with injections or oral drugs.

The authors of this study compared two groups of patients with recent (acute) problems of tennis elbow. One group got iontophoresis with a steroid drug called dexamethasone, while the second group received a “dummy” or placebo treatment. The placebo was iontophoresis using a salt solution.

The group receiving the steroid treatment got better quicker, though symptoms after a month were the same for both groups. Patients who got six treatments in 10 days or less had the best results. When it took longer than 10 days to complete the six treatments, the results weren’t as good. Iontophoresis showed good short-term results for patients with acute symptoms of tennis elbow.

A New Shot for Tennis Elbow

You don’t have to play tennis to have a common elbow problem called “tennis elbow.” This painful condition involves the outside “bump” or epicondyle of the elbow. It is typically caused by injury (strain) or repetitive stresses to the tendons that attach to the epicondyle.

Tennis elbow has long been treated as a form of tendonitis with inflammation as the problem. Treatments have included ice massage, steroid injections, splinting, and medication.

Researchers studying the muscle and tendon tissue have learned that chronic tennis elbow isn’t a problem of inflammation. Instead, there’s damage to the cells that form the tendons, a condition called tendonosis. The problem is compounded by a loss of blood supply to the damaged tendon.

The doctors in this study injected blood into the painful area of the elbows of 28 adults. The patients donated their own blood for this treatment. Eighty percent of the patients got complete relief of pain after one injection. A smaller number of patients needed two or even three injections.

It took about three weeks for the first injection to take effect. This matches the time needed for a healing process to take place. Repeated injections worked faster (one to two weeks). The authors think this is because the first injection started the steps toward healing.

The doctors say they can’t know for sure if the blood was what worked. It may be that the injection itself caused a small injury to the area that produced the healing. They think the blood is what made the difference because the patients had previously gotten steroid shots into the damaged tendons without getting relief.

Squeaky Elbow Hinge Gets the Grease

Sometimes the elbow gets dislocated and stays that way. Usually, elbow dislocations are treated right away. The doctor may be able to put the joint back in place without surgery. This is called a closed reduction. In some cases, surgery is needed to realign the joint. This is called an open reduction.

In some patients, treatment to reduce the elbow isn’t done. This occurs most often in countries where medical help isn’t readily available.

When an elbow is dislocated for weeks or months, the joint doesn’t move. There is a natural healing process that starts to take place. The body fills in the joint with fibrous tissue and new cells. Over a long period of time, the joint might actually fuse in place.

Surgery to repair an old elbow dislocation can be done with good results. No attempt is made to repair damage to the joint surfaces, nearby muscles, tendons, or ligaments. A special device, called an external fixator, is attached over the elbow. The external fixator connects through the bones on either side of the joint from the outside. This allows the joint to move during the first few weeks after surgery. It is used until the patient is able to move the elbow on his or her own.

Pain and loss of motion and function are common with elbow dislocations. The patient can’t move the joint, and everyday tasks and activities become difficult. Surgery up to two months later can reduce pain and discomfort while increasing motion and function. A major operation to reconstruct the entire elbow isn’t always needed.

Getting a Firmer Grip on Tennis Elbow

Tennis elbow is often treated by physical therapists. Therapists are always looking for ways to measure their results with these patients. Was the treatment successful? How can they tell? Measuring grip strength is one way to look for changes.

Grip strength can be measured in two different ways. The therapist can measure either maximum or pain-free grip strength. Maximum grip measures the strongest grip a patient has, even if it hurts. The pain-free grip measures strength up to the point of pain or discomfort. Which one is a better measure? This is the question answered by a group of researchers in the Netherlands.

A reliable test is one that can be done by two different therapists on the same patient and get the same results. This is called interobserver reliability. Both maximum and pain-free grip strength can be measured with equal reliability. However, the pain-free grip strength is a better way to measure the patient’s pain and function.

The researchers also looked at another test called pressure pain threshold. Therapists use a special tool called an algometer. This measures how much pressure can be placed on the skin without pain. In the case of tennis elbow, the algometer is pressed against the tendon until pressure changes to pain. This is the measure of pressure pain threshold.

The authors suggest that pressure pain threshold is not currently a reliable test to use with patients who have tennis elbow. Pain-free grip strength is the best measure of results. It is easy to use for research and in clinical practice.

Dealing with the Crooks That Steal Elbow Function

The elbow seems like such a simple joint. It’s formed with a hinge that allows it to bend and straighten. But, as anyone with arthritis of the elbow can tell you, things can get very complicated. Pain and loss of motion can occur when there are bone spurs inside the joint. These can break off and float freely in the joint.

Painful joint locking can occur when these pieces of tissue get caught in the joint. The nerves nearby can get pinched or scarred, causing numbness, tingling, and pain. Fortunately, this condition is uncommon.

Middle-aged men who use their arms in a repetitive motion are most often affected. Athletes and people who push themselves in a wheelchair are also susceptible. Constant use of crutches is another risk factor for elbow problems.

Doctors are searching for ways to treat this condition. The goal is to restore motion, improve function, and decrease pain or nerve symptoms. The hope is that the symptoms won’t come back later. A study done at the Mayo Clinic has been reported. Forty-six elbows were treated for osteoarthritis with surgery.

During the operation, any bone spurs or loose pieces of tissue were removed. Any nerve not moving freely was released. When the capsule of the joint was bound down, it was cut open or removed. (The capsule is a tightly woven envelope of fibrous tissue that surrounds the joint.)

About 74 per cent of the patients had a satisfactory result. This was based on pain level, motion, and function. In the remaining group, some patients thought they were the same or worse than before the operation. Twenty-eight percent reported ulnar nerve pain and numbness. This is the nerve that goes down the inside edge of the elbow and forearm.

According to doctors at the Mayo Clinic, surgery for elbow osteoarthritis has good results. The majority of patients treated had less pain and more motion after surgery. The symptoms may come back in some patients, but they are less severe. Problems with the ulnar nerve may be a limiting factor in this treatment.

Youthful Elbows Bent on Sports

The actions of weight lifting, gymnastics, and throwing among adolescents are the most common causes of osteochondritis dissecans (OCD) in the elbow. This is a condition in which a piece of bone and cartilage separate from the main bone. It occurs most often in older children and young adults. Boys are affected more than girls.

Elbow OCD usually happens at the end of the bone where the bone is still growing. Here, there are two separate parts of the bone, the bone itself and the growth plate. The growth plate is made of cartilage and gradually fills in with bone as the child grows and matures.

Bearing weight on the arms or stress from lifting weights places high loads on the elbows. This places the elbow joint at risk for OCD. For baseball players, throwing balls has the same affect. The increasing popularity of baseball has brought with it more cases of elbow OCD than ever before.

Left untreated, this condition can destroy the joint, cause bone spurs, and cause a painful loss of motion. This is not good for young athletes with a possible sports career ahead of them. Treatment starts with changing how the arm is used. Physical therapy with the use of ice, heat, ultrasound, and exercises is also advised.

If conservative treatment doesn’t help, surgery is the next step. The doctor can use an instrument called an arthroscope to look inside the joint and find the problem. The loose bone can be removed and the joint shaved or smoothed. The doctor tries to save and repair as much as possible before removing tissue.

After surgery, physical therapy is part of the recovery and rehabilitation program. Athletes can return to their sport after treatment for elbow OCD. However, many choose a different activity without so much stress to the elbows.

Which Pitch? And How Many?

Young children who pitch for baseball teams are at risk for elbow and shoulder problems. Physical trauma and stress over time add up from season to season. For this reason, parents and coaches are very interested in what guidelines to use for pitch type, count, and form.

A study of 467 baseball pitchers ages nine to 14 looked at pitch types. The curveball requires a snapping motion with a downward twist of the wrist to spin the ball so it curves away from the batter just as the batter starts to swing. The slider is similar to a curve ball, but requires a snapping motion in the opposite direction. This curves the ball over the plate toward the batter. The change-up pitch uses the same motion as a fastball but changes the speed. Usually, the pitcher is throwing the same pitch for quite a few pitches and then changes the speed of the pitch.

Both the curveball and the slider are “breaking” pitches. This means the ball travels two-thirds of the way to the plate and then “breaks” or changes. It either curves or drops down. The batter is already swinging to hit the ball when it breaks.

Shoulder or elbow pain in a young pitcher is a sign of an overuse injury. Muscle soreness is normal and expected. Joint pain is not. The curveball and slider are more likely to cause joint pain in young pitchers. These breaking pitches can cause injury to the growth plate, an area of cartilage near the end of long bones that eventually turns to bone. The change-up is a safe pitch for this age group. It works well because the key to its success is changing the speed of the pitch. This upsets the batter’s timing.

Pitch types are important, but so are pitch counts. Pitchers should be limited to 75 pitches in a game and 600 in a season. These young pitchers should not play in more than one league at a time. Pitching on a regular basis without exceeding the limits helps build strength, coordination, and endurance.

Shocking Results about Shock Wave Therapy for Tennis Elbow

In Europe, doctors often use shock wave treatment for tennis elbow and other joint problems. However, there is little evidence to show how well it works. These authors did a trial to rate the success of shock waves in treating tennis elbow.

About 270 patients were divided into two groups. The treatment group got local anesthesia to numb the elbow, followed by 2000 pulses of low-energy shock waves. The placebo group got local anesthesia followed by fake shock wave treatment.

Both groups were checked at six weeks, 12 weeks, and one year. After 12 weeks, about one fourth of the patients in the treatment group were better without any other therapy. However, a quarter of the patients in the placebo group had also been successfully “treated,” suggesting that shock wave therapy isn’t all it’s cracked up to be.

One year later, about two-thirds of the patients in both groups had improved. Time and conservative treatments seemed to work in the majority of cases.

The authors conclude that shock wave therapy as it was done in this study is not a useful treatment for tennis elbow. They suggest that doctors stop using it until further trials show if it has benefits when it is used in different ways.

Doctors Get the Elbow from Gymnasts

Intense training activities that repeatedly put pressure on the elbow joint can lead to joint damage. The result can be a condition called osteochondritis dissecans (OCD). Five female athletes, four of whom were gymnasts, presented with elbow OCD.

OCD in the elbow usually occurs in the outside edge of the elbow joint, where the rounded end of the upper arm bone (humerus) attaches to the radial bone of the forearm. The cartilage can become separated from the bone, which causes pain, swelling, and loss of motion.

Most athletes with OCD report a “locking” sensation. The elbow gets stuck in one position and can’t move. A similar condition in younger athletes (under age 12) can usually be successfully treated with rest.

However, elbow OCD from repeated trauma usually requires surgery. Even with rest, each of the athletes in this study eventually needed surgery. Removing any loose tissue from the elbow and smoothing the joint surface restores motion. Several of these athletes returned to their sport without pain.

OCD of the elbow has only a small chance of healing on its own. Delay in surgery can lead to more damage and a worse result in the end.

Shocking News about Tennis Elbow

There isn’t a cure-all for tennis elbow. The results of treatment vary with or without surgery. Nothing has been able to improve or cure this condition quickly, easily, or in all people.

A new treatment for tennis elbow called shock wave therapy was recently used and studied by a group of Doctors in Taiwan.

Shock wave therapy uses sound waves to improve symptoms. Normally, shock waves are not harmful. They just pass through tissues. Sometimes the shock waves reach a place where there is resistance. The force of the wave against the tissue causes a change in the tissue.

No one knows how or why this works for tennis elbow. In cases studied, almost everyone’s painful symptoms were gone or at least much better. There was improved elbow strength and motion, too.

Shock waves may be a good treatment for tennis elbow. Pain is reduced, and strength, motion, and function are improved. There are no problems from using the machine for this condition. After the treatment, no swelling or redness occurs. Long-term results are still unavailable. More research over a long period of time is needed.

Loosen Up! Treating Elbow Stiffness after Injury

The elbow may seem like a simple joint, but it can present complex problems. Injury to the elbow can have lasting effects, such as elbow stiffness. The cause of stiffness may come from inside or outside the elbow joint, or a combination of both.

Outside the joint, skin or other tissue can tighten, limiting elbow motion. Scar tissue may interfere with movement. Ligaments around the joint may have torn during the injury. The dense, fibrous tissue around the joint (called the capsule) can also cause problems.

Inside the joint, scar tissue may become pinched, leading to elbow stiffness. Pieces of bone can break off at the time of injury. These fragments can get stuck in the joint and block movement.

Once the elbow stiffens, it can be very difficult to treat. Elbow stiffness can often be prevented with medications, physical therapy, and elbow splinting to restore motion. If these methods don’t work, surgery may be required. The surgeon can release the scar tissue around the joint and remove any loose pieces of bone inside the joint. In severe cases, doctors use other types of surgery to correct the problem. This can include putting a spacer between the joint (a procedure called interpositional arthroplasty), or it could mean replacing the elbow with an artificial joint.

Here’s the Pitch: Elbows Widen with the Wind-Up

In baseball, many pitchers and outfielders are known to have elbow problems. Researchers are studying the effects of repeated throwing on the elbow joint. By understanding the mechanics of throwing, researchers may be able to suggest ways to prevent elbow injuries.

Ultrasound (also called ultrasonography) has been used to see inside the elbow. Ultrasonography uses sound waves at a very high frequency to make images of the joint and ligaments. Ultrasonography was used in a study of 30 college baseball players. Images of one elbow were compared to the other elbow for each player. Sound waves were directed to the medial side of the elbow. This is the side along the inside edge of the elbow. The throwing motion puts stress on this side of the joint. 

With ultrasound, researchers saw an increased space in the elbow joint of the throwing arm. Near the end of the wind-up, the elbow bends, and the forearm angles out to gather speed. The forces across the inside edge of the joint can cause the forearm bone (the ulna) to slide outward slightly. This shifting motion, called lateral shift, leaves a gap on the inside edge of the elbow joint. The ligament that crosses this part of the elbow (the ulnar collateral ligament) gets stretched as this gap widens. 

Repetitive pitching and throwing cause intense stress on the medial side of the elbow. This stress leads the ulna bone to shift, putting a stretch on the ulnar collateral ligament. Ultrasound can show widening in the joint and tears in the ligament. Information from studies like this one may help researchers find new ways to prevent elbow injuries in baseball players.

The Crooked Truth about Elbow Surgery for Children

“Contracture” is the term used to describe stiffness that keeps a joint from fully straightening or bending. Contracture of the elbow can result from problems at birth or from trauma such as a fracture. If caught quickly, this problem can be treated with physical therapy and splinting. Otherwise, surgery may be needed to create more movement in the joint.

Few studies report the results of surgery for elbow stiffness in young patients who don’t have muscular diseases. After treating adults and kids with this problem, it seemed to these authors that elbow surgery wasn’t as successful for patients under the age of 21. They reviewed the cases of 37 patients who had elbow surgery. The patients were 10 to 20 years old, with an average age of 16. Most of the patients had elbow stiffness due to fractures. They had all tried other treatments without success. About half of them had already had elbow surgery.

Surgeons “released” the ligament enclosure (joint capusle) around the elbow. They also removed any bone or other material that might get in the way of elbow movement. They did not try to lengthen the muscles or tendons. After surgery, patients wore elbow splints for three months, 16 hours a day. When not in splints, patients did exercises to improve elbow movement.

About a year after surgery, patients’ elbow motion had improved. However, these improvements were small and unpredictable. Only 75 percent of patients gained more than 10 degrees of elbow movement. Less than half of them achieved the amount of elbow movement necessary for activities of daily living. Two patients actually lost movement. Older kids in the study were a little more likely to get better results from surgery. But in general, their results were not as good as those seen in adults.

Patients with some types of injuries fared better than others. Patients who had fractures outside the elbow joint or simple dislocations of the elbow did better than patients who had joint fractures or fractures plus dislocations. Patients were more likely to have good results if they had not already undergone elbow surgery. They also had better results when loose pieces of bone and other material were removed during surgery.

The authors conclude that this surgery is less helpful for children than for adults. Improved but not normal elbow movement can be expected for most children who have surgery for elbow stiffness. Doctors should advise younger patients and their parents of this to avoid unrealistic expectations.

The Ins and Outs of Elbow Pain

Which would you rather have: tennis elbow or golfer’s elbow? What’s the difference? Lateral epicondylitis or tennis elbow consists of pain and sometimes swelling on the outside of the elbow. Medial epicondylitis or golfer’s elbow occurs on the inside of the elbow. Both conditions are mainly caused by overuse. Both involve pain, weakness, and loss of function.

Researchers in Finland studied two groups of adults with either tennis or golfer’s elbow. There were 25 men and women in each group. The researchers compared pain levels, grip strength, arm strength, and joint motion between the two groups.

Tennis elbow was more painful than golfer’s elbow when the arm or elbow was under strain. Tennis elbow was also characterized by more widespread pain, meaning a larger area of the elbow and arm hurt.

Golfer’s elbow left patients with more hand, wrist, and forearm function. With golfer’s elbow, patients were still able to rotate the forearm to turn the palm up or down. In contrast, both forearm rotations were reduced in patients with tennis elbow. However, grip strength was less in patients with golfer’s elbow. The grip strength of the healthy arms did not differ between the two groups.

If you have to choose between the two, choose golfer’s elbow. In general, golfer’s elbow is less painful than tennis elbow and leaves the individual with better muscle function. Understanding the differences between these two elbow conditions can help rehabilitation specialists plan effective treatment.

Removing the Thin Lining of Arthritic Elbow Pain

Can you blow your nose without bending your elbow? Can you reach for something on top of the refrigerator without straightening your elbow? These are some of the challenges people with rheumatoid arthritis face every day. Almost half of adults with rheumatoid arthritis (RA) have problems with pain and loss of motion in the elbow. These symptoms limit patients’ ability to use the arm and reduce overall function.

There are many treatments for RA of the elbow. These include medications, injections into the joint, physical therapy, and surgery. Surgery may mean removing part or all of the synovium. The synovium is the thin layer that lines the tissue capsule around a joint. This surgery can be done by opening up the joint and taking the synovium out.

A newer way to do this is with an arthroscope. An arthroscope is a tool that allows the surgeon to see inside the joint without actually opening it up. A thin tube with a camera on the end is inserted into a body cavity or joint. The arthroscope has a separate attachment that the surgeon uses to cut away the synovium.

Whenever a new operation comes along, researchers must compare the results of the new and old methods. A group of doctors in Japan reported the results of 29 elbow operations done with an arthroscope. The doctors looked at pain levels, motion, joint stability, and X-rays after surgery. Patients were followed for at least two years and sometimes up to 10 years.

Early results were very good for all patients. Patients had pain relief that made it possible to do daily tasks. Over time, there was a decline in the stability of the joint. Also, pain started to come back. The patients with the most severe RA had the worst results. Some needed joint replacement several years later.

Arthroscopic surgery to remove the synovium in arthritic elbows is a safe operation that often relieves pain. After surgery, there is a small incision and no need for a formal rehabilitation program. The best results come from having the surgery early, before the joint is severely damaged.

Forearm Stress Fracture in a Young Polo Player: A Rare Case

Polo is an exciting sport, but it can be dangerous as well. Horses can collide. Players can be thrown from their mounts. Injuries include cuts, bruises, and fractures. Injuries to the face and arms are less common but can occur after being hit with a mallet or ball.

A case of stress fracture of the forearm was reported in a 20-year-old male polo player. A stress or “fatigue” fracture is the reaction of bone to repetitive stress. Stress fractures are common in sports and activities that involve the same motion over and over.

What caused this injury in the polo player? The player increased his practice time to prepare for an upcoming series of games. He went from two hours per week to 10 hours during the two weeks before the tournament. Finally, pain and swelling in the right forearm kept him from playing. The pain was so severe, he couldn’t hit the ball with the mallet forcefully enough to compete.

X-rays showed an area of bone in the forearm that was lifted up and slightly disrupted. A bone scan showed increased bone activity in this same area. The player had a history of taking the steroid prednisone for Crohn’s disease (inflammation of the intestines). This medication is known to cause bone problems when taken over a long period of time.

The player also admitted to a tendency to “top the ball,” which may have contributed to his injury. Polo players strike the center of the ball when it is lined up with the player’s toe. A tendency to strike the ball above its center point causes topspin of the ball. Topspin creates increased force through the mallet into the player’s forearm. It’s possible that this improper form, combined with the increased practice time, led to the bone fracture.

Forearm stress fractures are not often seen in polo players. This young player was taking a medication that can affect muscles and bones. He also increased his practice time before competition and used an improper method for striking the ball. Each of these factors may have contributed to his injury.

Tennis Anyone? Serving Up a Successful Elbow Surgery

“Tennis elbow,” a term first heard in the 1800s, happens in the elbow but doesn’t usually have anything to do with tennis. In the medical world, tennis elbow is more accurately called lateral elbow tendonopathy or lateral epicondylitis. The main symptom is pain along the outside of the elbow. Elbow tendonopathy is often seen in the workplace. Work that requires repetitive motion of the arm with high-impact loads is a common cause of this condition.

The pain can occur only in the elbow, or it may travel down the arm to the wrist and hand. At first, pain occurs when the arm is being used. But left untreated, the pain can become constant, even when the arm is at rest. Early treatment with anti-inflammatory medications, rest or work restrictions, and steroid injections helps in 90 percent of all cases. Physical therapy may be advised. Sometimes the patient seeks out a chiropractor for manipulation.

When these methods are unsuccessful, surgery may be recommended. Various surgical methods for lateral elbow tendonopathy have been reported. A method called the V-Y slide has been used with excellent results. In this operation, the tendon on the outside of the elbow is cut and released, and the bone underneath is shaved or smoothed off. The tendon is allowed to slide down about half an inch, where it reattaches.

There are several advantages to this surgery. The joint is not disturbed. There is no damage to any of the ligaments that hold the elbow joint stable. The bone is protected afterwards. And the tendon is released without the attached muscle losing shape or form. Almost everyone who has this surgery can return to his or her previous level of work or activity.

Cutting-Edge Research Gives Surgeons Elbow Room–Literally

Problems can arise when a surgeon has to cut through ligaments, tendons, or muscles to get to bone. This is especially true in the case of repairing a broken bone in the elbow or replacing the elbow joint with a new one. Surgeons need to know if cutting through one or both of the ligaments on the outside of the elbow will give the patient an unstable or “loose” joint after surgery.

Most people aren’t willing to let doctors “cut now and see what happens later.” That’s the work of researchers in a laboratory. By using arms from cadavers (human bodies preserved for study), researchers can study joint motion under various conditions. Several studies have been published related to the ligaments on the outside (lateral side) of the elbow.

There are three important ligaments holding the lateral elbow in place. One of these ligaments comes from the outside of the elbow across the front. The other two are on the outer part of the elbow between the bones of the upper and lower arm. These two are so close together that even the researchers had to devote part of their work to deciding where each one begins and ends. Describing the location of each ligament in anatomical terms is very helpful to surgeons.

One study looked at whether these two ligaments were both necessary for a stable elbow joint. The researchers used 12 arms divided into two groups of six. Using incisions a surgeon would make, they cut one ligament in six of the specimens and the other ligament in the remaining six. Then they tested each elbow’s ability to hold steady. In all 12 cases, the elbow remained stable.

It wasn’t until both ligaments were cut that the elbow started showing signs of instability. This is important information for surgeons planning to operate on the elbow. It means that when the surgeon is trying to get into the elbow, one (but not both) of the ligaments on the outside can be cut and still keep a stable joint. Once both ligaments are disrupted, the amount of rotation and shifting of bones increases significantly.

Sticking Up for the Best Position in a Stuck Elbow

If your elbow needed to be fused in one position, what’s the best position to choose? A group of researchers asked that question. They studied different elbow positions in healthy volunteers. Each person bent his elbow to a different angle. Then a brace was strapped on, locking the elbow in place. The researchers took measurements to see which elbow position allowed the most function. Activities such as brushing the teeth, reading the newspaper, using a telephone, and drinking water from a cup were evaluated.

Fortunately, fusion surgery to lock the elbow in one position (called arthrodesis) isn’t required very often. This operation may be a final effort to help with some unusual medical condition or save a damaged elbow joint. Without use of the elbow, daily activities can be severely limited. Until now, the best position for elbow arthrodesis wasn’t known. Most reports suggest 90 degrees (elbow bent to form a right angle), but no data have proven that this position is best.

Other positions have been recommended, but it’s uncertain whether they’re good for the whole arm. These researchers wanted to know which elbow position would allow the best use of the whole arm for personal hygiene and daily activities. The researchers examined how much elbow motion was needed for each task and how much of each task could be done in each elbow position.

Twenty-four healthy adult volunteers were observed with the elbow locked in six different positions. The best position was 110 degrees of flexion, or slightly more than a right angle. All but three members of the study could complete all tasks with the elbow in this position.

There is no perfect position for an elbow fusion because the arm does a wide range of activities. Some activities require more bend in the elbow (drinking, brushing the teeth). Others need a straight elbow (putting on shoes, reaching objects). The position for elbow arthrodesis should also take into consideration the patient’s age, occupation, and preferences. Whether the person is right- or left-handed is also important. Before surgery, it is recommended that the patient try an adjustable brace to see what works best at home and on the job.