Kinetic chain disruption contributes to shoulder and elbow injuries

The kinetic chain or link theory provides the basis for understanding and evaluating human movement patterns as well as the justification for using exercise training and recovery services that emphasise the whole body,despite the damage to a specific joint or anatomical structure.The motion of one segment affects all proximal and distal segments to the first segment.The overhead throwing motion is produced and regulated by a sequential position and motion of the body,involving sequential activation.

Clinical study on improving the diagnostic accuracy of adult elbow joint cartilage injury by multisequence magnetic resonance imaging

BACKGROUND Due to frequent and high-risk sports activities,the elbow joint is susceptible to injury,especially to cartilage tissue,which can cause pain,limited movement and even loss of joint function.AIM To evaluate magnetic resonance imaging(MRI)multisequence imaging for improving the diagnostic accuracy of adult elbow cartilage injury.METHODS A total of 60 patients diagnosed with elbow cartilage injury in our hospital from January 2020 to December 2021 were enrolled in this retrospective study.We analyzed the accuracy of conventional MRI sequences(T1-weighted imaging,T2-weighted imaging,proton density weighted imaging,and T2 star weighted image)and Three-Dimensional Coronary Imaging by Spiral Scanning(3D-CISS)in the diagnosis of elbow cartilage injury.Arthroscopy was used as the gold standard to evaluate the diagnostic effect of single and combination sequences in different injury degrees and the consistency with arthroscopy.RESULTS The diagnostic accuracy of 3D-CISS sequence was 89.34%±4.98%,the sensitivity was 90%,and the specificity was 88.33%,which showed the best performance among all sequences(P<0.05).The combined application of the whole sequence had the highest accuracy in all sequence combinations,the accuracy of mild injury was 91.30%,the accuracy of moderate injury was 96.15%,and the accuracy of severe injury was 93.33%(P<0.05).Compared with arthroscopy,the combination of all MRI sequences had the highest consistency of 91.67%,and the kappa value reached 0.890(P<0.001).CONCLUSION Combination of 3D-CISS and each sequence had significant advantages in improving MRI diagnostic accuracy of elbow cartilage injuries in adults.Multisequence MRI is recommended to ensure the best diagnosis and treatment.

Elbow dislocation with ipsilateral diaphyseal forearm bone fracture： A rare injury report with literature review

Dislocation of the elbow along with shaft fractures of both bones of the ipsilateral forearm is a rare injury though elbow dislocation or fracture of the forearm bones may occur separately. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of forearm bones for optimal functional outcomes. We report a case of elbow dislocation with fracture of the lateral condyle of the hu- merus along with fractures of shafts of the radius and ulna in a 44-year-old female. Closed reduction of the elbow and operative stabilization of all fractures were done with good clinical, radiological and functional outcomes in 2 years follow-up period. A significant degree of force is needed to produce a combined dislocation of a joint and fracture of bones around that joint and these complex injuries may be missed if the clinician is not aware of the possibility of such injuries. The fact that the previously reported cases had a posterolateral dislocation while our case had a posteromedial dislocation and a fracture of the lateral humeral condyle as well makes it unique in its presentation and worth reporting. We have also included an up to date literature review on this topic.

A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults

Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults.The functional outcome of surgical repair has been evaluated too.;A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done.We only included complete TTA injuries.Children below 15 years,open injuries,associated fractures,and partial TTA were excluded.The data were obtained from hospital records.The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA.The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score.ANOVA test was used to assess the statistical significance.;There were 15 patients included,including 11 males and 4 females.The mean age was(31.5±9.15)years,and the mean follow-up was(22.4±8.4)months.Fall on outstretched hand was the mode of injury.In 6 patients,diagnosis was missed on the initial visit.TTA were classified as Type 1:palpable soft-tissue defect without bony mass;Type 2:palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray;Type 3:palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface;and Type 4:an olecranon fracture with less than 25%of the articular surface.An algorithm for treatment was recommended,i.e.transosseous suture repair/suture anchor for Type 1,transosseous suture repair for Type 2,and tension band wiring or steel wire sutures for Types 3 and 4.All the patients achieved good to excellent outcome:the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26±2.60 on final follow-up.;Our clinicoradiological classification and treatment algorithm for TTAs is simple.Surgical treatment results in excellent functions of the elbow.Since it is a single-center study involving a very small number of cases,a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.