Semin Musculoskelet Radiol 2022; 26(03): 271-294
DOI: 10.1055/s-0042-1743402
Review Article

Posttreatment Changes of the Elbow

Thomas Grieser
1   Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
› Author Affiliations

Abstract

Radiologists should be familiar with the typical surgical procedures applied at the elbow and aware of the spectrum of normal and pathologic appearances of posttreatment situations throughout all radiologic modalities. Most important in the case of posttraumatic surgical elbow procedures is correct postoperative elbow joint alignment, appropriate fixation of joint-forming fragments, and proper insertion of screws, plates, and anchor devices that do not conflict with intra-articular or bony structures. To report soft tissue repair procedures correctly, radiologists need to know the broad spectrum of different techniques applied and their appearance on magnetic resonance imaging.



Publication History

Article published online:
02 June 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Sheehan SE, Dyer GS, Sodickson AD, Patel KI, Khurana B. Traumatic elbow injuries: what the orthopedic surgeon wants to know. Radiographics 2013; 33 (03) 869-888
  • 2 Großstück R, Conrad T, Hofmann GO. Diagnostik und Klassifikation der Ellenbogenverletzungen. Trauma Berufskrankheit 2007; 9: S179-S182
  • 3 Zhang D, Nazarian A, Rodriguez EK. Post-traumatic elbow stiffness: pathogenesis and current treatments. Shoulder Elbow 2020; 12 (01) 38-45
  • 4 Landi A, Soragni O, Sacchetti GL, Cavana R, Caserta G. Neurovascular complications in the post-traumatic elbow. In: Celli L. ed., The Elbow. Current Concepts in Orthopaedic Surgery. Vol 2. Vienna, Austria: Springer; 1991: 127-137
  • 5 Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow replacement: a systematic review. J Shoulder Elbow Surg 2011; 20 (01) 158-168
  • 6 Ring D, Jupiter JB. Fracture-dislocation of the elbow. Hand Clin 2002; 18 (01) 55-63
  • 7 Rosas HG, Lee KS. Imaging acute trauma of the elbow. Semin Musculoskelet Radiol 2010; 14 (04) 394-411
  • 8 Coonrad RW, Roush TF, Major NM, Basamania CJ. The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg 2005; 14 (03) 312-317
  • 9 Sormaala MJ, Sormaala A, Mattila VM, Koskinen SK. MDCT findings after elbow dislocation: a retrospective study of 140 patients. Skeletal Radiol 2014; 43 (04) 507-512
  • 10 Lee YC, Pan NY, Chan HF. Computed tomography for elbow fractures: adding value to the radiology report. Hong Kong J Radiol 2019; 22: 263-270
  • 11 MacMahon PJ, Murphy DT, Zoga AC, Kavanagh EC. Postoperative imaging of the elbow, wrist, and hand. Semin Musculoskelet Radiol 2011; 15 (04) 340-356
  • 12 Reichert M, Ai T, Morelli JN, Nittka M, Attenberger U, Runge VM. Metal artefact reduction in MRI at both 1.5 and 3.0 T using slice encoding for metal artefact correction and view angle tilting. Br J Radiol 2015; 88 (1048): 20140601
  • 13 Hartley KG, Damon BM, Patterson GT, Long JH, Holt GE. MRI techniques: a review and update for the orthopaedic surgeon. J Am Acad Orthop Surg 2012; 20 (12) 775-787
  • 14 Delport AG, Zoga AC. MR and CT arthrography of the elbow. Semin Musculoskelet Radiol 2012; 16 (01) 15-26
  • 15 Waldt S, Bruegel M, Ganter K. et al. Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol 2005; 15 (04) 784-791
  • 16 Konin GP, Nazarian LN, Walz DM. US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics 2013; 33 (04) E125-E147
  • 17 Fessell DP, Jacobson JA, Craig J. et al. Using sonography to reveal and aspirate joint effusions. AJR Am J Roentgenol 2000; 174 (05) 1353-1362
  • 18 Tagliafico AS, Bignotti B, Martinoli C. Elbow US: anatomy, variants, and scanning technique. Radiology 2015; 275 (03) 636-650
  • 19 Daniels SP, Mintz DN, Endo Y, Dines JS, Sneag DB. Imaging of the post-operative medial elbow in the overhead thrower: common and abnormal findings after ulnar collateral ligament reconstruction and ulnar nerve transposition. Skeletal Radiol 2019; 48 (12) 1843-1860
  • 20 Signore A, Sconfienza LM, Borens O. et al. Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46 (04) 971-988
  • 21 Gierer P, Rocher S, Wichelhaus A, Rotter R. Typische Frakturen und Luxationen am Ellenbogengelenk und deren Behandlung. Radiologe 2018; 58 (11) 976-984
  • 22 Lenz R, Bonacker J, Mittelmeier W, Ellenrieder M, Tischer T. What do orthopedic and trauma surgeons expect from radiologists when interpreting imaging of the elbow?. [in German]. Radiologe 2018; 58 (11) 968-975
  • 23 Kodde IF, Kaas L, Flipsen M, van den Bekerom MP, Eygendaal D. Current concepts in the management of radial head fractures. World J Orthop 2015; 6 (11) 954-960
  • 24 Thayer MK, Swenson AK, Hackett DJ, Hsu JE. Classification in brief: Regan-Morrey classification of coronoid fractures. Clin Orthop Relat Res 2018; 476 (07) 1540-1543
  • 25 Zwingmann J, Neumann MV, Hammer TO, Reising K, Südkamp NP. Comminuted fractures of the elbow—osteosynthesis vs total joint replacement. Acta Chir Orthop Traumatol Cech 2016; 83 (04) 231-237
  • 26 Wegmann K, Hackl M, Leschinger T, Burkhart KJ, Müller LP. Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system. Arch Orthop Trauma Surg 2021; 141 (09) 1525-1539
  • 27 Bellato E, Zorzolo I, Comba A. et al. Periprosthetic fractures in the total elbow replacement: classification and current treatment algorithm. In: Castoldi F, Giannicola G, Rotini R. eds. Elbow Arthroplasty. Berlin, Germany: Springer; 2019: 163-170
  • 28 Kwak JM, Koh KH, Jeon IH. Total elbow arthroplasty: clinical outcomes, complications, and revision surgery. Clin Orthop Surg 2019; 11 (04) 369-379
  • 29 Gregory B, Nyland J. Medial elbow injury in young throwing athletes. Muscles Ligaments Tendons J 2013; 3 (02) 91-100
  • 30 Camp CL, Bernard C, Benavitz B, Konicek J, Altchek DW, Dines JS. Reconstruction of the medial collateral ligament of the elbow: biomechanical comparison of a novel anatomic technique to the docking technique. Orthop J Sports Med 2019; 7 (07) 2325967119857592
  • 31 Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med 2008; 36 (06) 1193-1205
  • 32 Camp CL, Sanchez-Sotelo J, Shields MN, O'Driscoll SW. Lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability of the elbow. Arthrosc Tech 2017; 6 (04) e1101-e1105
  • 33 Camp CL, Dines JS, Voleti PB, James EW, Altchek DW. Ulnar collateral ligament reconstruction of the elbow. The docking technique. Arthrosc Tech 2016; 5 (03) e519-e523
  • 34 Jones KJ, Dodson CC, Osbahr DC. et al. The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elbow Surg 2012; 21 (03) 389-395
  • 35 Tarallo L, Lombardi M, Zambianchi F, Giorgini A, Catani F. Distal biceps tendon rupture: advantages and drawbacks of the anatomical reinsertion with a modified double incision approach. BMC Musculoskelet Disord 2018; 19 (01) 364-374
  • 36 Garon MT, Greenberg JA. Complications of distal biceps repair. Orthop Clin North Am 2016; 47 (02) 435-444
  • 37 Alemann G, Dietsch E, Gallinet D, Obert L, Kastler B, Aubry S. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skeletal Radiol 2015; 44 (05) 629-639
  • 38 Marnitz T, Spiegel D, Hug K. et al. MR imaging findings in flexed abducted supinated (FABS) position and clinical presentation following refixation of distal biceps tendon rupture using bioabsorbable suture anchors. RoFo Fortschr Geb Rontgenstr Nuklearmed 2012; 184 (05) 432-436
  • 39 Fitzpatrick D, Petchprapa C, Rybak L. Imaging of posterior interosseous neuropathy following distal biceps repair: a report of 3 cases. Case Rep Radiol 2015; 2015: 508924
  • 40 Waterman BR, Dean RS, Veera S. et al. Surgical repair of the distal triceps tendon injuries: short-term to midterm clinical outcomes and risk factors for perioperative complications. Orthop J Sports Med 2019; 7 (04) 2325967119839998
  • 41 Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J Orthop Surg (Hong Kong) 2018; 26 (02) 2309499018778364
  • 42 Yeh PC, Stephens KT, Solovyova O. et al. The distal triceps tendon footprint and a biomechanical analysis of 3 repair techniques. Am J Sports Med 2010; 38 (05) 1025-1033
  • 43 Lappen S, Geyer S, Scheiderer B. et al. Distal triceps tendinopathies. Obere Extremität 2020; 15: 268-272
  • 44 Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am 2007; 89 (06) 1205-1214
  • 45 Smith MV, Bedi A, Chen NC. Surgical treatment for osteochondritis dissecans of the capitellum. Sports Health 2012; 4 (05) 425-432
  • 46 Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. Surgical technique. J Bone Joint Surg Am 2008; 90 (2, Suppl 2, Pt 1): 47-62
  • 47 Nobuta S, Ogawa K, Sato K, Nakagawa T, Hatori M, Itoi E. Clinical outcome of fragment fixation for osteochondritis dissecans of the elbow. Ups J Med Sci 2008; 113 (02) 201-208
  • 48 Arai Y, Hara K, Fujiwara H, Minami G, Nakagawa S, Kubo T. A new arthroscopic-assisted drilling method through the radius in a distal-to-proximal direction for osteochondritis dissecans of the elbow. Arthroscopy 2008; 24 (02) 237.e1-237.e4
  • 49 Tsuda E, Ishibashi Y, Sato H, Yamamoto Y, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the capitellum in nonthrowing athletes. Arthroscopy 2005; 21 (10) 1270-1276
  • 50 Chen E, Pandya NK. Failure of surgery for osteochondral injuries of the elbow in the pediatric and adolescent population. Curr Rev Musculoskelet Med 2020; 13 (01) 50-57
  • 51 Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff AB. Osteochondral transplantation to treat osteochondral lesions in the elbow. J Bone Joint Surg Am 2007; 89 (10) 2188-2194
  • 52 Krause M, Hapfelmeier A, Möller M, Amling M, Bohndorf K, Meenen NM. Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. Am J Sports Med 2013; 41 (10) 2384-2391
  • 53 LiMarzi GM, O'Dell MC, Scherer K, Pettis C, Wasyliw CW, Bancroft LW. Magnetic resonance arthrography of the wrist and elbow. Magn Reson Imaging Clin N Am 2015; 23 (03) 441-455
  • 54 Lee RK, Griffith JF, Yuen BTY, Ng AWH, Yeung DK. Elbow MR arthrography with traction. Br J Radiol 2016; 89 (1064): 20160378
  • 55 Elhassan B, Steinmann SP. Entrapment neuropathy of the ulnar nerve. J Am Acad Orthop Surg 2007; 15 (11) 672-681
  • 56 Assmus H, Antoniadis G, Bischoff C. et al. Cubital tunnel syndrome—a review and management guidelines. Cent Eur Neurosurg 2011; 72 (02) 90-98
  • 57 Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 2008; 33 (08) 1314.e1-1314.e12
  • 58 Chadwick N, Morag Y, Smith BW, Yablon C, Kim SM, Yang LJ. Imaging appearance following surgical decompression of the ulnar nerve. Br J Radiol 2019; 92 (1094): 20180757
  • 59 Ma KL, Wang HQ. Management of lateral epicondylitis: a narrative literature review. Pain Res Manag 2020; 6965381
  • 60 Kroslak M, Pirapakaran K, Murrell GAC. Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. J Shoulder Elbow Surg 2019; 28 (02) 288-295
  • 61 Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther 2015; 45 (11) 938-949
  • 62 Sirico F, Ricca F, DI Meglio F. et al. Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials. Eur J Phys Rehabil Med 2017; 53 (03) 483-491
  • 63 Pierce TP, Issa K, Gilbert BT. et al. A systematic review of tennis elbow surgery: open versus arthroscopic versus percutaneous release of the common extensor origin. Arthroscopy 2017; 33 (06) 1260-1268.e2
  • 64 Vauclair F, Goetti P, Nguyen NTV, Sánchez-Sotelo J. Distal humerus nonunion: evaluation and management. EFORT Open Rev 2020; 5 (05) 289-298
  • 65 Ring D, Jupiter JB, Gulotta L. Atrophic nonunions of the proximal ulna. Clin Orthop Relat Res 2003; (409) 268-274
  • 66 Babst C, Brunner A, Babst R. Isolated radial neck delayed union/nonunion after conservative treatment in adults: two case reports and a literature review. Arch Orthop Trauma Surg 2018; 138 (02) 179-188
  • 67 Allende C, Allende BT. Post-traumatic distal humerus non-union: open reduction and internal fixation: long-term results. Int Orthop 2009; 33 (05) 1289-1294
  • 68 Neumann MV, Zwingmann J, Jaeger M, Hammer TO, Südkamp NP. Non-union in upper limb fractures—clinical evaluation and treatment options. Acta Chir Orthop Traumatol Cech 2016; 83 (04) 223-230
  • 69 Rose SH, Melton III LJ, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop Relat Res 1982; (168) 24-30
  • 70 Hong CC, Nashi N, Hey HW, Chee YH, Murphy D. Clinically relevant heterotopic ossification after elbow fracture surgery: a risk factors study. Orthop Traumatol Surg Res 2015; 101 (02) 209-213
  • 71 Foruria AM, Augustin S, Morrey BF, Sánchez-Sotelo J. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 2013; 95 (10) e66
  • 72 Wahl EP, Casey PM, Risoli Jr T, Green CL, Richard MJ, Ruch DS. Heterotopic ossification formation after fractures about the elbow. Eur J Orthop Surg Traumatol 2021; 31 (06) 1061-1067