Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing
Background: Posterolateral rotator instability (PLRI) is the most common pattern of recurrent elbow instability, and current imaging to aid PLRI diagnosis is limited. Thus, we sought to define use of ultrasound (US) to determine normal lateral ulnohumeral joint measurements, with and without postero...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266663832100195X |
| _version_ | 1828001778900140032 |
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| author | Anesh Chavda, MBBS, MRCP Nicola Robertson, MBChB, MRCS Charis McNabney, MB, BCh, BAO Dyan Flores, MD, FRCR Kevin Murphy, MD, MB, BAO, BCh Yaron J. Berkowitz, MB, BChir, MRCS David Roberts, MBChB, MRCS Kenneth R. Holmes, MD, MSc Mark Cresswell, MB, BCh Thomas J. Goetz, MD Mathilde Hupin-Debeurme, MD Stephanie L. Sellers, MSc, PhD Darra T. Murphy, MB, BCh, BAO, FRCPC |
| author_facet | Anesh Chavda, MBBS, MRCP Nicola Robertson, MBChB, MRCS Charis McNabney, MB, BCh, BAO Dyan Flores, MD, FRCR Kevin Murphy, MD, MB, BAO, BCh Yaron J. Berkowitz, MB, BChir, MRCS David Roberts, MBChB, MRCS Kenneth R. Holmes, MD, MSc Mark Cresswell, MB, BCh Thomas J. Goetz, MD Mathilde Hupin-Debeurme, MD Stephanie L. Sellers, MSc, PhD Darra T. Murphy, MB, BCh, BAO, FRCPC |
| author_sort | Anesh Chavda, MBBS, MRCP |
| collection | DOAJ |
| description | Background: Posterolateral rotator instability (PLRI) is the most common pattern of recurrent elbow instability, and current imaging to aid PLRI diagnosis is limited. Thus, we sought to define use of ultrasound (US) to determine normal lateral ulnohumeral joint measurements, with and without posterolateral drawer testing to provide an insight into how US may aid diagnosis. Methods: Sixty elbows were evaluated in thirty healthy volunteers. The lateral ulnohumeral gap (LUHG) was measured with US in the resting position while the posterolateral drawer stress test maneuver was applied. Joint laxity was calculated as the difference between maximum stress and average rest measurements. Two independent readers assessed each elbow with comparison performed between stress and rest positions. Results: Differences in the LUHG were evident between stress and rest conditions (reader 1: P < .0001 and reader 2: P = .0002). At rest, median LUHG values were 2.31 mm and 2.05 mm for readers 1 and 2 respectively, while at stress 2.88 mm and 2.9 mm for readers 1 and 2. Median joint laxity was 0.8 mm for reader 1 and 1.1 mm for reader 2. Pearson correlation was r = 0.457 (absolute intraclass correlation coefficient [ICC] = 0.608) while under stress and r = 0.308 (absolute intraclass correlation coefficient [ICC] = 0.417) at rest. Median joint laxity demonstrated a Pearson correlation of r = 0.161 and absolute intraclass correlation coefficient [ICC] = 0.252. Conclusions: This study demonstrates a dynamic US assessment for PLRI, which aimed to assess the usefulness and feasibility of a laxity measurement after the application of a posterolateral drawer stress maneuver in a healthy population. Although establishing concordance between readers in measuring an LUHG under stress, the utility of a laxity measurement alone is not clear as correlation of measurements is not excellent; hence, an upper limit of normal for the ulnohumeral gap under stress may be more useful. Further evaluation of this technique is required in patients with PLRI. |
| first_indexed | 2024-04-10T06:34:09Z |
| format | Article |
| id | doaj.art-855099ae81ea4a40ae305dc501df90ac |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-04-10T06:34:09Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-855099ae81ea4a40ae305dc501df90ac2023-03-01T04:33:08ZengElsevierJSES International2666-63832023-03-0172342347Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testingAnesh Chavda, MBBS, MRCP0Nicola Robertson, MBChB, MRCS1Charis McNabney, MB, BCh, BAO2Dyan Flores, MD, FRCR3Kevin Murphy, MD, MB, BAO, BCh4Yaron J. Berkowitz, MB, BChir, MRCS5David Roberts, MBChB, MRCS6Kenneth R. Holmes, MD, MSc7Mark Cresswell, MB, BCh8Thomas J. Goetz, MD9Mathilde Hupin-Debeurme, MD10Stephanie L. Sellers, MSc, PhD11Darra T. Murphy, MB, BCh, BAO, FRCPC12Department of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Orthopaedics, University of British Columbia, Vancouver, CanadaDepartment of Orthopaedics, University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul’s Hospital and University of British Columbia, Vancouver, CanadaDepartment of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, Canada; Corresponding author: Darra T. Murphy, MB, BCh, BAO, St. Paul’s Hospital, Department of Radiology, 1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6.Background: Posterolateral rotator instability (PLRI) is the most common pattern of recurrent elbow instability, and current imaging to aid PLRI diagnosis is limited. Thus, we sought to define use of ultrasound (US) to determine normal lateral ulnohumeral joint measurements, with and without posterolateral drawer testing to provide an insight into how US may aid diagnosis. Methods: Sixty elbows were evaluated in thirty healthy volunteers. The lateral ulnohumeral gap (LUHG) was measured with US in the resting position while the posterolateral drawer stress test maneuver was applied. Joint laxity was calculated as the difference between maximum stress and average rest measurements. Two independent readers assessed each elbow with comparison performed between stress and rest positions. Results: Differences in the LUHG were evident between stress and rest conditions (reader 1: P < .0001 and reader 2: P = .0002). At rest, median LUHG values were 2.31 mm and 2.05 mm for readers 1 and 2 respectively, while at stress 2.88 mm and 2.9 mm for readers 1 and 2. Median joint laxity was 0.8 mm for reader 1 and 1.1 mm for reader 2. Pearson correlation was r = 0.457 (absolute intraclass correlation coefficient [ICC] = 0.608) while under stress and r = 0.308 (absolute intraclass correlation coefficient [ICC] = 0.417) at rest. Median joint laxity demonstrated a Pearson correlation of r = 0.161 and absolute intraclass correlation coefficient [ICC] = 0.252. Conclusions: This study demonstrates a dynamic US assessment for PLRI, which aimed to assess the usefulness and feasibility of a laxity measurement after the application of a posterolateral drawer stress maneuver in a healthy population. Although establishing concordance between readers in measuring an LUHG under stress, the utility of a laxity measurement alone is not clear as correlation of measurements is not excellent; hence, an upper limit of normal for the ulnohumeral gap under stress may be more useful. Further evaluation of this technique is required in patients with PLRI.http://www.sciencedirect.com/science/article/pii/S266663832100195XPosterolateral rotator instabilityPRLIUlnohumeral gapUltrasoundPosterolateral drawer testingDiagnosis |
| spellingShingle | Anesh Chavda, MBBS, MRCP Nicola Robertson, MBChB, MRCS Charis McNabney, MB, BCh, BAO Dyan Flores, MD, FRCR Kevin Murphy, MD, MB, BAO, BCh Yaron J. Berkowitz, MB, BChir, MRCS David Roberts, MBChB, MRCS Kenneth R. Holmes, MD, MSc Mark Cresswell, MB, BCh Thomas J. Goetz, MD Mathilde Hupin-Debeurme, MD Stephanie L. Sellers, MSc, PhD Darra T. Murphy, MB, BCh, BAO, FRCPC Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing JSES International Posterolateral rotator instability PRLI Ulnohumeral gap Ultrasound Posterolateral drawer testing Diagnosis |
| title | Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing |
| title_full | Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing |
| title_fullStr | Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing |
| title_full_unstemmed | Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing |
| title_short | Ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing |
| title_sort | ultrasound assessment of the posterolateral elbow ulnohumeral gap in normal subjects with and without posterolateral drawer testing |
| topic | Posterolateral rotator instability PRLI Ulnohumeral gap Ultrasound Posterolateral drawer testing Diagnosis |
| url | http://www.sciencedirect.com/science/article/pii/S266663832100195X |
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