Dohi Daisuke
Dohi Orthopaedic Hospital, Higashi Hiroshima, Japan.
J Pediatr Orthop. 2013 Dec;33(8):829-31. doi: 10.1097/BPO.0000000000000087.
Pulled elbow is a disorder commonly observed in children in routine medical practice; however, when the circumstances involved in the injury are unknown, difficulty has been encountered in differential diagnosis whether it is a bone fracture or pulled elbow. One of the reasons involved has been the unavailability of diagnostic imaging in confirming the diagnosis of the pulled elbow. Therefore, the author had performed ultrasonography for the pulled elbow and studied the specific ultrasonographic findings of the same.
Using as subjects a total of 70 cases of pulled elbow, with their age ranging from 4 months to 6 years, ultrasonography was performed from September 2010 to February 2013 with the use of Hitachi EUB 7500 ultrasonographic apparatus with a 12 MHz transducer. Careful observation was made of the specific ultrasonographic images of anterior long-axis view of the radiohumeral joint before and after the manipulation.
Before the manipulation in all the cases, both the supinator muscle originating from the annular ligament and the annular ligament itself were entrapped within the radiohumeral joint, and a hypoechoic image of J-shape (J-sign) was observed. After the manipulation, the hypoechoic image of the J-shape disappeared and normal annular ligament image was observed.
Accurate diagnosis of the pulled elbow can be done by ultrasonography through the confirmation of this specific J-sign.
Level IV-diagnostic studies.
牵拉肘是日常医疗实践中儿童常见的病症；然而，当损伤情况不明时，在鉴别诊断是骨折还是牵拉肘方面存在困难。其中一个原因是缺乏用于确诊牵拉肘的诊断性影像学检查。因此，作者对牵拉肘进行了超声检查，并研究了其特定的超声表现。
选取2010年9月至2013年2月间共70例年龄在4个月至6岁的牵拉肘患儿作为研究对象，使用配备12MHz探头的日立EUB 7500超声诊断仪进行超声检查。仔细观察手法复位前后肱桡关节前纵切面的特定超声图像。
所有病例在手法复位前，起自环状韧带的旋后肌及环状韧带本身均嵌顿于肱桡关节内，可见J形低回声影像（J征）。手法复位后，J形低回声影像消失，可见正常的环状韧带影像。
通过确认这种特定的J征，超声检查可准确诊断牵拉肘。
四级诊断性研究。
