Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Berlin, Germany.
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Berlin, Germany.
J Shoulder Elbow Surg. 2021 May;30(5):1142-1151. doi: 10.1016/j.jse.2020.11.023. Epub 2021 Jan 19.
The diagnosis of residual or chronic elbow instability is often challenging. Sonography allows a dynamic examination of the elbow joint without any radiation exposure. The purpose of this prospective single-center study was to investigate the application of sonography for the evaluation of ligamentous instabilities of the elbow joint. Therefore, asymptomatic (stable) and acute dislocated (unstable) elbows were examined by sonography.
A total of 72 elbows in 36 participants (23 women and 13 men; mean age, 40 ± 17 years [range, 18-82 years]) were examined. Group 1 (G1 [normal]) included 40 unaffected, asymptomatic elbow joints; 28 elbows belonged to 14 voluntary participants (bilateral), whereas 12 asymptomatic elbows belonged to patients who had an acute elbow dislocation (contralateral elbow). Group 2 (G2 [hypermobile]) included 20 hypermobile elbow joints in 10 participants (bilateral), and group 3 (G3 [unstable]) included 12 acute unstable elbow joints without bony lesions. Radiographic assessment included sonography of both elbow joints with standardized measurements of the neutral and stressed radiocapitellar and ulnohumeral distances (calculated as Δ values). Two investigators independently performed all measurements. Additionally, plain radiographs and magnetic resonance imaging of the affected elbow joints were obtained in G3.
On the radial side, the mean radiocapitellar Δ was statistically higher in G3 (2.2 ± 1.6 mm) than in G1 (0.5 ± 0.4 mm, P < .01) or G2 (0.8 ± 0.6 mm, P < .01). G3 also showed an increased ulnohumeral Δ (2.7 ± 0.7 mm) compared with G1 (1.0 ± 0.7 mm, P < .01) or G2 (0.9 ± 0.3 mm, P < .01). No significant differences in the mean radiocapitellar Δ (P = .06) and ulnohumeral Δ (P = .26) were found between G1 and G2. Within G3, Δ was significantly higher at the affected elbow joint than at the contralateral, unaffected elbow joint (P = .04 for the radial side and P = .04 for the ulnar side). The inter-rater correlation coefficient was 0.82 for the radial side and 0.74 for the ulnar side. Patients with collateral ligament injuries, diagnosed on magnetic resonance imaging, showed higher Δ values than those with intact collateral ligaments, although no significant difference was found.
Sonography of the elbow joint is a valuable imaging tool for the assessment of ligamentous instability. Nevertheless, a distinction between healthy and hypermobile elbow joints is not possible, and therefore, obtaining a complete clinical history and examination is vital. We further recommend comparing the affected elbow joint with the contralateral side to access intraindividual differences.
肘部残余或慢性不稳定的诊断常常具有挑战性。超声检查可在不产生辐射暴露的情况下对肘关节进行动态检查。本前瞻性单中心研究的目的是探讨超声在评估肘关节韧带不稳定方面的应用。因此，对无症状（稳定）和急性脱位（不稳定）的肘部进行了超声检查。
共检查了 36 名参与者的 72 个肘部（23 名女性，13 名男性；平均年龄 40±17 岁[18-82 岁]）。第 1 组（G1[正常]）包括 40 个未受影响的无症状肘部关节；28 个肘部属于 14 名自愿参与者（双侧），而 12 个无症状肘部属于急性肘部脱位（对侧肘部）的患者。第 2 组（G2[过度活动]）包括 10 名参与者的 20 个过度活动肘部关节（双侧），第 3 组（G3[不稳定]）包括 12 个无骨损伤的急性不稳定肘部关节。放射学评估包括双侧肘部的超声检查，并对中立位和加压桡尺侧及尺肱侧距离（计算为 Δ 值）进行标准化测量。两名研究者独立进行所有测量。此外，在 G3 中还获得了受累肘部关节的常规 X 线和磁共振成像。
在桡侧，G3 的平均桡尺侧 Δ 值明显高于 G1（2.2±1.6mm，P<.01）或 G2（0.8±0.6mm，P<.01）。G3 的尺肱侧 Δ 值也增加（2.7±0.7mm），与 G1（1.0±0.7mm，P<.01）或 G2（0.9±0.3mm，P<.01）相比。G1 和 G2 之间的桡尺侧平均 Δ 值（P=0.06）和尺肱侧 Δ 值（P=0.26）无显著差异。在 G3 中，受累肘部关节的 Δ 值明显高于对侧未受累肘部关节（桡侧 P=0.04，尺侧 P=0.04）。G3 中桡侧和尺侧的观察者间信度系数分别为 0.82 和 0.74。在磁共振成像上诊断为侧副韧带损伤的患者的 Δ 值高于侧副韧带完整的患者，但无显著差异。
肘部关节超声检查是评估韧带不稳定的一种有价值的影像学方法。然而，无法区分健康和过度活动的肘部关节，因此，获取完整的临床病史和检查至关重要。我们进一步建议将受累肘部关节与对侧肘部关节进行比较，以了解个体内的差异。
