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The Sonographic Posterolateral Rotatory Stress Test for Elbow Instability : A Cadaveric Validation Study

CAMP CL; O'DRISCOLL SW; WEMPE MK; SMITH J
PM & R , 2017, vol. 9, n° 3, p. 275-282
Doc n°: 182391
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.pmrj.2016.06.014
Descripteurs : DD55 - PATHOLOGIE - COUDE

Although clinical tests can detect posterolateral rotatory
instability (PLRI) of the elbow, the ability of ultrasound to evaluate PLRI has
not been assessed. OBJECTIVE: To determine whether increasing stages of
posterolateral rotatory subluxation of the elbow could be assessed accurately
with a sonographic posterolateral rotatory stress test.
DESIGN: Cadaveric study.
SETTING: Laboratory. PATIENTS: Ten, unpaired, cadaveric upper limbs. METHODS:
Posterolateral ulnohumeral distance was measured by ultrasound at rest and during
manual sonographic posterolateral rotatory stress testing at 4 stages of
increasing instability: (1) intact elbow, (2) extensor carpi radialis brevis
(ECRB) release, (3) ECRB release + lateral collateral ligament complex (LCLC)
release to produce a positive posterolateral drawer test, and (4) ECRB release +
LCLC and capsule release to produce a positive lateral pivot-shift test. Mean
values for sonographic resting ulnohumeral distance, stressed ulnohumeral
distance, and laxity were calculated for each stage and compared between stages.
MAIN OUTCOME MEASURES: Posterolateral ulnohumeral laxity. RESULTS: Mean
ulnohumeral laxities were 1, 3, 6, and 10 mm (P < .001) for stages 1-4,
respectively. Pairwise comparison of mean laxity between the intact elbow (Stage
1) and each pathologic state (Stages 2-4) demonstrated differences of 2 mm (Stage
1 versus 2); 5 mm (Stage 1 versus 3); and 9 mm (Stage 1 versus 4) (P < .001). The
minimal difference in ulnohumeral laxity noted between the intact elbow and an
elbow with a clinically positive posterolateral rotatory drawer test (Stage 3)
was 4 mm. CONCLUSIONS: The sonographic posterolateral rotatory stress test
detected increasing posterolateral ulnohumeral laxity as a function of increasing
clinical PLRI. This test may be used as an adjunct to history, examination, and
static imaging to assess ulnohumeral laxity in patients with lateral elbow pain
syndromes. Within the limits of this investigation, sonographic posterolateral
ulnohumeral laxity of >4 mm should raise suspicion of underlying instability.
LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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