Highlights
- •First study with simulated active overhead motion in elbow dislocation.
- •Overhead extension after elbow dislocation replicates intact elbow kinematics.
- •Muscle activation and forearm rotation have minimal effect in the overhead position.
- •Overhead exercise may allow early motion to reduce elbow stiffness.
Abstract
Study Design
In vitro biomechanical study.
Introduction
Elbow stiffness is a common complication following elbow dislocation. Overhead exercises
have been proposed to initiate early motion to reduce stiffness through employing
gravity to stabilize the elbow. The implications of this position with regard to elbow
kinematics after dislocation have not been reported.
Purpose of the Study
To determine the influence of the overhead position on elbow stability following combined
medial and lateral collateral ligament (MCL and LCL) injuries.
Methods
Passive and simulated active extension were performed on 11 cadaveric elbows with
the arm in the overhead, dependent, and horizontal positions and with the forearm
in pronation, neutral, and supination. Internal-external rotation (IER) and varus-valgus
angulation (VVA) of the ulnohumeral joint were assessed for the intact elbow and after
simulated MCL-LCL injury. Repeated-measures analyses of variance were conducted to
analyze the effects of elbow state, arm position, forearm rotation, and extension
angle.
Results
During passive extension with the arm overhead, the pronated position resulted in
more internal rotation than supination (-2.6 ± 0.7°, P = .03). There was no effect of forearm rotation on VVA. The overhead position increased
internal rotation relative to the dependent position when the forearm was neutral
(-8.5 ± 2.5°, P = .04) and relative to the horizontal position when the forearm was supinated (-12.7
± 2.2°, P= .02). During active extension, pronation increased valgus angle compared to the
neutral (+1.2 ± 0.3°, P= .04) and supinated (+1.5 ± 0.4°, P= .03) positions, but did not affect IER. There was no difference between active and
passive motion with the arm overhead (P > .05).
Discussion
Movement of the injured elbow in the overhead position most closely replicated kinematics
of the intact elbow compared to the other arm positions.
Conclusions
Overhead elbow extension results in similar kinematics between an intact elbow and
an elbow with MCL and LCL tears. As such, therapists might consider early motion in
this position to reduce the risk of elbow stiffness after dislocation.
Keywords
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JHT Read for Credit
Quiz: # 853
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.With active extension
- a.there was no effect on valgus stress
- b.supination increased valgus stress
- c.pronation reduced valgus stress
- d.pronation increased valgus stress
- a.
- # 2.PROM is generally withheld until _______ post-op
- a.4 weeks
- b.10 weeks
- c.6 weeks
- d.8 weeks
- a.
- # 3.The target population would be patients who sustain
- a.combined medial and lateral collateral ligament injuries
- b.posterior lateral instability
- c.Fx-dislocation of the distal humerus
- d.LUCL injury
- a.
- # 4.Elbow instability was determined at different angles of extension by
- a.neither VVA nor IER
- b.both c and d below
- c.VVA
- d.IER
- a.
- # 5.The advantage to performing extension overhead is that it more closely replicates the kinematics of the intact elbow
- a.not true
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: February 25, 2022
Accepted:
January 24,
2022
Received in revised form:
November 29,
2021
Received:
March 9,
2020
Footnotes
Conflict of interest: Dr King has a patent from Wright Medical resulting in the receipt of royalty fees, unrelated to the content of this manuscript. The remaining authors hereby declare that they have no conflicts of interest to disclose.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
