Abstract
Background
A mechanical block in the elbow due to osteophytes in the olecranon fossa is a common clinical symptom for elbow stiffness.
Purpose/hypothesis
This study aims to understand the biomechanical characteristics or changes in the stiff elbow in the resting (or neutral) and swing position of the arm using a cadaveric model. The hypotheses included the following: (1) a difference exists in the articular contact pressure of the elbow by comparing the non-stiff and stiff models in in vivo studies; (2) the degree of stiffness would affect the increase of the joint loading of the elbow.
Study design
Controlled laboratory study, cadaveric study.
Methods
Eight fresh-frozen specimens from individuals of both sexes were included in the biomechanical study. The specimen was mounted on a custom-designed jig system with gravity-assisted muscle contracture to mimic the elbow in a standing position. The elbow was tested in two conditions (the resting and passive swing). Contact pressure was recorded for three seconds in the resting position, which was the neutral position of the humerus. By dropping the forearm from 90° of the elbow flexion, the passive swing was performed. The specimens were tested sequentially in three stages of stiffness (stage 0, no stiffness; stage 1, 30° of extension limitation; and stage 2, 60° of extension limitation). After data collection was completed in stage 0, a stiff model was sequentially created for each stage. The stiff model of the elbow was created by blocking the olecranon by inserting a 2.0 K-wire into the olecranon fossa horizontally with the intercondylar axis.
Results
The mean contact pressures were 279 ± 23, 302 ± 6, and 349 ± 23 kPa in stages 0, 1, and 2, respectively. The increases in the mean contact pressure in stages 2 versus 0 were significant (P < 0.0001). The mean contact pressures were 297 ± 19, 310 ± 14, and 326 ± 13 kPa in stages 0, 1, and 2, respectively. The peak contact pressures were 420 ± 54, 448 ± 84, and 500 ± 67 kPa in stages 0, 1, and 2, respectively. The increases in mean contact pressure in stage 2 versus 0 were significant (P = 0.039). The increases in peak contact pressure in stages 0 versus 2 were significant (P = 0.007).
Conclusions
The elbow bears the load created by gravity and muscle contracture in the resting and swing motion. Moreover, extension limitation of stiff elbow increases the load bearing in the resting position and swing motion. Careful surgical management should be considered for meticulous clearance of bony spur around olecranon fossa to resolve the extension limitation of the elbow.
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Data availability
Available.
Code availability
Not applicable.
References
Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63:872–877
Chadwick EK, Nicol AC (2000) Elbow and wrist joint contact forces during occupational pick and place activities. J Biomech 33:591–600. https://doi.org/10.1016/s0021-9290(99)00184-0
Masci G, Cazzato G, Milano G, Ciolli G, Malerba G, Perisano C, Greco T, Osvaldo P, Maccauro G, Liuzza F (2020) The stiff elbow: current concepts. Orthop Rev (Pavia) 12:8661. https://doi.org/10.4081/or.2020.8661
Kim MS (2020) Is total elbow arthroplasty a reliable alternative treatment option for comminuted distal humerus fractures in elderly patients? Clin Shoulder Elb 23:59–61. https://doi.org/10.5397/cise.2020.00157
Kwak JM, Kholinne E, Sun Y, Lee GB, Koh KH, Chun JM, Jeon IH (2018) Hemiarthroplasty for distal humerus fracture: a systematic review and meta-analysis for functional outcome. Clin Shoulder Elb 21:120–126. https://doi.org/10.5397/cise.2018.21.3.120
Morrow MM, Hurd WJ, Kaufman KR, An KN (2009) Upper-limb joint kinetics expression during wheelchair propulsion. J Rehabil Res Dev 46:939–944. https://doi.org/10.1682/jrrd.2008.12.0165
Meyns P, Bruijn SM, Duysens J (2013) The how and why of arm swing during human walking. Gait Posture 38:555–562. https://doi.org/10.1016/j.gaitpost.2013.02.006
Søjbjerg JO (1996) The stiff elbow. Acta Orthop Scand 67:626–631. https://doi.org/10.3109/17453679608997771
Boone DC, Azen SP (1979) Normal range of motion of joints in male subjects. J Bone Joint Surg Am 61:756–759
Jupiter JB, O’Driscoll SW, Cohen MS (2003) The assessment and management of the stiff elbow. Instr Course Lect 52:93–111
Keener JD, Galatz LM (2011) Arthroscopic management of the stiff elbow. J Am Acad Orthop Surg 19:265–274. https://doi.org/10.5435/00124635-201105000-00004
Kwak JM, Kim H, Sun Y, Kholinne E, Koh KH, Jeon IH (2020) Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography-based classification. J Shoulder Elbow Surg 29:989–995. https://doi.org/10.1016/j.jse.2019.09.036
Kwak JM, Sun Y, Kholinne E, Koh KH, Jeon IH (2019) Surgical outcomes for post-traumatic stiffness after elbow fracture: comparison between open and arthroscopic procedures for intra- and extra-articular elbow fractures. J Shoulder Elbow Surg 28:1998–2006. https://doi.org/10.1016/j.jse.2019.06.008
Ramazanian T, Muller-Lebschi JA, Chuang MY, Vaichinger AM, Fitzsimmons JS, O’Driscoll SW (2018) Effect of radiocapitellar Achilles disc arthroplasty on coronoid and capitellar contact pressures after radial head excision. J Shoulder Elbow Surg 27:1785–1791. https://doi.org/10.1016/j.jse.2018.05.022
Bellato E, Fitzsimmons JS, Kim Y, Bachman DR, Berglund LJ, Hooke AW, O’Driscoll SW (2018) Articular contact area and pressure in posteromedial rotatory instability of the elbow. J Bone Joint Surg Am 100:e34. https://doi.org/10.2106/jbjs.16.01321
Bellato E, Kim Y, Fitzsimmons JS, Berglund LJ, Hooke AW, Bachman DR, O’Driscoll SW (2017) Coronoid reconstruction using osteochondral grafts: a biomechanical study. J Shoulder Elbow Surg 26:1794–1802. https://doi.org/10.1016/j.jse.2017.05.010
Bellato E, Kim Y, Fitzsimmons JS, Hooke AW, Berglund LJ, Bachman DR, O’Driscoll SW (2017) Role of the lateral collateral ligament in posteromedial rotatory instability of the elbow. J Shoulder Elbow Surg 26:1636–1643. https://doi.org/10.1016/j.jse.2017.04.011
O’Driscoll SW (2000) Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 370:34–43. https://doi.org/10.1097/00003086-200001000-00005
Drewniak EI, Crisco JJ, Spenciner DB, Fleming BC (2007) Accuracy of circular contact area measurements with thin-film pressure sensors. J Biomech 40:2569–2572. https://doi.org/10.1016/j.jbiomech.2006.12.002
Brimacombe JM, Wilson DR, Hodgson AJ, Ho KC, Anglin C (2009) Effect of calibration method on Tekscan sensor accuracy. J Biomechan Engineering 131:034503. https://doi.org/10.1115/1.3005165
Niosi CA, Wilson DC, Zhu Q, Keynan O, Wilson DR, Oxland TR (2008) The effect of dynamic posterior stabilization on facet joint contact forces: an in vitro investigation. Spine 33:19–26. https://doi.org/10.1097/BRS.0b013e31815e7f76
Bachman DR, Thaveepunsan S, Park S, Fitzsimmons JS, An KN, O’Driscoll SW (2015) The effect of prosthetic radial head geometry on the distribution and magnitude of radiocapitellar joint contact pressures. The Journal Hand Surg 40:281–288. https://doi.org/10.1016/j.jhsa.2014.11.005
Hogue RE (1969) Upper-extremity muscular activity at different cadences and inclines during normal gait. Phys Ther 49:963–972
Lewek MD, Poole R, Johnson J, Halawa O, Huang X (2010) Arm swing magnitude and asymmetry during gait in the early stages of Parkinson’s disease. Gait Posture 31:256–260. https://doi.org/10.1016/j.gaitpost.2009.10.013
Park J (2008) Synthesis of natural arm swing motion in human bipedal walking. J Biomech 41:1417–1426. https://doi.org/10.1016/j.jbiomech.2008.02.031
Kwak JM, Kholinne E, Sun Y, Lim S, Koh KH, Jeon IH (2019) Clinical outcome of osteocapsular arthroplasty for primary osteoarthritis of the elbow: comparison of arthroscopic and open procedure. Arthroscopy 35:1083–1089. https://doi.org/10.1016/j.arthro.2018.11.057
Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2021R1G1A1095581).
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Conceptualization: G Jung and J Kwak. Data curation: E Kholinne and J Kwak. Formal analysis: J Kwak. Funding acquisition: I Jeon and J Kwak. Investigation: I Jeon. Methodology: G Jung, E Kholinne, and J Kwak. Project administration: I Jeon. Resources: I Jeon. Software: E Kholinne. Supervision: I Jeon and G Lee. Validation: G Jung and E Kholinne. Visualization: J Kwak. Writing — original draft: J Kwak. Writing — review and editing: G Jung, E Kholinne, I Jeon, G Lee.
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This paper includes contents of the doctoral dissertation by the same author(s) below: https://oak.ulsan.ac.kr/bitstream/2021.oak/5806/2/200000507968.pdf.
Primary location where this investigation was performed at Asan Medical Center, Seoul, Korea.
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Kwak, JM., Lee, K.W., Jung, GH. et al. Biomechanical impact of elbow motion in elbow stiffness. International Orthopaedics (SICOT) 47, 1779–1786 (2023). https://doi.org/10.1007/s00264-023-05781-2
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DOI: https://doi.org/10.1007/s00264-023-05781-2