Clinics in Shoulder and Elbow最新文献

{"title":"Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?","authors":"Troy Li,&nbsp;Kenneth H Levy,&nbsp;Akiro H Duey,&nbsp;Akshar V Patel,&nbsp;Christopher A White,&nbsp;Carl M Cirino,&nbsp;Alexis Williams,&nbsp;Kathryn Whitelaw,&nbsp;Dave Shukla,&nbsp;Bradford O Parsons,&nbsp;Evan L Flatow,&nbsp;Paul J Cagle","doi":"10.5397/cise.2023.00199","DOIUrl":"https://doi.org/10.5397/cise.2023.00199","url":null,"abstract":"<p><strong>Background: </strong>For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair.</p><p><strong>Methods: </strong>This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures.</p><p><strong>Results: </strong>One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75).</p><p><strong>Conclusions: </strong>In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/14/cise-2023-00199.PMC10497929.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid- to long-term success rate and functional outcomes of acromioclavicular injections in patients with acromioclavicular osteoarthritis.","authors":"Nienke Miedema,&nbsp;Inger Sierevelt,&nbsp;Tjarco Dirk Willem Alta,&nbsp;Roderick Jan Maximiliaan Vossen,&nbsp;Arthur van Noort","doi":"10.5397/cise.2023.00031","DOIUrl":"https://doi.org/10.5397/cise.2023.00031","url":null,"abstract":"<p><strong>Background: </strong>Acromioclavicular (AC) osteoarthritis (OA) is a frequent pathology of the shoulder in elderly patients. Drug injection plays an important role in treatment of AC OA. Literature has demonstrated excellent short-term results regarding shoulder function and pain. However, mid- to long-term results are lacking. The aim of this study was to assess the efficacy of a single intra-articular AC injection in patients with AC OA and to identify predictive factors for success.</p><p><strong>Methods: </strong>A retrospective study was performed to analyze success rate, shoulder function, and pain perception after a single intra-articular injection in patients with AC OA. Success was defined as the absence of reinterventions such as additional injection or surgery. Outcome measures were 1-year success rate and clinical outcome scores of Numeric Rating Scale (NRS) for pain, Oxford Shoulder Score, and Subjective Shoulder Value.</p><p><strong>Results: </strong>Ninety-eight patients participated in this study. At a median final follow-up of 0.8 years (interquartile range, 0-6), 57 of these patients (58%) had undergone a reintervention. The 1-year success rate was 47% (95% confidence interval, 37%-57%), with NRS at rest as the sole factor significantly associated with success. Thirty patients not requiring reintervention reported significant improvement from baseline for all reported outcome measures at final follow-up.</p><p><strong>Conclusions: </strong>AC injections offer a 1-year success rate of 47%. The AC injection produces good mid- to long-term clinical outcomes regarding shoulder function, quality of life, and pain perception in one-third of patients. Further research is essential to analyze mid- to longterm outcomes of AC injections. Level of evidence: Level IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9b/38/cise-2023-00031.PMC10277705.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9659854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated acromioclavicular osteoarthritis and steroid injection.","authors":"Jin Woong Yi","doi":"10.5397/cise.2023.00311","DOIUrl":"https://doi.org/10.5397/cise.2023.00311","url":null,"abstract":"vial joint that aids in raising the arm over the head and rotates minimally in all directions [1]. The AC joint is conspicuously smaller than the glenohumeral joint and is referred to as the forgotten joint [2]. Primary osteoarthritic change of the AC joint is a common degenerative change typically seen in middle-aged or elderly patients [3]. But secondary osteoarthritis, mainly following traumas such as joint sprains or distal clavicular fractures, appears to be even more common than primary osteoarthritis [4]. A study found that 54%–57% of elderly patients had X-ray evidence of degenerative changes in the AC joint [5]. Magnetic resonance imaging (MRI) is the most powerful diagnostic tool for detecting osteoarthritic change in the AC joint [6]. There are many parameters for describing AC joint osteoarthritis (ACJOA) in an image. Joo et al. [7] said that the cross-sectional area of the AC joint seems to be a sensitive image parameter for ACJOA. However, some authors believe that image results have a poor correlation with clinical symptoms. Rajagopalan et al. [8] claimed that MRI characteristics in ACJOA are so prevalent that they can be considered a universal aspect of human aging, but imaging cannot be used as a reference standard to assess the reliability and accuracy of various symptoms and signs for diagnosis of symptomatic ACJOA. Symptomatic ACJOA is a relatively easy diagnosis clinically, presenting as pain localized at the lateral end of the clavicle that is exacerbated with cross-body adduction or with active contraction of the pectoralis major. In cases where differential diagnosis is difficult, local anesthetic injection into the AC joint or subacromial bursa can be helpful. Conservative therapy is the first option for shoulder pain caused by ACJOA, while surgical therapy, whether open or arthroscopic, is reserved only for patients who do not improve with conservative therapy [9]. Nonsteroidal anti-inflammatory medication and injections are commonly used modalities for conservative treatment of ACJOA or other joint diseases. The agent used for (intra-articular) injection include steroids, hyaluronic acid, and mesenchymal stem cells [10,11]. Steroid injection shows good short-term results but relatively poor midand longterm outcomes. Thus, it remains unclear which site should be targeted for the steroid injection to achieve good clinical outcomes in ACJOA. For frozen shoulder, there are reports suggesting no significant difference in clinical outcomes between subacromial space and intra-articular injections [12,13]. This is explained by the location of the pathology causing symptoms. A meta-analysis about wrist joints has suggested that the variability in clinical outcomes after steroid injections might be due to inclusion of cases where the steroid was unintentionally injected in extra-articular space [14]. Katt et al. [15] reported that intra-articular injections into the carpometacarpal joint guided by fluoroscopy demonstrated superio","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/54/cise-2023-00311.PMC10277703.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9666259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An objective assessment of the impact of tendon retraction on sleep efficiency in patients with full-thickness rotator cuff tears: a prospective cohort study.","authors":"Ashley E MacConnell,&nbsp;William Davis,&nbsp;Rebecca Burr,&nbsp;Andrew Schneider,&nbsp;Lara R Dugas,&nbsp;Cara Joyce,&nbsp;Dane H Salazar,&nbsp;Nickolas G Garbis","doi":"10.5397/cise.2022.01438","DOIUrl":"https://doi.org/10.5397/cise.2022.01438","url":null,"abstract":"<p><strong>Background: </strong>Sleep quality, quantity, and efficiency have all been demonstrated to be adversely affected by rotator cuff pathology. Previous measures of assessing the impact of rotator cuff pathology on sleep have been largely subjective in nature. This study was undertaken to objectively analyze this relationship through the use of activity monitors.</p><p><strong>Methods: </strong>Patients with full-thickness rotator cuff tears at a single institution were prospectively enrolled between 2018 and 2020. Waistworn accelerometers were provided for the patients to use each night for 14 days. Sleep efficiency was calculated using the ratio of the time spent sleeping to the total amount of time that was spent in bed. Retraction of the rotator cuff tear was classified using the Patte staging system.</p><p><strong>Results: </strong>This study included 36 patients: 18 with Patte stage 1 disease, 14 with Patte stage 2 disease, and 4 patients with Patte stage 3 disease. During the study, 25 participants wore the monitor on multiple nights, and ultimately their data was used for the analysis. No difference in the median sleep efficiency was appreciated amongst these groups (P&gt;0.1), with each cohort of patients demonstrating a generally high sleep efficiency.</p><p><strong>Conclusions: </strong>The severity of retraction of the rotator cuff tear did not appear to correlate with changes in sleep efficiency for patients (P&gt;0.1). These findings can better inform providers on how to counsel their patients who present with complaints of poor sleep in the setting of full-thickness rotator cuff tears. Level of evidence: Level II.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/5c/cise-2022-01438.PMC10277714.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9659858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Golf participation after rotator cuff repair: functional outcomes, rate of return and factors associated with return to play.","authors":"Thomas R Williamson,&nbsp;Patrick G Robinson,&nbsp;Iain R Murray,&nbsp;Andrew D Murray,&nbsp;Julie M McBirnie,&nbsp;C Michael Robinson,&nbsp;Deborah J MacDonald,&nbsp;Nicholas D Clement","doi":"10.5397/cise.2022.01361","DOIUrl":"https://doi.org/10.5397/cise.2022.01361","url":null,"abstract":"<p><strong>Background: </strong>Golf is a popular sport involving overhead activity and engagement of the rotator cuff (RC). This study aimed to determine to what level golfers were able to return to golf following RC repair, the barriers to them returning to golf and factors associated with their failure to return to golf.</p><p><strong>Methods: </strong>Patients preoperatively identifying as golfers undergoing RC repair at the study centre from 2012 to 2020 were retrospectively followed up with to assess their golf-playing status, performance and frequency of play and functional and quality of life (QoL) outcomes.</p><p><strong>Results: </strong>Forty-seven golfers (40 men [85.1%] and 7 women [14.9%]) with a mean age of 56.8 years met the inclusion criteria, and 80.1% were followed up with at a mean of 27.1 months postoperatively. Twenty-nine patients (76.3%) had returned to golf with a mean handicap change of +1.0 (P=0.291). Golf frequency decreased from a mean of 1.8 rounds per week preinjury to 1.5 rounds per week postoperatively (P=0.052). The EuroQol 5-dimension 5-level (EQ-5D-5L) index and visual analog scale (EQ-VAS) score were significantly greater in those returning to golf (P=0.024 and P=0.002), although functional outcome measures were not significantly different. The primary barriers to return were ipsilateral shoulder dysfunction (78%) and loss of the habit of play (22%).</p><p><strong>Conclusions: </strong>Golfers were likely (76%) to return to golf following RC repair, including mostly to their premorbid performance level with little residual symptomatology. Return to golf was associated with a greater QoL. Persistent subjective shoulder dysfunction (78%) was the most common barrier to returning to golf. Level of evidence: Level IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/c1/cise-2022-01361.PMC10277701.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9720495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myositis unrelated to the inoculation site after COVID-19 vaccination: a case report.","authors":"Jung Won Han,&nbsp;Jae Min Oh,&nbsp;Dae Hee Lee,&nbsp;Young Dae Jeon","doi":"10.5397/cise.2022.00983","DOIUrl":"https://doi.org/10.5397/cise.2022.00983","url":null,"abstract":"<p><p>We describe the case of a 49-year-old right hand-dominant woman with myositis of the biceps brachii muscle unrelated to the inoculation site following Pfizer-BioNTech COVID-19 vaccination on the deltoid muscle of the left shoulder. Coronavirus disease 2019 (COVID-19) pandemic has involved global spread, and different vaccines including inactivated, protein, vectored, and nucleic acid vaccines have been developed and administered. Common side effects of COVID-19 vaccines include general manifestations such as headache, fever, and fatigue, and various musculoskeletal symptoms. Here, we present a case of myositis occurring in the biceps brachii muscle unrelated to the inoculation site, which has not been reported previously, accompanied by a literature review.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/a3/cise-2022-00983.PMC10277710.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9720493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The elbow is the load-bearing joint during arm swing.","authors":"Bokku Kang,&nbsp;Gu-Hee Jung,&nbsp;Erica Kholinne,&nbsp;In-Ho Jeon,&nbsp;Jae-Man Kwak","doi":"10.5397/cise.2023.00101","DOIUrl":"https://doi.org/10.5397/cise.2023.00101","url":null,"abstract":"<p><strong>Background: </strong>Arm swing plays a role in gait by accommodating forward movement through trunk balance. This study evaluates the biomechanical characteristics of arm swing during gait.</p><p><strong>Methods: </strong>The study performed computational musculoskeletal modeling based on motion tracking in 15 participants without musculoskeletal or gait disorder. A three-dimensional (3D) motion tracking system using three Azure Kinect (Microsoft) modules was used to obtain information in the 3D location of shoulder and elbow joints. Computational modeling using AnyBody Modeling System was performed to calculate the joint moment and range of motion (ROM) during arm swing.</p><p><strong>Results: </strong>The mean ROM of the dominant elbow was 29.7°±10.2° and 14.2°±3.2° in flexion-extension and pronation-supination, respectively. The mean joint moment of the dominant elbow was 56.4±12.7 Nm, 25.6±5.2 Nm, and 19.8±4.6 Nm in flexion-extension, rotation, and abduction-adduction, respectively.</p><p><strong>Conclusions: </strong>The elbow bears the load created by gravity and muscle contracture in dynamic arm swing movement.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/b3/cise-2023-00101.PMC10277704.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9666263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addenda: Adding ORCID, Author contributions, Conflict of interest, Funding, Data availability, and Acknowledgments at the end of the main text.","authors":"","doi":"10.5397/cise.2023.00248","DOIUrl":"https://doi.org/10.5397/cise.2023.00248","url":null,"abstract":"","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/94/cise-2023-00248.PMC10277709.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10022766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core decompression for early-stage avascular necrosis of the humeral head: current concepts and techniques.","authors":"Michael D Scheidt,&nbsp;Saleh Aiyash,&nbsp;Dane Salazar,&nbsp;Nickolas Garbis","doi":"10.5397/cise.2022.00969","DOIUrl":"https://doi.org/10.5397/cise.2022.00969","url":null,"abstract":"<p><p>Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/9e/cise-2022-00969.PMC10277707.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9664541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review.","authors":"Giorgio Breda,&nbsp;Gianluca De Marco,&nbsp;Pierfranco Cesaraccio,&nbsp;Paolo Pillastrini","doi":"10.5397/cise.2022.00948","DOIUrl":"https://doi.org/10.5397/cise.2022.00948","url":null,"abstract":"<p><p>Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library, the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%-99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%-30.0%) to 69.4% (95% CI, 57.3%-79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/ab/cise-2022-00948.PMC10277706.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9664505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}