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Zubler et al. Osseous Causes of Elbow Stiffness Musculoskeletal Imaging Original Research
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Elbow Stiffness: Effectiveness of Conventional Radiography and CT to Explain Osseous Causes
Veronika Zubler 1 Nadja Saupe1 Bernhard Jost 2 Christian W. A. Pfirrmann1 Juerg Hodler 1 Marco Zanetti1
Zubler V, Saupe N, Jost B, Pfirrmann CWA, Hodler J, Zanetti M
OBJECTIVE. The purpose of our study was to evaluate the effectiveness of conventional radiography and CT for explaining the osseous causes of elbow stiffness. MATERIALS AND METHODS. Two independent readers analyzed loose bodies and osteophytes on conventional radiography and CT (or CT arthrography) of the elbow in 94 consecutive patients (71 men, 23 women; mean age, 41 years; range, 18–68 years). Arthroscopic or surgical correlation was available in 58 (62%) patients. In all 94 patients, the expected restriction of motion was measured on images and correlated (Pearson’s correlation) with the clinical restriction of motion. Kappa statistics were performed for interobserver agreement. RESULTS. Accuracy for detecting loose bodies was 67% with conventional radiography and 79% with CT. Differences in accuracy were most pronounced for detecting loose bodies in the posterior joint space (64% for conventional radiography vs 79% for CT). Accuracy for detecting osteophytes was 69% with conventional radiography and 76% with CT. Expected restriction of motion on conventional radiography correlated significantly with clinical restriction for only one reader for flexion (R = 0.21, p = 0.04). Expected restriction of extension on CT correlated significantly with clinical restriction of motion by both readers (R = 0.34 and 0.33, p = 0.001 and 0.001, respectively). Expected restriction of flexion on CT correlated significantly by one reader (R = 0.24, p = 0.02). Interobserver agreement with regard to detection of both loose bodies and osteophytes was higher for CT (κ = 0.83 and 0.76) than for conventional radiography (0.64 and 0.60). CONCLUSION. CT is more effective than conventional radiography in explaining the osseous causes of elbow stiffness. lbow stiffness can be caused by osseous or soft-tissue abnormalities that may be located either within the joint or outside of the joint. Intraarticular causes include posttraumatic arthritis, joint incongruity, ankylosis of articular surfaces, articular adhesions, loose bodies, and osteoarthritis with bone spurs and proliferative synovitis. Extraarticular causes include heterotopic bone formation, capsular thickening, and musculotendinous contracture . Soft-tissue abnormalities (e.g., synovitis, insertion tendinopathies, and collateral ligament lesions) are preferably evaluated by ultrasound or MRI . Soft-tissue abnormalities frequently can be treated conservatively, whereas osseous abnormalities, such as loose bodies, osteophytes, or joint incongruity, are more commonly treated by arthroscopy or open surgery [3–5]. Osseous abnormalities in elbow stiffness are most commonly clarified by radiography and CT.
Keywords: conventional radiography, CT, elbow stiffness, restriction of motion DOI:10.2214/AJR.09.3741 Received September 30, 2009; accepted after revision December 14, 2009.
1 Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. Address correspondence to V. Zubler (email@example.com). 2 Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist, Zurich, Switzerland.
WEB This is a Web exclusive article. AJR 2010; 194:W515–W520 0361–803X/10/1946–W515 © American Roentgen Ray Society
Conventional radiography is still the primary step in the evaluation of elbow stiffness . CT or CT arthrography is generally considered by radiologists to be more accurate for evaluation of loose bodies than conventional radiography. However, controversy exists [7–9]. Canadian orthopedic surgeons concluded in 2005 that neither CT arthrography nor MRI is reliable or more accurate than conventional radiography alone to detect loose bodies in patients with elbow stiffness . To our knowledge, even less evidence exists as to whether CT is at all more effective than conventional radiography in evaluating the osseous causes of elbow stiffness. The technologic advance of MDCT in the last decade with the possibility of excellent secondary reformations caused the assumption that CT may be superior to conventional radiography in explaining osseous causes of elbow stiffness. Thus, the purpose of this investigation was to evaluate the effectiveness
AJR:194, June 2010
releasing of fibrosis. 1—26-year-old man with clinically 20° restriction of extension and 25° restriction of flexion. beam orientation from radial to ulnar). arm 90° elevated.67. resection of plicae. All patients agreed to the use of their data.46. elbow flexion 90° [if possible]. views of the elbow (sitting patient. range 0–190 days) after CT. hemophiliac arthropathy (n = 2). and three of 58 (5%). 120 kV. However. Intraarticular contrast medium was injected in a standardized fashion. 2. 2. implantation of a prosthesis. resection of osteophytes. presence of an elbow prosthesis (n = 6). absence of secondary reformation. 60%) underwent CT arthrography. Not clearly visible are osteophytes in fossa olecrani and loose body. coronal. and CT Arthrography Conventional radiographic assessment included anteroposterior views (sitting patient. wrist supinated. W516 AJR:194. 0. 61%) and on a Brilliance CT 40 scanner (Philips Healthcare) (37 of 94. The mean interval between conventional radiography of the elbow and CT or CT arthrography was 32 days (range. 39%) underwent standard CT. Patients were examined in the prone position with the arm extend if possible over the head and the forearm as extended as far as possible.4 days. b2 [posterior]) to center of capitulum humeri. after a recent fracture or dislocation (within 6 months before CT) (n = 13). 2.13 on 08/17/13 from IP address 202.46. only one elbow was evaluated (34 left elbows. n = 3). 0–98 days). 0. matrix. arm 90° elevated. 20 × 0. 43. thickness. 450. CT was performed on a Somatom Plus 4 scanner (Siemens Healthcare) (57 of 94. June 2010 . Diagram (D) shows angles formed with rays connecting maximal extent of loose bodies (a1) or osteophytes (b1 [anterior]. and window width.Zubler et al. neurolysis of the ulnar nerve. Patients were excluded when image quality was nondiagnostic (motion artifact. posttraumatic pseudoarticulation of the humerus (n = 2).13. removal of loose bodies. For personal use only. 150.67. Our institutional review board does not require approval or informed consent for the retrospective review of patient records or images.org by 202. beam orientation anteroposterior) and lateral Fig. 18–68 years]). In each patient. Thirty-seven patients (37/94. severe posttraumatic deformity of the joint (n = 4). and spasm of the triceps muscle caused by a birth defect (brachial plexus damage) (n = 1). patients’ rights are protected by a law that requires that they must be informed that their charts and images might be reviewed for scientific purposes and that grants patients the opportunity to forbid such use of their data. Transverse CT image shows large osteophytes (arrowheads ) in fossa coronoidea and fossa olecrani. Lateral conventional radiograph obtained anteriorly in fossa coronoidea shows apparent small osteophyte (arrow ).33. By adding these measured angles. Patients older than 18 years were included in the study when conventional radiography was performed within 100 days before or after CT without any elbow surgery in between. all rights reserved Two hundred seven consecutive patients referred for CT or CT arthrography of the elbow between September 2004 and September 2008 were identified in our PACS system. and sagittal reformations were performed (thickness. increment. window center. B.0. Transversal. 60 right elbows). degree of compromise was estimated separately for flexion and extension. 27 of 58 (47%). and 57 patients (57/94. elbow extended (if possible). Surgery and arthroscopy included débridement.000. arthroscopy.625. 61%) underwent CT arthrography. Copyright ARRS. extensive osteosynthesis material (n = 2).ajronline. Twenty-eight of these 58 (48%) underwent open surgery.0). in the presence of a tumor (n = 12). of conventional radiography and CT for explaining the osseous causes of elbow stiffness. A B C D Conventional Radiography. Fifty-eight of the 94 patients (62%) underwent surgery within 190 days (mean. 39%) The imaging parameters were ultra high resolution. and the Outerbridge-Kashiwagi procedure. 39%) underwent standard CT and 57 patients (57/94. The final study group consisted of 94 patients (71 men and 23 women [mean age. ankylosis of the joint (n = 2). Sagittal CT reformation image (C) shows osteophytes in fossa coronoidea and fossa olecrani and loose body in anterior aspect of joint. CT. 41 years. A. Material and Methods Patient Population Downloaded from www.67. Thirty-seven patients (37/94. collimation. increment. 150 mAs. range. C and D.
humeral. 53%). It was not seen in anteroposterior view. were injected under fluoroscopic control. specificity. b. release 16. and sagittal reformations from the CT. The readers were blinded to the clinical findings. After separate reading. Copyright ARRS. a consensus was reached. AstraZeneca) and a mean of 6 mL of iodinated contrast agent (iopamidol. and c2 = ulnar radial osteophytes in the posterior aspect of the joint. Standard of Reference The standard of reference of the diagnostic accuracy for loose bodies and osteophytes was arthroscopy (27/58. A ) is suspected. osteophyte in anterior aspect of humerus (arrow. A p value < 0. posterior. and/or radial). on lateral conventional radiograph. c1 = angle restricted by ulnar and/or radial osteophytes in the anterior aspect of the joint.67. D).81–1. Statistical Analysis Sensitivity. the expected restriction of motion caused by osseous structures (loose bodies and/or osteophytes) was assessed. CT images correspond better with minimal restriction of motion of 5° produced by small osteophyte in radial aspect of humerus (arrow. For personal use only. 47%) and open surgery (31/58. a2 = loose bodies in the posterior aspect of the joint. Pearson’s correlation was calculated between restriction of motion as expected on images and restriction of motion measured clinically. 200 mg/mL. 1.67. C and D). C and D. Similar to Fig. and 0.Osseous Causes of Elbow Stiffness For CT arthrography.05 was considered statistically significant. Bracco).46.0. Angles (a. Downloaded from www.46. Sensitivity and specificity AJR:194. In the formulas. These abnormalities were categorized as calcified loose bodies (located anteriorly and/or posteriorly) and osteophytes (anterior. 2— 60-year-old man with restriction of extension (15°) and restriction of flexion (5°). SPSS). b2 = humeral osteophytes in the posterior aspect of the joint. kappa values were calculated.1. Iopamiro 200. The standard of reference for expected restriction of motion determined on images was the clinical restriction of motion in all 94 patients. 1–3).ajronline.13 on 08/17/13 from IP address 202.41– 0. a2 + b2 + c2 = restriction of extension with angles measured in degrees. and accuracy were calculated for the diagnosis of loose bodies and osteophytes at the various sites.61–0. Scandicain. Fossa coronoidea. the degree of compromise was estimated separately for flexion and extension (Figs. clinical restriction of motion was measured by orthopedic residents with a handheld goniometer. The delay between the injection and CT was less than 15 minutes. According to Landis and Koch  kappa values of 0. A B C D Fig. and c) were formed with rays connecting the maximal extent of the loose bodies (a) or osteophytes (b and c) to the center of the capitulum humeri. All analyses were performed with statistical software (SPSS for Windows.org by 202. The Results Diagnostic Accuracy for Detecting Loose Bodies and Osteophytes Accuracy for detecting loose bodies was 67% with conventional radiography and 79% with CT (Table 1). coronal. is completely free (arrowheads. On images. ulnar. We used following formulas: a1 + b1 + c1 = restriction of flexion. b1 = angle restricted by humeral osteophytes in the anterior aspect of the joint. 1 mL of local anesthetic (mepivacain hydrochloride 2%. all rights reserved Evaluation of Images Both conventional radiography and CT or CT arthrography were evaluated independently by two experienced musculoskeletal radiologists with 15 and 4 years of professional experience in musculoskeletal radiology. The readers evaluated the presence of osseous abnormalities potentially restricting flexion or extension using the anteroposterior and lateral views from conventional radiography and the transversal. however. By adding these measured angles. Loose bodies and osteophytes within this circle hampering the normal flexion and extension were noted. A circle was drawn with the center in the capitulum humeri on the conventional lateral radiograph or sagittal CT reformation. 0. A and B.13. a1 = angle restricted by loose bodies in the anterior aspect of the joint.80 substantial.60 indicate moderate.00 almost perfect agreement. For assessing interobserver agreement. June 2010 W517 .
especially in the fossa coronoidea and in the fossa olecrani.58. The 35° restriction of extension was not completely explained by radiographs. all rights reserved A B Fig. Interobserver agreement for detection of osteophytes was moderate or substantial at the various sites: anterior. were 86% and 48% for conventional radiography and 93% and 66% for CT. 66% vs 74%). Conventional radiographs show large anteriorly located loose body (arrow. ulnar. Restriction of Motion Measurements One single outlier was detected on correlation plots and then removed for analysis.67.21. any osseous obstacle restricts motion. Interobserver agreement for detection of osteophytes was substantial or almost perfect at the various sites (anterior.04) but not for the other measurements (extension. 0.001).34 and 0. June 2010 . CT images show osteophytes in fossa olecrani (white arrowheads ). Loose bodies and osteophytes in the anterior and posterior joint space. 0.73. main cause of restriction of extension. reader 2).Zubler et al. Expected restriction of motion in the lateral view on conventional radiography correlated significantly with clinical restriction by one reader for flexion (R = 0. 0.org by 202.53). p = 0. Restriction of motion is also explained by osteophytes in ulna (arrows . loose bodies and osteophytes in the fossa olecrani and coronoidea are preferably removed by débridement. 60% vs 90%. The higher effectiveness of CT is based on better detection of loose bodies and osteophytes. The humeroulnar joint is a classical hinged joint with one plane of motion in the flexion and extension direction. and specificity 96% vs 65%). Differences in accuracy were most pronounced for detecting loose bodies in the dorsal joint space (accuracy. are often invisible on conventional radiography. 0. Copyright ARRS.67) but moderate in the posterior aspect (0.24. For personal use only. ly evaluated. 0. A ). specificity 63%). sensitivity.73. 0.001 and 0. Accuracy for detecting osteophytes was 69% with conventional radiography (sensitivity 62%. ulnar. flexion and extension.13 on 08/17/13 from IP address 202.83). 64% for conventional radiography vs 79% for CT. 0. A and B. and radial. C and D. posterior. 93 patients instead of 94 were final- W518 AJR:194. and specificity. 0. p = 0.8) (Table 4). D). humeral. and radial.46.67. sensitivity 41% vs 84%.67.83 (anterior. either by Downloaded from www.72. Therefore. Large loose body on CT is shown in transverse CT image (arrow. 25° restriction of flexion and 35° restriction of extension were measured clinically.02) (Tables 2 and 3). Expected restriction of flexion on CT in the sagittal reformations correlated significantly for one reader (R = 0. Such osteophytes in the fossae may play an important biomechanical role. humeral. Expected restriction of extension on CT in the sagittal reformations correlated significantly with clinical restriction of motion by both readers (R = 0.64) and in the anterior aspect (0. Thus. CT— Interobserver agreement for detection of loose bodies on CT was almost perfect: 0.ajronline. posterior.6. Differences in accuracy were most pronounced for humeral osteophytes (accuracy 65% conventional radiography vs 76% for CT. reader 1. C).69. Interobserver Agreement Conventional radiography— Interobserver agreement for detection of loose bodies on conventional radiography was substantial overall (0. posterior.76. 0. The outlier could be explained by a pseudarthrosis in the proximal humeral shaft that was not visible on conventional radiography and CT images and that produced a restriction of motion due to extreme pain. and osteophytes in fossa coronoidea (black arrowheads ). For therapy.86. 0. explaining restriction of motion. 0.46. 0. 3— 66-year-old man with osteoarthritis of elbow. p = 0. specificity 87%) and 76% with CT (sensitivity 81%.13. C D Discussion Our study shows that CT is more effective than conventional radiography for evaluating the osseous causes of elbow stiffness.56.33.
33 CT Flexion p = 0.001.46. Conv. 16].16 p = 0. The use of CT in musculoskeletal radiology has increased in recent years because of the availability of high-resolution reformations associated with MDCT.04. R = 0.67 0. June 2010 W519 .73 0. theoretically a patient can suffer from a considerable restriction of motion caused by scars or a hypertrophic synovial plica AJR:194. When this procedure is performed.80 open surgery or by arthroscopy.13.43.58 CT κ 0. R = 0. The sagittal reformations seem to be most important. R = 0.86 0. loose bodies and osteophytes are removed from the olecranon and coronoid process through a posterior incision and a hole is trephined through the olecranon fossa in the distal humerus to allow access to the anterior part of the elbow joint .ajronline.59 0.001.34 p = 0. of Findings True-Positive Parameter Loose bodies Downloaded from www.69 0.76 0.76 0. MDCT reformations are widely used in musculoskeletal radiology after acute bone trauma and postoperatively after arthrodesis and spondylodesis [15.73 0.67. all rights reserved Anterior Posterior Osteophytes Anterior Posterior Humeral Ulnar Radial 25 16 12 26 18 18 13 22 7 27 17 18 34 28 29 27 30 14 True-Negative 14 26 25 14 21 19 25 16 40 19 29 28 10 15 12 17 11 38 False-Positive 15 12 13 2 1 3 1 1 2 10 9 10 6 7 10 9 6 4 False-Negative 4 4 8 16 18 18 19 19 9 2 3 2 8 8 7 5 11 2 Sensitivity (%) 86 80 60 62 50 50 41 54 44 93 85 90 81 78 81 84 73 88 Specificity (%) 48 68 66 87 95 86 96 94 95 66 76 74 63 68 55 65 65 91 Accuracy (%) 67 72 64 69 67 64 65 65 81 79 79 79 76 74 71 76 70 90 Radiography CT Radiography CT Radiography CT Radiography CT Radiography CT Radiography CT Radiography CT TABLE 2: Correlation Between Restrictions of Motion Measurements With Clinical Restriction Conventional Radiography Reader 1 2 Extension p = 0. Moreover.11 p = 0.56 0. Admittedly. For personal use only.06.53 0. Copyright ARRS. Thus. the quantitative restriction of motion caused by the loose bodies or osteophytes can be estimated by the method shown in this article.83 0. R = 0. Open débridement of the anterior and posterior compartments of the elbow can be performed either directly through a single posterior  or a single lateral approach  or through combined medial and lateral approaches. conventional lateral tomography was a preferred imaging technique by many elbow surgeons for assessing mechanical elbow stiffness .21 Extension p = 0.08 Flexion p = 0.72 0. Our study emphasizes that CT is also useful for assessing loose bodies and osteophytes in the elbow.24 p = 0. radiographs = conventional radiographs. given that quantitative assessment of restriction of flexion and extension can be performed only in the sagittal imaging plane. CT allows only a gross radiologic estimation of the restriction of motion. R = 0.19 Note— R = Pearsons`s correlation factor. Bold indicates statistical significance.02.67.46. Our orthopedic surgeons are comfortable when they can correlate the restriction of motion on images with the restriction of motion measured in their patients before surgical intervention.13. (p < 0.org by 202. A classical surgical technique is the Outerbridge-Kashiwagi procedure. On sagittal reformations.83 0. Before CT was available with high-resolution reformations.67 0.13 on 08/17/13 from IP address 202. R = 0.05). sagittal reformations resemble conventional lateral tomograms.64 0. R = 0.Osseous Causes of Elbow Stiffness TABLE 1: Diagnostic Accuracy in Percentages of Conventional Radiography and CT for Loose Bodies and Osteophytes No. R = 0. Soft-tissue abnormalities rather than osseous abnormalities may be responsible for restriction of motion as well. TABLE 3: Restriction of Motion Measurements Handheld Goniometer Type of Motion Flexion (°) Extension (°) Mean (SD) 18 (20) 21 (15) Conventional Radiography Reader 1 Mean (SD) 16 (17) 17 (17) Reader 2 Mean (SD) 21 (18) 16 (19) Reader 1 Mean (SD) 19 (17) 20 (18) CT Reader 2 Mean (SD) 19 (18) 23 (21) TABLE 4: Interobserver Agreement Results Conventional Radiography Parameter Loose bodies Anterior Posterior Osteophytes Anterior Posterior Humeral Ulnar Radial κ 0.28.60 0.
Morrey BF. De Mey J. used a section thickness of 1 mm. Railhac JJ. Cassar-Pullicino VN. but the overall number of patients (58) with surgical correlation is still substantial. One reason our study showed higher effectiveness of CT over conventional radiography may be related to the different CT technique. Wiche U. Gielen JL. 34:266–271 9. although such softtissue abnormalities can be seen with MRI [19. and finally. Nho SJ. Davies AM. 21]. Kijowski R.46. However.ajronline. Geijer M. In summary. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. . Clin Orthop Relat Res 1982. The question as to whether or not CT arthrography is superior to conventional CT for loose bodies is still controversial [7. Therefore. Arthroscopic management of the arthritic elbow: indications. they did not have our measurement method to assess the expected restriction of motion caused by osseous structures. The measurement of observer agreement for categorical data. Clin Radiol 1994.46. Morrey BF.g. 87:684–686 11. Patterson SD. Elbow joint: assessment with double-contrast CT arthrography. Belhobek GH. J Am Acad Orthop Surg 2008. Schmidt HM. J Magn Reson Imaging 1995. Shahabpour M.67 mm.Zubler et al. Kichouh M. 8:498–502 18. technique. Elbow arthroscopy. Landis JR. Keschner MT. Biometrics 1977. Pinney S. The detection of loose bodies in the elbow: the value of MRI and CT arthrography. Feldman F. Humeroradial plica: frequency and visualization on MRI [in German]. protocols.13 on 08/17/13 from IP address 202. Morrey BF. Dubberley et al. Williams RJ 3rd. Arthroscopy of the elbow: diagnostic and therapeutic benefits and hazards. 33:159–174 12. all rights reserved W520 AJR:194. Paksima N. Adams R. The retrospective study design is associated with an inhomogeneous study population. Our results contradict somewhat the results from a previous study  in which CT arthrography and MRI were found not to be more effective than conventional radiography . Anderson TE. On the other hand. 186:1754–1760 17. Extensive posterior exposure of the elbow: a triceps-sparing approach. This controversy is reflected by the referrals of patients to our department for imaging for whom CT and CT arthrography were requested for the same clinical problem. the consecutive study inclusion criteria guaranteed an unselected wide range of abnormalities. our study shows that CT is more effective than conventional radiography for evaluation of osseous elbow stiffness on the basis of higher accuracy and higher interobserver agreement for detecting loose bodies and osteophytes. and results. but the surgeons themselves were not specifically asked to report findings (e. De Smet AA. The search for joint loose bodies in the elbow joint: conventional or CT arthrography? [in German] Radiologe 1990. our study presents a CT measurement method that allows the prediction of the clinical restriction of motion to a certain degree. We retrospectively used the available arthroscopic reports or surgical reports. AJR 2001. References 1. the highest gain of diagnostic information with CT can be expected in patients with restricted extension. Holland P. The retrospective study design may partially explain why the accuracies were relatively low. Elbow synovial fold syndrome: MR imaging findings. Moreover. Emerg Radiol 2006. especially when they are located in the fossa coronoidea or fossa olecrani. 160:167–173 10. 20]. AJR 2006. and clinical applications. 16:77–87 5. Vahlensieck M. Noske H. Singson RD. 65:24–28 2. 8:214–219 15. J Radiol 2008. 30: 113–115 Downloaded from www. 188–192 13. Ward WG. Bull NYU Hosp Jt Dis 2007. J Bone Joint Surg Am 1992. Laridon E. The stiff elbow. used double-contrast CT arthrography and we used single-contrast CT arthrography. Sans N. J Bone Joint Surg Br 2005. June 2010 . 10. Koch GG. we have not found any data reporting the correlation of such findings (plicae. whereas 40% underwent CT without intraarticular contrast medium. Frahm R. Wimmer B. Nunley PD. osteophytes) as would have been done in a prospective study. Field LD. Bryan RS. 176:959–964 19. Dodson CC. 89:633–638. 65:194–200 3. Radiology 1986. Faber KJ.  found relatively high sensitivities (88–100%) for the detection of loose bodies with MRI and CT arthrography but relatively low specificities of between 20% and 70%. Rofo 2004. J Bone Joint Surg Am 1998. Morrey BF. Feng SA. Altchek DW. 80: 1603–1615 14. 5:473– 477 21. A further limitation of our study is that 60% of the patients underwent CT arthrography. MR assessment of posttraumatic flexion contracture of the elbow. 13:7–18 16. MDCT in the evaluation of skeletal trauma: principles. Eur J Radiol 2008. O’Driscoll SW. 639 7. Fortier MV. Computed tomographic arthrography in the assessment of osteochondritis dissecans of the elbow. Rosenberg ZS.org by 202. Skeletal Radiol 2005.67. Regan W. Mansat P. et al. Finally. Schweitzer ME. Dubberley et al. J Am Acad Orthop Surg 2008.13. whereas we used a section thickness of 0. Elbow: plain radiographs [in French]. Dubberley JH. El-Khoury GY. MDCT versus digital radiography in the evaluation of bone healing in orthopedic patients. Arthroscopy 1992. Primary osteoarthritis of the elbow: current treatment options. Dubberley et al. Awaya H. Cheung EV. 177:1377–1381 20. The absence of surgical correlation in 38% patients represents a limitation of the study. Our study had a number of limitations. Tiny osteophytes can be probably missed during arthroscopy. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. 16:574–585 6. Differences in accuracy between CT and conventional radiography are most pronounced for detecting loose bodies in the posterior joint space. 74:84–94 4. Arthroscopic elbow findings: correlation with preoperative radiographic studies. The column procedure: a limited lateral approach for extrinsic contracture of the elbow.67. Radiography had a similar sensitivity and specificity of 84% and 71%. Krestan CR. Copyright ARRS. scars) with elbow stiffness. Savoie FH 3rd. J Shoulder Elbow Surg 1999. Forster BB. et al. et al.. quiz. The relatively low specificity and high false-positive results for osteophytes on CT images may be explained by the use of arthroscopy as standard of reference. For personal use only. Vasilevska V. 49:231–235 8.
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