TITLE:
A Clinical Test for Diagnosis of Humeroradial Joint Lesions in the Presence of Lateral Elbow Pain: Single-Case Design with Arthroscopic Confirmation
AUTHORS:
Holly Jonely, Jean-Michel Brismée, David Lutton
KEYWORDS:
Epicondylalgia, Chondropathy, Loose Body, Plica
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.9 No.3,
March
12,
2018
ABSTRACT: INTRODUCTION: Lateral epicondylosis is a common cause of lateral elbow pain, however, some patients fail conservative management. One reason, many pathologies have similar presentations. There are no valid and reliable clinical tests to differentiate between tendopathy and arthropathy. This single case design looks at the utilization of the humeroradial joint (HRJ) distraction test to diagnose HRJ chondropathy. CASE SUMMARY: 38-year-old male recreational athlete with persistent lateral elbow pain, impaired motion, crepitus and locking. Disability of the Arm Shoulder Hand Questionnaire (DASH): 13.33/100. DASH Sport Module, 68.75/100. Differential Diagnosis: Chondropathy of the HRJ with loose body, based on history of elbow pain and locking, non-capsular pattern of limitation of motion and a positive HRJ distraction test. Intervention: loose body manipulation improved pain free range of motion with continued remarkable HRJ distraction test; referral to orthopedic surgeon. Plain radiographs and CT demonstrated a loose body and marked cartilage thinning within the HRJ. Arthroscopic removal of the loose body and plica resection was performed. Surgical exploration confirmed Grade 3 cartilage lesions within the radial head without involvement of the extensor muscle group. Post-operative physical therapy focused on restoration of accessory joint motion and education on return to functional and recreational activity. OUTCOMES: Full range and normal joint accessory motion, DASH score and DASH Sport Module score reduced to 8.33 and 25, 12-weeks post-operative. CONCLUSION: Arthroscopic exploratory surgery is recommended for chronic lateral elbow pain resistant to conservative management; however, patients who present with pain in the absence of a positive clinical examination and radiographic findings benefit least from arthroscopic evaluation. No clinical test(s) have been validated in the literature to diagnose HRJ lesions. This report is the first to propose the use of a new clinical test for HRJ lesion, with confirmation using imaging and arthroscopy. Level 4 Case Report.