Tommy John surgical reconstruction for ulnar collateral ligament injuries was first described by Frank Jobe in 1974. Although he estimated the chance for successful return very low, John, famous baseball pitcher, was able to return to play for another 14 years. Modern techniques and better understanding of anatomy and biomechanics have now resulted in a return-to-play rate of more than 80%. Ulnar collateral ligament injuries occur mainly in overhead athletes. Generally, partial tears can be treated nonoperatively, but in baseball pitchers, success rates are less than 50%. Complete tears often require surgery. Primary repair or reconstruction are feasible options, and the choice will depend not only on the clinical scenario, but also the surgeon. Unfortunately, the current evidence is not convincing, and a recent expert consensus study exploring diagnosis, treatment options, rehabilitation, and return to sports showed agreement among the experts, but not necessarily a consensus.

To establish consensus statements on the treatment of ulnar collateral ligament (UCL) injuries and to investigate whether consensus on these distinct topics could be reached.
A modified consensus technique was conducted among 26 elbow surgeons and 3 physical therapists/athletic trainers. Strong consensus was defined as 90% to 99% agreement.
Of the 19 total questions and consensus statements 4 achieved unanimous consensus, 13 achieved strong consensus, and 2 did not achieve consensus.
There was unanimous agreement that the risk factors include overuse, high velocity, poor mechanics, and previous injury. There was unanimous agreement that advanced imaging in the form of either magnetic resonance imaging or magnetic resonance arthroscopy should be performed in a patient presenting with suspected/known UCL tear that plans to continue to play an overhead sport, or if the imaging study could change the management of the patient. There was unanimous agreement regarding lack of evidence for the use of orthobiologics in the treatment of UCL tears as well as the areas pitchers should focus on when attempting a course of nonoperative management. The statements that reached unanimous agreement for operative management were regarding operative indications and contraindications for UCL tears, prognostic factors that should be taken into consideration in when performing UCL surgery, how to deal with the flexor-pronator mass during UCL surgery, and use of an internal brace with UCL repairs. Statements that reached unanimous agreement for return to sport (RTS) were regarding portions of the physical examination should be considered when determining whether to allow a player to RTS; unclear how velocity, accuracy, and spin rate should be factored into the decision of when players can RTS and sports psychology testing should be used to determine whether a player is ready to RTS.
V, expert opinion.

The purpose of this literature review is to develop an evidence-based guideline for the use of neuromuscular ultrasound in the diagnosis of ulnar neuropathy at the elbow (UNE). The proposed research question was: \"In patients with suspected UNE, does ulnar nerve enlargement as measured with ultrasound accurately identify those patients with UNE?\"
A systematic review and meta-analysis was performed, and studies were classified according to American Academy of Neurology criteria for rating articles for diagnostic accuracy.
Based on Class I evidence in four studies, it is probable that neuromuscular ultrasound measurement of the ulnar nerve at the elbow, either of diameter or cross-sectional area (CSA), is accurate for the diagnosis of UNE.
For patients with symptoms and signs suggestive of ulnar neuropathy, clinicians should offer ultrasonographic measurement of ulnar nerve cross-sectional area or diameter to confirm the diagnosis and localize the site of compression (Level B).

Radial head arthroplasty is a viable surgical option when a radial head fracture cannot be reconstructed. Radial head arthroplasty provides a load-bearing articular structure against the capitellum in unstable fractured elbows.
Studies have emphasized the importance of choosing the correct implant size to replicate the native radial head anatomy, citing various consequences of improperly sized radial head prostheses. Overstuffing of the radiocapitellar joint, or lengthening of the radius, has been extensively studied because of its detrimental effects on elbow biomechanics, but other types of improper sizing also have negative consequences.
In the setting of severe fracture-dislocation or revision surgery, anatomic landmarks that are useful for prosthesis sizing often are missing. Various methods have been described to provide guidance for the accurate sizing of a prosthetic radial head; a retrieved radial head, the proximal edge of the lesser sigmoid notch, the radiocapitellar synovial fold, and the ulnohumeral joint space all represent useful references.
Intraoperative radiographic examination is an important step while assessing implant size, including the height of the prosthetic radial head.
Since no single method is perfect on its own, the surgeon should combine as many reference measures as possible, both before and during the procedure, for accurate prosthesis sizing in order to achieve successful outcomes.

Ultrasound of the Elbow (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the elbow. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie des Ellenbogens erläutert. Hierbei werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Fundierte Kenntnisse der sonografischen Anatomie sind unabdingbar, um Pathologien zu erkennen.

BACKGROUND: Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic.
METHODS: A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as \"strong\" when more than 95% of panelists agreed and as \"broad\" if more than 80% agreed.
RESULTS: Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%).
CONCLUSIONS: There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice.
CONCLUSIONS: • The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. • Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. • Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).

Dislocations of the elbow during growth are rare but because of associated fractures a range of therapeutic methods are employed. The postoperative care is even more varied, so the scientific working group of the section for pediatric trauma of the DGU developed the following recommendations for the treatment of elbow dislocations in children and adolescents based on own experience and a review of the literature. Diagnosis is made from radiographs with at least one (preferably lateral) view showing the dislocation. Reduction is considered urgent and should be done as atraumatically as possible with the patient under general anesthesia. After reduction, mobility and stability of the elbow are assessed and associated fractures have to be ruled out by fluoroscopy while the patient is still under anesthesia. Any fractures requiring operative treatment should be addressed at this time. A short-term immobilization should be ordered according to the degree of injury and the stability of any osteosynthesis. The aim should always be to initiate mobilization as soon as possible with immobilization lasting not longer than 3 weeks in any case. Mobilization is initially limited to the activities of daily life at first. 6 weeks after reduction physiotherapy may be initiated as warranted and patients can participate in sports again. An MRI of the elbow may be necessary if there are persistent problems. Even if a measurable loss of range of motion is often recorded, prognosis regarding a good functional outcome is favorable.

OBJECTIVE: The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed.
METHODS: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders.
RESULTS: Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations.
CONCLUSIONS: Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.

BACKGROUND: Although closed reduction and percutaneous pinning is accepted as the treatment of choice for displaced supracondylar fracture of the humerus, there are some debates on the pinning techniques, period of immobilization, elbow range of motion (ROM) exercise, and perceptions on the restoration of elbow ROM. This study was to investigate the consensus and different perspectives on the treatment of supracondylar fractures of the humerus in children.
METHODS: A questionnaire was designed for this study, which included the choice of pinning technique, methods of elbow motion, and perception on the restoration of elbow ROM. Seventy-six orthopedic surgeons agreed to participate in the study and survey was performed by a direct interview manner in the annual meetings of Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand. There were 17 pediatric orthopedic surgeons, 48 hand surgeons, and 11 general orthopedic surgeons.
RESULTS: Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning, p = 0.017) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. Hand surgeons and general orthopedic surgeons tended to be more concerned about elbow stiffness after supracondylar fracture than pediatric orthopedic surgeons, and favored gentle passive ROM exercise as elbow motion. Pediatric orthopedic surgeons most frequently adopted active ROM exercise as the elbow motion method. Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient\'s age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor.
CONCLUSIONS: More investigation and communication will be needed to reach a consensus in treating pediatric supracondylar fractures of the humerus between the different subspecialties of orthopedic surgeons, which can minimize malpractice and avoid medicolegal issues.

BACKGROUND: Biomechanical energy harvesting from human motion presents a promising clean alternative to electrical power supplied by batteries for portable electronic devices and for computerized and motorized prosthetics. We present the theory of energy harvesting from the human body and describe the amount of energy that can be harvested from body heat and from motions of various parts of the body during walking, such as heel strike; ankle, knee, hip, shoulder, and elbow joint motion; and center of mass vertical motion.
METHODS: We evaluated major motions performed during walking and identified the amount of work the body expends and the portion of recoverable energy. During walking, there are phases of the motion at the joints where muscles act as brakes and energy is lost to the surroundings. During those phases of motion, the required braking force or torque can be replaced by an electrical generator, allowing energy to be harvested at the cost of only minimal additional effort. The amount of energy that can be harvested was estimated experimentally and from literature data. Recommendations for future directions are made on the basis of our results in combination with a review of state-of-the-art biomechanical energy harvesting devices and energy conversion methods.
RESULTS: For a device that uses center of mass motion, the maximum amount of energy that can be harvested is approximately 1 W per kilogram of device weight. For a person weighing 80 kg and walking at approximately 4 km/h, the power generation from the heel strike is approximately 2 W. For a joint-mounted device based on generative braking, the joints generating the most power are the knees (34 W) and the ankles (20 W).
CONCLUSIONS: Our theoretical calculations align well with current device performance data. Our results suggest that the most energy can be harvested from the lower limb joints, but to do so efficiently, an innovative and light-weight mechanical design is needed. We also compared the option of carrying batteries to the metabolic cost of harvesting the energy, and examined the advantages of methods for conversion of mechanical energy into electrical energy.