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Loose body in the elbow
Loose body in the elbow
One or more fragments, visible or not on medical imaging, can occasionally jam the joint in one direction only.
Position of the loose bodies
* if extension is limited :
in the triangle between capitellum humeri, basis processus coronoideus of ulna and caput radii.
* if flexion is limited :
between anterior humerus and processus coronoideus.
Loose body in the elbow (2)
Depending upon the patient's age, three histories suggest such an internal derangement :
a) In adolescence : sudden fixation of the joint (in flexion or extension), subsiding gradually in a few days
b) In adults in a non-arthrotic joint : rather sudden fixation of the joint, subsiding gradually in a few weeks
c) In an osteoarthrotic joint : gradual fixation of the joint in a few hours, subsiding even more gradually in a few days.
In cases a) and b) we have a normal joint without osteoarthrosis and then we find a clear non-capsular pattern : either the extension is slightly limited and the flexion is normal, or the opposite. There is another interesting finding when extension is limited : the end-feel is softer than the normal hard end-feel.
In adolescence, the cause is generally osteochondrosis dissecans (especially in gymnasts who have some hyperextension and valgus), occasionally a chip fracture. History and medical imaging are more important than clinical examination, which is only positive for a few days. The treatment is surgery, since the fragment(s) have an osseous nucleus and, if not removed, can damage the cartilaginous layer, leading to early osteoarthrosis (the loose bodies can have a diameter up to 1 cm).
In case b), the adult without osteoarthrosis, the cause is probably traumatic. The fragments are cartilaginous and do not show on medical imaging. Since the internal derangement lasts a few weeks, clinical examination becomes more important.
In an osteoarthrotic joint, the fragments are cartilaginous. Outside an attack, we find the capsular pattern of osteoarthrosis. During an attack it changes into a non-capsular pattern : one direction becomes more limited than usual, with a softer end-feel. There is a spontaneous recovery in a few days.
For a limited extension, manipulation generally succeeds in 1-2 sessions (10-12 manoeuvres per session). For a limited flexion, manipulation is of no use and spontaneous recovery should be awaited.
Remark : a loose body, blocking the joint in flexion, occasionally could lead, in the long term, to some permanent loss of flexion.
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