Intra‐articular inclusions of the elbow joint complex

Abstract

An abundant clinical literature implicates intra-articular inclusions in various pathological conditions of the elbow, but the anatomical literature offers piecemeal descriptions of these structures. The aim of this study was to determine the prevalence, disposition, and gross morphology of intra-articular inclusions of the entire elbow joint complex. Twenty-eight elbow joints from 17 adult embalmed cadavera were studied by macrodissection. Three types of inclusions were identified. Fat pads and fibroadipose meniscoids were found in all joints while capsular rims occurred in 50% of radiohumeral and humeroulnar joints. Fat pads were located opposite the olecranon, coronoid, and radial fossae. Fibroadipose meniscoids were found in the nonarticular waists of the trochlear notch and protruded into the posterolateral aspect of the radiohumeral joint. Fibroadipose meniscoids and fat pads are characteristic structures of the elbow joint complex. Fat pads appear to act as deformable space fillers, while the radio-humeral fibroadipose meniscoid appears to protect articular cartilage exposed during normal movement. Arguments are raised whether these structures may act as the nidus for arthrofibrosis and that the radiohumeral meniscoid may be involved in lateral epicondylalgia.

The application of mechanical diagnosis and therapy in lateral epicondylalgia

“…These structures are believed to be capable of causing nociception and obstruction to movement; noted characteristics of joint derangement. 7,23 This concept has been further supported by Duparc et al 8 and Mills, 9 who originally created a manipulation to reduce suspected joint displacement in patients presenting with tennis elbow. As theorized in this case series, a joint derangement can mimic a tendinopathy presentation, which is believed to be a cause of LE.…”

“…7 During elbow dissection, Mercer and Bogduk 7 found joint tissue displaced inside and outside the joint space. When displaced tissue was found outside the joint space, it was located under the proximal wrist extensor tendon, on the lateral aspect of the elbow.…”

“…When displaced tissue was found outside the joint space, it was located under the proximal wrist extensor tendon, on the lateral aspect of the elbow. 7 Articular tissue displaced under the wrist extensor tendon theoretically could explain why there was no longer without having to seek further health care. She reported no other instances of pain and continued to have no functional deficits.…”

“…Despite continued research, the true origin of pain from LE remains as an enigma. 2,[7][8][9] Poor understanding of the specific patho-anatomical pain origin may have led to wide variability in specific patho-anatomical treatment of LE; e.g. injection, medication, rest, ice, bracing, therapeutic modalities, therapeutic exercise, massage, mobilization and manipulation.…”

Rapid resolution of chronic shoulder pain classified as derangement using the McKenzie method: a case series

“…Also known as intra-articular intrusions, these structures have been implicated as a potential cause of derangements in the extremities. 20 However, the exact mechanism for shoulder derangements still requires further investigation. Although this study has limitations including the inability to establish the cause-and-effect relationship from a case series and the lack of long-term follow ups, the rapid improvement in symptoms observed in all patients suggests that using the MDT algorithm may be a useful approach to manage shoulder pain and that matching shoulder pain to a directional preference may result in good outcomes.…”