Case reportIrreducible anteromedial radial head dislocation caused by the brachialis tendon: a case report
Section snippets
Case history
A 16-year-old boy, otherwise healthy, presented to the local emergency department with nondominant left elbow pain after a fall on his outstretched arm from his all-terrain vehicle. On examination, the skin was intact with substantial swelling about the elbow and ecchymoses medially. Range of motion was absent in pronosupination, and he had only 20° of flexion-extension. Radiographs demonstrated an anteromedial subluxation of the radial head with an adjacent bone fleck and widening of the
Discussion
Isolated anteromedial radial head dislocations are rare, and there is much controversy as to whether this can even occur.12 We agree with Upasani et al12 in that for the radial head to dislocate, a ligamentous or bone injury must also occur. The radial head may become irreducible secondary to soft tissue interposition. Several case reports have described the pathoanatomy at the time of open reduction and have included interposition of the annular ligament,4, 5, 9, 11 anterior capsule,2, 10
Conclusion
We have presented a case of an irreducible anteromedial radial head subluxation caused by the superficial tendon of the brachialis. We also demonstrated, in a cadaver dissection, that both the biceps tendon and the superficial tendon of the brachialis can lead to an anteromedial radial head dislocation or subluxation, albeit with slightly different mechanisms. Their appearance is similar in size and location when viewed around the radial neck, with the brachialis tendon being more proximal and
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Cited by (7)
Irreducible anteromedial radial head dislocation without fracture caused by transposed biceps tendon in an adult: A case report and literature review
2023, Chinese Journal of Traumatology - English EditionIrreducible anteromedial radial head dislocation in a child caused by interposing brachialis tendons: a case report
2022, JSES Reviews, Reports, and TechniquesElbow Instability: Evaluation and Treatment
2020, Hand ClinicsCitation Excerpt :It can be difficult to obtain the images because of patient discomfort and the confines of splinting, as elbow flexion is hard to avoid; however, in some cases, we temporarily splint the elbow in as much extension as possible for the scan, then flex the elbow for final splinting. An MRI is rarely used in the setting of an acute dislocation or fracture dislocation; rarely, it may be helpful if there is believed to be soft tissue interposition prohibiting reduction.9 Although everyone can agree that closed reduction in an expedited fashion is appropriate, the duration (if any) and type of immobilization thereafter and rehabilitation remain a matter of discussion and difference among surgeons.10–13
Irreducible Monteggia fracture: interposed radial nerve and capsule
2017, JSES Open AccessCitation Excerpt :This revealed that the injury could be reproduced only with an accompanying ulnar collateral ligament tear at the elbow. The radial head has also been found to be buttonholed through the brachialis tendon, preventing radial head reduction in children.3,4 Capsular interposition blocking reduction has also been reported.8,14
Traumatic irreducible anterior dislocation of the radio-capitellar joint due to entrapment of the brachialis tendon lateral to the radial head: A case report
2022, Journal of Medical Imaging and Radiation Oncology
This case report is exempt from Institutional Review Board approval. The patient's informed consent has been obtained.