Elbow stiffness: effectiveness of conventional radiography and CT to explain osseous causes

OBJECTIVE
The purpose of our study was to evaluate the effectiveness of conventional radiography and CT for explaining the osseous causes of elbow stiffness.

MATERIALS AND METHODS
Two independent readers analyzed loose bodies and osteophytes on conventional radiography and CT (or CT arthrography) of the elbow in 94 consecutive patients (71 men, 23 women; mean age, 41 years; range, 18-68 years). Arthroscopic or surgical correlation was available in 58 (62%) patients. In all 94 patients, the expected restriction of motion was measured on images and correlated (Pearson's correlation) with the clinical restriction of motion. Kappa statistics were performed for interobserver agreement.

RESULTS
Accuracy for detecting loose bodies was 67% with conventional radiography and 79% with CT. Differences in accuracy were most pronounced for detecting loose bodies in the posterior joint space (64% for conventional radiography vs 79% for CT). Accuracy for detecting osteophytes was 69% with conventional radiography and 76% with CT. Expected restriction of motion on conventional radiography correlated significantly with clinical restriction for only one reader for flexion (R = 0.21, p = 0.04). Expected restriction of extension on CT correlated significantly with clinical restriction of motion by both readers (R = 0.34 and 0.33, p = 0.001 and 0.001, respectively). Expected restriction of flexion on CT correlated significantly by one reader (R = 0.24, p = 0.02). Interobserver agreement with regard to detection of both loose bodies and osteophytes was higher for CT (kappa = 0.83 and 0.76) than for conventional radiography (0.64 and 0.60).