The Elbow

non - capsular patterns

Loose Body in a normal joint in adulthood

Etiology
The cause of loose body formation in middle-aged patients is usually traumatic, the injury having chipped off one or more pieces of cartilage.
The loose bodies that result do not have an osseous nucleus and therefore do not show on radiography.

Symptoms
The history is that of chronic pain in the elbow: attacks of pain, during which exertion increases the pain.
'Twinges' may be mentioned
Unlike the history in youngsters: sudden locking and gradual unlocking in the following days does not occur.
Often the patient is thought to suffer from an ordinary tennis elbow.

Signs
A very clear non-capsular pattern is found with limitation either of flexion or extension, depending on the position of the fragment.

Limitation of extension and a full range of flexion

Limitation of flexion and a full range of extension

Radiography
Because the loose bodies are cartilaginous and do not contain a bony nucleus, they do not show on a plain radiography.
However, a tomography or arthrography can demonstrate the free bodies.

Treatment:

Manipulation:
A loose body that limits extension can usually be reduced by manipulation
A loose body that limits flexion cannot be reduced by manipulation but limitation of flexion, unless gross, is not of major concern.
Arthroscopy:
In case recurrences after successful manipulations are very frequent, removal during arthroscopy should be advised.