The Elbow

LOOSE BODY

• Correct diagnosis?:

• Not every non capsular pattern indicates an impaction of a loose-body.

• Sometimes there is a combination of limited movement and pain on resisted movements.

• Correct indication?

• Attempts to reduce a loose body causing a limitation of the passive flexion is useless.
  These lesions do not respond on manipulations.

• Reduction of a loose body with bony (visible on radiograph) nucleus will not succeed.
  Treatment consists of surgery.

• Correct technique?
  

  Continue the manipulations until you reach a normal endfeel.
  Very often, the passive extension remains painless during the first
  days after the manipulation. However, the endfeel should has become
  normal immediately after the manipulation, indicating that the loose
  fragment has moved.

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