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Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a controlled radiological study.

Beyeler C, Thomann SR, Gerber NJ, Kunze C, Aeberli D - BMC Musculoskelet Disord (2015)

Bottom Line: The most frequent sites affected were the olecranon (20.8%), lateral epicondyle (17.8%) and medial epicondyle (15.5%).In carriers of thoracospinal DISH significantly more hyperostotic spurs were present at the lateral and medial epicondyle compared to non-DISH carriers (OR 4.01 [95% CI 1.35-12.34] and 2.88 [1.03-8.24], respectively).Mechanical factors such as physical activities and handedness, and sex influenced the formation of these spurs.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland. christine.beyeler@iml.unibe.ch.

ABSTRACT

Background: Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis (DISH) have been described previously. We aimed to assess the prevalence of elbow hyperostotic spurs, to search for sites discriminating for elbow DISH and to analyze the effect of physical activities, handedness and sex.

Methods: Out of 284 patients hospitalized for extraskeletal disorders, 85 patients (33 with and 52 without thoracospinal DISH) agreed to bilateral elbow X-rays in two projections. Clinical information was collected by a standardized questionnaire and X-rays were graded blindly.

Results: A total of 400 hyperostotic spurs (210 unilateral, 95 bilateral) were present at 11 predefined sites. The most frequent sites affected were the olecranon (20.8%), lateral epicondyle (17.8%) and medial epicondyle (15.5%). In carriers of thoracospinal DISH significantly more hyperostotic spurs were present at the lateral and medial epicondyle compared to non-DISH carriers (OR 4.01 [95% CI 1.35-12.34] and 2.88 [1.03-8.24], respectively). The olecranon, lateral and medial epicondyle contributed significantly to the classification of elbow DISH (OR 22.2 [4.1-144.7], 9.6 [1.9-61.2] and 10.1 [2.2-52.1], respectively). The prevalence of elbow hyperostotic spurs was higher in 45 patients with a history of heavy physical activities (24.4% versus 18.0%, OR 1.48 [1.17-1.86]), at the right elbow (24.2% versus 18.6%, OR 1.39 [1.11-1.75]) and in 62 males (22.8% versus 17.6%, OR 1.38 [1.06-1.81]).

Conclusions: Hyperostotic spurs at the olecranon, lateral and medial epicondyle had the highest prevalence and disclosed the most pronounced discrimination for elbow DISH. Mechanical factors such as physical activities and handedness, and sex influenced the formation of these spurs.

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Frequency distribution of the 400 hyperostotic spurs detected at all localizations of both elbows, irrespective of thoracospinal and elbow grading, in 85 patients hospitalized for disorders not related to the locomotor system
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Fig1: Frequency distribution of the 400 hyperostotic spurs detected at all localizations of both elbows, irrespective of thoracospinal and elbow grading, in 85 patients hospitalized for disorders not related to the locomotor system

Mentions: Radiological classification revealed thoracospinal DISH to be present in 33 (38.8 %), absent in 52 (61.2 %); elbow hyperostosis present in 57 (67.1 %), absent in 28 (32.9 %); elbow DISH (defined by the features of both thoracospinal and elbow hyperostosis) present in 27 (31.8 %) and absent in 22 (25.9 %) patients. Detailed investigation of 11 predefined localizations of both elbows showed 210 unilateral and 95 bilateral hyperostotic spurs resulting in a total of 400 out of 1870 (21.3 %) possible hyperostotic spurs. Frequency distribution of these documented hyperostotic spurs is illustrated in Fig. 1. Prevalence at specified sites was as follows: olecranon 48.8 % (83 out of 170 possible spurs), lateral epicondyle 41.8 %, medial epicondyle 36.5 %, coronoid process 23.5 %, coronoid fossa 17.6 %, radial head 14.7 %, radial tuberosity 13.5 %, olecranon other localization 12.9 %, olecranon fossa 7.6 % and radius other localization 7.1 %, respectively.Fig. 1


Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a controlled radiological study.

Beyeler C, Thomann SR, Gerber NJ, Kunze C, Aeberli D - BMC Musculoskelet Disord (2015)

Frequency distribution of the 400 hyperostotic spurs detected at all localizations of both elbows, irrespective of thoracospinal and elbow grading, in 85 patients hospitalized for disorders not related to the locomotor system
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4493825&req=5

Fig1: Frequency distribution of the 400 hyperostotic spurs detected at all localizations of both elbows, irrespective of thoracospinal and elbow grading, in 85 patients hospitalized for disorders not related to the locomotor system
Mentions: Radiological classification revealed thoracospinal DISH to be present in 33 (38.8 %), absent in 52 (61.2 %); elbow hyperostosis present in 57 (67.1 %), absent in 28 (32.9 %); elbow DISH (defined by the features of both thoracospinal and elbow hyperostosis) present in 27 (31.8 %) and absent in 22 (25.9 %) patients. Detailed investigation of 11 predefined localizations of both elbows showed 210 unilateral and 95 bilateral hyperostotic spurs resulting in a total of 400 out of 1870 (21.3 %) possible hyperostotic spurs. Frequency distribution of these documented hyperostotic spurs is illustrated in Fig. 1. Prevalence at specified sites was as follows: olecranon 48.8 % (83 out of 170 possible spurs), lateral epicondyle 41.8 %, medial epicondyle 36.5 %, coronoid process 23.5 %, coronoid fossa 17.6 %, radial head 14.7 %, radial tuberosity 13.5 %, olecranon other localization 12.9 %, olecranon fossa 7.6 % and radius other localization 7.1 %, respectively.Fig. 1

Bottom Line: The most frequent sites affected were the olecranon (20.8%), lateral epicondyle (17.8%) and medial epicondyle (15.5%).In carriers of thoracospinal DISH significantly more hyperostotic spurs were present at the lateral and medial epicondyle compared to non-DISH carriers (OR 4.01 [95% CI 1.35-12.34] and 2.88 [1.03-8.24], respectively).Mechanical factors such as physical activities and handedness, and sex influenced the formation of these spurs.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Immunology and Allergology, University Hospital, 3010, Bern, Switzerland. christine.beyeler@iml.unibe.ch.

ABSTRACT

Background: Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis (DISH) have been described previously. We aimed to assess the prevalence of elbow hyperostotic spurs, to search for sites discriminating for elbow DISH and to analyze the effect of physical activities, handedness and sex.

Methods: Out of 284 patients hospitalized for extraskeletal disorders, 85 patients (33 with and 52 without thoracospinal DISH) agreed to bilateral elbow X-rays in two projections. Clinical information was collected by a standardized questionnaire and X-rays were graded blindly.

Results: A total of 400 hyperostotic spurs (210 unilateral, 95 bilateral) were present at 11 predefined sites. The most frequent sites affected were the olecranon (20.8%), lateral epicondyle (17.8%) and medial epicondyle (15.5%). In carriers of thoracospinal DISH significantly more hyperostotic spurs were present at the lateral and medial epicondyle compared to non-DISH carriers (OR 4.01 [95% CI 1.35-12.34] and 2.88 [1.03-8.24], respectively). The olecranon, lateral and medial epicondyle contributed significantly to the classification of elbow DISH (OR 22.2 [4.1-144.7], 9.6 [1.9-61.2] and 10.1 [2.2-52.1], respectively). The prevalence of elbow hyperostotic spurs was higher in 45 patients with a history of heavy physical activities (24.4% versus 18.0%, OR 1.48 [1.17-1.86]), at the right elbow (24.2% versus 18.6%, OR 1.39 [1.11-1.75]) and in 62 males (22.8% versus 17.6%, OR 1.38 [1.06-1.81]).

Conclusions: Hyperostotic spurs at the olecranon, lateral and medial epicondyle had the highest prevalence and disclosed the most pronounced discrimination for elbow DISH. Mechanical factors such as physical activities and handedness, and sex influenced the formation of these spurs.

Show MeSH
Related in: MedlinePlus