A 77-year-old, right-handed female was referred to us with right elbow pain that began a few years ago. She had a restricted range of motion with 60° of supination and 30° of pronation with painful crepitus of her right elbow during forearm rotation. She had a full range of motion, with 145° of flexion and 0° of extension. Tenderness existed on the tuberosity of the radius without redness, swelling, muscle atrophy, or neurological deficits. Blood test results were within normal limits. She had no history of trauma or disease. Radiographs of the elbow showed an irregular prominence of the bicipital tuberosity of the radius (Fig. 1). CT scan also showed this irregular prominence of the bicipital tuberosity of the radius, as well as narrowing between the bicipital tuberosity and the ulna.
First, conservative treatment was tried, with daily activity instruction and oral medication nonsteroidal anti-inflammatory drugs for three months. The conservative treatment was not effective and the patient desired the operation. A skin incision was made on the anterior site of the proximal forearm. The bicipital tuberosity of the radius was exposed between the ulnar side of the brachioradialis muscle and the radial side of the biceps tendon (Fig. 2). The irregular prominence was excised from the base of the bicipital tuberosity. Intraoperative CT scan was performed using 3D Accuitomo M (Morita Co. Ltd., Kyoto, Japan), and the shape of the bicipital tuberosity was confirmed. Because the resected volume was not large enough to decrease the prominence, we also excised the remaining part of the irregular prominence. We confirmed the improvement of the range of motion of supination and pronation. After the irrigation, the superficial fascia and skin was sutured. Postoperatively, immobilization with a long arm cast was undertaken for two weeks. Sutures were removed two weeks after the operation. After removal of the cast, gentle active range of motion was started.
At the latest follow-up one year after the operation, the patient had no pain and no motor weakness or limitation in forearm rotation (Fig. 3). CT scan showed no abnormal prominence of the bicipital tuberosity of the radius.