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© 1992 British Society for Rheumatology

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DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH) OF THE ELBOW: A CAUSE OF ELBOW PAIN? A CONTROLLED STUDY

CH. BEYELER*,, P. SCHLAPBACH*, N. J. GERBER*, H. FAHRER*, F. HASLER*, S. M. VAN DER LINDEN*, U. BÜRGI{dagger}, W. A. FUCHS{ddagger} and H. EHRENGRUBER§

*Department of Rheumatology, University of Berne Inselspital, CH-3010 Berne, Switzerland
{dagger}Department of Internal Medicine, University of Berne Inselspital, CH-3010 Berne, Switzerland
{ddagger}Department of Radiology, University of Berne Inselspital, CH-3010 Berne, Switzerland
§Department of Data Processing, University of Berne Inselspital, CH-3010 Berne, Switzerland

Correspondence to: Correspondence to Dr Ch. Beyeler, Department of Rheumatology, University of Berne, Inselspital, CH-3010 Berne, Switzerland

Elbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, X2 = 5.32, P<0.025, n = 85, odds ratio (OR) 3.30 (95% Cl 1.16–9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, x2 = 4.51, P<0.05, n = 84, OR = 3.20 (95% CI 1.06–9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent in cases with elbow hyperostosis compared to controls (21% versus l3%, x2 = 0.75, NS, OR = 1.84 (95% CI 0.46–7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

KEY WORDS: Hyperostosis, Spinal osteophytosis, Elbow, Pain


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