Clinical Reasoning in Mx and Tx of Elbow Flashcards
What are the steps of the healing process?
- Minimise pan, swelling, inflammation, haemorrhage to offer the best possible condition for healing.
- protection of DAMAGED tissue
- with collagen maturation and remodelling initiated controlled mobilisation
- loading of the tissue.
What would be expected during glides of dislocated elbow?
stiffness, hypermobile or reactive - hard bony) or firm (myofascial) end feel an asymmetry between sides
What are treatments for dislocations
Active mobilisations - MWM Passive Mobilisation Stretches - contract-relax, hold-relax PNF techniques Re-educate motor control strategies
S&S Medial epicondyle #
Sudden pop during a throw followed by pain.
Point tenderness over medial epicondyle
Although # usually acute traumatic event, medial epicondyle avulsion # is frequently preceded by a Hx of medial ebow pin.
May have weakness with throw
What would be treatment of medial epicondyle #
Stable - conservative (early active, active/assisted ROM exercises)
Unstable- ORIFfollowed by early movement if deemed stable post-op
How to restore joi8nt ROM ?
Early/active assisted flex/ext
Supination/pro several times per day, initiated 2-7 days pot reduction for dislocations
Forearm neutral Active sup/pro for early post # - if stable, as early as day 2. Can come ou of splint for exercises - the progresses to PROM and stretching
PROM/mobs 2 wees ost reduction, not aggressive or stretching, particularly in combined #/dislocation
NO stretching in early phases
What are the types of exercises to restore strength and endurance?
Isometric, Isotonic, Open/Closed
How can isometric exercises be used to restore strength and endurance?
Through multiple angles
Beginning with symptom-limited sub-mximal contractions. Slow onset and offset of contraction
What will occur with a sudden contraction with fastbuild up in tension in presence of effusion cause?
pain
How can isotonic exercises help to restore strength and endurance
submaximal, avoid symptom reproduction.
approx. 2-3 sets, 10-15 reps daily - promote endurance yet avoid overloading injured tissue.
Start no weight- slowly progress 0.5-1 khg increments
When are open and closed chain exercises?
Closed - more control
Open -need to be done for functional rehab
When does restoration of flexibility begin?
Only after strengthening is well under way -minimise stretch overload of healing tissue
What are different ways to restore flexibility?
Static stretch
Active stretching/PNF
mwm
How is general conditioning used in rehab?
Initiate ASAP
Avoid stress/protect injured area
Return to sport activities
e.g incorporate balls/racquet/any pieces of equipment early
What are some long term problems of acute traumatic elbow injuries?
Loss of ROM (especially ext - linked to duration of immobilisation
Loss of strength Recurrent instability Heterotopic ossifation Neurovascular compromise Chronic pain syndrome
What is the treatment for medial elbow instability?
Very little high quality literature reporting optimal conservative management.
- rest/splinting to protect from valgus stress
- Limit ext ROM
- avoid PROM
- Exercise
- Restoration of elbow/wrist flexor/ extensor synergies
AVOID activities that promote valgus stress
Exercises for medial instablity
pain free ROM (avoidingvalgus stress)
Proprioception
Strength
Endurance
Sport specific activities
Isometric-isotonic-proprioceptive-plyometric
If conservative management fails - surgery.
Among whom is ulnar nerve injury common in?
30-60 yrs
What is treatment for ulnar nerve injury?
Avoid sustained elbow flexion (don’t lean on elbow)
-splinting may help
Avoid repetitive elbow flexion and pronation
Avoid vibratory tols
Vitamin B6
Improve flexibility of forearm/wrist flexors and pronators
Surgical intervention if conservative management fails
Signs of flexor tendinopathy
- pain over medal epicondyle.
Aggravating factors:
- resisted wrist flex and ulnar deviation
- resisted pronation
- passive elbow and wrist extension in supination
Treatment for flexor tendinopathy?
Conservative management of acute symptoms effective in majority of patients.
- Counterforce brace
- Address technique/equipment/biomechanical faults
- If fails, surgical intervention
Treatment for displaced and non-displaced osteochondritis dissecans?
Limit number of throws - max 80/week
Non-displaced:
No throwing until symptom gone and full ROM restored.
Displaced:
- rest
- arthroscopic debridement
What makes for a poorer prognosis in osteochondritis dessicans?
displaced, older patient, large lesion, lesion on weight bearing area.
Treatment for radial nerve injury?
No evidence any particular treatment better than natural history,particlarly surgery.
Rest, Treat S&S
