Elbow

Question 1

Pathogenesis of Common Extensor Tendinopathy

Answer 1

ECRB is placed at high levels of mechanical stress as a result of shearing of the tendon during wrist flexion/extension activities, and compression against the rotating radial head during pronation/supination

Question 2

Pathophysiology of tendinopathy

Answer 2

1. Tenocyte alterations
2. collagen disorganisation (and microtears)
3. proteoglycan changes
4. neovascularisation

Question 3

Subjective features of Common Extensor Tendinopathy

Answer 3

Well localised lateral elbow pain
possible referral into the forearm
‘aching’

history associated with acute or chronic spike in workload

Question 4

Management of Common Extensor Tendinopathy

Answer 4

1. clarify diagnosis
   - educate patient about tendinopathy
   - X-ray if suspected trauma
2. reduce pain and promote healing
   - recovery = 16 weeks
   - taping: diamond de load
3. rectify impairments
   - increase wrist ext. strength
   - increase upper quadrant strength
   - pain-free grip isometric exercise
4. restore function dependant on patient goals

Question 5

Subjective features of common flexor tendinopathy

Answer 5

medial elbow pain
symptoms associated with flexion/pronation
possible referral into forearm

Question 6

Clinical features of common flexor tendinopathy

Answer 6

pronator teres +ve
wrist/finger flexors +ve
differentiate median nerve
weakened grip strength

Question 7

Management of common flexor tendinopathy (main impairments)

Answer 7

strengthen wrist flexors and pronators

Question 8

Pathogenesis of medial nerve entrapment

Answer 8

compression of median nerve as it passes through the 2 heads of pronator teres

Question 9

Subjective features of median nerve entrapment

Answer 9

neurogenic pain in the median nerve

anteromedial forearm and palmar lateral pain

Question 10

Diagnostic features of median nerve entrapment

Answer 10

median nerve palpation +ve
common flexor tendinopathy -ve

sensitised pronator teres

Median nerve test +ve

possible motor loss: FCR, PL, FDS, FPL, FDP (lateral 1/2), PQ, thenar eminence

possible MN sensory loss

Question 11

Pathogenesis of Radial Nerve entrapment (PIN syndrome)

Answer 11

posterior interosseous nerve becomes entrapped between the 2 heads of supinator, within the arcade of Frohse

Question 12

Subjective features of Radial Nerve entrapment (PIN syndrome)

Answer 12

pain in the course of the posterior interosseous nerve (PIN) - anterolateral forearm

reduced wrist extensor strength - gripping, writing etc.

Question 13

Diagnostic features of Radial Nerve entrapment (PIN syndrome)

Answer 13

palpation of radial nerve +ve
supinator sensitised

+ve radial nerve tests

NO SENSORY LOSS

possible motor loss of ext compartment: ECRB, ED, EPL, EPB, APL, ECU, EI, EDM

Question 14

Clinical Observations of elbow trauma

Answer 14

Obvious deformity/dislocation -> send to ED
swelling
bruising
Lack of ROM

?? neurovascular supply compromised

Question 15

Elbow trauma: 1st phase rehab (<2 weeks acute)

Answer 15

• early mobilisation
• elbow ROM whilst in sling
  
  • passive -> AAROM -> AROM
  • move with available range

Question 16

Elbow trauma: 2nd phase rehab (>2 weeks acute)

Answer 16

check ligaments - valgus and varus tests

passive ROM: flex/ext, sup/pron

once passive range ok -> active-assisted ROM
- broomstick flex/ext

Light use only - no driving yet

Question 17

Elbow trauma: 3rd phase rehab (4-6 weeks acute)

Answer 17

• full range and good function
• reload appropriate ADLs and functional goals
• should be able to load enough to drive
• articular exam! active and passive should be equal

Question 18

What is the MOI of a triceps rupture?

Answer 18

lengthened/active contraction - arm in flexed position

Question 19

What is the MOI of biceps rupture?

Answer 19

catching something heavy quickly

Question 20

How to assess biceps rupture?

Answer 20

pop-eye sign
biceps hook
supination (not flexion as brachialis can act)

Question 21

Clinical features of extensor tendinopathy

Answer 21

palpation of CET +ve
NCS of cervicothoracic spine 
isometric testing of ECRB +ve
cozens
mills
pain-free grip strength
resisted 2nd and 3rd finger ext 

AROM painful at end range pron/sup and ext

weakness of wrist ext
weakness throughout upper quad
weakness of grip strength