Elbow Flashcards
Pathogenesis of Common Extensor Tendinopathy
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
Pathophysiology of tendinopathy
- Tenocyte alterations
- collagen disorganisation (and microtears)
- proteoglycan changes
- neovascularisation
Subjective features of Common Extensor Tendinopathy
Well localised lateral elbow pain
possible referral into the forearm
‘aching’
history associated with acute or chronic spike in workload
Management of Common Extensor Tendinopathy
- clarify diagnosis
- educate patient about tendinopathy
- X-ray if suspected trauma - reduce pain and promote healing
- recovery = 16 weeks
- taping: diamond de load - rectify impairments
- increase wrist ext. strength
- increase upper quadrant strength
- pain-free grip isometric exercise - restore function dependant on patient goals
Subjective features of common flexor tendinopathy
medial elbow pain
symptoms associated with flexion/pronation
possible referral into forearm
Clinical features of common flexor tendinopathy
pronator teres +ve
wrist/finger flexors +ve
differentiate median nerve
weakened grip strength
Management of common flexor tendinopathy (main impairments)
strengthen wrist flexors and pronators
Pathogenesis of medial nerve entrapment
compression of median nerve as it passes through the 2 heads of pronator teres
Subjective features of median nerve entrapment
neurogenic pain in the median nerve
anteromedial forearm and palmar lateral pain
Diagnostic features of median nerve entrapment
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
Pathogenesis of Radial Nerve entrapment (PIN syndrome)
posterior interosseous nerve becomes entrapped between the 2 heads of supinator, within the arcade of Frohse
Subjective features of Radial Nerve entrapment (PIN syndrome)
pain in the course of the posterior interosseous nerve (PIN) - anterolateral forearm
reduced wrist extensor strength - gripping, writing etc.
Diagnostic features of Radial Nerve entrapment (PIN syndrome)
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
Clinical Observations of elbow trauma
Obvious deformity/dislocation -> send to ED
swelling
bruising
Lack of ROM
?? neurovascular supply compromised
Elbow trauma: 1st phase rehab (<2 weeks acute)
- early mobilisation
- elbow ROM whilst in sling
- passive -> AAROM -> AROM
- move with available range
Elbow trauma: 2nd phase rehab (>2 weeks acute)
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
Elbow trauma: 3rd phase rehab (4-6 weeks acute)
- 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
What is the MOI of a triceps rupture?
lengthened/active contraction - arm in flexed position
What is the MOI of biceps rupture?
catching something heavy quickly
How to assess biceps rupture?
pop-eye sign
biceps hook
supination (not flexion as brachialis can act)
Clinical features of extensor tendinopathy
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
