Elbow

Question 1

Carpal tunnel

Answer 1

SSX
Pn weakness pins and needles on palm surface (first 3.5 digits- pinkie normal)

Positive tines sign over carpel tunnel
Positive phalen and rev phalen test
Positive carpel tunnel compression test
Normal AROM PROM
Weak resisted wrist flexion and radial deviation

TX
Avoid provocation
Splint, steroids, padding
Stretching and strengthening of wrist flexors extensors
Ball squeeze

Question 2

Cubital tunnel (ulnar nerve)

Answer 2

SSX
Pn, numbness, tingling in 4th and 5th finger, weak grip
Positive tinel over funny bone
Positive elbow flexion test
Positive ULTT ulnar bias
Pn elbow flexion end range AROM And PROM
Weak pinkie addiction RROM

TX
A-ok neural flossing
Hand squeezes
Stretch forearm extensors

Question 3

Lateral / medial epicondylitis

Answer 3

SYMPTOMS
lateral - pn at lateral elbow , pn w repetitive forearm task or gripping (tennis)
Medial - pn at medial elbow, pn elbow flexion and pronation // hard to grip

SIGNS
Lateral- POS lateral epicondylitis test, cozen, resisted third finger, pn RROM supination
Medial -POS medial epicondylitis test, reverse cozen, reduced AROM and RROM

TX
3x 10-15 eccentric for 6 weeks
Isometrics, db or pole rotations

Question 4

Triceps bracii rupture

Answer 4

MOI
FOOSH, trauma
“Pop”, partial rupture more painful
SIGNS
Some AROM if partial Tear
Positive veigus test
Unable to extend elbow against gravity

TX
Police, 90 degree sling, week 1-6 immobile, week 6-12 ROM, week 12+ RROM, elb extension

Post op:
From week 0 to 6, adjustable elbow splint at 20 degrees, increase each week by 10 degrees,
Week 6-12 active elbow extension
Week 12+ RROM elbow extension

Question 5

Biceps bracii rupture

Answer 5

Moi - trauma
Proximal: tear pop in shoulder, swelling, bruising
Distal: pn, reverse Popeyes sign, sudden eccentric load w elbow at 90 degrees flexion

SIGNS
Proximal- AROM PROM pn shoulder flexion
RROM: weak elbow flexion and supination
Pos speeds, biceps load, biceps tension

Distal - pos hook test
AROM pn elbow flexion and supination, reduced strength

TX
Proximal : acute immobilisation elbow splint at 90 degrees, after 4-5 weeks strength exercises including shoulder flexion, abduction and IR ER
RTS after 2-3 months

DISTAL
Acute as per primi al
Supination w elbow in flexion (brachial is)
And elbow in extension (supinations)

Question 6

LCL/MCL sprain

Answer 6

MOI - baseball or tennis or trauma
SSX
Pn lateral or medial elbow “pop”
Pos valg and varus stress test , swelling, pins and needles along ulnar distribution

TX
NSAID
strength once pain reduces
Initially: forearm flexors
Second: strength above and below joint, scap stabilisers and core
Avoid throw and valgus /varus stress for 6 weeks