Elbow Flashcards
Content: differential diagnosis - Overuse (2)
- Epicondylitis
- Little Leaguer’s elbow
Q: What is another name for lateral epicondylitis?
tennis elbow
Q: What are the key points of pt. education for lateral epicondylitis? (4)
- avoid MOI
- Elbow and wrist extended and pronated
- Hit infront of body so core can contribute
- 2 handed back stroke
Q: What is another name for medial epicondylitis?
Golfer’s or thrower’s elbow
Q: One function of the elbow is transmission of ________ from the shoulder to the ______.
power, hand
Content: Proximal radioulnar pronation roll and glide
R = anterior
G = posterior/dorsal
Content: Clinical syndromes based on location of symptoms - medial (4)
- Medial epicondylitis
- MCL/UCL injury
- Ulnar neuritis
- Fracture
Defn: Medial epicondylitis
Inflammation in the origin of the flexor carpi radialis and pronator teres (interface between these muscles)
Q: Describe the arthrokinematics for elbow extension
The ulna slides posteriorly, proximally, and medially while the radial head glides posteriorly
Defn: epicondylitis
Inflammation of one of the epicondyles, which includes both the periosteum and the tendons
Q: What is the MOI of little leaguer’s elbow?
Excessive valgus stress and hyperextension and overuse
Ex. High pitch volume, early use of curve ball/slider, poor biomechanics, lack of necessary conditioning
Defn: Stage 1 Lateral epicondylitis
Inflammation without alteration in the tendons
Diagram: Identify the test
Cozen’s test
Content: Proximal radioulnar supination roll and glide
R = posterior
G = anterior/volar
Q: What are the typical symptoms of medial epicondylitis?
- medial elbow pain
- pain with wrist flexion and pronation
Content: Radiohumeral joint - Resting position, close packed position, CPR
RP = full extension and supination
CPP = elbow flexed 90, supinated 5
CPR = flexion > extension > supination > pronation
Diagram: Identify the ligaments (2)
L - Annular ligament
R - Ulnar collateral ligament
Q: Describe the arthrokinematics for distral radioulnar joint pronation
radial head glides volarly
Content: Proximal radioulnar joint - Resting position, close packed position, CPR
RP = 70 elbow flexion, 35 supination
CPP = 5 supination
CPR = supination/pronation
T/F: The modalities for medial and lateral epicondylitis are different.
False, the same
Q: What manual therapy is useful for medial epicondylitis?
Deep transverse massage and lateral glides
Term: Increase of cubital angle
Ulnar palsy
Content: Clinical syndromes based on location of symptoms - anterior (4)
- Anterior capsular strain
- Biceps rupture
- Elbow dislocation
- Pronator syndrome
Q: Describe the arthrokinematics for proximal radioulnar supination
Radial head glides anteriorly
Defn: Lateral epicondylitis
Inflammation in the origin of the extensor carpi radialis brevis and extensor carpi radialis longus
Content: Clinical syndromes based on location of symptoms - posterior (3)
- Olecranon bursitis
- Olecranon process
- Stress fracture, triceps tendinitis
Q: What 3 modalities are used for lateral epicondylitis?
- Ice
- Ultrasound
- Iontoforesis
T/F: There are more cases of medial epicondylitis than lateral epicondylitis.
False, flip it
Q: What education does the pt. need regarding medial epicondylitis?
Rest and modify activities
Defn: Stage 4 Lateral epicondylitis
Characteristics ofthe stage 2 and 3 plus fibrosis, soft matrix calcifications, and faint calcifications along the epicondylar margins
Q: What position during a tennis stroke can help prevent lateral epicondylitis?
Pronation with the wrist locked
Q: What is the carrying (cubital) angle in men and women?
M = 11-14
W = 13-16
Defn: Stage 2 Lateral epicondylitis
Associated with pathological changes in the tendon (tendinosis) and angiofibroblastic degeneration
Content: Little leaguer’s elbow - variety of injuries in the elbow of young pitchers (6)
- Osteochondritis dissecans of the capitulum or radial head
- growth plate fractures
- apophysitis or fracture of the medical epicondyle
- ulnar CL tear
- Anterior capulsar injury
- Olecranon trauma
Content: Differential diagnosis - Trauma (3)
- FOOSH
- Fall on tip of elbow/olecranon
- Ligament injury
Q: Describe the arthrokinematics for distal radioulnar supination
Radial head glides dorsally
Content: Ulnohumeral joint - Resting position, close packed position, CPR
RP = 70 elbow flexion, 10 supination
CPP = Extension with supination
CPR = flexion > extension
Content: Forearm valgus roll and glide
R = lateral
G = medial
Q: How do braces for lateral epicondylitis work?
“They take the force away from the tendon”
Q: Describe the arthrokinematics for elbow flexion.
The ulna slides anteriorly, distally, and lateraly while the radial head slides anteriorly
Content: Humeroradial flexion roll and glide
R = anterior
G = anterier
Defn: Stage 3 Lateral epicondylitis
Pathological changes in the tendon and rupture
Q: What manual therapy can be used for lateral epicondylitis? (2)
- Deep transverse friction with Mill’s manipulation
- Radial head and cervical mobilizations
Q: What are 2 special tests for medial epicondylitis?
- Resisted wrist flexion
- Passive stretch of elbow and wrist extension
Diagram: Fill in the differential diagnosis table
- Cervical spondylosis
- Radial tunnel syndrome
- PIN compression
- Intra-articular loose bodies
- Tumors
- Avascular necrosis
- Osteochondritis dessicans
Q; What is the conservative treatment for lateral epicondylitis?
Corticosteroid injection
T/F: The finger extension speacial test was originally used for nerve impingement and later applied to lateral epicondylitis.
True
Q: Describe the arthrokinematics for proximal radioulnar pronation
Radial head glides posteriorly
Content: Clinical syndromes based on location of symptoms - lateral (6)
- Lateral epicondylitis
- LCL/RCL injury
- Capitulum fracture
- Osteocondral degenerative
- Osteocondritis dissecans
- Radial head fracture
Content: Distal radioulnar supination roll and glide
R = posterior
G = posterior
Content: Distal radioulnar pronation roll and glide
R = anterior
G = anterior
Q: What modalities are appropriate for little leaguer’s elbow?
Ice and hot packs
Content: 3 special tests for lateral epicondylitis
- Finger extension
- Cozen’s test
- Mill’s test
Q: What are the symptoms of little leaguer’s elbow?
Pain in the medial aspect of the elbow with edema
Q: What TherEx is useful for medial epicondylitis? (3)
- Stretch
- Strengthen
- Eccentric muscle training
Content: Humeroradial extension roll and glide
R = posterior
G = posterior
Content: Forearm varus roll and glide
R = medial
G = lateral
Q: What are the typical symptoms of lateral epicondylitis? (3)
- Insidious onset of lateral elbow pain
- Pain with wrist extension
- Weakened grip strength
Content: Humeroulnar extension roll and glide
R = posterior
G = proximal/posterior
Q: What is the “Chair Test” for lateral epicondylitis?
Lifting a chair with pronated hand (positive is probably pain)
Q: What amount of hyper extension is available at the elbow?
10-15
Content: Humeroulnar flexion roll and glide
R = anterior
G = distal/anterior
Q: What is the MOI for lateral epicondylitis? (2)
- Over use - repetitive grasping with wrist extension
- Trauma
Q: What education is necessary for little leaguer’s elbow?
No throwing for 4-6 wks and biomechanical analysis is recommended
Diagram: Identify the test
Mill’s test
Q: What is the profile of individual who get epicondylitis?
35-50 yos and young athletes
Diagram: Identify the ligament
Radial collateral ligament
