Elbow

Question 1

List the stabilising factors of the elbow joint

Answer 1

Static: Coronoid process, radial head, olecranon
Dynamic: muscles around the elbow joint

Question 2

Describe the normal range of motion of the elbow joint

Answer 2

Elbow flexion 0-145 degrees

Supination 0-180 degrees

Question 3

Define lateral epicondylitis

Answer 3

Pain in the region of the lateral epicondyle, which is exacerbated by active and resisted movements of the extensor muscles of the forearm.

Question 4

Explain the pathology of lateral epicondylitis

Answer 4

Microtrauma to the insertion of the forearm extensor muscles, as a result of repetitive extensive of the wrist and grip-intensive activities.

Question 5

What differential diagnoses should be excluded in suspected lateral epicondylitis

Answer 5

Referred pain from the cervical spine
Osteoarthritis of the elbow
Radial tunnel syndrome: compression of the posterior interosseous nerve

Question 6

What test can be used to diagnose lateral epicondylitis?

Answer 6

Maudsley’s test: pain in region of lateral epicondyle during resisted extension of the middle finger.

Question 7

Describe the initial treatment options for lateral or medial epicondylitis

Answer 7

Activity modification

Analgesia: NSAIDs, paracetamol +/- codeine

Question 8

Discuss the further treatment options for lateral or medial epicondylitis

Answer 8

Corticosteroid injection
Referral to physiotherapy
Wrist splints and straps

Extracorporeal shock wave therapy
Platelet-rich plasma

Surgical: debridement with tendon repair or release

Question 9

Define medial epicondylitis

Answer 9

Pain in the region of the medial epicondyle, which is exacerbated by active and resisted movements of the flexor muscles of the forearm.

Question 10

Explain the pathology of medical epicondylitis

Answer 10

Microtrauma to the insertion of pronator teres and the forearm flexor muscles, as a result of repetitive flexion of the wrist and grip-intensive activities.

Question 11

What test can be used to diagnose medial epicondylitis?

Answer 11

Golfer’s elbow test: pain around medial epicondyle on supination and extension of the wrist and elbow.

Question 12

What is cubital tunnel syndrome?

Answer 12

Ulnar neuropathy due to compression of the ulnar nerve as it travels within the cubital tunnel.

Question 13

Outline the borders of the cubital tunnel

Answer 13

Medial: medial epicondyle of the humerus
Lateral: olecranon process of the ulna
Roof: epicondylo-olecranon ligament

Question 14

Describe the clinical findings of cubital tunnel syndrome

Answer 14

Weakness
Impaired grip strength
Tenderness over cubital tunnel
Tinel's sign
Numbness of medial side of hand

Question 15

What initial treatment options exist for cubital tunnel syndrome?

Answer 15

Activity monitoring
Extension splinting at night
NSAIDs
Vitamin B6