Elbow

Question 1

Extra screening qns for the elbow

Answer 1

• Handedness
• Clicking/ clunking
• Activities involving;
• Wrist ext
• Wt bearing ie leaning through hand/ elbow
• Grip
• Lifting
• Carrying

Question 2

Extensor tendinopathy (lateral) SE

Answer 2

• AREA:1-2cm below origin of ECRB, +/- radiating down forearm (mid- substance) or insertional (on CEO)
• Agg: gripping activities especially with load, activities with arm pronated & extended (hammer, computer etc)
• Ease: rest, splint, NSAID’s
• Hx : Insidious usually with new activity (rarely – trauma), repetitive activity
• SQs: steroid injection?
• Contributing: faulty technique, age 30+

Question 3

Extensor tendinopathy OE

Answer 3

• AROM: NAD unless acute
• PROM: pain with elbow E/PRON + wrist F/UD
• Special tests: Mill’s test +ve (same as above)
• Pass acc glides: NAD
• RSC: painful wrist E with EE (especially 3rd MC) (try to localise to specific tendon)
• Palp: tender 1-2cm distal to epicondyle or at insertion

Question 4

Extensor tendinopathy Management

Answer 4

• EPAs
• Deep tissue frictions & Myofascial release
• Stretches
• Strengthening – eccentric (eg. Lowering a hammer – supinator muscle; if
quickly lower its pronator)
• Activity modification
• Bracing/taping

Question 5

Lateral epicondylitis VS extensor tendinopathy

Answer 5

• Similar presentation although p/ tenderness is directly on the insertion of the CEO onto the lateral epicondyle
• Presentation is more inflammatory and therefore Rx is anti-inflammatory ie EPAs, RICE, modified use, NSAIDs

Question 6

PIN Entrapment SE

Answer 6

• Hx: gradual onset/ overuse
• Area: local tenderness +/- post forearm
• Nature: ache
• Agg: twisting action (pronation/supination)
• SHx: work/ sport contributing factors?

Question 7

What can PIN be irritated by and what does it supply?

Answer 7

• PIN passes through supinator in arcade of frohse and supplies ECRB and supinator
• Can be irritated by ECRB or supinator
• Supplies all extrinsic wrist, finger and thumb extensors except ECRL

Question 8

PIN entrapment OE

Answer 8

• AROM: supination - painful
• PROM: EOR pronation – painful +
• RSC: ECRB, sup, wrist E – painful+
• MMT: +/- weakness of wrist, thumb & finger Es if severe
• ULTT 2b: +ve; posterior interosseus nerve and brachial nerve come out of
brachial plexus and pass through shoulder and arm so if you move structures in neck and shoulder will cause inc symptoms as tractioning from nerve up where it originate
• Neurological: Sensation - normal ; Power: may have weakness

Question 9

PIN entrapment management

Answer 9

• Neural mobilising techniques
• Local treatment to CE tendon or supinator (treat tightness so less
compression on nerve)
• EPAs
• DTF and myofascial massage
• Eccentric exercises
• Bracing / strapping

Question 10

Other sources of lateral elbow pain

Answer 10

• Strain of lateral lgt
• Synovitis of RH joint
• RH bursitis
• Osteochondritis dissecans
• C6 Nerve Root
• Referral from Cx spine