Elbow and FA- Abd Elb thru Med Apophysitis Flashcards
What causes an abducted elbow?
Trauma with FOOSH
What are the pathomechanics of an abducted elbow?
Leads to medially fixated olecranon
What will we find in our scan with an abducted elbow?
- increased carrying angle
- ROM limitations with pain
What ROM limitations will we find with an abducted elbow?
- Elbow flexion and forearm supination due to lack of lateral ulnar glide
- Wrist flexion and radial deviation due to radius shifting distally from contact with capitulum
What will we find with resisted testing/MMT for an abducted elbow?
Wrist extension and radial deviation painful
What would be our findings with the biomechanical exam of an abducted elbow?
Accessory motion - limited lateral glide
Palpation - CET TTP
What is the rx for an abducted elbow?
- POLICED
- Correct lateral glide, possibly with manipulation
- Stabilization with MET
Will there be a protective/inflammatory stage with an abducted elbow?
YES - bc trauma
What is the cause of a radial nerve entrapment?
Overuse/repetitive stress/trauma
What is the prevalence of radial nerve entrapment?
Rare
What are the 3 names of where a radial nerve entrapment can happen?
- Radial tunnel syndrome
- Posterior Interosseous Nerve Compession Syndorme
- Wartenberg Syndrome
What is radial nerve entrapment often confused with?
Lateral elbow tendinopathy - BUT presentation is different
What is the course of the radial nerve?
- Off posterior cord from brachial plexus
- passes inferior to teres major
- posterior to brachial artery in posterior arm
- travels just anterior to lateral epicondyle before entering posterior forearm
Radial nerve syndrome only has ______ no _________.
Symptoms, NO signs
What is radial tunnel syndrome at the PIN?
Neuropathy involving posterior interosseous nerve (PIN) branch
What is the site and TTP with radial tunnel syndrome?
- TTP 2-5 cm distal to lateral epicondyle
- Between distal edge of supinator and around radial neck posteriorly
What are symptoms with radial tunnel syndrome?
- Dorsoradial proximal forearm pain and possibly paresthesias into dorsal thumb and web space
What are symptoms of radial tunnel syndrome provoked by?
Supination/pronation and elbow flexion
What is NOT present with radial tunnel syndrome?
Motor or sensory deficit
What are the symptoms of posterior interosseous nerve compression syndrome?
More severe radial tunnel syndrome with same symptoms plus…
- sensory and motor dysfunction
- positive dural mobility and special tests
What can the sensory and motor dysfunction with posterior interosseous nerve compression include?
- SENSORY: Decreased sensation over dorsoradial forearm and dorsal thumb and web space
- MOTOR: wrist and finger extension weak and painful
What will be positive in the biomechanical exam with posterior interosseous nerve compression?
Radial nerve dural mobility
special test: (+) resisted supination test
What is the difference between a a spinal nerve and C6? How can we tell?
Elbow flexion wont be limited because it is cutaneous, we won’t get confirmation of the spinal nerve which will tell it is the radial nerve
What is wartenberg syndrome?
Neuropathy; compression of superficial sensory radial nerve between brachioradialis and ECRL
What can we expect with Wartenberg syndrome?
- No motor innervation so no weakness
- only sensory symptoms or paresthesias and pain over dorsoradial forearm and dorsal aspect of 1st 3 and a half digits
What is the rx for terminal nerve branch injuries?
- POLI (NO C) ED- when compression is the cause we don’t use
- Bracing/Splinting
- Neural mobilizations if an adhesion
- MET with optimal stresses to create neural motion and the above elimination of compression
When is it okay to reproduce symptoms?
Tension restriction - NOT ok to reproduce
Adhesion restriction - OK to reproduce
What is the prevalence of medial tendinitis/ tendinosis
.4%
What is medial tendinitis/tendinosis also known as?
Thrower’s, little league, or golfer’s elbow
What structures are involved with medial tendinosis/tendinitis?
Pronator teres
flexor carpi radialis
flexor carpi ulnaris
flexor digitorum superficialis
flexor digitorum profundus
What are some hallmark S&S of tendinitis specific to the medial elbow?
- Pain with lengthening flexors/pronators
- TTP over medial epicondyle and common flexor tendon
- S&S more recent, overuse history, something changed
** tendinosis is over or equal to 6 months
What are complications with medial tendinosis/tendinitis?
- medial epicondyle apophysitis in adolescent overhead throwers
- Ulnar collateral ligament involvement
What is medial epicondyle apophysitis due to?
Growth with high activity
What population is medial epicondyle apophysitis most common in?
- adolescents, males more than females
- Mostly overhead throwers but also with racquet sports
What is medial epicondyle apophysitis also known as?
Little league elbow
What are the pathomechanics of medial epicondyle apophysitis?
- bone growth exceeds wrist flexor and pronator lengthening
- increased tendon tension
- Growth plate is the weak spot in adolescents
- Inflammation
What is the “weak spot” in adults? Children?
Tendons in adults, growth plate in children
What are complications with medial epicondyle apophysitis?
- avulsion and/or premature closure
- Ulnar collateral ligament involvement
What are symptoms of medial epicondyle apophysitis?
- Gradual onset with overuse
- A “pop” may indicate trauma or an avulsion
- Above etiology with possible loss of velocity
What are signs of medial epicondyle apophysitis?
- ROM - loss of extension with pain
- Resisted /MMT: possibly weak and/or painful muscles that attach to common flexor tendon
- Palpation: TTP over medial epicondyle
What is our rx for medial epicondyle apophysitis?
Pt education on:
- soreness rule
- load management (i.e. pitch count, active rest with alternate positions, rest days)
- movement cues (i.e. pitching mechanics)
POLICED
What rx do we have to be careful with concerning medial epicondyle apophysitis?
Prolonged stretching due to vulnerability of growth plate
What should our MET include for medial epicondyle apophysitis?
- for trunk, cuff, scapular, and LE impairements
What should we have caution with MET for medial epicondyle apophysitis?
Muscles and tendons attached to growth plate
Why would we want to exercise non-involved structures with medial epicondyle apophysitis?
They are already being overused, need to take stress off of involved structures
What is RTP?
A throwing progression program for those with medial epicondyle apophysitis
What is the prognosis for medial epicondyle apophysitis?
- can become recurrent/persistent problem
When does the growth plate typically fuse with medial epicondyle apophysitis?
Around 15 years of age
