Elbow Conditions Flashcards
Elbow Contractures:
- loss of motion in capsular pattern (loss flex>ext)
- loss of motion in dif pattern = loose body in jt, lig sprain, and/or CRPS
Elbow Contractures: Dx
clinical exam
Elbow Contractures: PT
biomechanical faults
soft tissue techniques
splinting as adjunct
Lateral Epicondylosis/Epicondylopathy “Tennis Elbow”
- most often chronic degen of ECRB at prox attachment to lat epicondyle
- gradual onset, with occupation requires **repetitive wrist ext, or strong grip w/ wrist extended = overload **
- MUST RULE OUT CERVICAL SPINE CONDITION
Lateral Epicondylosis/Epicondylopathy: Dx
lateral epicondylitis test
Lateral Epicondylosis/Epicondylopathy: PT
- correct ms imbalance
- endurance/strength w/ emphasis on **ECCENTRIC phase **
- biomechanical faults
- EDUCATION for prevention
- cryotherapy, thermotherapy. hydrotherapy, sound agents, TENS for symptom relief
- Counterforce bracing to reduce stress ECRB
Medial Epicondylosis/Epicondylopathy “Golfer’s Elbow”
- degenerative condition of pronator teres and flexor carpi radialis at prox attachment
- occurs w/ overuse in golf, baseball, swimming, or _strong hand grip & excessive pronation _
Medial Epicondylosis/Epicondylopathy: Dx
clinical exam
medial epicondylitis test
Medial Epicondylosis/Epicondylopathy: PT
- correct ms imbalance
- endurance/strength w/ emphasis on ECCENTRIC phase
- biomechanical faults
- EDUCATION for prevention
- cryotherapy, thermotherapy. hydrotherapy, sound agents, TENS for symptom relief
- Counterforce bracing to reduce stress ECRB
Distal Humeral Fractures:
- complications:
- loss of motion
- myositis ossificans
- malalignment
- neurovascular compromise
- lig injury
- CRPS
- Supracondylar fractures
- must be examined quickly for neurovascular status (radial n) and vascular structures (may result in volkmann’s ischemia)
- Assess growth plate in youth
- Lat Epicondyle fractures: fairly common in young people and require ORIF
Distal Humeral Fractures: Dx
plain film imaging
Distal Humeral Fractures: PT
pain reduction and control of inflammatory response
improve flexibility of shortened structures, etc
Osteochondrosis of Humeral Capitellum
- osteochondritis dissecans affects central and/or l**ateral aspect of capitellum or radial head . **
- osteochondral bone fragment becomes detached from an articular surface forming a loose body in joint
- caused by **rep compressive forces b/t radial head and humeral capitellum. **
- *adolescents b/t 12-15*
Osteochondrosis of Humeral Capitellum: Panner’s Disease
- localized avascular necrosis of capitellum leading to loss of subchondral bone, with f**issuring and softening of articular surfaces of radiocapitellar joint. **
- etiology unknown, occurs in _children age <10 _
Osteochondrosis of Humeral Capitellum: Dx
plain film imaging
Osteochondrosis of Humeral Capitellum: PT
- rest w/ avoiding throwing or UE activities
- when pt is pain free, initiate flex and strength
- late phase rehab: program to slowly increase load on joint
- persistence of sx = surgery
- after surg - min pain and increase flex
Ulnar Collateral Ligament Injuries
- occurs as result of repetitive valgus force to medial elbow w/ OH throwing.
- clinical signs:
- p! along medial elbow at distal insertion of lig
- some cases paresthesias are reported w/ positive tinels
Ulnar Collateral Ligament Injuries: Dx
MRI and clinical exam
medial lig instability test
Ulnar Collateral Ligament Injuries: PT
rest and pain management
elbow flexor strength and taping
Ulnar Nerve Entrapment
- direct trauma to cubital tunnel
- traction due to laxity at med elbow
- compression due to a thickened retinaculum
- hypertrophy of flex carpi radialis
- recurrent sublux or disloc
- DJD that effects cubital tunnel
- Clinical Findings:
- medial elbow pain
- paresthesias in ulnar distribution
- a positive tinels
Median Nerve Entrapment
- occurs w/in pronator teres ms and under superficial head of flexor digitorum superfiscialis w/ repetitive gripping activities
- clinical signs
- aching pain w/ weakness of FA ms
- (+) tinels
- paresthesias in median nerve distribution
Radial Nerve Entrapment
- entrapment of distal branches (PIN) occurs within radial tunnel (radial tunnel syndrome) as a result of OH activities/throwing
- clinical signs
- lateral elbow pain that can be confused with lateral epicondylitis
- pain over supinator
- parasthesias in radial nerve distribution
- tinels may be positive
Nerve Entrapment Dx
electodiagnostic tests and clinical exam
Nerve Entrapment: PT
- rest, avoidance of exacerbating activities, use of NSAIDs and modalities for soft tissue
- if abn neurotension present - neuro mob
- protective padding and night splints to maintain slackened position of involved nerve
- w. reduct of p!/parasthesias, rehab focuses on strength, endurance, coordintation to achieve balance b/t agonist and antagonist
- funx training and patient education
