Elbow/Forearm Lateral Pain with Muscle Function Impairments

Question 1

What is the Prevalence/Incidence with Lateral Elbow pain with muscle performance impairment?

What are the associated diagnosis?

Answer 1

• Elbow Tendinitis
• “Tennis Elbow”
• Lateral Elbow Tendinopathy
• Lateral Epicondylagia

The acuity, irritability, and severity of LET symptoms at any given time will guide the management of this condition

Question 2

What Outcome Measure are typically used with Lateral Elbow pain with muscle performance impairment?

Answer 2

• Patient Rated Tennis Elbow Evaluation (PRTEE)
• Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH
• Upper Extremitity Functional Scale (UEFS)
• Patient Rated Elbow Evaluation (PREE)

Question 3

What may you find in the subjective with patients with Lateral Elbow pain with muscle performance impairment?

(Agg Factors)

Answer 3

• Pain at Lateral Epicondyle
• Pain with repetitive elbow and wrist extension
• Grippng/Grasping activities
• Tennis swing

Question 4

During the Physcial Examination, what may you find during A/PROM with Lateral Elbow pain with muscle performance impairment?

Answer 4

Limited ROM / Symptomatic

Question 5

During the Physcial Examination, what may you find during Restisted Testing with Lateral Elbow pain with muscle performance impairment?

Answer 5

May be Strong and Painful with wrist or digit extension

Question 6

During the Physcial Examination, what may you find during the muscle performance and palpation portion with Lateral Elbow pain with muscle performance impairment?

Answer 6

• Decreased Flexibility of wrist extensors
• Grip strength will be painfree and maximum

With palpation, there would be tenderness at lateral epicondyle

Question 7

What Special Test would be done with Lateral Elbow pain with muscle performance impairment?

Answer 7

• Cozen’s Test
• Mill’s Test
• Maudsley’s Test

Question 8

What is Medial Elbow Tendinopathy (MET) commonly known as?

Answer 8

Golfer’s Elbow

MET primarily involves tendinopathy of the common flexor origin.

Question 9

Which muscles are primarily involved in Medial Elbow Tendinopathy?

Answer 9

FCR and the humeral head of the pronator teres

To a lesser extent, the palmaris longus, FCU, and FDS may also be involved.

Question 10

What types of activities can lead to Medial Elbow Tendinopathy?

Answer 10

Repetitive wrist flexion activities

This includes not only athletes but also workers in occupations demanding such movements.

Question 11

What is the primary cause of Medial Elbow Tendinopathy?

Answer 11

Overuse or repetitive stress

Direct trauma can also be a cause, but overuse is more common.

Question 12

What happens to flexor-pronator tissues under repeated stress?

Answer 12

Fatigue occurs

This fatigue predisposes to medial ligamentous injury.

Question 13

What is the initial injury site in Medial Elbow Tendinopathy?

Answer 13

Microtear at the interface between the pronator teres and FCR origins

This leads to the development of fibrotic and inflammatory granulation tissue.

Question 14

What symptoms characterize the typical clinical presentation of MET?

Answer 14

Pain and tenderness over the flexor-pronator origin

Symptoms are slightly distal and anterior to the medial epicondyle.

Question 15

What activities exacerbate the symptoms of Medial Elbow Tendinopathy?

Answer 15

Resisted wrist flexion and pronation; passive wrist extension and supination

These movements increase pain and discomfort.

Question 16

What are some differential diagnoses for medial elbow symptoms?

Answer 16

MCL injury or insufficiency; ulnar nerve entrapment; medial elbow intra-articular pathology

Ulnar neuritis often occurs alongside MET.

Question 17

What is the initial conservative intervention for Medial Elbow Tendinopathy?

Answer 17

Rest, activity modification, and local modalities

Complete immobilization is usually not recommended.

Question 18

What is the focus of intervention after the acute phase of MET?

Answer 18

Restoring ROM and correcting flexibility and strength imbalances

This includes a progressive strengthening program.

Question 19

What type of exercises are included in the strengthening program for MET?

Answer 19

Multiangle isometrics followed by concentric and eccentric exercises

These target the flexor-pronator muscles.

Question 20

What tool can be used for eccentric strengthening of wrist flexors in MET?

Answer 20

FlexBar

A twisting exercise using the FlexBar is designed for this purpose.

Question 21

Fill in the blank: The typical clinical presentation of MET includes pain and tenderness over the _______.

Answer 21

flexor-pronator origin