Elbow - itis and ligaments Flashcards
Lateral Epicondylitis
What structure is affected?
Common extensor muscles and their tendons @ origin of lateral humeral epicondyle
- ECR Brevis
- ECR Longus
- Extensor digitorum
- Extensor carpi ulnaris
Lateral Epicondylitis
What movement is limited with this pathology?
Wrist extenion and radial deviation
Lateral Epicondylitis
Where is pain located during specific movements?
Pain on the lateral side of the elbow during wrist extension and radial deviation
Lateral Epicondylitis
What is the prevalence of this dx?
Affects between 1-3% of the population
Lateral Epicondylitis
What population does this dx affect?
mostly ages 35-50 y.o
- rarely seen in less than 20 y.o
Lateral Epicondylitis
What is the MOI?
constant grasping (w/ wrist extension)
- sports that center on this movement are all at risk
Lateral Epicondylitis
If not an inflammatory condition, what kind of condition can this be?
A degenerative condition = tendinosis
Lateral Epicondylitis
Grade 1 stage of repetitive microtrauma
possible inflammatory injury - likely to resolve
Lateral Epicondylitis
Grade 2 stage of repetitive microtrauma
has to do with pathologic alterations
like tendinosis or angiofibroblastic degeneration
Lateral Epicondylitis
What is grade 2 mostly associated with?
sports-related tendon injuries and general overuse
Lateral Epicondylitis
In a grade 2, what is the response within the tendon?
fibroblastic and vascular response compared to an immune blood-cell response
Lateral Epicondylitis
Grade 3 stage of microtrauma
pathological changes and partial tears
Lateral Epicondylitis
Grade 4 stage of microtrauma
Macroscopic tears
- associated with other changes like fibrosis, matrix calcification and hard osseous
Lateral Epicondylitis
What are the subjective findings?
C/O of diffused achiness and morning stiffness
Localized tenderness over the lateral aspect of the elbow
Lateral Epicondylitis
What are the objective findings?
- Tenderness usually over ECRB and ECRL
- active motions = painless
- wrist flexion + elbow extension = possible pain
- PROM pain = wrist flexion + pronation + elbow extension
- Resistance pain = wrist extension + radial deviation + elbow extension
Lateral Epicondylitis
Type 1 - Palpation
lesion of the muscle of origin of the ECRL
Lateral Epicondylitis
Type 2 - Palpation
Insertion tendinopathy of the ECRB
- most common site
Lateral Epicondylitis
Type 3 - Palpation
Pain @ radial head
Lateral Epicondylitis
Type 4 - Palpation
ECRB muscle belly strain
Lateral Epicondylitis
Type 5 - Palpation
Inflammation @ origin of extensor digitorum
Lateral Epicondylitis
What are the confirming/special test needed for a dx?
Cozen test
Mill test
Radiographs to help with ruling out other dx
Lateral Epicondylitis
What is the overall intervention goal?
Initial = decreasing activities that cause pain
- be able to progress accordingly
Lateral Epicondylitis
What is the improvement percentage within 1 year?
around 80% improve within that time spams
Medial Epicondylitis
What structures are affected?
Tendinopathy @ the origin of flexor/pronator muscle
- pronator teres
- flexor carpi radialis
- palmaris longus
- flexor digitorum superficialis
- flexor carpi ulnaris
- medial collateral ligament
Medial Epicondylitis
What is the MOI?
Overuse = strain on the small origin of common tendon
- makes a high load
Medial Epicondylitis
How common is this pathology?
Only 1/3 as common as lateral
Medial Epicondylitis
What is the biomechanical movement?
pronation
wrist flexion
elbow flexion
Medial Epicondylitis
What are the subjective findings?
C/O of pain along medial elbow
Hx of reptitive grapsping or not use to the movement
increased pain w/ active wrist flexion and forearm pronation
Medial Epicondylitis
What are the objective findings?
TTP around 5 mm distal and anterior to the mid-point of medial epicondyle
Pain on resisted wrist flexion (w/ elbow straight) and pronate
Pain @ extreme PROM wrist extension w/ forearm supination w/ elbow extension and ulnar deviation
Medial Epicondylitis
What are the confimatory/special tests needed to dx?
sx = resisted forearm pronation and wrist flexion
- dx based on hx of medial epicondyle pain
- on exam = local tenderness and pain w/ iso wrist flexion, pronation or both
radiograph not helpful - rule out arthritis or loose bodies
Medial Epicondylitis
What is the success rate of conservative intervention?
as high as 90%
Medial Epicondylitis
What are the conservative methods for intervention?
Initial rest
modify activity
local modalities
Medial Epicondylitis
What is not a recommended intervention?
Immobilization because it takes away structural stresses that is needed for grow new collagen to return to activity
Medial Epicondylitis
What is needed once the acute phase has passed?
Need to get ROM back
Fix imbalances with flexibility and strength
Medial Epicondylitis
What is needed to strength program?
Include concentric and eccentric exercises of the flexor pronator muscles
MCL Tear
What is the purpose of the MCL?
Primary struture to resist valgus stress @ the elbow
MCL Tear
What is the MOI?
chronic attenuation of valgus and ER forces
seent in serves or pitches or FOOSH
MCL Tear
What can be affected with an MCL tear?
Ulnar nerve irritation
sx of ulnary neuritis (2nd to ligamentous inflammation)
MCL Tear
What are the subjective findings?
C/O medial elbow pain @ ligament origin
or
Insertion site if acute avulsion is there
MCL Tear
What are the objective findings?
Tenderness along course of MCL, ulnar nerve and (+) Tinel signs are common
Loss of terminal elbow extension
(+) valgus stress test
MCL Tear
What are the confirmatory/special tests?
Valgus stress test
AP and lateral to rule out a fracture
MRI gold standard
MCL Tear
What interventions are needed for early signs of MCL injury?
Rest and modify activity
Restrict for around 2 to 4 weeks
ROM exercises
PT modalities
NSAIDs
MCL Tear
What interventions are initiated once the acute inflammatory stage is done?
stretch and strengthen the flexor carpi ulnaris, pronator teres and flexor digitorum superficialis
Pain free @ mid-ROM
MCL Tear
What structures need empahsis on isometric ex to enhance their role as secondary stabilizers?
Forearm flexors
ulnar deviators
pronators
Also making sure shoulder and elbow muscles will help with reinjury
MCL Tear
What is the overall prognosis?
surgical repair is only needed for throwing athletes or manual labor
valgus laxity has minimal functional impairments
Little League Elbow
What is the most common population?
8-15 y/o
Little League Elbow
What is the objective findings?
Medial elbow pain
Decreased throwing power or methods
Medial swelling
sometimes flexion contractures
Little League Elbow
How are you able to dx?
Radiographs can assist with dx
Hx of pain when throwing or palpation
Little League Elbow
General pain is indicated from?
Injury to medial epicondyle and UCL
Osteochondritis dissecans of capitellum
Little League Elbow
What is the mechanism of injury during pitches?
During the cocking and acceleration phase
- there’s valgus stress happens at the medial elbow
- posterior shearing forces
- lateral elbow compression
What is the misdiagonsis of median nerve entrapment?
rare @ the elbow and often misdiagnosed
Pronator Syndrome
What is the subjective findings?
Sudden and unknown pain on the anterior aspect of elbow, radial side of the palm and palmar side of digits
Heaviness of the forearm
Pronator Syndrome
What are the digits affected?
1st
2nd
3rd
half of 4th
Pronator Syndrome
How is pain reproduced?
Pressure over the pronator teres - 4 cm distal to the cubital crease
Pronator Syndrome
What resisted movement reproduces pain?
Pronation
Elbow flexion
Wrist flexion
supination
long finger flexor
Pronator Syndrome
What is the treatment?
Usually repond well to activity modification
Rest, NSAIDs, Ice
Get flexibility and strength back at the wrist flexors and forearm pronators
Manual techniques to break up adhesions if need
