Elbow - itis and ligaments Flashcards by Jawric Cuyzon

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

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Lateral Epicondylitis

What movement is limited with this pathology?

Wrist extenion and radial deviation

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Lateral Epicondylitis

Where is pain located during specific movements?

Pain on the lateral side of the elbow during wrist extension and radial deviation

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Lateral Epicondylitis

What is the prevalence of this dx?

Affects between 1-3% of the population

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Lateral Epicondylitis

What population does this dx affect?

mostly ages 35-50 y.o
- rarely seen in less than 20 y.o

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Lateral Epicondylitis

What is the MOI?

constant grasping (w/ wrist extension)
- sports that center on this movement are all at risk

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Lateral Epicondylitis

If not an inflammatory condition, what kind of condition can this be?

A degenerative condition = tendinosis

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Lateral Epicondylitis

Grade 1 stage of repetitive microtrauma

possible inflammatory injury - likely to resolve

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Lateral Epicondylitis

Grade 2 stage of repetitive microtrauma

has to do with pathologic alterations
like tendinosis or angiofibroblastic degeneration

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Lateral Epicondylitis

What is grade 2 mostly associated with?

sports-related tendon injuries and general overuse

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Lateral Epicondylitis

In a grade 2, what is the response within the tendon?

fibroblastic and vascular response compared to an immune blood-cell response

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Lateral Epicondylitis

Grade 3 stage of microtrauma

pathological changes and partial tears

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Lateral Epicondylitis

Grade 4 stage of microtrauma

Macroscopic tears
- associated with other changes like fibrosis, matrix calcification and hard osseous

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Lateral Epicondylitis

What are the subjective findings?

C/O of diffused achiness and morning stiffness
Localized tenderness over the lateral aspect of the elbow

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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

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Lateral Epicondylitis

Type 1 - Palpation

lesion of the muscle of origin of the ECRL

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Lateral Epicondylitis

Type 2 - Palpation

Insertion tendinopathy of the ECRB
- most common site

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Lateral Epicondylitis

Type 3 - Palpation

Pain @ radial head

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Lateral Epicondylitis

Type 4 - Palpation

ECRB muscle belly strain

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Lateral Epicondylitis

Type 5 - Palpation

Inflammation @ origin of extensor digitorum

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Lateral Epicondylitis

What are the confirming/special test needed for a dx?

Cozen test
Mill test

Radiographs to help with ruling out other dx

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Lateral Epicondylitis

What is the overall intervention goal?

Initial = decreasing activities that cause pain
- be able to progress accordingly

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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 ## Footnote 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