Elbow pain

Question 1

Lateral epicondylitis (tennis elbow)

Answer 1

• Pain and degeneration of the extensor muscle of forearm
• From repetitive activities with wrist extension
  S&S:
• Aching pain worse with activity/extension
• Radiates down the LATERAL forearm
  DX:
• Resisted wrist extension: extension of elbow with forearm pronated and wrist in palmar flexion
  TX:
• Pain control
• No corticosteroids

Question 2

Medial epicondylosis (golfer’s elbow)

Answer 2

• Pain and degeneration of the flexor muscles of the forearm
• From repetitive movement
  S&S:
• Aching and pain with activity
• Tenderness at medial epicondyle
  DX:
• Resistsed wrist extension: extension of elbow with forearm supinated and wrist dorsiflexed
  TX:
• Pain control
• No corticosteroids

Question 3

Ulnar nerve entrapment

Answer 3

• Pain of 4th and 5th fingers: pinky and ring
• From throwing and racquet sports, weight lifting, keyboarding
  S&S:
• Medial elbow pain with paresthesias on 4th and 5th fingers
• Clumsy hand and diminished grip
  DX:
• Tinel’s over ulnar nerve: Tap this nerve
  TX:
• Pain control
• No corticosteroids
• Ergonomics

Question 4

Olecranon bursitis

Answer 4

• Localized trauma or pressure to elbow
• Chess players
  S&S:
• Painful or painless swelling of posterior elbow
• Bump
• Erythema will indicate sepsis
• If ROM impaired considered sepsis
  TX:
• NSAIDs
• Corticosteroids
• Sling

Question 5

Carpal tunnel

Answer 5

- Compression of median nerve at the wrist from repetitive motion
S&S:
- Paresthesias of 1st,2nd, and 3rd (thumb, index and middle) digits and wrist
- Worse at night
- Weakness and clumsiness
- Altered sensation
- Thenar nerve atrophy
DX:
- Phalen's sign + hands dorsally together for 30sec
- Tinel's over those digits
- Nerve conduction and EMG gold standard
TX:
- Corticosteroids injections
- NSAIDs
- Wrist splinting at night maybe day