Elbow pathologies

Question 1

Lateral tendinopathy

Answer 1

DD

• referred pain (C5-6)
• RH joint problems
• PIN entrapment
• LCL strain

MOI: repetitive activity
Pain on lateral elbow into forearm (but not hand)
Prognosis – poorer outcome if: high baseline pain and disability, concomitant neck pain, cold hyperalgesia, tear, work related factors, above 54 on tennis elbow

PE
-Reduced F and E strength in wrist and hand
Observe – flexed wrist posture when gripping, difficulty dissociating wrist and finger dissociation
Tender over lateral elbow
Pain and reduced grip strength
Pain with: passive wrist flexion, resisted wrist extension, 2nd and 3rd finger extension
TDT – PA radial head/ lateral glide with grip (significant =50%)

Mx:
Acute: RICE
Technique improvement
MWM with glide according to TDT OM is pain free grip, teach self glide
Strengthening exercises of extensors but must always be pain free – start isometric if can’t handle isotonic and focus on endurance first then strength at 4 weeks.
Suggest against corticosteroid injection

Question 2

MCL Rupture

Answer 2

DD-
golfer’s elbow, osteochondral defects, loose bodies, medial epicondylar apophysitis or avulsion fracture

Overhead athlete
May feel pop and can’t throw after
Pain in late cocking phase or early acceleration phase
May cause ulnar nerve compression

May x-ray to rule out fracture

PE:
Observe – swelling over medial elbow and arm held in slight flexion
Palpate – pain over medial elbow, swelling, may be hypersensitive if ulnar nerve compromised.
Movement – decreased elbow extension
Ligament stress test – positive altered end feel
Muscle exam – reduced length of elbow flexors, decreased power specific to training

Mx:
Conservative
Decrease pain and swelling (RICE)
Advice and education – surgery
Increase ROM pain free
Strengthen wrist flexors and pronators to stabilise medial elbow
Functional specific training at shoulder (thrower’s ten)
Correct throwing mechanics
Once full pain free ROM start strengthening
Surgery
RTS not as high in throwing athletes with conservative Mx so may need surgery but RTS is still like 10 months

Question 3

Instability/dislocation

Answer 3

MOI: posterolateral force from FOOSH

Pain

Question 4

Fractures

Answer 4

MOI: elbow dislocated, FOOSH or direct blow

x-ray if in supinated shoulder flexed position can’t fully extend arm.