Elbow Pathologies

Question 1

Common patient elbow pathologies

Answer 1

Lateral and medial tendinopathy
Fracture management
Post immobilization motion loss and/or contracture
Post-surgical inflammation, limited ROM, or weakness
Ligamentous/joint lesion from sport or injury
Nerve entrapment
Referral of symptoms from C/S, shoulder, or wrist (with or without elbow diagnosis)
Painful joint dysfunction such as a sprain

Question 2

What is lateral epicondylalgia?

Answer 2

Aching pain over lateral epicondyle that may radiate

Question 3

When does lateral epicondylalgia occur?

Answer 3

When healing can’t keep pace with repetitive micro-trauma

Question 4

What is the most common age to develop lateral epicondylalgia?

Answer 4

Age 35 and above

Question 5

What usually causes lateral epicondylalgia?

Answer 5

Work or activities that require lots of wrist flexion and extension or co-contraction/stabilization

Question 6

What activities can cause lateral epicondylalgia

Answer 6

Heavy lifting
Hammering
Gripping
Twisting

Question 7

What muscle is most effected by lateral epicondylalgia?

Answer 7

Extensor carpi radialis brevis

Question 8

What muscles are also effected by lateral epicondylalgia?

Answer 8

Extensor carpi radialis longus
Extensor digitorum communis
Articular ligaments

Question 9

What is a big difference between the new model of epicondylalgia vs the old view about epicondylitis?

Answer 9

It is no longer believed to be a true inflammatory condition, specifically in chronic presentations

Question 10

When treating lateral epicondylalgia, The model of epicondylalgia encompasses ALL causes of…

Answer 10

Lateral epicondyle pain without assuming underlying pathology

Question 11

What does the model of epicondylalgia force us to do?

Answer 11

Look at the global presentation of the patient as to what is causing these excess forces on the elbow

Question 12

What is the newest research for lateral epicondylalgia looking into?

Answer 12

Looking into the involvement of C/S, which might contribute to pain symptoms associated with LE (somatic pain referral due to facilitated nocioceptive afferent paths in CNS)

Question 13

Common history items for those with LE

Answer 13

Cumulative trauma or overuse syndrome
Tissues subjected to repetitive overload
Activities involving wrist extension, rotation, and grasping

Question 14

Common symptoms for those with LE

Answer 14

Gradual onset of pain
Tenderness over lateral epicondylar area
Diffuse morning achiness and stiffness common complaint
May complain of nocturnal pain and dropping things when forearm is pronated

Question 15

Differential diagnosis for LE

Answer 15

Cervical radiculopathy
Proximal neurovascular entrapment
Radial tunnel syndrome
Radial Head injury/arthritis
Posterolateral rotary instability

Question 16

How can you differentiate between LE and cervical radiculopathy

Answer 16

Higher pain responses to cervical/thoracic provocative tests and ULND-radial nerve bias
Cervical flexion and extension ROM loss

Question 17

What spinal nerves can radiate into the elbow?

Answer 17

C5, C6, and C7

Question 18

What spinal nerves refer to the lateral elbow?

Answer 18

C5 and C6

Question 19

What spinal nerves refer to the posterior elbow?

Answer 19

C7

Question 20

Reasons why you may be suspicious that C6 is involved in lateral elbow symptoms

Answer 20

If the pt is not responding to treatment
Weak wrist extensors without pain inhibition
Other sensory changes

Question 21

What might you observe in someone with lateral elbow tendinopathy?

Answer 21

Possible inflammation over the lateral epicondyle

Question 22

What might someone with lateral elbow tendinopathy present with when doing active movement testing?

Answer 22

May have pain with active wrist flexion combined with elbow extension (sometimes pronation as well)

Question 23

What might someone with lateral elbow tendinopathy present with when doing passive movement testing?

Answer 23

May have pain during wrist flexion combined with forearm pronated and elbow extended.

Question 24

What resistive tests may produce pain in someone with lateral elbow tendinopathy?

Answer 24

Wrist extension and radial deviation with elbow extended

Question 25

What are other things would you observe in resistive tests in someone with lateral elbow tendinopathy?

Answer 25

Decreased grip strength
Weak shoulder girdle muscles
Muscle imbalances in forearm and shoulder

Question 26

Where would you expect someone with lateral elbow tendinopathy to be tender?

Answer 26

The anterior aspect of the lateral epicondyle
Common extensor origin
Radial head

Question 27

Special tests in someone with lateral elbow tendinopathy

Answer 27

Cozen’s test
Resisted 3rd finger test (Maudsley’s)
Grip strength testing with elbow extended

Question 28

What imaging techniques are used to aid in the diagnostics of lateral elbow tendinopathy?

Answer 28

Radiographs
MRI
Diagnostic ultrasound

Question 29

Conservative management techniques for lateral elbow tendinopathy

Answer 29

Corticosteroid injections
Platelet-rich plasma
Prolotherapy (dextrose injection)
Botox (botulinum toxin)