Elbow Pathologies Flashcards
Common patient elbow pathologies
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
What is lateral epicondylalgia?
Aching pain over lateral epicondyle that may radiate
When does lateral epicondylalgia occur?
When healing can’t keep pace with repetitive micro-trauma
What is the most common age to develop lateral epicondylalgia?
Age 35 and above
What usually causes lateral epicondylalgia?
Work or activities that require lots of wrist flexion and extension or co-contraction/stabilization
What activities can cause lateral epicondylalgia
Heavy lifting
Hammering
Gripping
Twisting
What muscle is most effected by lateral epicondylalgia?
Extensor carpi radialis brevis
What muscles are also effected by lateral epicondylalgia?
Extensor carpi radialis longus
Extensor digitorum communis
Articular ligaments
What is a big difference between the new model of epicondylalgia vs the old view about epicondylitis?
It is no longer believed to be a true inflammatory condition, specifically in chronic presentations
When treating lateral epicondylalgia, The model of epicondylalgia encompasses ALL causes of…
Lateral epicondyle pain without assuming underlying pathology
What does the model of epicondylalgia force us to do?
Look at the global presentation of the patient as to what is causing these excess forces on the elbow
What is the newest research for lateral epicondylalgia looking into?
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)
Common history items for those with LE
Cumulative trauma or overuse syndrome
Tissues subjected to repetitive overload
Activities involving wrist extension, rotation, and grasping
Common symptoms for those with LE
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
Differential diagnosis for LE
Cervical radiculopathy Proximal neurovascular entrapment Radial tunnel syndrome Radial Head injury/arthritis Posterolateral rotary instability
How can you differentiate between LE and cervical radiculopathy
Higher pain responses to cervical/thoracic provocative tests and ULND-radial nerve bias
Cervical flexion and extension ROM loss
What spinal nerves can radiate into the elbow?
C5, C6, and C7
What spinal nerves refer to the lateral elbow?
C5 and C6
What spinal nerves refer to the posterior elbow?
C7
Reasons why you may be suspicious that C6 is involved in lateral elbow symptoms
If the pt is not responding to treatment
Weak wrist extensors without pain inhibition
Other sensory changes
What might you observe in someone with lateral elbow tendinopathy?
Possible inflammation over the lateral epicondyle
What might someone with lateral elbow tendinopathy present with when doing active movement testing?
May have pain with active wrist flexion combined with elbow extension (sometimes pronation as well)
What might someone with lateral elbow tendinopathy present with when doing passive movement testing?
May have pain during wrist flexion combined with forearm pronated and elbow extended.
What resistive tests may produce pain in someone with lateral elbow tendinopathy?
Wrist extension and radial deviation with elbow extended
What are other things would you observe in resistive tests in someone with lateral elbow tendinopathy?
Decreased grip strength
Weak shoulder girdle muscles
Muscle imbalances in forearm and shoulder
Where would you expect someone with lateral elbow tendinopathy to be tender?
The anterior aspect of the lateral epicondyle
Common extensor origin
Radial head
Special tests in someone with lateral elbow tendinopathy
Cozen’s test
Resisted 3rd finger test (Maudsley’s)
Grip strength testing with elbow extended
What imaging techniques are used to aid in the diagnostics of lateral elbow tendinopathy?
Radiographs
MRI
Diagnostic ultrasound
Conservative management techniques for lateral elbow tendinopathy
Corticosteroid injections
Platelet-rich plasma
Prolotherapy (dextrose injection)
Botox (botulinum toxin)
