Elbow Pathology Flashcards
in what plane does most elbow motion occur?
sagittal
there is some degree of frontal plane motion at the elbow with _____ accompanying elbow flexion and _____ accompanying elbow extension
adduction, abduction
how does limited elbow fxn limit fxn?
limited ability to bring arm up for eating/drinking or self care
what is lateral epicondylalgia?
irritation of the lateral epicondyle and the extensors, radial deviators, and sometimes supinators
what muscles are primarily effected in lateral epicondylalgia?
extensor carpi radialis brevis
1/3 extensor digitorum communis
what is tennis elbow?
lateral epicondylalgia
what age group is most effected by lateral epicondylalgia?
those 35-50 y/o
what extremity is usually effected by lateral epicondylalgia?
the dominant arm
what is the usual MOI of lateral epicondylalgia?
overuse, but can be traumatic too
what is the difference in treatment of inflammatory vs degenerative/fibrotic disease?
inflammatory disease is treated with US and is very protective
degenerative/fibrotic disease is not likely to focus on US treatment, but rather uses IASTM, TFM, stretching, and eccentrics
describe stage 1 lateral epicondylalgia
inflammatory
often resolves
describe stage 2 lateral epicondylalgia
fibroblastic and vascular response within tendon
describe stage 3 lateral epicondylalgia
pathologic changes (tendinosis) or rupture
describe stage 4 lateral epicondylalgia
fibrosis, calcification
when do symptoms occur in lateral epicondylalgia?
with active wrist extension or grasping
morning/night
does pro/sup tend to be more painful in elbow flexion or extension with lateral epicondylalgia?
elbow extension
t/f: pts with lateral epicondylalgia may frequently drop things
true
where is a pt with lateral epicondylalgia TTT?
over the lateral epicondyle
what tests would we expect to be positive in lateral epicondylalgia?
Cozen
Mills
what are some treatment options for lateral epicondylalgia?
US
iontophoresis
TFM
modify techniques
injections
mobilizations (wrist, elbow, cervical)
stretching
PREs (conc and ecc)
counterforce bracing
dry needling
Tenex
are PREs for concentric or eccentric contractions more important?
eccentric
what does counterforce bracing do?
applies pressure to the epicondyle just distal to the muscles insertion dispersing force and making the muscle think it inserts more distally than it does
is lateral or medial epicondylalgia more common?
lateral epicondylalgia
what is Golfer’s elbow?
medial epicondylalgia
what is medial epicondylalgia?
tendonopathy of the common flexor tendons, primarily the FCR and pronator teres with increased valgus stress and failure of the UCL
where is there pain and TTT in medial epicondylalgia?
over the medial epicondyle
what is the common MOI of medial epicondylalgia?
overuse due to repeated stress to the flexor-pronator tendons, increased valgus stress, and failure of the UCL
what motions cause pain with medial epicondylalgia?
resisted wrist flexion, pronation
passive wrist extension, supination
what are some treatment options for medial epicondylalgia?
RICE
modalities
avoid immobilization
stretching
PREs (conc and ecc)
bracing
what are the 5 criteria for classification of instability?
1) acute, chronic, recurrent
2) articulations involved
3) direction of displacement (valgus, varus, ant/post rotatory)
4) degree of displacement (sublux or disloc)
5) presence of fx
what causes an ulnar collateral sprain?
chronic valgus and ER forces (ie tennis and throwing)
what are some other common MOIs, other than throwing for ulnar collateral sprain?
FOOSH
chronic medial epicondylalgia
what tests would we expect to be positive with ulnar collateral sprain?
valgus stress test
moving valgus stress test
what are some treatment options for ulnar collateral sprain?
RICE 2-4 weeks
modalities
PREs for FCU, pronator teres, FDS, and shoulder
what types of forces are responsible for contributing to UCL sprain/instability?
valgus stress occuring with throwing
cooking phase of throwing puts a lot of medial stress of the elbow
what causes radial collateral sprain?
a combo of compression, ER, and varus forces, or secondary to chronic LE
can be caused by dislocation too
what can radial collateral sprain result in?
posterolateral rotatory instability
what are the interventions for radial collateral sprain?
RICE 2-4 weeks
modalities
PREs
what functional losses are associated with median nerve injury?
loss of pronation
loss of wrist flexion, RD
loss of thumb flexion, abduction, opposition
loss of gripping
ape hand deformity (loss of pinch)
closing hand of benediction
what functional losses are associated with ulnar nerve injury?
loss of wrist flexion, UD
loss of 5th digit PIP flexion
loss of finger adb/add
opening hand of benediction (loss of ext of PIP and DIP of digits 4-5)
what functional losses are associated with radial nerve injury?
loss of supination
loss of wrist extension
loss of gripping
loss of wrist stabilization
loss of finger extension
loss of thumb abduction
why is there a weaker grip in wrist flexion?
bc of active insufficiency do the finger and wrist flexors
what is cubital tunnel syndrome?
entrapment of the ulnar nerve at the medial intermuscular septum which slopes from a thick wide base at the medial epicondyle to a thin edge on the humeral shaft
t/f: cubital tunnel syndrome is caused by traction in flexion
true
t/f: the anconeus can cause entrapment of the ulnar nerve causing cubital tunnel syndrome
true
what are the s/s of cubital tunnel syndrome?
pain/paresthesia in digits 4-5
worse at night
reduced sensation in ulnar nerve distribution
inability to abd/add fingers
loss of grip
atrophy of intrinsics
contracture of digits 4-5
(+) Tinel over the medial elbow
what are some interventions for cubital tunnel syndrome?
ADL modification
night splinting 40-60 deg
padding
ulnar nerve transposition in severe cases
what should be avoided with cubital tunnel syndrome?
leaning on the elbow
elbow flexion while sleeping
what is pronator teres syndrome?
median nerve most commonly entrapped at the ligament of Struthers
what condition can look similar to carpal tunnel syndrome?
pronator teres syndrome
where is there pain in pronator teres syndrome?
wrist and medial forearm
pain in pronator teres syndrome is increased with what motions?
extension and pronation
where do we expect to see paresthesias in pronator teres syndrome?
digits 2-3
what are the 3 sites of entrapment for pronator teres syndrome?
Lacertus fibrosis
pronator teres
FDS
there can be reproduction of symptoms of pronators teres syndrome with palpation over what muscles?
pronators 4cm distal to the cubital crease
what is a unique spot we may perform a Tinel test at for pronator teres syndrome?
4cm distal to the cubital crease
what motions may cause reproduction of symptoms in pronator teres syndrome?
resisted pronation
supination
long finger flexion
elbow and Wrist flexion
t/f: pronator teres syndrome responds well to conservative measures
true
