Elbow soft tissue injuries Flashcards
lateral epicondylalgia
lateral elbow pain
tendinopathy
lateral epicondylalgia involves origin of what extensor muscles
extensor carpi radialis brevis - mainly lateral, wrist extensor
extensor digitorum communis - medial to ECRB, extends and abducts fingers
extensor carpi radialis longus - proximal, wrist extensor and elbow flexor
extensor carpi ulnaris - most medial, extensor and ulnar deviator
lateral epicondylalgia aetiology
overload injury by intrinsic muscular contraction
repetitive gripping, hammering, computer use
lateral epicondylalgia - tendinopathy pathology
overload of tendon- disorganised collagen in tendon leads to tear - degeneration
lots of fibroblasts and vascular granulation tissue - has lots of nerve endings - making it very painful
what do we also need to consider in lateral epicondylalgia and why?
cervical spine - root levels C5, C6 supply elbow
lateral elbow pain may be referred from cervical spine
what is diagnosis of lateral epicondylalgia based on
clinical history and physical examination
imaging for differential diagnosis
MRI or US can show tendon changes e.g thickening, disruption of collagen of tendon
symptoms (what patients report) of lateral epicondylalgia
pain over lateral elbow down to forearm
increased pain w/ - gripping, keyboard typing, using computer mouse, stretching, resisted extension
signs (what PT detect)
pain in gripping w/ squeezing ball, dynamometer - reduced grip strength in comparison to unaffected side
resisted wrist, middle finger extension
tenderness over tendon
management of lateral epicondylalgia
relative rest - from aggravating activity for 6 weeks strengthening - isometric can affect pain inhibition, conc/ecc stretching manual therapy corticosteroid injection acupuncture US/Laser/Shock-wave therapy Counterforce braces
strengthening exercise for lateral epicondylalgia
gripping - isometric until feel pain
isokinetic eccentric
progress to isotonic conc and ecc
mobilisations for lateral epicondylalgia
and mulligan mobilisation with movements
cervical spine
thoracic spine
elbow and wrist - lateral glide w. clench fist
- PA radius clench fist
how and why would counterforce bracing be used to treat lateral epicondylalgia
brace around arm - 10 cm below elbow, placed below painful area
constrains full muscle expansion when muscle contracts - lessens muscle activity and its force
common flexor origin - CFO
flexor pronator muscles with the origin of medial epicondyle pronator teres palmaris longus flexor carpi ulnaris flexor digitorum superficialis
negative prognostic risk factor - may take longer for injury to recover
high levels of pain and distress job is physically demanding over 40 yrs pain in shoulder, forearm, wrist or hand in path 3 months keyboard tasks cervical joint signs
medial epicondylitis/epicondylalgia
Tendinosis/tendinopathy of flexor/pronator
origin at the medial epicondyle
Golfer’s Elbow
clinical features of medial epicondylalgia
medial elbow pain
localised tenderness
pain on resisted wrist flexion or pronation
management of medial epicondylalgia
Similar to Extensor tendinopathy
Relative rest
Ice/Modalities for pain?
Strengthening/especially eccentric
Stretching
Massage
Manual Therapy?
Counterforce braces
Corticosteroid Injection
medial collateral ligament - MCLsprain is also called
Medial Ulnar Collateral Ligament
medial collateral ligament sprain - MCL cause
Acute injury or repeated valgus stresses due to
throwing e.g baseball pitchers, javelin throwers
Acute or Insidious (Chronic) onset
Acute: hear a ‘pop’,
MCL sprain cause
Throwing places repetitious high valgus stress on
the medial aspect of the elbow joint and MCL
Producing microscopic tears
ligamentous insufficiency- degenerative, traumatic arthritis, calcification
MCL signs and symptoms
Medial elbow pain Localised tenderness over the ligament Pain with valgus stress \+/- laxity May have ltd flexion/extension depending on grade MRI finding
conservative management of MCL
POLICE
Restore any loss ROM - passive, assist active ROM, in flexion extension, pronation supination
muscle strengthening - elbow flex/ext, scapular stabiliser, shoulder muscle
manual therapy
rehab exercise for MCL
conc/ecc strengthening
external rotation on stability ball
advanced - throwing exercises on stability ball
surgical repair for MCL
MCL Reconstruction (if rehab has
failed). Lengthy post-op rehab
required
Lateral collateral ligament - LCL sprain also called
radial collateral ligament
LCL Aetiology
Rarely occurs after isolated varus stress to the
elbow as few mechanisms deliver such a load
(exception – long term crutch use)
test for LCL sprain
Varus stress test
Posterolateral rotational
instability test
clinical features of LCL sprain
Symptoms of recurrent
subluxation – clicking,
catching, snapping,
locking
olecranon bursitis
caused by resting the head on the
elbow for sustained periods when reading
Results in pressure on olecranon bursa (which
lies between the skin and the olecranon)
traumatic -overuse, inflammatory, infectious
clinical features of olecranon bursitis
Pain with pressure on bursa Obvious swelling/thickening Tender on palpation over the olecranon pain with movement
management of olecranon bursitis
NSAIDs ?Electrotherapy Rest Corticosteroid injection Aspiration Rx infection: antibiotics Surgical excision
cubital tunnel syndrome
Compression or stretch of the
ulnar nerve at the cubital
tunnel
cause of cubital tunnel syndrome
medial epicondyle prolonged pressure on nerve - leaning on elbow repetitive flexion, lifting Overdevelopment of FC Ulnaris
signs and symptoms of cubital tunnel syndrome
Pain along medial aspect of elbow and
hand
P+n’s/numbness in ulnar nerve distribution
Weakness in muscles supplied by ulnar
nerve ….. What ones?
P+n’s with palpation of nerve in cubital
tunnel
Neural tissue provocation tests- ulnar nerve
(Second year)
management of cubital tunnel syndrome
Rest from aggravating movements/ positions Ergonomic advice Splinting surgical release and immob physio post release
