Elbow soft tissue injuries Flashcards by Kelliane Tambe

lateral epicondylalgia

lateral elbow pain

tendinopathy

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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

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lateral epicondylalgia aetiology

overload injury by intrinsic muscular contraction

repetitive gripping, hammering, computer use

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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

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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

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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

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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

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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

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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

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strengthening exercise for lateral epicondylalgia

gripping - isometric until feel pain
isokinetic eccentric
progress to isotonic conc and ecc

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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

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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

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common flexor origin - CFO

flexor pronator muscles with the origin of medial epicondyle
pronator teres
palmaris longus
flexor carpi ulnaris
flexor digitorum superficialis

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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

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medial epicondylitis/epicondylalgia

Tendinosis/tendinopathy of flexor/pronator
origin at the medial epicondyle
 Golfer’s Elbow

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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 ```