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NMSKI > Elbow soft tissue injuries > Flashcards

Elbow soft tissue injuries Flashcards

1
Q

lateral epicondylalgia

A

lateral elbow pain

tendinopathy

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2
Q

lateral epicondylalgia involves origin of what extensor muscles

A

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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3
Q

lateral epicondylalgia aetiology

A

overload injury by intrinsic muscular contraction

repetitive gripping, hammering, computer use

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4
Q

lateral epicondylalgia - tendinopathy pathology

A

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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5
Q

what do we also need to consider in lateral epicondylalgia and why?

A

cervical spine - root levels C5, C6 supply elbow

lateral elbow pain may be referred from cervical spine

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6
Q

what is diagnosis of lateral epicondylalgia based on

A

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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7
Q

symptoms (what patients report) of lateral epicondylalgia

A

pain over lateral elbow down to forearm

increased pain w/ - gripping, keyboard typing, using computer mouse, stretching, resisted extension

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8
Q

signs (what PT detect)

A

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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9
Q

management of lateral epicondylalgia

A 
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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10
Q

strengthening exercise for lateral epicondylalgia

A

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

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11
Q

mobilisations for lateral epicondylalgia

and mulligan mobilisation with movements

A

cervical spine
thoracic spine
elbow and wrist - lateral glide w. clench fist
- PA radius clench fist

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12
Q

how and why would counterforce bracing be used to treat lateral epicondylalgia

A

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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13
Q

common flexor origin - CFO

A 
flexor pronator muscles with the origin of medial epicondyle
pronator teres
palmaris longus
flexor carpi ulnaris
flexor digitorum superficialis
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14
Q

negative prognostic risk factor - may take longer for injury to recover

A 
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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15
Q

medial epicondylitis/epicondylalgia

A

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

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16
Q

clinical features of medial epicondylalgia

A

medial elbow pain
localised tenderness
pain on resisted wrist flexion or pronation

17
Q

management of medial epicondylalgia

A

Similar to Extensor tendinopathy

Relative rest

Ice/Modalities for pain?

Strengthening/especially eccentric

Stretching

Massage

Manual Therapy?

Counterforce braces

Corticosteroid Injection

18
Q

medial collateral ligament - MCLsprain is also called

A

Medial Ulnar Collateral Ligament

19
Q

medial collateral ligament sprain - MCL cause

A

Acute injury or repeated valgus stresses due to
throwing e.g baseball pitchers, javelin throwers
 Acute or Insidious (Chronic) onset
 Acute: hear a ‘pop’,

20
Q

MCL sprain cause

A

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

21
Q

MCL signs and symptoms

A 
Medial elbow pain
 Localised tenderness
over the ligament
 Pain with valgus stress
\+/- laxity
 May have ltd
flexion/extension
depending on grade
 MRI finding
22
Q

conservative management of MCL

A

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

23
Q

rehab exercise for MCL

A

conc/ecc strengthening
external rotation on stability ball
advanced - throwing exercises on stability ball

24
Q

surgical repair for MCL

A

MCL Reconstruction (if rehab has
failed). Lengthy post-op rehab
required

25
Q

Lateral collateral ligament - LCL sprain also called

A

radial collateral ligament

26
Q

LCL Aetiology

A

 Rarely occurs after isolated varus stress to the
elbow as few mechanisms deliver such a load
(exception – long term crutch use)

27
Q

test for LCL sprain

A

Varus stress test
 Posterolateral rotational
instability test

28
Q

clinical features of LCL sprain

A

Symptoms of recurrent
subluxation – clicking,
catching, snapping,
locking

29
Q

olecranon bursitis

A

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

30
Q

clinical features of olecranon bursitis

A 
 Pain with pressure on bursa
 Obvious swelling/thickening
 Tender on palpation over the
olecranon
  pain with movement
31
Q

management of olecranon bursitis

A 
NSAIDs
 ?Electrotherapy
 Rest
 Corticosteroid injection
 Aspiration
 Rx infection: antibiotics
 Surgical excision
32
Q

cubital tunnel syndrome

A

Compression or stretch of the
ulnar nerve at the cubital
tunnel

33
Q

cause of cubital tunnel syndrome

A 
medial epicondyle
 prolonged pressure on
nerve - leaning on elbow
 repetitive flexion, lifting
 Overdevelopment of FC
Ulnaris
34
Q

signs and symptoms of cubital tunnel syndrome

A

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)

35
Q

management of cubital tunnel syndrome

A 
Rest from aggravating movements/ positions
 Ergonomic advice
 Splinting 
surgical release and immob
physio post release

NMSKI (38 decks)

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