elbow soft tissue injuries Flashcards
what is lateral epicondylagia?
-commonly referred to as tennis elbow
-characterised by pain on the lateral side of the elbow
-overuse & repetitive strain of muscles of the forearm (extensors)
what are other names other than lateral epicondylagia for tennis elbow?
-lateral elbow tendinopathy
-lateral epicondylitis
what are examples of symptoms associated with tennis elbow?
-pain over lateral elbow which can radiate into forearm
- pain is aggravated by wrist mats and gripping eg computer works - typing and using mouse
-can get weakness in hand which is associated with pain
-occasional night pain
what are the extensor muscles of the forearm?
-extensor carpi radialis longus
-extensor carpi radialis brevis
-extensor digitorum communis
-extensor digiti minimi
-extensor indicis
-extensor carpi ulna’s
-anconeus
-supinator
describe the epidemiology of tennis elbow
-most common MSK complaint of the elbow
-7-10 times more common than medial
-1-3% of population
-males are equally as likely as females to get conditions
-35-5- yrs
-50% of tennis players report elbow pain
who is at more risk of developing LE?
-manual workers that involve repetitive arm & wrist mats
-office work
-older age
-previous tobacco use
who have a poorer prognosis of LE?
-manual workers that involve repetitive arm and wrist mvts
-repetitive key boarding tasks
-age greater than 40 yrs
-pain in the shoulder, wrist or hand within the past 3 months
-high level of baseline pain & distress
-longer symptom duration
what kind of manual work can lead to LET?
-handling heavy loads
-forearm rotating motions
- high gripping force
-working postures that require load handling with raised arms
which tendon is most likely affected with LE?
extensor carpi radialis brevis tendon
what 2 ligaments of the elbow does ERCB merge with?
the lateral collateral and annular ligament of the elbow
what kind of changes happen to the ECRB in LE?
-degenerative process - tendon structural changes
-alterations in nociceptive processing
-differences in sensory & motor function
what are examples of differential diagnosis of lateral elbow pain?
-intra-articular pathology
-ligamentiys pathology
-nerve pathology eg radial tunnel
-cervical / thoracic spine referral
-non specific arm pain
-inflammatory arthritis
- OA
what is PIN?
-posterior interosseous nerve entrapment
describe PIN
-a condition where the posterior interosseous nerve (a branch of the radial nerve) becomes compressed or entrapped
-compression can be due to trauma , repetitive use injuries etc
what is the function of the posterior interosseous nerve?
controls the movement of certain muscles in the forearm responsible for wrist and finger extension
what is wartenberg syndrome?
-radial nerve entrapment
-superficial branch of the dorsal radial nerve is entrapped
-sensory symptoms affected only
-often occurs after wrist fracture
what are the symptoms of LET that can be picked up in a subjective exam?
-pain over lateral elbow which may radiate into forearm
-pain increased with activities such as manual work and lifting, gripping, keyboard typing, using computer mouse, repeated wrist extension activities
how is the evaluation of pain and disability measured in LET?
-patient rated tennis elbow evaluation
-score 0-100
how would you carry out a physical exam for LET?
-assessment of pain free grip strength - using dynamometer - bets of 3 attempts & elbow extended and forearm pronated
-special tests including cozens, mills, maudsleys, resisted wrist extension etc
-pain on palpation
what are examples of simple advice you can give to a patient with LET?
-avoid heavy lifting, forceful gripping and twisting activities
-palm up lifting
-modify work
what does the physiotherapy management of tennis elbow involve?
-exercise & manual therapy may bet better than exercise alone
-consider treatment based on stage of tendinopathy eg acute reactive - modify load and isometric exercises … if degenerative - eccentric exercise & heavy slow resistance
what effects can manual therapy have on LET?
-short term pain relief
-improved grip
what are examples of manual therapy for LE?
-mobilisation - elbow lateral glide for movement & grip
-PA radius head -mvt and grip
what is counterforce brace?
orthopedic brace commonly used to alleviate pain and provide support for conditions such as lateral epicondylalgia (tennis elbow) or medial epicondylalgia (golfer’s elbow).
how does a counterforce brace work?
- constrains the full muscle expansion when the muscles contracts
-it diminishes muscle activity & the force generated by the muscle
what are examples of exercise for LET?
- individual to each patient
-focus to strengthen extensor muscles of the wrist and improve grip strength
-isometric, concentric , eccentric & stretching exercise to improve pain and function
-rotator cuff and proprioceptive exercises
what are the forearm muscles that originate from the common flexor origin (medial epicondyle)?
-pronator teres
-flexor carpi radialis
-palmaris longus
-flexor carpi ulnaris
-flexor digirotum superficialis
what is medial elbow tendinopathy?
-tendinopathy of the flexor/pronator origin at the medial epicondyle
-also called golfers elbow
Describe the epidemiology of MET
-most common cause of medial elbow pain
-only 15-20% as common as tennis elbow
-peak incidence in age 30-50
-male - female - 2:1
-dominant elbow in 60% of cases
what kind of clinical history would you pick up during a subjective exam with a patient with golfer’s elbow?
-medial elbow pain in the region of the common flexor origin
-activity related, esp repetitive or forceful pronation and wrist flexion
-golfers who hit the ground instead of the ball
-tennis players who use forehand top spin
what can be seen during physical examination of a patient with golfers elbow?
-localised tenderness on or just below the medial epicondyle
-pain on resisted wrist flexion
-pain on resisted pronation
what is cubital tunnel syndrome?
-compression of the ulnar nerve at the cubital tunnel
what are the causes of cubital tunnel syndrome?
-medial epicondyle - prolonged pressure on nerve
-repetitive flexion
-overdevelopment of FCU
-secondary to OA
what are the signs and symptoms of cubital tunnel?
-pain- along medial aspect if elbow and hand
-pins and needles along medial aspect of elbow and hand
-weakness in muscles supplied by ulnar nerve - thumb adduction, abduction fingers
-often might symptoms
what would you observe in the physical exam of a patient with cubital tunnel syndrome?
- loss of hypothenar eminence
-claw hand
-warternburgs sign
-froments - pink grip on paper - flexor pollicis longus flexes
-elbow flex test
what does management of cubital tunnel syndrome involve?
-rest from aggravating movements / positions
-splinting
-surgical release and immobilisation
-physiotherapy post release to restore ROM and strength for return to function
what is olecranon bursitis?
inflammation of the bursa overlying the olecranon process at the proximal aspect of the ulna.
what are the clinical features of olecranon bursitis?
-there may be pain with pressure on bursa / movement
-obvious swelling / thickening
-tender on palpation over olecranon
what are the causes of olecranon bursitis?
-traumatic - overuse or direct impact
-inflammatory - eg gout or arthritis
-infectious
how is olecranon bursitis managed?
-NSAIDS
-rest and avoidance of aggravating factors eg leaning on elbows
-corticosteroid injection and or aspiration
-if there is an infection - antibiotics prescribed by doctor
