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MSK Final (Fall) > Lateral Elbow Pain > Flashcards

Lateral Elbow Pain Flashcards

1
Q

Why should it be important to know functional ROM

A

Not every patient will have a full ROM but if they have functional they will be able to carry out their ADLs

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2
Q

What is the functional ROM at the elbow?

A

130 degrees average arc with flexion and extension

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3
Q

What two joints make up the forearm?

A

The proximal and distal radial - ulnar joints

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4
Q

What is the functional ROM in the forearm?

A

Average is 103 degrees with pronation and supination?

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5
Q

What is the max ROM for pronation while keyboarding?

A

65 degrees

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6
Q

What is the max ROM for supination while opening a door?

A

77 degrees

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7
Q

What is “lateral elbow pain” also known as?

A

Aka tennis elbow but most are NOT due to tennis

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8
Q

What is the etiology of lateral elbow pain?

A
  • Overuse/ Repetitive Stress
  • Trauma such as an abducted elbow
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9
Q

What kind of conditions fall under an overuse/ repetitive stress condition at the elbow?

A
  • Tendinopathy: Tendinitis and Tendinosis
  • Radial Nerve entrapment
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10
Q

What percentage of the population experience lateral elbow pain?

A

1% to 3%

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11
Q

What percentage of the laborers with hand tasks experience lateral elbow pain?

A

15%

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12
Q

What percentage of the tennis players experience lateral elbow pain?

A

Up to 40%

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13
Q

What are the risk factors for lateral elbow pain?

A
  • Dominant arm > non-dominant arm
  • Forceful activities
  • Repetitive activities
  • Smoking
  • Poor posture (think about regional interdependence)
  • 35-54 years of age
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14
Q

What are the primary muscles and tendons involved in lateral epicondylitis?

A
  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis
  • Extensor digitorum
  • Extensor digiti minimi
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15
Q

What tendon has the highest incidence level of injury with lateral epicondylitis?

A

Extensor Carpi Radialis Brevis

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16
Q

Is lateral epicondylitis a tendinosis or tendinitis?

A

Tendinitis

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17
Q

What is the etiology of lateral epicondylitis?

A

Overuse

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18
Q

What are hallmark signs of tendinitis?

A
  • pt did too much of XYZ
  • Pain with lengthening
  • Pain with palpation
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19
Q

What should you include in your scan for lateral epicondylitis?

A
  • Functional testing
  • ROM
  • Resisted testing
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20
Q

What functional testing will you do and what will you find for lateral epicondylitis?

A
  • Gripping/ fisting
  • Possible weakness
  • Pain
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21
Q

What will you find with ROM for lateral epicondylitis?

A
  • Pain and limitation with lengthening during wrist flexion without or with elbow extension
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22
Q

What will you find with resisted testing for lateral epicondylitis?

A
  • Pain with wrist extension and possibly 3rd finger extension (extensor carpi radialis brevis), radial deviation, and especially in a lengthened position
  • Possible weakness of involved muscle
  • Abnormal muscle activation patterns, including scapular muscle
23
Q

What will you do in your biomechanical exam for lateral epicondylitis and what might you find?

A
  • Special test: (+) Mill’s due to inflammation
  • Palpation: common extensor tendon (CET) TTP
24
Q

Can lateral epicondylitis lead to nociplastic pain?

A

Yes

25
Q

What are the etiologies of lateral elbow tendinosis?

A
  • Recurrent tendinitis
  • Regional interdependence
  • Spinal nerve impingement
26
Q

What is the pathogenesis of tendinosis?

A

Degeneration most often at a musculotendinous junction

27
Q

What are unique elbow signs of a lateral elbow tendinosis?

A
  • Possible “itis” signs and symptoms
  • Accessory motion testing: potentially limited posterolateral humeroradial glide
  • Special tests: (+) Mill’s for CET scarring so extension is limited and greater than pain
28
Q

What is the difference between a normal US image and a tendinosis US image for a lateral elbow tendinosis?

A
  • Normal: Arrow shows uniform fibers towards epicondyle
  • Tendinosis: arrow shows hypoechoic (“not many echos” basically a dark mass) focus or degeneration
29
Q

What is the most common spinal segment involved with lateral elbow tendinosis? (regional interdependence)

A

C5-C6 Joint Dysfunction

30
Q

Why is C5-C6 the most involved spinal segment for a lateral elbow tendinosis?

A
  • The wrist extensors share innervation of C6 with C5 (6 segment), which creates excessive recruitment of the wrist extensors
  • This also creates an excess CET (common extensor tendon) tension and compression
31
Q

When there is a spinal nerve impingement with lateral elbow pain, what nerve has decreased conduction?

A

C6

32
Q

What does the spinal nerve impingement of C6 cause?

A
  • Decreased activation of wrist extensors
  • Lowers supply of wrist extensors and creates overuse even without changing activity level
33
Q

What are signs and symptoms of a C6 spinal nerve impingement?

A
  • Decreased wrist extension myotome as well as elbow flexion (fatiguing weakness)
  • Decreased distal/ lateral forearm/ thumb sensation
  • Brachioradialis/ biceps are hypoactive (reflex)
  • (+) radial and median dural mobility
34
Q

For a tendinitis or tendinosis of the lateral elbow what should be the PT Rx? (big picture - not details yet)

A
  • Patient education
  • POLICED
  • Bracing and Taping
  • Modalities
  • STM
  • Stretching
  • JM
  • METs
35
Q

What kind of patient education should you be doing for a tendinosis/ tendinitis?

A
  • Soreness rule: it is okay to have mild symptoms during or up to 24 hours after exercise but no more and no longer
  • Load management including ergonomic corrections (I.e. with grip/ keyboarding)
36
Q

What are two other patient Rxs for tendinitis/ tendinosis?

A
  • POLICED
  • Bracing/ Taping: elbow straps, wrist splinting to provide greater pain relief than elbow straps, kinesio tape for short term pain relief
37
Q

What modalities can be used for tendinitis/ tendinosis?

A
  • More evidence is needed for a recommendation with laser
  • No consensus for shockwave therapy
  • TENS and microcurrent are not recommended
  • Weak evidence with US
38
Q

What kind of relief does trigger point dry needling provide for tendinitis/ tendinosis?

A

Short term pain relief

39
Q

Soft tissue mobilizations for tendinitis/ tendinosis are not as effective as…

A
  • Exercise or injections
  • TFM is not supported
  • IASTM is not supported
40
Q

Is stretching supported for tendinitis/ tendinosis?

A

More evidence is needed

41
Q

What do cervical manipulations/ joint mobilizations help with when it comes to lateral elbow pain?

A
  • Manipulations are effective with pain and grip strength
  • Fewer visits and equal success compared to isolated elbow Rx
42
Q

Are elbow and wrist manipulations/ joint mobilizations effective?

A

Yes, mills manipulation for pain and function and pulling apart scarring

43
Q

What two joint mobilizations are more effective together than alone?

A

Cervical and elbow

44
Q

Thoracic manipulations are not effective for lateral elbow pain but are helpful for what?

A

To increase grip strength

45
Q

What is the primary purpose of METs for tendinitis/ tendinosis?

A

Tendon proliferation and possibly addressing cervical spine dysfunction

46
Q

What is the tendinosis MET prescription?

A

2-3 sets of 10-15 reps with a heavy load

47
Q

What muscle actions are beneficial with METs?

A
  • Eccentrics same or better as concentric
  • Additive benefit with addition of isometrics
48
Q

Greater weekly frequency provides greater what?

A

Pain control

49
Q

What is an MET example with wrist extensors?

A
  • Isometric loading without compression from lengthening: isometrics in a shortened position
  • Isotonic loading without compression from lengthening: isotonic from neutral into shortened position
  • Isotonic loading with compression from lengthening: isotonic from a lengthened position
  • Isometric loading in weight bearing
  • Plyometric loading
50
Q

What kind of METs are possible for lateral elbow tendinitis/ tendinosis?

A
  • Sport specific corrections (ex: with tennis swing or larger grip)
  • Cuff, scapular, trunk, and/or LE muscle coordination, endurance, and strength training to decrease elbow stress
  • Rememeber 50% of tennis serve is from the LE
51
Q

Cortisone injections are associated with what kind of outcomes?

A
  • Poorer outcomes and higher recurrence rates versus “wait and see” approach
  • Placebo favored better for pain and function
52
Q

What percentage of patients with lateral elbow pain have surgery and what is it?

A
  • 5-10%
  • Arthroscopic procedure to promote inflammation with tendinosis not responding to PT
53
Q

What is the prognosis of a tendinitis/ tendinosis of the lateral elbow?

A
  • Prone to recurrent bouts
  • 6-24 months with an average of 1 year
  • 89% recovery

MSK Final (Fall) (15 decks)

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