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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?

25
What are the etiologies of lateral elbow tendinosis?
- Recurrent tendinitis - Regional interdependence - Spinal nerve impingement
26
What is the pathogenesis of tendinosis?
Degeneration most often at a musculotendinous junction
27
What are unique elbow signs of a lateral elbow tendinosis?
- 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
What is the difference between a normal US image and a tendinosis US image for a lateral elbow tendinosis?
- Normal: Arrow shows uniform fibers towards epicondyle - Tendinosis: arrow shows hypoechoic ("not many echos" basically a dark mass) focus or degeneration
29
What is the most common spinal segment involved with lateral elbow tendinosis? (regional interdependence)
C5-C6 Joint Dysfunction
30
Why is C5-C6 the most involved spinal segment for a lateral elbow tendinosis?
- 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
When there is a spinal nerve impingement with lateral elbow pain, what nerve has decreased conduction?
C6
32
What does the spinal nerve impingement of C6 cause?
- Decreased activation of wrist extensors - Lowers supply of wrist extensors and creates overuse even without changing activity level
33
What are signs and symptoms of a C6 spinal nerve impingement?
- 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
For a tendinitis or tendinosis of the lateral elbow what should be the PT Rx? (big picture - not details yet)
- Patient education - POLICED - Bracing and Taping - Modalities - STM - Stretching - JM - METs
35
What kind of patient education should you be doing for a tendinosis/ tendinitis?
- 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
What are two other patient Rxs for tendinitis/ tendinosis?
- POLICED - Bracing/ Taping: elbow straps, wrist splinting to provide greater pain relief than elbow straps, kinesio tape for short term pain relief
37
What modalities can be used for tendinitis/ tendinosis?
- 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
What kind of relief does trigger point dry needling provide for tendinitis/ tendinosis?
Short term pain relief
39
Soft tissue mobilizations for tendinitis/ tendinosis are not as effective as...
- Exercise or injections - TFM is not supported - IASTM is not supported
40
Is stretching supported for tendinitis/ tendinosis?
More evidence is needed
41
What do cervical manipulations/ joint mobilizations help with when it comes to lateral elbow pain?
- Manipulations are effective with pain and grip strength - Fewer visits and equal success compared to isolated elbow Rx
42
Are elbow and wrist manipulations/ joint mobilizations effective?
Yes, mills manipulation for pain and function and pulling apart scarring
43
What two joint mobilizations are more effective together than alone?
Cervical and elbow
44
Thoracic manipulations are not effective for lateral elbow pain but are helpful for what?
To increase grip strength
45
What is the primary purpose of METs for tendinitis/ tendinosis?
Tendon proliferation and possibly addressing cervical spine dysfunction
46
What is the tendinosis MET prescription?
2-3 sets of 10-15 reps with a heavy load
47
What muscle actions are beneficial with METs?
- Eccentrics same or better as concentric - Additive benefit with addition of isometrics
48
Greater weekly frequency provides greater what?
Pain control
49
What is an MET example with wrist extensors?
- 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
What kind of METs are possible for lateral elbow tendinitis/ tendinosis?
- 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
Cortisone injections are associated with what kind of outcomes?
- Poorer outcomes and higher recurrence rates versus "wait and see" approach - Placebo favored better for pain and function
52
What percentage of patients with lateral elbow pain have surgery and what is it?
- 5-10% - Arthroscopic procedure to promote inflammation with tendinosis not responding to PT
53
What is the prognosis of a tendinitis/ tendinosis of the lateral elbow?
- Prone to recurrent bouts - 6-24 months with an average of 1 year - 89% recovery

MSK Final (Fall) (15 decks)

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