msk conditions of elbow Flashcards
lateral elbow tendinopathy
Pain over lateral epicondyle with wrist extensor load
Pain with
-resisted wrist, 2nd, or 3rd digit extension
-Wrist extensor stretch
-with grip
risk factors
35 to 54 years old
Smoker
Manual labor
Tennis player
pathophysiology of lateral elbow tendinopathy
Extensor carpi radialis brevis degeneration, merges with LCL and annular ligament
Not inflammatory
Tendon pathology for lateral elbow tendinopathy
reactive- due to unusual or increased activity load; treat by reducing loads
degenerative- chronic symptoms; treat with eccentric exercise
surgery- large tear or LCL or failed 6 mo conservative care
lateral elbow tendinopathy treatment
mobilization with movement
strengthening of wrist extensors
wrist manipulations
impairments
regional interdependence
lateral elbow pain differential diagnoses
Radial tunnel syndrome
Posterior interosseous nerve entrapment
Posterolateral rotatory instability
Cervical radiculopathy
radiocapitellar pathology
radial tunnel syndrome and posterior interrosseous nerve
deep branch of radial nerve
Compression at proximal border of supinator arcade of froshe
Signs and symptoms
-pain lateral forearm
-Pain with wrist, 2, 3 extension
-No weakness
If weakness present, then consider posterior inter nerve entrapment (C6/7)
PIN is pure motor
treatment- consider radial nerve mobilizations
posterolateral rotatory instability
varus instability- lateral UCL complex disruption
Acute trauma
Result of chronic corticosteroid injections
Chronic UE weight bearing
connective tissue disorders
Unrestrained supination - Radial head dislocates posterior with full excessive supination
Clicking snapping instability sensation in extension and supinated position
radiocapitellar pathology
compression injury
Associated with throwing injuries
Secondary to medial instability
Usually children and adolescence
valgus stress
Address medial instability
medial elbow instability
injury to the UCL primarily the anterior band
Throwing valgus stress injury
Rarely caused by routine ADLs
pop, sudden pain, tearing, change in throwing velocity or accuracy
exam
+ Valgus tests, possibly loss of elbow extension
+ tenderness along UCL
Possible ulnar nerve involvement
treat- usually requires surgical repair
For adolescence, be aware of epicondylar apophysitis
ulnar nerve injury
sensory deficits palmar dorsal hand
Medial forearm is medial antebrachial cutaneous off of medial cord so not affected unless broader effects of injury
weakness- FDP and lumbricals 4 &5, interossei
+ tinels
+hyperflexion test
r/o C8 and T1 radiculopathy
myositis ossificans
similar to MO in quads
contusion, fracture, too aggressive rehab
brachialis and triceps are most at risk in UEs
Conservative care- gentle ROM, ice, no heat
Surgical- range of motion remains restricted, high recurrence
