MSK - the elbow

Question 1

Give some common elbow hypotheses and their mechanism and description of pain

Answer 1

1. OA
   - insidious
   - common in over 55
   - ache and stiffness
2. Inflammatory
   - insidious
   - swelling pain, am stiffness
3. Post-trauma
   - fracture or gament sprain
   - associated with inflammation
4. Musculo-tendon
   - overload onset
   - sharp pain with activity/ post activity
5. Local neurogenic
   - insidious/ repetitive use
   - pins and needles
   - ulnar nerve compression

Question 2

What special questions can you ask for the elbow?

Answer 2

• Have you experienced problems with this area before?
• Locking after trauma
• Persistent or progressive loss of ROM after trauma
• Unexplained swelling or warmth

Question 3

What are some different symptoms of a mechanical (OA) vs inflammatory (RA) injury

Answer 3

Mechanical (OA)
 - pain increases later in the day
 - am stiffness < 30 mins
 - worse with activity
 - locking
Inflammatory (RA)
 - pain worse in the am
 - am stiffness > 30-60 mins
 - better with activity
 - joint swelling/ heat

Question 4

What would be included in a physical examination of an elbow joint?

Answer 4

• posture and willingness to move
• deformities
• swelling/heat
• skin/autonomic changes

Question 5

What would be included in the palpation of an elbow joint?

Answer 5

• joint lines of elbow
• soft tissue tendon & insertions
• muscle

Question 6

What is a tennis elbow and golfers elbow injury?

Answer 6

Both Tennis Elbow and Golfer’s Elbow are forms of epicondylitis, an inflammation of tendons that attach to the elbow.
Tennis Elbow affects the lateral collateral ligament
Golfer’s Elbow affects the medial collateral ligament

Question 7

Name and describe the special test for the MCL

Answer 7

Valgus test
- tests for medial epicondylitis (golfers elbow)
Palpate MCL below medial epicondyle and stabilize humerus.
Flex elbow to 30degrees, apply abduction using your arm (valgus force)
Positive test = pain reproduced

Question 8

Name and describe the special test for the LCL

Answer 8

Varus test
- tests for lateral epicondylitis (tennis elbow)
Palpate LCL below lateral epicondyle and stabilize humerus.
Flex elbow to 30degrees, apply adduction using your arm (varus force)
Positive test = increased laxity, soft end feel or pain reproduced

Question 9

Name and describe 2 neurogenic special tests

Answer 9

1. Tinel’s test
   - the patient is sat, support arm, tap the ulnar nerve between the olecranon and the medial epicondyle.
   - positive test = similar symptoms reproduced (pain, tingling, numbness)
2. Elbow flexion test - cubital tunnel syndrome
   - elbows at max flexion and max supination and wrist in extension.
   - the position maintained for up to 3 minutes
   - positive test = reproduction of pain, tingling or numbness as the 2 heads of the flexor carpi ulnaris are drawn tight over the ulnar nerve to compress it

Question 10

Name 2 functional tests for the elbow

Answer 10

1. Grip strength

2. Opening jars