Pathology of the Elbow

Question 1

What are 4 categories of pathologies that refer symptoms to the elbow?

Answer 1

Viscogenic: heart, lung
Spondylgenic: C5-T2 (disc lesions, tumors, fractures, stenosis, facilitation).
Other Joint: Shoulder to radial side of elbow
Systemic: RA, AS, Reiter’s

Question 2

What is the medical term for tennis elbow?

What is the common characteristic of tennis elbow?

Answer 2

Lateral Epichondylosis/itis.

Lateral elbow pain on isometric wrist extension.

Question 3

What are the 4 sites where the extensor tendon may be affected and what treatment works best for each? How can you differentiate between the sites?

Answer 3

1. Supracondylar - friction massage
2. Epicondylar - friction massage or Mills manipulation if + Mills test.
3. Tendon body - friction massage
4. Myotendonous - injection
   You can differentiate with careful palpation for tenderness along the tendon.

Question 4

What 3 sites can tennis elbow be a 2° dysfunction from? How can you tell if this is a problem?

Answer 4

1. Cervical spine
2. Shoulder
3. Wrist
   Test isometric wrist extension in varying positions of the shoulder and neck to look for variations in the pain.

Question 5

A positive on which 6 tests will point strongly to Tennis Elbow as a culprit?

Answer 5

1. Resisted wrist extension
2. Resisted finger extension
3. Possible passive wrist and finger flexion, with ulnar deviation.
4. Mills Test
5. Cozen’s Test
6. Palpation over the lateral epicondyle.

Question 6

What is the main goal of treatment for Tennis Elbow? What are some things you can do for treatment?

Answer 6

Goal: Increase Blood Flow
Treatment:
Friction Massage
Modalities
Submaximal Exercises
Stretching
Self Frictions
Mills Manip
Mulligan Mob
ASTYM (shoutout to undeFEATable!)
Counterforce bracing
Pt. Education

Question 7

What are the 4 most common radial nerve pathologies?

Answer 7

1. High Radial Nerve Compression
2. Posterior Interosseus Nerve Entrapment
3. Radial Tunnel Syndrome
4. Radial Sensory Nerve Entrapment

Question 8

What is the common cause for a high radial nerve compression? Symptoms (3)? Other diff dxs that it could be?

Answer 8

Cause: Distal humerus fracture.
Symptoms:
1. Loss of wrist ext.
2. Inability to extend fingers/thumb
3. Loss of sensation in the first dorsal web space.
Other diff dxs: cervical radiculopathy and TOS.

Question 9

What are the 2 potential sites of posterior interosseus nerve entrapment that we have to know?
What are the symptoms of PIN entrapment?
What does conservative treatment include?

Answer 9

1. Leading edge of extensor carpi radialis brevis
2. As it passes between the 2 heads of the supinator muscle in the arcade or canal of froshse.
   Symptoms:
   Lat. elbow pain radiating to distal forearm aggravated by repetitive pronation and supination and resisted supination.
   Pain 3-4cm distal to lateral epichondyle.
   Functional involvement of forearm extensor muscles of wrist & fingers/thumb.
   Tx:
   Rest, Activitiy modification, use of cock-up wrist splint, gentle stretching of wrist extensors performed in full elbow extension.

Question 10

1. What is radial tunnel syndrome?
2. When does entrapment occur?
3. What pathology does it have similar signs/symptoms/treatment to?

Answer 10

1. Compression of the deep branch of the radial nerve
2. During elbow extension, forearm pronation, and wrist flexion.
3. Similar to post. interosseus nerve entrapment.

Question 11

1. What’s another name for Radial Sensory Nerve Entrapment?
2. Where does it occur?
3. Symptoms?
4. What condition does it mimic?

Answer 11

1. Wartenberg’s syndrome
2. Occurs where the nerve pierces the fascia between the brachioradialis and the ECRL.
3. Symptoms are shooting burning pain the posterior radial forearm wrist and thumb.
4. Can mimic Dquervain’s syndrome as it worsens with wrist flexion and ulnar deviation.

Question 12

What are the 4 Complications common with Radial head fractures?

Answer 12

1. Stiffness - need to get ROM back
2. Deformity
3. Post Traumatic ARthritis
4. Nerve Damage (all 3 major nerves at risk)

Question 13

1. What is the treatment for a Radial head fracture that has the best results?
2. What treatment for a radial head fracture has high rates of stiffness as a result?
3. What treatment for a radial head fracture often results in mal or non-union?

Answer 13

1. ORIF or Replacement
2. Closed Reduction in Casting
3. Closed Reduction with Early Movement

Question 14

What muscles does ulnar neuritis usually affect?

Answer 14

1. Flexor Carpi Ulnaris
2. Ulnar half of FDP
3. The hypothenar eminence (FDM, ODM, ADM, AP)

Question 15

Are the early signs of ulnar neuritis primarily sensory or motor?

Answer 15

sensory

Question 16

What is the usual cause of myositis ossificans?

Answer 16

Trauma that causes deep tissue bleeding, leading to a hematoma that may result in bone growing in the muscle.

Question 17

What is the usual treatment for myositis ossificans?

Answer 17

Conservative (rest, immobilization, anti-inflammatory meds) usually results in spontaneous reabsorption.
Occasional surgical debridement required.

Question 18

What is Golfer’s Elbow?

Answer 18

Medial epicondylosis/itis.

Question 19

What are symptoms of golfer’s elbow? How is it treated?

Answer 19

Pain with stretching of wrist flexors especially with elbow ext. added, and pain with resisted wrist flexion and finger flexion. It is treated similarly to tennis elbow.

Question 20

1. What may cause an increased carrying angle?

2. What are the functional problems with this?

Answer 20

1. ulnar abduction lesion from a FOOSH injury

2. Stuck in abduction, leading to loss in flexion, supination, and radial deviation.

Question 21

How do you treat an ulnar abduction lesion?

Answer 21

1. Manipulation (check contraindications!)
2. Lateral glide of the humeral ulnar joint.
3. Worked out if elbow flexion and supination are regained and carrying angle is reduced.