Week 3: Common elbow conditions and assessment

Question 1

What are the normal ranges for AROM/PROM at the elbow?

Answer 1

• flexion: 150deg
• extension: 0deg
• supination: 75-90deg
• pronation: 75-90deg

Question 2

How does m. length affect diagnosis?

Answer 2

• m. was limiting ROM if releasing stretch at the first j. increases ROM at the second j.
• the m. was not limiting ROM if releasing stretch at the first j. does not change ROM at the second j.

Question 3

What is extensor tendinopathy?

Answer 3

Pathology of the wrist extensor tendons (most commmonly ECRB) esulting from overuse and excessive shear and compression forces

Question 4

What are the clinical features in Hx of extensor tendinopathy?

Answer 4

• 40-60 year olds (F>M)
• pain around lat. epicondyle
• onset usually insidious and associated w/an increase/change in activity
• pain aggravated by gripping, lifting, typing, wrist extension
• neck and upper T/sp. can oft. be involved

Question 5

What are the clinical features in physical exam for extensor tendinopathy?

Answer 5

• tenderness on palpation (esp. 1-2cm distal to lat. epicondyle)
• pain free grip force reduced
• pain on resisted wrist extension
• pain on stretch
• radial n. neurodynamic test +ve
• global upper limb weakness

Question 6

What are the clinical features of a LCL injury?

Answer 6

• Hx:
• following dislocation
• physical exam:
• post. lat. elbow instability
• varus stress test +ve for laxity +/- for pain

Question 7

What is flexor tendinopathy?

Answer 7

Pathology of wrist flexors resulting from overuse and excessive shear and compression forces

Question 8

What are the clinical features of flexor tendinopathy?

Answer 8

• Hx:
• increase/change in wrist flexor/pronator activity
• physical exam:
• tender on palpation at or below med. epicondyle
• special tests = reverse of extensor tendinopathy
• pain on resisted wrist flexion and pronation
• pain on stretch

Question 9

What is MCL injury?

Answer 9

• can be acute or due to repetitive valgus force during throwing
• acute: will have a sudden onset and will sometimes hear a pop (immediate pain and unable to cont. throwing)
• chronic: gradual onset w/increases or changes to throwing load

Question 10

What are clinical features of MCL injury?

Answer 10

• med. elbow pain assoc./w late cocking or early acceleration phase
• local tenderness
• valgus test +ve for laxity and pain

Question 11

What are the 3 main presentations of post. impingement?

Answer 11

1. hyperextension valgus overload in younger Pt.’s (bony impingement at EOR extension +/- osteophyte formation)
2. secondary to valgus instability (i.e. abnormal tracking of the olecranon)
3. secondary to OA

Question 12

What are the clinical feature of post. impingement?

Answer 12

• Hx consistent of either hyperextension valgus overload, valgus instability or elbow OA
• painful EOR extension
• flexion deformity

Question 13

What is olecranon bursitis?

Answer 13

• occurs after single repetive trauma (i.e. fall) to post. elbow
• resting elbows on hard surface
• inflammatory condition
• egg shape swelling
• tender

Question 14

What is referred pain in the elbow?

Answer 14

• assoc./w C/sp, T/sp or shoulder pain
• affected by prolonged postures
• P&N/numbness may indicate neural component

Question 15

What are some serious elbow conditions?

Answer 15

• supracondylar fracture
• radial head fracture
• post. elbow dislocation
• gout (refer to GP)