Common Elbow problems

Question 1

Lateral Epicondylitis/epicondylalgia “tennis elbow” characterisitics/incidence

Answer 1

• common occurrence
• 35-50 years old
• usually dominant arm in 75% of cases
• younger cases due to sports
• older cases related to work or insidious onset
• tennis players typically have a lot of force going through the elbow with a a long lever arm

Question 2

Causes of lateral epicondylitis/epicondylalgia

Answer 2

• repetitive wrist motions and cumulative trauma
• gripping/twisting
• repetitive flex/ext
• heavy lifting
• easily re-aggrevated

Question 3

Signs and symptoms of lateral epicondylitis/epicondylalgia

Answer 3

• tender to palpation
• pain and weakness in wrist ext (ECRB/ECRL/Extensor digitorum)
• decrease grip strength
• granulation tissue and adhesions
• varus stress
• usually painless at rest and PROM
• reduced wrist extensor flexibility

Question 4

Differential diagnosis of lateral epicondylitis/epicondylalgia

Answer 4

• C5-C7
• posterior interosseous nerve entrapment
• lateral collateral ligament sprain
• common extensor tendon tear

Question 5

How to avoid stressing the Lateral epicondylitis/epicondylalgia?

Answer 5

• supinate to pick things up to use wrist flexors and biceps

Question 6

epicondylitis/epicondylalgia: treatment considerations

Answer 6

• protect healing tissues
• restore flexibility, strength and endurance
• manual therapy
• anti-inflammatory medication
• grip modification: nirschl = measure trip of ring finger to the palmar crease of hand

Question 7

How does the elbow counter force strap work for lateral epicondylitis/epicondylalgia

Answer 7

• dissipate force over the tendon
• minimize stresses on tendon
• prevents muscle from spreading during contraction therefore preventing force production

Question 8

Lateral epicondyle tendonosis differences and treatmetns for it

Answer 8

• they will say the more they move it the better it gets “losses up”
• due to incomplete healing

Treatment:

• stretching
• eccentric loading
  monitor carefully

Question 9

Primary involvement of medial epicondylitis/epicondylalgia

Answer 9

• overruse and microtrauma to wrist flexors
• pronator teres, flexor carpi radialis, flexor carpi ulnaris

Question 10

Differential diagnosis for medial epicondylitis/epicondylalgia

Answer 10

• traction neuropraxia ulnar nerve (differential)
• C7-8
• medial collateral ligament sprain
• tendon tear

Question 11

Treatment for medial epicondylitis/epicondylalgia

Answer 11

• protect healing tissues
• restore flexibility
• restore strength and endurance

Question 12

Modified Nirschl Method surgery

Answer 12

• for 10% who fail conservative methods
• chronic lateral epicondylitis/epicondylalgia

Question 13

Indications for the modified Nirschl method surgery

Answer 13

• constant focal unrelenting pain
• symptoms greater than 1 year
• 3 or more local steroid injections
• presence of calcification around lateral elbow

Question 14

Goal of modified nirschl method

Surgery(not grip modification)

Answer 14

• Alleviate pain
• degenerative portion of ECRB tendon is excised and then the muscle is reattached
• outcome 85% return to previous activities without pain

Question 15

Precautions with modified nirschl method surgery

For rehab/post op

Answer 15

• extension strong contraction
• prevent wrist flexion with elbow extension (stretching)
• about 6 weeks

pathologictissue of ECRB is removed