1
Q
Besides elbow impairments specifically, what else needs to be considered in an examination and evaluation of the elbow? (3 things)
A
- Upper quarter comprehensive exam (c-spine, clearing other joints)
- Comorbidity consideration
- Medical history
2
Q
What are 6 relevant scales used to assess the elbow?
A
- VAS
- DASH
- PSFS
- UEFS
- American Shoulder and Elbow Surgeons Elbow Form
- Boston Questionnaire (carpal tunnel)
3
Q
What are 7 general considerations when treating the elbow?
A
- Posture of the head and neck
- Muscle tone
- Quality, color, and temperature of skin
- Carrying angle - elbow (10 - 13 degrees)
- Swelling
- Resting position of elbow
- Ability to use limb
4
Q
What should be cleared when treating the elbow?
A
- Shoulder
- Wrist
- C-spine
5
Q
What are the accessory motions of the elbow and forearm?
A
- Distration and radial and ulnar gapping of the humeroulnar joint
- Distraction and radial and volar glides of the humeroradial joint
- Dorsal and volar glides of the proximal and distal radioulnar joints
6
Q
What are 4 performance based functional measures of the elbow?
A
- Pushing (push-off test)
- Pulling
- Curling
- Grip strength
7
Q
What are 4 non-muscular tests for the elbow?
A
- Ligament stability
- Soft tissue mobility
- Neurologic status
- Functional status
8
Q
What are 7 common pathologies of the elbow?
A
- Lateral epicondylitis/algia
- Medial “
- Olecranon bursitis
- Dislocation/ instability
- Radial head subluxation
- Volkman’s contracture
- Nerve entrapment syndromes
9
Q
What is the etiology of lateral epicondylitis?
A
- Degeneration
- Micro/macro tearing of common extensor tendon insertion
- Often due to repetitive forceful wrist extension and gripping
10
Q
What muscles are especially effected by lateral epicondylitis?
A
- ECRB
- EDC III
11
Q
What is the 3 part vicious cycle of lateral epicondylitis?
A
- Inflammation
- Tissue weakness
- Tearing
12
Q
What 4 other diganoses must lateral epicondylitis be discriminated from?
A
- Radiohumeral DJD
- Radial nerve entrapment
- Ligamentous injury
- Proximal pathology
13
Q
Past what age does lateral epicondylitis become more common?
A
35.
14
Q
Where is the elbow usually tender in lateral epicondylitis?
A
- Over lateral humeral epicondyle
- Extensor tendon
- Muscle belly
15
Q
In what phase is edema sometimes present in lateral and medial epicondylitis?
A
- Acute phase
16
Q
In what phase are tight fascial bands noted in lateral and medial epicondylitis?
A
- Chronic phase
17
Q
What active movements provoke pain, and what passive movements provoke pain in lateral epicondylitis?
A
- Active wrist extension (+ with radial deviation)
- Passive wrist flexion (+ with ulnar deviation, elbow extension, pronation)
18
Q
What do 7 % of plain films show in lateral epicondylitis?
A
- Calcification.
19
Q
What is the etiology of medial epicondylitis?
A
- Micro/macro tearing of common flexor tendon insertion
- Repetitive active forceful wrist flexion.
20
Q
What is another name for lateral epicondylitis?
A
- Tennis elbow
21
Q
What is another name for medial epicondylitis?
A
- Golfer’s elbow
22
Q
What active and passive motions provoke pain in medial epicondylitis?
A
- Active wrist flexion and pronation
- Passive wrist extension (+ with supination)
23
Q
What is the treatment for lateral and medial epicondylitis in the acute phase? Refer to medication, patient education, and 2 interventions.
A
- Topical NSAIDS
- Local injection of steroids
- Pt Ed: Refrain from aggravating activities
- Stretching
- Splints and/or Straps
24
Q
What treatment should be performed for lateral/ medial epicondylitis in the subacute phase? State manual therapy, exercises, and modalities.
A
- Deep friction massage
- Mill’s manipulation and radial head mobilizations
- Exercise progressed from iso to concentric to eccentric
- Acupuncture, laser, and ultrasound
25
What type of contraction promotes the realignment of collagen?
Eccentric.
26
Do corticosteroid injections or PT have better long term effects?
PT.
27
Corticosteroids have better effects than PT after 6 weeks, but what was the problem after that?
Higher recurrence/ regression of cases.
28
Is PT or wait and see a better method for lateral epicondylitis after a year?
No difference.
29
Did wait and see, steroid injections, or PT treatments result in lower additional treatments of lateral epicondylitis?
PT.
30
In what amount of patients with lateral epicondylitis are C-spine impairments prevalent?
57 - 90 %.
31
What are 4 common causes of elbow bursitis?
- Fall on elbow/ trauma
- Excessive friction
- Infection
- Systemic disease (RA, Gout)
32
How are ROM and strength affected by olacranon bursitis?
- Decreased extension ROM and strength
33
What will palpation of olecranon bursitis reveal?
- Swelling confined to elbow
- Pain
- Increased temperature
34
What is conservative treatment of olecranon bursitis?
- Symptom reduction treatment
- Warm soaks
- Splinting
- Protection
35
What are 2 more aggressive treatments of olecranon bursitis?
- Aspiration
| - Aspiration with a steroid injection
36
What are risks of aspiration of elbow in olecranon bursitis?
- Skin atrophy
- Septic bursitis
- Chronic pain on pressure
37
What are 2 common risks of elbow dislocation?
- Nerve compromise
| - Vascular compromise
38
What 2 things can sometimes complicate elbow dislocations?
- Fracture
| - Ligament disruptions
39
What individuals are prone medial elbow instability? Why?
- Throwing athletes
| - Stretching/ rupture of ulnar collateral ligament
40
What often leads to lateral elbow instability?
- Trauma to radial collateral ligament
41
What are 2 clinical signs of an elbow dislocation or instability?
- Feeling of "giving way"
| - Pain on activities that stress the ligaments
42
What is conservative treatment for an elbow dislocation or instability?
- Dynamic stability from FCU
- Stabilize proximal to the elbow
- Practice proper form
43
What is stressed during rehab following a surgical reconstruction of the elbow or its associated tissues?
Early protected motion.
44
What is conservative treatment for medial elbow instability for non-throwing athletes?
- Don't overstress healing tissue
- Establish flexibility
- Muscle balance
- Neuromuscular control
45
What is medial epicondyle apophysitis?
- Traction apophysitis at medial epicondyle
- Result of valgus stresses in immature elbow
- Inflammation along medial apophsysis.
46
What is a valgus extension overload?
- Olecranon on fossa with combined valgus
| - Swelling, medial and posterior pain
47
Which medial elbow pain is found in a skeletally immature individual?
Medial epicondyle apophysitis.
48
What is a common mechanism of injury for an olecranon fracture?
- FOOSH w/ elbow flexed
| - Triceps contracts
49
What nerve is vulnerable in an olecranon fracture?
Ulnar.q
50
What is a common mechanism of injury for a fracture of the radial head?
- FOOSH with supination
51
What is the common 3 step process of treatment for olecranon or radial head fractures?
```
- Short immobilzation with early motion
To address resultant biceps shortening:
- Contract-relax stretches and arm swings
To address extension loss:
- Joint mobilization
- Joint distraction
```
52
What is the etiology of a radial head subluxation?
- Longitudinal force at pronated forearm
| - Radial head pulled from annular ligament
53
What are clinical signs of a radial head subluxation?
- Localized pain
- Reluctancy to move forearm, and elbow held in pronation
- Palpate a sulcus between humerus and radial head
54
What is the 3 step treatment process for a radial head subluxation?
- Reduction at ER
- Guarded motion
- PT to control inflammatin, symptoms, and improve impairmentos
55
What is another name for a radial head subluxation?
Nurse-maid's elbow.
56
What is a Volkmann's Ischemic Contracture?
- Deformity of hand fingers and wrist caused by trauma induced ischemia
57
What type of trauma typically causes the ischemia associated with Volkmann's ischemic contracture?
- Crush injury to forearm
| - Elbow fracture in children
58
What does the swelling from trauma associated with Volkmann's ischemic contracture cause?
- "Compartment Syndrome"
- Pressure reduces blood inflow and prevents outflow
- Tissue death
- Tissue fibrotic and shortened
59
What are 2 treatments for Volkmann's contracture?
- Fasciotomy
| - Followed up by rehab to regain strength and ROM
60
What structures impinge on the ulnar nerve to cause cubital tunnel syndrome?
- Medial epicondyle
- Olecranon
- MCL
- Ligament of Struthers
61
What position causes further compression of the ulnar nerve and blood supply in the cubital tunnel?
- Flexion
62
What are signs and symptoms of Cubital tunnel syndrome?
- Parathesias/ pain of the medial forearm and ulnar hand
| - Provoked by flexion
63
What 4 common positions can cause flexion impingement of the ulnar nerve in the CT?
- Sleeping
- Combing hair
- Driving
- Telephone
64
What are 3 signs of chronic cubital tunnel syndrome?
- Weak key turning
- Grip/ pinch weakness
- Dropping objects
65
What are 4 areas of concern in suspected cubital tunnel syndrome during the exam?
- Upper limb tension tests
- Muscle bulk atrophy
- Digits 4 - 5
- Sensory testing
66
What 3 other pathologies may be confused with cubital tunnel?
- C8 - T1 nerve root impingement
- Thoracic Outlet Syndrome
- Guyon's Canal
67
What are 6 conservative treatments for cubital tunnel?
- Avoiding elbow flexion activities
- Night splints with 40 - 60 degrees flexion
- TENs and physical agents to reduce inflammation
- Nerve gliding
- Stretching of extrinsic flexors and ulnar innervated intrinsics
68
What is the surgical treatment for cubital tunnel?
- transposition of the nerve anteriorly.
69
What nerve becomes entrapped in radial tunnel syndrome?
Posterior interosseus nerve.
70
What 4 structures impinge on the posterior interosseus nerve and its associated vasculature in radial tunnel syndrome?
- Leash of henry
- ECRB tendon
- Arcade of Frohse
- Supinator origins
71
What repetitive actions cause radial tunnel syndrome?
- Pronation/ supination
| - Wrist flexion/ extension
72
What are 3 symptoms of radial tunnel syndrome?
- Pain in common extensors mid belly
- Can appear similar to tennis elbow
- Decreased strength
73
How can pain from radial tunnel be differentiated from pain due to tennis elbow?
- It is 3 - 4 centimeters below the extensor wad.
74
What are 5 conservative treatments for radial tunnel syndrome?
- Avoid aggravating activities (keep forearm in neutral)
- Cock-up splint at wrist for 3 - 6 motnhs
- Physical agents and TENS to control inflammation
- Nerve gliding
- Stretching of extrinsic extensors. flexors, and supinators
75
What is the surgical intervention for radial tunnel syndrome?
- Transposition of nerve anteriorly
76
What are 2 tests for lateral epicondylitis?
- Cozen's test
| - Lateral epicondylitis test
77
What are 4 tests for elbow stability?
- Moving valgus stress test
- Posterior lateral rotary instability
- Varus stress test
- Valgus stress test
78
What are 3 tests for nerve entrapment at the elbow?
- Elbow flexion test
- Pressure provocation
- Tinel's sign
Musculoskeletal I
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