Elbow Treatments

Question 1

How can LE be assessed during subjective exam?

Answer 1

Patient rated tennis elbow evaluation (PRTEE) score

Question 2

How is LE treated?

Answer 2

MT
NSIDS
steroid injections
other injections
US
ionisation
massage/TF
exercise
orthotics
acupuncture

Question 3

How effective are corticosteroid injections?

Answer 3

Help most in short term but no evidence for long term bnefis

Question 4

How does corticosteroid injections compare wit wait and see policy and MWM/Exercise

Answer 4

wait and see & MWM/exercise much lower rate of reccurence.

Not per protocol - MWM lower than wait&see and injections

Question 5

Which medical treatments have short term and long term effects in LE?

Answer 5

short:
corticosteroid vs.control
sclerosing agent vs local anaesthetic
nitric oxide patches vs. placebo

Long term
autologous platelet rich plasma vs Cl

Question 6

What manual therapy is effective in the short term and long term for LE?

Answer 6

short:
acupuncture vs placebo
MSM vs placebo/control
Elbow
Cx spine
wrist manipulation vs US
exercise
brace vs control

Long term:
MWM (?)
Exercise (?)

Question 7

When approaching LE treatment, what should be considered?

Answer 7

Target pan,motor, muscle.
Complex aetiology
Target specific deficits
No on treatment for everyone

Question 8

What is a self treatment for LE?

Answer 8

Self MWM against wall

Question 9

What are the guidelines for exercise in LE?

Answer 9

Pain free graduated progressive programme
supervised weekly
6-8 week

Question 10

What must an exercise programme for LE addres?

Answer 10

PFG strength defict
Any ROM restrictions
Altered wrist posture
Sensorimotor deficts

Question 11

What should be done in grip posture retraining

Answer 11

Thumb up/palm down/extended elbow

Extended wrist posture is very important

Question 12

How is eccentric loading effective in LE?

Answer 12

Limited evidence
positive effect on clinical outcomes such as pain, function, patient satisfaction/return to work
compared with stretching or concentric exercises

Question 13

How quickly should rehab be progressed after tenon/ligament/bone injurty?

Answer 13

accelerated rehab accepted to avoid adverse effects of immobilisation

Question 14

Where can median nerve become entrapped at elbow?

Answer 14

Above elbow remnant of ligament of struthers

Below elbow between pronator teres

Question 15

Symptoms of median nerve entrapment

Answer 15

Like carpal tunnel

Question 16

What does entrapment of superficial radial do?

Answer 16

pain/sensation over radial aspect wrist or thumb

Question 17

What can cause entrapment of deep radial neve?

Answer 17

may follow direct or indirect trauma to forearm or synovitis of elbow joint

Question 18

What can cause ulnar nerve entrapment?

Answer 18

commonly after prolonged elbow flexn

Question 19

Where can the ulnr neve becm entrapped?

Answer 19

retrocondylar groove
cubital tunnel
arcade of struthers
rarely between two heads of flexor carpi ulnari

Question 20

Treatment of nerve entrapment

Answer 20

Address cause eg stretch tight muscles, decrease swelling with EPA, rest, foam pads etc.

Neural mobilisations: sliders and tensioners

Medical: NSAIDs, cortisone injection, surgery e.g. nerve transportation