Medial Elbow Pain

Question 1

How does an abducted elbow occur?

Answer 1

Trauma with a FOOSH

Question 2

What does an abducted elbow lead to?

Answer 2

Medially fixated olecranon

Question 3

During your scan with an abducted elbow what might you observe?

Answer 3

Increased carrying angle

Question 4

What ROM limitations with pain will you see with an abducted elbow?

Answer 4

• Elbow flexion and forearm supination due to a lack of lateral ulnar glide
• Wrist flexion/ radial deviation due to the radius shifting distally from contact with capitulum

Question 5

What will you see when you provide resistance and MMT with an abducted elbow?

Answer 5

Wrist extension and radial deviation pain

Question 6

With an abducted elbow what glide would be limited and why?

Answer 6

Lateral because the elbow is stuck medially

Question 7

With palpation of an abducted elbow, what would be tender?

Answer 7

Common extensor tendon

Question 8

What kind of Rx would you provide someone with an abducted elbow?

Answer 8

• POLICED
• Correct lateral glide, possibly with a manipulation
• Stabilize with METs

Question 9

What is the prevalence of medial tendinitis/ tendinosis?

Answer 9

0.4%

Question 10

What is another name for medial tendinitis/ tendinosis?

Answer 10

Thrower’s, little league, or golfers elbow

Question 11

What are the structures involved in a medial elbow tendinitis/ tendinosis?

Answer 11

• Pronator Teres
• Flexor Carpi Radialis
• Flexor Carpi Ulnaris
• Flexor Digitorum Superficialis
• Flexor Digitorum Profundus

Question 12

What are the hallmark signs and symptoms of tendinitis specific to the medial elbow?

Answer 12

Opposite of lateral elbow tendinitis

Question 13

What are complications of medial tendinitis/ tendinosis?

Answer 13

• Medial epicondyle apophysitis in adolescents overhead throwers
• Ulnar collateral ligament involvement

Question 14

What is another name for medial epicondyle apophysitis?

Answer 14

Little league elbow

Question 15

What population experiences medial epicondyle apophysitis?

Answer 15

• Adolescents, biological males > females
• Mostly overhead throwers but also racquet sports

Question 16

What is the cause of medial epicondyle apophysitis?

Answer 16

Growth with high activity

Question 17

What are the pathomechanics of a medial epicondyle apophysitis?

Answer 17

• Bone growth exceeds wrist flexor and pronator lengthening
• Increased tendon tension
• Growth plate is the weak spot as opposed to tendon in the adult
• Most often inflammation

Question 18

What are complications of medial epicondyle apophysitis?

Answer 18

• Avulsion and or premature closure
• Ulnar collateral ligament involvement

Question 19

What are symptoms of a medial epicondyle apophysitis?

Answer 19

• Gradual onset with overuse
• A “pop” may indicate trauma or an avulsion
• Above etiology with possible loss of velocity

Question 20

What are signs of a medial epicondyle apophysitis?

Answer 20

• ROM: possible loss of extension with pain
• Resisted/ MMT: possibly weak and or painful muscles that attach to CFT
• Palpation: TTP over the medial epicondyle

Question 21

What is the Rx for a medial epicondyle apophysitis?

Answer 21

• Patient education
• Soreness rule
• Load management (ex: pitch count, active rest with alternate positions, rest days)
• Movement cues (ex: throwing mechanics)
• POLICED

Question 22

What do you need to be careful with in regards to Rx and medial epicondyle apophysitis?

Answer 22

Careful with prolonged stretching due to vulnerability of growth plate

Question 23

What kind of METs should you do for a medial epicondyle apophysitis?

Answer 23

• For trunk, cuff, scapular, and LE impairments
• Caution with muscle/ tendons attached to the growth plate

Question 24

What does RTP mean?

Answer 24

Return to play - throwing progression program

Question 25

What is the prognosis for someone with medial epicondyle apophysitis?

Answer 25

• Growth plate typically fuses around 15 years of age
• Can become a recurrent/ persistent problem