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MSK Final - ELBOW/ WRIST & HAND/ TMD > Elbow and FA- thru Lateral Tendonitis and -osis > Flashcards

Elbow and FA- thru Lateral Tendonitis and -osis Flashcards

1
Q

What is the average arc with flexion and extension of the elbow

A

130 degrees

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2
Q

What is the average rom with pronation and supination of the forearm?

A

103 degrees

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3
Q

What is the max pronation of the forearm with keyboarding?

A

65 degrees

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4
Q

What is the max supination of the forearm with opening a door?

A

77 degrees

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5
Q

What is another name for lateral elbow pain? Why is this misleading?

A

Tennis elbow - most not due to tennis

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6
Q

What is the cause of lateral elbow pain?

A

Overuse/repetitive stress
- tendinopathy
* Tendinitis
* tendinosis
Radial nerve entrapment
Trauma - abducted elbow

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7
Q

What is the prevalence of lateral elbow pain?

A

1-3% of population

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8
Q

15% of the population with this job are those who acquire lateral elbow pain?

A

Laborers with hand tasks

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9
Q

What is the percentage of tennis players that make up the 1-3% of those with lateral elbow pain?

A

up to 40%

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10
Q

What are risk factors for lateral elbow pain?

A

Dominant arm > non-dominant
Forceful activities
Repetitive activities
Smoking
Poor posture
35-54 years of age

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11
Q

Why is smoking a risk factor for lateral elbow pain?

A

Affects circulation and causes circulation changes

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12
Q

What are the primary involved tendons and muscles with lateral epicondylitis?

A
  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis
  • Extensor digitorum
  • Extensor digiti minimi
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13
Q

What is the muscle with the highest incidence of lateral epicondylitis?

A

ECRB (extensor carpi radialis brevis)

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14
Q

What is lateral epicondylitis: tendinitis or tendinosis?

A

Tendinitis

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15
Q

What is the etiology for lateral epicondylitis?

A

Overuse

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16
Q

What are the hallmark signs of tendinitis?

A

Tendon doesn’t like to be lengthened, used, or palpated.

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17
Q

What would be the S&S specific to lateral epicondylitis?

A
  • Pain with wrist extension (active or restricted)
  • gripping/fisting
  • wrist flexion
  • palpation of tendon P!ful
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18
Q

What would we find in our scan with lateral epicondylitis?

A

Possible weakness and pain with gripping/fisting

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19
Q

What would we find with ROM for lateral epicondylitis?

A

Pain and limitation with lengthening during wrist flexion with/without elbow extension

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20
Q

What would we find during resisted testing with lateral epicondylitis?

A
  • Pain with wrist extension and possible 3rd finger ext (ECRB), radial deviation, and especially in a lengthened position
  • possible weakness of involved muscle(s)
  • abnormal muscle activation patterns
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21
Q

Why would we have abnormal muscle activation patterns including scapular muscles with resisted testing of lateral epicondylitis?

A

We use shoulder muscles with all UE movements - to have better function distally you need proximal stability

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22
Q

What special test would be positive during the biomechanical exam of lateral epicondylitis?

A

Mills - due to inflammation

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23
Q

What would we find during palpation with lateral epicondylitis?

A

Common extensor tendon tender to palpation

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24
Q

What can happen with the pain associated with lateral epicondylitis?

A

May become nociplastic pain - due to persistency

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25
Q

What is Mill’s special test?

A

Mill’s- passive shoulder Internal Rotation/wrist flexion/pronation /then
full elbow extension

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26
Q

What is lateral elbow teninosis due to?

A

Recurrent tendinitis
regional interdependance
spinal nerve impingement

27
Q

What conditions can be due to a drop in supply / overuse?

A

Regional interdependance
spinal nerve impingement

28
Q

Overuse is not just over-demand but also….

A

a drop in supply

29
Q

What is the pathogenesis of tendinosis?

A

Change in structure of the tendon, change in supply, fill in with non-collagen matrix

30
Q

Where is degeneration most often with lateral elbow tenidinosis?

A

Musculotendinous junction

31
Q

What are typical tendinosis S&S anywhere?

A

enlarged tendon
TTP
stiffness/tightness
wont be tender with use if not acute
HX of failed PT
4-6 weeks or longer
takes less to aggravate it

32
Q

What are some unique elbow S&S with lateral elbow tendinosis?

A
  • possible -itis S&S
  • accessory motion testing potentially limited postero-lateral humeroradial glide
  • special tests positive - Mills for CET scarring so extension limitation more than pain
33
Q

How can scarring limit motion?

A

Fibrotic tissue cause loss of ROM

34
Q

Where does the regional interdependence with lateral elbow tendinosis happen most commonly?

A

C5,6 joint dysfunction

35
Q

What are the pathomechanics with C5,6 joint dysfunction regional interdependence?

A
  • excessive recruited wrist extensors that share innervation of C6 with C5,6 segment
  • creates excess CET tension and compression
36
Q

What does the spinal nerve impingement with lateral elbow tendinosis result in?

A
  • decreased conduction of C6
  • creates decreased activation of wrist extensors and lowers supply
  • lowers supply of wrist extensors and creates overuse even without changing activity level
37
Q

What are S&S of C6 spinal nerve impingement?

A
  • wrist ext myotome fatiguing weakness; elbow flx also
  • decreased sensation of distal lateral forearm into thumb with light and sharp touch
  • C5/6 Brachioradialis and biceps reflexes hypoactive
  • Dural mobility positive for radial and median nerves due to where they break off in brachial plexus
38
Q

What is the patient education that should happen with tendinitis/tendinosis?

A

Pt education of the soreness rule and load management including ergonomic corrections (i.e. grip/keyboard)

39
Q

What are the bracing / taping rx for tendinitis/tendinosis?

A
  • Elbow strap
  • wrist splint provided greater pain relief than elbow strap
  • kinesio tape for short term pain relief
40
Q

What are the PT rx with tendinitis / tendinosis?

A

Pt education
POLICED
Bracing/taping

41
Q

Why does a wrist splint provide greater pain relief than elbow strap with elbow tendinitis/tendinosis?

A

Due to the insertion of musculature - with the wrist splinted the muscles that attach on the epicondyle won’t move as much. A splint can help settle down the inflammation.

42
Q

What are some modalities associated with tendinitis/ tendinosis?

A

LASER - lack of evidence
Shockwave therapy - no consensus
TENS - not recommended
US - weak evidence
Dry needling - short term pain relief

43
Q

What modality can provide short term pain relief with tendinitis/tendinosis?

A

Trigger point dry needling

44
Q

What is STM for tendinitis/tendinosis not as effective as?

A

Exercise and injections

45
Q

What STM techniques are not supported for.tendinitis/tendinosis?

A

TFM and IASTM

46
Q

What PT rx needs more evidence for tendinitis/tendinosis?

A

Stretching

47
Q

What JMs can be prescribed for tendinitis/tendinosis?

A

Cervical and elbow
Thoracic manipulation

48
Q

What can cervical JMs help with tendinitis/tendinosis?

A

Pain and grip strength
fewer visits and equal success compared to isolated elbow rx

49
Q

What can elbow and wrist JMs do for tendinitis/tendinosis? What manipulation is helpful?

A

Effective
Mill’s manipulation for pain and function / pulling apart scarring

50
Q

What should we combine with elbow manipulations to be more effective?

A

Cervical and elbow together

51
Q

What is thoracic manipulation good for with tendinitis/tendinosis?

A

NOT effective with pain, but increases grip strength

52
Q

What is the primary purpose of MET with tendinitis/tendinosis?

A

Tendon proliferation and possible addressing cervical spine dysfunction

53
Q

What is the tendinosis prescription for MET?

A

2-3 sets of 10-15 reps with a heavy load

54
Q

What muscle actions are helpful with MET for tendinitis/tendinosis?

A

Eccentrics the same or better as concentrics

Additive benefit with addition of isometrics

55
Q

What can provide greater pain control in terms of MET for tendinitis/tendinosis?

A

Greater weekly frequency

56
Q

What about ranges of exercises with tendinitis/tendinosis?

A

Start with isometrics if that is all the patient can tolerate. Add mid-range as tolerated. The tendon lengthens, compresses bone underneath - if not as lengthened = not as much compression

57
Q

What is an example of MET progression with tendinitis/tendinosis?

A
  • Isometric loading without compression from lengthening- isometrics in a shortened position
  • Isotonic loading without compression from lengthening- isotonics from neutral into shortened position
  • Isotonic loading with compression from lengthening- isotonics from a lengthened position
  • (Isometric loading in weight bearing)
  • Plyometric loading
58
Q

What can possibly be included with MET for tendinitis/tendinosis?

A
  • Sport specific corrections (tennis swing or larger grips)
  • Cuff, scapular, trunk, and/or LE muscle coordination, endurance and strength training to decrease elbow stress
59
Q

What do we need to know about cortisone injections with tendinitis/tendinosis?

A
  • associated with poorer outcomes and higher recurrence rates vs. “wait and see” approach
  • Placebo favored better for pain and function
60
Q

What is the percentage of tendinitis/tendinosis cases that will have surgery?

A

5-10%

61
Q

What is surgery for tendinitis/tendinosis described as?

A

Arthroscopic procedure to promote inflammation with tendinosis not responding to PT
- scrape tendon

62
Q

What is the prognosis for tendinitis/tendinosis?

A

Prone to recurrent bouts
6-24 months with an average of 1 year to recover

63
Q

What percentage of tendinitis/tendinosis patients recover?

A

89%

MSK Final - ELBOW/ WRIST & HAND/ TMD (6 decks)

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