Flashcards in Chronic Elbow Conditions Deck (40):
What are the chronic elbow conditions?
Ulnar nerve irritation
What is the aetiology of osteochondritis dissecans?
Impairment of blood supply ->
degeneration of articular cartilage
repetitive microtrauma via elbow
motion (radiocapitular jt)
young athletes = throwing ++
What are the signs and symptoms of Osteochondritis Dissecans?
Sudden pain, locking (loose bodies)
swelling, pain, crepitus, decreased ROM
What causes medial valgus instability?
sprain to MCL of the elbow (main supporting ligament o valgus stress)
What can a sprain of the MCL of the elbow cause?
Medial/valgus instability and pain duringflexion.
What happens during the cocking phase to cause little leaguer elbow?
UCL undergoes repetitive stress deformation
Compressive injury to lateral joint surfaces - radio head on capitellum = avascular necrosis, osteochondritis dissecans or chondral chip fractures
What happens during ball release to cause little leagur ebow?
Should moves from max ER, elbow extends at 2500 degree/sec
- Elbow extension+ valgus strain -> olecranon impinges against medial trochlear groove on olecranon fossa = posteromedial osteophytes
What are the signs and symptoms of pitcher's elbow?
-Laxity on valgus stress test
- Pain over medial elbow during flexion
-Pain on palpation over MCL
-Unable to throw at full speed
- May eventually rupture (acute or chronic)
Possible swelling ( often absent n chronic conditions)
Loss of ROM - ext
Hyperalgsic on palpation over the ulnar nerve.
Positive on radiographic examination.
What would a thorough physical examination of someone with pitcher's elbow invlve
- Lateral elbow must also be included to ascertain the radiocapiteller impaction or combined lateral instability.
- Ipsilateral shoulder of the throwing athlete must also be examined for potential instability, impingement, rotator cuff strength, and scapular positioning, which could potentiate the medial elbow instability.
Who is most likely to get little leaguers elbow syndrome?
age <15 most likely.
What can happen if someone with LLES continues to throw despite pain?
Medial epicondyle avulsion fracture, which requires surgery.
What is the rehab for LLES?
Stop throwing, restore motion and when appropriate begin strengthening dynamic stabilizers of medial elbow.
What are the provocative maneuvers to assess the valgus stability?
- static valgus stress test at 70-90 degrees
- moving valgus stress test (pain at 70-90 degrees)
- the milk test
what are complications of medial valgus elbow instability?
- Bony impingement of the olecranon in superomedialaspect of the fossa.
- Osteochondral lesions, bony spurs and loose bodies in the olecranon fossa.
- Possible ulnar nerve injury at elbow cubital tunnel
- C8-T1 radiculopathy (pinched nerve in neck)
what is medial elbow pain commonly known as?
How common is medial elbow pan
Not as common as lateral condition
What is the cause of medal elbow pain.
Overuse of the common flexor tendons of the wrist.
Golf, tennis, throwing,racquet sports
What can cause ulnar nerve injury?
Traction with throwing activities
Prolonged bed rest
Leaning on elbow (repetitive)
What are the signs and symptoms of ulnar nerve injury?
posteromedial elbow pain
Pain on palpation of nerve
History- traction versus compression (secondary to valgus instability)
Tapping of nerve reproduces symptoms
Nerve conduction studies
May report snapping- hereditary subluxation over the medial epicondyle (a stretch aetiology rather than compression)
What are causes of lateral elbow pain?
Radial head dislocation or radio-ulnar joint pain
Somatic referred pain C5-6
Nerve root pain C5-6 origin
How can the radial nerve be compressed to cause lateral elbow pain?
-Compression at the humer (#, callus, direct blow)
-Compression in the Arcade o Frohse (PIN)
What is the PIN and what is its structure and function?
Posterior Interosseus Nerve
Branch of the radial nerve
Enters supinator muscle through the arcade of frohse
What can the MOI of the radial nerve be?
Repeated use of extensor/supinator muscle mass
Compression of posterior interosseus nerve entering the supinator musle
Particularly vulnerable with fractures and sugery
What are the signs & symptoms of a radial nerve injury
Similar to tennis elbow:
-Pain (elbow, forearm, wrist, mid humerus)
aggravated by isometric supinaton with elbow in 90 degrees flexion and maxmal pronation
-Weakness of thumb abduction/extension
- Weakness of extensor digitorum & ECU
Where can the radial nerve be palpated?
Between triceps and biceps laterally, over supinator, in snuff box
How many people are affected by LE and from what groups?
3% general community
Up to 30% repetitive hand activities
40%of all tennis players
35-55 yr age group
What is the natural course of LE?
10% progress to surgery
How dos the intergrative model of LE look?
tendon pathology + motor control impairments + sensory system impairments = tennis elbow
What type of tendon changes occur in LE?
What sensory system changes occur in LE?
Increased sensitivity to palpate
Pressure pain threshold changes
What relation does thermal hyperplasia have to LE?
distinguishes those with severe pain and disability in unilateral epicondylalgia
Where does the pain come from in LE?
Evidence of secondary hyperalgesia (distant to pain area)- pressure hyperplasia, thermalhyperplasia (severe case),
Other structures : cervical spine, neural tissue factors
How does wrist extensor muscle pathology relate to LE?
Morphological changes greater in LE:
- moth eaten fibres
- fibre necrosis
- high % fast twitch (2a)
morphological changes may contribute to decreed muscle performance in LE (along with pain)
What global muscle weakness can be observed in TE?
Grip, Wrist F&E, Should ABD, ER & IR.
All weaker in TE an recovered TE.
MCP E stronger in TE.
Where is the area of pain I TE?
lateral epicondyle +/- into forearm
NOT cervical, shoulder
NOT radiating above elbow
What aggravates pain in TE?
grip, twist, lift NOT head or shoulder movements.
What is the history of someone with TE?
may be associated with repetitive use (occupational o leisure), but often insidious/unknown
What can be observed in the physical exam of someone with LE/TE?
Pain on isometric wrist extension or ECRB (2nd/3rd finger ext)
TOP lateral epicondyle
pain on gripping ***
Pain on stretch (rare) NOT tight
Cx joint signs at C5-6
Upper limb neurodynamic text +ve
Negative joint signs
What are the special tests for E?
Pain free grip test to onset of pain
2nd/3rd finger isomeric resistance (ECRB,ECRL)