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Upper Limb Physiotherapy (PHTY206) > Chronic Elbow Conditions > Flashcards

Chronic Elbow Conditions Flashcards

1
Q

What are the chronic elbow conditions?

A 
Osteochondritis Dissecans
Valgus Instability
Ulnar nerve irritation
Lateral epicondylalgia
Medial epicondylalga
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2
Q

What is the aetiology of osteochondritis dissecans?

A 
Impairment of blood supply ->
degeneration of articular cartilage
repetitive microtrauma via elbow
motion (radiocapitular jt)
young athletes = throwing ++
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3
Q

What are the signs and symptoms of Osteochondritis Dissecans?

A

Sudden pain, locking (loose bodies)
swelling, pain, crepitus, decreased ROM
(full extension)

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4
Q

What causes medial valgus instability?

A

sprain to MCL of the elbow (main supporting ligament o valgus stress)

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5
Q

What can a sprain of the MCL of the elbow cause?

A

Medial/valgus instability and pain duringflexion.

“pitcher’s elbow”

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6
Q

What happens during the cocking phase to cause little leaguer elbow?

A

UCL undergoes repetitive stress deformation
Compressive injury to lateral joint surfaces - radio head on capitellum = avascular necrosis, osteochondritis dissecans or chondral chip fractures

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7
Q

What happens during ball release to cause little leagur ebow?

A

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

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8
Q

What are the signs and symptoms of pitcher’s elbow?

A

-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.

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9
Q

What would a thorough physical examination of someone with pitcher’s elbow invlve

A
  • 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.
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10
Q

Who is most likely to get little leaguers elbow syndrome?

A

age <15 most likely.

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11
Q

What can happen if someone with LLES continues to throw despite pain?

A

Medial epicondyle avulsion fracture, which requires surgery.

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12
Q

What is the rehab for LLES?

A

Stop throwing, restore motion and when appropriate begin strengthening dynamic stabilizers of medial elbow.

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13
Q

What are the provocative maneuvers to assess the valgus stability?

A
  • static valgus stress test at 70-90 degrees
  • moving valgus stress test (pain at 70-90 degrees)
  • the milk test
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14
Q

what are complications of medial valgus elbow instability?

A
  • 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)
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15
Q

what is medial elbow pain commonly known as?

A

Golfers Elbow

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16
Q

How common is medial elbow pan

A

Not as common as lateral condition

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17
Q

What is the cause of medal elbow pain.

A

Overuse of the common flexor tendons of the wrist.

Golf, tennis, throwing,racquet sports

18
Q

What can cause ulnar nerve injury?

A 
Traction with throwing activities
Anatomy/congenital variations
Perineural adhesion
Joint disease/osteophytes
Prolonged bed rest
Leaning on elbow (repetitive)
19
Q

What are the signs and symptoms of ulnar nerve injury?

A

posteromedial elbow pain
p&n/numbness/weakness
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)

20
Q

What are causes of lateral elbow pain?

A 
Tennis elbow
Radial nerve
Radial head dislocation or radio-ulnar joint pain
Somatic referred pain C5-6
Nerve root pain C5-6 origin
21
Q

How can the radial nerve be compressed to cause lateral elbow pain?

A
  • Compression at the humer (#, callus, direct blow)

- Compression in the Arcade o Frohse (PIN)

22
Q

What is the PIN and what is its structure and function?

A

Posterior Interosseus Nerve
Branch of the radial nerve
Enters supinator muscle through the arcade of frohse

23
Q

What can the MOI of the radial nerve be?

A

Repeated use of extensor/supinator muscle mass
Compression of posterior interosseus nerve entering the supinator musle

Particularly vulnerable with fractures and sugery

24
Q

What are the signs & symptoms of a radial nerve injury

A

Similar to tennis elbow:
- TOP
-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

25
Q

Where can the radial nerve be palpated?

A

Between triceps and biceps laterally, over supinator, in snuff box

26
Q

How many people are affected by LE and from what groups?

A

3% general community
Up to 30% repetitive hand activities
40%of all tennis players
35-55 yr age group

27
Q

What is the natural course of LE?

A

6-48 months

10% progress to surgery

28
Q

How dos the intergrative model of LE look?

A

tendon pathology + motor control impairments + sensory system impairments = tennis elbow

29
Q

What type of tendon changes occur in LE?

A

non inflammatory

30
Q

What sensory system changes occur in LE?

A

Increased sensitivity to palpate

Pressure pain threshold changes

31
Q

What relation does thermal hyperplasia have to LE?

A

distinguishes those with severe pain and disability in unilateral epicondylalgia

32
Q

Where does the pain come from in LE?

A

Evidence of secondary hyperalgesia (distant to pain area)- pressure hyperplasia, thermalhyperplasia (severe case),

Other structures : cervical spine, neural tissue factors

33
Q

How does wrist extensor muscle pathology relate to LE?

A

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)

34
Q

What global muscle weakness can be observed in TE?

A

Grip, Wrist F&E, Should ABD, ER & IR.
All weaker in TE an recovered TE.

MCP E stronger in TE.

35
Q

Where is the area of pain I TE?

A

lateral epicondyle +/- into forearm
NOT cervical, shoulder
NOT radiating above elbow

36
Q

What aggravates pain in TE?

A

grip, twist, lift NOT head or shoulder movements.

37
Q

What is the history of someone with TE?

A

may be associated with repetitive use (occupational o leisure), but often insidious/unknown

38
Q

What can be observed in the physical exam of someone with LE/TE?

A 
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
39
Q

What are the special tests for E?

A

Pain free grip test to onset of pain
Palpation
2nd/3rd finger isomeric resistance (ECRB,ECRL)

40
Q

What are the differential diagnoses for TE?

A 
Radial nerve compression in the Arcade of Frohse 
Radial head dislocation
Radio-ulnar joint pain
Somatic referred pain C5-6
Nerve root ain C5-6  origin.

Upper Limb Physiotherapy (PHTY206) (8 decks)

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