Common Elbow conditions

Question 1

Lateral Epicondyle Tendinopathy (LET) or Tennis elbow

Answer 1

• Overuse injury and/or micro trauma to tendon with manual task requiring wrist stabilisation (eg. gripping) or wrist extension movements
• Excessive repetitive use or eccentric strain of the wrist / forearm muscles

S&S:
PAIN around the lateral epicondyle and proximal forearm
- Gradual onset, following a repetitive activity (within 24-72h)
OR
- Sudden onset, following a single instance of exertion
(ex., lifting a heavy object)

CA:
- Pain reproduced with resisted wrist EX/ middle finger EX/ forced grip
- Grip strength decrease
+/- pins and needles
- Tenderness on palpat° along the tendon and associated muscles

Cozen test +
Maudsley test +
Mill’s test +

Question 2

Medial Elbow Tendinopathy (MET) or golfer’s elbow

Answer 2

An overuse syndrome of the common flexor tendon (CFT)

MOI:
Chronic repetitive concentric or eccentric loading of the wrist flexors and pronator teres, combined with valgus overload

S&S:
- Localised tenderness around the medial epicondyle
- Pain with resisted flexion/ pronation of the forearm
- Persisted - medial sided elbow pain with ADLs
- Usually, pain does not improve with rest
- Most of the time normal P/AROM

ST:
Reverse Cozen test +
Medial epicondylitis stress test +

Question 3

Cubital Tunnel Syndrome

Answer 3

Ulnar nerve entrapment at the cubital tunnel site

S&S:
- Insidious onset
- Numbness and paraesthesia over the small finger, ulnar half of the ring finger, and hypothenar eminence
- Muscle atrophy and weakness of the intrinsic muscles innervated by the UN resulting in decreased pinch strength and difficulty in fine motor activities (eg. buttoning and crossing fingers)

ST:
Tinel’s test for UN
Elbow flexion test for UN
Neurodynamic tests - ULNT 3 (ulnar)

Question 4

Posterolateral rotatory instability (PLRI)

Answer 4

MOI:
Fall on outstretched arm with shoulder in Abduction, axial compression, forearm supination and forced flexion of the elbow
=> Radial head + proximal ulna subluxate posterolaterally, away from the humerus in a rotatory fashion detaching or tearing the LCL complex

S&S:
Recurrent painful clicking, snapping, clunking, or locking of the elbow occurring in the extension of the arm with a supinated forearm (typically noted at 40° of flexion as the arm goes into extension)

ST:
Chair push up test

Question 5

Varus posteromedial rotatory instability (VPMI)

Answer 5

Result of a traumatic injury to the major elbow stabilisers, the anteromedial facet of the coronoid, and the LCL.
UCL complex injury is also reported

MOI:
Fall on an outstretched hand with the shoulder flexed and abducted resulting in axial loading and varus force at the elbow with pronation of the forearm

S&S:
Mechanical-type symptoms (clicking, popping, ans slipping) during elbow flexion and extension

ST:
Gravity-assisted varus stress test for VPMI