Elbow and FA- Abd Elb thru Med Apophysitis

Question 1

What causes an abducted elbow?

Answer 1

Trauma with FOOSH

Question 2

What are the pathomechanics of an abducted elbow?

Answer 2

Leads to medially fixated olecranon

Question 3

What will we find in our scan with an abducted elbow?

Answer 3

• increased carrying angle
• ROM limitations with pain

Question 4

What ROM limitations will we find with an abducted elbow?

Answer 4

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

Question 5

What will we find with resisted testing/MMT for an abducted elbow?

Answer 5

Wrist extension and radial deviation painful

Question 6

What would be our findings with the biomechanical exam of an abducted elbow?

Answer 6

Accessory motion - limited lateral glide
Palpation - CET TTP

Question 7

What is the rx for an abducted elbow?

Answer 7

• POLICED
• Correct lateral glide, possibly with manipulation
• Stabilization with MET

Question 8

Will there be a protective/inflammatory stage with an abducted elbow?

Answer 8

YES - bc trauma

Question 9

What is the cause of a radial nerve entrapment?

Answer 9

Overuse/repetitive stress/trauma

Question 10

What is the prevalence of radial nerve entrapment?

Answer 10

Rare

Question 11

What are the 3 names of where a radial nerve entrapment can happen?

Answer 11

• Radial tunnel syndrome
• Posterior Interosseous Nerve Compession Syndorme
• Wartenberg Syndrome

Question 12

What is radial nerve entrapment often confused with?

Answer 12

Lateral elbow tendinopathy - BUT presentation is different

Question 13

What is the course of the radial nerve?

Answer 13

• Off posterior cord from brachial plexus
• passes inferior to teres major
• posterior to brachial artery in posterior arm
• travels just anterior to lateral epicondyle before entering posterior forearm

Question 14

Radial nerve syndrome only has ______ no _________.

Answer 14

Symptoms, NO signs

Question 15

What is radial tunnel syndrome at the PIN?

Answer 15

Neuropathy involving posterior interosseous nerve (PIN) branch

Question 16

What is the site and TTP with radial tunnel syndrome?

Answer 16

• TTP 2-5 cm distal to lateral epicondyle
• Between distal edge of supinator and around radial neck posteriorly

Question 17

What are symptoms with radial tunnel syndrome?

Answer 17

• Dorsoradial proximal forearm pain and possibly paresthesias into dorsal thumb and web space

Question 18

What are symptoms of radial tunnel syndrome provoked by?

Answer 18

Supination/pronation and elbow flexion

Question 19

What is NOT present with radial tunnel syndrome?

Answer 19

Motor or sensory deficit

Question 20

What are the symptoms of posterior interosseous nerve compression syndrome?

Answer 20

More severe radial tunnel syndrome with same symptoms plus…
- sensory and motor dysfunction
- positive dural mobility and special tests

Question 21

What can the sensory and motor dysfunction with posterior interosseous nerve compression include?

Answer 21

• SENSORY: Decreased sensation over dorsoradial forearm and dorsal thumb and web space
• MOTOR: wrist and finger extension weak and painful

Question 22

What will be positive in the biomechanical exam with posterior interosseous nerve compression?

Answer 22

Radial nerve dural mobility
special test: (+) resisted supination test

Question 23

What is the difference between a a spinal nerve and C6? How can we tell?

Answer 23

Elbow flexion wont be limited because it is cutaneous, we won’t get confirmation of the spinal nerve which will tell it is the radial nerve

Question 24

What is wartenberg syndrome?

Answer 24

Neuropathy; compression of superficial sensory radial nerve between brachioradialis and ECRL

Question 25

What can we expect with Wartenberg syndrome?

Answer 25

- No motor innervation so no weakness - only sensory symptoms or paresthesias and pain over dorsoradial forearm and dorsal aspect of 1st 3 and a half digits

Question 26

What is the rx for terminal nerve branch injuries?

Answer 26

- POLI (NO C) ED- when compression is the cause we don't use - Bracing/Splinting - Neural mobilizations if an adhesion - MET with optimal stresses to create neural motion and the above elimination of compression

Question 27

When is it okay to reproduce symptoms?

Answer 27

Tension restriction - NOT ok to reproduce Adhesion restriction - OK to reproduce

Question 28

What is the prevalence of medial tendinitis/ tendinosis

Answer 28

.4%

Question 29

What is medial tendinitis/tendinosis also known as?

Answer 29

Thrower's, little league, or golfer's elbow

Question 30

What structures are involved with medial tendinosis/tendinitis?

Answer 30

Pronator teres flexor carpi radialis flexor carpi ulnaris flexor digitorum superficialis flexor digitorum profundus

Question 31

What are some hallmark S&S of tendinitis specific to the medial elbow?

Answer 31

- Pain with lengthening flexors/pronators - TTP over medial epicondyle and common flexor tendon - S&S more recent, overuse history, something changed ** tendinosis is over or equal to 6 months

Question 32

What are complications with medial tendinosis/tendinitis?

Answer 32

* medial epicondyle apophysitis in adolescent overhead throwers * Ulnar collateral ligament involvement

Question 33

What is medial epicondyle apophysitis due to?

Answer 33

Growth with high activity

Question 34

What population is medial epicondyle apophysitis most common in?

Answer 34

* adolescents, males more than females * Mostly overhead throwers but also with racquet sports

Question 35

What is medial epicondyle apophysitis also known as?

Answer 35

Little league elbow

Question 36

What are the pathomechanics of medial epicondyle apophysitis?

Answer 36

* bone growth exceeds wrist flexor and pronator lengthening * increased tendon tension * Growth plate is the weak spot in adolescents * Inflammation

Question 37

What is the "weak spot" in adults? Children?

Answer 37

Tendons in adults, growth plate in children

Question 38

What are complications with medial epicondyle apophysitis?

Answer 38

* avulsion and/or premature closure * Ulnar collateral ligament involvement

Question 39

What are symptoms of medial epicondyle apophysitis?

Answer 39

- Gradual onset with overuse - A "pop" may indicate trauma or an avulsion - Above etiology with possible loss of velocity

Question 40

What are signs of medial epicondyle apophysitis?

Answer 40

* ROM - loss of extension with pain * Resisted /MMT: possibly weak and/or painful muscles that attach to common flexor tendon * Palpation: TTP over medial epicondyle

Question 41

What is our rx for medial epicondyle apophysitis?

Answer 41

Pt education on: - soreness rule - load management (i.e. pitch count, active rest with alternate positions, rest days) - movement cues (i.e. pitching mechanics) POLICED

Question 42

What rx do we have to be careful with concerning medial epicondyle apophysitis?

Answer 42

Prolonged stretching due to vulnerability of growth plate

Question 43

What should our MET include for medial epicondyle apophysitis?

Answer 43

* for trunk, cuff, scapular, and LE impairements

Question 44

What should we have caution with MET for medial epicondyle apophysitis?

Answer 44

Muscles and tendons attached to growth plate

Question 45

Why would we want to exercise non-involved structures with medial epicondyle apophysitis?

Answer 45

They are already being overused, need to take stress off of involved structures

Question 46

What is RTP?

Answer 46

A throwing progression program for those with medial epicondyle apophysitis

Question 47

What is the prognosis for medial epicondyle apophysitis?

Answer 47

- can become recurrent/persistent problem

Question 48

When does the growth plate typically fuse with medial epicondyle apophysitis?

Answer 48

Around 15 years of age