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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

(63 cards)

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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
What is Mill's special test?
Mill’s- passive shoulder Internal Rotation/wrist flexion/pronation /then full elbow extension
26
What is lateral elbow teninosis due to?
Recurrent tendinitis regional interdependance spinal nerve impingement
27
What conditions can be due to a drop in supply / overuse?
Regional interdependance spinal nerve impingement
28
Overuse is not just over-demand but also....
a drop in supply
29
What is the pathogenesis of tendinosis?
Change in structure of the tendon, change in supply, fill in with non-collagen matrix
30
Where is degeneration most often with lateral elbow tenidinosis?
Musculotendinous junction
31
What are typical tendinosis S&S anywhere?
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
What are some unique elbow S&S with lateral elbow tendinosis?
* 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
How can scarring limit motion?
Fibrotic tissue cause loss of ROM
34
Where does the regional interdependence with lateral elbow tendinosis happen most commonly?
C5,6 joint dysfunction
35
What are the pathomechanics with C5,6 joint dysfunction regional interdependence?
* excessive recruited wrist extensors that share innervation of C6 with C5,6 segment * creates excess CET tension and compression
36
What does the spinal nerve impingement with lateral elbow tendinosis result in?
* 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
What are S&S of C6 spinal nerve impingement?
* 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
What is the patient education that should happen with tendinitis/tendinosis?
Pt education of the soreness rule and load management including ergonomic corrections (i.e. grip/keyboard)
39
What are the bracing / taping rx for tendinitis/tendinosis?
* Elbow strap * wrist splint provided greater pain relief than elbow strap * kinesio tape for short term pain relief
40
What are the PT rx with tendinitis / tendinosis?
Pt education POLICED Bracing/taping
41
Why does a wrist splint provide greater pain relief than elbow strap with elbow tendinitis/tendinosis?
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
What are some modalities associated with tendinitis/ tendinosis?
LASER - lack of evidence Shockwave therapy - no consensus TENS - not recommended US - weak evidence Dry needling - short term pain relief
43
What modality can provide short term pain relief with tendinitis/tendinosis?
Trigger point dry needling
44
What is STM for tendinitis/tendinosis not as effective as?
Exercise and injections
45
What STM techniques are not supported for.tendinitis/tendinosis?
TFM and IASTM
46
What PT rx needs more evidence for tendinitis/tendinosis?
Stretching
47
What JMs can be prescribed for tendinitis/tendinosis?
Cervical and elbow Thoracic manipulation
48
What can cervical JMs help with tendinitis/tendinosis?
Pain and grip strength fewer visits and equal success compared to isolated elbow rx
49
What can elbow and wrist JMs do for tendinitis/tendinosis? What manipulation is helpful?
Effective Mill's manipulation for pain and function / pulling apart scarring
50
What should we combine with elbow manipulations to be more effective?
Cervical and elbow together
51
What is thoracic manipulation good for with tendinitis/tendinosis?
NOT effective with pain, but increases grip strength
52
What is the primary purpose of MET with tendinitis/tendinosis?
Tendon proliferation and possible addressing cervical spine dysfunction
53
What is the tendinosis prescription for MET?
2-3 sets of 10-15 reps with a heavy load
54
What muscle actions are helpful with MET for tendinitis/tendinosis?
Eccentrics the same or better as concentrics Additive benefit with addition of isometrics
55
What can provide greater pain control in terms of MET for tendinitis/tendinosis?
Greater weekly frequency
56
What about ranges of exercises with tendinitis/tendinosis?
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
What is an example of MET progression with tendinitis/tendinosis?
* 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
What can possibly be included with MET for tendinitis/tendinosis?
* 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
What do we need to know about cortisone injections with tendinitis/tendinosis?
- associated with poorer outcomes and higher recurrence rates vs. "wait and see" approach - Placebo favored better for pain and function
60
What is the percentage of tendinitis/tendinosis cases that will have surgery?
5-10%
61
What is surgery for tendinitis/tendinosis described as?
Arthroscopic procedure to promote inflammation with tendinosis not responding to PT - scrape tendon
62
What is the prognosis for tendinitis/tendinosis?
Prone to recurrent bouts 6-24 months with an average of 1 year to recover
63
What percentage of tendinitis/tendinosis patients recover?
89%

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

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