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NMSK 2 - upper limb > elbow soft tissue injuries > Flashcards

elbow soft tissue injuries Flashcards

1
Q

what is lateral epicondylagia?

A

-commonly referred to as tennis elbow
-characterised by pain on the lateral side of the elbow
-overuse & repetitive strain of muscles of the forearm (extensors)

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2
Q

what are other names other than lateral epicondylagia for tennis elbow?

A

-lateral elbow tendinopathy
-lateral epicondylitis

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3
Q

what are examples of symptoms associated with tennis elbow?

A

-pain over lateral elbow which can radiate into forearm
- pain is aggravated by wrist mats and gripping eg computer works - typing and using mouse
-can get weakness in hand which is associated with pain
-occasional night pain

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4
Q

what are the extensor muscles of the forearm?

A

-extensor carpi radialis longus
-extensor carpi radialis brevis
-extensor digitorum communis
-extensor digiti minimi
-extensor indicis
-extensor carpi ulna’s
-anconeus
-supinator

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5
Q

describe the epidemiology of tennis elbow

A

-most common MSK complaint of the elbow
-7-10 times more common than medial
-1-3% of population
-males are equally as likely as females to get conditions
-35-5- yrs
-50% of tennis players report elbow pain

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6
Q

who is at more risk of developing LE?

A

-manual workers that involve repetitive arm & wrist mats
-office work
-older age
-previous tobacco use

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7
Q

who have a poorer prognosis of LE?

A

-manual workers that involve repetitive arm and wrist mvts
-repetitive key boarding tasks
-age greater than 40 yrs
-pain in the shoulder, wrist or hand within the past 3 months
-high level of baseline pain & distress
-longer symptom duration

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8
Q

what kind of manual work can lead to LET?

A

-handling heavy loads
-forearm rotating motions
- high gripping force
-working postures that require load handling with raised arms

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9
Q

which tendon is most likely affected with LE?

A

extensor carpi radialis brevis tendon

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10
Q

what 2 ligaments of the elbow does ERCB merge with?

A

the lateral collateral and annular ligament of the elbow

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11
Q

what kind of changes happen to the ECRB in LE?

A

-degenerative process - tendon structural changes
-alterations in nociceptive processing
-differences in sensory & motor function

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12
Q

what are examples of differential diagnosis of lateral elbow pain?

A

-intra-articular pathology
-ligamentiys pathology
-nerve pathology eg radial tunnel
-cervical / thoracic spine referral
-non specific arm pain
-inflammatory arthritis
- OA

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13
Q

what is PIN?

A

-posterior interosseous nerve entrapment

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14
Q

describe PIN

A

-a condition where the posterior interosseous nerve (a branch of the radial nerve) becomes compressed or entrapped
-compression can be due to trauma , repetitive use injuries etc

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15
Q

what is the function of the posterior interosseous nerve?

A

controls the movement of certain muscles in the forearm responsible for wrist and finger extension

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16
Q

what is wartenberg syndrome?

A

-radial nerve entrapment
-superficial branch of the dorsal radial nerve is entrapped
-sensory symptoms affected only
-often occurs after wrist fracture

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17
Q

what are the symptoms of LET that can be picked up in a subjective exam?

A

-pain over lateral elbow which may radiate into forearm
-pain increased with activities such as manual work and lifting, gripping, keyboard typing, using computer mouse, repeated wrist extension activities

18
Q

how is the evaluation of pain and disability measured in LET?

A

-patient rated tennis elbow evaluation
-score 0-100

19
Q

how would you carry out a physical exam for LET?

A

-assessment of pain free grip strength - using dynamometer - bets of 3 attempts & elbow extended and forearm pronated
-special tests including cozens, mills, maudsleys, resisted wrist extension etc
-pain on palpation

20
Q

what are examples of simple advice you can give to a patient with LET?

A

-avoid heavy lifting, forceful gripping and twisting activities
-palm up lifting
-modify work

21
Q

what does the physiotherapy management of tennis elbow involve?

A

-exercise & manual therapy may bet better than exercise alone
-consider treatment based on stage of tendinopathy eg acute reactive - modify load and isometric exercises … if degenerative - eccentric exercise & heavy slow resistance

22
Q

what effects can manual therapy have on LET?

A

-short term pain relief
-improved grip

23
Q

what are examples of manual therapy for LE?

A

-mobilisation - elbow lateral glide for movement & grip
-PA radius head -mvt and grip

24
Q

what is counterforce brace?

A

orthopedic brace commonly used to alleviate pain and provide support for conditions such as lateral epicondylalgia (tennis elbow) or medial epicondylalgia (golfer’s elbow).

25
Q

how does a counterforce brace work?

A
  • constrains the full muscle expansion when the muscles contracts
    -it diminishes muscle activity & the force generated by the muscle
26
Q

what are examples of exercise for LET?

A
  • individual to each patient
    -focus to strengthen extensor muscles of the wrist and improve grip strength
    -isometric, concentric , eccentric & stretching exercise to improve pain and function
    -rotator cuff and proprioceptive exercises
27
Q

what are the forearm muscles that originate from the common flexor origin (medial epicondyle)?

A

-pronator teres
-flexor carpi radialis
-palmaris longus
-flexor carpi ulnaris
-flexor digirotum superficialis

28
Q

what is medial elbow tendinopathy?

A

-tendinopathy of the flexor/pronator origin at the medial epicondyle
-also called golfers elbow

29
Q

Describe the epidemiology of MET

A

-most common cause of medial elbow pain
-only 15-20% as common as tennis elbow
-peak incidence in age 30-50
-male - female - 2:1
-dominant elbow in 60% of cases

30
Q

what kind of clinical history would you pick up during a subjective exam with a patient with golfer’s elbow?

A

-medial elbow pain in the region of the common flexor origin
-activity related, esp repetitive or forceful pronation and wrist flexion
-golfers who hit the ground instead of the ball
-tennis players who use forehand top spin

31
Q

what can be seen during physical examination of a patient with golfers elbow?

A

-localised tenderness on or just below the medial epicondyle
-pain on resisted wrist flexion
-pain on resisted pronation

32
Q

what is cubital tunnel syndrome?

A

-compression of the ulnar nerve at the cubital tunnel

33
Q

what are the causes of cubital tunnel syndrome?

A

-medial epicondyle - prolonged pressure on nerve
-repetitive flexion
-overdevelopment of FCU
-secondary to OA

34
Q

what are the signs and symptoms of cubital tunnel?

A

-pain- along medial aspect if elbow and hand
-pins and needles along medial aspect of elbow and hand
-weakness in muscles supplied by ulnar nerve - thumb adduction, abduction fingers
-often might symptoms

35
Q

what would you observe in the physical exam of a patient with cubital tunnel syndrome?

A
  • loss of hypothenar eminence
    -claw hand
    -warternburgs sign
    -froments - pink grip on paper - flexor pollicis longus flexes
    -elbow flex test
36
Q

what does management of cubital tunnel syndrome involve?

A

-rest from aggravating movements / positions
-splinting
-surgical release and immobilisation
-physiotherapy post release to restore ROM and strength for return to function

37
Q

what is olecranon bursitis?

A

inflammation of the bursa overlying the olecranon process at the proximal aspect of the ulna.

38
Q

what are the clinical features of olecranon bursitis?

A

-there may be pain with pressure on bursa / movement
-obvious swelling / thickening
-tender on palpation over olecranon

39
Q

what are the causes of olecranon bursitis?

A

-traumatic - overuse or direct impact
-inflammatory - eg gout or arthritis
-infectious

40
Q

how is olecranon bursitis managed?

A

-NSAIDS
-rest and avoidance of aggravating factors eg leaning on elbows
-corticosteroid injection and or aspiration
-if there is an infection - antibiotics prescribed by doctor

NMSK 2 - upper limb (16 decks)

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