Elbow, Wrist, and Hand Tendinopathies

Question 1

tendons

Answer 1

poorly vascularized connective tissue of collagen, tenocytes, and ground substance that connects muscle to bone

Question 2

tendinitis

Answer 2

an acute inflammatory response to injury of a tendon that produces the classical signs of heat, swelling, and pain
RARE

Question 3

tendinosis

Answer 3

most commonly seen

more of a degenerative pathalogic condition, not an inflammatory one

Question 4

general treatment of tendinopathies (3)

Answer 4

1. posture and conditioning
2. biomechanics and symptom management
3. progression of treatment

Question 5

Lateral Epicondylosis

Answer 5

ERCB most common (EDC 2nd)
night ache morning stiffness
pain w/ grip
decreased grip w/ elbow ext
tightness in extrinsic extensors
orthoses: 35 deg ext

Question 6

Cozen’s Test

Answer 6

for lateral epicodylosis
examiner's thumb on lat epicondyle
forearm pronated, fist, wrist ext, radial deviation
apply resistance
\+ w/ pain

Question 7

Mill’s Elbow Test

Answer 7

for lateral epicondylosis
palpate most tender aspect
pronate, wrist full flex while moving elbow to flex/ext
+ w/ pain

Question 8

Middle Finger Test

Answer 8

for lateral epicondylosis
extend elbow and hand and apply resistance to tip of the middle finger
+ = Radial Tunnel instead of Lat Epicondylosis

Question 9

Medial Epicondylosis

Answer 9

PT, FCR, PL (FCU/FDS)
less common than lat
pain over medial epicondyle
orthoses: wrist neutral

Question 10

DeQuervain’s

Answer 10

APL/EPB
pain over radial styloid w/ resistive thumb ext/abd
4x more common in women

Question 11

Finkelstein’s Test

Answer 11

for DeQuervain’sfist over thumb, press to ulnar deviation

+ w/ pain

Question 12

Treatment: Lateral Epicondylosis

Answer 12

Non Operative
ACUTE: orthoses 35 deg wrist ext, heat, ice, friction massage, AROM, gentle isometrics, short arc movements ECRB, prox distal strengthening
RESTORATIVE: flexibility, strength, endurance, graded conditioning, ergonomics, increased isometrics, add eccentric

Question 13

Treatment: Medial Epicondylosis

Answer 13

Non Operative
ACUTE: orthoses wrist neutral, heat, ice, friction massage, AROM, gentle isometrics, short arc movements PT/FCR/PL, prox distal strengthening
RESTORATIVE: flexibility, strength, endurance, graded conditioning, ergonomics, increased isometrics, add eccentric

Question 14

Treatment: DeQuervain’s

Answer 14

Non Operative
thumb spica - IP free
isometrics of ADL and EPB, short arc AROM, isolated wrist flex/ext, isolated thumb IP flex/ext
add strengthening, eccentric ex w/ caution

Question 15

Digital Stenosisning Tenosynovitis

Answer 15

Trigger Finger

Question 16

Trigger Finger

Answer 16

thickening of flexor tendon preventing gliding through a pulley
A1 pulley most common (volar to MP joint)
ring and thumb most common

Question 17

Treatment: Trigger Finger

Answer 17

Non Operative
refrain from aggravating activities
orthosis
modalities
tissue massage (ASTYM,SASTM)
taping
Operative: surgical release of pulley
most do not need therapy