Elbow Conditions at University Of Limerick | Flashcards & Summaries

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Lernmaterialien für Elbow Conditions an der University of Limerick

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Medial Epicondylalgia (golfers elbow) - presentation & pathology

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• Presentation: 

Pain from common flexor origin 

• Pathology: focused on flexor carpi radialis, and pronator teres 

• Pathology: similar to LE 

• Treatment: similar to LE

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Ligament most likely to be injured w/ elbow dislocation

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Lateral collateral ligament complex

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Elbow Subjec Ax

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Symptoms- tingling, pain numbness

Aggs- grip

​Hobbies- grip related e.g. tennis, golf

Occupation- hairdresser, cleaner etc

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Structure responsible for Lateral Epicondylalgia - histologic and macroscopic findings

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Common Extensor Origin (CEO), esp Extensor Carpi Radialis Brevis (ECRB) - increased/altered use of tendons - tendon load and response

ECRB tendon likely to rub against the lateral edge of capitellum - compression against underlying bone from ECRL 

ECRL thickening & oedema


Histologic and Macroscopic findings:

-Angiofibroblastic hyperplasia and neovascularisation (same as in tendonopathy)

-Disruption of the normal collagen structure

-Extensive increase in ground substance- like reactive tendionpathy but is not a full blown tendinopathy injury- be aware of LOAD

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Elbow dislocation / #- cause, mechanisms, associated w.. , ligament associated

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• Often assoc # radial head/ coronoid process/olecrenon 

• Fall from height/ contact sports 

 Radial / ulnar collateral ligt primary restraint to posterolateral instability 

• 2 mechanisms – hyperextension & posterolateral rotation 

• Most commonly – IR of humerus, supination, valgus elbow, axial compression into flexion

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S&S elbow disl., #

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Clicking, snapping, locking esp in extension with forearm supinated 

• Lateral pivot shift/ posterolateral rotary instability tests 


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Differential Diagnoses for LE


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• Cervical referred pain/radiculopathy 

• Local arthritis 

• Intra articular pathology: Loose bodies/OCD 

• Radial Tunnel syndrome 

• Posterior Interosseous Nerve entrapment 

• Posterolateral instability of the elbow

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Lateral Epicondylalgia / Tennis Elbow - most common pt, prevalence, cause

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3% prevalence in gen population

Occupation w/ repetitive activities & tennis players - older rec players higher prev than young championship

cause- improper backhand technique- lead w elbow, flip hand into ext, hit ball too late OR improper biomechanics

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PT education for LE

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•Reassurance- condition & resolution 

•Avoid pain-provoking activities (eg, by not lifting with a pronated forearm) 

•Advise - appropriate level and type of activity - R&R w app loading

•Reduce aggravating activities until little pain on resisted isometric wrist extension/ passively stretched

 •Resume activities gradually- reintroduce strenuous tasks, (deviated wrist postures, forceful exertions, and highly repetitive movements- ergonomic advice) w some protection of the part- Bracing/ taping to reduce the force generated in the muscle/ decrease tension at the attachment- reduce tendon load if recurrence is experienced 

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PT Exercise for LE

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• Graded tendon loading – isometric → concentric → eccentric is key, evidence for eccentric exercise programmes 

Eccentric exercises: 

• Slow progressive eccentric exercises performed with the elbow in extension, forearm in pronation and wrist in extension. Also consider wrist flexion. 

• Increase ROM if limited 

• Stretching exercises: - Passively stretching (maintain for 30-45 seconds) x 3 before and x3 times after eccentric exercises with 30 second rest in between each procedure

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LE onset (x2)

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- Insidious onset post unaccustomed activity involving wrist ext 

- Sudden onset post single incidence of exertion using wrist extensors

Max tenderness @ lateral epicondyle

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Elbow # - Galeazzi # 


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•FOOSH

•# radius with dislocation distal Radio-ulnar joint

•DRUJ capsule is a major contributor to stability 

•Complications - Mal-union 

•Unstable distal fragment 

•Rx ORIF immobilise carefully

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Q:

Medial Epicondylalgia (golfers elbow) - presentation & pathology

A:

• Presentation: 

Pain from common flexor origin 

• Pathology: focused on flexor carpi radialis, and pronator teres 

• Pathology: similar to LE 

• Treatment: similar to LE

Q:

Ligament most likely to be injured w/ elbow dislocation

A:

Lateral collateral ligament complex

Q:

Elbow Subjec Ax

A:

Symptoms- tingling, pain numbness

Aggs- grip

​Hobbies- grip related e.g. tennis, golf

Occupation- hairdresser, cleaner etc

Q:

Structure responsible for Lateral Epicondylalgia - histologic and macroscopic findings

A:

Common Extensor Origin (CEO), esp Extensor Carpi Radialis Brevis (ECRB) - increased/altered use of tendons - tendon load and response

ECRB tendon likely to rub against the lateral edge of capitellum - compression against underlying bone from ECRL 

ECRL thickening & oedema


Histologic and Macroscopic findings:

-Angiofibroblastic hyperplasia and neovascularisation (same as in tendonopathy)

-Disruption of the normal collagen structure

-Extensive increase in ground substance- like reactive tendionpathy but is not a full blown tendinopathy injury- be aware of LOAD

Q:

Elbow dislocation / #- cause, mechanisms, associated w.. , ligament associated

A:

• Often assoc # radial head/ coronoid process/olecrenon 

• Fall from height/ contact sports 

 Radial / ulnar collateral ligt primary restraint to posterolateral instability 

• 2 mechanisms – hyperextension & posterolateral rotation 

• Most commonly – IR of humerus, supination, valgus elbow, axial compression into flexion

Mehr Karteikarten anzeigen
Q:

S&S elbow disl., #

A:

Clicking, snapping, locking esp in extension with forearm supinated 

• Lateral pivot shift/ posterolateral rotary instability tests 


Q:

Differential Diagnoses for LE


A:

• Cervical referred pain/radiculopathy 

• Local arthritis 

• Intra articular pathology: Loose bodies/OCD 

• Radial Tunnel syndrome 

• Posterior Interosseous Nerve entrapment 

• Posterolateral instability of the elbow

Q:

Lateral Epicondylalgia / Tennis Elbow - most common pt, prevalence, cause

A:

3% prevalence in gen population

Occupation w/ repetitive activities & tennis players - older rec players higher prev than young championship

cause- improper backhand technique- lead w elbow, flip hand into ext, hit ball too late OR improper biomechanics

Q:

PT education for LE

A:

•Reassurance- condition & resolution 

•Avoid pain-provoking activities (eg, by not lifting with a pronated forearm) 

•Advise - appropriate level and type of activity - R&R w app loading

•Reduce aggravating activities until little pain on resisted isometric wrist extension/ passively stretched

 •Resume activities gradually- reintroduce strenuous tasks, (deviated wrist postures, forceful exertions, and highly repetitive movements- ergonomic advice) w some protection of the part- Bracing/ taping to reduce the force generated in the muscle/ decrease tension at the attachment- reduce tendon load if recurrence is experienced 

Q:

PT Exercise for LE

A:

• Graded tendon loading – isometric → concentric → eccentric is key, evidence for eccentric exercise programmes 

Eccentric exercises: 

• Slow progressive eccentric exercises performed with the elbow in extension, forearm in pronation and wrist in extension. Also consider wrist flexion. 

• Increase ROM if limited 

• Stretching exercises: - Passively stretching (maintain for 30-45 seconds) x 3 before and x3 times after eccentric exercises with 30 second rest in between each procedure

Q:

LE onset (x2)

A:

- Insidious onset post unaccustomed activity involving wrist ext 

- Sudden onset post single incidence of exertion using wrist extensors

Max tenderness @ lateral epicondyle

Q:

Elbow # - Galeazzi # 


A:

•FOOSH

•# radius with dislocation distal Radio-ulnar joint

•DRUJ capsule is a major contributor to stability 

•Complications - Mal-union 

•Unstable distal fragment 

•Rx ORIF immobilise carefully

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