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The Elbow. Differential Diagnosis & Treatment. Pathology. Throwing, hitting, punching, pushing, painting Shoulder dysfunction Cervical spine pathology. Capsular. Osteoarthritis. Post traumatic Capsular pattern Crepitus Older patient Electrotherapy and mobilisation or injec into joint.
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The Elbow Differential Diagnosis & Treatment
Pathology • Throwing, hitting, punching, pushing, painting • Shoulder dysfunction • Cervical spine pathology
Osteoarthritis • Post traumatic • Capsular pattern • Crepitus • Older patient • Electrotherapy and mobilisation or injec into joint
Rheumatoid Arthritis • Lax ligaments – reduced stability • Synovial thickening and swelling, flexion deformity • Steroid injec and rest or oral medication
Traumatic Arthritis • Cause – fall or hyperextension • Acute – x-ray and aspirate • Sub acute – steroid injection and rest or 1 week rest in flex and gradual gentle mobs • No friction – myositis ossificans
Loose body eg Osteochondritis Dissecans and OA • Pain and springy end feel • Locking • Either in coronoid or olecranon fossa • Treatment • EUA removal
Cubitus varus and valgus • Reduced or increased carrying angle • Following fracture • Children • Epiphyseal damage • May need surgical correction
Bicipital Bursitis • Pain at front of elbow • Pain – full passive pronation • Some pain on resisted flexion in supin • Treatment - injec
Olecranon Bursitis • Posterior elbow pain • Pain on full passive flexion • Some pain on resisted exten • Carpet fitters, RA, students • Treatment – aspiration and /or injection
Tennis Elbow • Causes: • 2 joint muscle – lengthening across 2 • joints + added force – sheer stress at origin • Overuse • Gripping
Tennis Elbow • Pathology • 6months – 2years • Microscopic tears – failed healing - inflammation • Fibroblasts • Vascular hyperplasia • Disorganised collagen • Tendinitis or tendinosis
On examination • 20-30’s most common and degen 40yrs + • Pain on resisted wrist extension with elbow extension • Reduced grip strength • Pain on palpation
Lateral Epicondylitis (tennis elbow) • 4 sites • 1)ECRL on supra-condylar ridge • 2)CEO • 3)Body of tendon • 4)belly of muscle
Tennis Elbow Treatments • 1)ECRL – friction and rest • (forearm in supination) • Frictions must be specific and transverse • Chronic – numbness + 10 mins
Tennis Elbow Treatments • 2)CEO Injec and rest or friction, mills manip, stretch and rest (forearm in supination)
Tennis Elbow Treatments • 2) CEO cont • 3)Body of tendon - injec and rest or friction and rest (forearm in pronation) • 4)Belly of muscle – injec and rest and frictions (forearm in mid position)
Tennis Elbow Other Treatments • Advice • Must adjust technique or grip in sports • Stretches • Strapping • SSTM/ muscle energy techniques • Acupuncture
Medial Epicondylitis (golfer’s elbow) • 2 sites • 1)CFO • 2)MT junction
Golfer’s Elbow cont • Overuse • Pain on resisted wrist flexion with elb ext
Golfer’s Elbow Treatments • 1)CFO – injec and rest or friction and rest • 2)MT junction – friction and rest
Biciptal Tendonitis • Overuse • Pain on resisted elbow flexion with supin • Treatment – MT junc friction and rest