Term
| Lateral Tendon Injuries (Tennis Elbow)MOI |
|
Definition
-Muscle Imbalance
-Trauma
-JT capsule laxity/ tightness
-Gradual onset of pain
-Related to wrist ext ( grasping, hitting backhand stroke In tennis, pruning shrubs)
-Lateral tendinitis involves = ECRB**, s/t Ext Digitorum, ECRL, & rarely ECU
ECRB = excessive force overload with hyperpronation is related to added tensile load imposed on tendon by radial head when tendon is stretched (wrist flexion, elbow ext, forearm pronation)
-Maybe caused by age related tissue changes
-If pt continues to perform activities that stress the tendon= immature collagen is produced in an attempt at repair which continues to break down tissue before it has chance to mature & chronic inflammatory process continues.
If immobilized = may be not adequate stress to new collagen to stimulate maturation, scar will again break down on resumption of activities.
For tx to be successful dilemma must be resolved |
|
|
Term
| Lateral Tendon Injuries (Tennis Elbow)S&S |
|
Definition
-Pain, Decreased function, Decreased grip, Soreness in forearm, Swelling, Decreased ROM
-Grade 1 = general elbow soreness with activity , irritation, inflammation, pain, weakness, inadequate healing
-Grade 2 = Working/Playing through the soreness may inc pain, localized at lateral condyle or radial head persist after activity, swelling, warm, tender to touch, pain may radiate down forearm to wrist & may extend upward into the upper arm and shoulder
-Grade 3 = Increase Pain with ADL (shaking hands, turning doorknobs), cont. activity leads secondary problems such as rotator cuff or low back pain or other jt attempt to compensate. If ignored arthritic changes in prox. Radial or humeral ulnar jt may occur. |
|
|
Term
| Lateral Tendon Injuries (Tennis Elbow)findings |
|
Definition
-Pain over lateral humeral epicondyle
-Referred into C7 segment down posterior forearm into dorsum of hand perhaps into
-ring and long fingers
- r/o: dequervains, ecu tendonitis, pronator involvement
Best Exam Findings:
MSTT – strong/ painful extension of wrist)
MLT – Painful with a stretch
Palpation for Tenderness – tender over involved muscle |
|
|
Term
| Lateral Tendon Injuries (Tennis Elbow)Tx |
|
Definition
-Cryotherapy to decrease swelling & pain
-AROM through pain free range
-Posture/position modification to reduce irritation of tendon
-Lateral epicondyle strap
- acute PRICE
- chronic stimulate inflammatory reaction with TFM then strenthen |
|
|
Term
| Medial Tendon Injury (Medial Tennis Elbow or Golfers Elbow) MOI |
|
Definition
-Occurs in middle aged pt
-Gradual onset with Wrist flexion activities & pronation
-Direct blow to epicondyle
-Tennis (forehand stroke)
-Throwing (acceleration phase)
-Swimming (pull through)
-Golf (hitting from the top)
-Carpentry involving repetitive hammering or screwing
-In sports or occupational activities that require a strong hand grip & add mvt of elbow
-Caused by medial tension overload of elbow from repeated microtrauma to flexor- pronator musculature at its insertion onto medial epicondyle.
Involves = pronator teres**, FCR**, Palmaris longus, FCU, FDS
Compression neurapraxia of ulnar groove |
|
|
Term
| Medial Tendon Injury (Medial Tennis Elbow or Golfers Elbow) S&S |
|
Definition
-Pain, Decreased function, Decreased grip, Soreness in forearm, Swelling, Decreased ROM
-Grade 1 = general elbow soreness with activity , irritation, inflammation, pain, weakness, inadequate healing
-Grade 2 = Working/Playing through the soreness may inc pain, localized at lateral condyle or radial head persist after activity, swelling, warm, tender to touch, pain may radiate down forearm to wrist & may extend upward into the upper arm and shoulder
-Grade 3 = Increase Pain with ADL (shaking hands, turning doorknobs), cont. activity leads secondary problems such as rotator cuff or low back pain or other jt attempt to compensate. If ignored arthritic changes in prox. Radial or humeral ulnar jt may occur. |
|
|
Term
| Medial Tendon Injury (Medial Tennis Elbow or Golfers Elbow) Findings |
|
Definition
-MSTT – strong/painful**
-MLT – Pain with stretch**
-Palpation for tenderness **
-Palpation for condition & MMT sometimes
-Provocation occurs with = resisted wrist flexion & forearm pronation, passive wrist -extension, supination
-Pain over medial epicondyle
-Rarely referred into ulnar aspect of forearm
-Dull ache, no pain at rest to sharp twinges or straining sensation |
|
|
Term
| Medial Tendon Injury (Medial Tennis Elbow or Golfers Elbow) Tx |
|
Definition
-Cryotherapy to decrease swelling & pain
-AROM through pain free range
-Posture/position modification to reduce irritation of tendon
-Lateral epicondyle strap
- acute PRICE
- chronic stimulate inflammatory reaction with TFM then strenthen |
|
|
Term
| Posterior Tendon Injuries (Posterior Tennis Elbow) MOI |
|
Definition
Tendinitis of triceps is rare
-Sudden severe strain to triceps tendon as the arm is fully extended
-Throwing a javeline or from twisted serve in competitive tennis players
-Primary overload abuse in tendinitis caused by intrinsic concentric muscular contration.
-Decreased flexibility causes muscle to be overstreched during eccentric contraction
-Overloading of extensors |
|
|
Term
| Posterior Tendon Injuries (Posterior Tennis Elbow) Findings |
|
Definition
-Pain with resisted elbow extension
-Snapping over posteromedial aspect of elbow (snapping triceps tendon) result of -subluxation or dislocation of portion of triceps mech. Or subluxation or dislocation of ulnar N
-Could be Asymptomatic
-Secondary irritation of ulnar nerve resulting in ulnar neuritis
-Pain over posterior compartment of elbow |
|
|
Term
| Posterior Tendon Injuries (Posterior Tennis Elbow) Tx |
|
Definition
-Max strengthening of muscle must included eccentric work b/c this is the nature of the force producing the injury
-Eccentric produces greater tensile force on tendon. |
|
|
Term
| Posterior Tendon Injuries (Posterior Tennis Elbow) Diff Dx |
|
Definition
De Quervains tenovaginitis
ECU tendinitis at wrist
Pronator teres syndrome
Radial nerve entrapment
Ulnar nerve neurapraxia
Carpal tunnel syndrome |
|
|
Term
| Medial Collateral Ligament Injuries (Valgus Overload Triad)MOI |
|
Definition
Problems related to post medial jt capsule, ulnar N. & MCL
MCL – site of frequent injury in overhead activities
Seen in rep. activities of throwing (baseball, javelin)
Hitting
Racquet ball
Traumatic valgus thrust to elbow during fall or after being hit which arm is outstretched (associated with elbow dislocation) |
|
|
Term
| Medial Collateral Ligament Injuries (Valgus Overload Triad)Hx |
|
Definition
Gradual onset
Symptoms may at first indicate a tendinitis
Medial elbow pain
Popping sensation worsened by activities causing valgus stress
Relieved by rest
Over time medial elbow pain may accompany ulnar N irritability or post elbow pain caused by olecranon impingement |
|
|
Term
| Medial Collateral Ligament Injuries (Valgus Overload Triad)S&S |
|
Definition
Effusion
Loss of elbow ext and supination owing to flexor & pronator contractures
Jt play = valgus laxity
Pain with resisted forearm pronation if flexor pronator tendons inv
Pain with making fist
Tender over ulnar collateral Lig
Ulnar N hypersensitivity in groove & possible subluxation
Tender over medial epicondyle insertion of flexor pronator tendon |
|
|
Term
| Medial Collateral Ligament Injuries (Valgus Overload Triad)Special test |
|
Definition
|
|
Term
| Medial Collateral Ligament Injuries (Valgus Overload Triad)Tx |
|
Definition
Decrease pain
Rest, NSAIDS
Proximal control of scap & RC muscles
Increase ROM of flexors and pronators
Strengthen both concentrically & eccentrically the pronators and supinators
Grip exercises
Progressive strengthening of ext and flex (FCU, FDS) using high rep low weight isotonics |
|
|
Term
|
Definition
S&S
Pain & tenderness with loss of full ext
Causes
-Accelerated growth of medial side or hypertrophy of medial epicondyle
-Fragmentation of the medial epicondylar epiphysis
-Delayed closure of medial epicondylar apophyseal line
-Osteochonrosis of the capitellum
-Osteochondritis of radial head
-Hypertrophy of ulna
-Olecranon apophysitis with or without delayed closure of olecranon apophysis |
|
|
Term
| Medial Epicondylar Apophysitis MOI |
|
Definition
Throwing
-Repetitive valgus stress with tension forces on the medial epicondyle via MCL and flexor- pronator muscle mass
-Valgus stress result in rep. microtrauma and ultimate stress Fx of medial epicondyle apophysis |
|
|
Term
| Medial Epicondylar Apophysitis S&S |
|
Definition
-Medial pain localized to medial epicondyle
-Diminished throwing effectiveness
-Delayed throwing distance and velocity |
|
|
Term
| Medial Epicondylar Apophysitis Tx |
|
Definition
-Elimination of repetitive valgus stress via
-Eliminating throwing
-Ice combined with NSAIDS
-Stretching
-Strengthening
-Gradual return to throwing when symptom free |
|
|
Term
| Osteochondrosis Dissecans of the Capitellum MOI |
|
Definition
uncertain but mimics perthes disease of hip
(Panners Disease, osteochondrosis deformans, osteochondritis dissecans)
Related to trauma or changes in circulation (Panners disease of aseptic necrosis)
Panners disease = most common in young children (esp under 10) |
|
|
Term
| Osteochondrosis Dissecans of the Capitellum S&S |
|
Definition
-Pain, swelling,
-Decreased ROM in non-capsular pattern
-Locking, clicking
-Classified into 3 stages:
-No radiograph evidence of subchondral detachment
-Evidence of subchrondral detachment
-Chondral or osteochondral fragments become detached & result in intra-articular loose body/ies |
|
|
Term
| Osteochondrosis Dissecans of the Capitellum Tx |
|
Definition
-Conservative in stages 1 & 2 = rest, avoid valgus stress
-Short period of immobilzation
-Same as for throwing injuries
-Restore Jt motion
-Strengthening
-Increase ROM
-Stretching – entire UE
- Plyometrics and high speed drills, eccentrics once above has normalized |
|
|
Term
| Subluxation of Radial Head (pulled elbow or nursemaids elbow)Hx |
|
Definition
Common in young children before the age of 8
Peak incidence btw 2 & 3
-Sudden traction injury that has been applied to childs arm while held in extended & pronated position above childs head by an adult, who then lifts childs arm suddenly upward
-Occurs with = swinging child, lifting child up from floor
-The imperfectly formed radial head may allow subluxation in association with damage & unfolding of immature annular ligament |
|
|
Term
| Subluxation of Radial Head (pulled elbow or nursemaids elbow)S&S |
|
Definition
-Painful inability to use arm accompany by audible palpable click in elbow
-Child holds elbow flexed at about 90* & in pronation
Dx
-difficult b/c pain is poorly localized ( look at shoulder & wrist 1st)
-Small loss of range of passive elbow ext & flexion
-Passive supination - resisted |
|
|
Term
| Subluxation of Radial Head (pulled elbow or nursemaids elbow)TX |
|
Definition
-Reduce via elbow flex & rotation of forearm
-One hand supports elbow with thumb over head of radius
-Childs hand held by other had
-Childs forearm is suddenly and firmly pulled into full supination
-A palpable/audible click in region of radial head
-Should see restoration of full ROM
-Resolution of pain
-Spontaneous reduction = passively bringing forearm into sup & flex
-Prevent recurrence
-IF reduction is delayed for more than 12 hrs = immobilization with the forearm in full -sup & elbow in 90 flex |
|
|
Term
|
Definition
If Fx are suspected = immediate referral
Sprains = ex of subluxation & injury to ligaments & jt capsule
Joint stiffness after trauma, Fx, Sx or sprained collateral lig that inv capsule are major concerns. |
|
|
Term
| Post-immobilization Caspular Tightness MOI |
|
Definition
-Immobilization from dislocation & Fx of arm or forearm (humeral shaft, supracondylar, -Colles)
-DJD = secondary & post traumatic
-Can occur prematurely in football lineman, gymnast, throwers
-Inflammatory arthritis
-Presentation:
-Decreased in capsular restriction
-Edema of forearm & hand |
|
|
Term
| Post-immobilization Caspular Tightness Tx |
|
Definition
-acute: isometric contractions, gd 1 and II, heat, HEP aarom in pain free
- chronic: US, joint distractions, low load long durations, stretching, progressive HEP |
|
|
Term
|
Definition
- can become torn, lock
-moi
- repeated pinching of capsule
S&S
-pain, catching |
|
|
Term
|
Definition
- MOI: tight capsule, muscle dysfunction, olecranon bursitis, effusion
- S&S: pain with AROM & PROM decreased elbow extension, PFC, PFT
- Rx reduce effusion (use anconeus to pull entrapped capsule out (not fat pad)) |
|
|
Term
|
Definition
MOI: compression
S&S pain with AROM extension and PROM flexion |
|
|
Term
|
Definition
Heterotophic bone formation/ metaplasia of contused tissue
Common locations: brachialis (bony endfeel with flexion), Quads
- Commonly occurs after supracondylar fracture or posterior dislocation |
|
|
Term
|
Definition
Positive clinical findings: appears in 4-6 weeks after injury
Decreased Classical AROM
Decreased Classical PROM
Normal Accessory PROM
Radiograph is best way to find it
Sudden increase in pain
RX: no a/prom stretching/massage/thermal US, ice to decrease blood flow, immob |
|
|
Term
| Posterior Dislocation MOI |
|
Definition
Severe hyperextension or fall on a hand with elbow slightly flexed
Soft Tissue Injury
Brachialis Muscle
Capsule |
|
|
Term
| Posterior Dislocation Complications |
|
Definition
Soft tissue injury
Capsular disruption
Collateral damage
Stiffness
Median nerve
Ulnar nerve
Brachial A
Minor Fx
Myositis ossificans |
|
|
Term
|
Definition
Compression of radial head into capitulum
Severe valgus force to extended elbow
Tx: Pin it |
|
|
Term
|
Definition
MOI:
Extension injury
Exam Findings:
Decreased ROM (AROM/PROM)
Deformity
If immobilization:
Contracture
Capsule Hypomobility
Atrophy/weakness
Edema/effusion |
|
|
Term
|
Definition
MOI:
sudden passive flexion with a powerful contraction of triceps
Avulsion Fx
Complications:
Malunion
Residual deformity
Brachialis damage
Median nerve injury
Brachial artery
Tx:
ORIF followed by immobilization
Strengthen, increase ROM, manipulate if healed & hypomobile |
|
|
