Elbow Pathologies




                          Ulnar (Medial) Collateral Ligament Sprain

Onset-acute or insidious
      ...
Special Tests -Varus stress test

Management
-RICE
-Sling
-Flexibility and strengthen




                              La...
Inspection- swelling in the area over the medial epicondyle

Palpation- point tenderness and crepitus over the medial epic...
Management
-x-ray
-flexibility/strengthen
-may need surgery


                                       Cubital Tunnel Syndro...
Elbow Dislocation

Mechanism-falling on an outstretched arm
         -dislocation from a violent twist
         -posterior...
Forearm Compartment Syndrome

History- three types: volar
                    dorsal
                    mobile
Mechanism-...
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Elbow and Forearm.doc.doc

  1. 1. Elbow Pathologies Ulnar (Medial) Collateral Ligament Sprain Onset-acute or insidious -pain characteristics meidal of elbow Mechanism- (acute) - valgus stress placed on the ulnar collateral ligament ( Insidious) - repeated valgus loading of the elbow - Repeated activities the exert tensile stresses on the medial aspect of the elbow Inspection- swelling may be present in the anterior rotation deficits in the throwing athlete Palpation- tenderness and crepitus Functional Test AROM: limited secondary to pain because of stretching of the ligaments or joint instability PROM: pain elicited by stretching of the ligaments RROM: strength decreased secondary to pain and joint instability Neurological Tests-Tinel sign at the ulnar nerve may be positive Special Tests- Posterolateral rotator instability test of the elbow Radial (lateral) Collateral Ligament Sprain Mechanism-varus force Pain characteristics -lateral pain -hear a pop -pain with pronation/supination Inspection-swelling -lateral aspect of the elbow -inability to flex and extend Palpation-pain at lateral epicondlye to lateral head Functional test AROM-Limit pronantion/supination due to pain PROM RROM-decease due to pain
  2. 2. Special Tests -Varus stress test Management -RICE -Sling -Flexibility and strengthen Lateral Epicondylitis (Tennis Elbow) Onset- insidious Pain characteristics -lateral epicondyle and proximal portion of the common tendons of the wrist extensors - Radicular pain into the wrist extensor muscles is possible with advanced cases Mechanism -overuse syndrome involving repeated, forceful wrist extension - Radial deviation, supination, or gasping in an overhead position - Repeated eccentric loading of the wrist extensor muscles Inspection- swelling possibly present over the lateral epicondyle Palpation- pain and possible crepitus over the lateral epicondyle and proximal portion of the common wrist extensor tendon Functional Tests AROM: pain with combined wrist extension and elbow flexion; radial deviation possible pain PROM: pain during passive wrist flexion, especially with elbow extension RROM: pain with resisted wrist extension and resisted finger extension when elbow extended Special Test- (“tennis elbow” test) Management -RICE -correct poor biomechanics -antinflamatory Medial Epicondylitis Onset- insidious Pain characteristics-medial epicondyle and the proximal portion of the adjacent wrist flexor and pronator muscles Mechanism -repeated, forceful flexion or pronation of the wrist (or both) -repeated activities that eccentrically load the medial elbow muscles
  3. 3. Inspection- swelling in the area over the medial epicondyle Palpation- point tenderness and crepitus over the medial epicondyle Functional AROM: pain during wrist flexion; wrist extension possibly resulting in pain secondary to stretching the involved muscles PROM: pain during wrist extension, especially with elbow extension RROM: decreased strength and pain during wrist flexion, pronation, or ulnar deviation Special Test -golfer’s elbow test Little Leaguer’s Elbow Mechanism/Etiology -Includes many disorders of growth in the elbow -10-25% in young pitchers (curve ball) -poor mechanics Signs and Symptoms -can avulse the medial epicondyle -nonunion stress fracture -tight anterior capsule -flexion contracture -catching and locking sensation -Decrease pronation and supination -refer to physician Elbow Osteochondritis Dissecans of the Capitulum Onset- insidious Pain characteristics- dull, lateral elbow pain that is increased with activity Mechanism - repetitive valgus loading of the elbow joint -compressive loading of the humeroulnar joint -improper biomechanics Inspection- arm possibly postured with the elbow in flexion Palpation-tenderness over the lateral epicondlye and lateral joint line Functional Test AROM: decreased extension; flexion contracture possible (stuck in slight flexion) PROM: decreased extension; flexion contracture possible (stuck in slight flexion) RROM: pain secondary to compression placed through the joint
  4. 4. Management -x-ray -flexibility/strengthen -may need surgery Cubital Tunnel Syndrome History –impingement to the ulnar nerve -can subluxate the ulnar nerve -carrying angle Mechanism-traction injury -irregularities -compression on the ulnar nerve Pain characteristics-medial pain Palpation -pain will referred distally and proximally Inspection-may see swelling near the medial aspect -claw hand (inability to make a fist) Functional Test AROM-elbow flexion, wrist extension PROM- elbow flexion, wrist extension RROM-weakness in finger flexion Special Test -tenile sign Radial Nerve Injury (Radial Tunnel Syndrome) Mechanism/Etiology -may appear like medial epicondyleitis -most often injured by deep laceration of the elbow -secondary to fractures of the humerus or radius -the radial nerve is entrapped and compressed -pain may be reproducing from repeated supination Signs and Symptoms -sensory loss on the posterior forearm and hand -inflammation or irritation of the ulnar and radial nerves as they cross the elbow joint
  5. 5. Elbow Dislocation Mechanism-falling on an outstretched arm -dislocation from a violent twist -posterior translation (most common) Inspection-the alignment Pain characteristics -severe pain Palpation-obvious deformity -can palpate the deformity -palpate the neurological distribution Management -immobilize from the position that there in Elbow Fractures Mechansim-falling on a outstretched arm -can fall on flex elbow direct blow -seen more in children than adults Inspection-may not always see an obvious deformity Palpation-can palpate deformity or crepitus -asses the nurological bundle Distal Biceps Tendon Rupture Onset- acute Pain characteristics- pain in the cubital fossa that decreases over time Mechanism- eccentric loading of the biceps brachii while the elbow is extended Inspection- swelling and ecchymosis in the cubital fossa Palpation- palpable defect in the distal biceps tendon - the lesion may be more easily recognized during 90 elbow flexion Functional tests AROM: possibly within normal limits or slightly decreased during elbow flexion and extension PROM: within normal limits RROM: decreased strength for elbow flexion and supination
  6. 6. Forearm Compartment Syndrome History- three types: volar dorsal mobile Mechanism-increase of pressure due to hyptrophy, hemorrhaging Pain characteristics -complaints of pressure of forearm Inspection -sensory deficits in fingers Functional tests -decrease hand strength -may see the compartment swell up -lost of function throughout the fingers Management -surgical repair Volkman’s Contracture History -forearm muscles die -pain and coldness to the forearm -may lose brachial and radial/ulnar pulses Management -immediate referral -no compression -is seen if fractures are missed

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