7. Medial Epicondylitis (golfer’s elbow)
• • Pathology
• – 30 - 50 years old
• – Repetitive micro trauma to common flexor tendon
• Mechanisms of injury
– Throwing a baseball
– Swimming backstroke
– Hitting a golf ball
8. Clinical signs and symptoms
• • Increased pain over medial epicondyle
• – Tenderness on palpation CFT
• – Tests
• • AROM; PROM
• • Resisted tests
9. Treatment of Golfer’s Elbow
• • Cryotherapy
• • Stretching
• • Strengthening
• • Modification of activity
• • Modification in functional activities / equipment use.
10. TRICEP TENDONITIS
• •Tendonitis of tricep at its attachment to olecranon is rare
• Etiology Forceful elbow extension (Javelin throw / TENIS) Occupational or
recreational activities
• •Snapping of tricep tendon due to ulnar nerve / tricep subluxation ulnar
neuritis
• •Sudden onset of pain on posterior elbow
• •Localized, Dull ache / sharp in nature
• •AROM - PROM full
• Key test -->Resisted elbow extension with fully supinated forearm
11. MEDIAL COLLETRAL LIGAMENT INJURIES
Valgus Over Load Traid / Medial tension overload
syndrome
• • SYNDROME INCLUDE:
• – MCL
• – Postereo-medial joint capsule
• – Ulnar nerve
• • OVER HEAD ATHLATIC ACTIVITIES & REPETITIVE ACTIVITIES:
• – Throwing, hitting & racquet sports
• • TRAUMA INVOLVE VALGUS STRESS ON ELBOW
• – Fall / hit while arm in outstretch position
12. • History
Medial elbow pain
Gradual onset ( associated with medial tendonitis)
Popping sensation with activities involve valgus stress
Over time Ulnar nerve irritability, posterior elbow pain
• • Observation:
Swelling on medial elbow
• • Palpation:
Point tenderness on MCL, ulnar nerve sensitivity/subluxation, flexor-
pronator tendon may be tender
13. • • Physiological movements:
• loss of elbow extension & supination due to flexor & pronator
contracture
• • Accessory movements:
• Hyper-mobility/ valgus instability
• • Special Test:
• Valgus stress test, valgus extension overload test
15. Management
Conservative treatment
Pain reduction Rest, NSAIDs
Proximal control of scapula & RC m/s coz fatigue sh. m/s may affect
arm angle during throwing thus increase load to medial elbow
Maintain & regain ROM i.e flexion & pronation
Strengthening of pronator, supinator, flexor, extensors (concentric &
eccentric)
Grip exercises
Surgical Repair, Reconstruction
In advance cases of MCL instability & posterior medial bony
impingement
16. Medial Epicondylar Apophysitis
• •Apophysis is an area of bone where ligaments and
tendons attach. Growth plate of long bones is
weaker than the attaching ligaments and tendons
and; therefore, it's more susceptible to injury
• •Apophysitis occurs when the area of growth is
irritated from overuse
• • Elbow has three apophysis:
• i. Medial epicondyle apophysis
• ii. Lateral epicondyle apophysis &
• iii. Olecranon apophysis
17. • Etiology:
• •Repetitive valgus stress (tension force on medial epicondyle via MCL) repetitive micro
traumas occur ultimately stress # of medial epicondylar apophysis
• Symptoms of apophysitis:
• •Point tenderness over the bony prominence rather than over tendons or ligaments
• •Pain is made worse by the ligaments pulling against their attachment on the bone
• Treatment:
• •Elimination of valgus stress.
• •Rest, ice, NSAIDS & PT for stretching and strengthening
• •Surgery is rarely needed
18. • Avulsion Fractures
Avulsion fractures occur when a tendon or ligament is forcefully pulled away
from a bone taking a piece of bone with it. Depending on how far the bone is
pulled away from its attachment site, some avulsion fractures can be treated
non-operatively. Others, where the bone is pulled farther out of place, may
need surgery to fix the bone back in its correct position for healing to occur.
• Ligament Injuries
• Because of the weakness of the growth plate in comparison to the
ligaments that attach at the elbow, When they do occur an athlete's pain is
localized over the tendons and ligaments rather than directly over the
boney prominences. Radiographs are usually taken to rule out bony injury.
An MRI may be ordered to confirm the diagnosis
• For ligament injuries where the joint is still stable, treatment consists of
rest, ice, anti-inflammatory medications, and physical therapy. Braces can
help relieve stress on an injured ligament while it is healing. Ligament
injuries rarely require surgery
19. Nursemaid's elbow
Nursemaid's elbow, babysitter's elbow, or pulled elbow is a radial head
subluxation in association with annular ligament damage
• Young children < 8 yrs (peak incidence 2-3 yrs)
Etiology sudden pull on extended pronated arm above child’s head,
such as:
• -swinging the child by arms during play
• -Lifting a child up from floor
• -Lifting a child’s arm as adult go up stair
20. • • Limitation of extension & supination
• • Painful inability to use arm
• • Palpable clicking in the elbow
• • Child hold elbow flexed at 90 and in pronation
• • Pain is poorly localized
• • Rx: Reduction by manipulation
21. Capsular Tightness
Common cause:
• Post traumatic Immobilization
• Including dislocations (post. Is common), # (humeral shaft,
supracondylar, colle’s)
• Rare causes:
• OA (in elbow usually sec. to trauma, prematurely in athletes)
• -RA,
23. Rheumatoid Arthritis
• Involve either one of both elbows
• Clinical features are marked synovitis, painful restriction of
movement, fixed flexion deformity
• Supination and pronation is painful and restricted
• Ulnar nerve and posterior radioulnar joint may be involve
24. Osteoarthritis
• Common in heavy workers, secondary to old fractures,
Clinical features are
• 1. formation of loose bodies
• 2. restrict movements
• 3. locking of joint
25. Myositis Ossificance
• Calcification of hematoma formed in brachialis muscles on anterior
aspect of elbow joint
• Leads to mechanical block
• Commonly occurs after supracondylar fractures and dislocations of
elbow joint
• Radial head injuries
• Over vigorous physiotherapy
26. OLECRANON BURSITIS
(Student’s Elbow)
• Olecranon bursa lies between skin and olecranon (pointy
bone)
• If bursa becomes irritated or inflamed, more fluid will
accumulate in bursa & will cause bursitis
• Signs and Symptoms
• Pain, swelling, and point tenderness
• Swelling is usually the first sign of elbow bursitis (w/out usual
pain and heat)
• If bursitis is infected skin becomes red and
• warm
27. ETIOLOGY:
• Trauma: A hard blow to the tip of the elbow
• Prolonged pressure: Leaning on elbow for long periods on hard
surfaces e.g tabletop. Certain occupations e.g carpet layers, plumbers
or heating and air conditioning technicians (have to crawl on their
knees in tight spaces and lean on their elbows)
• Infection: Any injury at tip of elbow that breaks skin e.g insect bite or
puncture wound, bacteria may get inside the bursa and cause
infection. If the infection goes untreated, the fluid may turn to pus
28. MANAGEMENT
• Infective bursitis: Needle aspiration + antibiotics
• Non-Infective bursitis: Elbow pads (to cushion elbow) Activity changes
(Avoid activities that cause direct pressure to elbow) NSAIDS
• If Pt. do not respond to these measures after 3 to 4 weeks remove bursa
fluid Corticosteroid injections
• If still not work surgical removal of bursa (the bursa usually grows back
over a period of several months)
29. NERVE ENTERAPMENTS
AROUND ELBOW
• I. Ulnar nerve entrapment/ cubital tunnel syndrome/ Ulnar nuritis/
Tardy nerve palsy
• II. Median nerve entrapment/ pronator syndrome -> CTS (ant.
Interosseous nr.)
• III. Radial nerve entrapment/ radial tunnal syndrome (post.
Interosseous nr.)
30. Cubital Tunnel Syndrome
(Ulnar Nerve Entrapment/ Ulnar nuritis/ Tardy
nerve palsy)
• Ulnar nerve subjected to pressure between medial epicondyle of
humours and olecranon process of ulna i.e cubital tunnel
31. • INDICATIVE READING
• References
• • Darlene H, Randolph M. K. Management Of theCommon
Musculoskeletal Disorders 4 ed (page numbers :370-381)
