Elbow joint pathomechanics and rehabilitation in physiotherapy explained in detailed manner.Each and every point from reference books mentiuoned above is included.

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3.  A strain of the brachialis tendon
 Repetitive pull-ups, hyperextension, or repeated forceful supination or
from violent extension against a forceful contraction.
 Rock climbers are susceptible to this injury
 Pain with extension or resisted flexion and supination.
 Resolution of the symptoms is obtained with rest and anti-inflammatory
treatment.
 Early rehabilitation should focus on regaining ROM before eccentric
strengthening is initiated.

5.  Tendonitis at the distal biceps insertion is
an uncommon overuse syndrome.
 Pain with resisted flexion and supination,
which can be elicited during the physical
examination
 Distal biceps tendon rupture is uncommon
but is seen more often than biceps
tendinopathy
 The mechanism is a sudden, forceful
overload with the elbow in midflexion.

6.  Localized pain and tenderness at the bicipital tuberosity,
proximal displacement of the biceps tendon with a bulge in the
distal arm, inability to palpate the taut tendon within the
antecubital fossa, and marked weakness of forearm supination
and elbow flexion (often associated with increased pain)
 Ecchymosis is usually present in the antecubital fossa

7.  Pronator syndrome is proximal
entrapment neuropathy of the median
nerve.
 Four anatomical sites of compression of
the median nerve can be found in the
elbow region.
 • Under the ligament of Struthers
 • Bicipital aponeurosis
 • Pronator teres muscle
 • Flexor digitorum superficialis muscle

8.  Pronator syndrome is seen in patients who engage in repetitive pronation
and supination activities, including pitching, rowing, weight training,
archery, and racquet sports.
 Activity-related pain in the anterior aspect of the elbow and forearm.
 Dull pain or an ache in the proximal anterior forearm just distal to the
antecubital fossa, and it may radiate distally to the wrist.

10.  Provocative tests that have been described for localizing pathology to a
specific anatomical structure should also be performed: resisted forearm
pronation and elbow extension for the pronator teres, active supination
against resistance with the elbow flexed for the bicipital aponeurosis, and
resisted flexion of the long finger for the arch of the flexor digitorum
superficialis.

11.  Associated with injury the radial head, either subluxation or dislocation,
and it often is seen in throwing athletes

12.  Pathological bone formation in non osseous tissues, usually referred to as
heterotopic ossification (HO)
 HO can often progress to disabling pain and stiffness.
 Surgical excision of HO have shown consistently good outcomes with
minimal recurrence and complications.
 Classification systems for HO are based on location and functional
limitation.
 The most common location about the elbow is posterolateral, but HO can
involve almost any part of the elbow.
 Associated nerve compression, most commonly of the ulnar nerve, can
develop secondary to ectopic bone

13.  Ulnar nerve transposition should be considered in conjunction with
procedures to gain ROM, even if no ulnar nerve symptoms are present
preoperatively, if large gains in elbow motion are expected.

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15.  The medial epicondylar apophysis
is the weakest as a result, injury to
the medial epicondylar apophysis
is common
 Inflammation of the apophyseal
growth plate or progress to
avulsion fractures of the medial
epicondyle.
 Common fractures in the immature
throwing athlete

16.  In throwing athletes, this injury generally occurs during an especially hard
pitch or throw when valgus stress is coupled with flexor/pronator muscle
contraction.
 There is pain on throwing and a decrease in throwing distance, accuracy,
and velocity
 The treatment of the inflamed apophysis is rest from throwing for 4 to 6
weeks, application of ice.
 Avulsion injuries can be treated nonoperatively short course of
immobilization, activity restriction for 2 to 3 weeks, and a gradual return
to ROM exercises, strengthening, and functional activities. Absolute
indications for surgery include incarceration of a fragment

18.  Medial epicondylitis, or golfer’s elbow, is a term for tendinosis at the
common medial flexor/pronator origin
 Middle-aged athletes involved in golf, tennis, and over head throwing are
most commonly affected.
 Swelling and medial elbow pain that is worse with gripping, batting,
hitting a serve in tennis, and/or throwing.
 Ulnar nerve irritation.
 Pain with resisted pronation and/or wrist flexion
 Treatment is generally nonoperative, rest and anti-inflammatory
medications with a gradual return to stretching and eccentric
strengthening of the involved muscles.

19.  Rehabilitation includes application of ice, anti-inflammatory medications,
and stretching and strengthening of the flexor/pronator muscle group.
 Surgical intervention involves excision of the abnormal degenerative
tissue at the common flexor/pronator origin and re approximation of the
remaining healthy tissue
 Ulnar neuropathy is present 40% to 60% of the time

20.  It generally occurs during the acceleration and follow-through stages of
throwing in an overhead athlete or in conjunction with dislocation of the
elbow
 Result of forceful extension of the elbow and pronation of the forearm or
forceful valgus stress
 A muscular bulge may be present in the medial forearm from muscular
contraction, as well as pain and/or weakness of wrist flexion and/or
pronation.

21.  Caused by dislocation of the medial head of the triceps tendon over the
medial epicondyle during elbow flexion,
 This most commonly involves anterior transposition of the ulnar nerve

23.  Overhead throwing athletes repetitive valgus stress.
 Particularly the anterior band of the AOL of the UCL complex, commonly
injured.
 Pain and soreness in the medial elbow with throwing, late cocking or
early acceleration phases or with ball release.
 Associated ulnar neuropathy is quite common
 Loose bodies, osteophytes, and a flexion contracture, can also produce
symptoms.
 Tenderness at the insertion of the UCL approximately 2cm (1 inch) distal
to the medial epicondyle.

24.  Milking Maneuver

25.  UCL reconstruction with a free tendon graft is the procedure generally
performed for acute rupture in overhead sports athletes and for chronic
UCL instability and elbow pain with UCL instability
 A palmaris longus autograft is most often used

27.  Ulnar nerve can be compressed by
the intermuscular septum or by a
hypertrophied medial head of the
triceps.
 Nerve irritation from osteophytes,
loose bodies, a thickened
retinaculum, or an inflamed UCL,
especially with elbow flexion
 With the elbow in full flexion, the
confines of the cubital tunnel
become restrictive and the
retinaculum becomes taut,
compressing the nerve.

28.  Surgical treatment most often involves either anterior subcutaneous or
submuscular transposition of the nerve.
 Submuscular transposition requires a longer rehabilitation because of
detachment and re approximation of the flexor/pronator origin, wrist must
be immobilized
 Simple decompression and medial epicondylectomy are thought to
produce poor results in the throwing athlete because of the risk of UCL
injury and subluxation of the nerve.1

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30.  Injuries tend to occur in adolescents result of valgus extension overload
 Pain on resisted elbow extension and tenderness over the olecranon
 Classification system has devised five different types, including
 physeal
classic
transitional
sclerotic
distal stress fractures.

31.  Surgical intervention to promote
fusion of the apophysis may
require internal fixation with a
screw, in addition to bone
grafting, because of the high
incidence of fibrous union when
bone grafting is not used

32.  Most often seen in weight lifter
and football players
 In the intact tendon, squeezing
the triceps will result in extension
of the elbow, whereas with
triceps rupture, this does not
occur.

33.  Repetitive valgus stresses involved in throwing, which causes the
olecranon to be repeatedly and forcefully driven into the olecranon fossa.
 High-extension velocities produced during overhead athletic activities
may result in impaction of the olecranon tip within the fossa, producing
localized inflammation, chondromalacia, and further osteophyte
formation.
 Syndrome (VEOS) have posterior elbow pain, pain with forced extension
of the elbow, and occasionally, locking caused by loose bodies.

34.  Surgery for VEOS require a second
operation, and 25% of these patients
required reconstruction of the UCL as a
result of valgus instability.
 Osteophytes on the olecranon tend not
to respond to therapy and require
surgery to remove the osteophytes.

35.  In this space over the olecranon, can become inflamed or infected.
 Direct or repetitive trauma over the olecranon is the most common cause
 seen frequently in football and rugby players, especially those who play
on artificial turf.
 If the bursitis is severe, therapeutic aspiration with or without injection of
a corticosteroid can be performed
 If septic bursitis is a concern, the bursa should be aspirated and the fluid
sent for Gram staining

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37.  Involves separation of a localized area of articular cartilage and
subchondral bone.
 It is localized to the capitellum,
 Slightly older age group and is associated with a history of repetitive
trauma and overuse
 Dominant arm of patients who participate in sports such as baseball,
gymnastics, weight lifting, racquet sports.

38.  Radiocapitellar joint acts as a secondary stabilizer of the
elbow and receives a large proportion of forces transmitted
across the elbow with axial compression . Microtrauma in
these patients can lead to fatigue fracture of the subchondral
bone.
 Repetitive microtrauma in a genetically predisposed individual
results in vascular insufficiency and necrosis of the bone at
the subchondral plate.

39.  They have tenderness laterally over the
elbow and often have limitation of full
extension. Flexion contractures of 5° to
23°
 Radiographs may show the capitellum
with flattening or irregularity of the
articular surface
 The initial treatment is rest with
avoidance of sports or other aggravating
activities for 3 to 6 weeks.
 When symptoms resolve, stretching and
gradual strengthening

40.  Unloading-type braces to protect the radiocapitellar joint and
help reduce stresses during healing.
 If loose bodies are present, the recommended treatment is
removal of the fragment or fragments, usually arthroscopically.
 In larger lesions persistent pain and the development of
degenerative changes.

41.  Radiocapitellar degeneration most often occurs with UCL insufficiency.
 Force at the radiocapitellar joint, which leads to softening and
degeneration of the articular cartilage
 Tenderness at the lateral elbow that is worsened by pronation and
supination of the elbow
 Arthroscopic surgery is effective for removing loose bodies

42.  Lateral epicondylitis, or tennis
elbow, is by far the most common
overuse injury of the elbow.
 Commonly seen in tennis players
and other athletes,
 In individuals who do repetitive work,
such as typing on the computer.

43.  Many racquet factors have been attributed to tennis elbow, including
heavy racquets, metal racquets, stiffer racquets, incorrect grip size, and
string tension.
 Lateral elbow pain, often a dull, aching, lateral pain, and may show
weakness of grip strength.
 Initial treatment is typically nonoperative.
 Rest (i.e., avoidance of the stress or overuse) must be combined with a
program that reestablishes the patient’s strength, flexibility, and
endurance.

44.  If 6 months of nonoperative treatment for lateral epicondylitis fails then
surgery is indicated
 Three main procedures for tennis elbow:
 percutaneous release,
 the open procedure
 arthroscopic release.
 The principal goals generally are to remove abnormal, degenerative
tissue at the origin of the extensor carpi radialis brevis
 Arthroscopy for lateral epicondylitis provides significant improvements in
pain and functional recovery up to 3 months after surgery

45.  Cases of persistent tennis elbow represent radial or posterior
interosseous nerve compression, the so-called radial tunnel syndrome.
 The tenderness associated with radial nerve entrapment is more distal
and medial than that seen in lateral epicondylitis
 Cases that do not respond to conservative treatment may require
surgical decompression

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56.  Pathology and Intervention in Musculoskeletal Rehabilitation
SECOND EDITION David J. Magee
 Brotzman and Wilk Clinical Orthopaedic - 2nd edition
 Therapeutic Exercises Kisner And Colby – 6th edition