Overuse Syndromes

Overuse can occur in any musculotendinous structure in the elbow region especially in the muscles attached to the lateral or medial epicondyles in response to repetitive stressful wrist motions.

Components:1. Inflammatory2. Degenerative

Repetitive TraumaSyndromes

1. Epicondylitis Inflammatory 2. Tendonitis3. Tendinosis or tendinopathy

Degenerative

Components

Tennis elbow Lateral epicondylitis Lateral epicondylalgia Lateral epicondylosis

Lateral Elbow Tendinopathy (Tennis Elbow)

Backhand stroke in tennis Repetitive work tasks that require repeated

wrist extension, such as computer keyboarding or pulling weeds in a garden

The most frequent location of involvement is in the musculotendinous junction of the extensor carpi radialis brevis

Etiology

Pulled elbow Pushed elbow Rotated elbow, Radial head fracture Pinched synovial fringe Radial tunnel syndrome, Tendinosis Periosteal bruise

Differential Diagnosis

Golfer’s elbow Medial epicondylitis Medial epicondylalgia Medial epicondylosis

Medial Elbow Tendinopathy (Golfer’s Elbow)

swinging a golf club pitching a ball work-related grasping shuffling papers lifting heavy objects

Etiology

Gradually increasing pain in the elbow region after excessive activity of the wrist and hand

Pain when the involved muscle is stretched or when it contracts against resistance

Decreased muscle strength and endurance for the demand

Decreased grip strength Pain Tenderness with palpation at the site of

inflammation, such as over the lateral or medial epicondyle, head of the radius, or in the muscle belly.

Common Structural and FunctionalImpairments

Inability to participate in provoking activities, such as racket sports, throwing, or golf.

Difficulty with repetitive forearm/wrist tasks, such as sorting or assembling small parts, typing on a keyboard or using a computer mouse, gripping activities, using a hammer, turning a screwdriver, shuffling papers, or playing an instrument

Common Activity Limitations andParticipation Restrictions

(FunctionalLimitations/Disabilities)

Nonoperative Management of Overuse Syndromes

1. Decrease Pain, Inflammation, Edema, or Spasm Immobilization Patient instruction Cryotherapy2. Develop Soft Tissue and Joint Mobility Multiple-angle muscle setting (low-intensity isometrics) Cross-fiber massage Neuromobilization3. Maintain Upper Extremity Function Active ROM Resistive exercises

Protection Phase

1. Increase Muscle Flexibility and Scar Mobility Manual stretching techniques Self-stretching techniques Cross-fiber (friction) massage2. Restore Joint Tracking at the RU Joint Mobilization with movement (MWM).

Controlled Motion and Returnto Function Phases

Mobilization with movement (MWM).

3. Improve Muscle Performance and Function Counter force elbow sleeve or strap Isometrics. Dynamic resistance exercise Functional patterns4. General strengthening and conditioning Plyometric exercises Activity modification

Exercise Techniques to Increase Flexibility and Range of Motion

Exercise Interventions for theElbow and Forearm

Flexibility of Elbow Flexors

Flexibility of Elbow Extensors

Flexibility of Forearm Supinator

Self-Stretching Techniques: Muscles of the Medial and Lateral Epicondyles

Self Stretching (Muscles of Common Extensor Origin )

Strength Training of Elbow Flexors

Strength Training of Elbow Extensors

Strength Training of Forearm Supinator/Pronator

Strength Training of Wrist Extensors

Closed Chain Exercise for Elbow Flexors

Closed Chain Exercise for Elbow Extensors

Strength Training of shoulder External and Internal Rotators