The Elbow

Differential Diagnosis & Treatment

Pathology

• Throwing, hitting, punching, pushing, painting

• Shoulder dysfunction

• Cervical spine pathology

Capsular

Osteoarthritis

• Post traumatic

• Capsular pattern

• Crepitus

• Older patient

• Electrotherapy and mobilisation or injec into joint

Rheumatoid Arthritis

• Lax ligaments – reduced stability• Synovial thickening and swelling, flexion

deformity

• Steroid injec and rest or oral medication

Traumatic Arthritis

• Cause – fall or hyperextension

• Acute – x-ray and aspirate

• Sub acute – steroid injection and rest or 1 week rest in flex and gradual gentle mobs

• No friction – myositis ossificans

Non capsular

Loose body eg Osteochondritis Dissecans and OA

• Pain and springy end feel

• Locking

• Either in coronoid or olecranon fossa

• Treatment

• EUA removal

Cubitus varus and valgus

• Reduced or increased carrying angle

• Following fracture

• Children

• Epiphyseal damage

• May need surgical correction

Bicipital Bursitis

• Pain at front of elbow

• Pain – full passive pronation

• Some pain on resisted flexion in supin

• Treatment - injec

Olecranon Bursitis• Posterior elbow pain

• Pain on full passive flexion• Some pain on resisted exten• Carpet fitters, RA,students

• Treatment – aspiration and /or injection

Contractile

Tennis Elbow

• Causes:

• 2 joint muscle – lengthening across 2

• joints + added force

– sheer stress at origin

• Overuse

• Gripping

Tennis Elbow• Pathology

• 6months – 2years

• Microscopic tears – failed healing - inflammation

• Fibroblasts

• Vascular hyperplasia

• Disorganised collagen

• Tendinitis or tendinosis

On examination

• 20-30’s most common and degen 40yrs +

• Pain on resisted wrist extension with elbow extension

• Reduced grip strength

• Pain on palpation

Lateral Epicondylitis (tennis elbow)

• 4 sites

• 1)ECRL on supra-condylar ridge

• 2)CEO

• 3)Body of tendon

• 4)belly of muscle

Tennis Elbow Treatments

• 1)ECRL – friction and rest• (forearm in supination)

• Frictions must be specific and transverse

• Chronic – numbness + 10 mins

Tennis Elbow Treatments

• 2)CEO Injec and rest or friction, mills manip, stretch and rest (forearm in supination)

Tennis Elbow Treatments• 2) CEO cont

• 3)Body of tendon - injec and rest or friction and rest (forearm in pronation)

• 4)Belly of muscle – injec and rest and frictions (forearm in mid position)

Tennis Elbow Other Treatments

• Advice

• Must adjust technique or grip in sports

• Stretches

• Strapping

• SSTM/ muscle energy techniques

• Acupuncture

Medial Epicondylitis (golfer’s elbow)

• 2 sites

• 1)CFO

• 2)MT junction

Golfer’s Elbow cont

• Overuse

• Pain on resisted wrist flexion with elb ext

Golfer’s Elbow Treatments

• 1)CFO – injec and rest or friction and rest

• 2)MT junction – friction and rest

Biciptal Tendonitis

• Overuse

• Pain on resisted elbow flexion with supin

• Treatment – MT junc friction and rest