The Elbow Differential Diagnosis & Treatment. Pathology Throwing, hitting, punching, pushing, painting Shoulder dysfunction Cervical spine pathology

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  • The ElbowDifferential Diagnosis & Treatment

  • PathologyThrowing, hitting, punching, pushing, painting

    Shoulder dysfunction

    Cervical spine pathology

  • Capsular

  • OsteoarthritisPost traumatic Capsular pattern CrepitusOlder patient

    Electrotherapy and mobilisation or injec into joint

  • Rheumatoid Arthritis Lax ligaments reduced stabilitySynovial thickening and swelling, flexion deformity

    Steroid injec and rest or oral medication

  • Traumatic ArthritisCause fall or hyperextension

    Acute x-ray and aspirate

    Sub acute steroid injection and rest or 1 week rest in flex and gradual gentle mobsNo friction myositis ossificans

  • Non capsular

  • Loose body eg Osteochondritis Dissecans and OAPain and springy end feelLockingEither in coronoid or olecranon fossa

    TreatmentEUA removal

  • Cubitus varus and valgusReduced or increased carrying angleFollowing fracture ChildrenEpiphyseal damage

    May need surgical correction

  • Bicipital BursitisPain at front of elbow

    Pain full passive pronationSome pain on resisted flexion in supin

    Treatment - injec

  • Olecranon BursitisPosterior elbow pain

    Pain on full passive flexionSome pain on resisted extenCarpet fitters, RA,students

    Treatment aspiration and /or injection

  • Contractile

  • Tennis ElbowCauses:2 joint muscle lengthening across 2 joints + added force sheer stress at originOveruseGripping

  • Tennis ElbowPathology6months 2yearsMicroscopic tears failed healing - inflammationFibroblastsVascular hyperplasiaDisorganised collagenTendinitis or tendinosis

  • On examination20-30s most common and degen 40yrs +

    Pain on resisted wrist extension with elbow extensionReduced grip strength

    Pain on palpation

  • Lateral Epicondylitis (tennis elbow)4 sites1)ECRL on supra-condylar ridge2)CEO3)Body of tendon4)belly of muscle

  • Tennis Elbow Treatments1)ECRL friction and rest(forearm in supination)

    Frictions must be specific and transverse

    Chronic numbness + 10 mins

  • Tennis Elbow Treatments2)CEO Injec and rest or friction, mills manip, stretch and rest (forearm in supination)

  • Tennis Elbow Treatments2) 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 TreatmentsAdviceMust adjust technique or grip in sportsStretchesStrappingSSTM/ muscle energy techniquesAcupuncture

  • Medial Epicondylitis (golfers elbow) 2 sites1)CFO2)MT junction

  • Golfers Elbow contOverusePain on resisted wrist flexion with elb ext

  • Golfers Elbow Treatments1)CFO injec and rest or friction and rest

    2)MT junction friction and rest

  • Biciptal TendonitisOverusePain on resisted elbow flexion with supin

    Treatment MT junc friction and rest