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