Elbow Pt 2 (diagnoses)

atraumatic elbow diagnoses

medial & lateral epicondylitis
cubital tunnel syndrome
elbow osteoarthritis

medial epicondylitis

aka golfer’s elbow
medial elbow pain, tender wrist flexors
worse with flexion & pronation

medial epicondylitis diagnosis

no special tests
pain with medial epicondyle & wrist flexors palaption
pain with full elbow & wrist ext
pain with resisted flexion or pronation

lateral epicondylalgia

aka tennis elbow
lateral elbow pain, tender wrist extensors
worse with repeated extension & gripping

lateral epicondylalgia diagnosis

Cozen’s — resisted wrist extension, high SN
Maudsley’s — resisted middle finger extension, high SN
pain with lat epicondyle & extensors palpation
pain with full elbow & wrist flex

cubital tunnel syndrome

pinky & ring finger numb/tingling
repeat elbow flex, trauma, valgus, positional irritation
muscle weakness

cubital tunnel diagnosis

pressure provocation test
tinel’s sign
flexion test

pressure provocation test

pt elbow in 20 flex & forearm supinated
60 sec of pressure to ulnar n (prox to cubital tunnel)
+ if symptoms (stop pressure)

Tinel’s sign

4-6 forceful taps prox to cubital tunnel
+ if symptoms

flexion test

elbow max flexion + supination + wrist ext
hold 1-3 minutes
dont let fingers flex/curl
+ if symptoms

elbow osteoarthritis (OA)

gradual onset, worse with activity
more common in males
crepitus, pain, decr ROM

traumatic elbow diagnoses

distal biceps rupture
UCL sprain/tear
radial head sublux
fractures
elbow instability
osteochondritis dissecans

distal biceps rupture

dominant arm, 40-60 yrs
acute, eccentric load w/ sharp pain
can be degenerative
starting lawn mower, overhead tennis serve, overhead lifting

distal biceps rupture test cluster

biceps crease interval
hook test
passive forearm pronation
high SN & SP if all 3 positive or negative

biceps crease interval (BCI)

draw line at antecubital crease
line at sharpest curve of biceps (end of muscle belly)
+ if distance >6cm
high SN

hook test

hook finger under biceps tendon
+ if nothing to grab (detatched)
high SN, higher SP

passive forearm pronation

move forearm into pronation
+ if lose visible & palpable biceps movement
high SN, higher SP

UCL tear

valgus stress trauma or repetitive stress
may hear pop
medial elbow pain & swelling
unstable if complete tear
throwers lose speed or control

UCL tear grades

grade 1 = few fibers torn, painful & functional
grade 2 = significant fibers torn, painful & moderate function loss
grade 3 = all torn, elbow unstable, severe function loss

moving valgus stress test

for UCL tear
pt seated, shoulder 90 abd & max ER
passively flex elbow, give valgus stress, extend to 30
+ if max pain between 120 & 70 flexion

radial head subluxation

usually <4 yrs
traction injury, minimal swelling
avoid arm use (hold in flex & pronation)

radial head sublux tests

no special tests
cant extend elbow
focus on mechanism & age

elbow fractures

distal humerus (kids), radius & olecranon (adults)
trauma, pop or crack
pain at rest, limited arm use/ROM
bony tenderness

elbow fracture tests

percussion test — distal to injury site
dont tap olecranon if suspect fx

osteochondritis dissecans

ischemia to cartilage
usually trauma & in young males
poorly localized pain in dominant arm
pop or click
no tests — supination & pronation in flex/ext