MES 3: ELBOW & FA

Lateral Epicondylitis

Lateral Epicondylitis

d/t repetitive wrist extension, FA supination, overuse/poor mechanics that lead to an overload of extensor/ supinator tendons.

aka tennis elbow

Lateral Epicondylitis

• tenderness just distal to lateral epicondyle at the extensor tendon origin

• pain and weakness in grip strength

• cozen test

• mill’s test

Lateral Epicondylitis test

Medial Epicondylitis

• d/t repetitive valgus stress to elbow
  aka golfer’s elbow

• little leaguer’s elbow (children)

• pitcher’s elbow

Olecranon Bursitis

also known as

• draftsman’s elbow

• student’s elbow

• miner’s elbow

Olecranon Bursitis

• d/t repetitive trauma

• inflammatory disorder (gout, pseudogout, RA)

• decreased elbow extension motion

• swelling and pain on posterior elbow

Elbow Dislocation

• most common type of dislocation in children

• second most common type in adults (young adults bet 25-30 y/o.)

• account for almost 50% of these injuries

elbow dislocation

• FOOSH Injury

• posterior dislocation (most common)

• fracture of the radial head, brachial artery and median nerve

• inability to bend elbow

• pain at SH and wrist

distal biceps tendonitis

• overloading of biceps tendon d/t repetitive elbow flexion and supination or resisted elbow extension

• microtear of distal tendon

• onset of pain in antecubital fossa after eccentric overload

• audible snap

• swelling and ecchymosis

triceps tendonitis

overuse syndrome secondary to repetitive triceps extension

triceps avulsion

decelerating counterforce during active elbow extension

VALGUS EXTENSION OVERLOAD (VEO) SYNDROME OF THE ELBOW

• common in baseball players

• repetitive valgus forced (cocking phase and acceleration phase)

• common in the posteromedial olecranon

• posterior elbow pain c lack of full elbow ext

• lacking/catching of full elbow ext

MCL SPRAIN

• sprain secondary to repetitive valgus stress

• prominently during acceleration phase of throwing

• medial pain/instability on valgus stress of elbow

valgus stress test

TEST FOR MCL SPRAIN

LCL SPRAIN

• recurrent locking/clicking of elbow c extension/supination

• lateral pain/instability on varus stress c elbow flexed to 20-30 deg if the R CL is torn

varus stress test

lateral pivot shift test

TEST FOR LCL SPRAIN

PRONATOR SYNDROME

• dull aching pain on proximal elbow

• median nerve distribution numbness

• exacerbated symptoms by pronation

• median nerve compression

CUBITAL TUNNEL SYNDROME

• ulnar compromised at elbow at cubital tunnel

• hypermobile ulnar nerve

• excessive valgus force

• excessive osteophyte

CUBITAL TUNNEL SYNDROME

• medial FA aching pain c paresthesia radiating distally (4th and 5th digit)

• d/t ulnar nerve distribution

• weakness of ulnar nerve mm

• muscle atrophy, weak grip strength

• (+) froment’s sign

OSTEOCHONDROSIS OF ELBOW

• common in young individuals, 5-11 years old; specifically in the dominant elbow

• there is interference of bloody supply, to epiphysis leading to resorption of ossification center, repair & replacement

• aka panner’s disease

HUMERAL SHAFT FRACTURE

d/t MVA or trauma

5% of the common injury

s/sx includes: severe arm pain, swelling, deformity, and radial nerve pasly

DISTAL HUMERUS FRACTURE

d/t direct trauma/ FOOSA

radial nerve palsy

RADIAL HEAD FRACTURE

d/t FOOSA

s/sx: pain, swelling, hematoma, ecchymosis

decreases ROM in flexion, extension, pronation, and supination

non-displaced

TYPE 1 radial head fracture

marginal fracture c minimal displacement

TYPE 2 radial head fracture

communal fracture

TYPE 3 radial head fracture

OLECRANON FRACTURE

• d/t direct blow on elbow

• fall on elbow c elbow flexed

• FOOSA

• s/sx: swelling, ecchymosis, c obvious deformity

• pain on gentle ROM

• numbness, paresthesia c radiation on 4th and 5th digit (ulnar nerve)