Elbow Diagnoses - Exam 1
what is the incidence of elbow pain in athletes? prevalence? lateral elbow pain incidence? prevalence?
-12-58% -17-58% -1-3% -1-3%
what is the average recovery for medial epicondyle apophysitis? average rest?
-3-6 months -4-6 weeks of rest
what is the nerve root for the musculocutaneous nerve? what are the locations that can pinch it?
-C5-C7 -pectoralis minor, coracobrachialis, lateral biceps/brachialis
what is the nerve root for the median nerve? what are the locations that can pinch it?
-C5-T1 -arcade of Struthers, bicep aponeurosis, pronator teres, flexor digitorum profundus, carpal tunnel
what is the nerve root for the radial nerve? what are locations where it can be pinched?
-C5-T1 -radial groove, arcade of Froshe, supinator/ECRB, radial tunnel, Lesh of Henry
what is the nerve root for the ulnar? what are the locations that can pinch it?
-C8-T1 -arcade of Struthers/intermuscular septum, cubital tunnel, flexor carpi ulnaris, Guyon's canal, anconeus
what are the critical phases of throwing for a UCL strain? what bundle is at the greatest risk for injury?
-cocking/late cocking to acceleration phases -anterior bundle (AMCL)
what are surgical treatment options for posterior impingement? what is the success rate? how long is rehab? what is often missed with this?
-debridement/osteophyte removal -42-85% success rate -follows surgery for ~3 months -combined lesions such as UCLs
what are important landmarks to look at on an x-ray for fractures of the olecranon?
-fat pads (intra vs extracapsular) -anterior humeral line (capitulum)
lateral epicondylopathy affects 1-3% of the population. what gender is more affected? what age? what arm is it typically seen in?
-females>males -40-60 year olds (suspected prevalence 7-10%) -dominant
with medial epicondyle what muscle that is innervated by the ulnar nerve is important to consider? innervated by the median nerve?
-flexor carpi ulnaris -pronator teres
For interventions do you prescribe flossing/sliders first or nerve tensioning first? what is the difference?
-flossing first -flossers stretch one end; more nerve excursion and less symptomatic -tensioner: keeps everything tight and push across it; less nerve excursion and more symptomatic
what is the chronic MOI for lateral epicondyle? indirect acute? direct acute?
-gradual onset and overuse -clear onset, bruising, loss of function -traumatic
what are benefits of surgical repairs of torn ligaments? what may not be maintained?
-induces faster and stronger healing through regeneration instead of scar formation -strength advantage may not be maintained as time progresses
what are inconsistent risk factors for athletes for elbow injuries?
-older youth players -workload -length of BE -pitch type -older adult players -weight or BMI -hip mobility -elbow ROM
According to the literature, what are the believed outcomes when doing conservative treatment for a UCL partial tear in terms of return to play and length of recovery?
-patient will do ok with conservative treatment - High probability to return to play, but return to prior play is less likely - 6-12+ week long recovery
what are consistent risk factors for athletes for elbow injuries?
-pitcher or catcher -shoulder ROM -ball velocity -shoulder strength -handedness -pitching role
with neurodynamic testing for peripheral nerves, what do you need to see in order to determine if a result is positive? If it is a negative result can you rule it out?
-reproduction of symptoms (same pain) and structural differentiation (changes in ROM) -no; need other tests, can't use this test in isolation
what are inconsistent risk factors for athletes for arm injuries?
-shoulder ROM -less humeral retrotorsion -greater humeral retrotorsion
what are traumatic MOIs for ligamentous sprains/tears? micro-traumatic/repetitive?
-sudden and typically FOOSH -excessive; unnatural/maladaptive stresses
what is the most common elbow fracture in children? 2nd most common?
-supracondylar (60%) -lateral condyle (20%)
what are surgical interventions for olecranon fractures?
-usually ORIF or excision of fragments with repair of extensor mechanism. -usually emphasis on early ROM; however, follow post-surgical guidelines
what are consistent risk factors for athletes for arm injuries?
-workload -pitcher or catcher
what lateral epicondylopathy pain phase? Soreness after activity, usually gone in twenty-four hours
1
what are the 3 special tests for lateral epicondylopathy?
1. Cosen's 2. Mill's 3. Maudsley's (3rd finger testing) none of these have evidence to support reliability, sensitivity, or specificity
when treating lateral epicondylopathy it should not cause pain. if an exercise causes phase 3 (Mild/moderate stiffness and soreness plus mild pain during activity which does not alter activity) pain or more what should you do?
1. Decreasing the amount of weight you are lifting and/or 2. Decreasing the number of repetitions you are performing and/or 3. Moving through "pain free" range of motion.
What are 3 tests other than Cozen's, Mill's, and Maudsley's that could be used to test for lateral epicondylopathy?
1. cervical spine exam 2. ULNT (radial) 3. grip strength: patient elbow extended and forearm in neutral, squeezing until discomfort
what are the 3 possible peripheral nerve impairments?
1. motor 2. sensory 3. autonomic
What are the 4 steps that need to be done when looking at the tissue during a manual treatment session according to EBP?
1.Assess Tissue 2.Treat Tissue 3.Reassess Tissue 4.Specific Exercises to Maintain Gains
what are the 5 types of lateral epicondylopathy?
1.Lesion ECRL 2.Insertional Tendinopathy @ ECRB 3.ECRB @ RCL/Radial Head 4.ECRB strain 5.EDC Inflammation
What are the 4 protocols for conservative treatment for a UCL partial tear?
1.Period of Rest (US stress test) 2.Stretching 3.Strengthening 4.Throwing Program
What are the 3 factors that contribute to medial epicondyle apophysitis?
1.Rapid Growth= Increase widening of growth plates 2.Decreased Flexibility / Strength = Poor Mechanics / Excessive Load 3.Active Individual= Repetitive overuse
medial epicondylopathy: •Only __ as frequent as lateral epicondylopathy •Most common in age __-__ yo •Often overuse or repetitive stress: fatigue of flexor/pronator tissues in response to repeated stress, Predisposition for medial ligamentous injury due to sudden change in stress levels, MCL fails to sufficiently stabilize against valgus forces
1/3, 35, 55
According to the literature, after a UCL reconstruction the patient can return to play in __-__months and could return to prior play in __-__ months
11.6, 14.3, 12.2, 19.8
For ulnar collateral ligament injuries the incidence is ___-___% for professionals and ___-___% for 15-19 yo athletes
16, 22, 8, 13
what phase of ligamentous sprains/tears healing? •Disruption of tissue: gap is filled with blood clot •Triggers leukocytes and lymphocytes to expand inflammatory response and recruit other types of cells to the wound
1: hemorrhagic
what lateral epicondylopathy pain phase? Mild stiffness and soreness before activity which disappears with warm-up. No pain during activity, but mild soreness after activity that disappears within 24 hours.
2
in __ of patients symptoms of peripheral neuropathies don't correlate with defined distributions of peripheral neuropathies
2/3
what phase of ligamentous sprains/tears healing? •Macrophages arrive within 24-48 hours, perform phagocytosis on necrotic tissue and secrete growth factors for neovascularization and formation of new tissue.
2: inflammatory
what lateral epicondylopathy pain phase? Mild/moderate stiffness and soreness plus mild pain during activity which does not alter activity.
3
Treatment UCL strain return to sport: •Usually begins around __ months •Criteria includes full, nonpainful ROM, no __ laxity, isokinetic testing criteria
3, increased
what phase of ligamentous sprains/tears healing? •Fibroblasts arrive and begin producing collagen within 1 week of injury and capillary buds begin to form.
3: proliferation
what lateral epicondylopathy pain phase? Pain during activity which alters activity.
4
what phase of ligamentous sprains/tears healing? •Gradual decrease in cellularity of healed tissue. •Type I to Type III begins to approach normal levels over several months •Can take up to 3 years to heal to the point of normal tensile strength
4: remodeling/maturation
what lateral epicondylopathy pain phase? Constant pain even at rest.
5
After Reconstruction at the UCL graft site you need to provide ice and compression for __-__ days and scar massage for __-__ weeks
5, 7, 2, 3
The UCL can also be repaired with a biobridge instead of just reconstruction. With the biobridge approach return to prior play occurs in 92-96% in __-__ months (in amateurs/non professionals because don't know anything about the __)
6.1, 6.9, longevity
conservative intervention for medial epicondylopathy has a success rate as high as __%.
90
Conservative Intervention for Olecranon Fracture: (non-displaced or minimally displaced) •Immobilized initially with elbow flexed to ___ degrees. Immobilized in some capacity until evidence of union (usually around __ weeks) •Roughly: begin pron/supination __-__ days then flexion/extension at __ weeks •Usually avoid resisted exercises for __ months
90, 6, 2, 3, 2, 3
what age are ulnar collateral ligament injuries most common?
<20
what type of fracture? radial head fracture and distal radioulnar joint interosseous membrane damaged
Essex-Lopresti
what is the typical cause for a posterior, anterior, lateral, medial, or divergent elbow dislocation?
FOOSH (direction of trunk can also influence this)
what Nirschl Stage of tendinopathy? inflammatory but no pathologic tissue changes
I
what stage of osteochondritis dissecans? -stable -lesion continuity with host bone -covered with intact cartilage
I
What are the "Mason Classifications" Type I, II, III for a radial head fracture?
I= un displaced and usually non-op; fissure or marginal fracture without displacement II = single fragment is displaced (may be non-op if displacement is minimal); marginal sector fractures with displacement III = comminuted and requires operative management (comminuted fracture involving the whole head of the radius)
what Nirschl Stage of tendinopathy? pathologic tissue changes; fibroblastic and vascular response
II
what stage of osteochondritis dissecans? -stable on probing -partial discontinuity with host bone
II
what Nirschl Stage of tendinopathy? pathologic change w/ structural failure (rupture)
III
what stage of osteochondritis dissecans? -unstable on probing -fragment not dislocated -complete discontinuity
III
Which stages of osteochondritis dissecans indicate the following: -Stage __ & __: surgical candidate -Stage __: most likely surgery, possible rehab (31.4% healed non-op) -Stage __: rehab, possibly surgical candidate (64.3% healed non-op)
III, IV, II, I
what Nirschl Stage of tendinopathy? stage II (pathologic tissue changes; fibroblastic and vascular response) or III (pathologic change w/ structural failure (rupture)) plus fibrosis & calcification
IV
what stage of osteochondritis dissecans? -dislocated fragment
IV
a special consideration for bicipital tendinopathy besides brachialis and anterior elbow pain is __ __, which is when there is a ball of swelling in the anterior arm under the bicep aponeurosis (aka compartment syndrome)
Lacertus Syndrome
what treatment for lateral epicondylopathy? •small amplitude, high-velocity thrust performed at the end of elbow extension while maintaining wrist/hand flexion. significantly greater (p<0.05) improvements regarding pain, pain-free grip, and functional status for the experimental group compared to the control group
Mill's Manipulation
Rehab for osteochondritis dissecans: •Protocol Driven: Period of ___ •Gradual return to __ •Time frame ___: Surgery and Size of lesion
NWB, function, dependent
what is another name for a posterior impingement that may be seen in the clinic? why is this not the best way to name it?
Valgus extension overload. If there is an overload into valgus extension the first thing to be injured is UCLR ligament. 2nd injury is due to compression so it is osteochondritis dissecans. The third injury is from the shearing so it would be posterior medial impingement from shearing.
medial epicondyle treatment: •Initial ___ phase: Rest, activity modification, and local modalities •Restore ROM and correct any ___ of flexibility/strength; Initially includes multiangle __, then concentric and ___ exercises of the flexor/pronator bundle; May use flexbar for eccentrics (similar to treatment for LET) •__ brace "may" be useful
acute, imbalances, isometrics, eccentrics, counterforce
Tendons become weaker, stiffer, tolerate load less due to vascular, cellular, and collagen related changes associated with ___.
aging
This is a secondary ossification center that serves as the attachment site for a muscle-tendon unit
apophysis
what position did a vast majority (92%) of elbows become dislocated?
at or near full extension
The following is surgical treatment of medial epicondyle apophysitis if a ___ fracture occurs: - Apophysis is pulled off the bone from a forceful muscle contraction (need to observe to see bone fragments displaced from origin) - If the displacement is significant, may need a screw fixation
avulsion
what type of elbow fracture in children is known as "little leaguer's elbow"?
avulsion medial epicondyle
Typically involve a sudden contracture of the Biceps against a significant load with the elbow in 90 deg flexion. PMHx includes complaint of sharp, tearing pain in the antecubital fossa. Sharp pain dulls over the next several days. Patient may also notice a decrease in strength
biceps tendon rupture
the following exam findings indicate what diagnosis? •Pain in anterior aspect of the distal part of the arm •Symptoms aggravated by elbow extension and shoulder extension •AROM pain with elbow flexion •PROM pain with shoulder and elbow extension •Strength: Pain on elbow flexion and supination •TTP: Distal Biceps belly, musculotendinous portion of biceps or at insertion at the radial tuberosity
bicipital tendinopathy
what diagnosis? •Age 20-50 years old •Often overuse or repetitive stress •MOI: Repetitive hyperextension of the elbow with pronation or repetitive stressful pronation/supination
bicipital tendinopathy
what type of fracture? radius and ulna are fractured
both bone forearm
Although there is agreement concerning bracing and limiting ROM following PLRI surgery there is currently no consensus in the rehabilitative- and conservative treatment modalities for patients with symptomatic PLRI according to the literature. It is important to follow the surgeon's post-op guidelines. Post-operatively there is usually some degree of ___/ROM restriction. Elbow strengthening often begins __-__ weeks post-operatively
bracing, 6, 8
Is conservative or surgical treatment of osteochondritis dissecans better if the patient is able to make a choice?
conservative would be better because it is better to keep the hyaline cartilage they have there. If they choose the surgery route it will heal into fibrous cartilage
what should be done during UCL injury rehab?
control inflammation, control stress, dynamic stress, and provide exercises for return to sport/occupation (work on hardening/conditioning and throwing program)
Intervention for conservative treatment OR post ORIF for radial head fracture: •Immobilization possible •Acute Phase: ___ pain, ___ inflammation, retard muscle atrophy •Subacute phase: maintain ___ elbow ROM, progress to strength & then function •Chronic phase: maintain full elbow ROM, ___ strength, initiate return to sport. Usually begin ___ around 12 weeks
decrease, decrease, full, increase, eccentrics
what are the outcomes for a baseball player associated with a UCL injury?
decreased spin rate, velocity, mechanics, workload, earned run average
Tendons of the ___ are very stiff and their length changes very little when muscle forces are applied through them (less elastic). The amount of "crimp" __ with age. Tendon strains of __-__% straighten "crimp". Tendon strains of __-__% tolerated in healthy individuals. Strain >__% leads to incomplete tear. Strain __-__% leads to structural failure
digits, decreases, 1, 2, 2, 6, 6, 8, 10
what type of strength exercises are the gold standard for treating lateral epicondylopathy?
eccentric
what intervention does this describe? •Help with tendon repair •Lengthening of muscle •Enhances neuromuscular control
eccentrics
what diagnosis is this an MOI for? •Fall on an outstretched hand may be a part of their history •**Forearm in supination •**Hyperextension force through the elbow •IF they remain unstable, the ulnar portion of the lateral collateral ligament may be injured
elbow dislocation
This is a thin layer of cartilage between the epiphysis (a secondary bone-forming center) and the bone shaft. The new bone forms along this
epiphyseal plate (physis)
Which muscle is most commonly implicated/affected in lateral epicondylopathy?
extensor carpi radialis
How often after UCL reconstruction does the graft fail (revision)?
fails 3.9-13% within the 1st year and usually a repair is needed 3-5 years + due to the UCL length not being able to be handled so retears
true/false: conservative treatment is successful with full tears of ulnar collateral ligament
false (it is not successful)
Bicipital Tendinopathy Treatment: •Focus is on restoring the strength, endurance, and flexibility of the __/__ mechanism •Focus on restoring strength of the shoulder __ •__ modalities •Transverse __ massage •Trigger point assessment •Specific elbow joint mobilization
flexor, supinator, stabilizers, thermal, friction
The following are all interventions for the diagnosis of __: - mobility (AROM vs PROM) with distraction, Mobilization, and Splinting - stability - modalities for symptom reduction - don't forget about the wrist and shoulder as well
fracture (hypomobility)
what diagnosis? •Acute Injury •Extreme pain at elbow or forearm •Swelling •Lack of feeling in the hand •Loss of ROM especially with straightening
fracture (hypomobility)
what type of fracture? fracture of distal radius with dislocation of distal radioulnar joint
galeazzi
what is another name for medial epicondylopathy?
golfer's elbow
After a UCL reconstruction, if a gracilis graft is chosen what muscle group should be the focus for stretching for 2 weeks, isometrics for 4 weeks, and isotonics for 6 weeks?
hamstrings
___ at the elbow and disuse dramatically compromises the structural properties of ligaments and leads to decrease in ability to resist strain and absorb energy. in recovery it is important to make sure that the forces applied to the ligament help it to develop in strength in the __ that the force is applied. very __ cyclical loads on the ligament promotes scar proliferation and material remodeling.
immobilization, direction, low
Lateral Epicondylopathy: •___ risk if previous smoking hx, De Quervain's, Carpal Tunnel Syndrome, Oral Corticosteroid Use •Sport /Work: __ sports (tennis, handball, etc.), gymnastics •Professions that require __ and/or __ heavy manual tasks, non-neutral wrist postures, & repetitive gripping •Occupation - ___ job control, __ social support, handling tools >__ kg, repetitive elbow/wrist movement >__ hours/day, or ___ twisting/rotating/screwing
increased, racquet, repetitive, forceful, low, low, 20, 2, repetitive
what are some potential causes of medial epicondyle apophysitis (little league elbow)?
irritation, inflammation, and repetitive micro-trauma
what intervention does this describe? •Muscle Strengthen at Set Angle; Can train end range ROM •Sub-max Work •Reduce Inhibition •Decreased Recovery Period •Quick / Easy / No Equipment...Can do directly after manual
isometrics
what intervention does this describe? •Move through ENTIRE Range, Especially new range •Following Strength and Conditioning Principles •Focus on Mechanics
isotonics
Elbow valgus torque increases with greater degrees of shoulder ___ rotation
lateral
The following are MOI for a ___ligament injury: - Crutch Ambulation - Elbow Dislocation - Iatrogenic (induced inadvertently as a result of medical treatment)
lateral collateral
the following are potential sources of what? •Periostitis •Infection •Bursitis •Radial head disease •Neurogenic causes •Osteochondritis Dissecans •Capsular/ligament lesions •Radial nerve entrapment •Impingement @ elbow •Radiculopathy (Cervical) •Shoulder induced brachioplexopathy •Lateral epicondylitis
lateral elbow pain
the following exam findings are associated with which diagnosis? •Pain at the lateral epicondyle •Palpation - tenderness w/ possible swelling •PROM - pain with combined passive wrist flex, pronation, and elbow extension •Gross muscle testing - pain w/ extension & radial deviation
lateral epicondylopathy
The following are MOI for a ___ ligament injury: - Typically ligament attenuation (repetitive): tennis/baseball - Iatrogenic (induced inadvertently as a result of medical treatment)
medial collateral
What diagnosis? -Age: 11-15 years old (females 9-13) -Medial Elbow/Epicondyle Pain -decreased ROM: Elbow Extension and Wrist Extension -decreased Elbow/Wrist Strength -decreased Performance
medial epicondyle apophysitis
the following are exam findings associated with what diagnosis? •Pain at the medial epicondyle •Palpation - tenderness w/ possible swelling •PROM - pain with combined passive wrist extension with radial deviation or supination •Gross muscle testing - pain w/ pronation and wrist flexion •Special Tests: passive supination of the forearm and extension of the wrist/elbow
medial epicondylopathy
what peripheral nerve? •C5 - T1 Nerve Roots •Medial Arm •Arcade of Struthers •Cubital Tunnel •Bicep Aponeurosis •Pronator Teres •Flexor Digitorum Profundus: Nerve Splits •Carpal Tunnel
median nerve
The following are surgical interventions for a patient with osteochondritis dissecans: -dependent on lesion and surgeon -Debridement (for a ___ usually ~<2 cm) -Fixation of lesion -Osteochondral transplant (autograft vs ___)
microfracture, allograft
what muscles should clinicians consider strengthening for a patient with lateral epicondylopathy?
middle and lower trapezius strengthening
according to CPGs for treatment of lateral epicondylopathy there is ___ evidence that clinicians __ use local elbow joint manipulation or mobilization techniques to reduce pain and increase pain free grip strength.
moderate, should
according to the CPGs for treatment of lateral epicondylopathy, there is ___ evidence that clinicians __ use isometric, concentric, and/or eccentric therapeutic resisted exercises of the wrist extensors in the treatment of individuals with subacute or chronic LET
moderate, should
what type of fracture? dislocation of proximal radius and ulna fracture
monteggia
Tendons have ___ parallel collagen fibers than ligaments and less realignment occurs during initial loading.
more
what peripheral nerve? •C5-C7 Nerve Roots •Inferior Border Pectoralis Minor •Pierce Coracobrachialis: Superficial to Brachialis/Deep Biceps •Emerge Lateral to Bicep
musculocutaneous nerve
what type of fracture? fracture of the ulna
nightstick
According to the literature, is nerve flossing/sliders and nerve tensioning an effective long-term treatment?
no; there is a low level of evidence that shows short-term improvements
what type of fracture? •Fairly common: Passive elbow flexion combined with forceful contraction of Triceps. Fall backward onto the elbow or a FOOSH •Classic signs: Loss of active elbow extension, Pain and swelling near Olecranon, Large hematoma/bruising?
olecranon fracture
what diagnosis? •10-18 years old •Vague elbow pain- Lateral: Valgus stress (Acceleration phase); Full Extension or Flexion •Decreased ROM: Crepitus and Locking or Catching •Decreased Strength/Performance
osteochondritis dissecans
what diagnosis? •Prevalence: 1.3% - 3.4% •Loss of blood supply to cartilage •Humeral - Capitelum Joint •Unknown Cause: Genetics, Repetitive Trauma, Ischemia
osteochondritis dissecans
There are 2 surgical approaches to a UCL strain: repair or reconstruction. What are the 2 possible grafts for reconstruction?
palmaris or gracilis
what is the most common type of elbow dislocation?
posterior
what diagnosis? •Pain at elbow extension •Loss of Elbow Extension: Firm End Point; Crepitus, Locking, or Catching •History of Valgus Instability: Ulnar Neuritis and Subluxation
posterior impingement
The most common dislocation of the elbow is posterior. If the symptoms persist, after 1 time the treatment is non complicated but if the symptoms persist or it keeps dislocating what can you be diagnosed with?
posterolateral rotatory instability (PLRI) aka instability of the ulnar portion of the lateral collateral ligament
what are the 3 typical elbow deforming forces?
progressive supination (94%) > an axial load (90%) > a valgus moment (89%)
what diagnosis? •Chief complaint: Vague elbow discomfort, lateral elbow pain, clicking or clunking which worsens with supination •Objective exam: MOI may be traumatic or non-traumatic; Observation/Palpation: Should see three points of epicondyles and olecranon on the same plane when in extension and an isosceles triangle in 90 deg flexion; If you do not observe the above, consider dislocation or fracture
radial collateral ligament injury
what diagnosis? •Varus Instability •Radial collateral ligament •Common extensor muscle origin •Postero-lateral capsule •Insertion of the capsule into the annular ligament
radial collateral ligament insufficiency
what fracture? •MOI: usually from a FOOSH as the radius is forced into the capitellum •Observation: localized swelling near radial head •ROM: loss •Nerve: vital to perform exam due to risk for injury with fracture/dislocation (radial n or median nerve on posterior side) •Palpation: tenderness near radial head
radial head fracture
what peripheral nerve? •C5- T1 Nerve Roots •Axilla Region - Below Teres Major •Radial Groove •Anterior Lateral Epicondyle •Arcade of Froshe - Deep and Superficial Heads of Supinator •Leash of Henry - Radial Recurrent Vessels •Radial Tunnel
radial nerve
Treatment UCL strain during the acute phase (2-4 weeks): •Include __ and activity __/restriction •Goals (Depending on patient's __): ___ ROM, improve healing, __ muscle atrophy, __ pain (compression and/or ice), __ for non-painful ROM (20-90 deg), AAROM and/or PROM elbow and wrist through __ranges.
rest, modification, impairments, increase, slow, decrease, brace, non-painful
conservative treatment for osteochondritis dissecans: •Immediate __: Throwing and Weight-bearing •Improve impairments •Improve poor ___ patterns •Return to light activities __-__ months and full around __ months •Constant Reassessments
rest, movement, 3, 4, 6
after a UCL revision, after 14-18 months is it more likely a patient will return to play or return to prior play?
return to play because 76.6% chance compared to 55.3% for return to prior play
what are the 3 most common arm positions for elbow dislocation?
shoulder abduction (97%) > forearm pronation (68%) > forward flexion (63%)
triceps tendinopathy treatment: •Focus is on restoring the strength, endurance, and flexibility •Focus on restoring strength of the shoulder __ •__ modalities •Transverse __ massage •Trigger point assessment •Specific elbow joint ___
stabilizers, thermal, friction, mobilizations
Treatment UCL strain during the subacute phase: •Goals include ___ of FCU, pronator teres, and FDS (in pain free ranges) •Goals also include increasing ROM (roughly __ deg/week until 0-135 deg) •__ activation of forearm flexors, ulnar deviators, and pronators (promote activation of secondary stabilizers)
stretching, 10, isometric
Non-Operative Management for Radial Collateral Ligament Injury: •Avoidance of __ + varus + ___ •Avoidance of exercises with shoulder __ + humeral ___ •Bracing •Theory: use of ___ muscles to assist with stabilization
supination, extension, abduction, IR, extensor
what diagnosis? •Acute, Inflammation •Micro-tears from overload •Quicker Healing •<3% of Cases
tendinitis
what diagnosis? •Chronic, Degeneration •No Inflammation •Collagen disorganization •Prolonged Healing / No Healing
tendinosis
What is another name for lateral epicondylopathy?
tennis elbow (may also here epicondylalgia/itis/osis or tendinitis/osis/pathy)
What are the 3 possible tendons to use as a graft for the radial collateral ligament to fixate the humerus to native ulnar attachment of LUCL?
triceps aponeurosis, palmaris longus, gracilis tendon
what diagnosis? •Often overuse or repetitive stress •Pain in posterior aspect of the distal part of the arm •Symptoms aggravated by elbow flexion and shoulder flexion •AROM pain with elbow extension •PROM pain with shoulder and elbow flexion •Strength: Pain on elbow extension •TTP: Distal triceps belly, musculotendinous portion of triceps or at insertion at the olecranon
triceps tendinopathy
true/false: Clinicians should use either tendon or trigger point dry needling for the treatment of pain and functional deficits associated with LET
true
true/false: according to evidence regarding lateral epicondylopathy treatment, there was a greater 3 week success rate in the wrist manipulation group compared to the US/TFM/stretching and strengthening exercise group. there was a greater 6 week improvement in pain in the manipulation group as well.
true
true/false: surgical treatment of a posterior impingement should only be performed after conservative fails
true
true/false: the treatment for bicipital tendinopathy and triceps tendinopathy is basically the same
true
what are the 2 nerves for the elbow that can give symptoms that may look like something else, but may a neural component with it?
ulnar and radial nerves
what diagnosis? •Medial Elbow Pain •Acute Pain (After repetitive stresses): Acceleration phase≈ 75% and Follow Through≈ 25% •Ulnar Nerve Symptoms •Decrease Performance •+ Valgus Stress Tests •Decreased Elbow ROM •Decreased Strength / Unremarkable •Glenohumeral Rotational Deficits •Swelling •MRI Results
ulnar collateral ligament injuries
what peripheral nerve? •C8-T1 Nerve Roots •Medial/Anterior Upper Arm •Medial Intermuscular Septum: Front Medial Head of Triceps and Arcade of Struthers •Cubital Tunnel •Flexor Carpi Ulnaris - Pierces •Guyon's Canal
ulnar nerve
What are the motor impairments that can be caused by neuropathies?
weakness or uncontrolled movemetns
according to the CPG regarding lateral epicondylopathy treatment there is __ evidence for cervical manipulation, but it may be used for short term ___ since cervical dysfunction is evident in individuals with this without obvious neck pain and may reflect central sensitization mechanisms
weal, analgesia
After a UCL reconstruction, if a palmaris graft is chosen what muscle group should be the focus for AROM, stretching for 2 weeks, isometrics, and isotonics at 3 weeks.
wrist flexors
what are conservative treatment options for posterior impingement?
•No Throwing/ Rest •NSAIDS •Rehab •Throwing Mechanics •Potential Corticosteroid
What are the 4 tests that should be part of the physical exam if you suspect a radial collateral ligament injury?
•Push up sign (apprehension) •Press up maneuver (3 step process) •Varus Stress Test •PLRI (lateral pivot shift)
What are the 3 Bellm Apophysitis "Special Tests" to cluster if you suspect a patient may have medial epicondyle apophysitis?
•Reproduce Symptoms with Palpation to Growth Plate •Reproduce Symptoms with Stretching Muscles that Attach •Reproduce Symptoms with Contracting Muscles that Attach
what are conservative interventions for medial epicondyle apophysitis?
•Rest: Relative - Position Change and Absolute •NSAIDs •Rehab •Throwing Mechanics •Game Management Skills
what should be included in patient education for lateral epicondylopathy treatment?
•Taping- rigid taping should be done •Bracing - counterforce •Tennis/racquet sports: Technique (Single vs. double grip), Grip size, Racquet head size, Gut vs. nylon strings, Materials (Graphite, wood, fiberglass vs. metal)
what is the normal recommendation for a patient with a biceps tendon rupture?
•surgical repair •ROM usually restricted for 6-8 weeks •Rehab in accordance with post-operative guidelines with expected return to prior level of activity at 6 months
