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The Elbow
Differential Diagnosis & Treatment
Pathology
• Throwing, hitting, punching, pushing, painting
• Shoulder dysfunction
• Cervical spine pathology
Capsular
Osteoarthritis
• Post traumatic
• Capsular pattern
• Crepitus
• Older patient
• Electrotherapy and mobilisation or injec into joint
Rheumatoid Arthritis
• Lax ligaments – reduced stability• Synovial thickening and swelling, flexion
deformity
• Steroid injec and rest or oral medication
Traumatic Arthritis
• Cause – fall or hyperextension
• Acute – x-ray and aspirate
• Sub acute – steroid injection and rest or 1 week rest in flex and gradual gentle mobs
• No friction – myositis ossificans
Non capsular
Loose body eg Osteochondritis Dissecans and OA
• Pain and springy end feel
• Locking
• Either in coronoid or olecranon fossa
• Treatment
• EUA removal
Cubitus varus and valgus
• Reduced or increased carrying angle
• Following fracture
• Children
• Epiphyseal damage
• May need surgical correction
Bicipital Bursitis
• Pain at front of elbow
• Pain – full passive pronation
• Some pain on resisted flexion in supin
• Treatment - injec
Olecranon Bursitis• Posterior elbow pain
• Pain on full passive flexion• Some pain on resisted exten• Carpet fitters, RA,students
• Treatment – aspiration and /or injection
Contractile
Tennis Elbow
• Causes:
• 2 joint muscle – lengthening across 2
• joints + added force
– sheer stress at origin
• Overuse
• Gripping
Tennis Elbow• Pathology
• 6months – 2years
• Microscopic tears – failed healing - inflammation
• Fibroblasts
• Vascular hyperplasia
• Disorganised collagen
• Tendinitis or tendinosis
On examination
• 20-30’s most common and degen 40yrs +
• Pain on resisted wrist extension with elbow extension
• Reduced grip strength
• Pain on palpation
Lateral Epicondylitis (tennis elbow)
• 4 sites
• 1)ECRL on supra-condylar ridge
• 2)CEO
• 3)Body of tendon
• 4)belly of muscle
Tennis Elbow Treatments
• 1)ECRL – friction and rest• (forearm in supination)
• Frictions must be specific and transverse
• Chronic – numbness + 10 mins
Tennis Elbow Treatments
• 2)CEO Injec and rest or friction, mills manip, stretch and rest (forearm in supination)
Tennis Elbow Treatments• 2) 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 Treatments
• Advice
• Must adjust technique or grip in sports
• Stretches
• Strapping
• SSTM/ muscle energy techniques
• Acupuncture
Medial Epicondylitis (golfer’s elbow)
• 2 sites
• 1)CFO
• 2)MT junction
Golfer’s Elbow cont
• Overuse
• Pain on resisted wrist flexion with elb ext
Golfer’s Elbow Treatments
• 1)CFO – injec and rest or friction and rest
• 2)MT junction – friction and rest
Biciptal Tendonitis
• Overuse
• Pain on resisted elbow flexion with supin
• Treatment – MT junc friction and rest