clinical patterns of elbow

• common extensor tendinopathy
• lateral epicondylitis
• posterior interosseous nerve entrapment

• handedness
• clicking/clunking
• activities involving:
• - wrist ext
• -weight bearing ie. lying, leaning, pushing through hand/elbow
• -grip
• -lifting
• -carrying

• extensor carpi radialis longus (lat. supracondylar ridge)
• extensor carpi radialis brevis (lat epicondyle)
• extensor digitorum (lat epicondyle)
• extensor carpi ulnaris (lat. epicondyle)

• repetitive activity
• age (30 years +) and associated degenerative tendon tissue changes - repetitive micro trauma leads to micro tears
• poor blood supply to tendon at CEO
• faulty technique or equipment in sport or workplace

• area: 1-2cm below origins of ECRB +/- radiating down forearm (mid substance) or insertional (on CEO)
• agg: gripping activities especially with load, activities with arm pronated and extended (hammer, computer)
• Ease: rest, splint, NSAIDs
• Hx: insidious, usually with new activity. Rarely trauma but blunt blow can do it
• SQ's - steroid injection can contribute to early problems with tendons

• AROM: NAD unless acute 
• PROM: pain with elbow E/pron + wrist F/UD
• special tests: mills test +ve (same as above)
• pass acc glides: NAD
• RSC: pain wrist E with EE (especially third MC)(2nd mc = ECRL, 3rd mc= ECRB)
• palp: tender 1-2cm distal to epicondyle or at insertion

• EPAs (US, IFR)
• DTF and myofascial release
• stretches - P, F, UD, full E of elbow to stretch, against wall
• strengthening - eccentric (hold hammer in hand then lower slowly into E. Use supinator eccentrically by lowering slowly into pronation with E)
• activity modification
• bracing/taping - alter line of pull (wear brace around elbow)

• similar presentation although p/tenderness is directly on insertion of CEO onto lateral epicondyle
• presentation is more inflam. and therefore treatment is anti-inflam i.e.. EPAs, RICE, modified use, NSAIDs, then treat similar to common extensor tendinopathy

• PIN passes through supinator and supplies ECRB and supinator
• may be irritated by ECRB
• OR by supinator in arcade of frohse
• Function: deep motor branch of radial nerve
• supplies all extrinsic wrist, finger and thumb extensors except ECRL.

• history: gradual onset/overuse
• area: local tenderness +/- post forearm
• nature: ache
• agg: twisting action (pronation/supination)
• Social history: work/sport contributing factors

• AROM: supination is painful
• PROM: EOR pronation - painful + (if supinator muscle is tight, as put on stretch)
• RSC: ECRB, sup, wrist E - painful + (particularly supinator)
• MMT: +/- weakness of wrist, thumb, and finger Es if severe
• ULTT 2b: positive 
• neurological: sensation - normal, power - may be weakness

Note - if you get pain from PIN, with arm extended then move the shoulder and neck. It will stretch the nerve and bring on pain by tractioning the arm.

• neural mobilising techniques - take pressure off the nerve by stretching. Get into elbow extension then AROM shoulder through depression and elevation, then glide arm - gliding nerve through area of compression.
• local treatment to CE tendon or supinator such as EPAs, DTF and myofascial massage, eccentric exercises, bracing and strapping to take the load off

• strain of lateral ligament
• synovitis of radiohumeral joint
• radiohumeral bursitis
• osteochondritis dissecans
• C6 nerve root
• referral from Cx spine

• golfers elbow (medial epicondylitis) eg. tendonitis of pronator teres, FRC, palmaris longus, FCU
• medial collateral ligament
• ulnar nerve entrapment (2 heads FCU)
• C8 nerve root
• Cx spine
• humeroulnar joint (intra-articular, capsular)

a fall onto the point of the elbow drives the olecranon (ulna) upwards, splitting the humeral condyles.

• undisplaced: elbow flex in 90 degrees in backslab for 2/52 weeks - AROM
• displaced: ORIF with screws +/- plates to fixate
• severely comminuted: (usually poor results)
• early active motion
• collar and cuff (c+c) or hinged brace
• may not regain full elbow ROM

undisplaced

angulated intact posterior fracture

displaced distal fragment posteriorly

• brachial artery disruption
• medial or ulnar nerve disruption
• joint stiffness 
• myositis ossificans - elbow can develop bone around areas if kept immobile for too long
• mal-union

• median nerve disruption
• brachial artery disruption

• FOOSH with elbow extended
• soft tissue disruption is usually severe 
• anterior capsule
• brachial torn
• collateral ligaments stretched or ruptured
• obvious deformity

• early: brachial artery, median, or ulnar nerve damage
• late: myositis ossificans, calcification of capsule or ligaments, recurrent dislocation
• associated fractures - medial epicondyle, head of radius, olecranon process

• collar and cuff for 3-5 weeks
• they are able to move within the confines of C+C
• early management is to:
• maintain shoulder range, wrist range and hand ROM
• EPAs ie. IFT
• passive rom of elbow with no pain
• active rom as tolerated (avoid extension as it could redislocate)
• exercises to relax brachialis and work on extension
• soft tissue damage of triceps, massage, relax techniques, AROM, through more range.

• passive mobilisations to elbow
• relax techniques to improve extension
• gentle stretches
• aquatic therapy
• strengthening of muscles triceps and biceps
• gradual return to functional activities
• avoid carrying heavy weights for at least 6/52