Red Flags-Elbow
What is compartment syndrome? What are some common signs and symptoms of it? What would you find during an exam?
Increased pressure in one of the compartments of the body
SxS: Hx of trauma or surgery, Persistent forearm pain and "tightness", tingling/burning/numbness
Exam findings: palpable tenderness and tension, pain is worse with STRETCH to involved muscles, paresthesia, paresis, and sensory deficits, diminished pulse
What is Lateral Epicondylalgia known as? What are some common patient complaints?
Tennis elbow- only 5-10% play tennis
Symptoms worse with activity, can be from acute strain, pain in lateral elbow- noticeable with gripping activities, grip strength deficit
What are some common things you might find during an exam for a patient with Lateral Epicondylalgia?
extensor carpi radialis longus/brevis manual resistive test= weak and painful
palpable tenderness to lateral epicondyle
pain with stretching wrist extensors
elbow and shoulder muscles flexibility, strength and coordination deficits
What is the ICF category for lateral and medial epicondylalgia? What kind of treatment would you provide this patient?
Elbow pain with muscle power deficits
Treatment:
- Lateral epicondylalgia: wrist extensor strengthening, grip strength
- Medial epicondylalgia: wrist flexor strengthening, grip strength
Which tests would you perform for Lateral Epicondylalgia?
Cozen's, Maudsley's, Mills, Grip strength
What is complex regional pain syndrome? What are some common signs and symptoms? What would you find during an exam? What is the Cardinal Symptom?
Chronic pain disorder, injury on somatic level that initiated sympathetic efferent activity, early on pain is greater than expected for degree of trauma to tissue
Sxs: Hx of trauma or surgery, severe burning/aching pain that doesn't align with the injury, pain NOT responsive to topical analgesics, secondary hyperalgesia/hypersensitivity
Exam findings: area swollen, pitting edema, warm and erythematous, temperature difference between involved and uninvolved side, pain, ANS dysfunction, inability to initiate movement, weakness, spasms, atrophy
Cardinal Symptom: A LOT of pain
What is Medial Epicondylalgia known as? Who is more at risk? What are some common patient complaints?
Golfers elbow. More common in 40-50 yr olds and baseball players age 10-14 yrs, males more than females
Symptoms worse with repetitive activities or from acute strain, pain in medial elbow that is more noticeable with grasping activities.
What are some common things you might find during an exam for a patient with Medial Epicondylalgia?
Wrist flexor manual resistive test: weak and painful
Palpable tenderness in medial epicondyle
Elbow and shoulder flexibility, strength and coordination deficits
What ICF category does post traumatic elbow stiffness fall into? What treatment would you give the patient
Elbow pain with mobility deficits
Treatment: elbow mobilizations, stretching
What tests would you perform for Medial Epicondylalgia?
Wrist flexor resistive test
Medial epicondyle palpation
Wrist flexion MMT
What is Melanoma? What makes someone more likely to have this? What might you find during an exam?
Skin cancer, deadliest form
Hx of cancer, female <40 years, male >40 years, fair skin, hx of sunburns
Findings: asymmetric or irregular shaped lesions, borders are notched, color uneven, diameter >6mm and evolving
When would a person present with post traumatic elbow stiffness? What would be their common complaints?
History of trauma (fracture), immobilization, residual stiffness
Complaints: elbow pain at end range of flexion, extension, supination, pronation activities
If someone presents with loss of elbow PROM, limitation in elbow flexion/extension and pronation/supination which pathology might we suspect?
Post-traumatic elbow stiffness
What ICF category does pronator teres syndrome, supinator syndrome, cubital tunnel syndrome and ulnar tunnel syndrome fall into? What are some treatments for each?
Elbow pain with radiating pain
Treatments:
Pronator teres: Median nerve sliders/tensioners, STM to median nerve entrapment sites (ligament of struthers, bicipital aponeurosis, pronator teres, carpal tunnel)
Supinator syndrome: Radial nerve sliders/tensioners, STM to radial nerve entrapment sites (bicipital groove, radial head, arcade of frohse, supinator)
Cubital and Ulnar tunnel syndrome: Ulnar nerve sliders/tensioners, STM to ulnar nerve entrapment sites (Arcade of struthers, cubital tunnel, flexor carpi ulnaris, guyon's canal). For cubital tunnel syndrome--> minimize elbow flexion
What tests would we do for post traumatic elbow stiffness?
Accessory mobility of elbow, elbow PROM
What is the most common MOA for a radial head fracture? What would you find in an exam?
FOOSH
Findings: elbow joint effusion, restricted/painful supination and pronation and AROM, tenderness over radial head, can't relieve symptoms
What nerve does pronator teres syndrome compress? What is this injury from? What would the patient complain of?
Median nerve. Could be from trauma or repetitive use of arm/forearm
Complaints: Pain in proximal anterior forearm, worse with repetitive activities, paresthesia/numbness in median nerve distribution, symptoms worse with activities that compress the nerve and with wrist flexion and extension
If a person had reproduction of symptoms during a median nerve neurodynamic test and symptoms with provocation of peripheral entrapment sites: pronator teres, carpal tunnel and thenar eminence what pathology would you suspect?
Pronator teres syndrome
What ICF category is a Ulnar collateral ligament sprain in the elbow? What are some treatments
Elbow pain with movement coordination deficits
What tests would you do for Pronator teres syndrome? Supinator syndrome? Ulnar and Cubital tunnel syndrome?
Pronator teres syndrome: Pronator teres resistive test, median nerve entrapment sites (ligament of struthers, bicipital aponeurosis, pronator teres, carpal tunnel), Median nerve ULNT
Supinator: Radial nerve entrapment sites, radial nerve ULNT
Cubital/Ulnar tunnel: Ulnar nerve ULNT, tinel at ulnar/cubital tunnel, assess ulnar nerve entrapment sites
What is Heterotopic ossification? What are some causes of this? What would you find in an exam?
Pathological bone formation in non osseous tissues
Direct trauma (most common), burns, genetic, neurogenic
Findings: elbow stiffness, sensory loss, weakness, locking, limited AROM/PROM elbow flexion and extension
What nerve is being compressed in Supinator syndrome? How does it happen? What are some common patient complaints?
What nerve is compressed in Ulnar/Cubital tunnel syndrome? What are some common complaints? What can cause this?
Radial nerve. Trauma or from overuse
Complaints: pain in lateral forearm, paresthesias, pain and numbness, tingling in radial nerve distribution
Ulnar nerve
Hand numbness, tingling or numbness in the ulnar nerve distribution, flicking hand helps resolve paresthesias
Can be caused by prolonged ulnar deviation and compression, seen in people using crutches, long distance cyclists or use of jackhammers
What pathology would you suspect if a person is having paresthesia, pain and numbness/tingling in ulnar nerve distribution and symptoms are worse with elbow flexion
Cubital tunnel syndrome
What is the common presentation of someone with a UCL sparin (elbow)? What do these patients most commonly complain of?
Usually related to overhead throwing athletes or history of repetitive use
Common complaints: medial elbow pain during the activity and aching afterwards, pain with reaching behind the body and with overhead activities
What tests are done for a UCL sprain? What are these tests assessing (which tissue is it stressing)?
Valgus stress test, moving valgus stress test
Both are putting stress on the UCL ligament in the elbow to see if it reproduces the symptoms or has excess laxity