Elbow Joint Anatomy & Treatment PDF

11/25/2023 Elbow joint 1  11/25/2023 Stability : Ulnar / medial collateral ligament restraint to valgus instability Radial / lateral collateral ligament restraint to varus instability Ulnohumera...

11/25/2023 Elbow joint 1  11/25/2023 Stability : Ulnar / medial collateral ligament restraint to valgus instability Radial / lateral collateral ligament restraint to varus instability Ulnohumeral articulation Annular ligament holds the head of the radius in proper position to the ulna and humerus Lateral epicondylitis – Tennis elbow One of the most common overuse injuries Any activity causing repetitive stress to the wrist extensors such as grasping, pulling, hammering or using a screwdriver 35% to 50% of tennis players tennis elbow More common in patients more than 35 years 2  11/25/2023 ❖ Tendinitis Acute, inflammatory the inflammatory response to increase rate of tissue healing ❖ Tendinosis - Chronic – Degenerative ❖ Tendinopathy 3  11/25/2023 Primary structure involved Extensor carpi radialis brevis tendon Extension and abduction wrist Symptom: ❖Gradual onset of lateral elbow pain ❖Aching pain generally increases with activity - Simple ADLs picking up a cup of coffee or a gallon of milk ❖ Pain may be present at night ❖ Referred pain into the forearm, hand, and lateral aspect of the arm could be present ❖ Symptoms are typically unilateral 4  11/25/2023 Diagnosis Localized tenderness Pain most common Muscle strength assessment weakened grip on the affected side resisted wrist extension Pain increases with resisted wrist extension, especially with the elbow in extension ROM assessment typically normal Special test: Cozen’s test palpation of the lateral epicondyle for tenderness and assessing pain with specific movements, such as gripping or wrist extension. 5  11/25/2023 In chronic cases ❖ noncompliant cases, be sure to fully assess shoulder integrity & scapular stability ❖ Weakness or instability of the scapular stabilizers may perpetuate lateral epicondylitis by leading to overuse of the wrist extensors ❖Referred pain from cervical spine (C5-C6) ❖Glenohumeral joint pathologies ❖Osteoarthritis of the elbow ❖Lateral epicondyle avulsion ❖Lateral ligament sprain 6  11/25/2023 Treatment: Reduce pain and inflammation Maintain or increase ROM Maintain or increase muscular strength Overall function of injured upper extremity Acute stage: ❖Protect injured tendon from stress but not from function-Avoid offending activities (e.g. Sport) ❖ Reduce pain and inflammation ▪ Ice (2-3 times/day) ▪ Ultrasound ▪ Iontophoresis with topical NSAIDs ▪ Wrist splint during activities: ✓Extensor muscles in rest position ✓Prevents maximal muscle contraction 7  11/25/2023 ❖ Counterforce bracing (tennis elbow strap) -Unload the area of muscle origin at elbow -Should not be used in isolation -Only as an adjunct to modalities and exercise/stretching -Further muscle atrophy & negative effects ❖ Transverse friction massage -Release underlying adhesions -Promote improved circulation -Promote proper orientation of immature collagen Exercises: ❖ ROM for elbow and wrist flexion/extension & pronation/ supination ❖ Gentle stretching exercises ❖Progressive resistive strengthening exercises: ✓ Progressing from isometric to concentric to eccentric contractions of the forearm muscles especially wrist extensors ✓ Progressive eccentric exercises done with the elbow in extension, forearm in pronation, and wrist in an extended position ✓Better than ultrasound 8  11/25/2023 Scapular stabilization exercises Rotator cuff strengthening 9  11/25/2023 Chronic Stage: Ultrasound Deep friction massage Stretching and strengthening Scapular stabilization Sports-specific training Prevent overuse of the wrist extensors during activities 10  11/25/2023 flexion and abduction wrist 11  11/25/2023 Risk factors include: ❖ Training errors ❖Repetitive activities requiring wrist flexion and forearm pronation ❖Biomechanical abnormalities (such as poor strength, flexibility imbalances, and joint instability) Special test: Golfer Elbow Test (Reverse Cozen’s Test) 12  11/25/2023 Treatment: The same as in lateral epicondylitis except for stretching / strengthening exercises wrist flexors 13  11/25/2023 Cubital tunnel syndrome Cubital tunnel syndrome also known as ulnar nerve entrapment, is a condition where the ulnar nerve is compressed or irritated as it passes through the cubital tunnel. The cubital tunnel is a narrow passageway on the inside of the elbow formed by bone, muscle, and ligaments. The ulnar nerve runs through this tunnel, and when it is subjected to pressure or stretching, it can lead to symptoms associated with cubital tunnel syndrome. 14  11/25/2023 ❖Paresthesias are often exacerbated by elbow flexion activities such as phone use or athletic activities that require repetitive elbow motion. ❖Night symptoms severe enough to cause awakening are a common complaint as many people sleep with the elbow in a flexed position. ❖A weak or clumsy hand, weakness affecting the ring or small finger, or muscle wasting. 15  11/25/2023 ❖Patients may have difficulties with day to day activities like opening jars or holding a pencil. ❖Eventually, the hand may begin to take on a claw deformity due to intrinsic muscle weakness and unopposed function of the FDP 16  11/25/2023 Special test: ❖Tinel's sign ❖ Elbow flexion test. 17  11/25/2023 Conservative treatment: ❖ Patient education and behavior modification, non-steroidal anti-inflammatories, night splints, elbow pads, physical therapy, ultrasound, pulsed signal therapy, and corticosteroid injections ❖ Patients should avoid aggravating activities, such as excessive motion of the joint or resting the nerve on hard surfaces. ❖ Night splints immobilize the elbow in 45° of extension with neutral forearm rotation, allowing inflammation to decrease. ❖ If conservative management is not successful surgery: decompression of the nerve alone, decompression with ulnar nerve anterior transposition, or medial epicondylectomy Forearm, wrist 18