What is Lateral Epicondylitis?

(4 points)

- Most common overuse injury of the elbow

- Microtears or tissue failure due to repetitive use or eccentric strain of the wrist or forearm

- Occurs more in males

- Typically involves the extensor tendon mass (ECRB, ECRL, EDC)

- weak or inflexible shoulder and wrist muscles

- backhand stroke

- chainsaw use, frequent use of hand tools

- hitting wet and heavy balls

- Gradual aching pain over the lateral elbow

- Pain may radiate from proximal to distal

- Usually unilateral

- Using the arm aggravates it

- Normal AROM

- Painful elbow extension/supination

- Painful resisted wrist extension with elbow flexion

- Painful resisted rad. deviation and ext of 2/3rd fingers

- Decreased wrist ext and grip strength

- Tender over the extensor tendon mass

- Overuse of the medial flexors (Pronator teres and FCR)

- Throwing/pitching

- Heavy suitcase

- Golf swing

- Forceful tennis serve

 - Painful resisted wrist flexion

- Painful tight grip

- Painful passive wrist extension abd supination

- Tender over the flexor tendon mass

- Weak grip strength

- Rest

- Activity modification

- Ice, NSAIDS

- Counterforce brace or wrist cock-up splint

- Stretch wrist extensors

- Strengthen wrist extensors/flexors, biceps, triceps, and grip after acute inflammatory phase

- Cross friction massage and joint mobilizations

- May require surgery if 6 months of conservative management is unsuccessful

- Valgus Extension overload

- Sudden or acute valgus, dislocation, or microtrauma

- Pop if acute

- More common in baseball, tennis, waterpolo, etc.

- Swelling at insertion

- Laxity and pain with valgus stress test

- Tinel sign may be positive if chronic

- Rest/Activity modification

- Grip exercises

- Isometric then concentric and then eccentric

- Supracondylar Fractures

- Medial Epicondyle

- Radial Head

- Radial Nerve injury

- Males to Females 2:1

- ROM loss

- Malalignment

- CRPS

- Brachial Artery compromise

- Volkmann's ischemic contracture (Flexion)

- MO/HO

- Dislocation of the distal radial-ulnar joint (DRUJ) and interosseous membrane disruption resulting from a radial head fracture

- Tensile loads on the medial side

- Compressive loads on the lateral side

- Medial epicondyle stress fracture

Caused by: Repetitive stresses from throwing

-  Medial elbow pain and a flexion contracture >15 degrees

- Local swelling

- Ulnar nerve dysfunction possible

- Widening fragmentation of the epiphyseal line of medial epicondyle

- Rest

- Sling

- Rest as needed

- Exercise of wrist and hand in sling

- Progressive strengthening

      - Isometric->isotonics->isokinetics->eccentrics->    plyometrics

- Stretching

- Patient Education

- AVN of the epiphysis

- Caused by:  macrotrauma, decreased circulation or microtrauma

- Resolves with growth and development

- Common in children 5-16; M>F

- Compression of the radial head

- Most common in younger males 15-20

- Often leads to DJD

- Prevention possible by limiting throwing

- Most commonly dislocated joint in children

- Posterior dislocation is the most common

- Caused by a FOOSH with hyperextension

- Splint elbow at 90 degrees ~4 days

- Sling

- Light gripping exercises

- 1st week AAROM is painfree

- Then AROM painfree

- Week 3+ elbow extension ROM, stretch and strengthen, HUJ traction mobs as needed

- HUJ Traction

- HR Dorsal/Volar glide and distraction

- RUJ proximal dorsal/volar glide

- RUJ distal dorsal/volar glide

- 1-3 months to regain flexion ROM

- 3-5 months to recover extension ROM/strength

(Extension ROM may never be fully regained)

- Swelling

- Tender &/or firmover area

- Limited ROM in one or more planes

- Painful resisted ROM

- Rest in a splint

- NSAIDS

- No massage, passive stretch or resistive exercise

- Surgery as needed to excise heterotopic bone

- Forearm rests in pronation because the radial head can't slide proximally in the annular ligament when supination is attempted

- Supination ROM is limited

- Pain with movement or inwilling to move

- Constant pain

- Severe loss of function

- Age >60

- RA or macrotrauma

Pronator teres

FCU

FCR

FDS

FPL

Supinator

ECU

ECRB

ED

ECRL

Brachioradialis

30-130 degrees of flexion

50 degrees for supination and 50 degrees for pronation

• Medial Epicondylitis
• Ulnar nerve neuritis
• Strain of the pronator teres
• Little Leaguer's Elbow
• Fracture of the medial epicondyle

• Lateral epicondylitis
• LCL injury
• Fracture of the capitellum
• Cervical radiculopathy
• OCD
• Radial head injury

Cozen's Test

Mill's Test

Tinel's Sign

Elbow Flexion Test

What does the P-RUJ Dorsal Glide do?

P-RUJ Volar Glide do?

Dorsal glide increases pronation

Volar glide increases supination

What does the D-RUJ Dorsal Glide do?

Volar Glide?

Dorsal Glide increases supination

Volar Glide increases pronation