The Elbow Differential Diagnosis Treatment Pathology Throwing hitting

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 • 6 months – 2 years • Microscopic tears – failed healing inflammation • Fibroblasts • Vascular hyperplasia • Disorganised collagen • Tendinitis or tendinosis

On examination • 20 -30’s most common and degen 40 yrs + • 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