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The Elbow

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.

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The Elbow

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  1. The Elbow Differential Diagnosis & Treatment

  2. Pathology • Throwing, hitting, punching, pushing, painting • Shoulder dysfunction • Cervical spine pathology

  3. Capsular

  4. Osteoarthritis • Post traumatic • Capsular pattern • Crepitus • Older patient • Electrotherapy and mobilisation or injec into joint

  5. Rheumatoid Arthritis • Lax ligaments – reduced stability • Synovial thickening and swelling, flexion deformity • Steroid injec and rest or oral medication

  6. 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

  7. Non capsular

  8. Loose body eg Osteochondritis Dissecans and OA • Pain and springy end feel • Locking • Either in coronoid or olecranon fossa • Treatment • EUA removal

  9. Cubitus varus and valgus • Reduced or increased carrying angle • Following fracture • Children • Epiphyseal damage • May need surgical correction

  10. Bicipital Bursitis • Pain at front of elbow • Pain – full passive pronation • Some pain on resisted flexion in supin • Treatment - injec

  11. Olecranon Bursitis • Posterior elbow pain • Pain on full passive flexion • Some pain on resisted exten • Carpet fitters, RA, students • Treatment – aspiration and /or injection

  12. Contractile

  13. Tennis Elbow • Causes: • 2 joint muscle – lengthening across 2 • joints + added force – sheer stress at origin • Overuse • Gripping

  14. Tennis Elbow • Pathology • 6months – 2years • Microscopic tears – failed healing - inflammation • Fibroblasts • Vascular hyperplasia • Disorganised collagen • Tendinitis or tendinosis

  15. On examination • 20-30’s most common and degen 40yrs + • Pain on resisted wrist extension with elbow extension • Reduced grip strength • Pain on palpation

  16. Lateral Epicondylitis (tennis elbow) • 4 sites • 1)ECRL on supra-condylar ridge • 2)CEO • 3)Body of tendon • 4)belly of muscle

  17. Tennis Elbow Treatments • 1)ECRL – friction and rest • (forearm in supination) • Frictions must be specific and transverse • Chronic – numbness + 10 mins

  18. Tennis Elbow Treatments • 2)CEO Injec and rest or friction, mills manip, stretch and rest (forearm in supination)

  19. 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)

  20. Tennis Elbow Other Treatments • Advice • Must adjust technique or grip in sports • Stretches • Strapping • SSTM/ muscle energy techniques • Acupuncture

  21. Medial Epicondylitis (golfer’s elbow) • 2 sites • 1)CFO • 2)MT junction

  22. Golfer’s Elbow cont • Overuse • Pain on resisted wrist flexion with elb ext

  23. Golfer’s Elbow Treatments • 1)CFO – injec and rest or friction and rest • 2)MT junction – friction and rest

  24. Biciptal Tendonitis • Overuse • Pain on resisted elbow flexion with supin • Treatment – MT junc friction and rest

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