Elbow Pain But I Don’t Play - MIMT

3y ago
25 Views
2 Downloads
3.12 MB
73 Pages
Last View : 15d ago
Last Download : 2m ago
Upload by : Josiah Pursley
Transcription

Faculty of HealthElbow pain – but I don’t playtennis or golfDr Deborah A. Pascoe AEP ESSAMPhD, MA, GDExRehab, BAppSc(PE),Dip Health (Rem Mass), Cert Hydro, Cert Sports, Cert Relax.

OverviewElbow Pain – but I don’t play tennis or golf!Assessment and management of elbow pain Functional anatomy of the elbow Common elbow injuries Assessment of the elbow Soft tissue management of the elbow Exercises and stretches to complement soft tissuetreatments The research

Elbow pain – but I don’t playtennis or golfFunctional Anatomy of theElbow

Anatomy2 joints- Humero-ulna- Proximal Radio-ulnaSurface markings- Medial epicondyle- Olecranon- Lateral epicondyle- Ulna nerve

AnatomyIn extension all 3 lie in a horizontal lineIn flexion forms an equilateral triangleIn dislocation / fracture landmarks are disturbed

6

Muscles of the upper arm7

Muscles of the forearm8

Elbow pain – but I don’t playtennis or golfCommon Elbow Injuries

Fractures around ElbowCommon in children in falls from gymnastic / playgroundequipment, or in riding & cycling fallsSupra-condylar #Most common # in this areaMechanismFalling on an outstretched handSigns & SymptomsIntense painUnwilling to move armRapid swelling & bruisingDeformity

SupracondylarfractureFracturedislocation

Fracture - treatmentSlingCheck pulse & sensation below #(nerve & blood vessel damage)Medical advice and X-rayReduced under anaestheticCollar & cuff immobilisation

Fractured Head of RadiusMechanismFall on an outstretched handSigns & SymptomsPainPronation &/or supination very painful* Ability to flex and extend elbowTenderness over siteTreatmentIce and splintPlasterIf alignment not good- decreased range of motion on supination and pronation

# OlecranonMechanismDirect blow to olecranon process of ulnaFall on flexed elbowSigns & Symptoms:Swelling & tenderness over elbowCannot straighten elbowTreatmentUsually surgically pinned due to triceps action topull fragment away

Olecranon fracture

Surgical fixation

Elbow DislocationMainly in contact sports eg. football, squash, skiing,cyclists, wrestling, weight- lifters.MechanismFalling on an outstretched hand with elbow bentHyperextension of the elbowCommon site- Radius and Ulna forced posteriorly

Elbow dislocationSigns & SymptomsIntense painSwellingLimited mobilityDeformity- olecranon prominentposteriorly

Elbow dislocation

Head of radius dislocation

ComplicationsProblems with ligaments healing- takes a long timeInjuries to blood vessels and nervesMay become recurrent if treatment is inadequateAccompanying #Myositis Ossificans- calcification of soft tissue around elbow

Overuse Injuries to the ElbowCommon Injury Sites - Medial and Lateral EpicondylesMore commonly known as :"Pitcher's Elbow""Little League Elbow""Tennis Elbow""Golfer's Elbow“These types of injury occur in golf, baseball, racquet sports,rowing, weightlifting, wrestling.CausesUnaccustomed use (Sports, ADLs, tools)Improper techniqueImproper or unsuitable equipmenteg. tennis racquet- grip too large- strings too tightLack of strength in forearm musclesLack of flexibility in wrist and elbow

Medial Epicondylitis- Pitcher's, Golfer's elbowMechanismResults from overload causing excessive stress on medialside

Medial EpicondylitisCaused by strain of origin ofmedial wrist flexor muscle groupTenderness over medial epicondyle"Little League Elbow"- last epiphysis of elbow to fusetherefore the weakestFlexor carpi ulnarisFlexor carpi radialisPronator teresPalmaris longus

Avulsion #Caused by excessive force of contraction of flexorsPossible also to have medial pain from playing tennis- less common- mostly in expert players cutting / slicing ball esp. on serve

Lateral EpicondylitisSmall site of origin for extensormuscle group- extensor carpi radialis brevis- extensor carpi radialis longus- extensor digitorum longus- extensor carpi ulnarisLarge load per unit area"tennis elbow"

Lateral EpicondylitisMechanismPoor technique esp. backhandOff centre ball contactActivities of daily living – gripping, hammerSigns & SymptomsPain on lateral side of elbowWeakness in wristPoint tenderness on lateral epicondylePain when attempting resisted wrist extension

TreatmentRICERAvoid painful tennis shotsSub-acute - apply heatForearm brace dissipates forces beforethey reach the epicondyle

Activities That Cause Pain and Symptoms Forced and repetitive gripping an object(hammer,tennis racket, pen / pencil) Repetitive bending and straightening of the elbow Playing an instrument with a bow, piano(orchestra) Golfing Typing Tennis Writer’s Cramp – writing or gripping other smallinstruments. Knitting and crocheting, sewing Twisting motions such as using a screwdriver ortwisting a doorknob.30

PreventionCorrect playing techniqueForearm braceCorrect racquet size (per person)Tight strings - impact forcesGut strings better than nylon (vibrations)Larger headed racquets (larger "sweet" spot)Progressive resistance exercise programProgress gradually with unfamiliar skills or activities

Grip MeasurementsGeneral RuleMeasure the distance between midline of palm and tipof middle finger size of grip circumference

GripsActivities require differentgrips and thereforedifferent combinations ofmuscles become strained33

Olecranon Bursitis

Loose Bodies

Loose bodies /degenerative changes

Cubital Tunnel Syndrome also known as ulnar neuropathy is caused by increased pressure on the ulnar nerve,which passes close to the skin’s surface in the area ofthe elbow commonly known as the "funny bone."37

Elbow pain – but I don’t playtennis or golfAssessment of the Elbow

ELBOW ASSESSMENTSUBJECTIVEOBJECTIVEObservationShoulder positionCarrying angle - cubitus valgus- cubitus varusSwelling- olecranon bursaScars39

ELBOW ASSESSMENTBony PalpationMedial epicondyleMedial supracondylar line of the humerusOlecranonUlnar borderOlecranon fossaLateral epicondyleLateral supracondylar line of the humerusRadial head40

Soft Tissue PalpationMedial aspect Ulnar nerve Wrist flexor / pronator group- Pronator teres- Flexor carpi radialis- Palmaris longus - Flexor carpi ulnaris Medial collateral ligament Supracondylar lymph nodesPosterior aspect Olecranon bursa Triceps muscle- Long head - Lateral head- Medial head41

Soft Tissue PalpationLateral aspect Wrist extensors- Brachioradialis- Extensor carpi radialis longus- Extensor carpi radialis brevis Lateral collateral ligament Annular ligamentAnterior aspectCubital fossaBiceps tendonBrachial artery Median nerve(Musculocutaneous nerve)42

ELBOW ASSESSMENTRANGE of MOTION TESTSTwo joints involved at the elbowi. humero-ulnar joint- elbow flexion / elbow extensionii. proximal radio-ulnar joint- forearm supination / forearm pronation43

ELBOW ASSESSMENTActive Range of MotionElbow Flexion135 Elbow Extension0 / -5 Forearm Supination 90 (from neutral)Forearm Pronation 90 (from neutral)Resisted Range of MotionFlexionExtensionSupination PronationPassive Range of MotionFlexion / ExtensionSupination / Pronation44

ELBOW ASSESSMENTNEUROLOGICAL TESTINGManual Muscle lisBiceps(Brachioradialis, supinator)Triceps(Anconeus)BicepsSupinator (Brachioradialis)Pronator teresPronator quadratus (Flexor carpi radialis)Reflex Testing Biceps reflexTriceps reflexBrachioradialis reflexSensation Testing45

SPECIAL TESTSCollateral Ligament TestsValgus Stress Test - medial collateral ligamentVarus Stress Test - lateral collateral ligamentTennis Elbow TestGolfer’s Elbow TestTinel Sign (ulnar nerve)EXAMINATION of RELATED AREASThoracic outlet syndromeCervical spine46

Tennis Elbow TestsTest for Lateral epicondylitis Resist wrist extensionResist extension of the 3rddigitThis causes stress to theextensor digitorum muscleand tendon.A positive sign would be pain ordiscomfort in the region of the lateralepicondyleMills Test – passive pronation andwrist flexionKonin JG, Wiksten DL, Isear Jr. JA, Brader H. Special Test for Orthopedic Examination 3rd ed. Thorofare, NJ: SLACKincorporated; 2006.Magee DJ. Orthopedic Physical Assessment. 5th ed. St. Louis, MO: Saunders Elsevier; 200847

Golfer’s Elbow testsCozen’s TestResisted wrist flexion (elbow bent / straight arm)Golfer’s elbow testFingers flexed into fistPassively extend wrist and elbow and supinate forearmCook CE, Hegedus EJ. Orthopedic Physical Examination Tests: An Evidence-Based Approach.Magee DJ. Orthopedic Physical Assessment. 5th ed. St. Louis, MO: Saunders Elsevier; 2008.48

Nerve TestsCubital tunnel test Elbow flexion testTinel’s sign Ulnar nerve sensitivity test49

Elbow pain – but I don’t playtennis or golfSoft Tissue Management ofthe Elbow

Massage & Exercises for ElbowStretch & Massage &StrengthenStretch & MassageBiceps BrachiiExtensor Carpi Radialis BrevisTriceps brachiiExtensor Carpi Radialis LongusBrachialisExtensor lexor carpi ulnarisFlexor carpi radialisPalmaris longusPronator teresForearm flexors andextensors and intrinsichand muacles

Massage Treatment - supineEffleurage / Petrissage / Deep Tissue Techniques Upper arm – deltoid, biceps and triceps (brachialis,coracobrachialis, brachioradialis) Forearm – wrist and finger extensors and flexors Hand– intrinsic musclesTriggers PointsECRB, ECRL, ED, SupFCR, FCU, PL, PTFriction massage – tendon onlyMyofascial ReleaseForearm extensorsForearm flexors

Trigger points therapy - extensors53

Trigger points therapy- flexors54

Deep Transverse frictions55

Elbow pain – but I don’t playtennis or golfExercises and Stretches toComplement Soft Tissue Treatment

StretchesStretching – static, PNF Biceps briachii Triceps brachii Forearm extensors (elbow bent / straight arm) Forearm flexors (elbow bent / straight arm)

58

Elbow pain – but I don’t playtennis or golfThe Research

Progressive Strengthening and Stretching Exercisesand Ultrasound for Chronic Lateral EpicondylitisPhysiotherapy, September 1996, vol82, no 9Tuomo T Pienimaki Tuula K Tarvainen Pertti T Siira Heikki VanharantaThirty-nine patients suffering from chronic lateralepicondylitis were randomised into two treatment groups.All clinical manual provocation tests for tennis elbowimproved within the exercise group.The results indicate that progressive exercise therapy ismore effective than ultrasound in treating chronic lateralepicondylitis, reducing pain and improving patients’ abilityto work.60

Progressive exercise programStep 1Clenching fist stronglyResisted wrist extensionResisted wrist flexionWrist rotation with a stick Towards the little finger Towards the thumbEnd: stretching at least 30seconds to flexion and extensionClenching fist stronglyResisted wrist extension exercises61

Resisted wrist flexion exercisesWrist flexion exercises against an elastic bandWrist rotation with a stick towards the little fingerExercises for radial deviation

Stretching to flexionWrist extension exercises against anelastic bandPressing hands against a wallTwisting a towel into a roll

Rehabilitation for Patients with Lateral Epicondylitis: ASystematic Review J HAND THER. 2004;17:243–266. Daniel Trudel, JenniferDuley,Ingrid Zastrow, Erin W. Kerr, Robyn Davidson, Joy C. MacDermid,To determine the effectiveness of conservative treatments forlateral epicondylitis and to provide recommendations based on thisevidence. a number of treatments, including acupuncture, exercisetherapy, manipulations and mobilizations, ultrasound andphonophoresis show positive effects in the reduction of pain or improvementin function for patients with lateral epicondylitis. Practitioners should use the treatment techniques that havestrongest evidence and ensure that studies findings aregeneralized to patients who are similar to those reported inprimary research studies in terms of patient demographics andinjury presentation.64

Tendinosis of the extensor carpi radialis brevis: Anevaluation of three methods of operative treatment JShoulder Elbow Surg 2006;15:721-727.)S. Joshua Szabo, MD,a Felix H. Savoie III, MD,b Larry D. Field, MD,b J. RandallRamsey, MD,b andChad D. Hosemann, BA,b Gastonia, NC, and Jackson, MSCompare 3 operative methods for treatment of recalcitrantlateral epicondylitis—open, orthroscopic, andpercutaneous.All patients with lateral epicondylitis who were operated onover a 7-year period were retrospectively reviewed.The outcomes were evaluated preoperatively andpostoperatively with a visual analog scale scores for pain atrest, worst pain, and pain with activity.Open, arthroscopic, and percutaneous treatments of lateralepicondylitis offer 3 highly effective ways for the clinician toaddress this common clinical problem.65

Corticosteroid or placebo injection combined with deep transverse frictionmassage, Mills manipulation, stretching and eccentric exercise for acute lateralepicondylitis: a randomised, controlled trial Olaussen et al. BMC MusculoskeletalDisorders (2015) 16:1221. Physiotherapy with two corticosteroid injections,2. Physiotherapy with two placebo injections or wait-and-see (control).3. Physiotherapy consisted of deep transverse friction massage, Millsmanipulation, stretching, and eccentric exercises.The main outcome measure was treatment success defined as patientsrating themselves completely recovered or much better on a six-point scale.Conclusions: Acute lateral epicondylitis is a self-limiting condition where 3/4 of patientsrecover within 52 weeks. and corticosteroid injection gave no added effect. Physiotherapy withdeep transverse friction massage, Mills manipulation, stretching, andeccentric exercises showed no clear benefit, Corticosteroid injections combined with physiotherapy might beconsidered for patients needing a quick improvement, but intermediate(12 to 26 weeks) worsening of symptoms makes the treatment difficult torecommend.66

Arthroscopic tennis elbow releaseFelix H. Savoie, Wade VanSice, Michael J. O’Brien, Shoulder Elbow Surg (2010) 19, 31-36Although it was first thought lateral epicondylitis was caused by aninflammatory process, most microscopic studies of excised tissuedemonstrate a failure of reparative response in the extensor carpiradialis brevis tendon and in any of these associated structures.Most cases of lateral epicondylitis respond to appropriate non-operativetreatment protocols.Non-operative management includes medication, bracing, physicaltherapy, corticosteroid injections, shock wave therapy, platelet-richplasma, and low-dose thermal ablation devices. When these areunsuccessful, however, surgical measures may be performed with ahigh rate of success.Satisfactory results of the arthroscopic surgical procedures have beendocumented, with reported improvement rates of 91% to 97.7%.The recent advances in arthroscopic repair and plication of theselesions, along with the recognition of the presence and repair ofcoexisting lesions, have allowed arthroscopic techniques to provideresults superior to other measures.67

Does effectiveness of exercise therapy and mobilisationtechniques offer guidance for the treatment of lateral andmedial epicondylitis? A systematic review Peter Hoogvliet, Manon SRandsdorp, Rudi Dingemanse, Bart W Koes, Bionka M A Huisstede Hoogvliet P, et al. Br J Sports Med2013;47:1112–1119 Owing to the change in paradigm of the histological nature ofepicondylitis, therapeutic modalities as exercises such as stretching andeccentric loading and mobilisation are considered for its treatment. Assess the evidence for effectiveness of exercise therapy andmobilisation techniques for both medial and lateral epicondylitis.Moderate evidence for the short-term effectiveness was found in favour ofstretching plus strengthening exercises versus ultrasound plus frictionmassage.Moderate evidence for short-term and midterm effectiveness was found forthe manipulation of the cervical and thoracic spine as add-on therapy toconcentric and eccentric stretching plus mobilisation of wrist and forearm.Conclusions: Strength training decreases symptoms in tendinosis. The short-term analgesic effect of manipulation techniques may allowmore vigorous stretching and strengthening exercises resulting in abetter and faster recovery process of the affected tendon in lateralepicondylitis.68

Chronic Lateral Epicondylitis: Comparative Effectiveness of a HomeExercise Program Including Stretching Alone versus StretchingSupplemented with Eccentric or Concentric StrengtheningJulio A. Martinez-Silvestrini,Karen L. Newcomer, Ralph E. Gay, Michael P. Schaefer,Patrick Kortebein, Katherine W. Arendt, J HAND THER. 2005;18:411–420.To evaluate the effectiveness of eccentric strengthening insubjects with chronic lateral epicondylitis stretching, concentric strengthening with stretching, and eccentric strengthening with stretching.Subjects performed an exercise program for six weeks.All three groups received instruction on icing, stretching,and avoidance of aggravating activities.Although there were no significant differences in outcomeamong the groups, eccentric strengthening did not causesubjects to worsen.69

70

71

72

73

Orthopedic Physical Examination Tests: An Evidence-Based Approach. Magee DJ. Orthopedic Physical Assessment. 5th ed. St. Louis, MO: Saunders Elsevier; 2008. Nerve Tests Cubital tunnel test Elbow flexion test Tinel’s sign Ulnar nerve sensitivity test 49 .

Related Documents:

pain”, “more pain” and “the most pain possible”. Slightly older children can also say how much they are hurting by rating their pain on a 0-10 (or 0-100) scale. Zero is no pain and 10 (or 100) is the worst possible pain. What a child is doing Often children show their pain by crying, making a “pain” face, or by holding or rubbing .

Texts of Wow Rosh Hashana II 5780 - Congregation Shearith Israel, Atlanta Georgia Wow ׳ג ׳א:׳א תישארב (א) ׃ץרֶָֽאָּהָּ תאֵֵ֥וְּ םִימִַׁ֖שַָּה תאֵֵ֥ םיקִִ֑לֹאֱ ארָָּ֣ Îָּ תישִִׁ֖ארֵ Îְּ(ב) חַורְָּ֣ו ם

Short-term pain, such as when you suffer a sprained ankle, is called 'acute' pain. Long-term pain, such as back pain that persists for months or years, is called 'chronic' pain. Pain that comes and goes, like a headache, is called 'recurrent' pain. It is not unusual to have more than one sort of pain or to have pain in several places

General discussions of pain often refer simply to three types: 1) Acute (brief that subsides as healing takes place) 2) Cancer 3) Chronic non-malignant pain - "persistent pain" Classification of pain by inferred pathology: 1) Nociceptive Pain 2) Neuropathic Pain (McCaffery & Pasero, 1999) Nociceptive Pain A. Somatic Pain B. Visceral Pain

Knee Pain 1 Knee Pain 2 Knee Pain 3 Knee Pain 4 Knee Pain 5 Lateral Knee Pain Medial Knee Pain Patella Pain 1 Patella Pain 2 Shin Splint. 7 Section 6 Ankle/Foot Big Toe 89 . For additional support, wrap another tape around the last finger joint. Step 3. No stretch is applied during application. 30 Step 1 Step 2 Finger Pain. 31 Requires;

Apr 04, 2015 · Pleaz lissen to me,‘cause me singin’ good And me love you like Greek man love chicken. Don don don, diri diri, don don don don. When me go on hunts, hunt with falcon; Me will bring you woodcock, fat as kidney. Don don don, diri diri, don don don don. Me no can tell you much beautiful, fancy stuff; Me no know Petrarch or spring of Helicon.

spectrum of elbow pathology. The PROs that have been used to assess elbow diseases include the Mayo Elbow Performance Score (MEPS), Oxford elbow score (OES), Disabilities of the arm, shoulder and hand (DASH), Visual Analog Scale (VAS) and the patient-rate

Tendinopathy (Tennis elbow, Golfer’s Elbow, Triceps, Distal Biceps Ruptures) Volker Musahl MD 3:20 pm – 3:35 pm Elbow Injuries in the Mature Throwing Athlete Marc R. Safran MD 3:35 pm – 3:50 pm Elbow Issues in the Skeletally Immature Athlete Jan Fronek MD 3:50 pm – 4:05 pm Elbow Disl