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ELBOW CONDITIONS (OTHERS (Fractures (Radial head / Capitellum from…
ELBOW CONDITIONS
ENTRAPMENT NEUROPATHY
MEDIAN NERVE
Carpal Tunnel Syndrome CTS
Pronator Teres Syndrome
Median n. entrapped by 2 heads of PT mm i.e. ulnar coronoid & medial epicondyle
Symptoms
aching pain in proximal forearm, paraesthesia along median n distribution into hand
Tests
palpate over entrapment area, resisted PT mm testing
Anterior Interosseous Nerve AIN
no sensory fibres, no sensory complaints, only motor weakness
Supplied to
PQ, FDP (index finger), FPL
Symptoms
Pinch Sign = loss distal flexion of thumb & index finger, dull aching pain in volar aspect of proximal forearm during resisted supination in elbow flexion
Supracondylar Process Syndrome
compression of median n. + brachial a. pass through the "arch" formed by supracondylar process + Struthers' lig over humeral body
ULNAR NERVE
median elbow pain
Cubital Tunnel Syndrome
Causes
Sleeping with the arm folded behind neck, elbows bent.
Pressing the elbows upon the arms of a chair while typing.
Resting or bracing the elbow on the arm rest of a vehicle ‘Truckers Elbow’
ulnar nerve is obstructed during its path along the cubital tunnel
Symptoms
tingling sensation along the 4th and 5th fingers
Grade I Mild Symptoms
intermittent paraesthesia, minor hypoesthesia
Grade II Moderate & Persistent Symptoms
paraesthesia, hypoesthesia, mild weakness FCU, FDP, lumbricals, opponens digiti minimi flexor digiti minimi, abductor digiti minimi, interossei, adductor pollicis; muscular athropy
Grade III Severe Symptoms
paraesthesia, hyperesthesia, significant mm weakness; muscular athropy, digital clawing (
Sign of Benediction
)
Guyon's Canal Syndrome
Handle Bar Palsy
ulnar n. entrapped between
hook of hamate
+
transverse carpal lig
- excessive gripping, twisting, repeated wrist hand motions
Symptoms
muscular atrophy, thenar muscle sparing, sensory loss & pain
Adductor Pollicis Ulnar N (Deep branch) Paralysis
Fremont (Card) Sign
Flexion of Thumb IP jt
RADIAL NERVE
Saturday Night / Honeymoon Palsy / Crutch Palsy
Causes
compress radian n. at spiral groove: Sleep with one arm hanging over arm rest of chair;
paralysis of posterior compartment of forearm mm
Symptoms
Wrist Drop, Numbness of back of hand & wrist & 1st web space, inability to extend thumbs or fingers
PIN / Supinator Syndrome / The Arcade of Forhse
Causes
PIN entrapped between 2 heads of supinator mm under
Arcade of Frohse
, or
Leash of Henry
fan out across PIN at level of radial neck
Symptoms
paralysis of PIN, sensory loss in radial n supply, wrist drop
Radial Tunnel Syndrome
Causes
compression of PIN at lateral intermuscular septum lf arm
Symptoms
pain in dorsal upper forearm, weakness is secondary to pain
Wartenberg's Syndrome / Handcuff Neuropathy / Cheiralgia Paraesthetica / Wristlet / Watch Syndrome
Causes
entrapment or isolated injury of superficial sensory branch of radial nerve
Erb's Palsy / Nerve Root or Plexus Palsy / Waiter's Tip Deformity
Causes
Difficult childbirth. trauma on head / shoulder -> nerves of plexus esp C5-6 violently stretched
Nursemaid's / Babysitter Elbow
Causes
Sudden pull on extended pronated forearm
Radial head pulled distally through annular radioulnar lig
OTHERS
Fractures
Radial head / Capitellum
from outstretched hand on ground with elbow
fully extended
Condylar & Supracondylar
structures due to
varus / vulgus
forces from impact
Olecranon
direct impact to elbow
Referred Pain
Cervical & thoracic spines lesions
Periscapular tissues
Posterolateral Dislocation
Outstretched hand on ground with elbow
flexed
Intra-articular Pathlogies
Symptoms
swelling, clicking, grinding
Structures
synovium, cartilage, bone
Osteochrondritis
Location
Capitellum, Radial head in young
Myositis Ossificans
Brachialis
Trauma to anterior upper arm
aggressive mobilisation increased haemorrhage
permanent contraction of elbow flexors
BURSITIS
Olecranon
Causes
trauma - single / repeated, rest elbow on hard surface too long
Involved in
Crystal arthropathies e.g. gout
Inflammatory arthritis e.g. RA
Septic
Radiohumeral
pain at anterior & distal to lat epicondyle
TENDINITIS / TENDINOPATHY
Triceps
Treatment
reduce excessive tightness of triceps musculotendinous area
Distal Biceps
bicipital (radial) tuberosity of radius, pain on resisted flexion & supination due to sports injury
Brachialis
Lateral Extensor Tendinopathy (LET) /
Lateral Epicondylitis
Partial tears
Degenerative change
Tennis Elbow
40-60yo caused by musculotendinous inflammation / degeneration
Ischaemic stress
Avascular tenoperiosteal junction & tendon, >30yo, reduced collagen content, cells, ground substance, increased lipids that predispose to injury
Symptoms
pain in lat epicondyle, painful resisted wrist flexion, impaired grip strength (dynamometer)
Resistant Lat Epi due to
radial n. entrapment at elbow
Flexor / Pronator Tendinopathy, Medial Epicondylitis
pain on resisted wrist flexion with extended elbow
POSTERIOR IMPINGEMENT
Valgus stress / forced extension
impinges Posterior medial corner of olecranon tip
Osteophyte formation
Fixed flexion deformity
Early
Osteoarthritis in elderly
of
radiocapitellar joint
LIGAMENTOUS SPRAIN / RUPTURE
MCL Ligament Sprain
Valgus
stress / Excessive
Throwing
/ Hyperextension
Tennis Elbow 40-60yo
Golfer's elbow
Olecranon compartment chondromalacia
Loose bodies
Symptoms
localised tenderness in lig, instability on valgus stress
UCL
Varus
stress
compress
radiocapitellar joint
FRACTURES
Smith's Fractures
distal radius
Colles Fractures
broken end of the radius is bent backwards