Msk Elbow

Front 1

What are 4 common elbow conditions we see in primary care?

Back 1

• olecranon bursitis
• ulnar nerve impingement
• medial epicondylosis "golfer's elbow"
• lateral epicondylosis "tennis elbow"

Front 2

Signs and Sx

Back 2

• painful or painless swelling of posterior elbow at olecranon
  
• hx of localized trauma or repetitive friction or pressure to elbow
• pain and erythema may indicate sepsis
• if ROM impaired, consider sepsis, gout, or inflammatory process
  

Front 3

Olecranon bursitis

Tx and Plan

Back 3

• Rx: NSAIDS
• corticosteroid injections (max 2) may dec recurrence
• Dx: needle aspiration r/o sepsis
• Pt ed: sling if needed, local protection (elbow pad) to decrease pressure

Front 4

In general, what are the common causes and hx assoc with elbow pain?

Back 4

Causes

• over use injury ex throwing sports
• nerve entrapment
• inflammatory conditions

History

• exact anatomic location
• activity causes pain
• presence of nuero vs mechanic sx

Front 5

What is lateral epicondylosis "tennis elbow"?

Back 5

pain and degeneration of the common extensor origin of the extensor muscles of the forearm

Front 6

signs Sx, and PE for lateral epicondylosis

Back 6

• Signs/Sx:aching pain, worse w activity such as racquet sports involving strong grasp with wrist in extension (wrist extensors: extensor carpi radialis brevis)
• radiates down lateral forearm
• PE: tenderness @ lateral epicondyle
• pain during resited extension of elbow with forearm pronated and wrist in palmar flexion

Front 7

Plan for lateral and medial epicondylosis

Back 7

Plan:

Dx: rarely needed

• pain control
  
• avoid corticosteroids (short term relief only)
• avoid exacberating activities
• ICE
• PT and exercise
• technique modification
• counter force bracing may help
• RTC if sx don't improve

Front 8

Medical epicondylosis " golfer's elbow"

- What is it?

Back 8

Pain and degenerative changes ofthe common flexor origin of theflexor muscles of the forearm

Front 9

Medial epicondylosis

HPI and PE

Back 9

Aching pain, worse with activityinvolving rapid wrist flexion andforearm pronation. Wrist flexors(flexor carpi radialis muscles)

PE:

• Tenderness @ medial epicondyle
  
• Pain during resisted extension of elbow with forearm supinatedand wrist in dorsiflexion
  

Front 10

Ulnar nerve entrapement

what is it?

Back 10

Medial elbow pain with distalparesthesias along ulnaraspect of forearm into 4th &5th digits

Front 11

ulnar nerve entrapment

- HPI and PE

Back 11

HPI: Weak grip, hand fatigue,clumsiness, throwing & racquet sports,weightlifting, repetitivemotion with arms in constantflexion

PE:

• + tinel's over ulnar nerve within the groove of medial epicondyle
  
• diminished grip and pinch strength
• hypothenar atrophy (muscles that control pinky)

Front 12

ulnar nerve entrapement

- PLAN

Back 12

Plan:

• Dx: none
  
• Pain control c analgesic
  
• avoid activities with frequent elbow flexion, avoid direct pressure on elbow
  
• ergonomic adjustments if necessary
  
• refer if persistent and worsening