Elbow And Forearm

Front 1

Radial Fractures:

Back 1

can cause loss in ability to pronate and supinate

Front 2

Biceps and Triceps tendinitis:

Back 2

usually at the point of insertion

Front 3

Olecranon Bursitis:

Back 3

often causes unexplained swelling, bewareof infectious causes.

Front 4

NerveEntrapments:

Back 4

· Ulnar nerve entrapments-posterior and medial dislocations, may cause atrophy and symptoms in the hand

· Radial nerve entrapments-radial tunnel, radial head, symptoms often appear lower in the nerves path

· Medial nerve entrapments-pronation, pronator teres. Can mimic carpal tunnel type symptoms

Front 5

Elbow and Forearm

CommonPresenting Complaints:

Back 5

· Epicondyle pain

· Pain at olecranon- avulsionfracture of the olecranon will occur before the triceps tendon will tear

· Lack of full extension-compartment syndromes

· Forearm pain and weakness- canoccur from holding a bag on your forearm for prolonged periods.

Front 6

ElbowRed Flags and Cautions:

Back 6

FOOSH, dislocations, direct trauma,vascular change, child and traction force, unexplained locking (usually loosebodies within the joint), unexplained swelling (rheumatoid arthritis, goutetc.) and altered carrying angle.

Front 7

OsteocondrititsDessecans:

Back 7

Compression of the Lateral side- radialhead (can cause loose bodies) as well as having a distraction injury of themedial side (can stretch ligaments)

Front 8

Osteocondritits Dessecans:

Back 8

Loose bodies which are either cartilage or bone

Front 9

Osteocondritits Dessecans History :

Back 9

· Acute traumatic and overuse

· Swelling, heat, discoloration

· Loss of function

. Locking of elbow

Front 10

Osteocondritits Dessecans Examination

Back 10

· Swelling, heat, discoloration-this flows into potential space in the arm · Functional ROM· Pain below medial epicondyle· Valgus stress increased- can dothis in neutral but often better to do with slight flexion and pronation.· Muscle weakness-extrinsic wristflexors· x-ray, MRI, ultrasounds

Front 11

Osteocondritits Dessecans Treatment

Back 11

· Adjust· STT to stabilizers- musclebalance, strengthen muscles inhibited by pain or trauma, muscle stripping forchronic conditions · Cross friction to ligament-chronic overuse situation · Ice· Strapping/bracing- tape in a Xshape, usually distal to proximal (in acute situation)· Ultrasound/laser· Exercise- acute/sub-acute phaseuse grip work/stress ball/rubber band wrapped around fingers. Flexion,extension, ulnar deviation, radial deviation- neutral, pronation. Activates ROMand strengthens muscles· Technique· Grade 3= referral- surgery toreattach the ligament· Be aware of the ulnar nerve

Front 12

MedialCollateral Ligament Sprain History:

Back 12

Acute or overuse injury resulting in swelling, heat, discoloration, lossof function and stability.

Front 13

Medial Collateral Ligament Sprain

Morphologyand Function:

Back 13

· Children can be prone toavulsion fractures· Anterior means there is stabilitythough flexion and extension· Posterior means there isstability at 60-135 degrees of flexion and extension· Be aware of instability

Front 14

Medial Collateral Ligament Sprain

Assessment

Back 14

· Pain below medial epicondyle· Function ROM changes· Increased valgus stress· Muscular weakness, diagnosticimaging

Front 15

Medial Collateral Ligament Sprain

Treatment

Back 15

· Elbow MAT· STT to stabilizing muscles· Ligament cross friction topromote healing· Ice· Strapping/bracing· Ultrasound/laser (physiologicaltherapies)· Exercise- generally andspecific/advice- technique, relative rest· Grade 3= referral

Front 16

ThrowersElbow:

Back 16

Flexor Tendinosis caused by medialcollateral ligament damage, muscle- acute or repetitive trauma.

Can lead to ostiocondritis desicans is a area of avascular necrosis thatdevelops, where the bone dies and that portion of bone will drop intojoint and cause locking of the elbow

Front 17

Throwers Elbow History:

Back 17

can be acute or overuse.· Throwing sports· Vague medial elbow pain· Signs and symptoms of flexortendinosis/medial collateral ligament· Instability· Action reproduces pain

Front 18

Throwers Elbow Examination

Back 18

· Signs and symptoms of flexortendinosis/medial collateral ligament· Instability· Action reproduces pain- as wellas having arm in position and provide resistances· Valgus stress increased-dynamic valgus stress test· X-ray- calcification, loosebodies, spurs, US/MRI- particular if they complain of locking or lack of ROM

Front 19

Throwers Elbow Treatment

Back 19

· Adjust- cervical, thoracic,shoulder, wrist and hand/kinetic chain· Muscle imbalance/crossfriction- if there is instability you need to treat muscles so that the dynamicsupport is balanced.· Ice, support (bracing andstrapping)· Ultrasound andDifflam/anti-inflammatory · Advice· Strength exercise· Referral

Front 20

Osteoarthritis:

Back 20

Can occur at any ages, change in axis ofrotation or interference of motion, micro or macro trauma.

Front 21

Osteoarthritis Pathology

Back 21

· Lateral swelling· Medial osteophytes· Loose bodies in radialcapitular region and other regions can occur- can be cartilaginous or calcific(these can be relative contraindications)

Front 22

Osteoarthritis Hx

Back 22

· Progressive pain interfereswith motion, rest it feels better, after activity gets worse, often triggeredby change in activity· Examination:· Flexion· Swelling· Decreased joint play orhypermobility (medial collateral ligament sprain)

Front 23

Osteoarthritis Treatment

Back 23

· Adjustment the kinetic chain· Mobilisations- open up tissue,increase flexibility (also can include other forms of stretching- self managementetc.)· STT· Heat- heat before exercise · Diet, Supplements-anti-inflammatory e.g. omega 3, vit E, glucosamine · Advice on aggravating factors-can be something as simple as siting instead of standing, widening the grip onsomething to there is less stress on the elbow.

Front 24

LooseBodies:

Back 24

Radial head epiphysis, capitulumn is the second most common location, itis more common in males than females and is often age related.

Front 25

Loose Bodies:

Back 25

· Osteochondritits Dessecans-enlargement of the radial head, more common in males, often involved withsports such as baseball, gymnastics, martial arts etc. occurs mostly inteenagers. Can be associated with trauma but mostly is involved with overuse· Osteochondrosis- calcificationof the cartilage, changes in circulation, repetitive trauma, premature fusion· Other types of loose bodies areinvolved more with DJD· Think about the integrity ofthe joint?

Front 26

Loose Bodies History :

Back 26

Pain, locking, stiffness, swelling,difference in ROM (can’t extend –possible triceps tendonopathy, DJD withoutloose bodies or can’t flex- possible biceps injury), insidious, intermittentpain with certain activities

Front 27

Loose Bodies Examination:

Back 27

· Blocked extension-fullextension· Synovial swelling· Springy-block end feel· Diagnostic imaging (x-raydetermines type as well as presence)

Front 28

Loose Bodies Treatment

Back 28

· Adjustments and mobilizations· Ice- for swelling· Referral (as withosteochrondrosis)

Front 29

Dislocations:

Back 29

•Most common is posterior and lateral

• Often associated with fractures in the area

•Be aware of possible damage to neurovascular component

Front 30

Dislocations History :

Back 30

​- Fall on outstretched hand with extension

​- High levels of pain

Front 31

Dislocations Treatment :

Back 31

​- Refer in acute condition ​

- Post dislocation care

Front 32

Fractures: Supracondylar fractures

Back 32

• Associated with posterior dislocation

• Can lead to acute compartment syndrome•Need to assess radial artery

Front 33

Fractures:

Intercondylar/transcondylar/

comminuted condylar

Back 33

Occur with compression

Front 34

Fractures: Olecranon

Back 34

• Avulsion fracture with triceps

• Be aware of olecranon bursa

Front 35

Fractures: Coronoid process

Back 35

• Associated with posterior dislocation

Front 36

Fractures: Radial head

Back 36

• Occur after foosh injury

• Commonly overlooked on the Xray

Front 37

Fractures: Radial neck

Back 37

Lateral epicondylar fracture

• Occur in traction injuries• Can lead to complications with growth plates

Medial epicondylar fracture

• Avulsion and wrist flexor overuse• Need to be careful of ulnar nerve damage

Front 38

Fractures: B-B fracture

Back 38

• Both bone fractures

• Occurs in the mid 1/3 of the bone

•Causes displacement, angulation, rotation

• Needs surgical stabilisation

Front 39

Fractures: Distal Ulnar (Nightstick)

Back 39

• Trauma to the raised arm

Front 40

Fractures: Proximal ulnar fracture (Monteggia)

Back 40

• Associated with radial displacement

• Green stick fracture in children

Front 41

Fractures: Distal Radial (Galeazzi)

Back 41

• Rare

• Is associated with dislocation of the distal radioulnar joint

Front 42

Fractures: Treatment

Back 42

​- Focus first on healing​- Healing involves nutrition, spinal adjustments, relative rest​- Focus then on rehabilitation​- Adjust VSC and peripheral joint subluxation complex​- STT to elbow stabilisers​- ROM activities​- Forearm strengthening and exercise as soon as arm is out of cast to try and restore function and flexibility before degeneration occurs​- Advise on leisure/sport/work

Front 43

HumeralEpicondyle Fractures:

Lateral Epicondyle

Back 43

Lateral- traction injury, fall on hand withvarus stress. Can cause complication with the growth plate, non-union, valgusdeformity and ulnar nerve palsy. Elbow will appear swollen but not deformed andpassive flexion will decrease.

Front 44

Humeral Epicondyle Fractures:

Medial Epicondyle

Back 44

Medial- avulsion fracture due to wrist flexor overuse, dislocation. Ulnar nerve damage other contraindications are if there is deformation, loose bodies.

Front 45

Volkmann’sIschemic Compression:

Back 45

· Problems with finger flexion,pronation and supination · Decreased expansion

Front 46

Volkmann’s Ischemic Compression: Hx

Back 46

Cause of compression, pain swelling, discoloration,flexor compartment compromised, median nerve signs and symptoms

Front 47

Volkmann’s Ischemic Compression:

Assessment

Back 47

Pain, swelling, discoloration, flexorcompartment, ROM decreased neurological signs and symptoms

Front 48

CompartmentSyndrome of the Hand and Forearm:

Back 48

Often caused by supracondylar humeralfractures or radial/ulnar fractures.

Median nerve involvement, carpal tunnelrelease, exploration of entrapment (usually one of lacertus fibrosis, proximaledge of pronator teres)

Front 49

Compartment Syndrome of the Hand and Forearm: Hx

Back 49

·Trauma or other cause ofcompression/overuse will result in pain, swelling and discoloration etc. · Flexor compartment issues· Decreased ROM· Neurological signs and symptoms

Front 50

Compartment Syndrome of the Hand and Forearm: Treatment

Back 50

· Prevention· Referral· Conservative treatment· Surgery