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Pathologies of the Elbow

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Pathologies of the Elbow Elbow Lateral Epicondylitis (tennis elbow) PathologyPathology 3030 –– 5050 yearsyears oldold RepetitiveRepetitive micro-traumamicro-trauma ChronicChronic teartear inin thethe originorigin ofof thethe extensorextensor carpicarpi radialisradialis brevisbrevis Lateral Epicondylitis (tennis elbow) MechanismMechanism ofof InjuryInjury OveruseOveruse syndromesyndrome causedcaused byby repeatedrepeated forcefulforceful wristwrist andand fingerfinger movementsmovements TennisTennis playersplayers ProlongedProlonged andand rapidrapid activitiesactivities Lateral Epicondylitis (tennis elbow) ClinicalClinical SignsSigns andand SymptomsSymptoms IncreasedIncreased painpain aroundaround laterallateral epicondyleepicondyle TendernessTenderness inin palpationpalpation CETCET TestsTests AROM;AROM; PROMPROM ResistedResisted teststests LidocaineLidocaine Treatment of Tennis Elbow Medial Epicondylitis (golfer’s elbow) PathologyPathology 3030 -- 5050 yearsyears oldold RepetitiveRepetitive micromicro traumatrauma toto commoncommon flexorflexor tendontendon Medial Epicondylitis (golfer’s elbow) MechanismsMechanisms ofof injuryinjury ThrowingThrowing aa baseballbaseball RacquetballRacquetball oror tennistennis SwimmingSwimming backstrokebackstroke HittingHitting aa golfgolf ballball Medial Epicondylitis (golfer’s elbow) ClinicalClinical signssigns andand symptomssymptoms IncreasedIncreased painpain overover medialmedial epicondyleepicondyle TendernessTenderness onon palpationpalpation CFTCFT TestsTests AROM;AROM; PROMPROM ResistedResisted teststests LidocaineLidocaine Ulnar Neuritis PathologyPathology SuperficialSuperficial positionposition atat thethe elbowelbow ExcessiveExcessive pressurepressure inin thisthis areaarea SecondSecond mostmost commoncommon entrapmententrapment neuropathyneuropathy inin thethe upperupper extremityextremity Ulnar Neuritis MechanismMechanism ofof injuryinjury CompressionCompression ofof thethe ulnarulnar nerve:nerve: cubitalcubital tunneltunnel (epicondyle,(epicondyle, olecranon,olecranon, MCL,MCL, archarch ofof arcuatearcuate ligamentligament andand ofof 22 headsheads ofof FCUFCU ElbowElbow flexionflexion tightenstightens archarch RepeatedRepeated rapidrapid activitiesactivities suchsuch asas throwingthrowing andand prolongedprolonged flexionflexion maymay tractiontraction oror compresscompress nervenerve NerveNerve cancan subluxsublux outout ofof tunneltunnel Ulnar Neuritis ClinicalClinical signssigns andand symptomssymptoms SensorySensory changeschanges inin classicclassic ulnarulnar distribution:distribution: littlelittle fingerfinger andand ulnarulnar sideside ofof ringring fingerfinger PositivePositive elbowelbow flexionflexion testtest PositivePositive Tinel’sTinel’s testtest WeaknessWeakness ofof gripgrip DeteriorationDeterioration ofof 22 pointpoint discriminationdiscrimination AdductorAdductor PollicusPollicus neuro-weaknessneuro-weakness Neuro-weaknessNeuro-weakness interosseiinterossei (Wartenburg)(Wartenburg) Ulnar Neuritis CommonCommon treatmentstreatments Non-operative:Non-operative: restrest isis imperative;imperative; NSAIDS;NSAIDS; determinationdetermination ofof causecause andand eliminationelimination ofof itit SurgicalSurgical intervention:intervention: decompressiondecompression oror transpositiontransposition Medial Overload Syndrome in Throwers PathologyPathology LateralLateral jointjoint line-line- compressivecompressive forcesforces ShearShear forcesforces posteriorlyposteriorly inin olecranonolecranon fossafossa TensileTensile forcesforces alongalong medialmedial jointjoint lineline Medial Overload Syndrome in Throwers ClinicalClinical signssigns andand symptomssymptoms PersistentPersistent medialmedial elbowelbow sorenesssoreness ArmArm fatiguefatigue isis thethe 11st indicatorindicator ofof impendingimpending injuryinjury MedialMedial tendernesstenderness ElbowElbow painpain Medial Overload Syndrome in Throwers: Treatment PrePre throwingthrowing stretchesstretches AdequateAdequate gentlegentle warmwarm upup withwith gradualgradual increaseincrease toto higherhigher velocityvelocity throwsthrows PostPost throwingthrowing stretchingstretching ICEICE afterafter throwingthrowing SurgicalSurgical InterventionIntervention Anterior Interosseus Nerve Syndrome (Median Nerve) PathologyPathology AreasAreas ofof possiblepossible compressioncompression BetweenBetween thethe headhead ofof thethe pronatorpronator teresteres TheThe proximalproximal tendontendon ofof flexorflexor digitorumdigitorum superficialissuperficialis Anterior Interosseus Nerve Syndrome MechanismMechanism forfor InjuryInjury RepetitiveRepetitive elbowelbow flexionflexion withwith forearmforearm pronatedpronated TendinitisTendinitis ofof deepdeep headhead ofof pronatorpronator secondarysecondary toto heavyheavy liftinglifting FracturesFractures oror D/CD/C ofof ulnaulna oror radiusradius ClinicalClinical SignsSigns andand SymptomsSymptoms PainPain NoNo sensorysensory complaintscomplaints oror losseslosses SignificantSignificant muscularmuscular weakness:weakness: lossloss ofof tiptip toto tiptip pinchpinch Radial Tunnel syndrome/Posterior Interosseous Syndrom PathologyPathology RadialRadial nervenerve compressed:compressed: InIn thethe proximalproximal radialradial tunneltunnel anterioranterior toto thethe headhead ofof thethe radiusradius wherewhere nervenerve suppliessupplies brachioradialisbrachioradialis andand ECRL,ECRL, betweenbetween thethe ulnarulnar halfhalf ofof thethe ECRBECRB andand itsits fascia,fascia, andand atat thethe distaldistal borderborder ofof supinator.supinator. OftenOften mimicsmimics tennistennis elbowelbow Signs and Symptoms ClassicClassic S&SS&S ofof laterallateral epicondylitisepicondylitis includingincluding painpain onon ROMROM andand resistiveresistive testing;testing; resistedresisted supinationsupination >> wristwrist ext.ext. MaximumMaximum tendernesstenderness shouldshould bebe overover thethe supinatorsupinator muscle;muscle; 44 fingersfingers breadthbreadth distaldistal toto thethe laterallateral epicondyleepicondyle PainPain cancan radiateradiate upup andand downdown armarm WeakWeak gripgrip DiagnosticDiagnostic locallocal anestheticanesthetic blockblock toto CETCET WRIST AND HAND Carpal Tunnel Syndrome MedianMedian nervenerve compressioncompression withinwithin thethe carpalcarpal tunneltunnel isis thethe mostmost commoncommon peripheralperipheral nervenerve entrapmententrapment syndrome.syndrome. AnyAny conditioncondition thatthat decreasesdecreases thethe crosscross sectionalsectional areaarea ofof thethe carpalcarpal tunneltunnel oror increasesincreases thethe volumevolume ofof itsits contentscontents maymay causecause thethe pathology.pathology. EX:EX: lunatelunate dislocation;dislocation; distaldistal radiusradius fracture,fracture, sustainedsustained flexionflexion oror extensionextension postures,postures, fluidfluid retention,retention, synovitissynovitis Signs & Symptoms of CTS Pain,Pain, paraesthesia,paraesthesia, oror numbnessnumbness inin thethe medianmedian nervenerve distributiondistribution distaldistal toto thethe wristwrist NocturnalNocturnal paraesthesiasparaesthesias commoncommon complaintcomplaint ClumsinessClumsiness andand decreaseddecreased prehension;prehension; tiptip toto tiptip oppositionopposition ofof tipstips ofof thumbthumb andand littlelittle fingerfinger SustainedSustained wristwrist flexionflexion bringsbrings onon symptomssymptoms Treatment of CTS EliminateEliminate riskrisk factorsfactors suchsuch asas taketake frequentfrequent restrest breaks;breaks; ergonomicergonomic setset upup analysisanalysis andand correction;correction; decreasedecrease vibrationvibration andand prolongedprolonged pressure,pressure, etcetc NeutralNeutral wristwrist splinting/rest/neuralsplinting/rest/neural mobilizationmobilization CheckCheck forfor doubledouble crushcrush problem:problem: elbow,elbow, shoulder,shoulder, neckneck andand treattreat correspondingcorresponding areasareas NSAIDSNSAIDS SurgicalSurgical release:release: failurefailure ofof conservativeconservative txtx oror ifif significantsignificant thenarthenar atrophyatrophy oror sensorysensory lossloss FINGER DEFORMITIES SwanSwan NeckNeck BoutonniereBoutonniere ClawClaw fingersfingers TriggerTrigger fingerfinger ApeApe handhand BishopsBishops handhand DupuytrenDupuytren ContractureContracture MalletMallet fingerfinger GamekeepersGamekeepers ThumbThumb .
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