Elbow Pain Peter Brukner OAM, FACSP Associate Professor in Sports Medicine Centre for Health, Exercise and Sports Medicine University of Melbourne Lateral Elbow Pain tennis elbow lateral epicondylitis extensor tendinopathy Lateral Elbow Pain degeneration of ECRB tendon 1 cm distal to attachment poor blood supply 1
Lateral Elbow Pain invasion of fibroblasts and vascular granulation tissue angiofibroblastic hyperplasia large number nociceptive nerve endings microscopic tears and scarring Lateral Elbow Pain repeated wrist extension tennis, squash, badminton carpentry, bricklaying, sewing age 40-50 Lateral Elbow Pain insidious onset 48-72 hrs post-activity new racquet, heavy (wet) balls poor technique 2
Palpation (Epicondyle) Palpation (ECRB) Resisted Extension 3
Treatment ice electrotherapy massage trigger points stretching Treatment ice electrotherapy massage trigger points stretching Massage Digital Ischemia Muscle Massage Myofascial Release 4
Treatment ice electrotherapy massage trigger points stretching Stretching (Forearm Flexors) Treatment strengthening cervical spine correct predisposing factors brace corticosteroid injection surgery 5
Strengthening Treatment strengthening cervical spine correct predisposing factors brace corticosteroid injection surgery Cervical Assessment / Mobilization 6
Neural Stretching Treatment strengthening cervical spine correct predisposing factors brace corticosteroid injection surgery Excessive Wrist Extension 7
Classic Backhand Treatment strengthening cervical spine correct predisposing factors brace corticosteroid injection surgery Counter-force Brace 8
Treatment strengthening cervical spine correct predisposing factors brace corticosteroid injection surgery Corticosteroid Injection GTN Patches 9
Treatment strengthening cervical spine correct predisposing factors brace corticosteroid injection surgery Lateral Elbow Pain other causes Entrapment of posterior interosseous nerve (radial tunnel syndrome) 4 sites of entrapment Fibrous bands in front of radial head Recurrent radial vessels Arcade of Frohse Tendinous margin of ECRB 10
Posterior interosseous nerve entrapment Repetitive pronation/supination of forearm Paresthesia in hand and lat forearm Pin over forearm extensors Wrist ache Max tender over supinator Marked pain on resisted supination of forearm with elbow flexed to 90º and forearm fully pronated Medial Elbow Pain flexor tendinopathy medial ligament sprain ulnar nerve compression Resisted Wrist Flexion 11
Medial Elbow Pain flexor tendinopathy medial ligament sprain ulnar nerve compression Valgus Stressing Elbow Taping 12
Strengthening Ulnar Nerve Compression Traction injuries with throwing Compression in cubital tunnel Recurrent subluxation Irregularities in ulnar groove eg spurs Ulnar Nerve Compression Posteromedial elbow pain P&N or numbness along ulnar border of forearm and ulnar one and a half fingers Tender behind medial epicondyle Tapping may reproduce symptoms 13
Nerve Tapping Posterior Elbow Pain olecranon bursitis triceps tendinopathy posterior impingement Olecranon Bursitis 14
Palpation Point Posterior Elbow Pain olecranon bursitis triceps tendinopathy posterior impingement Common Posterior Impingement 1. Younger athlete hyperextension valgus overload syndrome Repetitive hyperextension valgus stress results in impingement of the posterior medial corner of the olecranon tip on the olecranon fossa Leads to osteophyte formation and fixed flexion deformity 15
Posterior Impingement 2. Older patient Early osteoarthritis Predominantly radiocapitellar joint Mobilizing - Full Flexion Acute Elbow Injuries fractures supracondylar olecranon radial head dislocation medial ligament rupture tendon ruptures 16
Elbow Dislocation Reduction Mobilization (Full Extension) 17
Upper arm pain Referred pain cervical myofascial Upper Arm Pain Referred pain cervical myofascial 18
Myofascial Pain Trigger Point Palpation 19