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Pathologies of the Elbow
ByBy
Stephanie BelshStephanie Belsh
And And
Bobbi SnowBobbi Snow
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Lateral Epicondylitis (tennis elbow)
PathologyPathology 30 – 50 years old30 – 50 years old Repetitive micro-trauma Repetitive micro-trauma Chronic tear in the origin of the extensor Chronic tear in the origin of the extensor
carpi radialis brevis lateral epicondylecarpi radialis brevis lateral epicondyle Muscle imbalanceMuscle imbalance
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Lateral Epicondylitis (tennis elbow)
Mechanism of InjuryMechanism of Injury Overuse syndrome caused by repeated Overuse syndrome caused by repeated
forceful wrist and finger movementsforceful wrist and finger movements Tennis playersTennis players Prolonged and rapid activitiesProlonged and rapid activities
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Lateral Epicondylitis (tennis elbow)
Clinical Signs and Symptoms Clinical Signs and Symptoms Increased pain Increased pain Tenderness in palpation Tenderness in palpation TestsTests
Passive Passive Active Active Lidocaine Lidocaine
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Medial Epicondylitis (golfer’s elbow)
PathologyPathology 30 - 50 years old30 - 50 years old Repetitive micro traumaRepetitive micro trauma Muscle imbalanceMuscle imbalance
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Medial Epicondylitis (golfer’s elbow)
Mechanisms of injuryMechanisms of injury Throwing a baseballThrowing a baseball Racquetball or tennisRacquetball or tennis Swimming backstrokeSwimming backstroke Hitting a golf ballHitting a golf ball
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Medial Epicondylitis (golfer’s elbow)
Clinical signs and symptomsClinical signs and symptoms Increased painIncreased pain Tenderness on palpationTenderness on palpation TestsTests
PassivePassiveActiveActiveLidocaineLidocaine
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Lateral and Medial Epicondylitis
Common TreatmentsCommon Treatments Physical TherapyPhysical Therapy MedicalMedical SurgerySurgery
Injury preventionInjury prevention
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Ulnar Neuritis
PathologyPathology Superficial position at the elbowSuperficial position at the elbow Excessive pressure in this areaExcessive pressure in this area 30-60 years30-60 years Second most common entrapment Second most common entrapment
neuropathy in the upper extremityneuropathy in the upper extremity
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Ulnar Neuritis
Mechanism of injuryMechanism of injury Repeated activities Repeated activities Compression of the ulnar nerve Compression of the ulnar nerve Fractures Fractures Dislocation Dislocation
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Ulnar Neuritis
Clinical signs and symptomsClinical signs and symptoms Local tenderness Local tenderness R/O subluxation R/O subluxation Nerve conduction study/EMG Nerve conduction study/EMG Sensory changes Sensory changes Delayed injury onsetDelayed injury onset
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Ulnar Neuritis
Common treatmentsCommon treatments Non-operativeNon-operative Surgical interventionSurgical intervention
PreventionsPreventions
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Medial Overload Syndrome in Throwers
PathologyPathology Repetitive stress Repetitive stress
Mechanism of injury Mechanism of injury Pitching Pitching Partial or complete avulsion of the medial Partial or complete avulsion of the medial
apophysis apophysis Articular cartilage and subchondral bone Articular cartilage and subchondral bone
changes changes
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Medial Overload Syndrome in Throwers
Mechanism of injuryMechanism of injury (continued) (continued) Avulsion of the posterior olecranon Avulsion of the posterior olecranon
epiphysis epiphysis Stress fracture Stress fracture Ulnar nerve neuritis medially Ulnar nerve neuritis medially
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Medial Overload Syndrome in Throwers
Clinical signs and symptomsClinical signs and symptoms Persistent medial elbow sorenessPersistent medial elbow soreness Arm fatigue is the 1Arm fatigue is the 1stst indicator of indicator of
impending injuryimpending injury Medial tenderness Medial tenderness Elbow pain Elbow pain
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Medial Overload Syndrome in Throwers
Common treatmentsCommon treatments Non-operativeNon-operative Surgical interventionsSurgical interventions
Prevention.Prevention.
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Pronator Tunnel Syndrome (proximal
median nerve compression) PathologyPathology
Possible sights of compressionPossible sights of compression Between the humeral and Ulnar heads Between the humeral and Ulnar heads
of Pronator Teresof Pronator Teres Supracondylar process of the humerusSupracondylar process of the humerus Lacertus fibrosusLacertus fibrosus Proximal edge of the flexor digitorum Proximal edge of the flexor digitorum
superficialissuperficialis
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Pronator Tunnel Syndrome (proximal median nerve compression)
Mechanism for injuryMechanism for injury WomenWomen Repetitive movements Repetitive movements
Clinical Signs and Symptoms Clinical Signs and Symptoms Pain in the anterior forearm Pain in the anterior forearm Paresthesias or dysesthesias Paresthesias or dysesthesias Altered sensation Altered sensation TestsTests
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Pronator Tunnel Syndrome (proximal median nerve compression)
Common TreatmentsCommon Treatments Physical TherapyPhysical Therapy MedicalMedical SurgerySurgery
Injury prevention Injury prevention
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Anterior Interosseus Nerve Syndrome
PathologyPathology Areas of possible compressionAreas of possible compression
Between the head of the pronator teresBetween the head of the pronator teres The proximal tendon of flexor The proximal tendon of flexor
digitorum superficialisdigitorum superficialis An accessory muscleAn accessory muscle
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Anterior Interosseus Nerve Syndrome
Mechanism for InjuryMechanism for Injury Repetitive elbow flexion with forearm pronated Repetitive elbow flexion with forearm pronated Spontaneously Spontaneously Trauma or fractures Trauma or fractures
Clinical Signs and Symptoms Clinical Signs and Symptoms Pain Pain No sensory complaints or losses No sensory complaints or losses Significant muscular weaknessSignificant muscular weakness
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Anterior Interosseus Nerve Syndrome
Common TreatmentsCommon Treatments Physical TherapyPhysical Therapy MedicalMedical SurgerySurgery
Injury preventionInjury prevention
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Radial Tunnel syndrome
PathologyPathology Radial nerve compressed:Radial nerve compressed:
In the proximal radial tunnel In the proximal radial tunnel The tendon of extensor carpi radialis brevisThe tendon of extensor carpi radialis brevisThe superficial part of the supinator tendon.The superficial part of the supinator tendon.
Mechanism of injuryMechanism of injury
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Radial Tunnel syndrome
Clinical signs and symptomsClinical signs and symptoms PainPain and discomfort and discomfort Sensory changes Sensory changes Low dexterity in finger extension Low dexterity in finger extension Resistive testsResistive tests
Common treatments Common treatments Prevention Prevention
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Posterior Interosseous Nerve Syndrome
PathologyPathology Compression or entrapment of the nerve Compression or entrapment of the nerve
Mechanism of injuryMechanism of injury Repetitive motion Repetitive motion
Clinical signs and symptoms Clinical signs and symptoms Pain Pain
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Posterior Interosseous Nerve Syndrome
Clinical signs and symptoms (cont.)Clinical signs and symptoms (cont.) Loss of active extensionLoss of active extension Tenderness Tenderness Weakness Weakness
Common treatments Common treatments PreventionPrevention
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The End