Assessment of Elbow Pain

Course overview

Subjective examination Area of pain: local vs radiating; somatic structures vs neuropathic History: work history, training history, load targets for treatment planning Differential diagnosis most common elbow conditions: tendinopathy, olecranon impingement, loose bodies. Other potential diagnostic considerations: instability, plica syndrome, peripheral nerve entrapment, OA, inflammatory arthropathies Peripheral neuropathy: Symptoms may be similar to lateral/medial elbow tendinopathy Radial nerve tender on palpation (between triceps and biceps laterally, over supinator, in snuff box) Pain (elbow, forearm, wrist, mid humerus) + weakness aggravated by isometric supination with elbow in extension and maximal pronation PIN: Weakness of thumb abduction / extension Weakness of extensor digitorum & ECU History - traction versus compression (e.g. secondary to valgus instability) Tinel's sign May report snapping - hereditary subluxation over the medial epicondyle (a stretch aetiology, rather than compression) Nerve conduction studies Contributing risk factors to elbow symptoms: psychosocial, age, work/sport, genetics, medications, co-morbidities Instability: Baseball, Rugby, Gymnastics, Tennis, Power lifting, Snowboarding, volleyball S&Ss: +ve valgus stress tests, loss of function, pain on palpation Med Pain over medial elbow during elbow flexion, throwing, Possible swelling (absent in chronic) Loss of ROM - extension; Positive radiographic examination Patient-Rated Tennis Elbow Evaluation - validated and reliable self-reported questionnaire on pain and function. Physical examination Observation: Carrying angle, swelling, muscle contour ROM: Cx, shoulder, elbow - Loss of elbow extension is a sensitive indicator of intra-articular pathology Passive movts: F/ADD, F/ABD, E/ADD, E/ABD Ligament stress tests: MCL, LCL Palpation Medial: Medial epicondyle, MCL, Ulnar nerve Lateral: Lateral epicondyle and insertion of common extensor tendon, LCL, Radial nerve (Arcade of Froshe) Posterior: olecranon process and bursa, Triceps tendon Special tests PFG Isometric wrist and middle finger extension test Posterolateral rotary instability (table top relocation) Pronator Teres syndrome