Elbow Pain.

ELBOW PAIN
1.LATERAL ELBOW PAIN

 The lateral elbow is the most common site of pain about
the elbow Some diagnoses that need be considered are
tennis elbow, referred pain from the cervical and upper
thoracic spine, synovitis of the radiohumeral joint,
radiohumeral bursitis, osteochondritis dissecans of the
capitellum and radius, or a combination.
 If your patient is between 30 and 60 years with local

lateral elbow pain, with or without some spread into the
forearm, but no pain in the neck, arm, and beyond the
wrist, then "tennis elbow" is the likely diagnosis.
 Lateral epicondylitis (LE) – commonly
referred to as tennis elbow – is the most
frequently diagnosed condition affecting the
elbow.
 Tennis players often experience elbow pain,
 Archers or shooters may also present with
pain relating to the lateral epicondyle and
the extensor tendon.
Anatomy and biomechanics
 Theprimary structures involved in LE are
the extensor carpi radialis brevis (ECRB),
and less frequently, the extensor carpi
radialis longus (ECRL).
Symptoms of tennis elbow
 The main symptoms of tennis elbow are pain and muscle

weakness.
 The pain can radiate into the forearm and wrist.
 The weakness can make it difficult to grip objects, shake
hands, and turn doorknobs.
INCORRECT BACKHAND TECHNIQUE Lateral epicondylitis (LE)
SELECTING THE CORRECT TENNIS RACQUET GRIP
SIZE.?
EXAMINATION AND ASSESSMENT
 An assessment of a patient presenting with lateral

elbow pain should include grip strength using a
hand-held dynamometer – up to a loading where
pain presents.
 Active, passive and resisted movements of the
elbow, forearm and wrist must be performed – as
well as the neurodynamic testing of the radial nerve
to rule out spinal pathology.
 The special tests for testing medial and lateral
ligament instability should also be included. special
tests are available to assist with a diagnosis of LE.
These include the Cozen, Maudsley and Mills tests
Treatment and recovery time
 Tennis elbow can usually be managed with rest, icing, and
over-the-counter pain medications to relieve symptoms.
 Rehab exercises can help to gently stretch and strengthen
the muscles around the elbow joint.
 For more severe symptoms, need to wear a counterforce
forearm brace or strap to reduce stress and ease pressure on
the injured area.
 If the tennis elbow was caused by playing a racquet sport,
working on your technique may be helpful.
 feel better in a few weeks as the tendon heals, but complete
recovery from tennis elbow can take 6-12 months.
Exercises for strengthening and coordination
We recommend progressively graduated exercise to:
 Improve strength and endurance capacity.
 Normalize flexibility of the forearm muscles.
 Improve coordination.
PHASE 1 ELBOW REHAB
 Hot & cold therapy wrap

 Tennis elbow support/brace
 Exercise resistance bands(Mobility & stretching exercises)
PHASE 2 ELBOW REHAB
 Cold therapy
 Bracing
 1 mobility exercise
 2 strengthening exercises
PHASE 3 ELBOW REHAB
 Cold therapy
 Massage techniques
 Bracing
 1 mobility exercise
PHASE 4 ELBOW REHAB
 Cold therapy
 Massage
 Bracing
Eccentric exercise using a bucket with water (allowing for adjustable
resistance)
Tyler Twist exercise for eccentric loading of the forearm wrist extensors.
Kinesio Tex Tapes
 Follow contraindications and precautions when choosing Kinesio
Taping Method
 Apply the tape on dry skin, free of oils and lotion
 Remove body hair if possible by trimming or shaving the area
 Follow the tension guidelines
 Round all the edges of the tape to prevent premature peeling
 Avoid touching the adhesive side of the tape after removing the
backing as this may decrease the adhesive strength on the skin
 Once the tape is applied, activate the heat-sensitive adhesive
by rubbing the surface of the tape for a few seconds
MEDIAL ELBOW PAIN IN SPORTS
Anatomy and biomechanics
 The UCL is the primary medial restraint

and consists of 3 ligaments: anterior
oblique, posterior oblique, and transverse.
The anterior oblique ligament takes the
greatest load during the throwing motion.
 During throwing, supraphysiological near-tensile
failure valgus loads are placed across the elbow
joint,
 This causes large tensile forces across the medial
compartment, compressive forces across the
lateral compartment, and shear forces posteriorly,
a constellation of forces termed “valgus extension
overload,”
 Accurate diagnosis of UCL injury begins with a
thorough history and physical examination.
 Classically, there is chronic or acute on chronic

medial elbow pain during the late cocking/early
acceleration phase of throwing, possibly without a
distinct injury event.
 Diagnosis is oftentimes delayed, with

neurological symptoms present in as many as 23%
of patients.
 Polk's test may help the clinician to diagnostically differentiate between
Lateral Epicondylitis en Medial Epicondylitis,
POSTERIOR ELBOW PAIN
OLECRANON BURSITIS
 Olecranon bursitis may present after a single
episode of trauma or, more commonly, after
repeated trauma, such as falls onto a hard
surface affecting the posterior aspect of the
elbow.
 This is commonly seen in basketball players
"taking a charge."
 It is also seen in individuals who rest their
elbow on a hard surface for long periods of
time when it is known as "student's elbow." The
olecranon bursa is a subcutaneous bursa that
may become filled with blood and serous fluid
Posterior impingement
 It occurs in two situations.
 In the younger sportsperson there is the
"hyperextension valgus overload syndrome."
Repetitive hyperextension valgus stress to the
elbow results in impingement of the posterior
medial corner of the olecranon tip on the
olecranon fossa.
 Over time this causes osteophyte formation,
exacerbating the impingement and leading to a
fixed flexion deformity.
 Inthe older patient, the most
common cause is early osteoarthritis,
which often predominantly affects
the radiocapitellar joint.
 Generalized osteophytes form
through the elbow. Impingement of
these osteophytes posteriorly results
in posterior pain.
 The main clinical feature in
sportspeople with posterior
impingement is a fixed flexion
deformity of some degree and
posterior pain with forced extension.
ACUTE ELBOW INJURIES
 Given the nature of an acute elbow injury,
radiography is often used as an initial assessment.
In an does not respond to aspiration and injection,
surgical excision of the bursa is required.
 Occasionally, olecranon bursitis can become
infected. This is a serious complication that
requires immediate drainage, strict
immobilization, and antibiotic therapy.
Osteomyelitis and septic arthritis can follow.
Removal of the bursa is occasionally required.
Triceps tendinopathy
Tendinopathy at the insertion of the triceps

onto the olecranon is occasionally seen.
Standard conservative measures for treatment
of tendinopathy should be used. Soft tissue
therapy including self-massage with a
styrofoam roll,
FRACTURES
 Asthe complication rate for elbow fractures is
higher than with fractures near other joints, it is
essential that fractures in this region are
recognized and treated early and aggressively.
 Unstable fractures, usually those associated with
displacement, should be referred early for
orthopedic management. When the articular or
cortical surface has less than 2 mm (0.1 in.) of
vertical or horizontal displacement, the fracture
can be regarded as stable and treated
conservatively.
Supracondylar fractures
Supracondylar fractures are more common around the age of
12 years than in adults. They often occur from a fall on an
outstretched arm, either from a height or from a bicycle.
Because they are rotationally unstable and have a high rate of
neurovascular complications, these fractures should be
regarded as an orthopedic emergency.
Olecranon fractures
Olecranon fractures occur from a fall onto an outstretched
hand or from direct trauma to the elbow. If the fracture is
non-displaced and stable, the patient should be able to extend
the arm against gravity. Treatment consists of immobilizing the
arm for two to three weeks in a posterior splint, then in a
removable splint and a range-of-motion program commenced.
Radial head fracture
The most common fracture around the elbow in sports
people is the radial head fracture, almost always
resulting from a fall onto an outstretched hand. Most
radial head fractures are minimally displaced or non-
displaced (type I).
For displaced radial head fractures (type 2), surgical
intervention with operative fixation or excision is
preferred.
Comminuted fractures (type 3) are treated by excision.
Type 4 fractures occur in the presence of a dislocation
and can be very unstable. They always require surgical
treatment.
Dislocations Posterior
 The most serious acute injury to the elbow is posterior
dislocation of the elbow. This can occur either in contact
sports or when falling from a height.
 There is often an associated fracture of the coronoid
process or radial head. The usual mechanism is a
posterolateral rotatory force resulting from a fall on an
outstretched hand with the shoulder abducted, axial
compression, forearm in supination then forced flexion of
the elbow.
 The major complication of posterior dislocation of the
elbow is impairment of the vascular supply to the forearm.
Assessment of pulses distal to the dislocation is essential. If
pulses are absent, reduction of the dislocation is required
urgently.
Reduction
 With the elbow held at 45",
 stabilises the humerus by gripping the
anterior aspect of the distal humerus,
and traction is placed longitudinally
along the forearm with the other hand.
 The elbow usually reduces with a
pronounced clunk. If vascular
impairment persists after reduction,
urgent surgical intervention is required
Forearm pain
Fracture of the radius and ulna The bones of the forearm are
commonly injured by a fall on the back or front of the
outstretched hand. It is usual for both bones to break,
although a single bone may be fractured in cases of direct
violence or in fractures of the distal third where there is no
shortening.
Two types of dislocation occur-
the Monteggia injury (fractured ulna with dislocated head of
the radius at the elbow joint)
and the Galeazzi injury (fractured radius with dislocated
head of the ulna at the wrist joint)
Stress fractures
 forearm bones occur occasionally sports people

involved in upper limb sports (e.g. baseball,
tennis, swimming). Treatment involves rest and
correction of the possible predisposing factors,
such as faulty technique.

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ELBOW PAIN

1.LATERAL ELBOW PAIN

 If your patient is between 30 and 60 years with local

 The main symptoms of tennis elbow are pain and muscle

 An assessment of a patient presenting with lateral

 Hot & cold therapy wrap

 The UCL is the primary medial restraint

 Classically, there is chronic or acute on chronic

 Diagnosis is oftentimes delayed, with

Tendinopathy at the insertion of the triceps

 forearm bones occur occasionally sports people

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