Overuse Syndromes

 Overuse can occur in any musculotendinous structure in the elbow region especially in the muscles attached to the lateral or medial epicondyles in response to repetitive stressful wrist motions.  Components: 1.Inflammatory 2.Degenerative Repetitive Trauma Syndromes

1.EpicondylitisInflammatory 2.Tendonitis 3.Tendinosis or tendinopathy Degenerative Components

 Tennis elbow  Lateral epicondylitis  Lateral epicondylalgia  Lateral epicondylosis Lateral Elbow Tendinopathy (Tennis Elbow)

 Backhand stroke in tennis  Repetitive work tasks that require repeated wrist extension, such as computer keyboarding or pulling weeds in a garden  The most frequent location of involvement is in the musculotendinous junction of the extensor carpi radialis brevis Etiology

 Pulled elbow  Pushed elbow  Rotated elbow,  Radial head fracture  Pinched synovial fringe  Radial tunnel syndrome,  Tendinosis  Periosteal bruise Differential Diagnosis

 Golfer’s elbow  Medial epicondylitis  Medial epicondylalgia  Medial epicondylosis Medial Elbow Tendinopathy (Golfer’s Elbow)

 swinging a golf club  pitching a ball  work-related grasping  shuffling papers  lifting heavy objects Etiology

 Gradually increasing pain in the elbow region after excessive activity of the wrist and hand  Pain when the involved muscle is stretched or when it contracts against resistance  Decreased muscle strength and endurance for the demand  Decreased grip strength  Pain Tenderness with palpation at the site of inflammation, such as over the lateral or medial epicondyle, head of the radius, or in the muscle belly. Common Structural and Functional Impairments

 Inability to participate in provoking activities, such as racket sports, throwing, or golf.  Difficulty with repetitive forearm/wrist tasks, such as sorting or assembling small parts, typing on a keyboard or using a computer mouse, gripping activities, using a hammer, turning a screwdriver, shuffling papers, or playing an instrument Common Activity Limitations and Participation Restrictions (Functional Limitations/Disabilities)

Nonoperative Management of Overuse Syndromes

1. Decrease Pain, Inflammation, Edema, or Spasm  Immobilization  Patient instruction  Cryotherapy 2. Develop Soft Tissue and Joint Mobility  Multiple-angle muscle setting (low-intensity isometrics)  Cross-fiber massage  Neuromobilization 3. Maintain Upper Extremity Function  Active ROM  Resistive exercises Protection Phase

1. Increase Muscle Flexibility and Scar Mobility  Manual stretching techniques  Self-stretching techniques  Cross-fiber (friction) massage 2. Restore Joint Tracking at the RU Joint  Mobilization with movement (MWM). Controlled Motion and Return to Function Phases

Mobilization with movement (MWM).

3. Improve Muscle Performance and Function  Counter force elbow sleeve or strap  Isometrics.  Dynamic resistance exercise  Functional patterns 4. General strengthening and conditioning  Plyometric exercises  Activity modification

Exercise Techniques to Increase Flexibility and Range of Motion Exercise Interventions for the Elbow and Forearm

Flexibility of Elbow Flexors

Flexibility of Elbow Extensors

Flexibility of Forearm Supinator

Self-Stretching Techniques: Muscles of the Medial and Lateral Epicondyles

Self Stretching (Muscles of Common Extensor Origin )

Strength Training of Elbow Flexors

Strength Training of Elbow Extensors

Strength Training of Forearm Supinator/Pronator

Strength Training of Wrist Extensors

Closed Chain Exercise for Elbow Flexors

Closed Chain Exercise for Elbow Extensors

Strength Training of shoulder External and Internal Rotators