1. Differential Diagnosis & Treatment
The Elbow
Differential Diagnosis & Treatment

2. Pathology Throwing, hitting, punching, pushing, painting
Shoulder dysfunction
Cervical spine pathology

3. Capsular

4. Osteoarthritis Post traumatic Capsular pattern Crepitus Older patient
Electrotherapy and mobilisation or injec into joint

5. Rheumatoid Arthritis Lax ligaments – reduced stability
Synovial thickening and swelling, flexion deformity
Steroid injec and rest or oral medication

6. Traumatic Arthritis Cause – fall or hyperextension
Acute – x-ray and aspirate
Sub acute – steroid injection and rest or 1 week rest in flex and gradual gentle mobs
No friction – myositis ossificans

7. Non capsular

8. Loose body eg Osteochondritis Dissecans and OA
Pain and springy end feel
Locking
Either in coronoid or olecranon fossa
Treatment
EUA removal

9. Cubitus varus and valgus
Reduced or increased carrying angle
Following fracture
Children
Epiphyseal damage
May need surgical correction

10. Bicipital Bursitis Pain at front of elbow
Pain – full passive pronation
Some pain on resisted flexion in supin
Treatment - injec

11. Olecranon Bursitis Posterior elbow pain Pain on full passive flexion
Some pain on resisted exten
Carpet fitters, RA,
students
Treatment – aspiration and
/or injection

12. Contractile

13. Tennis Elbow Causes: 2 joint muscle – lengthening across 2
joints + added force
– sheer stress at origin
Overuse
Gripping

14. Tennis Elbow Pathology 6months – 2years
Microscopic tears – failed healing - inflammation
Fibroblasts
Vascular hyperplasia
Disorganised collagen
Tendinitis or tendinosis

15. On examination 20-30’s most common and degen 40yrs +
Pain on resisted wrist extension with elbow extension
Reduced grip strength
Pain on palpation

16. Lateral Epicondylitis (tennis elbow)
4 sites
1)ECRL on supra-condylar ridge
2)CEO
3)Body of tendon
4)belly of muscle

17. Tennis Elbow Treatments
1)ECRL – friction and rest
(forearm in supination)
Frictions must be specific and transverse
Chronic – numbness + 10 mins

18. Tennis Elbow Treatments
2)CEO Injec and rest or friction, mills manip, stretch and rest (forearm in supination)

19. Tennis Elbow Treatments
2) CEO cont
3)Body of tendon - injec and rest or friction and rest (forearm in pronation)
4)Belly of muscle – injec and rest and frictions (forearm in mid position)

20. Tennis Elbow Other Treatments
Advice
Must adjust technique or grip in sports
Stretches
Strapping
SSTM/ muscle energy techniques
Acupuncture

21. Medial Epicondylitis (golfer’s elbow)
2 sites
1)CFO
2)MT junction

22. Golfer’s Elbow cont Overuse
Pain on resisted wrist flexion with elb ext

23. Golfer’s Elbow Treatments
1)CFO – injec and rest or friction and rest
2)MT junction – friction and rest

24. Biciptal Tendonitis Overuse Pain on resisted elbow flexion with supin
Treatment – MT junc friction and rest