Ortho

Ortho

6/25/99

Elbow

Review anatomy
Variety of directions for movement
Annular ligament wraps around
Nursemaid's elbow
Infants
Dislocation of the head of the radius
Arm pulled into extension against their entire weight
Very painful for child
Do not necessarily have to tear the ligament
Reduction and watch for 24hrs. no rehab requirement

Lateral deviation of the elbow—Valgus (abduction stress) Stress—stress medial side of the joint—palpate gapping of the joint w/hypermobility of the joint (stretch of the ligament)
Adduction—Verus Stress—lateral collateral ligament
Sprain/hypermobility/instability
Head of radius is a rotary joint
Should feel rotation in the joint
Can change the mechanics of the hand and wrist if fixated

Epicondylitis—inflammation of the epicondyle
Covered w/periosteum
Highly innervated
From sprain to collateral ligaments
Strain from Sharpie's fibers (muscle attached to bone)
Lateral is tennis elbow—common e´ tensor tendonitis
Medial is golfer's elbow
Pain will be on the distal humerus
Will have no specific complaint above the joint
Pain will be going down forearm
Brier Table 4-5

	Lateral Epicondylitis	Myofascitis of forearm
Physical exam findings	Palpable tenderness anterior and distal to lateral epicondyle at extensor Capri radialis brevis Sometimes direct tenderness at lateral epicondyle Pain on active extension, w/or w/o resistance Bogginess or thickening over common extensor aponeurosis Weakness in grip Positive Mill's and Cozen's test	Pain on wrist extension Palpable tender points (trigger points) in extensors of forearm Hypertonicity of wrist extensors Weak grip
Treatment Plan	Active rest (limit work, not immobilized), transverse friction massage,(increase vascular activity and neural activity), ice, electrotherapy, putty exercise Counterforce brace for heavy activity Strengthening exercises for forearm Rest, ice, electrotherapy, or pulsed ultrasound Counterforce brace Oral NSAIDs If refractory, rest, ice, injections (limited to series of three), manipulation Surgical debridement as last resort	Ice massage, ultrasound, soft-tissue stretching Acupressure, isotonic exercise
x-ray findings	Usually normal Necessary to rule out soft-tissue calcification around lateral epicondyle	Usually normal

Bogginess—contained fluid

Wrist

Hoppenfeld's green book
Brachioradialis

Myofascitis—inflammatory b/w muscle and fascia

For every bundle there is ct
Microscopic adhesions that can have functional problems
Will get abnormal metabolic affects
Build up of toxic waste in an area
Impairs the lymphatic drainage
Constant contraction, continually working, creating waste
Trigger points
Inactive—reproduce pain on palpation
Active—pain all the time
Pattern of referral
Repetitive trauma disorder

Treat strain and myofascitis differently

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