Elbow Conditions

Guidelines below can be used to determine when to refer of a patient for therapy or surgery.

To make an appointment to see a hand therapist phone the Auckland Hand Institute on 09 444 9450

To make an appointment to see surgeon Dr Michael Boland phone (09) 443 3469

Lateral Elbow Pain

Diagnosis: Determining the cause of lateral elbow pain is often complex, as the common extensor tendon, collateral ligaments, radialhumeral joint, radial and musculocutaneous nerves, supinator muscle, brachial plexus, and cervical spine may all be implicated. It is not uncommon for there to be multiple components to the pain, and full subjective and objecting assessment is necessary to clarify the underlying pathology.

Management: Treatment is multimodal and dependent on specific assessment findings but may include radiohumeral and cervical spine mobilisation, controlled tendon loading, peripheral nerve glides, soft-tissue massage, postural re-education, activity modification, and ergonomics. In more severe cases immobilisation through casting may be considered.

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Medial Elbow Pain

Diagnosis: As with lateral elbow pain, there are multiple structures that need to be considered, including pronator teres origin (commonly implicated), common flexor tendon, ulnohumeral joint, ulnar nerve, brachial plexus, and the cervical spine. Provocative resisted muscle testing, neurodynamics, nerve sensitivity testing (Tinel’s), postural assessment, and active range of motion are all diagnostically useful. Xrays may be beneficial in determining intra-articular Management If medial epicondylagia (golfer’s elbow) is suspected, controlled degenerative changes, especially if the patient is reporting painful catches or stiffness.

Management: If medial epicondylagia (golfer’s elbow) is suspected, controlled tendon loading, soft-tissue massage, shoulder-girdle stability exercises, and joint mobilisation may form part of a treatment plan. Proximal nerve compression due to poor posture and muscle imbalance is common, and treatment to address these is also commonly employed.

Surgery: Paragraph about surgical options …

Elbow Dislocation

Diagnosis: Typically occurs as a result of traumatic hyperextension of the elbow associated with a fall. X-rays are critical to assess reduction, and determine presence of avulsion fragments. Presentation is likely to include reduced active range of motion, pain on extension, and local swelling.

Treatment: The patient will normally require an elbow brace to prevent full extension of the elbow, but allow functional flexion. The splint is worn for 6-8 weeks to allow soft -tissue healing followed by a weaning period. There is often significant stiffness of the joint at this point, and treatment in the form of massage and joint mobilisation is beneficial.

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Radial Tunnel Syndrome

Diagnosis: Caused by compression of the radial nerve in the proximal forearm, this syndrome presents with dull or burning pain in the area of the lateral musculature. This is in contrast to lateral epicondylagia which is felt more focally at, or just distal to, the epicondyle. Pain may be reproduced with resisted supination, and elbow extension, as compression of the nerve as it passes through the supinator muscle is often the cause. Onset is sometimes associated with the use of a tennis elbow brace, which has caused symptomatic nerve irritation.

Management: Resolution of the causative factors is key, and may include an initial period of elbow splinting to prevent provocative tensioning of the supinator muscle. Treatment may also include nerve glides, soft -tissue massage, and activity modification.

Surgery: Paragraph about surgical options …

Cubital Tunnel Syndrome

Diagnosis: Caused by compression of the ulnar nerve as it passes through the fibrosseous tunnel adjacent to the medial epicondyle. The patient will report sensory deficits in the ulnar nerve distribution, specifically the ring and little fingers. In more severe cases motor weakness may be present, as indicated by Froment’s sign (thumb IP flexion with lateral pinch) or Wartenberg’s sign (small finger held in abduction). Onset may be associated with degenerative changes in the elbow, or activities involving frequent repetitive movements.

Management: Night splinting to hold the elbow in extension and prevent prolonged tension of the ulnar nerve is often beneficial. Direct padding over the cubital tunnel, activity modification (avoiding prolonged flexion), and ergonomic advice may also be employed.

Surgery: Paragraph about surgical options …