Pathology
History
S/S
ROM
Olecranon
Bursitis
-Direct trauma
-repetitive
grazing and wt
bearing
- wrestlers,
football players
-Pain
-Swelling
-Tenderness
over olecranon
process
-redness and
heat (infection)
-AROM: may have
decreased motion c
acute injury and pn
-PROM: pn c
overpressure
-RROM: normal str but
can be pn limited
Biceptial
-repetitive
Tendionopathy hyperextension
c pronation
-repetitive
prontation and
supination
-pn anterior
aspect of distal
upper arm
Distal Biceps
Tendon
Rupture
Lateral
epicondylalgia
“Tennis
elbow”
-AROM: pn c shoulder
and elbow √
-PROM: pn c shoulder
and elbow / and
pronation esp. c
overpressure
-RROM: pn c elbow √
and supination
-sudden
-sharp, tearing
-AROM: pn c elbow √
contraction of
pn
and supination
biceps vs
-swelling (acute) -PROM: pn at end
significant load c -activity related range of / and
pn in cubital
pronation
elbow at 90 of
fossa (chronic)
-RROM: weakness of
flexion
elbow √, supination
-baggage
and grip
handlers
-cumulative
-gradual
-AROM: Full ROM but
trauma
-tenderness and may be pn c wrist √
-repetitive
swelling over
and elbow /
overload
lateral
-PROM: Full ROM, pn
-repetitive wrist epicondylar area during wrist √ c
Palpation
(tenderness)
-olecranon
process and
bursa
Special Tests
PT Interventions
Medical MNG
-Acute: ice,
compression, ionto,
splinting, pt education
-Subacute: heat
modalities, ROM, submax isometrics
-Chronic: rehab, str,
fnc training,
protective padding
-Modalities
-Transverse friction
massage
-correction of muscle
imbalances
-STM
-aspiration and
injection of
corticosterioids
-Anti-inflamm
-Surgical excision
followed by
immobilization
(3 wks)
-distal biceps
belly, tendon or
insertion
-Yergason’s
-Mill’s
-defect of distal
biceps tendon
-Biceps
squeeze test
(100% specific,
96% sensitive)
-Modalities
-ROM
-Gentle stretching
-pt education: return
not allowed up to 6
months post surgery
-surgical repair
-elbow protected
6-8 weeks post
surgery
-anterior aspect
of lateral
epicondyle
-insertion of
common
-resisted wrist
/ and radial
deviation c
elbow /
-passive elbow
-Pn control: rest,
splinting, counter
force bracing,
modalities, STM
(cross friction), MWM
-Anti inflamm
-surgical (6
months)
-Anti-inflamm
* most
common ECRB
/, rotation and
grasping
Medial
Epicondylalgia
“Golfers
elbow”
-overuse
-repetitive  and

Elbow sprains
-isolated varus
or valgus force
-hyperextension
force
-FOOSH
Elbow
dislocations
-trauma:
hyperextension
*most
-aching at night
-nocturnal pn
-stiffness in AM
-dropping things
in pronated
position
forearm pronated and
elbow /
-RROM: pn c wrist /,
radial deviation c
elbow extended,  grip
strength, weak
shoulder girdle m,
muscle imbalances in
forearm and shoulder
-pn over medial -AROM: normal c slight
epicondyle and
pn c wrist √
flexor forearm
-PROM: pn c wrist /,
-pn may radiate supination, elbow /
into wrist
-RROM: pn c wrist √
and pronation
-generalized pn
-AROM: non capsular, /
c pt tenderness
limited greater than √
over ligament
-PROM: pn c /, mucle
involved
guarding end feel
-worse c elbow / -RROM: initially (+) for
may be relieved pn
c elbow √
-Accessory motion:
-ecchymosis
laxity c distraction,
-guarding of arm medial and lateral
glides depending on
ligament
-Neuro: may get (+)
ulnar nerve
- severe,
-AROM: non-capsular
constant pn
pattern, / limited
-possible n/t
greater than √
-PROM: pn c /, spasm
and guarding end feel
extensor tendon
-radial head
/ c wrist √
-Cozen’s
-Mill’s
-3rd finger
-DIFFERENTIAL
DX
-Exercise: stretching,
prox. Stabilization,
plyo, fnc training
-pt education:
modification of
aggravating factors,
stretching, ice after
activity
-flexor-pronator
origin
-Golfer’s elbow
-Modalities
-Rest
-ROM and stretching
-Strengthening
-Activity modification
-Anti-inflamm
-corticosteriod
injection
- pt tender over
ligament
-Varus or
Valgus stress
-Posterolateral
pivot shift
apprehension
-moving valgus
stress (100%
sensitive, 75%
specific)
-Modalities
-ROM
-Sub-max isometrics
progressing to
isotonic
-Throwing and
conditioning
-taping/bracing for
sports
-anti-inflamm
-immobilization c
sling that
prevents full /
-surgical repair
(competitive
athletes)
-over ligaments
-monitor for
neural tension
-Immobilization (2-3
weeks): AROM of
shoulder, wrist and
hand, sub-max
isometetrics,
-immediate
reduction
-immobilization
for 2-3 weeks
post injury
-↑temperature
common is
posterior
Pulled
(Nursemaid’s)
elbow
-sudden traction
on the pronated
wrist and /
elbow
-pn in forearm
or wrist
-arm hangs
limply c elbow /
and forearm
pronated
Little Leaguer’s
Elbow
-insidious or
suddenly
-usually sudden
onset 2nd to fx at
sight of lesion
-pn medial
aspect of elbow
-persistent
discomfort or
stiffness
-locking or
catching (if
loose body)
-RROM: acute phase all
tests are painful
-Accessory motion:
laxity c humeroulnar
and humeroradial
glides
-Neuro: possible ulnar
or median nerve injury
-AROM: prior to
reduction child resists
any mvt
-PROM: child will resist
attempt to supinate
forearm at elbow
-RROM: may make
reduction more
difficult
-AROM: all motions
may be pn or limited
-PROM: acutely all
motions are pn
-RROM: may not be
accurate due to pn
-Acessory: muscle
guarding, laxity c
medial glide
-radial head
-deformity
-medial aspect
of elbow
modalities (for pn and
edema
-Post-immobilization:
active stretching,
ROM, restricted
strengthening
working into fnc, fnc
training
-reduction
-parental education:
AVOID longitudinal
traction
-possible sling for 1-2
days
-surgical repair
of ligaments
-ulnar nerve
transposition
may be needed
-Parent/coach
education
-rest and elimination
of aggravating factors
(3-6 wks)
-Adhere to little
league rules: limit # of
pitches per game, per
week, per session, # of
days btw pitching
-modalities
-ROM
-Correction of muscle
imbalances
-Gradual return to
activity
-Anti-inflamm
-surgery only for
pt c loose bodies
-reduction of
dislocated radial
head
Cubital Tunnel
Syndrome
Radial nerve
entrapment at
the elbow
High radial
nerve
compression
Posterior
interosseous
syndrome
-repetitive
activities
-trauma
-chronic
compression
(sleeping c
elbows bent)
-parasthesias in
ulnar nerve
distribution of
hand
-pn that radiates
prox. Or distally
along medial
aspect of elbow
-↓sensation
along ulnar n
-loss of grip
power and
dexterity
-atrophy of
ulnar intrinsics
-clawing of ring
and small finger
-fx of humerus
-strenuous
muscular
exercise
-extended
crutch
ambulation
-insidious onset
-repetitive
activity
-previous
-loss of wrist /
-loss of finger
and thumb /
-loss of
sensation in 1st
dorsal web
space
-weakness (NO
pn or
paresthesias)
-cramping
-AROM: WNL, late
-cubital fossa
-elbow flexion
-Non-surgical:
-anti-inflamm
stages difficulty / ring
test (99%
modalities, night
-Ulnar nerve
and small fingers and
specific, 75%
decompression
splinting at 40-60,
adducting the thumb
sensitive)
elbow pads, ulnar
-PROM: WNL, may
-Tinel’s
nerve glides,
reproduce pn c
-Froment’s
strengthening, activity
overpressure of elbow
-Wrinkle test
modification, sleeping
√
-ULNT 3
posture
-RROM: weakness in
-Pinch strength -Post-surgical:
wrist ulnar deviation, √
-Grip strength
modalities, splinting,
of ring and pinky,
scar mng, ROM,
adduction of thumb,
strengthening,
ADD/ABD/oppostion
desensitization, ulnar
of pinky
nerve glides, pt
-Accessory: may have
education
some laxity of UCL
-Neuro: sensory loss of
ulnar in hand
* RADIAL NERVE IS MOST FREQUENTLY INJURED NERVE IN FX OF HUMERUS
-most common entrapments are a high radial nerve palsy, posterior interosseous syndrome, and radial
tunnel syndrome
-AROM: difficulty /
fingers and thumb at
MP joints and
abducting thumb
-increased
muscle tone
-soft tissue
tightness
-3rd finger sign
-direct
pressure over
course of nerve
-dynamic splinting
with finger / assist
allowing full finger √
-static night splint in
-therapy referral
Radial Tunnel
syndrome
* dynamic
compression
syndrome
Median nerve
entrapment
Humerus
Supracondylar
Process
syndrome
*compression
at ligament of
Struthers
trauma
-difficulty to /
fingers and
thumb
-difficulty
grasping objects
-difficulty
stabilizing wrist
during activity
-PROM: WNL
-RROM: weak wrist /,
finger /, thumb radial
abduction
- Neuro: Semmes
Weinstein
monofiliament testing,
2 pt discrimination,
ULNT 2b
-insideous onset
-repetitive
activities
-pn and
cramping that is
poorly localized
over radial
aspect of
proximal
forearm
-worse at night
-AROM: WLN, pn c
wrist /, supination and
elbow /
-PROM: WNL, pn wrist
√, pronation, elbow /
-RROM: pn c wrist /
and finger /
-Neuro: Semmes
Weinstein
monofilament test, 2 pt
discrimination, ULNT
2b
-insidious
-Gradual
-onset of
symptoms
unknown
-pn in the wrist
or medial
forearm
exacerbated by
full elbow / and
pronation
-paresthesias in
index and long
finger
-
wrist and finger /
-STM
-thermal modalities
-Radial nerve glides
-Stretching
-Activity modification
-very tender
over radial
tunnel
-resisted
middle finger /
-resisted
supination c
elbow extended
-wrist-cock up splint
-thermal modalities
-STM
-Radial nerve glides
-stretching
-activity modification
-therapy referral
-occasional
surgical release
Pronator
Syndrome
*compression
btw humeral
and ulnar
heads of
pronator teres
-Insidious
-Gradual
-Repetitive
activities
-pn radial aspect
of palm and
palmer aspect of
thumb, index,
middle and
radial aspect of
ring finger
-experience
heaviness in
forearm
-NO nocturnal
Anterior
Interosseous
Syndrome
* compression
btw 2 heads of
pronator teres
-insidious
-some forearm
pn
-WEAKNESS
-inability to
make OK sign
Elbow
Fractures
(General)
-50-60% in
children
-60-70% occur
in boys age 4-10
years
-AROM: WNL, pn c
prontation and wrist √
-PROM: WNL, pn c
supination and wrist /
c overpressure
-RROM:
pn and weakness c
pronation, wrist √,
wrist radial deviation,
thumb oppostition,
thub radal and palmer
ABD, and long finger √
-Neuro: Semmes
Weinstein
monofilament test, 2 pt
discrimination, ULNT
1, 2a
-AROM: WNL
-PROM: WNL
-RROM: weakness in
thumb IP √ and index
finger DIP √
-Neuro: Semmes
Weinstein
monofilament test, 2 pt
discrimination, ULNT
1, 2a
-pronator teres
4 cm distal to
cubital crease c
resistance vs
pronation,
elbow √ and
wrist /
-Grip strength
-Pinch strength
-Wrinkle test
-thermal modalities
-splinting in neutral
position (4-6 weeks)
-STM
-Stretching
-Median nerve glides
-Correction of muscle
imbalances
-activity modification
- NO tenderness
-increased
tone/soft tissue
tightness
-Pinch test
-Grip test
-minimal intervention
bc it usually resolves
spontaneously
-strengthening for
pinch and grip
-Pn management
-edema control
-scar management
-ROM of shoulder,
elbow, forearm, and
wrist
-therapy referral
-Closed
reduction:
posterior splint
or cast in 120 √
-Open reduction:
treatment of
Condylar
fractures
-uncommon
-FOOSH (lateral
column
Intercondylar
fractures
-difficult to
estimate
-wedge effect of
the longitudinal
groove of the
olecranon
-“t” and “Y”
fractures
-common due to
subcutaneous
position
-fall backwards
onto the elbow
-FOOSH
Olecranon
Fractures
Radial head
fractures
-FOOSH due to
axial loading
through the
radial head
-Joint mobilization
-Gradual return to
activities
-Pn management
-Edema control
-Scar management
-ROM
-Strengthening
-Gradual return to fnc
activities
-Pn management
-Edema control
-Scar management
-ROM (all joints)
-Strengthening
-Joint mobilizations
-Gradual return to fnc
activities
-Pn management
-Scar management
-Edema control
-ROM (all joints)
-Stregthening
-Gradual return to fnc
activities
-Pn mangement
-Edema control
-Early AROM
-Stregthening:
choice, plates and
screws
-Closed
reduction: splint
4-5 weeks
-Open reduction:
screw fixation
provides stable
fixation, single
plate may
enhance stability
in presence of
communion
-closed
reduction: rarely
fone
-open reduction:
screws, plates,
wires
-Closed type: cast
2-3 weeks
-Open reduction:
internal fixation
-Closed
reduction: sling
for 3 days (Type
I), sling 2-3
Monteggia
fracture
Essex-Lopresti
fractures
-relatively rare
-direct blow to
the forearm
-FOOSH c arm in
hyperextension
or
hyperpronation
-fx of radial
head c proximal
radius migration
and disruption
of the DRUJ and
interosseous
membrane
-fall from height
isometrics at 3 weeks
progressiong to
isotonics at 5-6 weeks,
heavy resistance not
performed until at
least 8 weeks
-Joint mobilization
-Progressive return to
activity
-Pn management
-Edema control
-Scar management
-AROM
-Strengthening
-Return to fnc
activities
-Pn management
-Edema control
-Scar management
-AROM
-Strengthening
-Return to fnc
activities
weeks (Type II)
-Open reduction:
internal fixation,
immobilization
for 4 weeks in
90-120 of elbow
√
-ORIF:
immobilization in
cast for 6 weeks