Elbow II

Elbow II

1. Dislocation

   • 2nd most common
     • in terms of dislocations (first is shoulder)
   • LRCL tears first
   • PLRI if __ tears
     • LUCL & LRCL; annular ligament is typically intact!
   • symptom
     • mostly stiffness

2. PLRI

   • Postero-lateral rotary instability
   • cause
     • LRCL & LUCL tear; annular ligament is usually intact
   • symptoms
     • -radial head subluxes posteriorly w/supination (it rolls right off humerus and goes posterior) -lateral elbow pain, clicking, snapping or slipping typically @ 40 deg. flexion as elbow is brought into extension
   • locking, clicking, slipping
     • especially at 40 deg. flexion when moving into extension
   • Special Tests
     • Varus stress test, push-up from chair

3. Interventions

   • Hotchkiss Protocol
     • 0-3 weeks
       • -splint elbow at 120 flexion, full pronation -perform AAROM in supine, flexion/extension, and supination/pronation  (but NOT combined extension & supination... do these motions separately)
     • 3-6 weeks
       • -splint remodeled to put elbow at 90 deg. flexion, w/wrist in neutral -perform AAROM in sitting and standing -continue to avoid combined extension & supination
     • 6+ weeks
       • -progressive strengthening as tolerated at elbow and shoulder - NO more splint or restrictions

4. Little League Elbow

   • medial epicondyle apophysitis -9-12 y.o. -due to repetitive throwing/valgus forces -usually not recognized on radiographs
   • pain/tenderness
     • @ medial elbow
   • pain w/flexion
     • of wrist and fingers
   • pain w/gripping
   • Intervention
     • complete rest
       • -for 4-6 weeks -address shoulder impairments -->no IR/ER!! -ice
     • 6+ weeks
       • -gradual return to activity9 -strengthening of flexors and pronators
       • return to throwing
         • recommended:  -50-75 pitches/game-no more than 2x/week -rest 1-4 days in b/t

5. Contracture

   • loss of elbow ROM secondary to immobilization
   • post-trauma
     • fracture, sprain, dislocation
   • decr ROM
   • hypomobility
   • ms weakness
   • decr. soft tissue mobility
   • Interventions
     • joint mobs
     • strengthening
     • stretching
       • low load, long duration
     • dynasplint
       • applies tension in the desired direction @ resting, while also allowing free ROM --> dynasplint