00:00
We're going to move on
to the elbow now.
00:03
The elbow is another hinged joint .
It is made up of the humerus.
00:08
You'll have the medial epicondyle
and the lateral epicondyle.
00:12
We'll also talk about the
bony attachments
including the radius and the ulna
that's making up the elbow joint.
00:19
The ligaments that hold the elbow together
are typically strong ligaments.
00:24
You have the radial collateral ligament,
the ulnar collateral ligament,
the annular collateral ligament
and the interosseous membrane
holding the elbow
together.
00:36
These four are generally tight.
They're a little bit looser in infants
and maybe an issue more
in kids than in adults.
00:46
But when we look at the elbow,
I want to talk about range of motion.
00:50
Extension is generally to 0 degrees,
sometimes 5 degrees extra,
flexion 130-145. Pronation
goes to 75 degrees.
00:59
Supination goes to 85 degrees.
That's the elbow motion.
01:03
When we talk about pathologies,
I just wanted to mention four
which is lateral epicondylitis,
medial epicondylitis,
the tennis elbow and golfer's elbow,
radial head dysfunction, and collateral ligament injuries.
01:19
Starting with lateral epicondylitis, this is
elbow pain on the outside
that radiates down the forearm due to
repetitive motion of sports.
01:30
You'll feel the pain in
the wrist as well.
01:33
A provocative test is called
Cozen's test.
01:36
It's when you have the elbow
in full extension
and you extend their wrist
against their resistance.
01:45
If you have pain, that's
a positive test.
01:48
We will do strain counterstrain
for lateral epicondylitis,
finding the tender point
on the lateral aspect.
01:56
You can also do
muscle energy,
having the patient use
resistance against the elbow
in order to free up
motion of the elbow.
02:05
Medial epicondylitis is a very
similar problem on the inside.
02:09
It's generally elbow pain that radiates
to the dorsum of the forearm
due to repetitive finger
and wrist flexion.
02:18
It can also happen
from wrist pronation
especially when the
elbow is flexed.
02:24
So that's a
tennis elbow.
02:26
Provocative tests are when
you get pain during resistance
and pain with wrist flexion with
passive wrist extension.
02:35
Those are things
you want to check
to see if there is
a tennis elbow.
02:39
It is an overuse injury. Treatment is
first and foremost rest,
stop doing what's causing the problem.
Ice can help.
02:46
Analgesic can help.
Steroids can help.
02:48
We do manipulative procedures as well,
strain counterstrain,
muscle energy, myofascial release,
and facilitated positional release.
02:58
I want to talk about radial head
dysfunction as well.
03:00
More common in
kids than adults.
03:02
It is a radial head dislocation
that happens from a fall
with an outstretched arm
who are being pulled up
by somebody lifted by the arms
with a weak ligament
that allows the radial head
to be pulled out.
03:15
They'll be nursing the arm and not using the arm.
03:19
On examination, you’ll want to assess the range of motion of the joint.
Notably, they’ll be unable to supinate or pronate the arm.
03:28
It is easily treatable. It's more an awareness and a diagnosis being made.
03:33
Management is putting it back into place. It doesn't require surgery at first.
03:37
The osteopathic portion of treatment is loosening up the muscles prior to putting it back into place,
and using muscle energy to get the posterior head back into place or the anterior radial head put back into place.
03:52
Either one can occur.
03:53
The next item to talk about is medial and lateral collateral ligament injuries.
03:59
These are when you have swelling or inflammation of the ligaments on the medial or lateral aspect of the elbow.
04:07
Provocative tests are looking at the valgus or varus stress as applied to it.
04:13
Knowing that when you push, what does the patient look like?
Do they feel uncomfortable?
You want to see if there's pain or increased laxity in that area, if it feels loose and out of socket.
If you do, that's something that you want to rest as well and let the tendon have time to heal.
We can do muscle energy techniques
to treat the hypertonicity,
to help relax the muscle
and enhance motion,
and give it time to heal
but rest. Anti-inflammatory
and bracing are also very important
aspects of treatment.
04:44
In the elbow, we worry about
the neurovascular bundle
and the radial nerve
getting entrapped
or other areas in the elbow
being interrupted.
04:57
For a radial
nerve entrapment,
we do worry when
there is pain
just distal to the lateral
epicondyle with paresthesias,
numbness and tingling in the hand
due to the impingement.
05:11
This may be a medical
emergency
and needs to be addressed
right away.
05:15
There are osteopathic approaches
to treatment in the meantime.
05:19
But again, the definitive treatment
needs to be arrived at.
05:22
Cubital tunnel syndrome is ulnar nerve
entrapment on the medial side
with numbness and tingling
coming down
towards the fifth digit with
medial elbow tenderness.
05:35
This will have a positive
Tinel's sign.
05:37
When you tap on it,
are you going to elicit
the numbness and tingling
down the hand.
05:44
A positive test is when the symptoms
are reproduced with the tapping.
05:50
Again, osteopathic intervention is
the hypertonicity of the muscle,
the stretching of the muscle and
trying to loosen the muscles up
so that the symptoms will go away and
the patient will feel better.
06:01
The last neurovascular entrapment is
median nerve entrapment
which is the
pronator syndrome,
when you have an anterior
interosseous syndrome
with pain and tingling
down the forearm.
06:14
Pronator syndrome affects the
carpal tunnel-like symptoms.
06:19
It causes symptoms in the hands
which are worse with pronation.
06:24
Again, myofascial release
and counterstrain
are the osteopathic
interventions of choice.