Bicipital Tendonitis Bicipital Tendonitis It is an inflammation of the long head tendons and it is a common cause of shoulder pain. Usually associated with problems in the rotator cuff. Most common in athletes Dr Salameh Al dajah Ortho 2014 Symptoms Shoulder pain Shoulder pain when lifting heavy objects Shoulder pain when performing overhead activities Tenderness over bicipital groove Dr Salameh Al dajah Ortho 2014 By physical examination: Speed test: Patient complains of anterior shoulder pain with Diagnosis flexion of the shoulder against resistance, while the elbow is extended and the forearm is supinated. Yergason test: The patient complains of pain and tenderness over the Bicipital groove with forearm supination against resistance with the elbow flexed and the shoulder in adduction. Popping of subluxation of the tendon may be demonstrated with this maneuver. Elbow Injuries Elbow Fractures • • • • Olecranon fractures Radius head fractures Supracondyler fractures Elbow dislocations Tennis Elbow Also known as lateral epicondylitis. The incidence of LE is 1-2 % in general population. Peak incidence occurring at 40-50 years of age . In women aged 42-46 years incidence increases to 10%. Up to 50% of all tennis players experience some type of elbow pain, and 75–80% of these elbow complaints are attributed to tennis elbow. With tennis elbow, the common extensor tendon origin at the Lateral epicondyle of the humerus is irritated, inflamed, damaged and potentially torn. The occurrence: Acute onset typically seen in young athletes. Chronic condition seen in older people. Pathophysiology Small tears in the tendon occur through overuse. They begin to heal but when reinjured by continued use, the tendons seem to finally give up on trying to heal Then a condition called angiofibroblastic degeneration begins to take over. angiofibroblastic tendinosis tissue is a scar tissue that never reaches maturity and remains weak and painful. Causes This injury is caused by repetitively twisting the wrist or • forearm. The injury is classically associated with tennis playing, hence the name "tennis elbow," but any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to lateral epicondylitis. Symptoms Symptoms of LE are :Pain at the lateral elbow Tenderness Pain exaggerated on gripping or resisted wrist extension or middle finger extension Difficulty holding or gripping objects Golfer's Elbow It is also known as medial epicondylitis. Similar to Tennis elbow (the common flexor tendon origin at the medial epicondyle) 7-20x less common than LE 60% associated with Ulna neuropathy. It is characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm Causes Excessive force used to bend the wrist toward the palm, such as swinging a golf club or pitching a baseball. Other possible causes of medial epicondylitis include the following: weak shoulder and wrist muscles. Symptoms Pain along the palm side of the forearm, from the elbow to the wrist. The pain can be felt when bending the wrist toward the palm against resistance, or when squeezing a rubber ball. However, each individual may experience symptoms differently. Diagnosed of medial epicondylitis The diagnosis of medial epicondylitis usually can be made based on a physical examination. The physician may rest the arm on a table, palm side up, and ask the patient to raise the hand by bending the wrist against resistance. If a person has medial epicondylitis, pain usually is felt in the elbow. Carrying angle carrying angle - the acute angle that is formed by the longitudinal axis of the humerus and the longitudinal axis of .the ulna of valgus 25 -15 Female Male 5-15 of valgus cubitus valgus - carrying angle greater than 25 cubitus varus - carrying angle less than 5 (A) Cubitus varus; (B) cubitus valgus. Hand and Wrist • Collos’ fractures (ulnar and radius styloid dorsal fracture) • Smith fractures (Ulnar and radius styloid folar fractures • Scaphoid bone fractures • Carpal bones fractures • Metacarpal bones fractures • Tendons ruptures (Malt finger) • Carpal tunnel syndrome (median nerve compression • Ulnar nerve compression • Thumb and fingers fractures • Dequavarian tendonitis Treatment • • • • After fracture healing use Active exercise and ROM Paraffin wax For carpal tunnels and tennis/Golvers elbow Ice and US may help • Use FUTURA Splint on the wrist