Sprouting Up Therapy

Ulnar neuropathy/cubital tunnel syndrome

Mechanism of Injury
Compression

Signs and Symptoms
Night/morning pain, numbness/tingling in 4th and 5th digits, difficulty with hand coordination, decreased grip strength, pain along medial aspect of forearm, clawhand deformity (Duchenne’s sign), radial deviation of the hand with wrist flexion, elbow flexion test, Tinel’s sign, Wartenberg’s sign

Conservative Interventions
Nerve glides, elbow ROM and strengthening, stretching

Surgical Intervention
Anterior transposition of the ulnar nerve, decompression at Guyon’s canal in wrist

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Triceps tendonitis

Mechanism of Injury
Overuse injury, manual labor, weightlifting

Conservative Treatment
RICE, activity modification, splinting, no injections

Surgical intervention if fracture enthesophytes present

Medial epicondylitis aka Golfer’s elbow

Mechanism of Injury
Concomitant injury, overuse wrist flexion/pronation

Signs and Symptoms
Point tenderness over medial epicondyle, pain with resisted wrist flexion and pronation, pain with passive wrist extension and forearm supination

Conservative Treatment
Activity modification, ice, NSAIDs, heat, stretch, counterforce brace, corticosteroid injection (avoid multiple), massage, progressive strengthening (eccentric), ultrasound

Lateral epicondylitis (most common injury) aka Tennis Elbow

Mechanism of Injury
Overuse, repetitive trauma

Signs and Symptoms
Point tenderness over proximal extensor wad, pain with resisted wrist extension (Cozen’s), pain with massive wrist flexion and forearm pronation (Mill’s), dull ache over lateral epicondyle, decreased grip strength

Conservative Treatment
Activity modification, ice, NSAIDs, heat, stretch, counterforce brace, corticosteroid injection, massage, progressive strengthening (eccentric)

Surgical Treatment
Modified Nirschl Method-release ECRB and EDC tendons

Postop Rehab
Posterior splint 10-14 days, if muscle detached avoid wrist AROM for 4 weeks, submax isometrics at 5 weeks, scar massage, radial nerve glides

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Shoulder Osteoarthritis (OA)

Typical gradual onset

Surgery indicated:
Pain, intact RTC, fair ROM, age >65, limited activity level, later stages, avascular necrosis, fracture
Post-surgical rehab:
Immobilization-abduction pillow for up to 8 weeks, PROM 0-6 weeks, limited ER

Sternoclavicular joint injury

Mechanism of Injury
MVA, FOOSH involving flexion/adduction or extension/adduction
Anterior more common than posterior, posterior life-threatening due to trachea and major blood vessels

Signs and Symptoms
Discomfort/pain near end range of shoulder ROM, visual deformity, chronic subluxation

Conservative Treatment
3-4 day immobilization
2nd-3rd degree sprain treated with figure 8 brace for 2-3 weeks

AC joint sprain/degenerative joint disease

Mechanism of Injury
Macrotrauma, direct blow to shoulder, fall on shoulder with arm adducted
Prior trauma

Signs and Symptoms
Tenderness and pain at AC joint, localized swelling, pain with horizontal adduction, pt cradles arm
Type 1-partial tear of AC ligament, coracoclavicular intact, painful arc 160-180 degrees
Type 2-rupture of AC ligaments with sprain to CC ligament, slight separation
Type 3-full disruption of AC and CC ligaments, AC dislocated, marked “step off”
Type 4-clavicle displaced posterior through trapezius
Type 5->300-500% separation CC interspace
Type 6-rupture of SC joint with displacement of clavicle, potential brachial plexus involvement
DJD-Vague pain, tenderness at AC joint, worse with horizontal adduction

Conservative treatment
Types 1 & 2-sling 2 weeks, gentle ROM and strengthening
Type 3-nonoperative approach first: sedentary, limited overhead activities, non-dominant extremity
Operative: heavy laborer, active older patients, high-caliber throwing athlete

Surgical treatment
Joint sprain: Dunn-Weaver Procedure-excision of the lateral end of clavicle and transfer of the CA ligament
DJD: Mumford procedure-cut out lateral 1/3 of clavicle

Bicipital tendinitis/rupture

Mechanism of Injury
Microtrauma-secondary to impingement
Inflammation>instability>rupture
Powerful supination movement or FOOSH

Signs and Symptoms
Popeye deformity
Bruising

Conservative Treatment generally involves Eccentric strengthening