DeQuervain's Syndrome

Thumb Pain with Muscle Power Deficits

• Patients with DeQuervain’s Syndrome often report burning pain around the dorso-radial aspect of the wrist and thumb often exacerbated by grasping and/or general wrist movements. Be on the lookout for a history of repetitive gripping, lifting or use of hand tools with the effected extremity! For more clinical findings click here!

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Anatomy

Image via Complete Anatomy by 3D4 Medical

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Movement Fault

• Many upper quarter syndromes, including DeQuervain’s Tenosynovitis, result from repeated faulty movements during work and/or hobbies. In order to better serve patients, it is imperative to understand the movements they perform regularly and address any problematic patterns. (Click image to watch 1-2 minute video)

Key Findings

Finkelstein’s test is an excellent provocation exam to help the clinician determine if DeQuervain’s is indeed present! (Click image to watch 1-2 minute video)

Treatment

• If the patient suffers from acute symptomology, soft tissue mobilization for pain modulation and gentle range of motion exercises should be considered for early intervention. (Click image to watch 1-2 minute video)

Therapeutic Exercise

•  In the case of sub-acute or chronic symptomology, research continues to supports the use of eccentric loading of pathological tendons. It should be noted that the mechanisms behind the benefits of eccentric tendon loading are still being debated.

• As always, address the patient as a whole. Pathology in one area could be a result of compensation for other areas of the kinetic chain!

Sprain of Carpal Ligaments

Wrist and Hand Pain with Movement Coordination Impairments

• If your patient presents to clinic after falling on an outstretched arm or has a history of repetitive/forceful use of the wrist, they may have incurred a sprain of the carpal ligaments! For more clinical findings click here!

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Anatomy

Image via Complete Anatomy by 3D4 Medical

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Key Finding

• Although other mechanisms such as repetitive forceful use of the wrist can potentially cause carpal ligament sprains, a history of falling on an outstretched hand significantly increases the likelihood of carpal ligament pathology! (Click image to watch 1-2 minute video)

Special Test

The scapholunate ligament is one of the more common injured carpal ligaments. With moderate sensitivity and specificity, the Watson test can help the clinician determine potential involvement! (Click image to watch 1-2 minute video)

Treatment

• If the patient suffers from acute symptomology then techniques such as wrist isometrics for muscle activation and pain gating may prove beneficial; however, if subacute mobility deficits arise then wrist mobilizations with movement (MWM) can help restore the lost motions! (Click image to watch 1-2 minute video)

Therapeutic Exercise

• Various ways exist to help strengthen the musculature, which cross the wrist joint. Here is an example of wrist flexion and extension strengthening using a flexbar! This technique not only allows for strengthening, but can also help with range of motion! (Click image to watch 1-2 minute video)

Clinical Pattern Recognition - Elbow Pain

From anatomy to discovering the patient!

• Cubital tunnel syndrome is the second most common neuropathy involving the upper extremity with an estimated incidence of 24.7 cases per 100,000 person-years.

• Approximately 40% of people will experience lateral epicondylalgia (LE) at some point in their life

  • Most common in men and women aged between 35 and 54 years old

•  Up to 50% of all tennis players also experience some type of elbow pain, with 75 to 80% of these elbow complaints attributable to LE

• Approximately 12% of elbow injuries result in contractures requiring surgical release

• See more prevalence information in the Clinical Pattern Recognition: Orthopaedics app here

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Clinical Pattern Recognition

Click on the pain pattern to learn about the patients and develop your clinical patterns!

1. Cubital Tunnel Syndrome - Elbow and forearm radiating pain (1-minute video)

2. Lateral Epicondylalgia - Lateral elbow pain with muscle power deficits (1-minute video)

3. Medial Epicondylalgia – Medial elbow pain with muscle power deficits (1-minute video)

4. Post Traumatic Elbow Stiffness - Elbow pain with mobility deficits (1-minute video)

5. Ulnar Collateral Ligament Sprain - Elbow stability with movement coordination impairments (1-minute video)

6. Pronator Teres Syndrome - Elbow and forearm radiating pain (1-minute video)

7. Supinator Syndrome - Elbow and forearm radiating pain (1-minute video)

Sources: 

Bartels RH, Verbeek ALM. Risk factors for ulnar nerve compression at the elbow: a case control study. Acta Neurochir2007;149:669–74

Gruchow HW, Pelletier D. An epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies. Am J Sports Med. 1979;7:234–238.

Myden C, Hildebrand K. Elbow joint contracture after traumatic injury. J Shoulder Elbow Surg2011;20:39-44.

Nirschl R, Tennis. Elbow. Orthop Clin North Am. 1973;4:787–800 

Cubital Tunnel Syndrome

Elbow Pain and Forearm Radiating Pain

• Does your friend or family member have pain or tingling in their ring and pinky finger when they bend their elbow? Do those fingers often fall asleep on them? If either of those statements are true there is a chance that they have Cubital Tunnel Syndrome. This is caused from an irritation of the ulnar nerve as it is being entrapped in the cubital tunnel.

• If you do not know the common clinical findings no problem! Click here

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Anatomy

Image via Complete Anatomy 2018 by 3D4 Medical

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Special Test

A common test to check if your patient has Cubital Tunnel Syndrome is the elbow flexion test. This test puts the ulnar nerve on tension and has the ability to reproduce symptoms. In addition to this test it is also important that you make sure to check all of the other entrapment sites for the ulnar nerve.  (Click image to watch 1-2 minute video)

Treatment

Once the entrapment site is found manual therapy is a good choice to work on mobility in the area. Make sure to watch the video above to figure out how to help your patient! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Once you have worked on the entrapment site it is important to get the nerves moving again. This can be done through nerve sliders. Once the patient has mastered sliders, is not irritable, and only has pain at or near end range make sure to progress them to tensioners! (Click image to watch 1-2 minute video)

Lateral Epicondylalgia

Elbow Pain with Muscle Power Deficits

• Does your friend or family member have pain on the outside of their elbow? Does the pain get worse when they play tennis or golf?  Do they have pain with gripping? Lateral epicondylalgia is an overuse injury and is caused by repetitive motions.

• If you do not know the common clinical findings no problem! Click here

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Anatomy

Image via Complete Anatomy 2018 by 3D4 Medical

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Special Test

A common test to check if your patient has Lateral Epicondylalgia is to stretch and contract the extensor muscle group on the dorsal side of the forearm. This test puts the common extensor tendon on stretch and has the ability to reproduce symptoms. (Click image to watch 1-2 minute video)

Treatment

Soft tissue mobilization of the wrist extensors has the ability to increase flexibility and decrease pain in the extensor muscle group. (Click image to watch 1-2 minute video)

Therapeutic Exercise

Eccentric exercises are a popular treatment used to strengthen the common extensor tendon. Your patients pain should not be over a 5 on the VAS scale while performing this exercise. As always, make sure to look for other associated impairments! (Click image to watch 1-2 minute video)