Journal of Back and Musculoskeletal Rehabilitation

This article examines the basic structure and function of the elbow from a biomechanical perspective. Kinematics, including types and ranges of motion are described. Anatomical and functional parameters related to joint stability and loading patterns are discussed in relation to joint kinetics. A final section summarizes pertinent EMG findings related to elbow function.

The treatment of elbow injuries necessitates establishment of a proper diagnosis. An understanding of anatomic relationships serves as the basis for clinical evaluation. The history must ascertain the details of specific injury as well as identify intrinsic and extrinsic risk factors. Physical examination includes inspection, range of motion testing, palpation, provocative testing, and neuromuscular testing. Radiologic and ancillary testing supplement the clinical evaluation.

Overuse injuries result from repetitive microtrauma that can lead to inflammation and local tissue damage in the form of cellular and extracellular degeneration. The elbow, secondary to its central positioning, is predisposed to an array of injuries that are often companion to associated pathology of the spine, shoulder, and hand/wrist complex. An understanding of etiology and rehabilitative management will assist the clinician in the diagnosis and treatment of common overuse injuries involving the elbow.

The differential diagnosis of symptoms such as numbness, paresthesias, pain, or weakness in the hand must include entrapment neuropathies which can occur about the elbow region. Several potential entrapment sites have been described for the major peripheral nerves during their course down the upper arm and into the proximal forearm. With a well-directed history, physical and electrodiagnostic examination the localization of a specific entrapment site is possible.

The increasing involvement of children in sport and fitness related activity has been parallel by an increase in the frequency of sports-related childhood injury. Immature, open epiphyses, as well as soft articular cartilage predispose children to age-specific injury. An understanding of osseous development, normal radiologic variants, and the diagnosis and treatment of common elbow injuries in the pediatric population will assist the clinician who treats younger patients.

Tennis elbow tendinosis represents a degenerative change in the forearm musculature resulting from chronic repetitive activity. Most cases of tennis elbow will respond favorably to an aggressive rehabilitation program. A small percentage of cases, however, may not respond adequately and may therefore benefit from surgical management. In 1979, Nirschl and Pettrone introduced a new technique for the surgical treatment of tennis elbow. The key to this technique, which has been applied to lateral, medial, and posterior tennis elbow, is identification and removal of pathologic angiofibroblastic tendinosis. Surgical management is followed by aggressive postoperative rehabilitation.

Painful neurological syndromes in cancer patients require comprehensive clinical assessment for their accurate diagnosis. Early diagnosis of the painful neurological syndromes in cancer patients allows the clinician to target his therapy toward preventing escalating pain, disability, and further neurological morbidity. Active rehabilitation is critically important in the management of these patients with neurological pain syndromes. Rehabilitation helps prevent further pain due to the development of secondary problems of immobility or disuse, helps the individual patient achieve his maximal level of functioning and helps each patient adapt to his/her neurological deficits.

Dismal return to work rates and mounting disability costs in the chronic low back pain (LBP) population imply the need for innovative re-employment strategies. The supported employment approach utilizes a vocational specialist under close physician supervision. It is more proactive, less biased, and more specialized than the more traditional case management approach used by many insurance companies. Supported employment has been used extensively at our institution in the brain injured population and we have recently begun exploring its use in LBP patients. Herein, we describe the successful use of supported employment in two individuals with chronic disabling LBP.