The imaging can rule in or out a partial tear in the contractile tissue. The examiner should consider ultrasound or MRI imaging when muscle testing elicits a weak and painful response. The patient may have developed elbow pain secondary to a sports injury such as poor body mechanics on a backhand stroke in tennis. A grade two or three strain will elicit a weak and painful response.ĥ. A grade one strain will exhibit a strong and painful response on muscle testing. Typically, muscle belly strains frequently have a sudden onset. Severe tendinopathy will elicit a weak painful response.Ĥ. Strong and painful muscle testing is consistent with tendinopathy. Although sometimes the patient will report a sudden onset. Tendinopathies usually have a gradual onset of pain associated with muscle overuse. Osteoarthritis and rheumatoid arthritis tend to have a more gradual onset.ģ. With trauma, the loss of range of motion occurs almost immediately. Traumatic arthritis may occur after a fall on the elbow. Typically, at the elbow when arthritis occurs, the loss of flexion is greater than the loss of extension. This may be secondary to an arthritic condition. The patient may have a loss of both elbow flexion and extension. The loss of range of motion may be due to a loose body in the elbow or a positional fault limiting motion in one direction.Ģ. The onset can be secondary to an event or maybe insidious. The patient may have experienced a sudden loss of either elbow flexion or extension. When taking a history for soft tissue lesions at the elbow, the following are examples of what may have occurred:ġ. Therefore at the clinician’s discretion, it may be necessary to perform an examination of the cervical spine and shoulder before examining the elbow. This is particularly true if the patient’s complaints start proximal to the elbow. The examining clinician must keep in mind that lesions at the cervical spine and/or shoulder can refer to pain to the elbow. James Cyriax with the Mulligan concept of physical therapy for treating painful loss of elbow joint range of motion and tendinopathies. The purpose of this article is to introduce the integration of the examination and treatment approach developed by Dr. Excessive and painful valgus stress is frequently experienced by baseball pitchers. Bowlers may experience medial elbow pain due to overuse of their wrist flexors and/or pronators. Tennis players are vulnerable to lateral epicondylitis if their form on the backhand stroke is incorrect. Non-surgical problems at the elbow include sprained ligaments, tendinopathies, bursitis, nerve injuries, loose bodies, and capsulitis.

As the fracture heals and motion at the fracture is permissible, the physical therapist can provide important treatment to help the patient gain range of motion, strength, and function. Fractures require the immediate attention of the skills of a surgeon.

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