Jnana Myotherapy

• ℗ from throwing or racquet sports; valgus stress
• Clicking & Snapping

Compression Test:
Patient holds palm down & supinates & pronates fully extended arm

• anatomy: from the level of the radiocapitellar joint, extending distally past the proximal edge of the supinator
• Night ℗
• Localized tenderness over radial nerve 5cm distal to lateral epicondyle

PIN:

• anatomy: branch of the radial nerve that provides motor innervation to the extensor compartment
• Strength deficits of extensor musculature
• Weakness in finger, wrist & thumb movements
• Impaired ability to extend thumb (DeQuervain’s tendinopathy)
• Impaired ability to extend wrist in neutral or ulnar deviation

Tests:

• Resisted Hyperextension of Wrist (Cozen’s Sign) → ℗ in proximal radial forearm & over radial tunnel
• Resisted Supination (with wrist flexed) → ℗ in proximal radial forearm & over radial tunnel
• Passive Pronation, applying pressure on the posterior interosseous nerve → ℗ in proximal radial forearm & over radial tunnel + S1 supinator
• Resisted Extension of Middle Finger, Extended Elbow (Maudsley’s Test) → ℗
• Neurodynamic Tension Test

• Nerve Root; Disc Hernia
• Type of ℗ can vary

Tests:

• Axial Loading (Spurling manoeuvre)
• Shoulder abduction relief (Bakody’s Sign) → ↓℗
• Neck Distraction
• Valsalva manoeuvre
• Neurodynamic Tension Test

• persistent insufficiency of LCL complex, particularly the lateral ulnar collateral ligament
• ℗ from trauma causing elbow subluxation or dislocation

Tests:

• Posterolateral Pivot Shift (O’Driscoll’s Sign) (supine, arm overhead; supination & valgus with axial compression) → radial head subluxes at 40⁰ elbow flexion
• Posterolateral Rotary Drawer Test (supine, arm overhead, elbow flexed 40-90⁰)

• Tenderness on palpation over the lateral epicondyle
• Resisted Hyperextension of Wrist (Cozen’s Sign) → ℗
• Resisted Supination (with wrist flexed) → PB
• Passive Wrist Flexion with Radial Deviation (Mill’s Test) → ℗
• Passive Elbow Extension → ℗
• Resisted Extension of Middle Finger, Extended Elbow (Maudsley’s Test) → ℗
• Grip Strength Weakness

• inflammation of tendon & tendon sheath
• ℗ worse with activity

• response to an overuse injury resulting in a pathologic cascade of changes in normal tendon reparative process described as a cycle of degeneration & attempted failed regeneration
• ℗ worse @ night

• Non-inflammatory proliferative response, which is a short-term adaptive thickening in an attempt to reduce stresses
• Generally follows a period of acute overload or direct blow
• Fusiform swelling

• Loss of parallel & longitudinal alignment of collagen bundles
• Neurovascular ingrowth/proliferation from failed healing response
• Increase matrix disorganization & evident swelling
• Increased Tendon Thickening → ℗

• Degenerative Changes
• Extensive compromise of the tendon

• Co-existing neck or shoulder ℗
• Central Sensitization

• Prescribed meds
• Ergonomic/sport-specific advice
• Ice, heat, taping, brace, orthoses
• Electrophysical agents*
• Cervical and/or elbow manual therapy
• Exercise therapy (isometric contractions†)

• Repetitive manual loads
• Co-existing elbow pathology
• Neuromuscular impairments

• Self-administered meds
• Ergonomic/sport-specific advice
• Ice, heat, taping, brace, orthoses
• Electrophysical agents*
• Elbow manual therapy
• Exercise therapy (progressive resistance‡, motor control, general upper limb)

• General advice to reduce loads
• Self-administered meds
• Ice, heat