Feb '25 • CASE STUDY CORNER
MY OFFICIAL BREAKDOWN OF THE SECOND CASE STUDY (ELBOW)
Well done everyone!
You all did very well in the last case study! The hypothesis list was well thought out and clinicall navigated in accordance to what was most likely vs least likely.
In these cases wear we are exploring trauma, repetitive stress/impact over an extended period of time, wirth careful consideration previous structural damage to the elbow... It's EXTREMELY hard to neglect our very basics of biomechanics..
And that is -
STRUCTURE = FUNCTION
If the structure is compromised, this will primarily influence (in most cases) how the surrounding active structures will support the underlying passive system (joint capsule).
This man may present with what most soft tissue therapists would think as ''over active forerarm muscles'' or ''your forearm muscles are over compensating for your biceps, which could be coming from your elbow''.
No!
Whlst active supports do ''cop a beating'' from sports like boxing, there gets to a point where the structural stability that is supposed to provide leverage for muscles and tendons is compromised..
''Too far too gone''
So, in saying this, my diagnosis and problem list is as follows -
1) Elbow OA (mild-mod?) ; secondary muscular overload of wrist & elbow flexors/extensors (mod/chronic)
2) Common extensor/flexor origin tendon pathology (mod/acute on chronic) ; muscular overload symptoms a/a
3) Tricep insertional tendon pathology (mod/chronic) ; muscular overload symptoms a/a
4) Olecarnon #?
My first diagnosis is OA because it is clear that the structural integrity at the elbow joint capsule has been compromised enough in the past to predipose to the current severity of the irritation he is now experiencing.
I've placed my soft tissue/tendon problems later, as we know these are already existing problems that have been recentky excarbated but are not primarily responsible for his symptoms.
Plan of a attack?
Soft tissue forerarms/triceps
Dry needling - tendon focus on tricep/CEO/CFO
Refer out for regenerative medicine option - PRP/?peptide therapy
Rehab -
Pain free elbow loading -
Safe place to start -
A) Isometric holds - farmer carries/mid range curls/elbow extensions
B) Isokinetic loading - pain free pronated bicep curls/kettlebell twists for supination/pronation
Load management - cut the boxing! By at least 25% with modifcation to paddles from pads.
Can elaborate more on the rehab side, but I challenge YOU to design a rehab program for this gentleman...
Drop your thoughts below!
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MY OFFICIAL BREAKDOWN OF THE SECOND CASE STUDY (ELBOW)
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