after six months of lft fifth PIP fractre which is stiff now pstient has a tender point medial to medial epicondyl of same side .with decreased ROM and flexion above 90degree causes severe pain all investigations hav been normal xcept in MRI slight effusion is seen near ulna n olecranon...... wat could be the condition ???? NCV is not yet done... wat could be the cause as there is no history of fall or any abnormal sensation or pain. please help...i've been treating with tens and doing elbow activ passive ressissted ex's.... but range improved only by 10 degrees past 1 month wit same pain . patient has been suffering from psoriasis and had been on medication like steroids orally for two months . presently not taking medicines.
How old are you? What is your name? Are you a doctor?
I feel the patient might have ulnar nerve dysfunction. Nerve dysfunction due to trauma or may be due to injury while some procedure could be the cause.
Alternatively it could be Carpel Tunnel Syndrome.
Have you looked for Tinel sign on patient?
Ulnar nerve crosses the elbow superficially and posterior to the medial epicondyle in Cubital tunnel and innervates the intrinsic muscles of the hand.
You should also check for Medial epicondylitis (golfer's elbow).
Nerve conduction velocity test could be done to assess the functions of nerve.
Have you repeated any imaging study in recent past? If so what was the report?
What pain meds the patient is on? Is it been spaced out for 24 hours?
Keep me informed.
m a physio. and thr's no tinnel sign no injury n no golfers i did wat i cud may be i might have missd out sumthing jus wanted sum more differential diagnosis..... ru a doctor??? only flexn is restricted and extnsion lacks 5degrees..... i really wanna treat him right plz help if u can....thanx for ur concern...!
So you are a physiotherapist? Have you noticed any effusion behind the elbow? Just check for elbow effusion.
I am a doctor.
Have you done any imaging for the part? I feel you should get it done and also NCV test.
I think it might be elbow arthritis which commonly presents with flexion contracture (incomplete passive and active extension) and pain at terminal extension.
It presents with limitation in elbow flexion.
Elbow effusion can be variable.
Ask for routine AP and lateral radiographs of the elbow.
Activity should be modified to suit the level of symptoms.
I would be interested to know about the patient.
mri had bin done will ask him 2go 4 NCV too but the elbow flexion is too painfull and limited instead of extension.,...... how do we gain thaat the anti inflamatry isnt showin mch effect .... tell me if i can help him anywayz...rest i've told you complete details bout that patient nothin else to describe. therez no visible effusion at elbow n nothing in the Xrays...or MRI.
I think you should start him on 2 to 3 different group of analgesics.
For example you can start him on Tramadol with Acetaminophen with Ibuprofen with some opoid analgesics.
They should be spaced out over a period of 24 hours. It should be prescribed in such a way that no 2 medicines are given at the same time and there is one analgesic going on in every two hourly or so.
What medicines are you giving and in what dose are you giving?
I think there should be some nerve pathology or a scar tissue which is preventing elbow flexion since you have mentioned that he does not have any elbow effusion.
Keep me informed about the case.
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