Common intra articular

A loose body may be present following trauma or direct blow to the elbow. There may be a history of pain, swelling, heat, +/- loss of ROM. The patient may report a catching, locking or clicking sensation with intermittent pain and swelling.

This condition is common in people who undertake sports or occupations that involved repeated over head activity or heavy lifting (forced elbow extension) (Quinn et al, 1994).

Range of Movement

• Can be decreased in both flexion and extension.
• Extension can be blocked and/or a springy end feel can be found.
• Pronation and supination can be affected depending on location and size of the loose material.

AP and lateral X-ray of the elbow. In case of normal XR with persistent symptoms, MRI can be considered (see escalation).

Overview

• Optimise pain management
• Basic range of movement
• Education

Patient centred care

Treatment should take into account individual patient needs, preferences, expectations and functional status.  Clinical reasoning should inform treatment based on subjective and objective findings. Good communication between therapist and patient is essential if a successful outcome is to be achieved.

Treatment options should be clearly explained so that patients can make informed decisions with regard to their care and management.

Evidence based strategies

‘Cyriax loose body technique’ with Grade A mobilisation.

• Position patient against head of couch, with the arm resting against a pillow. Use a butterfly grip with the thumbs placed on the flexor surface of the forearm, over the radius. Face the direction of the supination movement and lift the leg farthest from the patient off the ground, leaning out to establish traction with straight arms. Step forwards, taking the elbow joint towards extension (not full range), whilst simultaneously rotating the forearm with several flicking movements towards supination or pronation depending on direction of preference for treatment. (Cyriax, 1998)

https://www.youtube.com/watch?v=eXYc5qPFWgc

Non-evidence based strategies

CSI is not indicated (Quinn et al, 1994).

Progressing as expected (up to 3 Rxs) before discharge or onward referral. 

Refer to ortho, GP, other

Referral to orthopaedics can be considered for orthopaedic opinion if the patient is not progressing and would consider orthopaedic intervention.

Kesson, M. and Atkins E. 1998. Orthopeadic Medicine:  A practical approach. Butterworth-Heinemann.

Quinn, S.F., Haberman, J.J., Fitzgerald, S.W., Traughber, P.D., Belkin, R.I. and Murray, W.T. 1994. Evaluation of loose bodies in the elbow with MR imaging. Journal of magnetic resonance imaging, 4(2), pp. 169-172. Link Here  (link correct as of 16/08/19).

NHS GGC Physiotherapy Service - Elbow

NHS Inform - Elbow Problems