Male patient aged 44 with pain on the medial side of the right elbow and on the ulnar side of the forearm. The problem has been present for a couple of years, but it always gets worse during the summer. Last winter was also painful, but symptoms were not constant, more following the activity level. Loss of strength in the forearm and grasping followed the pain. Symptoms started to present on the left side this year. Very active person who competes on high level endurance races cross country.
During examination we quickly found out that the ulnar nerve was very tight and that the nerve itself bounced anteriorly and posteriorly during extension and flexion of the elbow. Increased tightness of the ulnar nerve was palpated by the medial elbow/forearm when shoulder external rotation and abduction were introduced (more stretching of the nerve). Patient reported increased symptoms when ulnar nerve was tested. Patient presents restrictions in shoulder external rotation and abduction (more active than passive).
Her knees always get painful first and then the hips will start to hurt. This typically happens after 45 to 60 min. of playing tennis. She feels that it is a bit less painful and that it takes longer time to trigger the symptoms when playing on softer ground.
Examination indicated a compensatory pattern from the toes to the spine. Reproduced knee pain by testing and palpating the knee capsule, lateral meniscus and the insertion of the iliotibial band. Both feet were pronating. Stretching the external rotators of the hip showed restrictions and increase in pain. Adductors were sensitive and shortened. Decreased dorsal flexion of the ankle both side and decreased inversion of ankle joint. Squatting was difficult to perform. Poor activation of peroneus longus and brevis.
Male patient aged 44 referred by the GP with impingement diagnosis of the left shoulder. He had already tried physiotherapy and rehabilitation, this without positive results. He is now up for surgery (MRI showed bursitis and changes of the supraspinatus tendon). The patient works as a carpenter, which has been difficult the last year. He feels that he does not have any force left, its painful almost at all times and he can only abduct the shoulder 20 to 30 degrees and has extreme limited external rotation. He experiences sharp local pain by the acromion and some more diffuse pain on the posterior and lateral side of the upper humerus. Difficult to sleep due to pain. Classic impingement syndrome.