Elbow Flashcards
Observation
Observations – Bumps/Bruises/Redness/Scars/Swelling/Muscle Wasting/Discoloration/Alignment – carrying angle (normal ranges 5-10 males, 10-15 females)
Firstly I will be looking at the Carrying angle (patient relaxed, arms by your side and palms facing forward)
- Normal carrying angle – (5°-15°) as Dislocations, fractures and instability can all affect the carrying angle and may be present with bumps, bruises and swelling.
- If it is more than 15° it is described as Cubitus Valgus which could be congenital or through malunion of a supracondylar fracture or malunion of a lateral condyle fracture.
Swelling - I am looking for any swelling Medially and Laterally which could indicate Epicondylitis or swelling around the olecranon could indicate Olecranon Bursitis
- Rheumatoid nodules – Could indicate RA
- Swelling could also indicate gout
- and a Swelling with redness discolouration could indicate Septic arthritis (Red flag)
Muscle wasting
* I am looking for any muscle wasting or pronounced bulging of the biceps known as Popeye’s sign could indicate distal bicep tendon rupture
Wrist drop – Could indicate radial nerve injury
Scars – Previous surgery
Palpation
ANTERIOR – Warmth? Infection or swelling
* (Cubital Fossa) Antecubital Space – where the Anterior joint capsule is and the Distal bicep tendons- DPT tendinopathy (Distal biceps tendon/tug sign & Anterior Joint capsule)
* 4cms distal to cubital space a common area for median nerve compression (Heads of pronator teres)
* Brachial Artery
LATERAL –
* Lat epicondyle (Slightly distal is common extensor tendon/tennis elbow tender point).
* Lateral supracondylar ridge 2cm up LE – common fracture site, especially in children, also attachment of Extensor Capri Radialis Longus/Tricep/Brachioradialis.
* Arcade of Frohse - 3cms distal to Epicondyle: common site of Radial nerve entrapment by suppinators
* Common extensor muscles; Extensor carpi radialis longus/brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
POSTERIOR –
* Cubital Tunnel – Ulnar nerve
* Olecranon: Palpate for warmth, swelling could indicate Olecranon bursitis
* Distal triceps tendon : posterior olecranon (up 2cms from olecranon), Triceps tendinopathy
MEDIAL –
* Medial Epicondyle – site of common flexor tendon (Golfers elbow), Medial epicondylitis if its tender
* Medial collateral ligament – stabilizes the elbow, ligamentous sprains if it is sore
* Cubital Tunnel – Ulnar nerve compression site
* Medial Supracondylar ridge – common fracture site, especially in children, attachment site for Brachialis and Pronator Teres, tricep medial head
* Common flexor tendon – Flexor Carpi ulnaris, Palmaris longus
AROM/PROM
Active/Passive ROM – Good clear instructions, coach with external cues if required to get movement you want. Safe confident handling with PROM, ensure full end range on PROM, ensure stabilisation of appropriate joints
Assess the patients willingness and ability, asses the patients level of pain and assess their range.
Flexion: could you bend your arm up for me 130° to 150°
Extension: And all the way back down as far as you can go -6 to 10°
Pronation: could you put your arms out in front of you and turn them over 75°-80°
Supination: And turn them back again 80-104
All limited with a fracture
AROM/PROM talk about harder end range and what conditions affect passive elbow flexion e.g. osteoarthritis will affect elbow passive flexion, bursitis, dislocations, fractures, tennis and golfers elbow, cubital tunnel syndrome.
PROM:
Talk about harder end range feel and what conditions affect passive elbow flexion E.g. osteoarthritis will affect passive elbow flexion, Medial epicondilytis etc.
RIMS
- Provoking in order to confirm musculotendinous involvement -
- Gives quick information about which direction is painful against resistance to give an idea about which muscles/tendons could be involved
Ensure good position on Flexion (Bicep)
Extension (Tricep)
Resisted Pronation (Can light up median nerve compression),
Supination (Can light up radial nerve compression)
Individual specific muscle tests;
* Abduction - Supraspinatus (15-20 degrees), Deltoid.
- Adduction - Pec Major, Lat Dorsi, Teres Major, Triceps and Coracobrachialis.
- Flexion - Ant Deltoid, Pec Major and Coracobrachialis
- Extension - Lat Dorsi, Teres Major/Minor and Post Deltoid.
- Internal Rotation - Teres Major and Subscapularis
- External Rotation - Teres Minor & Infraspinatus
Special tests
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