Elbow Flashcards
Concept->Proxial stability determines distal function or distal function determines proximal stability?
-Proximal stability determines distal function
Concept->Full examination is based on what? Give an example.
- Full examination is based on regional interdependence
- And so, it is vital to examine above and below a joint and consider the upper extremity as a kinetic chain of function (going to the trunk). Even if the patient does not report a scapular deficiency as a possible source of elbow dysfunction it is very helpful for clinicians to keep an eye on the big picture.
The elbow joint frequently exhibits pathology leading to what?
hypomobility
Humero-ulnar joint: LPP, CPP, and capsular pattern
LPP: 70 flexion, 10 supination
CPP: Full extension, full supination
Capsular pattern: flexion > extension
Humero-radial joint: LPP, CPP, and capsular pattern
LPP: full extension, full supination
CPP: 90 flexion, 5 supination
Capsular pattern: flexion > extension
Prox Radio-ulnar joint: LPP, CPP, and capsular pattern
LPP: 70 flexion, 35 supination
CPP: maximum, pronation restriction or supination (double-check this one)
Capsular pattern: equal pronation/supination
In order, name the 4 tests and measures for the elbow
1) Observation; static and dynamic posture
2) AROM, PROM, end feel
3) Resisted isometrics
4) MMT
For the tests and measures OBSERVATION, name 5 things you’re checking for and briefly explain them
1) overall posture-cspine, scapulothoracic, thoracic, GH, pelvis etc……. (region interdependence)
2) position of elbow - normal carrying angle(frontal plane: the angle is formed by long axis of humerus to ulna with a fully extended elbow), cubitus varus(Gunstock deformity: reversal of the carrying angle as a result of a medial humeral condyle fx or bony overgrowth in lateral condyle) or valgus
3) triangular alignment–med/lateral epicondyles and tip of olecranon – bony alignment
Inverted equilateral triangle.
Altered alignment: prominent olecranon=posterior subluxation (typically due to a direct, high force trauma FOOSH)
4) edema/joint effusion - joint effusion easiest to assess in the triangular space (from a lateral perspective) between radial head, tip of olecranon, and lateral epicondyle
5) olecranon bursitis-extra capsular - warm, boggy, edematous at tip of olecranon
Surface relationship: radius to humerus
concave to convex
Surface relationship: radius to ulna
convex to concave
Surface relationship: ulna to humerus
concave to convex
With elbow joint play, what 3 things are we accessing?
1) Quantity
2) Quality
3) End-feel
Joint Play: Distal Radioulnar jt: Position of arm, convex/concave, name direction glides and indications
1) 10’ supination
2) Concave-distal radius, Convex-distal ulna
3) Anterior/Ventral glide-pronation, Posterior/dorsal glide-supination
Joint Play: Proximal Radioulnar jt: Position of arm, convex/concave, name direction glides and indications
1) 35’ supination, 70’ flexion
2) Convex –radial head, concave –notch for radius on ulna
3) Ventral or anterior glide of radius:
indication: supination
Dorsal or posterior glide of radius:
indication: pronation
Joint Play: Radiohumeral jt: Position of arm, convex/concave, name direction glides and indications
1) full supination and extension
2) concave – radius, convex – capitulum of humerus
3) Dorsal or posterior glide of radius:
indication: extension
Ventral or anterior glide of radius
indication: flexion
Joint Play: Ulnohumeral jt: Position of arm, convex/concave, name direction glides and indications
1) 10’ supination, 70’ flexion
2) Concave – olecranon fossa of ulna; Convex – trochlea of humerus
3) indication: overall joint play
Name the 2 tests for ligamentous stability
1) Varus stress
2) Valgus stress
Varus stress test-What does it test?
lateral collateral ligament
Varus stress test-What are the positive signs?
1) Laxity
2) Pain
3) End feel
4) Quality
Varus stress test-Method?
elbow flexed 20 -30 degrees , apply adduction force to distal segment
Valgus stress test-What structure does it test?
Medial collateral ligament
Valgus stress test-What are the positive signs?
1) Laxity
2) Pain
3) End feel
4) Quality
Valgus stress test-Method?
Elbow flexed 20-30 degrees, apply abduction force
Name the 3 types of structure specific tests
1) Ligamentous Stability
2) Musculotendinous Integrity
3) Peripheraol Nerve Integrity
Name the 2 types of musculotendinous integrity tests
1) Lateral epicondylitis
2) Medial epicondylitis
Lateral epicondylitis test (Cozel)-Method?
With elbow fully extended and forearm pronated , resist wrist extension with radial deviation (places a proximal stretch and distal force production to provoke symptoms)
Lateral epicondylitis test (Cozel)-What does it test?
wrist extensor musculotendinous unit
Lateral epicondylitis test (Cozel)-Positive sign?
- pain at lateral epicondyle
- resists supination and wrist extension; or, 3rd digit extension
Medial epicondylitis test (golfer’s elbow)-Method?
Resist wrist flexion with ulnar deviation
Medial epicondylitis test (golfer’s elbow)-What does it test?
Wrist flexor musculotendinous unit
Medial epicondylitis test (golfer’s elbow)-Positive sign?
pain at medial epicondyle
Name the 4 different types of peripheral nerve integrity test
1) Elbow flexion test
2) Tinel’s test
3) Pinch grip (O test)
4) Pronator Teres test (Median nerve provocation)
Elbow flexion test-Method?
fully flex elbow with wrist and finger extension-maintain for 1-3 minutes
Elbow flexion test-Wha does it test?
to test for ulnar nerve compression in the cubital tunnel
Elbow flexion test-Positive sign?
reproduction of paresthesiae and/or pain in ulnar distribution in the forearm hand; rapid resolution upon completion of the test
Tinel’s test-Method? Give example of ulnar nerve
- tap over location of peripheral nerve
- tap ulnar nerve in the ulnar groove at the elbow
Tinel’s test-What does it test? Give example of ulnar nerve
- tests for irritability of a peripheral nerve
- irritation and/or entrapment of the ulnar nerve in the ulnar groove
Tinel’s test-Positive sign? Give example of ulnar nerve
- reproduction of parathesias along that nerve’s distribution
- reproduction of paresthesias in ulnar distribution , medial elbow and forearm , 5th digit and medial-ulnar ½ of 4th
Pinch grip/pinch sign/OK test/O test-Method?
patient attempts to make an O with tips of thumb and index finger
Pinch grip/pinch sign/OK test/O test-What does it test?
entrapment of the anterior interosseus branch of median nerve at interosseus membrane
Pinch grip/pinch sign/OK test/O test-Positive sign?
- cannot make O, approximates with finger pads instead of tips
- Pt c/o pain in proximal forearm and weakness with pinching
Pronator teres test (median nerve provocation)-Method?
resisted pronation with elbow and wrist flexion
Pronator teres test (median nerve provocation)-What does it test?
tests: median nerve entrapment between heads of pronator teres
Pronator teres test (median nerve provocation)-Positive sign?
weakness as pronator is loaded
Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy: Where does the Pain and parasthesias are diffuse to?
Pain and parasthesias are diffuse t/o the hand and forearm
Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy: How is the pain compared to the injury or stimulus? What are symptoms?
Pain is not proportional to injury or stimulus, swelling, stiffness, discoloration, hyperhidrosis, trophic changes skin appears glossy
