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Extremities > Elbow > Flashcards

Elbow Flashcards

1
Q

Concept->Proxial stability determines distal function or distal function determines proximal stability?

A

-Proximal stability determines distal function

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2
Q

Concept->Full examination is based on what? Give an example.

A
  • 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.
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3
Q

The elbow joint frequently exhibits pathology leading to what?

A

hypomobility

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4
Q

Humero-ulnar joint: LPP, CPP, and capsular pattern

A

LPP: 70 flexion, 10 supination
CPP: Full extension, full supination
Capsular pattern: flexion > extension

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5
Q

Humero-radial joint: LPP, CPP, and capsular pattern

A

LPP: full extension, full supination
CPP: 90 flexion, 5 supination
Capsular pattern: flexion > extension

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6
Q

Prox Radio-ulnar joint: LPP, CPP, and capsular pattern

A

LPP: 70 flexion, 35 supination
CPP: maximum, pronation restriction or supination (double-check this one)
Capsular pattern: equal pronation/supination

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7
Q

In order, name the 4 tests and measures for the elbow

A

1) Observation; static and dynamic posture
2) AROM, PROM, end feel
3) Resisted isometrics
4) MMT

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8
Q

For the tests and measures OBSERVATION, name 5 things you’re checking for and briefly explain them

A

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

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9
Q

Surface relationship: radius to humerus

A

concave to convex

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10
Q

Surface relationship: radius to ulna

A

convex to concave

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11
Q

Surface relationship: ulna to humerus

A

concave to convex

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12
Q

With elbow joint play, what 3 things are we accessing?

A

1) Quantity
2) Quality
3) End-feel

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13
Q

Joint Play: Distal Radioulnar jt: Position of arm, convex/concave, name direction glides and indications

A

1) 10’ supination
2) Concave-distal radius, Convex-distal ulna
3) Anterior/Ventral glide-pronation, Posterior/dorsal glide-supination

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14
Q

Joint Play: Proximal Radioulnar jt: Position of arm, convex/concave, name direction glides and indications

A

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

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15
Q

Joint Play: Radiohumeral jt: Position of arm, convex/concave, name direction glides and indications

A

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
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16
Q

Joint Play: Ulnohumeral jt: Position of arm, convex/concave, name direction glides and indications

A

1) 10’ supination, 70’ flexion
2) Concave – olecranon fossa of ulna; Convex – trochlea of humerus
3) indication: overall joint play

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17
Q

Name the 2 tests for ligamentous stability

A

1) Varus stress

2) Valgus stress

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18
Q

Varus stress test-What does it test?

A

lateral collateral ligament

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19
Q

Varus stress test-What are the positive signs?

A

1) Laxity
2) Pain
3) End feel
4) Quality

20
Q

Varus stress test-Method?

A

elbow flexed 20 -30 degrees , apply adduction force to distal segment

21
Q

Valgus stress test-What structure does it test?

A

Medial collateral ligament

22
Q

Valgus stress test-What are the positive signs?

A

1) Laxity
2) Pain
3) End feel
4) Quality

23
Q

Valgus stress test-Method?

A

Elbow flexed 20-30 degrees, apply abduction force

24
Q

Name the 3 types of structure specific tests

A

1) Ligamentous Stability
2) Musculotendinous Integrity
3) Peripheraol Nerve Integrity

25
Q

Name the 2 types of musculotendinous integrity tests

A

1) Lateral epicondylitis

2) Medial epicondylitis

26
Q

Lateral epicondylitis test (Cozel)-Method?

A

With elbow fully extended and forearm pronated , resist wrist extension with radial deviation (places a proximal stretch and distal force production to provoke symptoms)

27
Q

Lateral epicondylitis test (Cozel)-What does it test?

A

wrist extensor musculotendinous unit

28
Q

Lateral epicondylitis test (Cozel)-Positive sign?

A
  • pain at lateral epicondyle

- resists supination and wrist extension; or, 3rd digit extension

29
Q

Medial epicondylitis test (golfer’s elbow)-Method?

A

Resist wrist flexion with ulnar deviation

30
Q

Medial epicondylitis test (golfer’s elbow)-What does it test?

A

Wrist flexor musculotendinous unit

31
Q

Medial epicondylitis test (golfer’s elbow)-Positive sign?

A

pain at medial epicondyle

32
Q

Name the 4 different types of peripheral nerve integrity test

A

1) Elbow flexion test
2) Tinel’s test
3) Pinch grip (O test)
4) Pronator Teres test (Median nerve provocation)

33
Q

Elbow flexion test-Method?

A

fully flex elbow with wrist and finger extension-maintain for 1-3 minutes

34
Q

Elbow flexion test-Wha does it test?

A

to test for ulnar nerve compression in the cubital tunnel

35
Q

Elbow flexion test-Positive sign?

A

reproduction of paresthesiae and/or pain in ulnar distribution in the forearm hand; rapid resolution upon completion of the test

36
Q

Tinel’s test-Method? Give example of ulnar nerve

A
  • tap over location of peripheral nerve

- tap ulnar nerve in the ulnar groove at the elbow

37
Q

Tinel’s test-What does it test? Give example of ulnar nerve

A
  • tests for irritability of a peripheral nerve

- irritation and/or entrapment of the ulnar nerve in the ulnar groove

38
Q

Tinel’s test-Positive sign? Give example of ulnar nerve

A
  • 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
39
Q

Pinch grip/pinch sign/OK test/O test-Method?

A

patient attempts to make an O with tips of thumb and index finger

40
Q

Pinch grip/pinch sign/OK test/O test-What does it test?

A

entrapment of the anterior interosseus branch of median nerve at interosseus membrane

41
Q

Pinch grip/pinch sign/OK test/O test-Positive sign?

A
  • cannot make O, approximates with finger pads instead of tips
  • Pt c/o pain in proximal forearm and weakness with pinching
42
Q

Pronator teres test (median nerve provocation)-Method?

A

resisted pronation with elbow and wrist flexion

43
Q

Pronator teres test (median nerve provocation)-What does it test?

A

tests: median nerve entrapment between heads of pronator teres

44
Q

Pronator teres test (median nerve provocation)-Positive sign?

A

weakness as pronator is loaded

45
Q

Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy: Where does the Pain and parasthesias are diffuse to?

A

Pain and parasthesias are diffuse t/o the hand and forearm

46
Q

Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy: How is the pain compared to the injury or stimulus? What are symptoms?

A

Pain is not proportional to injury or stimulus, swelling, stiffness, discoloration, hyperhidrosis, trophic changes skin appears glossy

Extremities (6 decks)

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