Elbow Ax and Rx

Question 1

SQs

Answer 1

• ?Trauma ?surgery ? onset/cause
• ?Neuro symptoms
• ?Aggs & Eases
• Red Flags

Question 2

Red Flags

Answer 2

• Myelopathy
• Infection
• Inflammatory disorders
• Age of onset of new symptoms <20 or >55 years
• Violent trauma, e.g. fall from height, RTA - #
• Constant, progressive, non-mechanical pain
• PMH – Carcinoma
• Systemic steroids
• Drug abuse, HIV
• Systemically unwell
• Unexplained weight loss
• Widespread neurology
• Structural deformity

Question 3

Infection symptoms

Answer 3

• General feeling unwell
• High temperature (fever)
• IVDU (intravenous drug use)
• Recent surgery / open wounds

Question 4

Cancer signs

Answer 4

• Previous Hx of cancer in themselves or family
• Unexplained weight loss
• Non- mechanical, constant pain
• Night sweats
• Generally feeling unwell

Question 5

Fracture signs

Answer 5

• Major trauma (motor vehicle accident, fall from height)
• Minor trauma or strenuous lifting in an older or osteoporotic patient
• Constant pain, worse on weight bearing
• Swelling/ bruising
• Steroid use
• Osteoporosis/ osteopenia

Question 6

Inflammatory Disorders (Ankylosing spondylitis etc.) signs

Answer 6

• Gradual onset
• Marked morning stiffness
• Persisting limitation of spinal movements in all directions
• Peripheral joint involvement/tendionpathies/aches
• Iritis, skin irritation (psoriasis), colitis, urethral discharge
• Family history

Question 7

Myelopathy (Central cord compression in cervical (most common), thoracic or lumbar (rare) spine) signs

Answer 7

• Neck, arm, leg or lower back pain
• Tingling, numbness or weakness
• Difficulty with fine motor skills, such as writing or buttoning a shirt
• Increased reflexes in extremities or the development of abnormal reflexes
• Difficulty walking (ataxic gait)
• Loss of urinary or bowel control
• Issues with balance and coordination

Question 8

Functional Assessment

Answer 8

• Interference with job, home, social life or sports.
• This will help aid and direct your objective assessment

Question 9

Observation

Answer 9

• Guarding / Function
• Swelling
• Deformity
• Splints or Aids
• Skin
• Posture & carrying angle 5-10°males; 10-15° females
• Asymmetry
• Muscle form
• Soft tissues swelling, colour, inflammation
  
  • Posterior swelling = olecranon bursitis
  • General swelling = shared joint capsule

Question 10

AROM and PROM

Answer 10

Flexion/extension 0-140, pronation/supination +/-90

AROM:

PROM:

Resistance/end feel

Capsular patten - flex, ext

Question 11

Muscle tests

Answer 11

Strength – via resisted AROM &/or isometrics

Question 12

Neurological Testing

Answer 12

Myotomes

• C1/C2 neck flexion/extension
• C3 Lateral flexion
• C4 shoulder elevation - upper fibres trapezius, levator scapulae (spinal accessory nerve)
• C5 Shoulder Abduction - deltoids, supraspinatus (axillary nerve)
• C6 Elbow flexion/wrist extension - Biceps brachii, Brachialis (musculocutaneous nerve)
• C7 Elbow extension/wrist flexion - triceps brachii (radial nerve)
• C8 Thumb extension - EPL (PIN
• T1 Finger Add/Abd - Lumbricals, Interossei (ulnar nerve)

Dermatomes

• Pin Prick
• Vibration
• Proprioception

Reflexes

• Biceps Reflex (C5)
• Brachioradialis Reflex (C6)
• Triceps Reflex (C7)

ULTT’s

• ULTT1 – Median Nerve
• ULTT2a – Median Nerve
• ULTT2b – Radial Nerve
• ULTT3 – Ulnar Nerve

Question 13

Special tests

Answer 13

• Medial Epicondylitis test:
  
  • Test – Medial Epicondylitis
  • Positive Sign = pain over medial epicondyle
  • Procedure: Palpate medial epicondyle, Supinate forearm, Extend wrist and fingers

Lateral Epicondylitis test:

• Mill’s Test:
  
  • Test: Lateral Epicondylitis
  • Postie Sign: Pain reproduction
  • Procedure: Pronate forearm, Flex wrist (in a fist) and Extend elbow
  • Considerations: Warning re radial nerve will get stressed so think how you may differentiate between the two
• Cozen’s test
  
  • Test: Lateral Epicondylitis
  • +ve = pain , can palpate for site of pain
  • procedure: Active contraction of extensor tendons, Elbow 90deg, Forearm pronation, resisted Wrist extension, Wrist Rad Dev

Question 14

Palpation

Answer 14

• Bony Landmarks
• Soft Tissue – Muscle belly, tendons etc.