Elbow Eval and Exam

Question 1

When screening for an elbow problem, looking at posture of the cspine, scapulothoracic, thoracic, GH and pelvis in particular (regional interdepence). What other examination elements can be discovered in posture inspection?

Answer 1

1. Abnormal position of the elbow: carrying angle
   - normal is 15* valgus in front plane)
2. Triangular alignment of med/lat epicondyle and tip of the olecranon (prominent olecranon = posterior subluxation due to FOOSH).
3. Edema/joint effusion: easiest to see laterally between the radial head, olecranon and lateral epicondyle.
4. Olecranon bursitis (extra capsular): seen at tip

Question 2

Describe a gunstock deformity (cubitus varus).

Answer 2

Occurs with a reversal of the valgus carrying angle as a result of a medial humeral condyle fracture or bony overgrowth in the lateral condyle.

Question 3

When assessing PROM for the elbow, there are 4 movements tested, 2 are firm end feels, 1 is soft and 1 is hard. True?

Answer 3

Yes. Name each.

Question 4

Resisted isometrics for the elbow are assessed in what position?

Answer 4

Anatomical for flexion / extension. At 90* for supination / pronation.

Question 5

When testing MMT, what important distal consideration needs to be made?

Answer 5

Motion at the wrist, as well as mass grip strength.

Question 6

What four joints is the elbow composed of?

Answer 6

1. Distal Radio-ulnar joint
2. Proximal Radio-ulnar joint
3. Radiohumeral joint
4. Ulnohumeral joint

Question 7

When assessing joint play of the distal radio-ulnar joint, it is best done in seated with the forearm in 10* of supination. Applying the concave/convex rule, what glide directions for pronation and supination?

Answer 7

Concave: distal radius
Convex: distal ulna

Pronation: anterior/ventral
Supination: posterior/dorsal

Question 8

When assessing PROM for the elbow, there are 4 movements tested, 2 are firm end feels, 1 is soft and 1 is hard. True?

Answer 8

Yes. Name each.

Question 9

Resisted isometrics for the elbow are assessed in what position?

Answer 9

Anatomical for flexion / extension. At 90* for supination / pronation.

Question 10

When testing MMT, what important distal consideration needs to be made?

Answer 10

Motion at the wrist, as well as mass grip strength.

Question 11

What four joints is the elbow composed of?

Answer 11

1. Distal Radio-ulnar joint
2. Proximal Radio-ulnar joint
3. Radiohumeral joint
4. Ulnohumeral joint

Question 12

When assessing joint play of the distal radio-ulnar joint, it is best done in seated with the forearm in 10* of supination. Applying the concave/convex rule, what glide directions for pronation and supination?

Answer 12

Concave: distal radius
Convex: distal ulna

Pronation: anterior/ventral
Supination: posterior/dorsal

Question 13

What is the most common type of elbow fracture in children, and what are its causes and implications?

Answer 13

Intra-articular fracture of distal humerus due to FOOSH. Can be associated with nerve damage and impaired circulation.

Question 14

At the radiohumeral joint is assessed in full supination and extension. What are the rules and glide directions?

Answer 14

concave – radius
convex – capitulum of humerus

Dorsal or posterior glide of radius: indication: extension
Ventral or anterior glide of radius indication: flexion

Question 15

The ulnohumeral joint is the main joint of the elbow. Assessed in 10* of supination and 70* of flexion, it is typically scooped during distraction. What re its rules and glide directions?

Answer 15

Concave – olecranon fossa of ulna
Convex – trochlea of humerus

Indication: overall joint play
-scouping of forearm away form humerus.

Question 16

What is the primary purpose of the RCL?

Answer 16

Elbow stabilizer over the joint capsule and common extensor origin. Limits supination.

Question 17

The UCL has an anterior, posterior and transverse band. What is its primary role?

Answer 17

Limiting valgus stress. Varus stresses are mostly limited by bony articulations.

Question 18

What is the most common type of elbow fracture in children, and what are its causes and implications?

Answer 18

Intra-articular fracture of distal humerus due to FOOSH. Can be associated with nerve damage and impaired circulation.

Question 19

What are 3 common risk factors for UE MS disorders?

Answer 19

1. Obesity
2. High physical demand
3. Repetitiveness of the task

Question 20

___ is key in determining the source of elbow stress.

Answer 20

Proximal stability (shoulder and truck).

Question 21

With a deficit in proximal stability, with overhead work, what part of the elbow is most commonly affected by excess joint stress?

Answer 21

The medial joint.

Question 22

What 3 types of structures are being assessed with an elbow screen?

Answer 22

1. Musculotendinous integrity
2. Ligamentous tissue
3. Articular cartilage

Question 23

For patients with pain in the elbow region, what non-muscle parameter needs to be assessed?

Answer 23

Pain from nerve entrapment.