Elbow Evaluation Flashcards
1
Q
History region specific
A
- connection to cervical spine: cervical ROM, radiating pain down arm
- neurological component: numbness/tingling, weakness, loss of grip
- position of elbow & activity when injured
- hand dominance
2
Q
Red flags in the history taking
A
- insidious onset
- related to CV activity
- history of CV disease
- are the symptoms constant/unrelenting
- radiating symptoms across multiple dermatomes
- sudden onset of severe pain
3
Q
Self assessments for elbow examination
A
- DASH: disabilities of the arm, shoulder, and hand
4
Q
What is a normal carrying angle (extension) for males and females
A
- Females: 5-16 degrees
- Males: 5-14 degrees
5
Q
Pathology suspected based on observation
A
- Swelling local to posterior tip: olecranon bursitis
- Diminished tip of olecranon: dislocation or fracture
- Altered carrying angle: non-union or mal-union of the humerus
- Nodules: RA (rheumatoid arthritis)
- Synovitis (inflammation at the joint line): RA (rheumatoid arthritis)
6
Q
Elbow ROM
A
- Active flexion: 145 degrees
- Passive flexion: 160 degrees (hard end feel or soft tissue end feel)
- Extension: 0-15 degrees (hard end feel)
7
Q
Vascular testing
A
- Brachial pulse
- Allen test
8
Q
Describe the Allen test
A
- patency of the radial & ulnar arteries
- compress both arteries & have the patient make a fist 3-5 times until hand is pale
- release compression on one artery & note time to flush to normal color
- repeat with other artery & note difference between sides
9
Q
Open packed position for the elbow
A
- about 70 degrees of flexion and slight supination
10
Q
Closed packed position for humeroulnar and humeroradial
A
- Humereoulnar: full extension
- Humeralradial: full flexion and supination
11
Q
Describe humeroulnar joint distraction
A
- test distraction: improves general mobility of flexion & extension
- test distraction at end range: improves end range motion
12
Q
Describe radiohumeral joint distraction when fixed proximally/superiorly
A
- test distraction: improves general elbow extension & radial head mobility
13
Q
Proximal radiohumeral joint posterior & anterior glide
A
- starting position in 70 degrees of flexion
- limited pronation: test posterior glide
- limited supination: test anterior glide
14
Q
Pathology of cubital tunnel syndrome
A
- compression at the elbow
- persistent elbow flexion
- tensile force with valgus stress
15
Q
Typical history for cubital tunnel syndrome
A
- numbness & tingling ulnar nerve distribution distal to elbow
- positional complaints
- trauma to elbow region
- repetitive elbow flexion tasks
- valgus stress
16
Q
Examination of cubital tunnel syndrome
A
- Observation: atrophy of muscles supplied by ulnar nerve (FCU, FDP 4 &5, hypothernar muscles, ADD policies, lumbrical 4 & 5, dorsal & palmar interossei)
- palpation: tenderness over ulnar groove
- AROM/PROM: possible symptoms in full flexion
- RROM: symptom reproduction
- MMT: weakness of muscles supplied by the ulnar nerve
- Accessory movements: WNL (within normal limits)
17
Q
Special tests for cubital tunnel syndrome
A
- Pressure provocation test (good test)
- Flexion test (good for ruling in test)
- Combined pressure & flexion test (good test)
- Tinel’s sign (good for ruling in test)
18
Q
Typical history for MCL tear
A
- trauma with valgus stress or repetitive stress (throwing); may have heard a pop
- pain along medial elbow
- swelling
- bruising
- if complete rupture: instability
19
Q
Describe the grades of MCL tears
A
- Grade 1: a small number of fibers are torn resulting in pain but full function
- Grade 2: a significant number of fibers are torn with pain & moderate loss of function
- Grade 3: all fibers are ruptured with elbow instability & major loss of function
20
Q
Examination of MCL tear
A
- Observation: swelling & possible bruising of medial elbow
- Palpation: tenderness medial elbow
- AROM/PROM: WNL (within normal limits)
- RROM: will be strong in every movement
- Accessory movements: excessive medial glide ulna with or without pain
21
Q
Special tests for MCL tear
A
- Moving valgus stress test (not good)
- Valgus stress test (not good)
22
Q
Typical history for lateral epicondylagia
A
- pain along lateral elbow usually initiated by repetitive elbow or wrist movements
- pain with grip activities (shaking hands, turning a door knob, holding a cup of coffee, etc.)
23
Q
Examination of lateral epicondylagia
A
- Observation: may be hesitant to shake hands; possible brace in place
- Palpation: tenderness along lateral epicondyle & common extensor tendon/muscles
- AROM/PROM: pain with flexion of wrist with extension of elbow actively & passively & pain with active extension of wrist
- RROM: pain with resisted wrist extension & resisted middle finger extension
- Accessory movements: WNL (within normal limits)
24
Q
Special tests for lateral epicondylagia
A
- Muscle palpation, AROM, PROM, & RROM
- Grip strength with dynamometer painful & limited
25
Q
Typical history for medial epicondylitis
A
- pain in medial elbow with wrist flexion & supination
- pain with activities such as using a screw driver, hammering, & any squeezing activity (golf club; baseball)
26
Q
Examination of medial epicondylitis
A
- Observation: may be hesitant to shake hands
- Palpation: tenderness along medial epicondyle & common flexor tendon/muscles
- AROM/PROM: discomfort with elbow extension with wrist extension active & passive
- RROM: pain with wrist flexion & forearm pronation
27
Q
Special tests for medial epicondylitis
A
- Palpation
- AROM
- PROM
- RROM
28
Q
Typical history for bicep tendon rupture
A
- patient reports incident followed by decreased strength in elbow flexion
29
Q
Examination of bicep tendon rupture
A
- Observation: may observe defect; bicep will retract
- Palpation: may palpate defect; tenderness along bicep
- AROM/PROM: limited elbow flexion AROM but full PROM
- RROM: weakness with resisted elbow flexion
30
Q
Special test for bicep tendon rupture
A
- Biceps squeeze test (good test)
- Bicipital aponeurosis flex test (good test)
- Test cluster: Hook test, Passive forearm pronation test, & Biceps crease interval
31
Q
Typical history for elbow fracture
A
- blunt trauma
32
Q
Special test for elbow fracture to determine need for radiography
A
- 4 way ROM test (good at ruling out)
- Elbow extension test (good at ruling out)
33
Q
Special tests for lateral epicondylitis/Tennis Elbow
A
- Mill’s stretch test
- Cozen’s test
33
Q
Describe Mill’s stretch test
A
- palpate lateral epicondyle
- PT passively pronates forearm, flexes wrist, & extends elbow
- (+) = reproduction of concordant symptoms/pain over lateral epicondyle of humerus
34
Q
Describe Cozen’s test
A
- place thumb over lateral epicondyle
- patient’s elbow is flexed & pronated with wrist extended/radial deviation
- PT resists wrist extension/radial deviation
- (+) = reproduction of concordant symptoms/sudden severe pain of lateral epicondyle of humerus
35
Q
Describe 4 way ROM test
A
- patient seated with injured arm their side with elbow extended
- ask patient to extend fully, flex elbow to 90 degrees, pronate & supinate fully while flexed at 90 degrees
- (+) = decreased ROM in any 4 maneuvers
- good at ruling out test
36
Q
Describe elbow extension test
A
- patient seated with arms supinated
- ask patient to actively flex their shoulders to 90 degrees
- ask patient to extend elbow
- (+) = decreased ROM in involved elbow
- good at ruling out test
37
Q
Describe biceps squeeze test
A
- patient seated with elbow flexed 60-80 degrees & forearm in slight pronation (resting in lap)
- PT squeezes biceps firmly with both hands
- (+) = lack of forearm supination when bicep is squeezed
- good for ruling out test
38
Q
Describe bicipital aponeurosis flex test
A
- patient arm is supinated & elbow extended
- ask patient to make a fist & actively flex wrist
- ask patient to actively flex elbow to 75 degrees while maintaining wrist position
- PT palpates medial antecubital fossa for thin edge of aponeurosis
- good test
39
Q
Describe hook test
A
- PT uses index finger to palpate bicep tendon
- (+) = no tendon
40
Q
Describe passive forearm pronation test
A
- PT passively moves patient forearm from a supinated position into pronation
- (+) = loss of visual & palpable proximal to distal movement of the bicep muscle belly
41
Q
Describe bicep crease interval
A
- measure the distance from antecubital crease to distal muscle belly
- (+) = >6 cm
42
Q
Describe valgus stress test
A
- patient elbow placed in 20 degrees flexion
- PT palpates medial joint line & applies valgus force to the elbow
- (+) = patient reports pain or excessive laxity compared to opposite UE
- bad test
43
Q
Describe moving valgus stress test
A
- patients shoulders ABD 90 degrees & elbow is fully flexed
- PT holds forearm in one hand & stabilizes elbow with other hand
- PT applies a vagus force & simultaneously externally rotate the shoulder
- PT then quickly extends elbow to 30 degrees
- (+) = pain at medial elbow & max amount of pain between 120-70 degrees of elbow flexion
- good for ruling out
44
Q
Describe pressure provocation test
A
- patients elbow is flexed 20 degrees
- PT applies pressure just proximal to cubital tunnel
- hold for 60 seconds
- (+) = symptoms along ulnar nerve dsitribution
- good test
45
Q
Describe flexion test
A
- place patients elbow in full flexion with forearm supination & the wrist in neutral
- hold for 60 seconds
- (+) = symptoms along ulnar nerve distribution
- good for ruling in test
46
Q
Describe combined pressure & flexion test
A
- place patients elbow in full flexion with forearm supination & wrist in neutral
- PT applies pressure just proximal to cubital tunnel
- hold for 60 seconds
- (+) = symptoms along ulnar nerve distribution
- good test
47
Q
Describe Tinel’s sign
A
- PT applies 4-6 taps to patient’s ulnar nerve just proximal to cubital tunnel
- (+) = tingling along ulnar nerve distribution
- good at ruling in test
