Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK I > Elbow Exam > Flashcards

Elbow Exam Flashcards

1
Q

Elbow-

A

Important UE “linkage” between hand and shoulder

Strong and stable joint

Prone to overuse injury, sudden acceleration and deceleration activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 Elbow Joints:

A

Humeroulnar joint
Humeroradial joint
Proximal radioulnar joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Joint capsule is strong =

A

but thin with medial and lateral ligaments

Capsule can resist 30-40% of resistance to varus/valgus force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Elbow Origin (local) pain:

A

Bone (fracture)
Joint (sprain; degeneration)
Muscle tendon unit
Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Non-Elbow Origin (referred) pain:

A

Cervical (Radiculopathy)
Shoulder
Thoracic Outlet
Vascular (Angina, MI)
Chronic pain (central sensitization)
Systemic (gout, RA) or infectious origin
Vascular (Volkmann’s Ischemia)
Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Subjective
Chief Complaint-

A

Understand the problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Subjective
Impairment/Function/Disability-

A

How is the problem inhibiting function?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Subjective
Pain:

A

Location, Quality, Duration, Affect, Intensity/irritability, Pain History

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Age

A

Young child = dislocation of the head of the radius; a child complaining of pain and lack of supination- (”nursemaid’s elbow / dislocation of radial head)

15-20 yr old = osteochondritis dissecans

35 yr old = lateral epicondalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mechanism of injury

A

Elbow injuries due to FOOSH; sometimes coupled with shoulder, wrist/hand injuries

Hyperextension injury, Traumatic

Fall on tip of the elbow = olecranon fracture, olecranon bursitis, ulnar n lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Subjective Examination: History

A

Insidious onset with weakness and pain, suspect cervical spine and perform upper quarter screening

Hand dominance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pain following overuse or repetitive activities

A

Cumulative overuse athletes and nonathletes

Repetitive hyperextension followed by pronation can affect distal biceps and lacertus fibrosus in the cubital fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

History of locking or catching of the elbow with movement, with pain?

A

Loose body within the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Inability to fully extend the elbow (especially with pain)

A

synovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is the patient an athlete?

A

“pop” + pain and swelling on medial aspect of the elbow of a throwing athlete = medial collateral ligament sprain

Recent changes in equipment? E.g. grip size, string tension?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Duration of symptoms?

A

Improving or worsening? (Stage of healing and severity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Location of symptoms?

A

Local or referred? In the elbow, it is typically from local structures

Peripheral n. vs cervical n. root problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lateral elbow pain:

A

tendinopathy if tender lateral epicondyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Medial elbow pain:

A

tendinopathy (superficial wrist flexors and pronator teres); but also consider MCL sprain or ulnar n. compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Posterior elbow pain:

A

olecranon bursitis, triceps tendinopathy, valgus extension overload- (Pitcher’s elbow-impact of olecranon into olecranon fossa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cubital fossa pain:

A

brachialis mm tear e.g. rock climbing; biceps lesion; compression of PIN or capsular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Left arm & elbow pain:

A

angina?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Sensory changes and muscle weakness in the ipsilateral limb?

A

spinal n. or peripheral n. lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Joint noises or crepitus?

A

Snapping elbow - recurrent dislocation of Ulnar nerve? But also Medial head of triceps? Or, both? (can be with/without discomfort; with/without ulnar neuropathy)

Joint crepitus may also indicate presence of loose body or synovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Aggravating activity:

A

grasping and twisting affect the elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Neck and shoulder pain?

A

Intermittent or constant pain?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

General Health Screening

A

As part of your general health screening, you will need to rule in or rule out some other health conditions that may manifest itself in and around the elbow

double crush syndrome

thoracic outlet syndrome (TOS)

Cancer screening- primary bone cancer can present as elbow pain

*compression at two or more locations along the course of a peripheral nerve that can coexist and synergistically increase symptom intensity

Infective arthritis- any signs of drug abuse, needle injection marks at elbow

Cellulitis

Complex regional pain syndrome (CRPS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

double crush syndrome =

A

axons that have been compressed at one site becomeespecially susceptible to damage at another site

compression at proximal site of nerve, get reduction of nerve conduction at distal compression site

The existence of double crush syndrome was further substantiated by Massey’s (1981) study of nineteen cases of carpal tunnel syndrome co-existing with a cervical radiculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Thoracic outlet syndrome (TOS) =

A

often seen and associated with double crush syndrome as well

the proximal neuropathy usually precedes the distal one

a high prevalence of TOS associated with carpal tunnel syndrome in 40 cases, TOS associated with ulnar neuropathy in 19 cases, and TOS associated with radial tunnel syndrome in 29 cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Complex regional pain syndrome (CRPS)

A

pain, swelling, stiffness, vascular changes as a result of minor or severe trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most responsive Patient-reported outcome measures of the elbow*

A

Disabilities of the Arm, Shoulder and Hand

Patient-Rated Tennis Elbow Evaluation (PRTEE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Disabilities of the Arm, Shoulder and Hand

A

6 items on symptoms/pain; function (24 items)

Has QuickDASH version

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Patient-Rated Tennis Elbow Evaluation (PRTEE)

A

5 items for pain and 15 for function (10 for specific, 5 for usual activities), scaled on an 11-point (range 0–10) numerical rating scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Elbow joint capsule

A

Does not respond well to injury or immobilization

Forms scar thick tissue

Prone to flexion contracture

All 3 elbow articulations exist in 1 capsule…. Humeroulnar joint, Humeroradial joint, and Proximal Radioulnar joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Loss of elbow extension =

A

is a sensitive indicator of intra-articular pathology

1st movement lost after elbow injury and 1st regained with healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Loss of terminal elbow ___ is most disabling (capsular pattern…)

A

flexion

very meaningful - more impactful functionally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Subjective- Pro Tips

A

Don’t forget the shoulder/cervical spine as an origin of elbow pain

Investigate hobbies, occupations, use of tools computers, etc = Patients don’t necessarily make the connection between other symptoms that may be contributory

If things don’t make sense, circle back around

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Systems Review

A

UQ screening

Reproduction of elbow symptoms with cervical motion vs elbow motion = indicator of C-spine and upper T-spine problem

Must clear the shoulder

Insidious elbow pain

rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Insidious elbow pain:

A

gout, infective arthritis, polyarthritis, vascular disorders

Deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.

(Volkmann’s ischemia) = Lack of blood flow (ischemia) to the forearm. This occurs when there is increased pressure due to swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Objective Outline:

A

Screening

Observation: Static, Dynamic, Function

Palpation

ROM, Strength, Muscle Length, Accessory motion, etc

Special Tests

41
Q

Upper Quarter Screen

A

Purpose: Screen the major systems and joints contributing to movement

Identify areas for further investigation

Identify patterns helpful for diagnosis

Central vs Nerve Root vs Peripheral (cervical vs TOS vs carpal tunnel)

42
Q

Objective Examination
1-9

A

1) inspection/observation posture
2) palpation
3) ROM
4) MMT
5) muscle length
6) reflexes, dermatomes, myotomes
7) special tests
8) accessory motion testing
9) functional testing

43
Q

Observation (inspection, posture)

A

Carrying angle Norm: 13-16 degrees (females), 11-14 males)

44
Q

Cubitus varus:

A

<10 deg cubitus varus

assoc. with supracondylar fracture

Gun stock deformity (in full extension)

45
Q

Cubitus valgus:

A

> 15 deg cubitus valgus

assoc. with lateral epicondylar fracture

46
Q

Observation Principles

A

Visualize and expose both arms

Inspect for scars, deformities, and swelling

Most swelling appears under the lateral epicondyle -may prevent full extension

Note any asymmetry

Note muscle hypertrophy, atrophy

Bruising, wasting, muscle spasm

Carrying angle and posture

47
Q

Swelling in the absence of trauma:

A

suspect infection, inflammation or gout

48
Q

“Triangle”:

A

consist of medial and lateral epicondyles and olecranon

at 90 deg flexion = isosceles triangle

at full extension = straight line

Triangle may be disrupted with fracture, dislocation, or degeneration

49
Q

Keyboard operators:

A

sustained elbow flexion and adduction = may increase connective tissue stiffness causing tension at the fibrous arch leading to compression of ulnar n.

decreased volume of cubital tunnel

50
Q

If swelling exists:

A

then all 3 elbow joints may be affected as they share a common capsule

will be most evident in the triangular space (radial head-tip of olecranon-lateral epicondyle)

51
Q

Olecranon bursitis:

A

elbow may be in 70 deg flexion (resting position)

52
Q

Any fracture in the elbow region or upper arm may lead to Volkmann’s ischemic contracture =

A

serious late complication of unrelieved compartment syndrome

Associated withsupracondylar fractureof thehumerus

Permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers

Passive extension of fingers is restricted and painful

Results from acuteischemia /necrosis of the muscle fibers of the flexor group ofmuscles of the forearm, especially FDP &FPL

53
Q

Volkmann’s ischemic contracture causes:

A

obstruction of thebrachial arterynear the elbow, possibly from improper use of atourniquet, improper use of aplaster cast, orcompartment syndrome

fractures of the forearm bones if they cause bleeding from the major blood vessels of the forearm.

54
Q

Bony structures:

A

Medial epicondyle
Olecranon process
Lateral epicondyle
Supracondylar ridge
Joint line
Head of the radius

55
Q

Soft-tissue:

A

Medial (ulnar n, muscles)
Posterior
Lateral (brachioradialis, ECRL, ECRB)
Anterior

56
Q

Observation (Dynamic)

A

Active and Passive movement has already been screened via Upper Quarter Screen

Have the patient perform a functional task (if appropriate) to observe movement quality and quantity = Must be appropriate and matched to the patient

57
Q

Capsular vs non-capsular pattern:

A

flexion more limited than extension

58
Q

End-feel:

A

compliant (soft tissue restriction) vs. rigid (mechanical bony limit); pain at the limit of motion suggests bony impingement

59
Q

Accessory Motion Testing:

A

Open loose pack position

Humeral ulnar
Humeral radial
Proximal RU

60
Q

pain with resisted flexion = lesion of:

A

biceps brachii
brachialis
brachioradialis
wrist extensors

61
Q

pain with resisted extension = lesion of:

A

triceps/anconeus

62
Q

pain with resisted supination = lesion of:

A

biceps brachii
wrist extensors
radial nerve
supinator

63
Q

pain with resisted pronation = lesion of:

A

wrist flexors
median nerve
pronator teres
pronator quadratus

64
Q

pain with resisted wrist flexion = lesion of:

A

wrist flexors

65
Q

pain with resisted wrist extensors = lesion of:

A

wrist extensors
radial nerve

66
Q

Functional assessment

A

The main issue is that the elbow is between the hand and shoulder (mobility vs stability)

Functional range of the elbow: 30-130 deg of flexion; 50 deg pronation and 50 deg supination

67
Q

___ degrees of elbow flexion and __ degrees of supination–pronation: eating, dressing, and daily hygiene.

10-20% greater ROM: required for ____

A

60–100
100

athletic activities, such as throwing a baseball

68
Q

Special tests should be selected based on diagnostic accuracy

A

Specificity (Spin): Rule in a diagnosis (ratio of false positives and true negatives)

Sensitivity (Snout): Rule out a diagnosis (ratio of true positives and false negatives)

69
Q

Special Tests

A

Ligamentous testing- MCL, LCL, pivot shift

Nerve testing- ulnar, median, radial

Tendinopathy (medial/lateral) Cozens, Mills

70
Q

Special tests – Ligamentous Testing

A

Valgus stress test
Milking maneuver
Moving valgus stress test
Varus stress test
Lateral pivot shift test

71
Q

Valgus stress test =

A

Elbow flexion at 20-30 deg to test anterior band of MCL

Stabilize patient’s arm with one hand at the elbow and the other hand at the patient’s wrist

Apply abduction (valgus) force at the distal forearm

Note for laxity, ↓ mobility, pain (compare with other arm)

72
Q

Milking maneuver =

A

Stress to posterior band of MCL

Patient sits with elbow flexed at 90 deg or more, supinated

PT grasps patient’s thumb or distal forearm and pulls it imparting a valgus stress to elbow

+ test is reproduction of pain

73
Q

Moving valgus stress test =

A

For chronic MCL tear

Patient’s shoulder in 90 degrees of abduction and 120 degrees of elbow flexion.

Patient’s shoulder in 90 degrees of abduction and 120 degrees of elbow flexion.

PT applies a modest valgus torque to the elbow until the shoulder reaches full ER. While applying a constant valgus torque, the elbow is quickly extended to 30 degrees.

+ test is reproduction of pain

74
Q

Varus stress test =

A

Patient’s elbow at 5-30 deg flexed and stabilized by PT

Apply adduction (varus) force to distal forearm

Note laxity, ↓ mobility, pain (compare with other arm)

75
Q

Lateral pivot shift test =

A

Patient is supine with the involved extremity overhead, & the elbow extended, forearm supinated

The forearm is supinated with a mild axial force at the wrist, and a valgus moment and compressive force is applied to the elbow during flexion

results in a typical apprehension response with reproduction of the patient’s symptoms and a sense that the elbow is about to dislocate

The clinician may observe a dimpling of the skin and a prominent radial head posteriorly as it subluxes and then relocates with increased elbow flexion.

76
Q

LUCL =

A

thickening of the capsule that attaches proximally to the lateral humeral epicondyle and distally to the tubercle of the supinator crest of the ulna

stabilizing the lateral aspect of the elbow

acts as a posterior buttress for the radial head to prevent its subluxation

77
Q

Injury to the LUCL =

A

allows an abnormal external rotation (supination) of the ulna on the humerus (external rotation of the ulna)

the radial head, which is locked into the sigmoid (radial) notch of the ulna by the annular ligament, subluxates posterior to the capitellum

78
Q

Lateral collateral ligament complex consists of four components:

A

the lateral (radial) collateral ligament (LCL)

the LUCL (ulnar part of LCL)

the accessory LCL

the annular ligament

79
Q

Insufficiency of the lateral ulnar collateral ligament (LUCL) leads to ____

A

posterolateral instability

80
Q

Special tests – Epicondalgia (Epicondylalgia, Epicondylitis)

A

Cozen’s test
Mill’s test
Middle finger extension
Golfer’s elbow test

81
Q

Cozen’s test =

A

Patient’s elbow is in 90 dg of flexion

Patient asked to make a fist, pronate forearm, and radially deviate and extend wrist while PT resists motion

Sudden severe pain in lateral epicondyle is +

Pro tip: you may identify painful resisted wrist extension during the UQ screen

82
Q

Mill’s test =

A

Patient may be seated, standing or supine

PT passively pronates the patient’s forearm, flexes the wrist fully, and extends the elbow

Pain over lat epicon is +

This test also puts stress on radial nerve (compression). Differential dx may be needed

83
Q

Middle finger extension (Maudsley’s test) =

A

PT resists extension of the 3rd digit distal to PIP joint stressing the extensor digitorum muscle and tendon.

Pain over lat epicon is +

84
Q

Golfer’s elbow test =

A

For medial epicondalgia

Active test: Patient’s forearm is supinated and the elbow is flexed. PT resists wrist flexion

Passive test: Patient’s forearm is passively supinated and PT extends elbow and wrist, stressing volar structures

Pain over medial epicon is +

85
Q

Hand Grip Dynamometry- pain free grip strength

A

Using standard test position: GHJ neutral, elbow 90, forearm neutral.

Measure the amount of force that the patient generates to the onset of pain

Repeat the testing three times with 1 minute rest intervals

average of 3 reps should be used for comparison between the unaffected and affected sides

Correlates with disability and perceived improvement in LE populations

86
Q

Special tests – Neurological dysfunction

A

Tinel’s at elbow
Elbow flexion test
Test for pronator teres syndrome
Resisted supination
“Ok sign” test

87
Q

Tinel’s at elbow =

A

PT holds the patient’s wrist

Ulnar nerve is tapped between olecranon and medial epicondyle.

If + has tingling sensation in the ulnar distribution of forearm and hand

88
Q

Elbow flexion test =

A

Patient asked to fully flex the elbows with full wrist extension

Hold position for 3-5 mins

Tingling in the ulnar n distribution is + for cubital tunnel syndrome

Elbow flexion test- specificity (.99), sensitivity (.75)

89
Q

Test for pronator teres syndrome =

A

Patient is seated with elbow flexed to 90 deg, forearm neutral or slightly supinated

PT can palpate first to assess for tenderness or reproduction of symptoms

PT resists pronation as the elbow is extended

Tingling in the median nerve distribution in the forearm and hand is +

90
Q

Resisted supination =

A

Patient is seated with elbow flexed to 90 deg, forearm neutral or slightly pronated

PT resists supination with the elbow flexed

Reproduction of lateral elbow pain, particularly distal into the extensor muscle bellies, is +

Suggest posterior interosseous nerve (PIN) involvement

91
Q

“OK sign” test =

A

Patient asked to pinch tips of index finger and thumb together

If patient unable to pinch tip but instead do pulp to pulp then + for anterior interosseous n (branch of median n)

+ entrapment of the anterior interosseous nerve (AIN) as it passes between the 2 heads of pronator teres

Can’t do the OK because FDP and FPL are not functioning – AIN branch of the median nerve

92
Q

Accessory motion testing
Open packed positions:

A

Humeroulnar = 70o flexion, 10o supination

Humeroradial = Full extension, full supination

Proximal radioulnar = 70o flexion, 35o supination

93
Q

Accessory motion testing: Humeroulnar joint
DISTRACTION

A

Supine or sitting, with the arm over the edge of the treatment table. Pt’s wrist resting on therapist’s shoulder.

When in the resting position, place the fingers of your ulnar hand over the pt’s proximal ulna on the volar surface; reinforce it with your other hand.

To isolate the mobilization force to the humeroulnar articulation, be sure that your hand is not in contact with the proximal radius

Apply force against the proximal ulna at a 45° angle to the shaft of the bone.

94
Q

Accessory motion testing : Humeroradial joint
Dorsal & Volar glide

A

Supine or sitting elbow extended and supinated to the end of the available range.

Stabilize the humerus with your hand that is on the medial side of the patient’s arm.

Place the palmar surface of your lateral hand on the volar aspect and your fingers on the dorsal aspect of the radial head.

Dorsal glide head of the radius to increase elbow extension; volar glide to increase flexion.

95
Q

Volar/ANTERIOR GLIDE

A

Stabilize humerus and apply an anterior glide of the radius to assess the accessory glide that accompanies flexion.

96
Q

DORSAL/POSTERIOR GLIDE

A

Stabilize the humerus and apply a posterior glide of the radius to assess the accessory glide that accompanies extension.

97
Q

Accessory motion testing: Proximal radioulnar joint

A

Sitting or supine, begin with the elbow flexed 70° and the forearm supinated 35°.

Approach the patient from the dorsal aspect of the forearm. Fixate the ulna with your medial hand around the medial aspect of the forearm

With your other hand, grasp the head of the radius between your flexed fingers and palm of your hand.

Force the radial head volarly or dorsally by pushing with your palm or pulling with your fingers

If a stronger force is needed, rather than pulling with your fingers, move to the other side of the patient, switch hands, and apply the force with the palm of your hand.

98
Q

Imaging

A

Radiographs remain the initial imaging choice

Good correlation between imaging vs. elbow extension test

Standard x-ray include A-P and lateral views

MRI for medial collateral ligament tear
> Specificity = 100%
> Sensitivity = 57%

Ultrasound: variable diagnostic accuracy for lateral epicondylitis

MSK I (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions