Elbow Examination Flashcards
1
Q
Elbow examination parts (9)
A
- History
- Observation
- AROM
- Repeated movements
- PROM
- Passive accessory motion
- Muscle performance testing
- Special tests and neuroscreen
- Palpation
2
Q
How does an elbow instability and subluxation and dislocation present (4)
A
- FOOSH
- May have deformity
- May have neural involvement
- May have vascular involvement
3
Q
How does an elbow fracture present (3)
A
- Trauma
- Presence of fat pad sign
- Inability to fully extend elbow
4
Q
What are the 4 common elbow fractures
A
- Medial and lateral epicondyle
- Olecranon
- Radial head
- Coronoid process
5
Q
What are complications of elbow trauma (5)
A
- Stiffness
- Loss of extension
- Mild to moderate pain
- Popping or locking
- Ulnar neuritis
6
Q
What is the power nerve of the hand
A
Ulnar nerve
7
Q
What innervates the hand and finger extensors
A
Radial nerve
8
Q
What is the fine motor skills of the hand and fingers
A
Median nerve
9
Q
What does heterotrophic ossificans present with (3)
A
- Pain with progressing loss of ROM
- May have hyperemia, swelling, warmth
- May show increased serum alkaline phosphatase, sedimentation rate, and WBC count
10
Q
Who is more likely to get complex regional pain syndrome
A
Women 40 years of age
11
Q
What is complex regional pain syndrome
A
Severe pain disproportionate to the injury
12
Q
How does posterolateral rotatory instability present (5)
A
- Vague elbow discomfort
- Lateral elbow pain
- Clicking, snapping, or clunking worse with supination
- Something is not right
- Elbow giving out with loading flexed elbow
13
Q
How does valgus instability occur acute and insidious
A
Acute: FOOSH
Insidious: Overuse in excessive valgus
14
Q
How does valgus instability present (3)
A
- Medial elbow pain
- Pop at time of injury
- Tenderness at UCL
15
Q
How does lateral tendinitis present (4)
A
- Point tenderness to distal humerus
- Difficulty gripping
- Pain with wrist flexion
- Pain with active wrist/finger extension
16
Q
Who most commonly get lateral tendinitis
A
Women age 35-50
17
Q
How does medial tendonitis present
A
Pain with flexion and pronation of wrist
18
Q
Who is more likely to get medial tendinitis
A
Men and women are the same
19
Q
What percent of medial tendinitis occurs in the dominant hand
A
75%
20
Q
What is the incidence of biceps tendon rupture
A
1.2/100000
21
Q
Who is most likely to rupture biceps tendon
A
Males 40-60
22
Q
How does biceps tendon rupture present (3)
A
- Pop
- Acute weakness
- May have deformity
23
Q
What is another name for the cubital tunnel
A
Ulnar tunnel
24
Q
The cubital tunnel is the sight of what common nerve entrapment in UE
A
2nd most common
25
How does cubital tunnel syndrome present (3)
1. Paresthesia along ulnar distribution
2. Clumsiness or loss of coordination of hand
3. Popping or snapping during flexion/extension
26
What nerve is involved in cubital tunnel syndrome
Ulnar nerve
27
What nerve is involved in pronator syndrome
Median nerve
28
How does pronator syndrome present (6)
1. Anterior elbow pain
2. Usually lack of specific injury
3. Pain volar proximal forearm
4. Sensory changes palmer surface of digits 2-4
5. Weakness of digits 1-3
6. Positive compression at pronator border
29
What nerve is involved in anterior interosseous syndrome
Median nerve
30
How does anterior interosseous syndrome present (6)
1. Pain volar proximal forearm
2. No sensory symptoms in fingers
3. Weak FPL, lateral FDP, thenar sparing
4. Negative compression at pronator border
5. Inability to make ok sign
6. Motor loss
31
What nerve is involved in radial tunnel syndrome
Radial nerve
32
How does radial tunnel syndrome present (5)
1. Deep ache distal to lateral epicondyle
2. Pain at belly of brachioradialis
3. Pain with resisted supination
4. Pain with repetitive wrist flexion, and/or pronation
5. No motor over sensory loss
33
What nerve is involved in posterior interosseous syndrome
Radial nerve
34
how does posterior interosseous syndrome present (5)
1. Lateral forearm or elbow pain
2. Weak wrist extension with radial deviation
3. Weakness of digital extensors
4. Thumb extension produces pain at lateral epicondyle
5. Motor loss
35
Who is most likely to get osteoarthritis
Males 40-60
36
How does OA present (5)
1. Repetitive use of UE
2. Insidious onset
3. Loss of terminal extension
4. Pain at end of flex/ext
5. Ulnar neuropathy
37
What percent of OA have ulnar neuropathy
26-55%
38
Who is most likely to have acute forearm compartment syndrome
Males under 30
39
How does acute forearm compartment syndrome present (3)
1. Supracondylar Fx in children
2. Distal radial fracture
3. 5 Ps
40
What are the 5 Ps
1. Pain
2. Pallor
3. Pain with passive stretch of muscle
4. Parathesia
5. Pulselessness
41
Do you have to have all 5 Ps at once
Nope
42
How does chronic forearm compartment syndrome present (3)
1. Increase in forearm pressure due to muscle activity
2. Forearm pain of gradual onset
3. Weakness, numbness, clumsiness, and pain
43
What is olecranon bursitis
Inflammation of bursal sac covering olecranon
44
What is the rate of septic olecranon bursitis
0.6/1.2-1000
45
How long does it take aseptic bursitis to heal
Very quick
46
How long does it take septic bursitis to heal
Up to 40 days
47
Diagnose: Pain over lateral elbow during gripping activities (2)
1. Lateral epicondylitis
| 2. Radial tunnel syndrome
48
Diagnose: Pain over medial elbow with wrist flexion and pronation (1)
1. Medial epicondylitis
49
Diagnose: Numbness and tingling along ulnar nerve distribution distal to elbow (1)
1. Cubital tunnel syndrome
50
Diagnose: Pain in anterior elbow and forearm worsened with wrist flexion combined with elbow flexion and forearm pronation (1)
1. Pronator syndrome
51
Diagnose: Pain with elbow movement with sensation of catching or instability (1)
1. Rotatory instability
52
Diagnose: Posterior elbow pain with elbow hyperextension
Valgus extension overload syndrome
53
What is the normal carrying angle for males and females
Males: 5-10
Females: 10-15
54
What is the carrying angle for cubital valgus
30
55
What is the carrying angle for cubital varus
-5
56
What is the carrying angle for gunstock deformity
-15
57
What does the carrying angle allow for
Us to clear hip joint with forearms
58
How are the epicondyles and olecranon orientated during extension
Straight line
59
How are the epicondyles and olecranon orientated during flexion
Equilateral triangle
60
What ligaments prevent varus
Lateral collateral ligaments
61
What ligaments prevent valgus
Medial collateral ligaments
62
When are the median and radial nerve tension loaded
Extension
63
When is the ulnar nerve tension loaded
Flexion
64
What is the motion at the humeroulnar articulation
Slide of ulnar trochlear ridge on humeral trochlear groove
65
What is the motion during extension at the humeroulnar joint
Olecranon process of ulna in olecranon fossa of humerus
66
What is the motion during flexion at the humeroulnar joint
Coronoid process of ulna in coronoid fossa of humerus
67
what is the motion at the humeroradial articulation
Concave radial head slides on convex capitulum of the humerus and tubercle/groove on lateral lip of trochlea
68
What is the motion during extension at the humeroradial joint
No contact is made between the radius and humerus
69
What is the motion during flexion at the humeroradial joint
Rim of radial head slides in capitulotrochlear groove into radial fossa
70
What holds the radial head in place
Annular ligament
71
What is normal flexion of elbow
150
72
What is normal extension of elbow
0
73
What is normal supination of elbow
90
74
What is normal pronation of elbow
80
75
What is functional ROM of the elbow
30-130
76
What is the roll and glide of forearm varus
Roll: Medial
Glide: Lateral
77
What is the roll and glide of forearm valgus
Roll: Lateral
Glide: Medial
78
True or False:
| Forearm varus/valgus configuration is convex on concave
True
79
True or False:
| The proximal radioulnar joint configuration is convex on concave
True
80
True or False:
| The distal radioulnar joint configuration is concave on convex
True
81
What is the resting position of the humeroulnar joint
70 elbow flexion and 10 supination
82
What is the closed pack position of the humeroulnar joint
Extension with supination
83
What is the capsular pattern of the humeroulnar joint
Flexion then extension
84
What is the resting position of the humeroradial joint
Full extension and full supination
85
What is the closed pack position of the humeroradial joint
Elbow flexed 90 and forearm supinated 5
86
What is the capsular pattern of the humeroradial joint
Flexion, extension, supination, pronation
87
What is the resting position of the superior radioulnar joint
Supination 35 and elbow flexion 70
88
What is the closed pack position of the superior radioulnar joint
5 supination
89
What is the capsular pattern of the superior radioulnar joint
Equal limitations of supination and pronation
90
How much valgus stress do the UCL, anterior capsule, and bony articulation resist at 0 elbow extension
UCL: 31%
Ant Cap: 38%
Bone: 31%
91
How much valgus stress do the UCL, anterior capsule, and bony articulation resist at 90 elbow extension
UCL: 54%
Ant Cap: 10%
Bone: 36%
92
How much varus stress do the RCL, anterior capsule, and bony articulation resist at 0 elbow extension
RCL: 14%
Ant Cap: 32%
Bone: 55%
93
How much varus stress do the RCL, anterior capsule, and bony articulation resist at 90 elbow extension
RCL: 9%
Ant Cap: 13%
Bone: 75%
94
How much distraction do the UCL and anterior capsule resist at 0 elbow extension
UCL: 5%
| Ant Cap: 70%
95
How much distraction do the UCL and anterior capsule resist at 90 elbow extension
UCL: Primary resistance
| Ant Cap: Minimal resistance
96
What are the passive accessory motions of the elbow (10)
1. Passive elbow flexion/extension
2. Passive elbow flexion/extension with overpressure
3. Passive elbow flexion/extension with varus
4. Passive elbow flexion/extension with valgus
5. PA of humeroulnar joint
6. PA of humeroradial joint
7. AP of humeroulnar joint
8. AP of humeroradial joint
9. PA of radioulnar joint
10. AP of radioulnar joint
97
What are the resisted isometrics of the elbow (6)
1. Elbow flexion
2. Elbow extension
3. Forearm supination
4. Forearm pronation
5. Wrist flexion
6. Wrist extension
98
When we extend our elbow we have a valgus or varus
Valgus
99
When we flex our elbow we have a valgus or varus
Varus
100
When is the biceps brachii isolated
Forearm supination
101
When is the brachioradialis isolated
Neutral forearm
102
When is the brachialis isolted
Forearm pronation
103
Motivation
Why stop now you can see the end
