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