elbow Examination (general trauma and hypomobility) Flashcards
1
Q
What are the ligaments of the elbow
A
- capsule
- LCL
- Annular ligament
- oblique cord
- MCL
2
Q
carrying angle normal and variations
A
- normal valgus 5-15
- excessive cubitus valgus = >15
- cubitus varus = -5 varus
- gunstock deformity varus = -15 (varus)
3
Q
Gunstock deformit varus casues
A
- can result from fracture or injury to epiphyseal plate
4
Q
Elbow flexion/extension osteokinematics/arthrokinematics
A
- flexion 0-145: roll and glide anterior with varus tilt
- extension: 145-0: roll and glide posterior valgus tilt
*possible hyperextension
5
Q
Pronation and supination pivot joint osteokinematics/arthrokinematics (proximal R/U joint)
A
- supination 0-90: spin
- pronation 0-90: spin
6
Q
Pronation and supination pivot joint osteokinematics/arthrokinematics (distal R/U joint)
A
- supination 0-90: roll and glide in same direction
- pronation 0-90: roll and glide in same direction
7
Q
Medial collateral ligaments
A
- resists valgus
- anterior fibers: also taut in extension
- posterior fibers: taut in flexion
8
Q
Common trauma to MCL or common injury with valgus forces at the elbow
A
- MCL sprain/tear from falling on hand and a valgus forces gets applied
- avulsion fx common in throwers
- compression of radius and capitulum: fracture, avascular necrosis, loose bodies
9
Q
Valgus force injury clinical test
A
- while maintaing valgus stress, preform flexion and extension of elbow
- (+) test = pain
(medial elbow pain due to tensile stress on MCL and lateral elbow pain from compression)
10
Q
Tommy John UCL reconstruction
A
- UCL reconstruction
- tunnels drilled into ulna and humerus
- new tendon in place
- can be tendon esp. palmaris longus or donor tendon
11
Q
LCL
A
- resists varus forces
- radial collateral ligament
- lateral ulnar ligaments: also taut in end range flexion and extension
12
Q
Annular ligament
A
- resists distraction of radius
- pulled elbow
- radial head displaced inferiorly through annular ligament
- forearm typically held in extension and pronation
- reduce by axial compression, elbow flexion and supination
13
Q
Olecranon fracture and how it is treated?
A
- fall on olecranon
- nondisplaced: splint 45-90 degress
- displaced = ORIF plates, screws, wires
14
Q
Radial head fracture
- mechanism
- treatment
A
- FOOSH: valgus force
- nondisplaed: splint
- displaced/comminuted = ORIF or RH replacement
15
Q
Alvusion fractureat the elbow
A
- trauma
- ligament pulled during muscle contraction
- medial or lateral epicondyle
16
Q
Fracture/elbow dislocation
A
- ulna and radius go posterior
- humerus goes anterior
- fracture epicondyle/coronoid
- can damage a lot of other tissues think cubital fossa
17
Q
intercondylar fracture is caused by
A
- impact Though the hand or elbow–> humerus splits condyles
18
Q
humeral shaft fracture
A
- radial nerve injures
- drop wrist
- decreased grasp due to active insufficiency of finger flexors
19
Q
distal humeral fracture in ulnar groove at elbow
A
- ulnar nerve injured
- diminished key grip
- diminished power grip (gripping hammer)
- wrist deviates radially during wrist flexion and extension
20
Q
bone/articular cartilage piece in joint “loose body”
A
- avulsion fracture, osteochondrosis
- bony block end feel in shortened range
21
Q
Volkmans Ischemic Contracture
A
- elbow fracture = blood and transudate into forearm
- rapid increase in pressure
- compression can cause nerve damage if its not relieved quickly
- muscle ischemia –> necrosis
22
Q
olecranon bursistis
A
“students elbow”
- bursa fills with fluid
- chronic problematic
- may need it drained or excised
23
Q
Tendiopathies at the elbow
A
- epicondylagia (pain at elbow)
- tendinitis
- tendinosis
- tennis elbow (lateral epicondyle)
- golfers elbow (medial epicondyle)
24
Q
Steps (general) to the elbow exam
A
- history interview systems review
- observation
- functional assessment/limitations
- elbow examination
- joint play
- resisted isometrics
- sensation testing (if indicated)
- special tests
- palpation
25
What to look at/ask in the history/interview for an elbow patient
- symptom type, location, severity
- MOI - trauma, overuse, onset, acute vs chronic
- what makes it feel better or worse
- functional limitations: dominate hand?
- occupation, leisure activities, sports
- diagnostic tests, Xrays, MRI
- previous treatment
- patient goals
26
what to observe at the elbow
- protection
- willingness to move
- alignment of elbow
- edema: typically around the epicondyles within the triangle
- olecranon bursitis
27
Funcation requirements of the elbow ROM
- 30-130 for flexion and extension
- 50 supination
- 50 pronation
28
Once you rule out CS and shoulder what do you do at the elbow
- AROM/PROM: is there a capsular pattern (flexion> extension)
- elbow: normal end feels vs abnormal end feels
29
Normal end feels at the elbow
- flexion = soft tissue aprox.
- extension: bony
- pronation/supination: tissue stretch
30
elbow abnormal end feels
- limited capsular = stiff with no creep
- limited boddy/squishy = swelling
- hard end feel that limits = bone cartilage, loose body
- empty = pain limits
31
elbow/forearm open pack
- UH = 70-90 flexion and 35 supination
- distal RU = 10 supination
32
Closed pack position for elbow/forearm
- UH = full extension
- RU = full supination or full pronation
33
Joint play at the elbow/forearm
- ulnar distraction: of olcranon process on the humerus in 70-90 flexion
- medial varus/lateral varus tilt: of radius and ulna on humerus in slight flexion
- proximal R/U joint = anterior posterior glide of radial head
- Distraction radioulnar joint = anterior glide radius on ulna
34
resisted isometrics
- elbow, forearm wrist and hand
- extrinsics
35
Sensation testing
- if indicated
- dermatomal
- peripheral nerve
- specialized = 2 point discrimination/monofilaments
