L9 Elbow Exam Flashcards
Radiocapitellar Line
when a line is drawn through the proximal radial shaft AND neck, and extended through the joint, it should pass through to the articulating capitellum
Anterior humeral line
on lateral view, when a line is drawn along the anterior surface of the ulnar cortex and extended, it should pass through the middle third of the capitellum
Immobilization causes individuals to lose
extension within a few weeks
Annular ligament
limits distraction and dislocation of radial head
Radial collateral ligament (LCL or RCL)
primary lateral stabilzer followed by capsule and common extensor group
taught through flexion and extension, tension increases in supination
Interosseous membrane
prevents proximal displacement of radius on ulna
Ulnar/medial Collateral Ligament Complex
has three different bands; anterior, posterior, and oblique
the anterior portion of UCL is the strongest, provides greatest restrain to valgus stress
Ant band of UCL
Ant portion: taut 0-60° flexion
Post portion: taught 60-120° flexion
Post band of UCL
taut at 90°
Oblique band of UCL
can be absent, blends with capsule
When the UCL is impaired
lateral structures can become overstressed
Arcade of Frohse
semicircular arch at the proximal edge of supinator muscle, about 2 cm distal to radiohumeral joint
deep radial nerve travels under the AOF
Common sites of r. nerve entrapment
- tendinous margin, origin ECRB
- arcade of frohse
- distal border of supinator
s/s: finger drop and radial wrist deviation on extension
Radial head dislocation
children 3-6
elbow pain and lacking supination
also known as nursemaid’s elbow
Osteochondriditis dissecans
12-20 yo
pain usually lateral, insidious onset, may have click or catch, loss of extension
MOI: repetitive stress. localized fragmentation of bone and cartilage
Distal Biceps Rupture MOI/RF
MOI: rapid eccentric contraction of biceps
load takes elbow from flexion into extension in supinated position
factors that could dispose you to it are degenerative changes, spurring of bicipital tuberosity, use of steroids, smoking
Distal Biceps Rupture population + S/S
males 4th to 6th decade of life OR young weightlifters and bodybuilders, manual labor
complains of painful pop at front of elbow, loss of supination, positive hook test, deformity, bruising
pain in multiple joints?
most likely RA
Joint pathology is relieved by
holding elbow into side and supporting wrist, it takes load off extensor group
Clicking or locking indicate
loose bodies
chondral injury
osteophytes
instability
Compression ulnar nerve locations
above elbow in region of intermuscular septum
medial epicondylar region
ulnar groove
region of cubital tunnel
where ulnar nerve exits from FCU
Observation of elbow
Swelling
Soft tissue contours
carrying angle
anterior view
posterior view
deformities
guarding
Swelling at elbow
olecranon bursitis
Tennis players age 55 and over may
have a loss of 10° of extension
Carrying angle
males: 5 to 10°
females: 10 to 15°
Anterior view of elbow
proximal rupture
distal rupture
erb’s palsy
Proximal rupture of biceps
popeye’s sign
muscle belly springs down
Distal rupture of biceps
muscle belly springs up
Erb’s palsy
C5 C6, (musculotaneous and axillary nerve)
elbow is extended, pronated. Shoulder is IR and adducted. Wrist is flexed (waiter’s tip)
What radigraphic guide should you use for a posterior dislocation of elbow?
radio-capetellar
Techniques for reducing nursemaid’s elbow
- Elbow ext, supination, traction, flexion
- elbow extension, hyperpronation
When should you exam the C-spine?
over 30 yrs old
1. no hx of trauma
2. radicular signs
3. trauma with radicular signs
4. altered sensation
Would you clear the c-spine as part of your standard elbow exam?
no the joint is above the shoulder
Capsular pattern for elbow
flexion more limited than extension
Biceps length test
- supine w/shoulder at edge of table
- passively extend shoulder to end range, then extend elbow
normal: elbow extension passively is the same range as AROM –>overpressure can’t go past bone to bone
Triceps length test
- sitting passively forward flex arm to full elevation with elbow in extension
- passively flex elbow
normal: elbow flexion is passively and actively in same range
Cubital fossa contains
coronoid process
head of radius
biceps and brachialis
Palpation of Radial tunnel
forearm is in neutral, palpate in line anterior to radiohumeral jt to the midpoint between the radius and ulna on posterior aspect of forearm, ECRB.
tunnel is about 4 fingertips wide
tenderness should be expected over radial tunnel, not lateral epicondyle. should perform special tests if both are painful
Joint play movements of elbow
radial deviation of the ulna and radius on humerus
ulnar deviation of the ulna and radius on humerus
distraction of olecranon from humerus in 90° flexion
anteroposterior glide of the radius on humerus
Biceps referral pattern
bicipital groove to anterior elbow
Brachialis referral pattern
anterior arm, elbow to lateral thenar eminence
Triceps referral pattern
posterior shoulder, arm, elbow, forearm to medial epicondyle
Brachioradialis referral pain
lateral epicondyle, lateral forearm to posterior web space BT thumb and index finger
Anconeus referral pain
lateral epicondyle area
Supinator referral pain
lateral epicondyle, post web space, BT thumb, index finger
ECRB referral pain
posterior forearm to posterior wrist
FCR pain referral
anteromedial wrist
FDS pain referral
palm to appropriate digit
Diagnostic imaging
should be used in conjunction with a physical exam to determine diagnosis
should not be used as sole method of diagnosisS
Supracondylar fracture
Cozen’s test
patient is asked to move the wrist to dorsal flexion and the therapist provides resistance to this movement
positive is pain in lateral epicondyle
testing for lateral epicondylitis
Mill’s test
clinician palpates the patient’s lateral epicondyle with one hand while pronating the patient’s forearm, fully flexing the wrist, the elbow extended
positive is pain over lateral epicondyle
testing for lateral epicondylitis
Tests for Lateral Epicondylitis
Cozen’s
Mill’s
Tennis Elbow
Golfer’s Elbow Test
palpate medial epicondyle
passively supinate forearm, extend elbow and wrist
positive is indicate by pain over medial epicondyle of humerus
Hook Test
patient actively flexes elbow to 90° and fully supinates
therapist uses index finger to approach lateral side, attempts to hook finger under lateral edege of biceps tendon
positive is no biceps tendon to hook
Tinel’s sign at the elbow
tap the ulnar nerve in the groove between the olecranon process and medial epicondyle
positive sign is indicated by tingling sensation in the ulnar distribution of forearm and hand distal to the point of compression of the nerve
Testing for TFCC injury
Impingement: elbow on table, palpate TFCC, then UD rotate forearm. Positive is clicking
Compression: as above, load as wrist is UD
Watson’s test
Thumb of one hand holds palmar aspect of scpahoid and index finger on radial tubercle dorsally.
maintaining firm pressure, push the pt into radial deviation
proximal pole will jump over the dorsal lip of radius with a clunk if positive
Grind Test for OA
hold patient thumb between your thumb and index finger and place your opposite hand over CMC joint. Apply axial compression and rotation to the mc base on trapezium
palpate for instability or crepitus, which is a positive for this test
Froment’s sign
as paper is pulled away by the examiner, thumb will either IP joint flex or not. Positive would be IP joint flexion
tests for ulnar nerve
Wartenberg’s sign
passively place all of pts fingers in abducted position and then ask to bring fingers together while keeping them flat on the table
positive if little finger remains in abduction
watch for other fingers moving towards little finger to compensate
Phalen’s test
place dorsum of hands together and lower elbows to create bilateral wrist flexion dorsum of hands are pressed together for 1 minute. Positive if patient reports pain in median nerve distribution
testing carpal tunnel
Reverse Phalen’s test
place palmar surface of hands together and raise elbows to create bilateral wrist flexion, pressed together for a minute
positive if pain in median nerve distribution
Tinel’s median test
tap over carpal tunnel at median nerve for 10s. Positive if pt reports pain in median nerve distribution
Testing of FDP and FDS
FDP: hold distal IP joint and flick with other hand. Should be tense
FDS: hold all fingers down except for affected. Flick finger into extension, should be flaccid
Elson Test
testing rupture of central slip, not boutonniere deformity
passively flex PIP to 90 over edge of a table and asks pt to extend the PIP while examiner resists. Positive would be no extension power and extension at DIP
