Patient Examination of Elbow Flashcards
The function of the elbow is to work with what other structures?
Shoulder and Hand
Is the elbow an unstable or stable joint?
Stable
What are the 3 articulations of the Elbow?
- Humeroulnar Joint
- Humeroradial Joint
- Proximal Radioulnar Joint
What surfaces are concave/convex for the humeroulnar joint
Ulna concave
Humerus convex
What surfaces are concave/convex for humeroradial joint?
Radius concave
Humerus convex
What surfaces are concave/convex for proximal radioulnar joint?
Ulna concave
Radius convex
What are the 3 lateral symptom locations?
Epicondyle, LCL, Radius
What are the 4 medial symptom locations?
Epicondyle, UCL, Ulnar Nerve, Ulna
What are the 3 posterior symptom locations?
Olecranon, Triceps, Valgus extension overload
What are the 3 anterior cubital fossa symptom locations?
Brachialis (biceps mm), posterior interosseous nerve, capsule
If pain changes with gripping activities, we are thinking?
Epicondyalgia
If the elbow was hyperextended at the injury, we are thinking?
Ligamentus or capsule
If symptoms increase with throwing activity, we are thinking?
Medial epicondyle
Red flags?
- angina (precipitated by physical exertion)
- severe persistent pain not affected by movement
- sudden swelling w/o trauma indicative of infection, inflammation, or gout
PROM with Overpressure (flex, ext, pronation, supination)
Flex: soft
Ext: hard
Pronation: hard or firm
Supination: firm
Reason why pronation is hard or firm overpressure is because of?
Dorsal radioulnar ligament
The carrying angle of the arm is approx?
15°
Carrying angle is bigger in males or females?
Females
Carrying angle is valgus or varus inclination
Valgus
Carrying angle increase what action of the elbow?
Elbow flexion
Carrying angle directs ulna medial or lateral during extension?
Lateral
What are 3 influences of the T/S or shoulder that have an affect on the elbow?
- kyphosis
- GHJ not rounded
- larger carrying angle
What is the resting/open-pack position for humeroradial joint?
Extension and supination
What is closed pack for humeroradial joint?
90° Elbow Flex and 5° supination
What is the humeroradial joint capsular pattern?
No true capsular pattern
What is the open-packed position for proximal radioulnar joint?
70° flex and 35° supination
What is closed pack for proximal radio ulnar joint?
5° supination
What is the capsular pattern for proximal radioulnar joint?
Minimal loss of motion, end ranges are pronation and supination
For the HU and HR joints, what 2 motions would you want to do for mobs?
Flexion and extension
For Proximal RU joint, what 2 motions would you want to do for mobs?
Pronation and supination
What are the 9 common diagnoses and injuries of the elbow?
- Cubital tunnel syndrome
- Bursitis
- Dislocation
- Fracture
- Compartment syndrome
- Lateral/medial epicondyle
- Nursemaid’s elbow
- Posterior impingement
- Tendinitis/osis
Tennis elbow is also known as what? And caused by overuse of what two actions?
Lateral epicondylalgia, overuse injury - combined rotation with extension
What are the primary and secondary muscles involved in lateral epicondylalgia?
Primary - ECRB and ECRL
Secondary - Anconeus and EDC (extensor digitorum communius)
What are the 4 typical signs and symptoms of tennis elbow?
TTP over lat epicondyle, pain with strong gripping, decreased grip strength, pain with passive stretching of forearm
What are the 3 aggs of tennis elbow?
Repetitive wrist turning/hand gripping, using tools/shaking hands/twisting, baseball/fencing/swimming/track & field throwing
What are the eases of tennis elbow?
Rest and activity modification
Overload of what two motions for tennis elbow?
Wrist ext, and radial dev
What is another name for medial epicondylalgia?
Golfer’s elbow
Golfer’s elbow is repetitive concentric/eccentric stress placed on
FCRB and pronator teres
Secondary structures affected for medial epicondylalgia are?
Palmaris longus, FDS, and FCU
5 What are the typical signs and symptoms for medial epicondylalgia?
Weak grip strength, pain with repetitive wrist flexion/pronation, contracture seen in throwing athletes, dull ache immediately after activity and at rest, sharp or achy pain radiating down the medial forearm
What are the typical aggs of golfers elbow?
Golf/tennis/bowling/racquetball/football/archery/weight lighting/javelin, carpentry/plumbing/meat cutting, throwing in late cocking and acceleration (ER to IR) bc of valgus stress
What are the typical eases for golfers elbow?
Rest and activity modification
What is the MOI for Biceps tendonitis?
Repetitive hyper extension of elbow with pronation or repetitive stressful pronation and supination
Olecranon Bursitis MOI?
Direct trauma
Secondary conditions to Olecranon bursitis?
Gout, SLE (lupus), chronic friction, infection, repetitive overuse
What populations does Olecranon bursitis typically affect?
Students and Athletes - from fall on elbow high
Signs and symptoms of Olecranon bursitis?
Swelling, warmth, heat to post elbow
Aggs for Olecranon bursitis?
Full ext, repetitive extension, wearing long sleeves, compression to elbow
Eases for Olecranon bursitis?
Rest, guarding of elbow in slight flexion
Medial ligament sprain or tear is injuring what ligament?
UCL
UCL sprain MOI is? Examples?
Chronic valgus and ER forces
(I.e. tennis serve, baseball pitch, FOOSH)
Repetitive stress of the UCL can lead to
Osteophyte formation
What are the signs and symptoms for UCL spain?
Medial elbow pain, decreased ROM
What ligament in the elbow is damaged laterally?
Radial Collateral ligament
RCL injury MOI is
Axial compression, ER, varus force, FOOSH
Signs and symptoms of RCL injury is
-lateral side pain
-clicking sound during ext
-catching when extended
-dislocation
-difficulty lifting objects
UCL is comprised of 3 components
Anterior bundle, posterior bundle, and transverse ligament
Cubital tunnel syndrome MOI
- trauma
- prolonged compressive or stretching forces
- secondary trauma or joint disfigurement or dysfunction
Signs and symptoms of cubital tunnel syndrome
- Initial: pain, point tenderness, swelling medial aspect
- Progress: numb, tingling, cold feeling medial distal 3rd of forearm and little and ring fingers
- if pt sleeps with elbow fully flexed, may wake with n/t
- ulnar distribution sensation changes
Aggs of cubital tunnel syndrome
- compression, stretching, or overload activities
- pitching
- resting with elbow on table
- sleep
Eases of cubital tunnel syndrome
- positional changes
Cubital tunnel syndrome is
Mononeuropathy caused by entrapment, compression, stretch, ischemia, infection or inflammation to the ulnar nerve
What is the most commonly injured peripheral nerve
Radial nerve
Radial nerve entrapment involved by
Contusion or mild stretching
Locations and sensory/motor loss for radial nerve entrapment
- High radial nerve compression (both)
- PIN syndrome (motor)
- Radial tunnel syndrome (sensory)
- radial sensory nerve entrapment (sensory)
What is nursemaid’s elbow?
Subluxation of radial head from the annular ligament
