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Patient Management II > Elbow Evaluation > Flashcards

Elbow Evaluation Flashcards

1
Q

History region specific

A
  • connection to cervical spine: cervical ROM, radiating pain down arm
  • neurological component: numbness/tingling, weakness, loss of grip
  • position of elbow & activity when injured
  • hand dominance
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2
Q

Red flags in the history taking

A
  • insidious onset
  • related to CV activity
  • history of CV disease
  • are the symptoms constant/unrelenting
  • radiating symptoms across multiple dermatomes
  • sudden onset of severe pain
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3
Q

Self assessments for elbow examination

A
  • DASH: disabilities of the arm, shoulder, and hand
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4
Q

What is a normal carrying angle (extension) for males and females

A
  • Females: 5-16 degrees
  • Males: 5-14 degrees
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5
Q

Pathology suspected based on observation

A
  • Swelling local to posterior tip: olecranon bursitis
  • Diminished tip of olecranon: dislocation or fracture
  • Altered carrying angle: non-union or mal-union of the humerus
  • Nodules: RA (rheumatoid arthritis)
  • Synovitis (inflammation at the joint line): RA (rheumatoid arthritis)
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6
Q

Elbow ROM

A
  • Active flexion: 145 degrees
  • Passive flexion: 160 degrees (hard end feel or soft tissue end feel)
  • Extension: 0-15 degrees (hard end feel)
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7
Q

Vascular testing

A
  • Brachial pulse
  • Allen test
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8
Q

Describe the Allen test

A
  • patency of the radial & ulnar arteries
  • compress both arteries & have the patient make a fist 3-5 times until hand is pale
  • release compression on one artery & note time to flush to normal color
  • repeat with other artery & note difference between sides
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9
Q

Open packed position for the elbow

A
  • about 70 degrees of flexion and slight supination
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10
Q

Closed packed position for humeroulnar and humeroradial

A
  • Humereoulnar: full extension
  • Humeralradial: full flexion and supination
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11
Q

Describe humeroulnar joint distraction

A
  • test distraction: improves general mobility of flexion & extension
  • test distraction at end range: improves end range motion
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12
Q

Describe radiohumeral joint distraction when fixed proximally/superiorly

A
  • test distraction: improves general elbow extension & radial head mobility
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13
Q

Proximal radiohumeral joint posterior & anterior glide

A
  • starting position in 70 degrees of flexion
  • limited pronation: test posterior glide
  • limited supination: test anterior glide
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14
Q

Pathology of cubital tunnel syndrome

A
  • compression at the elbow
  • persistent elbow flexion
  • tensile force with valgus stress
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15
Q

Typical history for cubital tunnel syndrome

A
  • numbness & tingling ulnar nerve distribution distal to elbow
  • positional complaints
  • trauma to elbow region
  • repetitive elbow flexion tasks
  • valgus stress
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16
Q

Examination of cubital tunnel syndrome

A
  • Observation: atrophy of muscles supplied by ulnar nerve (FCU, FDP 4 &5, hypothernar muscles, ADD policies, lumbrical 4 & 5, dorsal & palmar interossei)
  • palpation: tenderness over ulnar groove
  • AROM/PROM: possible symptoms in full flexion
  • RROM: symptom reproduction
  • MMT: weakness of muscles supplied by the ulnar nerve
  • Accessory movements: WNL (within normal limits)
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17
Q

Special tests for cubital tunnel syndrome

A
  • Pressure provocation test (good test)
  • Flexion test (good for ruling in test)
  • Combined pressure & flexion test (good test)
  • Tinel’s sign (good for ruling in test)
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18
Q

Typical history for MCL tear

A
  • trauma with valgus stress or repetitive stress (throwing); may have heard a pop
  • pain along medial elbow
  • swelling
  • bruising
  • if complete rupture: instability
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19
Q

Describe the grades of MCL tears

A
  • Grade 1: a small number of fibers are torn resulting in pain but full function
  • Grade 2: a significant number of fibers are torn with pain & moderate loss of function
  • Grade 3: all fibers are ruptured with elbow instability & major loss of function
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20
Q

Examination of MCL tear

A
  • Observation: swelling & possible bruising of medial elbow
  • Palpation: tenderness medial elbow
  • AROM/PROM: WNL (within normal limits)
  • RROM: will be strong in every movement
  • Accessory movements: excessive medial glide ulna with or without pain
21
Q

Special tests for MCL tear

A
  • Moving valgus stress test (not good)
  • Valgus stress test (not good)
22
Q

Typical history for lateral epicondylagia

A
  • pain along lateral elbow usually initiated by repetitive elbow or wrist movements
  • pain with grip activities (shaking hands, turning a door knob, holding a cup of coffee, etc.)
23
Q

Examination of lateral epicondylagia

A
  • Observation: may be hesitant to shake hands; possible brace in place
  • Palpation: tenderness along lateral epicondyle & common extensor tendon/muscles
  • AROM/PROM: pain with flexion of wrist with extension of elbow actively & passively & pain with active extension of wrist
  • RROM: pain with resisted wrist extension & resisted middle finger extension
  • Accessory movements: WNL (within normal limits)
24
Q

Special tests for lateral epicondylagia

A
  • Muscle palpation, AROM, PROM, & RROM
  • Grip strength with dynamometer painful & limited
25
Q

Typical history for medial epicondylitis

A
  • pain in medial elbow with wrist flexion & supination
  • pain with activities such as using a screw driver, hammering, & any squeezing activity (golf club; baseball)
26
Q

Examination of medial epicondylitis

A
  • Observation: may be hesitant to shake hands
  • Palpation: tenderness along medial epicondyle & common flexor tendon/muscles
  • AROM/PROM: discomfort with elbow extension with wrist extension active & passive
  • RROM: pain with wrist flexion & forearm pronation
27
Q

Special tests for medial epicondylitis

A
  • Palpation
  • AROM
  • PROM
  • RROM
28
Q

Typical history for bicep tendon rupture

A
  • patient reports incident followed by decreased strength in elbow flexion
29
Q

Examination of bicep tendon rupture

A
  • Observation: may observe defect; bicep will retract
  • Palpation: may palpate defect; tenderness along bicep
  • AROM/PROM: limited elbow flexion AROM but full PROM
  • RROM: weakness with resisted elbow flexion
30
Q

Special test for bicep tendon rupture

A
  • Biceps squeeze test (good test)
  • Bicipital aponeurosis flex test (good test)
  • Test cluster: Hook test, Passive forearm pronation test, & Biceps crease interval
31
Q

Typical history for elbow fracture

A
  • blunt trauma
32
Q

Special test for elbow fracture to determine need for radiography

A
  • 4 way ROM test (good at ruling out)
  • Elbow extension test (good at ruling out)
33
Q

Special tests for lateral epicondylitis/Tennis Elbow

A
  • Mill’s stretch test
  • Cozen’s test
33
Q

Describe Mill’s stretch test

A
  • palpate lateral epicondyle
  • PT passively pronates forearm, flexes wrist, & extends elbow
  • (+) = reproduction of concordant symptoms/pain over lateral epicondyle of humerus
34
Q

Describe Cozen’s test

A
  • place thumb over lateral epicondyle
  • patient’s elbow is flexed & pronated with wrist extended/radial deviation
  • PT resists wrist extension/radial deviation
  • (+) = reproduction of concordant symptoms/sudden severe pain of lateral epicondyle of humerus
35
Q

Describe 4 way ROM test

A
  • patient seated with injured arm their side with elbow extended
  • ask patient to extend fully, flex elbow to 90 degrees, pronate & supinate fully while flexed at 90 degrees
  • (+) = decreased ROM in any 4 maneuvers
  • good at ruling out test
36
Q

Describe elbow extension test

A
  • patient seated with arms supinated
  • ask patient to actively flex their shoulders to 90 degrees
  • ask patient to extend elbow
  • (+) = decreased ROM in involved elbow
  • good at ruling out test
37
Q

Describe biceps squeeze test

A
  • patient seated with elbow flexed 60-80 degrees & forearm in slight pronation (resting in lap)
  • PT squeezes biceps firmly with both hands
  • (+) = lack of forearm supination when bicep is squeezed
  • good for ruling out test
38
Q

Describe bicipital aponeurosis flex test

A
  • patient arm is supinated & elbow extended
  • ask patient to make a fist & actively flex wrist
  • ask patient to actively flex elbow to 75 degrees while maintaining wrist position
  • PT palpates medial antecubital fossa for thin edge of aponeurosis
  • good test
39
Q

Describe hook test

A
  • PT uses index finger to palpate bicep tendon
  • (+) = no tendon
40
Q

Describe passive forearm pronation test

A
  • PT passively moves patient forearm from a supinated position into pronation
  • (+) = loss of visual & palpable proximal to distal movement of the bicep muscle belly
41
Q

Describe bicep crease interval

A
  • measure the distance from antecubital crease to distal muscle belly
  • (+) = >6 cm
42
Q

Describe valgus stress test

A
  • patient elbow placed in 20 degrees flexion
  • PT palpates medial joint line & applies valgus force to the elbow
  • (+) = patient reports pain or excessive laxity compared to opposite UE
  • bad test
43
Q

Describe moving valgus stress test

A
  • patients shoulders ABD 90 degrees & elbow is fully flexed
  • PT holds forearm in one hand & stabilizes elbow with other hand
  • PT applies a vagus force & simultaneously externally rotate the shoulder
  • PT then quickly extends elbow to 30 degrees
  • (+) = pain at medial elbow & max amount of pain between 120-70 degrees of elbow flexion
  • good for ruling out
44
Q

Describe pressure provocation test

A
  • patients elbow is flexed 20 degrees
  • PT applies pressure just proximal to cubital tunnel
  • hold for 60 seconds
  • (+) = symptoms along ulnar nerve dsitribution
  • good test
45
Q

Describe flexion test

A
  • place patients elbow in full flexion with forearm supination & the wrist in neutral
  • hold for 60 seconds
  • (+) = symptoms along ulnar nerve distribution
  • good for ruling in test
46
Q

Describe combined pressure & flexion test

A
  • place patients elbow in full flexion with forearm supination & wrist in neutral
  • PT applies pressure just proximal to cubital tunnel
  • hold for 60 seconds
  • (+) = symptoms along ulnar nerve distribution
  • good test
47
Q

Describe Tinel’s sign

A
  • PT applies 4-6 taps to patient’s ulnar nerve just proximal to cubital tunnel
  • (+) = tingling along ulnar nerve distribution
  • good at ruling in test

Patient Management II (17 decks)

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