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Elbow lab Flashcards

(60 cards)

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1
Q

elbow clearing tests

A 
Flexion OP (neutral forearm)
Flexion OP (supination)
Flexion OP (pronation)
Extension OP (neutral forearm)
Extension OP (supination)
Extension OP (pronation)
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2
Q

Flexion (neutral, supinated, pronated

A

Purpose: To assess joint integrity related to the pain source

  1. Ask the patient to actively flex the elbow to the end of their available range of motion with neutral forearm.
  2. Stabilize the humerus at the glenohumeral joint
  3. Place wrist in a neutral position 4. Apply over pressure by gripping just proximal to the distal radioulnar joint 5. Apply 3 overpressures; remember to pause for patient response in between overpressures. 6. Repeat with forearm supinated, and forearm pronated
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3
Q

Flexion-Abduction

A

Purpose: To assess joint integrity related to the pain source. 1. With the therapist’s outside hand, place hand at the distal half of the humerus 2. Internally rotate patient’s humerus and hold in that position 3. With patient’s wrist in a slightly supinated position and humerus internally rotated, grip wrist just proximal to distal radioulnar joint 4. Move elbow joint into a flexion and abduction motion 5. Apply 3 overpressures; remember to pause for patient response in between overpressures

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4
Q

Flexion-Adduction

A

Purpose: To assess joint integrity related to the pain source
1. With the therapist’s outside hand, place hand at the distal half of the humerus 2. Externally rotate patient’s humerus and hold in that position 3. With patient’s wrist in a slightly supinated position and humerus externally rotated, grip wrist just proximal to distal radioulnar joint 4. Move elbow joint into a flexion and abduction motion 5. Apply 3 overpressures; remember to pause for patient response in between overpressures

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5
Q

Extension (neutral, supinated, pronated

A

Purpose: To assess joint integrity related to the pain source
1. Ask the patient to actively extend the elbow to the end of their available range of motion 2. Stabilize the humerus by placing hand on the posterior side midway down the Humerus 3. With the patient’s wrist supinated, apply over pressure by gripping just proximal to the distal radioulnar joint 4. Apply 3 overpressures; remember to pause for patient response in between overpressures 5. Repeat with forearm supinated, and forearm pronated

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6
Q

Extension Abduction

A

Purpose: To assess joint integrity related to the pain source
1. Grab posterior distal/humerus and apply an ER force 2. Grab distal forearm and move elbow joint into extension and abduction motion with arm hanging off the table 3. Apply 3 overpressures; remember to pause for patient response in between overpressures

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7
Q

Extension Adduction

A

Purpose: To assess joint integrity related to the pain source
1. Grab posterior distal/humerus and apply an IR force 2. Grab distal forearm and move elbow joint into extension and adduction motion with arm hanging off the table 3. Apply 3 overpressures; remember to pause for patient response in between overpressures

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8
Q

Pronation

A

Purpose: To assess joint integrity related to the pain source: superior radial ulnar joint
1. Pronate patient’s arm 2. Grab distal radioulnar joint (one thumb up and one thumb down) and apply overpressure; remember to pause for patient response in between overpressures

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9
Q

Supination OP

A

Purpose: To assess joint integrity related to the pain source: superior radial ulnar joint
1. Supinate patient’s arm 2. Grab distal radioulnar joint (one thumb up and one thumb down) and apply overpressure; remember to pause for patient response in between overpressures

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10
Q

Proximal radioulnar open pack

A

Open pack: 70 degree elbow flexion, 35 degree supination

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11
Q

Radial head posterior glide (Supine)

A

Purpose: To assess mobility
1. Therapist’s hand placements are medial hand blocking under the proximal ulna with the fingers on the posterior surface. Lateral hand is placed along proximal radius, anterior surface 2. Therapist applies force through lateral hand through the thenar eminence, stabilizing the ulna with the medial hand.

To help remember glide: PPP (Posterior glide, Proximal radioulnar joint increases Pronation)

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12
Q

Radial head anterior glide (Prone)

A

Purpose: To assess mobility
1. Therapist’s hand placements are medial hand blocking under the proximal ulna with the fingers on the anterior surface. Lateral hand is placed along proximal radius, posterior surface 2. Therapist applies force through lateral hand through the thenar eminence, stabilizing the ulna with the medial hand.

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13
Q

Humeroulnar Joint open pack

A

Open pack: 70 degree elbow flexion, 10 degree supination

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14
Q

Humeroulnar lateral glide

A

Purpose: To assess mobility
1. With your outside hand, stabilize the distal humerus, making sure to keep your elbow parallel to the floor 2. With your inside hand apply a laterally directed glide, making sure to keep your elbow parallel to the floor.

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15
Q

Humeroulnar medial glide

A

Purpose: To assess mobility
1. With your outside hand, stabilize the distal humerus, making sure to keep your elbow parallel to the floor 2. With your inside hand apply a medial directed glide, making sure to keep your elbow parallel to the floor.

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16
Q

Humeroulnar traction

A

Purpose: To assess mobility
1. Use one hand to stabilize distal posterior humerus 2. Use other hand to stabilize ulna 3. Distract by applying a caudal force

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17
Q

Humeroradial Joint open pack

A

Open pack: Elbow extended, fully supinated

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18
Q

Humeroradial posterior glide (Supine)

A

Purpose: To assess mobility
1. Therapist’s stabilizes distal humerus with one hand 2. Therapist palpates radial head with other hand 3. Apply a posterior glide and assess mobility

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19
Q

Humeroradial anterior glide (Prone)

A

Purpose: To assess mobility
1. Therapist stabilizes distal humerus with one hand 2. Therapist palpates radial head with other hand 3. Apply an anterior glide and assess mobility

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20
Q

Humeroradial traction

A

Purpose: To assess mobility
1. Therapist stabilizes distal humerus with one hand 2. With other hand take up skin slack on radial side as you grab radial head and Shaft 3. Apply a traction force by adding a caudal force

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21
Q

Elbow Fracture Screening tests

A
  1. Elbow extension test

2. Tuning fork

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22
Q

Elbow Extension Test

A

Purpose: Elbow fracture screening
1. Patient is asked to extend elbow 2. Positive test if unable to actively extend elbow indicating possible fracture (refer out for x-ray)

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23
Q

Tuning fork

A

Purpose: Elbow fracture screening
1. Use tuning fork against your shin or other firm surface 2. Put vibrating tuning fork on patient’s elbow 3. (+) positive test if patient has reproduction of symptoms

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24
Q

Median Nerve Tests and Entrapment Sites

A
  1. Pinch test 2. Pronator teres syndrome test 3. Tinel pronator teres 4. Ligament of struthers palpation 5. Bicipital Aponeurosis
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25
Pinch test- AIN involvement (median n.)
Purpose: Median Nerve Involvement testing 1. Patient is asked to pinch thumb and second finger together 2. Place piece of paper between finger 3. Instruct patient “Don’t let me pull this paper away 4. Pull on paper 5. Positive test if fingers look like an eye instead of a circle showing adductor pollicis use
26
Pronator teres syndrome test
Purpose: To assess Median Nerve entrapment 1. Grip patient’s hand 2. Instruct patient “Don’t let me move you” 3. Therapist applies supination force while the patient resists into pronation 4. Instruct patient “slowly let me pull you out” 5. Extend patient’s elbow 6. Positive test if symptoms are reproduced
27
Tinel Pronator Teres
Purpose: To assess Median Nerve entrapment 1. Palpate pronator teres 2. Tap on muscle belly. Start with light tap then progress to moderate tapping 3. (+) Positive test is reproduction of symptoms
28
Ligament of Struthers palpation
Purpose: To assess Median Nerve entrapment 1. Externally rotate shoulder 2. Palpate medial epicondyle and go 5 cm proximal 3. Assess tissue around area for hypertonicity or trigger points 4. (+) Positive test is reproduction of symptoms
29
Bicipital Aponeurosis palpation
Purpose: To assess Median Nerve entrapment 1. Palpate bicipital aponeurosis in cubital fossa 2. Tap on the structure. Start with light tap then progress to moderate tapping 3. (+) Positive test is reproduction of symptoms
30
Ulnar Nerve Tests and Entrapment Sites
1. Elbow flexion test 2. Cubital tunnel tinel 3. Arcade of Struthers palpation 4. Flexor carpi ulnaris palpation
31
Elbow flexion test
Purpose: Detecting cubital tunnel syndrome (ulnar nerve) 1. Patient is instructed to flex the elbow 2. Hold for up to 3 minutes 3. Positive test if symptoms are reproduced
32
Cubital tunnel tinel
Purpose: For detecting cubital tunnel syndrome (ulnar nerve) 1. Support patient’s arm under forearm 2. Tap on ulnar nerve over cubital tunnel 4-6 times 3. Positive test if symptoms are reproduced
33
Arcade of Struthers palpation
Purpose: To assess ulnar nerve entrapment 1. Externally rotate shoulder 2. Palpate medial epicondyle and go 8 cm proximal 3. Assess tissue around area for hypertonicity or trigger points 4. (+) Positive test is reproduction of symptoms
34
Flexor Carpi Ulnaris palpation
Purpose: To assess ulnar nerve entrapment 1. Palpate two heads of flexor carpi ulnaris muscle 2. Tap on the structure. Start with light tap then progress to moderate tapping 3. (+) Positive test is reproduction of symptoms
35
Radial Nerve Tests and Entrapment Sites
1. Radial Groove Tinel 2. Radial Head Tinel 3. Arcade of Frohse tinel 4. Supinator palpation/tinel
36
Radial groove tinel
Purpose: To assess radial nerve nerve entrapment 1. Locate posterior-lateral humerus 2. Tap on proximal 1/3rd of humerus first followed by middle 1/3rd. Radial groove is located between medial and lateral head of triceps 3. Start with light tap then progress to moderate tapping 4. (+) Positive test is reproduction of symptoms
37
Radial head tinel
Purpose: To assess radial nerve nerve entrapment 1. Palpate radial head by supinating and pronating the forearm 2. Tap on radial head moving proximal to distal. Start with light tap then progress to moderate tapping 3. (+) Positive test is reproduction of symptoms
38
Arcade of Frohse tinel
Purpose: To assess radial nerve nerve entrapment 1. Palpate Arcade of Frohse just proximal to the supinator muscle 2. Tap on area. Start with light tap then progress to moderate tapping 3. (+) Positive test is reproduction of symptoms
39
Supinator Palpation/Tinel
Purpose: To assess radial nerve nerve entrapment : 1. Find supinator muscle by having patient turn palm up 2. Tap on area. Start with light tap then progress to moderate tapping 3. (+) Positive test is reproduction of symptoms
40
Medial Epicondylitis Test
1. Resisted wrist flexion 2. Passive wrist extension-supination 3. Palpation of common flexor tendon
41
Resisted wrist flexion
Purpose: To identify the wrist flexor muscles as the source of medial elbow pain 1. Support the patient’s proximal wrist with your outside hand 2. Instruct the patient, “Don’t let me move you” as you apply an extension force to the patient on the palmar side of their hand 3. (+) Positive test is reproduction of symptoms
42
Passive wrist extension-supination
Purpose: To identify the wrist flexor muscles as the source of medial elbow pain 1. Support the patient’s proximal wrist with your outside hand 2. Bring patients wrist into full extension and supination 3. (+) Positive test is reproduction of symptoms
43
Common flexor tendon palpation
Purpose: To identify the wrist flexor muscles as the source of medial elbow pain 1. Support the patient’s proximal wrist with your outside hand 2. Locate medial epicondyle of humerus. 3. Palpate common flexor tendon for trigger point or hypertonicity 3. (+) Positive test is reproduction of symptoms
44
Lateral Epicondylitis Test
1. Resisted middle finger extension 2. Passive wrist flexion-pronation 3. Palpation of common extensor tendon
45
Resisted middle finger extension
Purpose: To identify the wrist extensor muscles as the source of lateral elbow pain : 1. Support the patient’s proximal wrist with your outside hand. 2. Instruct the patient, “Don’t let me move you” as you apply a flexion force on the dorsum of their middle finger (trying to bring their 3rd digit into flexion). 3. (+) Positive test is reproduction of symptoms
46
Passive wrist flexion-pronation
Purpose: To identify the wrist flexor muscles as the source of lateral elbow pain 1. Support the patient’s proximal wrist with your outside hand 2. Bring patients wrist into full flexion and pronation 3. (+) Positive test is reproduction of symptoms
47
Common extensor tendon palpation
Purpose: To identify the wrist flexor muscles as the source of lateral elbow pain 1. Support the patient’s proximal wrist with your outside hand 2. Locate lateral epicondyle of humerus. 3. Palpate common extensor tendon for trigger point or hypertonicity 3. (+) Positive test is reproduction of symptoms
48
Grip Strength
Purpose: To objectively measure the amount of pain free grip strength a patient has or the amount of grip strength a patient has. Patient Position: Sitting or standing with arm at side (rest), forearm in neutral, and elbow flexed at 90º Therapist Position: Sitting or standing in front of patient facing the patient. 1. Have patient grab dynamometer with gage facing you. 2. Have patient grip the dynamometer either at full strength or pain free grip depending on which one you want 3. Repeat test 2 more times and record the best of 3.
49
Elbow Movement Coordination Impairment Tests
1. Varus stress test 2. Valgus stress test 3. Milking maneuver/Moving valgus stress test 4. Chair Sign 5. Table Top Relocation
50
Varus stress test
Purpose: Test for Lateral Ulnar Collateral ligament laxity 1. Begin with patient’s arm in full extension 2. Put your stabilizing hand on the medial distal side of the patient’s humerus 3. Put your force hand on the proximal lateral side of the radius and ulna 4. Apply a varus force to the elbow 5. Repeat with elbow in 30 degrees of flexion 6. (+) Positive test is pain reproduction and laxity or abnormal end feel
51
Valgus stress test
Purpose: Assessment of medial collateral ligaments of the elbow 1. Begin with patient’s arm in full extension 2. Put your stabilizing hand on the lateral distal side of the patient’s humerus 3. Put your force hand on the proximal medial side of the radius and ulna 4. Apply a valgus force to the elbow 5. Repeat with elbow in 30 degrees of flexion 6. (+) Positive test is pain reproduction and laxity or abnormal end feel
52
Milking Maneuver/Moving Valgus Stress Test
Purpose: Assessment of ulnar collateral ligament 1. Hold the lateral portion of the patient’s elbow inferiorly and close to their body in shoulder ER 2. Have the patient’s hand and wrist supinated so you may grab their thumb as it points to the floor 3. Pull down on their thumb and move their elbow from 70-110º of flexion 4. To increase the tension, pronate the wrist and push down from on top of the wrist and take them through the same ranges 5. A positive test is reproduction of pain/patient’s symptoms and abnormal end feel
53
Chair sign
Purpose: To assess the stability of the proximal radius 1. Instruct patient to get up from the seated position 2. Look for patient facial signs of pain or if the patient reports pain in the lateral portion of the forearm.
54
Table Top Relocation
Purpose: To assess the stability of the humeral radial joint 1. Patient is instructed to straighten their elbows, putting stress on the humeral radial joint 2. Reports of pain by the patient is a positive reading for possible radial Hypermobility 3. Therapist restricts movement by using the contralateral hand to stabilize the humerus and ipsilateral hand along the proximal radius, applying an anteromedial force through the radius. 4. Patient repeats elbow straightening and is a (+) positive test when pain levels are reduced with the addition of the anterior medial force
55
Radial head posterior glide (Supine)
Purpose: To increase pronation Patient Position: Supine with elbow flexed 70 deg, 35 deg supination Therapist Position: Standing on ipsilateral side 1. Therapist’s hand placements are medial hand blocking under the proximal ulna with the fingers on the posterior surface. Lateral hand is placed along proximal radius, anterior surface 2. Therapist applies force through lateral hand through the thenar eminence, stabilizing the ulna with the medial hand. To help remember glide: PPP (Posterior glide, Proximal radioulnar joint increases Pronation)
56
Radial head anterior glide (Prone)
Purpose: To increase supination 1. Therapist’s hand placements are medial hand blocking under the proximal ulna with the fingers on the anterior surface. Lateral hand is placed along proximal radius, posterior surface 2. Therapist applies force through lateral hand through the thenar eminence, stabilizing the ulna with the medial hand.
57
Elbow flexion MWM
Purpose: To increase elbow flexion 1. Can use belt or hands (1 hand stabilizes humerus) 2. Add any glide (start off with lateral glide to ulna/radius), search the optimal glide, different angle, or even medial glide at other side 3. At end of motion have patient OP into flexion with other hand unless using belt, then therapist can add OP into flexion 4. Repeat multiple times
58
Elbow extension MWM
Purpose: To increase elbow extension 1. Can use belt or hands (1 hand stabilizes humerus) 2. Add any glide (start off with lateral glide to ulna/radius), search the optimal glide, different angle, or even medial glide at other side 3. At end of motion have patient OP into extension with other hand unless using belt, then therapist can add OP into extension 4. Repeat multiple times
59
MWM for gripping pain
Purpose: For lateral epicondylitis 1. Add a lateral glide at ulnohumeral joint 2. Have patient grip a dynameter or towel during the glide to reassess asterisk sign 3. 6 second reps with 15 second rest between reps. Do 10 reps
60
Nerve mob with cervical lateral glides
Purpose: Treat cervical hypomobility to affect epicondylagia pain 1. Have patient in supine and scoot up so the head is clear off the table 2. Support the patients head on your stomach 3. Cradle the neck with both hands 4. Using the 2nd MCP joint provide a contralateral glide to the painful side 5. Can have patient do nerve mobs while therapist does lateral C/S glides.

ortho 3 (12 decks)

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