Card Set Information
Elbow lab 1 and 2
What are the three jts of the elbow?
- radio- humeral
- humero- ulnar
- superior radio- ulnar
What are the movements at the elbow?
- Flexion- limited by mm approximation, coronoid process engages coronoid fossa R/H, H/U
- ext- limited by olecranon process contacting olecranon
- pronation- limited by radius contacting ulnar sup R/U, R/H
- supination- limited by soft tissue sup R/U, R/H
- ab/ adduction- in 5-10 degrees
- wrist RD- radial head moves caudad
- wrist UD- radial head moves cephalad
What are three basic Hx you need to find out about your pt?
- hand dominance
Pt has injred there R/H jt where do you expect them to feel pain?
Lateral pain A or P
You t is experiencing pain below the elbow crease what jt do u expect to be effected?
Sup R/U jt
A pt who has injured the H/U jt where do you expect them to experience pain?
- central deep pain- whole jt
- ant/ meial pain (coronoid/ trochlea)
- post, local ain (olecranon fossa)
Pain in elbow can be from?
- referred to forearm, wrist hand
- referral to elbow from cerivcal, shoulder, wrist (carpal tunnel?)
What are common aggravating factors for the elbow?
- combing hair
- turning tap
- WB through hand
- Leaning on elbow
- turning door handle
- making a fist
- opening jrs
- hotswollen jt
Night pain- not that common
- severe epicondalgia
- cervical nerve root
Conduct a physical examination- observation on a pt with elbow pain!
- valgus- standing in anatomical position-look at elbows- <5 degrees in males, 10-15 degrees in females
- flexion deformity eg OA, post #
- hyperextension- hypermobile >10 degrees
- Synovial effusion (inspect para- olecranon groove, dweling near olecranon fossa, elbow 90 degrees flex
- rheumatoid moddules (olecranonand extensor surface)-funny painful lumps
- mm wasting
What jts would you clear in a physical examination of the elbow?
- Csp- compression/ stretch
- Shoulder- F and Abd with OP
- Position and mobility of HOR and olecranon passive F, E in standing
Look at scap and thumb position
Coduction functional quick tests on your pt with elbow problems.
All are done in 90 degrees flexion
Start with supination
After each test OP
-Rapid F, E in S/P (fick)
- Rapid S, P in E/F (flick)
- aggravating or other injured movements
- clench fist
- squeeze fingers- pinch grip
- movements in WB
What are the active movement you wish for your pt to do and what are the normal degrees of these movements?
- Flex- 140
- Ext- 0
- Sup- 90
- Pro - 90
Note pain, resistence and end feel with OP
Combine in varying amounts of F/E and S/P
Rapid repeated movements
What passive physiological tests would you conduct on an elbow pt?
Usually in supination
Mm test- isometric (wrist and elbowmvts) and stretch tests appropriate for area of pain and for active movements
- specific tests for lateral and medial epicondylalgia
Pro and sup- position- shake hands and pro and sup- stabilise elbow.
What areas would we palpate?
- olecranon (para-olecranon- medial side, groove including ulnar nerve)
- olecranon bursa
- triceps insertion- tip olecranon
- biceps insertion- radius
- Medial epicondyle- common flex origin
- lateral epicondyle- common ext origin
- HOR- best to find posterior
- R/H jt line
What are some accessory movements you would conduct on the elbow?
-PA and AP
- lngitudinal caudad
- lateral glide
- caudad and cephalad
Conduct an AP and a PA on the HOR
AP- little bit flexed - towel underneath- arm supinated
PA- Stabilise the humerus- have arm supinated, go on ur knees
Do in pro and sup
R/H jt and R/U jt
Perform a PA on the olecranon
- pt prone, towel under the elbow
Perform a longitudinal caudad on the olecranon
can do in flexion- across the chest, supine
can do ext, prone, towel under arm
This is between H/U
Perform a lateral glide on on the olecranon
arm little flexed
stabilise elbow jt
Good to treat tennis elbow
sup R/U jt
Cephalad - up
Perform a caudad and ceph in the line with the radius, humerus and ulnar separately
Radius- R/H, Sup R/U- caudad- ulnar dev, ceph- radial dev
Humerus- H/R, H/U- distraction and compression
Ulnar-H/U, sup R/U- caudad- radial dev, ceph ulnar dev
Conduct PPMS on the elbow
Ad/Add in 5 degrees fles
Flex with longitudinal caud
PPMS- examination and treatments
Perform PPMS- ext/ abduction
- hold with forearm of humerus
- face towards feet
- abd force
PPMS- ext/ add
hold arm down 10 degres of ext then take into ext
good treatment for stiffness 3-4
Good if the pt has trouble with flick test
PPMS- flex/ add
- supinated hand
good if pt has trouble with flick test
PPMS- ab/add in 5 degrees flex
PPMS- flex with longitudinal caudad
- more like a treatment
- take arm into flex
- flex over your arm
- pull jts apart
What are the special tests for the elbow?
- valgus/ varus stress test (collateral lig)
- stretch test forearm ext (tenis elbow)
- resisted test forearm ext (tennis elbow)
- golfers elbow tests (stretch and resisted)
- tinel's test (ulnar nerve)
Conduct a valgus/ varus stress test
test for clollateral ligaments
Conduct a tinels test
this is to test the ulnar nerve
- tap over where the nerve is near the olecranon
+ve test pt will experience shooting pain
Conduct the golfers elbow test stretch
- palpate the medial epicondyle with one hand
- supinate the forearm and extending the wrist and elbow with other hand
a reproduction of pain in the area of the medial epicondyle indicates a positive test
Conducts golfers test resisted
grip and ulnar deviate
ASK THE GIRLS
Conduct the resisted test for tennis elbow
- tennis elbow- wrist extensor- lateral epicondyle pain
- resist wrist ext, more sensitive if you use the middle finger
Conduct the stretch test for tennis elbow
palpate lateral epicondyle
fully flex the wrist
ext the elbow
if pain is reproduced this is a positive test
How do you diferentiate between superior R/U?
by alter the degree of sup/ pro to increase/ decrease the pain
compress R/U to increase or decrease the pain
By performing a PA and AP on the HOR and a PA on coronoid
How do you differentiate if the pain is from the R/H?
generally alt degree of F/E to increase/ decrease the pain.
Compres along the line of the radius to increase pain
Ap/Pa HOR and UD/RD
How do u differentiate if the pain is coming from the H/U?
generally alt degree of F/E to increase/decrease pain
compress along the line of ulnar to increase pain
Pa, Longitudinal and lateral glides????
What treatment strategiegs would you do on a pt with elbow problems?
Ext- agains thigh
flex- against forearm
supination- face head, stablise huerus on bed, arm 90 degrees
Pronation- face feet, thumb down, thumb push on radius
How would you treat lateral epicondylagia
- most commonly used
-apply lateral glide and then get the pt to do whatever movement hurts eg grip
- pain should be gone
- 6 reps in this position- take glide off should be pain free a of a little while