Prav Viva

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Author:
jessiekate22
ID:
153940
Filename:
Prav Viva
Updated:
2012-05-16 19:51:24
Tags:
Elbow
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Description:
Elbow lab 1 and 2
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  1. What are the three jts of the elbow?
    • - radio- humeral
    • - humero- ulnar
    • - superior radio- ulnar
  2. 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
  3. What are three basic Hx you need to find out about your pt?
    • - hand dominance
    • - sport
    • - occupation
  4. Pt has injred there R/H jt where do you expect them to feel pain?
    Lateral pain A or P
  5. You t is experiencing pain below the elbow crease what jt do u expect to be effected?
    Sup R/U jt
  6. 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)
  7. Pain in elbow can be from?
    • - referred to forearm, wrist hand
    • - referral to elbow from cerivcal, shoulder, wrist (carpal tunnel?)
  8. What are common aggravating factors for the elbow?
    • - eating
    • - combing hair
    • - writing
    • - turning tap
    • - WB through hand
    • - Leaning on elbow
    • - turning door handle
    • - hammering
    • - making a fist
    • - opening jrs
    • - hotswollen jt
    • - RA
    • Night pain- not that common
    • - severe epicondalgia
    • - cervical nerve root
  9. 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
  10. 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
  11. 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
  12. What are the active movement you wish for your pt to do and what are the normal degrees of these movements?
    • OP
    • - 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
  13. What passive physiological tests would you conduct on an elbow pt?
    • As appropriate
    • 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.
  14. 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
  15. What are some accessory movements you would conduct on the elbow?
    • -PA and AP
    • - lngitudinal caudad
    • - lateral glide
    • - caudad and cephalad
  16. 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
  17. Perform a PA on the olecranon
    - pt prone, towel under the elbow
  18. 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
  19. Perform a lateral glide on on the olecranon
    • arm little flexed
    • stabilise elbow jt
    • Good to treat tennis elbow
    • H/U
    • sup R/U jt
  20. Caudad- down
    Cephalad - up
  21. 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
  22. Conduct PPMS on the elbow
    • Ext/ abduction
    • ext/ add
    • flex/abd
    • flex/ ad
    • Ad/Add in 5 degrees fles
    • Flex with longitudinal caud
  23. PPMS- examination and treatments
  24. Perform PPMS- ext/ abduction
    • - hold with forearm of humerus
    • - face towards feet
    • - abd force
  25. PPMS- ext/ add
    • hold arm down 10 degres of ext then take into ext
    • good treatment for stiffness 3-4
  26. PPMS- flex/abd
    • pronated hand
    • Good if the pt has trouble with flick test
  27. PPMS- flex/ add
    • - supinated hand
    • good if pt has trouble with flick test
  28. PPMS- ab/add in 5 degrees flex
  29. PPMS- flex with longitudinal caudad
    • - more like a treatment
    • - take arm into flex
    • - flex over your arm
    • - pull jts apart
  30. 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)
  31. Conduct a valgus/ varus stress test
    • ext abduct
    • ext adduct
    • test for clollateral ligaments
  32. 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
  33. 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
  34. Conducts golfers test resisted
    • grip and ulnar deviate
    • ASK THE GIRLS
  35. 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
  36. Conduct the stretch test for tennis elbow
    • palpate lateral epicondyle
    • pronate forearm
    • fully flex the wrist
    • ext the elbow
    • if pain is reproduced this is a positive test
  37. 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
  38. 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
  39. 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????
  40. What treatment strategiegs would you do on a pt with elbow problems?
    • PPM
    • 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
  41. How would you treat lateral epicondylagia
    • Mulligan's MWM
    • - 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

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