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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
- - sport
- - occupation
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?
- - 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
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?
- 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.
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
- Ext/ abduction
- ext/ add
- flex/ ad
- 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
- pronated hand
- 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
- ext abduct
- ext adduct
- 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
- pronate forearm
- 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
- 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