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Elbow Examination John M. Lavelle, D.O.. Anatomy.

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Presentation on theme: "Elbow Examination John M. Lavelle, D.O.. Anatomy."— Presentation transcript:

1 Elbow Examination John M. Lavelle, D.O.

2 Anatomy

3 Bones Bones: Bones: Humerus, ulnar, radius Trochlear, coronoid, capitellum, radial head 3 articulations: 3 articulations: –Radiocapitellar joint –Ulnarhumeral joint –Proximal radioulnar

4

5 Ligaments

6 Muscles

7 Muscles

8 Epicondyles

9 Nerves: Ulnar Nerve: Ulnar Nerve: –Passes behind the medial epicondyles and lies over ulnar collateral ligament and under bicipital aponeurosis and pronator teres. Median Nerve: Median Nerve: –Passes medial to the brachial artery, in front of the point of insertion of the brachialis muscle and deep to the biceps.

10 Nerves Radial Nerve: Radial Nerve: –Passes posterior to the distal humerus.

11 Observe Effusions Effusions –Bursitis Cubital vein Cubital vein –Fistula –Thrombus Muscles Muscles –Tear Scars Scars –Track marks Deformity Deformity –Dislocations

12 Palpate Active ROM & Passive ROM Active ROM & Passive ROM Flexion: 0 ° to 160 ° Flexion: 0 ° to 160 ° Pronation: 80 ° Pronation: 80 ° Supination: 85 ° Supination: 85 ° Include ab/adduction Include ab/adduction Appreciate crepitus, tenderness Appreciate crepitus, tenderness Lateral Epicondyle Lateral Epicondyle Brachioradialis, ECRL, ECRB, EDC Brachioradialis, ECRL, ECRB, EDC Medial Epicondyle Medial Epicondyle Pronator teres, FCR, PL, FDS, FCU Pronator teres, FCR, PL, FDS, FCU

13 Palpate Olecranon Olecranon Bursa Bursa Radial head Radial head Superior/Inferior dysfunction Superior/Inferior dysfunction Ulnar nerve Ulnar nerve Dislocation Dislocation Biceps tendon and Triceps tendon Biceps tendon and Triceps tendon Cubital fossa syndrome, Cubital fossa syndrome, Clicking triceps syndrome Clicking triceps syndrome Forearm tension Forearm tension Muscles Muscles Fascia Fascia

14 Neuro Exam MMT MMT –Biceps, Triceps, Wrist Extensors, Flexion of 3 rd DIP joint, Abduction of digiti minimi Sensation Sensation –Radial, median, ulnar, medial/lateral/posterior antebrachial cutaneous nerves

15 Muscle Tests Lateral Epicondylitis Lateral Epicondylitis –Resisted third digit extension – worsens pain as it tightens fascia over ECRB –Resisted wrist extension- ECRB (Cozen’s test) Medial Epicondylitis Medial Epicondylitis –Resisted wrist flexion- FCR (Cozen’s Test) Distal Bicep Distal Bicep –Yergason’s test Triceps Triceps –Resisted elbow extension Pronator Syndrome - Median Neuropathy Pronator Syndrome - Median Neuropathy –Resisted forearm pronation

16 Ulnar Collateral ligament Palpate optimally at ° flexion Palpate optimally at ° flexion

17 Ulnar Collateral ligament Milking Maneuver: Milking Maneuver: Arm at 70 ° and elbow at 90 °, a valgus pressure is applied by supporting the elbow and placing traction on the thumb…like milking a cow. Arm at 70 ° and elbow at 90 °, a valgus pressure is applied by supporting the elbow and placing traction on the thumb…like milking a cow. Moving valgus stress test: Moving valgus stress test: Shoulder abducted to 90 ° and elbow flexed fully, apply a valgus force to the elbow, until shoulder fully externally rotated. While maintaining valgus pressure elbow is quickly extended. Shoulder abducted to 90 ° and elbow flexed fully, apply a valgus force to the elbow, until shoulder fully externally rotated. While maintaining valgus pressure elbow is quickly extended.

18 Ulnar Collateral Ligament Valgus Stress: Valgus Stress: –Patient sitting with the elbow flexed to 20 to 30 °. Examiner stands with distal hand around the athlete's wrist (medially) and the proximal hand over the athlete's elbow joint (laterally) Examiner stabilizes the wrist and applies a valgus stress to the elbow with the proximal hand

19 Lateral Collateral Ligaments Radial Collateral Ligament Radial Collateral Ligament Lateral Ulnar Collateral Ligament Lateral Ulnar Collateral Ligament Acc. Lateral Collateral Ligament Acc. Lateral Collateral Ligament Annular Ligament Annular Ligament

20 Lateral Collateral Ligaments Pivot Shift Test: Pivot Shift Test: –Nursemaid Elbow –Performed with the patient in the supine position, with the affected arm positioned overhead. The wrist and the elbow are lightly forced into supination while a valgus strain is applied to the elbow as it is moved from extension to flexion and back again. A positive test result is an apprehension response by the patient and/or frank subluxation or dislocation with a "clunk" as the radial head reduces during manipulation.

21 Ulnar Nerve Flexion Test Flexion Test –Athlete maximally flexes the elbow and holds the position for 3 to 5 minutes. Radiating pain into the median nerve distribution in the athlete's arm and/or hand – Cubital Fossa Syndrome Passive Flexion Test/Ulnar nerve subluxation test Passive Flexion Test/Ulnar nerve subluxation test –As above but move elbow into flexion/extension –Can palpate snapping triceps and/or ulnar nerve over medial epicondyle Tinel sign Tinel sign Patient sitting with the elbow in slight flexion. Examiner grasps athlete's wrist (laterally) with distal hand. Examiner stabilizes the wrist and taps on the ulnar nerve in the ulnar notch with the index finger Patient sitting with the elbow in slight flexion. Examiner grasps athlete's wrist (laterally) with distal hand. Examiner stabilizes the wrist and taps on the ulnar nerve in the ulnar notch with the index finger Pinch Grip Test Pinch Grip Test Patient sitting or standing. Examiner instructs patient to pinch the tips of the thumb and index finger together – Positive test shows anterior interosseous nerve impinged between the two heads of the pronator muscle. Patient sitting or standing. Examiner instructs patient to pinch the tips of the thumb and index finger together – Positive test shows anterior interosseous nerve impinged between the two heads of the pronator muscle.

22 Thank You!


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