Elbow Eval (special tests, vocab, acronyms...)

FOOSH (mechanism)

Fall on an outstretched hand

valgus

inward, carrying angle is higher than normal

varus

outward, carrying angle is less than normal

Carrying angle

angle made from the elbow being not straight in comparison to the humerus?

The normal numbers for the elbow are:

* Women – 10-15 degrees
* Men – 5-10 degrees

What to look for during observation? \*bilaterally compare!

* deformity
* atrophy
* swelling
* discoloration (ecchymosis/bruise, erythema/redness)
* skin(wounds, abrasions)

Bony palpation points of the elbow

* olecranon
* humerus(medial epicondyle, lateral epicondyle)
* radius(head, neck)
* ulna

soft tissue palpation points of the elbow(and where to feel them)

* biceps brachii(anterior, in elbow pit)
* triceps brachii(by olecranon)
* brachioradialis(the fist pressure to see it)

ligament palpation points of the elbow

* medial collateral ligament(MCL, ulnar collateral ligament)
* lateral collateral ligament(LCL, radial collateral ligament)
* annular ligament(around the head of the radius)

palpation points for the wrist muscles

* wrist flexors origin(medial epicondyle)
* wrist extensors origin(lateral epicondyle)

What questions to ask for history of the elbow? (also go into follow up questions!)

* How did this injury occur? (mechanism)
* When did you hurt your elbow?
* Where does it hurt?
* Did you hear or feel a pop?
* Have you hurt this elbow before?

the three joints of the elbow

* humeroulnar joint
* proximal radioulnar joint
* radiohumeral joint

elbow actions

flexion, extension, pronation, supination

Humeroulnar joint actions

flexion, extension

Radioulnar joint actions

pronation, supination

What ligament is responsible for holding the radioulnar joint together and how is it palpated?

annular ligament, it can be palpated at the head of the radius

What are the three main nerves passing through the elbow and what part of the hand does each supply?

* ulnar nerve, supplies front and back of 3, 4, and 5th digits(dorsal and palmar/anterior and posterior)
* radial nerve, supplies first three digits on dorsal side of hand(posterior)
* median nerve, supplies palm side of the first three digits

tinel test (ulnar nerve)

tap over the nerve in groove between the olecranon and the medial epicondyle, positive sign is tingling

test/s for cubital tunnel syndrome (ulnar nerve injury)

tinel test

pinch grip test (anterior interosseous nerve entrapment)

match the index finger’s tip to the thumb’s tip to make a circle, positive sign is the inability to form a circle with finger tips, or only being able to make the finger pads touch

pronator teres syndrome test

(Compression of median nerve by pronator teres)

Contract pronator teres, basically pronator but while resisted, start in supinator, basically shake hand but tell them to turn palm down while you resist, check for neurological symptoms in first 3 digits, like tingle, burning…positive sign is neurological symptoms in palmar side of first 3 digits and the palm

Cozen’s test, tennis elbow test (lateral epicondylitis/tennis elbow)

Get wrist extensors to tense and pull on lateral epicondyle to recreate

Elbow to 45 degrees, person make fist, hand on back of elbow to feel tensing, ask them to wrist extend but resist it, positive sign is they say it’s the pain from whuteva, positive sign is pain over lateral epicondyle

golfer’s elbow test (medial epicondylitis/golfer’s elbow)

45 degree elbow, pain at point if positive, fist, and wrist flex while resisting, positive sign pain over medial epicondyle

tests for epicondylitis (inflammation of epicondyles, medial is wrist flexor origins, and lateral is wrist extensor origins)

* cozen’s test, tennis elbow test for lateral epicondylitis(tennis elbow)
* golfer’s elbow test for medial epicondylitis(golfer’s elbow)

tests for collateral ligament sprains

valgus stress test and varus stress tests

test for ulnar collateral ligament injury (valgus stress test 0 and 30 degrees)

Have your one hand on the humerus, palpate the ulnar collateral ligament below the medial epicondyle, put the other hand proximal to the wrist joint, and flex the elbow to 30 degrees(also without flexed elbow for 0 degrees) and stretch medially, bend elbow sideways so that the ligament is on the outer side, do it at 0 and 30 degrees. Positive sign is pain and laxity

test for radial collateral ligament injury (varus stress test 0 and 30 degrees)

Have your one hand on the humerus, palpate the radial collateral ligament below the lateral epicondyle, put the other hand proximal to the wrist joint, and flex the elbow to 30 degrees(also without flexed elbow for 0 degrees) and stretch laterally, push elbow outward, at 0 and 30 degrees, positive sign is pain and laxity

What do you do at the very end?!

refer to physician