Elbow

Intially

 

Introduce

Aids - slings

Expose - shirt off

Stigmata generalised disease

 

Look/ Move

 

Neck

 

ROM / exclude cervical radiculopathy

 

Shoulder

 

ROM

- touch hands on head 

- behind head

- to mouth 

- back pocket  

 

Elbows

 

1. Extend elbows to front

 

A.  Elbow

- carrying angle (N 7° - 12°)

- deformity

- bony prominences

- biceps bulk

 

B.  Forearm contour

- ulnar border - FDP

- radial border - mobile wad

 

C.  Hand

- thenar eminence

- hypothenar eminence

- look for clawing

 

2.  Flex elbows to front

- olecranon wounds / bursa

- medial or lateral surgical scars

 

3.  Flex elbows to side

- angle of flexion

- comment medial scars

- axilla

 

4 Extend  elbows to side

- angle of extension / FFD

 

5.  Pronation and supination 

- 80o each

- thumb up / thumb down with elbows in

 

Hands

 

Look at dorsum for interossei wasting

Wrist Flexion / Extension

Fist with thumb in and out 

Spread fingers

 

Feel

 

Medially

- medial epicondyle

- ulnar nerve tinel's / subluxation

 

Posterior

- oleranon/ triceps tendon

 

Laterally

- lateral epicondyle / tennis elbow

- radial head - stability / pain with rotation

 

Medially

- cubital fossa masses / biceps tendon

 

Special Tests

 

Medial Epicondylitis

- resisted wrist flexion & pronation

 

Lateral epicondylitis

- resisted wrist extension

- resisted MC Ill extension (ECRB)

 

Stability

 

Note stability in extension is predominantly bony

 

Valgus Instability

 

Jobe's Test

- MCL

- flex elbow to 25° (unlocks olecranon)

- pronate forearm (prevents false +ves due to lateral laxity)

- gentle valgus stress

- compare opposite side

 

Varus Instability

 

Varus strain 

- with elbow at 25°

 

O'Driscoll's Test / elbow Pivot Shift

- patients describe clunk on full extension & feel posterolateral pain

- ulnar portion of LCL (LUCL) is the key

- dislocation occurs with a valgus ER force pivoting the elbow on the intact MCL

 

Technique

- patient  supine with examiner at head of bed

- GHJ full flexed with hand over head

- Forearm supinated and Elbow extended

- Valgus stress applied

- Axial load

 

Positive if

- prominent radial head (dislocates) / pivot / pain

- max subluxation is at 40° flexion 

- with increased flexion reduces with snap

 

4Cs

 

Circulation

- brachial / radial pulse / ulnar

- Allen's test

 

Cephalad joint

- shoulder ROM

 

Collagen

- ligamentous laxity

 

Concealed

- cubital fossa