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Elbow & Forearm Assessment

Elbow & Forearm Assessment. Athletic Injury Assessment Chapter 14 p. 490. Humerus trochlea Capitulum/capitellum Radius Ulna Interosseus Membrane. Bony Anatomy-- p. 490. Ligamentous Support-- p. 491. Ulnar Collateral Ligament Complex 3 bands connecting humerus/ulna

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Elbow & Forearm Assessment

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  1. Elbow & Forearm Assessment • Athletic Injury Assessment • Chapter 14 • p. 490

  2. Humerus trochlea Capitulum/capitellum Radius Ulna Interosseus Membrane Bony Anatomy--p. 490

  3. Ligamentous Support--p. 491 • Ulnar Collateral Ligament Complex • 3 bands connecting humerus/ulna • Tension varies throughout ROM • Prevents valgus motion • Figure 14-3, p. 491

  4. Ligamentous Support--p. 492 • Radial Collateral Ligament • Prevents varus motion • Radio-humeral articulation • Annular Ligament • Encircles radial head • attaches to coronoid process of ulna

  5. Muscular Anatomy--p. 493 • Flexor/Supinators • biceps brachii, brachioradialis • Supinator--assisted by brachioradialis • Extensor/Pronators • triceps brachii, anconeus (stabilizer) • pronator teres, pronator quadratus

  6. History--p. 497 • PMH of c-spine or shoulder injury (referred pain?) • Location of pain? • Onset? Acute/chronic • Progression of symptoms (minor-->major) • Mechanism of injury--varus/valgus/hyperext/overuse? • Technique--changes;proper/improper • Crepitus/popping

  7. Observation/Inspection--p. 498 • Triangle sign—p.516 • Bursa inflammation—p. 496 • subcutaneous olecranon bursa • subtendinous olecranon bursa • Carrying angle-- • cubital valgus/varus • 10°-15° valgus NL for males ( in females) • Figure 14-9, p. 499

  8. Observation/Inspection-- • Swelling/bursitis—p.500, fig. 14-12 • Cubital fossa—p. 499, fig. 14-10 • Cubital recurvatum (p. 500, fig. 14-11)

  9. Palpation--p. 500-503 • Bony Alignment--fx, dislocation • Musculotendinous structures: • biceps tendon, extensor mass origins, flexor mass origins • Epicondyles & collateral ligaments • Picture/anatomy, p. 500, 502, 503

  10. Functional Testing/ROM--p.503 • Flexion/extension • 145°/155° to 0° WNL • limited by activity/use/hypertrophy • Pronation/supination • 90° from neutral

  11. Pathologies--

  12. Collateral Sprains p. 508/511 • History: • Varus/valgus/hyperext. Mechanism +/- rotation • “Valgus Extension Overload”--VEO mechanism • Observation: • Localized or generalized swelling • Guarded in flexion • Limited AROM • Palpation: • Tender at epicondyle • Localized inflammation • Possible crepitus with PROM • Examination: • Varus stress test OR • Valgus stress test

  13. Collateral Sprains: Special Tests--P. 508-509 • Varus Stress Test • Box 14-4, (509) • Elbow slightly flexed • Stabilize at jointline • Mobilize distally • (+) = laxity at RCL • may indicate annular ligament damage • Valgus Stress Test • fig. Box 14-3, (508) • Elbow slightly flexed • Stabilize at jointline • Mobilize distally • (+) = laxity at UCL

  14. Epicondylitis--p.511 • History: • acute (2° trauma) or chronic (overuse) • Prevalent in throwing & racquet sports • Pain  with activity • Observation: • localized swelling at epicondyle • altered mechanics • Decreased wrist AROM/PROM • Palpation: • Tender at epicondyle • No crepitus with AROM/PROM • Examination: • Tennis elbow test • R-ROM testing

  15. Epicondylitis--Special Tests--p. 512 • Tennis Elbow Test: • Box 14-6 (512) • Resist wrist ext. while palpating lat. epicondyle • (+) = pain at lat. Epicondyle (lateral epicondylitis) • Resisted ROM tests: • R-ROM to isolate muscles attaching to epicondyle • (+) = pain at epicondyle

  16. Nerve Trauma--p. 514 • History: • PMH of epicondylitis • usu. throwing sports • traumatic or overuse mechanism • Complaints of numbness/tingling in forearm • improves with rest • worsens with activity • Observation: • altered mechanics • muscle atrophy in forearm? • Inability to make a fist • Palpation: • (+) Tinel sign at ulnar nerve (“funny bone”) • tender at medial epicondyle • possible subluxation of ulnar nerve

  17. Bursitis • History: • traumatic or atraumatic • acute/chronic/overuse • nonpainful swelling at olecranon • Observation: • localized inflammation • closed injury • decreased AROM 2° edema • onset determined by mech., although usu. slow • Palpation: • no significant pain with palpation of edema • localized edema •  localized temp.(?) • Examination: • Monitor for signs of infection • R/O collateral injury & dislocation

  18. Dislocations--p. 517 • History: • Posterior force to forearm on humerus • FOOSH or hyperextension mechanism • Extreme pain • Observation: • Obvious deformity (p.393) • Slow capillary refill (>2sec) • Possible open fx • No AROM or PROM at elbow • Palpation: • Obvious deformity • (-) triangle sign • Dec. or absent distal pulse possible • Examination: • pulse checks • splint in position found • Medical Emergency • REFER IMMEDIATELY!

  19. Fractures--p. 517 • History: • FOOSH mechanism • heard/felt a “pop” • may complain of numbness/tingling in forearm • Observation: • Probable deformity • Possible dec. capillary refill • Open vs closed fx • Possible shock • Painful wrist AROM/PROM • Palpation: • Deformity • Crepitus • Examination: • Monitor distal pulse/sensation • Bump test? • Immobilize & refer

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