FRCSC Assistant Professor and consultant Orthopaedic surgeon KKUH KSU Elbow amp Forearm Exam Intro Important for UE function ADLs etc 3 articulations Ulnohumeral joint uniaxial ID: 911959
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Slide1
Abdulaziz Alomar, MD, MSc, FRCSCAssistant Professor and consultant Orthopaedic surgeon.KKUH, KSU
Elbow & Forearm Exam
Slide2IntroImportant for U/E function, ADLs etc3 articulationsUlnohumeral joint (uniaxial hinge)Radiocapitellar joint (uniaxial hinge)PRUJ (uniaxial pivot joint)
Slide3Important stabilizersMCL 3 bandsAnterior tight in extensionMost important one (mcq)Posterior tight in flexionTransverse ligamentOften torn during elbow dislocations
Slide4LCLRadial collateral ligamentLateral ulnar collateral ligament (PLRI)Annular ligamentAccessory lateral collateral ligamentRadiocapitellar articulationUlnohumeral articulation
Slide5Slide6Slide7InspectionSEADSolecranon bursaTriangular zoneCarrying angleMales 5 to 10, females 10 to 15Cubitus varusCubitus valgus
other
Slide8PalpationAll soft tissue and bony prominencesLCL, MCL, LUCL, annulusMedial and lateral condylesFlexor and extensor massesCubital fossaCubital tunnelIntraosseous
membrane (
essex
lopresti
lesions will be tender)
Slide9Range of MotionNormally 0 to 140Some (women) 10 hyperextension as normalFunctional range is 30 to 130 for ADL’s, etcSupination is 90Pronation is 80Functional range is 50 for bothActive before passive
Slide10Special TestsLigament stabilityUnlock ulnohumeral articulation by flexing the elbow to 20 or 30 degreesLCL complexPronate the forearm to tighten the extensor mass One hand on the elbow, one on the wristSome say to IR humerus (Regan & Morrey
, et al)
Apply a
varus
load
Compare to the opposite side
Slide11MCLSame thing, except valgus forceER of humerus recommended by same guysPLRILUCL tear in elbow injury / dislocationLateral pivot shift testPatient is supine with arm overheadThe elbow is extended fully
Slide12You apply an axial load with a valgus force, while bringing the arm into flexionAt around 20 to 30 degrees, you will get apprehension = + signIf fully relaxed (sedation), you may get subluxation and a palpable clunk at reduction with further flexion or return to extension
Slide13Slide14Lateral epicondylitisAKA tennis elbowPatient actively pronates and extends the wrist while you palpate the lateral condyle, positive with recreation of symptomsPassively move into pronation and full flexion, placing stretch on mass, positive is recreation of symptomsResisted extension of 3
rd
digit, tests EDC, pain +
Slide15Medial epicondylitisPassive supination and wrist extension, stretching the flexor mass, recreation of symptoms is +
Slide16NeurovascularTinel’s signUlnar nerve compression at cubital tunnelTingling at and distal is positiveWartenburg’s signHand on table, passively abduct fingersPatient adducts them together and little finger lags behindPositive for
ulnar
neuropathy
Slide17Kiloh – Nevin syndromeAIN motor“ok” sign unable do to flexor / pinch paralysisC5 is lateral arm, T1 is medialLateral cutaneous nerveMedial cutaneous nerve***Nerve Compression Tests***
Slide18Wartenberg’s SignKiloh-Nevin, “ok” is not achievable